Pycnodysostosis: Clinicoradiographic Report of a Rare Case

Pycnodysostosis is an uncommon autosomal recessive sclerosing bone disorder which is characterized by short stature and generalized diffuse osteosclerosis. Patients usually have a large head with separated sutures, open fontanels, aplasia of frontal sinuses, obtuse mandibular gonial angle, and acroosteolysis of the distal phalanges. This case report showed a 25-year-old female with features pathognomonic of pycnodysostosis. The emphasis is mainly on the early diagnosis as it has an important role in the general health of such patients and prevention of complications.

Serum Iron and Haemoglobin Estimation in Oral Submucous Fibrosis and Iron Deficiency Anaemia: A Diagnostic Approach

INTRODUCTION

Oral Submucous Fibrosis (OSMF) is a premalignant condition with potential malignant behaviour characterized by juxta-epithelial fibrosis of the oral cavity. In the process of collagen synthesis, iron gets utilized, by the hydroxylation of proline and lysine, leading to decreased serum iron levels. The trace element like iron is receiving much attention in the detection of oral cancer and precancerous condition like OSMF as it was found to be significantly altered in these conditions.

AIM

The aim of this study was to compare the haemoglobin and serum iron values of OSMF subjects with that of iron deficiency anaemia subjects.

MATERIALS AND METHODS

Total of 120 subjects were included, 40 subjects with the OSMF, 40 with the iron deficiency anemia without tobacco chewing habit, 40 healthy control subjects without OSMF and iron deficiency anaemia. A total of 5ml of venous blood was withdrawn from all the subjects and serum iron and haemoglobin levels were estimated for all the subjects. Estimation of iron was done using Ferrozine method and haemoglobin by Sahli's method. The statistical method applied were Kruskal Wallis, Mann Whitney and Pearson correlation coefficient test.

RESULTS

There was a statistically significant difference in serum iron and haemoglobin level in all three groups (p<0.05). The serum iron level was lowest in OSMF group and haemoglobin was lowest in iron deficiency anaemia group. A progressive decrease in serum iron and haemoglobin levels from Stage I of OSMF to the Stage IV of OSMF was also observed. The iron deficiency anaemia group was not found to be suffering from OSMF in the absence of areca-nut or tobacco chewing habits, but OSMF patients with chewing habits were found to be suffering from iron deficiency anaemia.

CONCLUSION

There is a progressive decrease in serum iron and haemoglobin levels from Stage I of OSMF to the Stage IV of OSMF so it can be used as an auxillary test in assessment of prognosis of the disease.

Primary tuberculous osteomyelitis of the mandible in a 3-year-old child

A 3-year-old girl child presented with swelling in her right lower jaw that had started 5 days previously. History revealed the child being non-immunised. Initial-evaluation revealed proptosis and bony hard swelling over the right body of the mandible. Radiological evaluation including a CT scan indicated expansile osteolytic lesion involving the body-ramus with onion-peel periosteal reaction suggesting osteomyelitis/malignancy. Blood investigations showed raised erythrocyte sedimentation rate and eosinophilia. Family screening for tuberculosis (TB) revealed that the patient, her father and siblings were PPD positive though chest screening and sputum examinations were negative in all of them. Lesion biopsy showed acute/chronic osteomyelitis with eosinophilia, tilting diagnosis towards eosinophilic granuloma/Hand-Schuller-Christian disease. Further investigations for diabetes insipidus, histiocytosis-X, skull-pelvic-femur radiographs, abdominal ultrasonography, ophthalmic consultation and PCR-TB test were negative. Histology, radiography, purified protein derivative (PPD)-positive result and history led to the diagnosis of primary TB of the mandible. Complete resolution occurred following antitubercular therapy. The case report emphasises that diagnosis of TB can sometimes be based on circumstantial evidence and positive response to antitubercular therapy even in view of a negative PCR result.

Unicystic Ameloblastoma Presenting as a Multilocular Radiolucency in the Anterior Mandible: A Case Report

Ameloblastomas are tumors of odontogenic epithelial origin. The term unicystic ameloblastoma is used to describe cystic lesions with clinico-radiographic features resembling an odontogenic cyst, but histologically showing the presence of ameloblastomatous epithelium lining part of the cyst cavity. A large majority of lesions are found in the mandible, and usually cause a painless swelling of the jaws. They can be radiographically subdivided into 'dentigerous' and 'non-dentigerous' types. The unicystic ameloblastoma is believed to be less aggressive than a solid/multicystic ameloblastoma, and thus has a more favorable response to enucleation and curettage. This case report presents a case of unicystic ameloblastoma with a multilocular radiographic appearance in the anterior mandible of a 45-year-old female patient, along with a literature review of the topic.

Fibrous Ankylosis of the Temporomandibular Joint in a Young Child

Temporomandibular joint (TMJ) ankylosis is an intracapsular union of the disccondyle complex to the temporal articular surface that restricts mandibular movements, including fibrous adhesions or bony fusion between the condyle, disc, glenoid fossa, and articular eminence. The leading causes include trauma and infection. It can be a serious and disabling condition that leads to difficulties in mastication, swallowing, speaking, esthetics and oral hygiene. Disturbances of facial and mandibular growth and acute compromise of the airway invariably result in physical and psychological disability. Treatment should be initiated as soon as the condition is recognized, with the main objective of re-establishing joint function and harmonious jaw function. The purpose of this report is to describe a case of unilateral fibrous ankylosis of the right TMJ in a three-year-old girl.

Myxosarcoma of the maxilla - a case report

Myxosarcoma is a rare malignant neoplasm of connective tissue which is characterized by tissue that resembles primitive mesenchyme, and contains relatively undifferentiated cells that show rapid growth and invasion. The cells are stellate or spindle-shaped and are present in a loose matrix which contains mucoid material, reticulum, and collagen fibers. This paper reports a rare case of a myxosarcoma of the left maxilla in a 50-year-old male, which clinically presented as a soft-tissue mass on the buccal gingiva and radiographically showed a mixed radiolucent-radiopaque appearance.

Ameloblastoma: A clinicoradiographic and histopathologic correlation of 11 cases seen in Goa during 2008-2012

Objectives:

The purpose of this case series was to compare the clinical, radiographic, and histopathologic features of 11 cases of ameloblastoma that reported to the Goa Dental College and Hospital over a period of 4 years from January 2008 to December 2012.

Study Design:

Data with respect to the patients’ ages, sex, location of lesions, radiographic features, histopathologic features and surgical treatment and follow-up, was analyzed.

Results:

The mean age in males was 23.25 ± 6.99 years, while that in females was 43.43 ± 17.13 years. Seven (63.63%) of the 11 subjects were females, and four (36.36%) were males. 10 (90.9%) of the 11 ameloblastomas were located in the mandible. Swelling was noted in all 11 patients. 10 cases showed radiographic findings, while one case was a peripheral soft-tissue variant. Seven (70%) of the 10 tumors were multilocular with a well-demarcated corticated border, and three cases (30%) were unilocular. Two cases showed a soap-bubble appearance. Histologically, five cases were unicystic, four were multicystic, one was desmoplastic and one was a peripheral variant. Follow-up ranged from 12 to 34 months and there were no signs of recurrence in any of the patients.

Conclusions:

Ameloblastomas more commonly occur in females at an older age, as compared with males. Radiographic features that could help in diagnosing ameloblastomas include its predominant occurrence in the mandible, multilocular radiolucency with well-defined, corticated, scalloped margins, expansion of buccal and lingual cortical plates, root resorption and tooth displacement.

Gender determination from pulpal tissue

OBJECTIVE

To evaluate the diagnostic performance of X (Barr body [BB]) and Y (F body [FB]) chromosomes observed in dental pulp tissue for gender determination of an individual.

MATERIALS AND METHODS

The study was carried out on 100 teeth (50 male and 50 female), which were indicated for extraction. The teeth were sectioned at various intervals (within 12 h to 49 days post-extraction), and the pulpal tissue was obtained. Two slides for each pulp tissue were prepared, one for 5% Quinacrine dihydrochloride stain (FB) and the other for Hemotoxylin and Eosin stain (BB). The slides were then observed under the fluorescent microscope for FB and under the light microscope for the BB respectively.

RESULTS

Gender determination from human pulp is possible up to 7 weeks. The percentage of FB and BB decrease gradually as the time interval increases. Further, an equation was derived from the data based on the canonical discriminant function coefficients.

CONCLUSION

The determination of gender based on a joint search for the presence or absence of X (BB) and Y (FB) Chromosome is a reliable and cost-effective technique.

Dental age estimation among female commercial sex workers in Goa

INTRODUCTION

Age estimation is a sub-discipline of the forensic sciences and an important part of every identification process, especially when information relating to the deceased is unavailable. In India, close to 3.5 million women work as commercial sex workers (CSW) of which 1.2 million are under aged.

AIM

To assess the dental and the skeletal age of rescued female CSWs with an intention of rehabilitation of the minors.

METHODOLOGY

Dental age assessment of 32 rescued female CSWs with unknown age was done based on the radiographic analysis using regression equations derived in a Qualitative and Quantitative study by Dinkar A D. The skeletal age was assessed based on physical and radiological examination of the skeletal bones by Forensic experts.

RESULT

It was observed that the estimated age of the CSWs ranged from 7 to 22 years out of which 22 cases (68.75%) were found to be below 18 years. When the dental and skeletal age was compared the maximum variation ranged between ± 12 months (1 year). Although the CSWs were found to be from different parts of India, maximum number of the cases (50%) was from Andhra Pradesh and one case (3.13%) was from Nepal.

CONCLUSION

Dental age assessment using qualitative and quantitative method given by Dinkar A D can be thought of a reliable method for dental age assessment as it didn't show much variation when compared to the skeletal age of the 32 CSWs. In the present study 68.75% of the females were minor which shows that the number of minors being trapped in the trade of prostitution is increasing. Rescuing and rehabilitation of these minors is of paramount importance.

Person identification in Ethnic Indian Goans using ear biometrics and neural networks

This study presents new insights and experimental results for the use of ears as a non-invasive biometric for human identification. To determine the uniqueness of the external ear pattern two methods were employed: The Weighted Scoring System and Pattern Recognition by Neural Networks. A total of 10 external ear features classified into 37 sub-features for both right and left ears of 400 Indians of Goan origin were studied after acquiring standardized side profile digital photographs. These features were then converted to numeric scores by the 'Weighted Scoring System' which were then compared to ascertain the uniqueness of ear pattern in same and different individuals. Apart from this feature-wise comparison, the initially acquired photographs of 800 individual ears were scrutinized and 80 visually similar ear patterns were found. After appropriate pre-processing of five train and five test images of each of these 80 visually similar ear patterns, the images were analyzed by a specially designed software and 360 feature vectors which were the distances from the centroid to the outer edge of the ear were extracted and saved. The feature vectors of train and test images were employed to train and test the Neural Networks. The result revealed that none of the individuals in the study sample had identical weighted scores when both right and left ear scores were considered in combination or when bilateral comparison was made in the same individual. The digital analysis of visually similar ear images by Neural Networks revealed a recognition rate of 94% with an Equal Error Rate at threshold value of 0.225. The inter-individual match score among train images were found to be less than the intra-individual match scores between train and test images or the differences found in former were more than that in the latter. Also, all intra-individual scores were above the system threshold (0.225) hence accepted as match, while all inter-individual scores were below it and hence rejected as a match. An independent t-test applied to the intra- and inter-individual match scores indicated that the two distributions were significantly different (p<0.0001). Thus, this study has been successful in determining the uniqueness of ear pattern for person identification and in designing and testing software for recognition of ear patterns from side profile photographs.

Cheiloscopy: revisited

Identification plays a very important role in any crime investigation. Cheiloscopy helps in identifying the humans based on the lips’ traces. The pattern of wrinkles on the lips has individual characteristics like fingerprints. A review of the literature reveals very little research done on lip prints so far. The present article reviews in detail the history, scope of cheiloscopy, and the use of lip prints in crime detection. It also highlights the current research carried out in the field of cheiloscopy. An effort has been made to help the researchers by reviewing in detail the various methods of classifying and analyzing the lip prints. It concludes by enlightening the readers with the fact that the possibilities to use the red part of lips to identify a human being are wider than it is commonly thought.

Primary hyperparathyroidism presenting as an exophytic mandibular mass

A 36-year-old female patient presented with a massive painless swelling in the left mandible. The patient's medical history was unremarkable. The initial clinical and radiological evaluation indicated an aggressive odontogenic neoplasm or a metastasis from an unknown primary; the suspicion of a systemic metabolic or endocrine disorder lay low on the list of differential diagnoses. Further investigations revealed gross skeletal changes and a hypoechoic right parathyroid mass. The total serum parathyroid hormone levels and ultrasound-guided fine needle aspiration cytology (FNAC) of the mandibular and parathyroid lesions provided the diagnosis of primary hyperparathyroidism presenting as a mandibular brown tumour. This case thus highlights the importance of a thorough diagnostic work-up for all lesions in the maxillofacial region and also serves to add another facet to the myriad of presentations associated with primary hyperparathyroidism.

Oral radiographic and clinico-pathologic presentation of Erdheim-Chester disease: A case report

A 69-year-old woman with unexplained fever and weakness was referred for evaluation of a solitary mandibular swelling adjacent to a severely resorbed edentulous mandibular ridge. The patient had coexisting craniofacial-skeletal lesions and diabetes insipidus. Histological and immunohistochemical staining of sections from mandibular lesions confirmed the rare diagnosis of Erdheim-Chester disease. The absence of cardiac, pulmonary, renal, and major neurological manifestations was suggestive of a diagnosis at an early stage of the disease. Early diagnosis has been rare with less than 100 reported cases. A review of the literature revealed only 2 cases that report detailed maxillomandibular radiographic findings. A seemingly benign clinical presentation of a potentially grave disease that presents with an osteolytic-sclerotic oral radiographic picture is reported.

Dentigerous cyst associated with multiple mesiodens: a case report

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. When observed with erupted and complete dentition the diagnosis is a surprise; as about 95% of dentigerous cysts involve the permanent dentition and only 5% are associated with supernumerary teeth. The usual age of clinical presentation of dentigerous cyst due to supernumerary tooth is during the first four decades. Mesiodens is a supernumerary tooth situated between the maxillary central incisors. More frequently the mesiodens occurs unilaterally, but it may also be bilateral, while three or more supernumerary teeth in the median region of the palate are more rarely found. We report a rare case of dentigerous cyst in association with multiple mesiodens in a 14-year-old female patient.

Pyogenic granuloma associated with bone loss in an eight year old child: A case report

Soft tissue enlargements of the oral cavity often present a diagnostic challenge because a diverse group of pathologic processes can produce such lesions. An enlargement may represent a variation of normal anatomic structures, inflammation, cysts, developmental anomalies and neoplasm. Within these lesions is a group of reactive hyperplasias, which develop in response to a chronic, recurring tissue injury that stimulates an exuberant or excessive tissue repair response. The pyogenic granuloma is a reactive enlargement that is an inflammatory response to local irritation such as calculus, a fractured tooth, rough dental restoration and foreign materials. This article aims to present a case of pyogenic granuloma in 8 year old child patient associated with resorption of bone in relation to the tooth.