Histopathological evaluation of odontogenic keratocysts and radicular cysts in Peshawar

Odontogenic cysts are jaw lesions that may be misdiagnosed due to lack of complete data. Clinical, radiographic and histopathological correlation is required for the diagnosis of these cysts. The study was thus designed to determine frequency and compare the histopathological features of radicular cysts and odontogenic keratocysts in population of Northern Pakistan. The study was conducted at Sardar Begum Dental College and Khyber College of Dentistry, Peshawar. Non-probability, consecutive sampling technique was used to select 70 cases of odontogenic cysts from 190 cystic jaw lesions. Formalin-fixed paraffin-embedded tissue samples of Odontogenic keratocysts [n=22] and radicular cysts [n=48] were retrieved from the archives of Khyber College of Dentistry and Sardar Begum Dental College, Peshawar. Frequencies of the cysts were calculated. These were then evaluated for histopathological variables which included thickness of epithelial lining, keratinization, foamy macrophages, mucous cells, Rushton bodies, cholesterol crystals and haemosiderin. Chi-square test/ Fishers exact test was applied to compare cysts. The data was analyzed using SPSS version 21. Frequency of the radicular cyst and odontogenic keratocyst was 68.5% [48N] and 31.5% [22N] re-spectively. The histopathological features showed presence of mucous cells, vacuolated cells, spongiosis, micro-abscesses, cholesterol crystals, hemosiderin and inflammatory infiltrate. The radicular cyst was the most prevalent in our study 48[68.5%], followed by the odontogenic keratocysts 22[31.5%]. The histopathological features observed in these cysts are comparable with other populations of Pakistan and abroad

Common factors delaying the diagnosis of oral cancer

Oral cancer is a serious health issue that has a universal occurrence. Cancer is the top cause of death in economically developed countries and the second most lethal entity in developing countries. Oral cancer has a five-year survival rate of 50% or less. This rate is much improved when lesions are diagnosed at an early stage of the disease [i.e. small and localized]. Detecting oral cancer at an early stage is believed to be the most effective means to reduce morbidity and duration of treatment. The objective of the study was to determine the frequency of common factors delaying the diagnosis of oral squamous cell carcinoma. A Descriptive, cross sectional study was carried out in Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar over a period of six months. Using structured proforma, data from 108 patients with delay in the diagnosis of oral squamous cell carcinoma were collected through history taking, clinical examination and histopathological confirmation. Delay in the diagnosis of squamous cell carcinoma was predominantly found in male patients with a male to female ratio of 3.15: 1. The mean age of the patient was 59.59. Most of the patients reporting with delay in the diagnosis were in the 6th decade of life [30.5%] followed by 5th decade [24.99%]. The most commonly involved site was mandibular left gingivolabial sulcus [22.2%]. Most of the patients with delay in diagnosis reported in stage IV [75%]. Patient delay was seen in 26.85% of the patients, with a professional delay of 14.81% of the patients. Both types of delay i.e patient and professional delay was seen in 58.33% of the patients. Amongst 108 patients a total delay in days of more than 200 days was seen in 39.82%, 25.92% of the patients had delay of more than 50 days. Delay in the diagnosis of squamous cell carcinoma was found more in males than females. Delay was most commonly seen in the 6th decade of life with most of the patients reporting in stage 4. Patient delay was 26.85%, professional delay in diagnosis was 14.81%. Both types of delay was seen in 58.33% of the patients and 39.82% of the patients reported with total delay of more than 200 days

Pattern of mandibular fractures resulting from fall

Fall is the third commonest cause of mandibular fracture throughout the world while in Pakistan and India it is considered to be the second most common cause. Mandible fracture resulting from fall is of great concern particularly in children because it has been found that in children majority of cases of joint fracture has resulted from fall, and found to have temporomandibular joint [TMJ] ankylosis. The purpose of this study was to evaluate the pattern of mandibular fractures resulting from fall. This will help in the prevention of subsequent complications particularly in children like TMJ ankylosis and aesthetic problems. This is a descriptive [cross sectional] study which was carried out on 60 patients presenting with mandibular fractures resulting from fall to the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa Province of Pakistan from 4th April 2009 to 3rd October 2009. Each patient was thoroughly examined both clinically and radiologically for the site of mandible fracture. The age, gender and site distribution of patients were determined. Majority of the fall injury patients presenting with mandibular fractures were in the 1st decade of life followed by 2nd and 6th decade. In the first three decades of life, males were predominantly involved while the 5th and 6th decade was dominated by female patients with overall male preponderance. The most common pattern of mandibular fracture resulting from fall was combination bony trauma [i.e., more than one mandibular fracture site] and the para-symphysis and condyle were the most frequent mandibular fracture sites both in combination and isolation

Etiology, clinical and radiographic features of temporomandibular joint ankylosis

Objective of the study was to find out the frequency of different etiological factors, clinical and radiographic features of Temporomandibular joint ankylosis. Ninety six patients suffering from Temporomandibular joint ankylosis visited Oral and Maxillofacial Surgery Department, Khyber College of Dentistry, Peshawar from December 9, 2009 to December 8, 2010 and were included in the study. Patient demographics, etiology and clinical features of the disease were noted. Orthopantomograph was taken of all patients to confirm the diagnosis and to record the radiographic findings of the disease. Males were the predominant group [60.4%] as compared to females [39.6%]. Trauma was the etiological factor in 88.5% cases followed by infection and inflammation. Clinical deformity was present in the form of facial asymmetry [85.4%], < 5mm inter-incisal distance [76%], disturbed occlusion [64.6%] and poor oral hygiene [78.1%]. Bilateral involvement was found in 40.6% cases, left side was involved in 30.2% cases while right side was effected in 29.2% cases. Radio-graphically, the disease presented in the form of mushrooming of condyle, loss of joint space, anti-gonial notch and coronoid hyperplasia. Trauma is the main etiological factor for Temporomandibular joint ankylosis. Clinically the disease presents in the form of facial asymmetry, limitation of mouth opening, disturbed occlusion and sleep apnea while on radiographs, there is partial or complete loss of joint space, mushrooming of condyle, anti-gonial notch and coronoid hyperplasia

Management of a maxillofacial trauma patient on warfarin

Maxillofacial trauma patients with prosthetic heart valves are a challenge to treat due to the risk of bacterial endocarditis. These patients are on anticoagulant therapy therefore, they are at a risk of bleeding and thrombosis. A case of 55 year old known epileptic male patient, with mitral valve replacement surgery performed in 1988, who presented to oral and maxillofacial surgery department, Khyber College of Dentistry, with fracture mandible due to fall is reported. The patient was on warfarin with an INR raised to 9.5 and a prothrombin time of 100 seconds. Routine investigations for general anaesthesia were performed and were in the normal range. Open reduction of the fractured mandible was planned under general anaesthesia, and the patient was switched from warfarin to low molecular weight heparin and INR and PT were lowered to 1.9 and 23 seconds respectively a day before surgery. Uneventful surgery was performed and complete recovery was achieved within 3 days

Kikuchis-Fujimoto disease

Kikuchi-Fujimoto disease or Sub-acute necrotizing lymphadenitis is a benign self-limiting condition. A case in a 24-year-old young female who presented with swelling in the right submandibular region and pain is reported. The erythrocyte sedimentation rate was elevated to 50 mm/h. Other serological tests for rubella, hepatitis B, hepatitis C, HIV, and toxoplasmosis, as well as tests for tuberculosis were performed which were negative. The excisional biopsy of the lesion showed necrotizing lymphadenitis consistent with Kikuchi-Fujimoto disease. No further treatment was given, and a full recovery was achieved within one month. Tuberculous lymphadenitis and lymphoproliferative disease were considered in differential diagnosis

Condylar fractures in children - a study

The purpose of the study was to highlight the etiology, age, gender and site distribution, treatment options available and complications occurring as a result of condylar fractures in growing children. This retrospective study was carried out on a total of 57 patients from Jan 2008 to Oct 2009 at the department of oral and maxillofacial surgery, Khyber College of Dentistry, Peshawar, Khyber Pakhthunkhwa province of Pakistan. Fifty seven patients were recruited in this study. The male to female ratio was 1.6:1. Fall was the most common cause of condylar fractures i.e., [73.7%]. The peak incidence of condylar fracture was high among 6-10 years age group i.e. 26 [45.6%]. Forty one patients [71.9%] had unilateral condylar fractures and [28.1%] had bilateral. Maxillomandibular fixation [MMF] was performed in 28 patients [49.2%] to correct occlusal disturbance, minor deviations and to reduce the pain associated with it, while occlusion was disregarded in 29 patients [50.8%] but were put on close follow up. Overall 41 patients [71.9%] were treated successfully with conservative treatment approach but 16 patients [28.1%] have reported after 1-2 years with complications of temporomandibular joint [TMJ] Ankylosis. Among these 10 patients [62.5%] had unilateral TMJ Ankylosis. Gap arthroplasty with disc interpositioning was performed in patients with established complication of temporomandibular joint ankylosis

Maxillofacial and associated fractures of the skeleton - a study

The purpose of the present study was to evaluate the incidence of associated skeleton fractures with maxillofacial fractures and to list age gender and bone involved with poly trauma patients. The study is first of its kind in the region and will help to develop a better poly trauma management team. A Descriptive study was carried out in Oral and Maxillofacial Surgery Department of Khyber College of Dentistry, Peshawar, Pakistan for a period of one year i.e., from 20[th] June 2009 to 19[th] June 2010. All the patients presenting with maxillofacial injures and associated fractures of the skeleton were included in this study. Age, gender distribution, aetiology, associated injuries and treatment modalities undertaken in these patients were recorded. A total of 505 patients reported to oral and maxillofacial surgery unit of Khyber College of Dentistry, Peshawar, and amongst them 54 [10.6%] had associated fractures of the rest of the skeleton of the body. The most commonly involved bone was mandible [67%] followed by zygomatic complex fratures i.e. 15% in these patients. 50% of the fractures resulted because of Road Traffic Accidents. Upper limb fractures were the most common bone fractures associated with maxillofacial trauma i.e., 53.25% of the cases

Retaining or extracting a tooth in the line of mandibular fracture - a study

The purpose of the study was to compare the treatment outcome of extractions and nonextractions of teeth in the lines of mandibular fractures and to determine the most common complications. A Quasi-experimental study was undertaken in the Department of Oral and Maxillofacial surgery, Khyber college of Dentistry Peshawar from January 2007 to January 2008. A total of 100 patients having tooth in the line of mandibular fracture were recruited in the study. The patients were divided into two groups of 50 patients each. In Group A the tooth was retained in the line of fracture, and while in Group B the tooth was extracted. Each patient was evaluated for postoperative results and the differences between them assessed. Statistical analysis included chi-square test. Results were considered significant if p d" 0.05. Majority of the patients were young adults. The most common site was parasymphysis while the most commonly involved teeth in the fracture line were incisors. The major operative morbidity proved to be infection followed by malunion and maloclusion. Both groups were not different in relation to postoperative infection [P= 0.461], malocclusion [P= 0.5577], malunion [P= 0.5577] delayed union and non-union. There was no significant difference in the outcome between the extraction and non-extraction of a tooth in the line of fracture

Post-traumatic stress disorder - a psychological aspect of maxillofacial trauma

The purpose of this study is to find out the incidence of Post-Traumatic Stress Disorder in patients with maxillofacial trauma and to provide a circumstantial evidence for certain precautionary measures which will play a basic role in the prevention and management of Post-Traumatic Stress Disorder amongst such patients. The study was carried out at the Department of Oral and Maxillofacial Surgery, Khyber College with maxillofacial Pakhtunkhwa, Peshawar from June 2009 to May 2010. Two hundred and Ninety patients with maxillofacial trauma were recruited in this study. For the collection of data, Post-Traumatic Stress Disorder Checklist Civilian version consisting of 17 items was used. The collected data and all relevant information were analysed using SPSS Version 17.0. The results of the present study showed that out of 290 patients, 90 patients [31.03%] had Post-Traumatic Stress Disorder symptoms in which 40 [44.44%] were males and 50 [55.56%] were females. The largest age group suffered from Post-Traumatic Stress Disorder symptoms were 16-25 years and 26-35 years [33.33% each]. Thirty four patients [27.78%] scored 50 or above on Check list indicating severe symptoms, where 27 females [30%] had severe symptoms as compared to 7 males [7.78%]. Young patients between ages 16-35 were the most common group who suffered from severe symptoms. The severe symptoms of Post-Traumatic Stress Disorder were seen in victims of road traffic accidents and bomb injuries [22.22% and 13.33% respectively] with poor and middle socioeconomic status. The importance of psychological morbidity after major trauma is continuing to gain attention in trauma outcomes research. Taking into account the burden of psychological consequences of maxillofacial trauma, further research and preventive strategies are needed to cope with this hidden epidemic in our society

Mucosal venous hemangiomas of the oral cavity - an analysis of 43 cases and literature review

To study the gender predilection, age group and affected site distribution of Mucosal venous hemangiomas of the oral cavity in patients reporting to Department of Oral and Maxillofacial Surgery at Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa. Forty three patients were included in this descriptive study after a diagnosis was confirmed on the basis of clinical examination and "Blanching" test, carried out at Department of Oral and Maxillofacial Surgery at Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa over a period of 3 years and 3 months. All patients with only mucosal hemangiomas were considered and those with intra-osseous, intramuscular, with or without soft tissue extensions of the condition, were excluded from the sample. Pertinent variables such as age, gender and affected site were noted and analyzed using Microsoft Excel 2007. Majority of the patients in this study were male [62.8%] whereas females constituted the remaining 37.2% of the sample. 11-20 years was the most prevalent age group whereas 41-50 years was the least prevalent age group in this study. Amongst the study sample, the tongue was found to be the most affected site, comprising 32.6% of cases and the maxillary gingival was the least affected site, accounting for only 2.3% of our study samples. Mucosal venous hemangiomas show a marked male predilection in our study sample. Patients falling in 11-20 year age range are affected mostly by the condition and the tongue is the most common affected site in patients from Khyber Pakhtunkhwa

Loss of consciousness in mandibular fractures an audit of 254 patients

The purpose of this study was to seek association between mandibular fractures and loss of consciousness [LOG]. The present study is a retrospective chart review of 254 patients of fracture mandible at the Department of Oral and Maxillofacial surgery, Khyber College of Dentistry, Peshawar, Khyber Pukhtoonkhwa Province of Pakistan from July 2009 to July 2010. The demographic data, LOC, mechanism of injury, site of fracture and number of fractures per mandible were collected for each patient. The frequency of LOC due to mandibular fractures in this study was 25.9%. The male to female ratio was 4.6:1. The mean age of the patients was 20.3 SD [+14.68]. Age ranged from 2 years to 65 years in the group with LOC and from one year to 80 years in the group without LOC. The highest incidence of patients with LOC was found in 3[rd] decade of life [33.3%] while the highest incidence of patients in non LOCgroup was in 1[st] decade of life [33.5%]. The most common cause of mandible fracture in patients with LOC was RTA [57.6%] followed by fall [37.9%] while in nonLOC group was fall [46.8%] followed by RTA [41.5%]. The most common site fractured in both groups was mandibular para-symphysis, accounting for 37% in LOC group and 38.9% in non LOC group. In the LOC group, the predominant fracture pattern seen was non displaced fractures [51.5%], while in the non LOC group, displaced fractures were predominant [52.1%]. Loss of Consciousness was more common when, there was a single mandibular fracture [54.5%], while in the non LOC group [51.6%] sustained double fractures. This observation is statistically non-significant with p- value [.18]

Odontomes-a descriptive case series on 38 patient

The objectives of the study were to evaluate the presentation pattern of odontomes of the jaws and their distribution by gender, age, site and histopathological types. A descriptive study was under taken in the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar over a period of 7 years. Information regarding the variables of the study i.e. gender, age, site distribution, histopathological types. and clinical features at the time of presentation were recorded. A total of 38 patients were recruited in the study. Males were predominantly affected by the condition with-the male to female ratio of 2.8: 1. The age range of the patients was from 7-26 years with time mean age of 16.52 +/- 5.24 years. The second decade of life was the most common age, group affected i.e. 63.16%. posterior mandible was the-predominant site .for odontomes of the jaw i.e. 52.63% while anterior maxilla was involved in 34.21% cases. Amongst the two histological types, complex odontomes were more common i.e. 58% while 42% were compound odontomes. The presenting complaint of the patients comprised of extra and intra oral swelling [47. 37%], pain [26.32%] and pus discharge [5.26%,]. While in 21.05% cases of odontomes were a chance radiographic finding. Majority of the odontomes were of compound variety with male predilection. Swelling has been the most common presenting complaint, while in a few patients they were chance radiographic findings

Bilateral facial nerve paralysis: a case report and review of literature

Bilateral Facial Nerve Palsy is an exceedingly rare condition with aetiology often heralding the presence of a serious underlying medical illness. Mastication, speech and aesthetics are disturbed. The face is totally immobile and conveys no messages through facial expression. Frequently these patients are treated as if they are emotionally and mentally incompetent. Most patients require oral hygiene maintenance, mouth opening exercises and eliminating the source of possible odontogenic infection. There are many surgical procedures which can be of benefit depending on the patient's particular problem with the goal to support the mouth at rest and provide animation of the mouth and cheek

Delayed consultation of patients having temporomandibular joint ankylosis with an oral and maxillofacial surgeon - factors responsible for it

To find out the factors responsible for delay in seeking consultation by patients having Temporomandibu-larjoint A kylo sis. A.H the patients of Temporomandibularjoint ankylosis visiting Oral and Maxillofacial Surgery Department at Khyber college of Dentistry Peshawar from 1[st] January 2009 to 31[st] December 2009 were included in the study. Patient s gender, age, address, socio-economic status, educational level of parents, history of disease, health care professional initially contacted and delay in seeking consultation with an Oral and Maxillofacial Surgeon were documented. Out of 60 patients, 33 were males and 27 were females. Majority of them [86.7%] were from Khyber Pakhtunkhwa with 83.3% having history of previous trauma. 51.7% of the patients initially contacted local practitioners, 10% contacted trained Medical specialists, 15% consulted an Oral and Maxillofacial Surgeon without prior referal while 23.3% did not consult any health professional. Overall, 50 patients were delayed in consultation with an Oral and Maxillofacial Surgeon. The mean delay was 9.1 +/- 9.05 years [1-50 years]. Poverty, illiteracy, mis-diagnosis or non-diagnosis of con ay larfractures due to lack of trained specialists, improper follow up and the trend of non-referral to the specialised health professionals are the main jactors delaying consultation of patients, having TMJ ankylosis, with an Oral and Maxillofacial Surgeon

Cancrum oris - a descriptive case series on 13 patients

To evaluate the age, gender, site distribution and associated systemic debelitating conditions [if any] of the patients with Cancrum Oris. A. descriptive retrospective study was undertaken in the Oral and Maxillofacial Surgery unit of Khyber College of Dentistry from January 2005 to January 2010. Information regarding the variables of the study i.e., age, gender, site distribution and associated systemic debilitating conditions, was collected from the ward charts during the study period. A. total of 13 patients reported to the unit during the study period, 8 males and 5 females with male to female ratio of 1.6:1. The age range of the patient was from 9 to 70years with the mean age of 37.69 SD + 22.65. The first and the third decade of life was the most common age group affected with Cancrum Oris i.e., 23.07% each, with another peak in the sixth decade of life i.e., 23.07%. bilateral anterior maxilla was affected in 30.76% cases. Uncontrolled diabetes was the common associated systemic debilitating condition i.e., 72%. All of the patients were from low socio-economic class. Cancrum oris is a disease of low-socioeconomic group. In our series of patients the most common associated debilitating systemic condition was diabetes melitis with a bimodal age distribution

effect of stress on the pain severity in temporomandibular joint dysfunction among college and university students

To evaluate the influence of stress and anxiety on the severity of pain in Temporomandibular joint Dysfunction and on the subjective pain report. The study was carried out in the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa, between the period of May 2010 to November 2010. One hundred and ten students reportingfrom universities and colleges with TMJpain were clinically diagnosed as Temporomandibular Joint Dysfunction and were interviewed using specially designed proforma. To measure the level of pain, Visual Analog Scale was used. Variables like gender, age, geography and various stress factors were determined and analysed using statistical tools [SPSS V. 17]. Students in the age group of 26-30years were commonly affected [30%] followed by age group of 16-20 years [22.73%]. Most commonly affected students [68.18%] were those with moderate to very severe pain symptoms. Students belonged to Malakand Division [28.67%] and FATA. [25.67%] were commonly in the low income [n-42, 38.18%] and middle income [n-36, 32.73%] categories. Post Graduate students [40%] showed increased pain intensity during eating [35.45%] and talking [29.1'0%], particularly in their busy academic days, were reported to be the victims of severe painful episodes. A large proportion of students with Temporomandibular Joint Dysfunction have potential psychological problems. Female gender, advanced educational levels and hostel residence as well as poor socioeconomic status are predisposing factors for pain severity in Temporomandibular Joint Dysfunction

Characteristics of maxillofacial fractures resulting from road traffic accidents- an analysis of 250 patients

The purpose of this study was to document the characteristics of maxillofacial fractures resulting from road traffic accidents. The study was carried on 250 patients presenting with maxillofacial fractures resulting from road traffic accidents. On the basis of history, clinical and radiological examination, fractures were classified as dentoalveolar fracture, mandibular fracture, maxillary fracture [Lefort I, II and III], isolated zygomatic arch fracture, zygomatic complex fracture, nasal bone and orbital fractures. Data was analysed by statistical analysis tool using SPSS version 17. Males in their 2[nd] and 3[rd] decades were the most common victims. Among the isolated bone fractures [n=208], mandible was the most commonly fractured bone [n=104] followed by zygomatic complex [n=50]. The frequently observed pattern among mandibular fracture was parasymphysis [31.6%], among zygomatic complex was Group IV [n=29] while maxillary fractures showed a pattern of combined Lefort I, II and III [n=21]. Road traffic accidents are predictable and preventable. Basic knowledge regarding road safety measures and its implementation is necessary. It can be concluded from this study that majority of the patients were young adult males. The most common bone fractured was mandible both in isolation and combination

Causes of tooth extraction in oral surgery an analysis of 400 patients reporting to Khyber college of dentistry

Tooth loss has been one of the major problems faced by the people around the world. Although a preventable disease at early stages, caries still remains one of the prime etiological factors of extraction of teeth. The aim of the present study was to find out the main causes and contributing factors to tooth loss. A representative sample of 400 patients attending the Department of Oral Surgery Khyber College of Dentistry Peshawar was selected. The collected information was documented on a specially designed proforma. In this study 400 patients were recruited. Out of these 204 were male and 196 were female patients. The average age group of extraction was found to be third decade of life [28.75%] while caries [63.25%] was the primary cause of tooth loss. Majority of the patients in this study were poor [46%]. Oral hygiene was not good as 40.75% of the patient did not clean their teeth at all while sweet consumption was also notably frequent. Dental caries is a preventable disease at early stages. Patient education is needed to change attitude from extraction to preservation of teeth as tooth loss is very alarming in young population

Clinical and radiological behaviour of sporadic odontogenic keratocyst: a study

Odontogenic Keratocyst [OKC] is the most aggressive of the jaw cysts because of their greater tendency to recur. They are relatively common developmental cysts of the jaws. The present study [A descriptive case series] is about the clinical, features i.e. age, sex, site distribution and radiological features of sporadic odontogenic keratocyst. The present study was performed on 30 biopsy confirmed > cases over a period of 5 years. This cystic lesion is common in males [63%] as compared to females [37%]. The most common age group is the third [36.6%] and second decade [30%] of life, the most common site according to the present study was the posterior mandible i.e., the body and ramus of the mandible [40%], followed by the anterior mandible crossing the midline [20%] Anterior and posterior maxilla is not frequently involved by this cyst. Only in 9.9% of the cases the upper jaw was involved. Swelling has been the most common chief complaint i.e. [61. 702%]. In 16. 6% of patients, Odontogenic keratocyst was a chance radiographic finding. Radiologically most of the cysts were multilocular radiolucencies [83%]