Browsing by Author "Nishtha Chauhan"

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Comparative Efficacy of Autologous Blood and Dextrose Prolotherapy in the Management of Temporomandibular Joint Hypermobility: A Rabbit Model Study
(Springer, 2025) Preeti Tiwari; Amit Nandan Dwivedi; T. P. Chaturvedi; Rahul Patel; Om Prakash Singh; Bitan Naik; Nishtha Chauhan
Introduction: Temporomandibular joint (TMJ) hypermobility affects broad demographic, challenging the efficacy of traditional treatments. The aim of this study is to investigate therapeutic potential of autologous blood injections (ABI) vs dextrose prolotherapy in rabbit model, through detailed histopathological & radiological analyses. Material and Methods: After ethical approval from the institutional committee, a hypermobile joint model was established in rabbits through surgery affirmed by MRI. Subsequently, rabbits were randomly divided into two groups i.e. ABI and dextrose solution. In each group, one joint was designated as control, treated with saline. Following surgical induction of TMJ hypermobility, treatments were administered, & outcome was assessed through histological examination for fibrosis grading & CD68 staining for macrophage infiltration. Results: The ABI group exhibited a higher fibrosis grade (> 75% in 50% of joints) & stronger CD68 staining, indicating a significant fibrotic response & macrophage infiltration compared to dextrose group. In contrast, control joints displayed no fibrosis grades & negative CD68 staining. Conclusion: The study highlights both ABI & dextrose prolotherapy elicit significant fibrotic responses in treating TMJ hypermobility, indicating their therapeutic mechanisms. ABI in particular, triggers more marked inflammatory reaction, underscoring its potential efficacy. Further evaluation is essential to understand its clinical significance and applicability in managing TMJ disorders. © The Association of Oral and Maxillofacial Surgeons of India 2025.
Comparative Evaluation of Nasolabial Flap, Buccal Fat Pad and Platysma Myocutaneous Flap for Reconstruction of Oral Sub Mucous Fibrosis Defects
(Springer, 2023) Akhilesh Kumar Singh; Rathindra Nath Bera; J.F. Neville; Richik Tripathi; Naresh Kumar Sharma; Jananni Anand Kumar; Mehul Shashikant Hirani; Nishtha Chauhan
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. © 2023, Association of Otolaryngologists of India.
Comparison of Methodologies for the Assessment of Clinical Ability in the Removal of Teeth Among Undergraduate Dental Students in India
(Springer, 2025) Preeti Tiwari; T. P. Chaturvedi; Nishtha Chauhan; Rathindra Nath Bera; Mehul Shashikant Hirani
Introduction: Exodontia, or tooth extraction, is a fundamental skill for dentists, particularly in regions where specialized dental care may be less accessible. Assessments often rely on the examiner’s experience, employing arbitrary criteria such as the application of local anesthetic, hygiene, aseptic precautions, and proper instrument use. Such methods risk subjective bias, prioritizing different aspects based on the examiner’s perspective and potentially leading to inconsistent evaluations. The objective of the study was to assess the reliability and validity of the conventional methodology of assessment with a format-based assessment (FM) tool in evaluating exodontia skills. Methods: Twenty students (n = 20) were randomly selected for the study. The conventional method (CM) assessments were given out of a total of 100 marks. To evaluate inter-item consistency, videos of the same procedure were randomly repeated for different examiners. The format-based assessment (FM) used two structured formats (a visual analog scale and an Assessment of Clinical Exodontia Skills (ACES) rating scale), with the formats slightly adjusted to suit the study’s requirements. Results: The rating scale and VAS methods demonstrated higher reliability in evaluating the students’ exodontia skills compared to the conventional method, yielding significantly higher scores (p < 0.01). Conclusion: Future research should explore the development and integration of hybrid assessment models that combine the objectivity of format-based tools with the holistic perspective of conventional methods. © The Association of Oral and Maxillofacial Surgeons of India 2025.
Efficacy of arthrocentesis with intra‑articular injection of hyaluronic acid and corticosteroid in the treatment of internal derangement of temporomandibular joint
(Wolters Kluwer Medknow Publications, 2023) Neeraj K. Dhiman; Chandresh Jaiswara; Mehul S. Hirani; Nishtha Chauhan; Arjun D. Mahajan; Aswathi Krishnan
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. © 2023 National Journal of Maxillofacial Surgery.
Evaluating Excision and Reconstruction Techniques Versus Intralesional Sclerotherapy in Facial Infantile Hemangioma Management: A Clinical Outcome Study
(Springer, 2025) Preeti Tiwari; Vaibhav Pandey; Amit Nandan Dwivedi; Rathindra Nath Bera; Nishtha Chauhan
Background: Different therapeutic strategies exist for managing propranolol-resistant/residual infantile hemangioma (IH) in children. The effectiveness of surgical management vs sclerotherapy for treating propranolol-resistant IH located in the head and neck region is subject to ongoing discussion. The aesthetic result is also a crucial consideration. This study compares the outcomes of these treatment modalities. Methods: In this 7-year prospective study, 123 children with propranolol-resistant IH (88 females and 35 males, mean age 12.7 ± 4.37 months) were enrolled. They were randomly assigned to either surgical treatment or sclerotherapy. The effectiveness of each treatment was assessed using the Patient and Observer Scar Assessment Scale (POSAS) and by recurrence rates. Results: The surgery group showed better POSAS scores (3.58 ± 0.61 and 4.8 ± 0.77) compared to the sclerotherapy group (6.83 ± 0.79 and 7.43 ± 0.88). The recurrence rate was 4.1% in the surgery group, with no recurrences observed in the sclerotherapy group. The dropout rate was higher in the sclerotherapy group. Various surgical techniques were utilized based on the specific characteristics and locations of the lesions. Conclusion: Surgical management yields better cosmetic outcomes and comparable recurrence rates to sclerotherapy in children with propranolol-resistant IH in the head and neck region. This underscores the necessity of personalized treatment plans, with the choice of surgical technique tailored to the lesion’s characteristics. © The Association of Oral and Maxillofacial Surgeons of India 2025.
How far we have come with the Management of Condylar Fractures? A Meta-Analysis of Closed Versus Open Versus Endoscopic Management
(Springer, 2022) Rathindra Nath Bera; Janani Anand Kumar; Shweta Kanojia; Fargol Mashhadi Akbar Boojar; Nishtha Chauhan; Mehul Shashikant Hirani
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. © 2021, The Association of Oral and Maxillofacial Surgeons of India.
Kite String (Manjha) Injuries Among Children: Single Center Experience Over Four Years
(Springer, 2023) Preeti Tiwari; Nishtha Chauhan; Rahul Patel; Rathindra Nath Bera; Vaibhav Pandey
We reviewed hospital records for kite-string injuries among children over four years (2017–2022). Of 42 affected children, mortality was 9.5%. The mean (SD) Pediatric Trauma Score (PTS) was 8.02 (2.66), with passively involved children facing greater severity [mean (SD) PTS, 5.58 (2.23)]. Kite-string injuries, alarmingly, endanger even bystanders, urging stricter preventive strategies. © 2023, Indian Academy of Pediatrics.
Magnitude of gonial angle influence on the commonness of mandibular angle fractures
(Wolters Kluwer Medknow Publications, 2020) Preeti Tiwari; Rathindra Bera; Nishtha Chauhan
Background: The aim of the study was to review the literature on the influence of gonial angle on mandibular angle fracture. The present systematic review addresses the following focus question: Does the magnitude of gonial angle influence the incidence of mandibular angle fractures? Materials and Methods: Electronic and manual literature searches were conducted on databases: PubMed/MEDLINE, Embase, Science direct, the Cochrane Library, and clinicaltrials.gov for studies published up to August 2019 to collect information about the effect of gonial angle, a skeletal morphological parameter with an incidence of fracture of the angle of the mandibular arch. Systematic literature review was performed to identify studies evaluating the effect of gonial angle in patients suffering from mandible fractures. Large retrospective studies were included and case reports were excluded. Results: Fifteen hundred articles published before August 2019 were identified. One hundred and sixteen articles met the inclusion criteria. Two articles remained when exclusion criteria were applied. As measured in the two included studies containing 280 panoramic radiographs of mandibular fractures, the mean gonial angle of patients in the angle fracture group ranged from 126.8° ± 7.9° to 128.5° ± 5.4°. The mean gonial angle of patients in the nonangle fracture group ranged from 118.5° ± 4.4° to 122.3° ± 4.9°. The mean gonial angle of patients in the angle fracture group displayed a range from 118.9° to 134.7° (confidence interval [CI] 95% 5.89-8.05), whereas the mean gonial angle of patients in nonangle fracture group displayed a range from 114.1° to 127.2° (CI 95% 3.89-4.95). Conclusion: A high gonial angle is an important factor influencing the occurrence of mandibular angle fractures owing to the poorer quality of bone and reduced height at the ramus angle region, all of which necessitate a modification of osteosynthesis techniques. © 2020 Annals of Maxillofacial Surgery | Published by Wolters Kluwer - Medknow.
Role of procalcitonin, interleukin-6 and interleukin-10 as a predictive marker for the use of perioperative steroid in maxillofacial trauma patients
(Churchill Livingstone, 2024) Preeti Tiwari; Rathindra Nath Bera; Nishtha Chauhan; Chandresh Jaiswara; Ragini Srivastava; Bikram Kumar Gupta
Maxillofacial trauma often brings significant challenges for surgeons in terms of preoperative oedema. Steroids offer oedema reduction, yet potentially increase the risks of postoperative infection. This study explores procalcitonin (PCT), as a marker for bacterial infection risk, and interleukins IL-6 and IL-10, which respectively signify pro-inflammatory and anti-inflammatory responses, as potential indicators of infection and inflammation in these trauma cases and thereby aid in refining perioperative guidelines for the use of steroids. A prospective study was conducted at a tertiary public hospital in India from 2019 to 2022 on patients >18 years with facial trauma. After specific exclusions, patients were randomised into steroid (Group A) and non-steroid (Group B) groups. Various parameters including oedema, PCT, IL-6, and IL-10 levels were measured and analysed using SPSS software. Out of 80 patients, 44 were in Group A and 36 in Group B. Post-24 hours, Group A showed significant oedema reduction, with 25 patients displaying a decline to mild oedema, versus 10 patients in Group B (p = 0.034). However, Group A witnessed a higher infection risk, with 20 patients showing positive wound cultures versus three in Group B. Subgroup analysis revealed a link between higher PCT levels and infections (p = 0.039). Additionally, Group A showed less intraoperative bleeding and reduced operating time. While perioperative steroids mitigate swelling, they might increase postoperative infection risk. Elevated PCT levels indicate potential wound infections, suggesting those patients should avoid perioperative steroids. IL-6 and IL-10 trends during perioperative phases can predict pronounced oedema outcomes. © 2024 The British Association of Oral and Maxillofacial Surgeons
The clinical utility of steroids in facial trauma: A retrospective study of 638 patients
(John Wiley and Sons Inc, 2022) Preeti Tiwari; Rathindra Nath Bera; Nishtha Chauhan
Glucocorticosteroids reduce post-operative swelling, trismus and pain after third molar extraction, maxillofacial trauma and orthognathic surgery. Steroids may affect immune system and retard wound healing. However, the use of steroids may or may not lead to infection. Patients were divided into two groups based on steroid therapy. The minimum follow-up was for 6 months. Independent t-test and chi-square statistics were used for quantitative and categorical data respectively. A p < 0.05 was considered significant at 95% confidence interval. A total of 638 patient records were divided into two groups; group A (steroid group) and group B (non-steroid group). After 6 months 45% of group A patients and 2% of group B patients had infection (p value-0.077). The mean duration of analgesic requirement in group A was 3.9 ± 1.5 days compared to 4.4 ± 2.1 days in group B (p = 0.01). Oedema was present in 9% of patients in group A compared to 12.5% in group B after 1 week (p < 0.0001). The mean VAS score at 1 week was 0.03 ± 0.18 in group B compared to 0 in group A (p < 0.001). Use of steroids does not increase the risk of infection. It significantly reduces the duration of analgesic requirement with the reduction in oedema and pain. © 2022 British Association of Oral Surgeons and John Wiley & Sons Ltd.
What is the Optimal Reconstructive Option for Oral Submucous Fibrosis? A Systematic Review and Meta-analysis of Buccal Pad of Fat Versus Conventional Nasolabial and Extended Nasolabial Flap Versus Platysma Myocutaneous Flap
(Springer, 2020) Preeti Tiwari; Rathindra Nath Bera; Nishtha Chauhan
Background: To systematically review the reconstructive options for oral submucous fibrosis utilizing buccal pad of fat versus conventional nasolabial and extended nasolabial flap versus platysma myocutaneous flap. Objective: The succeeding systematic review and meta-analysis addresses the following question, what is the optimal reconstructive option for oral submucous fibrosis? Study Design: A systematic electronic and manual database search revealed five relevant articles comparing buccal fat pad, nasolabial flap and platysma myocutaneous flap as reconstructive options in oral submucous fibrosis. Methods: A total of 1538 articles were found across PubMed, Cochrane and clinical trials.gov. Only five relevant articles were selected for the study. Quality assessment of the selected studies was executed by Newcastle–Ottawa scale. Statistical software RevMan (Review Manager [Computer program], version 5.3, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) was used for meta-analysis. Differences in means and risk ratios were used as principal summary measures. The overall estimated effect was categorized as significant where p ' 0.05. Results: Three of the five studies selected favoured buccal fat pad over nasolabial flap owing to its ease of harvest and lesser number of post-operative complications. One study favoured nasolabial flap because of the progressive increase in mouth opening and bulk of the tissue obtained for reconstruction. A single study favoured platysma flap over nasolabial flap although no difference was obtained in mouth opening, owing its excellent tissue bulk, fewer complications compared to the nasolabial flap. Conclusion: Definitive conclusions cannot be drawn as there are number of limitations in the studies included. However, a general consensus has been towards favouring buccal fat pad over nasolabial flap. The platysma flap owing to its excellent tissue bulk and fewer complications can be considered as an alternative when dealing with defects which are challenging to reconstruct with the buccal fat pad. © 2020, The Association of Oral and Maxillofacial Surgeons of India.