Factors Predicting Nodal Metastasis in Penile Cancer: Analysis from a Tertiary Center.

INTRODUCTION: Lymph node metastasis is an important prognostic marker in penile cancer. Identification of occult metastasis is by lymphadenectomy based on the histological features of primary tumor; however, this leads to unnecessary surgical morbidity in node negative patients. METHODS: A retrospective analysis of all surgically treated penile cancer patients managed at our institute from January 2011 to March 2014 was performed. Patient characteristics, histological factors, and lymph node involvement were identified. Logistic regression analysis was used to compute odds ratio (OR) in univariate and multivariate analysis. RESULTS: Ninety seven patients underwent surgical management at our institute during the abovementioned period. Grade III tumor, presence of lymphovascular invasion, tumor thickness >10 mm, perineural invasion (PNI) and Ki67 >50% were significantly associated with nodal metastasis. On multivariate analysis, only presence of PNI was found to be significant (OR: 6.82) (95% confidence interval: 1.72-27.03) (p = 0.006). CONCLUSION: PNI is a strong independent predictor of occult lymph node metastasis in penile cancers. Its inclusion in stratification of clinically node negative patients will identify high-risk patients who will benefit from prophylactic lymphadenectomy.

Tru-cut needle biopsy: A novel approach in the diagnosis of solid oral pathologies.

Nowadays, new biopsy techniques such as fine and wide needles are now employed instead of invasive biopsy techniques. Compared to open biopsy, true-cut needle biopsy has a number of advantages. It's quick and simple to do, can be done in an outpatient department, avoids incisions into previously irradiated skin, and has few risks. In order to examine malignant and benign tumours, there had been a debate in the past century on the utilisation and efficiency of tru-cut biopsy over Fine needle aspiration cytology (FNAC) and surgical biopsy in solid tumours. A non-odontogenic tumour that occurs in jaws, also classified as a fibro-osseous lesion of the jaw, is Cemento-Ossifying Fibroma. Clinically, these lesions occur as gradually growing, reaching an enormous size if not treated. In this article, a case of cemento-ossifying fibroma noticed in the maxilla with facial swelling is discussed and the diagnosis was done using a tru-cut needle biopsy.

A Prospective Study to Assess the Efficacy of 4% Articaine, 0.5% Bupivacaine and 2% Lignocaine using a Single Buccal Supraperiosteal Injection for Maxillary Tooth Extraction.

INTRODUCTION: The aim of this study was to demonstrate if articaine hydrochloride administered alone as a single buccal infiltration in maxillary tooth extraction can provide adequate palatal anesthesia as compared to buccal and palatal injection using lidocaine and bupivacaine. MATERIALS AND METHODS: A prospective double-blinded trial was conducted on 150 patients who required maxillary tooth extraction. The patients were divided into three different groups consisting of 50 patients each. Each group was administered with 4% articaine into buccal vestibular mucosa of the tooth to be extracted, 2% lignocaine and 0.5% bupivacaine was injected into buccal and palatal side of the tooth to be extracted, respectively. Following the tooth extraction, all patients were asked to complete a 10-score Visual Analog Scale (VAS) and 5-score facial pain scale (FPS) to assess the pain on extraction. RESULTS: According to the VAS and FPS scores, the pain on extraction between buccal infiltration of articaine and the routine buccal and palatal infiltration of lignocaine was statistically significant. CONCLUSION: The routine use of a palatal injection for extraction of maxillary teeth may not be required when articaine is used as a local anesthetic solution.

A Rare Incidence of Metachronous Neurovascular Lesions in a Child.

Neurofibroma is an uncommon benign tumor arising from nerve sheath fibroblasts. The diagnosis of solitary lesions becomes difficult in patients who do not have any family history of neurofibroma. An intra-oral solitary neurofibroma comprises 6.5% of reported cases of neurofibroma. Few cases of intraosseous solitary neurofibroma have been published as per literature. Treatment-surgical resection of tumor has an excellent prognosis with extreme rare malignant transformation which is more commonly seen in neurofibromatosis. A periodic follow-up is necessary in solitary tumors to rule out syndromic cases. Leiomyoma is a benign tumor of smooth muscle origin, which is usually diagnosed in the gastrointestinal tract, uterus, and skin. The most effective treatment for solid, vascular, and epithelioid angioleiomyomas is surgical resection along with tumor capsule. Here we report an uncommon occurrence of multiple benign tumors in a pediatric patient.

Transient diplopia: A loco regional complication of inferior alveolar nerve block.

A 34-year-old female patient required surgical removal of lower left third molar under local anesthesia. Two percent lignocaine with 1:80000 adrenaline was used for administrating inferior alveolar nerve block at dental clinic. Twenty five minutes after the surgical removal, patient developed diplopia on the left eye. This transient diplopia could be due to retro flow of local anesthetic agent through the inferior alveolar artery and indirectly to the ophthalmic artery paralyzing the lateral rectus muscle. Patient recovered after 60 minutes. This article discusses the possible etiologies of diplopia, the mechanism behind this ophthalmic complication, and the review of various reported literature.

Dentists' Knowledge, Attitude and Practice in Treating Patients Taking Oral Antithrombotic Medications - A Survey.

INTRODUCTION: India lists high on patients suffering from diabetes, hypertension, stroke and myocardial infarction. Hence, a large proportion of the population is on long term Oral Antithrombotic Medications (OAM). Though several guidelines exist on dental management of these patients, previous surveys have shown variation among the dentists. AIM: The purpose of this study was to assess the knowledge, attitude and practice of dentists in Chennai, India, towards dental management of patients taking OAM using a questionnaire survey. MATERIALS AND METHODS: The survey was conducted among 256 dentists in Chennai, India using a printed questionnaire containing 16 questions, at their university location. Descriptive statistical analysis was used to analyze the data. RESULTS: Of the final population of dentists who were included in the survey (n =212), majority of them were aware about drugs such as warfarin and aspirin compared to other newer drugs (dabigatran, rivaroxaban). Most participants took physician's opinion before proceeding with any invasive dental procedure and thromboembolic events were their major concern while treating patients on OAM. CONCLUSION: The survey revealed dentists are knowledgeable about management of patients on OAM. However, they tend to overestimate the bleeding risk, thus being cautious in their treatment approach. Based on the results of the study, the authors suggest that continuing dental education programs and further training on management of such medically complex patients will be beneficial in order to provide optimum dental care to people taking OAM.

Non Infiltrating Angiolipoma of the Palate in Geriatric Patient: A Case Report with Review of Literature.

Angiolipoma is one of the rare variant of lipoma. This benign tumour consists of both fatty and vascular elements. It mostly occur in the trunk and extremities and is uncommon in head and neck region. Angiolipoma is classified as infiltrating and non- infiltrating types. Among all neoplasms of the oral cavity, lipomas account for 1 to 5% and the incidence of angiolipoma is 5 to 17% in it. There is no sex predilection for this tumour. It is classified as infiltrative and non-infiltrative type. Surgical excision is the method to be considered for both the types of angiolipoma, however the infiltrating type recurs post-surgery. We report a rare case report of 55-year-old female with non-infiltrating angiolipoma of the hard palate mimicking a mucocele treated by surgical excision with no signs of recurrence and good wound healing after three months follow up with minimal scar formation.

Primary Synovial Sarcoma of the Kidney with Inferior Vena Caval Thrombus.

Synovial sarcomas occurs primarily in the soft tissues, mostly in para-articular regions of the extremities. These tumors have been described in other unusual locations like the pleura, lungs, mediastinum, and kidneys. Primary synovial sarcoma of the kidney is a recently described entity; to date, a total of approximately 35 cases have been reported. Only three cases of primary synovial sarcoma of kidney with IVC thrombus have been reported so far. Here we present the case of a 44 year old gentleman, with primary synovial sarcoma of the left kidney with caval thrombus.

"Histiocytosis X" - A Rare Case Report.

Histiocytosis X is an idiopathic disease, characterized by a disorder of the reticulo-endothelial system in the human body. Histopathological studies carried out right from the 1800s have seen a significant similarity in the pathologic process of different stages in particular clinical syndromes showing proliferation of mature histiocytes. It was then modified by Lichenstein in 1953 as "Histiocytosis X". The exact aetiology is unknown; hence, the name "Histiocytosis X". The disease classically presents with three syndromes namely Eosinophilic granuloma, Letterer-Siwe disease and Hand-Schuller-Christian disease. These syndromes present with a spectrum of clinical manifestations with histiocytic proliferation in the granulomatous lesion. The disease is neither familial nor hereditary, nor does it have any microbiological pathologic origin. This disease can be conservatively managed by antibiotics and steroids or surgical curettage with radiotherapy. We report a five-year-old male child who was incidentally diagnosed to have Histiocytosis X. This patient was managed with a moderate surgical procedure with total avoidance of radiotherapy. An adequate follow-up of this patient shows total regression of the lesion and good bone healing.

Solitary median maxillary central incisor: A case report of a rare dental anomaly.

The solitary median maxillary central incisor (SMMCI) syndrome is a rare dental anomaly and has an incidence of 1:50,000 live births. In SMMCI, there is only one central incisor present, and it develops exactly at the midline. SMMCI occurrence has been described with growth hormone deficiency or other structural anomalies in the midline of the body. In this case, the 8-year-old female patient reported a single median maxillary central incisor with missing maxillary and mandibular frena, with apparently no other abnormalities. Early diagnosis and recognition of SMMCI are important for all practicing Orthodontists, as it may be a sign of other severe congenital or developmental abnormalities.