Recurrence rate of odontogenic myxoma after different treatments: a systematic review.

Our aim was to establish the recurrence rate of odontogenic myxoma after different treatments. Our search covered papers from 1972-2017 from different sources. The papers were evaluated and critically appraised by two independent investigators. The recurrence rate and 95% CI were calculated in relation to each specific treatment, and the chi squared test was calculated to find out if there was any significant difference in the recurrence rate between conservative treatment and resection. The overall recurrence rate was 5 of 39 patients (13%) during a mean follow up period of 10 years. With conservative treatment the recurrence rate was 4/22 (19%) (mean follow up 11 years) and after resection it was 1/17 (6%) (mean follow up nine years). Maxillary lesions were more likely to recur than mandibular ones. Quality of life variables such as disfigurement and neural deficit were more common after resection than with conservative treatment. The frequency of recurrence was relatively low over 10 years' follow up, irrespective of whether resection or a more conservative approach was used, despite being slightly lower (as might be expected) after resection. Conservative treatment should be considered first to avoid resection-associated morbidity and the effect on the quality of life. Maxillary lesions have more room to spread before they are clinically evident, making them difficult to treat optimally and contributing to the recurrence rate.

The occurrence and pattern of ameloblastoma in children and adolescents: an Indian institutional study of 41 years and review of the literature.

Ameloblastoma in the paediatric age group is considered a rarity and it accounts for approximately 10-15% of all reported cases. This study assessed the clinical, radiological, and histopathological features of 39 cases of ameloblastoma in Indian children aged less than 18 years, seen over a 41-year period (1971-2011) in the Department of Oral Pathology, Nair Hospital Dental College, India. Out of 256 diagnosed cases of ameloblastoma, 39 (15.2%) occurred in patients ranging in age from 4.5 to 18 years (mean age 13.6 years; male-to-female ratio 2:1). All of the tumours were intraosseous, with a marked predilection for the mandible (97.4%), the body-angle-ramus being the most commonly involved site. Radiographically, 23 cases presented as unilocular radiolucency. Histologically, 20 cases presented as solid and 19 as unicystic ameloblastoma. The interesting finding of 10 solid ameloblastoma presenting as unilocular radiolucency and five cases of unicystic ameloblastoma manifesting as multilocular radiolucency suggests that solid ameloblastomas should be included in the differential diagnosis of unilocular radiolucency of the jaw in the paediatric age group.

Management-related outcomes and radiographic findings of idiopathic condylar resorption: a systematic review.

Idiopathic condylar resorption (ICR) is progressive resorption of the condyle of unknown aetiology. There is no consensus on the approaches for diagnostic imaging and management of this disease. The objective of this systematic review was to examine the best practices for imaging and to appraise the success of surgical and non-surgical therapy of ICR. Eleven search engines were queried via explicit literature searches for studies describing ICR, published until 2012. Two authors independently extracted data using predetermined characteristics. Studies that identified patients as having either ICR or progressive condylar resorption and that described the radiographic findings or treatment options were included. Seventeen studies contributing 178 cases met the eligibility criteria. The major radiographic findings, as assessed mostly by two-dimensional imaging, included decreased ramus height, decreased condylar height, altered volume of the condyle, decreased SNB angle and mandibular plane angle, and a retrognathic profile. Treatments included occlusal splints with orthodontic treatment, condylectomy with costochondral graft, and other surgical approaches. This systematic review was limited by the lack of meta-analysis. Nevertheless, we identified the need for future investigations: characterization of findings on three-dimensional imaging and its contribution to treatment planning, outcomes of non-surgical and pharmacological management of ICR, and randomized trials and comparative studies with longer follow-up periods.

Should cavitation in proximal surfaces be reported in cone beam computed tomography examination?

AIM: A clinical study was done to assess the clinical diagnostic accuracy of cone beam computed tomography (CBCT) in detecting proximal cavitated carious lesions in order to determine whether cavitation should be reported when a CBCT examination is available. MATERIALS AND METHODS: 79 adjacent proximal surfaces without restorations in permanent teeth were examined. Patients suspected to have carious lesions after a visual clinical and a bitewing examination participated in a CBCT examination (Kodak 9000 3D, 5 × 3.7 cm field of view, voxel size 0.07 mm). Ethical approval and informed consent were obtained according to the Helsinki Declaration. Radiographic assessment recording lesions with or without cavitation was performed by two observers in bitewings and CBCT sections. Orthodontic separators were placed interdentally between two lesion-suspected surfaces. The separator was removed after 3 days and the surfaces recorded as cavitated (yes/no), i.e. validated clinically. Differences between the two radiographic modalities (sensitivity, specificity and overall accuracy) were estimated by analyzing the binary data in a generalized linear model. RESULTS: For both observers, sensitivity was significantly higher for CBCT than for bitewings (average difference 33%, p < 0.001) while specificity was not significantly different between the methods (p = 0.19). The overall accuracy was also significantly higher for CBCT (p < 0.001). CONCLUSION: CBCT was more accurate in detecting cavitation in proximal surfaces than bitewing radiographs; therefore a CBCT examination performed for other clinical applications should also be assessed for proximal surface cavities in teeth without restorations, and when detected, this pathology must be part of the dentist's report.

Trace elements (copper, zinc, selenium and molybdenum) as markers in oral sub mucous fibrosis and oral squamous cell carcinoma.

Oral cancer is a major cause of cancer morbidity and mortality worldwide and is prevalent in most areas where tobacco related practices are observed. Essential elements play a role in many biochemical reactions as a micro-source and there is growing evidence that their concentrations are altered on the onset and progress of malignant disease. In this study the levels of copper (Cu), zinc (Zn), selenium (Se) and molybdenum (Mo) in serum of patients with oral sub mucous fibrosis (OSMF) (n = 30) and oral squamous cell carcinoma (OSCC) (n = 30); were determined and the alterations of these critical parameters were analyzed in comparison with controls (n = 30) to identify predictors amongst these parameters for disease occurrence and progression. The serum Cu and Zn were established using Flame Atomic Absorption Spectrometry. Serum estimation of Se and Mo was done by graphite furnace atomic absorption spectrometry (GFAAS). Data analysis revealed a marked, progressive and significant increase in Cu levels in precancer (OSMF) and cancer (OSCC) groups as compared to the normal group. The level of Zn in serum was slightly elevated in OSMF and OSCC though not statistically significant. Cu/Zn ratio was slightly but not significantly elevated. Serum levels of Se and Mo were significantly decreased in the precancer and cancer groups as compared to the normals.

Risperidone-induced rabbit syndrome: an unusual movement disorder.

Rabbit syndrome is an antipsychotic-induced rhythmic motion of the mouth and lips, resembling the chewing motion of a rabbit. The motion consists of vertical movement; the tongue is not involved. The reported prevalence of rabbit syndrome ranges from 2.3% to 4.4% of patients treated with typical antipsychotic drugs. There have been isolated reports of rabbit syndrome in patients treated with atypical antipsychotics. Rabbit syndrome needs to be closely differentiated from tardive dyskinesia, the tongue-involving movement disorder. Treatment of rabbit syndrome is empirical, reflecting poor understanding of this syndrome. The striking aspect of this syndrome is its specificity. The etiology of rabbit syndrome focuses attention on the basal ganglia, which is also implicated in oral dyskinesia. Continuing neuro-physiological research of the basal ganglia probably holds the key to better understanding of this syndrome. The aim of this article is to create awareness of rabbit syndrome and its implications in clinical dentistry.

Utility of thyroid collars in cephalometric radiography.

OBJECTIVE: A study was carried out to investigate the rationale that use of a thyroid collar (TC) in cephalometric radiography hampers the diagnostic and descriptive quality of lateral cephalogram. METHODS: A randomized observer blinded study was designed. The study consisted of two groups. The first group data were retrieved from the oral radiology archival system having lateral cephalogram without a TC. The second group was selected from the oral radiology department of patients where lateral cephalogram was taken using a TC. Lateral cephalogram was taken on direct digital system, the Kodak 9000 unit (Eastman Kodak, Rochester, NY). 2 observers blinded about the aim of the study were appointed to identify 15 sets of landmarks on the lateral cephalogram. Interobserver variance was also analysed for the study. RESULTS: 50 lateral cephalograms in each group were studied. Out of 15 sets of landmarks, 12 were identified consistent with the TC group. Three landmarks, namely the hyoid bone, second cervical vertebra and third cervical vertebra could not be identified on the TC group. There was no significant difference in the interobserver markings on lateral cephalogram. CONCLUSIONS: TCs do mask a few landmarks on the lateral cephalogram. These landmarks are mainly used for analysis of skeletal maturity index (SMI). Lead TCs are probably the most convenient and easily available means to protect the thyroid from unwanted radiation while taking lateral cephalogram. It is therefore encouraged to use a TC during routine cephalometric radiography where SMI information is not needed.

Plunging ranula: a case report.

Plunging ranulas, also known as deep, diving, cervical or deep plunging ranula, usually appear in conjunction with oral ranula. Rarely, these ranulas may arise independent of oral swelling. A rare case of plunging ranula without oral swelling is discussed along with review of literature.

Oral tuberculosis: unusual radiographic findings.

Oral tuberculosis and its radiographic findings are not commonly encountered in an oral and maxillofacial radiology practice. Literature has occasional mention of the radiographic findings of oral tuberculosis, which are still ambiguous. When affected, it is manifested majorly in the oral mucosa and rarely in the jaw bones. Here, we report certain unusual radiographic findings of oral tuberculosis which have been rarely mentioned in the literature. Four illustrative cases describe bony resorption, condylar resorption, resorption of the inferior border of the mandible and rarefaction of the alveolar bone as radiographic findings of oral tuberculosis. Follow up of the first case demonstrated regeneration of the condylar head after anti-Kochs therapy was completed, a hitherto unreported phenomenon. The importance of including tuberculosis in the differential diagnosis of some of the unusual radiographic manifestations is emphasized.

Early victims of X-rays: a tribute and current perception.

X-rays were discovered in 1895 and since then much has been written about Wilhelm Roentgen and the events surrounding the discovery. However, there have been only scattered references in the literature about the early workers who dedicated their life, and death, to X-rays. Radiology has come of age since then. Large exposure times have been reduced to milliseconds and there has been a change from analogue to digital. The advent of new and rapidly developing modalities and the ubiquitous presence of cone beam CT (CBCT) highlight the need to remember the early victims of X-rays, especially with the lack of universal guidelines for taking a CBCT scan. The aim of this article is to alert the oral radiologist to exposing patients irrespective of need, and to pay respect to the victims on the 116(th) anniversary of the discovery of X-rays.

The role of maxillofacial radiologists in gunshot injuries: a hypothesized missile trajectory in two case reports.

Gunshot injuries are an emerging form of trauma that oral radiologists increasingly have to deal with. There are two main types of gunshot injuries: high-velocity and low-velocity bullet injuries. The outcome of high-velocity gunshot injury is usually fatal; however, a non-fatal low-velocity injury to the maxillofacial region is more likely to be encountered by the oral and maxillofacial radiologist. It is therefore important to up-to-date knowledge of ballistic science and its implications in the field of maxillofacial radiology. The ability of oral and maxillofacial radiologists to predict the missile trajectory will aid the assessment and localization of the damage caused by the bullet and its splinters. Predicting the missile trajectory may also be of help to law enforcement agencies and forensic scientists in determining the type of firearm used and direction of fire. This article, which examines two cases, attempts to highlight to the oral radiologist this emerging form of trauma and its implications.

Decision support systems in dental decision making: an introduction.

In last decade, Dentistry has evolved tremendously, from manually operated micro-motor to the computer assisted technology has made great in roads into this specialty. Expert systems are knowledge-based computer programs designed to provide assistance in diagnosis and treatment planning. They assist the practitioner in decision making. Clinical decision support systems can be helpful in improving both clinical outcomes and adherence to evidence-based guidelines. This is one such article which reviews and gives an insight into types of system exists, how these system works and its uses related to Dentistry.

Circulating Immune complexes (CIC) as marker for disease progress in oral cancer.

Oral Cancer is one of the five leading sites of cancer in Indian population. The circulating immune complexes were investigated in 100 serum samples of 60 oral cancer patients having different grades of the disease and 40 patients with precancerous lesions obtained from Nair Hospital Dental collage, Mumbai. The results obtained were compared with those of group of 40 healthy blood donors. Elevated levels of Circulating Immune Complexes were observed in oral cancer patients and patients with oral precancerous lesions. 92% positive samples were observed in well differentiated squamous cell carcinoma whereas 100% positive samples were observed in both moderately and poorly differentiated squamous cell carcinoma. Oral leukoplakia and oral submucous fibrosis showed 15% and 90% positivity respectively. Increased level of Circulating Immune complexes in high grade tumor suggest that Circulating Immune complexes is likely to contribute in evaluating the degree of malignancy, but follow up study is needed to draw any conclusion regarding it's prognostic role.

Increased survivin expression in high-grade oral squamous cell carcinoma: a study in Indian tobacco chewers.

BACKGROUND: Oral cancer is one of the five leading sites of cancer in the Indian population. In the present study we analyzed the expression of apoptosis regulating genes, viz. survivin, Bcl-2, Bax and p53 in precancerous and cancerous lesions of the buccal mucosa of Indian tobacco chewers. METHOD: Paraffin-embedded tissue samples from 38 patients with primary oral squamous cell carcinoma (OSCC) and 17 patients with leukoplakia were used. The expression of survivin, Bcl-2, Bax, and p53 was evaluated using immunohistochemical staining method. RESULTS: Thirty-six percent OSCC were found to be positive for nuclear p53 staining while none of the precancerous lesions showed p53 positivity. Survivin, Bcl-2 and Bax expression was found to increase with increased grade of malignancy. Increase in survivin expression was statistically most significant (P < 0.001). CONCLUSION: Increased expression of anti-apoptotic survivin in high-grade tumors suggests that survivin is likely to contribute significantly to apoptosis resistance in response to therapy.

The intriguing shadow.

In the field of radiodiagnosis shadows often raise doubts. On these depend the invasive investigative procedures which lead to the final diagnosis. The radiologist's word is often considered as the last word in labeling a lesion. The treatment protocol which follows makes a world of a difference to the patient. We report interesting cases where the patients were radiographed prior to orthodontic treatment and coincidentally we found-un believable hidden treasure! This is a modest attempt to emphasize that each shadow in a radiograph should be scrutinized. Needless to say, the keen observation and experience of the diagnostician is of penultimate importance in deciphering the abnormal from the normal.

Use of cephalometry in diagnosing resonance disorders.

A comparative cephalometric study of the oronasopharyngeal dimensions was carried out on 20 patients with normal speech, 20 patients with nasality and 22 patients with cleft palate speech, with the help of cephalometric landmarks given by Proffit and McGlove, Proffit et al., and Ricketts. The data obtained were subjected to statistical analysis, to determine whether there were any significant changes in oronasopharyngeal dimension between the various groups. It was concluded from the obtained data that there was an increase in the width and depth of the nasopharynx, with a consequential increase in the pharyngeal cavity volume in patients with cleft palate speech when compared with patients who had normal speech and those who had nasality.