Phenytoin Induced Gingival Enlargement

Certain anticonvulsants, cyclosporine, and calcium channel blockers like amlodipine have been shown to produce clinically and histologically similar gingival enlargements in certain susceptible patients in response to local factors. These drugs appear to be similar with respect to their pharmacologic mechanism of action at the cellular level. Therefore, it is tempting to speculate that these agents may act similarly on gingival connective tissue and cause a hyperplastic response. This tissue reaction may involve a disturbance of calcium ion influx into specific cell populations with a resulting alteration in collagen metabolism and other host cell response mechanisms. A connection between ion exchange, folate uptake, collagenase activation, and bacterial inflammation may exist. The management involves Phase I therapy followed by surgical intervention. The purpose of these case reports is to highlight certain modifications in existing surgical techniques like gingivectomy, to have better aesthetic and functional outcome.

Carniofacial Microsomia

Cranoifacial microsomia is an unique clinical presentation of '1st and 2nd arch syndrome' with asymmetrical craniofacial development alongwith conductive hearing loss. A series of 11 patients (4 males, 7 females) is presented which include two patients of 'Goldenhar's variant' with epibulbar dermoids. Two patients had no response on pure tone audiometry (blank audiograms) and underwent CT scan of temporal bone which revealed 'Michel's aplasia' (complete labyrinthine agenesis), rarely reported in the literature.