Dr. Hemant Gupta - Academia.edu (original) (raw)

Papers by Dr. Hemant Gupta

Journal of Oral Biology and Craniofacial Research, 2016

Objective: Temporomandibular joint ankylosis (TMJa) is a distressing condition, but can be surgic... more Objective: Temporomandibular joint ankylosis (TMJa) is a distressing condition, but can be surgically managed by gap or interpositional arthroplasty, with an aim to restore joint function and prevent re-ankylosis. The aim of this paper is to compare two interposition materials used in management of TMJ ankylosis. Methods: 15 patients with TMJa were randomly allocated to two groups: group A (n = 6), interposition material used was medical-grade silicon elastomer, and group B (n = 9) where the interposition material used was temporalis fascia. Patients were followed up at regular intervals of 1 and 2 weeks, 1 month, 3 months, and 6 months and were assessed on following parameters: pain by VAS Scale, maximal mouth opening (MMO), implant rejection, and recurrence. Results: The results showed a loss of 4.6% and 7.9% in maximal interincisal mouth opening at 3rd and 6th months in Group A while Group B had a mean loss of 9% and 10% at 3rd and 6th months respectively without any significant difference. None of our cases showed recurrence or implant rejection. Conclusion: We conclude that silicone is comparable to temporalis fascia in terms of stability, surgical ease, and adaptability. It not only restores the function of mandible and ensures good maximum interincisal opening but also maintains the vertical ramal height. Also, it requires less operating time and is easy to handle but is not economical. It might be an effective way to restore function and prevent re-ankylosis.

Journal of Maxillofacial and Oral Surgery, 2019

Introduction The temporo-mandibular joint (TMJ) is a complex anatomical structure that is concern... more Introduction The temporo-mandibular joint (TMJ) is a complex anatomical structure that is concerned with mastication, deglutition, and speech. Ankylosis of the TMJ occurs when the condyle gets fused to glenoid fossa by bony or fibrous tissue. It is an incapacitating problem, commonly occurring in children and is usually associated with trauma or infection. Materials and Methods A total of ten patients with written informed consent having TMJ ankylosis (unilateral/bilateral) fulfilling the inclusion criteria were selected for the study and were operated under general anaesthesia with arthrectomy followed by reconstruction of ramal condylar unit with SCG (Group I) or CCG (Group II). Pre-operative and post-operative evaluation assessments were done at regular intervals for maximum mouth opening, range of mandibular movements, and height of ramus. Results Statistical analysis shows that the increase in maximum mouth opening was found 1.1% higher in Group II (75.9%) as compared to Group I (74.9%). The increase in lateral excursion at affected side was found 1.3% higher in Group I (84.6%) as compared to Group II (83.3%). The increase in lateral excursion at non-affected side was found 10.3% higher in Group I (76.9%) as compared to Group II (66.7%). The increase in protrusive movement was found 17.5% higher in Group II (88.9%) as compared to Group I (71.4%). Six months post-operative height of ramus was found 10.5% higher in Group II as compared to Group I. Conclusion The present study concludes the superiority of costochondral graft over sternoclavicular graft in terms of growth and function. Continued deliberation between the two grafts with larger sample size and a longer follow-up with multicentric consensus will be required to draw definitive indications of the two grafts.

Journal of Blood Transfusion, 2014

Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will g... more Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3±(18.5) years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of 10.4±10.8 mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant...

National Journal of Maxillofacial Surgery, 2013

Bisphosphonates (BPs) are potent inhibitors of bone resorption and are widely used in the treatme... more Bisphosphonates (BPs) are potent inhibitors of bone resorption and are widely used in the treatment of osteoporosis and other diseases that cause bone mass loss; such as Paget's disease, bone metastases, and multiple myeloma to prevent pathological fractures. [1] The clinical efficacy of such drugs in the treatment of osteopenia/osteoporosis has been well-established. [2] But with increasing use, evidence is emerging that patients taking BP drugs are at risk of developing osteonecrosis of the jaws (ONJs), sometimes occurring spontaneously, but more usually following dental extractions or oral bone surgery. For example in Australia, there were 2.3 million BP prescriptions in 2003 which were equal to the number of amoxycillin prescriptions in the same year. [1] In 2004, this had increased to 2.5 million BP prescriptions. [3] The association of BPs, that is, Zometa (zolendronic acid) and Aredia (pamidronate) with ONJs of 36 cases was first reported in 2003 by Marx. [4] In December 2004, Novartis, the manufacturer of pamidronate and zoledronate, called attention to the risk of osteonecrosis. [5] This article aims to review the available literature about the possible association between dental treatment and BPs as the dental management plan for these patients needs to be carefully formulated to minimize the risk of avascular necrosis of the jaws and allow for the maintenance of overall health care of the patient.

Kathmandu University Medical Journal, 2013

This paper describes the treatment of a male patient aged 14 years who presented with a skeletal ... more This paper describes the treatment of a male patient aged 14 years who presented with a skeletal class I, vertical maxillary excess, marked increase in overjet, thin palatal cortex and a gummy smile. Considering the severity of his malocclusion and its impact severity on his psychosocial well being, he was managed with a combined approach of Fixed Orthodontic therapy and Orthognathic surgery, even though his growth was not complete. Records of Pre treatment, Post treatment and three years in retention were analyzed and the functional and esthetic results were found to be fairly stable.

Australian Dental Journal, 2005

Background: Osteomyelitis of the maxillofacial skeleton is rare in developed countries such as Au... more Background: Osteomyelitis of the maxillofacial skeleton is rare in developed countries such as Australia. This case report describes the successful surgical treatment of chronic suppurative osteomyelitis (CSO) of the mandible in a 75 year old man. The precipitant factor was thought to be a retained tooth root in the (right) posterior body of the mandible. Methods: Treatment included a pre-surgical course of antibiotics (clindamycin 300mg, p.o. q.i.d. for two weeks) followed by removal of the retained root, surgical débridement of the affected bone, the intra-oral draining sinus, and resection of the cutaneous sinus tract. Specimens were taken for bacterial cultures and antibiotic sensitivity testing, and the resected tissue sent for histopathological review. Results: On clinical and radiographic review at three months, the patient was well, completely symptom free and the osteomyelitis had fully resolved. Conclusion: This case report demonstrates the typical features of CSO. The combination of antibiotic therapy and surgical débridement was effective in the treatment of chronic suppurative osteomyelitis of the mandible utilizing intravenous sedation, and so averting the need for a general anaesthetic.

Craniomaxillofacial Trauma and Reconstruction, 2016

Disarticulation resections are required for treatment of variety of pathologies of the jaws. Thes... more Disarticulation resections are required for treatment of variety of pathologies of the jaws. These resections are mostly carried out through extraoral approach, which bear significant postoperative morbidity. The transoral approach may be used for this purpose in benign pathological cases of the mandible to limit the postoperative morbidity of extraoral approach, as it provides sufficient access not only for resection and disarticulation but also for immediate reconstruction. This article shares our experience with transoral approach for resection and disarticulation in a case of kerato cystic odontogenic tumor and simultaneous reconstruction. Excellent cosmetic and functional results were observed in 6-month follow-up.

Journal of Oral Biology and Craniofacial Research, 2011

Introduction: Bone grafts are frequently used for the treatment of bone defects, but can cause po... more Introduction: Bone grafts are frequently used for the treatment of bone defects, but can cause postoperative complications, and sometimes a sufficient quantity of bone is not available. Hence, synthetic biomaterials have been used as an alternative to autogenous bone grafts. Recent clinical reports suggest that application of autologous blood plasma enriched with platelets can enhance the formation of new bone. There are very few in vitro or in vivo studies published on the efficiency of platelet-rich plasma (PRP). The objective of this study was to evaluate the alloplastic bone substitute for its osteogenic potential with or without PRP. Materials and Methods: Twenty-three patients with periapical bony defects were selected for this study. Clinical parameters such as pain visual analog scale (VAS), swelling, infection, graft migration, rejection, radiographical interpretations at regular interval and scintigraphic evaluation were done to evaluate osteogenic potential of alloplastic bone substitute with or without PRP. Results: The highest acceleration in bone formation was observed in groups where alloplastic bone substitute was used with PRP. There were no statistically significant differences between the two groups regarding other outcome variables throughout the postoperative period. Conclusion: Addition of PRP significantly accelerates vascularization of the graft, improves soft tissue healing, reduces postoperative morbidity and enhances bone regeneration.

Journal of Maxillofacial and Oral Surgery, 2009

Lateral neck soft tissue masses manifests with variable etiologies, clinical signs and symptoms. ... more Lateral neck soft tissue masses manifests with variable etiologies, clinical signs and symptoms. Although these lesions are congenital in nature, manifestations of these may not occur until adulthood. Also some of these lesions may undergo malignant transformations. We present two cases with lateral neck swellings which were excised successfully under general anaesthesia and later confirmed histopathologically as dermoid and branchial cleft cysts. Formulation of an appropriate diagnosis is necessary and requires a clinician to bear a host of skills to systematically arrive at a correct treatment plan. Use of advanced imaging techniques such as ultrasonography and magnetic resonance imaging along with proper knowledge of anatomy, pathology and application of basic surgical principles goes a long way in successful and uneventful management of such lesions, as these may overlap many important neurovascular structures or may in turn be wrapped by them.

Plastic Surgery International, 2012

Mandible is the second most common facial fracture. There has been a significant increase in the ... more Mandible is the second most common facial fracture. There has been a significant increase in the number of cases in recent years with the advent of fast moving automobiles. Mandibular fractures constitute a substantial proportion of maxillofacial trauma cases in Lucknow. This study was undertaken to study mandibular fractures clinicoradiologically with an aim to calculate incidence and study pattern and the commonest site of fractures in population in and around Lucknow. Patient presenting with history of trauma at various centers of maxillofacial surgery in and around Lucknow were included in this study. Detailed case history was recorded followed by thorough clinical examination, and radiological interpretation was done for establishing the diagnosis and the data obtained was analyzed statistically. Out of 66 patients with mandibular fractures, highest percentage was found in 21–30 years of age with male predominance. Road traffic accidents were the most common cause of fracture w...

National Journal of Maxillofacial Surgery, 2012

The complexity of structure and functions of the Temporomandibular Joint (TMJ) make the diagnosis... more The complexity of structure and functions of the Temporomandibular Joint (TMJ) make the diagnosis of its diseases/disorders difficult. Remarkable progress made in the field of imaging of this joint led us to compare four imaging modalities viz. plain radiographs, CT scan, MRI and ultrasound. We found that MRI was most specific and sensitive for interpretation of soft tissue and inflammatory conditions in the joint, whereas CT examination produced excellent image for osseous morphology and pathology. Plain X-rays are useful for destructive bony changes and sonography is a good in aid in diagnosing disc derangement and is very economical.

$Research paper thumbnail of Management of mandibular fracture in a medically compromised pediatric patient$

National Journal of Maxillofacial Surgery, 2010

Maxillofacial injuries in pediatric population warrant special attention because of anatomic cons... more Maxillofacial injuries in pediatric population warrant special attention because of anatomic considerations, potential for growth disturbances and rapidity of healing. The incidence and etiology of pediatric trauma is largely affected by age-related activity, besides social, cultural and environmental factors. [1] Midface fractures are rare in children because of retrusive position of midface relative to prominent calvaria. Therefore, mandibular fractures are more frequent facial skeletal injuries reported in hospitalized pediatric trauma patients. [2] While treating these mandibular fractures, one has to bear in mind the important differences between management of children and adults with facial fractures, with reference to both preliminary and definitive management.

Journal of Oral Biology and Craniofacial Research, 2012

Introduction: Oral submucous fibrosis (OSMF), a chronic debilitating condition of the mouth, has ... more Introduction: Oral submucous fibrosis (OSMF), a chronic debilitating condition of the mouth, has been treated both surgically and non-surgically, but non-surgical methods yield inconsistent results. The surgical methods essentially comprise of bilateral sectioning of fibrous bands with or without coronoidectomy followed by covering of the surgical defect with a graft or a wound dressing material such as collagen sheet. Materials and Methods: This study comprised 30 clinically diagnosed cases of OSMF. This study compared transposition of buccal pad fat graft with collagen sheet to cover the defect within the following parameters: pain, swelling, mouth opening, color of mucosa, palpability of fibrous bands, and suppleness of mucosa. Results: We found significant difference in the postoperative mouth opening, an insignificant difference for post surgical morbidity and higher grades of surgical convenience in using collagen sheet as a wound dressing material. Conclusion: Collagen membrane is a superior method compared to transposition of the buccal pad of fat as a graft to cover the surgical wound in the treatment of OSMF of grade III and above.