Long-term use of Le Fort I osteotomy for the management of nasopharyngeal rhinosporidiosis: A case series.

Rhinosporidiosis is a rare, chronic, granulomatous infection of the mucous membranes that mainly involves the nose and nasopharynx; it occasionally involves the pharynx, conjunctiva, larynx, trachea and, rarely, the skin. The characteristic clinical features of this disease include the formation of painless polyps in the nasal mucosa or the nasopharynx that bleed easily on touch. At our center, excision of the lesion with a Le Fort I osteotomy is carried out in patients (1) in whom two or more previous attempts at excision of biopsy-proven rhinosporidiosis arising from the nasal mucosa was carried out or (2) in whom the rhinosporidiosis arises from the nasophayrngeal mucosa and/or extranasal sites. In this article we retrospectively present 7 cases in which, according to our inclusion criteria, complete excision of the lesion was carried out with a Le Fort I osteotomy. Excellent visualization of the entire maxillary and ethmoidal air cells after the down-fracture of the maxilla helped in the total removal of the lesions. Most of these lesions had multiple points of origin through the nasal, maxillary, and ethmoidal mucosa; the excellent visualization enabled direct cauterization of all these points of origin. The mean follow-up period was 7.96 years, and all patients were disease-free by the time the study was prepared. This article presents details of the treatment protocol and technique followed at our center for the treatment of nasopharyngeal rhinosporidiosis and the details of long-term follow-up. Through this study we hope to prove the efficacy of Le Fort I osteotomy in the definitive management of nasopharyngeal rhinosporidiosis.

A Case of Pentastomiasis at the Left Maxilla Bone in a Patient with Thyroid Cancer.

Pentastomiasis, a zoonotic parasite infection, is typically found in the respiratory tract and viscera of the host, including humans. Here, we report for the first time an extremely rare case of intraosseous pentastomiasis in the human maxilla suffering from medication related osteonecrosis of the jaw (MRONJ). A 55-year-old male had continuously visited the hospital for MRONJ which had primarily developed after bisphosphonate and anti-neoplastic administration for previous bone metastasis of medullary thyroid cancer. Pain, bone exposure, and pus discharge in the right mandible and left maxilla were seen. Osteolysis with maxillary cortical bone perforation at the left buccal vestibule, palate, nasal cavity, and maxillary sinus was observed by radiologic images. A biopsy was done at the left maxilla and through pathological evaluation, a parasite with features of pentastome was revealed within the necrotic bone tissue. Further history taking and laboratory evaluation was done. The parasite was suspected to be infected through maxillary open wounds caused by MRONJ. Awareness of intraosseous pentastomiasis should be emphasized not to be missed behind the MRONJ. Proper evaluation and interpretation for past medical history may lead to correct differential diagnosis and therapeutic intervention for parasite infections.

Filariasis in Mandible and Maxilla: A Rare Entity-First Report of a Case.

Wuchereria bancrofti, Brugia malayi, and Brugia timori, categorized as nematodes, are responsible for causing lymphatic filariasis. Even though it can affect individuals of all age groups and both genders, it predominantly affects people of low socioeconomic strata. The filarial worms dwell in the subcutaneous tissues and lymphatics of human hosts. In India, W bancrofti is the primary nematode to cause filariasis, which is transmitted through the bite of blood-sucking infected female anopheles mosquitoes. Lymphangitis, leading to elephantiasis of the legs, arms, scrotum, and breast, is the most salient clinical feature of lymphatic filariasis. The presence of filarial worms in the oral and perioral soft tissues is uncommon; moreover, the presence of filarial worms in a centrally occurring bony lesion is highly unusual and has not yet been reported. We report a case of a central giant cell granuloma due to filariasis that was diagnosed after biopsy of innocuous radiolucent bony lesions of the maxilla and mandible.

Histological study of Trichosomoides nasalis (Nematoda: Trichinelloidea) in the nasal cavities of the murid Arvicanthis niloticus, with associated pathology.

Histological study of the nasal cavities and upper maxillae of Arvicanthis niloticus naturally infected with Trichosomoides nasalis shows that the female worms reside in the epithelial monolayer of the nasal mucosa of the posterior and median cavities. Eggs laid by T. nasalis were infiltrated between the female body wall and the epithelial lining. Small groups of eggs, mixed with mucus and polymorphonuclear cells, were found in the nasal lumen, freed by rupture of the stretched epithelium. Two females and a few eggs were also found in the connective tissues. One male was found in a female uterus and two were apparently in the lumen of the nasal cavity but the surrounding tissues were disrupted. No male was identified in the lamina propria of the mucosa. However, significant inflammatory lesions occurred in the lamina propria, similar to those induced by the males of Anatrichosoma spp. which live in this part of the mucosa. In rodents, the lesions resulted in rhinosinusitis characterised by a lymphocytic infiltration leading to nasal obstruction.

Microfilaria in a fine needle aspirate of primary solid malignant tumor of the maxillary antrum. A case report.

BACKGROUND: Lymphatic filarial disease is very common in tropical countries like India. The incidental finding of microfilariae in various benign cytologic smears is very common. Microfilariae in malignant effusions have also been reported, but their coexistence with solid malignant tumor at the primary site has not been reported so far. CASE: A 45-year-old male presented with a painful, rapidly growing swelling over the right maxilla that had been present for three months. On routine fine needle aspiration cytology, a microfilaria along with squamous carcinoma cells in a primary solid malignant tumor of the maxillary antrum was found. CONCLUSION: This is the first case reported in English of the incidental finding of a microfilaria in a primary tumor of the maxillary antrum.