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.

Prevalence and Distribution of Oral Mucosal Lesions and Normal Variants among Nepalese Population.

Background: Oral mucosa is encountered by various lesions and normal variants. Some are not to be worried about, whereas others may be of significance. Knowing the prevalence of oral mucosal lesions in a particular region helps better evaluate, diagnose, and, thus, manage these lesions. Objectives: To assess the prevalence and distribution of oral mucosal lesions and normal variants among various age groups, genders, and sites of the orofacial region. Methods: This cross-sectional study was conducted in the Department of Oral Medicine and Radiology, KIST Medical College and Teaching Hospital from January 2021 to March 2021. Three different proformas were designed according to age, gender, and location of lesions for entry as per the WHO's guide. The obtained data were entered into a Microsoft Excel sheet for frequency analysis by SPSS, and the results were tabulated. Results: Among the records of 16572 (9703 (58.55%) males and 6869 (41.44%) females) OPD patients, 3495 (21.08%) (1934 (55.33%) males and 1561 (44.66%) females) had OMLs and 2314 (13.96%) (1626 (70.26%) males and 688 (29.73%) females) had normal mucosal variants. The most commonly seen OML categories were tobacco-associated lesions, i.e., 2056 (34.07%), tongue lesions, i.e., 1598 (26.48%), oral potentially malignant disorders, i.e., 815 (13.50%), ulcers i.e., 728 (12.06%), and infectious lesions, i.e., 256 (4.24%). Conclusion: The Nepalese population has a wide range of oral mucosal lesions and normal variants, and this study has attempted to have baseline data for the same. The most common OML was smoker's melanosis.

Pleomorphic Adenoma of the Palate With an Atypical Malignant Presentation: A Case Report.

A pleomorphic adenoma is a mixed salivary gland tumor. The parotid gland is the most common site. The intraoral palate is the most common site due to the abundance of accessory salivary glands in the palatal area. It has a very slow growth rate and is usually painless. Consequently, patients often have a lengthy history of presentation. Herein, we report a case of pleomorphic adenoma of the palate in a 53-year-old male patient. The mass was 5 cm by 4 cm in size. The growth rate was rapid, and it attained a large size in just nine months. On clinical examination, the overlying mucosa was ulcerated. On general examination, lymphadenopathy of the right side level 1 b lymph node was found. These clinical findings were consistent with malignancy. However, the histopathological report negated the clinical findings of malignant salivary gland tumors. The tumor was managed with a wide local excision of the tumor with a 1 cm clear margin. The postoperative course was uneventful. No recurrence was seen after two years of follow-up. A thorough cytological or histological examination is a prerequisite to defining the malignant nature of the lesion.

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.

Assessment of Condylar Shape through Digital Panoramic Radiograph among Nepalese Population: A Proposal for Classification.

Background: Panoramic radiograph is the first and most commonly advised radiograph for screening of temporomandibular joints/condyles. Different shapes of the mandible have been discussed by various authors with no consensus for a definite classification for condyle shape. This study was conducted with the objective to observe various shapes of condyles, symmetry of bilateral condyles, and variations of condyle shapes among males and females. Materials and Methods: This cross-sectional study was conducted on digital panoramic radiographs available at a tertiary center of Lalitpur from 25.12.2020 to 20.06.2021 after ethical approval from the institutional review board (reference no. 077/078/27). Panoramic radiographs were selected on the basis of inclusion and exclusion criteria, and various shapes of condyles were noted on HP 15 inch flat LED monitor (1280 × 1024). The collected data was analyzed using SPSS (chi-square test: a p value of < 0.05 was considered significant). Intra- and interobserver agreement was observed for condylar shapes. Results: Among the selected 850 panoramic radiographs (1700 condyles), most of them, i.e., 1343 (79%), were round/oval, followed by flattened, i.e., 149 (8.76%), diamond/angled, i.e., 93 (5.47%), crooked finger shaped, i.e., 28 (1.6%), and mixed, i.e., 46 (2.7%), and the least common shape observed was bifid, i.e., 40 (2.3%) (18 (2.1%) left condyle and 22 (2.6%) right condyle). Conclusions: Six different types of condyle shapes were noted: type I, oval; type II, flat; type III, diamond; type IV, mixed; type V, bifid; and type VI, crooked finger among the study population of Lalitpur.

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.

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.

Temporomandibular Joint Disorders Associated With Psoriatic Arthritis: A Report of Three Cases.

Psoriatic arthritis is chronic inflammatory arthritis (seronegative) associated with psoriasis. Patients may present with different clinical symptoms as it progresses and involves multiple joints one after the other in an erratic pattern of aggravation and remission. A thorough examination is necessary for an accurate diagnosis and appropriate therapy of the disorder since it exhibits similar characteristics as reactive arthritis, rheumatoid arthritis, and ankylosing spondylitis. There haven't been many instances of the temporomandibular joint being involved, but records have to be maintained properly to assess its role in psoriatic arthritis. Here, we present three cases of temporomandibular joint disorders associated with psoriatic arthritis.

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.

Lactate dehydrogenase as a biomarker in oral cancer and oral submucous fibrosis.

BACKGROUND: Oral cancer is the commonest cause of death in the Indian population, with a mortality rate of 0.3 million deaths per year. Oral submucous fibrosis (OSMF) is a potentially malignant disorder that has a high prevalence rate in India. It has been found that serum lactate dehydrogenase levels are increased in potentially malignant and malignant disorders. There are very few data on the application of salivary LDH in the detection of such disorders. AIMS AND OBJECTIVES: The estimation of LDH levels in saliva as diagnostic markers, using a noninvasive method in patients with OSMF, oral cancer, and in the controls. METHODS: A total of 60 subjects with the age range of 20-70 years were selected from the Department of Oral Medicine & Radiology and were grouped into three groups. Twenty-five subjects with clinically diagnosed OSMF (Group I), 25 subjects with histopathologically diagnosed oral cancer (Group II), and 10 subjects as control (Group III). Five milliliters of unstimulated whole saliva was aseptically collected. Following which, the collected saliva was centrifuged and then analyzed by ERBA-CHEM 5 semi auto-analyzer. The values obtained were statistically analyzed using descriptive statistics and paired t-test using the SPSS software version 22. P-value < 0.05- was taken as significant. RESULTS: The mean LDH levels were Group I 608.28 ± 30.22, Group II 630.96 ± 39.80, and Group III 182.21 ± 34.85. The P-value obtained was 0.0009 for both Group I and Group II which was highly significant. CONCLUSION: Salivary LDH levels were consistently higher in OSMF and oral cancer; hence, it could be a future biomarker.

Evaluation of different diagnostic criteria of diseases manifesting the oral cavity - A review. Part-1.

There are many disorders affecting the oral cavity, which can cause difficulty in diagnosis for an oral physician. A criterion is defined as 'a principle or standard by which something may be judged or decided'. Several criteria have been given by different authors or committee, which further aids in diagnosis of certain disease. This article encompasses a collection and analysis of all the criteria of diseases affecting the oral cavity, which will be beneficial for an oral physician in their routine clinics.

Non-syndromic bilateral condylar aplasia: A rare case.

The temporomandibular joint is one of the most complex joints of the human body. It consists of the mandibular condyle, glenoid fossa and the articular eminence of the temporal bone. Aplasia of the condyle is usually seen as part of a syndrome otherwise it is rare. We report a case of bilateral condylar aplasia in a 20-year-old male not associated with any syndrome. The patient reported to the department with a chief complaint of the underdeveloped lower jaw. Clinical examination, conventional radiographs, and 3D computer tomography images revealed a complete absence of condyle on the right and left sides.

Benign lymphoepithelial cysts of parotid and submandibular glands in a HIV-positive patient.

Patients with human immunodeficiency virus (HIV) infection have been reported to have parotid swellings of various types such as diffuse infiltrative lymphocytosis syndrome, parotitis, intraparotid lymphadenopathy, benign lymphoepithelial cyst (BLEC), as well as salivary gland neoplasms such as adenoid cystic carcinoma, Kaposi sarcoma and lymphoma. LECs in the parotid gland are uncommon benign entities with increased incidence associated with HIV infection. We are presenting a case of 28-year-old HIV-positive patient with BLECs in the parotid and submandibular glands.

Intercanine width as a tool in two dimensional reconstruction of face: An aid in forensic dentistry.

CONTEXT: Dental evidence is a valuable tool in identifying individuals, especially when disasters befall. Reference points in faciomaxillary region such as interpupillary distance, intercanthal distance, interalar distance and bizygomatic width can significantly contribute toward reconstruction of two-dimensional (2D) facial profiles. This study was researched upon to determine the relationship between the maxillary intercanine width and the different reference points of the face. AIM: The aim of the following study is to ascertain whether maxillary intercanine width can be used to detect interpupillary distance, intercanthal distance, interalar distance and bizygomatic distance and to evaluate the role of maxillary intercanine width in the 2D reconstruction of the face. MATERIALS AND METHODS: The study was carried out by consent and involved 90 subjects-45 males and 45 females who satisfied the inclusion criteria. Subjects were divided into three age groups, i.e. 18-24, 25-28, 29-35. Four parameters were measured- intercanine width, interpupillary distance, intercanthal distance and interalar distance. All the measurements were carried out with a digital Vernier caliper. The bizygomatic width was measured from posterior-anterior view. Two empiricists were assigned for the task. Each test was carried out twice to validate the soundness of the findings and to reduce bias. STATISTICAL ANALYSIS: Analysis of variance and Pearson correlation was established. Regression analysis was performed to predict the study variables by intercanine width. RESULTS: Intercanine width showed a significant relationship with different points. The width varied with age and gender. CONCLUSION: Inter canine width can be used as a valuable parameter in the reconstruction of face in two dimensional as it shows significant relationship with faciomaxillary reference point such as interpupillary distance, intercanthal distance, interalar distance and bizygomatic width.