Ramen Sinha - Academia.edu (original) (raw)
Papers by Ramen Sinha
Journal of Maxillofacial and Oral Surgery, 2017
Aim To investigate the perception of Oral and maxillofacial surgery by healthcare professionals, ... more Aim To investigate the perception of Oral and maxillofacial surgery by healthcare professionals, students and general public. Materials and Methods A questionnaire form was created that listed ten clinical situations, and given by hand to 1200 individuals, divided into six groups: group 1, medical professionals; group 2, Specialties of dentistry; group 3, general dentists; group 4, medical students; group 5, dental students; and group 6, general public, each comprising 200 individuals. Respondents were asked to indicate who they would expect to treat them if they had one of the specified conditions listed in the questionnaire. We present the results and current awareness levels of this simple questionnaire. The present study addresses the common issue raised by many authors, 'What surgical education the speciality offers?' especially to medical professionals, medical students and general public to enhance an appropriate referral. Results Most of the respondents in groups 2, 3 and 5 agreed that specific conditions listed in the questionnaire were within the domain of oral and maxillofacial surgery, but such response was not seen in groups 1, 4 and 6 (p \ 0.001). An overall awareness level of oral and maxillofacial surgery was found to be 50.2%. Conclusion The onus of creating and improving the awareness and perception of our specialty lies on oral and maxillofacial surgeon. Unified efforts at individual as well as global level will help achieve this goal.
Journal of Maxillofacial and Oral Surgery, 2021
The aim of this study is to clinically and radiographically evaluate the stability of parasymphys... more The aim of this study is to clinically and radiographically evaluate the stability of parasymphysis fracture managed with lag screws, miniplates and 3D miniplates. Ninety- eight patients diagnosed with parasymphysis fracture were treated using lag screws in group 1, two 4-hole miniplates in group 2 and 3D miniplates in group 3. Intraoperative stability and duration of fixation was assessed. Postoperative clinical evaluation was done at 1 week, 1 month, 3rd month, 6th month and 1 year for complications and oral function. Radiological evaluation was done at 3rd and 6th month. Only 92 patients were considered for statistical analysis since 6 patients were lost during follow-up. Road traffic accident (65.3%) was the primary cause of mandibular fractures. Postoperative pain score showed a statistically significant difference after 1 week and 1 month duration (P value < 0.001). ANOVA test showed VAS was significantly higher at pre-op followed by 1st day and 1 week, but no significant difference after 3 months in all groups. Radiographic analysis did not show significant difference in approximation of fracture segment among 3 groups after 6 months (P-value = 0.117). Chewing efficiency at 6 months and occlusion by surgeon evaluation at 3 months showed a significant difference (P value < 0.001). Lag screw fixation was technique-sensitive, relatively inexpensive and was less time consuming method when compared to miniplates and 3D plates. Lag screws and 3D plates are superior in reducing the incidence of complications and better in oblique or sagitally displaced mandibular fractures.
Journal of Maxillofacial and Oral Surgery, 2020
Aim This study is designed to outline the probable patterns of mandibular fracture based on patie... more Aim This study is designed to outline the probable patterns of mandibular fracture based on patient demographics and mechanism of injury in a rural setup. Materials and Methods The data from the record section in our unit belonging to patients who sustained fractures in the maxillofacial skeleton and were treated in our unit between the period June 2012-May 2019 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation. Results A total of 224 patients with maxillofacial fractures were diagnosed, of which 195 were male and 29 were female. The ages ranged from 7 to 70 years. Road traffic accidents are noted to be the most common cause of mandibular fractures. The maximum cases were in the age group of 21-30 years with 85 (38%) patients. In a total of 224 patients, there were 278 mandibular fractures. The maximum incidence of fractures was in the mandibular parasymphysis region with 90 fractures accounting for 32.3% of the mandibular fractures. Males were more susceptible to mandibular fractures. Majority of them sustained mandibular fracture at more than one anatomical area. Conclusion It can be concluded that mandibular fractures are seen predominantly in the second and third decades of life due to road traffic accidents with high-speed vehicles and lack of protective safety accessories. Mandible when it fractured, it usually involved more than one anatomical location.
Journal of Dental Research and Review, 2019
Aim: The aim of this study was to evaluate the efficacy and reliability of fracture management in... more Aim: The aim of this study was to evaluate the efficacy and reliability of fracture management in the anterior mandible using miniplates (MPs), lag screws (LSs), three-dimensional (3D) plates, and Herbert screws. Materials and Methods: The study consists of forty patients randomly divided into four groups of ten, undergoing open reduction internal fixation of anterior mandible fractures using MPs, LSs, 3D plates, or Herbert screw. All the patients were evaluated for stability of fracture fragments, duration of procedure, requirement of maxillomandibular fixation, and other associated complications. Results: The results of this study showed that each fixation device has its own merits and demerits. The rectangular plates achieved good stability, but its placement and adaptation was challenging in certain clinical scenarios when the anterior mandibular height was less, especially in females and in situations where the fracture line was in close proximity to the mental foramen. The placement of LS and Herbert screw was technique sensitive but did achieve good initial stability in addition to shortening the procedure time. The MPs were more versatile but required more operating time and hardware for the management of the anterior mandibular fractures. Conclusion: All of these modalities were able to achieve satisfactory final outcome. The rigid fixation techniques achieved similar results with less hardware and required lesser times. The MP fixation techniques, on the other hand, are more versatile and less technique sensitive.
Annals of Maxillofacial Surgery, 2019
Background: Recently, oral and maxillofacial surgeons are favoring three-dimensional (3D) minipla... more Background: Recently, oral and maxillofacial surgeons are favoring three-dimensional (3D) miniplates to treat mandibular fractures. Aims: The aim of the study is to evaluate the efficacy of 3D-miniplates over standard miniplates in the management of mandibular parasymphysis fracture. Materials and Methods: Forty patients with mandibular parasymphysis fractures were divided into two groups of 20 patients each. Group I patients underwent osteosynthesis of mandibular fracture by noncompression, unicortical, and stainless steel 3D miniplates, and Group II patients underwent osteosynthesis by noncompression, unicortical, and stainless steel Champy's miniplates. All the patients were followed up 6 months' postoperatively, evaluating occlusion, mobility of fracture segment, pain, wound dehiscence, neurological deficit, and infection. Statistical Analysis Used: The data were analyzed by SPSS for windows (version 17) statistical package (SPSS Inc., Chicago, IL, USA). Chi-square test was carried out to determine the statistical difference between the groups. Results: Mobility of the fractured site was evaluated postoperatively after 2 weeks, and it was found that mobility was absent in all the cases of Group I and 36 (80%) cases in Group II. There was significant difference in the mean visual analog scale scores among the Group I and II when compared from preoperative to 4-week follow-up. In Group II, two patients showed wound dehiscence. After 2 weeks, infection was seen in two patients of Group II. Conclusion: 3D plates in mandibular parasymphysis fractures give dimensional stability and carry low morbidity and infection rates.
Journal of Oral Biology and Craniofacial Research, 2019
The aim of this study was to compare mouth opening exercise outcomes with wooden tongue depressor... more The aim of this study was to compare mouth opening exercise outcomes with wooden tongue depressors (WTDs) versus Heister jaw opener (HJO) in improving mouth opening after reconstruction of the surgical defect with buccal fat pad (BFP) in oral submucous fibrosis (OSF) patients. Materials and methods: Fifty consecutive patients were divided randomly into two groups (25 patients in each group) corresponding to postoperative physiotherapy with WTDs (group 1) and HJO (group 2) respectively. Groups 1 and 2 were evaluated for maximum interincisal distance at 3, 6 and 12 months of follow up. In groups 1 and 2, mouth opening differed substantially at all periods of follow up from preoperative values. Results: The increase in mouth opening was greater in group 2 at 3 (P = 0.003) and 6 (P = 0.010) month follow up visit respectively. No relevant difference was observed in mouth opening between groups 1 and 2 at 12 months (P = 0.066). The mean increase in mouth opening at 12 months compared with the preoperative value was 22.2 mm in group 1 and 25 mm in group 2. Conclusion: We conclude both WTDs and HJO are effective in improving postoperative mouth opening in OSF surgical patients.
Journal of Maxillofacial and Oral Surgery, 2017
Aim To compare the analgesic efficacy of Diclofenac visa-vis Ketoprofen transdermal patch, in the... more Aim To compare the analgesic efficacy of Diclofenac visa-vis Ketoprofen transdermal patch, in the management of immediate post-operative pain following orthognathic procedures. Material and Method A prospective, double-blinded, randomised controlled study was conducted among 50 subjects, between 2012 and 2015. These patients were diagnosed clinically and cephalometrically as skeletal and dental class II malocclusion and underwent bi-jaw surgical procedure. In total, 25 Diclofenac and 25 Ketoprofen transdermal patches, sealed in envelopes and numbered, were administered to subjects. The patches used, contained 100 mg of either Diclofenac or Ketoprofen and administered by a nurse prior to induction. Duration of analgesia, severity of pain using Visual Analog Scale, necessity of rescue analgesia (spontaneous pain [ 5 on a 10-cm scale) and any other adverse effect associated with the drug were evaluated. Results Mean duration of analgesia was significantly higher in the Ketoprofen group (20 h), compared to Diclofenac group (13 h) (p = 0.001). Rescue analgesia was required in 12% of subjects who received Diclofenac patch, compared to 4% in Ketoprofen group. None of the subjects showed any allergic reactions. Conclusion The study was designed to evaluate the efficacy of transdermal patch in reduction of post-operative pain in subjects undergoing bi-jaw surgeries. Subjects in both groups were comfortable and returned to early function. However, Ketoprofen transdermal patch had an edge over the Diclofenac transdermal patch with respect to analgesic efficacy.
Journal of Pierre Fauchard Academy (India Section), 2018
The most important aspect of impacted mandibular third molar surgery or in complicated exodontia ... more The most important aspect of impacted mandibular third molar surgery or in complicated exodontia is removal of roots. Based on our clinical experience, we modified the cryer elevator and compared with normal cryer elevator during surgical removal of roots in bilateral symmetrical impacted mandibular third molars. Therefore, a randomised single blind clinical trial was designed to analyze the efficacy of modified cryer elevator. Thirty-six patients with bilateral identical impacted lower third molars requiring surgical removal, under local anaesthesia, were included. A standard surgical protocol was followed. Roots were removed using Cryer elevator on one side and modified cryer elevator on the other. The ease of the removal of roots (easy, moderate and difficult) and time interval from the start of buccal guttering until removal of roots out of the socket were noted. The difference in ease of removal of roots (p =0.03) and duration (p<0.001) was statistically significant between the two elevators. We conclude use of modified cryer elevator is effective in surgical extraction of impacted mandibular third molars.
Journal of Maxillofacial and Oral Surgery, 2017
Aims The aim of this study was to evaluate cephalometrically the stability of hard tissues and so... more Aims The aim of this study was to evaluate cephalometrically the stability of hard tissues and soft tissue changes of advancement genioplasty 2 years after surgery. Methods A prospective study was conducted which comprised of 25 patients, who underwent advancement genioplasty alone with no other orthognathic surgical procedures. Immediate pre-operative, 6 months postoperative, and 2 years postoperative lateral cephalograms were compiled and assessed. Results The mean surgical advancement planned was around 8 mm. Six months post-surgery, the relapse rate was 15% of the surgical advancement which was considerably reduced in the following 18 months to 7%. The ratio of soft tissue to bony advancement at pogonion was 0.9:1. There are significant alterations in the soft tissue profile in terms of decrease in the soft tissue thickness, facial convexity angle, deepened mentolabial sulcus and minimal increase in the lower lip height. Conclusion Advancement genioplasty was considered as a relatively stable procedure, if adequate muscular pedicle and internal rigid fixation were maintained. The present study was of 2 years, and we can expect further changes in the hard and soft tissues, which are clinically irrelevant.
The British journal of oral & maxillofacial surgery, Jan 22, 2017
Journal of Maxillofacial and Oral Surgery, 2016
Purpose The purpose of this study is to determine the necessity and/or effectiveness of antibioti... more Purpose The purpose of this study is to determine the necessity and/or effectiveness of antibiotics in cases with maxillofacial trauma and emphasise the administration of antibiotics in maxillofacial fractures indicated for open reduction and rigid internal fixation (ORIF). Materials and Methods This study is a single blind, prospective, randomized clinical trial composed of subjects who presented with non-comminuted, linear fractures of the mandible and were treated by ORIF via an intraoral approach. One hundred and forty-four subjects (2011-2015) who belonged to the above entities were randomly categorized into 2 groups of 72 each, on lottery method. Patients in Group A were administered a 5 day course of antibiotic (1 day IV antibiotics followed by 4 days oral) while patients in Group B received a 1 day course of IV antibiotic (1 dose post op). Both the groups were followed up on the 1st day, 3rd day, 1st week, 1st month, 3rd month post operatively and were evaluated for pain, swelling, infection, fever, spontaneous wound dehiscence, purulent discharge and any other adverse effects. Results Post operative infection when measured clinically and radiographically was comparatively higher in Group B. Out of 72 patients in both the groups, 5 patients each in Group A and Group B reported with wound dehiscence, 9 patients in both groups developed pyrexia. Conclusion Though the post operative infection was slightly more in Group B compared to Group A, 1 day antibiotic regimen was found to be equally effective when compared to 5 day regimen and helps in reducing the after effects, superinfection and antibiotic resistance. It has better patient compliance and is cost effective.
International Journal Of Medical Science And Clinical Invention, 2016
Aim: To compare the effectiveness of five day versus one day perioperative dose of corticosteroid... more Aim: To compare the effectiveness of five day versus one day perioperative dose of corticosteroids in mandibular fractures operated via an intraoral approach. Materials and method: This is a prospective, randomized, controlled, double blind clinical study involving 144 subjects from (2011-2015) who underwent Open reduction and internal fixation (ORIF) via intraoral approach for simple, non-comminuted, fractures of mandible. The subjects were randomly assigned into 2 groups of 72 each by lottery method. Patients in Group A (control group) were administered a tapering dose of Dexamethasone 8mg IV over 5days while patients in Group B (test group) received one preoperative and one postoperative dose of intravenous (IV) Dexamethasone. Both groups were administered 1 st dose of 8mg Dexamethasone simultaneously. Both the groups were followed up on the 1 st day, 3 rd day, 1 st week post operatively and were evaluated for pain (VAS on 10cm scale), swelling, paraesthesia, nausea and vomiting and any other adverse effects. Results: Postoperatively swelling at 48hours was higher in test group by 7.5% which was statistically significant (p = 0.001). Paraesthesia was also 10% higher in test group but wound dehiscence was higher in control group by 7.5%. The test group also recorded lower incidence of infection clinically as well as radiographically. Conclusion: 5 day steroid regimen and 1 day regimen were equally effective in increasing patients comfort by reducing swelling. However, 1 day regimen was significantly satisfactory with regard to healing and long term outcomes while being cost effective at the same time.
Indian Journal of Oral Sciences, 2015
Juvenile psammomatoid ossifying fibroma (JPOF) is a rare fibro-osseous neoplasm in young children... more Juvenile psammomatoid ossifying fibroma (JPOF) is a rare fibro-osseous neoplasm in young children which is locally aggressive, spreads quickly and has a very high recurrence rate. Early detection and complete excision are essential. It generally occurs in extragnathic craniofacial bones such as periorbital, frontal, and ethmoid bones. Jaw bones are rarely involved. Here, we report a case of JPOF of the maxilla in a 16-year-old female patient. Complete surgical excision along with removal of the first premolar was done. It was initially thought to be Fibro-osseous lesions which were provisionally diagnosed as juvenile ossifying fibroma clinically and radiographically but confirmed histopathologically as JPOF. Definitive diagnosis and treatment of such lesions depend on the collective correlation of clinical, radiographic, and histopathological features.
Medical Journal Armed Forces India, 2014
British Journal of Oral and Maxillofacial Surgery, 2019
Recent decades have witnessed the genesis and progressive application of intelligent machines and... more Recent decades have witnessed the genesis and progressive application of intelligent machines and computer programs that have the ability to process information and execute cognitive functions similar to those of human logic and reasoning such as problem solving and decision making. That is artificial intelligence (AI) in a nutshell as envisioned by John McCarthy, "the father of AI". Healthcare has welcomed AI, giving rise to collaborations such as the Moorfields Eye Hospital and Google's DeepMind division in the screening and predicting of retinal disease. The use of AI by the maxillofacial surgical fraternity is, however, limited. We wish to highlight the fact that surgeons are uniquely positioned to help drive these innovations rather than passively waiting for the technology to become useful.
Giant cell lesions is a broad term encompassing a wide range of lesions that are biologically and... more Giant cell lesions is a broad term encompassing a wide range of lesions that are biologically and morphologically diverse with an uncertain aetiology, whether it is a benign tumour, reactive lesion, inflammatory lesion or a self-healing lesion is ill understood. Their relation to each other also is not very clearly defined as they differ in their clinical and radiographic characteristics and their only similarity is in the histologic finding of non-neoplastic osteoclast like giant cells of different lineage. Owing to this fact their exact diagnosis continues to be one of the most obscure making them a dilemma, leaving many questions regarding their treatment and prognosis unanswered. Here we present a case of Central Giant Cell Tumor that was misdiagnosed as fibrous dysplasia that lead to an elusive treatment plan.
Journal of Oral and Maxillofacial Surgery
Dynamic stability of the temporomandibular joint (TMJ) is the characteristic of the joint to achi... more Dynamic stability of the temporomandibular joint (TMJ) is the characteristic of the joint to achieve normal function by harmonious, balanced, synchronized interactions of the various functional subunits of the stomatognathic system. The aim of this study was to evaluate changes in the mechanics and dynamics of the TMJ during recovery from surgical treatment of an isolated condylar fracture. This is a prospective cohort study involving 30 patients who underwent open reduction and internal fixation for an isolated unilateral condylar fracture and were clinically asymptomatic at 6 months after surgery. The dynamics of the TMJ were assessed by bite-force analysis, both static and dynamic, to assess masticatory efficiency. Surface electromyography was recorded to assess changes in muscle dynamics. Joint vibration analysis was performed to evaluate the internal functioning of the TMJ. All the assessments were carried out bilaterally to allow comparison of the injured and uninjured joints, and the data were analyzed with the paired t test and independent-samples t test. Statistical significance was considered at P < .05. The study included 18 male and 12 female patients aged between 20 and 40 years. Bite-force analyses showed significantly higher bite forces on the uninjured side at 6 months after surgery. Similarly, surface electromyography analysis showed increased muscle activity on the affected side pointing toward some compensatory hyperactivity in the masticatory muscles. Joint vibration analysis showed that there was increased friction during function in both the injured and uninjured joints. The observations in this study suggest that residual imbalances are present in the TMJ at 6 months after open reduction and internal fixation of condylar fractures. Therefore, long-term studies are required to establish a complete timeline of adaptive changes occurring in the TMJ after condylar fractures, especially in comparison with other treatment modalities.
Indian Journal of Contemporary Dentistry, 2016
Journal of Indian Orthodontic Society, 2015
Journal of Maxillofacial and Oral Surgery, 2011
Transverse maxillary deficiencies are a common occurance, prevalent in both syndromic and non syn... more Transverse maxillary deficiencies are a common occurance, prevalent in both syndromic and non syndromic patients. Treatment usually combines a orthodontic-surgical intervention in adults. This article reviews the procedures along with the experience of the authors in the correction of maxillary transverse deficiency in adults.
Journal of Maxillofacial and Oral Surgery, 2017
Aim To investigate the perception of Oral and maxillofacial surgery by healthcare professionals, ... more Aim To investigate the perception of Oral and maxillofacial surgery by healthcare professionals, students and general public. Materials and Methods A questionnaire form was created that listed ten clinical situations, and given by hand to 1200 individuals, divided into six groups: group 1, medical professionals; group 2, Specialties of dentistry; group 3, general dentists; group 4, medical students; group 5, dental students; and group 6, general public, each comprising 200 individuals. Respondents were asked to indicate who they would expect to treat them if they had one of the specified conditions listed in the questionnaire. We present the results and current awareness levels of this simple questionnaire. The present study addresses the common issue raised by many authors, 'What surgical education the speciality offers?' especially to medical professionals, medical students and general public to enhance an appropriate referral. Results Most of the respondents in groups 2, 3 and 5 agreed that specific conditions listed in the questionnaire were within the domain of oral and maxillofacial surgery, but such response was not seen in groups 1, 4 and 6 (p \ 0.001). An overall awareness level of oral and maxillofacial surgery was found to be 50.2%. Conclusion The onus of creating and improving the awareness and perception of our specialty lies on oral and maxillofacial surgeon. Unified efforts at individual as well as global level will help achieve this goal.
Journal of Maxillofacial and Oral Surgery, 2021
The aim of this study is to clinically and radiographically evaluate the stability of parasymphys... more The aim of this study is to clinically and radiographically evaluate the stability of parasymphysis fracture managed with lag screws, miniplates and 3D miniplates. Ninety- eight patients diagnosed with parasymphysis fracture were treated using lag screws in group 1, two 4-hole miniplates in group 2 and 3D miniplates in group 3. Intraoperative stability and duration of fixation was assessed. Postoperative clinical evaluation was done at 1 week, 1 month, 3rd month, 6th month and 1 year for complications and oral function. Radiological evaluation was done at 3rd and 6th month. Only 92 patients were considered for statistical analysis since 6 patients were lost during follow-up. Road traffic accident (65.3%) was the primary cause of mandibular fractures. Postoperative pain score showed a statistically significant difference after 1 week and 1 month duration (P value < 0.001). ANOVA test showed VAS was significantly higher at pre-op followed by 1st day and 1 week, but no significant difference after 3 months in all groups. Radiographic analysis did not show significant difference in approximation of fracture segment among 3 groups after 6 months (P-value = 0.117). Chewing efficiency at 6 months and occlusion by surgeon evaluation at 3 months showed a significant difference (P value < 0.001). Lag screw fixation was technique-sensitive, relatively inexpensive and was less time consuming method when compared to miniplates and 3D plates. Lag screws and 3D plates are superior in reducing the incidence of complications and better in oblique or sagitally displaced mandibular fractures.
Journal of Maxillofacial and Oral Surgery, 2020
Aim This study is designed to outline the probable patterns of mandibular fracture based on patie... more Aim This study is designed to outline the probable patterns of mandibular fracture based on patient demographics and mechanism of injury in a rural setup. Materials and Methods The data from the record section in our unit belonging to patients who sustained fractures in the maxillofacial skeleton and were treated in our unit between the period June 2012-May 2019 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation. Results A total of 224 patients with maxillofacial fractures were diagnosed, of which 195 were male and 29 were female. The ages ranged from 7 to 70 years. Road traffic accidents are noted to be the most common cause of mandibular fractures. The maximum cases were in the age group of 21-30 years with 85 (38%) patients. In a total of 224 patients, there were 278 mandibular fractures. The maximum incidence of fractures was in the mandibular parasymphysis region with 90 fractures accounting for 32.3% of the mandibular fractures. Males were more susceptible to mandibular fractures. Majority of them sustained mandibular fracture at more than one anatomical area. Conclusion It can be concluded that mandibular fractures are seen predominantly in the second and third decades of life due to road traffic accidents with high-speed vehicles and lack of protective safety accessories. Mandible when it fractured, it usually involved more than one anatomical location.
Journal of Dental Research and Review, 2019
Aim: The aim of this study was to evaluate the efficacy and reliability of fracture management in... more Aim: The aim of this study was to evaluate the efficacy and reliability of fracture management in the anterior mandible using miniplates (MPs), lag screws (LSs), three-dimensional (3D) plates, and Herbert screws. Materials and Methods: The study consists of forty patients randomly divided into four groups of ten, undergoing open reduction internal fixation of anterior mandible fractures using MPs, LSs, 3D plates, or Herbert screw. All the patients were evaluated for stability of fracture fragments, duration of procedure, requirement of maxillomandibular fixation, and other associated complications. Results: The results of this study showed that each fixation device has its own merits and demerits. The rectangular plates achieved good stability, but its placement and adaptation was challenging in certain clinical scenarios when the anterior mandibular height was less, especially in females and in situations where the fracture line was in close proximity to the mental foramen. The placement of LS and Herbert screw was technique sensitive but did achieve good initial stability in addition to shortening the procedure time. The MPs were more versatile but required more operating time and hardware for the management of the anterior mandibular fractures. Conclusion: All of these modalities were able to achieve satisfactory final outcome. The rigid fixation techniques achieved similar results with less hardware and required lesser times. The MP fixation techniques, on the other hand, are more versatile and less technique sensitive.
Annals of Maxillofacial Surgery, 2019
Background: Recently, oral and maxillofacial surgeons are favoring three-dimensional (3D) minipla... more Background: Recently, oral and maxillofacial surgeons are favoring three-dimensional (3D) miniplates to treat mandibular fractures. Aims: The aim of the study is to evaluate the efficacy of 3D-miniplates over standard miniplates in the management of mandibular parasymphysis fracture. Materials and Methods: Forty patients with mandibular parasymphysis fractures were divided into two groups of 20 patients each. Group I patients underwent osteosynthesis of mandibular fracture by noncompression, unicortical, and stainless steel 3D miniplates, and Group II patients underwent osteosynthesis by noncompression, unicortical, and stainless steel Champy's miniplates. All the patients were followed up 6 months' postoperatively, evaluating occlusion, mobility of fracture segment, pain, wound dehiscence, neurological deficit, and infection. Statistical Analysis Used: The data were analyzed by SPSS for windows (version 17) statistical package (SPSS Inc., Chicago, IL, USA). Chi-square test was carried out to determine the statistical difference between the groups. Results: Mobility of the fractured site was evaluated postoperatively after 2 weeks, and it was found that mobility was absent in all the cases of Group I and 36 (80%) cases in Group II. There was significant difference in the mean visual analog scale scores among the Group I and II when compared from preoperative to 4-week follow-up. In Group II, two patients showed wound dehiscence. After 2 weeks, infection was seen in two patients of Group II. Conclusion: 3D plates in mandibular parasymphysis fractures give dimensional stability and carry low morbidity and infection rates.
Journal of Oral Biology and Craniofacial Research, 2019
The aim of this study was to compare mouth opening exercise outcomes with wooden tongue depressor... more The aim of this study was to compare mouth opening exercise outcomes with wooden tongue depressors (WTDs) versus Heister jaw opener (HJO) in improving mouth opening after reconstruction of the surgical defect with buccal fat pad (BFP) in oral submucous fibrosis (OSF) patients. Materials and methods: Fifty consecutive patients were divided randomly into two groups (25 patients in each group) corresponding to postoperative physiotherapy with WTDs (group 1) and HJO (group 2) respectively. Groups 1 and 2 were evaluated for maximum interincisal distance at 3, 6 and 12 months of follow up. In groups 1 and 2, mouth opening differed substantially at all periods of follow up from preoperative values. Results: The increase in mouth opening was greater in group 2 at 3 (P = 0.003) and 6 (P = 0.010) month follow up visit respectively. No relevant difference was observed in mouth opening between groups 1 and 2 at 12 months (P = 0.066). The mean increase in mouth opening at 12 months compared with the preoperative value was 22.2 mm in group 1 and 25 mm in group 2. Conclusion: We conclude both WTDs and HJO are effective in improving postoperative mouth opening in OSF surgical patients.
Journal of Maxillofacial and Oral Surgery, 2017
Aim To compare the analgesic efficacy of Diclofenac visa-vis Ketoprofen transdermal patch, in the... more Aim To compare the analgesic efficacy of Diclofenac visa-vis Ketoprofen transdermal patch, in the management of immediate post-operative pain following orthognathic procedures. Material and Method A prospective, double-blinded, randomised controlled study was conducted among 50 subjects, between 2012 and 2015. These patients were diagnosed clinically and cephalometrically as skeletal and dental class II malocclusion and underwent bi-jaw surgical procedure. In total, 25 Diclofenac and 25 Ketoprofen transdermal patches, sealed in envelopes and numbered, were administered to subjects. The patches used, contained 100 mg of either Diclofenac or Ketoprofen and administered by a nurse prior to induction. Duration of analgesia, severity of pain using Visual Analog Scale, necessity of rescue analgesia (spontaneous pain [ 5 on a 10-cm scale) and any other adverse effect associated with the drug were evaluated. Results Mean duration of analgesia was significantly higher in the Ketoprofen group (20 h), compared to Diclofenac group (13 h) (p = 0.001). Rescue analgesia was required in 12% of subjects who received Diclofenac patch, compared to 4% in Ketoprofen group. None of the subjects showed any allergic reactions. Conclusion The study was designed to evaluate the efficacy of transdermal patch in reduction of post-operative pain in subjects undergoing bi-jaw surgeries. Subjects in both groups were comfortable and returned to early function. However, Ketoprofen transdermal patch had an edge over the Diclofenac transdermal patch with respect to analgesic efficacy.
Journal of Pierre Fauchard Academy (India Section), 2018
The most important aspect of impacted mandibular third molar surgery or in complicated exodontia ... more The most important aspect of impacted mandibular third molar surgery or in complicated exodontia is removal of roots. Based on our clinical experience, we modified the cryer elevator and compared with normal cryer elevator during surgical removal of roots in bilateral symmetrical impacted mandibular third molars. Therefore, a randomised single blind clinical trial was designed to analyze the efficacy of modified cryer elevator. Thirty-six patients with bilateral identical impacted lower third molars requiring surgical removal, under local anaesthesia, were included. A standard surgical protocol was followed. Roots were removed using Cryer elevator on one side and modified cryer elevator on the other. The ease of the removal of roots (easy, moderate and difficult) and time interval from the start of buccal guttering until removal of roots out of the socket were noted. The difference in ease of removal of roots (p =0.03) and duration (p<0.001) was statistically significant between the two elevators. We conclude use of modified cryer elevator is effective in surgical extraction of impacted mandibular third molars.
Journal of Maxillofacial and Oral Surgery, 2017
Aims The aim of this study was to evaluate cephalometrically the stability of hard tissues and so... more Aims The aim of this study was to evaluate cephalometrically the stability of hard tissues and soft tissue changes of advancement genioplasty 2 years after surgery. Methods A prospective study was conducted which comprised of 25 patients, who underwent advancement genioplasty alone with no other orthognathic surgical procedures. Immediate pre-operative, 6 months postoperative, and 2 years postoperative lateral cephalograms were compiled and assessed. Results The mean surgical advancement planned was around 8 mm. Six months post-surgery, the relapse rate was 15% of the surgical advancement which was considerably reduced in the following 18 months to 7%. The ratio of soft tissue to bony advancement at pogonion was 0.9:1. There are significant alterations in the soft tissue profile in terms of decrease in the soft tissue thickness, facial convexity angle, deepened mentolabial sulcus and minimal increase in the lower lip height. Conclusion Advancement genioplasty was considered as a relatively stable procedure, if adequate muscular pedicle and internal rigid fixation were maintained. The present study was of 2 years, and we can expect further changes in the hard and soft tissues, which are clinically irrelevant.
The British journal of oral & maxillofacial surgery, Jan 22, 2017
Journal of Maxillofacial and Oral Surgery, 2016
Purpose The purpose of this study is to determine the necessity and/or effectiveness of antibioti... more Purpose The purpose of this study is to determine the necessity and/or effectiveness of antibiotics in cases with maxillofacial trauma and emphasise the administration of antibiotics in maxillofacial fractures indicated for open reduction and rigid internal fixation (ORIF). Materials and Methods This study is a single blind, prospective, randomized clinical trial composed of subjects who presented with non-comminuted, linear fractures of the mandible and were treated by ORIF via an intraoral approach. One hundred and forty-four subjects (2011-2015) who belonged to the above entities were randomly categorized into 2 groups of 72 each, on lottery method. Patients in Group A were administered a 5 day course of antibiotic (1 day IV antibiotics followed by 4 days oral) while patients in Group B received a 1 day course of IV antibiotic (1 dose post op). Both the groups were followed up on the 1st day, 3rd day, 1st week, 1st month, 3rd month post operatively and were evaluated for pain, swelling, infection, fever, spontaneous wound dehiscence, purulent discharge and any other adverse effects. Results Post operative infection when measured clinically and radiographically was comparatively higher in Group B. Out of 72 patients in both the groups, 5 patients each in Group A and Group B reported with wound dehiscence, 9 patients in both groups developed pyrexia. Conclusion Though the post operative infection was slightly more in Group B compared to Group A, 1 day antibiotic regimen was found to be equally effective when compared to 5 day regimen and helps in reducing the after effects, superinfection and antibiotic resistance. It has better patient compliance and is cost effective.
International Journal Of Medical Science And Clinical Invention, 2016
Aim: To compare the effectiveness of five day versus one day perioperative dose of corticosteroid... more Aim: To compare the effectiveness of five day versus one day perioperative dose of corticosteroids in mandibular fractures operated via an intraoral approach. Materials and method: This is a prospective, randomized, controlled, double blind clinical study involving 144 subjects from (2011-2015) who underwent Open reduction and internal fixation (ORIF) via intraoral approach for simple, non-comminuted, fractures of mandible. The subjects were randomly assigned into 2 groups of 72 each by lottery method. Patients in Group A (control group) were administered a tapering dose of Dexamethasone 8mg IV over 5days while patients in Group B (test group) received one preoperative and one postoperative dose of intravenous (IV) Dexamethasone. Both groups were administered 1 st dose of 8mg Dexamethasone simultaneously. Both the groups were followed up on the 1 st day, 3 rd day, 1 st week post operatively and were evaluated for pain (VAS on 10cm scale), swelling, paraesthesia, nausea and vomiting and any other adverse effects. Results: Postoperatively swelling at 48hours was higher in test group by 7.5% which was statistically significant (p = 0.001). Paraesthesia was also 10% higher in test group but wound dehiscence was higher in control group by 7.5%. The test group also recorded lower incidence of infection clinically as well as radiographically. Conclusion: 5 day steroid regimen and 1 day regimen were equally effective in increasing patients comfort by reducing swelling. However, 1 day regimen was significantly satisfactory with regard to healing and long term outcomes while being cost effective at the same time.
Indian Journal of Oral Sciences, 2015
Juvenile psammomatoid ossifying fibroma (JPOF) is a rare fibro-osseous neoplasm in young children... more Juvenile psammomatoid ossifying fibroma (JPOF) is a rare fibro-osseous neoplasm in young children which is locally aggressive, spreads quickly and has a very high recurrence rate. Early detection and complete excision are essential. It generally occurs in extragnathic craniofacial bones such as periorbital, frontal, and ethmoid bones. Jaw bones are rarely involved. Here, we report a case of JPOF of the maxilla in a 16-year-old female patient. Complete surgical excision along with removal of the first premolar was done. It was initially thought to be Fibro-osseous lesions which were provisionally diagnosed as juvenile ossifying fibroma clinically and radiographically but confirmed histopathologically as JPOF. Definitive diagnosis and treatment of such lesions depend on the collective correlation of clinical, radiographic, and histopathological features.
Medical Journal Armed Forces India, 2014
British Journal of Oral and Maxillofacial Surgery, 2019
Recent decades have witnessed the genesis and progressive application of intelligent machines and... more Recent decades have witnessed the genesis and progressive application of intelligent machines and computer programs that have the ability to process information and execute cognitive functions similar to those of human logic and reasoning such as problem solving and decision making. That is artificial intelligence (AI) in a nutshell as envisioned by John McCarthy, "the father of AI". Healthcare has welcomed AI, giving rise to collaborations such as the Moorfields Eye Hospital and Google's DeepMind division in the screening and predicting of retinal disease. The use of AI by the maxillofacial surgical fraternity is, however, limited. We wish to highlight the fact that surgeons are uniquely positioned to help drive these innovations rather than passively waiting for the technology to become useful.
Giant cell lesions is a broad term encompassing a wide range of lesions that are biologically and... more Giant cell lesions is a broad term encompassing a wide range of lesions that are biologically and morphologically diverse with an uncertain aetiology, whether it is a benign tumour, reactive lesion, inflammatory lesion or a self-healing lesion is ill understood. Their relation to each other also is not very clearly defined as they differ in their clinical and radiographic characteristics and their only similarity is in the histologic finding of non-neoplastic osteoclast like giant cells of different lineage. Owing to this fact their exact diagnosis continues to be one of the most obscure making them a dilemma, leaving many questions regarding their treatment and prognosis unanswered. Here we present a case of Central Giant Cell Tumor that was misdiagnosed as fibrous dysplasia that lead to an elusive treatment plan.
Journal of Oral and Maxillofacial Surgery
Dynamic stability of the temporomandibular joint (TMJ) is the characteristic of the joint to achi... more Dynamic stability of the temporomandibular joint (TMJ) is the characteristic of the joint to achieve normal function by harmonious, balanced, synchronized interactions of the various functional subunits of the stomatognathic system. The aim of this study was to evaluate changes in the mechanics and dynamics of the TMJ during recovery from surgical treatment of an isolated condylar fracture. This is a prospective cohort study involving 30 patients who underwent open reduction and internal fixation for an isolated unilateral condylar fracture and were clinically asymptomatic at 6 months after surgery. The dynamics of the TMJ were assessed by bite-force analysis, both static and dynamic, to assess masticatory efficiency. Surface electromyography was recorded to assess changes in muscle dynamics. Joint vibration analysis was performed to evaluate the internal functioning of the TMJ. All the assessments were carried out bilaterally to allow comparison of the injured and uninjured joints, and the data were analyzed with the paired t test and independent-samples t test. Statistical significance was considered at P < .05. The study included 18 male and 12 female patients aged between 20 and 40 years. Bite-force analyses showed significantly higher bite forces on the uninjured side at 6 months after surgery. Similarly, surface electromyography analysis showed increased muscle activity on the affected side pointing toward some compensatory hyperactivity in the masticatory muscles. Joint vibration analysis showed that there was increased friction during function in both the injured and uninjured joints. The observations in this study suggest that residual imbalances are present in the TMJ at 6 months after open reduction and internal fixation of condylar fractures. Therefore, long-term studies are required to establish a complete timeline of adaptive changes occurring in the TMJ after condylar fractures, especially in comparison with other treatment modalities.
Indian Journal of Contemporary Dentistry, 2016
Journal of Indian Orthodontic Society, 2015
Journal of Maxillofacial and Oral Surgery, 2011
Transverse maxillary deficiencies are a common occurance, prevalent in both syndromic and non syn... more Transverse maxillary deficiencies are a common occurance, prevalent in both syndromic and non syndromic patients. Treatment usually combines a orthodontic-surgical intervention in adults. This article reviews the procedures along with the experience of the authors in the correction of maxillary transverse deficiency in adults.