Shaji Thomas

Prevalence of oral soft tissue lesions in Vidisha

BackgroundThe purpose of this study was to determine the prevalence of oral soft tissue lesions in patients and to assess their clinicopathological attributes. 3030 subjects belonging to a semi-urban district of Vidisha in Central India were screened. Patients were examined with an overhead examination light and those who were identified with a questionable lesion underwent further investigations. Statistical analysis was done using the SPSS software.Findings8.4 percent of the population studied had one or more oral lesions, associated with prosthetic use, trauma and tobacco consumption. With reference to the habit of tobacco use, 635(21%) were smokers, 1272(42%) tobacco chewers, 341(11%) smokers and chewers, while 1464(48%) neither smoked nor chewed. 256 patients were found to have significant mucosal lesions. Of these, 216 cases agreed to undergo scalpel biopsy confirmation. 88 had leukoplakia, 21 had oral submucous fibrosis, 9 showed smokers melanosis, 6 patients had lichen planus, 17 had dysplasia, 2 patients had squamous cell carcinoma while there was 1 patient each with lichenoid reaction, angina bullosa hemorrhagica, allergic stomatitis and nutritional stomatitis.ConclusionsThe findings in this population reveal a high prevalence of oral soft tissue lesions and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals.

Enhanced field effect mobility on 4H-SiC by oxidation at 1500◦C

A novel 1500°C gate oxidation process has been demonstrated on Si face of 4H-SiC. Lateral channel metal-oxide-semiconductor-field-effect-transistors (MOSFETs) fabricated using this process have a maximum field effect mobility of approximately 40 cm2 V-1 s-1 without post oxidation passivation. This is substantially higher than other reports of MOSFETs with thermally grown oxides (typically grown at the standard silicon temperature range of 1100-1200°C). This result shows the potential of a high temperature oxidation step for reducing the channel resistance (thus the overall conduction loss), in power 4H-SiC MOSFETs.

Accessory mental foramen: a rare anatomical finding

Accessory mental foramen (AMF) is a rare anatomical variation with a prevalence ranging from 1.4 to 10%. Even so, in order to avoid neurovascular complications, particular attention should be paid to the possible occurrence of one or more AMF during surgical procedures involving the mandible. Careful surgical dissection should be performed in the region so that the presence of AMF can be detected and the occurrence of a neurosensory disturbance or haemorrhage can be avoided. Although this anatomical variation is rare, it should be kept in mind that an AMF may exist. Trigeminal neuralgia was diagnosed. On the basis of diagnostic test results, peripheral neurectomy of mental nerve was planned. Failure to do neurectomy of mental nerve branch in the reported case, coming out from AMF, would have resulted in recurrence of pain and eventually failure of the procedure.

Trigeminocardiac Reflex: A Reappraisal with Relevance to Maxillofacial Surgery

AbstractPurposenThe purpose of this paper was to undertake a review of literature on trigeminocardiac reflex in oral and maxillofacial online data-base and discuss the pathophysiology, risk factor assessment, presentation of the reflex, prevention, management with emphasis on the role of the attending anaesthetist and the maxillofacial surgeon.Materials and MethodsThe available literature relevant to oral and maxillofacial surgery in online data-base of the United States National Library of Medicine: Pubmed (http://www.ncbi.nlm.nih.gov/pubmed/) was searched. The inclusion criterion was to review published clinical papers, abstracts and evidence based reviews on trigeminocardiac reflex relevant to oral and maxillofacial surgery.ResultsSixty-five articles were found with the search term trigeminocardiac reflex in the literature searched. Eighteen articles met the inclusion criteria for this study. The relevant data was extracted, tabulated and reviewed to draw evidence based conclusions for the management of trigeminocardiac reflex.ConclusionsConclusions were drawn and discussed based on the reviewed maxillofacial literature with emphasis on the anaesthetist’s and the surgeon’s role in the management of this detrimental event in maxillofacial surgical practice.

Comparision Between Neocone, Alvogyl and Zinc Oxide Eugenol Packing for the Treatment of Dry Socket: A Double Blind Randomised Control Trial

ObjectivesTo prospectively evaluate and compare the effectiveness of Neocone, Alvogyl and Zinc Oxide Eugenol (ZOE) intra alveolar dressings for the management of dry socket and to study the epidemiological factors associated with the condition.Study DesignAll the patients who underwent extraction of teeth and who fulfilled our inclusion and exclusion criteria from 1st January 2012 to February 28th 2013 were included in our study. Patients who were diagnosed to suffer from dry socket were randomly allocated to three groups namely Group A (Alvogyl), Group B (ZOE), Group C (Neocone). Pain relief and healing of the socket were compared between these groups. The collected data were subjected to statistical analysis by Chi Square test, Z test of proportionality.Results and ConclusionAlvogyl is superior to the other two medications for providing initial pain relief. Neocone provides complete pain relief and the healing was fastest with Neocone. Neocone emerged as the most suitable dressing material for the management of dry socket by virtue of shorter time required for complete pain relief, fewer visits and faster clinical healing.

Extrafollicular adenomatoid odontogenic tumour

Adenomatoid odontogenic tumour (AOT) is an uncommon, benign tumour that represents 3–7% of all odontogenic tumours. It is slow growing, occurs twice as common in females and usually in the second decade of life. There are three subclinical types of this tumour with identical histology: follicular type (73%), extrafollicular variant (24%) and peripheral form (3%). Here, the authors have presented two rare cases of extrafollicular varieties of AOT in 25-year-old female patients, of which one was situated in the maxillary canine area and the other one situated in an unusual location of mandibular premolar area. Such lesions may be confused as an odontogenic cyst and should be carefully differentiated from other benign and malignant lesions arising in this region.

Incidence of impacted third molars: A radiographic study in People's Hospital, Bhopal, India

OBJECTIVESnThe aim of this study is to evaluate the position of impacted third molars based on the classifications of Pell & Gregory and Winter in a sample of Bhopal patients.nnnSTUDY DESIGNnIn this retrospective study, up to 1100 orthopantomograms (OPG) of the patients who were reported to the MaxilloFacial Department of PDA and Chowdhary hospital from January 2011 to December 2012 were evaluated.nnnRESULTSnAmong 1100 patients, 730 were male and 370 were female patients. Of the 1100 OPGs studied, 3,910 third molars were noticed either impacted or erupted and 490 third molars were missing. The most common angulation of impaction in the mandible was in vertical position (41.4%) followed by mesioangular impaction (33.3%) and the most common angulation of impaction in the maxilla was the vertical (67.4%) which was followed by 15.2% in distoangular impaction. The level of eruption of impacted third molar was found to be 43.9% at level A, 34.8% at level B and 21.3% at level C. There was no significant difference between the right and left sides in both the jaws.nnnCONCLUSIONnThe pattern of third molar impaction in the region of Bhopal is characterized by a high prevalence of impaction, especially in the mandible. The most common angulation was the vertical in the mandible as well as in the maxilla. The most common level of impaction in mandible was level A and in maxilla is level C and there was no any significant difference between the right and left sides in both jaws.

Submental Intubation in Maxillofacial Surgery: A Prospective Study

We designed a prospective study with the objective to evaluate the efficacy, indications and our experience of submental intubation in different types of maxillofacial surgeries. From May 2008 to August 2010, 23 patients with different conditions were intubated by submental route of tracheal intubation and patients were evaluated on different parameters during and after surgery to find its efficacy, indications and utilization in maxillofacial surgeries. All the patients were managed well with this technique of intubation with no significant difference in intubation and extubation time. We did not face any uneventful complication. There was only one reported complication that is rupture of the bulb of cuffed flexometallic tube but was managed well by changing tube. We found skull base access surgery as a new indication for submental intubation. The submental route for endotracheal intubation may be utilized as an alternative to blind nasal intubation or tracheostomy in the surgical management of patients involving complex maxillofacial surgeries. We hypothesized that the submental intubation should not be used where long term ventilation support is needed. We did a technique modification to deliver the endotracheal tube out from the submental region to avoid pilot cuff damage. Our study proposes that skull base access surgery is a safe and potential indication for submental intubation. In our experience submental intubation is a simple, secure and effective procedure for operative airway control in major maxillofacial surgeries.

Management of exaggerated gagging in prosthodontic patients using glossopharyngeal nerve block

When gag reflex becomes abnormally active, it poses difficulty for the prosthodontists, as it hinders the process of fixed partial denture construction beginning with tooth preparation till impression making. In this case-report, the authors used a nerve block technique which is popular among anaesthetist and otolaryngologist, but is being applied in the field of prosthodontics for the first time, to tide over the difficulty.

Brown tumour of the jaw

Brown tumours are classic bony lesions that arise as a result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. They are erosive bony lesions caused by rapid osteolysis and peritrabecular fibrosis, resulting in a local destructive phenomenon. Facial skeleton is involved in about 2% of all cases of which the mandible is frequently affected. A 35-year-old female who was diagnosed with osteomalacia and brown tumour in posterior mandible as the sign of secondary hyperparathyroidism secondary to vitamin D deficiency is presented.