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   Table of Contents - Current issue
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July-December 2019
Volume 9 | Issue 2
Page Nos. 225-488

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GUEST EDITORIAL  

Mandibular Repositioning Device (MRD) and obstructive sleep apnea syndrome Highly accessed article p. 225
Zoe Nicolaou
DOI:10.4103/ams.ams_255_19  
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EDITORIAL Top

Complications of Orthognathic Surgery Highly accessed article p. 228
SM Balaji
DOI:10.4103/ams.ams_235_19  
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ORIGINAL ARTICLE - COMPARATIVE STUDY Top

Evaluation of electrocautery and stainless steel scalpel in oral mucoperiosteal incision for mandibular anterior fracture p. 230
Gopal Lahudas Nagargoje, Sheeraz Badal, Syed Ahmed Mohiuddin, Arunachaleshwar Somnath Balkunde, Swati Suresh Jadhav, Dnyandeep Ramkrushna Bholane
DOI:10.4103/ams.ams_158_18  
Background: Traditionally, mucosal incisions are made by stainless steel scalpel due to its ease of use, accuracy, and minimal tissue damage effect, but these incisions are more bloody and painful. To obviate the inherent disadvantages of scalpel, surgical diathermy was introduced at the beginning of the 20th century. Aim and Objectives: The study aimed to compare the efficacy of electrocautery and stainless steel scalpel in oral mucoperiosteal incisions in terms of time taken for incision, blood loss, pain, edema, and healing for mandibular symphysis or parasymphysis fracture. Materials and Methods: Forty patients who reported to the Department of Oral and Maxillofacial Surgery between December 2015 and November 2017 with symphysis or parasymphysis fracture were divided into two groups by randomized envelope method. Results: The mean time taken and mean blood loss for electrocautery were less than that of stainless steel scalpel. The postoperative pain was significantly reduced at 24 h, 48 h, and 1 week in the diathermy group as compared to the scalpel group. At 24 h and 48 h, the extraoral edema measured was not significant. Wound healing at 24 h and 48 h was better in the scalpel group as compared to the electrocautery group. Conclusion: From present study, we can conclude that electrocautery is better than stainless steel scalpel in relation to time taken for incision, intraoperative blood loss and postoperative pain.
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Clonidine: An adjuvant to adrenaline in local anesthesia for third molar surgery p. 235
Shahbaz Alam, B Pramod Krishna, Santosh Kumaran, S Manu Prasad, MA Lakshith Biddappa, TM Kalappa, S Gowtham, N Anees Ahmed
DOI:10.4103/ams.ams_256_18  
Purpose: The aim of the study is to compare the efficacy of anesthesia and hemodynamic parameters of clonidine and epinephrine in lignocaine for lower third molar surgery. Materials and Methods: Thirty healthy controls with impacted mandibular third molar were randomly selected from both sexes between the age group of 20–47 years. Patients were divided equally into two groups: Group I (Adrenaline group) and Group II (Clonidine group). Patients received 2.5 ml of 2% lignocaine with adrenaline (12.5 μg/ml) in Adrenaline group and 2.5 ml of 2% lignocaine with clonidine (15 μg/ml) in Clonidine group. Hemodynamic parameters (heart rate, systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP]) were recorded preoperatively, intraoperatively, and postoperatively. The onset of anesthesia and duration of anesthesia were recorded using pinprick test for both groups. Postoperatively, patients were evaluated for pain experience by the visual analog scale and verbal rating scale. Results: Lignocaine with clonidine intraoperatively and postoperatively decreases SBP and DBP and MAP compared to lignocaine with adrenaline. There was no significant difference in the onset and duration of anesthesia in both the groups. There was a statistically significant difference seen in the visual analog scale, but no statistically significant difference was seen in the verbal rating scale. Conclusion: Clonidine has similar efficacy as that of adrenaline with better hemodynamic parameters and can be used as an alternative to adrenaline for third molar surgeries.
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Anesthetic efficacy of single buccal infiltration of 4% articaine and 2% lignocaine in extraction of maxillary 1st molar p. 239
Prasanna D Kumar, Mandeep Sharma, Vinay Patil, Rohit Singh Subedar, G Vijaya Lakshmi, Nithin Varalakonda Manjunath
DOI:10.4103/ams.ams_201_18  
Background: The extraction of tooth being the most common procedure in oral surgery should be pain free with limited dosage and limited needlepricks. Articaine being unique among amide local anesthetics contains a thiophene group, which increases its liposolubility, and an ester group which helps biotransformation in plasma. Because of the high diffusion properties, it can be used as a single buccal infiltration to extract a maxillary tooth. Aim and Objective: Objective of the study was to compare the efficacy of single buccal infiltration of 4% articaine with that of 2% lignocaine for maxillary first molar extraction. Methodology: A triple blind randomized controlled study was carried on 100 patients of age group 18-60 years who required maxillary first molar extraction, visiting the Department of Oral and Maxillofacial surgery. They were included in the study after obtaining informed consent. Buccal infiltration of 1.8 ml of anesthetic solution was given randomly to 100 patients with appropriate blinding of the cartridges. Objective signs were checked. If any additional injection was given, it was noted as type and number of rescue injection given. Postoperatively VAS score and surgeon's quality of anesthesia was noted. Duration of anesthesia was measured every 5 minutes for 50 minutes from infiltration. Results: Out of 50 patients in group A (Articaine), in 44 patients extraction was done without the need of additional injection whereas in group B(Lignocaine), 29 patients require additional infiltration on the palatal side. The VAS score values for group A were also significantly less in comparison with group B. The mean duration of anesthesia for Group A being (71.70 ± 17.82 min) in 44 patients who only received buccal infiltration. Interpretation and Conclusion: The efficacy of single buccal injection of articaine is comparable to buccal and palatal injection of lignocaine.
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ORIGINAL ARTICLE - EVALUATIVE STUDY Top

Carcinoma arising in the background of oral submucous fibrosis p. 247
Shruthi Rangaswamy, Rajkumar Garudanahally Chikkalingaiah, Priya N Sanjeevarayappa, Poornima Govindraju
DOI:10.4103/ams.ams_280_18  
Introduction: Oral submucous fibrosis is a chronic debilitating condition with potential for malignant transformation. Squamous cell carcinoma arising from a background of oral submucous fibrosis presents clinically as a distinct disease due to different etiopathogenesis. Methodology: This prospective case series describes thirty cases of oral squamous cell carcinoma (OSCC) alongside oral submucous fibrosis (OSF). Patient clinical data were recorded including type and duration of habits, site of tumor, size, histological grading and nodal status. Results: A total of 76% cases were reported in males and 24% in females. A total of 73.3% cases had a history of use of gutka of which 16% used only arecanut or gutka while the remaining used gutka along with smoking and quid habits and 26.7% cases smoked tobacco products or used smokeless tobacco. Primary site of presentation was buccal mucosa and seven cases of carcinoma at retromolar trigone (RMT) altogether accounting for 66% of the cases. 53.3% cases reported were advanced tumour T4 lesions, 10% T3 lesion, 30% reported as T2 lesions and 6.7% T1 lesion. 55% of cases showed nodal involvement of different level and 46.5% cases were N0. About 60% of cases were histologically well differentiated squamous cell carcinoma. Conclusion: Carcinoma arising from a background of oral submucous fibrosis follows a distinct clinical presentation. Malignant transformation occurs in younger age group and with better histological grading.
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Effect of Kenacort on pregnant Wistar albino rats p. 253
Julie Christy Amalraj, N Charanya, Saraswathi Perumal, V Sathialakshmi
DOI:10.4103/ams.ams_141_16  
Kenacort is a well-known synthetic glucocorticoid used in today's medical practice for various therapeutic uses. The drug has been known to induce cleft palate in rodents in specific doses. This study uses triamcinolone acetonide (TAC) as a teratogen for inducing cleft palate in rat embryos. The study discusses the molecular level action of TAC on the palatal mucosa in the rat palate. This study substantiates that the TAC given during the first trimester between 29th and 38th day of gestation can induce many congenital anomalies. The study shows an animal model to depict the drug toxicity on the pregnant Wistar albino rats.
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Foam polidocanol sclerotherapy for low-flow vascular malformations of tongue p. 257
Sailesh Kumar Mukul, Abhishek Singh, Amit Kumar, Shewta Pandey, Sumit Singh, Amarjeet Kumar
DOI:10.4103/ams.ams_81_19  
Introduction: Low-flow vascular malformations (LFVMs) of the tongue are one of the most common presentations among different vascular anomalies of oral and maxillofacial regions. The present study was conducted with the objective to assess the outcome of a simple, easily available, safe and cost-effective therapeutic measure using foamed polidocanol in patients with LFVMs of the tongue. Materials and Methods: Fifteen patients with LFVMs of tongue were randomly selected in the study from the pool of 32 individuals affected with vascular malformation of oral and maxillofacial region. The diagnosis was made by a combination of clinical presentation and Doppler ultrasound. Lesions on the tongue were measured along their longer axis using a calliper and assigned to one of the three groups according to size: small-sized (<1 cm; 3 patients), medium-sized (between 1 and 3 cm; Four patients), or large-sized (>3 cm; eight patients). Foam sclerotherapy was done by directly injecting the foam (polidocanol) into identified sinusoids, under real-time ultrasound guidance. Foam polidocanol was prepared using the Tessari method. Results: Fifteen patients (Nine males and Six females), aged 7–50 years, with an average age of 23.53 years were included in our study. Of these 15 vascular lesions, three were small (<1 cm), four were medium (1–3 cm) and eight were large (>3 cm) in size. Treatment results were evaluated based on a reduction in lesion size. Complete or partial regression of lesions was reported by 14 (93.33%) patients and remained unchanged in one (6.67%) patient. The number of sclerotherapy sessions performed in this study ranged from 1 to 6 and was directly related to lesion size. Small- and medium-sized lesions responded well and complete resolution was seen in 1–3 sessions. Of the eight large lesions, seven showed complete or partial resolution in 4–6 sessions except one lesion which did not show any responses in subsequent sessions. Conclusion: Foam polidocanol therapy for LFVM of tongue is cost-effective, less invasive and with added advantage of local anesthetic effect.
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Frontal bone fractures and frontal sinus injuries: Treatment paradigms p. 261
Priya Jeyaraj
DOI:10.4103/ams.ams_151_19  
Background: Timely, expeditious and appropriate management of Frontal bone fractures and associated Frontal Sinus (FS) injuries are both crucial as well as challenging. Treatment options vary considerably, depending upon the nature, extent and severity of these injuries as well as operator skill, expertise and experience. In cases of posterior table fractures of the Frontal Sinus, literature reports have in general, propounded direct visualization and exploration of the sinus via a bifrontal craniotomy, followed by sinus cranialization. Aims and Objectives: To review the standard protocols of management of Frontal bone fractures and Frontal Sinus injuries. To assess the efficacy of a more conservative approach in the management of outer and inner table fractures of the FS. Materials and Methods: Contemporary and evolving management protocols and changing treatment paradigms of different types and severities of frontal bone fractures and frontal sinus injuries, have been presented in this case series. A useful Treatment Algorithm has been proposed to efficiently and effectively manage these injuries. Results: In the present case series, effective and satisfactory results could be achieved in cases of significantly displaced inner and outer table fractures of the Frontal sinus by a more conservative protocol comprising of open reduction and internal fixation carried out via the existing scar of injury, without having to resort to the more radical intracranial approach and sinus cranialization. Nevertheless, presence of complicating factors such as cerebrospinal fluid rhinorrhea, evidence of meningitis or the development of encephalomeningocoeles necessitated the standard protocol of sinus exploration and its cranialization or obliteration. Conclusion: Management protocols of Frontal Sinus injuries vary, based on aspects such as the timing of presentation and intervention, degree of injury sustained, concomitant associated Craniomaxillofacial injuries present, presence of complicating factors or Secondary/Residual deformities & Functional debility, and need to be decided upon on a case to case basis.
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Comparision of vital surgical parameters, after administration of midazolam and dexmedetomidine for conscious sedation in minor oral surgery p. 283
Suryahanthmihiran Sivasubramani, Deepak Abraham Pandyan, C Ravindran
DOI:10.4103/ams.ams_17_19  
Aim: The aim of this study is to compare the efficacy between midazolam and dexmedetomidine in relation to vital parameters, sedation score, pain score, cognitive judgment, and postoperative amnesia to the event in conscious sedation for minor oral surgical procedure. Materials and Methods: A sample size of 30 patients were selected in each group: Group M (midazolam) and Group D (dexmedetomidine). Results: The mean heart rate (HR) and systolic and diastolic blood pressure measurements were significantly higher in Group M after the 20th min when compared to Group D. The visual analog scale (VAS) scores of pain were not statistically significant between the two groups during the procedure, but at the time of discharge, statistically significant VAS scores were found between the two groups. Nine (30%) patients in Group D and 21 (70%) patients in Group M showed cognitive judgment impairment with the Stroop Color and Word Test at the 30th min. Conclusion: The dexmedetomidine group of patients had reduced blood pressure and HR. No significant differences were noted in oxygen saturation or in respiratory rate between the two drugs. Patients had better sedation, analgesia, lesser cognitive impairment, and amnesia in the dexmedetomidine group.
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Histological diversity, diagnostic challenges, and surgical treatment strategies of fibrous dysplasia of upper and mid-thirds of the craniomaxillofacial complex p. 289
Priya Jeyaraj
DOI:10.4103/ams.ams_219_19  
Background: Owing to the overlapping clinical, radiographic and histopathological features among the diverse group of Fibro-osseous lesions, a precise and definitive diagnosis of Fibrous Dysplasia (FD) can be quite challenging. Moreover, FD itself may manifest with widely varying clinical presentations, radiographic appearances and histological pictures, depending upon the maturity of the lesion, and the relative quantum of its 'fibrous' and 'osseous components'. Prompt and accurate diagnosis of Fibrous Dysplasia (FD) of the Craniomaxillofacial region is particularly important, as the condition is capable of causing considerable facial asymmetry or deformity leading even to marked disfigurement, which can have a profound psychosocial impact on the patient. Involvement of Maxillofacial bones by aggressive forms of FD, can produce serious functional debility as well, by compromising airway, breathing, vision, hearing, occlusion, mastication and mouth opening. Calvarial bone involvement can produce cranial asymmetry, and cranial base involvement can lead to persistent headaches, facial pain, numbness, and other neurological deficits owing to compression of cranial nerves. Aims and Objectives: To evaluate the importance of early and precise diagnosis, with prompt surgical management of these lesions, for a successful overall esthetic and functional outcome. Materials and Methods: A Case series of 15 patients, showcasing the principal variants of FD affecting the Craniomaxillofacial complex, namely, the Monostotic and Craniofacial forms have been described. Diversity in their Clinical, Radiographic and Histopathological presentations; their management modalities elucidating the various surgical approaches employed to access and excise these bone pathologies, have been provided along with a review of existing literature. Results: Various surgical approaches may be employed to access the lesions, depending upon their location, extent and involvement. Treatment protocols range from complete surgical excision to surgical shaving and recontouring, and must be decided upon on a case to case basis, with the aim to achieve the best possible esthetic and functional outcome with the least postoperative morbidity. Conclusion: Correlation of HPE with history, clinical features, biological behaviour, radiographic and CT appearance, laboratory findings, and intra-operative findings is imperative, so that they can be distinguished from other bony lesions and an appropriate, ideal and effective treatment modality can be instituted in time, so as to achieve the most favourable esthetic and functional outcome.
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ORIGINAL ARTICLE - PROSPECTIVE STUDY Top

Interpersonal violence and maxillofacial fractures p. 315
Blair S York, Kimberley N Sent-Doux, Jaewon Heo, Mikayla Barnett, Reginald W Marsh, Craig A Mackinnon, Swee T Tan
DOI:10.4103/ams.ams_175_19  
Purpose: Accident Compensation Corporation statistics shows that maxillofacial fracture affects 11,000 people with an approximate $90 million annual cost in New Zealand dollars (NZD). Previous studies have demonstrated interpersonal violence (IPV), road traffic accidents (RTAs), sports injury, and falls being the common causes of maxillofacial fracture. This study investigated the causes and associated alcohol and/or drug use and fracture patterns in patients presenting with maxillofacial fractures in the Wellington region. Subjects and Methods: Demographic data of the patients, the cause of maxillofacial fracture and associated alcohol and/or drug use, and the fracture patterns were culled from our prospective maxillofacial fracture database at Hutt Hospital for a 5-year period from January 01, 2013, to December 31, 2017 and analyzed. Results: A total of 1535 patients were referred with maxillofacial fractures during the study. 38% of the maxillofacial fractures were caused by IPV, followed by sports injury (24%), falls (24%), and RTA (6%), with 33.4% associated with alcohol and/or drug use. Males were six times more likely to present with IPV-related maxillofacial fractures, compared to females. The 16–30-year age group was the most prevalent in the IPV group with NZ Maori attributing to significantly more maxillofacial fractures compared to NZ European, 54.6% vs. 32.0% (P < 0.0001). Conclusions: IPV, especially involving alcohol and/or drug use, is the most common cause of maxillofacial fractures in the Wellington region, especially in NZ Maori males aged 16–30 years. Public health strategies are needed to decrease IPV as a cause of maxillofacial fractures.
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Creation of bone and soft tissue in postmaxillectomy patients using curvilinear transport distraction osteogenesis p. 319
Rushdi Hendricks, George Vicatos
DOI:10.4103/ams.ams_88_19  
Background: Large surgical defects in the maxilla due to trauma or tumor are usually reconstructed with revascularized-free fibula flaps (RFFF). In the past, the use of curvilinear transport distraction osteogenesis (CTDO) has been shown to be an efficacious way in closing large defects in the maxilla, but it had limitations which have now been overcome by the present development. The present distractor is an improvement upon the previous three prototypes and employs the concept of tetrafocal distraction by means of hybridizing the bone with the tooth in the transport disc segment. This article aims to prove that tetrafocal distraction provides a viable alternative to the RFFF. Materials and Method: In a prospective cohort study of six postmaxillectomy patients, the method of CTDO was applied and investigated to ascertain the outcome. The regenerate bone was compared with the parent bone, using a new maxillary transport distractor. A linear bicortical fracture was created in the maxilla in a vertical direction (segmentally) to develop a mobile, vascularized transport disk. This transport disk underwent further subdivision to produce the concept of tetrafocal distraction. Results: After osseointegration of the dental implants, prosthetic rehabilitation of the dentition was successful. The authors report the successful outcome of two of the six cases subjected to CTDO to treat defects ranging from 25 mm (using bifocal distraction) to 80 mm along a curved trajectory (using tetrafocal distraction). Conclusions: The production of curvilinear bone and soft tissue along a horizontal plane has been demonstrated. From a clinical perspective, the new alveolar bone achieved the correct width and height to create a physiological vestibule and an esthetic zone for dental implants. In addition, the shape of the palatal vault is also reconstituted. The tetrafocal method of the CTDO is a reliable method of maxillary reconstruction.
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Psychological desire of facial esthetics in males p. 326
SM Balaji, Preetha Balaji
DOI:10.4103/ams.ams_224_19  
Background: Males have specific facial esthetic priorities for a variety of reasons. There exists a common perception that expectations from male facial cosmetic surgery are similar globally. The possibility of different esthetic requests of males at a single Indian center is not widely reported. This investigation aimed to identify the facial esthetic expectations and requests among males. Materials and Methods: The study was based on in-house, qualitative survey regarding facial esthetics conducted during the clinical interview among males seeking facial esthetics in a single Indian center. Preferences regarding the hairline, forehead periorbital region, nose, lip, and jaw features, were surveyed. Results: Facial esthetic preferences among males were identified. Despite the geographical and anthropological variation, the demand was largely correction of the lower eyelid, entire midfacial region – alteration of zygomatic prominence, nose, and premaxillary unit. There is a high demand for a sharp, long, straight nose as well as prominent jawline and gonial angle. The expectations of the patients appear to be influenced by the biopsychosocial constructs including race, age, and personality traits. Conclusion: The results demonstrate that there is a wide variation in facial esthetic expectation, especially one that has typical “metrosexual male” ideations. This possibly stems from their deep-seated psychological desire for a facial and personality trait. Only an in-depth clinical interview and detailed discussion would help the surgeon to understand the patient's concepts of beauty, their expectations, and surgical outcome reality.
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Three-dimensional miniplate: For the management of mandibular parasymphysis fractures p. 333
Yousuf Qureshi Mohd, Sreenatha Reddy, Ramen Sinha, Anmol Agarwal, Umayra Fatima, Mohammed Abidullah
DOI:10.4103/ams.ams_172_17  
Background: Recently, oral and maxillofacial surgeons are favoring three-dimensional (3D) miniplates to treat mandibular fractures. Aims: The aim of the study is to evaluate the efficacy of 3D-miniplates over standard miniplates in the management of mandibular parasymphysis fracture. Materials and Methods: Forty patients with mandibular parasymphysis fractures were divided into two groups of 20 patients each. Group I patients underwent osteosynthesis of mandibular fracture by noncompression, unicortical, and stainless steel 3D miniplates, and Group II patients underwent osteosynthesis by noncompression, unicortical, and stainless steel Champy's miniplates. All the patients were followed up 6 months' postoperatively, evaluating occlusion, mobility of fracture segment, pain, wound dehiscence, neurological deficit, and infection. Statistical Analysis Used: The data were analyzed by SPSS for windows (version 17) statistical package (SPSS Inc., Chicago, IL, USA). Chi-square test was carried out to determine the statistical difference between the groups. Results: Mobility of the fractured site was evaluated postoperatively after 2 weeks, and it was found that mobility was absent in all the cases of Group I and 36 (80%) cases in Group II. There was significant difference in the mean visual analog scale scores among the Group I and II when compared from preoperative to 4-week follow-up. In Group II, two patients showed wound dehiscence. After 2 weeks, infection was seen in two patients of Group II. Conclusion: 3D plates in mandibular parasymphysis fractures give dimensional stability and carry low morbidity and infection rates.
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ORIGINAL ARTICLE - RETROSPECTIVE STUDY Top

Maxillofacial injuries in motorcyclists following the implementation of helmet p. 340
Soumi Samuel, Shahnawaz Khijmatgar, Deeyah Miriam Deepak, Rajendra Prasad, Krishna U S. Nayak
DOI:10.4103/ams.ams_67_19  
Background: It has been reported that 20%–60% of all people injured in road traffic accidents (RTAs) tend to have some form of maxillofacial injury. Mangalore city, Karnataka State, India, traffic police has enforced the law to wear helmets to tackle the problem. The outcome of the initiative till date was not measured. Therefore, the objective of the study was to assess the prevalence of maxillofacial injuries among the victims of motorized two-wheeler RTAs, following the passing of the helmet law. Materials and Methods: The study was conducted at the Accident and Emergency Department of K.S. Hegde Medical College and Hospital and at the Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India. The inclusion criteria were the patients who had two-wheeler accidents during the time period of 2016–2017 was collected. The data related to age, gender, helmet wearing, diagnosis, and type of orthopedic injuries was included. A descriptive statistics was calculated along with 95% confidence interval; correlation coefficient and odds ratio using STATA software. Results: A total of N = 347 individuals were included in the study. The mean age of the individuals was 33.7 (2–85) years, and the median age was 32 years. 81.55% (N = 283) were male and 18.44% (N = 64) were female. Among the individuals, 51.5% (N = 179) were not wearing helmets and 44.38% (N = 154) of them were males. A total of 25.07 (N = 87) individuals had orthopedic injuries and 16.42% (N = 57) individuals had orthopedic injuries who were not wearing helmets. Conclusion: Under the limitations of the study, we conclude that majority of the two-wheelers are not wearing helmets. This study has demonstrated that the impact of wearing helmet on occurrence of craniofacial and orthopedic injuries is less.
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Maxillofacial fracture patterns in road traffic accidents p. 345
Suresh Menon, ME Sham, Veerendra Kumar, S Archana, Priyangana Nath, Satyapriya Shivakotee, Mahbubul Hoda
DOI:10.4103/ams.ams_136_19  
Objective: The objective of this study is to analyze the maxillofacial fracture pattern from road traffic accidents (RTAs) in cases treated surgically in a tertiary hospital during July 2008–June 2018. Materials and Method: Data available in the department of oral and maxillofacial surgery of the institution of patients with maxillofacial fractures sustained due to RTAs that were treated in the department between the period July 2008 and June 2018 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation. Results: A total of 348 patients with maxillofacial fractures were diagnosed, of which 335 were male and 13 were female. The ages ranged from 7 to 70 years. The maximum cases were in the age group of 16–30 years with 181 fractures followed by 31–45 group with 133 fractures, 45–60 years with 21 fractures, 0–15 years with 8 fractures, and >60 years with five fractures. The maximum incidence of fractures was in the mandible with 168 cases followed by 92 in zygomatic complex, combination of fractures in 53 cases, 13 LeFort I fractures, nine frontal bone fractures, three fractures in other areas, five nasal fractures, and five LeFort II fractures. Males predominated the cases of mandibular fractures involving multiple sites and cases involving multiple bones. Conclusion: A maximum number of maxillofacial fractures cases were in the second and third decades of life, and the high-speed vehicles and lack of protective safety accessories such as helmets and seatbelts were responsible for the wide variety of pattern fractures of facial bones.
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Analysis of mandibular fractures: A 7-year retrospective study p. 349
Naiya Shah, Shital Patel, Ramita Sood, Yusra Mansuri, Mruga Gamit, Taher Rupawala
DOI:10.4103/ams.ams_22_19  
Background: Mandibular fractures contribute to a substantial proportion worldwide. Various variables related to mandibular fractures such as demographics, etiology, pattern of fracture, and treatment have been studied, but fewer reports on their correlations are published. Hence, this study attempts to understand these factors which can be useful for setting up clinical and research priorities. Aim: The purpose of this retrospective study is to establish a correlation between different factors associated with mandibular fractures. Materials and Methods: A database of 277 patients between July 2011 and October 2018 with mandibular fractures was retrospectively retrieved. Information on age, gender, etiology, pattern of fracture, and treatment done was obtained, tabulated, and analyzed statistically. Entities such as age and gender, age and cause, gender and cause, site of fracture and cause, site of fracture and side, site of fracture and treatment done, and site of fracture and gender were correlated. Statistical Analysis Used: Descriptive and analytical statistics were calculated using the SPSS version 20 using Chi-square tests which include Pearson's Chi-square and likelihood ratio. Results: In a total of 277 patients, a statistically significant correlation was found between age and the etiologic agent, site and side of fracture, and site of fracture and the treatment done with value of P < 0.05. Conclusion: A definite correlation between multitude of overlooked relevant co-factors has been studied which can provide an operating surgeon, a valuable impetus to be more vigilant in terms of medicolegal record maintenance, diagnosis, and possible clinical strategy for the treatment of mandibular fractures.
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Mandibular ramus cortical tenting graft and particulate allograft in the management of unilateral alveolar cleft p. 355
Amin Rahpeyma, Saeedeh Khajehahmadi
DOI:10.4103/ams.ams_96_19  
Background: Alveolar bone grafting in the mixed dentition stage is an important step in the management of cleft lip/palate patients. Intraoral donor sites are favored by patients and their parents. Objective: This study investigated a novel bilaminar cortical tenting grafting technique. The technique used a combination of autogenous mandibular ramus cortical bone and particulate allograft in unilateral cleft lip/palate patients during the mixed dentition stage. Materials and Methods: Five patients with nonsyndromic unilateral cleft lip and/or palate, in mixed dentition stage, were included in the study. Results: The operation was performed on five patients, and patients were followed up at least for one-year postoperation. Permanent maxillary canine erupted in the grafted alveolar region spontaneously in 80% of the patients. One wisdom tooth bud that had been exposed during the ramus bone harvest was removed. There was no alteration in the sensation of the lower lip as checked by light static and two discrimination tests. Conclusion: Unilateral alveolar clefts can be repaired using mandibular cortical block ramus bone in the form of bilaminar tenting grafts combined with particulate allografts.
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Tooth agenesis in patients with complete bilateral cleft lip and palate p. 359
Yomna O Elhoseiny, Raghdaa A B. Mostafa, Marwa A Elkassaby, Mona M Abou-El-Fotouh
DOI:10.4103/ams.ams_34_19  
Aim: The aim of this study was to compare the number of teeth in the premaxilla (cleft area) and to assess the presence of tooth agenesis with the ultimate goal of finding whether differences existed in the two suggested subtypes of nonsyndromic bilateral cleft lip and palate (BCLP) patients. Settings and Design: A retrospective comparative study was conducted, where cone- beam computed tomography (CBCT) images of 22 BCLP patients (10 males and 12 females, with age range 8 to 14, mean age 9.6 years) obtained from archive of Cleft Clinic, affiliated to the Oral and Maxillofacial Surgery department, Ain-Shams University, Cairo, Egypt were assessed. Subjects and Methods: CBCT images were divided into two subtypes: Group (P) – this represents BCLP characterized by well-developed (P) prominent premaxilla and SNA >80 ± 2 and Group (R) – this represents BCLP characterized by ill-developed (R) rudimentary premaxilla and SNA <80 ± 2. The number of teeth in the premaxilla was evaluated, and the presence of agenesis in the premaxilla and posterior segments was documented. Statistical Analysis Used: Unpaired-Student's t-test was used to compare the number of teeth among the two groups and to test significance at P < 0.05. Intraobserver agreement was assessed using alpha (Cronbach) reliability analysis. A descriptive analysis using percentages was performed to characterize tooth agenesis. Results: A significant difference was found in the number of teeth in the premaxilla among Group R and Group P. Maxillary lateral incisor showed the highest percentage of agenesis in the two groups followed by the maxillary second premolar. Conclusions: The number of teeth might be useful in differentiating different subtypes of nonsyndromic BCLP.
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Prognostic indicators of oral squamous cell carcinoma p. 364
Girish Mysore Suresh, Ravi Koppad, BV Prakash, KS Sabitha, PS Dhara
DOI:10.4103/ams.ams_253_18  
Background: Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy worldwide and is the major public health problem in the Indian subcontinent, where it ranks among the top three types of cancer in the country. Here, we aimed to analyze the clinical and tumor characteristics which impact the survival of OSCC patients. Methods: A retrospective analysis of clinical records of all patients who underwent treatment for OSCC at Kidwai Memorial Institute of Oncology, between January 2009 and January 2012 was analyzed. Age, gender, site of the primary lesion, tumor size (T), nodal status (N), stage of the disease, marginal status, and modality of treatment data were collected and analyzed. Results: Data of 147 patients with OSCC were included in the study and analyzed. Of the patients analyzed 61% were male, with 56% were <65 years, and 40% presented with buccal mucosa cancer followed by 30% with tongue cancer. Of all patients, 30% of them presented with Stage 1 and rest were Stage 2 and above. In our study, 40% underwent surgery only followed by regular follow-up and 60% needed surgery with postoperative adjuvant treatment based on the marginal status, the lymph node status, and T status of the disease. Conclusion: Our data suggest that age <65 years, female patients, alveolus lesion and tongue lesion and the early T Stage and N0 and negative margin had a significant positive impact on disease-free and overall survival of oral cancer patients.
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Immediately loaded bicortical implants inserted in fresh extraction and healed sites in patients with and without a history of periodontal disease p. 371
Łukasz R Pałka, Aleksandar Lazarov
DOI:10.4103/ams.ams_147_19  
Background: Bicortical screw implants may be used in both healed bone and fresh extraction sockets and loaded immediately. To date, there have not been too many studies reporting clinical results of such screws used in periodontally involved sites. This study aimed to assess many aspects of bicortical screw implants used to retain full-arch and segmental cemented prostheses in the rehabilitation of the mandible and maxilla in patients with or without a history of periodontal disease. Materials and Methods: This retrospective review involved 87 patients, of whom 77 had a history of periodontitis diagnosed before implant placement and 10 did not. They were treated following the same surgical procedure and received a total of 1019 implants which were immediately loaded with fixed prosthetic works. Results: A total of 1019 polished surface, one-piece, bicortical screw implants were used in 87 patients who underwent the same surgical treatment, i.e., tooth extraction and immediate implant placement were investigated, of which 526 were placed in the healed bone and 493 in fresh extraction sockets with the mean follow-up time of 22.2 ± 7.3 months. Results were analyzed using log-rank test, the Kaplan–Meier method, Chi-square test, and t-test. Cumulative survival at 12, 24, and 35 months after placement was 99.3%, 98.6%, and 97.0%, respectively. Conclusion: Bicortical smooth surface implant concept with immediate loading protocol provided predictable outcomes and survival rate of 99% in patients with and without a history of periodontitis. More studies are needed to further support the clinical advantages of bicortical anchoraged smooth surface implants.
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SYSTEMATIC REVIEW Top

Indications and treatment modalities with corticobasal jaw implants p. 379
Stefan Ihde
DOI:10.4103/ams.ams_142_19  
This consensus document describes treatment modalities with corticobasal implants in the field of oral and maxillofacial implantology.
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Comparison of TORS with conventional surgery for oropharyngeal carcinomas in T1–T4 lesions p. 387
Khushal Gangwani, Lakshmi Shetty, Ratnadeepika Seshagiri, Deepak Kulkarni
DOI:10.4103/ams.ams_33_18  
Objectives: Transoral Robotic Simulation (TORS) is an innovative surgical technique indicated for resection of selected head-and-neck cancers. The authors conducted a systematic review discussing the indications, advantages, and disadvantages of this technique. Data Sources: The search included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, COCHRANE, and bibliographies of relevant studies through January 2006. Materials and Methods: Studies included patients treated for T1–T4 stage oropharynx cancer with TORS. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment specific details, as well as recurrence, survival, and adverse events, were collected. Methodological quality for each study was appraised. Results: Nine studies were included which met the inclusion criteria. Patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two-year overall survival estimates ranged from 82% to 94% for TORS. Conclusion: The minimally invasive transoral robotic simulation (TORS) for the treatment of oropharyngeal cancers is proved to be less time-consuming, compliant to the patients, and having less complications as compared to the more invasive techniques involving conventional surgery although the quality of this evidence is limited.
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TECHNICAL NOTES Top

An alternative approach for treating severe injured temporomandibular joints by gunshot wounds p. 393
Tâmara Melo Nunes Ota, Ana Paula Guerreiro Rodrigues Couto, Sílvio Augusto Fernandes de Menezes, João de Jesus Viana Pinheiro, André Luis Ribeiro Ribeiro
DOI:10.4103/ams.ams_35_19  
Temporomandibular joint (TMJ) reconstruction is a challenging clinical problem that has been revolutionized due to the development of total alloplastic TMJ replacement (TMJ-TJR); however, the costs are still very high. We used an alternative approach to treat comminuted mandibular condyle fracture with an unviable condyle head caused by gunshot wounds. Our surgical technique consisted of an extended preauricular incision; removal of the fractured condyle, bone fragments, and foreign bodies; reshape/flattening of the fracture edge; fixation of the articular disc (if viable); lining of the TMJ with temporalis muscle/fascia; application of Erich arch bars; and early elastic therapy. We successfully used this approach in five sequential cases that resulted in a good mouth opening (>35 mm) and satisfactory occlusion with teeth in maximum intercuspation. We believe that this technique is an excellent option for treating severe injured TMJs in places where TMJ-TJR is not available.
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Inferior repositioning of coronoid process for the treatment of temporomandibular joint subluxation/dislocation p. 397
VB Krishnakumar Raja, Sasikala Balasubramanian, Geetha Sridharan, Swetha Tarun, Elavenil Panneerselvam
DOI:10.4103/ams.ams_137_19  
Subluxation/dislocation of the temporomandibular joint (TMJ) is characterized by transient locking of the jaw following wide mouth opening. The etiology of the condition is multifactorial relating to hard-tissue or soft-tissue components of the joint. Myriad treatment procedures have been described in the literature, each with its own advantages and disadvantages. We present a new intraoral technique of coronoid repositioning for the treatment of TMJ subluxation/dislocation.
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Modified cut for gap arthroplasty in temporomandibular joint ankylosis p. 400
Neelam Noel Andrade, Shibani Abhay Nerurkar, Paul Mathai, Neha Aggarwal
DOI:10.4103/ams.ams_269_18  
Temporomandibular joint ankylosis is a debilitating disease affecting the function, esthetics and psychology of the patient. Treatment of this condition aims at establishing not only the function and esthetics but also aims to prevent reankylosis. Among the different treatment modalities, interpositional gap arthroplasty followed by aggressive jaw physiotherapy is considered most effective. This is achieved by making two horizontal osteotomy cuts at a distance of 10–15 mm in the TMJ region. The gap is then interposed with an autogenous or alloplastic graft material. However, during the application of a jaw stretcher intraoperatively with the surgical site open and with the jaw wide open, a bony contact was seen to occur between the posterior aspect of the upper and lower osteotomy cuts. Taking this into consideration, the lower osteotomy cut is modified by making the posterior one-third cut divergent. This eliminates the bony contact during maximum mouth opening and thus prevents the chances of reankylosis as well.
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CASE REPORT - TRAUMA Top

Orbital fractures in childhood p. 403
Luisa Valente, Riccado Tieghi, Giovanni Elia, Manlio Galiè
DOI:10.4103/ams.ams_185_19  
Pediatric orbital floor fractures exhibit distinctive features that distinguish them from orbital injuries seen in the adult population. This is mainly due to different anatomy and mechanical properties of the orbital bones in children. The management of pediatric orbital floor fractures requires consideration of these factors, including the age of the patient and therefore child's growth potential, using, if possible, a minimally invasive surgical approach. The aim of this paper is to report a case of a 1-year-old male child with a surgically treated blowout fracture of the orbital floor. To enable early diagnosis and treatment, accurate physical examination is mandatory, but a computed tomographic examination is important, especially in younger patients because of their inability to fully express their symptoms and poor compliance. We discuss the specific presentation and diagnostics of orbital floor fractures in early childhood and the related surgical planning and treatment.
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Bone cements in depressed frontal bone fractures p. 407
Alagappan Meyyappan, Eswari Jagdish, Jessica Yolanda Jeevitha
DOI:10.4103/ams.ams_155_19  
Skull fractures can be classified into four major types; linear, depressed, diastatic, and basilar. Of these, a depressed skull fracture presents a high risk of increased intracranial pressure or hemorrhage to the brain. A compound depressed skull fracture results when a laceration over the fracture exposes the internal cranial cavity to the outside environment. Such depressed skull fractures are indicated for elevation if the defect is more than 10 mm and in the presence of brain injury. Frontal bone contour defects result in marked facial deformity which becomes obvious to the observer. Esthetic correction of the depressed frontal bone fracture can be done with autogenous bone grafts or alloplastic materials. Autogenous bone grafts are meant to be the gold standard method of reconstruction, but they harbor the risk of donor-site morbidity. There are various materials available for the reconstruction of depressed frontal bone fractures. This is a case report which illustrates the use of easily injectable, self-setting calcium phosphate bone cement in the correction of a depressed frontal bone fracture measuring approximately 3 cm × 2.5 cm × 1.5 cm.
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Transnasal endoscopic approach for the treatment of medial orbital wall fractures p. 411
Anna Bonsembiante, Luisa Valente, Andrea Ciorba, Manlio Galiè, Stefano Pelucchi
DOI:10.4103/ams.ams_173_19  
The aim of this study is to report a case series of blowout fractures of the medial orbital wall that were treated endoscopically. Isolated fractures of the medial orbital wall are uncommon and can be asymptomatic. Various surgical methods for repairing medial orbital wall fractures have been described. The standard approach for the treatment of medial orbital wall fractures is the transcutaneous approach or the transconjunctival with retrocaruncular approach. In the last years, the attention on the use of minimally invasive techniques such as transnasal endoscopic approach is growing. This was a retrospective study of six cases completely managed endoscopically. In the presented case series, the endoscopic endonasal approach represented a safe and effective procedure for the reduction of medial wall orbital fractures.
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CASE REPORT - TUMORS AND TUMOR LIKE CONDITIONS Top

Ramon syndrome- A rare form of cherubism p. 415
LK Surej Kumar, DS Deepa, S Dilna
DOI:10.4103/ams.ams_12_19  
Cherubism is an inherited, autosomal dominant disorder that affects the jaws of children. The disease is usually obvious as a painless bilateral swelling in which bone is replaced with fibrous tissue. Affected children appear normal at birth. Swelling of the jaws usually occurs between 2 and 7 years of age and relapses as age progresses leaving a few facial deformities and malocclusion. The disease is microscopically indistinguishable from other giant cell lesions. The association of cherubism with gingival fibromatosis, epilepsy, mental retardation, stunted growth, and hypertrichosis is referred to as a rare case of possible Ramon syndrome with extraordinary tissue enlargement over the teeth. Here, we present a case of Ramon syndrome in a 6-year-old girl describing the clinical and radiographic features successfully treated with a brief review of literature.
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Primary Ewing's sarcoma of zygoma p. 419
Kapil Soni, Poonam Elhence, Amber Kesarwani, Nikhil Rajan
DOI:10.4103/ams.ams_267_18  
Ewing's sarcoma is a small round cell tumor, malignant in nature, typically affecting long bones and pelvis. It is most commonly presented in the pediatric age group. The occurrence of Ewing's sarcoma in the head-and-neck region is rare and is reported to be around 2%–3%, of which chances of having primary lesion are rarer. Among facial bones, mandible is the most commonly affected bone. Primary involvement of zygoma is extremely rare. Here, we present a case of primary Ewing's sarcoma of the left zygoma in a 17-year-old girl. The diagnosis was made after surgical resection, histopathology with immunohistochemistry confirmation, and cytogenetic study.
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Carotid body paraganglioma p. 423
Rashmi Maruti Hosalkar, Jayesh S Khivasara, Niharika Swain
DOI:10.4103/ams.ams_183_18  
Carotid body paraganglioma (CBP) is a type neuroendocrine tumour arising from paraganglial chief cells of carotid body. Situated at the bifurcation of the common carotid artery, it constitutes 0.5% of all body tumours. Though CBP's is most common paraganglioma of head and neck it is a rare neoplasm and requires a thorough examination for a proper diagnosis and therapeutic management. Here, we present a case of 36 year old female patient with CBP in left side of the neck.
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Sequential removal of a large odontoma in the angle of the mandible p. 429
R Saravanan, V Sathyasree, R Manikandhan, S Deepshika, Kavitha Muthu
DOI:10.4103/ams.ams_102_19  
Odontomas are the commonly occurring benign tumors of the jaw, which are odontogenic in origin. Lesion originates as the dental components are laid down in a disorganized manner, due to failure of normal morphodifferentiation. They are considered as hamartomatous developmental malformations rather than a true neoplasm. Mostly, these asymptomatic lesions are discovered as an incidental finding. Large odontomas may give rise to local disturbances, such as eruption delay of permanent teeth, asymmetric tooth eruption, malpositioning, displacement, resorption, or occasional devitalization of adjacent teeth. Odontomas may erupt into the mouth and tend to be associated with impacted teeth and other cystic lesions. The odontomas have a tendency to become symptomatic due to local infection such as sinusitis, infected adjacent tooth, and the exposure of tumor to oral environment. The aim of this paper is to elucidate the primary features and treatment of these lesions, depending on published data and individual witness.
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Mandibular condyle osteoma p. 434
Luisa Valente, Riccardo Tieghi, Stefano Mandrioli, Manlio Galiè
DOI:10.4103/ams.ams_174_19  
Background: Osteoma is a benign tumor composed of both cortical and cancellous bones that increase in size with continuous formation of bone. The pathogenesis is unknown. Osteomas can cause symptoms depending on their location and size. They can be asymptomatic or symptomatic, with trismus, limitation of mouth opening, and progressive malocclusion with facial asymmetry and can be painful. Aim: The aim of this paper is to report an unusual case of osteoma in the mandibular condylar neck and review the cases of mandibular condyle osteomas that have been reported in the last 15 years. Conclusions: Only a few cases involving the temporomandibular joint have been reported. We report an unusual case of osteoma in the mandibular condylar neck causing restricted mouth opening in addition to pain. Complete surgical excision in symptomatic cases is the therapy of choice with a low recurrence rate.
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Extraskeletal myxoid chondrosarcoma of the parotid gland p. 439
Nyimi Bushabu Fidele, Wu Tianfu, Bing Liu, Yanfang Sun, Zhao Yifang
DOI:10.4103/ams.ams_145_18  
Extraskeletal myxoid chondrosarcoma (EMC) is a rare tumor with an estimated incidence of <3% among of all soft-tissue sarcomas. It is characterized by a multinodular architecture, abundant myxoid matrix, and malignant chondroblast-like cells arranged in cords. The tumor is an entity from chondrosarcomas of bones, commonly found in the soft tissues of the lower extremities at 80%. There are very limited reports of this tumor in the head and neck, especially in the parotid gland. The purpose of this paper is to describe an EMC located at an unusual site in the parotid gland, and briefly, the literature review with special reference to the clinicopathological features and the treatment approach was discussed.
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Versatility of buccal pad fat and temporoparietal fascia flap in surgical management of oral submucous fibrosis p. 444
Somnath Mukherjee, Satyajit Dandagi
DOI:10.4103/ams.ams_4_16  
The various surgical procedures for surgical management of oral submucous fibrosis (OSMF) include excision of fibrous bands with or without grafts or flaps. Materials for attempted grafting included skin, placental grafts, and artificial dermis. Materials that can be used as flaps are tongue flaps, buccal fat pad, greater palatine pedicle flaps nasolabial flaps, anterolateral thigh flap, radial forearm flap, and temporalis fascia flap. The temporoparietal flap is ultrathin surgically single layer fibrovascular sheet with high vascularity, flexibility, pliability, and versatility. Ten cases with Grade III and Grade IV OSMF with 5 patients planned for reconstruction with buccal fat pad and 5 patients planned for temporoparietal fascia flap (TPFF) after surgical resection of fibrotic bands were undertaken for the study. After 7 days, both flaps healed nicely with complete epithelization of the two flaps occurred. There were no complications except for hyperplasia of TPFF that covered the defect. Postoperative histopathological examination of hyperplastic temporoparietal fascia revealed well-differentiated squamous-cell carcinoma in one patient and in another case, there was failure of TPFF. Both buccal pad fat and TPFF are reliable for the reconstruction of buccal mucosal defects in surgical management of OSMF.
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Priority of treatment in craniofacial fibrous dysplasia p. 451
Chembolu Neelima, Patlola Bal Reddy, Chembolu Nirupama, Endla Varun Kumar
DOI:10.4103/ams.ams_186_17  
Fibrous dysplasia (FD) is a nonneoplastic hamartomatous developmental fibro-osseous lesion, with anomaly in bone-forming mesenchyme which manifests as a defect in osteoblastic differentiation and maturation leading to fibro-osseous tissue formation characterized by deformities in the bone, fractures, nerve compression, and bone pain. The clinical behavior and progression of FD make the management of this condition difficult. Here is a case report of a young male patient who was diagnosed as having craniomaxillofacial FD. The diagnosis was based on clinicoradiological and histopathological investigations. In this case, management of FD poses significant challenges to the surgeon.
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CASE REPORT - INFECTION Top

Tuberculous infection and exodontia: A diagnostic & Treatment dilemma p. 455
Vedati Santosh Kumar, G Santosh Reddy, D Guru Charan, Karipineni Swetha, Chembolu Neelima, Nimeshika Ramachandruni
DOI:10.4103/ams.ams_5_19  
Tuberculous infection is more common in developing countries which are often overlooked by most of the doctors due to improper medical case history. This causes further complications as they proceed with their procedure. Till date, in dentistry, 90 such cases have been reported in literature. Hence, a dentist should be suspecting preexisting tuberculous osteomyelitis or postextraction complications from such an infection in patients with a positive history of tuberculous infection. Diagnosis as such is often overlooked despite a high prevalence of the disease in high-burden countries such as India. We report this case because of the rarity of its clinical presentation, which was misdiagnosed as odontogenic problem instead of preexisting tuberculous osteomyelitis in the mandibular retromolar region.
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Cervicofacial infections caused by Staphylococcus aureus p. 459
Carlos Lazarte, Leonel Paladino, Luciana Mollo, Romina Katra, Brusca Marķa Isabel, Sebastian Ariel Puia
DOI:10.4103/ams.ams_226_18  
Staphylococcus aureus (S. aureus) is an opportunistic pathogen that causes a wide range of diseases. Dissemination of perioral infections is a common problem in the field of oral and maxillofacial surgery. The aim of the study was to evaluate S. aureus carriage in the oral cavity and its dissemination to different cervicofacial regions. Clinical case 1 is a patient with a systemic history of type I diabetes which led to foot amputation one year previou sly, who presented alteration of ocular motility and the culture showed Grampositive cocci compatible with S. aureus. The patient was discharged after eight days of antibiotic therapy and drainage. Clinical case 2 was a young female without any comorbidities who had never been hospitalized before or even exposed to the hospital environment. The presence of lesions compatible with necrotizing fasciitis (NF) in the lower lip mucosal region, rapid evolution of the infection to deep planes, and evolution of the clinical picture alerted health-care providers to the need for prompt care. Clinical case 3 was an immunosuppressed patient with cellulitis which is a bacterial infection of the skin and soft tissues that occurs when the physical barrier of the skin and soft tissues, the immune system, and/or the circulatory system are affected. S. aureus is an opportunistic pathogen which causes a wide range of diseases. It inhabits the oral cavity, from where it can spread to distant cervicofacial regions. This is why it is important for health-care professionals to be aware of this niche in case of dissemination in order to provide prompt diagnosis and appropriate treatment.
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CASE REPORT - IMPLANTOLOGY Top

Dental implant treatment and immediate functional loading (1). Case report and considerations: Extended treatment options using the strategic implant® and indications and objectives for comprehensive dental implant treatment p. 465
Stefan Ihde, Olga Sipic
DOI:10.4103/ams.ams_146_19  
While materials for the restoration of teeth and new (digital) technologies develop fast, the choices of the treatment provider and the patients get wider. Choosing an adequate and long-lasting treatment is a question of “doing the right thing,” and only after that, the dentist has to think about the question how to do the work properly. This case report explains and illustrates a case, where an adequate treatment by means of conventional dentistry would not have been possible on one hand, and where treatment with the technology of the Strategic Implant® provided a perfect result within only a few days. Thanks to this technology, patients can be treated with fixed prostheses regardless of the amount of residual bone. Recently, published long-term observations on large amounts of implants have shown that the results are sustainable.
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Functional and esthetic indication for dental implant treatment and immediate loading (2) Case report and considerations: Typical attitudes of dentists (and their unions) toward tooth extractions and the prevention of early, effective, and helpful dental implant treatment in the European union p. 470
Stefan Ihde, Olga Sipic
DOI:10.4103/ams.ams_152_19  
The technology of the Strategic Implant® facilitates dental implant treatment almost regardless of the available bone. This explains its increasing use to resolve problems with the dentition of the middle-aged patient in a radical manner, simply by extracting the residual dentition and placing implants. While a radical change in the implant treatment paradigm has taken place in some countries, in other countries, dentists try hard to keep their work area free of implants or to deliver them only as a last resort. Liberating patients from the burdens of their own teeth are not advocated by dental universities, as their main field of teaching deals with the repair of teeth and conventional ways of replacing them. This case report shows a standard treatment with Strategic Implants®, discussing the topic from the point of view of practitioners, universities, and other parties involved in decision-making. The authors conclude that the interests of the patients are not respected in many cases because the parties involved have vested interests in other treatment modalities.
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CASE REPORT - DEVELOPMENTAL DISORDERS Top

Ectopically positioned tooth piercing the philtrum p. 475
Payal Dillipkumar Mehta, Nimisha Desai, Riddhi Matariya, Yama Patel
DOI:10.4103/ams.ams_149_19  
A variety of eruption disturbances arise during the transitional dentition period, which can be broadly classified as disturbances related to time and disturbances related to position. The occurrence of ectopic eruption is relatively common, but ectopically positioned tooth piercing the philtrum is a rare clinical presentation. This is a case report of a 70-year-old female who presented with the chief complaint of an abnormally positioned tooth piercing out from the upper lip to the Department of Oral and Maxillofacial Surgery, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India. As per the patient's history, labially erupted tooth was piercing the philtrum for 60 years and it was visible extraorally from the philtrum and was painful.
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Wilkes stage IV internal derangement-An osteochondromatosis of condyle p. 478
Deepak A Pandyan, Atmakuru Venkata Maheedhar, G. V. V. Giri, K Santosh Kumar
DOI:10.4103/ams.ams_27_16  
Osteochondroma (OC) or osteocartilaginous exostosis is characterized by cartilage capped, osseous projection protruding from the surface of affected bone. OC is the most common tumor of skeletal bones. This benign tumor can occur as a part of autosomal dominant syndrome called osteochondromatosis. Here, we describe a case report with our view in managing the patient and giving best treatment with the help of knowledge gained by literature and experience.
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CASE REPORT - MISCELLANEOUS Top

Remodeling of neocondyle p. 481
KR Ashok Kumar, R Ravikumar, TR Marimallappa, Hijam Thoithoibi Chanu
DOI:10.4103/ams.ams_70_19  
Temporomandibular joint (TMJ) ankylosis in children is one of the most complex and challenging problems managed by oral and maxillofacial surgeons. TMJ ankylosis in growing children often leads to facial deformity, difficulty in chewing and swallowing, severe malocclusion, poor oral hygiene, multiple decayed teeth, and impairment of speech. A good functional and esthetic outcome can be achieved after reconstruction with the autogenous grafts. Here, we present a case of a 9-year-old patient treated with condylectomy and ipsilateral coronoidectomy, followed by reconstruction with costochondral graft with 5 years of follow-up. During this period, the reconstructed graft remodeled into a neocondyle and also regrowth of the coronoid process. The mouth opening and facial symmetry were acceptable.
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Inverted maxillary third molar impactions p. 484
Padmanidhi Agarwal, Shailesh Kumar, Kanav Jain, Kamini Kiran
DOI:10.4103/ams.ams_152_17  
Maxillary third molars are one of the most commonly impacted teeth, but its inverted type is very rare. Five cases of inverted and impacted maxillary wisdom teeth are described here. Two were symptomatic and required transalveolar extractions, while three were conservatively managed. Complications may arise from surgical removal of inversions, and so, removal must be carefully weighed against the benefits of retaining them. This case series discusses the rare occurrence of impacted inverted maxillary third molars, its increased incidence in the Indian population, and the dilemma considering its treatment options. If left untreated, regular follow-up should be done to note for any complication.
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