Browsing by Author "Neeraj Kumar Dhiman"

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Adenoid cystic carcinoma of the floor of the mouth – A rare presentation
(Elsevier B.V., 2016) Chandresh Jaiswara; Neeraj Kumar Dhiman; Akhilesh Kumar Singh; Naresh Kumar Sharma; Vishal Verma; Arun Pandey
Adenoid cystic carcinoma (ACC) is an unusual salivary gland malignancy that remains poorly understood. It is a slow growing but aggressive neoplasm with a tendency for recurrence. It is characterized by the proliferation of ductal (luminal) and myoepithelial cells in cribriform, tubular, solid, and cystic forms. Standard treatment, including surgery with postoperative radiation therapy, has attained reasonable local control rates, but distant metastases do not allow any improvement in the survival rate. The understanding of the molecular mechanisms driving ACC is quite rudimentary. We present a case of a 55-year-old female diagnosed with ACC involving the floor of the mouth with an aim to present the carcinoma's behavior, immunohistocytochemistry, the staining pattern, its treatment, and prognosis. © 2015 Craniofacial Research Foundation
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.
Comparative evaluation of buccal pad of fat with and without bovine collagen membrane in the management of oral submucous fibrosis: A prospective clinical study
(Wolters Kluwer Medknow Publications, 2020) Arun Pandey; Naresh Kumar Sharma; Neeraj Kumar Dhiman; Chandresh Jaiswara; Preeti Tiwari; Akhilesh Kumar Singh; Vishal Verma; Shankar Singh
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 ± 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. © 2020 National Journal of Maxillofacial Surgery.
COVID-19-associated Mucormycosis: A clinico-epidemiological study
(Elsevier Inc., 2022) Jaya Chakravarty; Munesh Kumar Gupta; Ragini Tilak; Rajesh kumar; Rajendra Prakash Maurya; Nilesh Kumar; Susheel Kumar Aggarwal; Shiva S; Naresh Kumar Sharma; Neeraj Kumar Dhiman; Manaswi chaubey; Vishambhar Singh; Ashish verma; Tuhina Banerjee; Neeraj Kumar Agrawal; Ravi Shankar Prasad
Background: There was an unprecedented increase in COVID-19-associated-Mucormycosis (CAM) cases during the second pandemic wave in India. Methods: This observational study was done to know the epidemiological profile of CAM cases andincluded all patients admitted with mucormycosis between May 2021 and July 2021. Results: Out of the enrolled 208 CAM cases (either SARS-CoV-2 RT-PCR or serology positive), 204, three and one had rhino-orbital-cerebral, pulmonary and gastrointestinal mucormycosis, respectively. 95.7 % of the patients had diabetes, out of which 42.3 % were recently diagnosed. Mean HbA1c was 10.16 ± 2.56 %. 82.5 % of the patients were unvaccinated. During their COVID-19 illness, 86.5 % were prescribed antibiotics, 84.6 % zinc preparations, 76.4 % ivermectin, and 64.9 % steroids, while only 39.5 % required oxygen therapy. The frequency of blood groups A, B, O and AB in our CAM patients was 29.5 %, 18.9 %, 38.9 % &12.6 %, respectively. At three months follow up, 60 (28.8 %) patients died, four (1.9 %) stopped antifungal treatment, and 144(69.23 %) were on antifungal treatment. 55 % (n = 33) of deaths occurred within 15 days of admission. Mortality was significantly associated with higher age, RT-PCR positive for SARS-CoV-2, raised serum creatinine and alkaline phosphatase during treatment. At 6 months follow-up, eight more patients died, three due to chronic kidney disease, four patients who had stopped treatment and one patient who was on a ventilator due to COVID-19 associated pneumonia and the rest 140(67.3 %) survived. Conclusion: Uncontrolled hyperglycemia, SARS-CoV-2 infection, rampant use of antibiotics, zinc supplementation and steroids were some of the risk factors for mucormycosis. Despite the overwhelming number of patients with an uncommon disease like mucormycosis, the six months mortality was much lower than expected. © 2022
Does the Method of Open Reduction and Internal Fixation of Mandibular Angle Fracture Differentially Affect Postoperative Strength of Jaw Muscles as Assessed by Surface Electromyography? An Analytical Study
(Springer, 2025) Mehul Shashikant Hirani; Naresh Kumar Sharma; Bhupendra Singh Yadav; Neeraj Kumar Dhiman; Akhilesh Kumar Singh; Richik Tripathi
Objective: To analyze differential postoperative strength of masticatory muscles by surface electromyography (sEMG) in mandibular angle fractures (MAFs) using two open reduction and internal fixation (ORIF) approaches. Materials and Methods: Present study evaluated the two ORIF approaches in unilateral non-comminuted central MAFs operated by intraoral ORIF (group A, n = 17) and extraoral ORIF (group B, n = 8). Root mean square (RMS) values of sEMG (μV.s) of bilateral masseter and temporalis muscles for 10 s each, i.e., rest, maximum clenching, maximum mouth opening (MMO), ipsilateral and contralateral excursion, were compared from preoperative and postoperative visits at 1, 3 and 6 months. Further, MMO, ipsilateral and contralateral excursions were measured using caliper. Results: No significant difference (p > 0.05) in sEMG of all four muscles during all five conditions between the groups was observed from pre-op to post-op 6 months. Post-op group A showed significantly higher MMO and statistically significant difference in sEMG of ipsilateral masseter (p = 0.017) and temporalis muscles (p = 0.019) compared to contralateral muscles at 1 month. When comparing percentage sEMG change from pre-op to 6 months, muscles of both groups revealed positive changes. Conclusion: The intraoral ORIF technique for MAFs shows early improvements in MMO and subsequent changes in sEMG of the masticatory muscles due to minimal muscle stripping, thus favoring its use in clinical practice. © The Association of Oral and Maxillofacial Surgeons of India 2024.
Does the Method of Open Reduction and Internal Fixation of Mandibular Angle Fracture Differentially Affect Postoperative Strength of Jaw Muscles as Assessed by Surface Electromyography? An Analytical Study
(Springer, 2024) Mehul Shashikant Hirani; Naresh Kumar Sharma; Bhupendra Singh Yadav; Neeraj Kumar Dhiman; Akhilesh Kumar Singh; Richik Tripathi
Objective: To analyze differential postoperative strength of masticatory muscles by surface electromyography (sEMG) in mandibular angle fractures (MAFs) using two open reduction and internal fixation (ORIF) approaches. Materials and Methods: Present study evaluated the two ORIF approaches in unilateral non-comminuted central MAFs operated by intraoral ORIF (group A, n = 17) and extraoral ORIF (group B, n = 8). Root mean square (RMS) values of sEMG (μV.s) of bilateral masseter and temporalis muscles for 10 s each, i.e., rest, maximum clenching, maximum mouth opening (MMO), ipsilateral and contralateral excursion, were compared from preoperative and postoperative visits at 1, 3 and 6 months. Further, MMO, ipsilateral and contralateral excursions were measured using caliper. Results: No significant difference (p > 0.05) in sEMG of all four muscles during all five conditions between the groups was observed from pre-op to post-op 6 months. Post-op group A showed significantly higher MMO and statistically significant difference in sEMG of ipsilateral masseter (p = 0.017) and temporalis muscles (p = 0.019) compared to contralateral muscles at 1 month. When comparing percentage sEMG change from pre-op to 6 months, muscles of both groups revealed positive changes. Conclusion: The intraoral ORIF technique for MAFs shows early improvements in MMO and subsequent changes in sEMG of the masticatory muscles due to minimal muscle stripping, thus favoring its use in clinical practice. © The Association of Oral and Maxillofacial Surgeons of India 2024.
Electromyographic Assessment of Masticatory Muscles & their Asymmetries in Adult Indian Population
(Springer, 2024) Naresh Kumar Sharma; Bhupendra Singh Yadav; Mehul Shashikant Hirani; Neeraj Kumar Dhiman; Akhilesh Kumar Singh; Richik Tripathi
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. © 2022, The Association of Oral and Maxillofacial Surgeons of India.
Evaluation of Efficacy of 10% Dextrose Prolotherapy in Management of Temporomandibular Joint Disorders: A Prospective Study
(Springer, 2024) Shankar Singh; Naresh Kumar Sharma; Chandresh Jaiswara; Neeraj Kumar Dhiman; Preeti Tiwari; Janani Anandkumar; Arun Pandey
The aim of this study was to assess the efficacy of 10% dextrose prolotherapy in the management of temporomandibular joint disorder. Thirty patients aged between 18 and 62 years, diagnosed with Temporomandibular Disorders (TMDs) persisting for more than six months and unresponsive to other conservative treatments, were enrolled in the study. Over four subsequent visits, spaced six weeks apart, each patient received injections of 3 ml of 10% dextrose solution into the temporomandibular joint space. Parameters assessed included pain levels, frequency of luxations/dislocations, episodes of locking per month, maximal mouth opening, and clicking, evaluated every six weeks for a duration of three months. All patients exhibited improvements in Temporomandibular Disorders (TMDs), manifested as reduced pain, clicking sounds, locking episodes, and increased maximal mouth opening, following prolotherapy treatment. These improvements were found to be statistically significant (p-value < 0.05). Dextrose prolotherapy is a treatment method with broad applications and should be considered prior to resorting to long-term pharmacotherapy or surgical interventions. The use of 10% dextrose prolotherapy presents a promising treatment modality for temporomandibular joint disorders, as evidenced by its therapeutic benefits. © 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
Hyena bite: A rare intriguing mode of maxillofacial injury, its management, risks involved, scenarios to avoid
(Wolters Kluwer Medknow Publications, 2024) Arjun Mahajan; Chandresh Jaiswara; Neeraj Kumar Dhiman; Aswathi Krishnan
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. © 2024 National Journal of Maxillofacial Surgery | Published by Wolters Kluwer - Medknow.
Masticatory efficiency of fracture mandible after osteosynthesis with 2 mm conventional and locking miniplates: A comparative study
(Jaypee Brothers Medical Publishers (P) Ltd, 2020) Nitesh Mishra; Aditi Priya; Chandresh Jaiswara; Naresh Kumar Sharma; Neeraj Kumar Dhiman; T. Janani
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. © 2020, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.
Orthodontic-surgical management of severe skeletal class iii malocclusion: A case report
(Wolters Kluwer Medknow Publications, 2023) Rojalin Sahoo; Vipul Kumar Sharma; Sneha Singh; Neeraj Kumar Dhiman
Skeletal Class III malocclusion possess a difficult challenge to treat for clinicians. They are multifactorial and include genetic and environmental factors. Early intervention of Class III needs orthopedic correction, whereas, in adults, orthodontic camouflage can be done to treat mild cases while severe skeletal discrepancies demand orthognathic surgery along with orthodontic therapy. In this case report, a case of mandibular prognathism with Bilateral Sagittal Split Osteotomy (BSSO) setback was presented. © 2023 National Journal of Maxillofacial Surgery.
Temporomandibular joint ankylosis: A tertiary center-based epidemiological study
(Wolters Kluwer Medknow Publications, 2021) Nitesh Mishra; Naresh Kumar Sharma; Neeraj Kumar Dhiman; Chandresh Jaiswara; Preeti Tiwari; Akhilesh Kumar Singh
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. © 2021 National Journal of Maxillofacial Surgery.
The Comparative Evaluation of Novel Second Generation Platelet Rich Fibrin Membrane and Conventional Collagen Membrane as Grafting Materials in Post-Fibrotomy Defects of Oral Submucous Fibrosis Lesions
(Springer, 2025) Arjun D. Mahajan; Neeraj Kumar Dhiman; Chandresh Jaiswara; Monika Bansal; Richik Tripathi
Oral SubmucousFibrosis(OSMF) is a premalignant condition predominantly affecting people of south-east Asian origin. Histologically, progressive submucosal fibrous band formation is a characteristic feature which requires surgical excision in advanced cases. A various grafting materials have been used to cover post-surgical defects such as buccal fat pad, nasolabial flap, platysma flap, and collagen membrane each with different advantages and disadvantages. But in today’s era of tissue engineering Platelet Rich Fibrin (PRF) based on the platelet gel therapeutic concept is gaining popularity in restorative procedures, after its development by Choukroun et al. in 2001. PRF membrane being an autogenous growth factor-rich fibrin biomaterial is compared for efficacy with widely used collagen xenograft. As per our knowledge of the literature, this study is the first comparative analysis between PRF membrane and Collagen membrane as reconstructive materials post fibrotomy of OSMF bands. 30 patients including males and females diagnosed clinically with OSMF were grouped post randomization and post-fibrotomy defects were reconstructed with PRF membrane (Group 1) and Collagen membrane (Group 2). Post-operative pain, edema, epithelization, mucosal suppleness, mouth opening, and patient compliance were noted. Data was statistically analyzed with SPSS® IBM® (version 21) software. PRF membrane group showed significant reduction in pain, rapid recovery from mucosal edema, faster rate of epithelization and improvement in mucosal suppleness. Though trend for mouth opening over the period of follow-up was similar in both groups, patient compliance for post-operative jaw physiotherapy was found to be better with PRF membrane grafted patients. With the only drawback of technique sensitivity PRF membrane is emerging as an excellent option for the reconstruction of soft tissue defects. © Association of Otolaryngologists of India 2025.
The rarest cause of impaction of mandibular third molar – A case report
(Elsevier B.V., 2016) Chandresh Jaiswara; Alka Rani; Neeraj Kumar Dhiman
Mandibular tooth impaction is a very common finding and is usually associated with so many local and systemic causes in which the pathway of tooth eruption is obstructed or misdirected. The local causes are either a local bony lesion or an abnormal position of the adjacent tooth. The case presented here is associated with a very rare cause of impaction, which is the hamartomatus growth of the first and second molars causing the obstruction and leading to the impaction of the adjacent third molar tooth. © 2015 Craniofacial Research Foundation