Showing papers in "Journal of Cranio-Maxillary Diseases in 2014"

Deep neck space infections; retrospective review of 46 patients

Abstract: Aims: To study clinical presentation, management, and outcome of deep neck space infections (DNSI). Settings and Design: A retrospective case series was conducted in the Section of Otolaryngology of a tertiary care University Hospital from 2001 to 2011. Materials and Methods: A retrospective review of charts of the patients who were treated for deep neck space (DNSI) at our department from 2001 to 2011 was carried out. Forty-six patients fulfilled our inclusion criterion and were included in the study. A structured Performa was used for data collection and the following variables were recorded including demographics (age and gender), co-morbidities (diabetes mellitus, HIV), symptoms, etiology, infection site, bacteriology, culture growth imaging modality used, surgical intervention, and hospital stay. Results: The mean age of our patients was 30.8 years; 32 were male and 14 were female. Neck pain was the most common symptom found in 38 patients (82.60%) and most common space involved was parapharyngeal space which was seen in 20 patients (43.47%). Etiology of DNSI in majority of our patients, i.e., 18 (39%) was unknown followed by dental and tonsil problems in 12 (26%) and 10 (22%) patients, respectively. Of 46 patients, 36 underwent intervention and of these 26 cases had positive culture results. The most common organism cultured was Streptococcus seen in 8 patients (22.2%). Ten patients (21.73%) were treated medically alone. Mean hospital stay was 3.33 days with a minimum of 2 days and a maximum of 17 days stay. There was no mortality in our series of patients. Conclusions: The deep neck space infection is still a challenging disease in otolaryngology. Its presentation may be masked and bacterial culture might not be conclusive but it still needs early diagnosis and prompt management whether conservative or surgical. CT scan is a standard modality for differentiating between cellulitis and abscess. Most of the patients need surgical intervention and tracheostomy should be considered if air way protection is needed.

Cytohistopathological evaluation of the cervical lymph nodes by fine needle aspiration cytology

Abstract: Aims and Objective: To determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) in cervical lymphadenopathy along with the histopathological examination of the excised lymph node as gold standard. Materials and Methods: A total of 35 patients with cervical lymphadenopathy were included in the study. Informed consent was obtained from the patients, and FNAC of lymph node was performed. Later, the same lymph node was removed under local anesthesia for histopathological examination. Sensitivity, specificity, positive and negative predictive values, and diagnostic efficacy were calculated for both the modalities. Results: The age of patients ranged from 2.5 years to 65 years with a mean of 32.5 years. FNAC findings showed a sensitivity of 89.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 90.5%, and diagnostic efficacy of 91%. Conclusion: FNAC is a reliable, safe, and accurate test as a first line for evaluation of cervical lymphadenopathy. As the statistical values in the present study show a high degree of diagnostic accuracy, it indicates the clinical utility of FNAC in cervical lymph nodes.

Morphology of maxillary labial frenum in primary, mixed, and permanent dentition of Indian children

Abstract: Background: Maxillary Labial frenum is a soft tissue structure that may exhibit the most diverse types. Objective: To estimate the incidence of different morphologic types of maxillary labial frenum in primary, mixed, and permanent dentitions of Indian children. Materials and Methods: A study was conducted involving 3000 Indian children. The 3000 children were divided into three groups (primary, mixed, and permanent dentition) according to the dentition of the patients with each group containing 1000 children. The maxillary labial frenum was examined and classified according to Sewerin's frenum typology using direct visual method. The data obtained was subjected to statistical analysis. Results: The most prevalent frenum types observed in all the threee groups (primary, mixed, and permanent dentition) were the simple frenum followed by persistent tectolabial frenum and frenum with nodule. The prevalence of simple frenum was found to be increased with age, while the persistent tectolabial frenum decreased proportionally. There was no statistically significant gender difference found with respect to the frenum morphology in all three groups. Conclusion: Simple frenum is the most prevalent morphologic type recorded in all the three groups studied, followed by persistent tectolabial frenum. The prevalence of simple frenum was found to increase with age, whereas the persistent tectolabial frenum decreased gradually. Dentists should give due importance for frenum assessment during oral examination of children to avoid misdiagnosis of normal variations as abnormal frenum.

Detection of anatomical variations in mandible by panoramic radiography

Abstract: Aim: To assess the visibility, frequency and gender variations of mandibular canal, mental foramen, anterior loop of mental nerve, incisive canal and lingual foramen in Indian population. Material and Methods: Retrospective analysis of total 300 panoramic radiographs were selected for the study. Radiographs were analysed for the mandibular canal, mental foramen, anterior loop of mental nerve, incisive canal and lingual foramen by two independent observers and scores were recorded. Intra and inter-examiner reliability was assessed by kappa-statistics percentages of observations were obtained and Chi-square test was used to find out association of age and gender with visibility of anatomical landmarks. Results: The mandibular canal was visible in 100% of the 300 cases. Anterior looping of the mental nerve was not visible in 90% (270) of the cases, with 1.3% having good visibility. The mental foramen was moderately visible in 66% cases. The lingual foramen could not be visualized in 95.3% of the cases, with poor visibility in 0.7%. An incisive canal was observed in 33% of the cases, good visibility with only 1.3%. Contingency tables with Chi-square test showed that gender does not exert any effect on the visibility of the anatomical structures in the mental interforaminal region ( P > 0.05). Chi-square test reveled, significant difference exist between age and visibility of mandibular canal ( P Conclusion: The important conclusion drawn from the present study is that as far as mandibular canal and mental foramen is concerned, panoramic images provide sufficient information. However, it is insufficient for detection of interforamina structures especially for presurgical implant planning in the mental region and may need to be supplemented with three dimensional imaging for better visualization of the area.

Prevalence of benign oral ulcerations in the Indian population

Abstract: Aim: Patients with an oral ulcer may present initially to a general physician or a dental practitioner. Majority of the ulcers are benign and resolve spontaneously, but small proportions are malignant. The aim of the present study was to determine the prevalence of benign oral ulcerations in the Indian population. Materials and Methods: A total of 3,244 patients attending the Department of Oral Medicine and Radiology during the period from November 2010 to December 2012 with various complaints were examined. Of the patients examined, 1,669 were females and 1,575 were males. Results: A total of 1,444 patients had benign oral ulcers at the time of examination, giving an overall prevalence of 44.5%. Most of the patients presented with recurrent aphthous ulceration (47.4%). Females (57.9%) were more commonly affected than males (42.1%). Patients in the 3 rd and 4 th decade and those of lower socioeconomic status were commonly affected. However, there was no statistically significant difference (P > 0.05) between the oral ulceration and socioeconomic and marital status of the patients. Conclusion: The results of the present study indicate that benign oral ulceration is a common mucosal disorder in the Indian population. Majority of the ulcers require treatment of the underlying cause. The early and correct diagnosis of these lesions will lead to successful treatment and prevention of the lesions.

Odontogenic myxoma diagnostic dilemma: A case report and review of literature

Abstract: Odontogenic myxoma is a benign odontogenic tumour derived from the ectomesenchyme, known for its local aggressive nature. It is found almost exclusively in the jaws. It is rare in patients above 50 years of age. The presence of extensive inflammation and increased fibrous component can pose a diagnostic difficulty. We present a rare case of odontogenic myxoma in the mandible of a 55-year-old male patient with a brief review of pathogenesis, radiological features, diagnostic dilemmas and immunohistochemical aspects.

Tooth brushing behaviours and dental abrasion among the population in Shimla, Himachal Pradesh in India: A cross-sectional study

Abstract: Aim: To determine whether there is a correlation between tooth brushing behaviours and dental abrasions among population in Shimla city, capital of the state of Himachal Pradesh. To suggest appropriate remedial measures to prevent self-inflicted injury. Materials and Methods: The study was carried out on 515 adults (272 male and 243 female) aged 20 years and above who attended the Comprehensive Care Clinic of the Department of Public Health Dentistry, HP Government Dental College and Hospital. Assessment form comprises a questionnaire and information on brushing behaviours. P values ≤ 0.05 and ≤ 0.01 were considered as statistically significant and highly significant, respectively. Results: The study revealed a statistically significant relationship between abrasive lesions and age groups as well as genders. Statistically significant difference was found between abrasions and tooth brushing frequency, while no significant relation was found with the technique and type of toothbrush used. Conclusion: The prevalence of tooth brushing abrasions increases with age and is more common among males than females. Increased tooth brushing frequency and frequent changing of toothbrush result in an increase in the number of tooth abrasions. Therefore, dental professionals should make evidence-based recommendations to their patients and general masses.

Oral health-related quality of life- A changing revolution in dental practice

Abstract: Quality of life (QoL) creates positive associations for most of the people. Perception of QoL varies between individuals and is dynamic amongst them. People who have different expectations report that they have a different QoL even when they have the same clinical condition. People are now demanding a better QoL. It is conceded that a rise in the standard of living of people is not enough to achieve satisfaction and happiness. Clinical indication of a problematic tooth may be many, but the presence of a toothache or pain, described by the individual as a symptom or functional barrier, affects well-being and is not measured by any traditional epidemiological indicator. Thus, a major shortcoming in traditional oral epidemiological indicators is the inability to reflect the capacity of the individuals to perform desired roles and activities. When oral health related quality of life (OHRQoL) measures are used alongside traditional clinical methods of measuring oral health status, a more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective well-being becomes possible.

Salivary Gland Tumors: Clinicopathologic analysis of 73 cases

Abstract: Background: Salivary gland tumors are uncommon and constitute a highly heterogeneous histopathologic group of neoplasms. This retrospective study was done to investigate the clinicopathological profile, frequency, and distribution of salivary gland tumors in rural health care set-up in India. Study Design: The data was retrieved from the archival section of department of Oral and Maxillofacial Pathology, Rural Dental College, Loni, Maharashtra, India. All cases diagnosed as salivary gland tumors from January, 2001 to December, 2012 were included in the study. Results: A total of 73 Salivary gland tumors were diagnosed over a period of 12 years representing a frequency of 3.38% from 2156 biopsy samples. Malignant tumors (56.16%) predominated over benign tumors (43.83%), with an age range of 16-76 years (mean 46.2 years). Pleomorphic adenoma was the most frequent benign tumor (41.09%) while mucoepidermoid carcinoma (58.53%) was the most frequent malignant tumor. Overall sex distribution was almost equal (1:1.15). Palate was the most favored site amongst minor salivary glands while parotid gland was commonly affected major salivary gland. Intraosseous tumors were also noticed and all were malignant salivary gland tumors. Conclusion: The data discussed in this study was consistent with other hospital based studies with respect to age, sex, site, clinical presentation, and histopathological variants of salivary glands tumors.

Antigens specificities and characterization of antibodies against major periodontopathic bacteria: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis

Abstract: Bacterial biofilm have been shown to be the primary etiological factor in the initiation of gingival inflammation and subsequent destruction of periodontal tissues. At the same time, there is strong evidence that indicates that periodontal disease is not a conventional infectious disease, but an inflammatory disease triggered by host immune response to a constellation of periodontal biofilm-associated microorganisms. Earlier studies showed that adult periodontitis and advanced destructive periodontitis patients had significantly higher levels of IgG antibodies to P. gingivalis. In patients with localized aggressive periodontitis, elevation of IgG antibody was also found in response to Aggregatibacter actinomycetemcomitans. Serum IgG antibody was elevated in periodontitis subjects, with unique antigens on P. gingivalis and A. actinomycetemcomitans by the patient sera, indicating the antigenic specificities of antibody response. These antibodies against periodontopathic bacteria have been shown to function in antibacterial immunity by a variety of mechanisms like inhibition of adherences and colonization, lyses of bacteria, and the abilities to aggregate the bacteria and detoxify endo- and exotoxins. Both human and experimental animal studies have shown that there is considerable potential for intervention or interference with periodontitis by interference with the host immune system. Advances in our understanding, the critical role of host responses in the progression of periodontal disease, immunization strategies against periodontopathic bacterial infection may be feasible and may raise protective immunity against periodontitis.

Status of salivary iron in oral cancer and oral potentially malignant disorders

Abstract: Introduction: Iron (Fe) is an important micronutrient which is utilized in human body for the transportation of oxygen, hematopoiesis, production of enzymes, and immune surveillance. Existing clinical, epidemiological, and experimental studies have shown that decreased levels of Fe contribute to increased risk of cancer. Although extensive, serum Fe analysis studies have done recently the analysis of salivary Fe has not been studied for its role in oral malignancies. Materials and Methods: Salivary Fe levels were evaluated in 65 healthy controls (HC), 115 subjects with oral potentially malignant disorders, and 50 subjects with oral squamous cell carcinoma using the bathophenanthroline method. Results: A decrease in the levels of salivary Fe was observed in subjects with potentially malignant disorders and subjects with oral cancer. The decrease in the salivary Fe was significant ( P = 0.05) in group comprising of potentially malignant disorders and oral squamous cell carcinoma when compared to HC. Conclusion: The significant and encouraging findings of the present study thus validate and reinforce that; salivary Fe analysis can be used as an efficient, noninvasive, patient-friendly tool for the early diagnosis of oral potentially malignant disorders and oral squamous cell carcinoma for planning comprehensive treatment protocol.

A clinical and radiographic retrospective analysis of talon cusps in ethnic Indian children

Abstract: Objective: To report a detailed clinical and radiographic retrospective analysis of 21 talon cusps in Indian children. Materials and Methods: A retrospective analysis of 21 talon cusps was conducted in children examined in the period from 2003 to 2008. Patients found with talon cusps underwent complete clinical and radiographic examination and 21 talons were evaluated for gender distribution, affected dentition and teeth, symmetry, type of talon, radiographic findings of pulp extension and associated complications as well as the treatment required. Results: The study found 13 male patients (68.42%) and six female patients (31.57%) with talon cusps. Talon cusps were diagnosed in both primary (1 talon - 4.76%) and permanent dentition (20 talons - 95.23%). Of the 21 talons, 18 (85.71%) were found in the maxillary arch and three (14.28%) in the mandibular arch. In the maxilla, two talons (11.11%) were found in the permanent right central incisor, another two (11.11%) in the permanent left central incisor, seven (38.88%) in the permanent right lateral incisor and five (33.33%) in the permanent left lateral incisor. One talon (5.55%) was diagnosed in the mesiodens. In the mandible, two talons (66.66%) were found in the permanent left central incisor and one talon (33.33%) in the permanent right central incisor. Ten talons were type 1 talons (47.6%), seven were type 2 (33.33%) and four (19.04%) were type 3 talons. Thirteen of the talons (61.90%) had pulp extension into the cusp. In five talons (23.80%), occlusal interference was observed which required gradual grinding, 12 (57.14%) had very deep developmental grooves and required sealant application. One talon (4.76%) required extraction, as it was associated with the mesiodens. Conclusion: Talon cusps may present either as an isolated entity or associated with other anomalies. Studies involving a large number of subjects are required to find more unusual variants of the talon cusp.

Giant congenital dermoid cyst of scalp

Abstract: A 60-year-old female patient presented with large congenital dermoid cyst of anterior fontanelle region. This mass was present few days after her birth. Apart from mild neck ache and heaviness over head no other symptoms were reported. On imaging the mass was purely extracranial. Erosion of outer table of skull was seen in the region of bregma. This extracranial cyst was excised under general anesthesia. Histological findings proved it to be a dermoid cyst. The patient was free of recurrence at three-year follow-up.

Extensive oral myiasis

Abstract: Myiasis is the infestation of live human and vertebrate animal with dipterous larvae which feed on the host's dead or living tissue. Oral myiasis is a rare condition often associated with debilitating conditions. The aim of this article is to describe a rare case report of oral myiasis caused by Chrysomya bezziana in a 14-year-old boy with Down's syndrome and alarming low hemoglobin level of 2 mg%. C. bezziana is found in Africa, southeast Asia, the Indian subcontinent, and Persian Gulf area. Due to low hemoglobin level, he was transfused with blood followed by manual removal of larvae.

Orbital teratoma: Radiologist's perspective

Abstract: Orbital teratoma is a very rare tumor consisting of all the three germ layers and is very rare among birth disorders of the eye. We report a case of orbital teratoma in a 23-year-old female, highlighting the vital role of computed tomography (CT) in contributing to a precise diagnosis, after proper assessment.

Pediatric maxillary ameloblastic carcinoma

Abstract: Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor, more commonly occurring in mandible than in maxilla that has a silent presentation but aggressive course. Only 18 cases are reported in pediatric and adolescent population. Among these, 5 children died of disease (DOD), 8 are alive and status of others is unknown. Death is mainly due to metastasis and prognosis for maxillary tumors seems to be better as the reported cases have shown lesser tendency to metastasize. Hence, prognosis is determined by early and precise diagnosis, negative surgical margins and absence of distant metastasis. Therefore, after surgery, close monitoring of the patient by periodic imaging is mandatory. The purpose of this article is to report a rare lesion in a child with a review of literature pertaining to pediatric maxillary AC.

Structural modifications of the mandibular condylar process as one of the sequels of traumatism in infancy

Abstract: Context: Mandible and condylar process fractures are well and plentifully described in dental bibliography with the exception of greenstick fractures of the condylar process, which are rarely included. Aims: To compare laminographies and DICOM (Digital Imaging and Communications in Medicine) images of the mandibular condylar axis in patients that suffer blows to the chin with the same type of images of the mandibular condylar axis in patients with other pathologies that did not suffer blows to the chin. Settings and Design: A population of 55 patients who suffered blows in the chin was compared with a control population of 20 patients without historic reference of traumatism in that part of the mandible. The study included 28 Caucasian adult patients, 18 females and 10 males, age range from 22 to 43 years old and 27 Latin patients, 17 females and 10 males, age range from 22 to 43 years old. The control group included 12 Caucasian adult patients, seven females and five males, age range from 22 to 43 years old and eight Latin patients, five females and three males, age range from 22 to 43 years old. Materials and Methods: These patients were studied by images obtained by laminographies with the mouth open and in maximal occlusion and volumetric studies by DICOM method. DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. The communication protocol is an application protocol that uses transmission control protocol (TCP)/internet protocol suite (IP) to communicate between systems. TCP is one of the core protocols of the IP and is so common that the entire suite is often called TCP/IP . Statistical Analysis Used: Student's t -test. Results: This deflection of the condylar axis was not observed in patients with other pathologies that did not suffer blows to the chin region. Conclusions: These fractures provoke deformation of the mandibular condyle, which in turn creates a morphofunctional dysfunction of the Temporomandibular joint (TMJ). It is important to know that this type of fracture can produce growth disturbances.

Ameloblastic fibroma infiltrating into the infratemporal fossa

Abstract: Ameloblastic fibroma (AF) is a rare, benign tumor, which ranges in biological behavior from true neoplasms to hamartomas. The most common site is the posterior mandible and its occurrence in the maxilla is rare. We report a case of a 20-year-old male patient with a slow painless growth in the posterior maxilla, which turned out to be an ameloblastic fibroma. Based on the review, the recurrence rate and malignant transformation has been emphasized. The management of these tumors based on their biological behavior was presented.