Vidya Ajila

The varying clinical presentations of peripheral ossifying fibroma: A report of three cases

PURPOSE: Gingival growths are one of the most frequently encountered lesions in the oral cavity. Most of these lesions are innocuous, but some do have malignant potential. Different lesions with similar clinical presentations make it difficult to arrive at a correct diagnosis. One of the infrequently occurring gingival lesions is peripheral ossifying fibroma (POF). Lesions with histological features similar to POF have been given various names, adding to the confusion. We report the varied clinicopathological features of 3 cases of POF, discuss the contentious nomenclature and investigate the possible etiopathogenesis of this disease. CASE DESCRIPTION: Three cases of gingival growths (POF) are reported. Two of the lesions occurred in the maxillary anterior region, while the third occurred in the mandibular posterior region. Two of the cases showed radiographic evidence of bone loss. An excision biopsy was performed in all three cases. CONCLUSION: Because the rate of recurrence for peripheral ossifying fibroma is 8% to 20%, close postoperative monitoring is required. It is also necessary to use consistent and specific nomenclature in the literature to avoid confusion and the loss of important data.

Human Papilloma Virus Associated Squamous Cell Carcinoma of the Head and Neck

Oral cancer is one of the commonest causes for mortality and morbidity with squamous cell carcinoma being the sixth most frequent malignant tumour worldwide. In addition to tobacco and alcohol, human papilloma virus (HPV) is associated with a proportion of head and neck cancers. As in cervical cancers, HPV types 16 and 18 are the cause of malignant transformation. HPV-positive cancers of head and neck have unique characteristics such as occurrence in a younger age group, distinct clinical and molecular features, and better prognosis as compared to HPV-negative carcinomas. They also possess the potential for prevention by using vaccination. The present review describes in detail the salient features of HPV associated oral squamous cell carcinoma (OSCC), its differences from HPV-negative OSCC, diagnostic features, and recent strategies in prevention and management.

Rare features associated with Mobius syndrome: Report of two cases

Mobius syndrome is a rare congenital disorder with the preliminary diagnostic criteria of congenital facial and abducent nerve palsy. Involvement of other cranial nerves, too, is common. Prevalence rate of this syndrome is approximately 1 in 100,000 neonates. It is of unknown etiology with sporadic occurrence. However, data regarding the occurrence rate in India is limited. Features such as orofacial malformations, limb defects, and musculoskeletal, behavioral, and cognitive abnormalities might be associated. A thorough evaluation to identify the condition and establishing an adequate treatment plan is of utmost important in this condition. We are reporting clinical and radiographic features of Mobius syndrome in two cases along with unusual findings of limb and neck deformity.

Adenoid cystic carcinoma of the buccal mucosa: A case report and review of the literature.

Adenoid cystic carcinomas are deceptive malignancies that show slow growth and local invasion with recurrences seen many years after diagnosis. Upto 50% of these tumors occur in the intraoral minor salivary glands usually in the hard palate. Buccal mucosal tumors are relatively rare. We determined the incidence of buccal mucosal adenoid cystic carcinoma by reviewing the number of reported cases in the literature. This is the first article to analyze the occurrence of adenoid cystic carcinomas in the buccal mucosa through a review of 41 articles. Our review revealed 178 buccal mucosal adenoid cystic carcinomas among a total of 2,280 reported cases. We present a case of adenoid cystic carcinoma occurring in the left buccal mucosa of a 45-year-old female.

Etiological Trends in Oral Squamous Cell Carcinoma: A Retrospective Institutional Study

Aim: Oral squamous cell carcinomas (OSCCs) are among the most common cancers that affect human population worldwide. This study aims to analyze the epidemiology, risk factors, clinical and histopathological features, and metastasis in OSCC cases. Methods: This retrospective cross-sectional study included the subjects reported to Department of Oral Pathology and Microbiology in A B Shetty Memorial Institute of Dental Sciences between 2009 and 2013. Data on age, gender, tumor location, lymph node metastasis, associated risk factors, and histopathological grades were recorded and subjected to Pearson′s Chi-square analysis for any correlation between habits and other variables. Results: A total of 61 cases were included. Male: female ratio was 2.6:1 with maximum cases seen in the fifth and sixth decades of life. Totally, 59 cases reported tobacco chewing habit and 2 cases reported sharp teeth. Quid chewing was the most frequently reported habit and buccal mucosa was the common site. Most cases were well differentiated, associated with quid chewing and without nodal metastasis. The correlation of habits to other variables was statistically insignificant (P < 0.05). Conclusion: In this study, betel quid chewing was the most important etiological agent of OSCC and was associated with the few cases of poorly differentiated OSCC.

Serum folate levels among mothers of children with and without cleft lip and palate: A comparative biochemical study

Background: Cleft lip and palate is one of the major congenital malformations in the newborn. Folic acid or folate has been postulated to have a protective effect on the occurrence of cleft lip and palate if taken in the periconceptional period. Aims: The aim of this study is to evaluate and compare the serum folate levels of mothers of cleft children with that of mothers with healthy children and women of childbearing age. Materials and Methods: A total of 44 subjects were included in the study of which 28 formed the study group comprising of women who had delivered children with cleft lip and palate and 8 were women who had delivered healthy children and formed Control Group I. Control Group II consisted of 8 women of childbearing age. Serum folate levels were assayed using an automated chemiluminescence assay. Results: We observed no significant difference in the serum folate levels of the study group as compared with the control groups. However, the mean serum folate level in the study group was marginally lower than in Control Group I. Conclusions: Since, in our study, folic acid deficiency could not be demonstrated in the serum of women with cleft children, our results suggest that serum folate levels may not be the only reason for clefting. Furthermore, the range of folate in a population is usually narrow; therefore, a significant difference in the serum folate levels may not be demonstrable.

Intraoral Burkitt's lymphoma in an HIV positive patient

Burkitts lymphoma is an aggressive form of Non-Hodgkins lymphoma composed of malignant cells of B lymphocyte origin. Burkitts lymphoma is a rarity in the Indian subcontinent. Though intraoral Burkitts lymphoma in HIV positive individuals is very uncommon, its importance lies in the fact that it is often the first sign of the underlying immunosuppression. We present a case of Burkitts lymphoma in right maxillary region which was the first manifestation of HIV in the patient.

Botryomycosis of orofacial region: A rare case report

Botryomycosis is a rare chronic granulomatous infection that usually involves the skin and rarely viscera. The main causative organism is Staphylococcus aureus, and rarely, Pseudomonas and Escherichia coli. Both cutaneous and visceral forms of the disease are recognized. Botryomycosis may develop in apparently healthy individuals as well as the immunologically compromised. The involvement of orofacial region is rare in the literature. Diagnosing botryomycosis is very challenging. Dental specialists require thorough knowledge regarding the features and management of this infrequent entity in their practice. Isolation of the causative agent and antibiotic susceptibility tests are essential to provide appropriate treatment. We hereby report a rare case of a 37-year-old healthy male with recurrent episodes of botryomycosis involving the orofacial region. The present report highlights the clinical and histopathologic features of botryomycosis with literature review.

Goldenhar syndrome: Report of two cases with review of literature

Goldenhar syndrome consists of a varied group of malformations that can involve multiple systems of the body. It is believed to be a variant of hemifacial microsomia with ocular and vertebral involvement. Characteristic findings, such as hypoplasia of one half of the face, epibulbar dermoids, ear tags, and spinal cord defects, warrant the name occulo-auriculo-vertebral dysplasia. The syndrome occurs due to imbalance in cells during the blastogenesis period of embryo formation. It is found to involve the derivatives of first and second branchial arches. The condition is apparent at birth, but the phenotype can vary greatly in its severity depending on the activation and expression of the defective gene. Reported here are detailed clinical and radiographic features of two sporadic cases of Goldenhar syndrome in young males. This work mainly highlights the various theories of etiopathogenesis as well as step-wise management protocol for patients diagnosed with the syndrome.

Status of thiocyanate levels in the serum and saliva of non-smokers, ex-smokers and smokers

Background Use of tobacco is often implicated in the development of oral diseases. Questionable accuracy of the traditional questionnaires to assess cigarette exposure necessitates the use of biomarkers like thiocyanate which provide a definitive quantitative measure. Objective To assess the rise in the level of thiocyanate for measurement of smoking behaviour in adults. Materials and methods Serum and salivary thiocyanate levels were estimated in 20 non-smokers, 20 ex-smokers and 40 smokers. Smokers were divided into two groups based on the presence or absence of oral mucosal lesions. Results The mean serum and salivary thiocyanate levels were increased significantly in smokers when compared to non-smokers and ex-smokers. The levels were not significantly different between ex-smokers and non-smokers and between smokers with tobacco related oral mucosal lesions and those without. Statistically significant correlation was seen between the serum and salivary levels of thiocyanate. Conclusion This study highlights the high level of thiocyanate in the serum and saliva of smokers when compared to non-smokers and ex-smokers. Significant increase in thiocyanate level was also seen in saliva. Hence it can be stated that saliva can be used as a reliable, non-invasive tool to assess smoking behaviour in the population and its changes over time.