Maxillary molar distalization with first class appliance.

Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation.

Insight to a tobacco user's mouth: An epidemiological study in Bhopal.

BACKGROUND: The rampant tobacco abuse is escalating the Indian health sector towards a future overburdened with high prevalence of cancer and potentially malignant conditions. Thus manifestations of tobacco abuse have become a widely recognized but poorly tackled public health issue. To understand the same, a study was conducted in a dental college of Bhopal, India. METHODOLOGY: A hospital based cross sectional study was done over a period of 1.5 years. Patients giving history of deleterious habits were included in the study. The form of tobacco/areca nut used, duration and frequency of usage and awareness regarding their ill-effects were recorded. All documented data was subjected to statistical analysis using chi-square test. RESULTS: Out of 2033 individuals studied 21% were below the age of 25 years, 53% in 26-50 years, 20% in 51-75 years and 6% above 76 years of age with 85% being males. 67% used smokeless form, 21% smoked and 12% used tobacco in both smokeless and smoking form. 58% of the individuals had tobacco associated lesions, of which oral submucous fibrosis (OSMF) was the most prevalent. The relation between duration and frequency of abuse and occurrence of lesion was found to be statistically significant (p < 0.05). CONCLUSION: The smokeless form was most widely abused in this part of the country especially the younger population. OSMF, a premalignant condition with debilitating effects on the lifestyle, was the most prevalent lesion associated with tobacco use. These findings call for early and aggressive intervention methods be put into action.

Eustachian tube dysfunction in OSMF- often present seldom discovered.

OBJECTIVES: To evaluate the effect of OSMF on the eustachian tube function and to correlate it with various grades of the disease. STUDY DESIGN: Twenty OSMF patients (40 ears) and 20 healthy controls (40 ears) were evaluated for eustachian tube function by eustachian tube function test, tympanometry and audiometry. RESULTS: The audiometric and tympanometric analysis showed no significant differences in hearing abilities of OSMF patients and controls and between various grades of OSMF, indicating no hearing impairment. However, eustachian tube function test revealed a statistically significant difference in eustachian tube function in OSMF patients and controls. Further, there was a significant increase in severity of dysfunction with increase in severity of disease. CONCLUSIONS: From the present study it is evident that the subjective function of Eustachian tube may be affected by disease process. But, probably the amount of deviation found in function of the eustachian tube is non contributing to cause a conductive hearing loss. Key words:Oral submucous fibrosis, eustachian tube function, tympanometry.

Serum vitamin c and iron levels in oral submucous fibrosis.

BACKGROUND: In this study Serum Vitamin C and Iron levels in Oral submucous fibrosis (OSMF) were estimated. The objective was to evaluate the correlation between Serum Vitamin C and Iron levels in OSMF individuals. Serum Iron content can be a predictor for the progression of this condition. OSMF is basically a disorder of collagen metabolism where Vitamin C gets utilized in conversion of proline into hydroxyproline, this hydroxylation reaction requires ferrous Iron and Vitamin C. Many studies regarding micronutrients and other antioxidants levels have been emphasized, but very few studies are done on the Serum levels of Vitamin C and its correlation with Iron in OSMF patients. METHODS: Thirty five OSMF patients and 50 deleterious habit free healthy individuals (controls) were selected. Two ml of venous blood was collected from each individual. Vitamin C level in serum was estimated by 2-4 dinitrophenylhydrazine method and Iron estimated by Tripyridyl method. RESULTS: The level of Serum Vitamin-C and Iron was significantly decreased in OSMF patients when compared to controls which were statistically significant. CONCLUSION: On the basis of these observations, it seems possible that the chemical, thermal and/or mechanical factors associated with the use of areca nut may act in conjunction with the Vitamin C and Iron deficiency leading to the development of OSMF. Therapeutic substitution of vitamin C and Iron may be recommended in the management of OSMF.

Desmoplastic ameloblastoma of mandible.

Desmoplastic ameloblastoma is one of the six histopathological subtypes of ameloblastoma. The age and gender groups affected by desmoplastic are similar to those affected by the conventional ameloblastoma. It usually presents as a painless enlargement of the jaw. Owing to its deceptive radiological appearance as a mixed radiopaque-radiolucent lesion, it is often mistaken as a fibro-osseous lesion. Histologically, desmoplastic ameloblastoma has a densely collagenised and hypocellular stroma, where the epithelium tends to proliferate in the form of cords and nests instead of cellular islands. Most desmoplastic ameloblastomas display occasional classic islands of follicular ameloblastoma among the predominant strands and cords. Studies have shown that desmoplastic ameloblastoma shows a tendency to recur. We present a rare case of a tumour occurring in the anterior mandibular region in a 60-year-old man over a period of 11/2 months.

Pneumosinus dilatans multiplex associated with hormonal imbalance.

Pneumosinus dilatans describes an abnormal dilation of one or more paranasal sinuses without radiological evidence of localised bone destruction, hyperostosis or mucous membrane thickening. Dilation of mastoid air cells also occurs rarely along with involvement of paranasal sinuses. This rare combination of unknown aetiology was reported in two cases in the literature and termed 'Pneumosinus Dilatans Multiplex' (PSDM). It is usually asymptomatic, and is detected incidentally on plain radiography, CT or MRI. If left untreated, it can further erode the bone leading to complications such as facial asymmetry, neurological disorders and pathological fractures. The aetiology of the condition remains obscure. Various hypotheses proposed are the presence of gas-forming microorganisms, spontaneous drainage of a mucocele, the presence of a one-way valve, dysregulation of hormonal levels leading to a disturbance of osteoblastic and osteoclastic activity. This paper describes a case of PSDM possibly secondary to hormonal disturbance.

Familial ectodermal dysplasia: a peers' agony.

Ectodermal dysplasias include a various group of inherited disorders which share primary defect in the development of two or more tissues of embryonic ectodermal origin. Though there are many subtypes, ectodermal dysplasias are mainly hidrotic ectodermal dysplasia and hypohidrotic ectodermal dysplasia, among which the most common variety is X linked hypohidrotic ectodermal dysplasia. We report a rare case of X linked hypohidrotic ectodermal dysplasia occurring in a family with various skin, hair and oral abnormalities.

Ameloblastomatous calcifying odontogenic cyst: a rare histological variant.

The calcifying odontogenic cyst (COC) occurs mainly as an intraosseous lesion in mandible or maxilla, but the peripheral variation of COC has also been reported. The confusion regarding its nature as cyst or tumour has not been resolved and a vast diversity has been noted in clinicopathological aspects of COC. We report a case of COCs with minimal mural ameloblastomatous proliferation in a 13-year-old girl, who presented with a painless swelling in the left jaw causing mild facial asymmetry.

Spindle cell carcinoma in maxilla.

Spindle cell carcinomas (sarcomatoid carcinomas) are rare tumours. It is a variant of squamous cell carcinoma which has spindled tumour cells, which simulate a true sarcoma, but are epithelial in origin. They are extremely uncommon in the head and neck region. Only five cases with maxillary origin have been discussed in the literature. As compared to squamous cell carcinoma of maxilla, this variant is associated with poor diagnosis and advanced disease at presentation, as is demonstrated in the case presented. There are no standard recommendations for management owing to the rarity of this histology. Surgery and radiotherapy form the mainstays of treatment. We report a rare case of spindle cell carcinoma involving the maxilla.

Diversities in presentations of extrapulmonary tuberculosis.

The incidence of extrapulmonary tuberculosis (EPTB) has been increasing worldwide over the last few years. Tuberculous lymphadenitis is the most common form of the disease and is reported to occur in 25-60% of all EPTB cases. It is commonly seen in the cervical lymph nodes, but may also be in the larynx, pharynx, parotid and rarely, in the sinuses and petrous bone. The posterior triangle, supraclavicular and jugular nodes are most frequently affected. They are usually unilateral, although diffuse adenopathy may occur. TB involving cervical lymph nodes represents 50% of extrapulmonary TB. A series of six cases of tuberculous lymphadenitis with varying clinical features is documented here to alert one of its prevalence in developing countries.

Alveolar bone exostoses subsequent to orthodontic implant placement.

Alveolar bone exostoses (ABE), also known as a buttress bone formation, are not uncommon to the literature. Although, exostoses in response to the trauma from occlusion are a popular concept proposed more than 45 years ago, still the aetiological factors behind this development are unclear. Various risks and complications associated with orthodontic implants have been published, but buttress bone formation subsequent to this procedure has not been reported till date. This article describes a case of ABE, subsequent to the placement of orthodontic mini implants, where after careful evaluation, resective osseous surgery was performed.

Immature fibrous dysplasia: a mixed radio-opaque radiolucent lesion.

Fibrous dysplasia is a bone pathology characterised by abnormal differentiation of osteoblasts leading to replacement of normal marrow and cancellous bone by immature bone and fibrous stroma. A case report of a 20-year-old female patient with a chief complaint of a swelling in the right upper back tooth region, of 6 months duration which was diagnosed as an immature fibrous dysplasia is presented.

Parotid sialolithiasis.

Salivary dysfunction may be due to systemic diseases and medications. The development of sialoliths is a multifactorial event in which disturbance in secretion, microliths and bacteria may play a major role. A case of sialolith in the parotid gland of a 25-year-old man, with no relevant medical history is reported here.

Large ameloblastic fibro-odontoma in an 18-year-old girl and review of literature.

The ameloblastic fibro-odontoma is a rare, benign, mixed neoplasm composed of proliferating odontogenic epithelium, ectomesenchymal tissue and varying degrees of dental hard tissue formation. It occurs exclusively as an intraosseous lesion. It usually exhibits slow growth and is commonly seen in children and young adults. Radiologically, ameloblastic fibro-odontoma appears as a circumscribed radiolucency which may contain radiopaque foci. Most cases of ameloblastic fibro-odontoma exhibit benign behaviour, but cases of malignant transformation have been reported. The treatment modality in most cases involves conservative surgery, but in cases with malignant transformation more radical treatment will be required. A massive ameloblastic fibro-odontoma involving the mandible is being described here with its clinical, radiological and histopathological features.

Idiopathic facial swelling secondary to sickle cell anaemia.

Sickle cell disease is a common inherited autosomal disease that is characterised by abnormally shaped (sickle-shaped) red blood cells (RBCs). It can involve virtually any organ system. The clinical manifestations of sickle cell disease vary and are classified as vaso-occlusion, chronic anaemia and infection. The imaging appearances of central nervous system and musculoskeletal involvement by sickle cell disease have been well documented; however, involvement of the head and neck region is often unreported, although it is not uncommon. In the head and neck, sickle cell disease can involve the inner ears, orbits, paranasal sinuses, bones, lymph nodes and vessels. This paper describes a case of idiopathic facial swelling associated with sickle cell disease in a young patient.

Periapical actinomycosis.

Actinomycosis is a rare chronic infection caused by species of Actinomyces and characterised by abscess formation, tissue fibrosis, suppurative lesions and fistulas with purulent discharge containing sulphur granules. Owing to its multiform manners of presentation and non-specificity from its clinical features, it has been considered as a challenging diagnosis. Periapical actinomycosis is one of the rarest forms of actinomycosis occurring in the maxillofacial region. In its occurrence it presents in the form of persistent and recurrent draining fistula in the periapical region. We report a case of periapical actinomycosis occurred in endodontically treated teeth and accidentally found to be actinomycosis during histopatological examination. An insight towards the portal of entry of the organisms into the periapical region is also discussed. The practice of sending even a tiny bit of tissues to histopathology obtained from periapical surgery will very well demonstrate this disease and help in rapid resolution through appropriate antibiotic therapy.

Intraoral schwannoma--a report of two cases.

Schwannomas, also known as neurilemmomas, are uncommon neoplasms, derived from schwann cells. These neoplasms, although rare, should be considered in the differential diagnosis of slow growing tumour masses of the oral cavity. The growth of these tumours sometimes causes displacement and compression of the nerve of origin, giving rise to clinical signs and symptoms. It can develop at any age and there is no sex predilection. Intraorally, the tongue is the most common site followed by the palate, floor of the mouth, buccal mucosa, lips and jaws. Surgical excision is the treatment of choice for schwannomas, with few reports of recurrence or malignant transformation. In this paper, the authors report two cases of patients with intraoral schwannoma, where the preoperative clinical diagnosis was inconclusive and final diagnosis was established based on radiographic and histopathological examination.

'A harmless but confusing tumour on the anterior maxilla'.

Squamous odontogenic tumour (SOT) is a very rare benign neoplasm probably arising from rests of Malassez. Patients may present with an increase in the volume of the maxilla or mandible, tooth mobility, ulceration of the oral soft tissue, painful symptoms and tooth displacement. Radiographic features of SOT consist of a triangular-shaped radiolucent lesion adjacent to the roots of teeth. Histologically, care should be taken not to misdiagnose this condition as acanthomatous ameloblastoma or well-differentiated squamous cell carcinoma. The authors are presenting a case of a 65-year-old male patient who presented with a painless swelling and diagnosed to be having SOT.

Oro-dental findings in Bardet-Biedl syndrome.

The Bardet-Biedl syndrome (BBS) is a human genetic disorder with an array of clinical features affecting many body systems. BBS is a pleiotropic disorder with mostly monogenic causes. It is also considered a primary ciliopathy syndrome. It is characterised by obesity, pigmentary retinopathy, polydactyly, mental deficiency and hypogonadism and recently a sixth feature, renal disease, has also been described. Since none of the diverse symptoms of BBS by itself is diagnostic of the disorder and many of the symptoms only become apparent over time, diagnosis of the BBS is often delayed until about 9 years of age when visual problems first appear.

Pemphigus vulgaris--a report of three cases.

Pemphigus vulgaris (PV) is a potentially life-threatening illness that manifests in the mouth and on skin. In a majority of patients it affects the oral mucosa and is sometimes difficult to diagnose when only mucosal involvement is present. In an attempt to highlight the proper treatment plan of this potentially fatal disorder, the authors document a report of three cases. These patients were prescribed conventional steroids which brought about partial relief but early recurrence with discontinuation of the drug. Subsequent management of these patients with azathioprine along with corticosteroids improved the outcome of the disease with longer remission periods. In this case series, the steroid sparing effect of azathioprine was achieved successfully and hence needs to be considered as a primary drug in management of PV.