Maxillary sinus in gender determination: a morphometric analysis using cone beam computed tomography.

Gender determination of skeletal remains is an important forensic procedure in the identification process. Maxillary sinus remains intact even when the skull and other bones may be badly disfigured. Cone beam computed tomography (CBCT) can provide precise information about complex anatomical structures, as it is characterized by rapid volumetric image acquisition with high resolution. The present study aimed to assess the accuracy of maxillary sinus measurements using cone beam computed tomography in gender determination and to develop a formula using discriminate function analysis. Bilateral maxillary sinus images (left and right) were acquired for 200 patients (100 females and 100 males) and different parameters (width, length, height, area, perimeter, and volume) were measured and evaluated. Mean and standard deviation of both maxillary sinuses measurements were calculated and compared. The data was subjected to discriminative statistical analysis and analyzed using an unpaired t-test. The difference between all these variables was statistically significant between males and females. Based on discriminant analysis, the most pronounced variable in the differentiation of gender groups was maxillary sinus height. Gender assessment was established correctly with an accuracy of 75% for females and 64% for males with an overall accuracy of 69.5%. Adding other independent variables to the model did not result in an improvement in overall accuracy. Cone beam computed tomography measurement of maxillary sinus can be used as an aid in forensic anthropology for gender determination.

Palatal rugae as an unique and stable marker in personal identification-An interracial pilot study.

Background: In post-mortem scenarios, often it is a very difficult process to establish a person's identity. Rugae are unique in that they are protected from trauma as they are insulated from heat by tongue and buccal pad of fat unlike fingerprint or lip print that is prone to destruction. Aim and Objectives: This study was aimed to compare the palatal rugae among people of different races. The sole objectives of the study were to assess the predominant pattern in the selected groups, reliability of rugae pattern in personal identification, to evaluate reliability of sex determination and to compare the total number of rugae on right and left sides of the palate among the males and females. Study Design: A total of 90 subjects were enrolled into the study and divided into three groups that are African, Dravidian and Mongoloid population. Shapes of rugae present were analyzed according to the classification given by Kapali et al. (1997) and Thomas & Kotze (1983). Result: The predominant rugae shape in African and Dravidian population was wavy pattern, whereas Mongoloid race was predominant in curve pattern. African and Dravidian males were predominant in wavy pattern when compared to Mongoloid males where unification type was more predominant. Conclusion: A statistically significant association between the rugae shape in three populations exists, although subtle yet definite.

Prevalence and pattern of proximity of maxillary posterior teeth to maxillary sinus with mucosal thickening: A cone beam computed tomography based retrospective study.

Context: Odontogenic sinusitis is a prevalent but frequently unrecognized condition, and periapical pathologies of maxillary posterior teeth are accused as one of the main causative factors. Aim: This study aimed to evaluate the relationship between the periapical status of maxillary posterior teeth and its proximity to the maxillary sinus floor in the occurrence of incidental sinus pathologies using cone-beam computed tomography (CBCT). Methodology: CBCT scans of 118 patients of age range 18-77 years were evaluated retrospectively to determine the relationship of maxillary posterior teeth to sinus floor in which vertical relationship was assessed using modified Kwak's classification and periapical status using CBCT periapical index. Statistical analysis was performed using SPSS statistics software. Results: Of all 227 sinuses examined, 56.8% showed pathological changes, with mucosal thickening being the most common. More than 50% (50.2%) of sinuses were associated with periapical lesions of at least one maxillary posterior tooth based on evidence of pathological mucosal thickening. The presence of pathologic mucosal thickening was also significantly related (P < 0.05) to the presence of periapical pathologies. There was a significant association between tooth position and pathological sinus mucosal thickening, especially with second molars, first molars, and second premolars, respectively (P < 0.05). Second molar involvement was the most significant (P < 0.05). Conclusion: The present study established a positive association between periapical disease status of maxillary posteriors and maxillary sinus mucosal thickening. Maxillary second premolar and first and second molars pathologies can significantly affect the maxillary sinus compared to other maxillary posterior tooth. CBCT proved to be an efficient imaging modality in detecting these changes.

Résumé Contexte: La sinusite odontogène est une affection fréquente mais souvent méconnue, et les pathologies périapicales des dents postérieures maxillaires sont accusés comme l'un des principaux facteurs causals. Objectif: Cette étude visait à évaluer la relation entre le statut périapical du maxillaire dents postérieures et sa proximité avec le plancher du sinus maxillaire dans la survenue de pathologies sinusales accidentelles à l'aide du calcul par faisceau conique tomographie (CBCT). Méthodologie: Les scans CBCT de 118 patients âgés de 18 à 77 ans ont été évalués rétrospectivement pour déterminer la relation entre les dents postérieures maxillaires et le plancher sinusal dans laquelle la relation verticale a été évaluée à l'aide de la classification de Kwak modifiée et état périapical à l'aide de l'index périapical CBCT. L'analyse statistique a été réalisée à l'aide du logiciel de statistiques SPSS. Résultats: Sur les 227 sinus examinés, 56.8 % présentaient des modifications pathologiques, l'épaississement de la muqueuse étant le plus fréquent. Plus de 50 % (50.2 %) des sinus étaient associée à des lésions périapicales d'au moins une dent postérieure maxillaire sur la base de preuves d'un épaississement pathologique de la muqueuse. La presence d'épaississement muqueux pathologique était également significativement lié (P < 0.05) à la présence de pathologies périapicales. Il y avait un important association entre la position des dents et l'épaississement pathologique de la muqueuse des sinus, en particulier avec les deuxièmes molaires, les premières molaires et les deuxièmes prémolaires, respectivement (P < 0.05). L'atteinte de la deuxième molaire était la plus importante (P < 0.05). Conclusion: La présente étude a établi un bilan positif association entre l'état de la maladie périapicale des postérieurs maxillaires et l'épaississement de la muqueuse du sinus maxillaire. Deuxième prémolaire maxillaire et les pathologies des premières et deuxièmes molaires peuvent affecter de manière significative le sinus maxillaire par rapport aux autres dents postérieures maxillaires. Le CBCT s'est avéré être une modalité d'imagerie efficace pour détecter ces changements. Mots-clés: Tomodensitométrie à faisceau conique, épaississement de la muqueuse du sinus maxillaire, sinusite odontogène, pathologie périapicale.

Macroglossia Associated With Primary Systemic Amyloidosis - Case Report With Unusual Clinical Presentation.

BACKGROUND: Amyloidosis is characterised by the deposition of fibrillar insoluble proteinaceous material called amyloid in the extracellular spaces. It may present as localized form which is rare and systemic form. Systemic amyloidosis involves many organs like kidney, heart and liver. Manifestations of both types may vary based on the age of onset, degree and extension of the deposition. Understandably, the diagnosis is challenging but the early identification of the condition and the type of amyloidosis can increase the efficiency of treatment. Positive Congo red staining is the gold standard for demonstration of amyloid in tissue sections. Here we are presenting a case of a 77-year-old female patient who presented with the complaint of difficulty in swallowing for 2 years due to bilateral symmetrical enlargement of the tongue which was subsequently diagnosed as systemic amyloidosis.

Peripheral Odontogenic Keratocyst of Buccal Mucosa.

The odontogenic keratocyst is a developmental cystic lesion of jaw bones. There is an on-going debate about the pathogenesis of this entity. Odontogenic keratocysts are usually seen intraosseously in jaws with a predilection in the mandibular molar ramus regions. Extra-skeletal variants are reported rarely in the gingiva. Extra-skeletal variants occurring peripherally in other soft tissue components of the oral cavity are extremely rare. Even though histogenesis is ambiguous, such presentation may be related to the tumour-like behaviour of odontogenic keratocysts. Here, we present a case of peripheral odontogenic keratocyst in a 62-year male who presented with complaint of a painless lump on the right buccal mucosa. The diagnosis was made on biopsy of the lesion. The lesion was excised completely. Key Words: Buccal mucosa, Pathology, Keratocyst, Odontogenic.

Actual applications of magnetic resonance imaging in dentomaxillofacial region.

Magnetic resonance imaging (MRI) is a versatile imaging modality utilized in various medical fields. Specifically used for evaluation of soft tissues, with non-ionizing radiation and multiplanar sections that has provided great guidance to diagnosis. Nowadays, use of MRI in dental practice is becoming more pervasive, especially for the evaluation of head-and-neck cancer, detection of salivary gland lesions, lymphadenopathy, and temporomandibular joint disorders. Understanding the basic principles, its recent advances, and multiple applications in dentomaxillofacial region helps significantly in the diagnostic decision making. In this article, the principle of MRI and its recent advances are reviewed, with further discussion on the appearance of various maxillofacial pathosis.

Craniofacial Langerhans Cell Histiocytosis: A Rare Case Report.

Langerhans cell histiocytosis (LCH) is a rare haematological disorder characterised by accumulation and abnormal proliferation of bone marrow-derived Langerhans cells and mature eosinophils. The clinical presentation of patients with LCH may be localised or systemic, depending on the site and the degree of involvement. LCH may involve any bone, but the most commonly involved bones are long bones, pelvis, ribs, skull, vertebrae, and facial bones. In head and neck region, frontal and parietal bones are commonly involved followed by the jaws, with a predilection for mandible. In this report, we present a case of LCH involving the craniofacial bones in a 10-year boy, who presented initially with multiple ulcerative lesions on gingiva. Key Words: Craniofacial, Langerhans cell histiocytosis, Gingiva.

Knowledge and attitude toward COVID-19 and dental treatment - Its availability and treatment satisfaction during the pandemic among adult population - An online survey.

BACKGROUND: Corona virus disease 2019 (COVID-19) is a highly infectious disease primarily spreading through droplet infection which require significant restriction and modification in dental treatment. This study aims to assess the knowledge and attitude of adult population toward COVID-19 and dental treatment and to assess the availability of dental treatment and patient satisfaction during the time of pandemic. MATERIALS AND METHODS: An online survey was conducted using self-designed electronic questionnaire consisting knowledge and attitude about COVID-19 and dental scenario and questions regarding availability of dental treatment received during the time of pandemic. Knowledge scores were assessed on a maximum total score ranged from 0 to 8, and descriptive statistics were done for questions related to attitudes and dental treatment availability. RESULTS: A total of 495 participants with mean age of 36.6 years participated in the study. The mean knowledge score was 7.12 ± 0.99 and the participants were found to have good awareness and positive attitude regarding COVID-19 were as considerable number of participants were unaware about the risk associated with dental treatment as well as restrictions imposed on dental procedures. About 18% of participants experienced one or other form of dental complaints during the lockdown period. 4% of participants had no accessibility to any form of treatment. CONCLUSIONS: Public awareness is to be improved regarding risk of cross infection that can be associated with dental treatment and public should be motivated to use virtual facilities like tele-dentistry so that no dental emergencies is left untreated, at the same time avoiding any sort of unnecessary hospital visit during the pandemic time.

A Rare Case Of Shprintzen-Goldberg Syndrome.

Shprintzen-Goldberg syndrome is a relatively rare congenital connective tissue type of disorder with a constellation of dysmorphic features including craniosynostosis, craniofacial, skeletal, cardiovascular and neurological abnormalities. We present the case-report of a 5-year-old boy with Shprintzen-Goldberg syndrome and a brief review of literature pertaining to this condition. The patients with Shprintzen-Goldberg syndrome show a considerable phenotypic overlap with other craniosynostosis syndromes. So, a meticulous evaluation of these patients should be performed for a prudent diagnosis. Since these patients present with multiple systemic conditions,a multidisciplinary approach should be planned for their management.

Evaluation of mast cells and burning sensation in various stages of Oral Submucous Fibrosis.

BACKGROUND: Oral Submucous Fibrosis (OSMF) is a potentially malignant disorder and burning sensation is the initial complaint among these patients. Scientific literature has established that mast cells play a major role in various inflammatory disorders. However, OSMF being an inflammatory disorder, the role of mast cells is yet to be established. Hence the aim of this study was to evaluate mast cells and burning sensation in various stages of Oral Submucous Fibrosis. METHODS: The study population comprised of forty subjects, thirty were clinically confirmed cases of OSMF and ten healthy individuals served as control. A complete history and clinical examination followed by an incisional biopsy was performed. Samples obtained were subjected to routine histopathological examination and mast cells evaluation. RESULTS: Mean number of total mast cells in Stage I, II and III OSMF were 8.5 ± 0.7, 11.31 ± 8.8 and 24.7 ± 21.2 respectively. There was a significant difference in total mast cell count between cases and controls. Degranulated mast cells was a significant predictor (p = 0.028), indicating role in clinical staging of OSMF. Degranulated mast cells had a significant role and was a positive predictor (B = 0.763, OR 2.145[95%CI 1.055-4.630]) at moderate levels of burning sensation. A significant difference (p = 0.029) in burning sensation across histopathological grades was also observed in the study. CONCLUSION: Degranulated mast cells were found to have a significant influence in mild to moderate levels of burning sensation among OSMF patients. Role of degranulated mast cells were also found to be significant in various clinical stages of OSMF.

Radiographic evaluation of remodeling of mandible in adult South Indian population: Implications in forensic science.

INTRODUCTION: Panoramic X-ray is an imagiological examination produced by a technique that exhibits images of the facial structure present in the upper and lower dental arches, as well as the support structures in the diagnosis of problems that require a broad view of the oral-maxillofacial complex, such as the assessment of traumatisms, extensive lesions, dental development, tooth retention, and growth anomalies. Many morphological and anatomical changes are exhibited by the mandible with the advancement of age and changes in gender, as well as dentoalveolar condition of the patient, and it can be assessed with the help of such radiograph, thus playing an important role in personal identification in forensic dentistry. AIMS: This study aimed to evaluate the changes in gonial angle (GA), antegonial angle (AGA), and antegonial depth (AGD) in adult mandible with regard to age, gender, and dental status using panoramic radiographs. SETTINGS AND DESIGN: This cross-sectional retrospective study was done using hospital records. SUBJECTS AND METHODS: A total of 100 panoramic radiographs were evaluated. The images were grouped into three age groups (40-70) of 10 years each. GA, AGA, and AGD were digitally measured from the radiographs. STATISTICAL ANALYSIS USED: Descriptive statistics of the variables were expressed in percentage, frequencies, mean, and standard deviations. Statistical differences between the variables were explored using independent sample t-test and one-way ANOVA. The significant level was set as 0.05. RESULTS: There were no significant changes in GA, AGA, and AGD with age and dental status of the patients. Males had significantly smaller GA and AGA than females. Understandably, AGD was significantly greater in males than females. CONCLUSIONS: Remodeling changes of the mandible with respect to the age groups and dental status studied were minimal. However, gender-related differences in ante AGA, depth, and GA were significant, which can be used as a tool in forensic identification.

Marfan Syndrome.

Marfan syndrome (MFS) is the autosomal dominant-inherited multisystem connective-tissue disorder, with a reported incidence of 1 in 10,000 individuals and equal distribution in both genders. The main clinical manifestation of this disorder consists of an exaggerated length of the upper and lower limbs, hyperlaxity, scoliosis, alterations in the cardiovascular and pulmonary systems, and atypical bone overgrowth. Orofacial manifestations such as high-arched palate, hypodontia, long narrow teeth, bifid uvula, mandibular prognathism, and temporomandibular disorders are also common. Early diagnosis of MFS is essential to prevent the cardiovascular complications and treatment of orofacial manifestations, thus to increase the quality of life of the patient.

Large radiopaque lesion in the posterior mandible: A challenging case.

Radiopaque lesions of the jawbones are frequently encountered in dental radiographs. A variety of conditions such as chronic inflammation, soft tissue calcifications, fibrosseous lesions, odontogenic tumors, and bone neoplasms can manifest as radiopaque lesions on the jawbones. These radiopaque lesions are often difficult to distinguish from each other, hence making the formulation of differential diagnosis challenging. A thorough patient's history and clinical examination supplemented by appropriate investigations will enable the clinician in narrowing down the differential diagnosis and to identify the condition accurately. Presented here is a case of the large radiopaque lesion on posterior mandible surrounded by lytic areas in a 20-year-old male patient.

Epidemiology of Oral Lichen Planus in a Cohort of South Indian Population: A Retrospective Study.

BACKGROUND: Oral lichen planus (OLP) is an immune-mediated potentially malignant disorder of the oral cavity. Dysplastic OLP has an altered cytogenic profile and can progress into oral squamous cell carcinoma. The epidemiology of OLP is well-described in several relatively large series from various geographic locations, whereas such series from southern India is rare. The aim of the present study was to determine the epidemiology of OLP in a cohort of South Indian population. METHODS: All the case data records of 29,606 patients who visited Mar Baselios Dental College and Hospital, Kerala, India from 2014 to 2015 were retrospectively reviewed. For data review, 122 patients of OLP were selected Estimated were type, number, and location of lesions, clinical manifestation, age of the patient, gender, onset and duration of lesion, stressful life style, habits, skin involvement and associated systemic illness, and presence/absence of dysplasia. RESULTS: When the distribution of OLP among the gender was considered, we found more prevalence in females than males. Fifty-seven percent of patients were associated with stressful lifestyle. Reticular lichen planus was the most common clinical subtype found. Bilateral buccal mucosal was the common site, when the distribution of sites of OLP were compared (P < 0.05). Hypersensitivity reaction was frequently associated with systemic illness with OLP (P < 0.05). Anaplasia was found among 5% of lichen planus lesions. CONCLUSIONS: OLP patients had high incidence of hypersensitivity reactions and 5% of OLP lesions showed anaplasia. Long term follow-up is necessary to monitor the recurrence, prognosis, and malignant transformation of OLP.

Reliability of lip prints in personal identification: An inter-racial pilot study.

CONTEXT: Forensic science is a branch of science that deals with the application of science and technology in solving a crime and this requires a multidisciplinary team effort. The word "Forensic" is derived from the Latin word, "Forensis" which means the study of public. Dental professionals should develop interests in contributing to legal issues. AIMS: To study the lip prints among people of different races. SETTINGS AND DESIGN: Descriptive study. SUBJECTS AND METHODS: The present study comprised of ninety subjects of which Group A comprised of Africans, Group B comprised of Dravidian, and Group C of Mongoloid race. Each group was then further divided into 15 males and 15 females for whom the lip prints were recorded and evaluated. STATISTICAL ANALYSIS USED: ANOVA test. RESULTS: ANOVA statistical analysis was used to compare three races of African, Dravidian, and Mongoloid races. The observed data among male and female were found to be significant with a P = 0.000492. CONCLUSION: The present study showed a significant difference in lip pattern among the three races. Perhaps future studies with a larger sample size and comparison between many other races may be done for better personal identification.

Effect of copper-based fungicide (bordeaux mixture) spray on the total copper content of areca nut: Implications in increasing prevalence of oral submucous fibrosis.

BACKGROUND: Potentially malignant disorders like oral submucous fibrosis (OSMF) often precede oral squamous cell carcinoma (OSCC). The rate of transformation of OSMF to OSCC ranges from 3 to 19%. OSMF is etiologically related to chewing of areca nut (betel nut), and the high copper content in areca nut plays an important role in the pathogenesis of the disorder. Even though many studies estimated and confirmed increased copper levels in areca nuts, studies tracing the source of the increased copper content are scarce. Interestingly, on review of agricultural literature, it was found that most of the areca nut plantations in South India commonly use a copper-based fungicide, bordeaux mixture (BM). AIM: The aim of the study was to estimate and compare the copper content in areca nuts from plantations with and without copper-based fungicide usage. MATERIALS AND METHODS: Four areca nut plantations from Dakshina Kannada district, Karnataka (group A) and four plantations from Ernakulam district, Kerala (group B) were selected for the study. The plantations from Karnataka used copper-based fungicide regularly, whereas the latter were devoid of it. Areca nut samples of three different maturities (unripe, ripe, and exfoliated) obtained from all plantations were dehusked, ground, and subjected to atomic absorption spectrometry (AAS) for copper analysis. RESULTS: There was statistically significant difference in the copper content of areca nuts from both groups. The areca nuts from plantations treated with copper-based fungicide showed significantly higher copper levels in all maturity levels compared to their counterparts in the other group (P < 0.05). CONCLUSIONS: The high copper content in areca nut may be related to the copper-based fungicide treatment on the palms. These areca nuts with high copper content used in quid or commercial products may be responsible for the increasing prevalence of OSMF.

Evaluation and Comparison of the Biopathology of Collagen and Inflammation in the Extracellular Matrix of Oral Epithelial Dysplasias and Inflammatory Fibrous Hyperplasia Using Picrosirius Red Stain and Polarising Microscopy: A Preliminary Study.

BACKGROUND: The role of tumour inflammation and the dysplastic epithelial-stromal interactions on the nature of collagen fibres in the extracellular matrix of dysplastic epithelium is not fully understood. The present study was aimed to evaluate and compare the inflammation and pathological stromal collagen (loosely packed thin disorganized collagen) present in mild, moderate and severe epithelial dysplasias with that of inflammatory fibrous hyperplasias. The basement membrane intactness of epithelial dysplasias was also evaluated to determine if dysplastic epithelial mesenchymal interaction has any role in the integrity of stromal collagen in epithelial dysplasia. METHODS: Oral epithelial dysplasias, inflammatory fibrous hyperplasia and normal oral mucosal samples were used for the study. Packing, thickness and orientation of collagen fibres in mild, moderate and severe grades of oral epithelial dysplasias (n = 24), inflammatory fibrous hyperplasia (n = 8) and normal oral mucosal samples (n = 8) were analysed based on the polarisation of collagen fibres in picrosirius red polarising stain under polarising microscope. RESULTS: All the grades of epithelial dysplasias showed greenish yellow birefringence confirming the presence of loosely arranged pathological collagen in the presence of moderate inflammation. All the cases of inflammatory fibrous hyperplasia showed red polarisation hue and moderate inflammation. A statistically significant difference was found in the packing and orientation of collagen when epithelial dysplasias and inflammatory fibrous hyperplasia were compared (P < 0.01). When the intactness of basement membrane integrity was compared in all the groups of epithelial dysplasia, a statistically significant result was obtained (P < 0.05). CONCLUSIONS: Presence of significant amount of loosely packed thin disoriented collagen even in mild epithelial dysplasia suggests that tumourigenic factors are released to connective tissue stroma much earlier than expected. Hence we suggest considering the integrity of extracellular matrix collagen, intactness of basement membrane and inflammation associated with dysplasia along with the anaplasia of epithelial cells in the microscopic assessment of dysplastic epithelium.

Traumatic myositis ossificans of the masseter muscle: a case report with conventional and advanced imaging features.

Myositis ossificans of the head and neck is a rare heterotopic, nonneoplastic bone formation within a muscle. Traumatic myositis ossificans (TMO), also known as myositis ossificans circumscripta, is the most common form, resulting in muscle ossification after trauma or hematoma. This article presents a case of TMO in the left masseter muscle of a 26-year-old male patient who suffered from epilepsy. The various types of myositis ossificans, its epidemiology, pathogenesis, differential diagnoses, and various treatment modalities are outlined.

Slow growing, painful, nodular swelling on the buccal mucosa: a case report.

Nodular swellings of the oral cavity are frequently encountered in dental practice. The disease processes that give rise to nodular swellings in the oral cavity include inflammatory hyperplasias, obstructive minor salivary gland disorders, infections, benign connective tissue neoplasms and salivary gland neoplasms. Understandably, the nature of these entities also varies significantly, ranging from very innocuous to aggressive lesions, underscoring the need for accurate diagnosis.