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Sharma NK, Yadav BS, Hirani MS, Dhiman NK, Singh AK, Tripathi R. Electromyographic Assessment of Masticatory Muscles & their Asymmetries in Adult Indian Population. J Maxillofac Oral Surg 2024; 23:197-203. [PMID: 38312955 PMCID: PMC10830968 DOI: 10.1007/s12663-022-01770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To study the surface electromyography (sEMG) and it is asymmetry under resting and dynamic conditions in masticatory muscles. Materials and Methods sEMG of the masticatory muscles (bilateral masseter & temporalis) was done in 61 healthy subjects (mean age 28.5 ± 8.8 years) with bilateral functional molar occlusal relationship. Root mean square (RMS) values sEMG for each activity (rest, clenching, maximum mouth opening (MMO), left and right excursion) for a 10 s period were recorded and analyzed. Indices for asymmetry of muscles, relative activity and resultant torque were assessed and analyzed. Results RMS values of sEMG during clenching were significantly higher for all masticatory muscles in males compared to females (p < 0.05). During excursive mandibular movement a statistically significant difference seen in ipsilateral temporalis muscle in males. sEMG of masticatory muscles during rest as well as functional activities of mandible was asymmetrical. A predominant masseteric activity was observed for all functional activities of mandible except during rest for which temporalis muscle activity was higher. Right sided torque was observed during rest, MMO and right lateral movements while a predominant left sided torque was present during left lateral movement and clenching. Conclusion sEMG values of masticatory muscles obtained in our study can be used as reference for healthy Indian population. A perfect muscular symmetry might be illusive and a controlled asymmetry criterion appears to be more useful which corresponds to reality.
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Affiliation(s)
- Naresh Kumar Sharma
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Bhupendra Singh Yadav
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Mehul Shashikant Hirani
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Neeraj Kumar Dhiman
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Akhilesh Kumar Singh
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Richik Tripathi
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Singh AK, Bera RN, Neville JF, Tripathi R, Sharma NK, Kumar JA, Hirani MS, Chauhan N. Comparative Evaluation of Nasolabial Flap, Buccal Fat Pad and Platysma Myocutaneous Flap for Reconstruction of Oral Sub Mucous Fibrosis Defects. Indian J Otolaryngol Head Neck Surg 2023; 75:2945-2951. [PMID: 37974718 PMCID: PMC10646138 DOI: 10.1007/s12070-023-03887-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/14/2023] [Indexed: 11/19/2023] Open
Abstract
Moderately advanced (stage III) and advanced (stage IV a & b) OSMF requires surgical intervention for management A number of options are available for reconstruction of post OSMF oral cavity defects. In our study we retrospectively compared buccal fat pad, nasolabial flap and platysma flap for reconstruction of the buccal mucosal defects. Patient records were obtained from the medical records section of the Institute and divided into three groups; group A (buccal fat pad), group B (nasolabial group) and group C (platysma flap). Maximal mouth opening and intercommisural distance were the primary outcomes. Kruskal Wallis test was used to test the mean difference between three groups. Mann-Whitney test was used for intergroup comparisons. Wilcoxon signed rank test was used to evaluate the mean difference in outcomes at each follow up interval. A p value of < 0.05 was considered as statistically significant at 95% confidence interval. After 1 year follow up patients in platysma group had significantly better mouth opening (39.84 ± 1.65 mm) compared to both buccal fat pad (36.69 ± 3.41 mm) and nasolabial groups (37.94 ± 0.43 mm). Inter commisural distance was significantly better in patients reconstructed with platysma flap (59.21 ± 0.99 mm) compared to both buccal fat pad (54.11 ± 1 mm) and nasolabial flap (56.84 ± 1.48 mm). Platysma flap lead to significantly better maximal mouth opening compared to both nasolabial and buccal fat pad. Both buccal fat pad and nasolabial lead to comparable mouth opening. Inter commissural distance is maximum with platysma flap followed by nasolabial flap and buccal fat pad.
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Affiliation(s)
- Akhilesh Kumar Singh
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Rathindra Nath Bera
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
- Midnapore, India
| | - J. F. Neville
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Richik Tripathi
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Naresh Kumar Sharma
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Jananni Anand Kumar
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Mehul Shashikant Hirani
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Nishtha Chauhan
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
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Sharma NK, Singh AK, Hirani MS, Krishnan A, Mahajan A, Rajpoot R. Oral Manifestations of Malignant Immunoglobinopathy Hidden in Plain Sight - A Rare Case Report. Ann Maxillofac Surg 2023; 13:101-104. [PMID: 37711542 PMCID: PMC10499283 DOI: 10.4103/ams.ams_75_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 01/11/2023] [Accepted: 02/23/2023] [Indexed: 09/16/2023] Open
Abstract
Rationale Radiolucent lesions over the angle-body region of the mandible are frequently difficult to diagnose but crucial to provide patient-centred care. Patient Concerns An elderly female presented with a painless slow-growing swelling over her left lower face for one year, radiographically appearing as a well-defined unilocular radiolucency over the left body of the mandible. Diagnosis Aspiration was negative, and biopsy was inconclusive. Further imaging, bone marrow biopsy, immune profile and serum electrophoresis confirmed the diagnosis of multiple myeloma. Treatment She was referred to Medical Oncology for chemotherapy of lenalidomide, bortezomib and dexamethasone regimen cycle that was repeated every 21 days. Outcomes There was no increase in swelling, and radiographically 'punched-out' lesions were reduced significantly. Take-Away Lessons Maxillofacial clinicians should be attentive to the oral manifestations of underlying disease, have a high index of suspicion and start the treatment promptly to increase chances of a favourable outcome.
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Affiliation(s)
- Naresh Kumar Sharma
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Akhilesh Kumar Singh
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Mehul Shashikant Hirani
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Aswathi Krishnan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Arjun Mahajan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Ravina Rajpoot
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
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Tiwari P, Mishra N, Rashid M, Hirani MS. Management of Maxillary Sagittal Fracture by using Pre-activated Rapid Maxillary Expansion (RME). J Maxillofac Oral Surg 2022; 21:759-764. [PMID: 36274882 PMCID: PMC9474797 DOI: 10.1007/s12663-021-01516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 01/22/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction Different techniques of the management of sagittal maxillary fractures have been described with different advantages and disadvantages. We herein present our experience and results of managing these cases by reversing pre-activated maxillary expanders and evaluation of its efficacy. Patient and Methods A prospective study was conducted from April 2016 to February 2020 including all the patients managed for sagittal palatal fractures using the modified technique. The patients were evaluated for healing, occlusion and complications. Results A total of five patients with sagittal palatal fracture were managed. The mean Glasgow Coma (GCS) score and injury severity score (ISS) of patients were 11.6 ± 2.4 and 15.2 ± 4.3, respectively. Both had a significant strong negative correlation with a correlation coefficient of - 0.889 (p = 0.44). The median duration for initiating the treatment for facial fractures was 2 days (range 2-12 days). All patients achieved satisfactory outcomes and tolerated this technique well. No obvious complications were found. Conclusion This method could produce enough transversal force to reduce fractured fragments and then serve as an external fixator to maintain stability for bony healing.
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Affiliation(s)
- Preeti Tiwari
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India
| | - Nitesh Mishra
- Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana India
| | - Mohammed Rashid
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India
| | - Mehul Shashikant Hirani
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India
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Bera RN, Anand Kumar J, Kanojia S, Mashhadi Akbar Boojar F, Chauhan N, Hirani MS. How far we have come with the Management of Condylar Fractures? A Meta-Analysis of Closed Versus Open Versus Endoscopic Management. J Maxillofac Oral Surg 2022; 21:888-903. [PMID: 36274885 PMCID: PMC9475017 DOI: 10.1007/s12663-021-01587-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 05/01/2021] [Indexed: 10/21/2022] Open
Abstract
Background The treatment approaches for condylar fractures of the mandible include functional, closed reduction and open reduction-internal fixation. Recently endoscopic management of condylar fractures has been emphasized in the literature. We systematically review the studies comparing closed versus open versus endoscopic-assisted condyle fracture management with regard to the indications, effectiveness and complications of each modality. Methods A total of 11 articles were selected based on the inclusion and exclusion criteria from PubMed, Cochrane and clinical trials.gov. Differences in means and risk ratios were used as principal summary measures with p value < 0.05 as significant. For detection of any possible biases in sample sizes, the OR and its 95% CI for each study were plotted against the number of participants. Chi-square test, I2 test and the Cochrane bias tool were used to assess the bias in and across studies. Results Except for deviation on opening there was no significant difference between open versus closed treatment of condylar fractures. Endoscopic approach and open surgical approaches differed only in terms of operating time and TMJ pain. There was no significant difference in facial nerve injury among the two groups. Discussion Closed reduction is particularly indicated for minimally displaced fractures; for moderate to severe displacement, open reduction is preferred. Open reduction can also be preferred over endoscopic approaches as there is no significant advantage of using latter. Limitations of the study included specific treatment according to the site of fracture not addressed, limited data regarding pediatric condylar fracture, lack of homogenous classification schemes, etc.
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Affiliation(s)
- Rathindra Nath Bera
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
| | - Janani Anand Kumar
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
| | - Shweta Kanojia
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
| | | | - Nishtha Chauhan
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
| | - Mehul Shashikant Hirani
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
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Tiwari P, Bera RN, Kanojia S, Chauhan N, Hirani MS. Assessing the optimal imaging modality in the diagnosis of jaw osteomyelitis. A meta-analysis. Br J Oral Maxillofac Surg 2021; 59:982-992. [PMID: 34503859 DOI: 10.1016/j.bjoms.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022]
Abstract
Osteomyelitis is an inflammatory infectious disease that affects bone and bone marrow. Histopathology remains the gold standard method for diagnosis, but imaging modalities also play an important role. We systematically reviewed five articles with comparative studies on plain films, computed tomography (CT) scan, magnetic resonance imaging (MRI), cone beam computed tomography (CBCT), positron emission tomography (PET), single photon-emission computed tomography (SPECT), scintigraphy, and SPECT/CT. Scintigraphy and SPECT/CT has the highest sensitivity of 100%. PET is only to be used in cases of follow up. Orthopantomography (OPG) is the most common initial diagnostic tool despite its low sensitivity. CT provides the necessary specificity needed for radionuclide imaging, which has the highest negative predictive value of 100% and a positive predictive value >95%. SPECT/CT with 100% sensitivity and 85% specificity can be considered as the imaging modality of choice for initial diagnosis and follow up.
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Affiliation(s)
- P Tiwari
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences.
| | - R N Bera
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Room No 142 Sushruta Hostel Trauma Centre BHU, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India.
| | - S Kanojia
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
| | - N Chauhan
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
| | - M S Hirani
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
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