Oral Cysticercosis: A Case Series and Review of Literature

Disseminated cysticercosis with tongue involvement: a rare case report from Nepal

Introduction and importance

Cysticercosis is a condition in which humans are infected by the larval form of the pork tapeworm Tenia solium. Cysticercosis in humans is common in the cerebral tissue but rare in the tongue.

Case presentation

Here, the authors report a rare case of a 38-year-old male with neurocysticercosis and cysticercosis of the tongue. The patient presented with a complaint of loss of consciousness for 4-5 min. Local examination of his oral cavity revealed a swelling of ~2×2 cm on the tongue. An MRI of the brain showed various stages of neurocysticercosis involving the neuroparenchyma and tongue. For this, he was started on low-dose prednisolone of 50 mg tapered over 6 weeks and levetiracetam of 500 mg BD continued for his seizure episodes. He is responding well with the medications and is planned to start antiparasitic agent only after the perilesional edema decreases.

Clinical discussion

Cysticercosis may involve the central nervous system, muscle, heart, lungs, peritoneum, eye, and subcutaneous tissue. Oral cavity and perioral involvement by cysticercous larva is rare in humans. Radiologic imaging, serology, and tissue biopsy can be used to confirm a diagnosis of cysticercosis. The most common locations for oral cysticercosis are the tongue, buccal mucosa, lower lip, and upper lip.Only 102 cases of oral cysticercosis have been reported based on a PubMed English-language literature search.

Conclusion

Oral cysticercosis is a rare event, and it represents a difficulty in clinical diagnosis. But a patient with a mass in the tongue should be considered as a possible case of cysticercosis especially in endemic regions like Nepal.

Review of cysticercosis of maxillofacial region and report of two cases

Cysticercosis is a parasitic infection caused by the larval stage of Taenia solium, which very rarely manifests in the maxillofacial region. It usually presents as a painless swelling. The most common site for maxillofacial cysticercosis are the tongue and lips. When humans accidently ingest the eggs of Taenia solium, they become the intermediate host, a role which is typically played by pig. This paper describes two cases of cysticercosis cellulosae, presenting as non-tender swelling of left buccal mucosa and left temporalis region respectively. Case reports available on PubMed were searched and a review was performed. Excision of cystic lesion was the treatment modality in majority of published reports. It is emphasised that cysticercosis should be considered in differential diagnosis of solitary painless swellings of oral and maxillofacial region, especially in patients from an endemic region.

Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

Background

Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM).

Methods

A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 µg) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann–Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05.

Results

The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001).

Conclusion

Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

An atypical case of cutaneous cysticercosis in buccal mucosa

Cysticercosis is a recognized fatal disease to the humans. Taenia solium, a larval stage of pork tapeworm that causes cysticercosis which is an important cause of morbidity in the world. This case report shows the clinical presentations of an atypical case of cutaneous cysticercosis on the right buccal mucosa and its management. It presents the importance of thorough knowledge, proper investigation, symptomatic management with improved treatment regimens and important role of minimally invasive surgery. Its outcome and the treatment options mainly depend on the number, location, size and stage of parasites, as well as on the immune response of the host.

Lingual Cysticercosis: A Case Series with Review of Literature

Cysticercosis is a condition in which humans are infected by the larval form of Pork Tapeworm Taenia solium. Isolated lingual cysticercosis is a rare entity due to the high muscular activity and metabolic rate of tongue which prevents the development of larva. We present a series of three patients with isolated lingual cysticercosis. One patient was treated by medical management while the other two were treated with surgical excision followed by medical therapy. All patients are asymptomatic after repeated follow ups.