Topical application of tocopherol with corticosteroid in reducing the early signs and symptoms of oral submucous fibrosis patients

Objective: The aim of this study was to compare the topical application of steroid alone or with combination use of steroid and tocopherol in reducing oral mucositis in Oral Submucous Fibrosis [OSMF], patients

Methods: In Pakistani population a rapidly advancing premalignant condition, Oral submucous fibrosis [OSMF] is present which has deteriorated the quality of life. The study was conducted in Department of Oral Medicine and Diagnosis, College of Dentistry, Ziauddin University Karachi, from December 2013 till July 2015. Randomly selected 76 patients with diagnosed OSMF, with history of chewing areca/betal nut or other similar products, with burning sensation on having spicy ingredient, trismus >20mm with or without palpable fibrous bands on the buccal mucosa intraorally with rigidity and blanching were included in the study. Total 38 out of 76 patients were given a combination of topical tocopherol application100mg and betamethasone [betonil 0.1%] twice daily and remaining 38 were on topical rinse of betamethasone [betonil 0.1%] alone. OSMF patients were clinically examined to assess the mouth opening and other clinical symptoms during three months and were followed up for next two months

Results: In the amelioration of early signs and symptoms of OSMF topical tocopherol combination with steroid application was found to be significantly efficacious. Objective signs of OSMF were reduced with improved mouth opening in 69.56% [p<0.05] of the cases

Conclusion: This study has shown that tocopherol, appears to be an effective drug in treating the early signs of OSMF

Oral submucous fibrosis: successful management of fifty cases with interpositioning buccal Fat Pad Flap

Objective: The aim of this study was to evaluate the clinical and anatomical application of buccal fat pad as an interpositional material in the surgical treatment of oral submucous fibrosis [OSMF] for improvement of mouth opening and its movements

Methods: OSMF has become a chronic, distressing condition of uncertain aetiology in Pakistan which rapidly involves the oral structures along with other parts of upper gastrointestinal tract

The study was conducted in Department of Oral and Maxillofacial Surgery, Ziauddin College of Dentistry, Ziauddin University, Karachi, from December 2013 till July 2015. We evaluated 50 diagnosed OSMF patients, with history of chewing areca/betal nut or other similar products, with burning sensation on having spicy ingredient, trismus 4-25mm with palpable fibrous bands on the buccal mucosa intraorally with rigidity and blanching were included in the study. Good clinical improvement with minimal morbidity by the use of buccal fat pad was noticed in patients with severe limited mouth opening along with regular and vigorous physiotherapy

Results: In 50 patients, the range of preoperative mouth opening was 4-24mm [14 +/- 4.90], the intra operative mouth opening was 25-38mm [33.25 +/- 4.17]. The patients were discharged after 72 hours at this time mouth opening was 25-36mm [0.63 +/- 3.82]

Comparison of pre-operative with intra and post-operative mouth opening was statistically significant

Conclusion: This study has shown that use of interpositioning buccal fat pad flap improves the mouth opening and movement in OSMF patients

Histopathological predictors of nodal metastases in oral squamous cell carcinoma

Background: Oral cancer is regarded as the sixth most common malignant tumor and is one of the leading cause of death. Lymph node metastasis is a major factor for the prognosis of oral squamous cell carcinoma [OSCC]. The objective of study was to compare the lymph node metastases with different histopathological parameters to identify high risk patients with the need for extensive treatment plans

Methods: 140 histologically proven OSCC patients visiting Ziauddin College of Dentistry were included in this study. The clinico-pathological parameters were compared by using Chi-square, Kruskal-Willis and Mann-Whitney

Results: There were 90 male and 50 female patients with 29.8% in 49-58 years age group. Buccal mucosa was the most common site of tumor. The predominant morphology of OSCC was moderately differentiated OSCC with stage IV disease. Lymph node metastasis was present in 48.6% of patients. Perineural invasion [22.9%], lymphovascular invasion [8.6%] and distant metastasis [11.1%] were also recorded. The mean tumor size was 3.45mm +/-1.95mm and mean tumor thickness was 1.8 +/-1.6mm

Conclusion: A significant association between grade, stage, tumor size, tumor thickness and distant metastasis with lymph node involvement was found. However further studies with larger sample size are required to validate these results

Frequency and clinical presentation of oral submucous fibrosis

Oral submucous fibrosis [OSMF] is a chronic, precancerous condition of oral mucosa characterized by juxta-epithelial inflammatory reaction along with hyalinization of lamina propria. These alterations causes fibrosis and stiffness of oral mucosa leading to limited mouth opening and related problems.

To evaluate the frequency and clinical forms of Oral Submucous fibrosis

A retrospective study conducted on patients from Oral and Maxillofacial Surgery department of Dr. Ziauddin hospital Clifton, Kemari and North Nazimabad campus from 2009 till 2013. Patients with OSMF irrespective of age and gender were the inclusion criteria. The demographic information along with clinical presentation of patients was tabulated and analyzed by descriptive statistics

A total number of 70 patients with OSMF were evaluated. The most commonage group was 11-20 years in the study. There were 42 male and 28 female patients with male female ratio. The most common complaint of OSMF patients was burning sensation in oral cavity followed by limited mouth opening and dryness of mouth. The majority of patients presented with an advanced stage of disease with grade 3 interincisal distance

OSMF is becoming a disease of younger adults with a slight male predilection. The majority of patients presents with a progressive and advanced form of disease

Oral myiasis: a case series of 11 patients treated at Khyber College of Dentistry Hospital, Peshawar

In order to determine the clinical presentation and management f 11 patients suffering from Oral myiasis a descriptive case series study was carried out at Khyber College of Dentistry, Peshawar, from June 2008 to December 2011. 11 patients of Oral Myiasis reported over a time period of 5 years. Thorough history was taken from each patient followed by complete clinical examination, relevant radiographs were advised where necessary. Surgical debridement was carried out followed by larvae removal with the help of maggot oil. Two patients were advised systemic therapy with Ivermectin. Mean age of the patient at the time of presentation was 39.72 years SD + 21.5. Majority of patients were males [64%]. Anterior maxilla was found to be the predominant site. Head and neck malignancies were found to be the most common cause of Myiasis. Thus Oral myiasis is a rare but serious condition, involving necrotic and suppurative wounds in patients with deranged systemic conditions. Treatment includes cleaning, debridement, removal of larvae and systemic therapy with Ivermectin

Treatment of TMJ recurrent dislocation through eminectomy - A study

The purpose of this study was to evaluate the outcome of eminectomy in clinically diagnosed patients with recurrent temporo-mandibular joint [TMJ] dislocation. This study was carried out at May Hospital, Lahore; fifteen patients with recurrent TMJ dislocation were treated by eminectomy using pre-auricular approach. Our study showed no recurrences of complications such as restricted mouth opening, Frey's syndrome, salivary fistula and facial nerve paralysis during a follow up period of 8 months to 4 years

Causes of tooth extraction: three years follow-up of two teaching hospitals in Karachi

The objective of this study was to describe the causes on tooth extraction among the general population attending oral surgery outpatient department of two teaching hospitals in Karachi. Demographics of the public and private sector hospitals were compared. Prospective study of a cohort of adults [mean age 33.86 +/- 13.65] who had detailed extraction record and demographic data collected during the previous 3 years [2005 -2007]. The study was carried out at Oral Surgery Outpatient Department Fatima Jinnah Dental College Hospital and at Karachi Medical and Dental College. A total of 24580 subjects from KMDC and 21891 subjects from FJDC were included in the study. The main outcome measures were Chewing habits, education, brushing frequency and brushing timing in relation to tooth loss. The primary causes of dental extraction were dental caries 67.04% [31158], followed by periodontal causes 21.68% [10075] and impacted wisdom teeth 4.64% [2074]. Few extractions were performed in cases in which the patient needed a prosthetic solution 2.63% [1225] or orthodontic treatment 0.28% [130] or due to cosmetic concerns and discoloration 0.05% [26]. Dental carries came out to be the commonest cause of extraction. The results of this study demonstrated the need for policymakers in the country to consider oral health on priority so that people have awareness about the hazards thus leading to reduction of morbidity and tooth loss

Prevalence of malnutrition in male school children in rural areas of district Peshawar: a study of demographic and socioeconomic characteristics

A study was conducted to assess the nutritional status and the contributing factors for malnutrition of male school children in rural areas of district Peshawar. Five hundred children aged between 5 to 10 years were randomly selected from five villages and subdivided into five age groups. Of the total study population, 46.6% of the children were malnourished, 17.2% had first degree malnutrition, 20.2% 2nd degree malnutrition and 9.2% had 3rd degree malnutrition. The dietary intake data revealed that 19-35% children in different age groups had lower protein and 29-47% had lower caloric intake. The correlation coefficients among the different variables demonstrate that weight and height of the children were positively correlated with protein, calories, family income, education and number of family members