Co-existence of oral intra-muscular lipoma and lobular capillary hemangioma: A rare case report.

INTRODUCTION: Intramuscular lipoma are benign mesenchymal soft tissue neoplasm of mature adipocytes that arises within the muscle. Oral intramuscular lipoma are more commonly seen on tongue. Lobular capillary hemangioma (LCH) on the other hand are common benign vascular neoplasms which are often confused with pyogenic granuloma. PRESENTATION OF CASE: In this paper we present a rare case of co-existence of oral intramuscular lipoma with LCH. A 65 year old male complains of swelling on the left chin region from past 4-5 years. On complete intraoral examination another mass was noted on ventral surface of tongue. After performing USG and FNAC of the swelling in the chin region, an excisional biopsy was done and was sent for histopathological examination which showed thin connective tissue septa separating lobules of mature adipocytes. Histopathological examination of tongue mass revealed a benign tumor composed of blood vessels comprising of small capillary sized vascular channels. After a follow-up of 1 year patient showed no signs of recurrence. DISCUSSION: According to the literature recurrences are seen in case of intramuscular lipoma due to difficulty in total excision of the lesion. Immunohistochemistry plays a crucial role in distinguishing LCH from pyogenic granuloma. Intraoral LCH should be properly excised after understanding the vascularity of the lesion. CONCLUSION: In literature, the co-existence of intraoral lipoma with other lesions have been encountered hence for a surgeon a complete examination of oral cavity plays a crucial role to rule out such co-existence.

Combating inadequate anesthesia in periapical infections, with sodium bicarbonate: a clinical double blind study.

INTRODUCTION: Local anesthetics are generally much less effective when administered in inflamed tissues. PURPOSE: This study was conducted to validate the addition of sodium bicarbonate in local anesthetics to increase its effectiveness as local infiltrations in teeth associated with periapical infections. METHODS: Two hundred subjects requiring extraction of maxillary teeth with periapical infections were enrolled. These subjects were divided in two groups of 100 subjects each. One group received local infiltration with 2 % lignocaine and 1:80,000 adrenaline, and the other group received local infiltration with sodium bicarbonate as an adjunct to the above mentioned local anesthetic solution. All extractions were performed using a consistent intra-alveolar technique by a single operator. Both the patient and the operator were blinded to the contents of local anesthetic solution. Data related to the onset of action of local anesthesia, pain experienced by the patient while undergoing extraction on two scales-"the visual analog scale and the verbal response scale", and any requirement of repeated injections during the procedure was recorded. RESULTS: Clinical and statistical data confirmed that the addition of sodium bicarbonate in local anesthetics did increase the efficacy of local anesthesia in inflamed tissues. CONCLUSION: It has been observed in this study that the action of sodium bicarbonate in local anesthetics increases the pH levels of these solutions, thus possibly making them more effective in an acidic environment.