Maxillofacial Surgery

Oral cancer: A study in retrospection Niranjan Mishra National Journal of Maxillofacial Surgery 2019 10(1):1-2

Heterogeneous conceptualization of etiopathogenesis: Oral pyogenic granuloma Supriya Sharma, Shaleen Chandra, Shalini Gupta, Saurabh Srivastava National Journal of Maxillofacial Surgery 2019 10(1):3-7 Oral pyogenic granuloma or granuloma pyogenicum is a conspicuous lesion. The word pyogenic granuloma is a misterm since the situation is not related with pus and histologically does not exemplify a granuloma. An oral pyogenic granuloma is obvious to involve the gingiva generally. Extragingivally, it can present on the buccal mucosa, lips, tongue, and palate. A report of trauma is prevalent in such sites. The pathogenesis of the lesion is still unclear, although it was initially supposed to be a botryomycosis infection. It is suggested that etiology of pyogenic granuloma was the reaction of tissues to minor injury or chronic irritation, thus open a pathway for the entrance of nonspecific microorganisms, although microorganisms are not often expressed within the lesion. Hence, this review recapitulates all diverse concepts of pathogenesis associated with this most often and most mysterious lesion of the oral cavity.

Metastatic involvement of level IIb nodal station in oral squamous cell carcinoma: A clinicopathological study Partha S Chakraborty, Ashok Kumar Das, Ashutosh Vatsyayan, Tashnin Rahman, Rajjyoti Das, Seemanta Kumar Medhi, Kishore Das, Jagganath Dev Sharma National Journal of Maxillofacial Surgery 2019 10(1):8-12 Background: The purpose of this study was to determine the prevalence of Level IIb metastasis in patients with oral squamous cell carcinomas (OSCCs). Materials and Methods: A total of 110 newly diagnosed oral cavity cancer patients requiring surgery as the primary modality were included in the study. Preoperative clinical examinations were done and tumor-node-metastasis staging was noted. Intraoperatively, Level IIb nodal tissue was dissected and sent separately. Results: A total of 129 neck dissections (58 SOHD, 67 modified neck dissections, and 4 radical neck dissections) were carried out in 110 patients (males = 80 and females = 30), 91 patients required unilateral neck dissection, and 19 patients required bilateral neck dissection. Out of these 129 neck dissections, only 4 (3.2%) neck dissections (in a total of 3 patients out of 110 patients) had Level IIb positive (with bilateral Level IIb involvement in one patient). Conclusions: Dissection of the Level IIb region in patients with OSCC may be required only in cases with advanced N stage, positive Level IIa lymph nodes, and extracapsular spread. Furthermore, in tongue cancers (high propensity of isolated Level II involvement), retromolar trigone, and floor of mouth cancers, routine Level IIb clearance should be considered.

Radiographical and histological evaluation of bioactive synthetic bone graft putty in sinus floor augmentation: A pre- and post-intervention study Ankit Arora, Dipankar Khadtale, Bhaskar Agarwal, Rahul Yadav, Ongkila Bhutia, Ajoy Roychoudhury National Journal of Maxillofacial Surgery 2019 10(1):13-19 Objective: The main objective is to evaluate the quantity and quality of bone formed after use of bioactive synthetic bone graft putty in sinus augmentation and to radiographically and histologically evaluate increase in alveolar bone height in augmented sinus. Materials and Methods: It is a pre- and post-intervention study of 15 patients (present at both baseline and at 6 months) with 80% power and 95% confidence level. Results: The mean increase in alveolar bone height is 7.08 ± 1.42 mm ranging from 5.6 mm to 10.7 mm. It is evident from the data that there has been increase in alveolar bone height postbone graft augmentation. P < 0.001 shows that increase in alveolar bone height is highly significant as compared to preoperative bone height. The mean postoperative density is 525.43 ± 104.18 hounsfield unit ranging from 649 HU to 350 HU. This is also a D3 quality bone as per Misch classification. The mean difference in alveolar bone density is 104 ± 125.16 HU. P = 0.0053 shows that increase in alveolar bone density is significant as compared to preoperative bone density. Conclusion: Bioactive synthetic bone graft putty yields sufficient quantity of mineralized tissue for implant placement in patients with 2–6 mm of alveolar bone height before grafting. Histologically, it has shown that it has good osteoconductive properties and good quality of bone is formed within 6 months of its augmentation.

Toward early diagnosis of oral cancer: Diagnostic utility of cytomorphological features, a pilot study Zeeba Shamim Jairajpuri, Safia Rana, Apoorva Hajela, Sujata Jetley National Journal of Maxillofacial Surgery 2019 10(1):20-26 Introduction: Early detection of oral cancer is one of the most efficient ways to reduce the high mortality from this disease because of the ready accessibility of the oral cavity. We need to devise urgent diagnostic tools to detect early oral premalignant and malignant lesions. Aim: The aim of the present study was to grade the oral lesions in an attempt toward developing a novel cytological grading system. Further, morphometric analysis of cellular parameters was also performed to compare their significance in differentiating benign from malignant lesions. Materials and Methods: The present study was conducted at a tertiary care hospital catering to the low socioeconomic population. Patients presenting in the various Out Patient Departments with suspicious oral lesions were evaluated by cytology in the Department of Pathology. Results: A total of 72 patients were evaluated with a mean age of 43.54 ± 10.35 years. The involvement of the buccal mucosa was the most common site of oral lesions. Cytologically, the lesions were graded according to the oral/oro-pharyngeal cytology grading system into grades A to F. Cyto-morphometric analysis showed an increasing trend in mean nuclear diameter from benign to malignant cases while the mean cytoplasmic diameter decreased, value of P < 0.05 was observed indicating a statistically significant difference between the two groups. Conclusions: Cytological features of pleomorphism are a unique feature in oral carcinoma reflecting intracellular alterations in cells. Grading of lesions according to cytological characteristics can be helpful in standardizing the reporting of the oral lesion. However, our study was restricted by limited data; we emphasize more extensive studies to assess the usefulness and applicability of such a grading system. We also conclude that the use of cytomorphometry can improve the diagnostic reliability of exfoliative cytology.

Assessment and correlation between functional and histological staging of oral submucous fibrosis: A clinicohistopathologic study Pooja Bhatt, M Manjunath, Deepak Khakhla, Priyanka Gubrellay, Rahul Bhargava, L Guruprasad National Journal of Maxillofacial Surgery 2019 10(1):27-32 Background and Objective: Oral submucous fibrosis (OSMF) is a precancerous condition. It is widespread in the Asian subcontinent, with India bearing most of the burden. It is characterized by mucosal rigidity of varying intensity due to the fibroelastic changes of the juxta epithelial layer, resulting in a progressive inability to open the mouth. Early recognition with accurate staging of the disease and appropriate treatment planning is of utmost importance to prevent the malignant transformation and to improve the quality of life of the patient. In the present study, an attempt is made to clinically evaluate the condition and correlate it with the histopathological findings according to standard criteria. Materials and Methods: A hospital-based study was conducted on sixty OSMF patients. Detailed history was recorded, and functional staging was given depending on mouth opening. Punch biopsy was performed, and histological stages were given based on standard criteria. The data so received were mathematically evaluated to determine whether any correlation exists between the stages using Chi-square test. Results: The sixty patients were in the age range of 16–50 years. Male-to-female ratio was that of 97:3. The statistical analysis using Chi-square test showed statistically significant association (P < 0.001) between the functional and histologic stages. Conclusion: There is a definite correlation between functional and histological stages of OSMF which suggests that clinically advanced OSMF has extensive fibrosis histologically.

Parental self-perceived knowledge and attitudes toward emergency management of avulsed permanent teeth in Imphal: A cross-sectional study Sharna Ningthoujam, Deepa Gurunathan, Waikhom Robindro Singh, Braj Bhushan Mall National Journal of Maxillofacial Surgery 2019 10(1):33-42 Introduction: Dental avulsion is one of the dental traumatic injuries commonly affecting children aged between 6 and 12 years. One of the major limitations in obtaining a successful outcome while treating dental avulsions is the lack of knowledge on its first aid management among parents. The present study aims to assess the knowledge and attitude of parents in Imphal toward the emergency management of avulsed permanent tooth using a self-reported questionnaire method. Materials and Methods: The present cross-sectional study was undertaken among 777 parents of 6–12-year-old children who were recruited through 2 private schools in Imphal. A questionnaire consisting of 14 closed-ended questions used to assess the parental knowledge and attitude on emergency management of avulsed permanent teeth was distributed to the respondents after obtaining official consent from the respective schools and informed consent from the respondents. Statistical Analysis: Chi-square test was used to assess the association between the results and the educational status, gender, and geographical location of the respondents. Results: The study revealed that only a fraction of the respondents, i.e., 11.8% gave a positive response on attempting “self-replantation” and higher fractions (76.1%) of the respondents reported to have received no previous information on the emergency management of dental avulsion. Conclusion: About 96.1% of the respondents showed interest on acquiring knowledge on the emergency management of dental avulsion. This warrants the urgent need on educating the parents on the first aid emergency management of avulsed tooth.

A statistical analysis of incidence, etiology, and management of palatal fistula Ramneesh Garg, Sheerin Shah, Sanjeev Uppal, Rajinder K Mittal National Journal of Maxillofacial Surgery 2019 10(1):43-46 Objective: The purpose of this study was to retrospectively review the incidence, profile, and the management of palatal fistula occurring in patients operated for cleft palate in our institute. Materials and Methods: A retrospective analysis was performed on all cleft palatal fistula patients who presented during the period from August 2007 to October 2017, to classify their site, age of presentation, surgery performed, and outcome. A record of the type of cleft palate and previous palatoplasty was also obtained. The outcome in terms of incidence and fistula formation depending on Veau's classification was analyzed. Results: Twenty-two patients reported with palatal fistula during this period. The incidence of fistula formation of our institute was 9.6%. Incisive foramen (13/22) was the most common site of fistula formation. Among various techniques used, local and buccal flaps were found to be useful in a maximum number of cases (14/22). The rate of fistula recurrence was 18.2% (4/22). On retrospective analysis of our institutional data, it was found that the incidence of cleft palate fistula was significantly higher in clefts with Veau Types III and IV (13/18) as compared to Veau Types I and II (5/18). Conclusion: This study shows that the fistula rate of our institution was 9.6%. Complete clefts (unilateral or bilateral) involving both primary and secondary palates predispose more to fistula formation.

A comparative evaluation of immediate versus delayed loading of two implants with mandibular overdenture: An in vivo study Param Dev Singh, Varun Kumar, Geeta Arya National Journal of Maxillofacial Surgery 2019 10(1):47-55 Introduction: Implant-supported overdenture has been a common treatment for edentulous patients for the past several years and predictably achieves good clinical results, especially in those patients who were uncomfortable with their conventional dentures, as they provide additional retention and support. The concept of immediate loading is more applicable to completely edentulous patients because of their functional and esthetic requirements. Hence, the present study aims to evaluate the outcomes of immediate loading of mandibular two-implant-retained overdenture and compare it with the conventional delayed loading concept. Method: This in vivo study was conducted to compare immediate versus delayed loading of two implants with mandibular overdenture. A total of 20 completely edentulous patients (10 delayed loading and 10 immediate loading) were included in the study and certain parameters, i.e., bone loss around implants, periodontal pocket depth, pain and discomfort, implant stability, and microflora around implants, were measured immediately and after healing period of 3 and 6 months. Result: It can be analyzed from the observations that patients were more satisfied with delayed loading in terms of comfort, speech, function, pain, and chewing efficiency as compared to immediate loading. Conclusion: It is concluded that implants loaded under delayed protocol seem to have a higher success rate as compared to those that are loaded immediately.

Repeated peripheral alcohol injection is an effective treatment of Trigeminal Neuralgia in non-drug compliance patients Arunesh Kumar Tiwari, Amiya Agrawal, Anjani Kumar Pathak, Sumit Kumar, Kopal Goel, Siddhartha Chandel National Journal of Maxillofacial Surgery 2019 10(1):56-58 Introduction: Trigeminal neuralgia (TN) is an uncommon disorder seen in dental and neurologic practice, which presents with brief lancinating pain in the face, in the area distributed by the trigeminal nerve. The wide ranges of treatments currently used for TN are ample evidence that there is no simple answer to how it should be managed. Purpose: In this study, we want to evaluate, if repeated peripheral alcohol injection is an effective treatment of TN patients. Material and Methods: Retrospective data analysis of patients treated with peripheral alcohol injections from November 2011 to July 2017 were conducted. We selected the patients who reported at least three times for alcohol injection and duration of pain relief recorded as reported by patients. Results: Effects of 96% absolute alcohol injection alcohol injection ranging from 13 to 15 months pain relief, but in second or third time, this duration was decreased to 11–12 months, whereas no much significant complication were observed. Conclusion: Even single time neurectomy is not permanent cure, so patients choose less invasive option such as peripheral alcohol injections in repeated use instead of a surgical option.

Alexandros Sfakianakis
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alsfakia@gmail.com