Periodontal therapy for hopeless mandibular anterior teeth: a retrospective case report with a multidisciplinary approach and a 20-year follow-up

Introduction: This case report presents the intentional periodontal maintenance of two periodontal hopeless lower central incisors with a multidisciplinary approach and 20-year follow-up. Case presentation: A 36-year-old male, in 2001, was diagnosed with aggressive periodontitis, gingival swelling, bleeding, and mandibular central incisors with mobility and poor prognosis. Following periodontal therapy (phase I), root canal treatment, and occlusal adjustment, #31 and #41 were gently extracted to remove the granulation tissues, calculus, and infected cementum from the root surface. Then, tetracycline-HCl was applied for 5 minutes on the root surfaces. The teeth were repositioned into the sockets and splinted with a lingual bar. At 3 months, the bar was removed, and a free gingival autogenous graft was done to improve the local keratinized tissue width. Mobility scores, pocket depths, and clinical attachment levels were recorded, and radiographs were taken at 1, 5, and 20 years. The 5-year follow-up showed that the teeth were clinically and radiographically in function. There was a reduction in probing depth and a gain in clinical attachment and radiographic alveolar bone levels. After 20 years, #41 was stable, but #31 had external root resorption, leading to a new treatment plan (dental implants) and extraction. Conclusion: The clinical result of this case was satisfactory for 20 years. Intentional periodontal maintenance of the teeth may be an alternative treatment, even considering the high level of complexity.

Abdominal distension resulting from hematocolpos in children: A case report.

INTRODUCTION: Hymeneal imperforation is a rare genital malformation often discovered during abdominopelvic emergencies. Hematocolpos typically presents with pelvic pain, a palpable mass, and primary amenorrhoea. The diagnosis is confirmed by clinical evaluation and imaging studies such as ultrasound. CASE PRESENTATION: A 13-year-old girl presented a four-week history of abdominal distension and pain, which worsened over time, along with constipation, but without vomiting or fever. Examination revealed stable vital signs and abdominal guarding. A gynecological exam showed an imperforate hymen. Ultrasound identified a hypoechoic fluid collection in the retrovesical area. Hematocolpos was diagnosed and surgical intervention involved opening the hymen and releasing 800 cc of blood. The patient remained stable after the operation and was discharged painless after two days. DISCUSSION: Imperforate hymen, resulting from incomplete resorption of the hymeneal membrane during embryonic development, is a common cause of hematocolpos. Symptoms often manifest in menarche, with cyclical pelvic pain and primary amenorrhoea. The diagnosis is based on physical examination and imaging, while early intervention prevents complications such as endometriosis and infertility. Surgical treatment varies from hymenotomy to more complex reconstructive procedures based on the underlying cause. CONCLUSIONS: Although rare, imperforate hymen is the most prevalent congenital anomaly of the vagina, often remaining asymptomatic until menarche. Accurate diagnosis and timely surgical intervention are essential to avoid severe complications. This case highlights the importance of comprehensive clinical evaluation and appropriate imaging in the management of hematocolpos.

Transverse testicular ectopia in a newborn with transposition of the great arteries: A unique case report.

INTRODUCTION: Transverse testicular ectopia (TTE) is an extremely rare though well-documented congenital anomaly. In males with a 46XY karyotype, it is characterised by the herniation of both testes and part of the Müllerian organs into a single processus vaginalis. TTE is one of the three main clinical presentations of persistent Müllerian duct syndrome (PMDS). Transposition of the great arteries (TGA) is another rare congenital anomaly and severe cardiac condition. We present the likely first reported case of TTE with an accompanying malformation of TGA in a newborn. CASE PRESENTATION: A 3-day-old Caucasian 46XY newborn with TGA was referred to the paediatric surgeons and endocrinologists for possible variations of sex characteristics (VSC). Despite a clinical examination revealing phenotypical male genitalia, an early postnatal ultrasound (US) suggestive of a uterine structure raised the suspicion of VSC. This patient had an arterial switch operation at 2 weeks of age before undergoing an exploration of the left groin at 8 weeks of age. Intraoperative findings revealed bilateral testes either side of a rudimentary uterus with fallopian tubes in the left inguinal canal. To avoid de-vascularising any structures, modified bilateral orchidopexy was performed placing each testis in the respective hemiscrotum with the uterus placed across the scrotal septum. CONCLUSION: We present the first reported case of TGA accompanying TTE. Early and accurate diagnosis, combined with the coordinated care by the specialist paediatric surgeon, cardiothoracic team, endocrinologist, and radiologist are essential for delivering timely, optimal care. This unique case raises the possibility of there being a link between TTE and TGA.

Misleading Mercedes-Benz sign: A case report of misdiagnosed cholecysto-hydatid cyst fistula in acute cholecystitis.

INTRODUCTION: Liver hydatid cysts represent a significant health concern globally, particularly in endemic regions like Tunisia. While they often lead to complications such as biliary fistulas, diagnostic errors can arise from radiologic signs like the "Mercedes Benz sign," which indicates gas within the gallbladder. This report highlights the challenge of diagnosing a rare cholecysto-hydatid cyst fistula, where the presence of gas in the gallstones initially suggested a fistula. CASE PRESENTATION: A 30-year-old female presented with right hypochondrium pain and fever. Ultrasound suggested cholecystitis and identified two cystic formations in liver segments IVb and VII. CT scan revealed intravesicular air bubbles, suggesting a cholecysto-hydatid fistula. Emergency surgery was performed. Intraoperatively, there was an acute cholecystitis. The liver hydatid cyst of segment IVb communicated with the biliary tree and there was no cholecysto-hydatid fistula. We performed a cholecystectomy, cholangiography, and a total pericystectomy for the two liver hydatid cysts. The postoperative follow-up was uneventful. DISCUSSION: The "Mercedes Benz sign," often indicating gas within gallstones, is rare but can mislead the diagnosis toward a cholecysto-hydatid cyst fistula. This case highlights the diagnostic challenge posed by this radiological feature, which led to initial suspicion of a fistula. Hydatid cysts, though common in endemic regions, can lead to diagnostic dilemmas, especially when atypical signs are present. CONCLUSIONS: The presence of gas in the gallbladder can mislead the diagnosis, particularly when the "Mercedes Benz sign" is present, as it may suggest a rare cholecysto-hydatid cyst fistula. However, this is not always the case. Prompt and accurate evaluation, including intraoperative findings, to reinforce clinical suspicion and decision-making in endemic regions.

Emergency pancreaticoduodenectomy for complex pancreaticoduodenal damage with multiple organ injuries following blunt abdominal trauma: A case report and literature review.

INTRODUCTION: Pancreaticoduodenectomy is a complex surgical procedure with significant potential for complications such as pancreatic fistula, bile leakage, intra-abdominal abscesses, and hemorrhage. Emergency pancreaticoduodenectomy (EPD) performed for traumatic injuries carries even greater risks due to the patient's severely unstable condition upon admission. While the literature recommends that EPD be reserved for hemodynamically stable trauma patients, there are scenarios where it may be the last resort to save the patient's life. CASE PRESENTATION: A 49-year-old male presented in the emergency department after a collision with a truck. He sustained extensive pancreaticoduodenal deconstruction combined with IVC, liver, right kidney, and right adrenal injuries following blunt abdominal trauma. Despite the patient's hemodynamic instability, the surgical team proceeded with EPD combined with IVC repair, right nephrectomy, adrenalectomy, cholecystectomy, and liver hemostasis. Postoperative complications included biliary leakage and intraabdominal abscess, all of which were successfully conservatively managed. CLINICAL DISCUSSION: Upon entering the abdomen, the priority was rapid identification and control of the significant bleeding, particularly from the injured IVC. While additional procedures like nephrectomy and adrenalectomy were required, continued bleeding from the crushed pancreatic head left EPD as the only viable option to save the patient. CONCLUSION: EPD can be a lifesaving procedure for a small portion of trauma patients with non-reconstructable pancreaticoduodenal injury, even in the setting of hemodynamic instability. However, it should only be performed at high-volume centers and by experienced hepato-pancreato-biliary surgeons.

Linear IgA bullous dermatosis in a latin adolescent treated with cyclosporine and prednisone.

INTRODUCTION: Linear IgA bullous dermatosis (LABD) is a rare autoimmune disease. Although dapsone is the initial treatment, other immunomodulators are used in resistant cases or when dapsone is unavailable. CASE REPORT: A 12-year-old Mexican child, with no relevant medical history, developed in May 2023 a disseminated dermatosis affecting all body segments, including mucous membranes, characterized by erythematous patches and plaques evolving into the formation of serous and serosanguinous blisters and vesicles, distributed in a "string of pearls" pattern. LABD was suspected and confirmed by skin biopsy, which showed a subepidermal blister with neutrophilic infiltration and linear Immunoglobulin A deposits at the dermo-epidermal junction by direct immunofluorescence. Treatment with prednisone (2 mg/kg/day) and cyclosporine (5 mg/kg/day) resulted in improvement and lesion remission within 2 weeks. Both drugs needed to be discontinued for 3 months due to intermittent blistering. Cyclosporine was continued as maintenance therapy at a dose of 4 mg/kg/day for 8 months. CONCLUSIONS: The report highlights the use of cyclosporine as an alternative immunomodulator for DAAL, an immunosuppressive agent used in autoimmune disorders. Few cases, including this one, have described complete remission and control of the dermatosis with cyclosporine, accompanied by prednisone at the start of treatment.

INTRODUCCIÓN: La dermatosis ampollosa por IgA lineal es una enfermedad autoinmunitaria rara. Aunque la dapsona es el tratamiento inicial, se usan otros inmunomoduladores en casos resistentes o cuando la dapsona no está disponible. CASO CLÍNICO: Un niño mexicano de 12 años, sin antecedentes relevantes, desarrolló en mayo de 2023 una dermatosis diseminada a todos los segmentos corporales, incluyendo las mucosas, caracterizada por manchas y placas eritematosas que evolucionaron hacia la formación de ampollas y vesículas serosas y serohemáticas, distribuidas en forma de «cadena de perlas¼. Se sospechó dermatosis ampollosa por IgA lineal y se confirmó mediante biopsia cutánea, que mostró una ampolla subepidérmica con infiltrado neutrófilo y depósitos lineales de IgA en la unión dermoepidérmica mediante inmunofluorescencia directa. El tratamiento con prednisona (2 mg/kg al día) y ciclosporina (5 mg/kg al día) resultó en mejoría y la remisión de las lesiones a las 2 semanas. Fue necesario dejar ambos fármacos durante 3 meses debido a la aparición intermitente de ampollas. Se dejó ciclosporina como terapia de mantenimiento a dosis de 4 mg/kg al día por 8 meses. CONCLUSIONES: El reporte destaca el uso de ciclosporina como inmunomodulador alternativo para la dermatosis ampollosa por IgA lineal, un agente inmunosupresor utilizado en trastornos autoinmunitarios. Pocos casos, incluido este, han descrito la remisión completa y el control de la dermatosis con ciclosporina, acompañada de prednisona al inicio del tratamiento.

Pentalogy of Fallot with Anorectal Malformation: A Case Report.

ABSTRACT: Pentalogy of Fallot is a rare form of congenital cyanotic heart disease with a prevalence of 3/10,000 live births characterized by an association of Tetralogy of Fallot with Atrial Septal Defect. Pentalogy of Fallot with anorectal malformation is also a rare combination. Here we describe one of the rare case reports of a full-term, 38 weeks, female baby diagnosed with pentalogy of Fallot with imperforate anus and rectovaginal fistula at a tertiary care hospital. Pentalogy of Fallot combined with an imperforate anus and rectovaginal fistula is an exceptionally rare and complex congenital condition. The co- existence of these anomalies emphasizes the need for thorough prenatal and postnatal evaluation for early detection and management.

A case of convexity non-aneurysmal subarachnoid hemorrhage caused by cerebral sinus thrombosis.

BACKGROUND: Convexity subarachnoid hemorrhage (cSAH) is an uncommon presentation of subarachnoid bleeding, referring to bleeding more localized to the convexities of the brain. The diagnosis of cerebral venous sinus thrombosis (CVST) can be difficult especially when patients initially present with cSAH. The authors present a case and then discuss the pathophysiology and management. CASE PRESENTATION: A 56-year-old woman with a previous history of hypertension and ischemic heart disease presented to the emergency department after experiencing it. Two seizures following a severe headache. The patient's history was negative for recent illnesses, head trauma, history of migraines, smoking, alcohol consumption, or intravenous drug use. The patient was diagnosed with CVST based on magnetic resonance venography (MRV). Genetic studies further identified homozygous mutations in the Prothrombin and MTHFR genes. Anticoagulant therapy was initiated with 60 mg of Enoxaparin twice daily and subsequently transitioned to Warfarin after 48 h continued for 3 months, and then replaced by rivaroxaban. CONCLUSIONS: This study highlights the importance of considering CVST as a cause of SAH, emphasizes the role of advanced imaging in diagnosis, and demonstrates a successful treatment approach using both traditional and direct oral anticoagulants. The insights provided in this article can contribute to improving the management of patients with CVST-related SAH.

Lemierre's syndrome associated-diabetic ketoacidosis in an elderly female: a case report.

BACKGROUND: The co-occurrence of Lemierre's syndrome, primarily triggered by Fusobacterium necrophorum following oropharyngeal infection, with diabetic ketoacidosis (DKA) in diabetes mellitus (DM) patients, underscores a rare but life-threatening clinical scenario. Lemierre's syndrome induced DKA is extremely rare, with only one case report in adult and no case yet reported in elderly. CASE PRESENTATION: We reported a case of a 69-year-old female who presented with DKA triggered by deep neck space infection (DNSI), leading to rapid clinical deterioration within 6 h that necessitated high flow nasal cannula (HFNC) and antibiotic administration. Laboratory findings included leukocytosis, elevated serum C-reactive protein, hyperglycemia, ketonemia, and severe metabolic acidosis. Culture of the fluid from a neck mass puncture drainage and blood were positive for Klebsiella pneumoniae. The patient was further complicated by thrombosis of the left internal jugular vein with extension to the sigmoid and a neck abscess surrounding the carotid artery sheath, consistent with Lemierre's syndrome. This condition was managed aggressively with fluid resuscitation, insulin therapy, surgical drainage, antibiotics, and anticoagulation led to a significant improvement in her condition. Following a 13-day hospitalization, there was significant clinical improvement, culminating in the patient's discharge. CONCLUSIONS: The case highlights the need for greater awareness and understanding of the interrelated and mutually promoting conditions of DKA and Lemierre's syndrome among clinicians. Early recognition and treatment are crucial to prevent mortality in such complex cases.

A rare case of peritoneal tuberculosis mimicking peritoneal carcinomatosis: the ongoing challenge.

Tuberculosis (TB) is a serious infection that can involve any organ system and present in various forms. About one-third of the world's population are carriers of latent TB. Although most cases are from a pulmonary origin, there is a rising prevalence of abdominal TB. Patients with pulmonary or extrapulmonary TB are treated similarly through the use of pharmacological therapy. Nonspecific clinical manifestations of TB have made it difficult for clinicians to diagnose. Peritoneal tuberculosis (PTB) is a serious concern as its symptoms overlap with that of many other chronic conditions, especially in those who are immunocompromised. The lack of highly sensitive and specific testing methods has made early intervention difficult, therefore a high index of suspicion is crucial in the progression of the disease. Here, we present a case of a 71-year-old female with a history of abdominal pain, fever, and weakness. Initial investigation with computed tomography (CT) imaging revealed omental fat stranding that pointed towards peritoneal carcinomatosis (PC) from possible recurrence of her ovarian cancer. Further investigation with a peritoneal biopsy was remarkable for caseating granulomas with fat necrosis confirming extrapulmonary TB. This report highlights a rare case of PTB mimicking PC in an elderly patient who is immunocompromised from the use of long-term corticosteroids who continued to decline after pharmacological treatment of the disease.

Endobronchial lipoma with obstructive pneumonia: A case report.

Endobronchial lipoma (EL) is a rare benign lung tumor, and its incidence rate only accounts for a tiny proportion of all lung tumors. EL has non-specific clinical symptoms and signs, and chest computed tomography is helpful in diagnosis. When fat density nodules are found in the bronchial lumen with no enhancement, EL should be considered. Once this disease is diagnosed, bronchoscopic intervention therapy is the first choice for treatment, and patients generally have a good prognosis. The present report describes the diagnosis and treatment processes of a patient with EL. The patient sought medical attention due to recurrent fever, cough and white sputum for >1 month. The chest CT revealed a hypodensity nodule at the bronchial opening of the basal segment of the lower lobe of the left lung, with the margins showing foci of punctate calcification. The patient underwent a bronchoscopy and the pathological diagnosis was EL. In the present study, a literature review analysis is also included to provide a reference for the diagnosis and treatment of this disease.

Diastematomyelia with tethered cord and concurrent distal cord intramedullary dermoid cyst: A case report.

Diastematomyelia is a rare congenital anomaly in which the spinal cord splits into 2 lateral halves. Spinal dermoid cysts are uncommon lesions. Hereby authors present a case of type 2 diastematomyelia in a 5-year-old male patient with concurrent distal cord intramedullary dermoid cyst, diagnosed by MRI and treated surgically.

Pseudomyxoma peritonei of appendiceal mucinous neoplasm origin: A case report and review of literature.

Appendiceal mucinous neoplasms, a rarity comprising less than 1% of all cancers, present intricate challenges in clinical management, and their incidence is on the rise. Notably, these neoplasms tend to metastasize intraperitoneally, leading to peritoneal carcinomatosis and concurrent accumulation of mucinous material, resulting in pseudomyxoma peritonei. Due to its spectrum of presentation, the classification of the appendiceal mucinous neoplasms remains a controversial subject with a range of management from a simple appendicectomy to a complex hyperthermic intraperitoneal chemotherapy (HIPEC). A 42-year-old Chadian male presented to the hospital with a sudden onset of right lower abdominal pain radiating to the inguinal region for 24 hours, associated with nausea and vomiting. The abdomen was distended and ascitic. Laboratory investigations revealed anemia, leukocytosis, hypernatremia, hypokalemia, elevated ESR, high CEA marker, and normal CA19-9. An abdominopelvic CT with contrast demonstrated extensive ascites and cystic masses in the liver, and pancreas with soft tissue thickening of the cecum; however, the appendix is not well-delineated. Patient was managed with chemotherapy and HIPEC followed by removal of all the affected parts. Nodules of the peritoneum and liver were submitted for histopathological analysis and a final diagnosis of pseudomyxoma peritonei of primary appendicular origin was established. This case highlights a case of extensive pseudomyxoma peritonei of appendicular origin managed aggressively by HIPEC and multiple resections of the involved organs. Prognosis of such a case is determined by the grade of the appendiceal tumor and the extent of invasion.

Bronchial artery embolization combined with left pulmonary resection in the treatment of fibrosing mediastinitis complicated with massive hemoptysis: a case report.

Fibrosing mediastinitis (FM) is a rare and benign fibroproliferative disease that presents with the proliferation of extensive, dense fibrous tissue in the mediastinum. Hemoptysis is a common clinical manifestation of FM. Clinically, most patients exhibit mild to moderate hemoptysis. We report a case of FM complicated with life-threatening massive hemoptysis. The patient was successfully rescued through a combination of bronchoscopic balloon closure, bronchial artery embolization (BAE), and surgical interventions. Although FM is frequently benign, vascular involvement can progress to life-threatening massive hemoptysis and must be treated appropriately.

Case report: Advances in treating ligyrophobia with third-generation ACT approach.

Background and aims: Giulia, an 11-year-old girl diagnosed with ligyrophobia, has been experiencing intense anxiety related to loud noises since the age of two. This case report aims to explore the efficacy of Third-Wave Cognitive Behavioral Therapy, specifically Acceptance and Commitment Therapy (ACT), in addressing Giulia's anxiety and avoidance behaviors. The primary goal is to examine the impact of ACT on reducing ligyrophobic symptoms and enhancing psychological flexibility. Methods: The therapeutic intervention spanned 24 sessions and was divided into two phases. The initial phase focused on emotional competence using characters from the movie "Inside Out," aiding Giulia in recognizing and understanding her emotions. The subsequent phase targeted the six processes of psychological inflexibility identified in ACT, fostering increased flexibility. Results: Throughout the intervention, Giulia demonstrated significant improvements in anxiety symptoms, as evidenced by a decrease in Subjective Units of Distress (SUD) scores. Avoidance behaviors also diminished, and Giulia exhibited enhanced mindfulness skills. She became more cognizant of her emotional experiences and more certain of her personal ideals as a result of the therapy. Giulia's active participation and commitment to exposure exercises led to a substantial reduction in ligyrophobic reactions. Discussion: The successful application of ACT in Giulia's case suggests that targeting psychological inflexibility through mindfulness and values clarification can be effective in treating ligyrophobia in children. The integration of metaphors and creative exercises proved valuable in engaging Giulia and fostering therapeutic progress. The findings underscore the importance of a tailored, third-wave therapeutic approach in addressing specific phobias in pediatric populations.

Dentoskeletal Correction by Growth Modification in a Young Child Using Myofunctional Trainer: A Case Report.

Myofunctional trainer for kids (T4K, Myofunctional Research Co., Australia) is a prefabricated, single-size functional appliance that claims to correct malocclusion at an early age by acting on muscular dysfunctions and repositioning the mandible in a forward direction. Myofunctional therapy through the Trainer System™ was implemented in this case for the treatment of class II malocclusion in mixed dentition. The results showed that an early approach in selected cases, taking into account patient preferences and compliance, is possible and could be considered in treatment planning and relevant future research. How to cite this article: Jyoti D, Beni K, Shukla JN, et al. Dentoskeletal Correction by Growth Modification in a Young Child Using Myofunctional Trainer: A Case Report. Int J Clin Pediatr Dent 2024;17(6):728-733.

A Fortuitous Finding of Asymptomatic Compound Odontoma Consisting of 156 Denticles on a Routine Radiographic Examination: A Case Report.

Odontomas are the most common odontogenic tumors and are classified into compound and complex types. They result from a combination of odontogenic epithelium and ectomesenchyme. Complex odontomas frequently occur in the posterior mandible, whereas compound odontomas are more commonly found in the anterior region of the maxilla. Due to their small size and asymptomatic nature, odontomas are often diagnosed incidentally. Typically, odontomas are <3 cm in diameter; those exceeding this size are classified as giant odontomas and may present with extraoral swelling. This case report documents an unusual instance of a giant compound odontoma, containing 156 denticles, in a 15-year-old girl. Despite the odontoma's large size in the mandibular anterior region-an uncommon site for compound odontomas-the patient was completely asymptomatic and presented with only intermittent pain in the lower right back tooth region over the past month. The denticles were extracted, and intentional root canal treatment was performed on teeth 41, 42, 31, and 32 under general anesthesia. How to cite this article: Chiranjeevi S, Prabhuraj SN. A Fortuitous Finding of Asymptomatic Compound Odontoma Consisting of 156 Denticles on a Routine Radiographic Examination: A Case Report. Int J Clin Pediatr Dent 2024;17(6):723-727.

Early Detection and Interceptive Orthodontic Treatment of Impacted Canine: A Case Report.

Aim and background: Upper canines are the second most common teeth involved in impaction after the third mandibular molar. Accurate diagnosis at an appropriate age is important to reduce complications of the impacted tooth and its adjacent teeth. We present a case of early detection of an impacted left maxillary canine, which allowed spontaneous eruption through arch expansion. Case description: An 11-year-old patient was referred for monitoring of an unerupted left maxillary canine. The tooth was palpable labially, but there was a lack of space for an eruption for the tooth, with 2 mm of discrepancy as assessed using the Tanaka and Johnston space analysis method. The patient had generalized gingivitis, multiple carious teeth, and dens evaginatus of upper incisors. An orthopantomogram (OPG) confirmed the clinical findings and impaction of the tooth. Localization of the tooth was done using the parallax technique with the addition of an intraoral periapical radiograph (IOPA). The tooth was in line with the arch. Due to this favorable position, an upper removable appliance (URA) with an acrylic plate, metal clasps on the upper first molars and premolars, and an expansion screw in the midline was constructed for the patient. The patient activated the screw with a weekly quarter turn. Preventive and caries management strategies were done simultaneously. The impacted left maxillary canine erupted after 10 months of using the URA. Conclusion: Due to the high plasticity of bone structures in a growing child, interceptive orthodontic treatment using removable appliances works well. The impacted left maxillary canine erupted in place after 10 months of using the URA without the need for surgical or fixed orthodontic treatment. Clinical significance: Early detection of impacted teeth in a growing child is important in order for us to intervene in the problem at an earlier stage to avoid further complications. How to cite this article: Sockanathan L, Ahmad NS, Zakaria ASI. Early Detection and Interceptive Orthodontic Treatment of Impacted Canine: A Case Report. Int J Clin Pediatr Dent 2024;17(6):706-711.