Penetrating toothbrush injury in a child: an unusual presentation

We present an unusual case of a penetrating toothbrush injury in a 6-year old child. The injury was sustained due to a fall at home and resulted in accidental implantation of an adult toothbrush in the facial soft tissues. The toothbrush was removed under general anaesthesia without any complications. This case highlights a rare presentation involving extra oral penetration of a toothbrush which is not reported previously in the literature.

Diabetes mellitus and osteomyelitis of the jaws

The Diabetes Mellitus is a prevailing medical condition worldwide [6%] and also in Pakistan. Infection in the orofacial wounds of these patients is common. The aim of the study was to determine the effect of diabetes mellitus on the healing process of alveolar sockets/bone after tooth removal. Eighteen diabetic patients with chronic jaw bone infections were examined and managed in oral and maxillofacial surgery department of de, Montmorency College of Dentistry, Lahore from 2009 to 2013. All patients gave history of tooth extraction about two months earlier. Orthopantomograph [OPG] were used to confirm the diagnosis. Fourteen patients [77.77%] were on oral hypoglycemic agents, four did not know their diabetic status, four patients [22.22%] were on intermediate acting insulin. All patients were managed under general anesthesia for involucrum sequestrectomy followed by primary closure. One insulin dependent patient with radiated lower jaw developed osteomyelitis after tooth extraction and was also on bisphosphonate medication followed by breast cancer surgery. This patient was operated twice to resolve the osteomyelitis of the lower jaw in follow up six months. It was concluded that diabetes effects the healing of sockets after tooth removal

Frequency and pattern of presentation of neuralgia inducing cavitational osteonecrosis

Neuralgia inducing cavitational osteonecrosis is a bone disease which leads to neuralgia like pain. The aims of this study were to document the frequency and pattern of presentation of neuralgia inducing cavitational osteonecrosis and differentiate it from trigeminal neuralgia. This case series was conducted from August 2011 to July 2012 at Punjab Dental Hospital, Lahore. Patients having facial neuralgia like pain were assessed by history, clinical and radiographic examination. From these patients, seventy patients with signs and symptoms of neuralgia inducing cavitational osteonecrosis [i.e. oro-facial neuralgic pain with intra-oral trigger zone, previous history of surgical intervention and radiographic evidence of cavitational osteonecrosis in the jaws] were included in the study for surgical debridement and curettage of necrotic bone. Out of seventy patients, 25 were male [35.7%] and 45 were female [64.3%]. Age range was of 18 to 70 years. Positive diagnosis of neuralgia inducing cavitational osteonecrosis was confirmed in 45.7% of cases. Most of the patients were from fourth and fifth decade of life. Mandibular posterior region was mostly involved [61.4%] followed by maxillary posterior region [30%]. Anterior maxilla was involved [7.1%] more than anterior mandible [1.4%]. NICO most often causes sharp, shooting pain and is frequently misdiagnosed as trigeminal neuralgia. Consequently, patients are prescribed unwarranted anticonvulsant drugs and/or a variety of surgical procedures without significant pain relief. Such patients should be diagnosed properly for effective management i.e. surgical debridement of involved region

Treatment of odontogenic ameloblastomas and their long term follow up at tertiary centre

Fifty-two patients of ameloblastoma were operated with special emphasis on radiographic and histological appearance. The unicystic radiographico-histological [38] cases were managed conservatively with marsupialization followed by enucleation [Group A' 15 Patients] and enucleation with peripheral ostectomy [Group B' 23 Patients]. The radiographico-histological multicystic [solid] variety [Group C' 14 Patients] was treated aggressively by resection. In conservative treatment regimens Carnoy's solution was applied after enucleation of the tumour whereas, the patients of aggressive surgery were operated with minimum 5mm safety marginal clearance of the tumour. The recurrence rate with average four years follow up was 0.0% for resection, 13.33% for marsupialization followed by enucleation and 8.69% for enucleation with peripheral ostectomy. The results were encouraging for unicystic ameloblastoma treated patients [Group A' and B'], in best interest of jaw bone contour preservation

An unusual case of chronic suppurative osteomyelitis of the mandible

Osteomyelitis of the mandible, a serious complication of untreated odontogenic infection has been reported. This case report describes an interesting presentation of chronic suppurative osteomyelitis (CSO) of the mandible in a 13 years old anaemic male patient. Investigations revealed inversion of his permanent teeth leading to trans-cutaneous extra-oral eruption along with marked destruction of mandible on the affected side. The treatment included a pre surgical course of antibiotics followed by the removal of the retained second premolar tooth, surgical debridement of the affected bone, and resection of the cutaneous sinus tract. The post-operative healing was uneventful. A combination of antibiotic therapy and surgical debridement were effective in the treatment of chronic suppurative osteomyelitis.

Removal of a broken needle in the pterygomandibular space: a case report

Needle breakage following inferior alveolar nerve block is an unusual yet alarming complication in contemporary dental practice. We report a case of surgical retrieval of a broken needle in the pterygomandibular space following an inferior alveolar block in a 21 years old male. The postoperative recovery was uneventful and no complications were observed. Prompt removal of a broken needle is advisable to avoid complications.

Laparoscopic assisted right hemicolectomy. An experience of laparoscopic assisted right hemicolectomy in benign disease -- tuberculosis

To assess the outcome of laparoscopic assisted right hemicolectomy in benign diseases like tuberculosis. Prospective observational study. Surgical unit-I of Jinnah Hospital Lahore. Jan 2009 and June 2010. This study included a series of twenty patients with preoperative clinical diagnosis of ileocecal tuberculosis. A three trocar technique was used to perform laparoscopic right hemi colectomy and anastomosis was performed outside the abdomen by extending the supraumbilical incision. Data of 20 patients who underwent laparoscopic assisted right hemicolectomy was analyzed. Mean age of the patients was 27.5 years with male to female ratio 4:1 [Table-I]. There was zero conversion [0%] to open surgery and no intra-operative complications [0%] were observed. Average hospital stay was 5.8 days. No patients had to be re operated. On histopathology of specimen final diagnosis was 95% ileo cecal tuberculosis and one patients [5%] turned out to be having lymphoma [Table-III]. The laparoscopic colon surgery can produce excellent results in selected patients of abdominal tuberculosis. Advantages of laparoscopic over open surgery include less postoperative pain, short-term postoperative ileus, earlier return to daily activity

Pyogenic granuloma - review

Pyogenic granuloma is a common non-neoplastic soft tissue growth seen on a variety sites in the body including the oral cavity. It may also occur in pregnant subjects and is referred to as a granuloma gravidarum. Although the precise etio-pathogenesis is not established, it is regarded as a reactive lesion secondary to trauma or non-specific local irritation. Hormonal stimulation during puberty, pregnancy or oral contraceptive use may also be responsible. A variety of angiogenic factors may mediate exuberant endothelial proliferation. Mostly commonly it affects adolescents and young adults with preponderance in females. The most familiar site is anterior maxillary gingivae but may also affect the mandibular gingivae, lips, tongue and buccal mucosa. Conservative surgical excision is usually curative but recurrence is not unusual. Lasers and cryotherapy may also be employed. Granulam gravidarum, however, is best left untreated until parturition

Current concepts in central giant cell granuloma

Central Giant Cell Granuloma is a nonneoplastic intraosseous lesion, and constitutes a common nonodontogenic pathology to occur in the jaws. It is characterized histologically by cellular fibrous tissue containing multiple foci of haemorrhage, aggregations of multinucleated giant cells, and occasionally, trabeculae of woven bone. Various theories brand it from being a 'reactive' to hamartomatous to a neoplastic lesion. It has now been hypothesized that it is the mononuclear spindle shaped cell which controls the proliferative activity of this lesion, as opposed to the more frequently seen giant cell. It has an increased predilection for mandible and females, in younger age groups. Various radiological and histopathological differential diagnoses should be considered in case of giant cell lesions. Some of the lesions are thought to display a markedly 'aggressive' behaviour and a clinically 'aggressive' model of CGCG has been proposed. Smaller, 'nonaggressive' tumours generally respond very well to conservative enucleation or curettage but recurrence is seen to be common with 'aggressive' lesions. Various medical therapies including injections of intra lesional steroids, subcutaneous calcitonin and interferon have been proposed for the treatment of 'aggressive' lesions

Clinical presentation and management of adenomatoid odontogenic tumor

To document the clinical presentation and treatment protocols for adenomatoid odontogenic tumor in the oral cavity, this study was carried out at de, Montmorency College of Dentistry I Punjab Dental Hospital, Lahore-Pakistan. The sampling technique was purposive. Six cases of AOT were recorded. The age range was 11-16 years [mean 13.8years] with 4 cases in males [66.6%]. Maxillary involvement was seen in 5 cases [83%]. Only one case presented with mandibular involvement [left side]. AOT is a relatively uncommon lesion seen primarily in the adolescents. It should be managed at an early stage to prevent damage to the adjacent teeth

Typing of HLA class I by polymerase chain reaction-sequence specific oligonucleotide primer [PCR-SSOP] Technique in Iranian cord blood donors

HLA compatibility between transplant donor and recipient is one of the major determinants of transplant outcome. To determine HLA class I by PCR- Sequence-Specific Oligonucleotide Probe [PCR-SSOP] in cord blood donors. Genomic DNA of 142 cord blood samples registered at the Cord Blood Bank of Iran at Hematology, Oncology, and Bone Marrow Transplantation Research Center, was prepared and HLA class I was determined by the PCR-SSOP. A total of 284 HLA-A alleles was identified of which A*02 and A*24 were the most common. Among 284 HLA-B and HLA-C alleles, B*35, B*51, Cw*4 and Cw*12 were the most frequent alleles in the studied population. Amplification of HLA loci with PCR-SSOP has proved to be a reliable method for HLA-A, -B and -C genotyping

Spectrum of mandibular fractures at a tertiary case dental hospital in Lahore

Mandible being the only mobile bone of the facial skeleton plays a major role in mastication, speech and deglutition. Among the maxillofacial trauma, mandible is the high risk exponent. Its fractures result in severe loss of function and disfigurement. The increased vehicular accidents, conditions of our roads and other assaults have focused attention in recent years to prevent injuries. Method: A descriptive case series of 126 patients with mandibular fractures attending a tertiary referral centre over a six-month period is presented. Data concerning the patients' demographics, aetiology and pattern were obtained and analysed. Approximately 56% of the patients sustained fractures from road traffic accidents and 34% of the fractures occurred in the 21'30 year age range. There was a male preponderance with a male to female ratio of 9:1. Parasymphyseal fractures were the most common followed by those of the condylar and subcondylar regions. Conclusions: We need to encourage further research work in this field to provide better record keeping and quality of services to the injured people. Amendments in the traffic rules and legislation about seat-belt usage and traditional kite flying to reduce frequency of fractures are required

Assessment of undergraduate dental students

Undergraduate dental education in Pakistan needs to be organized on modern lines. One of the most important aspects of improving the standard of dental education is to modify the assessment methods. Students performance should be assessed on a wider scale rather than a mere university examination. Student profiles can serve as a useful means for assessment of undergraduate dental students