Granular cell tumor of the tongue in a 6-year-old girl : A case report

Granular cell tumor is a relatively uncommon benign hamartomatous lesion occurring in almost any part of the body. The tongue and the buccal mucosa are common intra oral sites. Granular cell lesions may be found in other diverse sites such as the jaw, skin, gastro intestinal tract and respiratory tract. The histogenesis of the lesion still remains unknown. However, histochemical and ultra structural studies propose the origin of the lesion from schwann cells, striated muscle, mesenchymal cells, histiocytes and epithelial cells. The tumor generally occurs in middle or older aged adults. The lesion is typically seen as an uninflammed asymptomatic mass measuring about two cms in diameter with a yellowish surface coloration. As most of the granular cell tumors are benign, surgical excision of the lesion is the treatment of choice. We describe a case of granular cell tumor of the tongue in a 6 year old girl along with a brief review of literature on granular cell tumors

Feasibility of training community health workers in the detection of oral cancer

Importance: Visual screening for oral cancer has been found to be useful in a large randomized clinical trial in Kerala, India, showing substantial reduction in mortality. To address the shortage of medical personnel in resource-deficient regions, using the services of community health workers has been proposed as a strategy to fill the gap in human resources in health care. Objective: To assess the feasibility of community health workers in screening and early detection of oral cancer using a mobile application capturing system. Design, Setting, and Participants A cross-sectional study using a household sample was conducted in 10 areas of Gautam Budhnagar district, Uttar Pradesh, India, from January 31, 2020, to March 31, 2021, to assess the feasibility of identification of oral lesions by community health workers using a mobile phone application compared with diagnosis by trained dentists in a screening clinic. Men and women aged 30 years or older as well as tobacco users younger than 30 years were eligible for screening. Interventions: Screening by trained community health workers vs dentists. Results: A total of 1200 participants were screened by the community health workers during their home visits; of these, 1018 participants (526 [51.7%] men; mean [SD] age, 35 [16] years) were also referred and screened by the dentists a clinic. There was near-perfect agreement (κ = 0.9) between the findings of the community health workers and the dentists in identifying the positive or negative cases with overall sensitivity of 96.69% (95% CI, 94.15%-98.33%) and specificity of identification of 98.69% (95% CI, 97.52%-99.40%). Conclusions and Relevance: In this cross-sectional study, trained community health workers were able after initial supervision by qualified dentists to perform oral cancer screening programs. These findings suggest that community health workers can perform this screening in resource-constrained settings

Report from a symposium on catalyzing primary and secondary prevention of cancer in India

PurposeOral, breast, and cervical cancers are amenable to early detection and account for a third of India’s cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts. MethodsIndian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages.ResultsInnovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences.ConclusionsSymposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival

Multiple myeloma of the jaw: A case report

Multiple myeloma is a systemic B-cell lymphoproliferative disease that causes osteolytic lesions in the vertebra, ribs, pelvic bone, skull and jaw. Rarely jaw lesions are seen as the first sign in multiple myeloma. This is a case report with follow up of a 57-year-old female patient, previously treated for osteoporosis, who presented with a swelling of the jaw. On radiographic examination, she was found to have osteolytic lesions in the mandible and skull bones. These conventional aids led to the diagnosis of multiple myeloma thereby proving that the osteoporotic lesions were a part of the spectrum of multiple myeloma. The patient underwent chemotherapy and is currently on follow-up. This case report emphasizes the importance of early diagnosis of multiple myeloma in the jaw using readily available technologies and illustrates the contribution that oral assessment can provide

Determination of Proximity of Mandibular Third Molar to Mandibular Canal Using Panoramic Radiography and Cone-beam Computed Tomography

Objectives: Position of inferior alveolar canal with respect to an impacted third molar reveals certain radiographic signs, but three-dimensional relationship to the canal can be provided with cone-beam computed tomography (CBCT). The purpose of this study was to determine which radiographic signs on panoramic radiography indicate a true relationship on CBCT. Materials and Methods: Forty samples with signs or symptoms of impacted mandibular third molar and panoramic radiograph showing signs of a close relationship with the mandibular canal as described by Félez-Gutiérrez et al. were included in the study and subjected to CBCT. Radiographic signs on panoramic radiography were compared with the relationship on CBCT. Statistical analysis was done using Chi-square test. Results: Twenty-one samples (52.5%) showed darkening of the apex, which was the most frequent type of radiographic sign of a close relationship on panoramic radiography. Twenty-three samples (57.5%) revealed a true relationship on CBCT. Darkening of the apex and narrowing of the canal were the signs most frequently associated with a true relationship. On CBCT, coronal and axial sections better predicted a true relationship. Conclusion: This study showed that the presence of any of the radiographic signs cannot definitely predict a true relationship; however, the presence of a close sign on panoramic radiography is often associated with a true relationship to the canal

Comparison of gray values of cone-beam computed tomography with hounsfield units of multislice computed tomography: An in vitro study

Purpose: Hounsfield unit (HU) provides a quantitative evaluation of bone density. The assessment of bone density is essential for successful treatment plan. Although, multislice computed tomography (MSCT) is considered as gold standard in evaluating bone density, cone-beam computed tomography (CBCT) is frequently used in dentomaxillofacial imaging due to lower radiation dose, less complex device, and images with satisfactory resolution. Aims and Objectives: The aim of this study is to determine and compare the gray value and HU value of hypodense and hyperdense structures on CBCT and MSCT, respectively. The study also evaluated and compared the gray values in different field of views within CBCT. Materials and Methods: A total of 20 dry human mandibles were obtained. The gray values and HU values of hypodense structures (extraction socket, inferior alveolar canal, and mental foramen) and hyperdense structures (enamel, cancellous, and cortical bone) were evaluated and compared between CBCT and MSCT images, respectively. The obtained data were statistically analyzed. Statistical Analysis: One-way analyses of variance, ANOVA F-test. Results: The gray value for hypodense structures in large volume CBCT scans resembled the HU value. The study showed statistically significant difference (P < 0.001) in gray values for all the hyperdense structures in CBCT when compared to HU values of MSCT scans. Conclusion: The gray value for hypodense structures in large volume CBCT scan was more reliable and analogous to HU value in MSCT. The determination of grey values in CBCT may not be as accurate as HU value in CT for hyperdense structures

A Novel Mobile Health Approach to Early Diagnosis of Oral Cancer.

AimThe incidence of oral cancer is high in India, which can be reduced by early detection. We aimed to empower frontline health care providers (FHP) for early detection and connect specialist to rural population through mHealth.Materials and methodsWe provided training to FHPs in examination of oral cavity, use of mobile phone for image capture, and risk factor analysis. The FHPs were selected from different cohorts in resource-constrained settings. The workflow involved screening of high-risk individuals in door-to-door and workplace settings, and capture of images of suspected lesions. Uploaded data were interpreted and recommendation was sent by specialist from a remote location. Their recommendation was intimated to FHPs who arranged for further action. Two more initiatives, one for multiple dental schools and another for private practitioners, were undertaken.ResultsDuring the period from 2010 to 2018, 42,754 subjects have been screened, and 5,406 subjects with potentially malignant disorders have been identified. The prevalence of potentially malignant disorders varied from 0.8 to 62% at different cohorts; 516 biopsies have been performed at remote locations.ConclusionConnecting specialists to rural population was made possible through the use of mobile health. Trained FHP were able to reach out to the population. Electronic data capture facilitated efficient follow-up. The program was very cost-effective with screening completed under $1 per person.Clinical significanceIn view of the high incidence of oral cancer in India, and the resource-constrained settings, mobile health paves the way for better access to specialist care for the rural population