Immunoexpression of BRAF, EGFR and CD10 in ameloblastoma.

The ameloblastoma is the most challenging odontogenic neoplasm to treat because of its locallyinvasive behaviour, severe clinical implication, risk of malignant transformation and high recurrence rate. Recent evidence suggests that BRAF, EGFR and CD10 have a role in the local invasiveness of ameloblastoma. However, the spatial distribution characteristics of these pro-invasive factors and their association with clinical parameters in this neoplasm are largely unexplored. We sought to address these issues in ameloblastoma subtypes and to determine their biological relevance. Nineteen unicystic (UA) and 20 conventional ameloblastoma (SMA) were subjected to immunohistochemical staining for BRAF, EGFR and CD10, and semiquantitative analysis was performed. All ameloblastoma cases (n=39/39; 100%) exhibited a BRAF+/EGFR+/CD10+immunoprofile. Their expression rates were significantly higher in SMA than UA (P<0.05). BRAF, essential for the progression and proliferation of ameloblastoma, was detected mainly in the cytoplasm of stellate reticulum-like>stromal>preameloblast- like cells (P<0.05). EGFR, a potent oncogenic protein, showed predominantly nuclear localisation. CD10, an apoptosis-inhibitory factor, was strongly expressed in the membrane of stellate reticulum-like cells. Taken together, present results suggest that the spatial distribution patterns of BRAF, EGFR and CD10 parallel the specific behaviours of SMA and UA. Their cellular and intracellular protein localisations have important targeted therapy implications.

Thirty years of submental intubation: a review.

Submental intubation has been used as an alternative to conventional intubation in the field of oral and maxillofacial surgery since its introduction by Francisco Hernández Altemir in 1986. A review of submental intubation was performed using data from all case reports, case-series, and prospective and retrospective studies published between 1986 and 2016. The indications, variations in incision length, incision sites, types of endotracheal tube used, methods of exteriorization, and complications were recorded and analyzed. A total of 70 articles reporting 1021 patients were included. The main indication was maxillofacial trauma (86.9%, n=887), followed by orthognathic surgery (5.8%, n=59), skull base surgery (2.8%, n=29), and rhinoplasty and rhytidectomy (1.5%, n=15). The complication rate was relatively low: 91.0% of patients (n=929) were complication-free. The most common complication was infection, occurring in 3.5% (n=36) of the total number of patients, followed by scarring (1.2%, n=12) and formation of an orocutaneous or salivary fistula (1.1%, n=11). In summary, submental intubation is a good alternative airway with minimal complications.

A case of dengue-related osteonecrosis of the maxillary dentoalveolar bone.

Dengue is a mosquito transmitted flaviviral infection which can give rise to severe haemorrhage (dengue haemorrhagic fever) and with capillary leakage induces hypovolaemic shock (dengue shock syndrome). Although dengue symptoms and complications have been known for many decades, there has only been one documented case of osteonecrosis of the maxilla which was treated by excision of the necrotic bone. In this case of dengue infection, extensive maxillary osteonecrosis and minimal root resorption appeared to follow factitious injury with a toothpick but resolved with non-surgical management.

Gaining surgical access for repositioning the inferior alveolar neurovascular bundle.

This study is aimed at determining anatomical landmarks that can be used to gain access to the inferior alveolar neurovascular (IAN) bundle. Scanned CBCT (i-CAT machine) data of sixty patients and reconstructions performed using the SimPlant dental implant software were reviewed. Outcome variables were the linear distances of the mandibular canal to the inferior border and the buccal cortex of the mandible, measured immediately at the mental foramen (D1) and at 10, 20, 30, and 40 mm (D2-D5) distal to it. Predictor variables were age, ethnicity, and gender of subjects. Apicobasal assessment of the canal reveals that it is curving downward towards the inferior mandibular border until 20 mm (D3) distal to the mental foramen where it then curves upwards, making an elliptic-arc curve. The mandibular canal also forms a buccolingually oriented elliptic arc in relation to the buccal cortex. Variations due to age, ethnicity, and gender were evident and this study provides an accurate anatomic zone for gaining surgical access to the IAN bundle. The findings indicate that the buccal cortex-IAN distance was greatest at D3. Therefore, sites between D2 and D5 can be used as favorable landmarks to access the IAN bundle with the least complications to the patient.

Trigeminal neuralgia. A retrospective survey of a sample of patients in Singapore and Malaysia.

This survey was undertaken to study the clinical features of trigeminal neuralgia in an Asian population. Demographic data of 44 patients treated at the Dental Faculty of the National University of Singapore and at the University of Malaya were reviewed. The results of the survey were analysed and comparisons made with those of Caucasian patients as reported in other studies where there was a general similarity in the clinical findings. Trigeminal neuralgia presented predominantly in females. Right-sided involvement occurred at a greater frequency, and the peak age at onset was between the sixth and seventh decades of life. The only significant variant in the present sample was the greater involvement of the mandibular branch of the trigeminal nerve rather than the maxillary division. In addition, there was a much greater representation from Chinese patients over Malays as compared with their ratios in the general population.

Factors involved in the diagnosis of oral squamous cell carcinoma in Malaysia.

The delay in the diagnosis of oral cancer has been variously reported as being contributed by the clinicians, patients or both. The purpose of this study was to evaluate the referral pattern of 65 patients eventually diagnosed as having oral squamous cell carcinoma. The results showed that 50% of the patients delayed seeking professional help for more than 3 months after being aware of the lesion. The majority of the patients consulted medical practitioners as the first source of help. The mean clinicians' and patients' delay were 10.3 weeks and 28.9 weeks respectively. Dental practitioners showed a tendency to refer more advanced lesions compared to the medical practitioners. The findings raise the concern that lack of patients' awareness, misdiagnosis by clinicians and late detection by dental practitioners prevail thus calling for urgent measures towards early detection of the disease.

Bilateral coronoid hyperplasia--a report with a view on its management.

Bilateral coronoid hyperplasia requires surgery (coronoidectomy) to improve mouth opening. An intra-oral approach is preferred with direct fibre-optic anaesthetic intubation. Myotomy of the masseter muscle is recommended in cases where fibrotic and calcifying effects have occurred. Pre-operative physiotherapy counselling and post-operative jaw exercises are important to the final success of the management.

A simple method to enable feeding during maxillomandibular fixation of the jaws.

The use of maxillomandibular fixation after surgery on the jaw bone invariably affects the dietary intake and the oral hygiene of patients. When the upper and lower jaws are kept in occlusion, the patient has to take bland food that has to sieve through the crevices between teeth to enter the oral cavity. This results in food accumulation around teeth, orthodontic appliances, and surgical wound. Feeding in this manner can also be very trying on some patients. A simple method is devised in which finely minced food can be introduced by a catheter directly into the oral cavity.

Transmigration of permanent mandibular canines. Case report.

Transmigration is the migration of a tooth across the midline of the jaw. This phenomenon is found only in relation to the permanent mandibular canines. Two cases are reported. In both, the cause of this deviation was an odontome found in the site normally occupied by the mandibular canine. The literature on transmigration is reviewed.

Susuks: charm needles in facial soft tissues.

Susuks or charm needles are a form of talisman inserted and worn subcutaneously, in the face and other parts of the body, in the belief that they will enhance or preserve the wearer's beauty, youth, charisma, strength or health, or bring success in business. This mystic practice is found among some south-east Asian people, especially Malayan and Muslim females. Most susuk wearers are secretive about their hidden talismans, but these gold or silver needles are being discovered with increasing frequency now that radiographs are used more widely. An understanding of this practice and an awareness of its existence is important to avoid misdiagnosis and mismanagement of these patients. The practice of susuk wearing and its relevance to dentistry is discussed. Nine cases of facial susuk wearers are presented and previous reports are reviewed.

Transpositions of maxillary teeth.

Transposition of teeth is a rare and special type of ectopic eruption where two contiguous teeth are found occupying each other's respective normal positions. Nine patients with transposed maxillary teeth are reported. The literature on transpositions, especially on the theories regarding the aetiology, is reviewed.

Extreme distal migration of a maxillary canine.

A case of extreme distal migration of the left maxillary canine is reported. The canine had erupted buccal to the contact area between the left second premolar and first molar. Past reports of similar ectopia are reviewed.