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   Table of Contents - Current issue
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July-December 2020
Volume 10 | Issue 2
Page Nos. 285-546

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EDITORIAL  

Emergency maxillofacial procedures for COVID-positive patients p. 285
SM Balaji
DOI:10.4103/ams.ams_451_20  
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ORIGINAL ARTICLE - COMPARATIVE STUDY Top

A comparative randomized prospective clinical study on modified erich arch bar with conventional erich arch bar for maxillomandibular fixation p. 287
V Venugopalan, G Satheesh, A Balatandayoudham, S Duraimurugan, TS Balaji
DOI:10.4103/ams.ams_20_20  
Introduction: Erich arch bar used for maxillomandibular fixation (MMF) since decades has several disadvantages such as risks of injury, additional operating room time, and gingival trauma. To overcome these downsides, modified Erich arch bar was introduced; however, there is not much available literature, indicating the efficacy of modified Erich arch bar over that of conventional arch bar wire. Therefore, the present study focuses on comparing efficiency of modified arch bar with conventional arch bar. Materials and Methods: This comparative randomized study was conducted on 32 patients that required MMF and were divided into Group A patients who received intermaxillary fixation (IMF) with modified Erich arch bars and Group B patients with conventional Erich arch bars. The parameters recorded were average surgical time required, wire prick injuries, IMF stability, occlusal stability, screw loosening, oral hygiene status, and vitality response of the teeth. The variables were statistically analyzed using Student's t-test and Wilcoxon signed-rank test. Results: The wire prick injury, intraoperative time noted in Group A was significantly reduced in comparison to Group B (P < 0.0001). Debris indices were significantly good in Group A in comparison to Group B (P < 0.0001). Nonvitality response of tooth was significantly more in Group B than in Group A patients (P < 0.05). Discussion: The efficiency of modified Erich arch bar group was superior to the conventional arch bar with very limited restrictions.
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Randomized clinical trial comparing three local hemostatic agents for dental extractions in patients under chronic anticoagulant therapy - A comparative study p. 292
Sebastian Ariel Puia, Ezequiel Matias Hilber, Matias Garcia-Blanco
DOI:10.4103/ams.ams_276_20  
Introduction: Oral anticoagulants are widely used worldwide for many systemic diseases. Recent oral surgical protocols suggest that therapeutic levels of the anticoagulant drug should be maintained for simple dental extractions because bleeding complications could be managed with proper local hemostasis. The aim of the present study was to compare bleeding complication of three different local hemostatic agents for dental extractions without interrupting drug administration in patients undergoing oral Vitamin K antagonist chronic anticoagulant therapy. Material and Methods: Randomized control trial of three hemostatic agents for dental extractions, in patients under oral anticoagulant therapy without drug interruption. The present study included 240 patients with international normalized ratio between 1.5 and 3.5. Patients took their anticoagulation drug normally. A single surgeon performed calibrated simple dental extractions and applied a plug of bismuth subgallate (BS), fibrin tissue adhesive (FTA) or microfibrillar collagen (MC), assigned randomly. Statistical analysis of bleeding between the groups was performed using the Chi-square test. Results: There was no hemorrhagic complication in the BS group, and only one in the FTA group. However, in the MC group, 10 patients (12.5%) suffered postoperative bleeding. Data analysis showed statistical differences between the MC group and the other two groups (P < 0.05). Discussion: BS and FTA showed similar clinical effectiveness and were more effective than MC for the control of postoperative bleeding in oral anticoagulated patients.
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Effect of cleft types on outcome of unilateral cleft lip repair p. 297
Adekunle Moses Adetayo, Abdurazzak Olanrewaju Taiwo, Modupe Olusola Adetayo, Omotayo F Salami
DOI:10.4103/ams.ams_293_20  
Introduction: It is generally assumed that the major phenotypes of unilateral cleft lip (UCL) represent its extent of severity. There are a few studies on this, but objectivity has been lacking. It was the aim of this study to assess the effect of different phenotypes of UCL on the outcome of surgical repair. Methodology: This study was a case series of the effect of phenotypes of cleft on the outcome of repair of UCL. Fifteen subjects each were in three UCL phenotype groups. Surgical outcome was assessed quantitatively with anthropometric measurements recorded from a full frontal face photograph of subjects. The analysis was done using Student's t-test and one-way ANOVA at P = 0.05. Results: The mean values of the preoperative horizontal and vertical lip height, and nasal width on the cleft side in the cleft lip (CL) group were closest to those of the noncleft side and control. The postoperative mean values of the horizontal and vertical lip height, and nasal width on the cleft side in the CL group were closest to those of the noncleft side and control, while those of the CL, alveolus and palate group were farthest from those of the noncleft side and the control. Discussion: The different phenotypes of UCL have different degrees of tissue distortion and deficiencies. CL group had its measurements closest to that of the noncleft sides and control, suggesting that it has the least distortion. Conclusion: The comparison between the three groups did not reveal any difference, suggesting that the skill of the surgeon and the selection of a well proven technique are more important factors in the outcome of repair of unilateral cleft lip.
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Revascularized fibula free flap reconstruction and curvilinear transport distraction osteogenesis in closure of large postmaxillectomy defects: A new gold standard? Highly accessed article p. 304
Rushdi Hendricks, Zaheed Patel, Anil Pooran, George Vicatos
DOI:10.4103/ams.ams_267_19  
Introduction: The revascularized fibula free flap (RFFF) is the most popular method of postmaxillectomy reconstruction. This article proves that the use of curvilinear transport distraction osteogenesis (CTDO) is an efficacious way in closing large defects in the maxilla and a superior alternative to the RFFF. Methods and Materials: In a prospective cohort study of six postmaxillectomy patients, CTDO was applied and the new bone (regenerate) was compared with the parent bone from which it had been regenerated. These results were compared with a retrospective group of six participants of similar age and sex who had undergone RFFF reconstruction as an external control. Clinical measurements taken at the depth of the alveolar vestibule were recorded at three different exact points juxtaposed, namely (A) lateral incisor, (B) first premolar, and (C) first molar. These areas of interest were similar to those chosen on the CT scans. Impressions were taken from all the patients and stone casts were made. The width of the alveolar bone was computed based on the measurements made from the stone casts. The stone casts were then used to calculate the width and depth of the soft tissue and bone in the maxilla in the (A), (B), and (C) regions. Results: The regenerate possessed anatomical and physiological characteristics equal to the parent bone. For the CTDO patients, prosthetic rehabilitation of the dentition was supported by dental implants after osseointegration of the latter into the newly created bone and soft tissue. Discussion: The production of the curvilinear bone and soft tissue along a horizontal plane has been demonstrated. The new alveolar bone achieved the correct width and depth to create a physiological vestibule and a functional/esthetic zone for the placement of dental implants. In addition, the shape of the palatal vault was also maintained. The CTDO method is a reliable method of maxillary reconstruction and has a better anatomical and functional outcome than the RFFF.
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Comparative evaluation of preemptive analgesia of dextromethorphan and ibuprofen in third molar surgeries p. 312
Saurabh Gajanan Kale, Akshay Shetty, Ayesha Moin, TS Archana, Praveen Kumar, Vivek Bagga
DOI:10.4103/ams.ams_252_19  
Introduction: Postoperative pain following third molar removal is one of the most common and unpleasant complications encountered in routine surgical practice. Various methods have been advocated to minimize the postoperative pain: preemptive analgesia is one of those found to be effective. Objective: The aim of this study was to compare the preemptive analgesic efficacy of Dextromethorphan (DM) and Ibuprofen in the third molar surgeries. Material and Methods: Thirty-six patients reporting to our institution were included in the study. Patients were randomized into three groups of 12 patients each to receive either DM 30 mg, ibuprofen 100 mg, or placebo in the form of multivitamin syrup, 90 min before the procedure. The difficulty of removal of the teeth was assessed using Campbell difficulty score. The study objectives were to evaluate the time elapsed since surgery after which the patient took their first dose of aceclofenac, to evaluate the postoperative pain using visual analog scale score, and to record the number of aceclofenac tablets consumed postoperatively. Results: The results of the study revealed that preemptive DM was significantly better than ibuprofen and placebo in the duration of time that elapsed before the patients consumed their first analgesic postoperatively. Preemptive DM also reduced the total number of aceclofenac tablets consumed on the day of surgery and on the 1st postoperative day, but the difference was not statistically significant. Between the two drugs, DM is better suited for providing preemptive analgesia. No side effects at a dose of 30 mg of DM were noted in any of the patients. Conclusion: DM premedication is a viable preemptive analgesic in reducing postoperative pain.
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ORIGINAL ARTICLE - EVALUATIVE STUDY Top

Assessment of healing using alvogyl and platelet rich fibrin in patients with dry socket - An evaluative study p. 320
MP Keshini, Sahith Kumar Shetty, Shyam Sundar, SN Chandan, S Manjula
DOI:10.4103/ams.ams_259_19  
Introduction: Dry socket is one of the most common postoperative complications following the extraction of permanent teeth, which is characterized by pain and exposed bone. The usual protocol followed for its management is irrigation of the socket and packing of the socket with medicated gel or paste to provide relatively faster pain relief and allow normal wound healing. In this study, we evaluated the outcome of management of dry socket with platelet-rich fibrin (PRF) and intraalveolar alvogyl dressing, in terms of improvement in pain and socket epithelialization after the treatment. Methodology: Thirty participants with established dry socket were randomly divided into two groups: Group A and Group B. The participants in Group A were treated with alvogyl and those in Group B were treated with PRF. Clinical parameters were assessed for both groups on the 1st day of the procedure and on the 3rd and 10th-day postoperatively for the reduction in pain and wound healing. Results: There was a significant decrease in pain and the number of socket wall exposure in both the groups by the 3rd postoperative day. In both the groups, the pain had completely resolved and socket fully epithelialized by the 10th postoperative day. Discussion: The use of PRF in the present study yielded promising results in terms of both pain reduction and improved wound healing which was comparable to the conventional alvogyl dressing. It may be concluded that PRF is an effective modality for the management of dry socket.
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Ergonomics among oral and maxillofacial surgeons in the Indian States of Telangana and Andhra Pradesh - An evaluative study p. 325
Uday Kiran Uppada, Ramen Sinha, Susmitha Madishetti, Siva Ganesh Pampana, Sunil Kumar, Prudhvi Raj Chidagam
DOI:10.4103/ams.ams_39_20  
Introduction: This study is designed to evaluate the work-related musculoskeletal disorders among oral and maxillofacial surgeons in the states of Telangana and Andhra Pradesh. Materials and Methods: This study was conducted to disclose the incidence, location, and intensity of musculoskeletal pain among oral and maxillofacial surgeons in the states of Telangana and Andhra Pradesh. A questionnaire study was designed. One hundred and fifty-six oral and maxillofacial surgeons participated in the survey working in different centers of Telangana and Andhra Pradesh. Demographic information, type of professional practice, duration of working hours, and posture of working were collected. If occupation-induced musculoskeletal pain was present, its location, intensity, and the preventive measure employed were noted. Results: It was observed that majority of the oral and maxillofacial surgeons were practicing exclusive oral and maxillofacial surgical practice, and they employ both sitting and standing postures to carry out their professional work. Lack of availability of a well-qualified/trained assistant in addition to the lack of sophisticated equipment was noted to be the cause for occupation-induced musculoskeletal disorders. Majority of the participants have lower back pain with a visual analog scale score of 4. The pain occurred more often in younger individuals. It was believed by most of the participants that a good physical exercise in the morning helps prevent such occupation-induced musculoskeletal disorders. Discussion: Oral and maxillofacial surgeons due to their unique work are more prone to muscle imbalances, and hence, ergonomic interventions are essential to maintain optimal health during the course of their professional career.
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Significance of microbial analysis during removal of miniplates at infected sites in the craniomaxillofacial region - An evaluative study p. 330
Vishal, Rohit, VK Prajapati, Ajoy Kumar Shahi, Om Prakash
DOI:10.4103/ams.ams_239_19  
Introduction: Open reduction and internal fixation (ORIF) can be complicated by miniplate exposure, loosening, or infection. Infected miniplates lead to exposure, extrusion, fistula formation, bony nonunion, and osteomyelitis. Whenever any posttreated cases of ORIF become infected, it is treated blindly with a high dose of antibiotics and surgical removal of infected miniplates or screws. The aim and objectives of the study were to identify the frequency and site of infection in craniomaxillofacial implants and significance of microbes isolated from the infected region. Materials and Methods: Removal of miniplates was being performed on 19 patients. Among them, 14 had infection or sinus opening, 3 had plate exposure, and 2 were removed asymptomatically according to patient willingness. Aspirated fluid/pus was collected and sent for microbial culture and sensitivity test. Test of significance of individual microbes was done using Z-test and the value of P was calculated. Results: Among 14 patients associated with miniplate infection, 11 (78%) had infection in the mandible and 3 at zygoma. The bacteria isolated were mainly Staphylococcus aureus (7) along with coagulase-negative Staphylococcus (2), Pseudomonas aeruginosa (3), Escherichia coli (2), Streptococcus salivarius (2), and Acinetobacter genre (1). S. aureus was predominantly present in majority of the samples and statistically significant at P = 0.023. Discussion: The present study observed that in contrast to other sites in the body, there is versatility in microbial flora in the craniomaxillofacial region. It is essential for routine microbial analysis of samples and antibiotic susceptibility test for proper treatment of such cases.
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Efficacy of sticky bone as a novel autologous graft for mandibular third molar extraction socket healing - An evaluative study p. 335
Taher Abbas Rupawala, Shital Mayank Patel, Naiya Hitesh Shah, Kunj Bhupeshchandra Sanghvi, Sanjay Vinubhai Makwana, Kruna Kantilal Bhimani
DOI:10.4103/ams.ams_40_20  
Introduction: Recently, initiation and enhancement of extraction socket healing has been amplified by platelet concentrates, whereas the positive role of Sticky bone has been focused on maintaining alveolar bone dimensions. This study aimed to determine the effectiveness of Sticky Bone for socket grafting of mandibular third molars (M3Ms) in terms of soft- and hard-tissue healing. Materials and Methods: This split-mouth prospective trial constituted prophylactic removal of M3Ms with Sticky bone grafted in the study site as a primary predictor variable. Patients underwent 3 months of mandatory follow-up where pain, swelling, interincisal mouth opening, and gingival healing were measured on the 3rd, 7th, and 14th day using the Numeric Rating Scale, anatomic landmarks, steel metric ruler, and criteria given by Landry et al. respectively. Radiological healing was calculated based on the height of the socket, Kelly's Index, and histogram values immediately after the procedure at 1 week, 1 month, and 3 months, respectively. Statistical comparison was made using Paired t-test. P < 0.05 was considered significant. Results: Forty-seven patients (mean 26.83 ± 6.58 years) demonstrated significantly lesser pain, swelling, and better gingival healing at the study site on multiple periods of follow-up. Rapid bone formation with superior density, lesser alveolar resorption, earlier bone blending, and trabecular formation were noticed on the study site with a significant difference at all time intervals. Discussion: Sticky bone was chosen as the graft owing to advantages such as simple preparation, convenient handling characteristics, safety, evident postoperative patient comfort, better retention of the clot, enhanced soft-tissue healing, absence of infection, and decreased osseous deformation as compared to the control site. This study validated the role of Sticky bone as an indispensable component of regenerative therapy in the orofacial osseous tissues as it was an ideal biologic graft with fibrin rich structure. Conclusion: This study validated the role of Sticky bone as an indispensable component of regenerative therapy in the orofacial osseous tissues as it was an ideal biologic graft with fibrin rich structure.
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Role of custom-made prosthesis for temporomandibular joint replacement in unilateral ankylosis - An evaluative study p. 344
Bharathi Mani, Saravanan Balasubramaniam, Sethurajan Balasubramanian, Balaji Jayaraman, Rohini Thirunavukkarasu
DOI:10.4103/ams.ams_132_20  
Introduction: Ankylosis is a physically and psychologically distressing condition to a patient. The aim of this study was to evaluate the efficiency of custom-made temporomandibular joint (TMJ) prosthesis (fossa-condyle component) in patients with unilateral ankylosis in restoring the form and functions of the TMJ. Materials and Methods: This retrospective study was conducted in ten patients with unilateral TMJ ankylosis who had undergone TMJ reconstruction with custom-made TMJ prosthesis. Clinical parameters assessed were maximal mouth opening, lateral movements, improvement of the pain levels, and dietary efficiency of the patient. The data were analyzed using SPSS version 20 (IBM Corporation, SPSS Inc.; Chicago, IL, USA). Results: The mean preoperative mouth opening was 5.70 ± 3.62 mm. After gap arthroplasty, it was 32.50 ± 3.31 mm. The postoperative mouth opening after the reconstruction of TMJ using alloplastic joint prosthesis was 34.90 ± 2.69 mm, and after a mean follow-up period of 4 years, the mean postoperative mouth opening was 34.60 ± 2.50 mm. The mean preoperative movement toward the right and left side was 0.9 ± 1.2 mm and 1.3 ± 1.25 mm, respectively. The mean right and left lateral movements of the TMJ after reconstruction were 3.5 ± 0.97 mm and 3.70 ± 1.06 mm, respectively. There was decrease in deviation of the unaffected jaw during mouth opening and closure. Functional occlusion was maintained postoperatively. There was no appreciable change in the visual analog pain scales. The dietary efficiency improved from a scale of 10 (liquids) to a scale of 0 (no restriction to diet) in eight patients and 1 in two patients. The dietary score improved significantly after alloplastic reconstruction (P = 0.000). No evidence of facial nerve paralysis or foreign body reactions was noted in the patients during the follow-up period. Radiographic assessment revealed good positioning and adaptation of the fossa component and the condylar ramal component both postoperatively and after a mean 4-year follow-up period. There was no evidence of screw loosening or prosthesis breakage during the follow-up period. Discussion and Conclusion: The custom-made TMJ-total joint replacement (TJR) devices provide stable, improved long-term results, thereby increasing the quality of life of the patient. The custom-made alloplastic TMJ-TJR prosthesis proves to be the optimal surgical procedure to reconstruct the TMJ in comparison to the autogenous grafts (to avoid complications) in severe degenerated and ankylosed joints. However, long-term clinical and radiological studies on a larger sample size are imperative to establish the versatility of this procedure.
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ORIGINAL ARTICLE - PROSPECTIVE STUDY Top

Analysis between retromandibular and periangular transmasseteric approach for fixation of condylar fracture - A prospective study p. 353
Saloni Gupta, Vishal Bansal, Apoorva Mowar, Jayendra Purohit, Mohit Bindal
DOI:10.4103/ams.ams_28_20  
Introduction: Condylar fractures make up for an average of 17.5%–52% of all mandibular fractures. The aim of the present study was to compare the ease, success, and complications between retromandibular and periangular transmasseteric approaches when used for open reduction and internal fixation of condylar fractures. Materials and Methods: A total 20 cases with condylar fracture, ten each for retromandibular and periangular transmasseteric approach, were included in the study. Patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Postoperative occlusion, maximum mouth opening, range of movement, facial nerve function, visibility, convenience of plating, and time taken for exposure, fixation, and closure were recorded. Incidence of complications such as wound dehiscence, wound infection, hematoma, sialocele formation, Frey's syndrome, and hypertrophic scars were also evaluated. Results: The mean exposure time in the retromandibular approach was 10 min 31 s and 9 min 17 s in the periangular transmasseteric approach. The incidence of facial nerve injury was 2 of 10 patients in the retromandibular group and 3 of 10 patients in the periangular transmasseteric group, all of which resolved within 6 months. The incidence of sialocoele was 2 of 10 in the retromandibular group. The time taken for exposure of the fracture site was statistically significant between the two approaches (P = 0.048) with longer time required for retromandibular approach. Discussion: It can be summarized that both the approaches are comparable and well suited for surgical management of condylar fractures. It was observed that in displaced condylar neck fractures, greater difficulty was experienced in the periangular transmasseteric approach than the retromandibular approach.
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Changes in blood pressure and pulse rate of patients without systemic diseases following the injection of 2% lidocaine plus epinephrine 1:80000 in an inferior alveolar nerve block - A prospective study p. 361
Ehsan Aliabadi, Vahid Divanpour, Mohsen Mardani
DOI:10.4103/ams.ams_187_19  
Introduction: An inferior alveolar nerve block is dental anesthesia produced by the local injection of lidocaine plus epinephrine; however, its administration could cause cardiovascular side effects. We aimed to assess the changes in blood pressure and pulse rate following the injection of 2% lidocaine with epinephrine 1:80000 for an inferior alveolar nerve block. Materials and Methods: Seventy-one patients without any systemic disease were enrolled in this study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate were measured using an automatic digital blood pressure monitor in four stages as follows: at the rest time (Stage 1), prior to injection (Stage 2), immediately after injection (Stage 3), and 10 min after the administration of anesthetic agents (Stage 4). All injections and measurements were carried out by a single operator to minimize the variability. Results: SBP and DBP in all stages were within the normal range (lower than 130 and 80 mmHg, respectively), and none of the patients showed evidence of arterial hypertension. Although the pulse rate increased significantly at Stages 2, 3, and 4 compared with Stage 1 (P < 0.05), no evidence of bradycardia or tachycardia was seen. Discussion: Local anesthesia with 2% lidocaine plus epinephrine 1:80000 for an inferior alveolar nerve block would be safe for patients without any systemic diseases.
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A prospective cohort study of maxillary sinus complications in relation to treatments with strategic implants® penetrating into the sinus p. 365
Aleksandar Lazarov
DOI:10.4103/ams.ams_85_20  
Introduction: Rehabilitation with dental implants of total or partial edentulousness in the maxilla encounters a number of difficulties due to the anatomical distinctions and the topography of this region. The maxilla is rigidly attached to the other skull bones, and therefore, its structure is functionally adapted to transmit loads through three main buttresses. Outside these supporting zones, the bone structure is poorly mineralized, or its volume is limited to the thin bone layer. In strategic implantology, a number of defined clinically-proven surgical methods have been proposed to utilize these maxillary load transmitting buttresses. This study was aimed to evaluate its safety with respect to maxillary sinus complications as a result of anchoring Strategic Implants® in the cortical boundaries of the sinus and/or passing through it, to reach the pterygoid plate of the sphenoidal bone. Materials and Methods: This prospective cohort study was carried on 217 cortico-basal implants penetrating through the cortical walls of the maxillary sinus (Simpladent GmbH, Gommiswald, Switzerland), placed between September 2013 and December 2014 in a total of 70 patients (131 maxillary sinuses). Two hundred and four implants were anchored in the cortical bone of the sinus protruding into the sinus up to 3 mm, and 13 were placed trans-sinuously. Results: None of the implants failed during the observation period, with only one instance of adverse reaction in the maxillary sinus to the polished corticobasal implants. Discussion: Anchoring polished corticobasal implants in the wall of the maxillary sinus as well as in the pterygoid plate of the sphenoid bone is a safe and effective procedure that per se (if executed properly) does not cause any adverse reaction of the maxillary sinus.
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ORIGINAL ARTICLE - IN VITRO STUDY Top

Three-dimensional bioprinting using a coaxial needle with viscous inks in bone tissue engineering - An In vitro study p. 370
Java Walladbegi, Christian Schaefer, Elin Pernevik, Sanna Sämfors, Göran Kjeller, Paul Gatenholm, George K Sándor, Lars Rasmusson
DOI:10.4103/ams.ams_288_20  
Introduction: Vascularized autologous tissue grafts are considered “gold standard” for the management of larger bony defects in the craniomaxillofacial area. This modality does however carry limitations, such as the absolute requirement for healthy donor tissues and recipient vessels. In addition, the significant morbidity of large bone graft is deterrent to fibula bone flap use. Therefore, less morbid strategies would be beneficial. The purpose of this study was to develop a printing method to manufacture scaffold structure with viable stem cells. Materials and Methods: In total, three different combinations of ground beta tri-calcium phosphate and CELLINK (bioinks) were printed with a nozzle to identify a suitable bioink for three-dimensional printing. Subsequently, a coaxial needle, with three different nozzle gauge combinations, was evaluated for printing of the bioinks. Scaffold structures (grids) were then printed alone and with additional adipose stem cells before being transferred into an active medium and incubated overnight. Following incubation, grid stability was evaluated by assessing the degree of maintained grid outline, and cell viability was determined using the live/dead cell assay. Results: Among the three evaluated combinations of bioinks, two resulted in good printability for bioprinting. Adequate printing was obtained with two out of the three nozzle gauge combinations tested. However, due to the smaller total opening, one combination revealed a better stability. Intact grids with maintained stability were obtained using Ink B23 and Ink B42, and approximately 80% of the printed stem cells were viable following 24 hours. Discussion: Using a coaxial needle enables printing of a stable scaffold with viable stem cells. Furthermore, cell viability is maintained after the bioprinting process.
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ORIGINAL ARTICLE - RETROSPECTIVE STUDY Top

Frequency of midfacial traumatic injuries - A report from the maxillofacial reconstructive and plastic surgery department of Kyrgyz Republic Health Service Ministry's National Hospital, Bishkek from 2013-17 - A retrospective study p. 377
Ilshat Yuldashev, Annamurad Rakhmanov, Bakyt Urgunaliev, Gaukharnisa Yuldasheva, Ulan Tynaliev, Almaz Kulnazarov
DOI:10.4103/ams.ams_2_20  
Introduction: The aim of the study was to conduct a retrospective analysis of the fractures of the mid-face zone from 2013 to 2017 years in the above hospital and to determine the nature of the injuries and the main methods of diagnosis and treatment. Materials and Methods: This was a retrospective analysis of 4966 patients who underwent treatment at the hospital from 2013 to 2017. Data about etiology, site of injury, time of admission to the clinic, number and type of associated injuries, type and length of treatment, and complications were analyzed. Results: Of total 4966 patients, 581 (11.69%) were with traumatic injuries and 114 (2.3%) were with injuries of the middle face zone. The most common age was 21–30 years, male-to-female ratio – 6:1, reason of trauma was assaults – 50 (44%), road traffic accidents – 28 (25%), falls – 19 (31%), and horse riding trauma – 16 (14%). Discussion: The main treatment approaches were wiring or titanium plates on open reduction and splint intermaxillary fixation.
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Efficacy and versatility of intraoral monoplanar distractors in the correction of extreme mandibular deformities and severe facial asymmetries - A retrospective study p. 381
Priya Jeyaraj
DOI:10.4103/ams.ams_166_20  
Introduction: Distraction osteogenesis, has emerged as a revolutionary concept and an effective means to treat extensive craniomaxillofacial defects and malformations. In cases of mandibular distraction for patients with extreme acquired mandibular deformities, there is so far, no recorded literature on precise quantification and scientific estimation of the percentage of the efficacy of intraoral monoplanar distractors, for an objective evaluation of their effectiveness. The objective was to study the efficacy of intraoral mandibular monoplanar distractors in the correction of severe acquired mandibular deformities and gross facial asymmetries. To objectively evaluate their effectiveness by calculating the percentage of distraction achieved as against that aimed for, and to evaluate early and late complications encountered with their use. Materials and Methods: Five patients in the age group of 10–22 years, with extreme mandibular deformity and gross facial asymmetry secondary to longstanding temporomandibular joint (TMJ) ankylosis, were treated. Four patients had unilateral and one patient had bilateral TMJ ankylosis, with varying degrees of acquired mandibular hypoplasia, retrogenia, retrognathia, and asymmetry. They were managed by unilateral (3 patients) and bilateral (2 patients) mandibular distraction. Results: Maximum horizontal corpus and vertical Ramal distraction achieved was 19 mm and 17.6 mm, respectively. The percentage of the efficacy of the intraoral monoplanar distractors used in this study ranged from 65.38% to 109.09%. Severe mandibular deformities and facial asymmetries were successfully corrected in all five patients, with no major early or late complications encountered in any of them. Results achieved were stable with nil incidence of relapse. Discussion: Estimation of percentage of the efficacy of distraction achieved, helped in objectively evaluating the effectiveness of the intraoral mandibular distractors. A low complication rate and good esthetic and functional outcomes achieved in all the patients demonstrated the reliability of this treatment modality in the management of extreme mandibular deformities and severe facial asymmetries.
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Unilateral sinus disease: Not just odontogenic! - A retrospective study p. 397
Manlio Galie, Simona Gueli, Andrea Ciorba, Chiara Bianchini, Giannicola Iannella, Francesco Stomeo, Luisa Valente, Stefano Pelucchi
DOI:10.4103/ams.ams_268_19  
Introduction: Unilateral sinus disease (USD), and especially unilateral maxillary sinusitis (UMS), is an increasingly common finding in the ear, nose, and throat and maxillofacial practice. The aim of this retrospective study was to describe the clinical features of a series of patients affected by USD and, in particular, UMS due to sinonasal anatomic anomalies and of odontogenic origin. Materials and Methods: A total of 292 patients affected by UMS were reviewed. Medical charts, radiological images, and surgical notes were all reviewed, particularly including data on UMS due to sinonasal anatomic anomalies and on UMS of odontogenic origin. Results: A total of 66 patients have been excluded due to a diagnosis of malignant disease or other benign-defined etiology. Forty-eight patients (21.2%) affected by UMS due to sinonasal anatomic anomalies, whereas 178 (78.8%) patients affected by an odontogenic sinusitis. All patients were surgically treated by functional endoscopic sinus surgery, often in combination with a maxillofacial approach. Discussion: UMS of odontogenic origin represented the greater group of USD. Computed tomography scans are always recommended to define UMS etiology (in particular excluding a malignant origin) and also to plan the most adequate surgical treatment.
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Experience with airway management and sequencing of repair of panfacial fractures: A single tertiary healthcare appraisal in Najran, Kingdom of Saudi Arabia - A retrospective study p. 402
John Spencer Daniels, Ibrahim Albakry, Ramat Oyebunmi Braimah, Mohammed Ismail Samara, Rabea Arafa Albalasi, Farzana Begum, Mana Ali-Mohamed Al-kalib
DOI:10.4103/ams.ams_202_19  
Introduction: Special cooperation is required among surgeons and anesthetists in airway management during repair of panfacial fractures, due to problems of shared airway and occlusion. Several methods have been proposed for airway management and sequencing of repair of panfacial fractures. The main objective of the current study was to share our experience in the airway management and sequencing of repair of panfacial fractures. Methods: This was a retrospective study of panfacial fractures in the Kingdom of Saudi Arabia from January 2008 to December 2018. Data collected included demographics, type of airway management, sequence of repair (as primary variables), and outcome of surgery (secondary variable), while surgeon and anesthetic expertise are confounders. Data were analyzed using IBM SPSS Statistics for Windows Version 25 (Armonk, NY, USA: IBM Corp). Results were presented as simple frequencies and descriptive statistics. Pearson Chi-square was used to compare categorical variables such as airway management and sequencing of repair with the panfacial fractures. Statistical significance was set at P ≤ 0.05. Results: Overall, 1057 patients sustained different categories of maxillofacial bone fractures with 23 females and 1034 males (M:F of 46:1). A total of 43 male patients out of 1057 patients had panfacial fractures during the study period, giving a prevalence rate of 4.1%. Only the 43 male patients with panfacial fractures were analyzed. All cases were as a result of motor vehicular accident. Six (13.9%) patients had tracheostomy while 37 (86.1%) patients had submental intubation. “Bottom-up” and “outside-in” approach was used in 33 (76.7%) patients, while “top-bottom” and “inside-out” approach was used in 10 (23.3%) patients. Discussion: Submental intubation was the major airway management of panfacial fracture, and “bottom-up” and “outside-in” approach was the main sequence of repair in our series. These approaches have been mentioned in the literature. Conclusion: From our study, victims of pan-facial fractures were found to be exclusively male with MVA as the sole etiological factor. Barring severe head injuries, which may necessitate the use of tracheostomy to sustain breathing over a longer period, submental intubation is extremely reliable as a mode of airway management during surgical treatment of panfacial fractures. The sequencing of repair of panfacial fractures can only be determined according to the case presentation rather than a predetermined one.
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Efficacy of platelet-rich plasma and concentrated growth factor in treating androgenetic alopecia - A retrospective study p. 409
Enosh Nirmalkumar Steward, Hiren Patel, Haren Pandya, Hitesh Dewan, Bijal Bhavsar, Urvi Shah, Kartik Dholakia
DOI:10.4103/ams.ams_154_19  
Introduction: Plasma derivatives have been practiced a lot in orthopedics, burns, and sport medicine. Microneedling (MN) with platelet-rich plasma (PRP) therapy has been proven to improve the micro-circulation and thus improve hair growth. The role of concentrated growth factor (CGF) for hair growth has not been mentioned anywhere in the literature for hair growth which we tried to prove in our article by comparing it with various other studies. Materials and Methods: This is a retrospective randomized study involving 20 male patients whose ages ranged from 21 years to 56 years. PRP was prepared using the dual-spin method and injected after activation; post-MN, CGF gel was applied topically. Four sessions were performed, and a follow-up was done after 6 months. Statistical analysis was done using the Statistical Package for the Social Sciences software version 21 for Windows (SPSS, IBM Corp, Armonk, NY, USA). Paired t-test was used for the various comparisons. Results: Hair loss reduced by the end of the first month. At the end of 6 months, postfirst session, microscopic examination showed statistically significant difference in the hair count compared to those during the baseline. Discussion: PRP having platelet-derived growth factor and vascular endothelial growth factor acts on stem cells in the follicles, stimulating the development of new follicles and promoting neovascularization. CGF helps stimulating cell proliferation and matrix remodeling due to numerous growth factors in a concentrated form. Thus, this therapy combined helps to boost the hair growth in a very significant way. Summary: This study provides the preliminary evidence of efficacy of PRP along with MN and CGF in treating androgenetic alopecia by promoting angiogenesis along with vascularization and promotes hair follicles to enter and extend the anagen phase. Most of the results obtained show improved results with this therapy. A larger case study for the same can further be done for a stronger recommendation of the use of CGF for hair growth therapy further.
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Plication of neck strap muscles and platysma for double chin correction - A retrospective study p. 417
SM Balaji, Preetha Balaji
DOI:10.4103/ams.ams_355_20  
Introduction: There is an increased need for recontouring chin and submental areas for esthetic reasons. Reports of such surgeries across the world are present in the literature. India too has its share of chin and neck reconstruction needs. This study was carried out to document a single-center experience of authors' approach in isolated submentoplasty. Materials and Methods: A retrospective analysis of case records of submentoplasty during 2012–2017 was collated. Cases fulfilling inclusion and exclusion criteria were selected for this study. A qualitative assessment of the outcomes was performed. Results: Sixteen cases who had undergone isolated submental lipectomy with platysma plication formed the study group. The mean age was 44.38 ± 5.49, with a range of 37–54 years. There were 9 females and 7 males. The mean age of females was 42.89 ± 4.01, while for males, it was 46.29 ± 6.79 years. The mean follow-up ranged for 16.2 ± 3.4 months (14–20 months). None of the patients had major complications. Discussion and Conclusion: The modified mini-neck lift approach for an isolated submental lipectomy and strap muscles of suprahyoid group with platysma plication is presented. Careful manipulation of the fat removal, plication of platysma, strap muscle and positioning of incision would help to a greater extent. The anatomical challenges for this variation are discussed.
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Computed tomographic study of remarkable anatomic variations in paranasal sinus region and their clinical importance - A retrospective study Highly accessed article p. 422
Amit Nautiyal, Arun Narayanan, Deepanjan Mitra, Thittamarnahalli Muguregowda Honnegowda, Sivakumar
DOI:10.4103/ams.ams_192_19  
Introduction: With the advent of functional endoscopic sinus surgery and coronal computed tomography (CT) imaging, more attention has been paid toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the pre- and post-operative assessment. The anatomical variants with some accompanying pathologies would directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. Our study intends to explore the anatomy of paranasal air sinus through CT and to describe its variants, which may predispose to chronic sinusitis and complications in endoscopic sinonasal surgery. Materials and Methods: This was a retrospective study carried out in a tertiary institution. Two hundred and fifty patients without paranasal sinus symptoms who presented for head CT studies and gave consent for a coronal section scan of the paranasal sinuses to be taken in addition to the axial section of the head were included in the study. The CT examination was performed with GE Hispeed-NX/I Base-2002 Dual Slice Helical CT machine. Results: Among 250 study population, 100 were females and 150 males. Among these 423 cases of anatomical variants were observed. The most common anatomical variants were pneumatization of the middle nasal turbinates 30.73%. This is followed by agger nasi cells 21.64%, Haller's cells 22.91%, septal deviation 21.91%, and sphenoid sinus septation (20.18%). Discussion: CT is the gold standard in the radiologic investigation of the paranasal sinuses, sinonasal lesions, and inflammatory disease or pre- and post-surgical assessment. It has the capability of disclosing in greatest detail any anatomical variations, which could be causing or precipitating the sinusitis.
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Parental age and the risk of cleft lip and palate in a Nigerian population - A case–control study p. 429
Olutayo James, Olufemi A Erinoso, Ajoke O Ogunlewe, Wasiu L Adeyemo, Akinola L Ladeinde, Mobolanle O Ogunlewe
DOI:10.4103/ams.ams_134_20  
Introduction: Orofacial clefts are one of the most common congenital malformations in the facial region. Older maternal or paternal age presents higher odds of a child with an orofacial cleft. The objective of the study was to assess the association between parental age and risk of orofacial cleft. Materials and Methods: This was a case–control study among 110 parents of children with orofacial cleft (case group) and 110 parents of children without orofacial cleft (control group). Information on maternal age, paternal age, and type of orofacial cleft in the children were obtained. The results were analyzed using descriptive statistics, Chi-square analysis, and bivariate logistic regressions to measure the association between parental age and orofacial cleft. The value of P was <0.05, with a 95% confidence interval (CI). Results: Information on 219 children (109 cases and 110 controls) was analyzed, of which 52% were females. One respondent from the case group withdrew from the study. The odds of a child with orofacial cleft was statistically significantly lower in mothers aged 26–35 years compared to mothers aged 25 years and less (odds ratio [OR]: 0.32; 95% CI: 0.16, 0.79). Similarly, fathers aged above 35 years had statistically significantly lower odds of children with orofacial cleft than those 25 years and less (OR: 0.18; 95% CI: 0.02, 0.99). Discussion: Our findings suggest that mothers aged 26-35 years may have lower odds of giving birth to babies with orofacial clefts, compared to younger mothers. Similarly, fathers aged above 35 years may have lower odds of giving birth to a child with orofacial cleft compared to fathers aged 25 years and less.
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Management of orofacial cleft in Nigeria - A retrospective study p. 434
Olutayo James, Adegbayi Adeola Adekunle, Olawale Olatubosun Adamson, Olushola Failat Agbogidi, Wasiu Lanre Adeyemo, Azeez Butali, Akinola L Ladeinde, Mobolanle Olugbemiga Ogunlewe
DOI:10.4103/ams.ams_104_20  
Introduction: Orofacial clefts (OFCs) are among the most common craniofacial developmental abnormalities worldwide and a significant cause of childhood morbidity and mortality. This study aimed to identify patterns of patient presentation, treatment approaches, and changes in our overall cleft care service between 2007 and 2019. Methods and Methodology: A retrospective review of patients managed at a tertiary health facility in Nigeria of all OFC cases operated between 2007 and 2019 was done using the postintervention data retrieved from the Smile Train database. Data of all OFC cases operated within the period were analyzed using the Statistical Package for the Social Sciences. Descriptive statistics were performed using the Statistical Package for the Social Sciences version 20.0. Results: A total number of 740 OFC surgeries were performed in 565 patients, consisting of 269 females (48.2%) and 289 males (51.8%). The majority (63%) of the patients presented before the age of 2 years. Thirty-seven percent presented with cleft lip and alveolus, 27.1% with cleft palate only, and 36.7% with cleft lip, alveolus, and palate. Primary cleft lip repair was the most performed surgery (n = 320, 43.2%), the mean age at repair was 2.1 years. Since 2017, additional services such as speech therapy, mixed dentition orthodontics, and nutritional support were added to services provided to our cleft patients. Fifteen patients have undergone speech assessment and three have completed speech treatment. Eight patients have undergone mixed dentition stage orthodontic treatment. Discussion: Our services have evolved from simply providing surgical care to comprehensive care with a multidisciplinary team approach and provision of a wide range of services including nutritional counseling, pediatric care, orthodontic services, and speech therapy. We believe these will improve the overall well-being of our patients while we continue to improve on services based on clinical research outcomes.
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REVIEWS Top

Oral and maxillofacial minor surgery practice post-COVID 2019 pandemic - An insight p. 439
Ankita Chugh, Amanjot Kaur, Aakash Kohli, Pravin Kumar
DOI:10.4103/ams.ams_189_20  
COVID-19, a worldwide pandemic, has given an awakening and introspective moment for all surgeons involved with aerosol-generating procedures. We ought to modify our practices to learn to live with it if we wish to prevail over it. This article outlines similar small changes that can be done in our minor maxillofacial surgery practice to safeguard both patients and healthcare workers.
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Mandibular retromolar foramen and canal - A systematic review and meta-analysis Highly accessed article p. 444
Setu P Shah, Deval Mehta
DOI:10.4103/ams.ams_19_20  
Introduction: The retromolar fossa is a small triangular area posterolateral to 3rd molar region in the mandible. The retromolar fossa often contains the retromolar foramen (RMF) as an anatomical variant. When the RMF is present, the foramen is connected with the mandibular canal (MC) through another canal known as the retromolar canal (RMC). RMC contains neurovascular bundle, which gives additional supply to the mandible. Although few studies have been conducted in past, a lacunae in comprehensive review is lacking. Although, these variations posed challenging situations for the practicing surgeons, they have been quite neglected and not well presented in textbooks. Hence, we made an attempt to provide a comprehensive and consolidated review regarding RMF and RMC. Materials and Methods: The relevant articles were selected by hand search and electronic media (Google scholar, PubMed, Science Direct, Medline, Embase and Cochrane) from 1987 to 2019. All the relevant articles were properly screened and findings were extracted from the articles. Results: There seems to be wide variations in morphology and morphometry of RMF and RMC. Discussion: Detailed knowledge of these anatomical variations is important in surgical procedure involving the retromolar area to protect the patient from complications such as unexpected bleeding, hematoma formation, and nerve damage. Furthermore, its knowledge makes us understand about the failed inferior alveolar nerve block, spread of infection, and metastasis in case of carcinoma. When there is any suspicious alteration in the MC, we suggest more accurate examination technique like CBCT.
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Gadgets and armamentarium of maxillofacial surgeons during coronavirus pandemic p. 450
Abhay Datarkar, Shikha Tayal, Hema Anukula
DOI:10.4103/ams.ams_164_20  
Introduction: We all know about the grave situation caused by the novel coronavirus in recent times. Although the maxillofacial surgeons are not at forefront of dealing with the coronavirus directly, they are at increased risk due to their working area on face, mouth, and oral cavity. There is an urgent need to upgrade the already set guidelines and follow them stringently. Any procedure done within the oral cavity is a high-risk procedure and this upgradation is necessary because present means are insufficient to prevent infection from this deadly virus. This article aims to review and discuss all the new gadgets and armamentarium required to deal with patients during and post coronavirus pandemic. Materials and Methods: The authors performed a thorough literature search on various armamentarium and new gadgets introduced into the field of dentistry during the coronavirus pandemic worldwide. The relevant armamentarium is discussed under three broad headings, namely, those required before, during and after the procedures for easy understanding. Results: A total of 15 gadgets and armamentarium related to oral and maxillofacial surgical practice are named and discussed in the literature review. Discussion: We are particularly vulnerable to the transmission of diseases easily both due to the field of interest of work and type of instrumentation. Thus, we need to be extremely cautious about the procedure. Since, the literature is scarce about the sequelae of the coronavirus disease; shift to the automated, contactless gadgets is the way to look forward to a healthy dental practice. Conclusion: These gadgets are user friendly for any small dental set-up as well. The choice of these upgraded instruments are prerogative of the individual professionals according to their exclusive practice. Yet, the authors encourage all health care professionals to focus on better training in infection control and cross-contamination.
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Consensus regarding 16 recognized and clinically proven methods and sub-methods for placing corticobasal® oral implants p. 457
Ihde Antonina, Alexander Lazarov, Vivek Gaur, Valeri Lysenko, Vitomir Konstantinovic, Gabor Grombkötö, Lukas Palka, Stefan Ihde
DOI:10.4103/ams.ams_62_20  
This Consensus-Document is issued by the International Implant Foundation (Munich/Germany). It describes distinct methods of placement of cortico-basal oral implants in different areas of the jaw bone and the maxillo-facial skeleton. The implants utilize the method of “osseofixation” instead of “osseointegration” for achieving primary, functional stability, hence they work according to the (AO-) principles of fracture treatment. The concept of the technology allows for immediate functional loading, just as it allows for various types of loading following orthopaedic surgery. The 16 methods and sub-methods as described and displayed here have been undergoing extensive observation and testing and they have been approved by the Board of the International Implant Foundation. All Consensus Documents of the International Implant Foundation are revised every three years. This is the 3rd version of the Consensus Document on placement of corticobasal oral implants Level of Evidence: S3 (evidence based, systematically developed consensus guideline).
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TECHNICAL NOTE Top

A novel modification of the sagittal split osteotomy as an access osteotomy p. 463
P Satish Kumaran, G Manikandan, V Anuradha, Preeti Satish, R BalaMurugan, Abhinav Anil Kumar
DOI:10.4103/ams.ams_264_19  
Pathologies present in the central zone of the mandible are difficult to access, primarily because of the presence of the inferior alveolar nerve (IAN) and the need to remove a large corticocancellous component to reach the area of interest. Many times, this bony window is replaced as a free graft and there is complete resorption in the long term or even rejection of the graft causing a bony defect which can weaken the mandible. Furthermore, the damage to the IAN is profound. To try and avoid these comorbidities the traditional sagittal split osteotomy was modified to access a central osteoma impinging on the IAN and the successful removal of the same without any comorbidities such as paraesthesia or loss of bone structure. We believe that this modification can be used for other scenarios such as benign cysts and difficult presentations of impacted teeth.
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Guidelines for the use of resection guides for subperiosteal maxillary implants in cases of terminal dentition - A novel approach Highly accessed article p. 467
Marco Rinaldi, Björn De Neef, Natalie A. J Loomans, Maurice Y Mommaerts
DOI:10.4103/ams.ams_135_20  
Introduction: We described our rationale and experiences with the use of cutting jigs for vertical ostectomy in cases of terminal maxillary dentition when edentulation and an additively manufactured subperiosteal jaw implant (AMSJI®) are planned. Material and Methods: Our experience covers 15 patients treated by four clinicians. We tabulated our criteria for planning and manufacturing vertical and horizontal ostectomy guides. Results: In order to guarantee accurate osteotomy, titanium guides are preferable to guides made of polymer. The most important consideration is to avoid acute angles in the buccal arms of the AMSJI®. It is up to the surgeon whether to screw-fix the ostectomy guides or to use handles to maintain their position. Discussion: Guided ostectomy has the potential to extend the use of AMSJI® to cases where teeth have yet to be removed or where the contours of the residual bone are not favorable. The use of guided ostectomy in such cases lessens the time between edentulation and implantation and improves the design of the implants.
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Surgical management of parotid duct injury using a feeding tube p. 472
Mohsen Mardani, Hamidreza Arabion
DOI:10.4103/ams.ams_238_19  
The parotid duct (Stenson's duct) can be damaged during traumatic injuries and surgical interventions. Early diagnosis and treatment of a duct injury is of great importance because complications such as sialocele and salivary gland fistula may develop if the duct is not surgically repaired. We think that the feeding tube is an ideal material in the parotid duct repair because of its technical characteristics, availability, and low cost. In this article, we described the use of a feeding tube for the treatment of a parotid duct rupture in a facial stab wound laceration, as it is a low-cost and easy-to-access material readily available in every operating room.
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CASE REPORT - CYSTS AND TUMORS Top

Lower lip cancer managed by reconstruction with a double abbe flap - A case report p. 475
Tomoki Sumida, Tomohiro Yamada, Hiroyuki Nakano, Yosuke Kobayashi, Miku Sadanari, Rikiya Daizen, Teruyoshi Chiba, Yoshihide Mori
DOI:10.4103/ams.ams_30_18  
Although the incidence of lower lip cancer is not high in Japan, its treatment requires an approach that considers both esthetics and function. When surgical resection is required, the method used for reconstruction varies depending on the affected part. Despite various studies proposing different types of algorithms, no single method is considered the best. If the loss of half or more of the lip is predicted, a free flap may need to be considered, depending on the case. Here, we report a case involving a 78-year-old edentulous woman with lower lip cancer whose resection area involved approximately 70% of the red and white portions of the lower lip. Fortunately, no resection was required at the commissure. We accordingly performed reconstruction with a double Abbe flap in accordance with a detailed treatment plan. The patient was extremely satisfied with the esthetic and functional outcomes of the surgery.
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Surgical ciliated cyst of the left maxilla - A case report of unusual pathogenesis p. 479
Divya Sanjeevi Ramakrishnan, PU Abdul Wahab, Pradeep Dhasarathan, M Madhulaxmi, Janani kandamani
DOI:10.4103/ams.ams_284_20  
Introduction: Surgical ciliated cyst (SCC) is a type of true epithelial lined antral cysts, which mostly occurs in maxilla from the sinonasal mucosa and gland, comprising 20% of all oral cysts in Japan. It is also called as postoperative maxillary cyst or postoperative paranasal cyst. The etiology is believed to be post trauma or surgery in the region of maxillary antrum. Patient concerns: Patient's concern is less evident in this cystic pathology, because this cyst even though an aggressive cyst, presents with fewer symptoms that can be uncomfortable to the patient or push them to seek medical attention. Often, this becomes an incidental finding during routine postoperative follow-up. Rationale: The rationale behind this report is to emphasize even a traumatic extraction of tooth can damage the floor of the sinus and lead to the cyst formation. Report: We report a case of SCC in a 76-year-old female of the left maxillary sinus possibly after a traumatic extraction of the tooth, for which enucleation of the cyst was done as a primary modality of treatment. Diagnosis: Diagnosis was made after a computed tomography (CT) scan and incisional biopsy. Diagnosis of such rare cases poses a great challenge due to its paucity in etiology, and it often requires a CT scan that becomes an essential gold standard investigation. Outcomes: Patient is currently under one year follow up and without any signs of recurrence. Lessons: It should be acknowledged that tampering trauma or with sinus mucosa can trigger the formation of a SCC of the maxilla, and it should always be considered as a possible sequel after any procedure of such potential in the maxilla.
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Adenomatoid odontogenic tumor associated with impacted mandibular canine - A case report Highly accessed article p. 484
Hirakben B Patel, Pratap N Movaniya, Nimisha N Desai, Tushar R Makwana, Kalpesh G Makwana, Payal D Mehta
DOI:10.4103/ams.ams_77_20  
Adenomatoid odontogenic tumor (AOT) is a relatively rare, benign, hamartomatous, and cystic odontogenic neoplasm that was first described more than a century ago. It accounts for 2-7% of all odontogenic tumors. The lesion still continues to intrigue experts with its varied histomorphology and controversies regarding its development. The present article describes a case of cystic AOT with an unusual histomorphology associated with an impacted 43 in a 15-year-old male.
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Incidental finding of oral white lesions due to tobacco chewing - A case report p. 488
Adriana Morales Buendia, Yedeh Ying, Chung How Kau
DOI:10.4103/ams.ams_114_20  
The diagnosis of oral white lesions might be quite challenging. White lesions are only 5% of all oral pathologies. Smokeless tobacco (ST), also known as tobacco chewing, spit tobacco, dip, plug, or chew, is one of the well-documented agents that causes white lesions. The use of ST is associated with a variety of oral cavity lesions, including tooth decay, periodontal disease, tooth loss, leukoplakia, keratosis, oral cancers such as carcinoma-in situ, verrucous carcinoma, and invasive squamous cell carcinoma. The prevalence and severity of lesions are dose related. Therefore, it can be best predicted by the amount, frequency, and duration of ST used. This case report highlights an unusual presentation of an adolescent child presenting in the orthodontic retention phase that was originally misdiagnosed as gingival recession due to treatment. A clinical examination of the oral cavity and careful history taken should be routinely performed in every patient presenting at a dental office.
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CASE REPORT - TRAUMA AND FRACTURES Top

The role of computed tomography in zygomatic bone fracture - A case report p. 491
Luiza Roberta Bin, Eleonor Álvaro Garbin, Natasha Magro-Érnica, Geraldo Luiz Griza, Ricardo Augusto Conci, Letícia Nadal
DOI:10.4103/ams.ams_9_20  
Introduction: The zygomatic complex is integral to the facial contour, protection of the eye and other facial structures, and dental occlusion. Its importance in facial function and aesthetics requires high quality outcomes of the treatment. Case presentation: This paper reports the case of a 46-year-old man who had an occupational accident resulting in extensive facial trauma and zygomatic fractures. The patient presented with hyposphagma, palpable step in the area of the infraorbital rim, paresthesia of the right infraorbital nerve, flattening of zygomatic prominence, abrasion of the chin and nose, a 7-cm laceration in the midface region, ecchymosis in the palate, and alteration in the dental occlusion without limitation of mouth opening. Computed tomography (CT) confirmed the zygomatic complex fractures. The treatment was reduction and fixation with plates and screws. CT was used throughout the treatment period as an essential diagnostic tool for accurate fracture assessment and classification, formulation of the surgical plan, and postoperative evaluation. Conclusion: This case study illustrated the correct use of CT for improved and efficient treatment of traumatic injury of the zygoma, an anatomical area where restoration of function and aesthetics is challenging. The patient signed a written informed consent statement for publication.
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Surgical decompression of the orbit due to frontal bone and roof of the orbit fractures - A case report Highly accessed article p. 495
Rafael M. A Pereira, Otávio C Barbosa, Ana Flávia P Basílio, Anna Cecilia S Santana, Douglas M De Paula, Helvécio Marangon Jr
DOI:10.4103/ams.ams_87_20  
Trauma in the face region has a very varied etiology and can be associated with several important structures. Isolated fractures in the orbit region correspond to about 4 to 16% of all facial fractures and this incidence increases to 30 to 55% if we take into account fractures that expand to extraorbital regions. The present clinical report aims to describe the case of a male patient, 21-years-old, victim of a motorcycle accident with facial trauma and traumatic brain injury due to frontal collision. Clinical and imaging examinations showed multiple fractures in the face with herniation of brain mass to the orbital region and consequent extrusion of the eyeball. Surgical procedures were performed to reduce and fix fractures and multidisciplinary treatment aimed at preserving vision and brain integrity. Thus, the surgical approach and the multidisciplinary treatment led to an excellent prognosis attested by the one-year postoperative period.
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CASE REPORT - IMPLANTS AND REHABILITATIONS Top

Immediate prosthetic rehabilitation of marginal mandibulectomy post radiation case by single-piece implant - A case report p. 501
Vivek Gaur, Anita Gala Doshi, Subhangini Gandhi
DOI:10.4103/ams.ams_260_20  
Prosthetic rehabilitation post resection and radiotherapy demand a thorough understanding of the biomechanics of the jaw, its associated structures, and their post radiation changes at the bone level. Restoring lost structures can often pose a challenge, especially with regard to the dentition. Due to inadequate hard- and soft-tissue structures as well as their demand for “biologic osseointegration,” it is difficult to conduct immediate loading as a treatment option on conventional implants. Alternatives are today available. Since piece smooth surface cortical implants transmit occlusal forces at cortical bone/buttress by engaging them, with or without reliance on the alveolar bone, it can be considered as an option. Here, we report a case of immediate loading with single-piece smooth surface implants in a male patient who had undergone a marginal mandibulectomy 3 years back for the removal of an oral squamous cell carcinoma of the retromolar trigone area that was closed by an anastomosed radial forearm flap, followed by radiation therapy. The dentition was restored successfully using a single piece smooth surface cortically anchored implant and reported favorable success and survival rate with high patient acceptance. Single piece corticobasal implant technology is one of the most predictable methods for the functional and sociopsychological correction, with minimal invasive immediate functional loading protocol restoring function and post resection surgical deformation of the jaw, thus improving lifestyle and survival.
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The role of custom-made subperiosteal implants for rehabilitation of atrophic jaws - A case report p. 507
David Faustino Angelo, José Ricardo Vieira Ferreira
DOI:10.4103/ams.ams_263_20  
Rehabilitation of atrophic jaws with conventional endosseous implant-supported overdentures and immediate loading protocols still presents a challenge nowadays. Custom-made implants with immediate loading overdenture are emerging as a solution for atrophic jaws rehabilitation. The authors describe the case of a 44-year-old male with a history of congenital dental agenesis. A previous oral rehabilitation with an all-on-6 type, implant-fixed mandibular overdenture, had failed due to peri-implantitis. The patient was successfully treated with bimaxillary custom-made subperiosteal implants with an innovative design, combining subperiosteal and endosseous support. The authors consider custom-made subperiosteal implants, in selected patients, present several advantages over classic bone-grafting plus endosseous implant-placement techniques such as (1) possibility of a single-stage procedure with immediate loading in atrophic jaws; (2) possible primary option to approach atrophic jaws as a simpler and less time-consuming technique; and (3) a valid rescue option for failed endosseous implants. More long-term studies with large samples of patients will be necessary to confirm previous assumptions.
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A Single-Step implant treatment of a patient presenting with a high smile line (Gummy Smile) – Surgical, prosthetic, and financial considerations of full-mouth rehabilitation with one-piece implants anchored in cortical bone - A case report p. 512
Stefan Ihde, Olga Sipic, Lukasz Pałka
DOI:10.4103/ams.ams_43_19  
Dental implant treatment and immediate loading protocol in the front maxillae provides severe esthetical difficulties, for example in cases where the transition zone of the patients' teeth and the gums is visible during habitual movements of the upper lip or when the patient presents excessive gingival display. In this case report, it is shown in detail how to overcome the esthetic problems in a straightforward manner in such clinical situations. The article also discusses in which financial environments treatments on teeth are endlessly continued and under which conditions patients manage to get (and prefer) an early switch to implant borne teeth.
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Maxillary occlusal splint following segmental mandibulectomy and osteocutaneous free flap reconstruction - A case report p. 518
Allison G Petty, Zain Uddin Ahmed, Amr A Habib, Joseph M Huryn, Evan B Rosen
DOI:10.4103/ams.ams_253_19  
Postsurgical malocclusion is a possible sequela of care following segmental mandibulectomy and osteocutaneous free flap reconstruction. Patient-specific factors may make surgical correction an impossibility. In addition, conservative occlusal adjustments may be insufficient for correction of the occlusion. An alternative approach for the management of severe postoperative malocclusion is to fabricate a maxillary occlusal splint, which establishes interocclusal articulating surfaces and facilitates mastication. The purpose of this report is to demonstrate the technique and utility of a maxillary prosthesis to correct posttreatment malocclusion in the oncologic patient.
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CASE REPORT - INFECTIONS Top

Management of oral myiasis caused by Chrysomya bezziana - A case series p. 521
Ramakrishna Shenoi, Vrinda Kolte, Pranav Ingole, Jignesh Rajguru, Jui Karmarkar, Sunil Kolte, Kunal Patankar
DOI:10.4103/ams.ams_177_20  
Myiasis is a rare disease caused by infestation of tissue by larvae of flies. Oral myiasis is still rare and unique owing to the fact that the oral cavity rarely provides a necessary habitat for a larval life cycle. We discuss the definition, etiology, predisposing factors, classification, and management of myiasis. We hereby report a rare case of oral myiasis in a 75-year-old female with a history of maxillofacial trauma. She complained of pain in the lower lip and commissure region on the left side through which numerous live maggots (larvae) were seen crawling out. Postremoval of approximate seventy maggots resulted in lower lip defect along its commissure which was repaired by Bernard's modification of Gillies flap. Another case was an 18-year-old girl, a known case of congenital cerebral palsy with pain and swelling in the upper vestibule region. Prevention of myiasis involves addressing open wounds, maintaining good oral and personal hygiene, control of fly population, basic cleanliness of surrounding areas, and provision for basic sanitation and health education.
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Actinomycotic osteomyelitis of the mandible - A rare case report Highly accessed article p. 525
Saurabh Sunil Simre, Anendd A Jadhav, Chirag S Patil
DOI:10.4103/ams.ams_99_20  
Actinomycetes are a relatively sporadic cause of infection of the head-and-neck region and their appearance is usually uncharacteristic, and hence pose a challenge for the diagnosis. The present article intends to exhibit this rarity afflicting mandible and highlight its management. The present report describes a case of a 55-year-old countryside female who presented with pain and swelling affecting the left side of the mandible. Orthopantomograph and cone-beam computed tomography imaging showed multiple ill-defined radiolucencies and perforations of the buccal and lingual cortical plates. Fine-needle aspiration microbiology was used to ascertain the microbial organism and the patient was treated with amoxicillin + clavulanic acid with curettage of the infected site. The patient responded well to prompt systemic antibiotics and local surgical measures with complete resolution of the infection and spontaneous bone regeneration. Although rare actinomycosis of the mandible is curable and should be included in the differential diagnosis of osteomyelitis of the jaw. Early and accurate diagnosis and prompt intervention confirm better outcomes.
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CASE REPORT - MINOR ORAL SURGERY Top

Third molar autotransplantation: An alternative to dental implant - 9 years follow up of a case p. 529
Sanjay Kumar, Mansi Jain, Suma Sogi, Prinka Shahi, Saru Dhir, Swati Rana
DOI:10.4103/ams.ams_237_19  
Autogenous tooth transplantation is the surgical movement of tooth from one location in the mouth to another in the same individual. It is an excellent option with good functional and esthetic outcome for rehabilitating young patients with growing alveolar bone and replaces missing tooth with a natural tooth rather than a prosthesis or an osseointegrated implant. This case reports discusses a 9 years follow up of a successful autotransplantation case of third molar in place of first molar justifying autotransplantation to be a viable treatment option in present day implant dentistry practice.
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CASE REPORT - SALIVARY PATHOLOGY Top

Surgical management of palatal pleomorphic adenoma (PPA) recurrence after 10 years, treated at a Brazilian center - A case report p. 533
Flávio Fidêncio De Lima, Catarina Pires Bezerra, André Caroli Rocha, Ivan Solani Martins, Wilber Edison Bernaola-Paredes
DOI:10.4103/ams.ams_107_20  
Pleomorphic adenoma, considered the most frequent benign mixed neoplasm of the minor salivary glands, occurs mainly in the region of the hard palate, with slight predilection in females and peak of incidence between the third and fifth decades of life. An increase in recurrence rates has been associated with the histopathological variants of the tumor, cellular characteristics, stroma, and capsule rupture during surgical removal of the lesion. The present case report aims to describe the surgical approach performed on the patient, a 45-year-old woman with a recurrent Pleomorphic Adenoma (PA) in the region of the hard palate on the right side, 10 years after initial enucleation of the lesion; her main complaint was an increase in volume in the palatal region. After extensive local surgical excision of the tumor and 2 years of follow-up, there were no signs of recurrence. Computed tomography and a correct histopathological diagnosis are essential to enable the establishment of an appropriate surgical treatment, with the purpose of achieving complete removal of the lesion, with wide surgical margins, including the lining mucosa and the underlying periosteum, as described in the present case.
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An extraoral surgical approach to treat chronic submandibular sialolithiasis - A case series p. 537
Renan Veiga Araujo, Basílio Almeida Milani, Ivan Solani Martins, Eleazar Mezaiko Vilela Dias, Wilber Edison Bernaola-Paredes
DOI:10.4103/ams.ams_102_20  
Sialolithiasis is the most common cause of sialadenitis in the submandibular gland, in which the highest incidence of this condition occurs, among the major salivary glands. This could be explained by the anatomy of Wharton's duct, and the chemical composition of the saliva produced by this gland. There are several alternatives and techniques for the treatment of sialolithiasis, including lithotripsy, sialoendoscopy, and conservative removal of the sialoliths or complete removal of the submandibular gland, through the transoral and extraoral routes for access to the gland. To determine the form of treatment, characteristics such as topography, diameter, and location of the sialolith in the duct are observed. The aim of this case series was to show our experience gained in two clinical cases of submandibular gland excision through an extraoral approach, using the submandibular access technique. In addition, we discussed the cause of sialolithiasis in these patients and after follow-up, compared the clinical results we obtained with this technique with those reported in the current literature. The submandibular approach or Risdon access continues to be a safe approach to removing the submandibular gland, as it is a commonly used technique and obtained satisfactory results, as shown in these cases. However, the major disadvantages were the less favorable esthetic results and paralysis of the marginal mandibular branch of the facial nerve.
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Unilateral submandibular gland aplasia with ipsilateral sublingual ranula - A case report p. 543
Dimitris Tatsis, Antonis Mantevas, Maria Kilmpasani, Ioanna Karafoulidou, Grigoris Venetis
DOI:10.4103/ams.ams_63_20  
Background: Congenital aplasia of major salivary glands is a very rare entity, especially if it concerns an ipsilateral aplasia in a nonsyndromic patient. Key points from the case: The aim of this report is to present a case of an aplasia of the left submandibular gland, which was incidentally diagnosed during presurgical imaging for an ipsilateral sublingual ranula. Histopathological evidence of the lack of sublingual gland tissue in the excised specimen of the ranula is discussed. Main lessons to be learned from this case report: Unilateral submandibular aplasia has unknown etiology. Clinicians should be aware of this condition mainly to be able to differentially diagnose a hypertrophy/dysplasia of the contralateral or other major salivary glands, or when xerostomia is the main patient's symptom.
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