Ultrasound elastography as a potential diagnostic aid in oral submucous fibrosis Sailesh Kumar Mukul, Subhash Kumar, Shweta Pandey, Ejaz Ahmad Mokhtar, Amit Kumar National Journal of Maxillofacial Surgery 2019 10(2):129-133 Background: Oral submucous fibrosis (OSMF) is a well-recognized “potentially malignant” disorder. It mostly affects the productive population of young adults and adolescents. The diagnosis of oral submucous fibrosis is primarily clinical and subjective. The only objective diagnostic method for OSMF is tissue biopsy. This study was conducted to find the potential use of ultrasound elastography to objectively quantify the clinical presentation in accordance with severity of the clinical condition in OSMF. Materials and Methods: The study sample consisted of 27 clinically diagnosed and staged participants with OSMF. Transcutaneous ultrasonography was done by a single operator on GE Logiq E9 machine with a 6–15 MHz linear matrix probe. Color-coded scheme was used to qualitatively grade the eight different zones of oral mucosa with the use of stress–strain elastography. The grades ranged from 0 to 5, where 0 represented artifacts and color range from red to blue corresponded to varying degree of increasing tissue stiffness. Clinical stage 1, 2, and 3 corresponded to mouth opening of >30 mm, 20–30 mm, and <20 mm, respectively. The summative elastography score range as follows: 8–10, 11–14, and ≥15 represented the respective degree of tissue stiffness from soft, mild stiff to severe stiff. Results: The results obtained by Pearson's correlation between the elastographic grading and clinical grading came out to be 0.007, and it was highly significant. The sensitivity and specificity of the diagnostic method were 90.9% and 20%, respectively. Conclusion: The advantages of ultrasound elastography as a diagnostic tool over the subjective clinical method of diagnosis and staging of OSMF looks promising. Further studies should be conducted with a suitable specific transducer probe and with quantitative diagnostic elastography method.

Health-related quality of life assessment for head-and-neck cancer patients during and at 3 months after radiotherapy – A prospective, analytical questionnaire-based study Ahmad Masroor Karimi, Munish Gairola, Parveen Ahlawat, Sarthak Tandon, Manoj Pal, Nishtha Sachdeva, Muhammed Ismail Sharief, Kiran Dobriyal National Journal of Maxillofacial Surgery 2019 10(2):134-140 Introduction: Health-related quality of life (HRQoL) is a more specific area of QoL that deals with the evaluation and assessment of the impact of the disease and its treatment-related morbidities on a patient's physical, psychological, and social aspects. The aim of the present study was to assess the HRQoL of patients with head-and-neck cancer (HNCs) during and at 3 months after completion of radiotherapy (RT) by intensity-modulated RT. Materials and Methods: This study was a prospective, longitudinal, observational, and self-completed questionnaire-based study that included 120 patients with HNC who underwent intensity-modulated RT. The questionnaire had adequate internal consistency. The questionnaires were given to each patient at the beginning of treatment (pretreatment), weekly visits during the course of RT (at the end of 1st, 2nd, 3rd, 4th, 5th, and 6th week), on the day of completion of RT, and then finally at 3 months after completion of RT. Thus, a total of successive nine time points were assessed. Results and Conclusions: One hundred and eleven patients completed the questionnaires at all nine time points. HRQoL usually decreases during treatment and then increases to pretreatment levels by 3 months after treatment. The Quality of Life Questionnaire, Core Module and Quality of Life Questionnaire, Head and Neck Module were found to be both valid and reliable. There was a significant QoL reduction for the patients throughout treatment in relation to functions and symptoms in the treatment of HNC. However, all the functions and most of the symptoms returned to baseline at the 3-month follow-up.

Microflora analysis in the postchemotherapy patients of oral cancer Sunita Singh, Seema Singh, MB Tiwari, US Pal, Santosh Kumar National Journal of Maxillofacial Surgery 2019 10(2):141-145 Background: To assess changes in oral microflora in dental plaque from cancer patients within 7 days of the first course of chemotherapy and the relationship of the changes with mucositis. Materials and Methods: Thirty cancer patients, divided into a test group undergoing chemotherapy and a control group not undergoing chemotherapy, were enrolled in this pilot study. Oral microflora was cultured from three samples of dental plaque at t0 (before chemotherapy), t1 (1 day after chemotherapy), and t2 (7 days after chemotherapy). Single and crossed descriptive analyses were used to establish prevalence, and the Chi-square test was used to establish the statistical significance of the differences observed in distributions (significance level: P < 0.05). Results: In most patients (55%), oral microflora consisted mainly of Gram-positive cocci, while the remaining 45% of the bacterial flora also had periodontal-pathogenic species. No Porphyromonas gingivalis appeared in the test group. Actinobacillus was the least frequently found bacterium among periodontal pathogens in the test group, while Fusobacterium nucleatum was the most frequently found. No significant differences were found in quantitative bacterial changes between t0, t1, and t2 in either the test or control groups, or between the two groups. According to World Health Organization scores, oral mucositis developed in 10 patients (66.6%) in the test group. Conclusions: The results of this pilot study indicate that there were no changes in microflora in dental plaque in cancer patients within 7 days of the first course of chemotherapy. No correlations between oral mucositis and specific microorganisms were assessed.

Zygomaticomaxillary “lateral swing” osteotomy for augmentation of midface deficiency Thomas Zachariah, RS Neelakandan, Aparna Murugan National Journal of Maxillofacial Surgery 2019 10(2):146-152 Introduction: Various surgical modalities have been proposed for the augmentation of midface deficiency without correction of the occlusal component. They include autogenous bone and cartilage grafts, alloplastic materials, and osteotomies. We propose an innovative osteotomy technique for augmentation of the midface including the infraorbital rims, the zygoma, the anterior maxillae, and the paranasal areas without advancing the dental-bearing segment. Materials and Methods: This procedure was carried out on a 21-year-old male patient who had a deficiency of the anterior maxillae including the infraorbital rims. His occlusion was in Class I molar relation. The surgical exposure was carried out through a midface degloving approach. This bilateral osteotomy encompasses the anterior maxillae and the zygoma; the osteotomy line running superiorly from the medial aspect of the infra-orbital rim to the root of the frontal process of maxilla. Inferiorly, the line runs above the apices of the maxillary teeth laterally underneath the zygomatic buttress, separating part of the zygomaticomaxillary suture posteriorly. Medially, the osteotomy line runs parallel to the piriform aperture. The osteotomy is pedicled on the zygomaticotemporal suture. A greenstick fracture at the zygomatic arch pedicled the osteotomized segment to the zygomatic process of the temporal bone. The entire segment was swung laterally outward, effectively separating part of the zygomaticomaxillary suture posteriorly. Fixation was achieved with a single 2-mm L-shaped, 4-hole plate with gap at the zygomatic buttress region. Results: This osteotomy technique resulted in fullness of the anterior maxillae and infraorbital rims, with increased anterior and lateral projection of the zygoma. Conclusion: The zygomaticomaxillary “lateral swing” osteotomy is a reliable and stable technique for total midface augmentation not requiring occlusion correction.

Evaluation of use of distraction osteogenesis in mandibular retrognathia and its effect on soft and hard tissues and airway Aditya Mohan Alwal, G Rajasekhar, Nandagopal Vura, M VS Sudhir, Srikanth Damera National Journal of Maxillofacial Surgery 2019 10(2):153-160 Objectives: Bone distraction is the process of new bone formation between the surfaces of bone segments gradually separated by incremental traction of soft tissues. These adaptive changes in the soft tissues allow for greater skeletal movements while minimizing the potential relapse. In this study, we are reporting our clinical experience with mandibular distraction used to achieve simultaneous skeletal and soft-tissue correction with distraction osteogenesis (DO). Methodology: A total of five patients who reported to the department for the treatment of mandibular deficiencies were selected. Cephalometric studies were done preoperatively and postoperatively for hard tissue assessment. Predefined reference points were used for the clinical evaluation for the evaluation of soft tissues. Results were compared between preoperative and 1st-, 3rd-, 6th-, and 12th-month postoperatively. Results: The clinical observations in our study showed that there is a remarkable improvement in the facial esthetics. Cephalometric analysis has shown lengthening of the mandibular corpus and increase in the height of the vertical ramus. Certain minimal complications have also been noted. Conclusion: Despite the few complications, DO has become a popular surgical modality due to its many advantages.

Soft tissue growth changes from 8 to 16 years of age: A cross-sectional study Ashish Kumar, Pradeep Tandon, Gulshan Kumar Singh, Gyan P Singh National Journal of Maxillofacial Surgery 2019 10(2):161-167 Objective: The present cross-sectional study was conducted to evaluate and compare the soft tissue growth changes between males and females of two groups from 8 to 16 years. Materials and Methods: One hundred sixty skeletal class I lateral head cephalograms were screened aged between 8 to 16 years-Subjects were divided into two groups. Group I (8 to 12 years) and Group II (12 to 16 years) and further these groups were subdivided into male and female subgroups. Total eight linear and four angular parameters were studied. Results: All the parameters increased in their dimension while angle of total facial convexity including nose and Nasolabialangle decreases. Among the linear variables, Noseheight, Lip thickness at laberale inferious, Lip thickness at B point, Soft tissue chin thickness and Measurements of lips to E-plane were found significant for both subgroups. While rest of the linear variables like Upper lip height, Lower lip height, Nose depth and Sagittal depth also increased but this increase wasfound non-significant. Among the angular parameters angle of total facial convexity including nose and Nasolabialangle decreases and angle of facial convexity excluding nose, and Nose inclination increases with the age, and these changes were found non-significant. Conclusion: In this study, we observed that males showed a greater value of all parameters in comparison to females, and with the advancement of age, all the parameters increased, except for angle of total facial convexity and nasolabial angle.

Inferior alveolar nerve canal position in relation to mandibular molars: A cone-beam computed tomography study KC Vidya, Jugajyoti Pathi, Sanjeeb Rout, Alok Sethi, NC Sangamesh National Journal of Maxillofacial Surgery 2019 10(2):168-174 Objective: This study was carried out to prevent the risk of iatrogenic injuries to the inferior alveolar nerve (IAN) canal associated with various surgical interventions in the area of mandibular molars, by using cone-beam computed tomography (CBCT). Materials and Methods: The present retrospective study was carried out by using CBCT of 100 patients between 18 and 40 years of age group. The linear measurements were made in relation to the 1st and 2nd mandibular molars on both the sides. Linear distances between buccal and lingual aspects to the mandibular, buccal, and lingual cortical bone thickness; IAN canal diameter; and the superior corticated border of the IAN canal from the periapex of the 1st and 2nd mandibular molars. The statistical evaluation was done using SPSS V.20 (SPSS: an IBM company), and P < 0.05 was considered statistically significant. Results: Both genders of all age groups showed statistically significant result (P < 0.00). All the linear measurements were statistically significant in relation to both the 1st and 2nd mandibular molars (P < 0.005), and also the bilateral comparison of the linear measurements showed statistically significant difference in relation to the mandibular 2nd molar (P < 0.03) and 1st molar (P < 0.04) among both the sexes. Conclusion: Clinicians should be aware of the proximity of root apices and cortical plates to the mandibular canal when performing surgical and root canal procedures in the posterior mandible to avoid serious nerve injuries.

Efficacy of hybrid implants in oral and maxillofacial surgery: A clinical prospective study Gaurav Mittal, Gagan Khare, Ritesh Garg, Abhishek Rathi, Siddharth Sharma, Dipika Raghaw National Journal of Maxillofacial Surgery 2019 10(2):175-181 Aim: The present study was aimed to evaluate the efficacy of hybrid implants in replacement of missing teeth in either jaw. Materials and Methods: Twenty hybrid implants were placed in maxilla and mandible and the implants were assessed for pain,implant exposure, mobility, infection and wound dehiscence at first, third and sixth month postoperatively. Results: According to our study the statistical data showed that all the parameters which were seen clinically were nonsignificant. Conclusion: Hybrid implants being a new option in this field, our study provides a platform for further research with larger sample size with longer follow ups to be judgemental on their efficacy.

Study on prevalence and sociocultural aspects of tobacco use in India Sana Farooqui, Shadab Mohammad, Divya Mehrotra, Abbas Ali Mahdi, Sandeep Bhattacharya, GG Agarwal, Saurabh Srivastava National Journal of Maxillofacial Surgery 2019 10(2):182-190 Aim: The present study focuses on the prevalence of tobacco use and aims to determine various sociocultural aspects of tobacco use in Indian population. Materials and Methods: The study sample comprised 384 participants. There were three study groups, and in each study group, there were 128 participants. Group A was tobacco users without oral precancer, Group B was tobacco users with oral precancer, and Group C was healthy individuals with no history of tobacco or areca nut use and oral precancer. Both male and female adults in the age group of 18 years and above visiting the Outpatient Department of Oral and Maxillofacial Surgery at King George's Medical University were recruited for the study. The study participants were explained in detail about the study, and informed consent was obtained through them. Data have been collected using a standard structured predesigned questionnaire. The questionnaire consisted of the details of the demographic profile of the study participants, details of tobacco use, and the major social and cultural reasons which motivated them to consume tobacco. Data were extracted from the case sheet, and the data were entered into a worksheet for the purpose of analysis. The analysis was performed using the commercially available Statistical Package SPSS. Conclusion: The rate of tobacco prevalence is very high among the Indian population, and a number of social and cultural factors are responsible for its use. To curb this problem, more studies could be done to find the causes responsible for its use.