Unusual Gigantiform Angiomatosis of Jawbone.

ABSTRACT: The purpose of this paper is to highlight rare highly infiltrative massive Angiomatosis and depict surgical outcome of a rare case series of gigantic lesions in the maxillofacial region. Data were recorded from the medical records of patients. Predictor variables were drawn from demographics, age, gender, site, evaluation of surgical treatment. The outcome variables were the challenges encountered and related complications. Out of 6 patients, the youngest was 10 and the oldest was 26 years old. Soft tissue and jawbone involvement were seen in 3 patients each with a single massive lesion involving both maxilla and mandible. All 6 patients had wide excision of the lesion with one patient having 2 stage procedures. No complications or recurrence was seen at 1-year follow-up. Angiomatosis is a rare and benign lesion in the head and neck region. its diffuse infiltrating nature may give a false malignant picture. it clinically mimics Hemangioma or Arteriovenous (AV) malformation thus requires thorough evaluation and its surgical intervention is challenging as described in this case series because of its magnitude and infiltrative nature.

Role of coronoidectomy and temporalis myotomy in surgical management of oral submucous fibrosis.

PURPOSE: The involvement of temporalis muscle fibers by oral submucous fibrosis (OSMF) and the procedure of coronoidectomy and temporalis myotomy in the surgical treatment protocol for the disease is a controversy. The primary objective of this study is to evaluate the histopathological changes in temporalis muscle fibers in patients undergoing surgical treatment for OSMF and to authenticate the importance of temporalis myotomy and coronoidectomy in surgical treatment protocol. METHOD: A 3-year prospective study was conducted to assess the histopathological changes in temporalis muscle in surgically treated OSMF cases. The predictor variables were drawn from demographic characteristics (age and gender) etiology, and mouth opening. The outcome variables were histopathological assessment of temporalis muscle fibers for parameters suggestive of degenerative changes and fibrosis changes at cellular level. RESULTS: Out of 56 patients, 30 patients were had surgical intervention. Twenty-eight (93.3%) were male and 2 (6.6%) were female with a ratio of 14:1. Histopathological examination of temporalis muscle fibers revealed hyalinization of muscle fibers in 80% of the patients followed by loss of striation (73.33%), fragmentation (60%), nucleus internalization (33.33%), infiltration of macrophages and other inflammatory cells (20.67%), multiple nuclei (20%), and swollen muscle fibers (6.67%). Mean preoperative mouth opening was 12.4 and post-operatively 41.3 mm on 1-year follow-up and this was stable on further follow-up. CONCLUSION: The results of this study suggest involvement of temporalis muscle with disease itself and the justification for coronoidectomy and temporalis myotomy in the surgical protocol was established.

Cell Block and Its Impact in the Diagnosis of Jaw Lesions over Fine Needle Aspiration Cytology.

OBJECTIVES: To determine the role and efficacy of fine needle aspiration cytology (FNAC) and cell block in diagnosis of jaw lesions and compare the agreement between FNAC and cell block to predict the diagnosis. METHOD: The sample comprised 51 cases, including 12 odontogenic keratocysts (OKCs), 8 ameloblastomas, 22 radicular cysts, 7 dentigerous cysts, and 1 each of intraosseous mucoepidermoid carcinoma (MEC) and adenomatoid odontogenic tumor (AOT). FNAC samples remaining after hematoxylin and eosin (H&E)-stained cytosmear diagnosis were centrifuged at 3,000 rpm for 10 min. The supernatant was discarded and sediment mixed with 2-3 mL alcohol and filtered. To this, 10% formalin was added, filtered, taken for routine processing, and stained with H&E. The result of FNAC smear and cell block was compared with histopathological diagnosis. RESULTS: On cytological examination of the smears, 7 OKCs and 22 radicular cysts were diagnosed, whereas ameloblastomas, AOT, intraosseous MEC, and dentigerous cysts were not. This gave an agreement of 56.8% with the biopsy reports. Cell block sections stained with H&E of 12 OKCs, 22 radicular cysts, 1 MEC, and 3 cases of ameloblastoma offered a diagnosis in accordance with the biopsies giving an agreement of 74.5%, while dentigerous cyst and AOT failed to do so. In comparison with FNAC, additionally 5 cases of OKC and 1 of MEC could be detected, and in ameloblastoma, out of 8 cases, only 3 yielded a concordant diagnosis through the cell block technique. CONCLUSION: In comparison with FNAC, the architectural pattern and the morphology of the cells were better preserved by the cell block technique. This substantiates that cell block could be used as an ancillary technique to aid in definitive diagnosis of head and neck swellings.

An aggressive pyogenic granuloma masquerading as a vascular neoplasm.

Pyogenic granuloma (PG) is a benign lesion, with a female predilection, commonly associated with local irritation or trauma. We report an unusual, destructive case of PG, displaying excessive loss of blood and destruction of alveolar bone leading to the loss of maxillary anterior teeth in an 18-year-old female, compromising function and esthetics. The incisional and excisional biopsy specimen of this recurrent lesion obtained during a 5-year span was studied, which revealed an increase in vascularity and extensive proliferation of endothelial cells admixed with varying degree of inflammatory cell infiltrate. The clinical, radiographic, and histopathological diagnostic tools enabled to precisely diagnose the lesion as an aggressive variant of PG, distinguishing it from other vascular neoplasms. No recurrence has been noted during a 5-year follow-up. The clinicians should be aware of the aggressive and destructive clinical behavior of PG to avoid the inadvertent treatment of this reactive lesion.

Evaluation of salivary sialic acid, total protein, and total sugar in oral cancer: a preliminary report.

AIM: Detection of cancer at the early stage is of utmost importance to decrease the morbidity and mortality of the disease. Apart from the conventional biopsy, noninvasive methods like analysis of saliva may provide a cost-effective approach for screening a large population. Thus, this study aimed to estimate salivary levels of sialic acid, total protein, and total sugar in the oral cancer patients and in healthy control group to evaluate their role in diagnosis and prognosis of oral cancer. STUDY DESIGN: Unstimulated whole saliva samples were collected from 30 healthy controls (Group I) and 30 squamous cell carcinoma patients (group II). Estimations of salivary levels of sialic acid, total protein, and total sugar were performed. This was correlated histopathologically with the grades of carcinoma. STATISTICAL ANALYSIS AND RESULTS: The Student's ' t ' test and multivariate regression analysis were performed. The results showed that salivary levels of total protein, total sugar, protein-bound sialic acid, and free sialic acid were significantly higher in oral cancer patients compared to those of normal healthy controls ( P values in all the results were less than 0.001). The salivary free sialic acid levels were found to be significantly higher in well-differentiated squamous cell carcinoma than in moderately differentiated carcinoma ( P < 0.001). However, protein-bound sialic acid, total proteins, and total sugars did not show any statistical significance between well and moderately differentiated carcinomas. CONCLUSION: Biochemical analysis of saliva can be used in early detection of cancer and is best correlated with histopathological degree of squamous cell carcinoma.

Reactive lesions of oral cavity: A retrospective study of 659 cases.

OBJECTIVE: This study reviews, analyzes, and compares the demographic data, histopathological features and discusses the treatment and prognosis of reactive lesions (RLs). MATERIALS AND METHODS: Retrospective study was performed on the departmental archives from July 2006 to July 2016 (total 5000 cases) comprising of 659 cases of RLs of the oral cavity. The recorded data included age, gender, size, site, duration, habits, etiology, histopathological diagnosis, treatment, and prognosis. RESULTS: The most common lesion was found to be inflammatory fibrous hyperplasia (47%) followed by pyogenic granuloma (PG) (27.16%) and the least cases were of peripheral giant cell granuloma (1.6%). The mean age for the occurrence was 4th-5th decade in all the RL's exceptperipheral ossifying fibroma (POF) which presented in the third decade. Female predominance was noted in all lesions except irritational FIB. The sizes of majority of the lesions were approximately 0.5-1 cm. The common sites were anterior maxilla followed by posterior mandible and least in tongue with no associated habits (82.2%). The duration of all the lesions was seen to be <1 year. Majority of them presented with poor oral hygiene status (87.2%). Recurrences were present in 13.5% of surgically excised lesions. CONCLUSION: The RLs present commonly in oral cavity secondary to injury and local factors which can mimic benign to rarely malignant lesions. The clinical and histopathological examination helps to categorize the type of lesions. The complete removal of local irritants with follow-up and maintenance of oral hygiene helps to prevent the recurrences of such lesions.

An unusual case of neural palatal swelling.

Neural tumors in the oral cavity occur both in the soft tissues and in the jaw bones. They occur as painless, smooth surface swelling in the soft tissues of the mouth, exhibiting a slow rate of growth and mild expansion of the cortical plates. Here, we report a rare case of a cellular variant of schwannoma in a young Indian female patient who presented with an asymptomatic nodule in the mid-palatine raphe region of the hard palate, mimicking a fibroma, thus creating a dilemma in the diagnosis.

Oral pulse or hyaline ring granuloma: A case report and a brief review.

Pulse or hyaline ring granulomas are rare but are well-defined oral and extraoral lesions due to implantation of the cellulose moiety of plant foods in contrast starch components. A unique form as reactive gingival growth showing histologic features of oral pulse or hyaline ring granuloma (OPHRG) which had resulted from implantation of food particles of plant or vegetable origin into the periodontium has been illustrated. Such a presentation is attributable to compromised periodontal health and poor oral hygiene favoring the implantation of food particles has been described here along with a literature update on OPHRG.

Analysis of salivary secretor status in patients with oral submucous fibrosis: a case-control study.

AIM: Many individuals have various tobacco-related habits, yet only some develop clinical manifestation of lesions. This raises the question of whether there any inherent or host risk factors involved in the pathogenesis which need to be further investigated. The aim of the present study was to analyze the ABO antigen, secretor status, and blood groups of patients. METHODS: The study consisted of 99 participants, with 33 patients allocated to three groups: (a) patients with a tobacco-related habit and oral submucous fibrosis (OSF); (b) patients with a tobacco-related habit, but no lesions; and (c) healthy controls. A total of 1 mL unstimulated saliva was collected in a sterile test tube, and the Wiener agglutination test was performed to analyze the ABO antigen in all three groups. RESULTS: All of the OSF patients were non-secretors, whereas 84.8% were non-secretors in the group of individuals with habits as compared to 15.2% in the healthy group. A statistically-significant difference was observed between the OSF and healthy groups. The patients in the OSF group were predominantly blood-group A, followed by groups O, B, and AB. CONCLUSION: There is a correlation between salivary secretor status and the development of OSF. Thus, non-secretors are at greater risk of and more prone to the development of oral lesions. Blood-groups A and O predominate over the B and AB blood groups.

Immunohistochemical expression of calretinin in ameloblastoma, adenomatoid odontogenic tumor, and keratocystic odontogenic tumor: a comparative study.

Calretinin is expressed primarily in the central and peripheral nervous system and extensively studied in colon adenocarcinoma and mesotheliomas. Calretinin is known to be expressed in the odontogenic epithelium and odontogenic tumors. However, the role of calretinin in the pathogenesis of odontogenic tumors is yet to be confirmed. Hence, the aim of the present study was to evaluate the expression and role of calretinin in selected odontogenic tumors. The study included 30 ameloblastomas, 30 adenomatoid odontogenic tumors, and 30 keratocystic odontogenic tumors. Staining intensity, pattern, and localization of the immunopositive cells were determined. Statistical analysis was performed using Mann-Whitney U test and Kruskal-Wallis analysis of variance test. P-values <0.05 were considered to be statistically significant. Results showed that 90% ameloblastomas and 80% keratocystic odontogenic tumors were immunopositive to calretinin, whereas none of the adenomatoid odontogenic tumors showed reactivity. Intensity was higher in the ameloblastomas compared with the keratocystic odontogenic tumors. Statistically significant differences were observed when the expression of calretinin was compared, except between the ameloblastoma and keratocystic odontogenic tumor. However, the intensity of calretinin was significantly higher in the ameloblastoma when compared with the keratocystic odontogenic tumor. On the basis of these results, it is suggested that calretinin might be used as a specific immunohistochemical marker for the ameloblastomas and could play an important role in the differentiation of aggressiveness of different odontogenic tumors. Depending on the cell regulatory processes, we suggest a possible role of calretinin in the pathogenesis of ameloblastomas and have to be further studied along with other proliferative cell cycle and apoptotic markers with larger sample size.

Viability of bacteria in dental calculus - A microbiological study.

AIM: The aim of this study was (1) To investigate the viability of bacteria within supragingival and subgingival calculus, (2) To examine motility of bacteria, and (3) To identify bacterial morphotypes in calculus. MATERIALS AND METHODS: Supra and subgingival calculus were harvested from 30 subjects having clinical evidence of chronic inflammatory periodontal disease and were divided into two groups. Samples from both groups were immediately transported to the Department of Microbiology for gram staining, acridine orange staining, bacterial culture and to the Department of Oral Pathology for dark field microscopy. RESULTS: Gram staining revealed presence of bacteria within the samples.Dark field microscopic examination revealed presence of filamentous organisms, spirochetes, and motile short bacilli. Acridine orange fluorescent stain showed that the viable bacteria appeared apple green. Bacterial culture revealed presence of a variety of aerobic organisms. CONCLUSION: From the results, it appeared that viable bacteria were present within calculus especially within internal channels and lacunae.

Comparative study of Candida in oral submucous fibrosis and healthy individuals / Estudo comparativo de Candida em fibrose submucosa oral e indivíduos saudáveis

PURPOSE: Oral submucous fibrosis (OSMF) is a high-risk precancerous condition that predominantly affects Indian youngsters due to the habit of gutkha chewing. Candida may play a role in the etiopathogenesis of premalignant and malignant lesions. The aim of this study is to compare the incidence, intensity, and species of Candida found in OSMF patients and healthy individuals. METHODS: This study included 20 OSMF patients and 20 healthy controls. A detailed history of each patient was recorded along with a clinical examination. Samples were collected with the oral rinse technique and cultured on Sabouraud's agar medium. The isolated yeast species were counted and identified based on Gram staining, a germ tube test, chlamydospore formation and a sugar assimilation test. RESULTA: In total, 40 percent of OSMF patients and 15 percent of healthy controls yielded Candida organisms on culture. C. albicans was the predominant species isolated, but C. krusei and C. tropicalis were also identified. Gender, gutkha habit and clinical staging had no influence on the candidal carriage in OSMF patients. CONCLUSION: The incidence and intensity of Candida (primarily C. albicans) was greater in OSMF patients than in healthy controls, but these findings were within the normal limit (3-47 percent). Therefore, Candida may not be an etiologic factor in malignant transformation. However, controversy still exists over whether the chewing of betel quid in cases of OSMF has an inhibitory effect or promotes the adherence and invasion of Candida.

OBJETIVO: Fibrose submucosa oral (FSO) é uma condição pré-maligna de alto risco que predominantemente afeta jovens da Índia devido ao hábito de mascar 'gutkha'. Candida pode ter um papel importante na etiopatogenia de lesões pré-malignas e malignas. O objetivo deste estudo foi comparar a incidência, intensidade e Candida spp encontradas em pacientes com FSO e em indivíduos saudáveis. METODOLOGIA: Este estudo incluiu 20 pacientes com FSO e 20 controles saudáveis. Obteve-se de cada sujeito uma história detalhada e exame clínico. As amostras foram coletadas com uma técnica de enxágue bucal e cultivadas em meio Agar Sabouraud. As espécies isoladas foram contadas e identificadas com base em coloração Gram, teste de tubo de ensaio e teste de assimilação de açúcar. RESULTADOS: No total, 40 por cento dos pacientes com FSO e 15 por cento dos controles saudáveis apresentaram resultado positivo de cultura para Candida. C. albicans foi a espécie predominante isolada, mas C. krusei e C. tropicalis também foram identificados. O sexo, hábito de mascar 'gutkha' e estadiamento clínico não influenciaram a presença de fungos nos pacientes com FSO. CONCLUSÃO: A incidência e intensidade de Candida (primariamente C. albicans) foi maior nos pacientes com FSO que nos sujeitos controle, mas estes achados estavam dentro dos limites normais (3-47 por cento). Portanto, Candida pode não ser um fator etiológico na transformação maligna. Entretanto, ainda há controvérsias se o hábito de mascar 'betel' em casos de FSO teria um efeito inibidor ou promoveria a aderência e invasão de Candida.