A Rare Condition of Ameloblastoma Transforming into Ameloblastomic Carcinoma - A Case Report

Rationale

Ameloblastic carcinoma is defined as an ameloblastoma in which there is histological evidence of malignancy in primary tumour or recurrent tumour regardless if it has metastasised or not. It is aggressive in nature.

Patient Concerns

The patient presented with a painful swelling associated with restricted mouth opening.

Diagnosis

This is the clinical profile of a patient who has presented with a recurrent ameloblastic carcinoma.

Treatment

Histological features of the excised specimen resemble ameloblastic carcinoma constituting cytological atypia with tall columnar cells.

Outcome

Excision of tumour was done. Reconstruction was done using pectoralis major myocutaneous flap.

Take-away Lessons

Ameloblastic carcinoma is an aggressive tumour and constitutes destruction and distant metastatic spread. Hence, aggressive resection is the choice of treatment along with a long-term follow-up for better quality of life.

Management of Alveolar Cleft Defect by Iliac Crest Secondary Bone Grafting: A Case Report

Aim and objective

This case report aims to describe the management of alveolar cleft defect by iliac crest secondary bone grafting.

Background

The secondary alveolar bone grafting performed during the mixed dentition period is an essential module of modern-day rehabilitation of cleft lip and palate patients with alveolar defects. Iliac crest bone graft is a frequent secondary graft used and is technique sensitive.

Case description

A 12-year-old girl with alveolar cleft defect having problems with speech and regurgitation of fluids from nostril was presented and its management by a combination of iliac crest bone grafting and platelet-rich fibrin (PRF) was described.

Conclusion

One year recall radiograph showed successful bone augmentation with this secondary alveolar bone grafting along with application of platelet rich plasma (PRP).

Clinical significance

Osseous integration can be enhanced by PRP application over the graft which gives greater clinical outcome with less invasiveness.

How to cite this article

Vemagiri CT, Damera S, Pamidi VRC, et al. Management of Alveolar Cleft Defect by Iliac Crest Secondary Bone Grafting: A Case Report. Int J Clin Pediatr Dent 2022;15(4):472-474.

Embryonal rhabdomyosarcoma of external ear - A rare case report

The Rationale:

Rhabdomyosarcoma (RMS) is an uncommon tumour which presents at a wide variety of different head and neck sites. They are highly aggressive malignant mesenchymatous soft tissue sarcomas. Their occurrence in the outer ear is extremely rare.

Patient Concerns:

A 17-year-old female patient reported with a chief complaint of steady increase in growth over the left ear since 6 months, which is not associated with pain and ulceration.

Diagnosis:

Edge biopsy sections of the swelling over the left pinna and immunohistochemistry records of cells show MYODI positive confirming as Embryonal RMS.

Treatment:

Left auriculectomy and supra-omohyoid neck dissection with level V lymph node was performed.

Outcomes:

Uneventful postoperative healing in the resected site was elicited in the follow-up period of 1 year with no recurrence.

Take-away Lessons:

External ear RMS is extremely rare. Careful clinical, radiological and histopathological evaluation are essential for prompt definitive diagnosis and for successful management.

Oral malignant melanoma

Malignant melanoma in the head and neck area is rare. The incidence of oral malignant melanomas of the head and neck is approximately four per 10 million populations per year. They are derived from epidermal melanocytes and are most frequently seen on the palate and maxillary gingiva. They are asymptomatic initially but become painful with progress and enlargement. Later, they are associated with ulceration, bleeding, mobility of tooth, paresthesia and ill-fitting prosthesis. The diagnosis is often delayed due to silent growth and development of the lesion. Oral malignant melanomas are associated with poor prognosis due to their invasive and metastasizing tendencies. This case report is presented to emphasize the role of a dentist in identifying the pigmented lesions of the oral cavity.

Evaluation of use of distraction osteogenesis in mandibular retrognathia and its effect on soft and hard tissues and airway

Objectives:

Bone distraction is the process of new bone formation between the surfaces of bone segments gradually separated by incremental traction of soft tissues. These adaptive changes in the soft tissues allow for greater skeletal movements while minimizing the potential relapse. In this study, we are reporting our clinical experience with mandibular distraction used to achieve simultaneous skeletal and soft-tissue correction with distraction osteogenesis (DO).

Methodology:

A total of five patients who reported to the department for the treatment of mandibular deficiencies were selected. Cephalometric studies were done preoperatively and postoperatively for hard tissue assessment. Predefined reference points were used for the clinical evaluation for the evaluation of soft tissues. Results were compared between preoperative and 1^st-, 3^rd-, 6^th-, and 12^th-month postoperatively.

Results:

The clinical observations in our study showed that there is a remarkable improvement in the facial esthetics. Cephalometric analysis has shown lengthening of the mandibular corpus and increase in the height of the vertical ramus. Certain minimal complications have also been noted.

Conclusion:

Despite the few complications, DO has become a popular surgical modality due to its many advantages.

Human Subthalamic Nucleus Theta and Beta Oscillations Entrain Neuronal Firing During Sensorimotor Conflict

Recent evidence has suggested that prefrontal cortical structures may inhibit impulsive actions during conflict through activation of the subthalamic nucleus (STN). Consistent with this hypothesis, deep brain stimulation to the STN has been associated with altered prefrontal cortical activity and impaired response inhibition. The interactions between oscillatory activity in the STN and its presumably antikinetic neuronal spiking, however, remain poorly understood. Here, we simultaneously recorded intraoperative local field potential and spiking activity from the human STN as participants performed a sensorimotor action selection task involving conflict. We identified several STN neuronal response types that exhibited different temporal dynamics during the task. Some neurons showed early, cue-related firing rate increases that remained elevated longer during high conflict trials, whereas other neurons showed late, movement-related firing rate increases. Notably, the high conflict trials were associated with an entrainment of individual neurons by theta- and beta-band oscillations, both of which have been observed in cortical structures involved in response inhibition. Our data suggest that frequency-specific activity in the beta and theta bands influence STN firing to inhibit impulsivity during conflict.

Surface based electrode localization and standardized regions of interest for intracranial EEG

Intracranial recordings captured from subdural electrodes in patients with drug resistant epilepsy offer clinicians and researchers a powerful tool for examining neural activity in the human brain with high spatial and temporal precision. There are two major challenges, however, to interpreting these signals both within and across individuals. Anatomical distortions following implantation make accurately identifying the electrode locations difficult. In addition, because each implant involves a unique configuration, comparing neural activity across individuals in a standardized manner has been limited to broad anatomical regions such as cortical lobes or gyri. We address these challenges here by introducing a semi-automated method for localizing subdural electrode contacts to the unique surface anatomy of each individual, and by using a surface-based grid of regions of interest (ROIs) to aggregate electrode data from similar anatomical locations across individuals. Our localization algorithm, which uses only a postoperative CT and preoperative MRI, builds upon previous spring-based optimization approaches by introducing manually identified anchor points directly on the brain surface to constrain the final electrode locations. This algorithm yields an accuracy of 2 mm. Our surface-based ROI approach involves choosing a flexible number of ROIs with different spatial resolutions. ROIs are registered across individuals to represent identical anatomical locations while accounting for the unique curvature of each brain surface. This ROI based approach therefore enables group level statistical testing from spatially precise anatomical regions.