Trigeminal trophic syndrome with features of oral CMV disease.

Trigeminal trophic syndrome (TTS) is an exceedingly rare complication following injury to the trigeminal ganglion, characterized by painless ulcerations, which has only rarely been reported with intraoral features. We present a patient with multiple intraoral ulcerations of the right buccal and alveolar mucosa that had previously been treated with nerve ablation therapy for trigeminal neuralgia. Positive immunohistochemistry staining of a biopsy specimen for cytomegalovirus suggested a viral etiology; however, lesions persisted despite antiviral therapy, and immunohistochemistry was negative on follow-up biopsy. Diagnosis of TTS is one of exclusion as it can mimic many other conditions, and should be considered in patients with unilateral painless ulcerations with a history of trigeminal nerve damage.

Malignant fibrous histiocytoma of the mandible in the context of a traumatic Marjolin's ulcer.

We present a rare manifestation of a chronic mandibular wound with a traumatic diathesis. A 38-year-old male patient sought medical consultation because of painless swelling in the mandibular symphysis and mild paresthesia of the lower lip. He mentioned a history of physical trauma to the mandibular symphysis 12 months ago. The radiographic evaluation and CT scan showed gross destruction of bone leading to a well-defined radiolucent lesion without any sclerosing margins. The histological examination revealed numerous spindle-shaped fibroblasts arranged in a fascicular pattern and scattered multinucleated and mononuclear cells with bizarre nuclei throughout the lesion. Moderate nuclear pleomorphism was evident with few mitotic cells. The lesion was diagnosed as a malignant fibrous histiocytoma of storiform-pleomorphic type based on the previous descriptions. After surgical removal of the lesion and the adjacent tissues and reconstruction, the patient was referred to a radiotherapist for continuation of treatment. Despite this therapy, the lesion recurred after a year, and prior to the second operation, the patient died as a result of brain involvement.

Effect of cigarette smoke exposure on the growth of Streptococcus mutans and Streptococcus sanguis: an in vitro study.

The aim of the present study was to determine the effect of cigarette smoke on the growth of Streptococcus mutans and Streptococcus sanguis. The standard strains of S. mutans (ATCC 25175) and S. sanguis (ATCC 10556) were cultured on blood agar and incubated for 48 hr in three main environments: atmospheric air, carbon dioxide, and cigarette smoke. Kent gold 1(nicotine: 0.1 mg, tar: 1 mg), Kent lights (nicotine: 0.8 mg, tar: 9 mg) and Bahman (nicotine: 1 mg, tar: 13 mg) were the brands used in the present study. Afterwards, digital photographs of the colonies were taken and the diameter of colonies was measured. Data were analyzed using Post Hoc and General Linear Model statistical tests. Cigarette smoke and carbon dioxide environments significantly increased the growth of S. mutans. However, high nicotine/tar content cigarette smoke (Bahman) had the greatest impact on S. mutans and S. sanguis. The mutans/sanguis ratio, which was 0.71 in atmospheric air, increased to 1.07 in the presence of carbon dioxide. Kent gold 1, Kent lights, and Bahman demonstrated a mutans/sanguis ratio of 1, 0.84, and 0.98 respectively. In conclusion, it seems that the growth of S. sanguis and S. mutans is accelerated in the vicinity of cigarette smoke.

Amlodipine-induced gingival hyperplasia.

Drug-induced gingival hyperplasia is a serious concern both for the patient and the clinician. A 45 year-old Caucasian male patient with hypertension, who received amlodipine (10 mg/day, single dose orally) for two months, sought medical attention because of the new-onset gingival enlargement. On clinical examination a generalized and firm overgrowth of the gingival throughout the maxilla and the mandible were evident. The lack of gingival inflammation and purulent discharge were other features of the clinical scenario. Histological assessment of the biopsy specimen revealed the hyperplasia of connective tissue, epithelial acanthosis, and elongated rete ridges along with few inflammatory cells. The histological and the clinical evidences were consistent with amlodipine-induced gingival hyperplasia. We believe that the present report indicates the most rapidly developed case of amlodipine-induced gingival hyperplasia reported to date. The related literature is reviewed and the underlying pathogenic mechanisms of this rare side-effect are discussed here.

Ansa cervicalis as a variant of spinal accessory nerve plexus: a case report.

The ansa cervicalis is a neural loop in the neck formed by the union of two main nerve roots, namely superior and inferior roots, derived from ventral rami of the cervical nerves. With the expanding use of the ansa cervicalis for reinnervation procedures and the fact that it is located in the vicinity of major nerves and vessels of the neck, knowledge of the topography and morphology of this loop is quite necessary in the modern era. Any variation in the course, contributing roots or branching pattern of the ansa cervicalis, potentially alters and perhaps complicates the course of the procedures involving this nerve such as neurorrhaphy, skull base surgery, neck dissection, and anterior cervical spinal approach. Here, we present an unusual case of an ansa cervicalis encountered upon routine dissection of an adult male cadaver. In this case, the inferior root of the ansa cervicalis was formed by the joining of two rootlets, one originating from spinal accessory nerve and the other from a branch of the cervical plexus to the sternocleidomastoid muscle. The fibers traversing the branch of spinal accessory nerve were derived from the first segments of the cervical spinal cord. This case demonstrates a variant of the spinal accessory nerve plexus that contributed to the formation of the ansa cervicalis. Review of the literature was performed to reveal the possible clinical aspects of this anatomical variation.