Myofibroma of mandibular alveolus: A case report.

Phenotypic heterogeneity has been a complex phenomenon lately, fetching attention in tumour pathology. Myofibroblastic differentiation is one such example and, besides, functional heterogeneity contributes to the biological behaviour of the tumours. Myofibroma is a distinctive neoplasm of myofibroblasts with a low incidence rate in the oral cavity. A case of myofibroma in mandibular alveolus in an adult patient is reported here for its rarity and diagnostic dilemma.

Comparison of Neurological Manifestations in the Two Waves of COVID-19 Infection: A Cross-Sectional Study.

Introduction: Coronavirus Disease-19 (COVID-19) is an ongoing pandemic caused by highly contagious virus severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) that has infected millions of people across the world. Most of the countries have seen two wave patterns of the pandemic. The second wave is potentially more challenging due to high influx of cases, differing properties of the emerging mutants, and other dynamics of the evolving pandemic. Neurological manifestations are common among COVID-19 positive patients. In this context, the present study attempts to compare the neurological manifestation in the first and second waves of COVID-19. Methodology: A single-center retrospective observational study was undertaken to compare neurological manifestations in the first and second waves of COVID-19. A sample of 1500 patients in the second wave admitted with COVID-19 were included in this study and the findings were compared with 1700 patients in the first wave (data derived from a former study in the same center). A detailed questionnaire addressing co-morbidities, admission details, and clinical features was employed to collect data from the hospital records. Results: Out of 1500 COVID-19 patients in the second wave of COVID-19, 355 (23.7%) of them had one or more neurological manifestations during their in-patient stay. The most common neurological symptom in the 2nd wave of COVID-19 was headache reported in 216 (14.4%) of patients followed by fatigue in 130 (8.7%), myalgia in 120 (8.0%), smell and taste disorders (STD) in 90 (6.0%), altered sensorium in 40 (2.7%), dizziness in 24 (1.6%), seizures in 34 (2.3%), encephalopathy in 26 (1.7%), strokes in 13 (0.9%), etc., Compared to the first wave of COVID-19, dizziness (P < 0.001), myalgia (P = 0.001), headache (P < 0.001) and meningoencephalitis (P = 0.01) were more common while cerebrovascular syndromes (P = 0.001) were less common in the second wave. The mortality in the 2nd wave neurological subgroup was higher [66 (18.6%)] than 1st wave neurological subgroup [23 (10%)]. Conclusion: Meningoencephalitis, headache, and seizures were found to be more common in second wave as compared to first wave. The severity and mortality rate were higher in the second wave.

The impact of patient autonomy on older adults with asthma.

BACKGROUND: Understanding patient preferences and desire for involvement in making medical decisions is important when managing chronic conditions. Previous studies have used the Autonomy Preference Index (API) in younger patients with asthma to evaluate these preferences. OBJECTIVE: To identify factors associated with autonomy and to determine whether autonomy is related to asthma outcomes among older adults. METHODS: A total of 189 older adults (>55 years old) with persistent asthma were included. Preferences for autonomy were assessed using the API, with a higher score indicating higher desire for autonomy. Scores were separated into 2 domains of information-seeking and decision-making preferences. The separated scores were correlated with asthma outcomes and demographic variables. To control for confounding factors, a linear regression analysis was performed. RESULTS: Higher decision-making preference scores correlated with female sex (P = .007), higher educational level (P = .01), and lower depression scores (P = .04). Regarding outcomes, decision-making scores positively correlated with Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) scores (P = .01). On linear regression analysis, the Mini-AQLQ score remained significantly associated with decision-making preference scores (P = .03). There was no association with asthma control test scores, spirometry values, and health care use. Information-seeking preference scores correlated with educational level (P = .03), but there was no correlation with asthma outcomes. CONCLUSION: Older adults with asthma and a greater desire for involvement in decision making have better asthma-related quality of life. Future studies with the intention to increase patient autonomy may help establish a causal relationship.

Perineural Invasion of Oral Squamous Cell Carcinoma: A New Hurdle for Surgeons.

The high rate of mortality associated with cancer is due to its inherent nature to metastasize. Perineural invasion (PNI) is a relatively rare mode of metastasis, and a distinct pathologic entity that can be observed in the absence of lymphatic or vascular invasion which is still shrouded by mystery. PNI is a marker of poor prognosis. Despite increasing recognition of this metastatic process, there has been little progress in the understanding of mechanisms behind PNI. The purpose of this article is to make surgeons aware of caudad to cephalad metastasis of oral cancer along trigeminal nerve.

Distinct Asthma Phenotypes Among Older Adults with Asthma.

BACKGROUND: Older adults have high rates of asthma morbidity and mortality. Asthma is now recognized as a heterogeneous disease, yet the distinct phenotypes among older adults are unknown. OBJECTIVE: The objective of this study was to identify asthma phenotypes in a diverse population of elderly patients with asthma. METHODS: Using cluster analysis, 180 older adults with persistent asthma were analyzed. Subjects completed detailed questionnaires, skin prick testing, and spirometry with reversibility. Twenty-four core variables were analyzed. RESULTS: Four groups were identified. Subjects in cluster 1 (n = 69) typically had asthma diagnosed after the age of 40 and the shortest duration of asthma. Cluster 2 (n = 40) had the mildest asthma defined by spirometry, Asthma Control test (ACT), and Asthma Quality of Life Questionnaire (AQLQ). They also had the lowest body mass index (BMI), lowest depression score, and least number of comorbidities. Cluster 3 (n = 46) had the longest duration of asthma (56 years) and the highest atopic skin test sensitization (74%). Cluster 4 (n = 25) had the most severe asthma, with extremely low FEV1% predicted (37.8%), lowest ACT, and lowest AQLQ scores. They were more likely to be black and had the highest comorbidities. Using BMI, posttreatment FEV1% predicted, and duration of asthma, 95.6% of subjects were able to be correctly classified. CONCLUSIONS: In older adults with asthma, distinct phenotypes vary on key features that are more pronounced among the elderly, including comorbidities, fixed airway obstruction, and duration of asthma ≥40 years. Further work is required to determine the clinical and therapeutic implications for different asthma phenotypes in older adults.

Clear cell odontogenic carcinoma of mandible: An unclarified entity.

Morphological tampering of cellular architecture is a frequent phenomenon, leading to a spectrum of histological melange at light microscopic level. One such group of tumors which exhibit diagnostic and therapeutic dilemmas are the Clear cell tumors. Clear Cell Odontogenic Carcinoma (CCOC) is an infrequent tumor, which is aggressive by nature among the odontogenic tumors. A case of CCOC of mandible in a denture wearer is presented with the emphasis on diagnostic work up and clarified and unclarified facts of the tumor.

Hidden Causes of Anaphylaxis.

PURPOSE OF REVIEW: This study aimed to review important hidden causes of anaphylaxis in ingestants, non-ingestants, and uncommon settings. RECENT FINDINGS: Multiple new and elusive causes of anaphylaxis have been described over the past 35 years. Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.

Single Miniplate Fixation for Mandibular Symphysis and Parasymphysis Fracture as a Viable Alternative to Conventional Plating Based on Champy's Principles: A Prospective Comparative Clinical Study.

To compare long term and short term outcomes of fixing mandibular symphysis and parasymphysis fractures with single mini plate and conventional fixation using two mini plates. STUDY DESIGN: in this prospective clinical comparative study, 30 patients with fracture in study region were randomly divided into two groups. Group A patients received single 2.5 mm titanium miniplate and Group B patients received two 2 mm titanium miniplates as per Champy's lines of osteosynthesis. Patients were followed up at intervals of 1, 12 and 24 weeks. Parameters assessed were: duration of surgery, fracture stabilization, paresthesia, occlusion and wound dehiscence. Statistically significant difference was observed in mean duration of surgery and wound dehiscence (P < 0.05). No significant difference was observed with respect to other parameters. Single 2.5 mm miniplate for mandibular symphysis and parasymphysis fractures is a time saving and cost effective technique with post-operative outcomes similar to conventional 2 plate fixation.

Comparison of 'sutureless' Transconjunctival and Subciliary Approach for Treatment of Infraorbital Rim Fractures: a Clinical Study.

PURPOSE: The aim of the study is to compare subciliary incision and 'sutureless' transconjunctival incision in the treatment of infraorbital rim fractures. MATERIALS AND METHOD: In this prospective study, 40 patients with fractures of the infraorbital rim were selected and divided into 2 groups using random sampling technique. Group A patients were treated using 'sutureless' transconjunctival technique and group B patients were treated using subciliary approach. The following parameters were compared a) time taken, intraoperative ease of access, exposure achieved; b) clinical outcome and postoperative complications; c) Aesthetic outcome at intervals of 15 days, 1 month and 3 months. RESULTS: Total time taken for completion of surgery was lesser in group A patients. The presence of subconjunctival ecchymosis (at 1 month interval) and neurological deficit was found to be statistically significant (P<0.05) in the 'subciliary' group of patients. The transconjunctival approach showed better esthetic results and fewer post-operative complications. CONCLUSION: The subciliary approach gives good exposure of the infra-orbital rim and is better suited to reduce extensively displaced fractures of the infra-orbital rim. The transconjunctival approach is comparatively faster, gives better esthetic results and fewer post-operative complications but is technique sensitive and requires an additional lateral canthotomy in cases where more exposure is needed.

Soft tissue development around pontic site: A case series.

An ideal emergence profile is vital for maintaining gingival health and developing esthetics. The ovate pontic which mimics a natural tooth gives the most appropriate emergence profile. For a successful ovate pontic restoration, an alveolar ridge of sufficient height and width is necessary to enhance the deficient ridge and to achieve an esthetic emergence profile. Interpositional graft was carried out along with ovate pontic to achieve an ideal esthetic restoration. After three months of the postoperative period, there was an increased horizontal dimension in the deficient ridge and an esthetic emergence profile. Interpositional graft technique is a simpler and predictable technique for pontic site development in moderate cases of bucco-lingual ridge deficiency.

Hyoid Bone Fracture: Associated With Head and Neck Trauma-A Rare Case Report.

Fractures of hyoid bone resulting from trauma other than strangulation are very rare; hyoid bone fracture associated with panfacial trauma are even rarer. They occur more frequently in young individuals, and in men more than in women [1]. We report a comprehensive review of a case of hyoid bone fracture associated with head and neck trauma, induced by a direct blunt trauma onto the anterior neck.

Pituitary Adenoma Leads to Adenoid Cystic Carcinoma in the Oral Cavity: An Intriguing Case.

Adenoid cystic carcinoma is a tumor of the exocrine glands originating primarily from the minor salivary glands. Though rare but there has been incidences of its spread into intracranial sites via different routes. We report of an intriguing case of remote metastasis of intracranial tumor in the pituitary diagnosed as pituitary adenoma which spread to the oral cavity as adenoid cystic carcinoma. To our knowledge, this is the first reported case of seeding of cells from intra cranial pituitary adenoma to intra-oral site manifesting as adenoid cystic carcinoma.

Primary squamous cell carcinoma of the submandibular salivary gland: a rare entity.

Salivary gland tumors make up about 3% of all neoplasms of the head and neck. Salivary gland tumors vary widely in histopathological appearance, thus it prompted the development of a revised histopathological classification of tumours. Malignant tumors can arise in the major salivary glands or numerous minor salivary glands lining the mucosa of the upper aerodigestive tract. This case highlights one of the rare variants of primary squamous carcinoma of the sub mandibular salivary gland and the management of submandibular salivary gland malignancies.

Amniotic membrane as a biological scaffold after vestibuloplasty.

Vestibuloplasty techniques are widely carried out to make the denture bearing area more suitable and adequate to receive the intended prosthesis. One of the major challenges after a vestibuloplasty procedure is to reduce post operative discomfort, scar contracture and subsequent loss in sulcular depth. A raw bony surface, as is obtained after Clark's vestibuloplasty is prone not only to infections and increased pain, but also to increased scarring during the healing phase. Skin grafts have been most commonly used to cover the exposed periosteal surface but they have their own disadvantages. There is a constant search for biocompatible membranes/materials which would satisfy most criteria required of a biological scaffold. Amnion is the innermost layer of the placenta with certain unique properties. Here we discuss the efficacy of amniotic membrane as a biological dressing after vestibuloplasty.

Leptomeningeal carcinomatosis associated with papillary renal cell carcinoma.

Leptomeningeal carcinomatosis (LMC), or neoplastic meningitis, occurs in about 5-20% of patients with metastatic cancer, depending on the type of the primary malignancy and kind of treatment received. The association of LMC with renal cell carcinoma (RCC) is a rare entity, and only two cases of papillary renal cell cancer with leptomeningeal metastasis have been reported. Leptomeningeal spread usually confers a poor prognosis despite the use of modern treatment strategies as compared to patients with extracranial metastases. We report a case of papillary RCC, a less common type of RCC presenting with LMC.

Carcinoma ex pleomorphic adenoma: Diagnostic dilemma and treatment protocol.

Carcinoma ex pleomorphic adenoma (CXPA) is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma. It often poses a diagnostic challenge to clinicians and pathologists. The entity is difficult to diagnose preoperatively. Pathological assessment is the gold standard for making the diagnosis. Treatment for CXPA often involves an ablative surgical procedure, which may be followed by radiotherapy. We report a case of a 65-year-old lady with a history of recurrent swelling in the left preauricular region and a history of surgery 10 years back, in the same region. Preoperatively, a diagnosis of pleomorphic adenoma of the parotid gland metastasizing to the cervical lymph node was made, but postoperatively it was reported as CXPA adenoma of the parotid gland. A radical parotidectomy involving en bloc resection of the facial nerve along with deep and superficial lobes of the parotid was performed followed by radiotherapy. The fact that pleomorphic adenomas are classified as benign tumors should not overshadow the wide range of biological behaviors associated with these tumors. On account of the potential for malignant transformation, surgical treatment must be properly performed. Surgery followed by radiotherapy should be considered as the standard care for a patient with carcinoma ex pleomorphic adenoma.

Percutaneous Radiofrequency Rhizotomy in Treatment of Trigeminal neuralgia: A Prospective Study.

INTRODUCTION: Trigeminal neuralgia (TN) often called as "Tic douloureux" is a syndrome characterized by paroxysmal facial pain, is one of the most painful and debilitating craniofacial pain disorders. The controversy regarding the etiology and treatment of TN still exists. OBJECTIVE: To evaluate the effectiveness of percutaneous radiofrequency rhizotomy (PRR) for TN, after failure of pharmacological management. METHOD: A nonrandomized, non comparative, descriptive, in vivo study of 15 patients with TN of maxillary and mandibular divisions of trigeminal nerve and patients with pain refractory to pharmacological management were done. It was performed as an O.P.D procedure. A routine follow up was done in all cases for 1 year. RESULTS: In a total of 15 patients, 8 female and 7 male patients were enrolled for the study. Early pain relief (immediately, postoperatively to 6 month) classified as excellent or good (successful), occurred in 12 of 15 patients (80 %). Fair or poor pain relief (unsuccessful) occurred in three patients (20 %).There was no mortalities and no major morbidity. SUMMARY: It was found that surgical treatment with PRR is a safe and effective way to manage patients with TN in whom pharmacologic therapy is either ineffective or not tolerated, with low side effects which are well tolerated.

"Transport distraction osteogenesis for reconstruction of mandibular defects": our experience.

INTRODUCTION: Mandibular defects usually involve a combination of osseous and soft tissue deficiency and are among the most challenging problems in maxillofacial surgery, many options are available for mandibular reconstruction. One of the options discussed in literature recently being distraction osteogenesis. AIM AND OBJECTIVE: The aims and objectives of the study were to evaluate clinically the technique of distraction osteogenesis to reconstruct mandibular defects, using indigenous transport distractors, and to evaluate the efficacy of Indigenous transport distraction osteogenesis device. MATERIALS AND METHODS: A prospective, experimental study was designed to examine the use of transport distraction osteogenesis in the treatment of defects of the mandible. Four patients with defects of the mandible were subjected to distraction osteogenesis with indigenously manufactured distraction device. The regenerate was assessed clinically and radiographically. RESULTS: The results showed that the regenerate was clinically as hard as the adjacent unaffected mandible and radiologic evidence of bone regeneration was observed. The major advantage being regeneration of hard tissue and soft tissue components without the morbidity of donor site, so that functional rehabilitation of the patient is possible. CONCLUSION: Thus from our study it is shown that transport distraction osteogenesis using indigenous distractors is a reliable yet affordable option for reconstruction of mandibular defects.

Ankylosis of temporomandibular joint in children.

BACKGROUND: Temporomandibular joint (TMJ) ankylosis or hypomobility involves fusion of the mandibular condyle to the base of the skull. It is a major clinical problem that affects many patients suffering from facial trauma, infection, or systemic disease. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. CASE REPORT: This report describes a case of a 4-year-old boy with inability to open mouth, diagnosed with unilateral right bony TMJ ankylosis. The surgical approach consisted of gap arthroplasty followed by vigorous physiotherapy. CONCLUSION: A detailed history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy can help us to restore physical, psychological, and emotional health of the child patient.

Decompression and cystectomy of the odontogenic keratocysts of the mandible: a clinical study.

OBJECTIVES: Owing to the aggressive nature of OKC's if one could stop or even reverse the growth of the cyst with a simple procedure like decompression, regardless of the histologic type, it would be an alternative to radical and disfiguring surgery. METHODS: Eight patients who were diagnosed with Odontogenic keratocyst of the mandible were chosen and the first stage of treatment being, insertion of the decompression stent into the most prominent or dependent part of the cystic cavity. Then based on assessment of regular second monthly OPG radiograph the second stage ie. Enucleation of the cyst and treatment of the cystic cavity with Carnoy's solution was carried out, when the size of the cystic cavity had decreased. RESULTS: The radiographs of all the patients were analyzed at a two month interval and compared with the pre operative radiograph. The percentage of change in radiodensity of the lesion ranged from 35.15% to 66.16% with a mean decrease of 53.85%. This also indicated that the quantum of bone regeneration which occurred simultaneously and as observed during the cystectomy procedure was commendable. CONCLUSION: Reduction of surgical morbidity while preserving anatomy and function, is the greatest advantage of decompression, however one should not forget the emphasis on the value of long term studies needed to be carried out with regular follow-up, to keep a check on those patients treated with decompression.