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

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
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Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

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.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
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

Images in Medicine
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : ZJ01 - ZJ02 Full Version

Weber-Ferguson Approach with Surgical Obturator for Mucormycosis of Maxilla: A Classic Case

Published: January 1, 2023 | DOI:
Arun Kumar, Senthil Kumar, Davidson Rajiah, Kamal Akannan, Kirush Nambigai

1. Associate Professor, Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India. 2. Senior Assistant Professor, Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India. 3. Senior Assistant Professor, Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India. 4. Senior Assistant Professor, Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India. 5. Postgraduate Student, Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Senthil Kumar,
No: 3, First Floor, Rajive Gandhi Nagar, South Mada Street Extention, Villivakkam, Chennai 600049, Tamil Nadu, India.


Diabetic mellitus, Fungal infection, Multidisciplinary approach, Post coronavirus disease 2019

A 35-years-old male patient came with complaints of swelling in right-side of the face and headache in right-side for past two months back. History of present illness showed that patient was apparently normal before two months after which he gradually developed swelling in right-side of face with dull aching pain. Head achein right-side for past two months relieved on medication and the pain in upper back tooth region for past two months was insidious in onset and dull aching type. Mucopurulent nasal discharge was presentin right-side for past one month (Table/Fig 1). Past medical history revealed that patient was diagnosed withDiabetes mellitus Type II and was on insulin for past one month. The patient was treated for Coronavirus Disease 2019 (COVID-19) infection one month back. Patient had given the history of Functional Endoscopic Sinus Surgery (FESS) done one month back in private hospital.

Extraoral inspection and palpation showed diffuse swelling over right maxillary and infraorbital region which was firm in consistency, tender on palpation, proptosis of right eye, mucopurulent discharge in right nasal cavity, extraoccular movement-restriction in elevation more in right eye compared to left eye.

Intraoral examination showed Grade II mobility of 14,15,16,17 and mobility of right maxilla during palpation, tenderness on percussion present in 11,12,13,21,22 (Table/Fig 2). Computed Tomography (CT), Magnetic Resonance Imaging (MRI) was taken to identify the extent of the lesion (Table/Fig 3),(Table/Fig 4),(Table/Fig 5). Patient gave history of Nasal swab specimenwas from middle meatus on Potassium Hydroxide (KOH) mount which showed few aseptate hyphae andfungal infection of mucormycosis was confirmed. Medical management was started with Inj. amphotericin B 50 mg , Inj. 100 mL of 5% dextrose , Intravenous fluid normal saline one unit before and after amphotericin B, Tablet rantac 150 mg twice a day, Tablet paracetamol 500 mg thrice a day, Tablet zinc once a day, Tablet multivitamin once a day, insulin was administered according to diabetologist opinion. Surgical managementof Subtotal maxillectomy under general anaesthesia was planned.

Weber-Ferguson incision was placed in right-side and subtotal maxillectomy was planned. Layer-wise dissection was done. Flap was elevated and osteotomy cut was made with 703 bur in nasal process, zygomatic process and palatine process. Bony disjunction was made with osteotome, pterygoid chisel, septal chisel (Table/Fig 6),(Table/Fig 7),(Table/Fig 8). The lesion was removed and peripheral osteotomy was done using vulcanite bur and adequate irrigation was done with betadine and saline and collagen sheet was placed with impression compound over the surgical site and stabilised with surgical obturator which was secured with SS wire to the zygoma (Table/Fig 9),(Table/Fig 10). Flap was closed layerwise with 3-0 vicryl. Skin closure was done with 3-0 proline and pressure dressing was placed (Table/Fig 11). Complete excised of the lesion is shown in (Table/Fig 12). Postoperatively one month later patient developed wound dehiscence at medial canthus of eye (Table/Fig 13) but by thorough wound care infection was over come. Patient was followed for six months (Table/Fig 14),(Table/Fig 15),(Table/Fig 16),(Table/Fig 17),(Table/Fig 18). Histopathological examination confirmed the presence of fungal hyphae (Table/Fig 19).

Nose is the primary mode of entry of the infection followed by mucosa and skin. Invasive mucormycosisis identified by first development of tissue necrosis due to vascular invasion and subsequent thrombosis. In most cases, the infection became serious which results in death unless treatment such as surgical debridement and anti fungal therapyis started early (1).The fungal hyphae produces a fibrin reaction and production of mucor thrombi which occludes the arteries leads to reduced blood flow and necrosis producing black colored necrotic crusts. The infection spreads quickly to adjescent sinuses, orbit and cranium via ethmoid bone, orbital vessels (2). The extent of the disease is clearly demonstrated by water’s view X-ray such as mucosal thickening, sinus opacification without fluid levels.

CT, MRI demonstrates spotty destruction of bony wall of para nasal sinuses and erosion of bone (3). COVID -19 infection predispose to developing fungal infection during the course or post COVID-19 stage of the diseases especially in severly ill patients who stayed long days in the hospital. The main cause of immune suppression is decreased response of CD4+ T-cells and CD 8+T-cells (4). Patient with severe infection of COVID-19 disease and those admitted in intensive care unit who required mechanical ventilation or patient who stays longer duration for example 50 days or more are likely to develop fungal infection such as mucormycosis, so it is very important to be aware about mucormycosis during middle and later stage of diseases (5).

Authors selected Weber-Ferguson incision for easy access and easy closure of the lesion after excision under general anaesthesia. The type of approach such as intra oral or extraoral is based on the extent of the lesion in CT, MRI scan and involvement of soft tissues and hard tissues. In this case the lesion was extended posteriorly upto pterygoid plates, involving sphenoid sinuses and superiorly upto superior ethmoid sinus, cresta galli anteriorly upto zygoma, anterior wall of maxilla. Surgical obturator construction is mandatory after excision of the lesion helped to take soft diet and nutrients via oral cavity and also helped the wound to heal without complications. Impression compound surrounded by collagen membrane technique really helped to avoid unwanted complications from the flap, the collagen membrane covers the inner part of the flap, so that there was no contact between impression compound and inner part of the flap. In conclusion multidisciplanary approach and addition of impression compound with collagen membrane in surgical obturator and extensive exposure with Weber-Ferguson incision will give best clinical out come in mucormycosis cases of maxilla.


Priyanka Choudhary B, Deepak Bhargava,VidyadeviChandavarkar S , Ritika Sharma, Mucormycosis of maxilla, Indian J Dent Adv. 2014;6(1):1503-06.
Rajeshwari A, Gangadhara Somayaji KS, RhinocerebralMucormycosis: an Unusual Presentation, American Journal of Medicine and Medical Sciences 2012;2(1):16-19. Doi: 10.5923/j.ajmms.20120201.04. [crossref]
Elo JA, Sun HB, Kang SY. Median maxillary alveolar osteolytic lesion in a 50-year- old female. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(1):03-07. Doi: 10.1016/j.oooo.2016.04.001. Epub 2016 Apr 16. PMID: 27165482. [crossref] [PubMed]
Sai Krishna D, Raj H, Kurup P, Juneja M. Maxillofacial Infections in Covid-19 Era- Actuality or the Unforeseen: 2 Case Reports. Indian J Otolaryngol Head Neck Surg. 2021;01-04. Doi: 10.1007/s12070-021-02618-5. Epub ahead of print. PMID: 34026593; PMCID: PMC8127475. [crossref] [PubMed]
Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol. 2021;135(5):442-47. Doi: 10.1017/S0022215121000992. Epub 2021 Apr 8. PMID: 33827722; PMCID: PMC8060545. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/50927.17317

Date of Submission: Oct 05, 2021
Date of Peer Review: Jan 05, 2022
Date of Acceptance: Nov 26, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Oct 06, 2022
• Manual Googling: Nov 18, 2022
• iThenticate Software: Nov 22, 2022 (5%)

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