Metal in Mandible

A 38 year old male patient presented to a radiology center for cone beam computed tomography (CBCT) and the working maxillofacial radiologist spotted a very peculiar finding - There was a large piece of metal in the mandible (size 0.5 cm X 0.5 cm). Here in we have provided a commentary on CBCT artifacts seen in this case along with a short explanation on the source of metal. Based on our observation the object in the mandible is certainly a metallic filling (See figure). This finding is based on the artifacts (acquisition artifacts) that were produced around the suspected material. Two types of artifacts were seen: 1. Scatter and 2.Beam hardening artifacts. Scatter occurs due to the diffraction of original beam after interaction with material. Scatter causes streak artifacts in the reconstruction (Blue arrows in panel A and C). Beam hardening artifacts were also found; they are more common. The lower energy rays suffer significant absorption when passing through the object. Higher the density and atomic number (metals) greater is the absorption. In the reconstruction image they are seen as darks streaks (Between blue arrows in panel B). Materials that often cause beam hardening include metallic restorations and titanium implants. Yes, even light metals such as titanium cause massive beam hardening and amalgam which is the material suspected in this case causes even greater hardening of beam. We strongly think that the metal must be amalgam. Some metal must have got displaced during the stage of condensation of filling in the tooth (most likely 36) just above the large radiolucent lesion. This is the most probable explanation. Unfortunately, this patient couldn’t be followed up and the source of metal is still unknown leading to many speculations.Pan African Medical Journal 2016; 2

Mucormycosis in a surgical defect masquerading as osteomyelitis: a case report and review of literature

Mucormycosis is a rare, highly lethal opportunistic fungal disease affecting immune compromised and diabetic patients. Mucormycosis is considered as the 3rd most common invasive mycosis after candidiasis and  aspergillosis in debilitating patients. It is caused by the filamentous fungi of the class zygomycetes. The infection usually begins in the nose due to inhalation of fungal spores. This fatal fungal disease needs a prompt and early definitive diagnosis, aggressive surgical therapy and high dose anti-fungal therapy. Here, we present a case report of Mucormycosis in a 64 year elderly diabetic male patient who was previously operated for myiasis and also the extensive review of the literature of the mucormycosis.Key words: Diabetes mellitus hyphae, myiasis, PAS stain, zygomycosi

Oral lichenoid reaction to tobacco

A 55 year old male patient came for routine dental examination. History revealed that he was a heavy tobacco chewer for the past 20 years. During examination, several radiating white lines were found on top of a slightly grey background, in relation to the right buccal mucosa. The location of the lesion clearly coincided with the site of placement of quid. A differential diagnosis of lichen planus, oral lichenoid reaction and discoid lupus erythematosis were considered. On microscopic examination, there was focal perivascular infiltrate and plasma cells in the connective tissue. After correlating clinically, a diagnosis of "lichenoid reaction" was confirmed. Oral lichenoid reactions (OLR) can occur as a result of contact of an irritant such as tobacco. OLR to tobacco and betel nut products presents as a unilateral, wavy, nonelevated, non scrapable white lesion. These lines are arranged in tree like configurations or in the form of a lacy network- Wickham's striae. Wickham's striae most often are a diagnostic sign of lichen planus and lichenoid reaction.The Pan African Medical Journal 2016;2

C-reactive protein: An inflammatory biomarker in oral cancer

C-reactive protein (CRP) is a plasma phase protein that takes part in systemic responses to inflammatory reactions. Its serum concentration can increase up to 1000 folds or more in relation to acute stimuli due to infections, tissue injuries, and malignant disorders. It is highly resistant to proteolysis, principally synthesized in the liver in response to proinflammatory cytokines, i.e. interleukin (IL)-6, IL-1β, and tumor necrosis factor. These cytokines are seen to be related to neoplastic disorders. It forms an integral component of innate immunity and serves primarily to recognize potential pathogens and damaged cells. The present article summarizes the importance of CRP and its significance in oral cancer and associated disorders. It was found that a lowered CRP level may prove to be beneficial in prevention and treatment of oral cavity cancer

Rare case of palatal schwannoma: Case report and review of literature

Schwannomas, also known as neurilemmoma, are benign, slow-growing nerve sheath tumors arising from Schwann cells. Approximately 25-40% of schwannomas occur in the head and neck region. However, schwannomas that present in the oral cavity are relatively rare, constituting around 1% of all described cases in the head and neck region. [1],[2] Here, we report a rare case of an intraoral schwannoma, in a 28-year-old male, with painless swelling located in the posterolateral aspect of the soft palate on the right side. Definitive diagnosis was obtained after histopathology examination. Surgical excision of the tumor was done with no complications or recurrences

Bloch Sulzberger syndrome (Incontinentia pigmenti): A rare case report with dental defects

Incontinentia Pigmenti (IP) is a multisystem genodermatosis characterized by cutaneous, neurologic, ophthalmologic, and dental abnormalities. This article reports the clinical features and management of a 4-year-old girl diagnosed with IP

Keratocystic odontogenic tumor involving the maxillary antrum with displacement of the third molar: A rare case report

Keratocystic odontogenic tumor (KCOT) is a benign intraosseous neoplasm of the jaw with a high rate of recurrence. The lesion commonly occurs in the mandibular molar-ramus area and is rarely seen in the maxilla. Its occurrence in the maxillary sinus along with a displaced third molar is very rare. This article reports a case of KCOT in a 15-year-old boy with a displaced third molar involving the right maxillary antrum

Central cemento-ossifying fibroma of posterior maxilla

Cemento-ossifying fibromas (COFs) are relatively rare, benign lesions affecting the jaws and other craniofacial bones and are included in the group of mesodermal odontogenic tumors by Gorlin. They have a predilection for females between the third and fourth decades of life, and about 60% of the lesions are seen most often in the mandibular arch, predominantly occurring in the premolar/molar region of the mandible. This report describes a case of central COF in a 49-year-old male involving the maxillary posterior region. The current case is reported because of the rarity of such lesions and the paucity of information concerning them in the dental literature. We believe that this case illustrates many of the clinical, radiographic, and histologic features associated with cemento-ossifying tumors

Adenoid cystic carcinoma of the palate: case report and review of literature

Adenoid Cystic Carcinoma (ACC) is a rare tumor constitutes for less than 1% of head and neck malignancies and 10% of all salivary gland tumors. Palate is the most common site to be involved in the oral cavity followed by parotid gland and submandibular gland. They are usually asymptomatic, slow growing, characteristically shows infiltrative growth and perineural invasion. This paper reports a case of Adenoid Cystic Carcinoma in a 35 year old female man reported with a swelling on the left side of palate involving the hard and soft palate since 8 months which was diagnosed histopathologically and review of literature of the peculiar clinical, and histopathological features.Pan African Medical Journal 2016; 2