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Iatrogenic displacement of high-speed bur during third molar removal

Rajaran JR, Nazimi AJ, Rajandram RK

BMJ Case Rep, 2017 Sep 27;2017.
PMID: 28954756 DOI: 10.1136/bcr-2017-221892

Surgical removal of impacted mandibular third molar is a routine procedure in oral surgery. Various iatrogenic complications related to the procedure has been discussed well in the literatures before. Some of these complications are related to the wrong usage of instruments and techniques. Here we discuss a rare complication on a 42-year-old male, related to the use of high-speed handpiece drill in mandibular third molar removal in a general dental office setting. He was referred when a high speed tungsten carbide bur was accidentally broken and displaced into the mandibular bone during surgical procedure. It is not common to use a high-speed handpiece in impacted third molar removal. This iatrogenic complication could have been totally avoided with the use of proper equipment and technique; therefore raising awareness regarding wrong usage of instrument is vital to avoid similar incidents in the future.
Posttraumatic growth: a novel concept in oral cavity cancer care?

Rajandram RK, Jenewein J, McGrath CP, Zwahlen RA

Oral Oncol, 2010 Nov;46(11):791-4.
PMID: 20850373 DOI: 10.1016/j.oraloncology.2010.08.010

Recently the importance of posttraumatic growth (PTG), a phenomenon of positive psychological growth beyond baseline values, has been discovered in the field of oncology. An evidence based review of the literature regarding PTG was performed, both to support its understanding and to consider its application within the research field of oral cavity (OC) cancer. A Pubmed, Medline, PsycINFO search from the earliest date until April 2010 was carried out. Full articles meeting the inclusion and exclusion criteria were reviewed. The search yielded 852 papers, 91 'potentially relevant papers' and 29 'effective papers', the latter of which formed the basis of this review. PTG was assessed in twenty-eight studies with the Posttraumatic Growth Inventory and in only one study with the Perceived Benefits Scale (PBS). PTG in cancer patients has been reported in five main domains (i) appreciation of life, (ii) relating to others, (iii) increased personal sense, (iv) sense of new possibilities and (v) positive spiritual change. Socio-demographic factors, stressor characteristics and coping strategies influence and predict the development PTG. In the past decade an increasing interest in the concept of PTG in the field of oncology has emerged. This evidence based review presents PTG to the research community in the field of OC cancer, appraises its modification capacity of the treatment outcome in other cancer research fields and hypothesizes its eventual benefit in the field of OC cancer research.
A large unilateral submandibular mass

Rajandram RK, Sha PP, Hussaini HM, Jabar NA

Oral Surg Oral Med Oral Pathol Oral Radiol, 2014 Apr;117(4):402-6.
PMID: 23183027 DOI: 10.1016/j.oooo.2012.08.456
Management of Bimaxillary Protrusion

Rajandram RK, Ponnuthurai L, Mugunam K, Chan YS

Oral Maxillofac Surg Clin North Am, 2023 Feb;35(1):23-35.
PMID: 36336600 DOI: 10.1016/j.coms.2022.06.006

Bimaxillary protrusion is a unique dentofacial deformity trait that can exist in an individual as an isolated problem or in combination with other skeletal and dental-related issues. Orthodontist and oral and maxillofacial surgeons are often the main primary team involved in the management of bimaxillary protrusion. Clinical dilemma often exists as cases can either be treated orthodontically or may require a combination of orthodontic and skeletal segmental orthognathic surgery. This article aims to help clinicians improve their approach to management of bimaxillary protrusion by creating a classification based on the severity that can guide treatment selection.
Maxillofacial injuries and traumatic brain injury--a pilot study

Rajandram RK, Syed Omar SN, Rashdi MF, Abdul Jabar MN

Dent Traumatol, 2014 Apr;30(2):128-32.
PMID: 23782407 DOI: 10.1111/edt.12052

Maxillofacial injuries comprising hard tissue as well as soft tissue injuries can be associated with traumatic brain injuries due to the impact of forces transmitted through the head and neck. To date, the role of maxillofacial injury on brain injury has not been properly documented with some saying it has a protective function on the brain while others opposing this idea.
Intraoperative Computed Tomography Scan for Orbital Fracture Reconstruction

Nazimi AJ, Khoo SC, Nabil S, Nordin R, Lan TH, Rajandram RK, et al.

J Craniofac Surg, 2019 Oct;30(7):2159-2162.
PMID: 31232997 DOI: 10.1097/SCS.0000000000005667

Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.
Necrotizing gingivitis: a possible oral manifestation of ticlopidine-induced agranulocytosis

Rajandram RK, Ramli R, Karim F, Rahman RA, Fun LC

N Z Med J, 2007;120(1256):U2590.
PMID: 17589558

Agranulocytosis is a rare complication of ticlopidine and can be life-threatening. We report a case of ticlopidine-induced agranulocytosis and neutropenia (neutrophil count of 0.1 x 10(9)/L) with necrotizing gingivitis in a 54-year-old Malaysian-Chinese female. She was started on ticlopidine 250 mg twice daily 3 weeks prior to this hospital admission. We started her on intravenous metronidazole and amoxicillin and clavulanic acid (Augmentin) and concurrently stopped ticlopidine. A series of clinical and laboratory investigations were carried out and a final diagnosis of necrotizing gingivitis possibly secondary to agranulocytosis was made. The patient was discharged home after 2 weeks of hospitalisation.
Efficacy of natural enzymes mouthwash: a randomised controlled trial

Chiam TL, Choo J, Ashar A, Hussaini HM, Rajandram RK, Nordin R

Clin Oral Investig, 2024 Apr 19;28(5):259.
PMID: 38639763 DOI: 10.1007/s00784-024-05658-7

OBJECTIVES: Natural enzymes mouthwash has been proposed as salivary substitutes to treat xerostomia. This study aims to evaluate the efficacy of the mouthwash to treat xerostomia.
MATERIALS AND METHODS: A double-blind, parallel group randomised control clinical trial involving N = 49 adult participants with xerostomia was carried out. Intervention group received natural enzymes moisturising mouthwash (with active ingredients lactoferrin, lysozyme, lactoperoxidase and glucose oxidase); while control group received benzydamine mouthwash. Mouthwashes were repacked, labelled with specific code, and were given to participants by third-party. Subjects were instructed to rinse with the mouthwash 4 times per day at a specific period, for 2 weeks. Symptoms of xerostomia were assessed using Xerostomia Inventory at day 0 and 14; together with the assessment of Clinical Oral Dryness Score (CODS), and measurement of resting and stimulated salivary flow rate.
RESULTS: 48 participants completed the clinical follow-up, and n = 1 had lost of follow-up. From the 48 participants, n = 23 received natural enzymes mouthwash, while n = 25 received benzydamine mouthwash. Intervention group achieved reduction in symptoms of xerostomia from baseline. Intervention group also showed significantly better improvements in the cognitive perception of dry mouth and oromotor function such as chewing, swallowing and speech of the participants; and reduction in waking up at night to drink water (p
Posttraumatic growth, depression and anxiety in head and neck cancer patients: examining their patterns and correlations in a prospective study

Leong Abdullah MF, Nik Jaafar NR, Zakaria H, Rajandram RK, Mahadevan R, Mohamad Yunus MR, et al.

Psychooncology, 2015 Aug;24(8):894-900.
PMID: 25612065 DOI: 10.1002/pon.3740

Positive and negative psychological reactions have been described in head and neck cancer patients. Nevertheless, the relationships between these responses across time need to be studied to understand the patients' strengths and vulnerabilities.
Fulltext Posttraumatic Growth and Coping Strategies Among Patients With Head and Neck Cancer: Do Approach Coping and Avoidant Coping Predict Posttraumatic Growth Over Time?

Nik Jaafar NR, Abd Hamid N, Hamdan NA, Rajandram RK, Mahadevan R, Mohamad Yunus MR, et al.

Front Psychol, 2021;12:716674.
PMID: 34764904 DOI: 10.3389/fpsyg.2021.716674

Despite an enormous number of studies addressing the importance of posttraumatic growth (PTG) among cancer patients, the literature lacks data regarding how different coping strategies affect PTG among head and neck cancer (HNC) patients over time. This longitudinal study investigated the PTG trend and coping over 5-7months among a cohort of HNC patients within the first year after their diagnosis. It determined an association between coping strategies and PTG over time. The study's HNC respondents were administered a socio-demographic and clinical characteristics questionnaire during their baseline assessments. Additionally, the Malay versions of the "PTG Inventory-Short Form" (PTGI-SF) and the "Brief Coping Orientation to Problems Experienced Inventory" (Brief COPE) were administered during respondents' baseline assessments and follow-up assessments (5-7months after the baseline assessments). In total, 200 respondents reported an increasing PTG trend and approach coping (active coping, planning, positive reframing, acceptance, emotional support, and instrumental support) and a decreasing trend of avoidant coping (self-distraction and denial) over time. Two approach coping strategies (acceptance and planning) significantly increased PTG while denial was the only avoidant coping strategy that significantly lowered PTG, after controlling for socio-demographic and clinical characteristics, over time. Our study's findings identified the need to incorporate psychosocial interventions that enhance approach coping and reduce avoidant coping into HNC patients' treatment regimes.
Prevalence of oral cancer, oral potentially malignant disorders and other oral mucosal lesions in Cambodia

Chher T, Hak S, Kallarakkal TG, Durward C, Ramanathan A, Ghani WMN, et al.

Ethn Health, 2018 Jan;23(1):1-15.
PMID: 27781495 DOI: 10.1080/13557858.2016.1246431

OBJECTIVES: To obtain data on the prevalence of oral mucosal lesions (OMLs) among Cambodians, and to assess the relationship between known risk habits of oral diseases with prevalence of oral potentially malignant disorders (OPMDs).
DESIGN: This was a population-based, cross-sectional study whereby subjects were adults aged 18 years old and above. A workshop on the identification of OML was held to train and calibrate dental officers prior to data collection in the field. Sociodemographic and risk habits data were collected via face-to-face interview, whilst presence of OML and clinical details of lesions such as type and site were collected following clinical oral examination by the examiners. Data analysis was carried out using the Statistical Package for Social Science (SPSS) version 12.0. The association between risk habits and risk of OPMD was explored using logistic regression analysis.
RESULTS: A total of 1634 subjects were recruited. Prevalence of OML for this population was 54.1%. Linea alba was the most common lesion seen (28.7%). This study showed an overall OPMD prevalence of 5.6%. The most common type of OPMD was leukoplakia (64.8%), followed by lichen planus (30.8%). Subjects who only smoked were found to have an increased risk for OPMD of almost four-fold (RR 3.74, 95%CI 1.89-7.41). The highest risk was found for betel quid chewers, where the increased risk observed was more than six times (RR 6.75, 95%CI 3.32-13.72). Alcohol consumption on its own did not seem to confer an increased risk for OPMD, however when practiced concurrently with smoking, a significant risk of more than five times was noted (RR 5.69 95%CI 3.14-10.29).
CONCLUSION: The prevalence of OML was 54.1%, with linea alba being the most commonly occurring lesion. Smoking, alcohol consumption and betel quid chewing were found to be associated with the prevalence of OPMD, which was 5.6%.