Melioidosis: an unusual diagnosis for deep temporal and masticatory space infection following trauma.

We report a patient in his early 70s, with an alleged history of trauma to the right temporal region, following which a swelling developed. A week later, erythematous changes, throbbing pain and occasional fever spikes were noted. A month after the initial trauma, he presented to our institution with necrosed skin over the right temporal region and swelling extending up to the vertex of the skull. The patient was an uncontrolled diabetic and had systemic conditions like chronic obstructive pulmonary disease and chronic kidney disease. A CT scan revealed a collection along the infratemporal space extending into the masticatory space. Routine investigations, blood culture sensitivity, were sent, which revealed the presence of Burkholderia pseudomallei sensitive to ceftazidime and imipenem. Under antibiotic coverage, the treatment was initiated, incision and drainage were done to reduce the bacterial load. However, the patient was lost to underlying systemic conditions and septic shock.

Does C-Arm Guidance Improve Reduction of Zygomatic Arch Fractures?-A Randomized Controlled Trial.

PURPOSE: Traditionally, in the assessment of the reduction of zygomatic arch fractures, the surgeon uses subjective measures such as palpation of a bony step deformity, the anecdotal "pop" sounds, and visual confirmation of symmetry. In the present study, we sought to objectively assess the accuracy of reduction and improvement in form and function after C-arm-guided reduction of isolated zygomatic arch fractures (IZAFs) and to compare these results with those obtained conventionally. PATIENTS AND METHODS: A prospective, randomization of patients scheduled for surgical closed reduction of IZAF was performed. The test group underwent C-arm-guided reduction of the fracture until the arch contour was re-established and visualized on fluoroscopic images. In the control group, palpation, auditory cues, and visualization of symmetry determined the adequacy of the reduction. The patients and evaluator were both unaware of the treatment technique used. The primary outcome measures were the maximum interincisal distance (IID), standardized measurements on computed tomography (CT), and measures of symmetry on facial photographs. Variables such as intragroup differences and patient-evaluator agreement were also studied. The data were analyzed using SPSS software, version 21. RESULTS: The study sample consisted of 20 patients (10 each in the test and control groups). Significant improvement in facial symmetry was observed in all 20 patients (P < .001) from preoperatively to 30 days postoperatively. The CT measurements confirmed acceptable symmetry, with insignificant differences between the 2 groups (C-arm group, P < .001; vs control group, P = .004 for intragroup improvement in symmetry). The IID had improved significantly (P < .001) at the end of follow-up in both groups. CONCLUSIONS: Although significantly superior outcomes were not inferred in the symmetry-related and CT measurements, C-arm-guided reduction provided an opportunity to instantaneously confirm the accuracy of bony reduction. Thus, the need for postoperative imaging and secondary surgery can be overcome, enabling even inexperienced surgeons to attain precise and reproducible results.

Status of trace elements in saliva of oral precancer and oral cancer patients.

BACKGROUND: Several studies in recent years have linked association between micronutrient levels and various forms of cancer. Copper and zinc have been the most researched micronutrients. AIM: The aim of the study was to evaluate the levels of copper, zinc and iron in saliva of patients with oral leukoplakia, oral submucous fibrosis and oral squamous cell carcinoma. RESULTS: There was a highly significant increase in the level of salivary copper in oral submucous fibrosis patients when compared to controls (P = 0.001). Salivary copper levels were also elevated in oral leukoplakia and oral cancer patients (P = 0.01). There was a significant decrease in the salivary zinc levels in all three study groups when compared to controls (P = 0.001). A highly significant reduction in salivary iron levels was noticed oral submucous fibrosis group. The copper to zinc ratio significantly increased in all the study groups when compared to controls. CONCLUSION: Results suggest that salivary copper zinc and iron could be used as biomarkers for oral precancer and cancer.

Osteolytic nasal polyp of the maxillary sinus mimicking malignancy.

We present an osteolytic nasal polyp of the maxillary sinus with clinical features and radiographic features mimicking that of a malignancy. Maxillary sinusitis being a common inflammatory condition progressed to cause destruction of the maxillary bone and spread into the facial soft tissue, which is quite a rare occurrence. We have discussed in detail the clinical, radiological, histopathology and management of this uncommon presentation of a common case.

Multiple trichoepitheliomas: A rare occurrence.

Trichoepitelioma is an extremely rare cosmetically disfiguring condition usually affecting the females. Trichoepitheliomas are benign lesions seen on the face, which are thought to derive from the hair follicle. Malignant transformation to basal cell carcinoma is rare and occurs late in the course of the disease These lesions are often misinterpreted and diagnosed clinically as neurofibromatosis or histpathologically as basal cell carcinoma. We report a case of multiple trichoepithelioma occurring in a male patient. The patient presented with multiple dermatologic growths on the face with varied histopathological presentations which have been described in detail.

Malondialdehyde levels in oral sub mucous fibrosis: a clinicopathological and biochemical study.

BACKGROUND: Oral submucous fibrosis is one of the most commonly occurring potentially malignant disorders in the South-East Asia. Levels of lipid peroxidation product malondialdehyde have been recently correlated with clinical grades of oral Submucous fibrosis. AIMS: The aims of this study were to estimate the levels of malondialdehyde in serum, saliva and tissue in patients with oral submucous fibrosis, to correlate change in levels of malodialdehyde with the histopathological grading. MATERIALS AND METHODS: The study group comprised of 65 clinically diagnosed and histopathologically confirmed cases of oral submucous fibrosis, 21 age and sex matched controls were also enrolled into the study. The serum saliva and tissue samples in the study groups were evaluated by the thiobarbutric acid reactive substances. RESULTS: There was a significant difference between the serum and salivary malondialdehyde among the histopathological grades of oral submucous fibrosis. Tissue malonaldehyde levels were significantly higher as the grading progressed but tissue levels in grade 3 oral submucous fibrosis were lower than the controls. CONCLUSION: This decrease in tissue malonaldehyde could possibly be associated to collagen cross linking occurring during the advanced stages of oral submucous fibrosis.

Evaluation of micronutrient status in serum and saliva of oral submucous fibrosis patients: A clinicopathological study.

BACKGROUND: Oral submucous fibrosis (OSMF) is one of the most commonly occurring potentially malignant disorders in India and south East Asian countries where betel chewing is common practice. Iron and ascorbic acid are important agents for collagen synthesis. AIMS: The aims of this study were to estimate the levels of iron and ascorbic acid in serum and saliva in patients with OSMF and to correlate change in levels of iron and ascorbic acid with the histopathological grading of OSMF. MATERIALS AND METHODS: The study group comprised of 65 clinically diagnosed and histopathologically confirmed cases of OSMF; 21 age- and sex-matched controls were also enrolled in the study. Serum and salivary ascorbic acid were analyzed by the dintrophenyl hydrazine method whereas serum and salivary iron were analyzed by the dipyridyl method. RESULTS: The serum and salivary ascorbic acid levels consistently decreased with the progression of histopathologiocal grading of OSMF. Serum and salivary iron levels were also decreased in OSMF patients, but this was not significant. CONCLUSION: Ascorbic acid and iron may have been used for the excessive collagen synthesis occurring during progression of OSMF. Hence, serum and salivary monitoring may play a crucial role in the early diagnosis and prognosis of OSMF.