Ashish M Warhekar

Incidental findings on cone beam computed tomography and reasons for referral by dental practitioners in indore city (m.p).

INTRODUCTION Cone beam computed tomography is a new diagnostic innovation to dental imaging. Despite the use of CBCT in oral and maxillofacial imaging, reports on its use either by individual practitioners or referral patterns to CBCT centers is lacking. Hence, a study was conducted to determine incidental findings on CBCT and reasons for referral by dental practitioners in Indore city. MATERIALS AND METHODS A retrospective analysis of 795 records that were referred for CBCT imaging at Institutional and Oracal CBCT Centre, Indore was undertaken. Referrals from both within and outside institution, as well as from private practitioners were considered. The reason for CBCT referral, provision diagnosis, final diagnosis and any incidental diagnosis were recorded. RESULTS This retrospective chart audit revealed that 56.7 % were male and 43.3% were females. Greatest source of patients was referred by oral surgeons (21.9%) followed by oral and maxillofacial radiologist (14.2%) and prosthodontist (9.3%). The most common reason for referral was for implant analysis (24.2%) and the most common incidental finding diagnosed by CBCT was oral malignancies. CONCLUSION In Institutional set-up, CBCT referrals were mostly for the reason of planning implant placement followed by trauma whereas private practitioners used CBCT mostly for implant placement followed by impaction. CBCT was being utilized more by Oral surgeons in private sector whereas it in an Institutional setup majority of referrals from Department of Oral Diagnosis and Radiology. Findings that were most commonly diagnosed incidentally on CBCT were Orofacial malignancies followed maxillary sinus pathologies.

A Rare Case Report of Neurofibromatosis I in HIV Positive Individual

Neurofibroma is an uncommon benign tumour of neural tissue origin rarely presenting in the mouth and jaws and thereby attracting the attention of oral physicians. A 22-year-old male patient reported with a complaint of swelling in left middle one third region of face since 8-10 y which was slowly progressive in size. He had history of multiple dark brown pigmentation on skin associated with progressively enlarging multiple small nodular growths over the body and single firm nodular growth in left side of maxilla intraorally. He had history of tuberculosis at the age of one year which was treated completely and since last 2-3 y he was suffering from recurrent episodes of sore throat, fever, diarrhea, abdominal pain with vomiting and excessive weight loss. Radiographic findings showed irregular osteolytic lesions involving ramus and angle of mandible, zygomatic bone and posterior part of maxilla with displacement of teeth with abnormal soft tissue enhancement observed by advance imaging. On serological investigation he was HIV positive and histopathologically, diagnosed with Neurofibromatosis-1. Oral manifestations of neurofibromatosis have been reported in only 4% to 7% of affected persons. This article presents a rarest of rare case report of neurofibromatosis-I in HIV positive individual also involving maxilla, mandible as well as zygomatic arch.

Panoramic Radiographic Appearance of Giant Bilateral Tonsilloliths.

A 52-year-old male patient reported with a chief complaint of pus discharge from left mandibular posterior region, with an associated history of extraction of tooth 36 one year ago. Past medical history of patient was not significant in relation to patient’s current complaint. Draining sinus was observed near the left body region of the mandible extraorally [Table/Fig-1]. Intraorally associated region disclosed a mobile root remnant [Table/Fig-2]. A provisional diagnosis of chronic suppurative osteomyelitis was made because of mobile root remnant of mandibular left first molar. A periapical radiograph showed extensive radiolucent bony changes surrounding the root remnant and hence a panoramic radiograph was advised. Interestingly, the panoramic radiograph showed the presence of two ovoid shaped radiopaque areas superimposed one on either side of the ramus of mandible measuring of size approximately 2.5cm x 2.8cm and 1.3cm x 1.6cm respectively on right and left side [Table/Fig-3] and large radiolucent lesion associated with periapical to root piece of lower left first molar. A lateral oblique view of left ramus showed the large ovoid shaped radiopacity above the sigmoid notch excluding intraosseous radiopaque lesion [Table/Fig-4], right lateral oblique view of ramus showed small calcified radiopaque area superimposed on sigmoid notch [Table/Fig-5]. On comparison with panoramic image radiopacity on right side ramus area appears larger in size giving an impression of “Ghost Image” formation. To rule out the size and determine the exact anatomical location patient was advised Computed Tomography (CT) Scan. Radiographic diagnosis of osteomyelitis of left body mandible and soft tissue calcification was given with a differential diagnosis of calcification of phleboliths, calcified lymph node, foreign bodies, an elongated styloid apparatus, large maxillary tuberosity, displaced mandibular third molar and calcified tuberculous lymphadenitis was made. His blood and serological investigations was normal.

Bifid mandibular canal: An unusual presentation

Bifid mandibular canal could be an interesting variation in the mandible. This condition can pose complications during surgical procedures in the mandible, such as extraction of lower molars, placement of implants, and surgery. Therefore, identification of this variation is sometimes very crucial and can assist in minimizing postoperative complications. Hereby, we report the presence of bifid mandibular canal in the first molar region, an unusual presentation. The patient was evaluated for implant prosthesis using cone beam computed tomography (CBCT) that confirmed the bifid canal which was seen as an unusual radiolucency on intraoral periapical radiograph.