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   2018| July-December  | Volume 8 | Issue 2  
    Online since December 26, 2018

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Evaluation of anxiety, pain, and hemodynamic changes during surgical removal of lower third molar under local anesthesia
Vandana R Gadve, Ramakrishna Shenoi, Vikas Vats, Amit Shrivastava
July-December 2018, 8(2):247-253
DOI:10.4103/ams.ams_216_18  PMID:30693240
Aim: The aim of this study are to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molar and to evaluate whether these variations are attributable to patient anxiety and pain experienced during surgical procedure. Materials and Methods: Sixty healthy patients were evaluated (i) to determine the hemodynamic changes (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and oxygen saturation) at nine occasions: before starting the surgical procedure, 1 min and 4 min after local anesthetic injection, during the incision, at the time of ostectomy, at the completion of tooth removal, at the start and completion of suturing, and finally, after completion of surgery and (ii) to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. Hemodynamic variables were compared between the gender and at different time points by performing two-way analysis of variance for repeated measures. Global mean values of hemodynamic variables were compared between male and female using unpaired t-test. Categorical variables were compared by Chi-square test. All the tests were two-sided. P < 0.05 was considered statistically significant. Results: SBP and DBP showed significant changes; the highest value was recorded at the time of ostectomy/tooth sectioning. Maximum HR was observed 4 min after local anesthetic injection and the lowest HR was recorded after completion of tooth extraction, i.e., during the suturing. In females, mean HR was significantly increased. Conclusion: The present study suggests that dental anxiety impacts the effect of delivery of local anesthesia on blood pressure and is significantly associated with increased HR.
  9 2,671 436
The submental island flap in head and neck cancer
Muhammad Faisal, Mohammad Adeel, Sheryar Riaz, Abdullah Anwar, Asma Rashid, Sadaf Usman, Arif Jamshed, Raza Hussain
July-December 2018, 8(2):287-291
DOI:10.4103/ams.ams_225_18  PMID:30693247
Objectives: The submental flap provides an alternative technique in orofacial reconstruction, especially in situations where free flap services are not available. The objective of this study is to demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction in a tertiary care cancer hospital. Materials and Methods: A total of 27 patients with oral cavity cancers, which underwent submental flap reconstruction from 2015 to 2017 at Shaukat Khanum Cancer Memorial Hospital, were included in the study. We have retrospectively reviewed records of these patients. Results: There were 25 male and 2 female patients with age ranging from 21 to 73 years. Most common primary tumor sites were buccal mucosa (13), tongue (7), and lower alveolus (7). All patients underwent ipsilateral selective neck dissection after flap was harvested. Complete flap loss was observed in three, whereas one patient had flap dehiscence that subsequently healed. Mean follow-up was 11 months. There were four regional recurrences but no local recurrence. On the last follow-up (minimum 6 months), 15 patients were alive without any disease, 4 were alive with disease, and 3 had died. Conclusion: Submental flap is a satisfactory option for oral cavity reconstruction. However, preoperative selection of clinically neck node-negative patient is extremely important as it has potential risk of occult metastasis.
  8 3,118 491
Direct maxillary sinus floor augmentation for simultaneous dental implant placement
Mamit Kumar, Sumit Chopra, Debdutta Das, Monika Gupta, Jyoti Memoalia, Gaurav Verma
July-December 2018, 8(2):188-192
DOI:10.4103/ams.ams_168_18  PMID:30693230
Aim: The present study was done to evaluate the efficacy of platelet-rich fibrin (PRF) with bovine bone graft (Bio-Oss™) in direct sinus augmentation for simultaneously dental implant placement. Materials and Methods: The study included 14 patients who fulfill the inclusion criteria, among them 10 were male and 4 were female with PRF with Bio-Oss™. For each patient, bone level was assessed preoperatively and postoperatively after 1, 6, and 12 months with a panoramic X-ray and radiovisiography to evaluate the vertical bone height from the shoulder of the implant to the most apical end. Results: The outcome of the sinus lift and the implants placed was evaluated periodically at 1, 6, and 12 months postoperatively. All the patients underwent two-stage procedures. At the end of 20th week, implants were exposed; radiological parameters were assessed again for implant integration, and prosthetic rehabilitation was started after 2 weeks and it was completed by the end of 24 weeks (6 months postoperatively). Twelve months postoperatively, the endosinus bone gain noted was 7 mm, which indicated the use of PRF with bovine bone graft as a reliable filling material during simultaneous sinus lift and implantation. Conclusion: PRF with bone graft (Bio-Oss) is used as an augmentation material after direct maxillary sinus lift, and the resulting bone formation was adequate for placement of dental implant.
  7 3,569 673
Comparison of attachment and proliferation of human gingival fibroblasts on different collagen membranes
Mohammad Reza Talebi Ardakani, Farhad Hajizadeh, Zahra Yadegari
July-December 2018, 8(2):218-223
DOI:10.4103/ams.ams_150_17  PMID:30693235
Background and Aim: Human gingival fibroblasts cultured on collagen membrane as an alternative treatment method used in tissue regeneration can lead to improved results in root coverage. The aim of this study was to evaluate the human gingival fibroblast proliferation and adhesion cultured on three types of collagen membranes. Materials and Methods: In this in vitro study, first-line human gingival fibroblast cells (HGF1-RT1) prepared and cultured on three membranes, including porcine pericardium (PP) (Jason, Botiss dental), human pericardium (HP) (Regen, Faravardeh Baft Iranian), and glutaraldehyde cross-linked (GC) (BioMend Extend, Zimmer Dental). Cell survival was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) after 24, 48, and 72 h and 7 days. Furthermore, morphology and adhesion of cells on the membrane were evaluated after 1 and 7 days by electron microscopy (scanning electron microscopy [SEM]). Statistical analysis was performed using two-way ANOVA with a significance level of 0.05. Results: Based on the results of MTT, cell survival on HP and PP membranes after 7 days significantly increased (P < 0.001), but for the GC membrane, it was reduced after 7 days (P = 0.031). Cell survival on HP and PP membranes did not differ (P = 1) and was more than GC (P < 0.001). SEM images showed that the adhesion of cells was better on HP and PP membranes than GC. Conclusion: The results of this study showed that natural collagen membranes (HP and PP) similarly support proliferation and adhesion of gingival fibroblasts. Survival and adhesion of gingival fibroblasts on cross-linked collagen membrane was less than two other membranes.
  6 2,366 275
Efficacy of alvogyl (Combination of Iodoform + Butylparaminobenzoate) and zinc oxide eugenol for dry socket
Narendra B Supe, Sneha H Choudhary, Sheetal M Yamyar, Kuldeep S Patil, Amit Kumar Choudhary, Vishwas D Kadam
July-December 2018, 8(2):193-199
DOI:10.4103/ams.ams_167_18  PMID:30693231
Context: Alveolar osteitis (AO) (dry socket) is a postoperative healing complication after tooth extraction. Pain is considered the most important symptom of dry socket which can vary in frequency and intensity. Aim: The aim of the present study was to evaluate the management of AO with alvogyl and zinc oxide eugenol (ZOE). Study Design: This study was designed as a single-blinded prospective study with a sample size of fifty patients included in the study after obtaining the informed consent. Materials and Methods: All the fifty patients with dry socket were randomly selected and divided into two groups as follows: (1) Group I: Patients who received alvogyl paste as an intrasocket medication and (2) Group II: Patients who received ZOE as an obtundant dressing. Statistical Analysis Used: Data were analyzed using t-test and Chi-square test. Results: The mean number of dressings required was less in Group I as compared to Group II, and thus Group I showed faster healing. In addition, the intensity of pain decreased more rapidly in Group I as compared to Group II. The mean time required for complete pain relief was less in Group I as compared to Group II, and thus Group I showed faster relief from pain. Conclusion: Alvogyl is better for the management of dry socket by virtue of shorter time required for complete pain relief, fewer visits for dressing change, and faster clinical healing of the socket.
  5 3,086 594
Cervicofacial actinomycosis and its management
Kishore Moturi, Vini Kaila
July-December 2018, 8(2):361-364
DOI:10.4103/ams.ams_176_18  PMID:30693266
Cervicofacial actinomycosis is an invasive destructive infectious syndrome, caused by Gram-positive, branching filamentous bacteria, Actinomyces. Most of the cases are traced to an odontogenic source with periapical abscess and posttraumatic or surgical complications with poor hygiene and immunosuppression as contributing factors. Diagnosis is often delayed because of nonspecific and prolonged symptoms usually mimicking a malignant or a granulomatous lesion. Solitary or multiple abscesses and fistula formation across normal tissue planes accompany chronic draining lesions and may lead to invasion of viscera. Hence, early diagnosis and appropriate treatment is mandatory to reduce morbidity. In this paper, we report two cases of cervicofacial actinomycosis, one presented with intraoral granulomatous lesion treated with surgical curettage and intramuscular penicillin and another case with extraoral swelling and multiple draining sinuses treated with oral antibiotics.
  4 3,207 319
Oncocytoma parotid gland
Vikas Sharma, Sunil Kumar, Ashwani Sethi
July-December 2018, 8(2):330-332
DOI:10.4103/ams.ams_154_17  PMID:30693257
Very few cases of parotid oncocytoma have been reported in literature. Because of its rarity (<1% of salivary gland tumors) and clinical presentation of the tumor, there is a tendency among the clinicians to misdiagnose it as pleomorphic adenoma, hemangioma, or other forms of oncocytosis. Only a histopathological examination can confirm it. We evaluate here a case of swelling of the parotid gland in a 70-year-old male who had the tumor for over 9 years to reach a diagnosis. Furthermore, our aim is to bring to the forefront how these lesions require a comprehensive workup and how to choose the best treatment strategy.
  4 2,042 248
Healing potential of platelet rich fibrin in impacted mandibular third molar extraction sockets
Manzoor Mohammad Dar, Ajaz Ahmad Shah, A Latief Najar, Mubashir Younis, Muneet Kapoor, Jahangir Irfan Dar
July-December 2018, 8(2):206-213
DOI:10.4103/ams.ams_181_18  PMID:30693233
Background: Healing of both hard and soft tissues have become one of the great challenges, faced in clinical research in development of bioactive surgical additives responsible for regulating inflammation and increasing healing. Platelet-rich fibrin (PRF) represents a new step in the platelet gel therapeutic concept with simplified processing minus artificial biochemical modification. Aims and Objectives: The aim of this study is to evaluate the effectiveness of PRF on soft-tissue healing and bone tissue healing in terms of postoperative pain, postoperative swelling, soft tissue healing, and the quality of bone healing at the mandibular third molar socket. Materials and Methods: A clinical study will be done on patients reporting to the Department of Oral and Maxillofacial Surgery in Government Dental College, Srinagar, requiring disimpaction of bilateral mesioangular impacted mandibular third molars in 60 patients. Results: The present prospective clinical study evaluates the effect of PRF in healing of mandibular third molar extraction sockets. There was no difference in the age gender and type of impaction between the two groups as the mean postoperative pain score (visual analog scale) was lower for the PRF group (Group A) at all points of time when compared with the control (Group B), and this was statistically significant (P < 0.05). The mean percentage swelling was lower for the PRF group (Group A) at all points of time when compared with the control (Group B). Evaluating the effect of treatments (with or without PRF) on lamina dura score shows that in both the groups at different time periods, significant (P < 0.001) difference was observed on lamina dura score. Conclusion: The results of the present study suggest that application of autologous PRF gel has a beneficial effect on the healing of extraction sockets after third molar surgery.
  4 2,759 518
Conscious sedation in dentistry
Arpita Kapur, Vinay Kapur
July-December 2018, 8(2):320-323
DOI:10.4103/ams.ams_191_18  PMID:30693254
Sedation in dentistry has been a controversial topic due to questions being raised over its safety, especially in dental chair. Dental fear and anxiety are not only common in children but also significantly prevalent among adults due to high intensity of pain. Sharing of airway between the anesthesiologist and the dentist remains the greatest challenge. The purpose of this review is to study the recent trends in conscious sedation in the field of dentistry from an anesthesiologist's perspective. It will provide a practical outline of the pharmacokinetics, pharmacodynamics, and routes of administration of the drugs or gases used.
  4 3,810 722
Chondroid tenosynovial giant cell tumor of temporomandibular joint
Sujeeth Kumar Shetty, Usha Hegde, Garima Agarwal, HS Sreeshyla
July-December 2018, 8(2):327-329
DOI:10.4103/ams.ams_161_18  PMID:30693256
Tenosynovial giant cell tumor (TGCT), a benign proliferative lesion arising from the synovial membrane of the joints, is rarely seen in the temporomandibular joint. It frequently presents as a painful, preauricular swelling and affects the jaw functions. Two types of TGCT seen are diffuse TGCT (TGCT-D) and localized TGCT. A case of TGCT-D is described here, the highlight of the case being extensive areas of chondroid metaplasia which mimicked chondroid lesions, but was ruled out based on negative immunohistochemical findings within the tumor cells.
  3 1,857 189
A comparative data analysis of 1835 road traffic accident victims
Alagappan Meyyappan, Prabhu Subramani, Sriram Kaliamoorthy
July-December 2018, 8(2):214-217
DOI:10.4103/ams.ams_135_18  PMID:30693234
Aims and Objectives: The purpose of the study was to analyze and compare the incidence of road traffic accidents (RTA) with head injuries and maxillofacial injuries in two arterial roads, Old Mahabalipuram road (OMR) and East Coast road (ECR), connecting with Chennai city and outlining the need of safety precautions to be followed to reduce the incidence of morbidity. Materials and Methods: This study involved the medical records of about 1835 trauma victims who reported to Chettinad Health city, kelambakkam, between August 2008 and June 2013. The data analyzed were, age of trauma victims, gender, type of trauma, type of vehicle, accident time, accident zone, presence of head injury, maxillofacial injury and history of alcohol consumption. Results: Trauma victims were predominantly male (84.3%), with majority of individuals in the age group of 21-40 yrs (56%). About 42% of the reported accidents occurred in OMR and 18.3% of accidents occurred in ECR. About 51.2% of the reported road traffic accidents occurred in the busy traffic hours, between 7am-10am and 5pm-9pm. About 66.4% of RTAs were due to two wheeler vehicles and 21.6% were due to four wheeler vehicles. The incidence of head injury was 47.5% and about 1417 (77.2%) patients reported with maxillofacial injuries. Conclusion: RTAs are more common in OMR than in ECR, involving mostly male victims and two wheeler vehicles, during the peak traffic hours. Rash driving and over speeding of vehicles are the preventable causative factors.Wearing of Helmets by the two wheeler riders and seat belts by the four wheeler riders are essential to prevent morbidity. We stress the need of separate lane for Ambulance on the roads for faster transport of accident victims to nearby Hospital and trauma care centers.
  3 1,994 263
Comparison of midface advancement by external and internal craniofacial distraction osteogenesis
SM Balaji, Preetha Balaji
July-December 2018, 8(2):200-205
DOI:10.4103/ams.ams_234_18  PMID:30693232
Background: Distraction osteogenesis (DO) is employed to address the midface abnormalities using either an external DO (EDO) or an internal DO (IDO) device. There are few studies that have reported EDO and IDO outcomes through cephalometric evaluation. The aim of this retrospective, record-based study is to compare the change in position of the midface resulting from distraction of noncomplicated cases of Le Fort III osteotomies with EDO as well as IDO and compare the groups using standard right facing lateral cephalometry. We hypothesized that there would be no difference between EDO and IDO in terms of displacement (of point of reference) as well as complications. Materials and Methods: Retrospective analyses of cases fulfilling inclusion and exclusion criteria were retrieved from archives. Using two sets of right-side cephalometry, preoperative and after consolidation (at the end of the treatment), the changes in Point A and Orbitale (O) as described by Lima et al. were used for the study. Movement in X-axis and Y-axis was noted down and subjected to statistical analysis. Descriptive statistics, the coefficient of variability (expressed as percentage), and the interquartile range (maximum and minimum values) were presented. P ≤ 0.05 was taken as statistically significant. Results: Significant midface advancement was achieved with the procedure. There were five cases of EDO and eight cases of IDO. The age at which patients were operated ranged from 9 to 18 years (mean: 13 years). The mean follow-up time was for 14 ± 8 months. There were eight females (3 – EDO and 5 – IDO) and five males in total. There was no complication in the entire study group. The difference in total bone length gain along the horizontal axis was as follows: 12.19 and 12.84 along the Point A for EDO and IDO and 3.89 and 4.65 along the Point O for EDO and IDO, respectively. The difference was not statistically significant (P = 0.833 and 0.622, respectively). The total movement along the vector at Point A in EDO and IDO was 13.08 and 12.56, respectively, the difference of which was not statistically significant (P = 1); while along the vector at Point O in EDO and IDO, the total movement was 10.98 and 11.48, respectively, the difference of which was not again statistically significant (P = 0.833). Discussion: The significance of the difference in EDO and IDO is discussed using the biomechanical principles and the results deliberated based on the existing literature. Conclusion: The positioning of the devices plays a significant role in deciding the outcome. Both the distractors have their distinct advantages and their applications have to be customized.
  3 2,542 275
Denosumab treatment for aggressive multiple recurrent familial central giant-cell granulomas
Eelis Rytkonen, Vuokko Ottavainen, Aleksi Rytkönen, Sanna Uusitalo, Petri Lehenkari, George K Sándor
July-December 2018, 8(2):265-269
DOI:10.4103/ams.ams_192_18  PMID:30693243
Background: Aggressive familial giant-cell granulomas of the jaws can be severely deforming. Surgical and nonsurgical treatments may be associated with multiple recurrences. Denosumab, a new generation antiresorptive drug, is an osteoclast inhibitor, which may be particularly useful to manage such potentially disfiguring lesions. Materials and Methods: Two sisters, both with a history of multiple recurrent aggressive central giant-cell granuloma (CGCG)-like lesions in both jaws, were referred for management. All lesions were histologically consistent with the diagnosis of CGCG. The lesions were treated surgically with curettage and perilesional injection of triamcinolone. In particular, the older sister had four separate anatomic sites where some of her lesions had multiple recurrences necessitating three repeat procedures. A course of subcutaneous denosumab was administered following the last giant-cell granuloma removal in both sisters. Results: Bony healing was normal. No further recurrences were observed over 3.5 years of follow-up after denosumab therapy in either sister. Conclusions: In this small cohort comprising two sisters with multiple aggressive recurrent giant-cell granuloma lesions at multiple sites in the mouth, subcutaneous denosumab administration was associated with success over 3.5 years of follow-up. This report cautiously adds to the clinical experience in the use of denosumab for the treatment of recurrent aggressive familial CGCG lesions.
  3 2,059 267
Evaluation of the different biomaterials used in alveolar cleft defects in children
Pedro Henrique Silva Gomes Ferreira, Danila De Oliveira, Ciro Borges Duailibe De Deus, Roberta Okamoto
July-December 2018, 8(2):315-319
DOI:10.4103/ams.ams_140_17  PMID:30693253
The aim of this study was to use a literature review to evaluate and compare the different biomaterials used in surgeries for the closure of the palatal and alveolar clefts as alternatives to isolated autografting. For the search strategy, the PubMed and Medline databases were used with the indexing terms “'cleft palate' (Mesh), 'biocompatible materials' (Mesh), and 'dentistry' (Mesh).” There was no restriction on language or publication time. After the research, 26 articles were found, and then, only the filter for clinical trials was selected. With this methodology, five articles were selected. The full texts have been carefully evaluated. The main issue among the five selected articles was the closure of a cleft palate and/or alveolar bone with the use of different types of biomaterials (e.g. autogenous bone from the iliac crest and chin, deproteinized bovine bone (DBB), β-tricalcium phosphate (β-TCP), synthetic resorption based on calcium sulfate, and the engineering of bone tissue); they evaluated preoperative and postoperative clinically and through imaging tests. The autogenous bone associated with DBB or β-TCP significantly reduces the amount of autogenous bone harvested from the iliac crest, morbidity, and the hospitalization of the patient, and the isolated use of bovine hydroxyapatite resulted in lower bone density compared to that from autogenous bone.
  3 2,033 314
Mandibular osteomyelitis associated with candida albicans in marijuana and heroin abusers
Mikhail Daya Attie, Isabella Alessandra Anderson, Jason Portnof
July-December 2018, 8(2):355-357
DOI:10.4103/ams.ams_83_18  PMID:30693264
Osteomyelitis of the mandible is most commonly caused by bacterial infections and is rarely linked to fungal infections. In 2003, Friedman et al. studied the relationship of multiple drugs including marijuana, opioids, nicotine, and alcohol and its effect on the immune system. It is important to consider potential risks and complications of patients who are immunocompromised and present a history of substance abuse. These complications include infections and osteomyelitis which can be associated with multiple microorganisms; some of the most common microorganisms isolated in mandibular osteomyelitis include Streptococcus, Eikenella, and Candida. Candida albicans is commonly found in the skin and mucosa of healthy individuals; however, it has been proven to cause disease in individuals who are immunocompromised. Two cases of mandibular osteomyelitis after routine dental extractions and a history of drug abuse, including heroin and marijuana, are presented in this case series. These specific infections were resistant to multiple antibiotic therapy and grew C. albicans species in cultures collected. These cases were treated with irrigation and debridement or mandibular resection in combination with antimicrobial treatment and fluconazole with complete resolution. Although osteomyelitis is most commonly caused by bacterial infections, special attention must be given to patients with medical histories of immunosuppression and intravenous drug use. Patients who do not respond to broad-spectrum antibiotics might benefit from bacterial and fungal cultures and sensitivity. Antifungal treatment with an antifungal agent, such as oral fluconazole, is indicated if fungal organisms are yielded in the culture.
  2 2,097 242
Actinomycosis which impersonates malignancy
Kalyani Gelada, Rajshekhar Halli, Husain Mograwala, Sanjana Sethi
July-December 2018, 8(2):358-360
DOI:10.4103/ams.ams_15_18  PMID:30693265
Actinomycosis is a suppurative and often chronic bacterial infection most commonly caused by Actinomyces israelii. Actinomycotic infections may mimic more common oral diseases or present in a similar way to malignant disease. Treatment of actinomycosis involves surgical removal of the infected tissue and appropriate antibiotic therapy to eliminate the infection. Rarely seen in day-to-day dental practice, actinomycosis of the oral cavity is a highly significant condition due to its aggressive and locally destructive nature. We report a case of actinomycosis leading to extensive destruction and sequestration of the maxillary bone and deviation of the nasal septum, affecting a patient who complained of an unhealed extraction socket, chronic halitosis, and exposure of the bone with gingival recession crossing the midline.
  2 1,821 161
Ameloblastoma: Reconstruction using titanium plates adapted using stereolithographic models
Mariano Sebastian Chutchurru, Maria Isabel Brusca, Roberto Palavecino
July-December 2018, 8(2):337-341
DOI:10.4103/ams.ams_196_18  PMID:30693259
Ameloblastoma is a benign but locally invasive odontogenic tumor that causes significant morbidity. The aim is to study an ameloblastoma treatment with reconstruction using titanium plates adapted using stereolithographic models. A 48-year-old female patient referred due to asymptomatic osteolytic lesion between teeth 47 and 48 discovered during routine radiographic study. The pathoanatomical study described a desmoplastic ameloblastoma. Due to the possibility of it being a malignant lesion, a computerized axial tomography scan was performed, which showed that the tumor was not malignant. A stereolithographic model was prepared to make the cutting guides and facilitate fitting of reconstruction plates. Three-dimensional printing technology enables fast, accurate mandibular reconstruction, helping to shorten operation time.
  2 1,672 243
Missing pharyngeal pack endoscopically retrieved: An avoidable complication
Mohammed Salman Basha
July-December 2018, 8(2):342-343
DOI:10.4103/ams.ams_188_18  PMID:30693260
Throat packing/pharyngeal packing routinely was done during almost all otorhinolaryngology and head and neck surgery, dental, and oral and maxillofacial surgeries. We present an unusual case of a pharyngeal throat pack inadvertently left behind postextubation. The pack was subsequently identified and retrieved successfully from the gastrointestinal tract.
  2 1,682 166
Histopathological evaluation of dental follicle associated with radiographically normal impacted mandibular third molars
Naqoosh Haidry, Madhumati Singh, NS Mamatha, Peeyush Shivhare, HC Girish, Narahari Ranganatha, Sandeep Kashyap
July-December 2018, 8(2):259-264
DOI:10.4103/ams.ams_215_18  PMID:30693242
Introduction: Removal of impacted mandibular third molar is a common procedure performed in oral surgery. Indications for removal of the third molar have generated much discussion in dentistry. The presence of pericoronal pathosis is generally accepted reason for the extraction of impacted mandibular third molars. Radiographic pathology is usually defined as a pericoronal radiolucency measuring about 2.5 mm or larger in any dimension. Purpose: This study aims to evaluate the histopathologic changes in radiographically normal dental follicles associated with impacted mandibular third molars. Methods: After extraction of 50 impacted mandibular third molars, dental follicle associated with extracted teeth was placed in 10% formalin solution. Histopathologic examination was done. The type of pathological changes was recorded based on histopathological reports. Patients' gender, age, and radiographic parameters were recorded. Results: Cystic changes were found in 24% of radiographically normal impacted mandibular third molars. Significant cystic changes were observed in position A vertically impacted lower third molars (ILTMs). Male predominance for cystic change was seen with a male–female ratio of 2:1. Conclusion: The result of the present study shows that radiographic analysis may not be reliable technique for the diagnosis of cystic changes in ILTM. The presence of cystic changes can be found even in radiographically normal impacted mandibular third molars. Hence, we recommend that impacted mandibular third molars should be removed and histopathological analysis should be conducted on all surgically extracted dental follicles.
  2 2,867 284
Patient perspective in the management of zygomatic fractures
Ananth Padmanavam, Sumita Mishra
July-December 2018, 8(2):239-246
DOI:10.4103/ams.ams_85_16  PMID:30693239
Background: A clinical study was undertaken on the management of zygomatic complex fractures using various surgical approaches in the Department of Oral and Maxillofacial surgery during the past 3 years. Aims: The aim of this study is to evaluate the versatility of various surgical approaches. Materials and Methods: A total of 15 cases were selected following a clinical and radiological examination of fractures of the zygomatic complex. A standard pro forma was used to record the case history and findings. These cases were treated by mini plate or micro plate osteosynthesis. Reduction techniques used were Gillie's temporal approach, Dingman's lateral eyebrow approach, upper buccal sulcus approach, and inferior orbital approach. Fixations were done either by mini plate or micro plate osteosynthesis. To compare the effectiveness of the reduction and fixation techniques the following parameters were assessed: facial symmetry-corrected/unaltered, wound healing-good/impaired, mouth opening good/restricted, diplopia-present/absent, infraorbital nerve – present/absent. Results and Conclusion: Successful surgical treatment of the zygomatic complex fracture is influenced by its geometry. Whether the alignment may be successfully achieved or not by open reduction at single or multiple locations, can vary with the individual surgeon's experience.
  2 2,819 327
Management of frontal sinus injuries
R Sathyanarayanan, K Raghu, S Deepika, K Sarath
July-December 2018, 8(2):276-280
DOI:10.4103/ams.ams_187_18  PMID:30693245
Purpose: The purpose of the present study is to report an overview of fracture patterns and surgical approaches for 15 patients who were treated in our Indhira Gandhi Institute of Dental Sciences, Pondicherry, India from 2010 to 2015. Method and Material: Fifteen people were included in the study, which were diagnosed with anterior table fracture of the frontal sinus and were randomly admitted in our institution. All patients were evaluated preoperatively with axial and coronal computed tomography scans before operating. The parameters used to classify the patients were age, mode of injury, associated injury, and details of fracture, surgical approaches, fixation, and conservative management. Results: Analysis of 15 patients based on parameters showed that the ages of patients varied between 22 and 36 years due to road traffic accident as the common etiology. There were associated fractures in the maxillofacial region seen in 11 patients and the rest were isolated frontal sinus fractures. Conservative management was opted in six patients and for others, surgical approach to the fracture site was done through existing laceration and by bicoronal approach. Three of the cases showed comminuted fracture of anterior and posterior table. The overall contour of the frontal bone was good in all the patients. None of the patients required any immediate reoperation or developed any delayed abscess or mucocele formation. Conclusion: Decision-making regarding the best time to treat, the surgical approach and the technique depends on the severity and the extent of the fracture and associated complications. Our protocol was to follow up and observe the undisplaced fractures and operate anterior wall defects. If there was a fracture involvement of posterior frontal wall, treatment can be planned along with neurosurgical consultation and then operate depending on the associated complications.
  2 2,210 291
Autologous fat grafting in total temporomandibular joint replacement surgery
Wendy Van Bogaert, Nikolas De Meurechy, Maurice Yves Mommaerts
July-December 2018, 8(2):299-302
DOI:10.4103/ams.ams_165_18  PMID:30693249
Context: Alloplastic temporomandibular joint replacement. Aims: To search for evidence for the use of periprosthetic autologous fat transplantation. Setting and Design: Systematic review. Materials and Methods: We searched in PubMed Central, Elsevier ScienceDirect Complete, Wiley Online Library Journals, Ovid Lippincott Williams and Wilkins, and Cochrane Library plus Results. Six studies reported improved results with the use of autologous fat graft (AFG) in patients treated with a total joint replacement, mainly about increased mobility. Three studies involved patients from the same surgeon with increased inclusions and increased follow-up period. A 1997 study by Wolford showed a significant difference in heterotopic bone formation between patients treated with AFG, compared to those who were not, indicating the potential and usefulness of AFG. Conclusion: A prospective multicenter randomized controlled trial of this promising concept is warranted before justifying common application because of the added morbidity and the questionable advantage.
  2 1,947 245
Temporalis muscle transfer with fascia lata sling: A novel technique for facial reanimation
Rajesh B Dhirawani, SM Balaji, Sauvik Singha, Anshalika Agrawal
July-December 2018, 8(2):307-310
DOI:10.4103/ams.ams_214_18  PMID:30693251
Bell's palsy is an idiopathic facial paralysis which is a lower motor neuron disorder. The ultimate goal of treatment is normalization of paralyzed hemi -face with symmetrical smile and face along with corneal protection. The aim of this article is to revisit all the current options available for management of facial nerve paralysis with main concentration on best surgical management in long-standing cases i.e. regional muscle transfer using temporalis tendon with fascia lata. A Case Report of a 38 year old Indian male is reported with chronic facial palsy. Static Facial paralysis reanimation with fascia lata and tarsorrhaphy is explained step by step. Others Treatment modalities are explained. This present case report adds one more case to the scanty number of publications.
  2 2,208 294
Considerations regarding dental implant surfaces, bone reaction and “Peri-implantitis”
Stefan Ihde, Antonina Ihde
July-December 2018, 8(2):365-368
DOI:10.4103/ams.ams_224_18  PMID:30693267
This article explains, based on a long-term observation, the hard-tissue reaction to different endosseous implant surfaces and different implant designs. A patient who had received a full maxillary implant-supported restoration on basal implants and compression screws followed by immediate loading presented no clinical problems at the 20-year follow-up, but the X-ray examination revealed different hard tissue reactions to different implant types. No bone loss was found around lateral basal implants with fully polished vertical aspects, whereas crater-like bone loss was observed around the vertical shafts of implants with a roughened surface and macromechanical retentions. The case seems to indicate that roughened surfaces around the crestal transmucosal aspect of a dental implant may promote vertical bone loss and peri-implantitis.
  1 1,699 232
Cherubism in 12 year young female
Heena Mazhar, Ratna Samudrawar, Rubi Gupta, Mukesh Kumar Kashyap
July-December 2018, 8(2):373-376
DOI:10.4103/ams.ams_177_17  PMID:30693269
Cherubism is a rare benign, autosomal-dominant inherited fibro-osseous lesion of jaw characterized by excessive bone degradation of the upper and lower jaws followed by the development of fibrous tissue masses. It is usually self-limiting; it starts in early childhood and involutes by puberty. The purpose of this clinical report is to describe a nonfamilial case of cherubism on a teenager female patient first treated by calcitonin nasal spray followed by surgical resection and recontouring after puberty.
  1 2,160 235
Management of maxillofacial injuries sustained after a bear attack
Tanmoy Nath, Mohammed Imran, Kaling Megu, Adil Shafath, Kesang Wangdi Thongdok
July-December 2018, 8(2):369-372
DOI:10.4103/ams.ams_169_18  PMID:30693268
There is a little available literature on injuries sustained due to bear attacks and their management. Bears are agile wild animals and injuries sustained after a bear attack have varying patterns. In general, such cases present to the emergency department with severe maxillofacial injuries with varying patterns, thereby limiting the use of common protocol for the management of such injuries. The aim of this article is to add to the current available literature on bear attacks, a present case of management of maxillofacial injury involving the orbit sustained after a bear attack.
  1 2,222 177
A rare case of ameloblastic fibro-odontoma of mandible with literature review
Selva Kumar Thulasirman, Guruprasad Thuasidoss, N Komagan Prabhu, VB Krishnakumar Raja
July-December 2018, 8(2):324-326
DOI:10.4103/ams.ams_127_18  PMID:30693255
Ameloblastic fibro-odontoma (AFO) is a benign, mixed odontogenic tumor of epithelial and mesenchymal origin. It is predominantly seen in the younger age group, with delayed or altered eruption of teeth. Being clinically asymptomatic, this is identified incidentally during routine radiographic examination. Although considered to be nonaggressive with minimal tendency for recurrence, AFO requires surgical excision with long-term follow-up. This paper presents a rare case report of an 11-year-old boy, who was provisionally diagnosed with complex odontoma and later turned out to be AFO of the mandible.
  1 1,928 233
Piezosurgery versus conventional method alveoloplasty
Khushal D Gangwani, Lakshmi Shetty, Deepak Kulkarni, Ratnadeepika Seshagiri, Ratima Chopra
July-December 2018, 8(2):181-187
DOI:10.4103/ams.ams_162_18  PMID:30693229
Purpose: Conventional alveoloplasty procedure using manual instruments results in higher resorption of the residual alveolar ridge, which is unsuitable for denture construction. The purpose of this study was to evaluate the effect of piezosurgery-assisted alveoloplasty using minimally invasive technique compared to that of the conventional technique. Materials and Methods: This was a comparative in vivo study. The study sample consisted of 35 edentulous patients with bilateral bony spicules requiring alveoloplasty. The primary outcome variables assessed were time required for alveoloplasty, postoperative pain using visual analogue scale (VAS), and postoperative healing using Landry, Turnbull, and Howley healing index. The differences between the outcome variables were statistically analyzed using paired t-test. Results: The participants consisted of 35 patients (25 men and 10 women; age range: 38–83 years) diagnosed with bilateral bony spicules on the edentulous alveolar ridge. There was a statistically highly significant difference between both groups with respect to the outcome variables such as time required, VAS at 2nd day, and healing index at 7th day with higher mean of time required (in sec), higher mean of VAS, and lower healing index for conventional group as compared to piezo group (P < 0.05). Conclusion: Alveoloplasty done using piezosurgery not only reduces patient's postoperative discomfort but also maintains the alveolar bone integrity by not disturbing the soft-tissue and hard-tissue architecture, allowing faster healing of tissues, which makes the future prosthesis replacement easier
  1 3,976 702
Healer granules in nonhealing infected wounds
Santosh Ashok Nandimath, Rajkumar Garudanahally Chickklingaiah, Viresh Ashok Nandimath, Adwait Madhav Godse, Bappaditya Mishra, S Priya
July-December 2018, 8(2):224-229
DOI:10.4103/ams.ams_35_18  PMID:30693236
Background: Head-and-neck infection is one of the most frequently encountered issues in the field of oral and maxillofacial surgery. Most of the cases with head-and-neck infections are managed by empirical antibiotic therapy and extraction of offending infected tooth/teeth. However, long-term systemic antibiotic therapy can have profound compromising effects on host immune defense and thereby hamper healing, which, in turn, may lead to life-threatening complications such as localized septic foci or widespread septicemia at times leading to death of an individual. In this study, we are reviewing management of 15 cases with space infection in the maxillofacial region by local drug delivery with the help of collagen particles combined with mupirocin 2% w/w and metronidazole 1% w/w (BioFil-AB). We intend to study its efficacy in managing the space infections associated with extraoral infected wound as well as in preventing hazards of long-term systemic antibiotic therapy. Aims: The aim of this study is to assess the efficacy of the topical use of BioFil-AB in infected maxillofacial wounds. Materials and Methods: A total of 15 patients with infected maxillofacial wounds reporting to the department of oral and maxillofacial surgery were categorized into three groups depending on the severity of infections. Of these 15 cases, 8 patients were suffering from infected extraoral wounds, 3 had traumatic infection, and remaining 4 had extraoral consolidated abscesses due to odontogenic infection. All patients had a history of prior antibiotic therapy. Incision and drainage of the septic focus/foci were performed in most of the cases, and healing of the site was assessed after application of topical BioFil-AB (mupirocin + metronidazole + collagen granules) dressing. Results and Conclusion: Dressing with BioFil-AB granules proved to be efficient in control of infection as well as in promoting uneventful wound healing, especially with good follow-up. Further studies with a large sample size may be necessary to corroborate the findings and provide substantial evidence. This novel local drug delivery therapy will definitely help in maintenance of good host immune response as well as in preventing or minimizing occurrence of antibiotic resistance.
  1 2,501 283
Esthetic outcome and airway evaluation following Bi-Jaw surgery V/S mandibular setback surgery in skeletal class III malocclusion using surgery first approach
Bushra Kanwal, Akshai Shetty, Varghese Mani, CS Prashanth, KM Pramod, Sharmila Arjunan
July-December 2018, 8(2):270-275
DOI:10.4103/ams.ams_152_18  PMID:30693244
Background: Class III skeletal deformity is the result of mandibular prognathism, maxillary deficiency, or a combination. Treatment frequently requires a combination of orthodontics and orthognathic surgical procedures to improve facial esthetics and harmonize facial profile. Objectives: The objective of the study is to assess and quantify, by means of cephalometric analysis, the pre- and postoperative soft-tissue and airway changes following bi-jaw surgery and mandibular setback surgery after the correction of skeletal Class III deformities using surgery- first approach. Materials and Methods: Patients with skeletal Class III malocclusion were classified based on the A point–nasion–B point, beta angle, and Witt's appraisal. The cases were divided based on the type of surgery- first orthognathic approach they received. Group A (20 patients) comprised patients who underwent bi-jaw surgery (Le Fort I + bilateral sagittal split osteotomy [BSSO]) and Group B (20 patients) who underwent BSSO alone. After the lateral cephalograms were digitized, the cephalograms were evaluated for soft-tissue changes and airway changes. Results: The soft-tissue response to simultaneous two-jaw surgery was superior to those seen in mandibular setback procedures with the exception of the changes seen in the facial contour angle and soft-tissue facial angle. There was a significant decrease in lower airway in cases treated with mandibular setback alone. Conclusion: Cases treated with bi-jaw surgeries had a significant soft-tissue improvement in the long term compared to mandibular setback surgeries. Since there was a significant reduction in the lower airway in cases treated with isolated mandibular surgeries, bi-jaw surgeries maybe preferred over mandibular setback surgeries.
  1 2,472 362
Sternoclavicular joint graft in temporomandibular joint reconstruction for ankylosis
Rohini Thirunavukkarasu, Saravanan Balasubramaniam, Sethurajan Balasubramanian, Suresh Kumar Gopalakrishnan, Srimathi Panchanathan
July-December 2018, 8(2):292-298
DOI:10.4103/ams.ams_209_17  PMID:30693248
Background: Temporomandibular joint ankylosis is one of the most distressing clinical condition resulting in loss of jaw function and impairment of growth. Ankylosis is a greek word meaning “Stiff Joint”. It is observed that in humans the Sternoclavicular joint and Temporomandibular joint are similar morphologically and histologically as they are the only two synovial joints covered with fibrocartilage. This similarity of the joints have encouraged the surgeons to use SCG as an alternative to costochondral grafts. Aims: The purpose of this article was to evaluate the feasibility of using sternoclavicular graft for TMJ reconstruction in TMJ ankylosis patients and to also assess this technique in restoration of mandibular movement, function and growth of the mandible. Settings and Design: This retrospective study was conducted in 10 patients with unilateral TMJ ankylosiswho had undergone Interpositional arthroplasty with temporalis fascia and reconstruction of ramus condyle unit with sternoclavicular graft. Methods and Material: Ten patients(8 male and 2 female) with unilateral TMJ ankylosis within the growth period were included in the study. Clinical parameters assessed were maximal incisor opening, lateral excursion and protrusive movements.,ramus height,wound infection, donor sitemorbidity, evidence of neurological deficit in both donor and recipient site. Pre and post operative radiographic analysis of graft in relation to glenoid fossa and ramus of mandible was also done and donor site regeneration was also assessed. Statistical Analysis Used: The data were analysed using SPSS version 20 (IBM Corporation, SPPSInc; Chicago, IL, USA). Paired T test was used to compare the pre operative and post operativelaterotrusive, protrusive movements and the height of the ramus of the mandible. Repeated measures ANOVA was used to analyse the mouth opening pre operatively ,immediate post operatively and a after 5- year follow up. Results: The mean post operative mouth opening achieved was 28.9+_7.57mm with reankylosis in two patients. The mean laterotrusive and protrusive movements were 5.2 +_2.82mm and 2.2 +_.78 mm respectively postoperatively on a five year follow up. There was a 6.2 +_2.57mm increase in ramus height. The sternoclavicular graft had integrated and remodelled satisfactorily in eight patients. There was no change in the body length or midline deviation. Regarding the healing of the donor site there was a complete regeneration of clavicle within one year, however there was a incidence of clavicle fracture in one patient. The shoulder movements were normal in all patients. Conclusions: The reconstruction of TMJ with SCG has proved to be successful in this study.With an impressive success rate, the sternoclavicular graft could become a versatile and viable alternative to the surgeons in reconstruction of TMJ as it is relatively simple to carry out with minimal complications and good results.
  1 2,404 344
Piezosurgery for intraosseous venous malformation of the mandible
Masakazu Hamada, Hidetaka Shimizu, Ayako Takasu, Kyoko Nishiyama, Yoshiaki Yura
July-December 2018, 8(2):333-336
DOI:10.4103/ams.ams_189_18  PMID:30693258
Intraosseous venous malformation of the mandible is rare. A 59-year-old woman was referred to our hospital for evaluation of a radiolucent lesion in the left body of the mandible that had been detected on a routine radiologic dental checkup. The patient wished for follow-up rather than operation. After 2 years' follow-up, the radiolucent lesion had slowly grown, and the patient decided to have an operation. The lesion was removed surgically using the piezosurgery system, and conservation of the inferior alveolar nerve was achieved under general anesthesia. After operation, she reported an initial change in sensation (paresthesia). The sensitivity was recovered after 6 months. Patient prognosis has been good to date, with no symptoms indicating recurrence. We used to treat intraosseous venous malformations using the piezosurgery system. The present report describes a patient with intraosseous venous malformation of the mandible by complete excision and conservation of the nerve. It was useful to use piezosurgery for conservation of inferior alveolar nerve.
  - 1,506 160
Unusual horizontal root fracture in a mandibular second molar after lower wisdom teeth removal
Luiz Fernando Magacho Da Silva, Jonathan Ribeiro Da Silva, Fabrizio Albieri, Rodrigo Dos Santos Pereira
July-December 2018, 8(2):344-346
DOI:10.4103/ams.ams_129_18  PMID:30693261
Dental trauma is a common injury observed at dental practices that normally occurs in young patients. It especially affects the anterior teeth, although trauma to the posterior teeth can also be observed frequently when caused by high-impact trauma and masticatory forces. Horizontal root fracture in the posterior teeth is even more rare and involves a more specific type of trauma. This article reports the case of a second molar root fracture that happened during the removal of an impacted wisdom tooth. The patient had no discomfort associated with the event, and the tooth had no change in sensibility or mobility during follow-up. Seven months after the fracture, there was complete radicular healing even though no treatment was given.
  - 2,099 225
Implant placement into the nasopalatine foramen: Considerations from anatomical and surgical point of view
Mukesh Kumar Singhal, Ramakant Dandriyal, Asish Aggarwal, Anshika Agarwal, Sudhir Yadav, Prashant Baranwal
July-December 2018, 8(2):347-351
DOI:10.4103/ams.ams_161_17  PMID:30693262
Implant placement is a challenge in the anterior maxilla if the available bone is reduced and esthetics is challenging. The ideal implant position should be considered in all three dimensions: mesiodistal, apicocoronal, and orofacial. This article includes a review and a case report for the anatomical and clinical perspective of implant placement in nasopalatine foramen (near incisal canal). In this case report, the edentulous space is mutilated in between the area #12 and #21 teeth. Therefore, only one, 3.0 W/10.00 L implant (bone size 4.2 mm width and 11 mm length) could be placed. Radiographically, D2 bone quality was diagnosed. Before surgery, an emphasis was given over the proper implant selection to avoid oversized implants due to critical anatomical landmark. Careful and with minimal trauma, the soft tissue was handled and implant placement was performed in a proper position, using information from panoramic radiograph, 3-D Dentascan. A surgical guide was used for placement of the implant. Finally, immediate loading of temporary implant prosthesis was done. The primary outcome was satisfactory, as after 72 h, no swelling and numbness were reported. The patient has been recalled after healing period of 24 weeks for permanent restoration.
  - 2,177 335
An extremely rare presentation of Zimmermann–Laband syndrome in a twin
Manjunath Reddy, Vijay Mehetre, Priyadarshani Jayprakash Gir, Varsha Ranmare
July-December 2018, 8(2):352-354
DOI:10.4103/ams.ams_203_17  PMID:30693263
Zimmermann–Laband syndrome is a rare condition which manifests as hereditary gingival tissue hypertrophy along with other clinical features. Till date, only few cases have been reported in the literature. This case report focuses on an extremely rare presentation of Zimmermann–Laband syndrome in a twin. There has not been a single case report of Zimmermann–Laband syndrome in twins.
  - 1,807 146
Unfavorable occlusion after facial fracture treatment
SM Balaji
July-December 2018, 8(2):179-180
DOI:10.4103/ams.ams_258_18  PMID:30693228
  - 1,880 471
The head-and-neck reconstructive surgeon
Aakshay Gulati
July-December 2018, 8(2):177-178
DOI:10.4103/ams.ams_265_18  PMID:30693227
  - 2,184 510
Drill bit guiding system for implant placement
Loganathan Deepanandan, Giridhar Karthikrajan
July-December 2018, 8(2):230-233
DOI:10.4103/ams.ams_163_18  PMID:30693237
Introduction: The implant angulation plays a very important role in the outcome of prosthetic and functional outcome. The conventional surgical stents uses a ring system to drill the pilot drill, only the CAD printed stents provides a guide sleeves for the sequential drill for implant placement. The Purpose of this Study: The purpose of the study was to fabricate a drill bit guide for the stent to transfer the angulation and implant placement planned using conventional method in prescribed drilling sequence. Material and Methods: A surgical stent with a threaded guide ring system was fabricated with internal drill bit guiding system. The interchangeable sequential drilling allows the drill bit to be in predetermined position throughout the procedure. Results: The surgical stent with the drill bit guiding system provided less than 1% error with a mean deviation of 0.48%. Conclusion: The drill bit guide fabricated has a complete limiting system and transfers the angulation and placement as desired with very minimal or no alteration, which enables the predetermined prosthetic outcome.
  - 1,661 235
Surgical specimen handover from operation theater to laboratory: A survey
Reshma Poothakulath Krishnan, Pratibha Ramani, Herald J Sherlin, Gheena Sukumaran, Abilasha Ramasubramanian, Gifrina Jayaraj, KR Don, Archana Santhanam
July-December 2018, 8(2):234-238
DOI:10.4103/ams.ams_51_18  PMID:30693238
Introduction: Essential communication between surgeons and pathologists is required when a specimen is transferred from operation theater to a laboratory. Any errors during transferring of specimen can lead to serious consequences such as wrong diagnosis, inappropriate treatment, reoperations, and physical and emotional disaster. Aim: To evaluate the incidence of mishaps and misses during the transfer of specimen from operation theater to pathology department. Methodology: This cross-sectional study was conducted among the oral and maxillofacial surgeons and postgraduate students of the Department of Oral and Maxillofacial Surgery. A self-administered questionnaire containing 15 questions pertaining to entry, collection, preservation, and transport of specimens to the laboratory was made. The questionnaire was validated and later distributed to the participants. Results: Our study showed that there are misses and mishaps during the entry, collection, preservation, and transport of specimen to the laboratory. 97.1% of participants reported that they require a checklist during the transfer of specimen. Conclusion: Use of checklist can reduce mishaps and communication failures which is an initial link for reporting.
  - 2,223 288
Prevalence and severity of mandibular asymmetry in non-syndromic, non-pathological caucasian adult
Shane J McCrea, Mark Troy
July-December 2018, 8(2):254-258
DOI:10.4103/ams.ams_293_13  PMID:30693241
Background: Mandibular Asymmetry has been analysed in diverse, non-Caucasian groups, principally children. No large-scale analysis has been carried out on non-syndromic Caucasian adults. Aims: To evaluate the prevalence and severity of mandibular asymmetry; to identify gender differences and evaluate side predominance, where no actual patient concern was reported and no surgery was being contemplated. Materials and Methods: Dental records of 437 patients were analysed. This large patient cohort had no reports of pathology involving the rami or condyles or the TMJ. Following strict 'Inclusion Criteria', 200 DPTs were analysed: 96 male, 104 female patients (age range 18-93 years, average 59.41 years, SD ±13.94). Statistical Analysis: Intra-observer error was determined, r = 0.99. The Student t-test determined differences between the sides for ramal height measurements. and gender. The Asymmetry Index evaluated the severity of asymmetry between condylar heights and ramus. Results: 18 % of the cohort presented substantial Mandibular Ramal Asymmetry (MRA). Male prevalence was 23.9%; female prevalence was 12.5%; severity was 18.82% and 32.88% respectively. Conclusions: Incidence of asymmetry, though significant, has no detrimental effect on the patient's well-being or dental health. Facial surgery that is contemplated in response to both minimal and extreme asymmetry may well be carried out as a result of other cultural demands.
  - 1,658 212
The reliability of free buccal fat graft for treatment of severe gingival recessions at mandibular and maxillary exposed roots
Fares Kamal Kablan
July-December 2018, 8(2):281-286
DOI:10.4103/ams.ams_149_18  PMID:30693246
Introduction: The occurrence of gingival recessions (GRs) is multifactorial, mainly due to trauma induced by traumatic toothbrushing, orthodontic tooth movement, as well as anatomical factors such as bone dehiscence, teeth malposition, and muscle pull. Fat tissue in the oral cavity is widely available and easily accessed. The use of pedicled buccal fat pad (BFP) graft is well known in maxillofacial surgery and has been shown promising results, becoming safe and effective graft for several clinical applications. However the use of fat tissue harvested from the buccal fat pad as a free graft (BFFP) is less common, but recently, it has been described by the author for different intraoral clinical applications. The aim of this study is to present additional application using the BFFG for coverage of severe muco-GRs and to discuss the promising outcomes of this procedure. Patients and Methods: A technique for harvesting intraoral BFFG for the use in mucogingival surgery is presented. A total of 10 patients (age: 38.3 ± 6.8 years) with 17 teeth presenting severe GRs (4.8 ± 1.8 mm) were included in the study. Recessions treated using BFFGs were recorded at baseline and 12 months after surgery. Results: A total of 17 GRs were treated using BFFG. At 12 months, significant reduction of recession occurred. Initial recession was reduced from 4.8 ± 1.8 mm to 1.7 ± 0.9 mm. A mean of 3.1-mm reduction in GR was achieved compared to baseline. Conclusions: The new, simple, technique for treatment of severe GRs using BFFG resulted in significant reduction of GRs.
  - 2,203 300
Zygomatic arch osteotomy for open reduction and internal fixation of medially displaced/dislocated condylar head in high condylar fractures
Elavenil Panneerselvam, Saravanan Chellappazham, Sasikala Balasubramanian, VB Krishnakumar Raja
July-December 2018, 8(2):311-314
DOI:10.4103/ams.ams_182_18  PMID:30693252
Purpose: Open reduction and internal fixation of high condylar fractures is challenging. The difficulty gets compounded when the condylar head is medially displaced or dislocated. The surgical procedure is limited by inadequate visibility and restricted access to the fractured condyle for proper reduction and fixation. When conventional methods of reduction fail, “osteotomy-osteosynthesis” is performed to retrieve and fix the fractured condylar head. However, they are extensive surgeries and associated with morbidity. Methods: This article presents a novel technique “zygomatic osteotomy (ZO)” performed on a cadaver to facilitate retrieval of the displaced head and achieve ideal reduction and fixation. A comparison of the existing techniques with the proposed ZO has been done in detail. Conclusion: The “ZO” technique is easy to perform with less potential for complications.
  - 2,218 229
Distraction osteogenesis after stem cell transplantation: A pioneer approach
Jan Oliver Voss, Jörg-Sven Kühl, Maike Holm, Kathrin Hauptmann, Nicolai Adolphs
July-December 2018, 8(2):303-306
DOI:10.4103/ams.ams_41_18  PMID:30693250
Allogeneic hematopoietic stem cell transplantation (HSCT) is an established therapy and is without alternative for certain groups of patients. Successful HSCT induces both long-lasting remission and tolerance without the need for further immunosuppression. In this case, cellular repair and regenerative processes work in a physiologic manner allowing elective surgical procedures, such as the interdisciplinary correction of dentofacial anomalies. Here, we report the successful management of transverse maxillary deficiency by transpalatal distraction and subsequent orthodontic treatment in a 12-year-old boy who underwent HSCT for high-risk acute lymphoblastic leukemia at 5 years of age.
  - 1,549 189