Delayed Presentation of Mandibular Osteonecrosis Following Herpes Zoster Infection - A Case Report.

Rationale: Apart from the usual presentation of herpes zoster (HZ) infection (HZI), reports of spontaneous teeth exfoliation and osteonecrosis are infrequent and sporadic. Patient Concerns: A 51-year-old male patient presented with spontaneous exfoliation of multiple teeth and subsequent pathological fracture on the right side of the lower jaw after three months of HZI. Diagnosis: Biopsy was taken from the alveolar bone of the oedematous region, which revealed the presence of trabeculae of dead bone with empty lacunae. Intervention: Necrosed part of the alveolar bone was excised under local anaesthesia and antibiotic coverage, which was followed by open reduction and internal fixation of the pathological fracture under general anaesthesia. Outcomes: The patient was followed up for one year without any evidence of recurrences. Take-away Lessons: Presentation of osteonecrosis following HZI is unique but rare and should be diagnosed at the earliest.

Intraoral Management of Latrogenic Tooth Displacement: A Report of Two Cases and a Brief Review of Literature.

Iatrogenic displacement of a tooth or tooth fragment is a rare but well-recognized complication that occurs during exodontia. The most common sites of dislodgment of a mandibular third molar fragment are the sublingual, submandibular, and pterygomandibular and lateral pharyngeal spaces. Removal of a displaced tooth from these spaces may be complex due to poor visualization and limited access. A thorough evaluation of all significant risk factors along with precise localization of the tooth by clinical and radiographic means should be performed to prevent untoward complications. This paper reports two cases of iatrogenic displacement of mandibular third molar teeth, in the sublingual space and lingual pouch. Both the cases were managed intraorally under general anesthesia, and the postoperative healing was satisfactory and uncomplicated. A brief review of literature is also provided in this paper.

Gorham's disease of mandible--a rare case presentation in pediatric patient.

Gorham's disease or vanishing bone disease is a rare, progressive musculoskeletal disorder characterized by resorption of bone matrix, and later replaced by fibrous connective tissue. The disease has no specific predilection for age, gender, or race. The most common sites of involvement are the shoulder and pelvic bones. To date, nearly 50 cases of Gorham's disease with maxillofacial involvement have been reported in the literature. The etiology of Gorham's disease is not known, clinical features are variable, and prognosis is generally good unless vital structures are involved. Due to the rarity of the condition, no definite treatment protocol exists for this disorder. Here, we described a pediatric case of Gorham's disease with mandibular involvement.

Clinical Evaluation of Neurosensory Changes in the Infraorbital Nerve Following Surgical Management of Zygomatico-Maxillary Complex Fractures.

INTRODUCTION: Zygomatico-orbital fractures are the second most common facial injuries. Trauma to mid-facial region can lead to an alteration or loss of sensation in the facial region which sometimes requires early surgical intervention to aid in an early recovery. AIM: To evaluate the different neurosensory changes in the infraorbital nerve function following common treatment modalities used in the management of zygomatico-maxillary complex fractures. MATERIALS AND METHODS: Thirteen patients selected for the study had unilateral zygomatic complex fracture with altered sensation in the region of distribution of the infraorbital nerve. The fractures were managed either by reduction followed by internal fixation with mini-plates (Group A), reduction alone (Group B) or conservatively (Group C). Infraorbital nerve function tests were done by mechanical, heat and pain threshold detection. Evaluation was done on 1(st), 3(rd), 7(th) day, one month, three months and six months interval in a manner similar to that done at the beginning of the study (Day0). RESULTS: A male predominance with male:female ratio of 5.5:1 and an age range of 21 to 50 years was found with the right side mostly affected. Road traffic accident was the most common aetiology. Most common clinical presentations were sub-conjunctival haemorrhage (84.61%), flattening of the malar prominence (69.23%) with deficit in neurosensory function of infra orbital nerve. Recovery in the infraorbital nerve function was relatively complete in 76.92% cases with partial recovery in 23.07% of the patients. CONCLUSION: Marked improvement in the neurosensory function of the infraorbital nerve was found when some form of treatment either in the form of Open Reduction and Internal Fixation (ORIF) or approach through Gillie's temporal or Keen's intraoral approach were applied as compared to when conservative treatment was provided. In zygomatic complex fractures, any form of treatment employed brought about decompression of the infraorbital nerve which aided in the recovery of the nerve within a span of 1-6 months, except when no treatment was applied.

A huge epidermoid cyst endangering life.

Epidermoid cyst of the neck or auricular area are relatively more common than that of the oral cavity. In most cases about 80% they remain asymptomatic. But in about 20% cases it becomes painful because of secondary infection seeking treatment. Here we present a case report of biopsy proved Epidermoid cyst with life threatening infection.