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   Table of Contents - Current issue
April-June 2020
Volume 32 | Issue 2
Page Nos. 93-202

Online since Saturday, June 27, 2020

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From the desk of editor in chief Highly accessed article p. 93
Dipti Bhatnagar
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Tribute to Dr. Aspi B. Surveyor (30th November 1933 - 3rd May 2020) p. 94
Hemant R Umarji
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Tribute to Dr. Soheyl Sheikh (17th April 1968 - 31st May 2020) Highly accessed article p. 95
Vaishali Keluskar Dr.
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Maxillary anterior cortical bone thickness: An imperative parameter for implant solidity - 3-dimensional cone beam CT study Highly accessed article p. 96
Shalu Rai, Deepankar Misra, Mansi Khatri, Tarun Vyas, Poulomi Bhakta, Priyank Mallick
Background: This study aims to evaluate alveolar height, buccal, and palatal cortical bone thickness using cone beam computed tomography (CBCT) useful for radiological pre-assessment for various surgical procedures of maxillary anterior region. Materials and Methods: Maxillary central and lateral incisors and canines were bilaterally evaluated in 200 selected patients. Images were obtained with New Tom CBCT and traced with New Net Technologies software. Alveolar height and cortical bone thickness at 3 mm, 6 mm, and 9 mm above the cemetoenamel junction were measured and statistically analyzed. Results: Significant differences in alveolar height were found genderwise and agewise and were found to be highest in age groups of 51–60 years and lowest in 11–20 years. Buccal thickness at 3 mm, 6 mm, 9 mm was highest in right central incisor, right central incisor and left central incisor and lowest in right canine, left canine and left canine, respectively. Palatal thickness at 3 mm, 6 mm, 9 mm was highest in right central incisor, left central incisor and left central incisor and lowest in left canine, left canine, and left canine, respectively. Bucco-palatal thickness at 3 mm, 6 mm, 9 mm was highest in left canine, right central incisor and left central incisor and lowest in right lateral incisor, respectively. Agewise and genderwise significant differences in buccal and palatal bone were found at different levels. Conclusion: Buccal bone is thinner than palatal bone; thus, require careful radiological appraisal in orthodontic tooth movement and any surgical procedure in this region.
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Effects of smoking on hemoglobin and erythrocytes sedimentation rate and its association with ABO blood groups p. 103
R Thriveni, P Manshi, D N S V Ramesh, Bharathi Rachel, Amit Byatnal, Pragati Kempwade
Context: “Smoking causes variation in different parameters of blood like hemoglobin (Hb) and erythrocyte sedimentation rate (ESR).” Continuous exposure to carbon monoxide leads to the formation of carboxyhemoglobin, an inactive form of Hb with no oxygen-carrying capacity; carboxyhemoglobin also leads to shifting in the Hb dissociation curve on the left side, causing a reduction in the ability of Hb to deliver oxygen to the tissue. Aims: The aim of this study was to compare the effect of cigarette smoking on Hb and ESR between smokers and nonsmokers and its association with ABO blood groups. Settings and Design: A total of 100 subjects which included 50 smokers and 50 age-matched nonsmoker controls were included in this study. Material and Methods: 5 ml of venous blood was collected by venipuncture method and Hb was measured by cyanmethhemoglobin method, ESR by Westergren's method, and ABO blood grouping by slide method. Statistical Analysis Used: Statistical software SPSS version 20 (SPSS, Chicago, Illinois) was used. Student's t test was performed for parametric numerical data and Chi-square test was performed for nonparametric categorical data. A value of P < 0.05 was considered statistically significant. Results: The mean Hb was 16.83 g/dL in smokers and 14.42 g/dL in nonsmokers. The mean ESR was 5.36 mm in smokers and 3.96 mm in nonsmokers. Conclusions: A significant increase was seen in Hb and ESR in smokers when compared to nonsmokers. No significant association was seen between the ABO blood groups among smokers and nonsmokers.
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Efficacy of ultrasound in the diagnosis of swellings of orofacial region: An original research p. 107
Mallika Kishore, Abhijeet Alok, Shivani Singh, Abhinav Kishore, Sunil R Panat, Vikash K Sah
Introduction: Accurate diagnosis of a head and neck swelling is of paramount importance. Various disease processes may affect head and neck regions which present clinically as swellings. Aims and Objectives: This study aimed to evaluate the efficacy of ultrasonography (USG) in the diagnosis of swellings of the head and neck regions. The objectives of this study were to assess the reliability of USG in differentiating various swellings of head and neck region and to correlate between diagnosis of swellings by clinical, histopathological, and by USG. Materials and Methods: A total of 70 patients with an age range of 15–70 years and clinically obvious swellings in the head and neck region were included. After clinical examination, all the seventy patients were subjected to ultrasonographic investigation. Features like shape, boundary, echo intensity, presence of necrosis and calcifications, and posterior echoes were considered in describing the ultrasonographic images of swellings. Following clinical and ultrasonographic diagnosis, surgical intervention was carried out. The obtained biopsy specimens were submitted for histopathological examination and a final diagnosis was made. Statistical Analysis: The collected data were subsequently processed and analyzed using the SPSS statistical package version 17. Results: The diagnostic accuracy of ultrasound was found to be 98% in the diagnosis of cystic lesions, 98.47% in benign tumors, 98.57% in malignant tumors, 100% in lymphadenopathies, and in muscle origin and 94.29% in space infections and abscesses. Conclusion: It can be concluded that, together with clinical and histopathological examinations, USG works out as a valuable adjunct in the diagnosis of orofacial swellings.
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Critical thinking skills among the oral medicine postgraduate students of Tamilnadu and Puducherry - A pilot study p. 115
Sarvathikari Ramasamy, NG Mogeshvaar, GK Divyapriya
Background: Critical thinking is the mental process of active and skillful perception, analysis, synthesis and evaluation of collected information through observation, experience, and communication that leads to a decision for action. Critical thinking applies to dentists in the process of solving the clinical conditions of patients and making crucial decisions for diagnosis and intervention. Aim: To assess the critical thinking skills (CTS) among oral medicine postgraduate students of dental colleges in Tamilnadu and Puducherry. Methodology: A convenience sampling method was used. The clinical scenario-based validated self-designed structured questionnaire was administered. The questionnaire was prepared using Google forms and the link was sent through WhatsApp among Oral Medicine postgraduate students. Descriptive statistics and Chi-square test were used for statistical analysis. A P value of less than 0.05 was considered to be significant. Results: A total of 49 responses were obtained. The participants who obtained the score >5 were considered to be high-level critical thinkers and those who obtained a score ≤5 were considered to be low-level critical thinkers. High-level critical thinkers among first, second, and third year postgraduates are 2 (12.5), 7 (43.8), and 7 (43.8). Similarly, low-level critical thinkers are 12 (36.4), 10 (30.3), and 11 (33.3) respectively. The association between the years of course and critical thinking skills were not statistically significant. Conclusion: The subjects with higher critical thinking score were less among oral medicine postgraduate students. Therefore, it is essential to pay more attention to improving critical thinking in clinical practice.
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Relationship of bone mineral density with panoramic radiomorphometric indices in tobacco users in India p. 119
B Suman, Anju Redhu
Background: Osteoporosis is a crippling disease that can eventually culminate in fracture. Smoking and smokeless tobacco (SLT) use are important contributors to this disease. Decreased bone mineral density (BMD) which marks osteoporotic bone changes are assessed using dual energy X-ray absorptiometry (DXA). Panoramic radiomorphometric indices (RI) which are inexpensive and widely used in dentistry also provide architectural details of jawbones. Hence the study was attempted to find the relationship between BMD and panoramic RI in tobacco users in the Indian Population. Materials and Methods: The hundred subjects were divided into study groups comprising 25 smokers, 25 SLT users, 25 subjects with a combination of habits, and 25 healthy controls were subjected to BMD assessment using DXA scan and digital panoramic radiographs for calculation of mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI). Results: SLT users had the least values of BMD (P <0.05). Both MI and PMI were markedly reduced in SLT users and had a strong positive correlation to BMD (r=0.600, P- value -0.002 for MI and r= 0.428, P value -0.033 for PMI). A strong negative correlation of MCI to BMD (rs= -0.510, P- value 0.009), MI (rs= -0.632, P- value-0.001),and PMI (rs= -0.432, P- value 0.031) was noted in SLT users with a maximum number of C3 found among them. However, no significant correlation of BMD with RI was obtained in smokers. The practise of both smoking and SLT showed a significant positive correlation of BMD to MI and PMI. Conclusion: Tobacco was found to have detrimental effects on BMD, well reflected in RI of MCI, MI, and PMI, thus, oral physicians must screen and educate tobacco users, particularly, SLT users for impaired bone health and refer them promptly for suitable treatment.
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Knowledge and practices of 3d printing in dental practitioners of Maharashtra: A cross-sectional study p. 127
Amol A Dhokar, Swarali Y Atre, Sunanda Bhatnagar, Nikhil V Bhanushali
Background: 3D printing has revolutionized dentistry. Along with 3D imaging, its use ranges from surgical planning, dental implants, and aligners to prosthodontic appliances and even study models. Aims: To assess the knowledge and practices of dental practitioners regarding the use of 3D printing in dentistry. Settings and Design: A cross-sectional study was conducted in the form of a self-administered online questionnaire consisting of 19 questions which was circulated among the dental practitioners of Maharashtra. Methods and Material: The survey's Google link was generated and sent to the willing participants via various social media platforms and e-mails. Statistical Analysis: SPSS version 17 software was utilized and Chi-square test was applied. Results: 85.2% of the respondents were aware about dental 3D printing. 47.6% knew its working principle. 52.5% knew the pre-requisites, while 58.7% were unaware of the best material for dental 3D printing. Only 55.5% were aware of all of its indications. Just 38.7% had an experience of either observing or working with this technology of which 78.7% thought that it had enhanced their ability to execute the surgical procedure. 61.3% had no experience of this technology, the reason mostly being unavailability in their area of practice and the technology being expensive. A statistical difference was found in the knowledge and practices based on age, sex, education, and experience with P value <= 0.05. Conclusion: Knowledge of 3D printing in the dental fraternity is necessary due to its wide applications in multitude of dental specialities. Its introduction at an institutional level with optional hands-on trainings shall ensure its use efficiently.
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Don't rush, first brush: A comparative study between Modified Brush Biopsy (MBB) and Liquid-Based Cytology (LBC) p. 134
Parul V Bhatia, Bhavin B Dudhia, Twinkal S Patel, Rutu K Jani, Ekta M Shah, Roseline A Patel
Introduction: Oral cancer accounts for 2–4% of all malignant tumors worldwide with the percentage going much higher in the Indian subcontinent. Many of these lesions are in the advanced stage at the time of diagnosis. Research is always on for newer techniques to improve early detection and diagnosis of oral malignancy. Oral brush biopsy is one such technique. Aims and Objectives: The aim of the study was to evaluate and compare the clinical usefulness of two modified oral brush biopsy techniques in the early detection of oral cancer. Study Design: Two modified oral brush biopsy techniques, one performed with a baby brush spreading the cells directly on slide and then fixed and another with a specially prepared brush submerged in a liquid fixer, were performed in 24 patients having oral submucous fibrosis clinically. These were followed by punch biopsy (as a gold standard). All specimens were analyzed for cytology and histopathology manually. Results and Conclusion: Modified brush biopsy (MBB) and liquid-based cytology (LBC) both can be potential methods for early detection of oral cancer in different conditions.
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CBCT-based active contour segmentation of bone invasion in oral squamous cell carcinoma - A preliminary retrospective study p. 140
Shilpa Shree Kuduva Ramesh, Jayachandran Sadaksharam
Context: Bone invasion by oral squamous cell carcinoma (OSSC) alone forms a predictor of overall prognosis, survival rate. Volume of actual bone osteolysis might give valuable information for treatment planning rather than planar measurements. Aim: To compare the manual and semiautomatic active contour segmentation in the volumetric analysis of mandibular bone invasion by OSCC through Cone Beam Computed Tomography (CBCT). Settings and Design: Hospital-based, preliminary, retrospective study. Methods and Material: Ten CBCT DICOM images of histologically confirmed cases of OSCC with frank bone invasion in the mandible were selected from the archive after satisfying our inclusion and exclusion criteria. Volumetrical analysis of tumor eroded area in the mandibular alveolus were done through ITK SNAP software (version 3.2) both by manual and semiautomatic segmentation and compared with each other. Statistical Analysis Used: R statistical computing software v3.6.3 (R core foundation, Vienna) was used. Intraclass correlation coefficient (ICC), Bland and Altman method, Passing Bablok analysis with Pearson's Correlation, Dice Similarity coefficient (DSC) were done for single examiner reliability, comparison of volumes and segmentation accuracy respectively. The third metric, that is, time needed for each segmentation method was also compared and statistically analysed. Results: Since Pearson's correlation coefficient of r = 1 and P value was 0.233 (>0.005), semiautomatic method of volumetric segmentation proved to be as accurate and reproducible as manual method without any significant volume difference. In addition to that, semiautomatic method was 10 times more rapid than manual method. Conclusions: This is the first kind of study in the literature showing the feasibility of active contour semiautomatic segmentation in the volumetric analysis of bone invasion caused by the OSCC which might be helpful in efficient oncological treatment planning.
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Comparative study to analyse the correlation between dermatoglyphics and impacted teeth p. 145
D N S V Ramesh, R Thriveni, Bellam B Rachel, P Manshi, Amit Byatnal, Pragati Kempwade
Background and Aims: Dental impaction is a serious challenge to the dental practitioners. Treatment for impaction is a complex procedure. During embryogenesis, the ridged skin and teeth develop from the same layer,. hence, suggesting that the genetic information in the genome is dissipated during this period, and any disturbance affecting tooth development and structure will be simultaneously reflected through change in dermatoglyphic patterns. This study aims to analyse the correlation between dermatoglyphics pattern variations and impacted teeth. Settings and Design: 100 patients, 50 impacted and 50 healthy patients, were selected who are attending to the department of oral medicine and radiology between the age group of 18-40 years. Methods and Materials: The fingerprints of both the hands were obtained using the duplicating ink pad. The fingertip patterns were analysed according to the classical method, and configurational types were classified according to the topological method. Statistical Analysis: The data obtained were subjected to statistical analysis using SPSS version 20.0 and the test of proportion and Chi-square test was used for the analysis. Results: Whorl type of fingerprints were observed more in impacted teeth patients whereas loop type of fingerprints was observed more in healthy patients. Conclusions: There is a significant correlation between impacted teeth and Dermatoglyphics and it can be used as a predilection marker.
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Prevalence of tobacco associated oral mucosal lesions in the population of Mahabubnagar District of Telangana State: A cross-sectional study p. 149
Ramesh Kumar Koothati, D Rama Raju, Ch Leela Krishna Prasad, Bhavana Sujanamulk, Ankit Srivastava, Kotya Naik Maloth
Aim: We aimed to evaluate the prevalence of tobacco-associated oral mucosal lesions in Mahabubnagar district of Telangana state in South India. Methodology: A cross-sectional study was conducted in Mahabubnagar district for 6 months on 3200 subjects of both rural and urban people and the study was carried out by conducting camps at the Government Hospitals to assess the prevalence of oral mucosal lesions. People aged from 16 to 75 years, both men and women in same proportions, were included in the study. Results: 750 subjects had the habit of tobacco usage among a total of 3200 subjects. Among the 750 subjects, 225 (30.0%) subjects were being diagnosed with oral mucosal lesions. Of 225 subjects, 6 (2.67%) subjects had erythroplakia, 22 (9.78%) subjects had leukoplakia, 58 (25.78%) subjects had lichenoid reaction, 62 (27.56%) subjects had oral submucous fibrosis (OSMF), 45 (20.0%) subjects had palatal hyperkeratosis, and 32 (14.22%) subjects had tobacco pouch keratosis. Conclusion: From this study, we can conclude that prevalence of oral mucosal lesions was seen in tobacco-related oral habits where palatal hyperkeratosis was found among smokers; similarly OSMF was more among tobacco chewers and potentially malignant disorders were more prevalent in tobacco chewers than smokers.
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Gender determination using mandibular ramus and gonial angle on OPG p. 154
Heena Mehta, S Bhuvaneshwari, Mohit P Singh, Prashant Nahar, Kanishk Mehta, Tulika Sharma
Background: The forensic osteologist is usually asked to provide information that may confirm, or assist in determining, the identity of an individual from their skeletal remain. Mandibular ramus can differentiate between the two genders as the stages of mandibular development, growth rates, and duration are distinctly different in both sexes. Aim: To measure and evaluate the various dimensions of the mandibular ramus and the angle of the mandible as observed on orthopantomogram (OPG) and compare it with both sexes. Setting and Design: It is a retrospective study where OPG of 900 mandibles were studied on each side and analyzed to evaluate gender variations. Materials and Methods: KODAK 8000C Digital Panoramic and Cephalometric System and Masterview 4.5.4 software was used for data tabulation. Statistical Analysis: Descriptive analysis was used to analyze the results. Result and Conclusion: Mandibular ramus breadth and gonial angle have been found to be the most reliable parameters in gender determination
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Fullerene and its applications: A review p. 159
Poulomi Bhakta, Bhavna Barthunia
Fullerene molecules are composed entirely of carbon, in the form of a hollow sphere, ellipsoid, or tube. Fullerenes in the cylindrical form are called carbon nanotubes (CNTs) or buckytubes and fullerenes in the spherical form are referred to as buckyballs. The CNT represents one of the unique inventions in nanotechnology. CNTs have been studied closely over the last two decades by many researchers around the world for their great potential in different fields. Fullerenes have attracted considerable attention in different fields of science since their discovery in 1985. Their unique carbon cage structure coupled with immense scope for derivatization makes them a potential therapeutic agent. The fullerenes can be utilized in organic photovoltaic (OPV), portable power, medical purpose, antioxidants, and biopharmaceuticals and dentistry.
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COVID-19 pandemic and safe dental practice: Need of the hour p. 164
G Anup Kumar, Remya Mohan, Darshan R Prasad Hiremutt, K Bala Vikhram
The COVID-19 pandemic has spread across the globe and is the greatest challenge faced by world nations today. The first outbreak of this disease occurred in a seafood market of Wuhan City, China. The community pattern of spread was alarming and has gripped the entire international society. The dentists and other health care professionals should take stringent measures to prevent the spread of infection while providing care. In this article, we discuss the etiology, clinical manifestations, route of transmission, general and specific infection control protocols to protect the dental health care professionals as well as patients from COVID 19 disease while providing emergency dental care.
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Delve into the third dimension: Pertinence of 3D printing in forensic odontology p. 172
Alekhya Kanaparthi, Tejaswi Katne, Ramlal Gantala, Srikanth Gotoor
Three-dimensional (3D) printing is the forerunner in today's digital dentistry. It has revolutionized the field of healthcare and is making critical in roads today in forensics, driven primarily by its superior customization propensity. Application of this technique allows presentation of any evidence of human origin without any bias, with minimal degradation thereby reducing subjective errors. 3D printing has several applications, and this article is an attempt to enhance the knowledge of the forensic expert and to give an insight on its possible applications in forensic odontology.
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Minor salivary gland mucoepidermoid carcinoma in an adolescent - A curious clinical presentation p. 178
MS Archana, Anu Babu, Geeta Sharma
Salivary gland tumors (SGTs) are classified as benign, malignant epithelial, soft tissue, hematolymphoid or secondary tumors. SGTs commonly affect the parotid gland and among the minor salivary glands, the hard palate is the commonest site as it harbors the highest number of salivary glands. According to various statistics, mucoepidermoid carcinoma (MEC) represents less than 0.5% of all the malignancies and less than 5% of malignant head and neck tumors. As the tumor can arise from different cells of excretory ducts these tumors often display a diverse biological behavior and unusual clinical presentation. We report a case of MEC which has a low incidence in adolescents with a rare clinical appearance.
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Phakomatosis pigmento vascularis with bulbar melanosis and oral changes in an Indian male patient - A rare case report p. 182
Anudeep Raina, SV Ravindra, MK Sunil, Geetanjali Jina
Phakomatosis Pigmento Vascularis (PPV) refers to a developmental abnormality characterized by concurrence of pigmented and capillary malformation with or without systemic manifestations. Abnormal development of melanocytic nevus cells and vasomotor neural cells arising from the neural crest has been attributed in the pathogenesis of PPV. It is classified into 5 major subtypes. Although there is no sex predilection, a preponderance of these cases has been noted in Japan. Through this rare case report, we describe the oral changes of PPV type II b in a 28 year old Indian male patient.
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A rare case of parotid gland lipoma arising from the superficial lobe of the parotid gland p. 186
Danaveni Raju, Goud G Srikanth, Arutla Rashmitha, Shivaranjani Kistareddy
A lipoma is a fatty tissue tumor presenting as a painless slowly growing mass that arise in any location where fat is normally present. It is a soft tissue tumor of the mesenchymal origin, quite uncommon in the head and neck region, only occurring in about 15% of all cases. Posterior cervical triangle and forehead are usually the sites of occurrence, with very few cases occurring in oral cavity, pharynx, larynx, parotid and parapharyngeal space. Lipoma affecting the parotid gland is extremely rare, consisting of only 0.6–4.4% of all parotid tumors. Considering the rarity, here we report a case of 55-year-old male who presented with swelling in the left parotid region.
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Aggressive osteolytic lesion of mandible - A case report p. 189
Deepa J Patil, Rahul Thakur, Manjiri Joshi, Rashmi Phulare
Odontogenic tumors are rare entities, often derived from epithelial remnants in the gnathic bones following odontogenesis. Ameloblastoma is benign locally invasive accounting for 1% of tumors of jaws. Among the various ameloblastoma, solid multicystic ameloblastoma is believed to be locally aggressive lesion that has the tendency for recurrence. In this report, we present a large aggressive solid multicystic ameloblastoma in a 33-year-old male patient diagnosed by computed tomography and successfully managed by hemimandibulectomy with simultaneous reconstruction using fibula. We have also briefly discussed the molecular pathogenesis and new treatment aspects of ameloblastoma.
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”Myxoma of the Jaws”: Report of an atypical presentation and review of literature p. 192
Giridhar S Naidu, Ramanpal S Makkad, Gopakumar R Nair, Ravleen Nagi
Oral lesions of myxomatous origin are relatively rare and include nerve sheath myxomas, soft tissue myxomas, oral focal mucinosis, and odontogenic myxomas. These lesions have a common histologic appearance of abundant myxoid ground substance. A 61-year-old edentulous female presented with nasal stuffiness since the past 4 months. Clinical examination revealed an asymptomatic intraoral swelling in the edentulous maxillary ridge which had ulcerated. Plain film radiography and CT showed an expansile osteolytic lesion involving the right maxillary sinus. A partial maxillectomy was performed and direct microscopy showed a predominant embryonic mesenchymal stroma with fibroblasts and calcifications suggestive of a myxoma. The central myxoma is hypothesized to originate from the odontogenic apparatus due to its almost exclusivity to the jaw bones. However, when a central myxoma occurs in an edentulous jaw at an age when the odontogenic apparatus is apparently nonfunctional, explaining the genesis of this unique tumor based on present understanding becomes difficult. We present one such case while reviewing the existing literature on the present concepts of pathogenesis.
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Oral verruciform xanthoma: The great imitator p. 196
Sweety Lalawat, Nalini Tomar, Arati Chaudhary, Vanaja Reddy
Oral Verruciform xanthoma (OVX) is an uncommon benign muco-cutaneous lesion having various concepts regarding its etiopathogenesis. Intraorally, this usually occurs on the gingiva and alveolar mucosa. Often asymptomatic, this lesion presents with a flat to verruco-papillary surface morphology. The clinical features of OVX can be misleading and resembles diverse hyperplastic, non-malignant, potentially malignant, and malignant lesions of the oral cavity. Histopathological examination is a key for the diagnosis of this lesion with xanthoma cells being the hallmark. Surgical excision remains the treatment modality and recurrence is rare. This paper presents a case of oral verruciform xanthoma on the buccal mucosa, mimicking a potentially malignant lesion, and a review of its major clinical, histological features and differential diagnosis.
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Paget's disease of bone: A rare case report p. 199
Mohsin M Tak, Altaf H Chalkoo, Tauseefa Jan
Paget's disease of bone (PDB) is a localized bone remodeling disorder that is chronic, non-inflammatory.. It is also known as “osteodystrophia deformans” as described by Sir James Paget. PDB is the second most common bone disease after osteoporosis. This disease is found to be relatively more common in older people, occurs in approximately 3–4% of the population aged over 50 years with a slight male gender predilection. Jaw involvement is seen with the ratio of maxilla to mandible 2:1.
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