Browsing by Author "Rathindra Nath Bera"

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Adenomatous Hyperplasia of Palatal Minor Salivary Gland and Angiolipoma of the Floor of Mouth: The First Documented Case Report in a Neonate
(Springer, 2022) Rathindra Nath Bera; Vaibhav Pandey; Preeti Tiwari
Adenomatous hyperplasia of the salivary glands usually affects the parotid gland. Within the oral cavity, palate is the most common site. However, this lesion occurs in adults and till date no case has been documented in neonates. Angiolipomas are a variant of congenital lipomas which undergoes vascular proliferation. Angiolipomas of the oral cavity have not been documented till date among neonates. We herein report the first case of combined angiolipoma of the floor of the mouth with adenomatous proliferation of the minor salivary glands in a neonate. The case was managed through surgical excision, and the follow-up was uneventful. Histopathology confirmed the diagnosis. © 2021, The Association of Oral and Maxillofacial Surgeons of India.
Bleomycin-triamcinolone sclerotherapy in the management of propranolol resistant infantile hemangioma of the maxillofacial region: A single arm prospective evaluation of clinical outcome and Doppler ultrasound parameters
(Elsevier Masson s.r.l., 2023) Preeti Tiwari; Rathindra Nath Bera; Vaibhav Pandey
Introduction: Propranolol has emerged as a first line agent in the management of hemangiomas. With increased use of propranolol, studies have also focused on relapses following propranolol therapy. Our current study evaluates the role of bleomycin triamcinolone sclerotherapy for the management of propranolol resistant Infantile Hemangioma (IH). We also evaluated the role color Doppler USG for response assessment of sclerotherapy. Methods: Patients with Propranolol resistant (Non- responders/ Partial responders) IHs were included in the study. Patients received intralesional bleomycin at a dose of 0.5 IU/kg followed by intralesional injection of triamcinolone at a dose of 2mg/kg body weight. Clinically patients were grouped into excellent, partial and non responders. Doppler parameters; Resistivity index (RI), Pulsatility index(PI) and Peak systolic velocity (PSV) were used to evaluate the response to sclerotherapy. These parameters were evaluated prior to sclerotherapy and 3 months following completion of therapy. The clinical responses of the patients were compared with the change in Doppler parameters before and after treatment. Results: A total of 115 participants were considered for analysis; 60.86% had excellent response, 32.17% had partial response and 6.95% had poor response. There was a significant change in terms of RI, PI and PSV in patients who were either excellent or partial responders. Poor responders did not have a significant change in Doppler parameters. Conclusion: Combined bleomycin- triamcinolone sclerotherapy is an effective therapy for the management of propranolol resistant IHs. Doppler parameters RI, PI and PSV are reliable indicators of response in the management of IH. © 2022 Elsevier Masson SAS
Color Doppler Ultrasound Indices as Predictors of Propranolol Response in Infantile Hemangioma: A Prospective Study
(Springer, 2024) Vaibhav Pandey; Rathindra Nath Bera; Amit Nandan Dhar Diwedi; Om Prakash Singh; Preeti Tiwari
Objective: To evaluate the utility of color Doppler ultrasonography in assessing infantile hemangioma response to treatment with oral propranolol. Method: A prospective study was conducted between January, 2016 and December, 2022, wherein children with symptomatic (ulceration, bleeding, pain and scarring) infantile hemangioma were given oral propranol (2 mg/kg per day in three divided doses) as outpatient therapy. The clinical response was assessed three months post-initiation of treatment (intermediate clinical response) and three months post-completion of treatment (final clinical response, FCR). The primary outcome measurement was a clinical and radiological response (resistivity index (RI), pulsatility index (PI) and peak systolic velocity) to treatment. The secondary outcomes assessed were the complications related to treatment. Result: Out of 601 patients who were started on propranolol, 99 developed severe adverse effects and were excluded from analysis. At FCR assessment, out of 502 participants, 64.3% (n = 323) showed excellent response, 17.7% (n = 89) showed partial, and 17.9% (n = 90) were non-responders. A significant increase in RI and PI values was noted in all children following propranolol treatment for six months. An increase > 7.5% in RI could identify responders with 92% sensitivity, 91% specificity and area under the curve (AUC) of 0.963. An increase of > 11.5% in PI could identify responders with 86% sensitivity, 91% specificity and AUC of 0.896. Patients initially showing no response but later becoming excellent responders had significantly higher RI and PI values. Conclusion: Color Doppler ultrasonography is a valuable tool in predicting the treatment outcome of infantile hemangioma using propranolol. © Indian Academy of Pediatrics 2024.
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.
Correction to: Influence of Site, Size, Depth of Invasion and Histologic Grading on the Occurrence of Cervical Level IIb Metastasis and Extranodal Extension in Clinically N0 Neck of Patients with OSCC: A Single Center Retrospective Analysis (Journal of Maxillofacial and Oral Surgery, (2022), 10.1007/s12663-022-01776-5)
(Springer, 2022) Rathindra Nath Bera; Akhilesh Kumar Singh; Richik Tripathi; Naresh Kumar Sharma
In the original publication of the article, in the subheading, extranodal extension, a sentence has been published incorrectly as However; DOI > 5 mm and size of the metastatic nodes were the predictors. size of lymph nodes and DOI > 5 mm were the prime predictors and this needs to be corrected as follows: " DOI > 5 mm and size of metastatic nodes were the prime predictors for ECS." The original article has been updated with this correction. © 2022, The Association of Oral and Maxillofacial Surgeons of India.
Does Early Treatment of Paediatric Orbital Fracture Offer Any Advantage in Terms of Post-Operative Clinical Outcomes
(Springer, 2022) Rathindra Nath Bera; Preeti Tiwari; Vaibhav Pandey
Background: Trapdoor fractures commonly occur in children below 6 years of age. The high resiliency of bone, pneumatisation of sinuses and other factors lead to entrapment of muscle and/or soft tissue which undergoes ischaemic changes leading to residual diplopia. The timing of intervention in children ranges from 24 h to greater than 2 weeks. Early surgical intervention is particularly indicated in cases of Oculocardiac reflex. Methods: A Prisma guided systematic review of literature was conducted with no filters on language till September 2020. Studies on paediatric orbital fractures with data on timing of intervention and clinical outcomes were considered eligible for the review. The Oxford Level Of Evidence was used to assess the strength of individual studies. Results: A total of 19 studies (18 English, 1 French) were selected; except for one study all were retrospective series. The timing of intervention ranged from 24 h to more than 1 month. Most of the studies agreed that orbital fractures in children should receive early intervention preferably within 2 weeks. In case of white-eyed blowout fracture, oculocardiac reflex and trapdoor fractures with muscle entrapment surgical intervention should be carried out within 24–48 h. Discussion: Children presenting with facial injuries should be thoroughly examined for signs of muscle entrapment, diplopia, nausea, vomiting and bradycardia. If present these should receive early intervention. In cases with no signs of oculocardiac reflex and muscle entrapment a treatment within 2 weeks is recommended. If diplopia is mild or resolving with minimal hypoglobus and enophthalmos a wait and watch policy should be carried out. © 2021, The Association of Oral and Maxillofacial Surgeons of India.
Effect of Selective Serotonin Reuptake Inhibitors on Dental Implant Survival Rate in Patients with Neurological Disorders: A Systematic Review and Meta-analysis
(Jaypee Brothers Medical Publishers (P) Ltd, 2020) Bappaditya Bhattacharjee; Rathindra Nath Bera; Atul Bhatnagar; Nachammai Nagarajan
Aim and objective: The aim and objective of the review was to evaluate how implant survival rate changes with the intake of selective serotonin reuptake inhibitors (SSRIs) in patients with neurological disorders. Materials and methods: A systematic literature search was done in an electronic database (PubMed). In addition to this manual search of the references and gray literature was also done. Case reports, animal studies, literature reviews, and articles in non-English languages were not included. The Newcastle–Ottawa Scale was followed to assess the quality of the included studies. The meta-analysis was performed using statistical software Review Manager 5.03 and the outcome mean was measured by bivariate differential mean statistic with an intergroup estimate with a 95% confidence interval. Results: A total of 344 articles were found in the PubMed database (n = 344) during the literature search. Five studies were included in the qualitative and quantitative analysis after removing duplicates and screening of titles and abstracts. Two studies were excluded by using eligibility criteria for the review. A total of 988 implants survived in the test group and 4,585 implants survived in the control group among all the studies (odds ratio: 0.41, 95% CI: 0.30–0.55). p < 0.00001 value from the analysis indicated a significant implant success rate in patients who were not taking any SSRI group of medications. Conclusion: After evaluating the data from included studies, it can be concluded that patients taking the SSRI group of drugs for any neurological disorders had a higher chance of implant failures compared to the control group of patients. © Jaypee Brothers Medical Publishers. 2020.
Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis
(Springer, 2023) Bappaditya Bhattacharjee; Rathindra Nath Bera; Arju Verma; Romesh Soni; Atul Bhatnagar
Background: Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of joint. The purpose of this analysis was to evaluate the efficacy of arthrocentesis procedure in comparison with stabilization splints used for disc displacement disorders without reduction. Materials and Methods: A systematic search was done in electronic databases (PubMed, Cochrane Central, Web of Science). In addition to this hand search of references and grey literatures was done. Qualities of randomized controlled clinical trials were assessed by Cochrane’s tool for Systematic Reviews of Interventions and the Newcastle–Ottawa Scale was followed to assess the prospective and retrospective studies. Outcome variables pain (VAS) and maximum mouth opening were assessed by the software review manager 5.03. Results: A total of five studies were included in the review. Three studies showed greater improvement of symptoms in patients of arthrocentesis group in terms of maximum mouth opening, pain (VAS) value. Two other studies found no significant advantage of arthrocentesis over the other treatment protocol. The meta-analysis resulted in statistically significant difference between outcome variables favouring arthrocentesis group (VAS 1–10) (Mean Difference: 3.10; 95% CI 1.74, 4.45; P ≤ .00001, Mean difference: 2.00; 95% CI 0.29, 3.71; P = 0.02). Conclusion: Arthrocentesis showed effective result in terms of increase in mouth opening and reduction of pain level compared to stabilization splint and other non-invasive approaches in patients with disc displacement disorders without reduction. Overall, results supported the rationale of using arthrocentesis in patients with disc displacement disorders without reduction. © 2021, The Association of Oral and Maxillofacial Surgeons of India.
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.
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.
Factors related to risk of recurrence and recurrence free survival in ameloblastoma of the Jaws: A single centre retrospective analysis
(Springer Science and Business Media Deutschland GmbH, 2025) Rathindra Nath Bera; Preeti Tiwari
Purpose: Ameloblastoma is a benign tumor originating from odontogenic epithelium with a global incidence of about 0.5 cases per million persons per year. The overall recurrence rate of ameloblastomas range from 55% -90%. In this retrospective study we have analyzed the factors associated with recurrence and recurrence free survival in ameloblastoma of the jaws. Methods: Retrospective chart review of 10 years was done from records directory. All demographic data, data on diagnostic modalities, clinical presentations, radiology, management and histology were taken into consideration. Kaplan Meir estimator was used to evaluate recurrence rate and Cox regression analysis (univariate and multivariate) was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence and influence recurrence free survival. ROC curve (Receiver Operating Characteristic) was used to find out the optimal cut off point for size of the lesion in predicting recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval. Results: A total of 75 patients had recurrence with a median follow up of 65 months. The overall 5 year RFS was 19.5%. Conventional ameloblastomas, cortical/ soft tissue invasion, conservative treatment and tumor size ≥ 4 cm were independent predictors of recurrence. Conclusion: Aggressive treatment is preferred for conventional ameloblastomas ≥ 4 cm with cortical/ soft tissue invasion. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
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.
Implant survival in patients with neuropsychiatric, neurocognitive, and neurodegenerative disorders: A meta-analysis
(Wolters Kluwer Medknow Publications, 2021) Rathindra Nath Bera; Richik Tripathi; Bappaditya Bhattacharjee; Akhilesh Kumar Singh; Shweta Kanojia; Vikram Kumar
Neurologic disorders impede oral hygiene measures and routine clinical follow-up, along with the various drugs used may jeopardise oral health and the peri-implant tissue health. A total of 7 studies were considered eligible for the current systematic review. The overall estimated effect was categorized as significant where P < 0.05. Funnel plot was used to assess the publication bias within the studies. Difference in means was used as principal summary measure. P value <0.05 was considered as statistically significant. 1069 implants survived in test group and 4677 implants survived in control group (odds ratio: 2.58, 95% CI: 1.93-3.43) indicating significant success in patient without any disorders or taking medications for these disorders. Subgroup analysis was done to check the implant survival rate in patients taking selective serotonin reuptake inhibitors (SSRI) compared with SSRI non-users. Subgroup analysis showed that SSRI non-users had higher implant survival rate than patients taking SSRI (odds ratio: 2.45, 95% CI: 1.82-3.31). Serotonin significantly inhibits bone mineralization and osteoblast differentiation. The presence of any form of neuropsychiatric or neuromuscular disorders precludes proper oral hygiene and may contribute towards implant failure. © 2021 National Journal of Maxillofacial Surgery.
Influence of Site, Size, Depth of Invasion and Histologic Grading on the Occurrence of Cervical Level IIb Metastasis and Extranodal Extension in Clinically N0 Neck of Patients with OSCC: A Single Center Retrospective Analysis
(Springer, 2022) Rathindra Nath Bera; Akhilesh Kumar Singh; Richik Tripathi; Naresh Kumar Sharma
Background: Depth of Invasion ≥ 4 mm, T stage and primary site with more than 20% chances for occult metastasis are currently the accepted indications for elective neck dissection. Nodal metastasis decreases survival by 50%. ENE further reduces the prognosis. Dissection of level IIb lymph nodes in clinically N0 neck does not improve survival. Methods: A total of 320 patients were evaluated. Binary and multiple logistic regression and chi-square test were used for data analysis. ROC curve with Youden’s J index was used to set up a cutoff value for DOI. The predictor variables were site, size, grading and depth of invasion of primary tumor. Incidence of level IIb metastasis and ENE were the outcomes. Results: The study revealed a significant association and risk stratification between primary tumor characteristics with the occurrence of ENE. The cutoff value for DOI predicting ENE was 12.5 mm. Tumors of the oral tongue were an independent risk factor for level IIb metastasis. Discussion: Size of primary tumor, DOI, tumors of the mandibular alveolus and poor grading are independent risk factors for ENE. Isolated metastasis to level IIb rarely occurs in the absence of concomitant level IIa metastasis. Size, DOI and grading were significantly associated with level IIb metastasis. However, only tumors of the oral tongue were independent risk factor. © 2022, 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.
Lateral augmentation of the posterior edentulous mandible: A retrospective single arm comparison of ridge split, block bone grafts and guided bone regeneration
(John Wiley and Sons Inc, 2022) Rathindra Nath Bera; Naresh Kumar Sharma; Bappaditya Bhattacharjee; Atul Bhatnagar; Puvvadi Gopalakrishna Naveen Kumar; Ananta Kusumakar
Background: A deficient hard and soft tissue at the surgical site is a definitive challenge for dental implant placement. Commonly used procedures for augmentation include block bone grafts, guided bone regeneration, distraction, ridge expansion, ridge split, sandwich osteotomy, etc. The current study evaluates three techniques employed for horizontal augmentation of the mandible. Methods: A retrospective chart review was conducted for patients reconstructed with either block bone (A), guided bone regeneration (B), or ridge split (C) for lateral augmentation of posterior mandible. The primary outcome variables assessed were immediate postoperative bone width and bone width after 4 months, bone gain and resorption. Complications were evaluated as secondary outcomes. ANOVA and post hoc turkey tests were used for statistical analysis. A p-value of <0.05 was considered as statistically significant. Results: A total of 250 patient records were included in the study. Group C had a mean bone gain of 5.8649 ± 0.6520 mm statistically significant from others. Resorption was maximum in Group B 1.1612 ± 0.2821 mm. Iliac crest graft gave a mean 5.7285 ± 0.1823 mm bone gain. Overall no difference in bone gain between particulate or block interposition. Discussion: Grafts from intraoral sites are comparable in terms of resorption. ARS considerably provides better augmentation compared to GBR and onlays. Conclusion: Ridge split followed by onlay block bone grafting provides the best outcomes. Ramus and symphysis grafts are comparable. Iliac grafts are still the best for significant augmentations. Guided bone regeneration suffers maximum resorption. © 2021 The British Association of Oral Surgeons and John Wiley & Sons Ltd
Locally Advanced oral Squamous cell Carcinomas: Auditing and Outcome Appraisal
(Springer, 2024) Rathindra Nath Bera; Richik Tripathi; Sapna Tandon; Mohd Adil; Sanober Sohail; Shashank; Avishek Chakraborty
Introduction: Patients with OSCC in India (oral squamous cell carcinoma) presents at a later stage with approximately 28% presenting at stage III and 64% at stage IV disease. In this retrospective study we have reviewed the treatment modalities rendered and outcomes associated for the management of locally advanced oral squamous cell carcinoma in our Institute. We evaluated the survival data and the factors effecting survival. Methods: Kaplan Meir method was used to evaluate OS and DFS rate and log rank test was used to compare the survival amongst groups. Cox regression analysis (univariate and multivariate) was used to evaluate the hazard ratio to find out the possible factors influencing risk of death and disease. Results: The median OS and DFS in our study were 32 and 24 months respectively. On a subset analysis of only T4b patients who underwent either upfront surgery or induction chemotherapy followed by surgery there was no significant difference in OS and DFS. All patients with TURD had partial response after induction chemotherapy and were subjected to surgical resection followed by adjuvant therapy. Conclusion: Extracapsular spread, bone involvement, skin infiltration, treatments, surgical margins and Lymph node size are the prime predictors of survival.Upfront surgery remains the standard of care for resectable LAOSCC. Induction chemotherapy might improve the resectability in technically unresectable OSCC. There is no difference in survival between concurrent chemoradiation, sequential chemoradiation and radical radiotherapy in the management of unresectable disease. © Association of Otolaryngologists of India 2023.
Outcome of Mandibular Reconstruction with Fibula free Flaps: Retrospective Analysis of Complications
(Springer, 2023) Senthil Murugan; Rathindra Nath Bera; Preeti Tiwari
Rationale: Fibula free flap has become the workhorse for head and neck reconstruction. In this retrospective study we aimed at determining the outcomes of mandibular reconstruction with fibula free flaps. Methods: Any patient who underwent a mandibulectomy and reconstructed with vascularised fibula flap was included in the study. The predictor variables were age, sex, type of lesion, tobacco and alcohol use, tracheostomy, neck dissection, post operative radio and chemotherapy. Flap failure, fistulas, dehiscence, bone exposure and hardware complications were the outcomes. A P value of < 0.05 was considered statistically significant. Results: 242 patient records were selected for evaluation. PORT, CRT, neck dissection, no. of segments were the factors significantly associated with every complication. Malignant lesion was significantly associated with every complication except for plate fracture. Plate fracture although occurred more frequently with malignant diseases, the association was insignificant. Tobacco consumption was significantly associated with increased incidence of post –operative complications. Alcohol consumption was significantly associated with plate fracture, screw loosening, fistulas, bone exposure and flap failure. Conclusion: Overall the fibula free flap has a success rate of 90.0% with fistulas being the most significant complication. © 2022, Association of Otolaryngologists of India.
Predictors of Extracapsular Spread in T1/T2 Oral Squamous Cell Carcinoma: A retrospective study
(Elsevier B.V., 2022) Sapna Tandon; Rathindra Nath Bera; Akhilesh Kumar Singh; Madan Mishra
Introduction: In the N0 neck the incidence of ECS might range from 13 to 60%. In this retrospective study we intended at evaluating the primary tumor and nodal characteristics that might influence the presence of ECS in early stage OSCC. Methods: The predictor variables were tumor and nodal features and the incidence of ENE was the outcome. Univariate and multivariate regression models along with ROC curve and Youden's J statistics was used for analysis. A p value < 0.05 was considered statistically significant. Results: The cut off value for DOI was 6.5 mm and LN size was 12.5 mm with overall accuracy of 80.15% and 84.93% respectively. Primary tumor features and LN size was significantly associated with ENE. Discussion: Oral tongue tumors and PNI are independent risk factors for ENE. An elective neck dissection remains the standard of care from both diagnostic and therapeutic viewpoints. © 2022 Craniofacial Research Foundation