Gorham's disease of the maxilla - A rare case report with literature overview.

Gorham's disease is a rare condition characterized by progressive osteolysis of bone ultimately resulting in the total disappearance of bone. The etiology is unknown and the disease predominantly affects the pelvis, humerus, and axial skeleton. Because of its unusual, ambiguous presentation and rare occurrence, the disorder goes unrecognized and is often masqueraded by other disorders. The diagnosis of this disorder is by exclusion. About 50 cases of Gorham's disease involving the maxillofacial region are reported to date and most of them involve the mandible. Exclusive involvement of maxilla is documented in only 4 cases. We report an exceptional case of Gorham's disease of the maxilla in a 68-year-old male patient presenting with chronic pain and masquerading as an odontogenic infection.

Diagnostic efficiency of methylene blue and lugol's iodine double staining method in oral leukoplakia in detecting dysplasia.

OBJECTIVES: Early detection of dysplasia in oral potentially malignant disorders (PMD) might facilitate screening for possible subsequent malignant transformation. Vital staining is a non-invasive clinical adjunct used for determining the biopsy site, which facilitates early detection of dysplastic changes in PMD. Some authors suggested that double staining method has superior results over staining with a single dye. AIM: The aim of the study was to evaluate the accuracy of in vivo staining with methylene blue (MB) and Lugol's iodine (LI) double staining method in comparison with MB staining alone. MATERIALS AND METHODS: Fifty patients of oral leukoplakia were recruited for the study. After obtaining written informed consent from the patients, the lesions were stained consecutively with 5% MB and 3% LI. The pattern of dye retention of MB alone, followed by MB and LI was noted. Incisional biopsy from the lesion was taken based on the retention of MB and the absence of staining of LI or by clinical judgement in case both stains were not retained. The clinical uptake of the stains was correlated with the degree of dysplasia on histopathological examination. RESULTS: Out of 50 subjects, MB was retained in 47 cases (94%), while 3 cases (6%) failed to retain the dye. However, out of 47 cases, 20 cases had dark blue stain and were considered as MB positive, while the rest 27 cases had pale blue stain and were considered to be negative for MB staining. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of MB staining were 57.82%, 100%, 100%, 26.53% and 46%, respectively. After applying both stains, i.e., double staining method, the outline of the lesion was better defined. Out of 50 PMD cases, 3 patients retained only LI and showed no dysplasia. Out of 47 cases which showed dysplasia, 27 cases showed pale blue retention of MB (-) and also were negative for LI. The rest 20 cases were positive for MB but negative for LI. The sensitivity, specificity, PPV and NPV with double staining technique were 100%. CONCLUSION: The accuracy and reliability of double staining method was superior to MB staining. CLINICAL RELEVANCE: Increased accuracy of double staining method aids in better detection of dysplasia and is of great help to the clinician in deciding the nature of PMD in question.

Psychological status and uric acid levels in oral lichen planus patients - A case- control study.

BACKGROUND AND AIMS: Oral lichen planus (OLP) has varied etiology and clinical expression may be influenced simultaneously by different mechanisms. Psychological disturbances and oxidative stress are some such factors proposed in the etiopathogenesis of OLP. The aim was to assess the possible association of psychological traits like stress, anxiety, depression, serum and salivary uric acid levels with disease expression in OLP patients. METHODS: A case-control study was conducted in OLP subjects (n = 43) with a clinical and histopathological diagnosis, age and gender matched healthy controls (n = 42) to evaluate psychometric properties through DASS - 42 scale and uric acid (serum and salivary levels) evaluation through "Modified Trinder Method, End point" method. RESULTS: The mean depression, anxiety, stress scores in OLP group were 16.51 ± 7.21, 15.58 ± 6.78 and 15.05 ± 6.11 and the scores in control group were 6.31 ± 3.48, 5.02 ± 2.70 and 5.69 ± 3.39 respectively. The mean value of serum UA level and salivary UA level in OLP group were 4.70 ± 1.33 mg/dl and 5.25 ± 1.61 mg/dl respectively, while the corresponding scores in control group were 5.86 ± 1.12 mg/dl and 6.18 ± 1.28 mg/dl. CONCLUSION: OLP group had significantly higher depression, anxiety, stress and total scores. Mean serum and salivary uric acid levels were significantly lower in OLP subjects when compared with controls. CLINICAL RELEVANCE: Correction of psychological traits in oral lichen planus patients may significantly improve the clinical picture, while uric acid levels can be employed for biochemical evaluation in lichen planus patients to analyse oxidative stress.

Clinical applications and performance of intelligent systems in dental and maxillofacial radiology: A review

Intelligent systems (i.e., artificial intelligence), particularly deep learning, are machines able to mimic the cognitive functions of humans to perform tasks of problem-solving and learning. This field deals with computational models that can think and act intelligently, like the human brain, and construct algorithms that can learn from data to make predictions. Artificial intelligence is becoming important in radiology due to its ability to detect abnormalities in radiographic images that are unnoticed by the naked human eye. These systems have reduced radiologists' workload by rapidly recording and presenting data, and thereby monitoring the treatment response with a reduced risk of cognitive bias. Intelligent systems have an important role to play and could be used by dentists as an adjunct to other imaging modalities in making appropriate diagnoses and treatment plans. In the field of maxillofacial radiology, these systems have shown promise for the interpretation of complex images, accurate localization of landmarks, characterization of bone architecture, estimation of oral cancer risk, and the assessment of metastatic lymph nodes, periapical pathologies, and maxillary sinus pathologies. This review discusses the clinical applications and scope of intelligent systems such as machine learning, artificial intelligence, and deep learning programs in maxillofacial imaging.

Fusion imaging: a bipartite approach.

Image fusion is the process of registering and combining multiple images from single or multiple imaging modalities to improve the imaging quality and applicability. It reduces randomness and redundancy to increase the diagnostic value of images for better assessment of medical problems. Fusion imaging was designed to overcome the disadvantages of morphological and/or functional imaging, and attempts to provide inputs that improve treatment planning, resulting in better prognostication. This review attempts to summarize the techniques and their applications in head and neck imaging.

Effect of TENS on stimulation of saliva in postmenopausal women with or without oral dryness - An interventional study.

BACKGROUND: Decreased estrogen levels in postmenopausal women may cause an increase in oral symptoms including dry mouth, burning sensation of the mouth, and taste alterations. Management of salivary gland hypofunction by various modalities had been tried with variable results and associated side effects or discomfort. AIM: To evaluate the effects of transcutaneous electric nerve stimulation (TENS) on whole salivary flow rate in postmenopausal females with and without oral dryness. METHODS: Fifty postmenopausal women, based on their response to Xerostomia Inventory, were divided into 2 groups of 25 each; group 1 were postmenopausal women with oral dryness (PMD + OD) and group 2 were postmenopausal women without oral dryness (PMD - OD). Unstimulated whole saliva collection was done by low forced spitting method. External salivary stimulation of parotid gland by electrodes of TENS unit was done and sialometry was repeated. The salivary flow rates were compared within both groups before and after stimulation and between the two groups. RESULTS: The mean salivary flow rates at baseline were statistically significantly lower in the PMD + OD group than the PMD - OD group. There was a mean increase of 0.33 ml and 0.46 ml with TENS stimulation in PMD + OD and PMD - OD groups, respectively. CONCLUSION: Postmenopausal women with perception of oral dryness had lower salivary flow rates. 90% of the subjects, irrespective of oral dryness status, responded to TENS therapy. TENS stimulation resulted in a statistically significant increase in the quantity of whole saliva flow rate in postmenopausal women with or without oral dryness.