Metastatic Malignant Glomus Jugulare Tumor: A Rare Case Report with Clinical Manifestations and Treatment Approach.

BACKGROUND Paragangliomas are neuroendocrine neoplasms derived from paraganglia of the sympathetic and parasympathetic nervous systems. Parasympathetic ganglia-derived tumors, also called non-chromaffin, are located almost exclusively in the neck and skull base and are usually non-secretory and inactive. A case of malignant glomus jugulare with a metastatic cervical lymph node is described here. CASE REPORT A 24-year-old woman was referred to an otolaryngology clinic for concern of voice change for 1 month, which was associated with right progressive hearing loss, pulsating tinnitus, and right facial weakness. A clinical examination revealed a reddish mass in the right ear behind an intact tympanic membrane with right facial weakness of House-Brackmann grade VI. A bedside flexible nasopharyngoscopy revealed an immobile right vocal fold. A computed tomography scan of the brain revealed a destructive lesion within the right jugular foramen. The patient underwent embolization followed by glomus tumor resection via infra-temporal fossa with Fisch type A approach. Pathology revealed that the tumor was an infiltrative epithelioid tumor with a spindle and nesting pattern separated by fibrovascular stroma. The submitted lateral neck lymph node revealed a metastatic tumor. CONCLUSIONS Glomus jugulare tumors are uncommon paragangliomas, and malignant behavior with metastasis is extremely rare. Metastatic tumors are often associated with facial and vagal nerves palsy. There are no histological features that distinguish malignant glomus jugulare tumors. Malignant neoplasms are characterized by the presence of metastases. Tumors of the glomus jugulare that are malignant are treated with surgery, radiotherapy, or both. However, our search of the literature revealed no clear guidelines, given the scarcity of cases. Moreover, the presence of metastasis increases the risk of death.

Effect of khat extract on color stability of digitally and manually fabricated provisional restorations: an in vitro comparative study.

BACKGROUND: The aim of this in vitro study was to evaluate the effect of khat extract on the color stability of five different provisional restorative materials (PRMs). METHODS: In this study, 50 specimens were fabricated from five different PRMs with different techniques. Twenty specimens were digitally fabricated of poly-methyl methacrylate (PMMA) CAD/CAM milling and 3D printing PRMs, while the other thirty specimens were manually fabricated of three different PRMs: PMMA self-cured (SC) acrylic resin, light-cured (LC) composite, and Bis-acrylic SC composite. Milling and 3D printing machines were used to fabricate the digital specimens, while the manual specimens were fabricated using a metallic mold. The material was placed in the mold, covered by a polyester stripe, and held between two glass slabs with a constant load for 30 s. After setting, the specimens were removed and checked. Ten disc-shaped specimens with 2 ± 0.3 mm thickness and 10 ± 0.3 mm diameter were prepared from each of the tested PRM. Then all the specimens were polished. Five specimens of each PRM were immersed in khat extract, while the other five were immersed in distilled water medium as a control group. The color measurements were recorded before and after 1 and 7 days of immersion using a spectrophotometer. The immersion media were renewed every 24 h and kept along with the specimens at 37 °C. The T test, paired T test, and ANOVA analysis of variance were used to analyze the results. The Bonferroni test was used for post-hoc multiple comparisons. RESULTS: The interaction between the tested PRMs, the media, and the duration of immersion time was statistically significant (p < 0.05). PMMA CAD/CAM milling PRM was the most stable in color, and this was statistically significant (p < 0.05). The LC composite PRM composite was the least stable in color and was statistically insignificant (p > 0.05) when compared to the 3D printing and Bis-acrylic SC composite PRMs, respectively. CONCLUSIONS: This study demonstrated that khat extract medium has a high staining ability on the tested PRMs. CAD/CAM milling PRM was the most stable in color and could therefore be used as a long-term provisional. The increase in immersion time was a significant factor in the color change of the tested PRMs. The color of the 3D-printed PRM was the most affected over time.

A misdiagnosed aneurysm of the petrous internal carotid artery: A case report.

INTRODUCTION: An aneurysm is characterized by the weakening of the arterial wall, which leads to a bulge that can be filled with blood. Aneurysms of the petrous portion of the internal carotid artery are rare and predominantly detected incidentally. This is a report of multiple misdiagnoses of an aneurysm of the petrous segment of the internal carotid artery (ICA) that highlights its imaging-based diagnosis and risk of mortality. PRESENTATION OF CASE: A 60-year-old woman with chronic kidney disease and a history of stroke presented with left ear discharge, decreased hearing, and non-pulsatile tinnitus that had persisted for four months. Clinical examination showed wet tympanic membrane perforation, and imaging revealed an ill-defined infiltrative mass involving the left petrous apex initially misdiagnosed as glomus jugulare. Diagnostic computed tomography (CT) angiography revealed a left aneurysm in the petrous part of the ICA, which was successfully treated with interventional radiology. Follow-up was planned for infectious diseases and internal medicine, but she was lost to follow-up by the otolaryngology department. DISCUSSION: Aneurysms in the petrous portion of the ICA are rare and usually asymptomatic. However, their clinical manifestations vary, and they have various differential diagnoses. CT and magnetic resonance imaging are essential for diagnosis, and CT angiography is the gold standard. CONCLUSION: Diagnosing petrous ICA aneurysms requires a high level of suspicion and CT angiography. Their clinical presentations vary from asymptomatic to severe. Case-specific management and endovascular treatment yield positive neurological outcomes.

Evaluation of the quality of fixed prosthesis impressions in private laboratories in a sample from Yemen.

BACKGROUND: Fixed prosthodontics require an accurate impression for the teeth and the area to be restored for the laboratory to fabricate the desired restoration without mistakes. This study evaluated the quality of impressions received by private laboratories for the fabrication of fixed prosthesis by describing the frequency of clinically detectable errors and by analyzing association between the various factors involved. METHODS: 165 impressions were collected from four dental laboratories. Jaw involved, type of tray, size of tray, number of prepared units, type of impression materials, techniques and viscosity in case of elastomeric impressions and type of prosthesis requested were recorded. Data referring to errors and visible defects including errors in finish line, in preparation area, in silicone impression technique and blood in impression were also documented. Factors affecting errors present were also assessed. Association between dentist gender and experience years and impression errors was assessed. Chi square and Fisher exact tests used to examine the association between categorical variables and outcomes. RESULTS: The total of error considering not immediately pouring as an error. Alginate was the most impression used. of impressions evaluated (50.9%), 97% were have at least one visible error; 92.1% had errors in finish line, 53.9% had errors in preparation area and (72.8%) of elastomeric impressions were have at least one error in technique. Blood in impression was detected in 52.1% of impressions. Significant association was found between material type and errors in finishing line and preparation area. Significant relationships were found between gender and errors in silicone impression technique (p < 0.05). CONCLUSION: Within the limitations of this study, high frequency of detectable errors was found in fixed prosthesis impressions received by private dental laboratories. This high frequency is of serious concern, as this will result in poor fitted fixed prosthesis provided to patients.

Middle ear odontoma: A case report and review of the literature.

INTRODUCTION: Odontomas are benign neoplasms originating from odontogenic tissues. Most of these masses are asymptomatic and can only be diagnosed correctly via radiological studies. Treatment of choice for management of odontoma involves surgical excision to prevent secondary complications and result in a favourable prognosis. CASE PRESENTATION: This paper presents a rare case of odontoma of the middle ear in a four-year-old girl. The mass caused unilateral conductive hearing loss and facial nerve entrapment. We shed light on the typically vague clinical presentations of odontomas, as well as the available options in terms of diagnostic imaging modalities and their outcomes. Standard management of odontoma was followed to improve prognosis and avoid relapse. The aim of highlighting this case is to report on unique clinical, radiographical, and histological findings. DISCUSSION: Retrotympanic odontomas are extremely rare. Only five cases in the English-language literature have investigated such an incident. All of the reviewed cases were asymptomatic and discovered only using radiological evidence. Two cases were managed surgically while the remainder were conservatively managed. CONCLUSION: In five of the six cases mentioned in the English-language literature (including this paper), odontomas occurred in the first decade of life, with an obvious female predilection. In one case, odontoma occurred in the third decade of life. Although odontoma is marked by its frequently benign origin, the absence of symptoms, and the necessity of surgical intervention, further studies are needed to analyse the different clinical pictures, and to allow these to add to what is currently known.

Familial hypercholesterolemia with bilateral cholesterol granuloma: A case series.

INTRODUCTION: Cholesterol granuloma is a benign mass that commonly involves the petrous apex but rarely affects other structures, such as the mastoid cavity. It is diagnosed histologically by the presence of giant cells, and Its management is individualized based on some factors such as the size and location of the lesion. PRESENTATION OF CASE: The first case was a 33-year-old man who presented to the outpatient clinic with a two-year history of right-sided pulsatile tinnitus, hearing loss, and vertigo. Upon investigations, a large, destructive mass in the tympanomastoid region was found and managed surgically. The other case was for a 41-year-old man who presented to the emergency department with loss of consciousness. Urgent CT was done and revealed an aggressive hypodense posterior fossa mass destroying the right temporal bone that was managed surgically. DISCUSSION: In this report, we describe two patients with familial hypercholesterolemia who developed bilateral cholesterol granuloma that were managed surgically. CONCLUSION: These cases are reported because of their rare location and presentation since few cases of bilateral cholesterol granuloma have been reported in the literature.

Effect of Surface Treatments on the Bond Strength to Turkom-Cera All-ceramic Material.

AIM: The aim of this study was to evaluate the effect of surface treatments on shear bond strength (SBS) of Turkom-Cera (Turkom-Ceramic (M) Sdn. Bhd., Puchong, Malaysia) all-ceramic material cemented with resin cement Panavia-F (Kuraray Medical Inc., Okayama, Japan). MATERIALS AND METHODS: Forty Turkom-Cera ceramic disks (10 mm × 3 mm) were prepared and randomly divided into four groups. The disks were wet ground to 1000-grit and subjected to four surface treatments: (1) No treatment (Control), (2) sandblasting, (3) silane application, and (4) sandblasting + silane. The four groups of 10 specimens each were bonded with Panavia-F resin cement according to manufacturer's recommendations. The SBS was determined using the universal testing machine (Instron) at 0.5 mm/min crosshead speed. Failure modes were recorded and a qualitative micromorphologic examination of different surface treatments was performed. The data were analyzed using the one-way analysis of variance (ANOVA) and Tukey honestly significant difference (HSD) tests. RESULTS: The SBS of the control, sandblasting, silane, and sandblasting + silane groups were: 10.8 ± 1.5, 16.4 ± 3.4, 16.2 ± 2.5, and 19.1 ± 2.4 MPa respectively. According to the Tukey HSD test, only the mean SBS of the control group was significantly different from the other three groups. There was no significant difference between sandblasting, silane, and sandblasting + silane groups. CONCLUSION: In this study, the three surface treatments used improved the bond strength of resin cement to Turkom-Cera disks. CLINICAL SIGNIFICANCE: The surface treatments used in this study appeared to be suitable methods for the cementation of glass infiltrated all-ceramic restorations.