Osteomyelitis of Jaw Bone due to Aspergillosis in Post-COVID-19 Patients: An Observational Study.

Background: In the second wave of COVID-19 pandemic, there has been an increase in number of cases with Post-COVID-19 fungal osteomyelitis of jaws. Aspergillosis was found to be one of the causes of osteomyelitis of jaw bones in these patients. Aim: To evaluate the incidence and pattern of osteomyelitis of jaw due to aspergillosis in post-COVID-19 patients and to discuss the management protocol of the same. Method: Data were obtained at our institution from the period of January 2021 to June 2021. Patients of all age groups with Post-COVID-19 osteomyelitis of jaw due to aspergillosis and those with combined aspergillosis and mucormycosis infection were included. Patients having rhino-orbito-cerebral fungal infection were excluded. Results: A total of 47 patients reported to our center. Demographically the average age of the patients was 49.11 years with 72% being males. All 47 patients (N = 100%) had received steroids. 21 of them (N = 44.7%) had diabetes mellitus and 14 (N = 29.8%) patients had other comorbidities. Out of 47 patients, 42 (N = 89.7%) patients were diagnosed with aspergillosis and the remaining 5 (N = 10.3%) cases had a mixed fungal infection of mucormycosis and aspergillosis. On fungal culture Aspergillus flavus was the most common species detected followed by Aspergillus niger and Aspergillus fumigatus. All patients were treated with oral Voriconazole and local surgical debridement. Prompt laboratory testing such as a timely KOH mount, galactomannan test, beta-D-glucan test, histopathology of tissue specimens could help to give an early and definitive diagnosis. The mortality rate we encountered in this study was nil. Conclusions: Early and definitive diagnosis and immediate initiation of antifungal drug therapy and surgical intervention will significantly reduce the rate of morbidity and mortality.

Management of bilateral condylar agenesis by distraction osteogenesis: a rare case report.

Condylar agenesis is a rare case involving developmental disturbances related to growth of mandible, facial aesthetics, dentition development, muscle deformation, and occlusal problems. As such, this is a rare condition, and there is no internationally accepted protocol for the same. Underdevelopment or defective formation of condyle may be congenital or acquired. Condylar agenesis is congenital non formation of condyle, while hypoplasia is poor development. We report a case of bilateral condylar agenesis in a 30-year-old female patient.

Zygomaticomaxillary Osteomyelitis due to COVID-19 Associated Mucormycosis (CAM): A Case Series of 10 Patients.

Aim: To highlight the incidence of osteomyelitis due to CAM and to elucidate the mode of spread of infection from maxilla to zygomatic bone, to highlight how that is distinct from other cases of zygomatic osteomyelitis due to other etiologies. Methods: A standard protocol of treatment of the cases of CAM with zygomatic involvement based on our own outcomes was furnished. All 10 patients were treated with dual antifungal therapy and aggressive surgical resection via extraoral approach, in conjunction with functional endoscopic sinus surgery (FESS). Results: Ten out of 116 patients of CAM reporting to our institute presented with zygomatic bone involvement with an incidence rate averaging at 8.6%, whereas in previous literature osteomyelitis of zygomatic bone was extremely rare with an incidence pattern of just 1.42%. Conclusions: The treatment protocol followed by the authors gave good outcomes to all patients treated, with no mortalities.

Evaluation of Anxiety, Pain, and Hemodynamic Changes during Surgical Removal of Lower Third Molar under Local Anesthesia.

AIM: The aim of this study are to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molar and to evaluate whether these variations are attributable to patient anxiety and pain experienced during surgical procedure. MATERIALS AND METHODS: Sixty healthy patients were evaluated (i) to determine the hemodynamic changes (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and oxygen saturation) at nine occasions: before starting the surgical procedure, 1 min and 4 min after local anesthetic injection, during the incision, at the time of ostectomy, at the completion of tooth removal, at the start and completion of suturing, and finally, after completion of surgery and (ii) to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. Hemodynamic variables were compared between the gender and at different time points by performing two-way analysis of variance for repeated measures. Global mean values of hemodynamic variables were compared between male and female using unpaired t-test. Categorical variables were compared by Chi-square test. All the tests were two-sided. P < 0.05 was considered statistically significant. RESULTS: SBP and DBP showed significant changes; the highest value was recorded at the time of ostectomy/tooth sectioning. Maximum HR was observed 4 min after local anesthetic injection and the lowest HR was recorded after completion of tooth extraction, i.e., during the suturing. In females, mean HR was significantly increased. CONCLUSION: The present study suggests that dental anxiety impacts the effect of delivery of local anesthesia on blood pressure and is significantly associated with increased HR.

Unusual giant sialolith of Wharton's duct.

Salivary gland calculi account for the most common disease of the salivary glands. Most of the salivary calculi are small in size. Some calculi that reach several centimeters are reported as megaliths or giant calculi in the literature. They may occur in any of the salivary gland ducts but are most common in Wharton's duct and in the submandibular gland. This report presents clinical and radiographical sign of an unusually large sialolith. A patient came with pain in the floor of mouth. There was a swelling on floor of mouth on the left side. Radiographical examination revealed large irregular radio-opaque mass superimposed on left lateral incisor to molar areas. This case report describes a patient presenting with an unusually large submandibular gland duct sialolith, the subsequent patient management, the etiology, diagnosis, and its treatment.

Peripheral Calcifying Cystic Odontogenic Tumour - A Rare Case Report.

Odontogenic lesions are derived from remnants of the components of the developing tooth germ. The calcifying cystic odontogenic tumour (CCOT) is a benign cystic neoplasm of odontogenic origin that is characterized by ameloblastoma-like epithelial cells and ghost cells. Most peripheral CCOTs are located in the anterior gingiva of the mandible or maxilla. This is a rare case report of CCOT. The rare feature in our case was its peripheral nature of existence and its location in the left buccal vestibule and retromolar region. Based on the radiological, cytological and histopathological findings the lesion was surgically excised.