Metastasis in the mandible involving gingiva: An intriguing case with a perplexing pathology.

Oral metastasis, although rare, tends to involve jawbones, particularly the posterior region of the mandible, and involvement of oral soft tissues, even when less likely, is most often seen on the gingiva and tongue. Clinically, the soft-tissue masses tend to mimic pyogenic granuloma, peripheral giant cell granuloma or an epulis and thus are difficult to diagnose and identify. The jaw bone is preferred by prostate carcinoma as a metastatic target. Prostate malignancy, which is more common in Western countries than in India, may be adenocarcinomas or carcinomas. Oftentimes, metastatic lesions develop in the alveolar region and are a cause for tooth mobility, yet, they tend to be detected only after extraction of the affected tooth. In such cases, the symptomatic presentation therefore, is vague and indicative of tooth mobility secondary to periodontal pathology unless, a detailed history and follow-up is done. We report a case of a male patient who presented to our department with a proliferative, painful, swelling postextraction of the left first molar region, and the lesion was seen at the extraction site as well as in the mandibular anterior tooth region. The swelling was associated with palpable lymph nodes. Orthopantomogram showed an irregular, radiolucent lesion extending from the lower left central incisor to the left first molar region in the mandibular alveolus. Incisional biopsy tissue came with provisional diagnosis of osteomyelitis or squamous cell carcinoma as the patient was a habitual bidi smoker for more than 20 years. Histologically, it was an undifferentiated tumor with tumor cells seen in deep connective tissue with a lack of lineage differentiation. An undifferentiated malignant tumor represents either a metastasis of unknown origin or a primary neoplasia without obvious cell line of differentiation. Immunohistochemistry (IHC) of undifferentiated tumors helps to categorize them into small round blue cell tumors or large cell tumors. The oral pathologist was perplexed as there was no mention of any other malignancy in the patient's history, which, however, was noted by the surgeons few days later. Hence, initially, a hematopoietic malignancy was suspected which was ruled out by IHC, and later, staining with cytokeratin 7 (CK7), CK-high molecular weight and P63 confirmed prostate metastases as all three were negative.

Ameloblastic carcinoma of the mandible: Report of a case and review.

Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that can arise either as a de novo lesion or from pre-existing ameloblastoma. Histopathologically, the tumor retains an ameloblastomatous differentiation pattern but shows cytological features of malignancy. Owing to variable biologic behavior and paucity of long-term follow-up cases, there has been no clear consensus on treatment protocol. The present case of ameloblastic carcinoma arose in the mandible of a 24-year-old male. Surgical treatment involved resection of the mandible along with regional lymph nodes. The patient has been on follow up for the past one year without any recurrence or metastases. An update on ameloblastic carcinoma encompassing the histogenesis, immunohistochemical features and treatment aspects are included.

Intraoral schwannoma in retromolar region.

Schwannomas of the intra oral region are relatively uncommon; these are benign nerve sheath tumors that arise from schwann cells of the neural sheath. They are solitary, slow-growing, smooth-surfaced, usually asymptomatic, and encapsulated tumors, about 25% of all schwannomas are located in the head and neck, but only 1% show intraoral origin. We are contributing a report of 24 years old woman with slow progressive swelling over the right retromolar region. Magnetic resonance imaging presented a well defined mass over the right retromolar area measuring 19 × 19 mm(2) and fine needle aspiration cytology revealed that it was a tumor mass of neurogenic origin. Diagnosis was confirmed by excisional histological identification of Antoni A areas with marked palisading of nuclei. Although these rare entities of oral cavity are routinely not encountered in practice, they should be added in differential diagnosis of intraoral tumors.

Lag screw fixation of fracture of the anterior mandible: a new minimal access technique.

OBJECTIVE: Purpose of this study to introduce a new minimal access technique for management of anterior mandible fracture with several advantages over conventional methods. METHOD: Four cases of undisplaced anterior mandibular fracture were selected. Tension band was achieved either by arch bar fixation to mandible or placement of interdental wire followed by intermaxillary fixation. With a 1 cm vertical incision was placed adjacent to fractured line. Fractured segment was immobilized with lag screw with minimal stripping. All patients were followed for 6 months. RESULTS: All four cases shown good stable segment after 6 months of post operative follow up. OPG revealed well placed lag screw and there were no surgical complications, for example parasthesia, scarring and odema. CONCLUSION: Fixation of anterior mandible fracture using this technique can achieve good stability and appropriate compression. The technique is simple and easily performed, reducing the surgical time, reduce the chances of infection due to less exposure and promote the healing process by producing stress in the fracture lines.

Dermoid cyst of the floor of the mouth with abundant hair: a case report.

Dermoid cysts are developmental cysts and considered to develop from enslavement of epithelial debris in the midline during closure of the mandibular and hyoid brachial arches. These cysts are painless, slow growing and most commonly occur in young adults with no gender predilection. They are uncommon in the head and neck region. Oral dermoid cysts are found usually in the submental or sublingual triangle in variable relation to mylohyoid, geniohyoid, and genioglossus muscle. The cyst is lined by epidermis like epithelium and contains dermal adnexal structures in the cyst wall. We report a case of dermoid cyst arising in the sublingual region of a young adult male with abundance of hair which is rare finding.