Exploring the supremacy of microvascular coupling devices for arterial anastomosis in terms of added expeditiousness, safety concerns: A systematic review Ajit Kumar Vishwakarma, Naresh Kumar Sharma, Neeraj Kumar Dhiman, Shankar Singh, Chandresh Jaiswara, Sadhana Swaraj Journal of Oral Biology and Craniofacial Research, 2024 Background: Arterial anastomoses are still most commonly performed using orthodox hand sewing technique. Various rationale such as non-pliable, atherosclerotic, thick-walled or irradiated vessels limit the competency of coupler devices for arterial micro-anastomosis. Microvascular coupling devices (MCD) are well known for venous anastomoses but arterial MCD have relatively been less navigated in reported literatures. This review outlines the current applications, troubleshooting, safety and efficiency of arterial MCD in free flaps. Methods: Comprehensive search of electronic databases (PUBMED/MEDLINE) in accordance with PRISMA guideline was performed. Data were extracted and collected in four groups of standardised variables. Results: Out of a total of 263 identified articles, 38 studies were analysed and 16 amidst these were included in final data synthesis. Included studies contained a combined total of 2416 patients who went through 521 arterial and 2460 venous anastomoses using 3 M/Synovis coupling devices. Among all coupled arterial anastomoses, 407 were conducted in head and neck free tissue transfer and 114 were performed in breast reconstruction. The aggregate coupled arterial micro-anastomosis success rate reported was 90.01 % (469/521). Only 9.98 % (52 out of 521) manifested pooled incidence of troubleshooting, thrombosis or flap failure. Conclusion: Microsurgeons are resisting the frequent use of arterial coupling devices owing to inherent arterial characteristics, but with suitable vessel selection, arterial coupling may be a powerful tool and can be executed in safe, expeditious and reliable fashion. This study embellishes collaborative suggestions and troubleshooting issues related to arterial coupling, however further assessment would be required with controlled trials.
Hyena bite: A rare intriguing mode of maxillofacial injury, its management, risks involved, scenarios to avoid Arjun Mahajan, Chandresh Jaiswara, Neeraj Kumar Dhiman, Aswathi Krishnan National Journal of Maxillofacial Surgery, 2024 The striped hyena (Hyaena hyaena) is a rarely spotted carnivore in India listed as Near Threatened (red list) by International Union for Conservation of Nature (IUCN) in 2014. Hyena is considered as scavenger but also executes rare opportunistic attacks on humans. In India, reported cases of hyena attack on humans are very rare, because of remote locations of these attacks majority of which go unreported to higher medical centres. This article describes about the circumstances and management of Hyena inflicted maxillofacial injury in North India, which is as per our knowledge first scientifically documented maxillofacial injury caused by Hyena in Indian subcontinent.
Efficacy of arthrocentesis with intra‑articular injection of hyaluronic acid and corticosteroid in the treatment of internal derangement of temporomandibular joint Neeraj K. Dhiman, Chandresh Jaiswara, Mehul S. Hirani, Nishtha Chauhan, Arjun D. Mahajan, Aswathi Krishnan National Journal of Maxillofacial Surgery, 2023 Introduction: Various techniques have been used to treat internal temporomandibular joint derangements (TMJ ID), with arthrocentesis one of the most successful in reducing symptoms and promoting function. In cases of TMJ ID, this research study compares and evaluates the efficacy of arthrocentesis with injections of corticosteroids (CS) or hyaluronic acid (HA). Methods: This prospective randomized, non-blinded study involving 91 patients with symptoms of TMJ ID treated by arthrocentesis followed by intra articular injection of 1 ml of either corticosteroid (group A) or HA (group B) . Maximum mouth opening, lateral excursive movements, TMJ pain at rest and during function, masticatory efficiency, pre-treatment functional TMJ limitation and subjective judgment of efficacy of treatment were assessed with millimeter scale. All the parameters measured before the procedure and further followed at 1st week, 1st month, 3rd month and 6th month post-procedure. Results: Maximum mouth opening post procedure improved significantly in Group B at follow up visits (P < 0.05). Subjects in group B showed significant reduction in pain at rest (P = 0.001) at 1 week and 1 month follow up & increased masticatory efficiency at 6 months (P = 0.042) as compared to that of group A subjects. Conclusion: Injection of HA post-TMJ arthrocentesis is found be comparatively more effective method of treating TMD IDs with resultant decrease in pain & improved functionality of the jaw. TMJ arthrocentesis along with injection of HA could serve as a possible alternative to treat chronic TMJ pain sufferers who are unresponsive to conservative medical therapies.
Temporomandibular joint ankylosis: A tertiary center-based epidemiological study Nitesh Mishra, NareshKumar Sharma, NeerajKumar Dhiman, Chandresh Jaiswara, Preeti Tiwari, AkhileshKumar Singh National Journal of Maxillofacial Surgery, 2021 Introduction: Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint (TMJ) as a sequel to trauma, infection, or autoimmune diseases. The incidence of TMJ ankylosis differs significantly in different parts of the world. The purpose of this study was to analyze the etiological incidence of TMJ ankylosis at our tertiary-level center, which covers a huge population from parts of Bihar and eastern Uttar Pradesh. Materials and Methods: This study was conducted from July 2016 to April 2019, and a total of 1607 children were screened in the duration of 33 months. Participants were included in this study as per the inclusion and exclusion criteria. Results: After screening of the 1607 children, 128 TMJ ankylosis cases were identified. Out of the 128 cases of TMJ ankylosis, 33 cases were bilateral and 95 cases were unilateral (48 left sided and 47 right sided). Most of the patients (83.5%) were in the 10–15-year-old age group (mean age was 12.1 ± 2.83 years). There was a female preponderance, and the male-to-female ratio was 7:10. Overall, the most common cause of ankylosis was found to be childhood trauma. Conclusion: The major etiologic factor of TMJ ankylosis was found to be birth/childhood trauma. TMJ ankylosis cases were detected in significant numbers in this study. This increased prevalence may be due to the lack of knowledge about this pathological entity among the general population and health-care professionals at primary level, which leads to poor initial management.
Masticatory efficiency of fracture mandible after osteosynthesis with 2 mm conventional and locking miniplates: A comparative study Nitesh Mishra, Chandresh Jaiswara, Aditi Priya, Naresh Kumar Sharma, Neeraj Kumar Dhiman, T Janani World Journal of Dentistry, 2020 Ab s t r Ac t Aim: To evaluate and compare the effectiveness of locking vs conventional 2.0 mm titanium miniplate in the fixation of mandibular fractures and to compare masticatory efficiency. Materials and methods: In this study, 30 patients were selected and randomly divided into two groups (I and II). Both groups I and II consisted of 15 patients who underwent mandibular osteosynthesis using locking and conventional (non-locking) 2-mm miniplates, respectively. Postoperative follow-up was done at first, second, fourth week, and at third month for radiological and clinical assessment of all the patients. Results: In this study, a statistically insignificant result was found in the following parameters: pain, swelling, paresthesia, infection, hardware failure, and postoperative occlusal bite forces. An increase in bite force is recorded at each follow-up (first, second, fourth week, and at third month) for both the groups. When occlusal bite forces were compared, group I showed greater mean bite force than group II at each follow-up, however, the results were statistically insignificant (p value > 05). Conclusion: This study concludes that both locking and conventional miniplates are equally effective in withstanding masticatory load, with locking plates/screw system having added advantage of higher initial stability and stiffness thereby minimizing the duration of IMF. Locking miniplates system was found to have less infection and hardware failure. Clinical significance: In this study, locking plate group was found to be clinically superior because of ease of handling, higher initial stability, and stiffness, hence minimizing the total duration and had less infection and failure.
Comparative evaluation of buccal pad of fat with and without bovine collagen membrane in the management of oral submucous fibrosis: A prospective clinical study AkhileshKumar Singh, Arun Pandey, NareshKumar Sharma, NeerajKumar Dhiman, Chandresh Jaiswara, Preeti Tiwari, Vishal Verma, Shankar Singh National Journal of Maxillofacial Surgery, 2020 Background: Oral submucous fibrosis (OSMF) is a chronic, debilitating disease characterized by juxtaepithelial fibrosis. The present study evaluates the efficacy of buccal fat pad (BFP) and bovine collagen membrane as reconstruction options. Materials and Methods: The sample size includes 22 patients between 20 and 60 years, randomly distributed in two groups: Group I in which BFP was used and Group II where BFP with bovine collagen membrane was used after surgical resection of fibrotic bands. The clinical evaluation on postoperative 1st, 3rd, and 5th days and 1st, 2nd, 3rd, 4th, 12th, and 24th weeks subsequently. Results: The mean age in Group I was 27.17 ± 3.157 years and Group II was 37.90 ± 6.657 years. The mean preoperative mouth opening was 9.75 ± 6.717 and 8.90 ± 3.784 mm in Groups I and II, respectively. The mean duration of presenting illness in Group I was 9.75 ± 2.598 years and in Group II was 8.80 ± 1.989 years. There was no significant difference observed between Groups I and II in relation to reduced mouth opening and duration of symptoms (P > 0.05) except for age. No significant difference was observed between both the groups in relation to preoperative pain, burning sensation, cheek stiffness, mucosal suppleness, postoperative infection, and postoperative pain at days 1 and 5 and 1st week. There was a significant difference observed in postoperative pain among both the groups on the 3rd day and 2nd week. Conclusion: In the present study, both the groups have proved to give better results, as BFP in the form of interposition material showed rapid epithelization and minimum wound contracture.
