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   2011| July-December  | Volume 1 | Issue 2  
    Online since February 11, 2012

 
 
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REVIEW ARTICLES
Role of macrophages in malignancy
Rishikesh C Dandekar, Amaar V Kingaonkar, Gauri S Dhabekar
July-December 2011, 1(2):150-154
DOI:10.4103/2231-0746.92782  PMID:23482819
Macrophages themselves are a heterogeneous mixture of cells which mediate their effects not only through phagocytosis but also through the production of various soluble factors such as cytokines and chemokines. The most important function of macrophages is the defense of the body against pathogen aggressions. However, when recruited within neoplastic tissues, tumor-associated macrophages polarize differently and do not predominantly exert their immune function but rather favor tumor growth and angiogenesis.
  16 4,009 551
CASE REPORTS - SURGICAL PATHOLOGY
High-grade chondroblastic and fibroblastic osteosarcoma of the upper jaw
Tommaso Cutilli, Secondo Scarsella, Desiderio Di Fabio, Antonio Oliva, Pasqualino Cargini
July-December 2011, 1(2):176-180
DOI:10.4103/2231-0746.92790  PMID:23482406
Osteosarcomas (OS) are extremely uncommon in maxillofacial region (6%-10% of all sarcomas). Jaw lesions are diagnosed on average two decades later than sarcomas of long bone, with a peak incidence between 20 and 40 years. Head and neck OS (HNOS) are associated with a lower metastatic rate than long bone OS, and they have a better 5-year survival rate, ranging between 27% and 84%. Approximately 80% of HNOS originate from soft tissues, while 20% arise from bone. The majority of OS were classified as osteoblastic HNOS (77.0%), followed by chondroblastic (15.8%) and fibroblastic (3.4%). Patients older than 60 years were more likely to be diagnosed with other histologic types compared with patients 60 years or younger. The authors describe a rare case of Stage II high-grade mixed chondroblastic and fibroblastic osteosarcoma of the upper jaw diagnosed in a subject older than 60 years. CT i.e., total body scintigraphy, radiograph of chest, and epathic ultrasonography have been executed to staging (T3N0M0). The size of the tumor >6 cm, histopathological findings, and patient older than 60 years, made necessary a multimodality therapy. Surgery (right subtotal maxillectomy with closure of surgical area by local sliding and advanced cheek flap) and adjuvant radiotherapy (for overall 6500 Gy) were the definitive treatment. Follow-up at 2 years shows no local recurrence and the patient is disease free.
  7 5,944 606
ORIGINAL ARTICLES
Role of povidone iodine in periapical surgeries: Hemostyptic and anti-inflammatory?
K Senthil Kumar, G Vinay Kumar Reddy, Gayathri Naidu, Rajesh Pandiarajan
July-December 2011, 1(2):107-111
DOI:10.4103/2231-0746.92768  PMID:23483078
Introduction: Periapical surgery needs asepsis, a bloodless field for ensuring success of the treatment. Efficacy of Povidone Iodine (PVI) in the elimination of pathogen causing periapical lesions is well established. PVI is also widely used as a disinfectant, sclerosing agent, styptic as well as an anti-odematous agent. Materials and Methods: This prospective pilot study done on 20 males between 20-40 years age group with periapical lesions in single rooted maxillary anterior tooth of 1-2 cm in diameter. The bleeding time, clotting time, bleeding time at the apex, drugs used and visual analogue scale of oedema on postoperative days were obtained. Descriptive statistics, paired t test and independent t-test were used. Results and Conclusion: Results show a statistically significant reduction in the time required to achieve a bloodless field and a marked decrease in oedema in the first and second postoperative days resulting in lesser consumption of NSAIDs. In conclusion, the effect of PVI in periapical surgery seems to reduce the bleeding time at apex, total dose of NSAIDs used, oedema on first two postoperative days with high statistical significance. Hence the routine use of saline in periapical surgeries may be effectively substituted with PVI. The finding of this pilot study has to be evaluated using wider samples for effective clinical translations.
  7 6,326 828
CASE REPORTS - MAXILLOFACIAL SURGERY
Vocal cord paralysis following orthognathic surgery intubation
Sandeep Fauzdar, James Kraus, Maria Papageorge
July-December 2011, 1(2):166-168
DOI:10.4103/2231-0746.92785  PMID:23483672
The incidence of recurrent laryngeal nerve paralysis following short-term oro-endotracheal intubation for any surgical procedure is very rare. The diagnosis becomes very difficult if the surgical procedure may alter the vocal characteristics following surgery. We report a case of a 24 year-old healthy male patient who developed prolonged hoarseness which developed after having undergone a bimaxillary orthognathic surgical procedure. Following surgery, the patient's complaints of hoarseness and mild coughing on taking thin liquids were investigated with the assistance of the otolarynology voice department. A flexible fiberoptic laryngoscopy and videostroboscopy showed a partial paralysis of the left vocal cord suggesting damage to the left recurrent laryngeal nerve. The recovery was gradual and resolved without any intervention in approximately 6 weeks. Prolonged change or loss of voice quality following an orthognathic surgical procedure, as discussed in this case, when associated with difficulty in swallowing thin or thick liquids warrants a thorough investigation and can be managed at times with observation alone.
  5 3,022 340
REVIEW ARTICLES
Molecular markers of tumor invasiveness in ameloblastoma: An update
Yi Zhong, Wei Guo, Li Wang, Xinming Chen
July-December 2011, 1(2):145-149
DOI:10.4103/2231-0746.92780  PMID:23482687
The aim of the present article was to review the current new knowledge on the molecular markers of tumor invasion in ameloblastoma. In this review, tumor molecular markers were identified and allocated to the following six groups according to their functions: (I) Markers involved in extracellular matrix degradation, (II) Molecular markers involved in cell adhesion lost, (III) Molecular markers involved in bone remodeling, (IV) Cytokines involved in angiogenesis, (V) Molecular markers related with the function of tumor stromal cells on the invasion of ameloblastoma, and (VI) Molecular markers involved in cell proliferation related with invasion. In general, the location of markers within the tumor and not their quantitative assessments as such is emphasized. Data showed that the correlation among molecular markers of invasive relevance is still not quite clear. Results on markers of tumor invasion and metastatic potential appeared to be too premature for a statement regarding the instinct invasive nature of ameloblastoma. The unraveling of specific new details concerning these mechanisms, whereby the expression and relationships among the molecules are mediated, may provide an opportunity to afford efficient prevention and develop new treatment therapies.
  5 4,334 1,067
CASE REPORTS - SURGICAL PATHOLOGY
Reparative giant cell granuloma of the maxilla
K. A. Jeevan Kumar, S Humayun, B Pavan Kumar, J Brahmaji Rao
July-December 2011, 1(2):181-186
DOI:10.4103/2231-0746.92791  PMID:23482504
Giant cell reparative granuloma accounts for 1-7% of all benign lesions of the jaw. It often arises in the maxilla followed by mandible and affects children and young adults. It is usually a slow-growing lesion. The fast growing lesions are rare and despite the innocent histological appearance, has an aggressive behavior mimicking a malignant lesion. In the present report, the clinical features, diagnosis, and surgical treatment of an unusually large aggressive variety of reparative giant cell granuloma found in the cheek with extensions into maxilla, antrum, and infratemporal region in a 23-year-old female is described. The impact of delay in correct diagnosis on massive enlargement of the lesion, the importance of computed tomography-guided biopsy in the diagnosis of such inaccessible lesions, and the role of a general dentist in the early detection are also emphasized.
  4 6,300 454
CASE REPORTS - MAXILLOFACIAL SURGERY
Osteopetrosis-A rare entity with osteomyelitis
RS Bedi, Poonam Goel, Navbir Pasricha, Sachin , Ashish Goel
July-December 2011, 1(2):155-159
DOI:10.4103/2231-0746.92783  PMID:23482851
Osteopetrosis is a rare genetic disorder that causes generalized sclerosis of the bone due to defect in bone resorption and remodeling. Albergs-Schonberg disease or autosomal dominant osteopetrosis type II is a rare form of osteopetrosis. Osteomyelitis is a well-documented complication of osteopetrosis. Any associated dental abnormality may be attributed to the pathological changes in bone remodeling. This case report discusses a case of osteopetrosis with osteomyelitis as a complication in a 8-year-old boy.
  3 4,761 400
GUEST EDITORIAL
Providing quality assurance for the Annals of Maxillofacial Surgery
Khursheed F Moos
July-December 2011, 1(2):99-100
DOI:10.4103/2231-0746.92762  PMID:23479556
  3 2,878 10,036
CASE REPORTS - MAXILLOFACIAL SURGERY
Supernumerary nostril: A rare congenital anomaly
Sanjeev K Uppal, Ramneesh Garg, Ashish Gupta, Davinder S Pannu
July-December 2011, 1(2):169-171
DOI:10.4103/2231-0746.92788  PMID:23483576
We report the 23rd case of the world of one of the rare congenital anomalies, supernumerary nostril. The disease has a variable presentation and more than half of the reported cases are from Asian continent. This patient had a supernumerary nostril in the form of a accessory blind tract above the left ala. The tract was excised and raw areas approximated with a bolster dressing.
  2 2,986 301
CASE REPORTS - SURGICAL PATHOLOGY
Juxtacortical osteosarcoma of mandible
Sushrut B Vaidya, Srivalli Nadarajan, Jyotsna S Galinde, Alok S Bhardwaj
July-December 2011, 1(2):172-175
DOI:10.4103/2231-0746.92789  PMID:23483235
This article presents a case of juxtacortical (paraosteal) osteosarcoma in a 43-year-old female, which is rare malignant mesenchymal tumor. As per the literature, it accounts for less than 4% of all osteosarcomas. Due to its rare variety, this tumor can cause diagnostic dilemma and clinicians should be aware of it. Due to its clinical picture, it can be confused with peripheral fibro-osseous lesions. Success rate of treatment are good if the tumor is detected early and resected with wide margins giving a negligible chance for recurrence.
  2 5,637 382
CLINICAL STUDIES
A study on orthomorphic correction of mandibular dysmorphology
Saikrishna Degala, Sujeeth Shetty, Gen Morgan
July-December 2011, 1(2):120-125
DOI:10.4103/2231-0746.92774  PMID:23483027
Purpose: To evaluate the usefulness of orthomorphic surgery in correcting mandibular dysmorphology. Materials and Methods: This is a prospective study in which five patients having mandibular dysmorphology were treated using orthomorphic surgery. The patients were evaluated for outcome in terms of duration of surgery, assessment of mandibular split, mental nerve paresthesia/ neurosensory changes after surgery, assessment of mouth opening before and after surgery, postoperative assessment of mandibular symmetry, and postoperative complications. Statistical Analysis Used: Descriptive statistics, frequencies, contingency coefficient test (cross tabs). Results: Our study has revealed results in support of the technique mentioned, showing good success rate in terms of mandibular dysmorphology correction when used in mild to moderate dysmorphology cases. Conclusion: Orthomorphic surgery will play an increasingly important role in the repertoire of the maxillofacial surgeon in correcting mandibular dysmorphology.
  2 3,331 548
Assessment and determination of human mandibular and dental arch profiles in subjects with lower third molar impaction in Port Harcourt, Nigeria
Akinbami Babatunde Olayemi
July-December 2011, 1(2):126-130
DOI:10.4103/2231-0746.92775  PMID:23482900
Aim: The aim of this study was to determine the normal size of the mandible and the difference in dental arch length and total teeth size space that is necessary to prevent lower third molar impaction. Background: The mandible is an important component of facial skeleton and its morphology is relevant to the determination of acceptable aesthetics. In addition, function of the dentition is dependent on the available space for positioning of all the teeth including the third molar, and for enough space to be created, the sizes of the mandible and dental arch must be within normal ranges. Materials and Methods: Impaction of the lower third molar was assessed by clinical evaluation and radiography. The total length of the mandible is determined by adding the distance between the midpoint of the tragus and soft tissue around the angle of the mandible to the distance between the angle and the soft tissue in the region of the chin. Mandibular width is the distance between the two angles of the mandible. The teeth sizes of the three anterior teeth, the two premolars, and the two molars were measured with a divider/ruler and recorded. The anterior-posterior distance of the arch from the midline to the retromolar pad was also measured. Results : There were 44 (53%) females and 39 (47%) males. Eighty-one (97.6%) of the participants were between 16 and 23 years old, while 2 (2.4%) were in the fourth decade. There were 38 (45.8%) cases of impaction and 45 (54.2%) cases of unimpacted mandibular third molar. The means/standard deviation values for mandibular length for males in each group are 18.20 ± 0.98 and 18.20 ± 1.13 cm, respectively. The values for mandibular length for females in each group are 17.20 ± 0.76 and 17.60 ± 1.07. There are significant differences between the genders for mandibular length (P < 0.05, 95% CI). The means/standard deviation values for mandibular width for both genders in each group are also shown. There are also significant differences between the genders for mandibular width (P < 0.05, 95% CI). Normal sized mandible should have a length within or above 17.22-19.33 cm in males and 16.44-18.67 cm in females, while normal dental arch-total teeth size difference range should be within or above 0.71-1.20 cm in males and 0.76-1.10 cm in females in order to accommodate a properly erupting third molar. Conclusions : Based on these figures, clinicians may be justified to perform a preventive or therapeutic surgical removal of the impacted lower third molars of the postpubertal patients whose parameters fall below these set values. This study is also useful for evaluation of patients who would need orthognathic and reconstructive surgeries.
  2 4,015 429
ORIGINAL ARTICLES
Efficacy of double gloving technique in major and minor oral surgical procedures: A prospective study
Mukul N Padhye, Charu Girotra, Aman R Khosla, Kavita V Gupta
July-December 2011, 1(2):112-119
DOI:10.4103/2231-0746.92771  PMID:23483758
Background: A prospective analysis was carried out over a 1-year period to assess gloves used during 100 major and 100 minor oral surgical procedures to test for efficacy of double gloving in oral surgical procedures. Purpose: The purpose of this study was to assess the efficacy of double gloving technique in preventing cross infection in both major and minor oral surgical procedures. Materials and Methods: Gloves used during 100 major and 100 minor oral surgical procedures were analyzed to check for glove perforations and skin punctures. 100 sterile gloves were tested as control. Statistical Analysis Used: Chi-square test was used to determine whether there was any difference between the expected and observed values in various categories. Results: A higher number of glove perforations was seen in minor oral surgical procedures compared with major surgeries, dominant hand compared with the nondominant, outer gloves compared with the inner, in procedures which took a longer duration of time to complete, in procedures involving wiring and in the index finger followed by the thumb and the palm. Conclusion: Double gloving technique using sterile gloves can be used as an effective means of infection control for all major and minor surgical procedures, especially high-risk procedures involving patients who maybe suffering from or carriers of blood-borne infections.
  2 3,090 718
Cardiovascular monitoring and its consequences in oral surgery
J Thomas Lambrecht, Andreas Filippi, Jeannine Arrigoni
July-December 2011, 1(2):102-106
DOI:10.4103/2231-0746.92766  PMID:23483785
Objective: Higher life expectancy has lead to an increase of elderly patients in dental practices, thus also causing an increase in high-risk cardiovascular patients. Study Design: In all, 3012 patients had oral surgery with local anesthesia at the Department of Oral Surgery, Oral Radiology and Oral Medicine at the University of Basel. The Colin BP 306 compact monitor was used during these surgeries. The patient's heart rate, blood pressure, and oxygen saturation were routinely checked, both before and during the procedure. Results: The oral surgical procedure had to be discontinued 17 times, because the patient developed significantly elevated blood pressure. Twice, the procedure had to be discontinued due to cardiac arrhythmia. The average age of these 19 patients was 63.5 years. Conclusions: Pre-and intraoperative monitoring allows the dentist to identify patients with high-risk diagnostic findings and to reduce problematic cardiovascular situations.
  2 3,367 1,370
CASE REPORTS - MAXILLOFACIAL SURGERY
Versatility of a single upper border miniplate to treat mandibular angle fractures: A clinical study
P Satish Kumaran, Lalitha Thambiah
July-December 2011, 1(2):160-165
DOI:10.4103/2231-0746.92784  PMID:23482950
Context: Mandibular fractures are among the most common of facial fractures. Fractures of the mandibular angle are associated with the highest incidence of postsurgical infection of all mandibular fractures. The treatment of facial fractures has traditionally involved reestablishment of a functional dental occlusion with various types of intermaxillary fixation. Treatment modalities range from simple maxillo-mandibular fixation to rigid internal fixation of the bone fragments. Aims: The aim of this study was to determine the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle with access via an intraoral route. Materials and Methods: Cases of unfavorable fractures of the mandibular angle were selected for the study of intraoral surgical management of mandibular angle fractures using a single 2.0-mm noncompression miniplate. Statistical Analysis and Results: An observational study was carried out on treatment of fractures of the angle of the mandible, and the findings were recorded and presented. Conclusions: We studied the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle and found no complications associated with superior border miniplate fixation of mandibular angle fractures.
  1 5,037 734
CASE REPORTS - SURGICAL PATHOLOGY
Multiple teeth in a single dentigerous cyst follicle: A perplexity
Mamta Agrawal, Pramod D. S. Raghavendra, Bhawana Singh, Neha Agrawal
July-December 2011, 1(2):187-189
DOI:10.4103/2231-0746.92792  PMID:23483109
Dentigerous cysts are always associated with an embedded or unerupted tooth; involvement of more than one permanent tooth in a single cyst follicle is exceedingly rare and only a few such cases can be found in the literature. The cysts reported in the literature involving multiple teeth typically consist of mesiodens or odontomas. Here we report a rare case of dentigerous cyst associated with two permanent teeth causing displacement of maxillary canine into the osteo meatal complex and maxillary premolar to lateral nasal wall. The possible etiopathogenesis of such cases is also discussed here.
  1 3,850 344
CLINICAL STUDIES
Longitudinal changes in muscle activity of masseter and anterior temporalis before and after Lefort I osteotomies, An EMG study
P Priyadarsini, MR Muthushekar
July-December 2011, 1(2):131-135
DOI:10.4103/2231-0746.92776  PMID:23482429
Aims: The aim of this study was to compare the levels of electromyography (EMG) activity of masseter and anterior temporalis present presurgically with changes in the intensity of muscle activity that took place post surgically for a period of 6 months follow up. Settings and Design: Ten patients with vertical maxillary excess were selected from the department of Oral and Maxillofacial surgery at Saveetha Dental College and Hospitals, Chennai. Materials and Methods: Electromyography was used as a kinesiology tool to study muscle function of Masseter and Anterior Temporalis of all ten subjects pre surgically and post surgically with a 6 month follow up. Statistical Analysis Used: The statistical package SPSSPC+ (Statistical Package for Social Science, Version 4.0.1) was used for statistical analysis. Mean and standard deviation were estimated from the sample. The tests that were used for the statistical analysis were one way ANOVA and student's T test. Results: The final inference elucidates that the muscular activity of masseter and temporalis are improved during chewing and clenching in the postoperative 6 months period when compared to preoperative values. The duration was constant at 7 milliseconds for both the positions. Conclusions: From this study, it can be concluded that there is a strong correlation between vertical maxillary excess and associated weak musculature. Electromyography has been used as an important tool to demonstrate improved muscle activity after surgical correction of vertical maxillary excess and improvement in functional deficits associated with this dentofacial deformity. From this study it can be concluded that surgical correction of vertical maxillary excess improves occlusion, leading to increased eccentric tooth contacts, increased mean amplitude and increased mean power frequency of the muscles all of which translate into improved muscle activity.
  - 2,297 308
EDITORIAL
Annals of Maxillofacial Surgery- Looking forward
SM Balaji
July-December 2011, 1(2):101-101
DOI:10.4103/2231-0746.92764  PMID:23479557
  - 2,165 2,142
RETROSPECTIVE STUDY
Influence of third molars in Le Fort 1 osteotomy
SM Balaji
July-December 2011, 1(2):136-144
DOI:10.4103/2231-0746.92777  PMID:23482647
Background : The influence of maxillary third molar (M3) on the outcomes of Le Fort 1 osteotomy is not deeply investigated. Aim : To investigate the influence of M3 on Le Fort 1 osteotomies. Setting : Tertiary Referral Center, operated by a single surgeon, prospective study. Period : January 2005 to December 2010. Patients : Consecutive Le Fort 1 osteotomy patients with both M3. Predictor Variable: Gender, position, M3 root morphology, and degree of impaction. Outcome Variable: Time taken after all osteotomy cuts to point of time when maxilla is placed in predetermined plane. Result : A total of 658 M3 in line of cut were studied. Of all M3, 312 were impacted, 28.9% were partially impacted and 23.7% were erupted. Of all the M3, 2.9% had their cuspal tips above the horizontal cut, 13.8% along the line of cut, and in 20.7% below the line but not erupted. Buccoverted tooth took shortest time (7.74 minutes), while palatoversion required more time (8.44 minutes) (P = 0.000). When the cuspal tip of M3 was located above the horizontal line of cut, the mean time required to achieve the planned position was 7 minutes, while the completely erupted teeth took a mean of 8.24 minutes (P = 0.000). Conclusion : When the M3 is placed higher, it takes lesser time to prepare basal bone to receive the maxilla at its predetermined level. Angulation of M3 influences the outcome. Deeply placed M3 reduces the manipulation of the greater pterygoid palatine vessels in the area thereby minimizing the bleeding in the surgical field.
  - 5,234 743
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