Ancient schwannoma arising from mental nerve : a case report and review

Schwannoma is an intraoral rare, benign neoplasm derived from the nerve sheath of peripheral nerves. ?Ancient schwannoma? shows histopathological features, such as degenerative changes and atypical nuclei, and may easily be confused with malignant neoplasms. Ancient schwannoma of the head and neck region is relatively uncommon and very few cases had been reported in the oral cavity. We present a case of ancient schwannoma arising from the mental nerve in a 19 year old male which was of eight months duration. Examination revealed a 30 x 25 mm firm, strawberry-like mass in the periapical region of the left lower first premolar, extending anteriorly to the canine and posteriorly to the first molar, obliterating the buccal vestibule, with an intact overlying mucosa. Ultrasonography showed that the tumor was closely associated with the mental nerve on the left side, suggestive of a peripheral neural sheath tumor. Complete excision of the lesion was done under local anesthesia, preserving the mental nerve. The histological picture was strongly suggestive of ancient schwannoma (Antoni A type). There was no evidence of recurrence 18 months after excision. The clinicopathological aspects of this special case are discussed, and the literature regarding this entity is reviewed

Cervical necrotizing fasciitis : an unusual sequel of odontogenic infection

Cervical necrotizing fasciitis is a rare infection of the fascial planes, which is less common in head and neck, because of the rarity and higher vascularity in the region. We reviewed five patients with cervical necrotizing fasciitis of odontogenic infection managed at a teaching hospital at Chennai, India. There were four men and one woman, of whom four patients were diabetic and hypertensive, with a mean age of 53 years. Mandibular molars (periapical or pericoronal abscess) were found to be the source of infection in all of the cases. The treatment involved incision and drainage and debridement. Anti-microbial drugs were given for all the patients, which included cephalosporins, metronidazole and gentamycin. In four patients the wound healed by contracture and one patient required split skin grafting. Due to the smaller extent of the necrosis, better control of the systemic disease and small size of the sample, there was neither a major complication nor death. This paper reminds us that cervicofacial necrotizing fasciitis (CNF) remains one of the potential complications of long standing odontogenic infections in patients with immunecompromised status, particularly in lower dentition

Trauma in the elderly caused by traffic accident: integrative review

OBJECTIVE To describe the scientific knowledge produced about trauma in the elderly caused by traffic accidents in healthcare area studies. METHODS Integrative review of studies from 2003 to 2013 searched in LILACS, SciELO, PubMed and CINHAL databases. We used combination of the descriptors injuries, wounds and accidents, in English, Portuguese and Spanish languages. RESULTS 32 studies were selected. In the thematic analysis, three categories emerged: epidemiological data from traffic accidents involving elderly; traffic accidents with elderly pedestrians; and trauma care in the elderly. We observed increased incidence of trauma in most countries and pedestrians represented a large part of the victims. Among these, the elderly are the most vulnerable group. CONCLUSION Studies showed that trauma care in the elderly need protocols and professionals with training in gerontology specialized in trauma care services

Maxillofacial intervention in trauma patients aged 60 years and older

The purpose of this study was to evaluate the incidence of trauma victims of age 60 years and older who required maxillofacial intervention. The study analyses the pattern of injuries and the various factors that predict the treatment plan of these patients. A retrospective study was carried out in 1820 trauma patients who reported to the Sri. Ramachandra Dental College and Hospital and required maxillofacial intervention, over a period of 5 years (October 2000 and September 2005). Of the total trauma victims, 185 patients were found to be aged 60 years more. In the majority of the patients, the injury was due to road traffic accidents (79.4%). Males (72.4%) sustained more injuries than females (27.6%). Soft tissue injuries were seen in 49.1% of the patients, while 14% had mandibular fractures. People in their early 60s were injured more often than their older counterparts. The findings of this study highlight the present situation with regard to maxillofacial trauma in patients aged 60 years and older and its management in this part of the country

Efficacy of inferior alveolar nerve block and intraligamentary anesthesia in the extraction of primary mandibular molars: A randomized controlled clinical trial

Objective: The study aims to compare the effectiveness and quality of intraligamentary anesthesia (ILA) and inferior alveolar nerve block (IANB) for primary mandibular molar extraction. Methods: This prospective, randomized clinical study included patients aged 5 to 13 years scheduled for primary mandibular molar extraction. A total of 208 participants were randomly allocated into two groups (n = 104 each group), IANB and ILA, who were administered 2% lignocaine with epinephrine 1:100,000. Patients rated their pain during injection and extraction (VAS pain score). Frankl’s behavior rating score, quality of anesthesia as perceived by clinician, and duration of procedure were recorded. Demographic and other variables were analysed using Pearson x2 test, Pearson correlation coefficient, Fisher exact test, or an analysis of variance, as appropriate. Results: In patients who received IANB, the clinician reported a slightly better quality of anesthesia (p = 0.19) than those who received ILA (VAS score 1.3 ± 0.7 Vs 1.6 ± 0.4). Mean (±SD) score for pain during extraction were found be 1.7 (±0.6) for the IANB group and 1.8 (±0.5) for the ILA group. The clinician observed 46.2% of patients in the IANB group and 39.4% of patients in the ILA group had no discomfort during extraction. Frankl’s behavior score was negatively correlated with the quality of anesthesia and the time taken to complete the extraction (p = 0.017 and p = 0.053, respectively). Conclusion: The efficacy of conventional ILA was similar to IANB, and thus ILA might be a good alternative to the IANB while extracting primary mandibular molars