Membrane Assisted Palatal Fistula Closure in a Cleft Palate Patient: A Novel Technique.

Palatal fistula following cleft palate repair, is one of the considerable complications and remains a challenging problem to the surgeons. The reported recurrence rate of the fistula is between 33% to 37%. Due to fibrosis and poor vascularity of adjacent tissues, high recurrence rates are typical. Closure of palatal fistulas can be achieved by different surgical techniques like local, regional and distant flaps, local turnover flaps, pedicled flaps from oral mucosa, buccal fat pad flaps, inter-positional cartilage grafts can be utilized for management of small fistulas. For larger fistualas, tongue flaps, temporalis muscle flaps, musculomucosal flaps, nasal septal flaps and free flaps can be used. These procedures are often cumbersome and leave a raw nasal or oral surface, which may increase the incidence of postoperative problems or some flaps can be bulky and may require a second-stage procedure. Different synthetic materials such as alloderm, Poly-D and L-Lactic Acid or "PdLLA" and collagen membrane are used in multilayer repair represented by the nasal mucosa, the inter-positional graft and oral mucosa. These interpositional grafts provide a scaffold for in growth of tissues, revascularization and mucosal epithelialization. We present a case of closure of an oronasal fistula, using resorbable collagen membrane in three layered repair to avoid recurrence.

Intralesional Sclerotherapy - A Novel Approach for The Treatment of Intraoral Haemangiomas.

In infancy and childhood haemangiomas are the most common neoplasms in head and neck region with an occurrence of about 60%. Approximately 40%-50% of all haemangiomas resolve incompletely, leaving permanent changes in the skin, such as telangiectases, epidermal atrophy, hypopigmentation or redundant skin with fibro-fatty residue but a few stubborn, problematic haemangiomas may result in serious disfigurement and dysfunction, and even become life-threatening. Most haemangiomas are managed by conservative methods that include corticosteroids (either systemic or local injection), sclerotherapy, interferon-alpha, laser therapy, embolization, cryotherapy, and radiation. Due to risk of haemorrhaging, surgical removal for small vascular lesions is not considered and it is more invasive than sclerotherapy. This case report presents the efficacy of intralesional sclerotherapy for the management of haemangiomas on dorsum and lateral border of tongue.

Rare Case of Spindle Cell Haemangioma.

Spindle cell haemangioma (SCH) is a benign vascular lesion which usually occurs on distal extremities. It was previously regarded as haemangioendothelioma and was initially perceived to be low grade angiosarcoma.They are characterized by cavernous blood vessels and spindle cell proliferation. It is now considered as a reactive lesion and conservative surgical excision is preferred treatment. Intraoral occurrence is rare; hence we present a case of SCH in a 33-year-old male that presented as a swelling below the tongue. Histopathology showed well circumscribed proliferating spindle cells attached to vessel walls, dilated vascular spaces. The lesion was positive for CD31 and CD34 markers suggesting it to be of endothelial cell origin.

Large complex odontoma of mandible in a young boy: a rare and unusual case report.

Odontomas are the most common odontogenic tumors. They are broadly classified in to Compound Odontoma and Complex Odontoma. Among them complex odontoma is a rare tumor. Occasionally this tumor becomes large, causing expansion of bone followed by facial asymmetry. Otherwise these tumors are asymptomatic and are generally diagnosed on radiographic examination. We report a rare case of complex odontoma of mandible in a young boy. The tumor was treated by surgical excision under general anesthesia.

Gaint epidermoid cyst of external ear- a rare case report.

Epidermoid cysts are developmental, benign, cutaneous cysts which are commonly found on face followed by trunk and neck. They account for approximately 80% of follicular cysts of the skin. They are slow growing lesions and remain asymptomatic until or unless secondarily infected. They occasionally have tendency to develop into a malignancy. We describe a case of giant epidermoid cyst of posterior part of external ear, a location where very few cases have been reported in the literature. Since cyst was attached to the external ear, esthetics was also one of the important concern apart from the cyst getting infected, as they cause disfigurement of the face. The cyst was excised surgically. Histopathology confirmed the presumptive diagnosis of Epidermoid cyst. Two-years after the resection there was no recurrence. Due to the possibility of the cyst to transform into a malignancy and for appropriate diagnosis, histopathological examination remains a gold standard for confirmatory diagnosis.

Nonsyndromic bilateral multiple impacted supernumerary mandibular third molars: a rare and unusual case report.

A supernumerary tooth is that which is present additionally to the normal series and can be found in any region of the dental arch. An impacted tooth is defined as the one which is embedded in the alveolus, so that its eruption is prevented, or the tooth is locked in position by bone or the adjacent teeth. The occurrence of multiple supernumerary teeth in only one patient in the absence of an associated systemic condition or syndrome is considered as a rare phenomenon. The occurrence of supernumerary teeth in the lower molar region is rare. A prevalence of less than 2% of cases occurring in this region has been estimated. Their occurrence presents a clinical problem for orthodontists and oral surgeons. The cause, frequency, complications, and surgical operation of impacted teeth are always interesting subjects for study and research. An impacted tooth can result in caries, pulp disease, periapical and periodontal disease, temporomandibular joint disorder, infection of the fascial space, root resorption of the adjacent tooth, and even oral and maxillofacial tumours. The management of impacted wisdom teeth has changed over the past 20 years from removal of nonsymptomatic third molars to simple observation. The aim of this paper is to present a rare case of bilateral multiple impacted supernumerary mandibular third molars.

Odontogenic fibromyxoma of maxilla: a rare case report.

Fibromyxoma is a rare odontogenic tumour which is benign, but locally aggressive. The etiology of these tumours is unknown, but because of its limitation to the teeth bearing areas and occasional presence of odontogenic epithelial fragments within the tumour which suggest that it is of odontogenic origin. It is a slow growing painless tumour that frequently occurs in second and third decades of life. Females are more commonly affected than males. The tumour can cause gradual expansion of the cortical plates and cause loosening and displacement of teeth, although root resorption may be rare. The surgical treatment of these tumours consists of complete enucleation or radical excision. The aim of this paper is to present the rarity of a fibromyxoma of the maxilla.

Iatrogenic inflammatory fibrosis of hard palate in a 13-year-old female patient.

Palatal swellings are rare in children and the incidence differs from that of the adult counterparts. When the palatal swellings do arise in children, they usually are palatal abscess from periapical region, and few cases like pleomorphic adenoma in young adults have also been reported. But inflammatory fibrosis of palate in children is a rare occurrence. Inflammatory fibrosis is formation of excess fibrous connective tissue in an organ or tissue, as a reparative or reactive process. This report describes an unusual case of iatrogenic inflammatory fibrosis on the palate due to extraction of tooth number 22 in a 13-year-old female patient. The patient presented with a single large well-circumscribed oval palatal swelling that was soft, fluctuant, not fixed, and nontender. Surgical excision of the lesion was done and it was sent for histopathological assessment. The biopsy showed fibrous tissue with collagen fibers, spindle shaped fibroblasts, neovascularization, RBCs, chronic inflammatory cells, and traces of salivary gland and nerve tissue.

Surgical Management of Aggressive Central Giant Cell Granuloma of Maxilla through Le Fort I Access Osteotomy.

Giant cell granuloma (GCG) is an uncommon bony lesion in the head and neck region, most commonly affecting the maxilla and mandible and has a female predilection. The clinical behavior of central GCG ranges from a slowly growing asymptomatic swelling to an aggressive lesion. The clinical, radiological, histological features and management of an aggressive GCG of maxilla in an 18-year-old female patient are described and discussed. It is emphasized that surgery is the traditional and still the most accepted treatment for GCG. Le Fort I osteotomy has been advocated as one of the access osteotomy for the surgical management of aggressive and extensive GCG involving the maxilla. The postoperative morbidity and recurrence have been discussed.

Aggressive form of cherubism.

Cherubism is a rare non-neoplastic hereditary disease related to genetic mutations characterized by symmetrically swollen cheeks, particularly over the angles of the mandible, and an upward turning of the eyes. The affected mandible and maxilla begin to swell in early childhood, and gradually increase until the age of puberty. Apparently, surgical intervention is unnecessary unless significant functional, esthetic, or emotional disturbances develop. In the present paper, we report a case of cherubism, with classic features that was classified as grade 3, managed with surgery and followed up for 2-years after treatment.