Long-term results of post-operative pelvic image guided intensity modulated radiotherapy in gynecological malignancies

Objective: To assess late clinical outcomes with image guided intensity modulated radiotherapy [IG- IMRT] in gynecological malignancies

Patients and methods: We have been practicing IG IMRT for gynecological malignancies since January 2009. Here we are presenting our experience with this modern technique at median follow up of 38 months. During whole treatment bladder filling protocol was followed, Both target volumes and critical structures were contoured according to RTOG guidelines. Dose prescribed to clinical target volume [postop bed and nodal volume] was 50.4 Gy in 28 fractions. Cone beam CT [CBCT] scans were taken to quantify the status of target volume and normal structures

Results: 80 patients were evaluated and analyzed who were treated from January 2009 to December 2014. Median age of our patients was 56.5 years. Out of eighty forty four patients [55%] were of carcinoma endometrium and the rest 36 [45%] were of carcinoma cervix. None of our patients experienced late grade 3 or 4 bladder toxicity Although late grade 3 and 4 bowel and rectal toxicity was experienced by single patient. 2.5% patients developed local recurrence, 5% patient developed nodal with distant metastases and 6.25% only distant metastases. Three ol our patients developed lung cancer as second primary during follow up. 76.2% patients are alive with regulaf follow up

Conclusions: Our study concluded that IG IMRI increases patient compliance and reduces long-term side effects in post-operative gynecological malignancies without compromising local-regional control, disease free survival and overall survival

Orthodontic extrusion of subgingivally fractured tooth using a removable appliance: An alternative treatment to reestablish biological width.

Restoration of a traumatically injured tooth presents a clinical challenge for a predictable aesthetic outcome. This case report describes a multidisciplinary approach of a subgingivally fractured permanent maxillary central incisor. A removable orthodontic appliance was used for orthodontic extrusion of root, and surgical gingival recontouring was done with electrocautery to reestablish the biological width. Form and function were restored establishing biological width and esthetics was repaired with porcelain fused to metal crown.

Facial talon cusp on mandibular incisor: A rare case report with review of literature.

Talon cusp is a relatively rare developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. It is characterized by cusp‑like projections from the cingulum area, or cemento‑enamel junction of maxillary or mandibular anterior teeth, in both the primary and permanent dentition, usually observed on the lingual surface of the affected tooth. The cusp may or may not contain an extension of the pulp. The etiology remains unknown. The incidence is 0.04‑8%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors. The anomaly has been reported to be rare especially when it occurs on mandibular teeth. This article reports a case of talon cusp on permanent mandibular central incisor that too on facial aspect which makes it a rare entity.

Pleomorphic adenoma of cheek: A rare case report and review of literature.

Pleomorphic adenoma (PA) is the most common tumor of the salivary glands. About 90% of these tumors occur in the parotid gland and 10% in the minor salivary glands. The most common sites of PA of the minor salivary glands are the palate, followed by lips and cheeks. Throat, floor of the mouth, tongue, tonsil, pharynx, retromolar area and nasal cavity are rarely involved. Here, we report a case of PA of the cheek in a 42-year-old female. The mass was excised and the patient was followed for 3 years post operatively with no recurrence.

Correlation of morphological variants of the soft palate and Need's ratio in normal individuals: A digital cephalometric study

PURPOSE: The present study was aimed to investigate the variation of soft palate morphology in different age and gender groups. The correlations of radiographic velar length (VL), velar width (VW), pharyngeal depth (PD), and Need's ratio with soft palate variants were also studied in the North Indian subpopulation. MATERIALS AND METHODS: The study sample consisted of 300 subjects aged between 15 and 45 (mean: 31.32) years. The velar morphology on lateral cephalograms was examined and grouped into six types. The results obtained were subjected to a statistical analysis to find the correlation between variants of the soft palate with gender and different age groups. RESULTS: The most frequent type of soft palate was leaf shaped (48.7%), and the least common was crook shaped (3.0%) among both the genders and various age groups, showing a significant correlation. The mean VL, VW, and PD values were significantly higher in males and significantly correlated with the types of soft palate. A significant correlation was observed between the mean VL, VW, PD, and Need's ratio with various age groups, showing an inconsistent pattern with an increase in age. The types of soft palate, gender, and Need's ratio were also significantly correlated, with an overall higher mean value of the Need's ratio among female subjects and the S-shaped soft palate. CONCLUSION: The knowledge of a varied spectrum of velar morphology and the variants of the soft palate help in a better understanding of the velopharyngeal closure and craniofacial anomalies.

Cleidocranial dysplasia: a dilemma in diagnosis?

Cleidocranial dysplasia is a developmental anomaly and is characterized by craniofacial and skeletal malformations as well as the presence of numerous supernumerary and unerupted teeth. A 16-year-old patient presented with an unaesthetic facial appearance due to unerupted front teeth. General examination showed the absence of the clavicles, a brachiocephalic skull with frontal bossing and a depressed nasal bridge with concave facial profile. Radiographic examination showed multiple supernumerary teeth, rudimentary clavicles with a bell shaped rib cage and an open sagittal suture. A final diagnosis of cleidocranial dysplasia was made and comprehensive management was planned which involved multi disciplinary approach. The role of dentist is vital in the early diagnosis and management of such cases which require interdisciplinary cooperation for better results.