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   2011| January-June  | Volume 1 | Issue 1  
    Online since July 26, 2011

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Platelet-Rich fibrin: A second generation platelet concentrate and a new friend of oral and maxillofacial surgeons
Harish Saluja, Vipin Dehane, Uma Mahindra
January-June 2011, 1(1):53-57
DOI:10.4103/2231-0746.83158  PMID:23482459
To assess the potential use and benefits of Platelet-Rich Fibrin (PRF) over Platelet-Rich Plasma (PRP), for wound healing post oral and maxillofacial surgeries. This article describes the evolution of this second generation platelet concentrate and its multiple uses in various surgical procedures. Around 5 ml of whole venous blood is collected from the patients in each of the two sterile vacutainer tubes of 6 ml capacity without anticoagulant. The vacutainer tubes are then placed in a centrifugal machine at 3000 revolutions per minute (rpm) for 10 minutes, and the middle fraction containing the fibrin clot is then collected 2 mm below lower dividing line, to obtain the PRF. Cavities filled with PRF post oral and maxillofacial surgical procedures, at the institute, showed faster healing in half the time as compared to physiologic healing. PRF, which belongs to a new second generation of platelet concentrates, with simplified processing, and not requiring biochemical blood handling, has several advantages over traditionally prepared PRP, which has been widely used for accelerating soft tissue and hard tissue healing. However, the preparation being strictly autologous, the amount of PRF obtained is limited.
  48 20,711 3,208
Review of biomechanical experimental studies on different plating techniques of mandibular condyle fractures
Ertunç Dayi, Mehmet M Omezli
January-June 2011, 1(1):48-52
DOI:10.4103/2231-0746.83157  PMID:23483016
Mandibular condyle fractures are one of the most frequent injuries of the facial skeleton. The option for open treatment of mandibular condyle fractures has become more favorable since osteosynthesis materials were developed in the past few decades. However, the rigid fixation techniques of treating condyle fractures remain one of the controversial issues in maxillofacial trauma. These injuries are currently treated by plate-screw osteosynthesis and, depending on the case, the bone segments are fixed by one or two miniplates. Several techniques and plate types like adaption miniplates, minidynamic compression plates, resorbable plates and double plates have been evaluated biomechanically in various experimental and clinical studies. The biomechanical and physical behavior of mandibles have been investigated by different approaches. It can be divided into computer biomodels (e.g., finite element analysis) and physical models. Physical models allow testing on a gross level to give fatigue performance and fracture strength. The aim of this article is to carry out a review of the literature which deals with biomechanical evaluation made with physical models of plating techniques of mandibular condyle fracture. Based on the results of these studies, osteosynthesis with two miniplates seems to be the most stable way of treating mandible subcondylar fractures, and PLLA plates were not strong enough compared with metal plates.
  9 5,248 934
Fibro-osseous lesions vs. central giant cell granuloma: A hybrid lesion
NT Geetha, Rajesh Kumar B Pattathan, HR Shivakumar, Amarnath P Upasi
January-June 2011, 1(1):70-73
DOI:10.4103/2231-0746.83162  PMID:23483611
Fibro-osseous lesions of the jaws can have certain histologic features in common with central giant cell granuloma (CGCG) including the presence of multinucleated giant cells. The clinical, radiologic and histologic features of these lesions should be carefully evaluated to distinguish between these conditions. Fibro-osseous lesions of the jaws are a heterogenous group of lesions characterized by the replacement of normal bone by fibrovascular tissue containing newly formed mineralized material. Central giant cell lesions are defined as an intraosseus lesion consisting of cellular fibrous tissue containing multiple foci of hemorrhage and aggregation of multinucleated giant cells. These lesions may sometimes lead to a confusion in their diagnosis as many pathologists report them taking into consideration one of the prominent histopathologic feature. These confusions may be because of the small number of cases reported in the literature with uncertain clinical, radiographic and histopathologic features of these lesions. So even surgeons may end up treating these lesions inadequately or patients may need to undergo multiple surgeries. We report such a case of Juvenile ossifying fibroma associated with CGCG and discuss the clinical, imaging, histologic, and treatment aspects of this hybrid lesion.
  7 5,753 738
Efficacy of 4% articaine hydrochloride and 2% lignocaine hydrochloride in the extraction of maxillary premolars for orthodontic reasons
Shahid Hassan, BH Sripathi Rao, Joyce Sequeria, Gunachander Rai
January-June 2011, 1(1):14-18
DOI:10.4103/2231-0746.83145  PMID:23482319
Background: Articaine is an amide local anesthetic that differs from other agents of its group due to the presence of a thiophene ring instead of a benzene ring, and it is one of the commonly used local anesthetic agents for day care surgeries. Some researches claim that articaine is superior to lidocaine in its biologic profile. Purpose: To evaluate the efficacy, time of onset of anesthesia, duration of action and intra- or post-administration complications of articaine in comparison with lignocaine for bilateral extraction of maxillary premolars for orthodontic reasons. Materials and Methods: The study was carried out in 20 patients visiting the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College and Hospital, Mangalore, needing bilateral extraction of maxillary premolars for orthodontic purposes. A volume of 0.6-1 ml of 4% articaine hydrochloride (HCl) was injected in the buccal vestibule on one side and 1-2 ml of 2% lignocaine HCl was injected on the other side. After attaining adequate anesthesia, the extraction procedure was carried out under aseptic conditions. Results: An onset period 0.975 ± 0.1118 and 2.950 ± 0.5104 min and duration of anesthesia of 72 ± 17.275 and 49 ± 5.026 min was found for articaine and lignocaine, respectively. Statistically significant differences were noted in the perception of pain using the visual analogue scale. Conclusion: Articaine can be used as an alternative to lignocaine, especially in the extraction of maxillary premolars for orthodontic reasons. The clinical advantages including rapid onset, longer duration of action and greater diffusing property over lignocaine and the elimination of the need for a painful palatal injection were demonstrated.
  5 6,769 855
Stress distribution analysis during an intermaxillary dysjunction: A 3-D FEM study of an adult human skull
Rahul Shyamsunder Baldawa, Wasundhara Ashok Bhad
January-June 2011, 1(1):19-25
DOI:10.4103/2231-0746.83148  PMID:23482925
Background: With the increased interest in adult orthodontics, maxillary width problems in the nongrowing patients have been encountered with greater frequency. In view of the negative outlook for successful nonsurgical palatal expansion in adult patients it seemed appropriate to evaluate the biomechanical effects of nonsurgical rapid maxillary expansion (RME) in adults using the finite element method (FEM). Objectives: To evaluate the biomechanical effects of RME on the craniofacial complex as applied to three-dimensional (3D) model of an adult human skull using the finite element method. Settings and Design: The Department of Orthodontics and Dentofacial Orthopedics at Government Dental College and Hospital, Nagpur. The study was done on an analytical model developed from a dry human skull of an adult female with an approximate age of 20 years. Materials and Methods: A 3D finite element analysis of the craniofacial complex was developed from sequential computed tomography scan images. Known transversal (X) displacement with magnitudes of 1, 3, and 5 mm were applied and the displacement and Von-Mises stresses in different planes were studied on different nodes located at various structures of the craniofacial complex. Results: Transverse orthopedic forces not only produced an expansive force at the intermaxillary suture but also high forces on various structures of the craniofacial complex, particularly at the base of the sphenoid bone and frontal process of the zygomatic bone. Lateral bending of the free ends of the pterygoid plates were noted. Conclusion: RME must be used judiciously in adults because of its far-reaching effects involving heavy stresses being noted at the sphenoid bone, zygomatic bone, nasal bone, and their adjacent sutures.
  5 3,578 540
Development and evolution of distraction devices: Use of indigenous appliances for Distraction Osteogenesis-An overview
Neelam Andrade, Trupti Gandhewar, Rinku Kalra
January-June 2011, 1(1):58-65
DOI:10.4103/2231-0746.83159  PMID:23482829
An attempt has been made to review various devices as well as the outstanding studies done in the past for understanding the methodology of distraction for regeneration of bone. Lengthening of underdeveloped bones inclusive of the maxillofacial complex has been obtained by distraction osteogenesis by many authors. This could be achieved by the use of various extraoral or intraoral devices. Devices used for distraction osteogenesis must have a minimum of 2 important characteristics - they should be able to transfer distraction forces directly to the bone and secondly, should offer adequate rigidity for osseous consolidation to occur. With advanced technology and biomechanical engineering, preformed intraoral distraction devices are now available worldwide. The introduction of these intraoral bone-bourne devices have eliminated the need for bulky, cumbersome extraoral distraction devices which had problems such as external scars, pin tract infections, nerve or tooth bud injuries and poor patient compliance. The design of completely internalized custom made appliance has opened new vistas in the field of Oral and Maxillofacial Surgery. Indigenous internal devices are also economical and locally available.
  5 10,515 1,845
Oral pulse granuloma associated with keratocystic odontogenic tumor: Report of a case and review on etiopathogenesis
Vijayalakshmi S Kotrashetti, Punnya V Angadi, Deepa R Mane, Seema R Hallikerimath
January-June 2011, 1(1):83-86
DOI:10.4103/2231-0746.83153  PMID:23482677
Pulse granuloma is a distinct oral entity characterized as a foreign body reaction occurring either centrally or peripherally. It is usually seen in the periapical or in the sulcus area. Occasionally the lesions occur in the wall of the cyst, commonest being the inflammatory odontogenic cyst. Histologically, they present as eosinophilic hyaline mass with giant cell inclusions and inflammatory cells. They may show different histological characteristics, possibly related to the length of time in the tissue. Adequate recognition is important to avoid misdiagnosis. Many authors suggest that pulse granuloma results due to implantation of food particles of plant or vegetable origin into the tissue following tooth extraction. This paper aims to report a case of pulse granuloma associated with keratocystic odontogenic tumor with its histochemical and polarizing microscopic features and discuss on etiopathogenesis of pulse granuloma.
  4 5,029 591
Alveolar cleft defect closure with iliac bone graft, rhBMP-2 and rhBMP-2 with zygoma shavings: Comparative study
SM Balaji
January-June 2011, 1(1):8-13
DOI:10.4103/2231-0746.83144  PMID:23482715
Aim : To present the outcome measures of the use of iliac bone graft, rhBMP-2 and rhBMP-2 with zygoma shavings in alveolar cleft defect closure. Materials and Methods : Retrospective analysis of details of treated alveolar defect cases (5-10 years during January 2008-December 2010) from records with 4 months follow-up in accordance with the inclusion criteria. Predictor Variables : Type of graft used (iliac crest graft/rhBMP-2/rhBMP-2 with zygoma shaving). Outcome Variables : Duration of the operation, blood loss, postoperative drugs used, donor site morbidity, efficiency of bone deposition (radiologically) at 4 months. Statistics : Descriptive statistics, one-way ANOVA. P < 0.05 was taken as significant. Results : Forty two cases met the inclusion criteria. Mean efficiency of bone deposition was 89.97 ± 4.79%. Mean efficiency of bone formation in rhBMP-2 (n=13), rhBMP-2 with zygoma shavings (n=9) and iliac crest graft (n=20) was 89.42%, 95.38% and 87.91%, respectively (P=0.000). Drugs usage and postoperative morbidity differed significantly between groups (P < 0.05). Conclusion : The use of rhBMP-2 evades the need for additional surgery and overcomes the postoperative morbidity that is associated with the conventional iliac grafting technique. The rhBMP-2 with zygoma shavings showed maximum benefits.
  4 8,133 1,218
Submental orotracheal intubation: Our experience and review
Ramakrishna S Shenoi, Samprati J Badjate, Nilima J Budhraja
January-June 2011, 1(1):37-41
DOI:10.4103/2231-0746.83154  PMID:23482892
Introduction: In maxillofacial injuries, a choice has often to be made between different ways of intubation when surgical access to fractured nasal bone and simultaneous establishment of occlusion are required. We report our experience with submental intubation in the airway management of complex maxillofacial trauma patients. Aims : To evaluate the outcome of airway management in patients with complex maxillofacial fracture by submental intubation, time required for intubation, accidental extubation, postoperative complications, and to discuss indications, contraindications, advantages and disadvantages of submental intubation. Settings and Design : A retrospective study is designed. Materials and Methods : The medical records of seven patients who underwent submental intubation from December 2008 to June 2010 were reviewed and no statistical analysis was used. Results : At the end of the procedure all seven patients were extubated without any complications. Postoperatively only one patient presented with superficial infection of the submental wound. Conclusions : Submental endotracheal intubation is a simple technique with very low morbidity and can be used as an alternative to tracheostomy in selected cases of maxillofacial trauma.
  4 9,240 875
Intraosseous infantile myofibroma of the mandible
Natarajan Nirvikalpa, Vinod Narayanan
January-June 2011, 1(1):87-90
DOI:10.4103/2231-0746.83151  PMID:23483036
The myofibroma, especially the intraosseous variety, is an uncommon benign tumor that occurs primarily in children younger than 3 years of age. Since 1966, less than 40 cases of solitary myofibromas of the mandible have been reported in the literature. Myofibroblasts and spindle cells are predominantly found in this benign lesion. These cells are also commonly found in many lesions due to which great difficulty can be encountered in the diagnosis. A rare case of the intraosseous variety of an infantile myofibroma of the mandible diagnosed in a 10-month-old child has been reported. The tumor was completely excised via an intraoral approach and no recurrence has been noted 15 months postoperatively. A brief review of the differential diagnosis of this lesion in terms of its clinicopathologic, histologic, and immunohistochemical features is also discussed.
  3 3,243 392
Mucoepidermoid carcinoma presenting as a retromolar mucocele
Mahesh Kumar Ranganath, Veeresh Matmari, Umashankar D Narayanaswamy, Radhika M Bavle
January-June 2011, 1(1):66-69
DOI:10.4103/2231-0746.83161  PMID:23483321
A 44 year old female presented with an intraoral soft tissue swelling in the retromolar region, which was painless, mobile and fluctuant in nature. Computed tomography as well as preoperative ultrasound revealed thick walled cystic lesion. The lesion was clinically diagnosed as mucocele. Ultrasound guided fine needle aspiration was done, which revealed turbid, straw colour fluid. This cystic swelling was completely excised and histopathologically identified to be low grade Mucoepidermoid carcinoma. This unusual presentation of Mucoepidermoid carcinoma as an intraoral cyst is one of the rare and unique reported case.
  3 8,010 660
Chondroid syringoma with extensive ossification
Kingsly Paul, H Sreekar, Prema Dhanraj, Shashank Lamba, Sophia Merilyn George
January-June 2011, 1(1):91-92
DOI:10.4103/2231-0746.83149  PMID:23483813
Chondroid syringoma is a rare appendagel skin tumor. Due to its uncharacteristic presentation, it is rarely diagnosed clinically. Here we present one such case in a 50-year-old lady. She presented with a hard mobile lesion over her nose which was excised. The histologic picture is characterized by a combination of epithelial and myoepithelial structures within a chondromyxoid and fibrous stroma. For these tumors, excision is the treatment of choice.
  2 8,572 380
An objective assessment of proximal and distal facial nerve exploration during superficial parotidectomy
Rohit Sharma, PS Menon, R Sinha
January-June 2011, 1(1):3-7
DOI:10.4103/2231-0746.83143  PMID:23482865
Aim: This study was undertaken to compare the proximal and distal facial nerve exploration approach during superficial parotidectomy. Materials and Methods: A retrospective analysis of patients who underwent superficial parotidectomy at our center was conducted. Cases were divided into those who underwent superficial parotidectomy using distal facial nerve exploration and those who underwent standard proximal facial nerve exploration. Statistical comparisons of intraoperative blood loss and margin status (negative, focally, positive) were conducted between these two approaches. Results: A total of 39 patients underwent superficial parotidectomy at our center between 2008 and 2010. The technique used in most of the cases was conventional proximal nerve exploration technique (29 cases). Distal exploration of the buccal branch was undertaken only in 10 cases, on account of difficulty in locating the main trunk intraoperatively due to the presence of postinflammatory fibrosis. The average patient age was 48 years with a female preponderance (67%). Both the techniques consumed almost same average operative time (2.4 hours) and average intraoperative blood loss (68.0 cc vs 25.4 cc) was more in the cases where proximal nerve exploration was resorted (S.E (d) = 0.89). No significant difference in surgical margin status was noticed between the two techniques (P > 0.05). Conclusion: Both the techniques are efficient without compromising the surgical margins, but the average intraoperative blood loss is less in distal facial nerve exploration technique.
  2 8,673 699
Histological and physical analysis of bone neoformation by osteogenesis distraction: A preliminary report
Marcello Gaieta Vannucci, Juliana Dreyer, Paulo Kreisner, Leonilson Gaião, João Feliz Duarte Moraes, Marilia Gerhardt de Oliveira
January-June 2011, 1(1):26-31
DOI:10.4103/2231-0746.83150  PMID:23482632
Introduction: Osteogenesis distraction (OD) is a mainstream technique in maxillofacial surgical reconstruction with varied applications. OD technique employs a distractor with the aim to get new bone in the site of interest. Osseous maturation time is necessary before the device can be removed and few patients' complaint of related discomfort, especially when these devices are external, and induces superficial infections, paresthesia, hypertrophic scars and social relationship difficulties. The use of Low Level Laser Therapy (LLLT) has been proved beneficial to soft tissue and osseous repairs. Materials and Method: 12 rabbits were randomly divided in to two groups. In all animals, distractor was placed and one group was exposed to LLLT while the other group served as control. After consolidation, animals were sacrificed, the new bone formed were subjected to investigations including histomorphometric, physical analysis and tomographical analysis. Statistical analyses were performed using SPSS software. Result: Newly formed bone was significantly different between the groups. The physical properties of the neobone were comparatively better when the animals were exposed to LLLT with varying statistical significance. Conclusion: The results obtained with smaller sample size in this study need to be interpreted with care. The results of this preliminary pilot study encourage the use of LLLT during healing period. However the histological, tomographical and physical findings need to be ascertained using a larger sample size to study the bio-stimulatory effects with laser therapy from basics to clinical relevance on wound and bone healing.
  2 3,014 483
Retrospective analysis of survival of patients with squamous cell carcinoma of the maxilla after primary resection and elective bilateral neck dissection: An institutional experience
Balakrishnan Ramalingam, Vijay Ebenezer
January-June 2011, 1(1):42-47
DOI:10.4103/2231-0746.83155  PMID:23483114
Background: A retrospective analysis of the 5-year survival rates of patients who underwent treatment for oral squamous cell carcinoma (OSCC) of the maxillary region was performed to analyse the prognostic factors for patient's survival. Materials and Methods: Twenty-four patients with SCC of the maxillary region, who underwent treatment at our hospital between 1999 and 2009 were included in the study. The patients underwent primary surgical resection and elective bilateral neck dissection. The patients with tumor positive margins were referred for chemo-radiotherapy after surgery. Results: The overall 5-year survival rate was 25%. The patients who had recurrence had presented with T3 or T4 lesions only. Of the patients who died, 14 out of the 18 were those who had tumor-positive margins and had undergone radiotherapy following surgery. Conclusions: Primary surgical treatment of SCCs of the maxillary region along with elective bilateral neck dissection yielded some improvement in survival rates, and can therefore be seen as a valuable strategy. Tumor-free resection margins and early detection of the lesion are the most important indicators for favorable prognosis.
  2 4,297 482
The syndromic multiple odontogenic keratocyst in siblings: A familial study
Vimal Kalia, Nitin Kaushal, Geeta Kalra
January-June 2011, 1(1):77-82
DOI:10.4103/2231-0746.83156  PMID:23483828
Purpose: Our aim is to demonstrate the importance of postoperative assessment and highlight the need for a lifetime follow-up of the patient and the siblings in cases of Nevoid Basal Cell Carcinoma Syndrome (NBCCS). Materials and Methods : Three siblings out of which two were of syndromic multiple odontogenic keratocysts, with multiple basal cell nevae were followed-up for manifestations of NBCCS from year 2001 till date. Two of the patients were treated for multiple bilateral odontogenic keratocysts (OKCs). Familial occurrence of the syndromic multiple odontogenic keratocysts was studied. Result: Although NBCCS is associated with multiple OKCs, it does not imply that a patient should have more than one cyst at a given point in time, rather it refers to the lifetime history of the patient. Early diagnosis will often make it possible to use conservative therapies rather than complex treatments. Conclusion: Recognition of the syndrome permits early treatment in other but possibly asymptomatic relatives. Close attention of the family and past medical history and physical examination will alert the clinician to its presence, allowing for appropriate genetic counseling and serial screening for the development of malignancies and other complications besides OKCs.
  1 11,293 635
Fiberoptic bronchoscope assisted difficult airway management in maxillofacial trauma
Pramendra Agrawal, Babita Gupta, Nita D'souza, Neelesh Bhatnagar
January-June 2011, 1(1):95-96
DOI:10.4103/2231-0746.83146  PMID:23479555
  1 4,715 453
Effect of surgically assisted rapid maxillary expansion on masticatory muscle activity: A pilot study
Cássio E Sverzut, Karinna Martorelli, Roberto Jabur, Alice D Petri, Alexandre E Trivellato, Selma Siéssere, Simone C. H. Regalo
January-June 2011, 1(1):32-36
DOI:10.4103/2231-0746.83152  PMID:23482404
Background: The aim of the present study was to analyze the electromyographic (EMG) activity of masseter and temporal muscles of adult patients submitted to surgically assisted rapid maxillary expansion (SARME) before and after the surgery. Materials and Methods: The sample consisted of 19 adults, with ages ranging from 20 to 47 years (mean 25.4 years), with bilateral posterior cross bite requiring SARME treatment. The electromyographic activity of masseter and temporal muscles was analyzed before treatment (T1) and after the surgical procedure (T2). The mean interval between the two electromyographic analyses was 15 days. Results: The muscular active was electromyographically analyzed during the clinical situation of habitual gum chewing (10 sec), dental clenching (4 sec), mouth opening and closing (10 sec), rest (10 sec), protrusion (10 sec), and right and left laterality (10 sec). The measured differences between T1 and T2 data were evaluated using the paired t-test (SPSS 17.0 for Windows). The electromyographic analysis showed that the activity of the masseter and temporal muscles decreased significantly after the SARME in all the clinical situations after the surgery. Conclusion: According to the results of the present study, individuals after SARME surgery presented patterns of electromyographic contraction similar to those developed by dentate individuals during the movements of mandibular excursion.
  1 3,738 466
Acute onset progressive hemiparesis in a case of head and neck injury
Amit Agrawal, Lakshmi Narayan Garg, Brij Raj Singh
January-June 2011, 1(1):74-76
DOI:10.4103/2231-0746.83160  PMID:23483667
Traumatic carotid artery injury is an increasingly recognized complication of severe blunt head or neck trauma in patients with motor vehicle accidents. A 22-year-old male presented after a high-velocity road traffic accident and sustained head, neck and systemic injuries. Initially the patient was neurologically stable and initial CT scan brain was also apparently normal. Few hours after the injury, the patient developed progressive left hemiparesis. MRI of brain was suggestive of acute infarct involving right internal carotid artery territory. In accordance with the literature and as in present case, it would be emphasized that the patients who develop gross neurological abnormalities after blunt trauma to the head or neck, there should be a high index of suspicion of having sustained injury to the carotid arteries.
  - 3,578 349
Lipoma involving the masticator space
Anuradha Navaneetham, Arati Rao, Amul Gandhi, CA Jeevan
January-June 2011, 1(1):93-94
DOI:10.4103/2231-0746.83147  PMID:23483080
The lipoma is a common tumor of mesenchymal origin, usually seen on the trunk and lower limbs. In the head and neck region, it is usually seen in the posterior neck. It is rarely seen in the anterior neck, infratemporal fossa, oral cavity, pharynx, larynx and parotid gland. It may present in a variety of ways. We report a rare case of a lipoma involving the masticator space.
  - 3,395 372
About the Annals of Maxillofacial Surgery....
SM Balaji
January-June 2011, 1(1):2-2
DOI:10.4103/2231-0746.83142  PMID:23479554
  - 3,086 622
Improving the dissemination of surgical knowledge
Daniel M Laskin
January-June 2011, 1(1):1-1
DOI:10.4103/2231-0746.83141  PMID:23479553
  - 2,226 403