Case report: intraosseous capillary hemangioma presenting as an expansile lesion of the mandibular body with sunburst appearance with 2-year follow-up

The Rare Radiographic Sunburst Appearance of Odontogenic Myxomas: A Case Report and Review of the Literature.

Primary osteosarcoma of the calvarium is rare. A 22-year-old female patient was admitted for a progressively enlarging, indurated mass under her scalp for 6 months. A computed tomographic scan revealed a 4 x 3 x 2-cm3 osteolytic lesion over the right parietal cortex with a sunburst appearance. The patient underwent en bloc tumor resection using bicortical parietal craniectomy with a 2-cm margin of normal bone, including the tightly adherent periosteum over the tumor. Immediate cranioplasty was performed with split-thickness autogenous calvarial bone grafts. Histopathologic examination showed the tumor to be a primary high-grade osteosarcoma of the skull. She received postoperative chemotherapy. She has recovered well and remains without any evidence of disease at her most recent, 8-year follow-up. The key to disease-free survival in treating primary osteosarcoma of the calvarium is complete surgical resection with immediate reconstruction followed by adjuvant chemotherapy.

Purpose: Edentulism has been demonstrated to have negative social and psychological effects on individuals that include adverse impacts on facial and oral esthetics, masticatory function and speech abilities, that when combined, are translated into significant reductions in patients’ quality of lives. It is well-known that immediate placement of implants is a challenging surgical procedure that requires proper treatment planning and surgical techniques. Therefore, the present study describes a 4-year follow-up case report where short implants were placed in an atrophic mandibule and were loaded with the utilization of an all-on-four prosthetic protocol. Case report: A 54 year-old woman dissatisfied with her oral and facial esthetics, masticatory function and speech ability came to the implantology clinic of the Positivo University seeking for oral rehabilitation treatment. After detailed physical and clinical examination, a Computer Tomography scan (CT-scan) was performed to determine the patient’s bone ridge density, dimensions and eligibility for the placement of dental implants. The CT-scan results have indicated the presence of an extremely atrophic mandibular bone ridge. The CT-scan was also used as an aid during the final restoration treatment planning in terms of vertical dimension of occlusion, masticatory function, and stabilization of the lower denture. An all-on-four protocol supported by short implants was then treatment-planned to reduce time, costs and morbidity, and also to achieve superior immediate esthetic results and masticatory function. To reconstruct the patient’s atrophic edentulous mandibule, 4 short implants, including 2 distally tilted, were placed with a final torque of 45 Ncm. Results: Following the development and implementation of a complex treatment plan, the patient displayed stable soft and hard tissues at 4-year postoperative follow-up assessment, demonstrating the effectiveness of the all-on-four technique supported by short implants. Conclusion: Within the limits of this study, the present case report demonstrated that the all-on-four prosthetic protocol with immediate loading on short implant was effective in an atrophic mandible over a 4-year follow-up.

Metastatic tumours of the oral cavity are not common. The most common site for bone metastases in the head and neck region is the mandible. Metastatic lesion of the mandible most commonly originate from the lungs in men and breast in women, and these lesions (or tumours) usually are carcinomas rather than sarcomas. We report two cases of metastatic lesions in the mandible: (1) A 19year old male with right mandibular swelling and a nodular swelling in the distal two-third of the right tibia. Radiograghs revealed sclerotic lesion with a sunburst appearance in both the jaw and tibia. Histology of the jaw lesion confirmed a metastatic osteosarcoma of the mandible. (2) A 51year old female with a right mandibular swelling with associated swelling in the anterior neck, right shoulder and right parietal region of the skull. Computerised tomography scan (CT) of the jaws showed an osteolytic lesion of the right mandible. CT scan of the brain also showed a large lytic lesion seen in the posterior aspect of the right parietal bone. Histology of the jaw mass confirmed a metastatic follicular carcinoma from the thyroid. Mandibular metastasis may be the first presenting feature of underlying occult malignancy of another primary site. Therefore, clinicians should maintain a high level of suspicion while evaluating patients with a history of cancer presenting with oral lesions.

Calvarial hemangiomas: Series of 6 cases and review of literature

Neuroblastoma is a common solid extracranial tumor in children which usually presents at an early age. It has a high propensity to metastasize and the skull is one of its favored metastatic sites. Here, we reported a case of a neuroblastoma lesion in the skull managed in a resource-limited setting and discussed potential pitfalls. We presented our case as a descriptive report in accordance with the CARE case report guideline. An 11-year-old girl was referred to the neurosurgery clinic with a large lump on her left head which was discovered 2 weeks prior. Aside from an intermittent headache, she was otherwise healthy. A non-contrast head computed tomography (CT) scan showed a bone destruction by an isodense mass on the right parietal region which extended to the extradural space. Interestingly, a sunburst appearance was noted within the tumor mass. Complete tumor removal was performed and the dura was macroscopically intact. She was later discharged without any symptoms. Initial histopathological result was inconclusive and the samples had to be sent to another facility for immunohistochemistry examinations. The result came back supporting the diagnosis of neuroblastoma. As neuroblastoma in the skull was most likely a result of metastasis, we scheduled the patient for further work-up examinations. Unfortunately, due to financial reasons, she and her parents were unable to travel back to the hospital. Neuroblastoma should still be considered in older children with neoplastic skull lesion. A high degree of suspicion for neuroblastoma and other metastatic skull lesions is important and would allow clinicians to perform required diagnostic examinations to establish the primary site in the shortest time possible and prevent loss to follow-up. This is especially important in a resource-limited setting where the patients often come from families with low socioeconomic status. Subsequent follow-up and hospital visits impose additional costs which most of them cannot afford.

Meningiomas and pilocytic astrocytomas are benign intracranial tumors. Pilocytic astrocytomas arises frequently at the posterior fossa in childhood. Meningiomas have several image findings, such as a dural tail sign, bony erosion, and sunburst appearance on angiography. However, pilocytic astrocytomas with these findings have been rarely reported. In this report, we describe a mass with typical image findings of a meningioma, but diagnosed as a supratentorial pilocytic astrocytoma with early anaplastic transformation.

Rationale:Cronkhite-Canada syndrome (CCS) is a rare, nonhereditary gastrointestinal polyposis syndrome with known malignant potential. This case report aims to present the clinical course, management, and long-term (3-year) follow-up of a CCS patient, highlighting the discrepancy between symptomatic improvement and endoscopic progression, and to discuss associated carcinogenic risk.Patient concerns:A 50-year-old man presented with diffuse abdominal pain of unclear origin, bloody stools, hair loss, melanosis on the hands, and nail dystrophy.Diagnoses:Laboratory tests revealed hypoalbuminemia, hypocalcemia, hypokalemia, and positive fecal occult blood. Enteroscopy and subsequent pathological examination confirmed the presence of characteristic intestinal polyps, leading to a diagnosis of CCS.Interventions:The patient was treated with a continuous regimen of corticosteroids combined with mesalazine. After 1 year of medical therapy, he underwent endoscopic mucosal resection.Outcomes:The patient’s clinical symptoms improved significantly following treatment. However, endoscopic and pathological findings showed a tendency to deteriorate over time. At the 3-year follow-up, this disparity between clinical well-being and pathological progression persisted.Lessons:CCS carries a risk of malignant transformation. Even with clinical improvement on long-term corticosteroid and mesalazine therapy, endoscopic progression may occur. Therefore, we recommend intensive endoscopic surveillance every 3 to 6 months following initial diagnosis, maintained for at least the 1st year, as a strategy to mitigate cancer risk.

An 18-year-old female patient presented with complaint of swelling on the lower right side of the face since six months. Swelling was initially small but gradually increased in size up to the present dimension within four months. Since two months there was no increase in the size of the swelling. There was no history of trauma, paresthesia, pain or fever. Patient was having difficulty in mastication. On general physical examination, the patient was well nourished and her vital signs were normal. The past medical history was non-contributory.

Introduction:Giant cell tumor (GCT) arising in the small bones of the feet is a rare entity, often presenting diagnostic and therapeutic challenges due to local aggression and the need to preserve foot architecture. This report details the case of a 27-year-old female diagnosed with a GCT of the left fifth metatarsal.Case Report:This particular patient was managed with en masse resection of the fifth metatarsal followed by reconstruction using a non-vascularized autologous hemifibular strut graft fixed with K-wire. The patient demonstrated good clinical and radiographic fusion at 6 months and excellent functional recovery at 2-year follow-up.Conclusion:GCT of the metatarsal has been managed with vascularized bone graft, which is technically difficult. We could achieve good results with a non-vascular hemifibular graft, confirming this as a viable method for managing rare GCTs in critical load-bearing locations.

Gingival fenestration (GF) is scarcely reported in the literature. We present a unique case of GF defect combined with gingivitis and altered passive eruption (APE). An 18-year-old female patient with gingivitis, APE, and GF in the mandibular left central incisor presented for periodontal treatment. The gingival lesion was successfully treated with basic periodontal therapy gingivectomy, and gingivoplasty and resulted in an excellent aesthetic long-term outcome. This case report shows its 8-year clinical follow-up. There are no earlier reports dealing with the use of gingivoplasty for the treatment of GF, as it is not the usual therapeutic intervention for these defects. Gingivoplasty proved to be effective in treating GF. Why is this case new information? Available literature on gingival fenestration defects does not describe gingivectomy and gingivoplasty as a treatment of choice. Gingivectomy and gingivoplasty proved to be effective in treating gingival fenestration defects. What are the keys to successful management of this case? Proper diagnosis. What are the primary limitations to success in this case? Gingival fenestration has been defined when the overlying gingiva is denuded, exposing the root to the oral cavity. However, in this case report, only the crown was exposed because the patient had altered passive eruption.

Clinical and radiological documentation of complete remodeling of the mandibular bone after the enucleation of a large odontogenic keratocyst: 15 years follow-up of a unique case - A case report

A few teaching points and a few changes

Successful treatment of pancreaticopleural fistula by nasopancreatic drainage and endoscopic removal of pancreatic duct calculi: a case report

Aim and backgroundDentigerous cysts are the second most common type of odontogenic cysts, typically associated with impacted teeth, particularly maxillary canines and mandibular third molars. They often remain asymptomatic until they reach a significant size, leading to complications, such as cortical bone expansion, root resorption, and potential infections. The management of dentigerous cysts in pediatric patients requires a multidisciplinary approach involving surgical, orthodontic, and prosthetic rehabilitation strategies. Advanced imaging techniques, such as cone-beam computed tomography (CBCT), are instrumental in accurately assessing the lesion's extent and guiding treatment. This case report highlights the diagnostic and therapeutic challenges associated with an impacted maxillary canine and a dilacerated lateral incisor, emphasizing the importance of timely intervention to prevent cystic progression and associated complications.Case descriptionA 13-year-old boy presented with persistent pain in the upper right anterior region. His past dental history revealed the extraction of tooth #53 due to infection. Clinical and radiographic examination, including an orthopantomogram (OPG) and CBCT, confirmed the presence of an expansile radiolucent lesion associated with an impacted maxillary canine (tooth #13) and a dilacerated lateral incisor (tooth #12). However, noncompliance of the patient with further treatment at that time led to the recurrence of pain and increased severity of the lesion after 5 years. The lesion extended to adjacent structures, including the nasal cavity and maxillary sinus, with cortical bone perforation. A provisional diagnosis of a dentigerous cyst was established, with a differential diagnosis of an adenomatoid odontogenic tumor. In 2024, surgical management under LA involved enucleation of the cyst, extraction of teeth #12 and #13, and application of Carnoy's solution. Histopathology confirmed an infected dentigerous cyst. Following healing, a removable partial denture (RPD) was provided for esthetic rehabilitation. The patient was placed on periodic follow-up for a year.ConclusionThis case highlights the importance of early diagnosis and intervention in pediatric patients presenting with impacted teeth and associated cystic lesions. The combination of advanced imaging, surgical enucleation, and adjuvant therapy proved effective in managing an extensive infected dentigerous cyst. The case further highlights the importance of a multidisciplinary approach to restoring both function and esthetics, ultimately improving patient outcomes in pediatric dentistry.Clinical significanceEarly diagnosis and intervention are crucial in managing dentigerous cysts to prevent complications, such as bone destruction and infection. CBCT aids in precise assessment, while a multidisciplinary approach ensures optimal functional and esthetic outcomes. Long-term follow-up is essential to monitor recurrence and ensure successful rehabilitation.How to cite this articleDutta K, Shetty YR, Nayak PP, et al. Interdisciplinary Management of an Infected Dentigerous Cyst Associated with an Impacted Maxillary Canine: A Case Report with a 6-year Follow-up. Int J Clin Pediatr Dent 2025;18(10):1288–1293.