Palato-Antral Involvement of a Primary Extracranial Sinonasal Meningioma

Primary extracranial sinonasal meningiomas are one of the rarest tumours involving the head and neck region. Very few reports exist with additional involvement of the palato-antral region. This paper describes a case of primary extracranial sinonasal meningioma with palatal involvement and the management of the same.  The patient was taken up for surgical excision via intra-oral and endoscopic approaches.  Postoperative healing was uneventful with no recurrence noted over 2 years. A palatal obturator was used for rehabilitation. The diagnosis of this pathology needs additional immunohistochemistry testing for confirmation and treatment entails complete surgical excision which assures no recurrence or delayed presentation of residual disease in follow-up. Keywords: primary extra cranial  meningioma; sinonasal; maxilla ; palate

Pterygoid implant: Option for rehabilitation of the atrophic posterior maxilla

Background: The anatomy of the atrophic posterior maxilla presents many limitations to implant placement. Factors affecting implant placements include poor bone quality and quantity, location of maxillary sinus. Posterior cantilevers on implant prostheses produce complications, such as prosthesis fracture, screw loosening, loss of osseointegration, and crestal bone loss. Pterygoid implants are an alternative to grafting solutions for posterior maxillary rehabilitation. Aim: This systematic review describes various implant treatment options for posterior maxillary rehabilitation. It highlights the use of pterygoid implants as a graftless solution with its anatomy, technique of placement, and advantages. Conclusion: Pterygoid implants have high success rates, less bone loss, and good acceptance by patients thus being an excellent alternative to treat patients with severely atrophic maxilla. Clinical Significance: Pterygoid implants avoid the need for sinus lifts and grafting procedures. They allow anchorage in the posterior atrophied/resorbed maxilla, achieving proper stability, and high rates of long-term succ

HEPARIN INDUCED SUBLINGUAL HEMATOMA: A RARE ORAL COMPLICATION

lingual and sublingual hematoma is a rare complication following heparin therapy which may result in serious life-threatening airway obstruction. A 75-year-old female with ischemic heart disease was heparinized for percutaneous transluminal coronary angioplasty of the left anterior descending artery leading to sublingual hematoma with difficulty in swallowing and breathing. This paper presents a case report and management of sublingual hematoma following heparin therapy

Cervical lymph node metastasis in squamous cell carcinoma of the buccal mucosa:a retrospective study on pattern of involvement and clinical analysis

The study was performed with an aim to map the pattern of metastasis of squamous cell carcinomas of buccal mucosa to various cervical lymph node levels and analyze its correlation with primary tumor size and histo-pathological grading. 254 patients with squamous cell carcinoma of the buccal mucosa treated with surgery first approach were analyzed retrospectively. The tumor size was noted from pre-operative CT Scans and were divided into early and advanced tumors. The resected specimen was studied to note the histo-pathological grading of the squamous cell carcinoma and the metastatic deposits at various lymph node levels. Out of 254 patients (149 females, 105 males), 145 patients showed histo-pathologically proven metastatic deposits in one or more lymph nodes out of which there were 56 patients showing occult metastasis. 78/145 patients showed metastatic involvement of level IB and/or IA lymph nodes, 31 showed involvement of level II and/or I lymph nodes, 27 showed involvement of level III with or without involvement of level I and II and 9 showed metastasis to level IV and V lymph nodes with or without level I, II or III lymph nodes. Cervical lymph node metastasis had statistically significant association with tumor size with advanced tumors showing worse pattern of metastatic spread beyond level I and II lymph nodes. As the degree of differentiation of squamous cell carcinoma reduced, they were more prone for cervical metastasis with moderately and poorly differentiated squamous cell carcinoma showing higher involvement of level III, IV and V lymph nodes. The majority of buccal mucosa cases showed metastasis to level I, II and III lymph nodes out of which level IB and/or IA was most frequently involved. Metastasis to level IV and V lymph nodes was rare and was seen especially in patients with advanced primary tumor and poor histo-pathologic differentiation

Central giant cell granuloma: An uncommon presentation

Central giant cell granuloma is a benign, non odontogenic lesion accounting for fewer than 7% of all benign tumors of the jaws. It commonly occurs in anterior mandible with a female prediction in ages below 30yrs. Multiple treatment modalities have been used with varying degrees of success, there is no accepted algorithm for therapeutic intervention. Surgical treatment has been the traditional accepted modality reducing chances of recurrence. Non-surgical treatments with alpha interferon (a-IFN), calcitonin, Denosumab and corticosteroids have been described in literature as adjuvants or as definitive treatments. This case report reviews presentation and currently used therapies for CGCG while describing a uncommon case of central giant cell granuloma occurring in a 45 year old female who presented with a swelling in relation to the left edentulous mandible. Surgical curettage of the lesion along with reconstruction and local delivery of steroid in the cavity was done allowing for the best esthetic and functional result with no recurrence during follow up. Keywords: Central giant cell granuloma, Edentulous mandible, Surgical curettage, Steroid

Keratocystic Odontogenic Tumor Involving Maxillary Antrum

Keratocystic odontogenic tumor (KCOT) is a benign intraosseous neoplasm of the jaw which is derived from epithelial remnants of the tooth germ and basal cells of the overlying oral epithelium. The occurrence of KCOT in the maxilla is very less compared to the mandible. The incidence of KCOT in maxillary sinus with impacted third molar is very uncommon. This paper reports such a case of KCOT associated with maxillary third molar involving maxillary sinus, diagnosis and treatment of which was based on thorough radiographic evaluation. Very few cases have been reported so far in literature pertaining to the same

Significance of cervical node necrosis in preoperative MRI as a prognostic indicator: retrospective study of patients with SCC of tongue

Aim: To ascertain the prognostic value of cervical nodal necrosis (CNN) observed in patients of tongue squamous cell carcinoma with magnetic resonance imaging. Materials and methods: In this retrospective observational study, records of 144 patients diagnosed with newly diagnosed SCC of tongue were considered. Preoperative MRI study, demographic and clinical data were reviewed. Based on MRI reports, patients were categorised into: with or without the presence of cervical node necrosis (CNN or non CNN). Subsequent treatments, histopathological reports and follow up data were studied to determine key prognostic elements, overall survival and disease free survival by statistical analysis. Results: The incidence of CNN was 55.55% in the study sample. CNN category, depth of invasion, N stage and extra nodal extension were significant negative prognostic factors for overall and disease free survival. Conclusion: Based on our results, pre operative MRI based presence of cervical node necrosis in tongue squamous cell carcinoma is an independent prognostic indicator for poor overall and disease free survival. Long term prospective studies with larger cohorts could be undertaken to establish its role as an important biomarker for precision treatments