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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)
E-mail: drrajendrak1@rediffmail.com
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.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
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
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Case of Impacted Foreign Body in Zygomatic Region- A Missed Diagnosis
Correspondence Address :
Dr. K Santhosh Kumar,
Associate Professor, Department of Oral and Maxillofacial Surgery, Sri Ramachandra Dental College, SRIHER, Chennai-600116, Tamil Nadu, India.
E-mail: santhoshkumark@sriramachandra.edu.in
Foreign body impaction in the soft tissues is not uncommon following maxillofacial trauma. Traumatic injuries in this region often cause penetrative injury of the soft tissues. Immediate closure of the soft tissue wound becomes the primary management strategy for control of haemorrhage. Foreign bodies may sometimes remain unnoticed in these wounds. Here, the authors present a case of retained metallic foreign body in the left zygomatic region in a 21-year-old male patient with history of simple slip and fall from staircase at home. Clinical evaluation and primary management of the facial wounds were done in a nearby healthcare centre by a general physician where the facial wounds were closed primarily using cyanoacrylate tissue glue to control the bleeding. Further, on clinical and radiographic examination by an oral maxillofacial surgeon, a 2×1 cm metallic foreign body was noted in the left zygomatic region. Immediate surgical removal under local anaesthesia was planned and performed. The purpose of reporting this case is to highlight the importance of thorough clinical and radiographic assessment as well as the need for an oral maxillofacial surgeon for prompt assessment, diagnosis, and management of these facial injuries.
Foreign body impaction, Maxillofacial trauma, Radiography
A 21-year-old male presented to the Department of Oral and Maxillofacial Surgery with complaints of pain and swelling in the left cheek region following facial injury. The patient gave a history of slip and fall at home in the stairs from a height of approximately four feet following which the patient had pain and diffuse bleeding from wounds in the left cheek region. The patient had visited a local healthcare centre where primary management of facial wounds was done using tissue adhesive cyanoacrylate glue.
The patient was neurologically stable. On local examination, the patient’s face was apparently symmetrical; there was severe tenderness and mild oedema in relation to left malar region with evidence of abrasive injuries. No palpable step deformity/segmental mobility were present in maxillofacial region. The patient had mild restriction in mouth opening (35 mm). Intraoral examination revealed stable dental occlusion.
With the above clinical findings, the patient was suspected to have left zygoma fracture and was advised X-ray paranasal sinus view. Radiographic examination revealed no fractures in the maxillofacial region but showed a 2×1 cm radiopacity near the left body of zygoma (Table/Fig 1).
This raised suspicion for the presence of foreign body and hence, the patient was advised ultrasound which revealed a well-defined linear hyper echoic lesion suggestive of foreign body with haematoma in deep subcutaneous planes of left maxillary region (Table/Fig 2).
Immediate surgical removal under local anaesthesia was planned. Through the primarily closed wound in the left zygomatic region, access was gained (Table/Fig 3). Haematoma was drained following which a 2×1 cm metallic plug was identified and removed (Table/Fig 4)a,b.
Thorough irrigation was carried out with saline. After achieving haemostasis, the surgical site was closed using 5-0 vicryl and 6-0 ethilon. At one week follow-up, it was noted that the patient was pain free with satisfactory healing (Table/Fig 5).
Maxillofacial injuries are seen in significant number of trauma patients. They can occur in isolation or in combination with other injuries, including spinal, abdominal, upper and lower body injuries (1). Patients with maxillofacial injuries often have contaminated wounds due to the presence of foreign bodies (2). Foreign body impaction can commonly occur following traumatic injuries of a penetrating nature. These foreign bodies penetrate into the soft tissues through injuries sustained during the trauma and can sometimes be difficult to identify. Depending on the aetiology of trauma, the type of foreign body and its location vary considerably. Different types and sizes of foreign bodies may get impacted in the maxillofacial region including glass, stones, wire, metal, wood, or pen cap (3).
Out of all the cases of impacted foreign bodies reported, about one-fourth is missed during preliminary examination due to their variable size, shape and/or deep location (4). If left untreated, they have the risk of causing an array of complications ranging from simple infection to serious injury of adjacent structures (5). Barros MA et al., described a case of an impacted foreign body in a patient with history of slip and fall from height during simple domestic activity (6). Removal of the foreign body was performed under general anaesthesia. Kuang R et al., reported a case of 19-month-old child with history of penetrative injury to the face that subsequently led to the development of facial artery pseudoaneurysm (7). In rare cases, foreign body injuries in the maxillofacial region can pose a serious threat to the patient, so a prompt initial treatment and appropriate management would increase the survival of this kind of patient (8). Some of them may remain in situ for clinical reasons and removing them could bring more harm than benefits (9). Wulkan M et al., reports common complications associated with the foreign body removal such as excessive haemorrhage, infection, pain, oedema, and trismus (10). But most of the foreign bodies are removed before the onset of any serious complications. The preferred path of removal is usually along its path of entry (11).
Various imaging techniques can be used to identify the presence of impacted foreign bodies. The most commonly used modality in the head and neck region is plain radiography followed by Computed Tomography (CT), ultrasound and Magnetic Resonance Imaging (MRI). Plain radiographs have sensitivity of 69-90% for metallic foreign bodies and 71-77% for glass (12). But when a foreign body is suspected to be in deeper plane with risk of injury to vital structures, it is advisable to get a CT scan done for accurate localisation and anatomic proximation. Recent reports have shown the advantage of helical CT scans to be as accurate as conventional CT scans, but with less radiation exposure for the patient (13).
In head and neck region, ultrasound is another useful imaging modality in identifying foreign bodies like wood. It can demonstrate wooden fragments as small as 2.5 mm with 87% sensitivity and 90% specificity (14). When the presence of metallic foreign body is suspected, MRI should be avoided as the magnetic field associated with it may mobilise the foreign body leading to serious damage of surrounding tissues (15).
When there is a significant risk of injury to vital structures, navigation systems for the purpose of localisation of the foreign body has been suggested in the maxillofacial region (16). In the present patient, plain radiograph was taken to rule out suspected zygoma fracture, which led to accidental finding of metallic foreign body in the cheek region. Additionally, the patient was advised ultrasound to identify the plane of involvement and its relative position from vital structures.
Removal of impacted foreign bodies in the superficial planes can be done under local anaesthesia and those in deeper planes may require removal under general anaesthesia. In the present case, removal of foreign body was performed under local anaesthesia as 20the foreign body was in the subcutaneous tissues without risk of injury to vital structures. In addition, surgical guides have also been used to assist in the removal of foreign bodies. Ma W et al., reported a case of a 11-year-old boy with extensive facial contusions who underwent emergency surgical removal of multiple impacted glass shards in the face (17). Computed tomography scan taken after two months revealed two glass pieces left behind. Computer printed 3-dimensional digital guide was fabricated and used to precisely locate and successfully remove the foreign body.
The possibility of foreign body injury should be ruled out in any patient presenting with history of maxillofacial trauma. In the reported case, a simple slip and fall from stairs had resulted in a penetrative injury in the face, caused by a metallic plug with subsequent bleeding. Immediate primary care was given in a primary healthcare centre by a medical physician.
It has been observed that the knowledge regarding management of such maxillofacial injuries among medical professionals is not sufficient [18,19]. Due to the unavailability of specialists like oral and maxillofacial surgeons, these types of injuries in the face may remain undiagnosed. Hence, it is pertinent to mention that the availability of an oral and maxillofacial surgeon in any health care centre holds great significance for management of these injuries. However, such a need has been found to be low in many primary health care centres in South India (20). Thus, this case report signifies the need for such professionals to identify, manage and provide adequate care for those individuals presenting with maxillofacial injuries.
The possibility of foreign body injury should be ruled out in any patient presenting with a history of maxillofacial trauma. Radiographs are crucial elements for early diagnosis and proper management of these injuries. When required, advanced imaging modalities should be used. It is also important to emphasise the availability of an oral and maxillofacial surgeon in any health care centre would significantly reduce the chances of any misdiagnosis or missed diagnosis in a patient presenting with history of maxillofacial trauma, thereby avoiding unnecessary complications that may follow.
DOI: 10.7860/JCDR/2023/65209.18501
Date of Submission: May 04, 2023
Date of Peer Review: Jul 01,2023
Date of Acceptance: Aug 08, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• 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 CHECKING METHODS:
• Plagiarism X-checker: May 10, 2023
• Manual Googling: Jul 13, 2023
• iThenticate Software: Aug 05, 2023 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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