Pre-operative contrast enhanced computer tomographic evaluation of cervical nodal metastatic disease in oral squamous cell carcinoma.

Aims: This prospective study was undertaken to evaluate the contrast enhanced computed tomography (CECT) criteria in detecting cervical lymph node metastasis in 50 patients with an oral squamous cell carcinoma (OSQCC). Materials and Methods: A total of 50 patients with OSQCC who underwent clinical assessment, routine CECT scanning of cervical lymph node and radical neck dissection were analyzed. Radiologic criteria for diagnosing nodal metastasis in this imaging study were: A nodal size of 1 cm, the presence of central lucency despite the size of the lymph node and grouping of lymph nodes. These criteria were based on modified American Joint Committee on Cancer Radiological Nodal Staging Guidelines. Statistical Analysis: Chi-square test/Fisher Exact test has been used to find the significant association of findings. Diagnostic statistics viz.: Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were obtained. The results were considered significant when P value was less than 0.05. Results: On using a nodal size of 1 cm and the presence of central nodal necrosis (CNN) as radiological criteria for nodal metastasis CT scanning staged 23 of the 27 histopathologically positive necks, providing accuracy of 88%, sensitivity of 92%, and specificity of 84% in detection of nodal metastasis. A significant relationship between the incidence of CNN, different nodal densities, and primary tumor differentiation was observed. Conclusions: The nodal size cut-off of 1-1.5 cm had a maximal sensitivity of 90.91% and PPV of 86.96%. Furthermore, observation of nodal densities in the absence of frank CNN on the CT scan may be necessary especially in low grade primary tumor. CT assessment of cervical node metastasis was found acceptable, although adjuncts like ultrasound guided fine needle aspiration may further increase efficacy of CT scan in nodes lesser than 1 cm in size.

Multiple internal resorption in permanent teeth associated with hyperparathyroidism.

Internal resorption has been described as a resorptive defect of internal aspect of tooth. It is caused by transformation of normal pulp tissue into granulomatous tissue with giant cells which resorb dentin. Though mostly idiopathic in origin, trauma, caries and restorative procedures have also been suggested to be contributing factors of internal resorption of pulp. Most of the internal resorption cases were found on isolated individual tooth. There are few case reports on multiple root resorptions. External root resorption have been frequently associated with systemic disorders like renal diseases hyperparathyroidism, rickets etc. A rare association of multiple internal resorption of permanent teeth (including lateral incisors, canines, premolars, sparing 2 nd and 3 rd . Permanent molars and missing 35,36, 42) with elevated levels of PTH and uric acid was evident in a 28 year old female patient who presented with fracture of crowns of permanent teeth. Though many cases related to dental manifestations of chronic renal disease and internal resorption of permanent teeth have been documented in literature, there is no evidence on association of hyperparathyroidism with multiple internal resorptions of teeth.

Evaluation of extensions of sinonasal mass lesions by computerized tomography scan.

Introduction : Cross-sectional imaging has had a significant impact on the management of the sinonasal malignancy. Staging of these lesions has been closely monitored by dependence on computerized tomography (CT) scan and now in small proportion with MRI. The objective of the study was to evaluate the reliability of CT scan in assessing the extensions of the sinonasal mass lesions and their impact on tumor staging. Materials and Methods : All cases of sinonasal lesions were reviewed retrospectively from June 2001 to May 2006 (five years) at KMIO, Bangalore. Only those cases that had CT scan reports and Histopatholgy Examination (HPE) reports were included in the study. All the cases, which were subjected to radiotherapy prior to surgery, were excluded from the study. There were a total of 38 cases with slight male preponderance. Tumor staging was done according to the sixth edition of TNM classification of malignant tumors. Two observers evaluated all the cases (Blinded Study) and sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy were estimated. Results : The relation between the CT scan findings and HPE reports was high. Though false positivity was noted more in the ethmoid sinuses, significant impact on tumor staging was noted with false positivity of the nasopharynx. Also, false positivity was noted with orbital wall/content extensions, resulting in unnecessary exenterations of the orbit. However, CT scan reliably predicted infratemporal fossa extension in the absence of trismus. False negativity was noted more often in soft palate, indicating the need of using MRI for delineation of tumor extension. Thus, we conclude that judicious use of CT scan in all cases and MRI in selected cases will translate into better tumor-free resections and improves survival.