Role of cone-beam computed tomography in diagnosis and management of nasopalatine duct cyst.

Nasopalatine duct cysts (NPDCs) are the most common nonodontogenic cyst of the jaw, with a reported prevalence of between 1% and 11.6% of all jaw cysts.1 It is believed to arise from epithelial remnants of the nasopalatine duct, the communication between the nasal cavity and anterior maxilla in the developing fetus. For huge NPDCs, total excision is difficult, and there is an increase in the possibility of postoperative complications including submucosal hematoma, wound dehiscence, wound infection, injury to tooth roots, injury to nasopalatine neurovascular bundles, paresthesia of the anterior palate, facial swelling, and oronasal fistula formation. This article discusses a case with a large NPDC, which was managed surgically without any complication. Radiological findings emphasizing the importance of cone-beam computed tomography in diagnosis and optimized treatment planning of NPDCs are discussed.

The efficacy of Punica granatum extract gel in the treatment of symptomatic oral lichen planus in an Indian population: A clinical study.

INTRODUCTION: The autoimmune disorder, oral lichen planus (OLP), primarily affects oral mucous membranes. Current drug treatments are only palliative and have serious side effects. Pomegranate has been used as a potential herbal remedy for the treatment of OLP. MATERIALS AND METHODS: The study consisted of a sample size of 30 individuals who were diagnosed with symptomatic OLP based on both clinical and histological evidence and were equally assigned to Group A (4% topical Punica granatum seed extract gel, which has been customized for this particular study purpose only) and Group B (0.1% topical steroid). All patients were evaluated for the outcome criteria of pain, burning sensation, and lesion size. RESULTS: In the present study, results were highly statistically significant (P = 0.001) in intragroup observation for both Group A and Group B from baseline to the end of 30 days of follow-up for all three parameters. There was no statistically significant difference between groups for each week of follow-up. CONCLUSION: P. granatum has been used in very few studies, but this is one of the few where a gel made from P. granatum seed extract is used as an oral gel. In conclusion, it can be said that topical P. granatum extract gel is as good as topical corticosteroids at getting rid of the signs and symptoms of OLP, so it can be used as an alternative treatment.

Pectoralis major myocutaneous flap--still a workhorse for maxillofacial reconstruction in developing countries.

PURPOSE: To retrospectively evaluate the utility of the pectoralis major myocutaneous (PMMC) flap for head, face, and neck (HFN) reconstruction in the Indian population. MATERIALS AND METHODS: The hospital records of 496 patients in whom the PMMC flap was used (saving the deltopectoral flap) for reconstruction of HFN defects from January 1991 to December 2010 were reviewed retrospectively. All the patients were followed up for a minimum period of 6 months, and the utility of the PMMC flap was evaluated for HFN reconstruction. RESULTS: Of the 496 patients, complications developed in 84 patients. The complications included complete flap failure in 12, partial skin paddle loss in 24, wound infection in 12, peripheral wound dehiscence in 16, plate exposure in 12, and donor site morbidity such as infection and a decrease in function in 8. CONCLUSIONS: The PMMC flap or its modification was used in 496 cases of reconstruction after resection surgery for malignancy of the HFN region with minimal morbidity and 1 death. This technique is a useful alternative in places with a high incidence of HFN malignancies and microsurgical free tissue transfer is not possible or as a salvage procedure in selected large, full-thickness, oral cavity lesions. In our 19-year experience, the final functional and cosmetic results were satisfactory with this sturdy flap.

Numbness over the distribution of trigeminal nerve--trigeminal trophic syndrome or viral neuritis: a diagnostic dilemma!

Numbness and ulceration of the face, particularly erosion of ala of the nose, sometimes occur after sensory denervation in the territory of the divisions of the trigeminal nerve. The incidence is uncertain and usually follows surgical treatments for trigeminal neuralgia. Such condition is known as trigeminal trophic syndrome (TTS), although some authors believe it to be a special form of dermatitis artefacta. Trigeminal trophic syndrome most commonly affects adults, after iatrogenic, vascular, viral, or neoplastic damage to the trigeminal nerve. We present a rare case of TTS in a 32-year-old woman who was referred to us with progressive numbness in the right upper and lower lip region.

Transosseous fixation of pediatric displaced mandibular fractures with polyglactin resorbable suture--a simplified technique.

Management of pediatric mandibular fractures presents a unique challenge to surgeons in terms of its numerous variations compared to adults. Both conservative and open methods have been advocated with their obvious limitations and complications. However, conservative modalities may not be possible in grossly displaced fractures, which necessitate the open method of fixation. We present a novel and simplified technique of transosseous fixation of displaced pediatric mandibular fractures with polyglactin resorbable suture, which provides adequate stability without any interference with tooth buds and which is easy to master.

Mandibular subsigmoid access osteotomy in the management of parapharyngeal space tumors.

Primary parapharyngeal space tumors are rare presentation in the head, face, neck region. Most of these tumors are benign in nature and significantly cast a challenge in terms of diagnosis and their surgical management. Anatomical location of these tumors, either prestyloid or poststyloid, size of the tumor, and proximity to the vital structures determine the appropriate surgical approach. The surgical approach to the parapharyngeal tumors should provide adequate visibility and access for complete removal, preserving the adjacent vital structures and also preventing recurrence. We report our experience in diagnostic workup and management of a series of 18 primary parapharyngeal space tumors with long-term follow-up.

Anatomical Variants of Condylar Process, Coronoid Process, and Sigmoid Notch in a Maharashtrian Population: A Radiographic Study.

Background The cornerstone of an individual's singularity is identification. Digital orthopantomography (OPG) helps to illustrate the varying condylar process, coronoid processes, and sigmoid notch found within a population to facilitate individual recognition. This study aims to assess the various shapes of the condylar process, coronoid process, and sigmoid notch found using OPG in a sample population of an Indian city. Methodology This retrospective, cross-sectional study was conducted using 1,000 good-quality digital OPG scans to evaluate the different shapes. The scans were evaluated by two experienced oral radiologists and tabulated for statistical analysis. Results The current investigation revealed varied morphological forms of the three entities, with the round shape being the most frequently observed condylar process, coronoid process, and sigmoid notch. Comparisons across sides and between sexes revealed differences in all three variables which were found to be statistically significant. We discovered a crooked finger condyle (58.56% on the left side and 41.44% on the right side), a beak-shaped coronoid process (50.0% on the left side and 50.0% on the right side), and a V-shaped sigmoid notch (41.35% on the left side and 58.65% on the right side) in this study. This is a unique finding not reported by other studies. Conclusions Analyzing the shape of the condylar process, coronoid process, and sigmoid notch found on an OPG scan can help with gender identification in forensic odontology and anthropology as these anatomical features show strong sexual dimorphism.

Efficacy of Sodium Bicarbonate-Buffered Local Anesthetic Solution in Cases Requiring Bilateral Maxillary Premolar Orthodontic Extraction: A Comparative Split-Mouth Study.

Aims and objectives This study was carried out to evaluate the efficacy of 8.4% sodium bicarbonate-buffered local anesthetic solution and conventional local anesthetic in patients requiring bilateral maxillary orthodontic extractions in terms of pain on injection, onset of action, and duration of action. Methods 102 patients requiring bilateral maxillary orthodontic extractions were included in the study. Buffered local anesthetic was administered on one side while conventional local anesthesia (LA) was administered on the other side. Pain on injection was measured using a visual analogue scale, while onset of action was measured by probing the buccal mucosa after 30 seconds of administration and duration of action was measured by the time after which the patient experienced pain or took a rescue analgesic. The data was statistically analyzed to determine the significance. Results The pain during injection was found to be lesser at sites where buffered local anesthetic was administered (mean visual analogue scale (VAS) score = 2.4) as compared to conventional local anesthetic (mean VAS score = 3.9). The onset of action was faster with buffered local anesthetic (mean value = 62.3 seconds) as compared to conventional local anesthetic (mean value = 157.16 seconds). Lastly, the duration of action was found to be longer for buffered local anesthetic group (mean value = 225.65 minutes) as compared to conventional local anesthetic (mean value = 187 minutes). Conclusion 8.4% sodium bicarbonate-buffered local anesthetic was found to be more efficient than conventional local anesthetic in terms of reduction in pain on injection as well as faster onset and longer duration of action.

Retrospective analysis of sutureless skin closure in cleft lip repair.

The technique of approximating tissues resulting in minimal amount of scar usually requires skillful suturing techniques by the surgeons, especially in cleft lip repair. Increased awareness and demand for aesthetic surgical correction with quality in tissue closure has led to the invention of new materials and techniques. Amcrylate (iso amyl 2-cyanoacrylate) is retrospectively evaluated as tissue glue in cleft lip repair, and the results are compared with skin closure by 6-0 Prolene. A retrospective analysis of 60 patients with unilateral or bilateral cleft lip repair was carried out to compare the results of skin closure with Amcrylate and 6-0 Prolene. Patients were randomly divided into 2 groups, each group containing 30, and the study was designed to evaluate the quality of scars after the use of Amcrylate tissue adhesive to close the skin during cleft lip repair and its advantages over sutures (6-0 Prolene). Both groups were analyzed for the time taken for skin closure, resultant scar, parental satisfaction, and complications, and the results were found to be statistically significant for the Amcrylate group. Amcrylate, when used as tissue glue for skin closure in cleft lip repair, definitely has an edge over conventional suturing techniques.

Aggressive inflammatory pseudotumor of the mandible.

Inflammatory pseudotumor (IP) is a nongranulomatous inflammatory process with no apparent local or systemic cause. The distinction between IP and malignant tumor is of great clinical importance. The incidence of IP in the head and neck region is very low. Inflammatory pseudotumor is a distinct pathological entity rarely found in the jaw bones. A rare case of aggressive IP of the mandible is presented along with its clinicopathologic features and surgical management.

Correlation of panoramic radiographs and spiral CT scan in the preoperative assessment of intimacy of the inferior alveolar canal to impacted mandibular third molars.

Iatrogenic origin of neurosensory dysfunction is a distressing sequel to the surgical removal of impacted mandibular third molars, which is frequently overlooked. According to various surveys, the rate of neurologic complications related to the surgical removal of impacted mandibular third molars varies between 0.5% and 1% for permanent damage and 5% and 7% involving temporary damage. Prevention always stands as the best modality to avoid patient's discomfort and lawsuits by sophisticated consumerism.Preoperative assessment of the topographic relationship of the impacted mandibular third molar to the inferior alveolar canal has been performed by different imaging modalities. However, none of the imaging techniques give cent percent information. The best available imaging modality in time and resources should be adopted by the surgeon to avoid complications and lawsuits. Orthopantomography has often been cited as the imaging modality of choice before surgical removal of impacted mandibular third molar. However, it depicts a two-dimensional view of an intricate three-dimensional anatomic relationship and also fails to accurately project the buccolingual relation between the tooth and the inferior alveolar canal. The current study was designed to evaluate the potential advantages of spiral computed tomography and compare its efficacy as a presurgical planning tool with orthopantomography in patients with impacted mandibular third molars showing proximity to the inferior alveolar canal on an orthopantomogram.

Giant aneurysmal bone cyst of the mandible.

The aneurysmal bone cyst is a type of pseudocysts of the jaw. It is a nonneoplastic lesion of the bone, characterized by replacement with fibro-osseous tissue containing blood-filled sinusoidal or cavernous spaces. The lesion remains a relatively uncommon finding in the facial bones, and the cause and pathogenesis are yet to be elucidated. Aneurysmal bone cyst was first described as a distinct clinical and pathologic entity by Jaffe and Lichtenstein in 1942. Aneurysmal bone cyst comprises 1.5% of all nonodontogenic cysts of the jaws and 1.9% of all aneurysmal bone cysts of skeleton. A rare case of giant aneurysmal bone cyst of mandible in a 10-year-old child is presented, which was managed by surgical curettage with a long-term follow-up.

Horizontal flip pedicled genioplasty for correction of asymmetric chin in adult unilateral temperomandibular joint ankylosis.

It has been the desire and a great challenge to clinicians treating maxillofacial deformities to bring about symmetry in asymmetric faces. As one understands, it is very difficult to reproduce nature, that is, the normal side out of abnormal side, and it is easier to manage bilateral symmetrical deformities. Temporomandibular joint (TMJ) ankylosis, when it occurs in early childhood, will have devastating effects on the future growth and development of the jaws and teeth with obvious facial deformity including the chin, which worsens with advancing age and the time elapsed between the onset of ankylosis and the treatment instituted. We have been treating these chin deformities in adult unilateral TMJ ankylosis cases for over more than a decade with horizontal flip pedicled genioplasty, which has a mathematical basis of turning a scalene triangle to an isosceles triangle and thereby achieving symmetry. Fixation of the genial segment in an overriding position not only adds to the length of mandible but also overcomes the obstructive sleep apnea many times associated with TMJ ankylosis. We have successfully treated 15 patients using horizontal flip pedicled genioplasty during last 14 years. This instantaneous corrective and unique technique requiring minimal patient compliance is put forward with refinements developed during a period of years.

Treatment of midline cleft of the mandible-A 2-stage approach.

Midline clefts of the lower lip and mandible are rare congenital anomalies. They may present as complete or incomplete in nature along with associated bifid tongue and ankyloglossia. Some may present with cleft of lower lip, cleft of mandible, fissured tongue, absent hyoid bone, cleft of manubrium sterni, or an extremely rare anomaly known as Tessier cleft no. 30. We present this unique case of midline cleft of the lower lip (incomplete) and mandible (complete) with initial soft-tissue surgery for the lower lip. The hard-tissue surgery for this case is deferred at a later date, and the reasons are discussed.

Adenoid cystic carcinoma associated with mucous retention cyst of the parotid gland.

Mucous retention cysts of the parotid gland are rare, and a coexistent adenoid cystic carcinoma is even an unusual occurrence. Such coexistent adenoid cystic carcinomas with mucous retention cyst of the parotid gland are difficult to diagnose clinically and, at times, stage difficulty in their management. We report a rare case of adenoid cystic carcinoma associated with mucous retention cyst of the parotid gland with its diagnostic and management dilemma in a 14-year-old adolescent girl.

Modified lateral orbitotomy approach: a novel technique in the management of lacrimal gland tumors.

Lateral orbitotomy is a well-known approach in the surgical management of lesions in the lateral orbital regions. It is still appropriate for laterally situated tumors, although contemporary cranial base approaches were defined and developed within the last decades. The extent of lateral orbitotomy should depend on the size, consistency, and nature of the lesion for easy surgical removal and reconstruction thereafter. In this regard, contrast-enhanced computed tomographic scans provide useful information for operative strategy. Although there is a wide range of histopathologic diagnosis for orbital tumors, lateral orbitotomy is a safe approach, particularly if the lesions are extraconal. We present a case of pleomorphic adenoma of lacrimal gland managed by a modified lateral orbitotomy approach with pleasing results.

Comparative Evaluation of Intranasal Butorphanol and Oral Diclofenac Sodium for Analgesia After Surgical Removal of Impacted Mandibular Third Molars: Split-Mouth Prospective Controlled Clinical Study.

AIM: The study intended to compare the analgesic effect and patient satisfaction of intranasal butorphanol with oral diclofenac sodium after surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: This split-mouth prospective controlled clinical study included 50 patients with bilateral symmetrically impacted mandibular third molars with the same difficulty on the Pederson Index. All patients had two appointments of surgery. In the first, the molar on one side was surgically removed and depending upon the chit selected by the patient, either intranasal butorphanol or oral diclofenac sodium was prescribed postoperatively for pain relief. Two weeks later, the impacted mandibular third molar on the other side was surgically removed and if butorphanol was selected for the first side, then oral diclofenac sodium was prescribed for the other side and vice versa. Pain relief was recorded on the Facial Visual Analogue Scale at 1, 2, 3, 4 and 5 h postoperatively and on postoperative day 1 and 2 at the same time for both the drugs. RESULTS: Intensity of pain was less with intranasal butorphanol as compared to oral diclofenac sodium at all the time intervals and especially in the 1st postoperative hour. Overall acceptance (88%) to butorphanol nasal formulation was statistically similar to diclofenac sodium tablets. CONCLUSION: Intranasal butorphanol at the very acceptable 1 mg dose after the surgical removal of impacted mandibular third molars provides a profound degree of analgesia. It is a well-tolerated drug with a high acceptance rate if administered correctly.

Ameloblastic Fibroma Mimicking Dentigerous Cyst: A Diagnostic Dilemma.

Ameloblastic fibroma is a rare, slow-growing odontogenic mixed tumor with neoplastic epithelial and ectomesenchymal tissue, which does not show inductive changes to form enamel and dentin. It is frequently found in the first two decades of life. It is often confused with ameloblastoma and dentigerous cyst due to the presence of an impacted tooth and can be distinguished histologically. Ameloblastic fibroma can be differentiated from ameloblastoma by the presence of myxoid appearance of connective tissue. A case of an 11-year-old female with a slow-growing swelling on the left side of mandible in the molar ramus region has been presented which was diagnosed as ameloblastic fibroma postenucleation.

Incidence and pattern of mandibular fractures in rural population: a review of 324 patients at a tertiary hospital in Loni, Maharashtra, India.

The aim of this study was to document the pattern and incidence of mandibular fractures occurring in rural population, at Rural Dental College and Hospital, Maharashtra, India. A retrospective analysis of patient records and radiographs for the 5-year period from January 2003 to December 2007 was conducted. Data were identified and analyzed based on age group, gender distribution, anatomic location, and cause of injury. A total of 324 patients with 486 injuries were reviewed, males formed 80.9% and females 19.1% of the studied population, with peak incidence occurring in the 21-30 years age group. The most common fractures site was parasymphysis (39.3%). The etiology of mandibular fractures was road traffic accidents (42.9%), followed by falls (25.9%), assaults and interpersonal violence (20.7%), and animal injuries (10.5%). Our results exhibit that road traffic accidents remain the major cause of mandibular trauma and animal injuries being found exclusively in rural population. There is a variation of incidence and pattern of maxillofacial trauma from region to region.

Dentinogenic ghost cell tumor: Tumor in the garb of a cyst!

The dentinogenic ghost cell tumor (DGCT) is a relatively uncommon locally invasive neoplasm that mimics several inflammatory/reactive lesions of the gingiva or odontogenic cysts. The confirmatory diagnosis of this rare lesion can only be made with histopathological examination. Routine staining reveals features of a "mixed" tumor as ghost cells with calcification, dysplastic dentin and islands of epithelium in rosette pattern in mature connective tissue are visible. The case report describes an asymptomatic growth in the maxillary gingiva of a young patient that was incidentally diagnosed as a DGCT after biopsy. Malignant transformation of this lesion to its more aggressive counterpart, odontogenic ghost cell carcinoma has been described, and hence, regular follow-up of diagnosed cases is imperative. The purpose of the paper is to report a case that adds to the literature and this will consequently help to diagnose and understand the biological behavior of these lesions better.