Early Stage Oral Submucous Fibrosis is Characterized by Increased Vascularity as Opposed to Advanced Stages.

INTRODUCTION: The degree of vascularity of the diseased mucosa in Oral Submucous Fibrosis (OSMF) has always been a matter of debate with conflicting results. Knowledge of this aspect is important to understand pathogenesis of OSMF, which in future could be translated into therapeutic strategies. AIM: In the present study, attempt has been made to investigate parameters like Mean Vascular Density (MVD), Total Vascular Area (TVA) and Mean Vascular Area (MVA) using CD34 antibody. MATERIALS AND METHODS: Forty five previously untreated histopathologically diagnosed cases of OSMF were retrieved from archives and fifteen age and sex matched healthy volunteers without habits were included in the control group. Sections were immunohistochemically stained for CD 34 and morphometric analysis was performed. For statistical analysis ANOVA, Kruskal Wallis test and Mann Whitney U tests were used and p-values <0.05 were considered statistically significant. RESULTS: MVD was more in Stage I OSMF followed by Control, Stage II and Stage III with statistically significant differences (p< 0.001). Statistically significant differences were observed in the MVD between control versus Stage III OSMF. Similarly, TVA was statistically significant when compared between control versus OSMF, control versus Stage II OSMF, control versus Stage III OSMF, Stage I versus Stage II OSMF, Stage I versus Stage III OSMF, and Stage II versus Stage III OSMF. For MVA, significant differences were between control versus OSMF, control versus Stage II OSMF, control versus Stage III OSMF, Stage I versus Stage III OSMF and Stage II versus Stage III OSMF. CONCLUSION: Angiogenesis is seen in early stages of OSMF with decreasing trend in advanced stages. Decreased vascular areas seen in advanced stages could be attributed to the increasing fibrosis surrounding the blood vessels.

Papillary cystadenocarcinoma of the hard palate.

Papillary cystadenocarcinoma (PCC) is an uncommon malignant tumour of the salivary gland, sometimes involving the minor salivary gland. Previously this entity was classified as an atypical type of adenocarcinoma, malignant papillary cystadenoma, low-grade papillary adenocarcinoma or mucus producing adenopapillary carcinoma. PCC is a glandular tumour with an indolent biological behaviour characterised by cysts and papillary endophytic projections. We report two cases of PCC involving the minor salivary gland of the hard palate. Both the patients presented with a swelling in the palate with difficulty in chewing. MRI revealed an extensively destructive lesion involving hard palate, alveolar ridge and maxillary antrum. Clinical and radiological features suggested the malignant nature of the lesion. Histopathology of incisional biopsy revealed tumour proliferation in a multicystic pattern, with extensive papillary proliferation. Diverse and cellular cytomorphology, and cellular and nuclear pleomorphism with few mitotic figures were the prominent features. Both the lesions were confirmed as PCC.

Oral cysticercosis: a clinical dilemma.

Cysticercosis is a potentially fatal parasitic disease caused by cysticercus cellulosae, the larval stage of Taenia solium. Oral cysticercosis is a rare entity and represents difficulty in clinical diagnosis. This article reports two cases of oral cysticercosis involving buccal and labial mucosa. Both the cases presented with solitary, nodular swelling that had been clinically diagnosed as a mucocele. Histopathology of excisional biopsy revealed it to be cysticercosis. Single, cystic nodular swelling of oral cavity may be the only evidence of cysticercosis and may present first to dentist. These cases emphasise the role of dentist and thorough histopathological examination in the early diagnosis of disease that can prevent potential systemic complication.

Multiple non-syndromic odontogenic keratocysts in three siblings.

Occurrence of multiple cysts (MC) involving the jaw is rare. When multiple, it is usually associated with a syndrome. Occurrence of MC without syndromic association is extremely rare. Multiple odontogenic cysts mostly could be odontogenic keratocysts or dentigerous cysts. Odontogenic keratocyst shows involvement of mandible over maxilla, with peak incidence in second and third decade and it is exceedingly rare before 10 years of age. However multiple odontogenic keratocysts found in children are often reflective of nevoid basal cell carcinoma syndrome. Here is a case report which documents multiple jaw cysts involving both the jaws, in three siblings of ages 10, 13 and 17 years with negative parental history. All three reported cases were free of any systemic involvement. As odontogenic keratocyst spreads through bone marrow, destruction is more before any clinical manifestation. Therefore, early detection and intervention are essential in preventing extensive destruction.

Oral squamous cell carcinoma associated with myiasis.

Myiasis is a general term for infection by fly larvae feeding on the host's necrotic or living tissue. Although infestation by fly larvae is much more prevalent in animals, it is a relatively frequent in occurrence. Oral myiasis is a rare pathology in humans and is associated with poor oral hygiene. Larvae cause itching and irritation due to their crawling movements and can destroy vital tissues, inducing serious or even life-threatening haemorrhage. The treatment is a mechanical removal of the maggots one by one; however, a systemic treatment with macrolide antibiotics, have been recently used for treatment. We present a case report of a 70-year-old man indigent, alcohol-dependent with an extensive necrotic wound in mandible and fetid odour. The prevention of human myiasis is by education, but unfortunately in the developing countries some people live in low social condition, predisposing the occurrence of the infestation.

Correlation of salivary and serum IgG, IgA levels with total protein in oral submucous fibrosis.

Oral submucous fibrosis (OSMF) is a disabling, potentially malignant condition of the oral cavity. The aetiology of OSMF is multifactorial but remains obscure. Although arecanut is considered to be the most important causative agent, responses observed in individuals using arecanut vary in relation to quantity and duration. It is considered that an immunological process is responsible for the pathogenesis of disease. We correlated salivary immunoglobulin A (IgA), salivary immunoglobulin G (IgG) and serum immunoglobulin A (IgA), serum immunoglobulin G (IgG), levels by turbidometric immunoassay. We estimated the levels of total serum protein (TSP) and haemoglobin (Hb) to determine the role of nutritional deficiency. The study population comprised 30 cases of OSMF and 10 controls. Five milliliters of blood and 2 ml of saliva were collected. Quantitative analysis of serum and salivary IgG, IgA was done by turbidometric immunoassay. TSP and Hb were estimated by Biuret and cyanmethaemoglobin methods, respectively. All patients showed significant (P < 0.01) increase in serum and salivary IgG, IgA levels as compared to controls. TSP patients showed significant (P < 0.01) decrease as compared to controls. Results of Hb in patients were not significant. The estimation of immunoglobulin levels is important to support the concept of autoimmune basis. Estimation of TSP and Hb suggests that nutrition has a definite role in OSMF.