Extraosseous odontogenic fibroma with a clear cells component: a 5-year follow-up

The extraosseous/peripheral odontogenic fibroma (E/POF) is a benign mesenchymal odontogenic tumour found on the gingival surface with clinical characteristics identical to those of reactive lesions. A histopathological analysis is the only method for determining the difference between reactive lesions and these neoplastic lesions, whose recurrence potential varies between 38.9% and 50%, highlighting the importance of correct diagnosis. The following report describes an E/POF case with a clear cells component, as well as a long-term follow-up treatment, which we emphasise due to its potential for recurrence.

Classic Eagle's Syndrome: Styloidectomy via the Transcervical Approach

Eagle's syndrome was first described by Watt Eagle in 1937, as a syndrome of vague orofacial and cervical pain. He reported two variants, classic styloid and stylocarotid artery syndrome. Eagle's syndrome is a non-perceived and underdiagnosed clinical condition of the head and neck. This anomalous entity presents with neck pain, globus sensation, difficulty in turning the head, dysphagia, odynophagia and various other symptoms occurring as a result of irritation to the nearby structures. The surgical management of Eagle's syndrome consists of two major approaches: the transoral and the transcervical approaches. We report a case of classic bilateral elongated styloid process syndrome, treated with transcervical styloidectomy for painful left elongated styloid process. This gave permanent relief to the patient. The transcervical surgical approach for resection of elongated styloid process in patients with Eagle's syndrome appears to be safe and effective, although the risk for transient marginal mandibular nerve weakness is notable.

Oral ulceration in Stüve-Wiedemann syndrome: a new presentation

Stüve-Wiedemann syndrome (SWS) is a rare, autosomal recessive disorder, causing dysautonomia and multisystem failure. Symptoms include skeletal malformations, restricted joint mobility and desensitisation to pain. Patients with SWS presenting with intraoral lesions are extremely rare and this is probably due to their shortened lifespan. We present a case of a 9-month-old patient who presented to our Oral and Maxillofacial Surgery (OMFS)Unit with a chronic inflamed ulcer affecting the tongue, secondary to trauma from erupting central incisors. We believe that depapillation in conjunction with an increased pain threshold contributed to its development. The patient was successfully treated by extraction of the lower central incisors and intralesional steroid injections under general anaesthetic. This case highlights that patients with SWS can present to the OMFS clinician with oral lesions and that they can be safely managed under general anaesthesia.

Tooth autotransplantation in a patient with rapidly progressing periodontitis aided by 3D printing

Patients with rapidly progressing periodontitis may require extractions of teeth with poor periodontal prognosis. Although replacement with a dental implant is a popular choice, teeth autotransplantation remains a viable option. Herein, we report a case of a 23-year-old patient with rapidly progressing periodontitis resulting in severe clinical attachment loss on the left maxillary first molar, which required extraction. The tooth was replaced by tooth autotransplantation of the unerupted immature left mandibular third molar, which was delivered carefully without compromising the periodontal ligament. Cone beam computed tomography and three-dimensional printing of the third molar donor tooth significantly aided the tooth autotransplantation procedure. Recovery was uneventful. At the 1-year follow-up, healthy periodontal parameters and radiographic features were noted, and the autotransplanted tooth remained vital. This case showed that tooth autotransplantation is a viable option for replacing tooth loss due to rapidly progressing periodontitis.

Placement of a customised load-bearing titanium plate for prevention of iatrogenic mandibular fracture in surgical removal of odontogenic keratocyst recurrence

A 72-year-old woman with a history of removal of a right hemimandibular keratocyst 10 years ago was referred to our attention for a large swelling of the right cheek. The orthopantomography and the CT scan showed a huge osteolytic area of the right mandibular ramus and angle. The patient's refusal to resection and reconstruction with a free flap pushed us towards a conservative treatment. The high probability of a iatrogenic mandibular fracture during and after surgery required the design of a customised titanium plate to be preliminary placed through cervical incision along the posterior border of the mandible. The patient successfully underwent the surgical positioning of the customised plate and subsequent removal of the keratocyst. She was discharged fit and well 5 days after surgery. She did not experience any infections, pathological fractures or relapse in the 6-month follow-up.

Benign myoepithelioma of the soft palate: an unusual clinical entity

Myoepitheliomas are rare benign tumours that affect the exocrine glands and are sporadically located in the salivary glands. The most common location of myoepithelioma in the oral cavity is the parotid gland and it is seldom encountered in the palate. The diagnosis of this entity is challenging since its clinical presentation may resemble those of more common neoplasms, rendering a complex histopathological diagnosis. The aim of the present case report is to describe an unusual case of myoepithelioma of the soft palate in a male patient, which developed as an asymptomatic, slowly growing mass. The tumour was assessed with histopathological examination and the diagnosis was verified via immunohistochemistry. Finally, the treatment included surgical resection of the tumour and no signs of recurrence were noted 2.5 years after the surgical procedure. Early diagnosis and treatment plays an important role in the prognosis of this pathological entity.

Patient-induced progressive facial subcutaneous emphysema masquerading as odontogenic abscess

Facial subcutaneous emphysema (SE) is an uncommon sequelae of dental procedures and often attributed to the use of high-speed air-driven handpieces during surgical extractions, forcing air through fascial spaces. Rarely have there been documented cases of patient-induced SE. In this case report, we present an 18-year-old woman who was referred to the emergency department with a 5-day history of progressive swelling and pain to her right cheek, following a prolonged, but simple extraction of tooth 18. While the dentist and emergency physicians were concerned about an infectious aetiology, history taking, clinical review and imaging corroborated the diagnosis of patient-induced SE secondary to habitual straw use. This report highlights the need for routine postextraction counselling of sinus precautions irrespective of extraction complexity. Additionally, emergency physicians should be aware of SE masquerading as other pathology, including odontogenic abscesses, allergic reactions, angioedema and gas-forming bacterial infections, such as necrotising fasciitis, to ensure appropriate treatment is provided to patients.

Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland

Pleomorphic adenoma, otherwise called as benign mixed tumour, is the most common salivary gland tumour which accounts for 60% of all benign salivary gland tumours. The clinical, radiological and histopathological presentations are varied. The tumour occurs in diverse anatomical sites and can consist of epithelial and mesenchymal components. In this case report, the patient reported with an asymptomatic swelling on the face. CT scan with contrast was advised. The clinical, roentgenographic findings and Fine Needle Aspiration Cytology were indicative of pleomorphic adenoma of the parotid gland. Treatment included partial superficial parotidectomy under general anaesthesia using the modified Blair's incision. The facial nerve was not involved. Part of the gland along with the tumour was resected completely superficial to the facial nerve with a margin of normal tissue all around. Histopathologic examination of tissue specimen confirmed the lesion as pleomorphic adenoma. The patient was asymptomatic at 6-month follow-up.

Facial subcutaneous emphysema in a patient with connective tissue disorder

A 47-year-old woman presented to the emergency department with sudden onset of swelling in her face, which had been triggered by blowing her nose. She had no other symptoms, but was known to have Ehlers-Danlos syndrome. A CT confirmed bilateral subcutaneous facial emphysema attributed to a defect in her left nasal cartilage. The condition was managed conservatively with prophylactic antibiotics and self-resolved within 48 hours. Only eight cases of sudden facial subcutaneous emphysema following nose blowing or sneezing have been found in the English literature and this is the first known case in a patient with a connective tissue disorder. In this case, her condition is suspected to have contributed to her presentation and may be underlying in other similar cases.

Long-term treatment outcomes from a patient's perspective with Treacher Collins syndrome

The management of patients with Treacher Collins Syndrome (TCS) is complex and involves many different specialists within multidisciplinary teams (MDT). The treatment pathway extends from birth well into adulthood and is associated with a heavy burden of care. Due to the extensive nature of the interaction with these patients, MDT members have opportunities to provide enhanced patient-centred care and support.This case report provides an overview of the current knowledge of the aetiology of TCS, the management of these patients and provides a unique perspective from one of the coauthors who has TCS and reports on his treatment experiences and long-term treatment outcomes. By having a better understanding of the impact of TCS and treatment provided, MDT members can not only provide improved clinical treatment but also offer improved patient experiences for those with craniofacial anomalies in particular an increased awareness of the psychosocial challenges they endure.

Comprehensive management of major aphthous ulcer

Recurrent aphthous ulcers are the most prevalent oral mucosal disease, but the subset major aphthous ulcer is a less frequent type. These ulcers are refractory, may persist for several weeks to months, and interfere with the normal state of health. The aetiology is multifactorial and so is the treatment. We present a case of an adolescent male patient reported with multiple oral ulcers. He developed three ulcers simultaneously and suffered for 10 months despite using topical medications prescribed by different dental practitioners. We executed a multidisciplinary treatment approach that resulted in a long-term disease-free state. The treatment methods followed in our case could be a successful model to implement by medical practitioners and oral physicians when the situation demands.

Ameloblastoma of the maxillary sinus: conservative surgical management considering high recurrence risk potential

Ameloblastoma (AM) in the maxillary sinus is rare. This benign entity shows locally invasive, destructive and aggressive behaviour and a high rate of recurrence. Therefore, the course of treatment is radical resection. We report the case of a 38-year-old man presenting with signs of recurrent sinusitis in the Ear, Nose and Throat Department. Transnasal flexible endoscopy revealed a cystic mass in the right inferior and middle nasal passage. CT scan showed an obliterated right maxillary sinus with a ballooning effect and pressure atrophy of the lateral sinus wall, without possible differentiation of the middle and low nasal turbinate. The patient was treated with transnasal functional sinus surgery; pathology stated AM. AM in the maxillary sinus is rare, locally destructive and therefore as a gold standard is resected radically to prevent recurrence. We demonstrate a conservative approach; explicitly, we combined a transvestibular and functional endoscopic sinus surgery resection of the AM to maintain function and reduce the possibility of postoperative impairments. Whether the strategy of treatment for AM is conservative, it nonetheless can result in a recurrence-free status. Nevertheless, inclusion into an oncological follow-up-programme with regularly performed MRI and CT is recommended.

Oral myofibroma presenting as an aggressive gingival lesion

Myofibromas are benign neoplasms of myofibroblastic origin and rarely encountered in the oral cavity. Myofibroma may frequently grow rapidly leading to suspicion of malignancy. This may lead to a tendency for aggressive management. The histopathology of this tumour has similarity with other spindle cell tumours and often requires immunohistochemical staining for diagnosis. Here, we present a case of myofibroma in a 15-year-old female patient who reported with an aggressive gingival swelling and discuss the various histopathological differential diagnosis.

Velopharyngeal dysfunction following botulinum toxin type A injection to the lateral pterygoid muscles for recurrent jaw dislocation

Complications related to lateral pterygoid muscle (LPM) botulinum toxin A (BtA) injection for recurrent temporomandibular joint dislocation are uncommon. No cases of velopharyngeal dysfunction (VPD) following LPM BtA injection have been reported to date. This report details the perioperative and follow-up findings for a patient developing VPD following LPM BtA injection.

Ghost cell odontogenic carcinoma of the left maxilla

We report the case of a 25-year-old man with a maxillary ghost cell odontogenic carcinoma (GCOC). The patient presented to the maxillofacial and head and neck surgery clinic with a growing lump in the left maxilla. Initial workup with CT revealed a cystic lesion in the left upper jaw with associated bone erosion and an enhancing soft-tissue component. Enucleation showed a GCOC associated with a calcifying odontogenic cyst. After the diagnosis was obtained, the patient underwent widening of the first surgical resection. GCOCs are rare odontogenic neoplasms with unspecific clinical and imaging presentation, whose definitive characterisation is based on pathology. Current treatment approaches mainly involve surgical excision, but the prognosis is highly unpredictable due to intertumoral heterogeneity. As tumour recurrences occur in 73% of cases, radical surgery with negative margins is highly recommended. Therefore, it is essential to recognise this entity to offer patients adequate management.

Neurofibroma of the hard palate

Neurofibromas are defined as benign tumours arising from peripheral nerve sheaths. Few intraoral palatal cases have been reported. Neurofibromas can occur as part of neurofibromatosis, type 1 (NF1) or type 2 (NF2). A 41-year-old patient presented with a slowly enlarging soft tissue mass on the hard palate. An incisional biopsy was performed, which confirmed the diagnosis of a neurofibroma associated with NF1. It should be considered that there is a chance of malignant transformation. Here, we discuss the clinical features, types, diagnosis, histopathology and treatment options.

Mucoepidermoid carcinoma of retromolar area: an incidental finding

Salivary gland tumours can arise in any location in the oral cavity but are rather rare in the retromolar region. The majority of the salivary neoplasms arising here are malignant in nature. Mucoepidermoid carcinoma is more commonly seen in the palate. Tumours arising in the retromolar region tend to show symptoms late in onset and may be greater in extent than evident clinically. Imaging studies will help in understanding the full extent of these lesions. We report a case of mucoepidermoid carcinoma arising in a young female patient who reported for orthodontic correction. In the course of examination, a palpable swelling was identified in the right retromolar area, which was eventually diagnosed as intermediate-grade mucoepidermoid carcinoma. Wide resection with adjuvant radiotherapy was the treatment given for the patient.

Oral submucous fibrosis in children: an alarming condition and challenges in management

Oral submucous fibrosis (OSF) is a well-documented potentially malignant condition. It affects most commonly the adult patients of India and Indian subcontinent, only few cases affecting children have been reported in the literature. This paper presents three cases of OSF below the age of 12 years and reviews the aetiology, clinical presentation, treatment modalities in children with improved follow-up results. Clinical features like restricted mouth opening, burning sensation and history of betel nut chewing helps in the diagnosis of the patients, which can be confirmed by histopathological examination. Conservative management and oral physiotherapy in children help in improved mouth opening. Counselling the children, their friends and parents also plays a vital role. The present paper highlights that children on a larger scale are using tobacco products and further studies are required with larger sample size.

Rare, post-periodontitis spondylodiscitis caused by Fusobacterium nucleatum in a patient with multiple sclerosis: challenge of diagnosis and treatment

Fusobacterium nucleatum is part of the commensal flora of the oral cavity, frequently associated with periodontal infections. We describe the case of a 49-year-old woman, on immunsuppressive therapy for multiple sclerosis, who presented with a 3-month history of debilitating back pain. She had a recent episode of periodontitis, and was under regular dental review. Her MRI scan demonstrated findings suggestive of L2-L3 spondylodiscitis. Her CT-guided biopsy yielded negative cultures and the patient failed two courses of empirical antibiotic treatment. With clinical and radiological disease progression, she underwent a percutaneous disc washout and biopsy, which subsequently grew F. nucleatum Treatment with clindamycin and metronidazole was commenced orally for 6 weeks. She improved gradually, and at 1 year follow-up was asymptomatic. The diagnosis of spondylodiscitis caused by F. nucleatum is challenging. The perseverance on identification by surgical biopsy, minimally invasive washout and targeted antibiotics are the mainstay of effective treatment.