Browsing by Author "Nitesh Mishra"

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Bipaddled Pectoralis Major Myocutaneous Flap in Complex Oral Cancer Defects- A Single Center Experience with Quality of Life Assessment
(Springer, 2023) Akhilesh Kumar Singh; Neville J F; Naresh Kumar Sharma; Janani Anandkumar; Nitesh Mishra; Arun Pandey
Introduction: Advanced stage malignancies of oral cavity commonly result in complex full thickness defects with subsequent functional and aesthetic loss. Through this article we describe our center’s experience in reconstruction of such defects with bipaddled pectoralis myocutaneous (PMMC) flap through an immediate, single-staged procedure. Materials And Methods: The study included a total of 54 patients who underwent composite resection and neck dissection followed by reconstruction of the defect with bipaddled PMMC flap. All patients were followed up post-operatively for 1 year and were monitored for flap and donor site related complications. Using University of Washington Quality of life v4 questionnaire (UW-QOL4), we assessed the QOL of 54 patients. The mean scores were compared to other similar studies. Results: The overall complication rate was 66.6%, whereas, 33.3% patients had no complications. The most common complication was wound dehiscence seen in 31.5% of cases in the recipient site and 12.9% in the donor site. Other complications were seroma, hematoma, plate exposure, orocutaneous fistula etc. Around 73.7% patients reported a good, very good or outstanding overall quality of life in the post-operative period. The mean composite QOL score was 65.84. Our study showed comparable domains of pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder function and taste with other similar studies. Conclusion: Bipaddled PMMC flap proves to be a considerable alternative for microvascular free flaps in reconstruction of full-thickness defects of oral cavity owing to its reliable blood supply, accessibility, easier harvesting technique, cost effectiveness, high success rate and acceptable quality of life. © 2022, Association of Otolaryngologists of India.
Bone augmentation with sticky bone and platelet-rich fibrin by ridge-split technique and nasal floor engagement for immediate loading of dental implant after extracting impacted canine
(Wolters Kluwer Medknow Publications, 2019) Romesh Soni; Aditi Priya; Himanshi Yadav; Nitesh Mishra; Lakshya Kumar
Nowadays, dental implants are the best treatment option for tooth loss, but implant placement requires sufficient bone volume. In defect area of alveolar ridge, augmentation is done by various available methods. Utilizing the growth factors such as platelet-rich fibrin (PRF) derived from patient's blood platelets improve treatment outcome. PRF accelerates the wound healing, enhances osteogenic activity as well as regulates the inflammation. Bone grafting, guided bone regeneration, and ridge-split technique promote new bone formation. The aim of this case report is to demonstrate an efficient method of bone augmentation using sticky bone along with PRF membrane, followed by ridge-split technique and engagement of nasal floor to place implant. © 2019 National Journal of Maxillofacial Surgery | Published by Wolters Kluwer - Medknow.
Effects of curcumin on oral cancer at molecular level: A systematic review
(Wolters Kluwer Medknow Publications, 2023) Akhilesh Kumar Singh; Naresh Kumar Sharma; Nitesh Mishra; Arjun Mahajan; Aswathi Krishnan; Ravina Rajpoot; Janani Anand Kumar; Arun Pandey
This systematic review mainly focuses on the effects of curcumin on oral cancer cells at the molecular level and summarizes the results of the studies. We searched and analyzed various databases such as Pub Med, ProQuest, Google Scholar, Science Direct, and Scopus. Searches were conducted from 2006 to 2021. This systematic review evaluated various effects of curcumin on oral cancer at the molecular level. All the studies related to the effects of curcumin on oral cancer, both in‑vivo and in‑vitro, were included. After abstract and text screening a total of 13 articles were finally selected for the study based on the inclusion and exclusion criteria. All most all the included studies reported that after treating the cell lines with curcumin there is a reduction in cell proliferation and cell growth, analyzed using MTT (3‑(4,5‑dimethylthiazol‑2‑yl)‑2,5‑diphenyl tetrazolium bromide) assay. Curcumin also induces S phase cell cycle arrest and also prevents Tregs migration. The curcumin reverses the process of epithelial mesenchymal transition (EMT) back to mesenchymal epithelial transition (MET). From this review, it is concluded that curcumin inhibited proliferation, migration, invasion, and metastasis, and induced apoptosis via modulating multiple signaling pathways in oral cancer cell lines. But further clinical trials are needed for a detailed evaluation of the effects of curcumin on patients with oral cancer. © 2023 National Journal of Maxillofacial Surgery.
En Block Versus Separate Management of Cervical Nodes in Tongue and Floor of the Mouth Cancers- Is There a Difference? An Analysis of 85 Cases in a Tertiary Care Institute
(Springer, 2022) J.F. Neville; Mandar Tilak; Akhilesh Kumar Singh; Naresh Kumar Sharma; Janani Anand Kumar; Nitesh Mishra; Farhan Durrani
To evaluate difference in local recurrence, regional (neck) recurrence as well as distant metastases between cases operated with en-block excision of primary cancer and neck nodes versus their separate removal, in squamous cell carcinomas of anterior 2/3 of tongue and floor of the mouth. A total 85 patients of cT1-T4a N0-N2b of carcinoma anterior 2/3 of tongue and floor of mouth were evaluated. Amongst these patients 39 cases of in-continuity en-block neck dissection and 46 cases of discontinuous neck dissection were evaluated for post-operative complications as well as oncological outcome for a follow up period of 3 years. Patient population was similar in both groups with tongue cancers being the commonest site and tobacco being the most common addiction. Primary site hematoma was seen more in the in-continuity en-block neck dissection group with a p-value of 0.0276, which was statistically significant. Post-operative oro-cutaneous fistula occurred more in in-continuity enblock neck dissection as compared to discontinuous neck dissection, but the difference was not statistically significant. Local recurrence rate was significantly more in cases of discontinuous neck dissection (19.565) as compared to in-continuity en-block neck dissection (5.12%) with a p-Value 0.0481. A statistically non-significant but higher loco-regional recurrence was observed in cases of discontinuous neck dissection as compared to cases of in-continuity en-block neck dissection (10.56% vs 2.56). In the present study recurrence-free survival RFS 3 year in cases of en-block in-continuity neck dissection (84.06%) cases as compared to discontinuous neck dissection cases (63.04%) with p Value 0.025698. In-continuity en-block in continuity neck dissection has lower loco-regional recurrence and may impact overall distant metastases. Though early postoperative complications are more in in-continuity en-block in continuity neck dissection as compared to discontinuous neck dissection, most are managed conservatively. Further studies with a larger sample size are needed to evaluate its outcome in a comprehensive manner. © 2021, Association of Otolaryngologists of India.
Evaluation of Arthrocentesis with and Without Platelet-Rich Plasma in the Management of Internal Derangement of Temporomandibular Joint: A Randomized Controlled Trial
(Springer, 2021) Akhilesh Kumar Singh; Naresh Kumar Sharma; P. G. Naveen Kumar; Shreya Singh; Nitesh Mishra; Rathindra Nath Bera
Purpose: The purpose of this study was to compare the efficacy of intra-articular injection of platelet-rich plasma after arthrocentesis versus arthrocentesis alone as a treatment modality in patients with internal derangement of temporomandibular joint. Methods: Twenty-four patients suffering from internal derangement of temporomandibular joint were included in the study. The patients were randomly divided into two groups as follows—twelve patients underwent arthrocentesis followed by intra-articular injection of platelet-rich plasma (study group) and the other twelve were treated by arthrocentesis alone (control group). Pain intensity was recorded on visual analogue scale (VAS); maximum mouth opening and joint sound were measured before and after intervention. The patients were clinically evaluated at the intervals of 1 month, 3 and 6 months subsequently. Results: There was no statistically significant difference in all the parameters between the groups. Intra-group analysis showed statistically significant improvement in all the parameters. Conclusion: In both groups, improvement of pain, maximum mouth opening and TMJ sound were observed at all intervals, but there was no statistically significant improvement in arthrocentesis with PRP group when compared with arthrocentesis alone. © 2019, The Association of Oral and Maxillofacial Surgeons of India.
Management of Maxillary Sagittal Fracture by using Pre-activated Rapid Maxillary Expansion (RME)
(Springer, 2022) Preeti Tiwari; Nitesh Mishra; Mohammed Rashid; Mehul Shashikant Hirani
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. © 2021, The Association of Oral and Maxillofacial Surgeons of India.
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.
Multilayered platelet-rich fibrin as a barrier membrane in guided bone regeneration with simultaneous implant placement: A 3-year follow-up
(Jaypee Brothers Medical Publishers (P) Ltd, 2020) Romesh Soni; Aditi Priya; Himanshi Yadav; Vikram Kumar; Nitesh Mishra
Aim: To demonstrate the use of multilayered platelet-rich fibrin (PRF) membranes as a barrier membrane in the guided bone regeneration (GBR) procedure. Background: Ridge deformities, defects, and insufficient volume at the intended implant sites are common challenge. Simultaneous implant placement along with GBR gives benefits of reduced treatment cost, time, and need of additional surgical procedure. Platelet-rich fibrin has a versatile nature and is a regenerative tool in both hard and soft tissue surgery. This case report presented an alternative approach using PRF as a membrane (multilayered) in GBR to correct buccal wall defect in conjunction with implant placement. Case description: A 23-year-old male was referred for rehabilitation of edentulous area concerning to 32 and 33 regions. After clinical and radiological evaluation and discussion of various treatment modalities, GBR with simultaneous implant placement was planned. Ridge augmentation was done in defect using sticky bone formed by bio-oss bone granules of particle size 1.0–2.0 mm and PRF membranes after implant placement. A proper surgical procedure was followed and postoperative follow-up was done from time to time. Conclusion: Sufficient bone volume was achieved through GBR as shown clinically at second-stage surgery done after 4 months. Three years’ follow-up reveals stable implant prosthesis and healthy interdental papilla and gingival tissue. The multilayered PRF membrane is safe, more economical, and may be feasible as a barrier membrane and could be used in some selected scenarios. Clinical significance: Platelet-rich fibrin membranes can act as resorbable barrier and allow faster healing, improve bone formation, provide soft tissue regeneration, and improve the soft tissue profile. © 2020, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.
Reconstruction of large lower lip defect with bilateral nasolabial flap: A report of case series
(SciDoc Publishers, 2020) Akhilesh Kumar Singh; Nitesh Mishra; T. Janani; Naresh Kumar Sharma; Arun Pandey
In the present era of medical advancement, the concept of a microvascular free flap technique has significantly gained popu-larity in the reconstruction of head and neck surgical defects. Therefore, the routine need for various local and regional flaps that were previously in use, has decreased to a considerable extent. However, a number of such local and regional flaps are quite useful and are still in practice, being used by the reconstructive surgeons. Nasolabial flap is a versatile, reliable, simple, easy to harvest local flap that can cover a variety of intra and extraoral defects. In this case series, we present the success and utility of bilateral nasolabial flap in reconstruction of two large lower lip defects and the restoration of function and aesthetics. The patients had been followed for one year, which was uneventful with no signs of recurrence. © Nitesh Mishra© 2020.
Systematic Review of Intra Parotid Facial Nerve Schwannoma and a Case Report
(Springer, 2022) Akhilesh Kumar Singh; Janani Anand Kumar; Naresh Kumar Sharma; Arun Pandey; Nitesh Mishra; Rathindranath Bera
To evaluate the clinico-epidemiological aspects, pathological features, diagnostic methods, management protocol and functional outcome of the intra-parotid facial nerve schwannoma (IFNS) and to present a case report on intra parotid facial nerve schwannoma. PubMed, ProQuest, Google scholar, Science direct and Scopus were screened for studies. Article selection and data extraction was done by one investigator and other investigator confirmed its accuracy. After abstract and text screening a total of 69 articles were finally selected for the study with the inclusion and exclusion criteria of the systematic review as per PRISMA guidelines. With addition of one case reported to our department. The mean age of diagnosis was 43 ± 16 years with a slight female predominance. The mean duration of the tumour was 29.5 months and the mean size of the tumour on initial diagnosis was 3.6 ± 1.67 cm. Pleomorphic adenoma was the primary diagnosis in 44 cases. Superficial parotidectomy was done in 64 cases followed by resection in 47 cases. Reconstructive treatment was carried out by an end-to-end anastomosis in 3 patients and by facial-hypoglossal anastomosis in 16 patients, GAN cable grafting in 5 patients, a greater auricular nerve graft was done in18 patients and end-to-side interposed sural nerve graft in 8 patients. The type D tumours are treated by extended resection of the facial nerve, which is difficult to reconstruct and also employs a nerve graft that does not often give acceptable recovery of facial function. Facial nerve schwannomas being a rare entity poses a dilemma in diagnosis and management. Managing the lesions is also difficult as intraoperative adherence to the nerve makes a tumour free margin difficult without sacrificing the nerve. At present there is no consensus regarding the management of various types of intra-parotid facial nerve shwannoma. © 2021, Association of Otolaryngologists of India.
Temporalis myofascial flap in reconstruction of maxillary defect: A case series
(Wolters Kluwer Medknow Publications, 2020) Akhilesh Kumar Singh; Nitesh Mishra; T. Janani; Naresh Kumar Sharma
Ablative surgery of midface often leads to compromised aesthetics as well as function. Defects caused by ablative surgery need reconstruction that provides satisfactory results with minimal or no compromise in form and function. Various flaps can be used to reconstruct the maxillary defect. However, medium to large-sized defects can only be appropriately reconstructed using free or regional flaps. Moreover, as free flap reconstructions are tedious and require technique sensitive procedure whereas loco-regional flaps are versatile and more predictable. Temporalis myofascial flap (TMF) seems to be one of the best options among all other regional flaps as it has a reliable blood supply, adequate bulk and its anatomical location is close to primary defect. © 2020 The Author(s).
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 immediate impact of mandatory helmet law on maxillo-facial trauma: A comparative study in a major trauma center, Uttar Pradesh
(Wolters Kluwer Medknow Publications, 2024) Arun Pandey; Thakur P Chaturvedi; Naresh K. Sharma; Akhilesh K. Singh; Janani A. Kumar; Nitesh Mishra
Aim: To analyze the effect of the mandatory helmet rule in helmet usage among motorcycle riders and on facial trauma and to determine the significance of difference in the possibility of facial trauma between the helmeted and non-helmeted motorcycle riders. Setting and Design: A retrospective comparative study conducted in a major trauma center at Uttar Pradesh. Material and Method: Data for the present study was obtained from records of the Emergency Department of Trauma Center, for a period of two months before and after the implementation of The Motor Vehicles Act in UP. The study included patients with a history of non-fatal motorcycle accidents who sustained facial injuries regardless of the presence of injuries to other areas of the body during the study period. Information regarding helmet usage during the accident was also recorded. The results were compared between the pre-law period and post-law period. Statistical Analysis Used: Sample t-test was applied to find the level of significance. Results: Out of 219 injured patients, 152 (69.40%) subjects were not wearing helmets, whereas only 67 (30.59%) subjects were wearing helmets. It was observed that around 68.18% of people stated wearing helmets after law implementation with a statistical significance (P value < 0.05). Conclusion: Our study shows that the mandatory helmet rule with elevated penalty rates has significantly increased the usage of helmet among the motorcycle riders, and it also proves that the possibility of facial trauma is significantly higher in non-helmeted riders when compared to helmeted riders. © 2024 Wolters Kluwer Medknow Publications. All rights reserved.