Histopathological Insight of a Case of Adenoid Ameloblastoma: A Rare Odontogenic Tumor.

Adenoid ameloblastoma with dentinoid had been perceived as a rare odontogenic tumor with bridging histopathological features between ameloblastoma and adenomatoid odontogenic tumor. Due to the mixture of histopathological features of two separate and well-recognized entities, adenoid ameloblastoma was also regarded as a hybrid lesion. The diversity in the histopathological presentation among the cases has disaccorded the nature, behaviour, and prognosis of this pathology. Despite the literature acknowledging the histopathological diversity, categorizing all these variations into one and addressing them as a single entity was lagging till the 5th edition of the odontogenic tumor classification by the WHO was forwarded. With the establishment of the new terminology of adenoid ameloblastoma and the enlistment of its diagnostic criteria, the scientific literature has advocated updating, contributing, and redefining the various aspects of this pathology. Here, we present a case of a 34-year-old male who presented with a chief complaint of swelling in the lower front region of his jaw in the past one month. The swelling was associated with pain that was sudden in onset with a progressive increase in size. The swelling was also associated with discharge that resembled pus. A panoramic radiograph showed a mixed radiopaque and radiolucent area, extending from the distal aspect of 32 up to the distal aspect of 43. The entire cystic lining along with the growth was excised and sent for histopathological examination. Correlating clinically, the histopathological features are suggestive of adenoid ameloblastoma. Scientific literature has stood as a boon to evidence-based practice. The diagnosis for the present case report is truly an outcome of the literature-based update which helped the diagnosis of the case as a separate entity rather than as a hybrid pathology. The goal was to enhance the understanding of the lesions in terms of their clinical characteristics and diverse histopathological morphology.

Effectiveness of pre-injection use of cryoanesthesia as compared to topical anesthetic gel in reducing pain perception during palatal injections: a randomized controlled trial.

Background: Palatal injections are often painful. We aimed to compare topical ice and 20% benzocaine gel for pre-injection anesthesia before greater palatine nerve block (GPNB) injections. Methods: A randomized split-mouth clinical trial was conducted among patients aged 15-60-years needing bilateral GPNB injections. A total of 120 palatal sites from 60 patients were randomly allocated to Group A (topical ice) or Group B (20% benzocaine gel). Pain was evaluated using sound, eye, motor (SEM), and the visual analog scale (VAS) in both groups. Inferential analysis was performed using the Mann-Whitney U test. Results: The mean age of the participants was 20.5 ± 3.9 years. The median VAS score for group A was 11 (Q1 - Q3: 5.25 - 21.75), which was slightly higher than the 10 (Q1 - Q3: 4.0 - 26.75) reported in group B. However, the difference was not statistically significant (P = 0.955). The median SEM score for group A and group B was 3.5 (Q1 - Q3: 3.0 - 4.0) and 4.0 (Q1 - Q3: 3.0 - 4.0), respectively, which was statistically insignificant (P = 0.869). Conclusion: Using ice as a form of topical anesthetic for achieving pre-injection anesthesia before GPNB was as effective as 20% benzocaine gel.

Histopathological Characterization of a Series of Oral Basaloid Squamous Cell Carcinoma.

Basaloid squamous cell carcinoma (BSCC) is a rare, distinctive, and aggressive variant of squamous cell carcinoma (SCC) primarily seen in the upper aerodigestive tract with epiglottis, soft palate, and base of the tongue being site of high preference in head and neck region. It differs from conventional SCC histologically and immunologically, is most frequently found in males in their sixth and seventh decades, and is frequently linked to alcohol and tobacco use. High stage disease with distant metastases, a high recurrence rate, and a dismal prognosis is how BSCC typically manifests. In the present article, we report four cases of BSCC.

Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study.

BACKGROUND/AIMS: Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1-year period. METHODS: The following data were collected: age (preschool [0-6 years], school age [7-12 years], and adolescent [13-18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software. RESULTS: Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0-18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001). CONCLUSION: The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0-6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.

A multicentric prospective analysis of maxillofacial trauma in the elderly population.

BACKGROUND/AIMS: The growth of the global elderly population will lead to an increase in traumatic injuries in this group, including those affecting the maxillofacial area, with a heavier load on health systems. The aim of this multicentric prospective study was to understand and evaluate the incidences, causes and patterns of oral and maxillofacial injuries in patients aged over 60 years admitted to 14 maxillofacial surgical departments around the world. METHODS: The following data were collected: gender, cause and mechanism of maxillofacial fracture, alcohol and drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment and length of hospitalization. Statistical analyses were performed using non-parametric and association tests, as well as linear regression. RESULTS: Between 30 September 2019 and 4 October 2020, 348 out of 2387 patients (14.6%), 197 men and 151 women (ratio 1.3:1; mean age 72.7 years), were hospitalized. The main causes of the maxillofacial fractures were falls (66.4%), followed by road traffic accidents (21.5%) and assaults (5.2%). Of the 472 maxillofacial fractures, 69.7% were in the middle third of the face, 28% in the lower third and 2.3% in the upper third. Patients with middle third fractures were on average 4.2 years older than patients with lower third fractures (95% CI 1.2-7.2). Statistical analysis showed that women were more involved in fall-related trauma compared with males (p < .001). It was also shown that road traffic accidents cause more fractures in the lower third (p < .001) and in the middle third-lower third complex compared with upper third (p < .001). CONCLUSIONS: Maxillofacial fractures in the elderly were more frequent in European and Australian centres and affected men slightly more than women. Falls were the leading cause of fractures, especially among women. The middle third of the face was most often affected, and conservative treatment was the most common choice for the management of such patients.

Intra-operative application of ultrasonography (USG) for reduction of zygomatic arch fracture.

Zygomatic arch fractures are the most common facial fractures or second in frequency after the nasal fractures. The high incidence of zygomatic fractures probably relates to its prominent position in the facial skeleton; hence, it is frequently exposed to fractures. This case report presents an left-sided isolated zygomatic arch fracture after subjected to routine investigations and radiographs like submentovertex and CT scans. The patient was operated under general anesthesia for the reduction of zygomatic arch by Gille's temporal approach with the use of Ultrasound intra-operatively. Recommendation for the use of ultrasonography in the identification of zygomatic arch fractures intra-operatively operatively.

Clinico-pathological profiling of peripheral ossifying fibroma of the oral cavity.

POF represents a separate entity with diverse histological presentation. Considerable overlapping of clinical and histological features are present among different reactive gingival lesions, which warrant a meticulous review for the diagnosis of POF.

"Choledochoscope" as an Important Addition in Difficult Airway Management: A Case Report.

The choledochoscope is an additional tool to manage a difficult airway. We successfully used it for the first time for awake nasal intubation in a patient with no mouth opening resulting from bilateral temporomandibular ankylosis. The visual appearance of the airway structures was not compromised. However, the shorter length and larger diameter of the choledochoscope in comparison with the fiberoptic bronchoscope are crucial limiting factors of this method. We, therefore, suggest considering a choledochoscope for intubation in patients with difficult airway as a second-line alternative when a fiberoptic bronchoscope is not available.

Dentigerous Cystic Changes in the Follicles Associated with Radiographically Normal Impacted Mandibular Third Molars.

OBJECTIVE: To assess the incidence of dentigerous cystic changes in the follicles of radiographically normal impacted mandibular third molars. METHODS: One hundred and thirteen follicles obtained after surgical removal of impacted mandibular third molars with radiolucency of less than 2.5 mm in the radiograph were sent for histopathologic evaluation to evaluate pathologic changes. RESULTS: The incidence of dentigerous cystic changes observed was 15.9%, that is, 18 out of 113 patients (51 males and 62 females), with the maximum incidence of cystic changes seen in the follicular space size of 0.5 mm. The mean age of the patients included was 27.8 ± 8.1. The most common indication for extraction among the patients in this study was recurrent pericoronitis (95%). There were no statistically significant differences in occurrence of cystic changes based on age, gender, angulation, relation to ramus, depth, side of impaction, and follicle size (P > 0.05). CONCLUSION: Dental follicles obtained from surgically removed impacted mandibular third molars should be submitted for histopathologic examination irrespective of the radiographic size of the follicle.

Animal Inflicted Maxillofacial Injuries: Treatment Modalities and Our Experience.

INTRODUCTION: Animal inflicted injuries to the face and neck are becoming much more common as people lavish affection on pets. Injuries caused by animal attacks to the face can cause complex injuries to soft and hard tissues, presented as perforations, lacerations, crushes, avulsion or fractures. An uncountable number of bacteria and virus can be found in such injuries, with a potential pathological effect to humans, regarding infections. Although the infection rate is low due to excellent blood supply to face, the injuries have disfiguring effect with possible psychological repercussion to the patients. The treatment of animal inflicted injuries must address the soft tissue defect, neurovascular injuries, and bone injuries as well as prevention of post treatment infection. Primary wound repair is the treatment of choice for most clinically uninfected bite wound where as delayed closure should be reserved for wounds at high risk of infection or already infected wounds and tissue defect may require local flap or micro-vascular re-implantations. MATERIAL AND METHODS: In this article, we have elicited up to date considerations regarding the management of animal inflicted injuries to the face based on literature search and exemplified by multiple case reports. CONCLUSION: For bite injuries on face, immediate primary wound repair after meticulous wound debridement and irrigation with sufficient volume added by antibiotic prophylaxis gives good cosmetic results with minimum risk of infection. Depending upon type of attack and age of victims, psychiatric or social counseling may also be required.

Frazier Metallic Suction Tube: An Adjunct in Irrigation of Deep Fascial Spaces.

Once incision and drainage of fascial space abscess is performed, irrigation of deep spaces with saline and antibiotic solution should be done daily for effective elimination or reduction of infection. Various advocated aids for irrigation into deeper areas are: small pediatric nasogastric feeding tubes, French catheter, polyethylene irrigation tubes and scalp vein infusion set. All these aids have major inherent disadvantages like, they tend to kink inside the deep spaces limiting the reach of irrigating solution into deeper spaces, are not readily available in dental departments and have to be discarded after every use. Overcoming these disadvantages, a simple yet an effective method is proposed here-use of a Frazier suction tube.

A randomized clinical trial of the effects of submucosal dexamethasone after surgery for mandibular fractures.

PURPOSE: To evaluate the effects of immediate postoperative submucosal dexamethasone administration on postoperative pain, edema, trismus, and mandibular functions after open reduction and internal fixation (ORIF) for mandibular fractures. PATIENTS AND METHODS: We conducted a prospective, randomized, controlled, double-blind study of 40 patients who required ORIF for mandibular fractures under general anesthesia. The patients were divided into 2 groups, an experimental group (n = 20) who received immediate postoperative submucosal 8 mg of dexamethasone through the surgical incision site, and a control group (n = 20) who did not receive dexamethasone. Pain was assessed using a visual analog scale (VAS) score and the frequency of analgesic consumption at the various postoperative intervals. The maximum interincisal distance and facial measurements were compared before surgery and at 24, 48, and 72 hours and 7 days after surgery. The difficulty in mandibular function after surgery was graded as mild, moderate, or severe. RESULTS: The analgesic drugs required 2 hours after surgery and the VAS score 72 hours after surgery were significantly less (P < .05) in the experimental group than in the control group. The total number of diclofenac tablets required by the experimental group was less than that for the control group, but the difference was not statistically significant. The control group had significantly increased swelling (P < .05) compared with the experimental group from preoperatively to 24 hours postoperatively (experimental group 0.115 ± 0.143, control group 0.253 ± 0.173). No statistically significant difference was present in the mouth opening or difficulty in mandibular function at the different follow-up intervals between the 2 groups (P > .05). CONCLUSION: The results of our study suggest that submucosal administration of dexamethasone after ORIF for mandibular fractures is effective in reducing postoperative pain and edema.