Is Site-Specific Assessment of Neck Nodes Relevant for Neck Dissection.

PURPOSE: To highlight the strategy of neck dissection for various subsites of oral squamous cell carcinoma. MATERIALS & METHODOLOGY: Retrospective study of 153 patients with 164 neck dissection was involved between 2010 and 2016. Predictor variables were patient demographics, biopsy reports, imaging assessment and outcome variables were type of neck dissection and reconstruction performed and histological assessment of regional metastasis to the neck in relation to various primary subsites was carried out. RESULTS: Out of 153 patients, 126 (82.3%) were males and 27 (17.6%) were females with male-to-female ratio being 4.6:1. The mean age among the patients was 49.9 which ranged from 20 to 80 years. Lymph node metastasis was found in 22.6% of T1 and T2 tumors and 77.4% of T3 and T4 tumors. Incidence for gingivobuccal sulcus accounted for 49.6% of primary sites, tongue and floor of the mouth for 15.2%, retromolar trigone for 11.7%, lower alveolus for 8.6%, upper alveolus for 5.9%, lower lip for 3.9%, buccal mucosa for 3.3% and hard palate for 2.6%. Histologically metastasis was seen in level Ib (46%), IIa (33.1%) followed by others. Level V involvement was seen only in 5.5%. CONCLUSION: For all subsites for N0 neck, minimum level III clearance should be performed, and for positive neck in RMT region, level IV or level V clearance is warranted. Apart from subsite, other factors to be considered are tumor stage, tumor thickness (DOI) and morphological characteristics of the primary tumor. The role of lymph node metastasis, number, size, extracapsular spread, its proximity and fixity to greater vessels in the neck.

Observing the Eruption of Canine After Secondary Alveolar Bone Grafting.

PURPOSE: Alveolar bone grafting is undertaken to provide stability to the dental arch and facilitate the eruption of permanent canine as teeth in the line of cleft usually have an altered pattern of eruption. The purpose of this study was to assess the eruption status and the change in the position and pattern of canine eruption after secondary alveolar bone grafting. METHODS: An ambispective cohort study was conducted in patients operated for alveolar bone grafting with unilateral/bilateral alveolar cleft between the age of 9 to 13 years using autogenous iliac crest bone graft. The predictor variables of interest include the preoperative eruption status of canine (completely erupted/partially erupted/unerupted), stage of root development (one-third/two-third/more than two-third/complete) and position (vertical/lateral/buccopalatal) of the canine. The primary outcome variable is the eruption status of the canine (completely erupted/partially erupted/unerupted) at 6 months postoperatively. Secondary outcome variables include the stage of root development, change in the vertical, lateral and buccopalatal position of the canine observed in the first 6 months postoperatively with follow-up at 1 and 3 months. Another secondary outcome variable was the status of bone graft at 6 months postoperatively. Statistical analysis was done using Spearman's rank correlation and ANOVA chi-square test. RESULT: The study sample consisted of 30 non-syndromic alveolar cleft patients with a mean age of 11.9 years, out of which partial and complete eruption of canine was seen in 43.33 and 36.67%, respectively. The canine was unerupted in 20% of the cases (P = .001). There was evidence of continued root development through the grafted bone. No significant change in the angulation of canine was observed in the postoperative period. CONCLUSION: Significant change in the eruption status and root development of canine with no statistically significant change in the vertical and lateral angulation during eruption was observed. Identifying these risk factors by continuous postoperative monitoring will help in identifying the malposition at an early stage.

4% Articaine and 2% Lignocaine for Surgical Removal of Third Molar by Mandibular Nerve Block: A Randomized Clinical Trial for Efficacy and Safety.

OBJECTIVE: Articaine entered clinical use in 1976; however, evidence basis for articaine's reputation is not entirely clear. The aim of the study is to compare and analyze 4% articaine with 1:100,000 epinephrine and 2% lignocaine with 1:100,000 epinephrine in patients operated for mandibular third molar impaction with respect to efficacy and safety, time of onset and duration of anesthesia and duration of postoperative analgesia. METHODS: The study was done on fifty patients requiring surgical extraction of mandibular third molar; randomly divided into two groups of 25 each, receiving 4% articaine hydrochloride with 1:100,000 epinephrine and 2% lignocaine hydrochloride with 1:100,000 epinephrine. Difficulty index for extraction, volume, onset and duration of anesthesia and duration of postoperative analgesia were recorded. Pain was assessed using Heft-Parker VAS. The data were analyzed using appropriate statistical analysis. RESULTS: The mean onset time for articaine and lignocaine is 3.16 ± 0.55 and 3.2 ± 0.48 min, respectively. Articaine group experienced statistically significant longer period of analgesia and duration of action 289.04 ± 40 and 361.88 ± 40 min, respectively, as compared to lignocaine which is 144.2 ± 12 and 197.44 ± 25 min, respectively. No statistical difference between the two groups with regard to pain experience. CONCLUSION: 4% Articaine is more potent and has longer duration of action with better postoperative analgesia and could be considered as an alternative to lignocaine in clinical practice. With management of postoperative pain being the critical component of patient care, clinical trials are required to develop long acting local anesthetic with increased postoperative analgesia effect.

Intraoral Superficial Angiomyxoma: A Case Report.

Angiomyxomas are a group of relatively uncommon myxoid mesenchymal tumors associated with a high risk of local recurrence without any metastatic potential. Till date only five cases of intraoral superficial angiomyxoma have been reported. This is a case report of a middle aged Indian male patient diagnosed with superficial angiomyxoma of lower left buccal vestibule.

Myositis ossificans in medial, lateral pterygoid, and contralateral temporalis muscles: a rare case report.

Myositis ossificans is ossification and bone formation within muscle. It is a rare and unusual pathologic entity that has defied most efforts to establish definite etiology, pathogenesis, and satisfactory treatment. Myositis ossificans is mainly of 2 types: myositis ossificans progressiva (MOP) and myositis ossificans traumatica (MOT). Myositis ossificans idiopathic is also reported in the literature. When it affects the muscles of mastication, it causes severe trismus. Computed tomography scans and magnetic resonance imaging can effectively delineate the calcified mass. In this article, we present a case of MOT of the medial, lateral pterygoid, and contralateral temporalis muscles.

Adenocarcinoma of the sublingual salivary gland - A case report.

BACKGROUND: This report and review of literature aimed to assess a case of adenocarcinoma of sublingual salivary gland. METHOD: We present a case of a 52-year-old female with adenocarcinoma of sublingual salivary gland displaying painful swelling in the floor of the mouth, which was affecting her speech and mastication. CONCLUSION: Surgery is the treatment of choice for malignant sublingual gland tumors, but the type of surgical intervention depends on the extent of the primary tumor itself. Even though the tumors of the sublingual salivary gland are rare, they are a diagnostic challenge to every head and neck surgeon.

Oral Teratoma with a Primitive Neuroectodermal Tumor Component: A Case Report.

Teratomas are tumors of germ cell derivation consist of tissues derived from all the three germ cell layers. They comprise the most common extragonadal germ cell tumors (EGCT) in childhood. EGCTs of head and neck region account for only 5% of all benign and malignant germ cell tumors and for 6% of all teratomas. Primitive neuroectodermal tumor (PNET) arising from germ cell tumor is a distinct entity. It develops from the malignant transformation of teratomas along ectodermal lines. This paper presents a rare case of oral teratoma in a 6-year-old male who reported with pain and swelling in the right upper back teeth region of jaw. Under light microscopy, mature and immature structures representatives of trilineage derivatives were appreciated. Sheets of small round cells showing vague rosette and membranous positivity to CD-99 directed us to consider the above diagnosis.