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   Table of Contents - Current issue
October-December 2020
Volume 32 | Issue 4
Page Nos. 321-420

Online since Monday, December 28, 2020

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From the desk of the Editor - In - Chief p. 321
Dipti Bhatnagar
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Oral physicians in the management of head and neck cancers p. 322
Natarajan Kannan
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Therapeutic effect of proton pump inhibitor (Omeprazole) on homogenous leukoplakia with clinico-fractal analysis: A pilot study Highly accessed article p. 323
Nivethitha Nagarajan, S Jayachandran
Background: Oral leukoplakia is a white patch or plaque that cannot be characterized clinically or pathologically as any other disease and is not associated with any physical or chemical causative agent except the use of tobacco. The prevalence of leukoplakia in India varies from 0.2% to 4.9% with variable clinical pattern and tendency towards malignant transformation. Current treatment strategies for oral leukoplakia include chemotherapeutic and surgical approaches. Aim and Objective: The study was done to compare the clinical and therapeutic effects of proton pump inhibitor therapy and vitamin-A therapy in oral leukoplakia. Setting and Design: Hospital based in-vivo prospective study. Materials and Method: The study compared two treatment groups; Proton pump inhibitor therapy-(Omeprazole - 20 mg) and vitamin-A therapy (200000 I.U.). The clinical assessment (size and surface texture), salivary pH and fractal dimension values were compared in pre-treatment and post-treatment periods. Statistical Analysis: SPSS® 25.0 (Statistical Package for the Social Sciences) was used for statistical analysis. Mean, standard deviation and independent t test were calculated. Results: The clinical assessment of pre-treatment and post-treatment revealed reduction in size and surface roughness in both the groups. The salivary pH and fractal dimension showed significant alterations in post treatment period of both groups but the P value (0.949) was not significant between the groups. Conclusion: This study demonstrated the efficacy of proton pump inhibitor therapy for oral leukoplakia in comparison with vitamin-A therapy. The study revealed reduction in the size, roughness of oral leukoplakia and alteration of salivary pH with proton pump inhibitor therapy.
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Elongated styloid process evaluation on digital panoramic radiographs: A retrospective study Highly accessed article p. 330
MunBhawni Bagga, Deepankar Bhatnagar, Nishant Kumar
Background: The precise knowledge about anatomy of both normal and abnormal styloid process is important for clinicians, surgeons, and radiologists. Thus, the present study highlighted the prevalence of anatomic-radiological features of elongated Styloid process on panoramic radiography. Aim: The aim of the study was to evaluate and classify the radiographic appearance of the Styloid process (SP) along with morphologic characteristics and patterns of calcification according to the subject gender and site predilection. Materials and Method: A random sample of 1706 good quality digital panoramic radiographs were included in present study. Elongated SPs were classified with the radiographic appearance based on morphology and calcification pattern. The data were analyzed by using student t test and Chi-squared with significance set at P = 0.05. Results: Bilateral elongation having “Elongated” Type SP with “partially calcified” pattern was the most frequent SP. No correlation was found between SP type and calcification pattern and subject gender, although elongated Styloid was more prevalent among male population (P < 0.001). Conclusion: Dentists should recognize the existence of morphological variation in elongated Styloid process apparent on panoramic radiographs. According to our knowledge, this is the first study conducted in Solan region to evaluate Styloid process elongation (SPE) and also had recorded highest prevalence of SPE in comparison with other studies conducted in Indian population. We found calcification of the Styloid process is common in older age groups with no correlation to gender and site predilection. “Type I” with “partially calcified” of the Styloid process was observed most frequently in the population studied.
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Effect of hand-held mobile phones on the parotid gland: A cross sectional study p. 335
G Jeevitha, G Anuradha
Background: The mobile phones widely used today uses electromagnetic radiations for signal transmission. These radiations have been speculated to cause pathological changes, especially in the salivary glands. Aim: The aim of the present study was to compare the salivary flow rate, pH, total protein concentration, Immunoglobulin A, total antioxidant capacity and salivary amylase levels of the parotid saliva between the dominant and non-dominant sides of mobile phone usage. Settings and Design: A total of 40 participants who used hand-held mobile phones were selected for the study. Materials and Method: Group A comprised of participants who used mobile phones for 0-2 hours a day, group B comprised of participants who used mobile phones for 2-4 hours a day and group C comprised of participants who used mobile phones for more than 4 hours a day. The parotid salivary pH, total protein concentrations, immunoglobulin A (IgA), salivary amylase, and total antioxidant capacity were estimated. Statistical Analysis: One-way ANOVA, Tukey HSD test and Pearson's correlation were used. Results: There was an increase in the mean salivary flow rate, pH and salivary IgA levels on the dominant side of participants. The mean total protein levels and IgA levels in the dominant sides of group A, B and C was 22.56 ± 9.35, 20.10 ± 4.95, 17.44 ± 4.52 and 3.39 ± 0.62, 5.03 ± 0.72, 7.51 ± 1.17, respectively. There was a decrease in the mean total protein, amylase and total antioxidant capacity in the dominant side. Conclusion: Our study has shown an increase in the levels of salivary flow rate, pH and IgA in the dominant side of usage.
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Digital cephalometric analysis of pharyngeal airway space changes in oral submucous fibrosis patients: A cross sectional observational study p. 341
Yash Agrawal, Giridhar S Naidu, Ravleen Nagi, Supreet Jain, Manjari Choudhary, Vishal Choudhary
Background: Oral submucous fibrosis (OSMF) causes changes over the pharynx that may cause changes in airway dimensions. Cephalometry could be a reliable diagnostic tool for evaluation of the changes happening in the pharyngeal structures, so that preventive measures such as areca nut habit cessation could be initiated at an earlier stage. Aim: To test pharyngeal changes and airway dimensions in OSMF patients using digital lateral cephalograms. Setting and Design: This was a crossectional observational study done in the Department of Oral Medicine and Radiology. Material and Method: Twenty-two subjects with clinically diagnosed OSMF formed the study group A, and 30 healthy subjects formed the control group B. OSMF subjects were further divided into stage I, II, III according to Nagesh And Bailoor (1993) criteria. We tested all study subjects for velopharyngeal and upper airway dimensions as measured on Digital Lateral Cephalographs using Sirona Sidexis software. The findings were compiled to arrive at data in the study population. Result: Statistically significant difference was observed for mouth opening tongue between different stages of OSMF (p = 0.000) and significant difference was also observed for hyoid position to vertical, AH-FH (p = 0.023), tongue length (VT) (p = 0.002), mid airway width (p = 0.031), soft palate width (p = 0.012) between the groups. Conclusion: There was a significant change in the pharyngeal airway with the advancing stage of OSMF. Lateral cephalometric radiographs are a useful, non-invasive diagnostic tool to analyze pharyngeal airway changes in OSMF patient's to prevent the development of complications associated with advanced stages.
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Detection of oral submucous fibrosis using ultrasonography in a Navi Mumbai population: An analytical cross sectional study p. 347
Priyanka Vijay Patil, Amita Navalkar
Background: Ultrasonography (USG) has emerged as a real time imaging modality capable of assessing the thickness and depth of the affected oral mucosa in a potentially malignant condition like Oral Submucous Fibrosis. Aim: To test the efficiency of Ultrasonography as a diagnostic tool in Oral Submucous Fibrosis and correlate it with clinical staging. Settings and Design: Analytical Cross-sectional study conducted in Department of Oral Medicine, Diagnosis and Radiology (OMDR) for patients with a history of areca nut chewing, with and without Oral Submucous Fibrosis with USG for assessing Masseter thickness on right and left side. Materials and Methods: USG was done to assess Masseter muscle thickness on the right and left side for 90 patients, 45 with a history of habit and Oral Submucous Fibrosis and 45 with history of habit and without Oral Submucous Fibrosis. Statistical Analysis: Using SPSS Software, Intra, and Intergroup comparison of frequencies of clinical variables and thickness of masseter muscle on USG was done using the Chiquare test. Result: In group 1, intergroup comparisons showed a concomitant increase in Masseter thickness with an increase in severity of Oral Submucous Fibrosis on USG, which was statistically significant. In group 2, USG could detect the increased thickness of the masseter despite the absence of clinical signs and symptoms. Conclusion: Ultrasonography was effective in determining the thickness of the Masseter in subjects with Oral Submucous Fibrosis. Initial thickening of the muscle in patients with no Oral Submucous Fibrosis was noted, thus proving the diagnostic value of USG in Oral Submucous Fibrosis.
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Salivary cortisol could be a promising tool in the diagnosis of temporomandibular disorders associated with psychological factors p. 354
Gaurav Goyal, Deepak Gupta, Shambulingappa Pallagatti
Background: Biopsychosocial models emphasize the multifactorial nature of temporomandibular disorders (TMDs). The role of cognitive, social, and biological factors in the etiology of TMDs has been reported. Aim: To test the salivary cortisol levels in young adults with the temporomandibular joint disorder and having positive depression level and with TMD but with negative depression level and compared with the control group. The correlation between cortisol levels and depression levels according to axis-II of Research Diagnostic Criteria (RDC) was assessed. Settings and Design: The study was a randomized, prospective, and double-blinded study. Materials and Method: The total sample comprised 60 subjects. The study comprised 20 subjects with TMD and depression, 20 subjects with TMDs and without depression, and 20 subjects were taken as the control group. To measure these variables, research diagnostic criteria (RDC/TMJ) were used for the study. Salivary cortisol levels were determined by Enzyme-linked immunosorbent assay (ELISA). Statistical Analysis: A paired t-test, ANOVA, and linear multi regression tests applied to compare the TMD groups with the control group. Results: The results showed that there was a positive correlation between morning and evening salivary cortisol levels in all the groups and the correlation coefficient was 0.729. There was a significantly higher value of salivary cortisol in TMD patients with depression than TMD patients without depression and the control group. Conclusion: Salivary cortisol could be a promising tool in identifying underlying psychological factors that could be associated with TMD.
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Impact of COVID-19 on Indian dentists: A cross sectional survey p. 360
Harneet Singh, Adarsh Kumar, Ambika Gupta, Anju Redhu, Aarti Singh
Background: COVID-19 and associated lockdown have had some detrimental effects on the health care professionals. With the maximum fear of getting infected and further transmitting the infection, dentists are suffering from the psychological meltdown along with the physical changes due to altered lifestyle. Aim and Objectives: To evaluate the psychological and physical effects of COVID-19 and consequential lockdown on dentists and to understand the possible reasons for the problems they were facing amidst lockdown due to the changes in their lifestyle. Settings and Design: A questionnaire-based survey to evaluate disaster mental health and analysis of musculoskeletal symptoms was designed and sent to the various groups of dentists. A total of 453 respondents completed the survey. Materials and Method: Cluster sampling method was used and the dentists were segregated into four groups. The responses were evaluated for Post-traumatic stress disorder, Depression, Anxiety and Pain or discomfort. Statistical Analysis: Chi Square test was applied to statistically assess the association of responses. Results: Out of 453 respondents 65.1% were females and 34.9% were males. Based on profession, 23% were academicians, 18.8% private practitioners, 16.8% post-graduate students and 41.5% undergraduates. Females were significantly affected and showed a tendency towards Post traumatic stress disease (PTSD) and potential depression along with pain and discomfort. All the three groups except undergraduate students showed potential symptoms. Conclusion: COVID-19 and the lockdown exhibited significant psychological and physical effects on the dentists. Counselling centers or helplines/portals need to be set up to avoid any grave consequences and untoward losses.
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Awareness of dental students towards CBCT: A cross sectional study p. 366
Sivesh Sangar, Jayanth Kumar Vadivel
Background: Cone-beam computed tomography (CBCT) is a new technology, in which two-dimensional detectors and conical beam are used instead of fan shaped beam in conventional computed CT. In CBCT, volumetric data are collected by the rotation of beam and detectors around the desired area of interest. The principal advantages of CBCT are in the smaller footprint of the machine and lower radiation dose. The knowledge of this imaging modality is limited and hence the application in clinical practice is not fully achieved. Aim: The present study aimed to assess the knowledge about Cone Beam Computed Tomography (CBCT) among interns of two Dental colleges in Chennai and their willingness to use this piece of imaging for their routine dental practice. Material and Methods: A closed-ended questionnaire was circulated to the interns of two dental colleges after obtaining necessary consent. Results: The results showed that there is a lack of knowledge regarding the application of this imaging modality and it is being applied in some areas where it is prone to give false-positive results. Conclusion: Overall, dentists had an average level of knowledge for CBCT. It is recommended that qualification programs to held for dentists to strengthen their awareness toward cone-beam computed tomography.
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Characteristics and prevalence of underwood's septae on digital panoramic radiographs p. 371
Anudeep Raina, MK Sunil, Lucy Pradhan, Garima Yeluri, SV Ravindra, Roopika Handa
Background: The term Underwood's septae is eponymously used for maxillary sinus septae. Septae may be defined as cortical bony partitions found in the form of inverted gothic arches that protrude from the sinus walls, dividing the sinus into two or more cavities. Aim: This study was aimed to determine the prevalence of maxillary sinus septae on digital panoramic radiographs. Settings and Design: This retrospective radiographic study was carried out in the Department of Oral Medicine and Radiology at Teerthanker Mahaveer Dental College and Research Centre, Moradabad. Materials and Methodology: This retrospective study comprised of panoramic radiographs of 100 subjects of either gender, aged between 16 and 80 years. Bony projections having a minimum height of 2.5mm were considered as septae according to the criteria suggested by Velasquez Plata D et al. The location of maxillary sinus septae was defined by Underwood classification as anterior, middle, and posterior. Statistical analysis: The data were analyzed using the SPSS statistical software 21.0 Version. Results and conclusion: Maxillary sinus septae were seen in 18 out of 100 radiographs, out of which unilateral maxillary sinus septae were noted in 08 cases (right-sided in 3, left-sided in 5) while bilateral septae were seen in 10 cases. The prevalence of maxillary sinus septae was found to be 18% on digital panoramic radiographs. Oral radiologists should thus report maxillary sinus septae and the possibility of surgical complications that may arise during maxillary sinus surgeries.
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Correlation of anthropometric measurements and odontometric measurements: A possible forensic tool in stature estimation p. 376
Tungala Navya Teja, K Naga Venkata Sai Praveen, Reddy Sudhakara Reddy, Tatapudi Ramesh, K Roja Reddy, D Geetanjali
Background: Stature or body height is one of the most essential and useful anthropometric parameters; determining an individual's physical identity. A proportional biological relationship of stature exists with every part of the human body, which plays a vital role in forensic investigations. Apart from them, teeth also have the advantage of being composed mainly of hard tissue, which is relatively indestructible. The careful study of these can enable reliable determination of the stature of the person. Aim: The aim is to correlate hand length, middle phalanx length and Carrea's index with that of actual individual height in determining the stature. Materials and Methods: A total of 150 subjects constituting a sample size of 300 (both right and left sides) of age range 20-25 years were considered in the present study. Height of the subject was measured using Standard Anthropometer. Hand length and Middle phalanx length was measured using digital vernier callipers. Mandibular impression was taken using alginate impression material, arch and chord length was measured on dental cast using digital vernier callipers. Statistical Analysis and Results: Regression equations were derived for hand and middle phalanx length to calculate estimated height and Carrea's index was used to calculate estimated height. The estimated heights from all parameters were compared with the actual height and linear correlation was obtained for all the parameters. Conclusion: Among all parameters hand length on both right and left sides predict stature more accurately whereas Carrea's method was used just as an auxillary tool.
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3D evaluation of maxillary sinus in gender determination: A cone beam computed tomography study p. 384
Anju Mathew, Lisa Elizabeth Jacob
Background: Gender determination is a subdivision of forensic medicine and very crucial especially when information relating to the deceased is unattainable. Maxillary sinus remains intact even when the skull and other bones may be badly disfigured. Aim and Objectives: This study aimed at assessing the reliability of morphometric measurements performed on the maxillary sinus for gender determination by Cone Beam Computed Tomography. Materials and Methodology: The present study was conducted in the Department of Oral Medicine and Radiology to assess maxillary sinus dimensions of 100 patients with 200 sinuses [left and right maxillary sinuses] by Cone Beam Computed Tomography. Two independent observers measured the maxillary sinus parameters such as width, length, height, intermaxillary distance, bizygomatic distance in axial and coronal view. Discriminative analysis was performed using the derived values and independent t-test was used to compare the values between males and females. Results: The overall values of the maxillary sinus dimensions were significantly greater (p < 0.05) in males as compared to females except intermaxillary distance (p > 0.05). There was no significant difference while comparing the right and left side within the same gender (p > 0.05). Maxillary sinus height was a better discriminant parameter for sexual dimorphism with 80% accuracy. Conclusion: Maxillary sinus can be used as an aid in forensic anthropology for gender determination. CBCT measurement of Maxillary Sinus can be used as supplementary tool for gender determination.
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Evaluation of orbital morphometry using 3D computed tomographic images in biological sex determination: A retrospective study p. 390
Sudhaa Mani Mani, S Yasmeen Ahamed, P Ambiga, Valarmathi Ramalingam, G Sivaraman, N Balan
Background: Forensic science, also known as Criminalistics is a field of science that uses science for investigation and its application in civil and criminal proceedings. One of the main challenges is to identify the dead during criminal and mass disaster investigations. Aim: The study aims to evaluate the morphometry of the orbital aperture and to verify its relationship with biological sex discrimination using three-dimensional Computed Tomography (3D CT). Study Design: This retrospective study involves 100 3D CT images of 50 males and 50 females (age 18-60 years). Materials and Methods: The exclusion criteria were congenital anomalies affecting the head and neck region, orbital fracture, systemic diseases affecting bone and head and neck tumor. Eight orbital parameters such as Orbital width, orbital height, orbital roof length, orbital floor-length, lateral orbital wall length, medial orbital wall length, intraorbital distance, and extra orbital distance were measured for all the 3D CT images using RadiAnt DICOM Viewer (64 bit). Statistical Analysis: Descriptive statistics including mean, standard deviation, and percentage distribution were calculated. Mann Whitney U-test assessed the comparison between groups. The linear regression equation and Wilk's lambda were also calculated for every parameter. Results: All the orbital measurements except for intraorbital distance were statistically significant between male and female subjects. Totally, 92.0% of the individuals were correctly classified. Conclusions: Orbital measurements were significantly larger in males than in females. Orbits exhibit the least dimensional change throughout one's life. Hence, it could be used as an adjunct in biological sex determination.
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Unilateral agenesis of the mental foramen p. 396
Ajay Pratap Singh Parihar, Sheetal Singar, Sonam Gehi, Ashish Saxena, Arvind Jain
The inferior alveolar nerve canal opening in the anterior labial aspect called mental foramen (MF) is a vital anatomic landmark of the mandible, through which the mental nerve and blood vessels emerge. The importance of MF is particularly associated with dental implant placement and various surgical procedures within this region. It is elementary to use caution in and around the MF region during surgical procedures and implant placement to avoid nerves and vessel injury. Anatomic variations of the MF are often found, like the prevalence of multiple foramina and unusual locations in the mandible. On rare occasions, the absence of MF is often detected. The modern imaging-resource cone-beam computed tomography (CBCT) permits correct three-dimensional assessment of MF and identification of its variations. This article aims to report the unilateral absence of MF detected in CBCT images of a 70 years-old male patient.
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Malignant transformation rate of oral leukoplakia: A meta analysis p. 399
P Ramaswamy, Ch Sai Kiran, B Mrudula Raju, Munipati Swathi Kiranmai
Background: Oral squamous cell carcinoma is the most common form of head and neck cancer which is sometimes preceded by potentially malignant disorders such as leukoplakia. Oral leukoplakia is a potentially malignant lesion that has been considered to confer increased risk for the development of oral cancer. Tobacco smoking and alcohol intake have been attributed as major risk factors. Many articles were published connecting the malignant transformation rate to lifestyle modifications. As contemporary sources of information regarding malignant transformation rate of oral leukoplakia are lacking, there is a need to have a comprehensive evaluation of leukoplakia and its malignant transformation potential. Aim: This study aims to provide a systematic review of research on the current malignant transformation rate of oral leukoplakia. Objective: To find association between malignant transformation rate and other parameters in oral leukoplakia. Results: The malignant transformation rate of oral leukoplakia was observed to be 5.7% from the year 1963 and has increased by two-fold from year 1996 to 10.9%. Malignant transformation rate of verrucous leukoplakia was 28.2%. Dysplastic malignant transformation rate of leukoplakia was 53.7% [95% Confidential interval: 32.9%, 74.5%] overall malignant transformation rate of oral leukoplakia was 10.9%. Conclusion: The two-fold increase in the malignant transformation rate since 1990s should be considered as an alarming issue, and necessary steps have to be taken in this regard.
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Ascher Syndrome: A Case Report p. 405
Sunil S Mishra, Anita D Munde, Sneha S Tambe, Anjum Ara J. Farooqui
The Ascher or Laffe–Ascher syndrome is characterized by blepharochalasis, double lip and nontoxic thyroid enlargement. The syndrome is a rare manifestation and often remains undiagnosed. We report a case of Ascher syndrome in a 16 years old boy with double lip including upper and lower lip, blepharochalasis and an additional finding of mild clinodactyly which makes it a rare presentation. The article describes in brief an overview of the syndrome.
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Malignancy of the maxillary antrum: A case report p. 408
Annette M Bhambal, Ajay Bhambal, Ekta Ingle, Navin Anand Ingle
Malignant tumor of the maxillary sinus is an uncommon tumor of the head and neck. It is a destructive lesion involving the oral and paranasal sinuses. Since it remains confined to the antral region and produces no symptoms, it is usually diagnosed at an advanced stage and has a very poor prognosis and survival rate. We report a case, of a patient who presented with a large painless swelling in the left maxillary region for 3-4 months. Unfortunately, as the tumor was in the advanced stage and involved vital structures, only supportive management could be provided. As the symptoms of malignancy in the maxillary sinus can be non-specific, it can result in late diagnosis and poor prognosis. This case report highlights the necessity of comprehensive knowledge of sinus pathologies for a maxillofacial physician to arrive at an early diagnosis and help for a better prognosis.
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Osteomyelitis of maxilla: An unusual case p. 411
SriMallika Dasam, Tatapudi Ramesh, Moturi Kishore, Ravikanth Manyam
Osteomyelitis of facial bones is a common condition. It tends to occur more commonly in the mandible than in the maxilla as the maxilla has collateral blood flow, a thin cortical bone, which makes it less prone to infections. We report an unusual case of maxillary osteomyelitis involving the left half of the maxilla in a 43-year-old, systemically healthy male with a literature review. Intraoral examination revealed exposed denuded bone in the left maxillary region. Radiograph investigations confirmed the diagnosis of osteomyelitis of the left maxilla.
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Innocuous presentation of low-grade mucoepidermoid carcinoma of the palate p. 414
Thilak T John, Manisha M Khorate, Nivedita Chinam, Poonam R Sawant
Mucoepidermoid carcinoma (MEC) is a malignant epithelial tumor and is the most common minor salivary gland neoplasm. The initial presentation of this pathology can resemble benign lesions and can be misleading. They often present as asymptomatic swellings along minor salivary gland bearing areas. Proper attention to clinical features and the use of advanced imaging is of paramount importance to detect these innocuous lesions. We report an incidental finding of a palatal swelling in a 27-year-old female. This paper reports a low-grade MEC with unremarkable clinical features showing underlying bone involvement. It highlights the need for decisive investigations and accurate diagnosis in cases of malignant tumors of the minor salivary glands as it can reduce morbidity and prevent mortality.
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Herpes zoster of trigeminal distribution - A case series p. 417
Anka Sharma, Jaishri S Pagare, Vikrant O Kasat, Amit R Parate
Herpes Zoster (HZ) is an acute vesiculobullous condition affecting dermatomes supplied by cranial or extracranial nerves. It is caused by reactivation of varicella zoster virus (VZV) in a patient with a history of chickenpox. Usually, a single dermatome is affected and the patient presents with erythema, burning pain, and vesicular eruptions in the affected segment. Antivirals like acyclovir are the mainstay of treatment. This manuscript discusses three cases affecting the three branches of the trigeminal nerve. The first (a 36-year-old male), second (a 59-year-old male), and the third case (a 50-year-old male) are affected by HZ involving the maxillary, mandibular and ophthalmic-maxillary dermatomes, respectively.
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