A Predictive Model to Determine the Pattern of Nodal Metastasis in Oral Squamous Cell Carcinoma.

BACKGROUND: Developing histological prediction models that estimate the probability of developing metastatic deposit will help clinicians to identify individuals who need either radical or prophylactic neck dissection, which leads to better prognosis. Identification of accurate predictive models in oral cancer is important to overcome extensive prophylactic surgical management for neck nodes. Therefore, accurate prediction of metastasis in oral cancer would have an immediate clinical impact, especially to avoid unnecessary radical treatment of patients who are at a low risk of metastasis. METHODS: Histologically confirmed OSCC cases with neck dissection were used. Interrelation of demographic, clinical, and histological data was done using univariate and multivariate analysis. RESULTS: 465 cases were used and presence of metastasis and extracapsular invasion were statistically well correlated with level of differentiation (p < 0.001) and pattern of invasion (p < 0.001). Multivariate analysis showed level of differentiation, pattern of invasion, and stage as predictors of metastasis. CONCLUSIONS: The proposed predictive model may provide some guidance for maxillofacial surgeons to decide the appropriate treatment plan for OSCC, especially in developing countries. This model appears to be reliable and simple and may guide surgeons in planning surgical management of neck nodes.

Root canal morphology of mandibular permanent molars at different ages.

AIM: To investigate differences in the root canal morphology of permanent mandibular molar teeth at various ages. METHODOLOGY: Four hundred and eighty permanent mandibular first and second molars were examined. First and second molars were divided into six and five groups, respectively, according to the age of the patient at the time of extraction. Root canal morphology was studied using a clearing technique. The canal morphology of the mesial root was classified into three stages depending on its developmental pattern. When the root canal system was completely differentiated, the canal classification and the number of lateral canals and inter-canal communications were recorded. Vertucci's classification was taken as the main reference. Canal morphology was compared amongst age groups. RESULTS: In both first and second molars, developmental stages of canal morphology amongst age groups were significantly different (P < 0.0001). The prevalence of inter-canal communications was highly significantly different in the first (P < 0.0001) and less significant in the second molar (P < 0.05). After completion of the canal differentiation, the mesial roots of first molars had type IV and II canal forms. The majority of the mesial roots of second molars had type I and III canals. C-shaped canals were found in 3% of second molars. CONCLUSIONS: Mesial roots of first and second molars mostly had one large canal until 11 and 15 years of age, respectively. In both molars, the canal system was completely defined at 30-40 years. The prevalence of inter-canal communications was low at young and old ages but high at intermediate ages.

Intra-oral Dirofilaria repens infection: report of seven cases.

Cutaneous dirofilariasis usually affects animals such as cats and dogs which are known to be the natural host of Dirofilaria. Dirofilariasis displays a worldwide distribution. Certain geographic regions account for the majority of reported cases. South-eastern United States, Australia and Europe have been identified as endemic regions (1, 2). However, new endemic areas are arising with increased awareness in African and Asian regions. Out of about 40 different species of Dirofilaria only a few species are commonly known to infect man, namely Dirofilaria immitus, D. tenices and D. repens. Human infection occurs when a human becomes a blood meal of an infected arthropod vector and on accidental entering of the worm. Rarely this zoonotic infection affects the oral mucosa (3). Man is the dead end of this parasite. Since the human body is an abnormal environment for the parasite, the development of the larvae is inhibited by means of retardation of sexual maturity. Lesions are presented as single non-tender subcutaneous nodules, and most patients are asymptomatic. Diagnosis is established by H&E sections prepared from excised nodules. In a majority of the cases, only a single worm either a male or a female could be identified. The worm is usually dead and degenerated with a massive inflammatory cell infiltration. Seven new cases presented as intra-oral nodules with their clinicopathological correlation are discussed.