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   Table of Contents - Current issue
Coverpage
July-December 2017
Volume 7 | Issue 2
Page Nos. 163-321

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GUEST EDITORIAL  

To infinity…. and beyond!! p. 163
Wynand Van Der Linden
DOI:10.4103/ams.ams_92_17  PMID:29264279
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EDITORIAL Top

Understanding and prevention of orofacial clefting: A myth or possibility? p. 165
SM Balaji
DOI:10.4103/ams.ams_181_17  PMID:29264280
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REVIEW ARTICLE Top

Fast-track orthognathic surgery: An evidence-based review Highly accessed article p. 166
Joel Joshi Otero, Olivier Detriche, Maurice Yves Mommaerts
DOI:10.4103/ams.ams_106_17  PMID:29264281
The aim of this study was to establish a fast-track protocol for bimaxillary orthognathic surgery (OGS). Fast-track surgery (FTS) is a multidisciplinary approach where the pre-, intra-, and postoperative management is focusing maximally on a quick patient recovery and early discharge. To enable this, the patients' presurgical stress and postsurgical discomfort should be maximally reduced. Both referral patterns and expenses within the health-care system are positively influenced by FTS. University hospital-literature review through Medline, Embase, and the Cochrane Library (January 2000– July 2016) using the following words – “fast track, enhanced recovery, multimodal, and perioperative care” – to define a protocol evidence based for OGS, as well as evidenced-based medicine search of every term added to the protocol during the same period. The process has resulted in an OGS protocol that may improve the outcome of the patient through several nonoperative and operative measures such as preoperative patient education and intra/postoperative measures that should improve overall patient satisfaction, decrease morbidity such as postoperative nausea, headache, dizziness, pain, and intubation discomfort, and shorten hospital stay. A literature review allowed us to fine-tune a fast-track protocol for uncomplicated OGS that can be prospectively studied against currently applied ones.
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ORIGINAL ARTICLE - CROSS-SECTIONAL STUDY Top

Orthognathic surgery or overlay prosthesis: Quality of life in bilateral cleft lip and palate patients p. 176
Michelly Lima Moro Alves, José Fernando Scarelli Lopes, Ana Lúcia Pompéia Fraga de Almeida, Karin Hermana Neppelenbroek, Thais Marchini de Oliveira, Simone Soares
DOI:10.4103/ams.ams_135_16  PMID:29264282
Background: The concern to restore and evaluate bilateral cleft lip and palate (BCLP) patients' quality of life, after rehabilitation, is an issue that has been discussed in the literature because it is the ultimate goal of any proposed treatment. Objective: To evaluate the overall and oral quality of life of BCLP patients who had completed their treatment with orthognathic surgery (OrSg) compared to those who completed theirs with prosthetic rehabilitation in the form of overlay prosthesis (OP). Materials and Methods: The study comprised 40 patients, 20 in OrSg group and 20 in OP group. Epidemiological survey and application of two questionnaires (World Health Organization Quality of Life-brief [WHOQOL-bref] and Oral Health Impact Profile-14 [OHIP-14]) were done. The final results were evaluated statistically by the Mann– Whitney test. Results: Regarding the comparison with the WHOQOL-bref, no significant statistical differences between groups were found. In the analysis of the OHIP-14, only in “psychological limitation” field difference could be observed, where OrSg group showed more negative impact when compared to the OP group. Conclusion: Both rehabilitations provide a satisfactory quality of life for patients.
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ORIGINAL ARTICLES - EVALUATIVE STUDY Top

A study on dorsal pedicled tongue flap closure of palatal fistulae and oronasal communications p. 180
Priya Esther Jeyaraj
DOI:10.4103/ams.ams_94_17  PMID:29264283
Introduction: Residual defects of the palatal region following ablative resection of tumors and Gunshot wounds (GSWs) of the maxillofacial region can be quite painstaking, daunting and challenging to reconstruct, due to the extent and composite nature of the tissue loss. A shortage of available donor areas and local flap options in the intraoral region, add to the difficulty. Further compounding the situation, are factors such as excessive fibrosis and scarring of the palatal tissues as a result of multiple previous surgeries in the region. Objective: To evaluate the effectiveness of the Dorsal Pedicled Tongue Flap in the reconstruction of complex palatal defects resulting from maxillofacial GSWs and ablative tumor resections. To also device techniques to reduce the incidence of postoperative tongue flap detachment, thus improving its efficiency and reliability. Results: The palatal fistulas in all the patients were closed successfully, with no post-operative complications such as bleeding, hematoma formation, congestion, infection, partial or total flap necrosis or flap detachment. The tongue flap at the recipient site remained healthy with no recurrence of the fistula in any of the patients in the two years follow up period. There was a complete resolution of the problem of nasal regurgitation of orally ingested fluids and food particles. There was observed no deformity or articulation defect resulting from the flap harvested from the tongue dorsum, in any of the patients. Conclusion: In GSWs and tumor ablative surgery, where composite tissue defects are involved, the tongue provides a reliable and efficient means of restoring lost tissue bulk as well as ensuring a permanent closure and sealing off of the oronasal fistulas. Its reliability can be further increased by avoiding a common complication, namely, flap detachment in the postoperative period brought on by movements of the tongue, by immobilizing the tongue by tethering it to the maxillary teeth and also, maintaining the patient on Nasogastric feeding for the three weeks postoperative period, until the patient is taken up for surgical separation the pedicle. This helps to ensure a successful and predictable take of the flap at the donor site.
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Lugol chromoscopy in the follow-up of head and neck carcinoma p. 188
Cesar Augusto Simões, Marcelo Doria Durazzo, Flávia Caló de Aquino Xavier, Marina Helena Cury Gallottini, Sílvia Vanessa Lourenço, Décio dos Santos Pinto Júnior, Natália Martins Magacho de Andrade, Aline Paterno Miazaki, Rogério Aparecido Dedivitis, Cláudio Roberto Cernea
DOI:10.4103/ams.ams_95_17  PMID:29264284
Introduction: Lugol is helpful in identifying early second primary tumors (SPTs) during oroscopy and pharyngoscopy, but this technique has not been assessed during follow-up visits with these patients. Aim: The aim of this study is to describe the use of Lugol (a low-cost method) to diagnose SPTs in the oral cavity and oropharynx. Methods: Patients treated for squamous cell carcinoma of the head and neck were randomly assigned to two groups. Group A was examined with routine oroscopy and pharyngoscopy without Lugol, and Group B was examined with routine oroscopy and pharyngoscopy without stain and with Lugol. A total of 211 patients were included during 4 years. Results: Six oral and oropharynx carcinomas were detected in Group A. Eighteen oral and oropharynx carcinomas were detected in Group B, twelve of which were not seen without chromoscopy but were detected with Lugol. Conclusion: Lugol increases the detection of malignant lesions compared to routine examination alone.
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Evaluation of the sternoclavicular graft for the reconstruction of temporomandibular joint after gap arthroplasty p. 194
JK Dayashankara Rao, Nahida Dar, Aadya Sharma, Anil K Sheorain, Vijaylaxmi Malhotra, Varun Arya
DOI:10.4103/ams.ams_120_16  PMID:29264285
Introduction: Ankylosis may be defined as the fusion of the articular surfaces with bony or fibrous tissue. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high incidence of recurrence. A number of interpositional materials have been used including alloplastic materials (acrylic, proplast– teflon, silastic), and autogenous tissues (temporalis muscle flaps, buccal fat pad, dermis, costochondral grafts, metatarsal, fibula, tibia, iliac crest, cranial bone and Sternoclavicular graft SCG and cartilage). Literature suggests that rather than growth centre, we need adaptive centre. SCG is presumed to be a more suitable material for interpositional arthroplasty because Sternoclavicular Joint (SCJ) and TMJ are very similar developmentally, histologically and morphologically throughout the growth period. Material and Method: Patients with TMJ ankylosis (8 males, 2 females) underwent release of the ankylosed joint by the senior author, between June 2013 and Novemeber 2015. The age of the patients ranged from 10 to 19 years. Pre- and post- operative assessment included a thorough history and physical examination to determine the cause of ankylosis, the maximal incisal opening, etiology and type of the ankylosis, recurrence rate. Result: MIO at 6 months follow up was 37.4±2.633 mm (range 32-40 mm), greater than MIO achieved in immediate postoperatively {34.4±2.22 mm (range 30-38 mm). After reconstruction of temporomandibular joint with sternoclavicular graft in the growing child there was a significant increase in the growth of mandible which was stunned due to ankylosis. And the ramal height also increased. Conclusion: The articular reconstruction with alloplastic or autogenous grafts, or gap arthroplasty for the treatment of ankylosis is shown to be efficient in relation to the post-operative maximal incisal opening, recurrence and articular function.
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A randomized control trial of awake oral to submental conversion versus asleep technique in maxillofacial trauma p. 202
Shahna Ali, Manazir Athar, Syed Moied Ahmed, Obaid Ahmad Siddiqi, Amrin Badar
DOI:10.4103/ams.ams_10_17  PMID:29264286
Aim: This study was designed to evaluate the efficacy of awake oral to submental conversion over asleep technique. Materials and Methods: This randomized clinical study was conducted in maxillofacial department of a tertiary care hospital in patients who had panfacial or mandibular fractures requiring elective surgical correction. The patients were randomly divided into two groups of 12 patients each, asleep fiberoptic-assisted submental intubation (SMI) (Group G; n = 12) and awake fiberoptic-assisted SMI (Group A; n = 12). The primary predictor was mean conversion time of oral to SMI while other predictors were overall success rate, ease of conversion, and complications. Data are presented as mean (±standard deviation) and frequencies (%) as appropriate. Statistical analysis done using unpaired t-test or Chi-square test was performed and P < 0.05 was considered statistically significant. Results: Twenty-four patients (19:5;Male:Female) aged 18– 55 years (Group G = 35.96; Group A = 32.43 years) were included in the study. SMI was successful in all except two patients in group G. Overall success rate was similar in both groups. Time to convert orotracheal intubation to SMI was significantly less in group A (Group G = 9.55 ± 1.42, Group A = 5.67 ± 1.73; P < 0.001). Ease of SMI was found Grade I in 30% and 83% of the patients of group G and A, respectively. No serious complications were observed except 2 cases of bleeding, and 1 case of tube damage. Conclusion: Awake oral to submental conversion requires lesser time in comparison to asleep technique besides improving the ease (Δ = 53%) of the procedure.
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ORIGINAL ARTICLES - PROSPECTIVE STUDY Top

Low-level laser therapy on postoperative pain after mandibular third molar surgery p. 207
May Ayad Hamid
DOI:10.4103/ams.ams_5_17  PMID:29264287
Introduction: The analgesic effect of low-level laser therapy (LLLT) after mandibular third molar (MTM) extraction is controversial. The aim is to evaluate the effect of intraoral LLLT on postoperative pain after MTMs extraction. Methods: Thirty patients with bilateral symmetrical impacted MTMs underwent surgical extractions. Experimental and control sides were randomly selected to receive LLLT or placebo. Following suturing, a dental assistant applied 810 nm gallium aluminum arsenide (GaAlAs) at three points for 30 s each with a total energy of 9 J. Pain was recorded on a visual analog scale on the 7 successive days. Results: Data analyzed by IBM SPSS Statistics 23 for Windows with P ≤ 0.05 signifi cance level. LLLT appeared to have a high signifi cant effect on pain reduction; however, there was a mild increase in pain after the 4th day. Conclusion: Intraoral 810 nm GaAlAs is effective in reducing postoperative pain when a dose of 32.86 J/cm2 is used.
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Evaluation of knowledge of physical education students on dental trauma p. 217
Danilo Louzada de Oliveira, Paulo Domingos Ribeiro-Junior, Ana Camila Sbroggio, Priscila Góis dos Santos, Graziela Garrido Mori
DOI:10.4103/ams.ams_115_17  PMID:29264288
Introduction: Sports' practitioners are vulnerable to dental trauma; if this occurs, the emergency treatment should be fast and efficient. This may be performed by any person at the site of the accident, not only by dental professionals. Physical educators may face dental trauma and should be able to provide proper care. This study had the objective evaluated the knowledge of physical education graduates on dental trauma. Materials and Methods: A questionnaire containing questions on dental trauma was applied to 199 physical education students; after collection of the questionnaires, data were tabulated and processed on the software Epi Info 2000 (Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA). As a result, only 36.7% of participants would take the individual suffering trauma to the dental professional, 56.8% believe that the avulsed tooth should be replanted, and 42.2% would replant it. Only 7.5% would store the avulsed tooth in an ideal storage medium for transportation. Conclusion: It was concluded that there is a lack of knowledge on dental trauma among physical education graduates, evidencing the need of public policies to allow education on this issue.
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ORIGINAL ARTICLES - RETROSPECTIVE STUDY Top

Craniosynostosis of the sphenofrontal suture: Definition of the main signs of craniofacial deformity p. 222
Sergey Alexandrovich Yasonov, Andrey Vyacheslavovich Lopatin, Alexandr Yurievich Kugushev
DOI:10.4103/ams.ams_96_17  PMID:29264289
Aims: The aim of this study is to compare clinical features of sphenofrontal craniosynostosis (SFC) and unilateral coronary craniosynostosis. Settings and Design: This was a retrospective study with two groups of patients with sphenofrontal and coronary craniosynostosis. Materials and Methods: This was a retrospective study of the 1999– 2016 archive data in Russian Children's Clinical Hospital. Ninety-five patients were diagnosed with frontal plagiocephaly. Eighty-three had deformations of unilateral craniosynostosis of coronary suture, 12 had premature closures of sphenofrontal suture. The age at the time of diagnosis varied from 5 months to 2, 5 years. Results: SFC is featured by ipsilateral flattening of forehead and supraorbital margin, and ipsilateral dystopia of supraorbital margin downward. X-ray signs are the closure of sphenofrontal suture on the lesion side with open and symmetrically located remaining skull sutures and contralateral deviation of the midline of the ethmoid. Conclusions: SFC distinguishes from other plagiocephalias by following signs: supraorbital margin on the affected side is shifted downward; tip of the nose is displaced toward the affected side, root of the nose toward the healthy side. These signs facilitate correct diagnosis and treatment tactics.
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Features of prevertebral disease in patients presenting to a head and neck surgery clinic with neck pain p. 228
Scharukh Jalisi, Osamu Sakai, Basem T Jamal, Vartan Mardirossian
DOI:10.4103/ams.ams_54_17  PMID:29264290
Introduction: Untreated prevertebral space infections, which can be overlooked because of connections with surrounding spaces, may lead to spinal epidural accumulations that cause cord compression. The aim of this study was to analyze the epidemiologic and diagnostic features of cases of prevertebral disease encountered by head and neck specialists. Materials and Methods: The study was designed as a retrospective chart review of 11 patients with prevertebral disease who presented to a head and neck surgery specialist for consultation from 2004 to 2010. Epidemiologic characteristics, clinical signs, diagnostic modalities, time to diagnosis, treatment, and final outcome were analyzed. Ethical Approval: This article does not contain any studies with human participants or animals performed by any of the authors. Results: Seven patients were diagnosed with prevertebral abscess, two with prevertebral cellulitis, and two with calcific cervical tendonitis. The most common presenting signs were neck pain (100%), odynophagia (54%), dysphagia (36%), neck rigidity (36%), fever (27%), and back pain (9%). Five patients (45.5%) showed a bulge on the posterior pharyngeal wall. Four patients with prevertebral abscess showed epidural accumulations on magnetic resonance imaging. Patients with prevertebral abscess and cellulitis were treated with surgical drainage or intravenous antibiotics or both while patients with calcific cervical tendonitis were treated with anti-inflammatory and pain medications. Ten patients were cured, and one with multiple comorbidities succumbed to the disease. Conclusion: Clinicians should have a high index of suspicion of prevertebral abscess or cellulitis in patients presenting with neck pain, fever, dysphagia, and limited range of motion of the neck. Head and neck specialists may be the first to encounter and diagnose this highly morbid disease.
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Surgical management of long-standing eagle's syndrome p. 232
Scharukh Jalisi, Basem T Jamal, Gregory A Grillone
DOI:10.4103/ams.ams_53_17  PMID:29264291
Introduction: Eagle's syndrome is a rare condition that refers to chronic recurrent pain in the oropharynx, face, and neck due to elongation of the styloid process or calcification of the stylohyoid ligament. It can be treated medically or surgically through a styloidectomy. In this paper, we review our experience with the two surgical approaches for the management of Eagle's syndrome. Materials and Methods: We conducted a retrospective chart review, which covered the period between 1997 and 2008. The review included seven patients with a long-standing diagnosis of Eagle's syndrome. Six patients underwent surgical intervention and one patient elected to observe her condition. Ethics Approval: The retrospective design of the study was approved by Boston Medical Center Institutional Review Board with no need for another consent other than the one obtained before surgical interventions. Results: Out of the seven patients identified, there were three men and four women. The median age and mean age at diagnosis were 44 years and 26.2 years, respectively. Neck pain and odynophagia were the most common symptoms reported. Three patients underwent styloidectomy through transoral approach and the three through transcervical approach. The average time to resolution of symptoms was 26.5 days. Conclusion: The review suggests a favorable role for surgery in the management of Eagle's syndrome with all the patients undergoing styloidectomy experiencing complete resolution of symptoms. Both surgical approaches provide the desired outcome; however, the choice of the surgical approach depends on the patient's wishes and the surgeon's experience.
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ORIGINAL ARTICLES - COMPARATIVE STUDY Top

Implant survival between endo-osseous dental implants in immediate loading, delayed loading, and basal immediate loading dental implants a 3-year follow-up p. 237
Ritesh Garg, Neha Mishra, Mohan Alexander, Sunil Kumar Gupta
DOI:10.4103/ams.ams_87_17  PMID:29264292
Introduction: With introduction of the term “ossteointegration of dental implant” by Branemark, advancement in implantology from 1957 to 2017 has come a long way with modification in implant type and in loading time. This study aims to evaluate the survival of endo-osseous immediate loading (IL) implant and basal IL implants in atrophic jaws with objective to compare implant survival in atrophic jaws for full mouth rehabilitation between endo-osseous IL versus endo-osseous delayed loading (DL) versus basal IL during 3-year follow-up. Materials and Methods: Fifty-two (34 endo-osseous and 18 basal) implants were placed in 4 patients requiring full mouth rehabilitation in atrophic jaws. Case 1: Endo-osseous DL implants in upper and lower arch, Case 2: Endo-osseous IL implants in upper and lower arch, Case 3: Basal IL implant in upper and lower arch, and Case 4: Endo-osseous DL in upper arch and basal IL implant in the lower arch. Intraoperative evaluation was done on the basis of pain (visual analog scale [VAS]), operative time, and initial primary implant stability. Postoperative evaluation was done on pain (VAS), infection, radiographically successful implant (orthopantomogram), and patient satisfaction (Grade 0– 10). Results: All cases showed satisfactory results but more amount of intra- and post-operative pain was felt with immediate basal implants. Conclusion: We believe that clinicians should comply with patient requests, and for this reason, we agree with some authors to use minimally invasive techniques and to avoid when possible esthetic or functional problems associated with the use of removable prosthesis after teeth extractions.
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Autologous platelet-rich plasma after third molar surgery p. 245
Adil Gandevivala, Amit Sangle, Dinesh Shah, Avneesh Tejnani, Aatif Sayyed, Gaurav Khutwad, Arpit Arunbhai Patel
DOI:10.4103/ams.ams_108_16  PMID:29264293
Aim and Objective: The aim of this study is to compare the efficacy of autologous platelet-rich plasma (PRP) in the third molar impactions, with respect to: pain, swelling, healing, and periodontal status distal to the second molar in patients who need surgical removal of bilateral impacted mandibular third molars. Materials and Methods: Twenty-five patients of both sexes aged between 16 and 60 years who required bilateral surgical removal of their impacted third molars and met the inclusion criteria were included in the study. After surgical extraction of the third molar, primary closure was performed in the control group, whereas PRP was placed in the socket followed by primary closure in the case group. The outcome variables were pain, swelling, wound healing, and periodontal probe depth that were follow-up period of 2 months. Quantitative data are presented as mean. Statistical significance was checked by t-test. Results: There was a difference in the pain (0.071) and facial swelling (0.184), reduction between test and control on day 3, but it was not found to be significant. Periodontal pocket depth (0.001) and wound healing (0.001) less in case group compared with the control group was found to be significant. Conclusion: The use of PRP lessens the severity of immediate postoperative sequelae and decreases preoperative pocket depth.
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Efficacy of exclusive lingual nerve block versus conventional inferior alveolar nerve block in achieving lingual soft-tissue anesthesia p. 250
Sasikala Balasubramanian, Elavenil Paneerselvam, T Guruprasad, M Pathumai, Simin Abraham, VB Krishnakumar Raja
DOI:10.4103/ams.ams_65_17  PMID:29264294
Objective: The aim of this randomized clinical trial was to assess the efficacy of exclusive lingual nerve block (LNB) in achieving selective lingual soft-tissue anesthesia in comparison with conventional inferior alveolar nerve block (IANB). Materials and Methods: A total of 200 patients indicated for the extraction of lower premolars were recruited for the study. The samples were allocated by randomization into control and study groups. Lingual soft-tissue anesthesia was achieved by IANB and exclusive LNB in the control and study group, respectively. The primary outcome variable studied was anesthesia of ipsilateral lingual mucoperiosteum, floor of mouth and tongue. The secondary variables assessed were (1) taste sensation immediately following administration of local anesthesia and (2) mouth opening and lingual nerve paresthesia on the first postoperative day. Results: Data analysis for descriptive and inferential statistics was performed using SPSS (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp. Released 2013) and a P < 0.05 was considered statistically significant. In comparison with the control group, the study group (LNB) showed statistically significant anesthesia of the lingual gingiva of incisors, molars, anterior floor of the mouth, and anterior tongue. Conclusion: Exclusive LNB is superior to IAN nerve block in achieving selective anesthesia of lingual soft tissues. It is technically simple and associated with minimal complications as compared to IAN block.
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Tomographic analysis of the impact of mandibular advancement surgery on increased airway volume p. 256
Danilo Louzada De Oliveira, Thiago Calcagnotto, Thessio Mina Vago, Hugo Nary Filho, Danilo Pinelli Valarelli, Caio Peres Bellato
DOI:10.4103/ams.ams_136_17  PMID:29264295
Purpose: This study aimed to quantify, using cone-beam computed tomography (CBCT) in patients who underwent a mandibular advancement surgery associated with genioplasty, three-dimensional changes in airway space and to evaluate whether these changes differ between men and women. Materials and Methods: Preoperative and 8-month postoperative CBCT scans of 38 patients aged 18– 45 years of either sex and any ethnicity who underwent mandibular advancement surgery associated with genioplasty were analyzed using the Xoran software (Xoran Technologies, Ann Arbor, MI, USA). The linear distances gonion-gnathion (Go-Gn) and condylion-menton (Co-Me) were obtained. Airway volume was measured using the Dolphin Imaging software, version 11.0. Then, data were tabulated and analyzed using Student's t-test. Results: Mean patient age was 30.3 years; 39.47% were men and 60.63% were women. The mean Go-Gn distance was 72.05 mm before surgery and 78.56 mm after surgery, with a mean gain of 6.51 mm. The mean Co-Me distance was 113.47 mm before surgery and 119.89 mm after surgery, with a mean increase of 6.42 mm. Both differences were statistically significant. The mean volume of airway space was 17,272.92 mm3 before surgery and 24,173.74 mm3 after surgery, with a statistically significant mean increase of 6900.82 mm3. There was no statistically significant difference in mean volumetric gain between men (7566.69 mm3) and women (7456.69 mm3). Conclusion: Mandibular advancement surgery results in significant increase of airway space, and there is no difference in airway volume between men and women.
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TECHNICAL NOTE Top

Computed tomographic analysis of the sagittal orbit-globe relationship p. 260
Zachary R Abramson, Srinivas M Susarla, Anand R Kumar, Asim F Choudhri
DOI:10.4103/ams.ams_172_16  PMID:29264296
Identifying the normal relationship of the orbital rims to the globes is critical in planning surgical correction of craniofacial deformities affecting the orbit. This article illustrates a technical proof of principle and mathematical basis for a computed tomography-based measurement of the sagittal orbit-globe relationship. The technique does not require subject cooperation and is, therefore, optimal for pediatric craniofacial surgical treatment planning and outcome evaluation.
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SYSTEMATIC REVIEW Top

Guided bone regeneration for the reconstruction of alveolar bone defects p. 263
Arash Khojasteh, Lida Kheiri, Saeed Reza Motamedian, Vahid Khoshkam
DOI:10.4103/ams.ams_76_17  PMID:29264297
Background: Guided bone regeneration (GBR) is the most common technique for localized bone augmentation. Purpose: The purpose of this review was to categorize and assess various GBR approaches for the reconstruction of human alveolar bone defects. Materials and Methods: Electronic search of four databases including PubMed/Medline, EMBASE, Web of Science, and Cochrane and hand searching were performed to identify human trials attempting GBR for the reconstruction of alveolar bony defects for at least 10 patients from January 2000 to August 2015. To meet the inclusion criteria, studies had to report preoperative defect dimensions in addition to outcomes of bone formation and/or resorption. Results: Twenty-five human clinical trials were included of which 17 used conventional technique that is the use of space maintaining membrane with bone grafting particles (GBR I). Application of block bone graft with overlying membrane and particulate fillers was reported in seven studies (GBR II), and utilizing cortical bone block tented over a defect preserving particulate fillers was reported by one study (GBR III). A wide range of initial defects' sizes and treatment results were reported. Conclusions: This review introduces a therapeutically oriented classification system of GBR for treating alveolar bone defects. High heterogeneity among studies hindered drawing definite conclusions in regard to superiority of one to the other GBR technique.
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CASE REPORTS Top

Post herpetic frey's syndrome p. 278
Jigna S Shah, Vijay K Asrani
DOI:10.4103/ams.ams_86_17  PMID:29264298
Frey's syndrome is characterized by unilateral sweating and flushing of the skin in the area of the parotid gland, occurring during meal, or on salivary stimulation. It is a common complication following surgery/injury in the parotid gland region/temporomandibular joint surgery; however, very few cases have been reported of its occurrence following herpetic infection. It is important for the clinician to recognize its unusual symptoms as early as possible to prevent its potential negative social and psychological effect on the patient. It is diagnosed on clinical presentation and confirmed by objective testing methods. The treatment ranges from topical application of glycopyrrolate to local injections of botulinum toxin and lastly to surgical intervention. An interesting case of Frey's syndrome is presented in a young patient having the previous history of herpes zoster infection, which was diagnosed clinically and confirmed by starch-iodine test and was successfully treated with topical application of glycopyrrolate.
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Multiple dentigerous cysts as a rare presentation of maroteaux– Lamy syndrome p. 282
Ajaz Ahmad Shah, Tajamul Ahmad Hakim, Shahid Farooq, Mubashir Younis, Shamina Kosar, Altaf Malik, Latief Najar
DOI:10.4103/ams.ams_13_17  PMID:29264299
Maroteaux– Lamy syndrome is one of the genetic disorders involving disturbances in mucopolysaccaride metabolism, due to deficiency of aryl sulfatase-B which leads to accumulation of dermatan sulfate in tissues and their excretion in urine. The diseases has several oral and dental manifestations, is first diagnosed on the basis of clinical findings. It is characterized by coarse facial features, normal intelligence, organomegaly, enlarged head, short neck, corneal clouding, enlarged tongue, and prominent metachromatic inclusions in leukocytes. Death is usually a result of either respiratory tract infection or cardiac disease, which is caused by the deposition of mucopolysaccharides. An 18-year-old with Maroteaux– Lamy syndrome is described in this article with multiple dentigerous cysts as the first presentation.
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Two-stage corrections of rare facial tessier's cleft - 3,4,5,6,7 p. 287
SM Balaji
DOI:10.4103/ams.ams_98_17  PMID:29264300
Congenital transverse and oblique facial clefts are rare congenital anomalies, and cooccurence of these is still more a rare anomaly. The condition most commonly is often associated with anomalies of the first and second branchial arches. The manuscript intends to present one such rare case of Tessier's cleft type 3– 7 and present its early management as well as long-term treatment plan.
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Rehabilitation of unilateral congenital microtia by implant-retained prosthesis p. 291
Abhay Datarkar, Surendra Daware, Ravi Dande, Ujwala Datarkar
DOI:10.4103/ams.ams_69_17  PMID:29264301
Microtia is a major congenital anomaly of the external ear. It includes a spectrum of deformities from a grossly normal but small ear to the absence of the entire external ear. These deformities account for three in every 10,000 births, with bilaterally missing ears seen in fewer than 10% of all cases. Extraoral implant-retained ear prosthesis has been proven to be a predictable treatment option for rehabilitation of such congenital anomalies. This paper aims to present principles of maxillofacial implants, review of literature, advantages, disadvantages, and considerations in treatment planning and treatment phases of an implant-supported auricular prosthesis and prospective developments for ear prosthesis are also discussed. Implant supported ear reconstruction provides excellent support, good retention, and esthetically acceptable appearance to the patient.
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Short root anomaly - A potential “Landmine” for orthodontic and orthognathic surgery treatment of patients p. 296
Ejvis Lamani, Katelyn B Feinberg, Chung H Kau
DOI:10.4103/ams.ams_128_16  PMID:29264302
Short root anomaly (SRA) is a poorly understood developmental disorder and can significantly compromise the patient's dental treatment. This case report describes the treatment of a 15-year-old girl with SRA and discusses the implication of this disorder on orthodontic and orthognathic treatment of patients.
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Karapandzic flap for esthetic and functional reconstruction of large defect of lower lip p. 300
Anuj S Dadhich, Seemit Shah, Harish Saluja, Parul Tandon, Vinayak More
DOI:10.4103/ams.ams_127_17  PMID:29264303
Squamous cell carcinoma is the most common cancer occurring in the oral cavity. The lips are one of the most common sites of occurrence with involvement, lower lip being more common than upper. Reconstruction of large defects of lower lip with good functional and esthetic outcome is the biggest challenge faced by the surgeon. Karapandzic flap is one the most commonly used technique for reconstruction of large defects of the lower lip.
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Ameloblastic fibro-odontoma with a predominant radiopaque component p. 304
Saurabh Gajanan Kale, Akshay Shetty, Jintu Balakrishnan, Praveen Purvey
DOI:10.4103/ams.ams_84_17  PMID:29264304
Ameloblastic fibro-odontoma (AFO) is a rare odontogenic tumor. Initially believed to be a lesion similar to ameloblastic fibroma (AF), it is now considered as a separate entity in the WHO odontogenic tumor classification. Commonly associated with a painless swelling and an associated absence of eruption of a tooth, AFO presents as a mixed radiopaque and radiolucent lesion in the younger population with a predilection for the posterior region. Histologically, it shows the characteristics of an immature complex odontoma with irregularly arranged enamel, dentinoid, cementoid-like structures, and ectomesenchymal tissue. The following case report describes a case of AFO with a predominantly radiopaque component and briefly discusses the available literature pertaining to this rare entity.
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Unusual case of acquired capillary hemangioma of the eyelid in an adult p. 308
S Vijayanand, Narahari Ranganatha, Madhumati Singh, Ramesh Babu
DOI:10.4103/ams.ams_168_14  PMID:29264305
Acquired capillary hemangioma of the eyelid is very uncommon in adults. To our knowledge, only eight such cases have been reported in the literature till date. We report the case of a 25-year-old female with acquired capillary hemangioma of the left lower eyelid treated by cutting diathermy followed by reconstruction of the cutaneous and cartilaginous defect. This patient had a history of a similar lesion in the left malar region treated 5 years back. This case is being presented to highlight the occurrence of such lesions in an adult and to discuss the dilemmas in the diagnosis and management.
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Management of non-hodgkin's lymphoma in maxillofacial region with chemotherapy p. 312
Ayesha Moin, Akshay D Shetty
DOI:10.4103/ams.ams_85_17  PMID:29264306
Malignant lymphomas form a heterogeneous group of neoplasms of the lymphoid tissue with different clinical courses, depending on the treatment and prognosis. Lymphoma is a malignant neoplasm of the lymphoid tissue; it is broadly classified into Hodgkin lymphoma (HL) and Non-HL (NHL) depending on the presence or absence of the Reed– Sternberg cells. The main types of lymphomas are (1) HL and (2) NHL. This case report describes about primary NHL involving the mandible. Chemotherapy was advised by the oncologist, and a total of 14 cycles were suggested at the gap of every 2 weeks. The treatment regimen followed was classical Cyclophosphamide hydrodaunorubicin oncovin Prednisolone (CHOP) therapy. NHL can be managed by chemotherapy, radiotherapy, and surgery in various combinations. NHL arising in bone is best treated by chemotherapy and may not require radiotherapy. Survival and prognosis are excellent in localized disease, whereas disseminated disease seems less favorable.
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Dual pathology of mandible p. 316
Suday G Rajurkar, Mohan D Deshpande, Noaman Kazi, Dhanashree Jadhav, Pallavi Ranadive, Snehal Ingole
DOI:10.4103/ams.ams_146_16  PMID:29264307
Aneurysmal Bone cyst (ABC)is a rare benign lesion of the bone which is infrequent in craniofacial region (12%). Rapid growth pattern causing bone expansion and facial asymmetry is a characteristic feature of ABC. Giant cell lesion is another distinct pathological entity. Here we present to you a rare case of dual pathology in an 11 year old female patient who presented with a large expansile lesion in the left hemimandible. All radiographic investigations were suggestive of ABC, aspiration of the lesion resulted in blood aspirate. However only after a histologic examination the dual nature of the lesion was revealed.
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Surgical resection of a parotid gland hemangioma in teenager managed with external carotid artery ligation p. 319
Fernando M Saldivar-Galindo, David F Navarro-Barquin, Francisco Santamaría-Orozco, Felipe A Piña-Avilés, Norma G Saldivar-Álvarez, Javier E Anaya-Ayala
DOI:10.4103/ams.ams_99_17  PMID:29264308
Parotid gland hemangiomas represent <0.6% of the total tumors of the gland and there are <50 tumors reported during adult age, so there is no standard treatment. A 18-year-old female presents with a mass in the right parotid gland of 18 months of a slow progressive asymptomatic growth; on physical examination, only the mass was detected. An angiography was performed, and it reported a possible hemangioma that depends on the right internal maxillary artery and right facial artery and was not suitable for embolization. Total parotidectomy was performed with prior ligation of the right external carotid artery, complete resection was achieved and preservation of the facial nerve and all branches with minimal loss of blood (150 cc). External carotid artery ligation is a safe technique that can be considered in carefully selected patients with vascular tumors that affect the head and neck to achieve a clean and safe surgery with minimal sequels.
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