Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr. Mamta Gupta,
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
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Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2010 | Month : April | Volume : 4 | Issue : 2 | Page : 2337 - 2340 Full Version

Oral Reconstruction Of Retromolar Trigone Carcinoma Using Buccal Fat Pad

Published: April 1, 2010 | DOI:

*Reader,Dept. of Oral & Maxillofacial Surgery Dashmesh Institute of Research & Dental Sciences,Faridkot (Punjab), (India)**Asst.Prof.,Department of microbiology,Adesh Medical College,Bathinda(Punjab),(India).

Correspondence Address :
DR.Deepak Arora

There are a variety of methods to reconstruct the oral defect after ablative surgery (3). The choice of a flap for reconstruction is governed by the type and size of defects and the advantages and disadvantages of the various reconstructive options (7).

Buccal fat pads have long been a source of free fat graft in facial augmentation and when exposed can be mobilized and spread out into a pedicled graft (7).

Its use as a pedicled graft was first reported by Egyedi (5) and its embryology, vascularisation, volume and function was studied by Tideman (15), Marx (16) and other authors (4),(14). Buccal fat pad excision improves the facial contour in some patients with buccal lipodystrophy (9).

The purpose of this article is to show the advantage of buccal fat pad as a donor site for procedures in the maxillofacial region.

Material and Methods

A study of a case of squamous cell carcinoma of the left retromolar trigone was carried out in the Department of Oral and Maxillofacial Surgery,Dashmesh Institute of Research and Dental Sciences, Faridkot& the Department of Microbiology Adesh Medical College. Bathinda .

A detailed personal history and a thorough clinical examination were done.

A physician’s opinion was obtained regarding the patient’s fitness to undergo surgery under general anesthesia. The patient was evaluated post-operatively for color, mouth opening(in mm), trauma from lower teeth, necrosis of BFP, persistent fistula and infection for a period of 6 months respectively to rule out any infection by any aerobe or anaerobe, in case it arises post-operatively. The Department of Microbiology was involved.

The patient received intravenous penicillin and metronidazole for coverage of aerobic and anaerobic bacteria.

Case Report

A 45 year old male patient reported to the Dept. of Oral and Maxillofacial Surgery with the chief complaint of growth in the left lower posterior region for 3 months.

On extra oral examination, left level 1 and level II lymph nodes were palpable.

Intraoral examination revealed ulcero-proliferative growth in the left retromolar trigone region measuring 5Ă—3 cm distal to III molar, as shown in (Table/Fig 1)

The patient complained of left inferior dental nerve anesthesia over the previous 2 months.

Panoramic radiographs had shown a large radiolucent lesion in the left retromolar trigone region.

After administration of local anesthetic, a biopsy specimen of the tumor was taken at the bulging site in the left lower retromolar trigone region.

A histopathology report indicated squamous cell carcinoma.

A week later, with the patient under nasotracheal intubation, the tumor was excised with marginal mandibulectomy, the repair of which was done at the same time with buccal fat pad and masseter cross over flap.

Surgically, the buccal fat pad was accessed through a horizontal incision posterior to zygomatic buttress and gently teased out of its bed and advanced into its new position and sutured into place as shown in (Table/Fig 2).

The resulting defect was quite large and hence a masseteric cross-over flap was used in conjugation with buccal fat pad transfer as shown in (Table/Fig 3).

Post-operatively at 1 week, clinically the surface of orally exposed fat became yellow. At 2 weeks, the color gradually changed to red and turned pinkish at the end of 3 weeks. At 1 month post-operatively, the color of normal mucosa was attained and at 3 months post-operatively, the appearance of mucosa was normal in color indicating that healing was uneventful as shown in (Table/Fig 4).


The buccal fat pad can be identified as early as in 6-8cm fetuses (1). The average weight of each fat pad was found to be 9.3gm and its average volume was 9.6ml (11). The size of the buccal fat pad is constant among different persons regardless of the overall body weight and fat distribution. Because of the ease of access and rich blood supply, the main body and some parts of the pterygoid extension of the buccal fat pad are suitable for closure of defects of posterior maxilla as far as the region of the hard and soft palate and the retromolar region of the mandible (1),(10).

The BFP provides a vascularised tissue bed over which normal epithelization can take place, thus there is no need for skin grafting. Histologically, fat tissue is replaced by fibrous tissue (7). Post-operative radiotherapy does not affect the BFP graft but should be deferred till complete epithelisation of the graft (15).

It is estimated that the body and buccal extension of the BFP are accessible through the mouth and thus available as a pedicle graft. This brings many defects into the range of reconstruction by the BFP, thus increasing the indications for its use13. A fact has to be borne in mind that excessive stretching in the flap invariably impairs the vascularity, so the closure of larger defects cannot be guaranteed without producing flap necrosis or creating a new fistula (2)

A double buccal fat pad flap in association with Le Fort I osteotomy approach can be adopted to remove tumours of the palate and nasal fossae (12).

In the case of squamous cell carcinomas of the left molar trigone, the left modified neck dissection and marginal mandibulectomy involving all the molars were carried out. Due to the large size of the defect, masseteric cross-over flap was used in addition to BPF. Both the flaps healed without complication and adequate epithelization was observed over a period of three weeks. For larger defects such as those resulting after classical maxillectomy the use of BFP together with ipsilateral temporalis myofacial flap, buccal mucosa, palatal mucosa and tongue myomucosal flaps can be used (13) when reconstruction is contemplated,. Haanazawa,et al reported that the orally exposed fat gradually transformed into granulation like tissue and epithelization occurred in 3 weeks (6).


The use of BFP graft is a logical, convenient and reliable method for reconstruction of oral defects up to 4cm in diameter on the ipsilateral side of the soft palate, posterior alveolar ridge of the maxilla and mandible. It can also be used in conjunction with other local flaps and with regional myofacial flaps. Since both donor and recipient sites are in the oral cavity, there is no visible scar in the donor area (8).

The use of BFP for reconstruction of small to medium sized intraoral defects is a simple and effective technique that can be performed in a very short time without causing any additional morbidity to the patient.


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Chakrabarti J., Tekriwal R., Ganguli A., et al: Pedicled buccal fat pad flap for intraoral malignant defects: A series of 29 cases. Indian Journal of Plastic Surgery. 2009; 42: 36-42.
Chien C. Y., Hwang C. F., Chuang H. C, et al : Comparison of radical forearm free flap, pedicled buccal fat pad flap and split- thickness skin graft ion reconstruction of buccal mucosal defect. Oral Oncology. 2005; 41: 694-97.
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