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National Journal of Maxillofacial Surgery
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   2016| July-December  | Volume 7 | Issue 2  
    Online since March 2, 2017

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Treatment modalities for surgical management of anterior palatal fistula: Comparison of various techniques, their outcomes, and the factors governing treatment plan: A retrospective study
Krishnamurthy Bonanthaya, Pritham Shetty, Abhimanyu Sharma, Jyoti Ahlawat, Deepak Passi, Mahinder Singh
July-December 2016, 7(2):148-152
DOI:10.4103/0975-5950.201357  PMID:28356685
Aim: Aim of this retrospective study was to access the various surgical treatment options available for repair of Anterior palatal fistula depending upon their size and presenting age, and also to anticipate the treatment outcome. Materials and Methods: The series include study report of forty patients with secondary anterior palatal fistula post cleft palate repair, reported in a single unit during a duration of 3 years. All the cases were managed surgically under general anesthesia. The patients were classified depending upon the location of anterior palatal fistula (APF), the quality of tissue and age of patients to chalk out a justified treatment option outlay. Results: Forty cases were split for surgical correction into various options depending on their size, site, and quality of the tissue. Most of the cases were operated with a Bardach's Redo for fistula closure (n = 16) (40%) and crevicular flap technique (n = 13) (32.5%). Our overall success (satisfactory results) was 77.5% as observed in 31 out of 40 cases with individual success rates for Bardach's and crevicular being 75% and 77%, respectively. There was reduction in size of fistula in three cases (7.5%) and a remnant pinpoint hole in four cases (10%) among all the operated cases. Conclusion: Management of post palatoplasty fistulas of the hard palate presents a challenging situation for a clinician following the surgical correction of cleft palate. Current paper describes the diagnosis and clinical management of forty cases reporting with unilateral APF following cleft palate surgery, over 3 years. Authors have attempted to propose different treatment modalities for surgical management of unilateral APF. It was concluded in the primary review that the size of fistula was irrelevant in determining the clinical outcome. Instead, the quality and condition of the adjacent tissue appear to be the major governing factors for selecting treatment modality as well as the surgical consequences.
  4 1,986 421
Evaluating the use of octyl-2-cyanoacrylate in unilateral cleft lip repair
Vijaylaxmy Malhotra, JK Dayashankara Rao, Varun Arya, Shalender Sharma, Sushil Singh, Payal Luthra
July-December 2016, 7(2):153-158
DOI:10.4103/0975-5950.201364  PMID:28356686
Background: Facial cosmetic results are one of the most concerning issues for the parents who get their children operated for cleft lip. Moreover, the postoperative care of the surgical site, the discomfort associated with the suture removal, and additional visit for suture removal are other reasons which encourages one to use any new technologies that may replace the need for suture placement. In this study, we used octyl-2-cyanoacrylate, a tissue adhesive which offers a viable alternative to traditional techniques without compromising optimal wound closure. Objective: To perform a comprehensive comparison of the outcomes from the use of Dermabond in patients undergoing primary repair of congenital cleft lip ± palate anomalies. Materials and Methods: Twenty patients, in the age group of 3–18 months were treated surgically for unilateral cleft lip deformity using Millard rotation-advancement flap. Pre- and post-operative photographs of the patients were taken at 1 week, 2 week, 1 month, 6 months, and 1 year postoperatively and were evaluated using Vancouver scar scale which was given by Sullivan in 1990. Paired t-test was used for statistical analysis. Results: Increased vascularity (hyperemia) was seen in the 1st and 2nd week in 35% and 30% patients, respectively which gradually reduced to normal in subsequent follow-ups. The scar was flat in 85% of patients in 1st week, and the number decreased to 10% at the end of 1 year. No wound dehiscence was found in any patients. Statistical analysis showed that among all the follow-ups, only the difference between the first and second follow-ups. Comparison of the results of 1 week with all other follow-ups yielded no significant results. Conclusion: Octyl-2-cyanoacrylate can be used for cleft lip closure effectively. The procedure is relatively painless and quick. Added to this are benefits of protection from wound infection since the material is bacteriostatic.
  3 1,156 355
Dental implants in children: A multidisciplinary perspective for long-term success
Nidhi Agarwal, Dipanshu Kumar, Ashish Anand, Surendrakumar Kaluram Bahetwar
July-December 2016, 7(2):122-126
DOI:10.4103/0975-5950.201362  PMID:28356682
Congenital hypodontia or trauma is a frequent cause of loss of teeth in children. The absence of teeth leads to loss of function and lack of normal alveolar growth, along with unpleasant esthetics that hamper the psychosocial development of the young child. Traditionally, the management of tooth loss in the young child is done by conservative means. None of those methods of treatment are completely satisfactory and have their own drawbacks. Dental implants in a young child would be an ideal mode of treatment for the absence of teeth. One of the main deterring factors for implant placement in children is the impending growth. Growth in the maxilla and mandible does not happen uniformly in one plane. It is multidirectional, occurring in sagittal, vertical, and transverse planes. It does not happen at a fixed pace, slow periods of growth are followed by phases of accelerated growth called the growth spurts. Successful implant treatment in children has been achieved by several clinicians when they incorporated a multidisciplinary approach in their treatment plan. The design and type of implant system used in pediatric patients is also responsible for successful treatment outcome. The purpose of this review is to understand the implications of growth and growth assessment and recommendations for the formulation of the treatment plan in pediatric dental implant patients.
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Naso-orbital fistula and socket reconstruction with radial artery forearm flap following orbital mucormycosis
Ankur Bhatnagar, Amit Agarwal
July-December 2016, 7(2):197-200
DOI:10.4103/0975-5950.201361  PMID:28356694
Invasive mucormycosis is an uncommon cause of orbital exenteration. Reconstruction of an exenterated orbit is a surgical challenge. The loss of eyelids, adnexal structures, and even surrounding skin causes significant facial disfigurement. The goal for reconstruction demands a symmetrical orbital cavity with good prosthetic rehabilitation. Multiple reconstructive options in the form of skin grafts, local flaps, and free flaps are available. However, none of them provide ideal reconstruction. Our patient not only had extensive soft-tissue loss and unstable lining but also a large naso-orbital fistula. Reconstruction for this complex defect was done using an adipofascial radial artery flap which not only closed the fistula but also provided soft-tissue bulk and good skin match. Radial artery forearm flap provides a simple, stable, and good reconstructive option postorbital exenteration.
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Comparing hemodynamic and glycemic response to local anesthesia with epinephrine and without epinephrine in patients undergoing tooth extractions
Paramjot Kaur, Rashi Bahl, Sameer Kaura, Sumit Bansal
July-December 2016, 7(2):166-172
DOI:10.4103/0975-5950.201370  PMID:28356688
Introduction: Lignocaine with epinephrine as local anesthetic (LA) provides hemostasis and decreases the risk of systemic toxicity.The purpose of the present study was to investigate and compare the response of lignocaine with and without epinephrine to evaluate hemodynamic and metabolic response in normotensive and type II controlled diabetic patients. Material and Methods: A total of 50 patients (25 healthy and 25 controlled type II diabetics) undergoing multiple tooth extractions (age group of 20–80 years) were included in this prospective, randomised, clinical study. On their first visit, the patients were given 2% lignocaine HCl with 1:200,000 epinephrine, and 2% lignocaine HCl was given on the second visit, to carry out tooth extractions. Blood pressure (BP), pulse rate, oxygen saturation, and blood glucose estimations were done at definite intervals (before, immediately after, and 20 min after the administration of LA) on both the visits. Results: The increase in blood glucose concentration following the administration of 2% lignocaine HCl with 1:200,000 epinephrine was statistically significant (P < 0.05) in controlled diabetic patients. Statistically significant variability in diastolic BP (DBP) was also noted in controlled diabetic patients. Both systolic BP and DBPs were statistically significantly elevated after the administration of 2% lignocaine HCl. Conclusion: 2% lignocaine HCl with 1:200,000 epinephrine in type II diabetics and 2% lignocaine HCl should be used with caution in normotensive as well as type II controlled diabetic patients.
  2 1,510 402
Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam
Niranjan Mishra, Krishna Gopal Birmiwal, Nibedita Pani, Subhrajit Raut, Gaurav Sharma, Krushna Chandra Rath
July-December 2016, 7(2):178-185
DOI:10.4103/njms.NJMS_78_16  PMID:28356690
Introduction: Sedation is an important component of day care oral and maxillofacial surgical procedures under local anesthesia. Although various sedative drugs in different regimens have been used for sedation, an ideal agent and regimen are yet to be established. Aim: The aim of this study is to compare the efficacy of intravenous (IV) dexmedetomidine and midazolam as a sedative agent for day care oral and maxillofacial surgical procedures. Settings: The study was conducted in the Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. Materials and Methods: A total of sixty adult patients of age group 18–65 years, of either sex were randomly selected equally in two groups for the study. One group named Group D received dexmedetomidine and the other named Group M received midazolam. Patients were evaluated for oxygen saturation (SPO2), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Ramsay sedation score, bispectral index (BIS) score, amnesia, Aldrete score, relaxation during the surgery, and drug preference. Results: Midazolam was associated with greater amnesia. Dexmedetomidine was associated with lower heart rate, SBP, and DBP. There was no significant difference in SPO2, RR, Aldrete score, Ramsay sedation score, and BIS score between the two drugs. Patient preference and relaxation were more in dexmedetomidine group. Conclusion: IV dexmedetomidine is a comparable alternative to midazolam for sedation in day care oral and maxillofacial surgery under local anesthesia. It is the preferred drug when a lower heart rate and blood pressure or less amnesia is needed without any serious side effects.
  2 1,420 370
Ameloblastic fibroma or fibrosarcoma: A dilemma of oral surgeon
Nitin Verma, Neha
July-December 2016, 7(2):191-193
DOI:10.4103/0975-5950.201359  PMID:28356692
Ameloblastic fibroma (AF) is an uncommon true mixed odontogenic tumor, with a relative frequency between 1.5% and 4.5% of all odontogenic tumors. It may behave either as a true neoplasm or as a hamartomatous proliferation of odontogenic epithelium of the enamel organ and odontogenic mesenchyme of the primitive dental pulp. Frequently diagnosed between the first and second decades of life with 75% of cases was diagnosed before the age of 20 and present with a well-defined unilocular or multilocular radiolucencies. A conservative approach, enucleation with curettage, and long-term follow-up are absolutely necessary for any recurrence or change to fibrosarcoma. We report a case of AF in a 10-year-old male patient who presented with a chief complaint of swelling in the right mandibular posterior region. Enucleation and curettage were done under general anesthesia, followed by immunohistochemical markers (Ki-67, Mib-1) to assess the sarcomatous changes and aggressiveness of the tumor.
  1 1,439 312
Orofacial cysticercosis: Report of a rare case with review of literature
Sharad Chand, Madan Mishra, Gaurav Singh, Abhishek Singh, Sapna Tandon
July-December 2016, 7(2):209-212
DOI:10.4103/0975-5950.201353  PMID:28356697
Cysticercosis is common in developing countries in which the combination of rural society, crowding, and poor sanitation facilities allows greater contact between humans and pigs and thus more opportunities for fecal contamination of food and water occurs. They are rarely located in oral and perioral tissues, particularly in the muscles of mastication, muscle of the facial expression, suprahyoid muscles, and postcervical musculature and also as in the tongue, buccal mucosa, and lip. Cysticercosis is a potentially fatal parasitic disease that rarely found in the maxillofacial region in humans. This paper reports the case of a young female patient presented with isolated lesion of cysticercosis involving buccinator muscle. In conclusion, we suggest that cysticercosis should be considered in the differential diagnosis of intraoral solitary nodules within the oral and maxillofacial region, especially in endemic areas. High-resolution ultrasonography is an excellent noninvasive and cost-effective modality for the diagnosis and also suggests that localized parasitic infections such as Cysticercus cellulosae can be successfully treated with conservative management using oral antiparasitic (antihelminthic) medication.
  1 1,588 205
Evaluation of two socket healing procedures with and without mesenchymal stem cells: A comparative study
Abhinav Jain, Mahinder Singh, KP Ganapathy, Vikas Ramola, Deepak Passi, Komal Jain
July-December 2016, 7(2):159-165
DOI:10.4103/0975-5950.201366  PMID:28356687
Aims and Objectives: Successful preservation of the edentulous ridge after extraction may eliminate or reduce the need for ridge augmentation procedures. It is proved that grafting of fresh extraction sockets with bone grafts promotes ridge preservation. An objective method of maintaining height and width of alveolar ridge using mesenchymal stem cells (MSCs) seeded on collagen membrane was implemented in this study. Methodology: Ten bilaterally symmetrical extraction sockets scheduled for extraction were selected for this study. Involved teeth were extracted atraumatically and the sockets were curetted. MSCs seeded on collagen membrane were placed in the extracted socket on one side. On the other side, only collagen membrane was placed inside the socket. Both the sockets were closed primarily with nonresorbable sutures. Buccolingual and mesiodistal widths of the ridges at three different levels (2 mm below cementoenamel junction [CEJ], 5 mm below CEJ, and 8 mm below CEJ) were assessed immediately after extraction and postoperatively at 3 and 6 months. Results: There was statistically significant observation in maintaining the alveolar ridge width in the grafted site when compared to the nongrafted site. Conclusion: Socket healing procedure using MSCs and collagen membrane was successful in maintaining width of alveolar socket.
  1 1,011 329
Effects of honey in the management of alveolar osteitis: A study
Nikita Soni, Vibha Singh, Shadab Mohammad, RK Singh, US Pal, Ranjana Singh, Jyatasana Aggrwal, Mahesh Pal
July-December 2016, 7(2):136-147
DOI:10.4103/0975-5950.201354  PMID:28356684
Introduction: Alveolar osteitis (AO) is a complication of tooth extraction which indicates inflammation of alveolar bone of either maxilla or mandible. This study uses Apitherapy where honey catalyses biological reactions to improve immune system, makes local environment unbearable for microorganisms in the affected socket and enhances healing. Materials and Methods: 50 patients of AO were included in the study. After cleansing of the affected socket, honey dressing was applied. Dressings were changed daily for first 2 days and then altenatively. In biochemical investigations, CRP levels in the body were measured using Nephelometry method. Microbiological examination was done for the identification of microorganism and semi quantitative count of colony forming units. Result: Results were assessed from clinical, microbiological, biochemical and radiological findings at 1st, 2nd, 3rd, 5th, 7th day based on VAS score, erythema, pus discharge, swelling, lymphadenitis, fever, bleeding on probing, exposed bone and necrotic debris. Pre-Treatment CRP was 2.08 ± 1.62 which significantly (P = 0.0001) decreased to 0.82 ± 0.48. Mean change and average percentage change were 1.25 ± 1.51 and 44.1% respectively. Conclusion: Majority of the patients with exposed bone got healed socket with evidance of granulation tissue and healing gingiva in about one week. CRP levels at the completion of treatment of AO with honey dressing showed a significant decrease from the pre-treatment values indicating fast recovery. Microbiological examination showed presence of normal commensal flora at AO sites like Streptococcus, Staphyloccocus and Enterococcus. So, the role of bacteria in the genesis of AO, if any, appears unclear.
  1 1,450 375
Sialocele: A rare sequlae of transparotid approach in subcondylar fracture management
R Rajeev, S Sajesh, Mathew Jose, N Dhineksh Kumar
July-December 2016, 7(2):201-204
DOI:10.4103/0975-5950.201363  PMID:28356695
Iatrogenic injury and/or damage to the parotid salivary gland during transparotid approach for open reduction and internal fixation of mandibular condyle fracture is a rare event. Accumulation of saliva in the gland leads to formation of a sialocele. Huge sialocele often seeks drain through the most dependent area through an extraoral wound, whereas in the absence of extraoral fistula, saliva can be redirected intraorally using a stent. A case of mangement of sialocele caused by damage to glandular elements during a transparotid approach for a subcondylar fracture reduction is reported. The various conservative methods and surgical management for this condition are discussed.
  - 1,211 251
HIV-associated large aggressive extranodal lymphoma of the oral cavity
Rahul Dilip Kamat, Vikas Dhupar, Francis Akkara, Anita Dhupar
July-December 2016, 7(2):205-208
DOI:10.4103/0975-5950.201371  PMID:28356696
Malignant lymphomas form a heterogeneous group of neoplasms of the lymphoid tissue with different clinical courses, depending on the treatment and the prognosis. Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) have been associated with an increased risk for the development of lymphoproliferative disorders. The incidence of lymphoma is associated with 60-fold increase in seropositive patients as compared to seronegative patients. The present case describes a diffuse aggressive extranodal lymphoma in a known HIV patient.
  - 756 161
Inadequate vertical bone dimension managed by indirect sinus grafting technique and simultaneous implant placement
Shikha Nandal, Pankaj Ghalaut, Deepika Nandal
July-December 2016, 7(2):213-216
DOI:10.4103/0975-5950.201355  PMID:28356698
Implant placement into the posterior maxilla often creates a challenge due to inadequate bone height because of close sinus proximity. This article presents a case report of indirect sinus lift technique involving hydraulic pressure to elevate the floor of the maxillary sinus.
  - 1,221 318
A systematic noninvasive approach for rehabilitation of traumatized maxillary incisors
Rakesh Kumar Yadav, Aseem Prakash Tikku, Anil Chandra, Shibha Mehta
July-December 2016, 7(2):217-220
DOI:10.4103/0975-5950.201356  PMID:28356699
Esthetic and functional impairment due to dental trauma is a major concern for patients. The management of such traumatic cases is complex, and it requires a comprehensive knowledge, diagnosis, and treatment planning. It is also important to take into account the patient's desire as well as economical status. The present case report describes a simple, conservative, and noninvasive approach for the rehabilitation of traumatized maxillary incisors.
  - 631 144
The use of mini plates for intermaxillary fixation in a severely comminuted mandibular fracture with bilateral condylar fractures
James William Clohessy, Frank Chang, Shiva S Subramaniam
July-December 2016, 7(2):194-196
DOI:10.4103/0975-5950.201360  PMID:28356693
Intermaxillary fixation (IMF) is an integral technique utilized by maxillofacial surgeons to appropriately reduce and relate maxillary and mandibular fractures to both one another and the facial skeleton. This case report reviews the management of a comminuted mandibular fracture including inoperable bilateral condylar fractures that precluded the use of convention IMF techniques necessitating an alternative technique. This was achieved in the form of modified bony plates extending intraorally. Postoperative review showed favorable results with occlusion and range of motion comparable to the premorbid function and no unforeseen complications.
  - 1,123 343
Indolent palatal swelling: Catch 22
Preeti Sharma, Vijay Wadhwan, K V. Arun Kumar, Arvind Venkatesh, Timsy Thapa
July-December 2016, 7(2):221-224
DOI:10.4103/0975-5950.201352  PMID:28356700
We present an interesting but intriguing case of an indolent palatal swelling. The lesion was asymptomatic causing little discomfort to the patient and thus was an incidental clinical finding. Provisional diagnosis was a benign, minor salivary gland tumor. Clinical differential diagnoses included benign lymphoepithelial lesion or mucus extravasation phenomenon. Nevertheless, we also considered malignancies such as mucoepidermoid carcinoma, lymphoma, and neoplasm of the maxillary sinus. However, the histopathology revealed a rare clinicopathologic entity prompting immediate treatment of the lesion.
  - 2,235 158
Micro surgery - need of the hour
Vijay Kumar
July-December 2016, 7(2):113-114
DOI:10.4103/njms.NJMS_8_17  PMID:28356680
  - 910 3,737
A study on total intravenous anesthesia in orthognathic surgical procedures
PL Vasundhar, Gokkulakrishnan Sadhasivam, Satya Bhushan, Siva Kalyan, Kho Chai Chiang
July-December 2016, 7(2):127-135
DOI:10.4103/0975-5950.201351  PMID:28356683
Aims and Objective: To assess the use of propofol for induction and maintenance of anaesthesia among patients undergoing various combinations of orthognathic surgical procedures. Materials and Methods: Following Preoperative evaluation, patients were given Fentanyl (2 micrograms/kg) intravenously. Induction (2 mg/kg) and maintenance (10 mg/kg/hr) of anaesthesia was achieved by Propofol infusion. Blood Pressure and heart rate were maintained at >70 or 80 mm Hg and >50 respectively and were monitored continuously. Infusion was stopped approximately 30 to 40 minutes before the end of surgery. Immediate recovery recorded and was assessed. Results: The average duration of anaesthesia and surgery were found to be 4 hrs 28 min (SD= 1 hr. 35 min) and 4 hrs 3 min (SD=1 hr 38 min). None of the patients experienced pain on injection of induction agent. No significant change was observed in the mean heart rate and mean BP at different time intervals from baseline value to 30 minutes after the recovery. The average time taken to obey simple commands after stopping Propofol infusion was 42.60 ± 9.09 min. Time taken for spontaneous eye opening, full orientation and to count backwards was 43.45 ± 9.11, 47.85 ± 8.18 and 50.9 ± 9.14 respectively. Face-Hand test performed at 15 min after extubation was positive in all the patients. The mean Aldrete score at 15 min after extubation was 11.65 ± 0.75. The mean value of unaided sitting time for at least 2 min was after 119.00 ± 20.56 min. The average score of picture card test, time taken in “picking up matches” test, Ball bearing test, time taken to walk and to void urine were 5.80 ± 1.47, 67.95 ± 5.72, 9.80 ± 2.57, 172.75 ± 39.25 and 163.75 ± 55.96 respectively. Ninety percent of the patients were amenable for a repeat of this anaesthetic using the same regime but 10% of them did not answer anything. Seven patients (35%) had chills post-operatively. Conclusion: Propofol is an excellent anaesthetic for day care procedures.
  - 915 315
An epidemiological survey in hospital setup in Lucknow district: A cross-sectional study
Uma Shanker Pal, Mayank Singh, Lakshya Kumar, Pankaj Verma, RK Singh, Shailendra Kumar, GG Agarwal, Akash Asthana
July-December 2016, 7(2):173-177
DOI:10.4103/njms.NJMS_72_16  PMID:28356689
Introduction: Oral cancer is the sixth most common form of cancer reported globally which includes lip, tongue, mouth, and throat. Developing countries face several challenges to identify and remove potential risk factors. Chewing tobacco/pan masala is considered to be the most potential risk factor for oral precancerous lesions and oral cancer. Objective: To study the clinical-epidemiological profile of oral cancer cases and potential risk factor associated with it. Materials and Methods: This is cross-sectional study which includes all major tertiary hospital in Lucknow district. Five hundred and eight cases of oral cancer reported in all major tertiary hospitals in Lucknow district during 2013–2016. Study Variable: Clinicoepidemiological characteristics of oral cancer cases. Statistical Analysis: percentages, proportions. Results: Out of 508 cases, majority of the subjects included in the study belonged to 18–75 years age group. Reported cases of oral cancer in males were higher as compared to females. Most of the subjects belonged to lower middle and upper lower socioeconomic group. It was found that 199 (39.2%) subjects consumed smokeless tobacco. Buccal mucosa was the common site of oral cancer being present in 50.4% of the subjects. Histopathologically, 256 cases of buccal mucosa, 17 cases of lip, 33 cases of alveolar region, 16 cases of mandible region, 156 cases of tongue region, 7 cases of gingival buccal sulcus region, and 23 cases of palate were diagnosed as oral squamous cell carcinoma. Conclusion: In the present study, the most affected site was buccal mucosa (50.4%), tongue (30.7%), and other diagnosis was <10%.
  - 874 181
Preoperative evaluation of cervical lymph nodes for metastasis in patients with oral squamous cell carcinoma: A comparative study of efficacy of palpation, ultrasonography and computed tomography
Niranjan Mishra, Krushna Chandra Rath, Upendra Nath Upadhyay, Subhrajit Raut, Shadab Ali Baig, Krishna Gopal Birmiwal
July-December 2016, 7(2):186-190
DOI:10.4103/0975-5950.201368  PMID:28356691
Introduction: Oral cancer is a major health threat in a country like India, where patients frequently present with advanced disease with regional dissemination to cervical lymph nodes. The management and prognosis depend on the status of cervical lymph nodes. Thus, it becomes imperative to diagnose and evaluate them preoperatively. Aim: This study aims to compare the efficacy of palpation, ultrasonography (USG) and computed tomography (CT) in the preoperative evaluation of cervical lymph node for metastasis in patients with oral squamous cell carcinoma. Settings: Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. Methodology: A total of thirty patients of either sex of age group 20–70 years, diagnosed with oral cancer were randomly selected for the study and subjected to palpation, USG and computer tomography followed by histopathology for confirmation. The results were evaluate statistically by sensitivity, specificity, positive predictive value, and negative predictive value and accuracy. Results: For level IA palpation, USG and CT were equally sensitive (100%) and specific (100%). Although palpation, USG and CT were equally sensitive (80%) for level IB, the specificity of palpation (70%) <USG (95%) = CT (95%). For level II sensitivity of palpation (25%) <USG (75%) <CT (100%) whereas specificity was CT (84.6%) <palpation (92.3%) <USG (100%). Conclusion: CT (96.1%) and USG (97.7%) were more accurate than palpation (92.7%), for detection of metastasis in cervical lymph nodes in patients with oral squamous cell carcinoma. CT along with USG should be used for accurate preoperative evaluation of cervical lymph node.
  - 1,218 270
Complications in the use of bilateral inferiorly based nasolabial flaps for advanced oral submucous fibrosis
Rajesh Kshirsagar, Ajay Mohite, Suman Gupta, Amod Patankar, Vikrant Sane, Pratik Raut
July-December 2016, 7(2):115-121
DOI:10.4103/0975-5950.201358  PMID:28356681
Surgical management of advanced oral submucous fibrosis (OSMF) using bilateral inferiorly based nasolabial flaps is becoming increasingly popular. However no comprehensive analysis of delayed complications using this technique is available in the literature. The authors have conducted a retrospective study to examine the delayed complications of bilateral inferiorly based nasolabial flaps used in advanced oral submucous fibrosis at their institute along with a detailed review of literature on the subject. Thirty-two patients from January 2004 to December 2015 with OSMF and an interincisal distance less than 15 mm were included. All patients were treated with bilateral inferiorly based nasolabial flaps for correction of the restricted mouth opening. All patients had postoperative physiotherapy and were followed up for a minimum period of 6 months. All complaints of patients during the follow up phase were included in this study. In this series, complications such as partial necrosis, intra-oral hair growth, unacceptable extra-oral scar, wound dehiscence, orocutaneous fistula, and pincushioning effect were observed. Numerous complications can occur with the use of nasolabial flaps for the management of advanced oral submucous fibrosis. Although most complications are of inconsequential nature the surgeon must observe due diligence when using this flap.
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