COVID-19-associated mucormycosis of head-and-neck region: A systematic review.

BACKGROUND AND AIM: With the second wave of COVID-19, there has been a substantial rise in opportunistic infections like mucormycosis. Mucormycosis is a fatal fungal infection and understanding the associated risk factors and their management plays a key role to reduce mortality and morbidity caused due to such infections. This systematic review was conducted to assess the risk factors, clinical characteristics and to understand the pathogenesis of COVID-19-associated mucormycosis (CAM) affecting the head-and-neck region. METHODS: The PubMed database was searched with the keywords; ((Mucormycosis) OR (invasive fungal sinusitis)) AND (COVID-19) and the PRISMA chart was prepared for the selection of the reports based on the inclusion and exclusion criteria. RESULTS: A total of 261 cases of CAM affecting the head-and-neck region were analyzed in this systematic review. Most of the patients presented with rhino-orbital/rhino-orbito-cerebral form of mucormycosis (rhino-orbital mucormycosis/rhino-orbital-cerebral mucormycosis). Pulmonary mucormycosis along with rhino-orbital form, involvement of hard palate, and maxillary sinus was seen in one case each. A total of 224 (85.8%) patients were diabetic, 68 (30.3%) of them had poor glycemic control. Steroids were administered in 210 (80.4%) patients. Except for two, antifungal treatment was given to all patients. Follow-up data revealed 67 (25.6%) deaths and 193 (73.9%) were alive with one patient lost during follow-up. CONCLUSION: The findings of this systematic review suggested that the occurrence of mucormycosis in COVID-19 patients is related to the inherent effects of COVID-19 infection on the immune system, comorbidities especially diabetes, and treatment aspects. Hence, a detailed understanding of these factors may aid in the personalized management of CAM and improve the disease outcome. RELEVANCE FOR PATIENTS: The risk factors in patients affected by CAM should be recognized and closely monitored in post-COVID-19 patients. A multidisciplinary team must be in place to reduce the mortality and morbidity in such patients.

Intraoral HIV-associated Burkitt's lymphoma: a rare case report with special emphasis on differential diagnosis.

Individuals with human immunodeficiency virus (HIV) infection present with unique intraoral manifestations of various neoplasms. Intraoral HIV-associated Burkitt's lymphoma is a rare presentation, especially in patients of Indian origin and may present as an initial sign of HIV. The objective of this paper is to report a rare case of Burkitt's lymphoma in an HIV-positive Indian patient along with a special emphasis on differential diagnosis. A 30-year-old Indian female presented with a solitary, well-defined, exophytic mass extending anteroposteriorly and buccolingually from the 35th to 38th regions with no evidence of intraosseous extension. An incisional biopsy was performed, and histopathology showed sheets of neoplastic lymphoid cells with numerous tingible body macrophages with clear cytoplasm, presenting a starry sky appearance, suggesting a diagnosis of BL. The tumor cells were positive for CD10, CD20, c-myc, and Epstein-Barr virus, with a nearly 100% Ki-67 proliferative index. The patient tested positive for HIV. This report indicates the importance of immunohistochemical analysis to differentiate Burkitt's lymphoma from other similar lesions like diffuse large B-cell lymphoma. Thorough knowledge of the clinical presentation, etiopathogenesis, histopathology, and immunoprofile of intraoral HIV-associated Burkitt's lymphoma is essential among clinicians and pathologists.

Orthokeratinized odontogenic cyst with calcification: A rare case report of a distinct entity.

Orthokeratinized odontogenic cyst (OOC) is a relatively rare odontogenic cyst, distinct from odontogenic keratocyst (OKC). In the 4th edition of WHO Classification of Head and Neck Tumors (2017), OOC has been included as a separate entity in the category of developmental odontogenic cysts. It presents as a unilocular radiolucent lesion in the posterior mandible and is frequently related to impacted teeth, thus mimicking dentigerous cyst. Due to low local aggressiveness and no association with nevoid basal cell carcinoma syndrome, it does not show tendency to recur. When compared to OKC, OOC exhibits substantial number of differences with respect to clinical, pathological and behavioral features and treatment modalities. Hence, recognizing OOC as unique lesion is mandatory to avoid unnecessary overtreatment. This paper aims to report a rare case of OOC associated with impacted tooth, showing calcifications and emphasizes its differences from OKC. Furthermore, the recent concepts about OKC and OOC are discussed.

Verruciform xanthoma of the tongue.

Verruciform xanthoma is a benign, soft tissue lesion occurring on the orogenital mucosa. Presentation of oral lesions can be pink, yellow, or gray raised plaque or papule with granular, papillary, or verrucous in nature. There are many theories proposed for the etiopathogenesis of verruciform xanthoma. Clinical observations may be misguiding as the lesion resembles malignant and premalignant lesions. Histopathological confirmation is essential for diagnosis and avoiding radical surgery. Once excised, the lesion does not recur. Here, we present a case report of verruciform xanthoma of the tongue in a 50-year-old female patient.

Systemic Assessment of Patients Undergoing Dental Implant Surgeries: A Trans- and Post-operative Analysis.

BACKGROUND: Procedure-related and patient-related factors influence the prognosis of dental implants to a major extent. Hence, we aimed to evaluate and analyze various systemic factors in patients receiving dental implants. MATERIALS AND METHODS: Fifty-one patients were included in the study, in which a total of 110 dental implants were placed. Complete examination of the subjects was done before and after placement of dental implants. Implant surgery was planned, and osseointegrated dental implants were placed in the subjects. Postoperative evaluation of the dental implant patients was done after 3 weeks. Anxiety levels were determined using State-Trait Anxiety Inventory (STAI) questionnaire on the surgery day and after 1 week of surgery. The participant describes how they feel at the moment by responding to twenty items as follows: (1) absolutely not, (2) slightly, (3) somewhat, or (4) very much. All the results were recorded and statistical analyzed by SPSS software. RESULTS: Out of 51, 29 patients were males while 22 were females, with ratio of 1.32:1. Female patients' mean age was 50.18 years while male patients' mean age was 52.71 years, with statistically nonsignificant difference between them. Functional rehabilitation was the main purpose of choosing dental implants in more than 90% of the subjects. Diameter of 3.75 mm was the shortest implants to be placed in the present study, whereas in terms of length, 8.5 mm was the shortest length of dental implant used in the present study. Tooth area in which maximum implants were placed in our study was 36 tooth region. Maximum implants were placed in Type II bone quality (n = 38). Implants installed in the mandible were clamped more efficiently than implants placed in the maxilla (P < 0.001). The difference of average STAI-State subscore before and after the surgery was statistically significant (P < 0.05; significant). CONCLUSION: Mandibular dental implants show more clamping (torque) than maxillary dental implants.

Clear cell odontogenic carcinoma: A rare case report with emphasis on differential diagnosis.

Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic malignancy with a female predilection, typically presenting as swelling in anterior region of mandible. CCOC was classified as a malignant neoplasm of odontogenic origin by the WHO in 2005 as it exhibits an aggressive growth pattern, local recurrence, and tendency of distant metastasis. Histologically, CCOC is characterized by sheets and islands of vacuolated/clear cells. Since clear cells are present in few odontogenic tumors, salivary gland neoplasms, and metastatic tumors to the jaws; presence of clear cells in a lesion of head and neck area poses a diagnostic challenge. Knowledge about the clinical course, histopathologic pattern, and immunoprofile of CCOC aids in differentiating it from other clear cell tumors. Herein, we present a case of CCOC in anterior mandibular region of 60-year-old female patient with an emphasis on its differential diagnosis from other clear cell lesions of the jaws.

Glucose Levels and Hemodynamic Changes in Patients submitted to Routine Dental Extraction under Local Anesthesia with and without Adrenaline.

INTRODUCTION: In maxillofacial surgery, the simplest procedure that we perform is dental extraction. However, this simple procedure is challenged by the patient's poor medical condition. We generally use local anesthesia in combination with adrenaline; however, as we come across patients with diabetes mellitus and cardiovascular diseases who seek dental extraction, we need to be doubly cautious while using adrenaline. In this study, we intend to compare the effects of local anesthesia with adrenaline and local anesthesia without adrenaline on hemodynamic changes (blood pressure and pulse rate) and random blood sugar levels. The comparison is both within the group and between the two groups. MATERIALS AND METHODS: Healthy patients between the ages 20 and 60 years were included and randomized into two groups of 50 each. In one group, plain local anesthesia was used, whereas in the other group, local anesthetic solution containing adrenaline was used. Medically compromised patients were excluded from the study. Random blood sugar levels, blood pressures, and pulse rates were recorded in both groups before and 10 minutes after injecting the solutions. The findings were compared. RESULTS: When results are compared within the group, a modest increase in the blood sugar level was noted with the group receiving local anesthetic with adrenaline. However, blood pressure and pulse rate showed no significant difference. Similarly, when between-the-groups comparison was done, not a single variable showed any significant difference. CONCLUSION: The patients injected with local anesthesia containing adrenaline showed similar results to that observed in the patients injected with local anesthesia without adrenaline. However, there is a statistically significant rise in blood sugar levels when a local anesthetic is injected with adrenaline. CLINICAL SIGNIFICANCE: Dental extractions in healthy individuals can be safely performed with local anesthetic containing adrenaline. However, in diabetic patients, it should be cautiously used.

Oral hobnail hemangioma: a case report.

Hobnail hemangioma is a benign vascular lesion and intraoral of the lesions are relatively rare. Histopathologically, it shows distinctive biphasic pattern with vascular channels lined by endothelial cells showing characteristic "hobnail" cytomorphology. Since hobnail hemangioma shares similar clinical and histopathologic features with many other benign and malignant vascular tumors, accurate diagnosis is mandatory for proper treatment and prognosis. In the present study, emphasis was given to discuss the differential diagnosis and delineate the hobnail hemangioma from other vascular lesions. Further, immunohistochemical study was performed which showed strong immunopositivity for CD31 and factor VIII in all endothelial cells lining the vascular channels. CD34 was moderately immunopositive and vascular endothelial growth factor was negative.

Oral cancer in India: an epidemiologic and clinical review.

Oral cancer is one of the most fatal health problems faced by the mankind today. In India, because of cultural, ethnic, geographic factors and the popularity of addictive habits, the frequency of oral cancer is high. It ranks number one in terms of incidence among men and third among women. Several factors like tobacco and tobacco related products, alcohol, genetic predisposition and hormonal factors are suspected as possible causative factors. Hence the study was designed to determine the prevalence of Oral Cancer in patients who attended the outpatient department, at Bharati Vidyapeeth Deemed University Dental College Sangli India during a period of 24 months in 2009-2010. Further various modes of tobacco and alcohol consuming habit were assessed along with the site of occurrence of oral cancer. About 35,122 subjects belonging to a semi-urban district of Sangli in Western Maharashtra (India) were screened. Tobacco and alcohol consumption was the common habit among the study population. Out of these about 112 cases showed Oral Cancer. The prevalence of Oral Cancer was 1.12%. Statistical analysis was done using the SPSS software 11. The findings in the present study reveal a high prevalence of Oral Cancer and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. Education about ill effects of tobacco and alcohol consumption is necessary at a broader scale. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals.

Prevalence of oral soft tissue lesions in Sangli, India.

The purpose of this study was to determine the prevalence of oral soft tissue lesions in patients who attended the outpatient department, at Bharati Vidyapeeth Deemed University Dental College during a period of 18 months in 2009-2010. About 24,422 subjects belonging to a semi-urban district of Sangli in Western Maharastra (India) were screened. Out of these about 623 cases showed soft tissue lesions. Statistical analysis was done using the SPSS software. 2.5% of the population studied had one or more oral lesions associated with prosthetic use, trauma and tobacco consumption etc. Six hundred and twenty-three patients were found to have significant mucosal lesions. 75 had leukoplakia, 152 had oral submucous fibrosis, 14 had both both leukoplakia and oral submucous fibrosis, 82 had oral squamous cell carcinoma, 35 had oral lichen planus, 195 had apthous ulcers, 23 had denture stomatitis, 28 had fibroma and 19 cases had pyogenic granuloma. The findings in the present study reveal a high prevalence of oral soft tissue lesions and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals.