Osteosarcoma: A Diagnostic Dilemma.

OBJECTIVE: Osteosarcoma is a primeval disease which is still partly understood. It is a malignancy of mesenchymal cells that have the capacity to generate osteoid or immature bone. There have been an abundance of debate and controversies about the nature, aggressiveness, behavior, and various treatment modalities of this entity. Different histologic variation has been common in osteosarcoma; hence multiple diagnostic approaches are vital in all cases. Detection of precise anatomic and histologic variants is of prime importance in view of better outcome. The purpose behind writing this case report was to highlight the importance of various investigation techniques for an affirmative diagnosis.

Leiomyosarcoma of maxilla: a case report with review of literature.

OBJECTIVE: One challenging feature of head and neck pathology is that a dizzying array of spindle cell lesions occurs here which ranges all the way from reactive, very aggressive forms to malignant lesions. Leiomyosarcoma is one such malignant tumour of mesenchymal origin exhibiting smooth muscle differentiation; presenting generally nonspecific signs and symptoms. Here we present a case of leiomyosarcoma in a 21 year old female patient associated with single reddish pink swelling present in the posterior right maxillary tuberosity region with moderate facial asymmetry. On histopathological analysis, all the classic features were noted and diagnosis of a spindle cell neoplasm was made without any obscurity. There are many lesions like rhabdomyosarcoma, fibrosarcoma, liposarcoma, multiple peripheral nerve sheath tumour, angiosarcomas, melanomas, kaposi sarcoma, solitary fibrous tumors, etc., which mimic leiomyosarcoma clinically and histopathologically and therefore immunohistochemical staining with specific markers plays a vital role in arriving at a conclusive diagnosis.

Comparative Assessment of Clinical and Quality of Life Outcomes in Mandibular Angle Fractures Treated with Standard and Three-Dimensional Mini-Plates.

Aims and Objectives: To undertake a multidimensional comparative assessment of the standard and three dimensional (3D) mini-plates in managing isolated mandibular angle fractures (MAFs). Patients and Methods: Thirty-six subjects were divided equally into two groups. Group A underwent fixation with a standard 2 mm miniplate, while group B with 2 mm 3D mini-plates. Evaluations were done preoperatively (T0), postoperatively at one week (T1), one month (T2) and three months (T3). Maximal inter-incisal mouth opening (MIO) and mean bite force (MBF) at the central incisors, right and left molars were calculated. Postoperative complications and Quality of life (QoL) outcomes were evaluated using the short form Oral Health Impact Profile (OHIP-14). Results: Mean operative time was almost similar for both groups. Although mean MIO improved significantly from T1 to T3 in both groups, intergroup comparison of MIO was not significant. The MBF values were significantly higher in group B on the right and left molars at T2 and T3. Although significant improvement in OHIP-14 scores was seen from T2 to T3 in both the groups, intergroup comparison of OHIP was not significant. Conclusion: 3D plates demonstrated similar clinical and QoL outcomes compared to the standard mini-plates.

Ameloblastoma: Retrospective Study and Analysis of 102 Cases Over 10 Years, Single Centre, Institutional Experience.

Objective: The purpose of the study was to analyse the long-term results of ameloblastoma, which was treated at our centre. Study Design: We carried out a retrospective study of 10 years of clinical records from 2007 to 2016 with 102 consecutive cases of ameloblastoma. Data of all patients were collected and analysed with follow-up to 9 years. Results: The data analysis revealed male (59.8%) predominance over female (40.2%) with a mean age of 30.35 ± 15.12 years was observed. We have observed a mandibular (93.1%) than maxilla (6.9%) with left side predominance (54.9%). Anatomically, in the mandible, most of the cases were located in ramus (27.5%). On radiographic analysis, multilocular lesion (66.4%) was observed in association with involvement of impacted mandibular third molar teeth. On histopathological examination, conventional type (63.8%) was most commonly noted. The most frequently performed procedure was segmental mandibulectomy (30.4%). Reconstruction was done in most of the cases by recon plate (41.2%). The recurrence rate was seen at about 20.6%. Conclusion: Ameloblastoma has got mandibular posterior region with male predominance. Follicular ameloblastoma was the most common histological type found. So, Radical approach for adult patients wherein younger and growing patients conservative approach could be a justified as a treatment of choice.

A Rare Case of Mucoepidermoid Carcinoma of Parotid with Mandibular Metastasis.

Mucoepidermoid carcinoma is the most common malignant tumor of salivary gland. Majority of the salivary gland tumors arise in parotid gland with maximum being of benign nature. Although Mucoepidermoid carcinoma accounts for less than 10% of all tumors of the salivary gland, it constitutes approximately 30% of all malignant tumors of the salivary gland. It is characterized by a mixed pattern of the two main cell types: epidermoid and mucus-producing cells. Metastasis from salivary gland malignancy is infrequent and predominantly found in bone, lung, liver and lymph nodes. We are presenting a rare case of metastasis of mucoepidermoid carcinoma of parotid gland to the contralateral mandible.

Implant Placement into the Nasopalatine Foramen: Considerations from Anatomical and Surgical Point of View.

Implant placement is a challenge in the anterior maxilla if the available bone is reduced and esthetics is challenging. The ideal implant position should be considered in all three dimensions: mesiodistal, apicocoronal, and orofacial. This article includes a review and a case report for the anatomical and clinical perspective of implant placement in nasopalatine foramen (near incisal canal). In this case report, the edentulous space is mutilated in between the area #12 and #21 teeth. Therefore, only one, 3.0 W/10.00 L implant (bone size 4.2 mm width and 11 mm length) could be placed. Radiographically, D2 bone quality was diagnosed. Before surgery, an emphasis was given over the proper implant selection to avoid oversized implants due to critical anatomical landmark. Careful and with minimal trauma, the soft tissue was handled and implant placement was performed in a proper position, using information from panoramic radiograph, 3-D Dentascan. A surgical guide was used for placement of the implant. Finally, immediate loading of temporary implant prosthesis was done. The primary outcome was satisfactory, as after 72 h, no swelling and numbness were reported. The patient has been recalled after healing period of 24 weeks for permanent restoration.

Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable?

The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t -test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B ( p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B ( p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.

Solitary Cysticercosis of the Temporalis Muscle: Report of a Rare Case.

Patient presented with swelling over right temporal region causing the dilemma over diagnosis. Sonography and CT scan confirmed the presence of cysticercus in right temporal region. Pharmacological management was instituted and the cyst resolved eventually. Ultrasonography and CT imaging play an important role in establishing the diagnosis of rare case of cysticercosis of temporalis muscle and can be treated successfully by pharmacological modality.

Giant osteochondroma of the coronoid process.

Osteochondroma or solitary osteocartilagenous exostosis is characterized by cartilage-capped osseous lesion, protruding from the surface of affected bone. It is one of the most common benign bone tumor in axial skeleton and infrequent in maxillofacial skeleton. This paper describes a giant osteochondroma of coronoid process in a 20 year old woman, presented with limited mouth opening (15 mm inter incisal distance) and pain without any facial swelling, asymmetry and TMJ problems. Based on clinical examination, panoramic radiography and computed tomography images a provisional diagnosis of osteoma or osteochondroma of the coronoid process was made. Under general anaesthesia through intra oral approach excision of the bony tumor along with the coronoid process was performed, with recovery of mouth opening up to 40 mm immediately following surgery. The histopathology of excised specimen revealed features suggestive of osteochondroma. After follow up period of 54 months patient is symptom free. Here we are presenting and discussing the complete diagnostic and treatment aspect of this unusually large osteochondroma of coronoid process of mandible.

Bite Force Evaluation of Conventional Plating System Versus Locking Plating System for Mandibular Fracture.

AIMS AND OBJECTIVES: To compare and evaluate the variation in recorded bite forces in patients with mandibular fractures undergoing open reduction and rigid internal fixation using standard 2.0 versus 2.0 mm locking miniplates. MATERIALS AND METHODS: A prospective randomized study was conducted for the treatment of mandibular fractures. Twenty adult patients with 31 mandibular fractures requiring an open reduction and internal fixation were included in the study. The sample was divided into two groups depending upon whether the patients received 2.0 mm non-locking (standard) or 2.0 mm locking miniplates for rigid fixation respectively. Bite force was evaluated at 1st, 3rd and 6th week after the open reduction and rigid fixation using miniplates. RESULTS: A statistically significant difference was not found in the clinical parameters such as pain, swelling, infection, paresthesia, hardware failure, and mobility between the fracture segments. The results showed that amongst locking vs non-locking miniplates, the former showed a greater bite force enhancement when compared to baseline values(post-trauma).A comparison between 2nd day post-operative vs 6th week post-operative values showed a significant increase in bite force in Group 1 (non-locking) (p < 0.05) whereas the values Were highly significant (p < 0.001) in Group 2 (locking Plate). CONCLUSION: The findings were suggestive that the efficacy of locking miniplates plate in mandibular fracture was superior in terms of bearing the masticatory loads during osteosynthesis of the fracture. However, the clinical results were almost similar to those seen with non-locking miniplate osteosynthesis.

Incidence and pattern of mandibular fractures in Rohilkhand region, Uttar Pradesh state, India: A retrospective study.

AIMS: To understand and evaluate the significance of various aetiological factors in determining the incidence and dictating the patterns of mandibular fractures in Rohilkhand region. METHODS: The patient records and radiographs for 144 patients treated for mandibular fractures were reviewed between the time periods from January 2012 to December 2013. Data on age, gender, aetiology, use of intoxicants, head injury, associated injuries, days of the week, anatomic site and multiple fractures within the mandible were recorded and assessed. RESULTS: Maximum incidence of fractures was observed among the individuals in 3rd decade (35.4%) followed by 2nd and 4th decades, which exhibited 32 and 30 cases (22.2% and 20.8%), respectively. Male to female ratio was biased (4:1) portraying a male predominance. Road traffic accidents (RTAs) were observed to be the predominant aetiological factor responsible accounting for 79.2% of the total injuries followed by assaults (11.8%) and falls (9%). Parasymphysis exhibited the highest incidence (32.63%) amongst the anatomic sites, followed by body (18.75%), angle (16.66%), condyle (15.27%), symphysis (12.50%), ramus (2.77%) and coronoid (1.38%). CONCLUSION: The study reveals that majority of affected patients were in the 2nd and 3rd decades. A definitive relationship existed between RTA and the incidence of mandibular fractures. The frequency further increased with consumption of social intoxicants. The most commonly fractured site was parasymphysis either isolated or associated with other fractures in the mandible.

Accidental intraoral formalin injection: a rare case report.

Formalin is a hazardous chemical that needs cautious handling and special storage. Owing to its disinfectant and fixative (i.e. for preserving pathologic tissue specimens in histopathology) properties, it is widely used in dentistry. Although, the terms formaldehyde and formalin are often confused as being identical, these are different as to the concentrations of the primary component i.e. formaldehyde. In fact, the common fixative available as 10% neutral buffered formalin is actually a 4% solution of formaldehyde (i.e., a 10% solution made from a 37-40% commercially pure formaldehyde solution). This case report describes an unfortunate case of accidental injection instead of local anesthetic, of formalin into the pterygomandibular space in a 35-year old woman during inferior alveolar nerve block for surgical removal of impacted lower right third molar and its successful management by cautious debridement (under both local and general anesthesia) and empirical drug therapy (utilizing analgesics and antibiotics).

Psammomatoid juvenile aggressive ossifying fibroma of mandible.

A female patient, aged 14 years, came to dental OPD, with a large swelling of the right mandibular region, progressing since 4-5 years. The swelling initially started with a small size and later it became a large swelling extending from left lower premolar region to right mandibular angle region. Inferiorly, the swelling was extending below the inferior border in the symphysis region. No paresthesia was experienced by the patient. There was quite a marked facial disfigurement of the right mandibular body and symphysis region extending to left side. No other bones were involved and no other abnormalities were found on general physical examination. The medical history was noncontributory. There was no family history of skeletal disease. The case was surgically treated by segmental resection of the mandible and reconstruction was done using stainless steel reconstruction plate. With the follow-up period of 1 year, there was no recurrence.

Surgical management of ameloblastoma: Conservative or radical approach.

AIM: The ameloblastoma is a benign odontogenic tumor of epithelial origin that exhibits a locally aggressive behavior with a high level of recurrence, being believed theoretically to come from dental lamina remains, the enamel organ in development, epithelial cover of odontogenic cysts or from the cells of the basal layer of the oral mucosa. Especially larger, aggressive lesions require a more radical surgical approach resulting in large jaw defects. This paper discusses our experiences in the management of ameloblastoma tumor in 20 such patients. MATERIALS AND METHODS: A review of 20 cases of ameloblastoma (6 in the maxillary and 14 in the mandibular region) is presented. The lesions were between 4 and 8 cm in diameter. The methods of treatment consisted of radical surgery (i.e., segmental resection) and conservative treatments (i.e., enucleation with bone curettage). Half the cases were treated conservatively and others surgically. RESULTS: Enucleation with curettage was done in 10 cases, out of which six (60%) showed recurrence, whereas one (10%) case in the surgical group showed recurrence. Relatively higher tendencies of recurrence were observed in the cases treated conservatively. The aesthetic and functional outcomes were satisfying in all patients. CONCLUSION: According to our opinion, radical surgical resection of ameloblastoma is the treatment of choice, followed by the reconstruction of the defects, allowing good functional and aesthetic outcome.