Browsing by Author "Ajit Kumar Vishwakarma"

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Chondroblastic Osteosarcoma in an Adolescent: Are Conventional Biopsy Techniques Just Scratching the Surface?
(Springer, 2025) Neeraj Kumar Dhiman; Arjun D. Mahajan; Trupti Jain; Ajit Kumar Vishwakarma; Rahul Agrawal
Osteosarcoma, although the most common malignant bone tumor in long bones, represents only 5–8% of head and neck tumors, making it uncommon for clinicians. Conventional biopsy techniques can complicate diagnosis due to varying tissue representation in surrounding areas. This article discusses a case involving a 19-year-old female who presented with facial swelling and a rapidly growing intraoral mass. Initial panoramic radiography showed localized radio-opacity and root resorption. Incisional biopsies initially suggested diagnoses of ossifying fibroma and fibrous hyperplasia, which did not align with the clinical presentation. Repeat excisional biopsy extending to the periosteum revealed findings consistent with chondroblastic and fibroblastic proliferation, including malignant osteoid and myxomatous stroma, confirming chondroblastic osteosarcoma. The patient subsequently underwent neo-adjuvant chemotherapy followed by surgical resection and radiotherapy. This case underscores the critical importance of timely and accurate diagnosis in osteosarcoma, as delays can significantly impact patient prognosis. The article emphasizes the lessons learned from such experiences in managing this challenging malignancy. © Association of Otolaryngologists of India 2024.
Evaluation of Transport Distraction Osteogenesis in Maxillofacial Region
(Springer, 2025) Ajit Kumar Vishwakarma; Neeraj Kumar Dhiman; Naresh Kumar Sharma; Chandresh Jaiswara; Preeti Tiwari; Mehul Shashikant Hirani
Introduction: Transport distraction osteogenesis (TDO) is a novel reconstructive modality for mandibular ablative defects, precluding donor site morbidity. Assessing of TDO regenerate that could assist in modifying the distraction strategy for patient specific needs. Materials and Methods: Present study enrolled 17 patients with mandibular defects of size < 12 cm, divided in two groups ≤35 years (A) and > 35 years (B); and assessed the TDO regenerate by clinically examining intra as well as post operatively, using orthopantomogram (OPG), ultrasonography (USG), color Doppler (CD) and cone beam computed tomography (CBCT). Results: Group B had a longer latency period (p = 0.001) and consolidation period (p = 0.002) than group A. Paired sample correlation study of clinical defect and TDO regenerate (p 0.004) indicate that a better length of regenerate is possible with TDO in mandibular defects. OPG, USG and CBCT shown a significant difference in bone mineralization observed within different age groups except for CD. USG representing earlier detection of mineralization than OPG over the consolidation period. Conclusion: Use of TDO for reconstruction of mandibular defects is advantageous as the regenerated bone and soft tissues matches the existing anatomical tissues. Evaluation by USG, OPG and CBCT could aid in providing patient specific protocols for TDO in Maxillofacial region. © The Association of Oral and Maxillofacial Surgeons of India 2024.
Exploring the supremacy of microvascular coupling devices for arterial anastomosis in terms of added expeditiousness, safety concerns: A systematic review
(Elsevier B.V., 2024) Ajit Kumar Vishwakarma; Naresh Kumar Sharma; Neeraj Kumar Dhiman; Shankar Singh; Chandresh Jaiswara; Sadhana Swaraj
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. © 2024 The Authors