Peripheral Giant Cell Granuloma - A Case Report of a 9-Year-Old Male Child.

"Giant cell epulis" nowadays known as "peripheral giant cell granuloma" (PGCG) is a soft tissue benign overgrowth seen in the oral cavity. It is a type of reactive exophytic lesion of gingiva whose etiology is still not specific. Peripheral giant cell lesion may not be a life-threatening condition but when the size of the lesion exceeds a certain limit it hampers day-to-day activity of the oral cavity. It may also have a psychological effect on the person. We report a case of a 9-year-old boy with a large peripheral giant cell lesion, which interfered with his chewing habits. The purpose of reporting this case is to create awareness about peripheral giant cell lesions and its treatment modality. Under general anesthesia, the soft tissue growth was excised using an electrocautery that was approximately 5.3 cm in length and 2 cm in width. The patient was reviewed on the 7th day (postoperative), followed by 10, 20, and 30 days. After this, the patient was reviewed monthly for 6 months. Healing was successful without any events. Proper history taking is mandatory before coming to a final diagnosis. Various diagnostic aids help in coming to a confirmatory diagnosis. Complete surgical excision and elimination of any irritant factor along with clearing of the base of the lesion is mandatory to avoid recurrence rate and have a complete uneventful healing.

Does dexmedetomidine improve analgesia of superficial cervical plexus block for thyroid surgery?

BACKGROUND AND AIMS: Bilateral superficial cervical plexus block (BSCPB) is effective in reducing pain following thyroid surgeries. We studied the effect of dexmedetomidine on duration and quality of analgesia produced by BSCPB with 0.5% ropivacaine in patients undergoing thyroid surgeries. METHODS: In this prospective double-blinded study, 60 adults undergoing thyroid surgeries were randomised into two equal groups to receive BSCPB, either with 20 ml 0.5% ropivacaine (Group A) or 20 ml 0.5% ropivacaine with 0.5 µg/kg dexmedetomidine (Group B) after induction of anaesthesia. Visual analogue scale (VAS) was used to assess analgesia postoperatively at 0, 2, 4, 6, 12 and 24 h and patient satisfaction at 24 h. Haemodynamics were recorded peri-operatively. Wilcoxon signed rank test and Mann-Whitney U-test were applied for VAS and sedation scores. Unpaired t-test was applied for age, weight, duration of surgery and duration of post-operative analgesia. RESULTS: There was significantly longer duration of analgesia in Group B (1696.2 ± 100.2 vs. 967.8 ± 81.6 min; P < 0.001) and higher patient satisfaction at 24 h (7 [7-9] vs. 5 [4-6]; P < 0.001). While VAS score for pain were similar up to 6 h, they were lower in Group B at 12 h (0 [0-1] vs. 2 [1-2]; P < 0.001) and 24 h (2 [2-2] vs. 5 [5-6]; P < 0.001). Haemodynamic stability and sedation scores were similar across the groups. There were no adverse events. However, pain during swallowing persisted in both the groups. CONCLUSION: Combination of 0.5% ropivacaine and dexmedetomidine for BSCPB provided significantly prolonged and better quality of postoperative analgesia and patient satisfaction than with 0.5% ropivacaine alone in patients undergoing thyroidectomy.

Efficacy of oxitard capsules in the treatment of oral submucous fibrosis.

AIM: Oral submucous fibrosis (OSMF) is a high-risk premalignant condition predominantly seen in the Indian subcontinent. The aim of the present study was to evaluate the efficacy of oxitard capsules in the management of OSMF. MATERIALS AND METHODS: Total of 120 subjects with clinico-pathologically diagnosed OSMF were included in the study and divided equally in 2 groups; Group A (oxitard group) and Group B (placebo group). Group A was administered 2 oxitard capsules twice daily and Group B was given placebo tablets twice daily, for 3 months. Evaluation for different clinical parameters was done at regular intervals and data was analyzed using the Student's paired t test and Chi-square test. P < 0.001 was considered to be statistically significant. RESULTS: Clinical improvements in mouth-opening and tongue protrusion were significant in the Group A (P < 0.001). Subjective symptoms of burning sensation (P = 0.0001), pain associated with the lesion (P = 0.000), difficulty in swallowing (P = 0.0003) and speech (P = 0.0005) also significantly improved in the Group A. There was a mild to moderate decrease in the size of the lesion. CONCLUSION: Though there is no definitive treatment for the condition; however, oxitard capsules can bring about significant clinical improvements in the symptoms like mouth-opening, tongue protrusion, burning sensation, difficulty in swallowing and speech and pain associated with the lesion, thereby improving the quality of life of the affected individuals.

Comparative study of the efficacy of herbal antioxdants oxitard and aloe vera in the treatment of oral submucous fibrosis.

OBJECTIVES: Oral submucous fibrosis (OSMF) is a potentially malignant disorder predominantly seen in the Indian subcontinent due to areca nut, tobacco and their products. The aim of the present study was to compare the efficacy of oxitard and aloe vera in the management of OSMF. MATERIAL AND METHODS: 120 subjects with OSMF were included in the study. The patients were clinico-pathologically diagnosed and divided equally in 2 groups, Group A (oxitard group) and Group B (aloe vera group). Group A was administered 2 oxitard capsules twice daily and Group B was given 5 mg aloe vera gel to be applied topically thrice daily for 3 months. Different clinical parameters were evaluated at regular intervals. Data was analyzed using the Student's paired t test and Chi-square test. P-value <0.001 was considered to be statistically significant. RESULTS: Clinical improvements in mouth opening and tongue protrusion was significant in the oxitard group (p=0.0005). Subjective symptoms of pain associated with the lesion (p=0.0003), difficulty in swallowing (p=0.0000) and speech (p=0.0001) also significantly improved in the Group A. The improvement in burning sensation was not statistically significant between the 2 groups (p=0.002). There was a mild to moderate decrease in the size of the lesion. CONCLUSIONS: Though there is no definitive treatment for the condition however, overall assessment of symptoms like mouth opening, tongue protrusion, difficulty in swallowing and speech and pain associated with the lesion showed that oxitard capsules can bring about significant clinical improvements than aloe vera gel in the treatment of OSMF. Key words:Oral submucous fibrosis, oxitard capsules, aloe vera, burning sensation, mouth opening.

Oral verrucous hyperplasia: a case report.

Oral verrucous hyperplasia is a whitish or pinkinsh elevated pre malignant lesion which occurs rarely. Its is also considered to be an early form of verrucous carcinoma. We have reported a case of verrucous hyperplasia which was diagnosed and treated with buccal fat pad as graft.

Prevalence of cysts and tumors around the retained and unerupted third molars in the Indian population.

AIM: Tooth impaction is a frequent phenomena and surgical removal of these teeth are the commonest of the dental surgical procedures. The debate over the removal of asymptomatic impacted third molars still continues. The aim of this retrospective study was to determine the incidence of development of cysts and tumors around the retained and unerupted third molars in the Indian population. MATERIAL AND METHODS: 5486 impacted third molars of 4133 patients were studied through the panoramic radiographs for the presence of associated cysts and tumors. The ages of the patients ranged from 17 to 67 years, with a mean of 33.7 years. The results were evaluated using the Pearson chi-square test. P-values less than 0.05 were considered to be statistically significant. RESULTS: There were 134 cysts (2.24%) and 63 tumors (1.16%) found that were associated with impacted third molars, of which 3 were malignant (0.05%). 143 patients had symptoms such as swelling or pain due to cystic or neoplastic lesions. The remainder 54 patients had no symptoms suggestive of pathology. The most common cyst was dentigerous cyst and the most common tumor was ameloblastoma. CONCLUSION: The results indicate that cysts and tumors do develop in a relatively small but still considerable minority of patients. The fact that a considerable number of patients had no signs or symptoms indicating pathology is certainly worth considering. Consultation should be sought from dental specialists if there are symptoms in the third molar region.

Transconjunctival preseptal approach for orbital floor and infraorbital rim fracture.

PURPOSE: To evaluate the transconjunctival preseptal approach for time required for exposure, adequacy of exposure, intraoperative and postoperative complications. MATERIALS AND METHODS: Materials for this study involved 15 cases of maxillofacial injuries with orbital floor and infraorbital rim fracture. RESULTS: The average exposure time taken for placement of incision till the exposure of the fracture was 21 min. Exposure obtained for fracture site was adequate in all cases, for the reduction of orbital floor and internal fixation of infraorbital rim. No cases had intraoperative and postoperative complications. In all cases postoperative esthetic outcome was satisfactory. CONCLUSION: The transconjunctival preseptal approach is most effective surgical access to infraorbital rim and orbital floor and even to medial orbital wall. This approach is surgically similar in providing exposure and access, but aesthetically superior to other approaches and has minimal complications. There are no disadvantages to transconjunctival preseptal approach, if performed meticulously with sound knowledge of anatomy of periorbital tissues.