Pleomorphic Adenoma of the Orbital Ectopic Lacrimal Gland: An Extremely Rare Occurrence with Review of Literature.

Only three cases of pleomorphic adenomas (PAs) of ectopic lacrimal gland mass in deep orbital location have been reported in the literature. This report describes a case of PA of the ectopic lacrimal gland situated deep in the orbit leading to proptosis, which was managed successfully by supraorbital orbitotomy via eyebrow incision. A 60-year-old female presented with complaints of gradually progressive, painless proptosis of the right eye. Imaging revealed a well-defined circumscribed mass lesion in the right orbit located predominantly in the postero-superior aspect of the globe. The patient underwent complete excision through supraorbital orbitotomy approach, using eyebrow incision. There was no clinical evidence of recurrence at eight months follow up. In orbit, PAs of the ectopic lacrimal gland are extremely rare, and the success of the treatment depends on the removal of the tumor with its capsule.

Prevalence of oral lichen planus in patients with hypothyroidism versus non-hypothyroidism - A case control study of 1000 cases.

Background: The oral cavity is a unique environment where systemic maladies may be amplified by the oral mucosa. Oral diseases are usually local, but may also be the sign of systemic disease. Oral lesions are mostly one of the first indications of a systemic problem. Lichen planus (LP) is an inflammatory disease that involves the skin and mucous membrane. It is one of the most common oral diseases that manifest itself in the oral cavity. The exact cause of oral lichen planus (OLP) is unknown, but the immunologic system plays a leading role in the pathogenesis. It is well documented that OLP represents a cell-mediated immune response. Materials and Methods: The study population was drawn from the patients attending the outpatient Department of General Medicine and Department of Oral Medicine and Radiology with a total of 1000 subjects, out of which 500 subjects were clinically diagnosed with hypothyroidism and 500 subjects were without the history of hypothyroidism. The data collected was compiled and analysed to obtain the result. A Chi-square test was used to compare the categorical variables and the analysis was carried out on SPSS 16.0 version. Results: The study revealed an increased prevalence of OLP in hypothyroidism. Cases clearly had a predilection of 2.37 times more tendency to develop OLP as compared to the control. Conclusion: To conclude, it seems that OLP was more prevalent in hypothyroid individuals, especially in females in the third and fourth decades of life.

A comparative study to evaluate the efficacy of lycopene and curcumin in oral submucous fibrosis patients: A randomized clinical trial.

BACKGROUND: : Oral submucous fibrosis (OSMF) is a most prevalent potentially malignant disorder associated with betel quid chewing frequently observed in the Indian population. The present study conducted is much of a keen interest because there is much new information, both in the press and the medical literature, about the benefits of fresh fruits and vegetables and antioxidants (such as lycopene and curcumin) for both prevention and treatment of diseases. As clinicians, we often prescribe medications with significant adverse effects, and certainly, if armed with evidence to support using such antioxidants as safer therapeutic alternatives for treatment of OSMF. AIMS AND OBJECTIVE: The aim of the study was to compare and evaluate the efficacy of lycopene and curcumin given orally in clinically diagnosed OSMF patients. MATERIALS AND METHODS: Sixty patients were divided randomly into two groups Group A and Group B. After fulfilling the eligibility criteria, sixty patients were randomly allotted based on fishbowl method into thirty each. This technique eliminated the selection bias arising in the study. Group A individuals were treated with 4 mg of lycopene and Group B individuals were given 300 mg of curcumin thrice daily for 3 months. Both the groups were assessed in terms of mouth opening and burning sensation. The statistical analysis was done using SPSS Version 16.0 statistical Analysis Software. RESULTS: In Group A, the initial burning sensation was 65.83 ± 3.98%, and in Group B, it was 62.33 ± 5.22% (visual analog scale). After 3 months, there was complete cessation of burning sensation in both the groups. Burning sensation between the groups was statistically nonsignificant (P > 0.05). In Group A, mean mouth opening at baseline (1st visit) observed was 3.17 ± 0.08 cm which improved to 3.52 ± 0.07 cm after 3 months of the treatment period. In Group B, mean mouth opening at baseline (1st visit) observed was 3.32 ± 0.07 cm which improved to 3.52 ± 0.08 cm after 3 months of the treatment period. On comparing intergroup, the difference was statistically nonsignificant (P > 0.05). However, on comparing intergroup, average percent change in mean mouth opening from 1st visit to subsequent time intervals across the time period was found to be statistically significant (P < 0.05). Group A showed 11.1 ± 1.0% improvement in mean mouth opening and Group B showed 6.2 ± 0.4% improvement in the mean mouth opening from the 1st visit till the posttreatment period. The change in the mean mouth opening from 1st visit till posttreatment in Group A was 0.35 ± 0.14, and in Group B, it was 0.20 ± 0.09. CONCLUSION: Lycopene showed better results than curcumin in improving mouth opening; both the drugs were equally effective in decreasing burning sensation in OSMF patients.

Pleomorphic adenoma of a deep orbital ectopic lacrimal gland.

Ectopic lacrimal gland, being one of the choristomas, is comprised of lacrimal gland tissue outside the lacrimal gland fossa in the fronto-lateral part of the orbital roof. Ectopic lacrimal gland is a rare condition where the gland may be found in the orbit, eyelids, ocular adnexa or within the globe. Neoplastic transformation of such tissue may occur. A sixty-two-year old male patient presented with right eye proptosis and slight nasal displacement of the globe. Computerized tomography scan revealed a well-defined hypodense lesion of size 19 x 18 x 20 mm supero-lateral to lateral rectus muscle, with mild proptosis and thinning of the right lateral orbital wall. Excisional biopsy was performed through a lateral orbitotomy approach. A well circumscribed globular mass was removed from the right orbit, well behind the fossa for the lacrimal gland in the retrobulbar space. Histopathology was suggestive of pleomorphic adenoma of lacrimal gland. Pleomorphic adenoma is an epithelial tumor of the lacrimal gland which is extremely rare from an ectopic lacrimal gland and only few cases have been reported in literature till date.

Neonatal orbital abscess.

Orbital abscess generally occurs in older children but it can rarely affect infants and neonates too. We report a case of community acquired methicillin resistant staphylococcus aureus (CA-MRSA) neonatal orbital abscess in a 12-day-old term female neonate with no significant past medical history or risk factor for developing the infection. The case highlights the importance of consideration of CA-MRSA as a causative agent of neonatal orbital cellulitis even in a neonate without any obvious predisposing condition. Prompt initiation of appropriate medical therapy against MRSA and surgical drainage of the abscess prevents life threatening complications of orbital cellulitis which more often tend to be fatal in neonates.

Estimation of serum zinc, copper, and iron in the patients of oral submucous fibrosis.

INTRODUCTION: The role of trace elements in various diseases has been a matter of controversy with various authors reporting on conflicting data. They are receiving much attention in the detection of oral cancer and precancer as they are found to be significantly altered and have an important role in carcinogenesis. Trace elements have been extensively studied in the recent years to assess whether they have any modifying effect in the etiology of oral malignant conditions. MATERIALS AND METHODS: A study was conducted on fifty subjects with clinically diagnosed oral submucous fibrosis (OSMF) and fifty controls with no apparent lesions of the oral mucosa and without any areca nut-related oral habit. RESULTS: The level of serum zinc was significantly (P < 0.0001) lower among cases (73.48 ± 24.21) compared with controls (119.48 ± 52.78). However, the serum copper level was significantly (P < 0.0001) higher among cases (155.50 ± 40.13) than controls (100.40 ± 24.52). The level of serum iron was observed to be lower among the cases (66.57 ± 27.76) as compared to controls (94.19 ± 35.70), and the difference was statistically significant. CONCLUSION: It can be concluded from this study that serum zinc, copper, and iron levels could be used as a potential prognostic and diagnostic markers in OSMF patients.

A rare case of bilateral optic nerve sheath meningioma.

A 60-year-old female presented with gradual, painless, progressive diminution of vision, and progressive proptosis of left eye since 7 years. Ophthalmological examination revealed mild proptosis and total optic atrophy in the left eye. Magnetic resonance imaging (MRI) and computed tomography (CT) brain with orbit showed bilateral optic nerve sheath meningioma (ONSM) involving the intracranial, intracanalicular, intraorbital part of the optic nerve extending up to optic chiasma and left cavernous sinus.

Ocular manifestations in porphyria cutanea tarda.

A 24-year-old man presented with pain, sticky discharge and loss of vision in the right eye. He has had typical skin manifestations of porphyria cutanea tarda (PCT) since 6 years and ophthalmological symptom for 6 weeks. On ophthalmological examination, visual acuity was light perception in the right eye and 6/12 in the left. There were bilateral, symmetrical temporal scleromalacia along with temporal corneal melting in both eyes and perforation in the right eye. Ultrasonography B-scan (USG B-scan) revealed a retinal detachment in the right eye. Artificial tear instillation was started every hour along with topical antibiotic coverage in both eyes. Additionally, ultraviolet protective sunglasses and hat for photo-protection was advised. The vision in the right eye improved to 5/60 along with subsidence of retinal detachment on repeat USG B-scan after 3 weeks.

Clinical profile and visual outcome of ocular injuries in a rural area of western India.

BACKGROUND: Ocular trauma is a major cause of visual impairment and morbidity worldwide. AIMS: To identify the various type of ocular injury in a rural area, determine the presence of any associated visual damage and assess the final visual outcome after treatment. METHOD: Hospital-based, prospective study conducted over a period of two years. A total of 60 patients of ocular trauma were included. RESULTS: Ocular injuries were more commonly seen in adult (55 per cent) patients who were associated with agricultural work (43.33 per cent). They were more common in male patients (71.67 per cent). Closed globe injury (68.33 per cent) was more common than open globe injury (31.67 per cent). Both in open and closed globe injuries, the commonest object causing injury was a wooden stick. Just 26.7 per cent of the patients had a visual acuity better than 6/60 at presentation; while after completed treatment at two months follow-up, 68.3 per cent had best corrected visual acuity better than 6/60. CONCLUSION: Agricultural trauma is an important cause of monocular blindness in rural India. The visual outcome depends upon the site and size of the injury and the extent of the ocular damage.

Orbital myiasis caused by green bottle fly.

An 80-year-old farmer, presented with large, maggot infested ulceration involving the medial part of the right upper lid. The left eye was phthisical. There was history of untreated traumatic laceration of the right upper lid. Mechanical removal of maggots was done under turpentine coverage with regular antibiotic dressing. Microbiological examination of maggots revealed the larvae to be of Lucilia sericata (green bottle fly). The ulceration completely healed in two weeks following manual removal of maggots and regular dressing. Orbital myiasis is an uncommon clinical condition, with isolated case reports in literature.

Osteoma of temporomandibular joint: a rarity.

Osteoma is a benign tumour consisting of mature bone tissue. It is an uncommon lesion that occurs in the bones of the craniofacial complex. Only a few cases involving the temporomandibular joint have been reported. An osteoma of the left temporomandibular joint causing limited mouth opening in a 22-year-old man with CT findings revealing the unusual possibility in differential diagnosis of trismus.

A case of conjunctival malignant melanoma with local recurrence.

Malignant melanoma of the conjunctiva is a rare tumour of middle and old age. It is seen predominantly in whites, and is rare in those of pigmented ethnicity. Its clinical presentation varies, and making a clinical diagnosis may be difficult. The tumour is potentially fatal and displays a high rate of recurrence, which can be attributed to delay in diagnosis, as well as inadequate surgical approach. The literature on this melanoma is scanty, even in the West, particularly regarding the precise surgical technique. We report a case of malignant melanoma of the conjunctiva which showed a local recurrence one year after the primary surgery. However, there was no evidence of distant metastasis on either occasion. This case highlights the need for care in making a diagnosis, meticulous attention to the surgical technique, and careful follow-up to detect further disease activity.

Recurrent neurofibroma of the orbit.

A 55-year-old male patient presented with gradual progressive outward and downward deviation of right eye since last two years, with history of a similar complaint 10 years ago when he was diagnosed as having neurofibroma of the orbit. Computed Tomography imaging revealed a large, multilobulated, heterogeneous, soft tissue density mass lesion in the retro bulbar region on the medial side of right orbit suggestive of a neurofibroma. Excision and histopathology confirmed it to be a recurrence of neurofibroma of the orbit.

Bilateral lateral periodontal cyst.

The bilateral lateral periodontal cyst is a rare nasological entity, which despite clinical and radiological presentation is being diagnosed by histological characteristics. It is asymptomatic in nature and is observed in routine radiography. The aim and objective of this article is to present a rare case of bilateral lateral periodontal cyst in a 14-year-old child. The clinical and radiographical findings, along with its management have been discussed. Enucleation of bilateral cyst without extraction of the adjacent tooth was performed. Lesion samples were sent for histopathological analysis. The histopathological analysis revealed a thin, non keratinised stratified squamous epithelium resembling reduced enamel epithelium. Epithelial plaques were also seen. A clinicopathological correlation incorporating the surgical, radiographical and gold standard histopathological findings was obtained to suggest the final diagnosis of the bilateral lateral periodontal cyst.

940 nm diode laser therapy in management of recurrent apthous ulcer.

Recurrent apthous stomatitis (RAS) is one of the most common oral inflammatory diseases characterised by painful recurrent ulcerations of the orofacial region. The ulcers occur in three clinical forms: minor, major and herpetiform. Several therapies have been advocated to manage these lesions such as topical corticosteroids (triamcinolone acetonide, hydrocortisone acetate and clobetasol propionate), chlorhexidine mouth rinses, tetracycline oral rinses, thalidomide, fluocinonide, colchicines and the immune boosting agent levamosile, vitamin therapy and topical interferon α-2a. Laser therapy is used as an alternative method in treatment of RAS. In this paper one patient with RAS was treated using a 940 nm diode laser for symptomatic relief of pain and burning sensation and healing of ulcer.

Efficacy of diode laser in the management of oral lichen planus.

Oral lichen planus (OLP) is a common chronic disease of uncertain aetiology. Treatment of patients with symptomatic OLP represents a therapeutic challenge. Despite numerous existing remedies, there are many treatment failures. The diode laser therapy is used as a possible alternative method in the treatment of lichen planus. The patient with OLP lesions was treated using diode laser (940 nm) for the symptomatic relief of pain and burning sensation. The patient was assessed before, during and after the completion of the treatment weekly. The treatment was performed for 2 months and the patient showed complete remission of burning sensation and pain (visual analog scale 0%). The follow-up was performed for 7 months and no recurrence of burning sensation was found. Diode laser therapy seems to be an effective alternative treatment for relieving the symptoms of OLP.

Nasopalatine canal cyst: often missed.

Nasopalatine canal cyst may occur within the nasopalatine canal or in the soft tissues of the palate, at the opening of the canal, where it is called the 'cyst of the palatine papilla'. These are normally asymptomatic, constituting casual radiological findings. We present a case report of a male patient with infected nasopalatine canal cyst seen clinically as swelling over palate. Radiographic interpretation should be thoroughly performed for maxillary anterior region and any occlusal radiograph in routine radiography to screen this entity and must be distinguished from other maxillary anterior radiolucencies by the clinician.

Modified technique of soft liner application.

Soft liners are materials that can be advocated successfully to manage clinical situations like atrophic edentulous ridges with flabby displaceable tissues and in cases of severely resorbed ridges which adversely affect the retention and stability of complete dentures and further enhance bone loss. Soft liner provides a cushioning effect and distributes uniform occlusal forces to compromised residual ridges. In this paper a modified technique of soft liner application in mandibular denture has been discussed.

Angina bullosa haemorrhagica.

Angina bullosa haemorrhagica is the term used to describe benign subepithelial oral mucosal blisters filled with blood that are not attributable to a systemic disorder or haemostatic defect. It is a very rare condition. Elderly patients are usually affected and lesions heal spontaneously without scarring. The pathogenesis is unknown, although it may be a multifactorial phenomenon. Trauma seems to be the major provoking factor and long-term use of steroid inhalers has also been implicated in the disease. We present a 50-year-old patient with angina bullosa haemorrhagica. Trauma by sharp cusp of adjacent tooth and metal crown were identified as aetiological factors in this case. Lesions healed after removal of the metal crown and rounding of the cusp. Therefore, recognition of the lesion is of great importance to dentists, to avoid misdiagnosis.