Diagnostic efficacy of color Doppler ultrasound in evaluation of cervical lymphadenopathy.

BACKGROUND: To evaluate the efficacy of color Doppler ultrasound (CDUS) in differentiating benign and malignant cervical lymph nodes by detecting differences in blood flow patterns. MATERIALS AND METHODS: In this cross-sectional prospective study, 25 untreated patients with clinical evidence of cervical lymphadenopathy were evaluated. CDUS was performed for 80 cervical lymph nodes. The gray scale parameters of the lymph node and intranodal perfusion sites were the key CDUS features used to differentiate between reactive and metastatic lymph nodes. Histopathological confirmations were obtained and compared with the results of CDUS. RESULTS: Initially, 53 cervical lymph nodes were evaluated by clinical examination. Twenty-seven additional lymph nodes (53 + 27 = 80) were discovered by CDUS evaluation. Gray scale parameters for lymph nodes such as size of lymph node, shape of lymph node, and presence or absence of hilum revealed highly significant results (P < 0.0001). Color Doppler flow signals revealed that central/hilar flow was characteristic for benign nodes whereas peripheral/mixed flow was characteristic for malignant nodes, the findings were highly significant (P < 0.0001). Gray scale and color Doppler features are used to differentiate benign and malignant nodes. CONCLUSION: Within the limitations of this study, CDUS evaluation was found to be highly significant with a high sensitivity and specificity over clinical evaluation CDUS examination provides a prospect to reduce the need for biopsy/fine needle aspiration cytology in reactive nodes.

Computed tomography based forensic gender determination by measuring the size and volume of the maxillary sinuses.

PURPOSE: Identification of human body or remains after death is a forensic procedure, which is difficult to perform and is mandatory by law and in compliance with social norms. Sexing the recovered human remains is an integral part of the identification process. Maxillary sinus can be used for gender determination as it remains intact even when the skull and other bones may be badly damaged in casualties where the body is incinerated. Computed tomography (CT) provides an excellent method for examining maxillary sinuses. MATERIALS AND METHODS: CT images were used to measure the mediolateral, superoinferior, and anteroposterior dimensions and the volume of the maxillary sinuses in 30 patients (15 males and 15 females) to investigate whether these parameters could be used to determine the gender of an individual for forensic identification. The t-test for independent samples was used to compare these values in males and females and the data were subjected to discriminative analysis using SPSS software. RESULTS: Our method was able to predict the gender with an accuracy of 80.0% in males and 86.7% in females, with an overall accuracy rate of 83.3%. CONCLUSION: The accuracy rate in this study was comparable, if not higher than many other methods that have been used to predict the gender of an individual from skeletal remains. The length, width, height, and volume of the maxillary sinuses together with other bones could be used for gender determination with a fair degree of accuracy when the whole skeleton is not available.

Management of myofascial pain by therapeutic ultrasound and transcutaneous electrical nerve stimulation: A comparative study.

OBJECTIVE: The present comparative study was aimed to determine the effectiveness of Th US and TENS in the management of myofascial pain in TMD patients. MATERIALS AND METHODS: The present randomized comparative study was on 90 patients who were further assigned in three different groups each having 30 patients; Group I was healthy control patients, Group II was receiving Th US therapy, and Group III was receiving TENS therapy. All the 90 patients were further evaluated for maximum inter incisor subjective evaluation regarding muscle pain, impediment to daily life, massage impression on visual analog scale (VAS) scale, and intensity and duration used in Th US massage. RESULTS: The masseter muscle thickness in control group was 12.00 (standard deviation [SD] ±1.1) mm when compared with TMD patient of 13.00 (SD ± 1.1) mm before treatment. Statistical significant findings on VAS score of muscle pain, impediment to daily life, and massage impression were observed in Th US. After treatment, the anechoic areas disappeared or were reduced in Th US group by 95.6% and in TENS by 74.4%. CONCLUSION: Th US appeared to be subjectively better which was related to VAS score of massage impression, muscle pain, and impediment to daily life after treatment as well as sonographically related to existence of anechoic areas.

Computed Tomography in Diagnosis of Admantinoma.

CONTEXT: Admantinoma is second most common benign odontogenic tumor which clinically appears as an aggressive odontogenic tumor, often asymptomatic and slow growing, associated with symptoms such as swelling, dental malocclusion, pain, and paresthesia of the affected area. The radiographic appearance may vary from unilocular to multilocular radiolucencies, imparting a characteristic honey comb, soap bubble appearance or may resemble a caricature of spider. CASE REPORT: This report highlights the importance of conventional and advanced imaging in the diagnosis of large and invasive lesions. Patient reported with complaint of swelling in jaw, which progressively increased; and was found to be bony hard, both intra- and extraorally. Radiographs revealed large multilocular radiolucency on left body and ramus of mandible with soap bubble pattern and knife edged root resorption. Computed tomographic examination evaluated the extent of the lesion, internal structure, and relation to adjacent structures; further a reconstructed image was obtained to evaluate extent of destruction in three dimensions. CONCLUSION: Computed tomography has an important role in the diagnosis and treatment planning is imperative as it is superior in revealing the cortical destruction and extension into the neighboring soft tissues than conventional radiography.

Dentinogenic ghost cell tumor - a neoplastic variety of calcifying odontogenic cyst: case presentation and review.

CONTEXT: The calcifying odontogenic cyst (COC), also referred to as calcifying ghost cell odontogenic cyst (CGCOC) is a heterogeneous lesion existing either as cystic or solid variant. Due to the fact that all CGCOC lesions are not cystic, and the biological behavior is often not consistent with a cyst, there has always been a controversy as to whether COC is a cyst or a tumor. The dentinogenic ghost-cell tumor (DGCT), a solid variant of the COC, is an uncommon odontogenic neoplasm occurring predominantly in later life. Case report is followed by a concise review and disambiguation of controversial terminologies regarding nomenclature of COC. CASE REPORT: We report a case of 33-year-old female patient who presented with an insidious, steadily increasing swelling on the left side of her face since 8 months. Patient reported slight difficulty in eating because of reduced intraoral space and an obvious concern with facial disfigurement. There was no contributory dental or medical history. Intraorally, a hard, well defined, bicortical swelling was noted in left maxillary region with slight mobility of the associated teeth and normal appearing overlying mucosa. A provisional diagnosis of adenomatoid odontogenic tumor was made, and orthopantomogram, paranasal sinus radiograph and computed tomograpy scan of the face were acquired. A radiographic diagnosis of COC was made, which was subsequently confirmed on histopathology postenucleation of the tumor mass. COC has been seen to be of extensive diversity in its clinical and histopathological features as well as in its biological behavior. CONCLUSION: The present case of 33-year-old female was diagnosed as DGCT, a tumorous form of COC, due to its characteristic histological features; numerous ghost cells and dentinoid material.

Eagle's syndrome veiling as pain of odontogenic origin: Report of two cases with cone beam computed tomography illustration.

Eagle's syndrome, also known as an elongated styloid process, is a condition that may be the source of craniofacial and cervical pain. It is infrequently reported but is probably more common than generally considered. The symptoms related to Eagle's syndrome can be confused with those attributed to a wide variety of facial neuralgia and or oral, dental, and temporomandibular joint diseases. In this paper, there are two cases, which reported to the Department of Oral Medicine, Diagnosis, and Maxillofacial Radiology, with a chief complaint of radiating pain in the preauricular region of the face. After radiographic investigation, these cases are considered as a case of Eagle's syndrome because of increase in the size of the styloid process.

Unilateral segmental odontomaxillary dysplasia: a rare entity of 3 cases and review.

Segmental odontomaxillary dysplasia (SOD) is an uncommon, nonhereditary, rare developmental disorder primarily involving the posterior part of the maxilla and related dental components. It is a rare condition of uncertain etiology that results in painless unilateral expansion of the posterior dentoalveolar complex, gingival hyperplasia, lack of one or both premolars in the affected area, delayed eruption of adjacent teeth and malformations of the primary molars. Radiographically, the affected bone is thickened and irregular in outline, with a coarse trabecular pattern that is vertically oriented resulting in a relatively radioopaque granular appearance. The treatment is focused on extraction of the involved teeth, while in some milder cases the teeth may be retained for a long period. The treatment plan should be based on the degree of involvement as well as the functional and esthetic needs in each case. Considering the rarity of the condition, we report three cases of SOD with variable presentations in a 45-year-old, 24-year-old and 23-year-old individual.

Estimation and comparison of levels of salivary nitric oxide in patients with oral lichen planus and controls.

BACKGROUND: Normal salivary function is considered to be critical for the maintenance of healthy oral mucosa. Oral fluids provide an easily available, non-invasive medium for the diagnosis of wide range of diseases and clinical situations. The objective of this study was to estimate and compare salivary nitric oxide levels in patients with oral lichen planus and healthy individuals. METHODS: Saliva was collected by spitting method. Unstimulated whole saliva thus collected was refrigerated at 4°C, and processed within 24 h for the estimation of nitric oxide levels which was done using Griess reaction. The results were analyzed using Student's "t" test. RESULTS: There was statistically significant difference in the levels of salivary nitric oxide between the study and control groups. CONCLUSIONS: The present study clearly indicates a significant increase in salivary nitric oxide levels in oral lichen planus patients as compared to controls.

Assessment of anxiety and depression in patients with burning mouth syndrome: A clinical trial.

INTRODUCTION: Burning mouth syndrome is a chronic pain syndrome primarily affecting elderly women with hormonal changes or psychological disorders. It is multifactorial in origin, often idiopathic and its etiopathogenesis, majorly being neuropathic, largely remains enigmatic. AIM: To determine the prevalence of burning mouth symptom, in elderly women and evaluate local and systemic causes responsible for burning sensation. MATERIALS AND METHODS: 100 elderly postmenopausal women were included in the study out of which 56 had a chief complaint of burning sensation. These patients were evaluated for the levels of anxiety and depression by means of questionnaire. The severity of burning and the response to the treatment was assessed with a five point Visual Analog Scale. The results were analyzed using "Chi-square test". RESULTS: There was statistically significant increase in the levels of anxiety and depression in the study group. CONCLUSION: The present study clearly indicates that most of the patients had moderate to severe levels of depression, which suggests that anxiety and depression are constant features in postmenopausal female patients.

Prospective utility of therapeutic ultrasound in dentistry-Review with recent comprehensive update.

BACKGROUND: The utility of ultrasound (US) for therapeutic purposes is still in its infancy. Therapeutic US (TUS) has been used widely in medical field for urological application, surgical intervention, bone healing, and osteointegration in cancer and healing of full thickness excised skin lesions, and within dentistry as a prediagnostic, diagnostic and therapeutic purpose. The purpose of the paper is to review and determine the efficacy of US as one of the treatment modalities for its role in maxillofacial region to reduce pain and promote soft tissue healing. MATERIALS AND METHODS: A Medline search included of the international literature published between 1976 and 2011 and was restricted to English language articles, published work of past researchers including in vitro and in vivo studies, recent additions of textbooks on surgical and therapeutic applications of US and, current articles in conference papers and reports accessed from the internet using Google search engine on therapeutic ultrasound. RESULTS: Very few article regarding effect of therapeutic of US for its use of insonation for treatment of patient with pain and soft tissue injury are available. This review article mainly emphasizes the therapeutic utility of US in dentistry for its effectiveness to decrease joint stiffness, reduce pain and muscle spasms and improve muscle mobility. In vivo studies have shown very little clinical effects. CONCLUSIONS: Further research is warranted in this clinically important area to make the development of noninvasive, multifunctional ultrasound devices for repair, regeneration and other therapeutic utility a success.

Gardner's Syndrome.

Gardner's syndrome is an autosomal dominant disease and is a subtype of familial adenomatous polyposis. It is characterized by adenomatous intestinal polyps, multiple osteomas in the skull, maxillae, mandible, and multiple cutaneous and subcutaneous masses (epidermoids and desmoid). Intestinal polyps, if not treated, have 100% chance of becoming malignant. We report a case of a 25-year-old female patient with Gardner's syndrome, with clinical manifestations including impacted supernumerary teeth, odontomes, sebaceous cyst on the scalp, and osteomas. It is important for the general dental practitioners to be aware of the clinical and radiological characteristics of Gardner's syndrome.