The Burden and Correlates of Waterpipe (Hookah) Smoking among Adolescents and Youth: A Systematic Review.

BACKGROUND: This systematic review evaluated the available medical literature on the prevalence and trends of waterpipe tobacco smoking among adolescents and youth in jurisdictionally representative populations. METHODS: PubMed, Embase, and Scopus were searched for relevant studies from inception until 31 December 2022 that reported the burden of waterpipe smoking among adolescents and youth (10-24 years of age). We extracted qualitative data on the demographic characteristics, burden, and correlates of waterpipe smoking (PROSPERO ID: CRD42022310982). RESULTS: A total of 2,197 articles were screened and 62 were included in the analysis. The majority (29) of the studies was from the United States of America and there were no studies from the south-east Asian region. The prevalence of ever waterpipe smoking among the 10-24 years age group was noted to be 18.16% (95% CI, 18.03-18.29). The prevalence of current (30-day) waterpipe smoking was 6.43% (95% CI, 6.34-6.50). The age of initiation of waterpipe smoking was variable. The prevalence of waterpipe smoking was higher among males, among those who belong to the high- and middle-income groups, and among university students. The common risk factors of waterpipe smoking included cigarette smoking, alcohol, and substance use. Waterpipe smoking resulted in increased susceptibility to the use of conventional forms of tobacco (e.g. smoking) among those who were never smokers. CONCLUSION: Waterpipe smoking usage was significantly high among adolescents and young adults. Developing regulatory guidelines for water-pipe smoking, surveillance of its use, intervention, and specific policy frameworks may be considered a public health priority.

Effects of post-COVID-19 vaccination in oral cavity: a systematic review.

OBJECTIVES: SARS-CoV-2 virus and its variants continue to be on a rampage worldwide. Several vaccines are being marketed to control their spread and reduce severity of symptoms in the affected. Various adverse events are being reported following the vaccine administration and therefore this systematic review investigated the oral adverse events post-COVID-19 vaccination. MATERIALS AND METHODS: A systematic search of five databases was conducted. Case reports, case series and observational studies describing oral lesions/oral adverse effects (outcome) following anti-SARS-CoV-2 vaccination (exposure) in humans were included. Quality assessment of the studies was done using Joanna Briggs Institute Critical Appraisal tools. A working classification was developed from reported final diagnosis. RESULTS: The systematic review included 18 individual cases. Majority of oral lesions occurred following BNT162b2 vaccination with average age of occurrence at 59.94 years. 67% of the affected individuals were female, with hypertension being the most common comorbidity. DISCUSSION: Immune-mediated oral events have a propensity of occurrence following COVID-19 vaccination. mRNA-based vaccinations may have an affinity for causing oral adverse effects. It might be due to the immune dysregulation caused by these vaccinations. CONCLUSION: The female, geriatric population and older individuals with co-morbidities might have an increased affinity to develop oral lesions post-COVID-19 vaccination.

Evaluation of two rehydration protocols for fractured tooth fragments for characteristics of penetration of resin tags using confocal laser scanning microscopy.

BACKGROUND: Fragment reattachment is the recommended treatment modality in uncomplicated crown fractures. There is a paucity of literature regarding the mechanisms responsible for increased resistance to fracture after fragment rehydration in such cases. Hence, the aim of this proof-of-concept study was to decipher the microscopic changes in the penetration characteristics of resin in tooth fragments after different rehydration protocols. MATERIAL AND METHODS: Sixty bovine incisors free of structural deformities were fractured as per a standard protocol and the fragments were stored in saline at 4°C. They were randomly allocated into three groups (n = 20)-Group 1: negative-control, no-rehydration, Group 2: rehydration by immersion in distilled water for 15 min, Group 3: rehydration by humidification for 15 min. They were subjected to the "experimental bonding protocol" using an eighth-generation bonding agent mixed with rhodamine-B dye. The samples were subjected to decalcification and sectioned into cubical blocks (2 × 2 × 2 mm3 ). They were embedded in paraffin wax, sectioned by an ultramicrotome and evaluated by using a confocal laser scanning microscope. The depths and width of the resin tags were assessed by image analysis software, and the number of tags was counted manually by blinded evaluators. Statistical analysis was done with Stata-14. RESULTS: The depth of penetration of the resin tags was greatest in Group 2 (927.81 ± 280.38 µm) followed by Group 3 (902.03 ± 371.85 µm) and Group 1 (287.74 ± 124.80 µm). Similarly, the width of the penetrated resin tags was greatest in Group 2 (58.29 ± 21.15), followed by Group 3 (35.53 ± 22.15) and Group 1 (23.89 ± 6.88). The number of resin tags in the majority of the samples in Group 1 had less than 25 tags (65%), whereas there were more than 25 tags in Group 2 (70%) and Group 3 (75%). These differences were statistically significant (p < .05). CONCLUSION: The resin penetration, as observed by the number of tags and their depth and width, was significantly affected by the rehydration of the fragments. The fragments rehydrated in the distilled water had greater penetration of resin tags than those rehydrated in a humidification chamber.

Next Generation Sequencing and Cytogenetic Based Evaluation of Indian Pierre Robin Sequence Families Reveals CNV Regions of Modest Effect and a Novel LOXL3 Mutation.

BACKGROUND: Pierre Robin Sequence (PRS) affects approximately 1 per 8500 to 14000 new-borns worldwide. Although the clinical entity is well defined, the pathogenesis of PRS is debated. The present study aims to understand the contribution of genomic imbalances and genetic variants in patients clinically diagnosed of PRS. METHODOLOGY: A total of 7 independent patients with nonsyndromic PRS thoroughly evaluated by a medical geneticist at a tertiary care hospital, were included in the study. Blood samples were collected from these patients and their family members. Array CGH was performed on all 7 patients and their respective family members for detection of underlying cytogenetic defects. Whole exome sequencing (WES) was performed for 5 families to capture single nucleotide variants or small indels. RESULTS: Cytogenetic analyses did not detect any previously reported gross chromosomal aberrations for PRS in the patient cohort. However, copy number variations (CNVs) of size <1 Mb were detected in patients which may have implications in PRS. The present study provided evidence for the occurrence of de novo deletions at 7p14.1 locus in PRS patients: further validating the candidate loci susceptibility in oral clefts. WES data identified LOXL3 as candidate gene, carrying novel deleterious variant, which is suggestive of the role of point mutations in the pathogenesis of PRS. CONCLUSION: The present study offered considerable insight into the contribution of cytogenetic defects and novel point mutation in the etiology of nonsyndromic PRS. Studies comprising large number of cases are required to fully elucidate the genetic mechanisms underlying the PRS phenotype.

Central granular cell odontogenic tumor of mandible in a child.

Central granular cell odontogenic tumor (CGCOT) is sporadic benign odontogenic tumor and it especially occurs in women older than 50 years of age. Radiologically it manifests as unilocular to the multilocular radiolucency with sometimes mixed densities. Histopathology displays sheets and islands of large eosinophilic cells with abundant granular cytoplasm, however few cases exhibit inadequate epithelium, thus creating a diagnostic confusion. Though, resection is advocated by some surgeons, however because of the non-aggressive biological behaviour, enucleation or curettage is the treatment of choice for this lesion. Till now only 39 cases have been reported in the past six decades. We are reporting the first case of CGCOT occurring in the youngest age of eleven-year-old patient with massive size of 11 × 7 × 6 cm. This would add CGCOT as a differential diagnosis in the bony lesions of younger individuals. In addition, the importance of immunohistochemistry studies in cases with scarce odontogenic epithelium and the potential role of Carnoy's solution in the management of this rare tumor in this age group was emphasized.

Sinonasal IgG4-related disease: a rare and emerging entity broadening the differential diagnosis in the sinonasal universe.

BACKGROUND: IgG4-related disease (IgG4-RD) is a multi-organ immune-mediated disorder characterized by fibroinflammatory mass-forming lesions, mimicking malignancy or infection. While well-documented in salivary glands, orbit and thyroid in the head and neck, sinonasal IgG4-RD is rare. METHODS: Cases of sinonasal IgG4-RD were retrieved, and clinicopathological features reviewed. RESULTS: Seven cases of sinonasal IgG4-RD were identified over a 2-year period, including three males and four females, with an age range of 13-48 years (median: 32 years). Patients presented with cheek swelling, pain and visual disturbances. Serum IgG4 levels were mildly elevated. Storiform fibrosis, obliterative phlebitis and plasma cell infiltration were seen in varying proportions. Destruction of bone and subepithelial mucoserous glands was present. ALK-1 negativity distinguished from inflammatory myofibroblastic tumor. CONCLUSION: Sinonasal IgG4-RD expands the growing spectrum of IgG4-RD. A high degree of suspicion is required to include IgG4-RD in differential diagnosis of sinonasal masses, and perform detailed histological and immunohistochemical workup for accurate diagnosis.

Chemokine-Cytokine Networks in the Head and Neck Tumor Microenvironment.

Head and neck squamous cell carcinomas (HNSCCs) are aggressive diseases with a dismal patient prognosis. Despite significant advances in treatment modalities, the five-year survival rate in patients with HNSCC has improved marginally and therefore warrants a comprehensive understanding of the HNSCC biology. Alterations in the cellular and non-cellular components of the HNSCC tumor micro-environment (TME) play a critical role in regulating many hallmarks of cancer development including evasion of apoptosis, activation of invasion, metastasis, angiogenesis, response to therapy, immune escape mechanisms, deregulation of energetics, and therefore the development of an overall aggressive HNSCC phenotype. Cytokines and chemokines are small secretory proteins produced by neoplastic or stromal cells, controlling complex and dynamic cell-cell interactions in the TME to regulate many cancer hallmarks. This review summarizes the current understanding of the complex cytokine/chemokine networks in the HNSCC TME, their role in activating diverse signaling pathways and promoting tumor progression, metastasis, and therapeutic resistance development.

Ostium primum atrial septal defect with persistent left superior vena cava opening into unroofed coronary sinus-A rare entity.

Raghib syndrome is a rare developmental complex consisting of termination of the left superior vena cava in the left atrium, absence of the coronary sinus, and an atrial septal defect commonly located at the posterior-inferior angle of the atrial septum. This complex was considered unique to Raghib syndrome; however, cases with a normal atrial septum have been reported where the orifice of the unroofed coronary sinus functions as the inter-atrial communication. Our patient demonstrated an isolated persistent left superior vena cava draining into the left atrium through unroofed coronary sinus and presence of ostium primum atrial septal defect.

Testicular Mixed Germ Cell Tumor in a Newborn Child: A Rare Case.

Testicular tumors are rare in children but highly treatable and usually curable. Seminomas are extremely rare in prepubertal children. Among nonseminomatous germ cell tumors, the most common are teratomas and yolk sac tumors. Mixed germ cell tumor (MGCT) contains more than one germ cell component. MGCT is very rare in prepubertal age group. Here, we are presenting a case of MGCT in a newborn child with a review of literature. It is the first reported case in the world literature.

Birefringence mapping of biological tissues based on polarization sensitive non-interferometric quantitative phase imaging technique.

OBJECTIVE: Oral cancer is a leading cause of mortality globally, particularly affecting developing regions where oral hygiene is often overlooked. The optical properties of tissues are vital for diagnostics, with polarization imaging emerging as a label-free, contrast-enhancing technique widely employed in medical and scientific research over past few decades. MATERIALS AND METHODS: We present a novel polarization sensitive quantitative phase imaging of biological tissues by incorporating the conventional polarization microscope and transport of intensity equation-based phase retrieval algorithm. This integration provides access to the birefringence mapping of biological tissues. The inherent optical anisotropy in biological tissues induces the polarization dependent refractive index variations which can provide the detailed insights into the birefringence characteristics of their extracellular constituents. Experimental investigations were conducted on both normal and cancerous oral tissue samples by recording a set of three polarization intensity images for each case with a step size of 2 µm. RESULTS: A noteworthy increment in birefringence quantification was observed in cancerous as compared to the normal tissues, attributed to the proliferation of abnormal cells during cancer progression. The mean birefringence values were calculated for both normal and cancerous tissues, revealing a significant increase in birefringence of cancerous tissues (2.1 ± 0.2) × 10-2 compared to normal tissues (0.8 ± 0.2) × 10-2. Data were collected from 8 patients in each group under identical experimental conditions. CONCLUSION: This polarization sensitive non-interferometric optical approach demonstrated effective discrimination between cancerous and normal tissues, with various parameters indicating elevated values in cancerous tissues.

Multispectral polarization microscopy of different stages of human oral tissue: A polarization study.

Many optical techniques have been used in various diagnostics and biomedical applications since a decade and polarization imaging is one of the non-invasive and label free optical technique to investigate biological samples making it an important tool in diagnostics, biomedical applications. We report a multispectral polarization-based imaging of oral tissue by utilizing a polarization microscope system with a broadband-light source. Experiments were performed on oral tissue samples and multispectral Stokes mapping was done by recording a set of intensity images. Polarization-based parameters like degree of polarization, angle of fast axis, retardation and linear birefringence have been retrieved. The statistical moments of these polarization components have also been reported at multiples wavelengths. The polarimetric properties of oral tissue at different stages of cancer have been analyzed and significant changes from normal to pre-cancerous lesions to the cancerous are observed in linear birefringence quantification as (1.7 ± 0.1) × 10-3 , (2.5 ± 0.2) × 10-3 and (3.3 ± 0.2) × 10-3 respectively.

Compact Linnik-type hyperspectral quantitative phase microscope for advanced classification of cellular components.

Hyperspectral quantitative phase microscopy (HS-QPM) involves the acquisition of phase images across narrow spectral bands, which enables wavelength-dependent study of different biological samples. In the present work, a compact Linnik-type HS-QPM system is developed to reduce the instability and complexity associated with conventional HS-QPM techniques. The use of a single objective lens for both reference and sample arms makes the setup compact. The capabilities of the system are demonstrated by evaluating the HS phase map of both industrial and biological specimens. Phase maps of exfoliated cheek cells at different wavelengths are stacked to form a HS phase cube, adding spectral dimensionality to spatial phase distribution. Analysis of wavelength response of different cellular components are performed using principal component analysis to identify dominant spectral features present in the HS phase dataset. Findings of the study emphasize on the efficiency and effectiveness of HS-QPM for advancing cellular characterization in biomedical research and clinical applications.

Assessment of MUC5AC and MUC2 Immunoexpression in Glandular Odontogenic Cysts, Dentigerous Cysts, and Mucoepidermoid Carcinomas.

Glandular odontogenic cysts (GOCs) and dentigerous cysts may show mucous metaplasia. Central mucoepidermoid carcinoma is very rare and mostly associated with dental cysts. It is hypothesized that odontogenic cysts showing mucus differentiation in their lining, have a propensity to transform into MEC. The present study is the first attempt to explore the relationship between odontogenic cysts [GOCs and dentigerous cysts with mucus metaplasia (DCMM)] and MEC by evaluating immunoexpression of MUC5AC and MUC2. Immunoexpression of MUC5AC and MUC2 was evaluated semiquantitatively in GOCs (20 cases), DCMMs (20 cases), and MECs (20 cases). The percentage of positive cells, intensity, and localization of immunoexpression were assessed for each marker in all cases. Of GOCs, DCMMs, and MECs cases, 85%, 70%, and 80%, respectively, were immunopositive for MUC5AC. Strong cytoplasmic immunoreactivity for MUC5AC was noted, particularly in mucous cells present diffusely within MECs. However, the immunoreactivity was limited to the epithelial lining of GOCs and DCMMs. Most of the MECs (60%) showed more than 25% positivity for MUC5AC, followed by GOCs, and the least in DMMCs. Mild cytoplasmic and nuclear positivity of MUC2 was noted only in epithelial lining cells of 70% GOCs and 45% DCMMs. Whereas, 55% of MECs displayed moderate to strong cytoplasmic and membranous immunopositivity for MUC2 exclusively within mucous cells. As MECs showed strong MUC5AC immunoreactivity in mucous cells, immunoexpression of MUC5AC in odontogenic cysts with mucus cells can possibly explain the pathogenesis of MEC from cysts. However, the variable expression of MUC2 did not give any strong evidence regarding its role as a marker.

Anthropometric investigation of cephalic parameters for stature estimation: Through regression analysis.

Background: Stature or body height is one of the most important and useful anthropometric parameters which determines the physical identity of an individual. Cranium encompasses hard tissue components with approximately immortal behavior, reason being cranial measurements were selected for the present study for estimation of stature. Objective: This investigation aimed to assess the stature of unknown using cephalometric parameters by creating equations through regression analysis. Materials and Methods: We selected 361 dental students for the present research; among them, 210 were females and 151 were males in the age range of 21-32 years. Stature and cephalic parameters, i.e., fronto-occipital circumference, head length, and head breadth were measured for each contributor following standard methods and techniques. Cephalic Index was calculated by using the formula: Cephalic Index (CI) = (Head width/Head length) ×100. Karl Pearson's correlation coefficient of stature with cephalic parameters was calculated, and regression analysis was done to generate the formulae for stature estimation. Results: Results indicated that all cephalic measurements have strong correlation with stature, and among them, circumference of head was found to be the most reliable predictor. Conclusion: Stature of unknown or deceased can be identified using cephalic parameters as an auxiliary practice.

Characterization of tumors of jaw: Additive value of contrast enhancement and dual-energy computed tomography.

BACKGROUND: Currently, the differentiation of jaw tumors is mainly based on the lesion's morphology rather than the enhancement characteristics, which are important in the differentiation of neoplasms across the body. There is a paucity of literature on the enhancement characteristics of jaw tumors. This is mainly because, even though computed tomography (CT) is used to evaluate these lesions, they are often imaged without intravenous contrast. This study hypothesised that the enhancement characteristics of the solid component of jaw tumors can aid in the differentiation of these lesions in addition to their morphology by dual-energy CT, therefore improving the ability to differentiate between various pathologies. AIM: To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw tumors. METHODS: Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy CT. Morphological analysis of the tumor, including the enhancing solid component, was done, followed by quantitative analysis of iodine concentration (IC), water concentration (WC), HU, and normalized IC. The study population was divided into four subgroups based on histopathological analysis-central giant cell granuloma (CGCG), ameloblastoma, odontogenic keratocyst (OKC), and other jaw tumors. A one-way ANOVA test for parametric variables and the Kruskal-Wallis test for non-parametric variables were used. If significant differences were found, a series of independent t-tests or Mann-Whitney U tests were used. RESULTS: Ameloblastoma was the most common pathology (n = 20), followed by CGCG (n = 11) and OKC. CGCG showed a higher mean concentration of all quantitative parameters than ameloblastomas (P < 0.05). An IC threshold of 31.35 × 100 µg/cm3 had the maximum sensitivity (81.8%) and specificity (65%). Between ameloblastomas and OKC, the former showed a higher mean concentration of all quantitative parameters (P < 0.001), however when comparing unilocular ameloblastomas with OKCs, the latter showed significantly higher WC. Also, ameloblastoma had a higher IC and lower WC compared to "other jaw tumors" group. CONCLUSION: Enhancement characteristics of solid components combined with dual-energy parameters offer a more precise way to differentiate between jaw tumors.

Epithelioid inflammatory myofibroblastic sarcoma arising in the maxilla: first reported case in the jaws.

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of inflammatory myofibroblastic tumors located mostly in the intra-abdominal region. Herein, we present a case of a 32-year-old male with a lobulated growth in the right maxilla. Radiology revealed a solitary osteolytic lesion with an irregular margin, causing buccal and palatal cortex erosion. Histopathology revealed a tumor composed of spindle-shaped fascicles that blend into sheets of round to ovoid-shaped epithelioid cells, areas of myxoid changes, and necrosis. Tumor cells showed a moderate amount of eosinophilic cytoplasm, large vesicular nuclei with coarse chromatin, nuclear pleomorphism, and increased mitoses. Tumor cells were immunopositive for ALK-1, focal positivity for smooth muscle actin, panCK, epithelial membrane antigen, and immunonegativity for CD 30, desmin, CD34, and STAT6. P53 showed a wild-type staining pattern, and INI-1 expression was retained. The Ki-67 proliferative index was 22%. To the best of our knowledge, this is the first case of EIMS occurring in the maxilla.

Effect of fluorescein dye concentration in oral cancer tissue: Statistical and spectroscopic analysis.

Oral cancer screening with exogenous agents is highly demanding due to high sensitivity, as the early diagnosis plays a vital role in achieving favorable outcomes for oral squamous cell carcinomas (OSCC) by facilitating prompt detection and comprehensive surgical removal. Optical techniques utilizing the local application of fluorescein dye or fluorescence-guided surgery offer potential for early OSCC detection. The use of fluorescein dye in oral cancer is significantly less, and there is a need to inspect the local application of fluorescein dye in oral cancer patients. Concentration-based investigations of the dye with OSCC patients are essential to ensure accurate fluorescence-guided surgery and screening with fluorescein labeling and to mitigate possible adverse effects. Additionally, analyzing the dye distribution within OSCC tissues can provide insights into their heterogeneity, a critical indicator of malignancy. The present study includes a concentration-based statistical and spectroscopic analysis of fluorescein dye in ex-vivo and in-vivo OSCC patients. In the ex-vivo examination of OSCC tissues, five concentrations (18.66 ± 0.06, 9.51 ±    0.02, 6.38 ± 0.01, 4.80 ± 0.004, and 3.85 ± 0.002 millimolar) are employed for optical analysis. The ex-vivo OSCC tissues are analyzed for multiple statistical parameters at all concentrations, and the results are thoroughly described. Additionally, spectroscopic analysis is conducted on all concentrations for a comprehensive evaluation. Following optical analysis of all five concentrations in the ex-vivo study, two concentrations, 6.38 ± 0.01 and 4.80 ± 0.004 millimolar, are identified as suitable for conducting in-vivo investigations of oral cancer. A detailed spectroscopic and statistical study of OSCC tissues in-vivo has been done using these two concentrations.

Role of immunohistochemistry in diagnosing round-cell tumours affecting the oral and maxillofacial regions.

Background: One of the most challenging spectra of lesions in the oral and maxillofacial region (OMFR) are round-cell tumours (RCTs). They show a considerable degree of overlap in microscopy and immunophenotypes. The main aim of this study is to analyse the spectrum of RCTs encountered in the oral and maxillofacial regions. We emphasise the role of immunohistochemistry (IHC) which in conjunction with histological, clinical, and imaging findings is necessary for their correct characterisation. The secondary objectives are to discuss differential diagnosis, workflow, and diagnostic algorithm for round-cell lesions affecting the OMFR. Methods: Formalin-fixed, paraffin-embedded sections of RCTs were retrieved from the archives of the Department of Oral Pathology (January 2018 to March 2020). These cases were analysed by three pathologists independently by evaluating haematoxylin and eosin-stained sections, and immunohistochemical markers employed to characterise these lesions. Results: Under the spectrum of RCTs, 11 cases (0.53%) were diagnosed with a predominance of non-Hodgkin lymphoma (55%) followed by Ewing sarcoma (18%). The remaining were Langerhans cell histiocytosis (9%), neuroendocrine carcinoma (9%), and sinonasal undifferentiated carcinoma (9%). Except for one case, in all cases, the final diagnosis was established with the use of adjunctive IHC. Conclusion: RCTs can pose a diagnostic challenge for inexperienced oral pathologists. Thorough knowledge of the differentials of RCT occurring in oral and maxillofacial is helpful. An algorithm-based diagnostic approach incorporating the clinical, imaging, and histomorphological findings and immunohistochemical evaluation can help in minimizing diagnostic confusion and errors.

Post-COVID steroid induced avascular necrosis of the jaw: Emerging challenge in India.

The COVID-19 pandemic continues to evolve and spread with new variants of SARS-CoV-2 across the globe, as well as bring to clinical attention several post-COVID conditions. We report a post-COVID condition observed at our tertiary care center: spontaneous de novo development of steroid induced avascular necrosis in patients who have recently recovered from COVID-19 following high dose steroid usage in a short span of time. Pre-COVID published literature indicates that these lesions were seen very rarely in the jaws and were related to long-term usage of steroids and recent tooth extraction. They were considered under the broad spectrum of medication-related osteonecrosis of the jaws. Present authors believe that the post-COVID-19 steroid-induced avascular necrosis of the jaws is a distinct new entity. It is analogous to the avascular necrosis noticed in the femoral head of individuals recuperating from COVID-19, a condition conventionally known to be strongly associated with steroid therapy. Rapid progression, associated morbidity and mortality, and its possible differential diagnosis require pathologists to be vigilant regarding the chance encounter of such cases in jaws. Further reporting of such cases is required to gain additional insight into its features.

Long term follow-up results of enucleation as the definitive treatment for melanocytic neuroectodermal tumour of infancy and a review on its treatment.

Introduction: Melanotic Neuroectodermal tumour of Infancy (MNTI) is a rare entity of pigmented neoplasms of head and neck region. It predominantly occurs within the first year of life. The authors present enucleation as the definitive surgical treatment, with reference to the five departmental cases of MNTI with no recurrence at 5years and 1year of follow-up of other 4 cases. Case presentation: Five cases of MNTI (age group of 2.5months-7 months) presented to our department as a large bluish-brown non tender swelling protruding into the oral cavity. Radiologic imaging revealed a well-circumscribed solid-cystic enhancing lesion causing elevation of orbit and nasal obliteration in maxillary region and causing buccolingual expansion in mandible. The tumor was enucleated without any bony margin. Histopathological and immunohistochemical evaluation (EMA, Pan Cytokeratin, HMB45, S100, p53, ki67) were done. Patients were followed up at regular intervals and had no recurrence at mean 3years follow-up. A detailed mention of surgical pearls, differential diagnosis and a brief literature review are also done. Conclusion: MNTI is a pigmented neoplasm that occurs in infants and in head and neck region mostly involves the upper alveolus and maxilla, followed by skull and mandible. Incisional biopsy is needed to confirm the tumour and rule out other malignant round cell tumours. Enucleation of the lesion is necessary without the need for any extra bony margin removal. Close long term follow up is necessary. Conservative surgical approach is usually the best first choice for MNTI treatment.