Yogesh Chhaparwal

The hazards of gutka chewing

To the Editor: The review by Javed et al. addresses a very important health problem: gutka chewing, facing the populace of the Indian subcontinent and migrants thereof. It was interesting to read the concepts put forth, especially where the authors have focussed on gutka as a form of smokeless tobacco, thereby giving an impression that areca nut is only a secondary component. However, we would like to point out that gutka is primarily an areca nut–based product with processed additives that also include tobacco. Oral submucous fibrosis (OSF) is mentioned to be more common in gutka chewers than in nontobacco chewers, an erroneous comparison, because it has been conclusively proven that OSF occurs because of areca nut consumption and is not associated with tobacco. If tobacco had been a causative factor for OSF, then other forms of tobacco usage, such as raw tobacco chewing and cigarette/beedi/cigar/pipe smoking should manifest OSF; however, clinically it is never seen in individuals practicing exclusively tobacco abuse. By the same yardstick, the explanation of nicotine causing synergistic damage to fibroblasts does not hold true, as fibroblast damage in exclusive tobacco usage has never been reported. It is well known that fibroblast metabolism is altered owing to activation of procollagen genes, elevation of procollagen proteinase levels, and up-regulation of lysyl oxidase activity brought about by chewing areca nut, leading to increased fibrosis in the oral submucosa. In the discussion, the authors state that cessation of the habit may help to reduce the severity of the condition. Again in the context of OSF, the fibrotic bands once formed do not regress by just cessation of the habit, although the progression may be halted, but the risk of malignant transformation still exists. The review has relied chiefly on articles based on case-control studies, which although they provide very valuable information, tend to have an element of selection bias that is under the control of the investigators depending on the decided/set inclusion and exclusion criteria. Moreover, these studies appear to have been conducted in tertiary care establishments that may not be as accessible to the people of the Indian subcontinent as compared with their western counterparts, and thereby may not represent the true picture of the ground reality in the community at large. Population-based

Rebamipide gargle in preventive management of chemo-radiotherapy induced oral mucositis

BACKGROUND & OBJECTIVES Oral mucositis is inflammation of mucosa of oral cavity which is an inevitable and acute side effect in patients undergoing chemoradiotherapy for head & neck cancer. Though many agents have been tried in prevention & treatment of oral mucositis, until date no single agent exists that is universally established to be effective. METHODS 60 Patients diagnosed with Head & Neck cancer recruited for concurrent chemo-radiotherapy were assigned in a double blind fashion into 2 groups using computer based 1:1 ratio randomization. Subjects in Group 1 were given Rebamipide gargle while subjects in Group 2 were given Placebo gargle in similar colour coded bottles to gargle 6 times/day. Subjective assessment of oral mucositis was done by Numeric Rating Scale (NRS) and objective scoring according to RTOG system. RESULTS All subjects in the Group 1 reported good treatment compliance but 4 subjects in Group 2 developed burning sensation to gargle and were excluded. Onset of oral mucositis was 3.5days earlier in Group 2 (mean=11.17) as compared to Group 1 (mean=14.63). At the end of chemo-radiotherapy, severity of oral mucositis was significantly lower in Group 1 (mean=1.97) than in Group 2 (mean=2.81). INTERPRETATION & CONCLUSION Findings of this study revealed that Rebamipide gargle may be an effective means to prolong the onset of oral mucositis and may reduce the severity of oral mucositis in undergoing chemo-radiotherapy.

Hybrid ameloblastoma: An Amalgam of Rare and Conventional Ameloblastoma

Ameloblastoma is a common benign odontogenic tumor with multiple histologic types. This case report describes an unusual type of ameloblastoma called “Hybrid Ameloblastoma” with features of both follicular and desmoplastic ameloblastoma in a 50-year-old female. This is a very rare form of ameloblastoma as <30 cases have been reported so far in literature. Though this rare form of ameloblastoma is only a histologic variant, it poses a great challenge to diagnosticians and thus to surgeons as there will be mismatch of biopsy reports at different sites in the same tumor thereby changing the treatment plan. This case report is one such example of diverse presentation of this ameloblastoma with conflicting histopathological diagnosis at initial biopsy and on surgical excision.

Evaluation of the effect of age, gender, and skeletal class on the dimensions of sella turcica using lateral cephalogram

Context: Sella turcica or pituitary fossa is a saddle-shaped concavity housing the pituitary gland and seen clearly on lateral cephalogram. This makes it a good source of additional diagnostic information related to pathology of the pituitary gland or to various syndromes that affect the craniofacial region. Aims: The aim of this retrospective study was to determine the average dimensions and morphological variations of the sella turcica in different age groups and to evaluate any difference in size between males and females in the study population. Settings and Design: All the lateral cephalograms were taken by trained radiographic technicians using Planmeca Promax Ceph X-ray Machine, Finland, Inc., in a standardized manner using the same cephalostat. Materials and Methods: Four hundred and eighty lateral cephalograms were obtained under standardized conditions. With age range between 7 and 43 years, all the radiographs were distributed according to skeletal class and gender. Size and morphology of sella turcica were recorded and compared with age, gender, and skeletal class. Statistical Analysis Used: A Students t-test, one-way ANOVA test, and Pearsons correlation coefficient were used. Results: The mean age of the study population was found to be 16.8 years comprising 48.6% males and 51.3% females. There was a gradual increase in linear dimensions of sella turcica with the advancement of age. The normal sella was observed in 20.6%, whereas 79.35% showed variation in morphology. Oblique anterior wall was a most common abnormal variant, whereas pyramidal shaped dorsum was rarest. Conclusions: There was no statistically significant difference in linear dimensions or morphological variations with age, gender, or type of malocclusion.