Suresh Yadav

Qualitative and quantitative assessment of relationship between mandibular third molar and angle fracture on North Indian population: A clinico-radiographic study

Objective: To assess the relationship between impacted mandibular third molar presence and the risk for mandibular angle fracture with the effect of various positions of mandibular third molar and the risk of mandibular angle fracture. Materials and Methods: In the North Indian territory, a total of 289 patients with mandibular angle fractures were studied and evaluated for the possible relationship with impacted third molar on the basis of clinical and panoramic radiographical findings. Results: Results that confirmed the highest risk for mandibular angle fracture was associated with mesioangular angulations (45.42%) followed by vertical (26.34%), distoangular in sequence and least risk was found with bucco-version angulations (2.67%) according to Winter′s classification. Additionally, the highest risk of mandibular angle fracture was reported with partially erupted third molar (47.75%), followed by erupted (23.53%) and unerupted third molar (19.38%). Conclusion: The risk for mandibular angle fracture is not only affected by status of eruption, angulations, position, number of roots present in third molar but also by the distance of mandibular third molar from inferior border of mandible and the percentage of remaining amount of bone at the mandibular angle region.

Measurements of aperture and beam lifetime using movable beam scrapers in Indus-2 electron storage ring

In this paper, the measurements of vertical and horizontal aperture which are available for stable beam motion in Indus-2 at beam energy 2.5 GeV using movable beam scrapers are presented. These beam scrapers are installed in one of the long straight sections in the ring. With the movement of beam scrapers towards the beam centre, the beam lifetime is measured. The beam lifetime data obtained from the movement of vertical and horizontal beam scrapers are analyzed. The contribution of beam loss due to beam-gas scattering (vacuum lifetime) and electron-electron scattering within a beam bunch (Touschek lifetime) is separated from the measured beam lifetime at different positions of the beam scrapers. Vertical and horizontal beam sizes at scrapers location are estimated from the scraper movement towards the beam centre in quantum lifetime limit and their values closely agree with measured value obtained using X-ray diagnostic beamline.

Triplication of deciduous teeth: A rare dental anomaly

Fusion of teeth is the union of two or more tooth germs, which are usually separated. Depending upon the stage of odontogenesis, it can be complete or incomplete. The present case describes fusion between the maxillary primary right central and lateral incisor with a supernumerary tooth. Clinical and radiographic examination revealed the presence of fused triple teeth. The fused teeth were extracted, sectioned and were visualized under stereomicroscope at three levels and the diagnosis of fusion of three teeth was confirmed histologically.

Oral cancer as a leading annoyance of the South Asian territory: An epidemiologic and clinical review

Oral cancer is one of the most fatal health problems faced by the mankind today. In India, because of cultural, ethnic, geographic factors, and the popularity of addictive habits, the frequency of oral cancer is high. It ranks number one in terms of incidence among men and third among women. Several factors such as tobacco and tobacco-related products, alcohol, genetic predisposition, and hormonal factors are suspected as possible causative factors. The exciting opportunity provided by the well-established oral precancerous lesions for intervention and early detection programs is also discussed. The poor survival revealed by existing studies is mainly due to the overwhelming proportion of advanced cases. The excellent opportunity for more research and efforts in prevention and control of oral cancer in India is highlighted in this review. Here authors sought to epidemiologically review oral cancer in South Asian province with special focus on major risk factors and future perspectives.

Identifying the Factors Causing Delayed Presentation of Cancer Patients to a Government Medical College of Central India

BACKGROUND The incidence of cancer is increasing throughout the world. One of the prime aims of its management is early diagnosis and therapeutic intervention. Factors causing delay to either of these goals should be identified and rectified. AIM To identify the factors causing delayed initial diagnosis and subsequent management in patients presenting to the Oncology department. MATERIALS AND METHODS Three hundred proven cancer patients were prospectively evaluated for the pattern of presentation to the outpatient Department of Radiation Oncology of a Government Medical College (MC) in Central India. RESULTS The mean age of presentation was 51.05 years (range 7 months-77 years). The number of male patients was 168 while females were 132. The duration of symptoms ranged from 20 days to 3 years. The number of patients with little/no education presented mainly in advanced stages as compared to their educated counterpart and this difference was statistically significant (p<0.001). The number of patients presenting directly to the department was 108, those diagnosed outside and referred to us was 84 while those diagnosed and received some form of oncologic treatment outside and referred thereafter was 108. The difference in the primary delay between patients presenting directly to the MC versus those diagnosed outside was significant (p=0.0126). The mean duration of starting definitive treatment after presentation to the outpatient was 4.68 days (range 0-22 days) and was very significantly (p< 0.001) less than the secondary delays caused to the other two subsets of patients. CONCLUSION Factors causing delayed presentation are both patient and system related. It is imperative to educate the common people regarding the early signs and symptoms of cancer. At the same time, the system needs to overhaul its efficiency to avoid secondary delays that adversely affect the treatment outcome. An upgradation of the existing oncology facilities in the public sector can achieve this target efficiently.

Five versus ten fractions per week radiotherapy in locally advanced head and neck cancer

Introduction: Conventional fractionated radiotherapy (CFRT) is in use since a long time, but the invention of altered fractionation such as hyperfractionation has improved survival in head and neck squamous cell cancer (HNSCC). Aims: Our aim of this prospective randomized study is to compare conventional 5 fractions per week (CFRT) with hyperfractionation 10 fractions per week (hyperfractionated radiotherapy [HFRT]) in locally advanced head and neck cancer. Patients and Methods: The study period is from November 2013 to April 2015. Totally, 100 patients with proven head and neck cancer were submitted to radiotherapy on theratron 780 (cobalt 60) machine. Fifty patients in each CFRT group and HFRT group randomized to receive radiotherapy following induction chemotherapy. Patients in CFRT group have received 66–70 Gy/33–35 fractions Monday to Friday, while HFRT group have received 70.4 Gy/64 fractions Monday to Friday. Results: Our results show manageable toxicity profile of a combined therapy consisting of cisplatin and paclitaxel, followed by concomitant chemoradiotherapy in the form of either CFRT or HFRT with cisplatin as a radiosensitizer in both treatment groups. The overall response at the completion of radiotherapy was 95.7% in HFRT versus 89.5% in CFRT with 76.6% complete response in HFRT versus 64.6% in CFRT. Conclusions: After induction chemotherapy, HFRT seems to be more efficacious than CFRT in locally advanced HNSCC, by increasing significantly the probability of progression-free survival and locoregional control.

Assessment of treatment tolerance and response of elderly head and neck cancer patients: A single institution retrospective study

Background: Head and neck (H and N) cancers are the leading cancer in elderly Indian population especially in Central India. Poor socioeconomic (SE) factors, lack of knowledge, and that of proper facilities is responsible for delayed presentation in advanced stages of the disease. Management of such patients is challenging for an oncologist. Aim: The present study evaluated the pattern of tolerance and response to treatment in elderly (>65 years) H and N cancer patients. Materials and Methods: Medical records of elderly H and N cancer patients presenting from January to December 2014 to the Department of Radiotherapy, Gandhi Medical College, Bhopal were reviewed, and data were collected from the departmental case files. Results: A total 112 patients were selected for this study. The mean age of presentation was 70 years. There was a marked male preponderance, with male to female ratio of 5.22:1. 102 patients presented in advanced stages (stage III and IV). The mean duration of symptoms was 6.5 months. Records of 99 patients were available and further analyzed. 59 patients were advised three courses of induction chemotherapy (CT) out of which 44 patients completed the treatment. 28 of these patients showed a positive response to the treatment while 16 showed no response (NR)/progression. Similarly, 24 patients were advised concurrent chemoradiotherapy out of which 17 patients completed the treatment. 13 of these patients showed a positive response while 04 showed NR/progression. On subgroup analysis, the difference between tolerance, response and overall treatment time between the two arms was not statistically significant. Conclusions: Treating elderly H and N cancer patients is a major therapeutic challenge for a clinician because of its poor prognosis, aggressive clinical behavior, associated co-morbidities, and SE factors. However, it is possible to achieve a quality outcome in select patients with basic CT and radiation.

Large intraductal sialolith in Wharton's duct

Sialolithiasis is one of the most common disease of salivary glands and it has been estimated that it affects 12 in 1000 of the adult population. More than 80% occur in the sub mandibular gland or its duct, 6% in the parotid gland and 2% in the sublingual gland or minor salivary glands and are a common cause of acute and chronic infections. Clinically, they are round or ovoid, rough or smooth and of a yellowish color. They consist of mainly calcium phosphate with smaller amounts of carbonates in the form of hydroxyapatite, with smaller amounts of magnesium, potassium, and ammonia. Sub mandibular stones are 82% inorganic and 18% organic material whereas parotid stones are composed of 49% inorganic and 51% organic material. The organic material is composed of various carbohydrates and amino acids. Bacterial elements have not been identified at the core of a sialolith and this report describes the case of a patient who had an unusual large submandibular gland sialolith (calculus) completely obstructing the sub mandibular gland duct. Patients with sialolithiasis require definitive surgical treatment in most cases, which results in an excellent prognosis.

Circummandibular wiring: An absolute answer to paediatric maxillofacial trauma: An unusual case report

On an average the incidence of pediatric maxillofacial injuries accounts for 4-6% of cases. Operative management should involve minimal manipulation and may be modified by the stage of skeletal and dental development. The goal of treatment of these fractures is to restore the underlying bony architecture to pre-injury position, in a stable fashion, as non-invasively as possible, and with minimal residual esthetic and functional impairment. The purpose of this article is to provide an insight on maxillofacial injuries in pediatric patient and to assist the clinician in the management of mandibular parasymphysis fracture in children with occlusal acrylic splint fixed with circummandibular wiring, a definitive treatment modality.

Imperative role of early diagnosis in precancerous lesions: Oldideas, new findings, yet more questions

In India, cancers of the oral cavity and oropharynx are most common of all malignancies. Over 90% of these tumors are squamous cell carcinomas (SCCs), which arise from the oral mucosal lining. In spite of the ready accessibility of the oral cavity to direct examination, these malignancies still are often not detected until a late stage, and the survival rate for oral cancer has remained essentially unchanged over the past three decades. The purpose of this article is to review the clinical features of premalignant oral lesions, with an emphasis on early detection.