A Rare Melanotic Neuroectodermal Tumor of Infancy in a 3-month-old Child: A Case Report.

A rare case of melanotic neuroectodermal tumor of infancy (MNTI) occurring in a 3-month-old male child affecting the left maxilla is described. Computed tomography showed the benign expansile type of lesion affecting the left maxilla. The lesion was surgically excised completely. Histopathology confirmed the diagnosis of melanotic neuroectodermal tumor. Almost 6 months of follow-up showed no recurrence. How to cite this article: Patankar SA, Pawar SR, Sharma R, et al. A Rare Melanotic Neuroectodermal Tumor of Infancy in a 3-month-old Child: A Case Report. Int J Clin Pediatr Dent 2024;17(1):79-81.

A Naturalistic, Non-interventional Investigation of the Clinical and Sociodemographic Characteristics and Prescription Patterns in Patients With Psychotic Disorders at a Tertiary Care Facility in South Asia.

OBJECTIVES:  This study aimed to evaluate the trends in the sociodemographic, clinical, and prescription characteristics of patients with psychotic illnesses seen in the outpatient psychiatry department of a tertiary care facility. METHODS:  Between March 2021 and April 2022, a cross-sectional, prospective, observational, naturalistic, non-interventional study was conducted. A total of two hundred prescriptions were analyzed. To assess the rationality of prescriptions, World Health Organization (WHO) indicators were also computed. RESULTS:  With a range of 18 to 75 years, the cohort's mean age was 40.26 years, and its average disease duration was 10.75 years. Sixty-seven patients (68.5%) were diagnosed with schizophrenia. Of the 200 prescriptions that were analyzed, 13 antipsychotic prescriptions were written 343 times. Olanzapine was prescribed as an antipsychotic the most frequently (132, 66%), followed by clozapine (75, 37.5%). Haloperidol (41, 20.5%), trifluoperazine (3, 1.5%), loxapine (1, 0.5%), and flupenthixol depot (1, 0.5%) were the most commonly prescribed typical antipsychotics. 91% (181/200) of patients received prescriptions for other drugs in addition to antipsychotics. Trihexyphenidyl (45%), escitalopram (30%), clonazepam (26.5%), sodium valproate (10%), propranolol (10.5%), and modafinil (9.5%) were the most frequently prescribed concurrent medicines. Forty-eight percent (95/200) of prescriptions demonstrated polypharmacy. Among patients, the frequency of antipsychotic prescriptions was 1 in 44% (88/200), 2 in 36.50% (73/200), 3 in 17% (34/200), 4 in 0.5% (1/200), and 5 again in 0.5% (1/200).  Conclusions: On average, the cohort of the current study was young. The commonest diagnosis was mainly schizophrenia. Atypical antipsychotics accounted for the majority of antipsychotic prescriptions in the current study. In this study, a high prevalence of polypharmacy was noted.

Quantification of Chemotherapy Drug Wastage and Incurred Financial Loss in Paediatric Cancer Care: A Cross-Sectional Study at a Tertiary Care Public Hospital in India.

AIM: The evolving chemotherapy landscape continually introduces effective agents, but escalating costs call for an evaluation of drug wastage and financial consequences to enhance resource utilization. This study seeks to estimate chemotherapy drug wastage and its economic loss in paediatric cancer care. METHODS: In this cross-sectional study of paediatric cancer patients receiving parenteral chemotherapy, we evaluated both the drug used and wasted during each administration. The monetary value of drug loss was calculated using the formula: Cost = Proportion of drug wasted X Cost of drug vial. RESULT: A total of 100 paediatric cancer patients who received 140 parenteral drug administrations of 22 chemotherapy drugs were studied. The total amount of drug procured was 25,515 mg, out of which 5,004.9 mg were wasted. Wastage amounted to 19.61% of the procured drugs in varying proportions. The total estimated cost of chemotherapy stood at 110,143.1 INR (1,328.7 USD), with cost wastage accounting for 31,929.95 INR (385.19 USD), equivalent to 28.98% of the total expenditure. Notably, doxorubicin 112.2 mg (37.4%) exhibited the highest drug wastage, followed by cytarabine 280 mg (35%) and l-asparaginase 83,400 IU (26.9%), primarily prescribed for acute lymphocytic leukaemia. Cytarabine resulted in the highest financial loss. Dose rounding occurred in 22 cases (15.71%), while vial sharing was observed in only five cases (3.57%) during drug administrations. Methotrexate, doxorubicin, and cytarabine doses never matched the available vial sizes. CONCLUSIONS: In resource-limited healthcare settings, implementing centre-specific measures, such as vial sharing and drug categorization, can reduce drug wastage and financial losses. Evaluating the viability of optimizing vial sizes and producing multidose vials is essential.

Quantifying Drug Wastage and Economic Loss of Chemotherapy Drugs at an Adult Oncology Care of a Tertiary Care Public Hospital in India.

Background and objective New drugs have revolutionized cancer care, but their high cost requires cost-effectiveness studies. However, these studies only consider optimal use, neglecting real-world wastage. We aim to assess chemotherapy drug wastage and financial loss in our adult oncology care. Methods A total of 100 adult patients attending daycare oncology were prospectively evaluated. The total dose of parenteral anticancer drug, the amount administered, and the amount of drug wasted were recorded for each patient. The economic loss estimation was done considering the unit cost for the drug. Results Our study evaluated 157 parenteral drug administrations of 10 different anticancer drugs in 100 enrolled patients. The most common diagnosis was breast cancer (39/100; 39%), and the most commonly prescribed drugs were paclitaxel (36/157; 23%) and cyclophosphamide (21/157; 13%). However, the wastage percentage varied from 6% to 35.06%, and the overall wastage estimated was 16,298 mg (20.06%) of the total drug procured. Notably, the highest proportion of drug wastage was observed for carboplatin (2,525/7200 mg; 35.06%), whereas oxaliplatin, gemcitabine, 5-FU, and cisplatin wastage were more than 20% of the ordered drug. The total cost of the chemotherapy drug procured was 7,26,005 INR (8,738.78 USD), and drug wastage amounted to 17.14% of the total drug cost, resulting in an economic loss of 1,24,485 INR (1,498.40 USD). Gemcitabine (542.86 USD), oxaliplatin (452.66 USD), and paclitaxel (286.15 USD) were responsible for the maximum cost of wastage. Conclusion Drug wastage and financial loss are significant for carboplatin, oxaliplatin, and gemcitabine, with small proportions of paclitaxel also contributing to economic loss. Possible solutions include planning pharmacy inventory for multiple vial sizes and drug-wise batching strategies to facilitate vial sharing. However, these approaches may present challenges. The pharmaceutical industry can consider initiatives such as providing varying packaging sizes to minimize drug wastage.

Investigator knowledge, awareness, and registrations of academic clinical trials with the Clinical Trial Registry of India: An observational study.

Introduction: In 2019, the Central Drugs Standard Control Organization (CDSCO) introduced the New Drugs and Clinical Trials Rules 2019 (NDCTR), which separated the research guidelines for "Clinical Trials" and "Biomedical and Health Research." As a result, guidelines issued by Indian Council of Medical Research were stated to apply to academic clinical trials (ACTs). This change is important because academic studies are crucial for scientific advancement and repurposing of approved drugs in health-care industry. However, conducting an ACT can pose challenges. We assessed the level of awareness, knowledge, and challenges faced by investigators. Our aim is to overcome some of these challenges and encourage more academic studies for the betterment of healthcare and scientific knowledge in India. Methodology: The study was conducted in two phases after obtaining approval from the Institutional Ethics Committee (EC) of three tertiary care hospitals in Mumbai. In the first phase, the number of ACTs was assessed from the clinical trial registry India website, while the number of registered and re-registered ECs were assessed from the CDSCO website. The second phase involved assessing investigator awareness and knowledge about ACTs using a prevalidated questionnaire with a content validity index score of 0.93. Results: In 2020, the highest numbers of studies were registered, with the highest numbers of registered and re-registered ECs from Maharashtra. All participants completed the questionnaire and were aware of the need to follow guidelines for clinical trials. Sixty-seven percent of participants knew that the guidelines for ACTs differed from those of sponsored clinical trials, but only 58% were aware of the exact definition of an ACT as per NDCTR, 2019. Eighty-five percent of participants knew who could initiate an ACT, but only 27% knew about the applicability of results of an ACT and 33% had in-depth knowledge about the required approvals, while only 10% knew the archival period. Although 71% of participants had knowledge about serious adverse event reporting, few answered in-depth questions correctly. Only 31 participants reported facing varied challenges. Conclusion: To conduct ACTs effectively and contribute to healthcare and scientific advancement, it is crucial to enhance investigators' existing knowledge about ACTs.

Evaluation of the Efficacy of Oral and Intramuscular Administration of Dexamethasone on Postoperative Pain, Swelling, and Trismus After Surgical Removal of Impacted Third Molar: A Comparative Split-Mouth Study.

Context Over the past 60 years, several researchers have conducted extensive studies on the use of dexamethasone to reduce the postoperative complications of lower third molar surgery, namely, pain, edema, and trismus. In this study, we compared the oral and intramuscular methods of dexamethasone administration. Purpose The aim of this research was to assess pain, edema, and trismus in the postoperative period following the surgical removal of the lower third molar using 8 mg of dexamethasone given orally or by intramuscular injection. Method A split-mouth technique was employed for the study, in which each of the two bilaterally impacted mandibular third molars was removed one at a time, separated by at least two weeks. There were 26 participants in this experiment. Two groups were created from the research sample: group A (injection dexamethasone) and group B (tablet dexamethasone). The pain was assessed on the first, second, and third postoperative days. On the first, third, and seventh postoperative days, the parameters, such as edema and trismus, were evaluated. Results As per our study, in terms of edema and trismus, there was less of a statistically significant difference between the two interventions at all time points. While the pain score had a significant difference between both interventions. Conclusion Hence, we conclude that oral dexamethasone is an effective alternative to intramuscular dexamethasone. Oral dexamethasone is comparatively simple, less invasive, painless, and easy for the surgeon and for apprehensive patients, and it offers a cost-effective solution for the suffering often associated with the extraction of impacted lower third molars.

Evaluation of the Effect of Distant Cold Stimulation on Pain During Palatal Injection: A Randomized Split-Mouth Study.

Objective Delivery of a robust local anesthetic injection aids in the successful management of all patients' fears, anxieties, and discomfort during dental treatments. The most expected or frightening stimuli in the dental operatory are local anesthetic injections. The objective of this trial was to study the analgesic efficacy of distant cold stimulation in relieving injection pain from the greater palatine nerve block. Before receiving local anesthetic injections, employing cryotherapy by using an ice bath changes the pain perceptions and also increases the pain threshold. Purpose The aim of this study is to evaluate the effect of distant cold stimulation on palatal injection pain using an ice-cold bath. Method This was a randomized, controlled trial conducted at an oral and maxillofacial surgery department. A split-mouth technique was employed for the study, in which patients requiring bilateral greater palatine nerve block for any dental procedures were included. The bilateral greater palatine nerve block was given one at a time, separated by an interval of three days. The inclusion criteria for this study were no history of drug allergy and an extraction site free of any active infection. There were 28 participants in this experimental study. Two groups were randomly created from this research sample: group A (palatal injection with distant cold stimulation) and group B (palatal injection without distant cold stimulation). In group A, the patient was asked to put his or her hand of the same side as the palatal injection in an ice-cold bath till the time patient could tolerate it; immediately after the patient removed his hand, the greater palatine nerve block was given, and the patient was assessed for the injection pain. In group B, the patient was directly given the greater palatine nerve block without any distant cold stimulation. The time interval between the two extractions/dental procedures was three days. Outcomes of interest were pain severity with and without distant cold stimulation which were assessed using a Visual Analogue Scale (VAS) pain scale, and a comparison was made between the two groups. Results As per our study, in terms of pain, there was a statistically significant difference between the two interventions at all time points. Patients in group A had a lower score on the VAS pain scale as compared to group B. The standard deviation (STD) for group A was 0.81, and the standard deviation for group B was 0.92. P value was derived to be P < 0.001, which is suggestive of a significant difference between the pain scores of both groups. Conclusion Hence, we conclude that the use of distant cryotherapy as an adjunct is an effective way to reduce pain perception and increase pain threshold. This technique is comparatively simple, painless, and easy for the surgeon and for apprehensive patients, and it offers a fair cost solution for the suffering often associated with dental procedures requiring local anesthetic injections.

A drug utilisation pattern in non-dialysis patients of diabetic nephropathy in a government-run tertiary care hospital in South-Asia.

OBJECTIVES: The objective of the present study was to evaluate the Drug utilisation pattern in patients of diabetic nephropathy (stage 1-4) in a tertiary care hospital in South-Asia. METHODS: A cross-sectional observational study was conducted in the nephrology out-patient-department of a tertiary care hospital in South-Asia. WHO core prescribing, dispensing, and patient care indicators were evaluated, and adverse drug reactions (ADRs) encountered by the patients were analysed for causality, severity, preventability, and outcome. RESULTS: The most commonly prescribed antidiabetics in diabetic nephropathy patients were insulin (17.42%), followed by metformin (4.66%). Current drugs of choice SGLT-2 inhibitors were prescribed in a lesser frequency than expected. Loop diuretics and calcium channel blockers (CCBs) were the preferred antihypertensives. The use of ACE inhibitors (1.26%) and ARBs (3.45%) for hypertension was restricted to Stage 1 and 2 nephropathy. The patients were on 6.47 drugs on average. 30.70% of drugs were prescribed by generic names, 59.07% of the drugs were prescribed from the national essential drugs list and 34.03% of the prescribed drugs were supplied by the hospital. CTCAE grade 1 (68.60%) and grade 2 (22.09%) ADR severity was the highest. CONCLUSIONS: Prescribing patterns in patients of diabetic nephropathy were adapted from relevant medical evidence, affordability and availability of the drugs. Generic prescribing, availability of drugs and ADR preventability in the hospital have a broad scope for improvement.

Patient-Specific Implants in Maxillofacial Reconstruction - A Case Report.

Rationale: The successful utilisation of three dimensional (3D) techniques in engineering a titanium patient specific implant (PSI) for a patient who underwent hemimaxillectomy following post COVID mucormycosis infection. Patient Concerns: Issues related to problems associated with resection following mucormycosis, such as occlusal function, aesthetics and facial asymmetry. Diagnosis: The patient affected by mucormycosis was left with Aramany class 1 and Cordeiro type II sub total maxillectomy defect. Treatment: The patient was operated for mucormycosis followed by reconstruction with patient specific implant. Outcome: Positive clinical outcomes, including improved facial symmetry, function and psychological well being with immediate replacement of the teeth, the benefits of which far outweigh the traditional approach. Take away Lessons: The advances in the use of PSI by integration of 3D printing and computer aided design computer aided manufacturing (CAD-CAM) technology for extensive and challenging defects in the maxillofacial region have been highlighted in this case report.

Syringoma - a rare tumour: Case report and review of literature.

Syringomas are benign tumours originating from the eccrine ducts. Lower eyelid is the commonest site of origin. Very few cases have been reported in literature till date. Histopathology demonstrates normal compressed eccrine ducts in the fibrous capsule along with tumour cells arranged in tubules and solid islands. This report describes a case of syringoma on the lower eyelid in a female patient.

Validity and Reliability of a Questionnaire Measuring Knowledge, Attitude, and Practice Regarding Dementia Among General Population and Healthcare Workers in Urban India.

Objective: The present study aimed to validate a questionnaire and measure the previous knowledge, attitude, and practice (KAP) of the general population and healthcare professionals regarding the debilitating disorder of dementia. Design: A questionnaire including 27 items was compiled by the authors and was circulated via the online platform. Setting:A questionnaire-based survey was conducted using the online modality. Participants: A convenience sampling method was used to recruit participants aged 18 and above from all walks of life. Measurements: Test-retest reliability, item analysis, and Cronbach's alpha were calculated for the compiled questionnaire. The responses of the participants were assessed using descriptive statistics and the chi-square test. Results: A total of 503 responses were collected. The internal consistency (Cronbach's alpha=0.70) was acceptable and the test-retest reliability (0.823) was good. Eighty-one percent (408/503) of participants had heard the word dementia. Seven percent (27/408) of the participants who had heard the word dementia did not have any knowledge about the symptoms of dementia. Thirty-three percent (136/408) of participants believed that dementia could not be prevented. Almost half, i.e., 46% (187/408) of participants, considered dementia as a normal part of aging. Conclusions: The present study provides a fully validated questionnaire, which could prove helpful in research as it permits generating high-quality data and reducing measurement error. Knowledge of dementia among the general participants seems to be moderate and prompts towards the development of advocacy programs.

One hundred years since insulin discovery: An update on current and future perspectives for pharmacotherapy of diabetes mellitus.

Diabetes mellitus was considered a fatal malady until the discovery, extraction and commercial availability of insulins. Numerous other classes of drugs ranging from sulfonylureas to sodium-glucose co-transporter-2 inhibitors were then marketed. However, with the prevalence of diabetes mellitus increasing every year, many more drugs and therapies are under investigation. This review article aimed to summarize the significant developments in the pharmacotherapy of diabetes mellitus and outline the progress made by the recent advances, 100 years since insulins were first extracted successfully. Insulin analogues and insulin delivery pumps have further improved glycaemic control in diabetes mellitus. Cardiovascular and renal outcome trials have changed the landscape of diabetology, with some of these drugs also efficacious in nondiabetics. Newer drug delivery systems are being evaluated to improve the efficacy and reduce the dosing frequency and adverse effects of antidiabetics. Some newer drugs with novel mechanisms of action targeting type 1 and type 2 diabetes have also shown promise in recent clinical trials. These drugs include dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1-agonists, glucokinase activators, anti-CD3 monoclonal antibodies and glimins. Their efficacy needs to be evaluated in larger studies.

Neuroinflammation and oxidative stress in schizophrenia: are these opportunities for repurposing?

PURPOSE: To summarize the main findings on the subject of neuroinflammation and oxidative stress in patients with Schizophrenia (SCZ). METHODS: A narrative review of all the relevant papers known to the authors was conducted. RESULTS: SCZ is a chronic, debilitating, neuropsychiatric disorder associated with an immense and adverse impact on both the patient and the caregiver, and impairs the overall quality of life. The current modality of treatment involves the use of antipsychotics to balance the disturbances in the neurotransmitters in the dopaminergic and serotonin pathways in the brain, which have a role to play in SCZ. Contemporary management of SCZ focuses mainly on symptomatic control due to the lack of effective curative treatments.Despite the optimum use of antipsychotics, there is a considerable proportion of the patient population who are poor responders. This has necessitated the exploration of new etiopathologies in order to evolve new modalities of treatment. This narrative review, conducted over a period of 3 months, throws light on the large-scale evidence pointing toward neuroinflammation and oxidative stress as key etiopathological markers that merit further consideration in SCZ, and may even be the basis for devising novel pharmacotherapies for SCZ. CONCLUSIONS: This review discusses the various plausible hypotheses, viz., cytokine hypothesis of peripheral inflammation, acute-phase reactants in SCZ, microglial hypothesis of central inflammation, neurogenesis in relation to neuroinflammation, and oxidative stress in SCZ. It also highlights the many opportunities available for repurposing already marketed drugs with anti-inflammatory and antioxidant properties with a view to devising more effective and comprehensive therapies to manage SCZ.

Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla.

Aim: To present a case of adenomatoid odontogenic tumor (AOT) associated with impacted maxillary lateral incisor in a 12-year-old female that mimicked dentigerous cyst. Background: Adenomatoid odontogenic tumor (AOT) was first mentioned by Steensland in 1905, which is a rare tumor of odontogenic origin. Dreibladt in 1907 coined the term pseudo ameloblastoma. In 1948, Stafne considered it a distinct pathological entity. Case description: A 12-year-old female reported to the Department of Oral and Maxillofacial Surgery with the chief complaint of progressive swelling on the left maxillary anterior region for 6 months. The clinical and radiographical findings of the case represented a dentigerous cyst or unicystic ameloblastoma, but the histopathological interpretation was interpreted as AOT. Conclusion: The AOT is an unusual entity that is commonly misdiagnosed as a dentigerous or odontogenic cyst. Histopathology plays a vital role in diagnosis and further management. Clinical significance: The interest and relevance of the present case are the difficulties in diagnosing accurately based on the radiograph and histopathology. Both dentigerous cysts and AOT are entirely benign and encapsulated lesions, and enucleation poses no major difficulties. The case report highlights the importance of early diagnosis of neoplasm arising in odontogenic tissues. The fact that in cases of unilocular lesions surrounding the impacted tooth in the anterior maxillary region, AOT should also be considered as a differential diagnosis. How to cite this article: Pawar SR, Kshirsagar RA, Purkayastha RS, et al. Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla. Int J Clin Pediatr Dent 2022;15(6):770-773.

Past, present and future perspectives of therapeutic drug monitoring in India.

Therapeutic drug monitoring (TDM) is the clinical practice of performing drug assays and interpreting results to maintain constant therapeutic concentrations in patients' bloodstream. Conventional TDM was started way back in the 1960s and served to optimise pharmacotherapy by maximising therapeutic efficacy by evaluating efficacy failure and monitoring drug compliance, while minimising adverse events, in drugs with a narrow therapeutic range. Currently, the scope of TDM has been extended to additional indications which are of importance to India. Apart from the conventional indications, TDM can also help combat drug resistance amongst patients treated with antimicrobials, including anti-tubercular drugs and critically ill patients with compromised pharmacokinetics. TDM is also indicated for patients on antiretroviral drugs under specific clinical scenarios and is of high importance to India. Target concentration intervention (TCI) and apriori TDM (by merging TDM with pharmacogenomics) are emerging fields explored in developed nations. The authors sought to assess the evolution of TDM in India and evaluate the potential impact of newer indications in rationalising pharmacotherapy. In the mid-1980s, TDM was presented to India. Despite showing some initial progress, its use is limited to conventional indications. Its utility is also challenged by cost and higher reliance on conventional prescribing practices. However, the newer indications such as antimicrobial resistance, tuberculosis and HIV, with their high prevalence in developing nations, present an opportunity for the growth of TDM in these countries. Indian clinician's awareness and buoyant demands alongside expert contributions from clinical pharmacologists could widen its scope.

Evaluation of Neurosensory Function Following Inferior Alveolar Nerve Lateralization for Implant Placement.

BACKGROUND: Adequate bone height and width is the most important parameter for success of implants. Prolonged edentulous area in mandibular posterior region is often associated with atrophy precluding the use of dental implants. Inferior alveolar nerve (IAN) lateralization is a challenging surgical procedure as it involves the exposure of the neurovascular bundle from its compact bony compartment and adequate retraction while immediate placement of implant. AIM: Evaluation of neurosensory disturbances related to IAN lateralization for implant placement in the posterior atrophic edentulous mandible. MATERIALS AND METHODS: Ten patients above the age of 18 years with an edentulous span in mandibular posterior region showing distance from alveolar crest to IAN ≤ 8 mm (CBCT) were included in the study. The postoperative analysis of NDs was done using Semmes-Weinstein Monofilaments (SWM). Readings were made on the 1st and 7th postoperative day and every month thereafter until the neural sensations were restored. RESULTS: All patients reported neurosensory disturbance on post-op day 1. None of the patients responded to SWM lesser than 4.56 on first postoperative day, which indicated 100% incidence of neurosensory disturbances. The minimum time required for complete recovery was 2.0 months, and maximum was 4.0 months. CONCLUSION: IAN lateralization is a useful method for managing the atrophic posterior mandible with dental implants. If done precisely with experienced personnel, it can provide a worthy option for surgical restoration of atrophic mandible with minimal temporary NDs.

Maxillofacial injury from a leopard attack.

Although leopards are found worldwide, the incidence of leopard attack on humans is reported most often from India and Nepal. Usually, leopards avoid contact with people, but humans may occasionally be targeted as prey. Animal bite wounds may express as punctures, abrasions, tears, or avulsions. The force and bluntness of the teeth increase the probability of a crush injury with devitalized tissue. The clinical presentation and appropriate treatment of infected bite wounds vary according to extent of the wound. These wounds are considered complex injuries infected with a unique polymicrobial inoculum. As the bite injuries are commonly found on the face, an oral and maxillofacial surgeon should be familiar with the management of animal bites. This article reviews a case of a victim attacked by the leopard, the treatment provided to the victim, and brief notes on the management of such facial animal bite injuries.

A Rare Simultaneous Occurrence of Odontogenic Keratocyst and Unicystic Ameloblastoma in Mandible: A Case Report.

Odontogenic Keratocyst (OKC) and Ameloblastomas are slow growing benign odontogenic lesions that primarily occur in the molar region of the mandible. Clinically and radiographically both ameloblastoma, especially the Unicystic ameloblastoma and OKC are indistinguishable due to the similar location of occurrence and the age of patients. It is very rare for these lesions to arise simultaneously in a patient's jaw. The co-occurrence of Ameloblastomas with odontogenic cysts or other odontogenic lesions (histologically in a single lesion)have already been described as combined or hybrid lesions. There are very few reported cases in the English literature for simultaneous occurrence of Unicystic Ameloblastoma and OKC as completely distinct lesions. Here we present such a rare case of the simultaneous occurrence of OKC and ameloblastoma in the posterior region of the mandible of a 22-year-old male in close relation.

Immediate, Non Submerged Root Analog Zirconia Implant in Single Rooted Tooth Replacement: Case Report with 2 years Follow Up.

This report demonstrates the clinical use of a modified, truly anatomic, root analogue zirconia implant for immediate replacement of a right mandibular first premolar. A 22-year-old female patient with chronic apical periodontitis of the right mandibular first premolar was referred and the tooth was carefully extracted. A truly anatomical, root identical, roughened zirconia implant modified by macro-retentions was manufactured and placed into the extraction socket by tapping 3 days later. After 4 months a composite crown was cemented in place. No complications occurred during the healing period. A good functional and aesthetic result was achieved with minimal bone resorption and soft tissue recession at 18 months follow-up. This report describes the successful clinical use of an immediate, single stage, truly anatomical root-analogue zirconia implant for replacement of a single rooted tooth. Significant modifications such as macro-retentions yielded primary stability and excellent osseointegration. This novel approach is minimally invasive, respects the underlying anatomy and aids socket prevention. In addition the procedure saves time and cost, has good patient acceptance as there is no need for osteotomy, sinus lift or bone augmentation.

Management of Late Post-traumatic Facial Artery Pseudoaneurysmal Cyst: Review of Literature.

Pseudoaneurysms of the branches of the external carotid artery as a result of trauma are rare in oral and maxillofacial surgery practice. The most affected branches are the superficial temporal artery, internal maxillary artery and distal part of facial artery, usually where they pass over the bone. Very few cases of facial artery pseudoaneurysms of proximal parts (from external carotid artery up to the lower border of the mandible) are reported in the literature. We present a review of literature for management of late post-traumatic pseudoaneurysmal cyst and a case report involving proximal part of facial artery in the submandibular region following open reduction and rigid fixation of the condylar fracture in a 25-year-old male. To our knowledge this is the fourth reported case of proximal facial artery pseudoaneurysm.