Computed Tomographic Analysis of Position of Mandibular Canal and Mandibular Foramen in Patients with Mandibular Asymmetry.

Introduction: Mandibular osteotomies in facial asymmetry are complicated by the abnormal position and course of inferior alveolar nerve. This manuscript aims to evaluate the possible variations in the preoperative positions of mandibular canal and mandibular foramen in patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia. Materials & Methods: This study included 15 patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia for which bilateral sagittal split osteotomy (BSSO) was performed as a corrective procedure. The presence/absence and extent of postoperative neurosensory deficiency was recorded subjectively and objectively. The measurements were done using multiplanar reconstruction (MPR) of three-dimensional radiographic imaging and were compared to normal subjects. Discussion: The results revealed that the mandibular canal was closer to the buccal cortex on the affected side and the inferior border on both sides in the region of second molar in condylar hyperplasia. In condylar hypoplasia, the canal was nearer to the inferior border and the alveolar crest in relation to second and third molars respectively on the affected and contralateral sides.The mandibular foramen was also more superior to the occlusal plane on both sides in both condylar hyperplasia and hypoplasia. Conclusion: Based on the study outcomes, the authors propose that assessment of the positions of mandibular canal and mandibular foramen is crucial to avoid postoperative neurosensory deficiencies.

Congenital granular cell epulis: a rare paediatric tumour of newborn.

Congenital granular cell epulis is a congenital growth rarely found on the gingiva of neonates. These remarkably large tumours present in an infant's mouth may impede with feeding, respiration or adequate mouth closure. Recognition of this entity and prompt treatment are essential for preventing any difficulties for the neonate. This is a case report of a 35-day-old female neonate who presented with a single exophytic lesion in the maxillary alveolar ridge. The differential diagnosis, management regimens and complications of this condition are reviewed. The lesion was excised under intravenous sedation and subjected to histopathological analysis. Based on the microscopic findings, the diagnosis of congenital granular cell epulis was confirmed. Clinicians including paediatricians, sonographers, dentists and surgical pathologists should be able to timely recognise and intervene such tumours as they may be potentially harmful to the infant.

Canalicular adenoma: palatal presentation of an uncommon lesion.

Canalicular adenoma is a unique, rare, benign salivary gland neoplasm whose reported prevalence varies in different studies. According to literature, this neoplasm has a marked predilection to occur in the upper lip of elderly women. Histological features are usually distinctive and diagnostic. This neoplasm has good prognosis after conservative surgical management but the propensity of multifocal nature and recurrence of this lesion mandates regular follow-up. This case report illustrates the case of a canalicular adenoma in the palate in a 71-year-old male patient. Here, we discuss the differential diagnosis with a brief review of literature.

Mucoepidermoid carcinoma of retromolar area: an incidental finding.

Salivary gland tumours can arise in any location in the oral cavity but are rather rare in the retromolar region. The majority of the salivary neoplasms arising here are malignant in nature. Mucoepidermoid carcinoma is more commonly seen in the palate. Tumours arising in the retromolar region tend to show symptoms late in onset and may be greater in extent than evident clinically. Imaging studies will help in understanding the full extent of these lesions. We report a case of mucoepidermoid carcinoma arising in a young female patient who reported for orthodontic correction. In the course of examination, a palpable swelling was identified in the right retromolar area, which was eventually diagnosed as intermediate-grade mucoepidermoid carcinoma. Wide resection with adjuvant radiotherapy was the treatment given for the patient.

CBCT evaluation and surgical management of an unusual cystic lesion: A case report.

This is a case of swelling originating from dens invaginatus associated with lateral incisor, misdiagnosed as a globulomaxillary cyst. The initial diagnosis of globulomaxillary cyst was made solely from radiographs by observing a reverse pear-shaped radiolucency between the lateral incisor and cuspid. The results following pulp testing and Cone Beam Computed Tomography (CBCT) evaluation revealed the endodontic origin of the lesion, which entailed the treatment carried out by surgical enucleation and apicoectomy. This also details the clinical and diagnostic dilemma as well as conflicts associated with the diagnosis and management of the cystic lesion.

Extranodal diffuse large B cell lymphoma of maxillary sinus presenting as a palatal ulcer.

A multitude of disease processes ranging from periodontitis to malignancies can lead to formation of solitary ulcer on the palate. Hence solitary ulcers of palate can often be a challenging one to diagnose. We report an interesting case of a diffuse large B cell lymphoma of the maxillary sinus which perforated the palatal bone and presented clinically as a palatal ulcer. Initially the lesion manifested as a small ill-defined swelling in the posterior palatal slope in relation to 24and25 which were mobile and hence was erroneously diagnosed as chronic periodontal abscess. This paper is intended to stress the relevance of including non-Hodgkin's lymphoma in the differential diagnosis of solitary palatal ulcers as it may be often misdiagnosed as more common reactive or inflammatory lesions.

Profile Changes and Stability following Distraction Osteogenesis with Rigid External Distraction in Adult Cleft Lip and Palate Deformities.

OBJECTIVES: The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result. MATERIALS AND METHODS: Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin. STATISTICAL ANALYSIS USED: Wilcoxon Signed-Ranks test was used, and the probability value (P value) of 0.05 was considered as statistically significant level. RESULTS: Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm (P < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° (P < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm (P < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm (P < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable. CONCLUSION: The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This stressed on the need for overcorrection of about 35%-40% for adult CLP patients.

Temporomandibular Joint Dislocation in an 18-month-old Child.

Temporomandibular joint (TMJ) dislocation in children is extremely rare. In our case, an 18-month-old child presented with a history of inability to close her mouth. To confirm the clinical diagnosis, a computed tomogram was taken. Clinical examination and X-ray of the TMJ revealed bilateral TMJ dislocation. Bilateral TMJ reduction was achieved manually after giving analgesia and procedural sedation. This is one of the few case reports of an acute dislocation in a toddler.

Hematological and surgical management in Glanzmann's thrombasthenia: a case report.

Glanzmann's thrombasthenia (GT) is a rare, congenital, and moderate to severe platelet disorder. The bleeding time is increased, due to lack of platelet aggregation, since the patients with GT have deficient or dysfunctional integrin membrane glycoproteins IIb and IIIa essential for platelet aggregation. Children with GT are mostly diagnosed very early in life due to the spontaneous and unexplained mucocutaneous bleeding. It is quite a challenging task when any surgery is indicated for children with GT. This case report is about the medical and surgical management of an 11-year-old girl diagnosed with Glannzmann's thrombasthenia who had to undergo a maxillary cyst enucleation.

Filariasis of the buccal mucosa: A diagnostic dilemma.

Filariasis is an endemic disease in tropical and subtropical countries. Filarial nematodes can infect humans through vectors, commonly mosquitoes. Human infection can manifest as lymphatic filariasis, subcutaneous or pulmonary nodules and with eye involvement. Intra-oral presentation is very rare and often poses a diagnostic dilemma to the dentist. We report a case of intra-oral Dirofilaria repens infection in a 54-year-old female patient, involving the buccal mucosa. History was unremarkable and on clinical examination, a diffuse swelling with no significant signs and symptoms was seen. Laboratory investigations and radiographs were non-contributory to diagnosis. Ultrasound findings revealed a hypo-echoic lesion in the muscular layer of the left cheek. Differential diagnoses considered were minor salivary gland tumor, parotid sialolith, and cysticercosis among others. The presence of a Dirofilaria worm in the excised nodule confirmed the diagnosis. Medical awareness of the risk of intra-oral nematode infection is essential. A detailed travel history, awareness of endemic status of certain diseases, proper diagnosis and management helps in better prognosis for the patient.