Mohan Baliga

Effect of topical honey on limitation of radiation-induced oral mucositis: an intervention study

Radiation therapy for oral carcinoma is therapeutically useful in dose of at least 6000 cGy but causes mucositis that severely interferes with oral function. The literature indicates that honey appears to promote wound healing, so the authors investigated whether its anti-inflammatory properties might limit the severity of radiation-induced oral mucositis. A single-blinded, randomized, controlled clinical trial was carried out to compare the mucositis-limiting qualities of honey with lignocaine. A visual assessment scale permitted scoring of degrees of mucositis and statistical evaluation of the results was performed using the χ(2) test. Only 1 of 20 patients in the honey group developed intolerable oral mucositis compared with the lignocaine group, indicating that honey is strongly protective (RR=0.067) against the development of mucositis. The proportion of patients with intolerable oral mucositis was lower in the honey group and this was statistically significant (p=0.000). Honey applied topically to the oral mucosa of patients undergoing radiation therapy appears to provide a distinct benefit by limiting the severity of mucositis. Honey is readily available, affordable and well accepted by patients making it useful for improving the quality of life in irradiated patients.

Options in orbital floor reconstruction in blowout fractures: a review of ten cases

ObjectiveThe purpose of this case series was to assess the aesthetic and functional outcome of orbital floor reconstruction performed with calvarial bone graft, titanium mesh or prolene mesh.MethodsTen cases of orbital blowout fractures treated at our centre from October 2006 to July 2008 were considered for this study. Clinical examination, patient satisfaction and radiographic investigations were used to assess repaired fractures.ResultsProlene mesh was used in four cases, titanium mesh was used in four cases and calvarial graft used in two cases. Nine patients had significant improvement in their esthetic appearance. Symmetry was restored in all cases. All ten cases had a noticeable improvement in the function. Of total ten cases six had diplopia, three recovered completely during the six months after the surgery. Three cases showed improvement later. All ten cases with enopthalmos recovered completely. Of the nine patients with infraorbital numbness, all recovered completely during the six months following surgery. One patient where the reconstruction was done with calvarial bone graft showed mild discrepancy in the ocular level.ConclusionFor small, linear defects measuring less than 2cm with enopthalmos and restricted ocular movements, prolene mesh (four cases) was used. For larger defects and impure blowout fractures involving the infraorbital rim, calvarial graft (two cases) or titanium mesh (four cases) was used. The outcome of surgery with all three materials was satisfactory. No postoperative complications were seen except for mild hypoglobus in a case reconstructed with calvarial graft. All three materials, calvarial graft, titanium mesh, prolene mesh, have the potential to be useful reconstructive materials in orbital floor blowout fractures.

Oral filariasis--a case report.

Filarial worms are nematodes that dwell in the subcutaneous tissues and lymphatics of human hosts. In India, filariasis is predominantly caused by a species of nematode called Wuchereria bancrofti. The disease is transmitted through the bite of blood sucking mosquitoes. The salient clinical feature of the disease is lymphangitis leading to elephantiasis of the legs, arms, scrotum and breast. Oral or perioral involvement is very rare. We report a case of filariasis which was diagnosed after biopsy of an innocuous cheek nodule.

Schwannomas of the head and neck: a case series

Schwannomas are relatively slow growing benign tumors of the nerve sheath with a well developed capsule. They can reach a considerable size. Typically, symptoms of schwannomas are based on the affected nerve. We present four cases of this tumor that occurred in the head and neck. The differential diagnosis of small painless nodules in head and neck must include schwannomas as it is likely that nerve sheath neoplasms are more common than previously reported. However, due to benign nature and low recurrence prognosis is excellent.

Epidermoid cyst of the floor of the mouth

Dermoid cysts are malformations that are rarely seen in the oral cavity. An intraoral dermoid cyst grows slowly, but may enlarge and interfere with deglutition and speech, or can pose a critical risk to the airway and therefore require immediate surgical intervention. Dermoid cysts may develop above or below the mylohyoid muscle, causing a submental or submandibular swelling. Surgical excision is the treatment of choice and recurrence is rare. An intraoral approach for the treatment of large lesions presenting above the mylohyoid muscle provides good cosmetic and functional results. We report a case of a 26-year-old female who developed an epidermoid cyst presenting as a large sublingual swelling causing speech and swallowing difficulties. The lesion was surgically excised using an intraoral approach. Microscopic examination revealed a dermoid cyst of the epidermoid type. This case shows that dermoid cysts may be successfully diagnosed and managed using a series of simple yet effective clinical procedure.

Improper reduction and fixation of bilateral anterior mandibular fractures: a case report

IntroductionBiomechanical principles for osteosynthesis are emphasized upon in oral and maxillofacial surgery residency programs.DiscussionOur case was referred from another specialty which had treated the patient for bilateral fractures of the anterior mandible. The gross malunion and other findings in this reported case serve to remind students and surgeons alike that principles of fracture reduction and fixation must be respected.

Bone wax to improvise a screw-holder: a makeshift emergency tool

A missing screw-holder threatened cancellation of a case of facial trauma surgery. We present a simple makeshift tool using bone wax to improvise a temporary replacement for the screw-holder missing in our surgical instrument kit. This impromptu set-up is especially useful when operating in the field and faced with mass casualties.

Tumour-Associated Tissue Eosinophilia in Oral Squamous Cell Carcinoma- A Boon or a Bane?

INTRODUCTION The infiltration of tumour stroma by eosinophils, Tumour-Associated Tissue Eosinophilia (TATE) is known to modulate the evolution of Oral Squamous Cell Carcinoma (OSCC). Identification of eosinophils in the inflammatory stroma has been proven to be an important factor in prognostication of malignant tumours including cancers of mouth, oesophagus, larynx, pharynx, breast, lung, intestine and genitourinary tract. AIM Our study aimed to assess the role of TATE as a prognosticator in OSCC as visualized by Haematoxylin and Eosin (H&E) and congo red staining. MATERIALS AND METHODS Thirty histologically-proven cases of OSCC were retrieved from the archives of Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal University, Karnataka, India. Two serial sections of 4μm thickness were made and subjected to routine staining with H&E and modified congo red staining, where eosinophil granules stained red and nuclei stained blue. In 40x magnification, 10 HPF at invasive tumour front were assessed for counting eosinophils by placing a 49 square grid (measuring 0.0289 sq mm). STATISTICAL ANALYSIS The TATE was compared with the prognosticators using Mann-Whitney U-test. The grades of carcinoma were correlated with TATE using Kruskal-Wallis test followed by Post-hoc Bonferronis correction. Agreement of the number of eosinophils counted in the two staining techniques (H&E and Congo red) in OSCC was achieved using interclass correlation coefficient, and Friedmans test. A value of p< 0.05 was considered statistically significant. RESULTS Our results showed that tissue eosinophil counts were higher in well-differentiated cases of OSCC, cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. H&E stain showed significantly better visualization of eosinophils resulting in higher eosinophil counts than when seen with Congo red (p=0.008). CONCLUSION Thus, TATE can be used as a surrogate marker in prediction of survival and recurrence in OSCC. H&E proved to be a better stain for evaluation of eosinophils.

Palatal Swelling in a Patient Suffering from Filariasis

Sclerosing mucoepidermoid carcinoma (SMEC) is a distinct but an uncommon salivary gland neoplasm with only 19 cases reported in English literature till date. Densely collagenous sclerotic stroma, resemblance to other benign lesions and rarity of this tumour often makes the diagnosis of SMEC challenging. Here we report a case of SMEC in a 73-year old female patient suffering from filariasis. Clinical, radiological, fine needle aspiration biopsy, gross and histopathological features are discussed with detailed review of literature and probable pathogenesis.

Dentoalveolar surgery in oral submucous fibrosis: need for caution.

Performing exodontia in patients with the precancerous condition of oral submucous fibrosis is difficult but frequently necessary. There is mucositis and trismus, faulty wound healing and predisposition to infection. Exodontia and dentoalveolar surgery in these patients may result in distressing sequelae and diagnosis of any subsequent complications like space infection is difficult. Hence, these patients must be treated as a special care group and measures adopted to ease distress. Literature has been reviewed with an eye to understand the underlying nature of the disease and factors that contribute to these problems.