Shadab Mohammad

Oral cancer: risk factors and molecular pathogenesis.

IntroductionOral cancer is one of the most common cancers and it constitutes a major health problem particularly in developing countries. It is one of the leading causes of death. Tobacco and alcohol consumption appears to be the major determinants of oral cancer.Materials and methodsThe literature search was carried out in NCBI Pubmed database using keywords “oral cancer”, “risk factor”, “epidemiology” and “patho*”. Some basic information was also obtained from textbook and medical university websites.ResultsSeveral risk factors have been well characterized to be associated with oral cancer with substantial evidences. The development of oral cancer is a multistep process involving the accumulation of genetic and epigenetic alterations in key regulatory genes. Experimental pathological studies of oral cancer in animal models and direct molecular genetic analysis of oral cancer subjects in recent times have revealed a substantial amount of knowledge on specific gene alterations or other genetic mechanisms involved in initiation and subsequent progression.ConclusionConsidering known risk factors, oral cancer appears to be to a certain extent, a preventable disease. Recent development of molecular picture of pathoprogression and molecular genetic tools opens the avenue for easier diagnosis, better prognostication and efficient therapeutic management.

Random control trial of dermis-fat graft and interposition of temporalis fascia in the management of temporomandibular ankylosis in children.

Temporomandibular ankylosis is a disabling condition that affects hygiene and cosmetic appearance. Several interpositional grafts such as meniscus, muscle, fascia, skin, cartilage, fat, dura, alloplastic materials and xenografts have been used to prevent recurrence of ankylosis. We studied the advantages and disadvantages of dermis fat graft as an interposition material after arthroplasty and compared it with temporalis fascia interposition. Seventeen patients with temporomandibular ankylosis involving 20 joints were randomly divided into two groups; the first group had operations for interposition of dermis-fat graft that was taken from the groin. Patients in control group had operations to interpose temporalis fascia and muscle from the same surgical site. All were assessed by age, sex, etiology, clinical features and post surgical complications. The groups were matched in age and the male: female ratio was 0.89:1.The median duration of ankylosis was 7.3 (range 2-11) years. Postoperative and follow up interincisal mouth opening was satisfactory with good healing of the dermis-fat graft donor site. We conclude that the use of dermis fat grafts has minimal donor site morbidity, and is a safe and effective interposition material to prevent the recurrence of temporomandibular ankylosis.

An Epidemiological Study on Pattern and Incidence of Mandibular Fractures

Mandible is the second most common facial fracture. There has been a significant increase in the number of cases in recent years with the advent of fast moving automobiles. Mandibular fractures constitute a substantial proportion of maxillofacial trauma cases in Lucknow. This study was undertaken to study mandibular fractures clinicoradiologically with an aim to calculate incidence and study pattern and the commonest site of fractures in population in and around Lucknow. Patient presenting with history of trauma at various centers of maxillofacial surgery in and around Lucknow were included in this study. Detailed case history was recorded followed by thorough clinical examination, and radiological interpretation was done for establishing the diagnosis and the data obtained was analyzed statistically. Out of 66 patients with mandibular fractures, highest percentage was found in 21–30 years of age with male predominance. Road traffic accidents were the most common cause of fracture with parasymphysis being commonest site. Commonest combination was parasymphysis with subcondyle. There was no gender bias in etiology with number of fracture sites. The incidence and causes of mandibular fracture reflect trauma patterns within the community and can provide a guide to the design of programs geared toward prevention and treatment.

Prospective randomized clinical trial comparing bite force in 2-mm locking plates versus 2-mm standard plates in treatment of mandibular fractures.

PURPOSE To compare the efficacy of the 2-mm locking miniplates to 2-mm standard miniplates in the osteosynthesis of mandibular fractures on the basis of clinical parameters and bite force recording. PATIENTS AND METHODS A prospective randomized clinical trial was conducted at the Faculty of Dental Science, CSMMU (formerly King Georges Medical College), Lucknow, India, from January 1, 2007, to January 31, 2008, to treat consecutive mandible fractures. The patients were randomly divided into 2 groups. The patients underwent osteosynthesis--group 1 with Synthes 2-mm locking titanium miniplates and group 2 with Synthes 2-mm nonlocking titanium miniplates. The cause of trauma, the number of days from injury to surgery, average age, gender, and site distribution were all reviewed. The assessment of the patients was done at 1, 3, and 6 weeks and 3 months using the clinical parameters and bite force recording. RESULTS A total of 20 patients with 32 fractures met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as pain, swelling, infection, paresthesia, hardware failure, and mobility between the fracture segments. A statistically significant difference was found between the change in bite force from the previous follow-up visit in groups 1 and 2. From 1 week to 3 months, the change in the incisor bite force was significantly greater for group 1 than for group 2. At 6 weeks and 3 months, the change in right molar bite force from the previous follow-up visit was significantly greater for group 1 than for group 2. At the 1-, 3-, 6-week and 3-month follow-up visits, the change in left molar bite force from the previous follow-up visit was significantly greater for group 1 than for group 2. CONCLUSION These findings show that the use of locking miniplates plate in mandibular fracture was efficacious enough to bear the masticatory loads during osteosynthesis of the fracture. The locking miniplates provide the advantage of a greater bite force, with clinical results almost similar to those seen with nonlocking miniplate osteosynthesis.

The maxillofacial injuries: A study

Objectives: The aim of this study was to evaluate the incidence and etiology of maxillofacial fractures and also to evaluate different treatment modalities. Study design: The sample consisted of 1,038 patients, with maxillofacial injuries treated at our center from June 2006 to June 2011. Cause, type, site of injury, gender, age and treatment given to them, all these parameter are evaluated. Conclusion: The results of this study exhibit that road traffic accidents is the main reason for maxilla facial injuries followed by fall from height. Maxillofacial injuries are more frequent in male than in female. The mandible was most frequently involved facial bone. The miniplate osteosynthesis was the most widespread of the fixation technique but conservative management of the fractured bone also has a significance importance in treatment modalities.

Pediatric facial injuries: It's management

Background: Facial injuries in children always present a challenge in respect of their diagnosis and management. Since these children are of a growing age every care should be taken so that later the overall growth pattern of the facial skeleton in these children is not jeopardized. Purpose: To access the most feasible method for the management of facial injuries in children without hampering the facial growth. Materials and Methods: Sixty child patients with facial trauma were selected randomly for this study. On the basis of examination and investigations a suitable management approach involving rest and observation, open or closed reduction and immobilization, trans-osseous (TO) wiring, mini bone plate fixation, splinting and replantation, elevation and fixation of zygoma, etc. were carried out. Results and Conclusion: In our study fall was the predominant cause for most of the facial injuries in children. There was a 1.09% incidence of facial injuries in children up to 16 years of age amongst the total patients. The age-wise distribution of the fracture amongst groups (I, II and III) was found to be 26.67%, 51.67% and 21.67% respectively. Male to female patient ratio was 3:1. The majority of the cases of facial injuries were seen in Group II patients (6-11 years) i.e. 51.67%. The mandibular fracture was found to be the most common fracture (0.60%) followed by dentoalveolar (0.27%), mandibular + midface (0.07) and midface (0.02%) fractures. Most of the mandibular fractures were found in the parasymphysis region. Simple fracture seems to be commonest in the mandible. Most of the mandibular and midface fractures in children were amenable to conservative therapies except a few which required surgical intervention.

Platelet-rich growth factor in oral and maxillofacial surgery

Platelet-rich growth factor is an innovative regenerative therapy used to promote hard and soft tissue healing. It involves the application of autologous platelet-leukocyte-rich plasma containing growth factors and thrombin directly to the site of treatment. It is the intrinsic growth factors released by activated platelets which are concentrated in a topical gel formula. Clinically, it is an affordable treatment with potentially broad spectrum of applications in maxillofacial surgery especially in the treatment of complex or refractory wounds. The present article reviews its various applications not only in the specialization of oral and maxillofacial surgery but also in regenerative medicine.

Buccal fat pad versus sandwich graft for treatment of oroantral defects: A comparison.

Aim: To compare the efficacy of buccal fat pad (BFP) graft with sandwich graft (hydroxyapatite crystals embedded within collagen sheath) in closure of oroantral defects. Materials and Methods: A 2-year prospective study was conducted; 20 patients were included in the study were divided into two groups having 10 patients in each. Group I patients underwent surgical closure of oroantral fistula with sandwich graft and Group II patients with buccal pad of fat. Results: In Group I, the mean pain scores were 7.60 ± 0.84, 3.90 ± 1.10, 2.30 ± 1.16, 1.10 ± 0.99 and 0.40 ± 0.70 at immediate post-op., 1, 3, 6 and 12 week time intervals, respectively, whereas in Group II these were 7.30 ± 0.67, 3.50 ± 0.53, 1.70 ± 0.48, 1.00 ± 0.47 and 0.30 ± 0.48, respectively, at the corresponding time intervals. In Group I, swelling was seen to be present in 10 (100%), 7 (70%), 2 (20%) and nil (0%) patients at 1, 3, 6 and 12 weeks, respectively, whereas in Group II, it was seen to be present in 10 (100%), 10 (100%), 2 (20%) and nil (0%) patients at the corresponding time intervals. At 1 week, infection was seen to be present in 1 (10%) patient of Group I and 2 (20%) patients of Group II. At 3 and 6 weeks, infection was seen to be present in 1 (10%) patient of Group I and none of the patients of group II. No radiologic evidence of bone formation was seen in either group up to 1 week. At 3 week interval, there were 6 (60%) patients in Group I and nil (0%) in Group II showing bone formation, thus showing a statistically significant difference between the two groups. By 6 week time interval, radiologic evidence of bone formation was seen in 9 (90%) patients of Group I but in no patients of Group II, thereby showing a statistically very highly significant (P < 0.001) difference between the two groups. In Group I, in 1 (10%) patient, graft was rejected by first week; however, no further graft rejection took place. In Group II, no case of graft rejection was reported. Conclusions: The sandwich graft technique yielded a more promising closure of oroantral communication by provision of a more biologically apt base in terms of regeneration of lost bone structure at the floor of the maxillary sinus

Efficacy of plain radiographs, CT scan, MRI and ultra sonography in temporomandibular joint disorders.

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

Bite Force Evaluation of Mandibular Fractures Treated With Microplates and Miniplates

PURPOSE The purpose of this study was to determine the clinical stability and efficacy of 1 microplate combined with 1 miniplate in the management of mandibular fractures of the interforaminal region compared with the standard 2-miniplate treatment using bite force measurements. MATERIALS AND METHODS Twenty patients were treated for isolated mandibular fractures of the interforaminal region. They were randomly divided into group A (test group) and group B (control group), with 10 patients per group. Group A underwent osteosynthesis using the combination of 1 microplate (subapical) and 1 miniplate (at the lower border). Group B underwent osteosynthesis using the standard 2-miniplate protocol. The bite force measurements were performed preoperatively and postoperatively at each follow-up using a bite force recorder. As a secondary outcome, the patients also were assessed for complications, such as infection, that might interfere with successful osteosynthesis at the fracture site. RESULTS A statistically significant increase in incisor bite force was found in the 2 groups compared with the preoperative bite force measurements. No statistically significant difference was seen in the incisor bite force of either group at the different follow-up visits. No statistically significant difference was seen in the molar bite force (right vs left) of the test and control groups during follow-up. Molar bite force on the nonfractured side was greater than on the fractured side in the 2 groups. Infection was seen in 1 patient (ie, 10%) in each group. On surgical exploration, the fracture had united and the infection was resolved in the 2 patients, with no further complications. CONCLUSIONS The replacement of an upper miniplate by a microplate in the management of mandibular fractures is stable and adequately efficacious to withstand the masticatory loads and torsional forces acting in the anterior region of the mandible.