Dose dependent slurred speech and laryngopharyngeal dysesthesia due to oxaliplatin.

INTRODUCTION: Oxaliplatin is a platinum containing alkylating agent commonly used in the management of colorectal cancers. The most common dose-limiting toxicity of oxaliplatin is peripheral neuropathy, which can be severe enough to cause treatment discontinuation. We present a case of dysarthria and laryngopharyngeal dysesthesia (LPD) that developed during the first dose of oxaliplatin, which showed dose-dependent reduction in severity in subsequent cycles. CASE REPORT: A 52-year-old female patient with adenocarcinoma of rectum (pT4N2M0) was prescribed oxaliplatin (130 mg/m2) and capecitabine(2000mg/m2). She developed heaviness in the tongue, slurred speech, jaw pain, perioral paresthesia within 30 min after the end of 3 h infusion of oxaliplatin in the first cycle. The symptoms subsided without any sequelae in two days. However, in the subsequent cycles as the dose of the oxaliplatin was reduced, similar symptoms reappeared but were of reduced in severity. No dysesthesia symptoms were observed in the 4th cycle when the oxaliplatin was administered at 85 mg/m2. MANAGEMENT AND OUTCOME: As and when the patient developed symptoms - slurred speech, jaw pain during the first three cycles, she was managed with inj. Hydrocortisone (100 mg i.v.) and one ampoule of pheniramine (45 mg i.v.). DISCUSSION: Occurrence of laryngopharyngeal dysesthesia due to oxaliplatin does not warrant drug withdrawal, dose titration can be helpful, thereby preventing the drug withdrawal for the patient management.

Turner's tooth with unique radiographic presentation: a case report.

Hypoplasia--the result of a disruption in the enamel matrix formation process--causes a defect in the quality and thickness of enamel. Enamel formation is a complex and highly regulated process. Enamel defects have been associated with a broad spectrum of etiologies, including genetic, epigenetic, systemic, local, and environmental factors. An enamel defect in the permanent teeth caused by periapical inflammatory disease in the overlying primary tooth is referred to as Turner's tooth (also known as Turner's hypoplasia). This article presents a case of Turner's hypoplasia of the first mandibular premolar, with an unusual radiographic presentation.

Osteoradionecrosis of the mandible and mastoiditis after radiotherapy for parotid mucoepidermoid carcinoma.

Osteoradionecrosis of the mandible in conjunction with mastoiditis is an extremely rare occurrence following irradiation of salivary gland malignancy in the orofacial region. We report one such case of a patient who presented to us with trismus, jaw pain, and ear discharge. Imaging of the jaws revealed classical features of osteoradionecrosis and mastoiditis. This case is important because presenting features like trismus and dental infection led us to investigative procedures that revealed extensive bone involvement including mastoiditis. Trismus progressively increased over a period of 8 years. In this case, we would like to emphasize the importance of good oral hygiene in the postradiotherapy stage for head and neck cancer.

A rare case of long-standing mucoepidermoid carcinoma of minor salivary glands of the palate.

Salivary gland carcinomas are the uncommon and clinically diverse group of neoplasms with mucoepidermoid carcinoma (MEC) being the most common among them. MEC accounts for 5% of all salivary gland tumors. As the name implies, the tumor is composed of both mucus secreting cells and epidermoid type cells in varying proportions. Most patients are aware of the lesion for 1 year or less. We report clinical, radiographic and histological features of a long-standing case of mucoepidermoid carcinoma of minor salivary glands of the palate in a 35-year-old male patient. The patient reported with a slow growing swelling on the palate which began 15 years ago. The patient was treated with hemi-maxillectomy and is currently under follow up.

Prevalence of soft tissue calcifications in the maxillofacial region: a radiographic study

Aim: To evaluate the prevalence of soft tissue calcifications in orofacial region and their panoramic radiographic characteristics using digital panoramic radiographs among patients reporting to a tertiary dental hospital. Methods: 1,578 digital panoramic radiographs were retrieved from the archives and scrutinized for the presence of calcifications. Soft tissue calcifications were recorded according to age, gender, site (left or right). Data were analysed using Chi-square and Fisher's exact test using SPSS software and a p < 0.05 was considered statistically significant. Results: Among the total number of radiographs, calcified carotid artery (34.3%), calcified stylohyoid ligament (21%), tonsillolith (10.3%), phlebolith (17.6%), antrolith (6.3%), sialolith (5.9%), rhinolith (2.5%) and calcified lymph nodes (1.9%) were identified. The most commonly observed calcifications were calcification of carotid artery and stylohyoid ligament and the least commonly observed calcifications were rhinolith and calcified lymph node. A statistically significant association of the presence of calcifications of carotid artery and stylohyoid ligament on the left and right side was observed in females and tonsillolith on the right side in males (p-value < 0.05). Considering the gender and age group, the occurrence of antrolith among males and rhinolith among females of young-adult population, tonsillolith among the males, calcified carotid artery and stylohyoid ligament among the females of middle-aged population was found to be significant. Conclusion: Soft tissue calcifications are often encountered in dental panoramic radiographs. Our study revealed that the soft tissue calcifications in orofacial region were more common in women and were found to be increased above 40 years of age

A Rare Clinical Presentation of an Osteochondroma of Coronoid Process of Mandible.

Osteochondroma (osteocartilaginous exostosis) is one of the most common benign tumors of bone but is rare in the craniofacial region. Only a few cases of osteochondroma of the coronoid process have been reported in the literature, since the time of its discovery (osteochondroma of a coronoid process) by Jacob in 1899. We present a case of osteochondroma of the left coronoid process in a 16-year-old female patient. Contrary to the literature, our patient had no limited mouth opening despite a close approximation of left hyperplastic coronoid process with zygomatic arch, making it a unique case among similar cases. Plain radiography can be used for this hyperplastic condition but due to its inherent distortion and being only two-dimensional (2D) it has a limited diagnostic advantage. Cone beam computed tomography (CBCT) was employed for necessary diagnostic information. We managed our patient with an intraoral coronoidectomy.

Serum and salivary lactate dehydrogenase levels as biomarkers of tissue damage among cigarette smokers. A biochemical study.

OBJECTIVE: To estimate the serum and salivary lactate dehydrogenase levels in cigarette smokers and non-smokers. MATERIALS AND METHODS: In this study lactate dehydrogenase levels were estimated in 30 healthy individuals with no tobacco related habits and in 30 patients with history of smoking cigarettes for a minimum of 2 years using Spectrophotometry. RESULTS: The mean values for serum and salivary lactate dehydrogenase levels were higher in cigarette smokers when compared to non-smokers. Serum lactate dehydrogenase levels on comparison between the groups was statistically significant (p=0.04). The values of salivary lactate dehydrogenase levels between the groups was highly significant (p<0.001). CONCLUSION: Cigarette smoking leads to an increase in serum as well as salivary Lactate dehydrogenase levels as indicator of tissue damage in the oral cavity. The present study indicates saliva as a better test medium than serum in determination of lactate dehydrogenase levels.

Co-occurence of florid cemento-osseous dysplasia and simple bone cyst: a case report.

BACKGROUND: The purpose of this report is to present a rare case of co-occurrence of florid cemento-osseous dysplasia with simple bone cyst in a middle aged Asian woman. Most of the reported cases are isolated cases of simple bone cyst or florid cemento-osseous dysplasia, but co-occurrence of these two entities is extremely rare. METHODS: The authors report a 41 year old female patient with co-occurrence of mandibular florid cemento-osseous dysplasia with simple bone cyst. A thorough clinical and radiological examination was carried out. RESULTS: It was diagnosed mandibular cyst with possible co-occurrence of florid cemento-osseous dysplasia. Surgical exploration of the multilocular lesion was applied. Since, the patient was symptomatic at the time of presentation utmost caution was taken during the surgical procedure as florid cemento-osseous dysplasia is associated with hypo-vascularity of the affected bone. Based on histopathological, as well as supporting clinico-radiological findings a confirmative diagnosis of florid cemento-osseous dysplasia co-occurring with simple bone cyst was made. Patient was followed-up for a period of six months and was reported to be asymptomatic. CONCLUSIONS: Timely diagnosis and well planned treatment is important to obtain a good prognosis when a rare co-occurrence of two or more bone lesions affects the jaws.

Oromandibular-limb Hypogenesis Syndrome Type II C: A Rare Case.

The oromandibular-limb hypogenesis syndrome comprises a group of anomalies which simultaneously affect the mandible, tongue, and maxilla with or without reductive limb anomalies. It is characterized by failure of development of the intraoral region and distal extremities. Multiple and variable deformities of the mandible, maxilla and tongue may occur in combination with a variety of limb defects. The wide range of presentation and combination of anomalies make classification difficult. They usually feature primarily in sporadic case reports because of their low incidence. The genetic origin of this syndrome is uncertain. It is congenital and there seems to be no sex predilection. The key radiographic features are retruded mandible, impacted teeth and malformed phalanges. When compared to available literature, frequently reported features like hypodontia, hypoglossia, microstomia, protruded maxilla and limb anomalies were present in our case. The case presented here is one of the rarest subtypes of this rare syndrome.