Cemento-ossifying fibroma transforming to osteosarcoma.

Ossifying fibroma is a type of fibro-osseous lesion categorised into cemento-ossifying fibroma and juvenile ossifying fibroma. Malignant transformation of fibro-osseous lesions is documented especially for fibrous dysplasia, but scarcity is seen when we search for malignant transformation of ossifying fibroma. Thus, we are presenting an extremely rare case of cemento-ossifying fibroma transforming into osteosarcoma with long sequential radiographic details.

A Novel Classification System for Oral Cavity Mucormycosis: a Hospital Based Cross-Sectional Study.

Background: Rhino-oculo-cerebral Mucormycosis (ROCM) is a well-known complication post-COVID-19 infection. The extension of this disease into the oral cavity is a grey area with no proper protocol for management of the same in the existing literature. Based on our experience in the management of oral extension, this study aims to propose a protocol to treat these cases. Aim: To derive a classification for the surgeon from retrospectively collected data of 53 operated cases of oral Mucormycosis. Settings and Design: Hospital record-based cross-sectional study; evaluation of the previously treated 53 cases of oral extension of post-COVID-19 Rhino-oculo-cerebral Mucormycosis in the duration between May 2021 to August 2021. Follow-up for a period of 1 year. Methods and Material: Based on the preoperative data, 4 parameters were taken -Tooth tenderness, Tooth mobility, Palatal perforation, and Radiological findings. A clinical-radiological classification system was derived based on the intraoperative data from the OT notes and the preoperative findings corresponding to the 4 parameters. Statistical Analysis: The statistical analysis was done using SPSS for windows version 20 software (SPSS Inc., Chicago, IL, USA). Results: Totally 220 cases of ROCM were recorded in our institute. Of this, 53 patients were treated for ROCM extending into the oral cavity. In 27 patients, we were able to achieve primary closure. In 26 patients, there was oro-antral communication after removal of the palate. Based on this data, we derived a protocol that may be used by the treating surgeon to manage oral cavity cases of ROCM, so that aggressive tissue resection may be avoided unnecessarily. Conclusion: This protocol will help the treating surgeon to have a clearer outlook on treating this disease.

Drug-Induced Erythema Multiforme.

Erythema multiforme (EM) is an acute inflammatory, mucocutaneous, psychosomatic, and vesiculobullous condition that varies from minor to major forms. The acral distribution of target lesions is a characteristic of this condition. The aetiology of erythema multiforme is multifactorial. 90% of the cases are triggered by a herpes infection, whereas 10% occur secondary to drug intake. The offending drugs include nonsteroidal anti-inflammatory drugs, antibiotics, and anticonvulsants. The present case series discusses four cases of drug-induced erythema multiforme and their management.

Gorlin-Goltz Syndrome: A Case Series.

Gorlin-Goltz syndrome (GGS) among Indians is rarely reported. Since 1960, only 38 cases having 48 patients of Gorlin-Goltz syndrome have been identified in the Indian population. It is crucial to diagnose this illness early because it can be connected to a malignant lesion like fibrosarcoma, leiomyosarcoma or rhabdomyosarcoma. The four patients in this case series were identified and treated in our department between 2019 and 2023. The average patient age was around 20 years old. Jaw swelling and tooth movement were the two most typical presenting concerns. Odontogenic keratocysts (100%), palmer pits (100%), plantar pits (50%), calcification of falx cerebri (50%), and rib abnormalities (50%), were the most prevalent characteristics. None of the patients had basal cell cancer, cleft lip, or medulloblastoma. Multiple odontogenic keratocysts were present in three cases, whereas a single odontogenic keratocyst (OKC) was seen in one patient. Patients were managed with either marsupialization or enucleation, depending on the size of the cyst. Two cases with a large cyst size were marsupialized by using a modified obturator. Two cases with small cysts were managed with enucleation of the cyst followed by chemical cauterization. Recurrence was seen in two cases. In one patient, we noticed the formation of a new cyst. A GGS diagnosis can be made by having a systemic evaluation of the patient. A thorough examination of the patient should be performed in every histopathology-diagnosed case of OKC. This will help to miss the syndromic cases. The treatment part should be conservative, like marsupialization with an obturator in a large cyst. The obturator helps maintain patient hygiene and prevents regular visits for changing dressings. Small-sized cysts can be managed with enucleation and chemical cauterization. Radical resection should be avoided.

Mandibular Mucormycosis: A Report of Four Cases and a Discussion on Their Management.

Mucormycosis of the mandible (MOM) is a rare fungal infection, and only 23 cases had been reported during the last 50 years worldwide, from seven different countries. Most of the cases were reported in India (n=8, 34%), followed by the United States (n=5, 22%). It is usually associated with an immunocompromised state and generally occurs after tooth extraction. Radiographically, it presents with the characteristic sign of osteomyelitis. Most of the previous case reports/series on MOM described successful outcomes with the resection of the involved segment. However, our experience in managing these cases was quite different and it was observed that resection is seldom required. It was seen that MOM rarely causes cortical perforation. One of the probable reasons is the thicker cortical bone and well-confined boundary of the mandible. Another reason could be the fulminating nature of the disease that leads it to rapidly spread in less resistant medullary bone before perforating cortical bone. During surgery, a clear line was seen separating necrotic medullary bone from healthy cortical bone. The thicker cortical bone of the mandible was found to be resistant to fungal invasion; however, the medullary bone was rapidly invaded. Therefore, the healthy cortical bone could be saved. The preservation of the cortical parts thus helps in maintaining the continuity of the bone. Surgical curettage of necrotic medullary bone is usually the optimal method to manage MOM affecting the mandibular body or ramus region.

Comparative Evaluation of Efficacy and Safety of the Diode Laser (980 nm) and Sclerotherapy in the Treatment of Oral Vascular Malformations.

Background: Vascular malformations are structural abnormalities which are formed by progressively enlarging aberrant and ecstatic vessels without endothelial cell proliferation and composed of the type of vessel involved, i.e., capillary, veins, and arteriovenous. Treatment of vascular malformations may involve many techniques like sclerotherapy, embolization, surgical resection, cryotherapy, laser treatment, or medical therapy. This observational prospective study is aimed at evaluating and comparing the effects and efficacy of diode laser and sclerotherapy in the treatment of oral vascular malformation. Materials and Methods: 40 patients presenting with oral vascular malformation were included in the present study. The patients were divided equally (20 in each) into two groups, i.e., the laser group and sclerotherapy group. Sclerotherapy was performed with 3% sodium tetradecyl sulfate while the laser group was treated with diode laser 980 nm with transmucosal thermophotocoagulation. The patients were assessed for the response, remission, and side effects. The results obtained were tabulated and compared with the chi-square test. Results: Side effects were found significantly lesser in the laser group compared to the sclerotherapy group (p < 0.05). Statistically significant difference was seen for postoperative pain between two groups. The laser group had mild to moderate pain compared to severe pain in the sclerotherapy group. Recurrence was observed more in the laser group compared to the sclerotherapy group. Conclusions: Laser and sclerotherapy with 3% sodium tetradecyl sulfate both are effective in the treatment of vascular malformations. Diode laser seems to be better than sclerotherapy given lesser side effects and comfort to the patients while sclerotherapy seems to be better in respect to recurrences.

A Rare Case of Mandibular Mucormycosis in a Post-COVID-19 Patient.

Mucormycosis or black fungus is one of the most lethal, progressing, and rapid form of deep fungal infections in humans which is caused by group of molds called mucormycetes. It is called black fungus infection due to black nasal discharges and black patches around nose found in the initial stage. The most common variety is rhino-orbito-cerebral-maxillary, although there are also pulmonary, gastrointestinal, cutaneous, and disseminated variations. In recent years, mucormycosis has become increasingly prevalent in immunocompromised individuals, with coronavirus disease 2019 (COVID-19) infection and associated consequences as the primary source of the cause. Rhino-orbito-cerebral-maxillary variety usually involves the nose, paranasal sinuses, brain, and maxilla but the involvement of mandibular bone is exceedingly rare. In this case report, we present a case of a 59-year-old male affected with mandibular mucormycosis in post-COVID scenario which is quite rare situation.

Comparative Evaluation of Efficacy and Safety of the Diode Laser (980 nm) and Sclerotherapy for the Treatment of Oral Pyogenic Granuloma.

Background: Pyogenic granuloma (PG) is a tumor-like, non-neoplastic lesion of the soft tissue that commonly appears in the oral cavity. Various treatment modalities have been discussed, including surgical excision, cryosurgery, curettage, electrodessication, corticosteroid injection, sclerotherapy, and lasers. This observational retrospective study compared effectiveness between diode lasers and sclerotherapy for PG treatment. Materials and Methods: From July 2016 to January 2021, data of oral PG cases treated with sclerotherapy and diode lasers were gathered. Patients were evaluated and categorized according to their gender, sex, site of lesions, size of lesions, number of sessions, details of side effects, details of the VAS (Visual Analogue Scale) on third postoperative day, response of treatment to individual groups, time required for complete resolution, and details of recurrence. Inferential statistical analysis was performed. Results: We included 73 patients, of whom 43 and 30 received laser and sclerotherapy treatment, respectively. Compared with the sclerotherapy group, the laser group had less side effects including pain, edema, ulceration, ecchymosis, infections, and scarring. The difference in postoperative pain (VAS scale) between the groups was statistically significant (p-value 0.004). Complete remission was seen in the laser group, while 3 cases of the sclerotherapy group had no response (p-value -0.034). The laser group experienced greater recurrence than did the sclerotherapy group. Conclusions: Both sclerotherapy with laser and 3% sodium tetradecyl sulfate are effective for treating oral PG. Sclerotherapy is more effective in preventing recurrence. In terms of side effects, diode lasers are superior to sclerotherapy.

Diode Laser in the Management of Leukoplakia - A Retrospective Study.

Introduction: Leukoplakia is among the most common potentially malignant disorders encountered in clinical dental practice. The treatment of leukoplakia includes nonsurgical and surgical management. The surgical treatment includes excision, electrocauterisation, laser surgery or cryosurgery. This retrospective study aimed to analyse the efficacy of diode lasers in the management of leukoplakia. Methods: The sample consists of 56 cases with 77 leukoplakia sites treated with diode laser between January 2018 and December 2020 with a minimum of six months follow-up. For each patient, personal data was collected along with site of lesions, leukoplakia phase, type of treatment performed (laser ablation or laser excision), side effects, recurrences and malignant transformation. Inferential statistical analysis was then conducted. Results: After applying exclusion criteria, 56 cases with 77 leukoplakia sites were included in this study. Males aged >45 years were predominantly affected. Homogeneous leukoplakia (48.1%) was the most common phase. Recurrences were noted in 19.48% of the cases. Compared to laser excision, laser ablation had more recurrences. Gingival lesions showed a higher recurrence rate than other sites in the oral cavity. None of the cases showed malignant transformation. Discussion: Laser offers many advantages over other conventional methods including lesser postoperative pain and swelling, bloodless dry operating field and increased patient comfort and requires minimal local anaesthesia. The study concluded that diode laser is an effective surgical treatment modality for treating leukoplakia. Furthermore, the laser excision technique was found to be superior to laser ablation due to lesser recurrence.

Evaluation of the Effects of Polidocanol Injection in the Treatment of Temporomandibular Joint Hypermobility - A Prospective Study.

Introduction: Sclerosing agents have been used for temporomandibular joint (TMJ) hypermobility since decades, some of which are ethanolamine oleate, and OK-432, sodium psylliate (sylnasol), but there are no studies on the usage of polidocanol - a well-known sclerosing agent which does not have much side effects and is inexpensive. Hence, this study evaluates the effect of polidocanol injection in the treatment of TMJ hypermobility. Methodology: This was a prospective observational study in which patients with chronic TMJ hypermobility were included. Out of the 44 patients who had symptoms of clicking and pain of the TMJ, 28 were diagnosed as internal derangement of the TMJ. The final analysis included 15 patients in whom multiple injections of polidocanol were given on the basis of post-operative parameters. The sample size was calculated based on a significance level of 0.05 and a power of 80%. Results: Overall, a success rate of 86.6% (13/15) was encountered at the end of three months, with seven patients not reporting any further episodes of dislocation after one injection and six patients not reporting any episode of dislocation after two injections. Discussion: Polidocanol sclerotherapy can be used as a treatment modality for chronic recurrent dislocation of the TMJ, rather than opting for more invasive procedures for the same.

Lymphangioma of the Oral and Maxillofacial Region: A Report of Three Cases.

Lymphangiomas, or lymphatic malformations (LM), are benign malformations of the lymphatic system characterized by abnormal proliferation of lymphatic vessels. It was first described by Virchow in 1854. They occur rarely in the oral cavity and involve the tongue dorsum more often. Though complete surgical excision is the gold standard and most desirable management, certain limitations restrict this approach. Laser therapy, cryotherapy, electrocautery, sclerotherapy, and intralesional injections of steroids and Bevacizumab are other treatment options in such cases. Here, we present three cases of diverse forms of lymphatic malformations treated with two different modalities of treatment.

Quantitative and Mathematical Analysis of Mental Foramen along with Its Correlation with Sex and Age Using Cone-beam Computed Tomography.

AIM AND OBJECTIVE: The aim of the present study was to perform quantitative and mathematical analysis of mental foramen (MF) along with its correlation with study subject's sex and age using three-dimensional imaging like cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT scan images stored in the database were used in this study. Two-hundred sixty-seven scans were selected. They were divided into four different age-groups. These age-groups were 16-23 years, 24-38 years, 39-55 years, and more than 56 years. Each age-group was further divided into two subgroups. One subgroup was of males, while the other subgroup was of females. Following this, there was evaluation of all CBCT-scanned images considering certain parameters like position of MF, size of MF, distance X, distance Y, and distance Z. RESULTS: The MF was located generally apically to the premolar and molar. It was more commonly located between the first premolar and second premolar among females, while in males, it was mostly located along the long axis of the second premolar. In most of the age-groups, the MF was located between the long axis of the first premolar and second premolar. The average distance of MF from the apex of first premolar was 5.01 mm. Further, the average size of MF and its distance from the base of the mandible were greater in males as compared with females. When all these measurements were compared in different age-groups, the difference was not statistically significant. CONCLUSION: The average distance of MF from the apex of the first premolar was 5.01 mm. The average size of MF and its distance from the base of the mandible were greater in males as compared with females. When the measurements were compared in different age-groups, then the difference was not statistically significant. CLINICAL SIGNIFICANCE: MF is an important structure in the mandible because it acts as an important landmark in the anesthetic procedure; therefore, there was a need to carry out detailed quantitative and mathematical analysis for MF.

Dynamic profile and clinical implications of hematological and immunological parameters in COVID-19 patients. A retrospective study.

BACKGROUND: Ever since the World Health Organization (WHO) announced the SARS-CoV-2 or nCOVID-19 infection (a pandemic), continuous spread of the virus has been observed which has continuously seen to affect and kill multitudes of individuals all over the world. An understanding of the pathophysiology of this disease is necessary for an effective treatment. Laboratory investigations play an important role in the diagnosis as well as treatment of this infectious disease. Hematological parameters demonstrate alterations during the progression of nCOVID-19 infection. Of these, many are indicative of extremely poor clinical outcome. Hematological findings like leukopenia, lymphopenia, thrombocytopenia and coagulation-related abnormalities are the most common manifestations. The aim of this study was to assess the dynamic profile and clinical implications of hematological and immunological parameters among nCOVID-19 infections. MATERIALS AND METHODS: This retrospective study was designed after categorizing patients suffering from COVID-19 into three groups: (a) Group I; (b) Group II and (c) Group III or severe critical patients. Hematological and immunological parameters of neutrophilic and white blood cell counts, d-dimer levels, hemoglobin levels, immunoglobulin G (IgG) and M (IgM) levels and interleukin-6 (IL-6) levels were assessed. Statistical analysis using Kruskal-Wallis test was used. RESULTS: Normal white blood cell and neutrophil count among COVID-19 patients was seen. However, median values in Group II (P < 0.01) and Group III (P < 0.0001) were found to show significantly higher values when compared to Group I. A significant (P < 0.01) decrease in lymphocytic counts was found among severe and critical patients. Hemoglobin level was found to demonstrate higher decrease (P < 0.01) among severe and critical patients. Platelet count was found in normal range in all COVID-19 patients. Routine coagulation tests revealed increased fibrinogen (P < 0.01) and d-dimer levels (P < 0.0001) in severe and critical patients. Normal proportions of total CD3+ and CD4 + T lymphocytes were observed in COVID-19. However, CD8 + T lymphocytes proportion was found to be decreased (P-value < 0.05). Immunoglobulin G levels among Groups II and III patients were found to be lower when compared with Group I (P < 0.001). No statistical significance was observed between the groups in IgM levels. Plasma IL-6 levels were found to show progressive rise among Groups II and III patients (P < 0.05). CONCLUSION: Analysis of hematological and immunological parameters profiles in COVID-19 patients may help in deciphering the clinical progression of patients suffering from COVID-19 disease. Thus, regular monitoring of the hospitalized patients may help in planning the management of these cases.

Histopathological Evaluation of Dental Follicle Associated with Radiographically Normal Impacted Mandibular Third Molars.

INTRODUCTION: Removal of impacted mandibular third molar is a common procedure performed in oral surgery. Indications for removal of the third molar have generated much discussion in dentistry. The presence of pericoronal pathosis is generally accepted reason for the extraction of impacted mandibular third molars. Radiographic pathology is usually defined as a pericoronal radiolucency measuring about 2.5 mm or larger in any dimension. PURPOSE: This study aims to evaluate the histopathologic changes in radiographically normal dental follicles associated with impacted mandibular third molars. METHODS: After extraction of 50 impacted mandibular third molars, dental follicle associated with extracted teeth was placed in 10% formalin solution. Histopathologic examination was done. The type of pathological changes was recorded based on histopathological reports. Patients' gender, age, and radiographic parameters were recorded. RESULTS: Cystic changes were found in 24% of radiographically normal impacted mandibular third molars. Significant cystic changes were observed in position A vertically impacted lower third molars (ILTMs). Male predominance for cystic change was seen with a male-female ratio of 2:1. CONCLUSION: The result of the present study shows that radiographic analysis may not be reliable technique for the diagnosis of cystic changes in ILTM. The presence of cystic changes can be found even in radiographically normal impacted mandibular third molars. Hence, we recommend that impacted mandibular third molars should be removed and histopathological analysis should be conducted on all surgically extracted dental follicles.

Multilocular Radicular Cyst - A Common Pathology with Uncommon Radiological Appearance.

Radicular cyst is the most common odontogenic cyst of inflammatory origin. It is almost all the times associated with pulpal necrosis leading to inflamed periapical tissues. The cyst is usually asymptomatic unless infected. Radiographically, it presents as a well defined unilocular radiolucency. Although, multilocular radiolucent radicular cysts have also been reported, which is extremely rare and there are very few reported cases. Here, we present a rare case of radicular cyst periapical to the first molar of third quadrant, presenting clinically as a painless, bony hard swelling and radiographically presented as a multilocular radiolucency.