Finite Element Analysis of New Modified Three-dimensional Strut Miniplate versus Conventional Plating in Mandibular Symphysis and Angle Fractures - An In vitro Study Haren Pandya, Hiren Patel, Smit Vithalani, Bijal Bhavsar, Urvi Shah, Aliasgar Chunawala Annals of Maxillofacial Surgery, 2024 Introduction: Mandibular fractures are common injuries during maxillofacial trauma, and currently, open reduction and internal fixation are considered gold-standard treatments. There is a wide discussion about which plates give the best outcomes. Hence, we are conducting a biomechanical comparison of two plates for mandibular symphysis and angle fracture with finite element analysis (FEA). The aim of this study was to do a comparative study of FEA between the conventional and our new modified three-dimensional (3D) strut miniplate in mandibular fractures at symphysis and angle regions. Materials and Methods: Finite element models of symphyseal and angle fractures of the mandible were developed. Each fracture model was then realigned and fixed by the conventional method 2.0 mm system, and our modified 3D strut plating method 2.0 mm system followed by the analysis of various stresses developed in plates and mandibular fracture area after application of load was observed in the study. Results: The modified 3D strut plating system with 2.0 mm miniplates is significantly better in preventing displacement of fracture segments by better distribution of forces compared to the conventional plating system. Rest of the parameters were within the permitted limits. Discussion: Modified 3D strut plating method was reasonably effective and superior in managing force-displacement compared to the conventional method of fixation for comminuted and unfavourable mandibular symphyseal fracture and angle fracture.
An Unusual Presentation of an Ectopic Mandibular Third Molar in the Condylar Region: A Case Report and Review of Literature Hiren Patel, Haren Pandya, Hitesh Dewan, Bijal Bhavsar, Urvi Shah, Parth Makwana Annals of Maxillofacial Surgery, 2023 Rationale: Ectopic teeth arise from developmental abnormalities, pathological conditions or iatrogenic factors. They can be supernumerary, deciduous or permanent and cause dental and facial pain, swelling and infection. Limited cases reveal limited knowledge about causes, symptoms, treatment options and surgical procedures. A thorough evaluation, including radiographic imaging and clinical examination, aids diagnosis and treatment planning. Patient Concern: A 54-year-old female patient complains of tooth mobility in the upper right back tooth region for one month and occasional pain in the right pre-auricular region. Diagnosis: Chronic generalised periodontitis with an impacted tooth in the right condylar region. Intervention: Extraction of Grade III mobile 17 and conservative treatment for ectopic molar in the condylar region. Outcome: The patient is on regular follow-up with no similar complaints. Take-Away Lesson: A personalised approach is crucial in managing ectopic mandibular third molars and should take into account the patient’s symptoms, preferences and potential complications. Successful treatment requires informed decision-making and thorough evaluation.
Epiphora and nasal blockage - An unusual presentation of Pindborg tumor: A case report and literature review Urvi Shah, Hiren Patel, Haren Pandya, Hitesh Dewan National Journal of Maxillofacial Surgery, 2022 Odontogenic tumors are silent ailments which can affect any individual. One such lesion is a calcifying epithelial odontogenic tumor (CEOT). It is a rare lesion with a locally aggressive nature. A 33-year-old male presented with nasal blockage and continuous flow of tears from the left eye for the past 7–8 months. Clinical examination revealed slightly protruded left eyeball and altered level of eyeballs with continuous watery discharge. Hess chart confirmed normal eye movements. Intraoral findings were not significant. The final diagnosis of CEOT was established based on the histopathological aspects. CEOT is mostly found in the third to fifth decade of life without gender predilection. Presenting symptoms and signs comprise painless expansile mass, although there are reports associated with pain, nasal obstruction, epistaxis, and proptosis. In this article, we would like to present a case of CEOT with epiphora and nasal blockage as the main and only presentation, an uncommon finding. Furthermore, discussing and posing a question of an adequate period of follow-up required to negate the presence of recurrence. One must stay vigilant enough not only to attest a singular symptom to the commonest ailment related to it but also to explore the possibility of the less known. Furthermore, we need to further research in depth to establish a certain duration after which the likeliness of recurrence is to the minimum.
Chondrosarcoma of maxilla - A rare case report Hitesh Dewan, Hiren Patel, Haren Pandya, Bijal Bhavsar, Urvi Shah, Parth Suthar Annals of Maxillofacial Surgery, 2021 RATIONALE: Chondrosarcoma, although being a rare entity in jaws, may turn fatal if left untreated or inadequately excised. Prognosis in terms of 5-year survival rate ranges from 90% for Grade I, 81% for Grade II and 43% for Grade III respectively. PATIENT CONCERNS: A 35-year-old male patient reported with a gradually progressive hard painless growth over right maxillary molar region. His main concern was removal of pathology without long-term morbidity. DIAGNOSIS: Computed tomography revealed ill-defined mass with internal calcification involving posterior half of upper right alveolus. TREATMENT AND OUTCOMES: Mandatory biopsy suggested benign chondroma, however wide excision and infrastructural maxillectomy revealed Grade II chondrosarcoma. TAKE-AWAY LESSONS: Complex anatomy of maxilla renders surgical excision of chondrosarcomas with histological clear margins, a daunting task. Due to misdiagnosis of preoperative biopsy, suboptimal excision of malignant mass may lead to local recurrence and occasional distant metastasis. This necessitates further therapy and long term follow up, with occasional poor patient compliance.
Efficacy of platelet-rich plasma and concentrated growth factor in treating androgenetic alopecia - A retrospective study EnoshNirmalkumar Steward, Hiren Patel, Haren Pandya, Hitesh Dewan, Bijal Bhavsar, Urvi Shah, Kartik Dholakia Annals of Maxillofacial Surgery, 2020 INTRODUCTION: Plasma derivatives have been practiced a lot in orthopedics, burns, and sport medicine. Microneedling (MN) with platelet-rich plasma (PRP) therapy has been proven to improve the micro-circulation and thus improve hair growth. The role of concentrated growth factor (CGF) for hair growth has not been mentioned anywhere in the literature for hair growth which we tried to prove in our article by comparing it with various other studies. MATERIALS AND METHODS: -test was used for the various comparisons. RESULTS: Hair loss reduced by the end of the first month. At the end of 6 months, postfirst session, microscopic examination showed statistically significant difference in the hair count compared to those during the baseline. DISCUSSION: PRP having platelet-derived growth factor and vascular endothelial growth factor acts on stem cells in the follicles, stimulating the development of new follicles and promoting neovascularization. CGF helps stimulating cell proliferation and matrix remodeling due to numerous growth factors in a concentrated form. Thus, this therapy combined helps to boost the hair growth in a very significant way. SUMMARY: This study provides the preliminary evidence of efficacy of PRP along with MN and CGF in treating androgenetic alopecia by promoting angiogenesis along with vascularization and promotes hair follicles to enter and extend the anagen phase. Most of the results obtained show improved results with this therapy. A larger case study for the same can further be done for a stronger recommendation of the use of CGF for hair growth therapy further.
Idiopathic macrocheilia Haren Pandya, Hiren Dharmendrabhai Patel, Jigar Mayankbhai Purani, VIvek Ramesh Rayththa BMJ Case Reports, 2018 A 13-year-boy presented with painless swelling of upper and lower lips accompanied with gingival enlargement. The aetiology for these symptoms included vast pathological varieties but none of them could fit in. Clinical features were similar to orofacial graulomatosis but histopathological examination revealed chronic non-specific infection. Therefore, the final diagnosis was made as idiopathic macrocheilia through exclusion criteria. Management with intralesional triamcinolone acetonide 40 mg, twice a week for 3 weeks, resulted in significant remission in lip swelling without recurrence after a 6-month follow-up.
Ameloblastomatous calcifying odontogenic cyst: A rare entity Urvi Shah, Hiren Patel, Haren Pandya, Hitesh Dewan, Bijal Bhavsar, Enosh Steward Annals of Maxillofacial Surgery, 2018 INTRODUCTION: Ameloblastomatous calcifying odontogenic cyst (COC) is an extremely rare histopathologic variant of COC, an odontogenic cyst of the jaws. It needs to be differentiated from closely associated variant ameloblastoma ex COC that is entitled to a more aggressive form of surgical management. AIM: The aim of this paper is to present a case of ameloblastomatous COC of the right mandibular angle region with review of literature describing this rare entity. The paper also highlights the requirement of including this lesion in differential diagnosis of various jaw lesions. MATERIALS AND METHODS: Google search, Wikipedia, ScienceDirect, MEDLINE, the Cochrane library, and PubMed were used extensively to search and collect all reported cases of ameloblastomatous COC using keywords such as ameloblastomatous COC, COC, maxilla, mandible, and gorlin cyst ameloblastic proliferation. RESULTS: To the best of our knowledge, a total of twenty one cases of ameloblastomatous COC have been reported in the literature in the maxilla-mandibular region and we represent the twenty second case in a 20-year-old female patient along with the review. CONCLUSION: Ameloblastomatous COC - a subtype of COC needs to be differentiated from true ameloblastoma arising from COC as it warrants a conservative form of surgical management unlike other neoplastic variants of COC. Owing to scarcity of data of this lesion in literature, more reporting of such cases is required to shed light on its behavior.
