Clinicopathological Analysis of Oral Lesions - A hospital based retrospective study

Background Proper diagnosis plays a key role that determines treatment and prognosis of the disease. To give appropriate clinical diagnosis, clinicians must be well aware of the presentation and demographic information of the lesion including the rare ones. Histopathology is still considered as gold standard in diagnostic pathology but final diagnosis becomes difficult unless detailed clinical and radiological descriptions are given. Hence an interdisciplinary approach is needed which requires correlation between both clinical and pathological details. Objective To analyze the clinicopathological details of all the oral lesions diagnosed in Dhulikhel hospital within the period of two years and to assess the concordance between clinical and histopathological diagnosis of these lesions. Method Laboratory record file of all the oral lesions diagnosed between January 2016 to December 2017 were retrieved from the department archives and the data were collected. The extracted data were analyzed using SPSS version 23.0. Result A total of 237 cases were analysed in the present study. Odontogenic cysts were the most common category followed by benign lesions. However considering the individual lesion, mucocele was the commonest lesion followed by squamous cell carcinoma. Total concordance between clinical and histopathologic diagnosis was found in 56.5% cases. The most clinicopathological agreement was seen for benign lesions followed by malignant lesions. Conclusion Mucocele and oral squamous cell carcinoma are the two most common lesions found among the patients visiting our hospital. The cases of oral squamous cell carcinoma are on a rise with each subsequent year. At present, though it is the second most common entity, it can be hypothesized that it may be higher up on the list. Therefore, oral healthcare awareness is paramount and this may be one of the best ways to reduce the oral cancer incidence rates and lowering the healthcare management burden.

Oral Cysticercosis Presenting as an Innocuous Lesion

Cysticercosis is a parasitic infection with potential of causing significant morbidity especially in developing countries. The larval form of the parasite Taenia Solium, 'Cysticercus Cellulosae' primarily colonizes in the small intestine and has the potential to disseminate to different sites of the body. Oral presentation is rare and difficult to detect owing to its innocuous presentation. This report describes the presentation of cysticercosis involving the tongue and presenting as a submucosal mass. An incisional biopsy was performed and evaluation of the histopathological features lead to the diagnosis of oral cysticercosis. This article highlights the importance of inter-departmental collaboration for the accurate diagnosis and effective management of oral cysticercosis in order to avoid potential systemic complications.

Diversity of Root Canal Morphology in Mandibular First Premolar

Background Mandibular first premolars have been reported to have complex anatomical aberration making them one of the most difficult teeth to manage endodontically. Objective To determine the root canal anatomy of mandibular first premolar in a Nepalese population using decalcification and clearing technique. Method One hundred and fifty extracted mandibular first premolars were collected from Nepalese population. Access cavities were prepared on the occlusal surface of each tooth. Teeth were decalcified by immerging in 5% nitric acid, dehydrated in ethyl alcohol and made transparent using methyl salicylate. Methylene blue dye was injected through access cavity and canal anatomy were observed and classified according to Vertucci's classification. Result The average length of mandibular first premolar was 20.43mm. One rooted teeth were 96% and two rooted were 4%. Vertucci's type I canal configuration was most prevalent (72%) followed by type V (18.6%), type III (3.3%), type II (2.6%) and type IV (2.6%). An unusual configuration was found in one tooth. Isthmus and apical deltas were found in 8.6%) and 14.6% of the cases respectively. Conclusion Type I canal configuration were the most frequently observed root canal configuration in mandibular first premolar followed by type V configuration. Such variation in root canal anatomy should be taken into consideration to ensure successful endodontic therapy of these teeth.

A Large Dermoid Cyst in the Floor of the Mouth

The dermoid cyst in the floor of mouth is considered to bea rare condition which comprises only 1.6 to 6.5% of all body dermoid cysts. Dermoid cyst in the floor of mouth may be congenital or acquired. The congenital form results from defective embryonic development and the acquired form may be due to traumatic or iatrogenic causes; and as a result of the occlusion of a sebaceous gland duct. We report an unusual case of huge dermoid cyst in the floor of the mouth in a 12 year old male who presented with progressively increasing swelling below his tongue and reviewed the relevant literature.

Bee Honey as a Safer Alternative for Routine Formalin Fixation

Background Formaldehyde (10% buffered formalin) is still in use as the gold standard fixative in the field of biology however, as reported by Occupational Safety and Health Administration (OSHA) the use of formalin causes health hazards due to its toxicity. Hence, we considered to substitute formalin with natural Bee-Honey to achieve a formalin free laboratory for preservation of the biological specimens. Objective To assess the efficacy of honey as a fixative agent for the preservation of the tissue specimens and to study their cellular and structural characteristics by using routine stains, special stains and Immunohistochemistry (IHC) and compare its effectiveness with the currently, universally accepted formalin fixation. Method Our study contained sample size of 10 tissue specimens. All samples were fixed in two different solutions one in honey and other in conventionally used formalin solution for 24 hrs in room temperature and then were routinely processed, sectioned and stained using routine, special stains and with immuno-histochemical markers. The slides were viewed by two independent examiners and the entire procedure was blind folded. Result We obtained good comparable results with bee honey for Hematoxylin and Eosin, special stains including immunohistochemistry when compared to formalin fixed tissues. Conclusion Based on the observations of this study, it can be suggested that natural bee honey could be a safer alternative to formalin as a fixative, considering the health hazards of formalin.

Peripheral Cemento-Ossifying Fibroma

Peripheral cemento-ossifying fibroma (PCOF), a relatively uncommon lesion, reactive in nature is seen as an overgrowth of the gingival tissues often leading to periodontal problems. It is a benign tumor with slow-growing potential commonly affecting the anterior maxilla whose pathogenesis till date is uncertain. It is usually challenging to diagnose peripheral cemento-ossifying fibroma based on clinical observation and examination, hence histopathological examination is mandatory to arrive at an accurate diagnosis. Recurrence of the lesion is common unless and until it is completely excised. We present the report of two cases of peripheral cemento-ossifying fibroma of our department, complaining of a mass in the gingiva of posterior maxilla and mandible.

Assessment of The Relationship of Incisive Papilla to Maxillary Central Incisor and Canine-Papilla-Canine Line among the Dentate population of Central Nepal

Background Incisive papilla has been used as a fixed anatomical landmark to guide in teeth arrangement. Objective To assess the relationship of distance from central incisor to incisive papilla with various types of arch forms, shapes of incisive papilla and types of canine-papillacanine relation. Method Two hundred maxillary stone casts were prepared. Eighteen casts were excluded as they had voids and the final study was carried out in 182 participants. The arch form was assessed according to Testut L. and shape of incisive papilla was recorded according to Filho IE et al. A digital Vernier caliper was used to measure the distance from posterior point of incisive papilla to the mesio-incisal edge from the labial side of maxillary central incisor. The inter-canine line was drawn and its position with incisive papilla was assessed. The analysis was done using SPSS version 20.0. One way ANOVA was done. Result Result showed that parabolic type of arch was the most common i.e. 76.4%. Mean distance of central incisor to incisive papilla was 11.093±1.894 mm. No significant difference was observed in the distance of Central incisor to Incisive Papilla among different arch forms (p=0.854) and various shapes of incisive papilla (p=0.091). The mean distance of central incisor to incisive papilla was significantly greater when canine-papilla-canine line passed from the middle than from posterior part of incisive papilla. Conclusion These results suggest that incisive papilla is a reliable biometric guide which would help to reduce the clinical time of both the dentist and the patients in placement of the anterior teeth.

Gender Based Comparison of Gingival Zenith Esthetics

Background The size, proportion and gingival zenith position of maxillary anterior teeth plays in the anterior teeth esthetics. Objective To compare the gingival zenith positions and levels between male and female in right and left side as an esthetic parameter. Method Impression of the maxillary arch was made in each participant with irreversible hydrocolloid, and dental cast was made with dental stone type IV. Two clinical parameters were evaluated: (1) the gingival zenith position (GZP) from the vertical bisected midline along the long axis of each individual maxillary anterior tooth; and (2) the gingival zenith level (GZL) of the lateral incisors in an apical-coronal direction relative to the gingival line joining the tangents of the GZP of the adjacent central incisor and canine teeth under healthy conditions. Statistical analyses were conducted using SPSS with the level of significance (α) = 0.05. Descriptive statistics was done and Independent t-test was used to compare the GZP and GZL between male and female. Result In male, the gingival zenith position for right side central, lateral and canine were 1.05 mm, 0.57 mm and 0.14 mm, and in left side were 1.02 mm, 0.53 mm, 0.15 mm. In female, the gingival zenith position for right side central, lateral and canine were 0.99 mm, 0.48 mm and 0.15 mm, and in left side were 0.94 mm, 0.44 mm and 0.14 mm. The gingival zenith position was significantly different between male and female for both lateral incisors. In addition, significantly different was found for the lateral incisor between right and left side. In male, the gingival zenith level of right and left lateral incisors 0.74 mm and 0.71 mm. In female, the gingival zenith level of right and left lateral incisors 0.76 mm and 0.72 mm. No significant difference was found between male and female for the gingival zenith level of right and left lateral incisors. Conclusion The GZP and GZL obtained from this study can be clinically applied to reestablish the GZP of the maxillary anterior teeth during periodontal surgery; crown lengthening or root coverage procedures.

Clinico-histopathological Survey of Head and Neck Cancer at Tertiary Health Care Centre -Dhulikhel Hospital

Background Head and neck is one of the most prevalent site for cancers along with lungs, cervix, breast and stomach. Hospital based cancer registries required for effective evaluation of diagnosis and management of cancer is inadequate in Nepal. Cancer registry system established by WHO is acquired by seven major hospitals in our country. However, data from tertiary health care centres like ours remain undocumented. Objective The objective of this study is to perform retrospective analysis of clinicohistopathological types of head and neck lesions which were eventually diagnosed as cancer in Dhulikel Hospital, a tertiary health care centre of Central East Nepal. Method Data regarding head and neck lesions diagnosed as cancer (January 2001- December 2014) were extracted from the archives of Department of General Pathology. These cases were categorised according to demographic profile, site of cancer and histological diagnosis. Result A total of 240 cases matched the inclusion criteria and were selected for this study. Male: Female ratio of 1.3:1 with a mean age of 52 years (52.82±1.8) was found. Two hundred and two (84.16%) patients were diagnosed with carcinoma, 31 (15%) with lymphoma, 3 (1.25%) with melanoma, 2(0.83%) with small round cell tumor and 2 (0.83%) with sarcoma. The most common histological types of carcinoma seen were Squamous cell carcinoma (138 cases; 57.5%) followed by papillary carcinoma (26 cases; 10.8%). Among the lymphomas Non-Hodgkin's lymphoma (21 cases; 8.75%) was the most predominant type. The most common site of presentation was oral cavity (60 cases; 25%) followed by skin (36 cases; 15%), thyroid (32 cases; 13.33%) and oesophagus (27 cases; 11.25%). Metastasis to cervical lymph node was found in 39 cases (16.25%). Conclusion Based on these finding, it was observed that Squamous cell carcinoma was the most common type followed by different epithelial and mesenchymal malignancies in head and neck region. The results revealed by this study will provide useful information for planning the health care policies about cancer in Nepal and will be more effective and helpful to the patients of remote areas.