Sachin Rai

Adenomatoid odontogenic tumor associated with dentigerous cyst of the maxillary antrum: A rare entity

Adenomatoid odontogenic tumor (AOT) is an uncommon tumor of odontogenic origin composed of odontogenic epithelium in a variety of histoarchitectural patterns. Most cases are in females and have a striking tendency to occur in the anterior maxilla. However, AOT of the maxillary antrum is extremely rare. A 25-year-old female presented with a large radiolucent lesion associated with the crown of an unerupted canine located in the maxillary antrum, which was clinically diagnosed as dentigerous cyst. The microscopic examination revealed the presence of AOT in the fibrous capsule of a dentigerous cyst. Very few cases of AOT associated with dentigerous cyst have been reported till date. A case of gigantic AOT that occupied the maxillary sinus and associated with dentigerous cyst is described. Also, an attempt has been made to determine whether the AOT derived from the dentigerous cyst could represent a distinct hybrid variety.

Do costochondral grafts have any growth potential in temporomandibular joint surgery? A systematic review.

PURPOSE OF THE STUDY To assess the growth potential of costochondral graft in temporomandibular joint reconstruction in patients with temporomandibular ankylosis and hemifacial microsomia. METHOD Systematic review after inclusion of articles fulfilling the following criteria: (1) only human studies; (2) patients of temporomandibular joint ankylosis and hemifacial microsomia; and (3) studies with minimum of five cases and with a minimum follow-up for a period of 5 years. The primary outcome measure was the percentage of patients with optimum growth of costochondral graft. Secondary outcomes were any abnormal growth and restoration of function. Delphis criteria were used for assessing the quality of the included studies. RESULT Only three studies satisfied all the inclusion criteria. A total of 96 costochondral grafts were placed in the included studies. Optimum growth was reported in 54 grafts, undergrowth in 1 graft, overgrowth in 7 grafts, lateral overgrowth in 1 graft and no growth in 1 graft. Graft resorption, reankylosis and sequestration were seen in 21, 8 and 3 cases, respectively. When the Delphis criteria were applied to the case series for the assessment of quality, majority of the studies could be considered as satisfying at least 50% of the criteria. CONCLUSION There are no randomised clinical trials and the only evidence is in the form of case series that is considered as the lowest level of evidence for any study. No inference can be interpreted regarding growth potential of costochondral graft. Thus, on the basis of available evidence, it can be concluded that use of costochondral graft for temporomandibular joint reconstruction lacks scientific evidence.

Traumatic superior orbital fissure syndrome: Review of literature and report of three cases

The classical features of superior orbital fissure syndrome arise due to compression of all or some anatomical structures passing through the fissure. A conservative approach is advocated in this condition unless there is a bony impingement of the neuronal structure and/or simultaneous compression of optic nerve leading to blindness or diminished vision. This paper reports three cases of this rare complex and also presents a review of literature.

Oro-mandibular manifestations of primary hyperparathyroidism

AIMS AND OBJECTIVE To determine the effects of Primary Hyperparathyroidism on oral cavity in a symptomatic contemporary Indian population by taking note of the following parameters: (1) Radiological alteration of lamina dura, (2) mandibular cortical width, (3) prevalence of brown tumor, and (4) mandibular tori. STUDY DESIGN Twenty-six patients of Primary Hyperparathyroidism were examined clinically and radiologically for extra- and intraoral abnormalities. Loss of lamina dura, mandibular cortical width, presence of mandibular tori, and brown tumors were assessed and correlated with serum Calcium, Phosphate, Parathormone, and Alkaline phosphatase. The results were compared with twenty-six age- and gender-matched control subjects. The data was expressed as mean ± SD, and a probability (p) value of < 0.05 was considered significant. Pearsons statistical method was used to assess the significant correlation between radiological measurements and biochemical values. RESULTS Generalized absence of the lamina dura was the most consistent finding and there was a significant correlation between its loss and altered parathormone, alkaline phosphatase, and inorganic phosphate, but not with serum calcium or the duration of the disease. Mean values (in mm) for the cortical indices were significantly lower in the patients compared to the controls and correlated significantly with parathormone and alkaline phosphatase. None of the patients had mandibular tori and only one patient had a brown tumor. CONCLUSION Loss of lamina dura, ground glass appearance, and mandibular cortical width reduction are common findings in primary hyperparathyroidism and these are significantly correlated with elevated parathormone and alkaline phosphatase. However, the presence of brown tumors and oral tori are less commonly encountered features.

Intraoral management of displaced root into submandibular space under local anaesthesia -A case report and review of literature.

Accidental displacement of an impacted third molar, either a root fragment, crown, or the entire tooth, is a rare complication that occurs during exodontia. The most common sites of dislodgment of an impacted mandibular third molar fragment are the sublingual, submandibular, and pterygomandibular spaces. Removal of a displaced root tip from these spaces may be complex due to poor visualization and limited access. A thorough evaluation of all significant risk factors must be performed in advance to prevent complications. This paper reports the case of a patient who presented with a mandibular third molar root that was displaced into submandibular space. The case was managed intraorally under local anaesthesia and review of the literature.

Midline mandibulotomy for reduction of long-standing temporomandibular joint dislocation.

Long-standing temporomandibular joint (TMJ) dislocation is an uncommon condition, and due to its rarity, no definitive guidelines have been developed for its management. Various reduction techniques ranging from indirect traction techniques to direct exposure of the TMJ have been used. Indirect traction techniques for reduction may fail in long-standing dislocation. Management of two cases of long-standing TMJ dislocation with midline mandibulotomy is discussed in which other indirect reduction techniques had failed. Midline osteotomy of the mandible can be used for reduction in difficult TMJ dislocations. An algorithm for the management of long-standing TMJ dislocation is proposed and related literature is reviewed.

Hyalohyphomycosis of maxillary antrum

Fungal infection of the paranasal sinuses is an increasingly recognized entity, both in normal and immunocompromised individuals. The recent increase in mycotic nasal and paranasal infections is due to both improved diagnostic research and an increase in the conditions that favor fungal infection. Although fungal infections of the paranasal sinus are uncommon, 3–5% of incidence is reported. Aspergillus, Candida, and Mucor species are the most common causative agents of fungal sinusitis, but infection with lesser known species have been reported across the world infrequently. This article reviews and presents a case report of chronic fungal sinusitis in an immunocompetent adult male infected with two species of Hyalohyphomycosis group namely, Paecilomyces and Scopulariopsis which are opportunistic soil saprophytes, uncommon to humans.

Management of Long-standing Anteromedial Temporomandibular Joint Dislocation

Abstract Temporomandibular joint dislocations that persist for more than a month are labelled as long-standing or chronic temporomandibular joint dislocations, and are the most challenging and difficult to treat. No definite guidelines have been laid down for the management of such dislocations in the literature. This paper reports 5 such cases and recommends an algorithm for the management of long-standing temporomandibular joint dislocations.

Reconstruction of anterior maxillary defect with buccal pad fat after excision of melanotic neuroectodermal tumor of infancy

This paper highlights a rare case of melanotic neuroectodermal tumor of infancy involving the anterior maxilla in a 3-month-old infant. The tumor was excised completely, and the defect was reconstructed with a bilateral buccal pad of fat. The patient has been followed for 2 years without any evidence of recurrence. We propose that for similar anterior maxillary defects in infants and children, a buccal pad of fat can be utilized as an appropriate pedicled flap for coverage after tumor resection.

Primary leiomyosarcoma of the maxilla: An investigative loom-report of a challenging case and review of literature.

Leiomyosarcoma (LMS) is a malignant neoplasm composed of cells showing distinct smooth muscle features. Majority of the tumors are located in the retroperitoneum, including the pelvis and the uterus but are rare in the oral and pharyngeal region. Intraorally, they are present as painless, lobulated, fixed masses of the submucosal tissues in middle-aged or older individuals. Lesions are usually slow growing and are less than 2 cm in diameter at the time of diagnosis. Here we report the clinico-pathological findings of a case of primary LMS of the maxilla in 63-year-old male patient with an emphasis on the judicious use of ancillary diagnostic modalities to arrive at a definitive diagnosis.