Comparison of the length of styloid process in panoramic radiographs to computed tomography as the gold standard

Aims:

To compare the length of styloid process assessed using computed tomography (CT) and panoramic radiographs (PAN).

Materials and Methods:

PAN were taken for 15 patients requiring CT reporting to PMS Dental College or metro scans, after obtaining informed consent and fulfilling all the inclusion and exclusion criteria. CT images were taken in metro scans. The apparent lengths of styloid process were measured in both CT and PAN using software provided with the respective machines. Ethical committee approval was obtained from PMS Dental College, Trivandrum.

Results:

The length of left styloid process in CT was observed 20–30 mm in 4 (27%) patients and same in PAN was observed in 5 (33%) patients. Out of 15 patients, abnormal styloid process (length >30 mm) was observed in 11 (73%) patients when measured with CT and 10 (67%) patients in PAN. In CT, the length of the styloid process on the right side was observed between 20 and 30 mm, in 3 (20%) patients. PAN of 2 (13%) patients were found between 20 and 30 mm. On the right side, abnormal styloid process (length >30 mm) was noted in 12 (80%) patients using CT and 13 (87%) patients in PAN. The length of styloid process in the combined sample (both right and left side) was found to be between 20 and 30 mm in 3 (10%) patients and styloid process >30 mm long (in both CT and PAN) was observed in 12 (40%) patients.

Conclusions:

This study demonstrated positive correlation between CT and panoramic measurements. “P” values were statistically significant on both sides with values of right side (P = 0.01) and left side (P = 0.002), respectively. Hence, PAN, which are routinely taken, cost-effective and involving relatively low radiation dose, may be used as substitute for CT for the purpose of diagnosis of elongated styloid process. However, for precise measurement of the length of styloid process, CT is still the imaging modality of choice.

Pseudovascular Adenoid Squamous Cell Carcinoma of Buccal Mucosa-a Rare Aggressive Variant

Pseudo-vascular adenoid squamous cell carcinoma (PASCC) is an uncommon histological variant. It is characterized by an acantholysis of the tumor cells and the formation of anastomosing spaces and channels. It gives a false appearance of glandular differentiation mimicking angiosarcoma. PASCC has been reported in the head and neck, as well as in other organs like the breast, lungs, urinary bladder, vulva, and the uterine cervix. We report a case of PASCC of the oral cavity in a recently operated case of squamous cell carcinoma of the buccal mucosa.

Optical diagnosis of oral lichen planus: A clinical study on the use of autofluorescence spectroscopy combined with multivariate analysis

Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory condition of stratified squamous epithelia. OLP is a potentially malignant condition in oral mucosa. Patients with OLP have an increased risk of developing squamous cell carcinoma. Therefore an early and accurate diagnosis is necessary to avoid further damage to the oral mucosa. Biopsy followed by histopathological examination is the gold standard for the diagnosis of oral mucosal lesions including OLP. But this invasive procedure is traumatic and time consuming with limited statistical confidence level. Autofluorescence spectroscopy (AFS) has recently emerged as a potential tool to evaluate the biochemical changes associated with oral cavity disorders. In this study, we used AFS to differentiate the oral cavity tissue of 20 OLP patients from that of 16 normal volunteers. Spectra from oral mucosa were acquired at 280, 320 and 410 nm excitation wavelengths which correspond to the excitation energy of major endogenous fluorophores. Normalized spectral data at 320 nm excitation showed significant increase in the intensity of collagen peak for OLP. Optical redox ratio and total hemoglobin concentration estimated from the spectral data revealed significant increase and decrease respectively in OLP and normal patients. Principal component analysis followed by linear discriminant analysis (PCA-LDA) provided sensitivity and specificity of 71 and 80%, 80 and 90%, and 72 and 75% respectively for 280, 320 and 410 nm excited spectral datasets. Meanwhile, partial least square discriminant analysis (PLS-DA) provided sensitivity and specificity of 69 and 77%, 78 and 91% and 73 and 78.13% respectively for 280, 320 and 410 nm excited spectral datasets. From the results, it is concluded that AFS is an efficient tool for the non invasive diagnosis of OLP, with 320 nm light identified as the best wavelength for excitation.

Giant Cervicodorsal Schwannoma

Schwannomas are benign slow growing tumors that arise from myelin producing Schwann cells. Schwannomas developing in cervical-dorsal region are rare benign neoplasms which are emerges leisurely remains asymptomatic some times and functionally inactive tumours. Giant Schwannomas extending over two or more vertebral levels have been documented and attempts have been made to classify these in available literature, however inadequate. Advancement in imaging modalities and microsurgery has bettered management of these tumors. A rare case of intradural extramedullary cervicodorsal schwannoma extending along seven vertebral levels to thoracic levels is reported in a 55 year old male patient with progressive weakness and numbness of over one and a half years. MRI of cervical spine showed a heterogeneously lesion with cord oedema till D7 level on T1contrast saggital view. Histological examination revealed encapsulated spindle cell lesion with hypocellular and hypercellular areas with verucay bodies, occasional bizzare nuclei, hyalinized blood vessels, with no evidence of necrosis/atypical mitosis, suggestive of schwannoma. In the prone position, C4 to D7 enbloc laminotomy was done and total excision of intradural extramedullary lesion was done. Post-operative CT scans revealed normal spinal canal dimensions with implants in situ. At quarterly follow up upto one year post-operative, the patient had near normal power in all four limbs and normal bladder function.

An extensive swelling in the anterior mandible - A case report

INTRODUCTION

Glandular odontogenic cyst is a rare developmental odontogenic cyst, which often pose a challenge to diagnose it clinically.

PRESENTATION OF A CASE

A 32 year old female patient was referred to the oral and maxillofacial surgery department with a chief complaint of a painless swelling in the anterior mandible, extending from mandibular left premolar to right first molar region, with fluctuancy and egg shell crackling at right premolar region. The associated teeth were firm. Radio graphically a large radiolucent lesion was seen extending from mandibular left premolar to right first molar region.

DISCUSSION

We had many differential diagnoses including keratocystic odontogenic tumour, ameloblastoma and radicular cyst. Incisional biopsy was taken from the most fluctuant area, which was histopathologically suggestive of glandular odontogenic cyst. Enucleation of the cyst, peripheral ostectomy, extraction of teeth and Carnoy's solution application were done under general anaesthesia.

CONCLUSION

We often neglect to include uncommon lesions in the differential diagnosis, which may lead to inadequacy in the management protocol. Whenever possible, incisional biopsy should be performed to confirm the lesion before surgical enucleation. Here we present a case in which we were fortunate enough to diagnose the lesion by an incisional biopsy and managed according to the standard protocol.

Impact of Malnutrition, Inflammation, and Atherosclerosis on the Outcome in Hemodialysis Patients

Malnutrition, inflammation, and atherosclerosis are significant problems in patients on hemodialysis. A prospective, observational study in 100 hemodialysis patients for 2 years was conducted. The primary outcomes were hospitalizations and mortality at the end of 2 years. The mean age was 61 ± 11.3 years and 69% were male. Seven patients did not complete the study (five underwent transplant and two were shifted to other units). Serum albumin was significantly lower in malnourished patients at 6 months from the beginning of the study period (3.58 vs. 3.79 g/dl, P = 0.001). Malnutrition based on subjective global assessment (SGA) was seen in 30 (32%) patients: mild to moderate in 27 (29%) and severe in 3 (3%). Inflammation was seen in 73 (78.5%) patients and intimal-medial thickness of >1.1 mm indicating significant atherosclerosis was seen in 73 (78.5%) patients. Modified SGA score and malnutrition-inflammation score (MIS) were significantly more in the malnourished group. Statistically significant association was seen between hospitalization and mortality in the malnourished population, and the odds ratio of death in malnourished patients was 9.83 (95% confidence interval: 2.8-34.3, P < 0.001). There was a moderate correlation between malnutrition assessed by modified SGA and MIS score (r = 0.54, P < 0.001). Mortality rate was 37% in patients with mild to moderate and 67% in severe malnutrition. Hospital admission was seen in 43 (46%) patients and was significantly more common in malnourished compared to well-nourished patients (77% vs. 32%, P < 0.001). Multiple logistic regression analysis showed that malnutrition by Modified SGA was the only significant variable associated with mortality at 2 years, and addition of MIS score did not improve the predictive ability of the model to modified SGA. We recommend the use of modified SGA and serial serum albumin to monitor nutrition in hemodialysis patients.

Post-operative endophthalmitis due to Fusarium dimerum

Fungal endophthalmitis is a destructive intraocular infection resulting in poor visual prognosis. Endophthalmitis due to Fusarium spp has the worst visual prognosis. We report a case of a 58-year-old female patient who underwent cataract extraction and intraocular lens implantation in the right eye and presented two months after the surgery with fungal endophthalmitis. The aqueous humor culture grew Fusarium dimerum. The patient was treated with intravitreal and oral voriconazole and topical prednisolone. The patient experienced one episode of recurrence following by remarkable improvement. To our knowledge, this is the first reported case of Fusarium dimerum endophthalmitis.

Three-year follow-up of oral leukoplakia after neodymium:yttrium aluminum garnet (Nd:YAG) laser surgery

Oral leukoplakia is a relatively common lesion with a significant proportion of cases changing into cancer. Since most leukoplakias are asymptomatic, the primary objective of treatment must aim at the prevention of such malignant transformation. The main objectives of the study are to observe (1) the efficacy, safety and acceptability of the neodymium:yttrium aluminum garnet (Nd:YAG) laser in the management of oral leukoplakia; (2) the nature of postoperative complications, if any, associated with laser ablation, and (3) the 3-year prognosis of oral leukoplakia treated with laser. Twenty-eight patients with histologically proven leukoplakia were treated with Nd:YAG laser. From this study, we observed that the patients treated with Nd:YAG laser had only mild to moderate pain, swelling and restricted mouth opening, which peaked between 72 h and 1 week. In a majority of the patients the healing was prolonged, to a maximum of 5 weeks, and there was no clinical evidence of scarring in 26 out of 28 cases. In this study we achieved a cure rate of 92.86% in a 6-month period. Further follow-up after 3 years yielded almost the same result, except that one patient was not available for follow-up. We concluded that Nd:YAG laser is an effective device in the management of oral leukoplakia, which is one of the major pre-cancerous lesions in our country.

Spectroscopic and thermal analysis of a submandibular sialolith of Wharton’s duct resected using Nd:YAG laser

A sialolith observed in the Wharton's duct of a male patient was resected using an Nd:YAG laser. This is the first report on the resection of sialolith using laser. The resected sample was analyzed for structural details using Fourier transform infrared (FTIR), FT-Raman, and fluorescence spectroscopic techniques. Other techniques like energy dispersive X-ray analysis, scanning electron microscopy, and thermal analysis were also used for the analysis of structural details. The major peaks of the vibrational spectra are observed to be due to the vibrations of the phosphate and hydroxyl groups of the inorganic part of the sample and the proteinaceous component of the organic part. The major elements in the sample are identified as calcium and phosphorous in the ratio 7:3. The fluorescence spectra recorded at excitation wavelengths 280, 325, and 410 nm showed emission maxima corresponding to the endogenous fluorescence of structural proteins and amino acids. The inorganic part of the sialolith remained stable even at temperatures up to 1,673 K. The spectroscopic studies indicated that the structure of the sialolith is similar to that of the dentine part of the human teeth. In situ disintegration of the sialolith involves very high temperature. High calcium and phosphorous content in the food may be attributed to one of the reasons for the formation of sialoliths.