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   Table of Contents - Current issue
January-June 2021
Volume 9 | Issue 1
Page Nos. 1-66

Online since Tuesday, June 29, 2021

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Progress in head-and-neck cancer: Promise versus reality p. 1
Tejpal Gupta, Jai Prakash Agarwal
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Imaging advances in oral cavity cancer and perspectives from a population in need: Consensus from the UK-India oral cancer imaging group Highly accessed article p. 4
Narayana Subramaniam, Harish Poptani, Andrew Schache, Venkataraman Bhat, Subramania Iyer, HV Sunil, Naveen Hedne Chandrasekhar, Vijay Pillai, Pankaj Chaturvedi, Shri Harsha Krishna, Arvind Krishnamurthy, Vikram Kekatpure, Moni Abraham Kuriakose, N Gopalakrishna Iyer, Alok Thakkar, Rajesh Kantharia, Abhinav Sonkar, Vivek Shetty, Vidya Bhushan Rangappa, Trupti Kolur, Sivakumar Vidhyadharan, Samskruthi P Murthy, Akshay Kudpaje, Vijay Kumar Srinivasalu, Abhishek Mahajan
Oral squamous cell carcinoma (OSCC) accounts for a third of the cancer burden in India, with a correspondingly high cancer-specific mortality. Although treatment of OSCC in India mirrors that of high-income nations, extreme burden of disease, late presentation, and the associated advanced stage of disease pose unique challenges in a resource-constrained environment. Despite a multimodal treatment paradigm, survival rates are low. Often the cause for late presentation is the delayed diagnosis, inappropriate investigation and referral, and compromised or incorrect treatment, leading to poor patient outcomes and costs to the health-care provider. To address these issues, the first UK-India Symposium on Advances in Oral Cancer Imaging Symposium was organized in Bangalore, India, in April 2019; participants included radiologists, imaging scientists, clinicians, and data scientists from the United Kingdom, India, Singapore, and the United States. Following the discussions held during this meeting, in this manuscript, we present evidence-based guidance for the role of imaging in OSCC, recommendations for service development, and details of future potential for evolution in head and neck imaging.
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Management of surgical complication during dental implant placement p. 13
Preeti Prakash Kale, Ameet Mani, Raju Anarthe, Gowri Pendyala, Pranay Thakkur, Anuraga Vidyasagar Sekharamantri
Replacement of missing teeth with dental implant is now preferred treatment option for edentulous space. Treatment with dental implants has evolved much in recent times and has good success rates which have sometimes led to unfortunate outcomes during procedure or after procedure. The present review gives insight about complications of dental implants associated with surgical procedures and its management in brief.
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Orthognathic cephalometric norms for a sample of Sudanese adults p. 20
Wadie Magdi Gilada, Amal Hussien Abuaffan, Marwa Mahmoud Hamid
Background: With the recent global increase in the number of adult patients seeking orthodontic treatment in general and orthognathic surgery in specific, the need for population-specific cephalometric norms emerges. This is essential in diagnosing and formulating more optimum treatment plans. Aim: To establish orthognathic cephalometric standard values for an sample of Sudanese Adults. Design: Cross-sectional observational analytical study. Materials and Methods: A total of 106 cephalometric radiographs of Sudanese adults aged between 17 and 25 years (48 males and 58 females) were digitally traced and analyzed using Burstone's Cephalometric for Orthognathic Surgery analysis (COGS). Statistical Analysis: Descriptive statistics, means, and standard deviations were used to present Sudanese standard values. Paired sample t-test was used to test for significant differences between Sudanese and Caucasian norms. Results: When compared to European–Americans, Sudanese adults, in general, had a shorter cranial base, lower values of some vertical height measurements, shorter maxillae, and larger mandibular plane angle. In addition, Sudanese females had a more convex profile and more protrusive maxillae in comparison to their European–Americans counterparts. Regarding dental measurements, Sudanese males had statistically significant lower values of upper and lower anterior and posterior dental heights, steeper occlusal plane, and more proclined incisors. Moreover, Sudanese females had steeper occlusal plane as well as more proclination of the anterior teeth when compared to their European–American counterparts. Conclusions: Considerable differences in skeletal and dental configuration exist between Sudanese and European-American adults. These variations must be considered during treatment planning. This study can provide a useful database for orthognathic surgery treatment planning for Sudanese adults.
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Neurogenic tumors of parapharyngeal space – Clinical evaluation and management: Our experience p. 28
MB Bharathi, BS Rakesh, Babu Amabale Rudrappa, Nitish Aggarwal, Kumar Shankar de
Context: Neurogenic tumors are the second most common parapharyngeal space (PPS) lesions, with schwannoma being the most common neurogenic tumor seen. PPS tumors account for 0.5% of all head-and-neck masses, and most surgeons might not encounter it in their lifetime. Anatomical complexity and histological diversity of PPS pose various diagnostic and treatment challenges. Relevant literature about lesions of this space is growing but is still limited. Aims: The aim of our study was to evaluate neurogenic tumors of PPS and their management over a period of 5 years. Settings and Design: A retrospective study was conducted in our institution for a duration of 5 years from January 2014 to December 2018. Materials and Methods: Clinical features were analyzed. All patients were subjected to radio imaging-contrast-enhanced computerized tomography and contrast magnetic resonance imaging, and findings were noted. After imaging, patients were subject to fine-needle aspiration cytology. Transcervical approach was used for 11 cases and endoscopic-assisted transoral transpharyngeal approach (EATA) used for 4 cases. Results: A total of 27 patients with PPS tumors were evaluated and treated. The incidence of neurogenic tumors was 55.5% (15 cases). Out of the 15 patients with neurogenic tumors, 11 cases were schwannomas, 1 case was vagal neurofibroma, and 3 cases were paragangliomas from the carotid body. Conclusions: Neurogenic tumors of PPS are more common than traditionally thought. Neck swellings and oropharyngeal masses are the most common presenting features. FNAC is a very useful tool to establish a preoperative cytological diagnosis. Both external approach and EATA are effective approaches, provided that careful patient selection is done.
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Rapid prototyping technology for silicone auricular prosthesis fabrication: A pilot study p. 35
V Manju, Anna Serene Babu, VN Krishnapriya, J Chandrashekar
Context: Three-dimensional printing technologies have been used recently for patients with maxillofacial deformities who seek esthetic prosthesis. The aim of the present study was to assess the accuracy, surface texture, marginal adaptation, patient satisfaction, and ease of fabrication of silicone auricular prostheses fabricated by the rapid prototyping technology (RPT) when compared to the conventional method (CM). Materials and Methods: A pilot study was conducted on five patients who had partial auriculectomy defects. Ear prostheses fabricated by CM and RPT were compared. RPT include the fabrication of prostheses by the duplication of polymer model fabrication or by injecting silicone to mold obtained by Vacuum casting method (VCM). The prostheses were evaluated by 15 randomly allotted trained independent observers based on the Likert Scale. The patients performed a self-rating assessment followed by a report from the clinician and technician. Statistical Analysis: The scores for each of the dimension were analyzed using the ANOVA. The cost, time, and quantity of silicone material were expressed in means for three fabrication methods. Results: Prostheses fabricated by RPT yielded superior scores in terms of accuracy, texture, and marginal fit; the vacuum casted prostheses being more precise. The patient perspective was in favor of RPT though not significant statistically. Time for fabrication and number of patient visits were less for rapid prototyping methods than CM. Conclusion: The present study demonstrated the potential benefits of digital method in the fabrication of auricular prosthesis using RPT in the field of maxillofacial rehabilitation.
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Evaluation of incidence and reasons of wrong side dental surgery in central Maharashtra p. 41
Harish Saluja, Shivani Sachdeva, Kirti Chawla, Syeda Nikhat Mohammadi
Background: Wrong side surgery (WSS) has gained national attention now. These errors are as terrifying as these involve patients who have undergone surgery on the wrong body part, undergone wrong procedure, or had a procedure intended for another patient. Materials and Methods: A questionnaire survey dealing with WSS was prepared, and 300 dental professionals were randomly mailed. All responses were gathered in Excel and analyzed using software SPSS version 19. Results: In the present study, the 213 dental professionals working in dental colleges in Ahmednagar gave the feedback, 29 of them had attempted WSS. The study was carried out on in two groups. The first comprised students undergoing bachelors in dentistry and other group was with professionals completed their bachelors in dentistry. The results were highly significant in those undergoing bachelors in dentistry with more incidence of WSS. Conclusion: The Joint Commission on Accreditation of Healthcare Organizations (JCAHOs) found WSSs as the 3rd highest event. The data are definitely more than that recorded in literature but due to fear clutched at the throat people do not disclose their mistakes though it happens.
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Dissection and snare method of tonsillectomy, hemostasis by ligature technique in a tertiary care center: A decade study p. 47
D Senthamarai Kannan, G Soundara Rajan, Veerasigamani Narendrakumar, Arya N Baby
Background: Despite advances in surgical technique, postoperative hemorrhage remains a common cause of morbidity and mortality for patients following tonsillectomy. Attempts to reduce the morbidity of tonsillectomy have included changes to the surgical techniques and perioperative medications to reduce the risk of bleeding. Here, we did a decade study about ligature technique in tonsillectomy for the achievement of hemostasis and its effectiveness in controlling morbidity. Aim: The aim of this study was to analyze the posttonsillectomy hemorrhage rate when we use ligature technique in tonsillectomy procedure. Materials and Methods: We retrospectively reviewed data of all patients who underwent tonsillectomy by dissection and snare method in the ENT Department, Chengalpattu Medical College and Hospital, Tamil Nadu, between March 1, 2010, and February 29, 2020. The rate of postoperative hemorrhage after using ligature technique was measured and compared with other methods used in other studies. Results: Totally 12,536 patients who underwent tonsillectomy were analyzed in this study. Posttonsillectomy hemorrhage occurred only in 62 patients (0.494%). Only 14 (0.001)) patients required re-intubation and correction procedure. The hemorrhage rate was very minimal when compared with other techniques in other studies. Conclusion: We conclude that the ligature technique used in tonsillectomy for hemostasis remains one of the best methods even though it is an ancient method.
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The nescience of the art of conversing and making the shift happen p. 51
Gowri Pendyala, Sourabh Ramesh Joshi, Ameet Mani, Viddyasagar Mopagar, Preeti Kale
Background: Motivational interviewing (MI), a patient-centered therapeutic approach, has demonstrated to be effective for a wide range of health behaviors including dentistry. It resolves patient's ambivalence by evoking their own motivation to change, thereby improving clinical outcomes and enhancing clinician patient relationship. Objective: The aim of this study is to evaluate the knowledge and awareness of dental clinicians about MI and predict the likelihood of their use of the MI approach. Methodology: A cross-sectional survey was used to collect data. In total, a purposive sample of 600 dentists including dental professionals, postgraduate students, and interns inclusive of both genders participated in the study. Results: The results of this study indicated that dentists had inadequate knowledge about MI and also their practical implication was less. Conclusion: The results of this study may contribute to positive social change by supporting the development of effective training for dental clinicians as MI is helpful in enhancing patient awareness and obedience leading to better therapy outcomes.
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Reconstruction of scalp defects in electrical burns: Challenges and options p. 56
Karthik Aithal, Unmesh Kumar Jena, Sravya Vasireddy, Sravani Muddada, PV Sudhakar
Introduction: Electrical burn injury in India comprises a fair percentage of overall burn injuries, and they cause significant morbidity. Reconstruction of scalp defects often poses challenges to the plastic surgeon regarding the timing of surgery, choice of reconstruction, and postoperative management. The objective of this article is to throw light on various options for reconstruction of scalp defects as the involvement leads to significant morbidity. Materials and Methods: The study was conducted at a tertiary burn care unit. The period of this study was from 2016 to 2019. Retrospective analysis was done. Results: In this study, retrospective analysis of 40 cases of scalp burns was evaluated from 2016 to 2019. Out of these, 6 patients were managed with primary suturing, 8 patients underwent split-thickness skin graft, 24 patients required local flaps, and 2 patients were managed with extracorporeal radial forearm flap. There were no major complications. Minor complications like wound infection were seen in five of the local flap patients which were managed with antibiotics and regular dressing. Two patients had partial flap loss which was revised and managed conservatively. All flaps healed well. There was hair loss patch evident in patients where split-thickness graft was used. Conclusion: Thorough debridement of the wound is necessary in electrical burns. Smaller scalp wounds can be managed with split-thickness skin graft and local flaps, but larger defects should be managed with distant flaps and free flaps. This study shows that local flaps are the ideal choice for reconstruction of scalp defects due to their easy availability, minimal complications, and acceptable cosmesis.
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Tobacco consumption patterns and coping behavior during the COVID-19 Lockdown p. 59
S Sujatha, V Shwetha, P Vaishnavi, P Sreekanth, Ravleen Nagi
Background: During the COVID-19 pandemic, millions of Indians were self-quarantined generating exceptional challenges and stress for all people and more so among regular tobacco users. Tobacco use is known to be detrimental to lung and immune function, thus suppressing the body's ability to combat infections including the novel coronavirus, COVID-19. This study was intended at surveying the stress, tobacco consumption patterns, and the coping behavior during the COVID-19 pandemic. Methodology: Seven hundred and twenty-nine current tobacco users aged 18 years and above participated in the questionnaire study on stress due to COVID-19, tobacco consumption patterns during lockdown, years of tobacco use, prior quit attempts, thoughts of quitting currently, and means of purchasing and coping behavior. The data were subjected to statistical analysis. Results: The average Fagerström Test for Nicotine Dependence score was 6, and males had higher scores than females. 68.4% of tobacco users reported increased use, 5.07% decreased use, and 26.4% no change in tobacco use during the lockdown. Causes for increased tobacco use were stress (62.1%), being alone and restrictions in movement (21.6%), and boredom (16.3%), while the fear of contracting COVID infection and becoming severely ill has motivated few (31.6%) to decrease tobacco use. 50.9% wanted to quit, the thought of quitting tobacco was more among men (54%) as compared to women and was higher among smokers as compared to smokeless tobacco users. Conclusion: Tobacco users appear to be affected by stress related to the COVID-19 pandemic, with majority of them increasing the consumption.
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A recurrent hibernoma in neck: An extremely rare entity p. 64
Shirish Chandanwale, Rumaanah Khan, Arpana Dharwadkar, Ruchi Randive
Lipomatous lesions are very commonly encountered in clinical practice. Although they are commonly encountered in the third and fourth decades, they can occur at any age. Clinically, they present as slowly painless growing mass commonly in subcutaneous tissues. Clinically and radiologically, they are difficult to differentiate from other lipomatous lesions. The four morphological variants have been identified. Hibernoma cells are key to diagnosis. Hibernomas do not have malignant potential or metastatic ability. However, local recurrence is known to occur and is extremely rare. Wide local excision with negative margins is the key to prevent further recurrence.
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