Extraoral Examination Research Articles

HISTOPLASMOSIS IN A MAN WITH AIDS: CASE REPORT

Histoplasmosis is a systemic infectious disease caused by Histoplasma capsulatum. Patient, male, 40 years old, melanoderma, with AIDS, referred from a Reference Center for Tropical Diseases for stomatological care, complaining of a "tongue lesion". Nothing noteworthy was seen in the extra-oral examination. Intra-oral, a nodular lesion disseminated in a red tongue, papillary and ulcerated surface with sessile base. The clinical diagnosis was Histoplasmosis and Paracoccidioidomycosis. An incisional biopsy was performed and the histopathological sections were stained with hematoxylin and eosin (HE) revealing a granulomatous inflammatory process associated with pseudoepitheliomatous hyperplasia compatible with histoplasmosis. Positive PAS reaction and Grocott staining; and negative in the Ziehl-Neelsen staining. The patient died before starting the treatment. This case reinforces the importance of the stomatologist and oral pathologist in the elucidation of cases of systemic diseases when it is shown exclusively in the mouth and the diagnostic challenge. Histoplasmosis is a systemic infectious disease caused by Histoplasma capsulatum. Patient, male, 40 years old, melanoderma, with AIDS, referred from a Reference Center for Tropical Diseases for stomatological care, complaining of a "tongue lesion". Nothing noteworthy was seen in the extra-oral examination. Intra-oral, a nodular lesion disseminated in a red tongue, papillary and ulcerated surface with sessile base. The clinical diagnosis was Histoplasmosis and Paracoccidioidomycosis. An incisional biopsy was performed and the histopathological sections were stained with hematoxylin and eosin (HE) revealing a granulomatous inflammatory process associated with pseudoepitheliomatous hyperplasia compatible with histoplasmosis. Positive PAS reaction and Grocott staining; and negative in the Ziehl-Neelsen staining. The patient died before starting the treatment. This case reinforces the importance of the stomatologist and oral pathologist in the elucidation of cases of systemic diseases when it is shown exclusively in the mouth and the diagnostic challenge.

LYMPHANGIOMA OF LIP: A CASE REPORT

The present case involves a 10-year-old child, male, treated at the stomatology clinic, presenting a tumoral lesion in the lower lip region with a three-year history of evolution. On extraoral examination, the lower lip was voluminous. On intraoral examination, there was a sessile swelling with lobulated consistency, well delimited, in the lower lip of the left side, measuring approximately 4 cm. The diagnostic hypotheses were mucocele, irritative fibroma, benign mesenchymal neoplasm, or salivary gland tumor. An excisional biopsy showed a mucosal fragment lined with stratified, squamous, parakeratinized epithelium and a large number of lymphatic vascular spaces in the fibrous connective tissue, containing lymph, lined with a thin layer of endothelial cells. The diagnosis was Lymphangioma. The patient showed an improvement after the procedure, but still presented a slight swelling in the lip. To verify the aesthetic condition, the patient was referred to a plastic surgeon for examination. The present case involves a 10-year-old child, male, treated at the stomatology clinic, presenting a tumoral lesion in the lower lip region with a three-year history of evolution. On extraoral examination, the lower lip was voluminous. On intraoral examination, there was a sessile swelling with lobulated consistency, well delimited, in the lower lip of the left side, measuring approximately 4 cm. The diagnostic hypotheses were mucocele, irritative fibroma, benign mesenchymal neoplasm, or salivary gland tumor. An excisional biopsy showed a mucosal fragment lined with stratified, squamous, parakeratinized epithelium and a large number of lymphatic vascular spaces in the fibrous connective tissue, containing lymph, lined with a thin layer of endothelial cells. The diagnosis was Lymphangioma. The patient showed an improvement after the procedure, but still presented a slight swelling in the lip. To verify the aesthetic condition, the patient was referred to a plastic surgeon for examination.

AFATINIB-RELATED ORAL ULCERATION

Treatment of malignant neoplasms with antibodies is associated with oral mucosal side-effects. Afitinib may cause mucocutaneous lesions that mimic ordinary oral ulceration due to the blockage of the epidermal growth factor. This report aimed to describe a case of mucocutanous lesions associated with Afatinib. A 63-year-old Caucasian female, diagnosed with non-small cell lung carcinoma, presented painful, recurrent oral ulcerations since starting treatment for her lung disease. Upon intraoral examination, irregular 3 to 6-mm ulcers surrounded by an erythematous halo were detected in her lower labial mucosa, hard palate, and lingual frenulum. Upon extra-oral examination, ulcerative lesions were also detected on both the right and left aspects of her hallux (big toe) nail. The patient was treated with low-level laser therapy with marked clinical and symptomatic improvement. Treatment of malignant neoplasms with antibodies is associated with oral mucosal side-effects. Afitinib may cause mucocutaneous lesions that mimic ordinary oral ulceration due to the blockage of the epidermal growth factor. This report aimed to describe a case of mucocutanous lesions associated with Afatinib. A 63-year-old Caucasian female, diagnosed with non-small cell lung carcinoma, presented painful, recurrent oral ulcerations since starting treatment for her lung disease. Upon intraoral examination, irregular 3 to 6-mm ulcers surrounded by an erythematous halo were detected in her lower labial mucosa, hard palate, and lingual frenulum. Upon extra-oral examination, ulcerative lesions were also detected on both the right and left aspects of her hallux (big toe) nail. The patient was treated with low-level laser therapy with marked clinical and symptomatic improvement.

MAXILLOFACIAL DIPROSOPUS: AN EXTREMELY RARE CONGENITAL ANOMALY AND ITS SURGICAL MANAGEMENT

Diprosopus characterizes congenital craniofacial duplication, an exclusive maxillofacial involvement that has only been documented twice. A seven-month-old girl attended the surgical outpatient clinic due to a congenital mandibular alteration and cervical tumor mass. Extraoral physical examination revealed a 3cm right sessile appendiceal nodule with a central ostium, which secreted a hyaline fluid in the mandibular cutaneous region and was mobile during breastfeeding. Moreover, an ipsilateral level II asymptomatic cervical enlargement was observed. A computed tomography showed the duplication of the condyle, ramus, and mandibular body on the right side, which had a mandibular canal and teeth germs emerging toward the skin nodule, as well as a 4.1cm submandibular/cervical well-defined cystic hypodense image. Clinicoradiographic aspects were conclusive for mandibular and mouth duplication. Surgical excision of the accessory mandible, cutaneous nodule/accessory mouth, and cervical cyst were performed and sent for pathological examination. The patient is undergoing strict follow-up, without post-surgical complications. Diprosopus characterizes congenital craniofacial duplication, an exclusive maxillofacial involvement that has only been documented twice. A seven-month-old girl attended the surgical outpatient clinic due to a congenital mandibular alteration and cervical tumor mass. Extraoral physical examination revealed a 3cm right sessile appendiceal nodule with a central ostium, which secreted a hyaline fluid in the mandibular cutaneous region and was mobile during breastfeeding. Moreover, an ipsilateral level II asymptomatic cervical enlargement was observed. A computed tomography showed the duplication of the condyle, ramus, and mandibular body on the right side, which had a mandibular canal and teeth germs emerging toward the skin nodule, as well as a 4.1cm submandibular/cervical well-defined cystic hypodense image. Clinicoradiographic aspects were conclusive for mandibular and mouth duplication. Surgical excision of the accessory mandible, cutaneous nodule/accessory mouth, and cervical cyst were performed and sent for pathological examination. The patient is undergoing strict follow-up, without post-surgical complications.

ORAL MALT-LYMPHOMA IN A PATIENT WITH SJÖGREN´S SYNDROME

A 61-year-old male patient presented a painless, soft, well-defined, expansive tumor in the soft palate, measuring 40 × 30mm, with superficial telangiectasia and five years of evolution. Extra oral examination revealed a fibrous nodular mass of 15mm in the left parotid gland. The patient reported dry mouth, gastritis, arthritis and arthrosis. Radiographs were uneventful. Blood tests were positive for rheumatoid factor, SS-A, SS-B, and antinuclear factor (HEP2) (nuclei). Sialometry was 0.09mL/minute. Incisional biopsy was performed in the soft palate tumor and in the lower lip. Neoplastic cells were immunopositive for CD20 and bcl2, CD3, CD138, and CD68 were positive in reactive cells. Cytokeratin evidenced lymphoepithelial lesions and Ki67 was around 30%. Absence of light chain monoclonality and negativity for bcl6, CD10, CD23, Cyclin-D1, and SOX11 were observed. The final diagnosis was oral MALT-lymphoma in a patient with Sjögren´s syndrome. The patient was referred to the onco-hematology center for treatment. Support: CAPES. A 61-year-old male patient presented a painless, soft, well-defined, expansive tumor in the soft palate, measuring 40 × 30mm, with superficial telangiectasia and five years of evolution. Extra oral examination revealed a fibrous nodular mass of 15mm in the left parotid gland. The patient reported dry mouth, gastritis, arthritis and arthrosis. Radiographs were uneventful. Blood tests were positive for rheumatoid factor, SS-A, SS-B, and antinuclear factor (HEP2) (nuclei). Sialometry was 0.09mL/minute. Incisional biopsy was performed in the soft palate tumor and in the lower lip. Neoplastic cells were immunopositive for CD20 and bcl2, CD3, CD138, and CD68 were positive in reactive cells. Cytokeratin evidenced lymphoepithelial lesions and Ki67 was around 30%. Absence of light chain monoclonality and negativity for bcl6, CD10, CD23, Cyclin-D1, and SOX11 were observed. The final diagnosis was oral MALT-lymphoma in a patient with Sjögren´s syndrome. The patient was referred to the onco-hematology center for treatment. Support: CAPES.

ORAL MANIFESTATIONS OF SECONDARY SYPHILIS: A CASE REPORT

Syphilis is a sexually transmitted disease caused by Treponema pallidum infection. Oral manifestations of secondary syphilis can be more extensive and variable than those of primary syphilis. A 57-year-old female presented a one-month history of mouth and throat ulcers. Extraoral examination revealed cervical lymphadenopathy and erythematous spots on her wrists and side of left foot. Intraorally, there were multiple erosive plaques on palatine tonsils, border of the tongue, and lower labial mucosa. Diagnostic hypotheses included erythema multiforme, pemphigus vulgaris, and syphilis. Incisional biopsy was performed and histopathological analysis revealed chronic inflammatory infiltrate rich in lymphocytes and plasma cells. Therefore, infection was suspected and serological tests were performed. VDRL, TPPA, and FTA-ABS tests yielded positive results, indicating a diagnosis of syphilis. Antibiotic therapy was begun, and oral and skin lesions disappeared within one month. Clinicians must be familiarized with the oral manifestations of syphilis, an emerging disease with varied clinical aspects. Syphilis is a sexually transmitted disease caused by Treponema pallidum infection. Oral manifestations of secondary syphilis can be more extensive and variable than those of primary syphilis. A 57-year-old female presented a one-month history of mouth and throat ulcers. Extraoral examination revealed cervical lymphadenopathy and erythematous spots on her wrists and side of left foot. Intraorally, there were multiple erosive plaques on palatine tonsils, border of the tongue, and lower labial mucosa. Diagnostic hypotheses included erythema multiforme, pemphigus vulgaris, and syphilis. Incisional biopsy was performed and histopathological analysis revealed chronic inflammatory infiltrate rich in lymphocytes and plasma cells. Therefore, infection was suspected and serological tests were performed. VDRL, TPPA, and FTA-ABS tests yielded positive results, indicating a diagnosis of syphilis. Antibiotic therapy was begun, and oral and skin lesions disappeared within one month. Clinicians must be familiarized with the oral manifestations of syphilis, an emerging disease with varied clinical aspects.

BIRT-HOGG-DUBÉ SYNDROME: A CASE REPORT WITH ORAL MANIFESTATION

Birt-Hogg-Dubé Syndrome (BHDS) is a rare autosomal dominant disorder characterized by cutaneous papules (fibrofolliculomas, trichodiscomas, and acrochordons), pulmonary cysts, and renal tumors. A 38-year-old man presented with pain in the right upper molars. His medical history included lung cysts due to BHDS, which also affected his mother. Extraoral examination revealed multiple skin-colored dome-shaped papules on his face, neck, ears, and upper thorax. Intraorally, there was mandibular prognathism, abfraction mainly in the posterior teeth, and asymptomatic whitish papules located on the ventral tongue. The panoramic radiograph revealed bone loss around the upper molars. The oral papules were conservatively removed, and microscopic diagnosis was consistent with fibrous hyperplasia covered by stratified epithelium with prominent rete pegs. The patient was submitted to periodontal treatment and long-term follow-up was recommended. We present an illustrative case of BHDS with oral manifestation, which is considered very rare in the literature. Birt-Hogg-Dubé Syndrome (BHDS) is a rare autosomal dominant disorder characterized by cutaneous papules (fibrofolliculomas, trichodiscomas, and acrochordons), pulmonary cysts, and renal tumors. A 38-year-old man presented with pain in the right upper molars. His medical history included lung cysts due to BHDS, which also affected his mother. Extraoral examination revealed multiple skin-colored dome-shaped papules on his face, neck, ears, and upper thorax. Intraorally, there was mandibular prognathism, abfraction mainly in the posterior teeth, and asymptomatic whitish papules located on the ventral tongue. The panoramic radiograph revealed bone loss around the upper molars. The oral papules were conservatively removed, and microscopic diagnosis was consistent with fibrous hyperplasia covered by stratified epithelium with prominent rete pegs. The patient was submitted to periodontal treatment and long-term follow-up was recommended. We present an illustrative case of BHDS with oral manifestation, which is considered very rare in the literature.

AMELOBLASTIC FIBROMA: A CASE REPORT

A 27-year-old male was referred to a Brazilian School of Dentistry, in November 2016, complaining about a slowly progressive asymptomatic swelling on the right side of the posterior mandible. The medical history was unremarkable. Upon intraoral examination, the right lower buccal vestibule was obliterated due to the expansion of the buccal cortical plate. The extraoral examination showed slight facial asymmetry. Panoramic radiographs showed a large unilocular radiolucent lesion with well-defined borders involving the unerupted 48 teeth. An incisional biopsy was performed. Microscopically, hematoxylin and eosin sections presented strands, cords, and nests of odontogenic epithelium supported by a primitive-looking myxoid connective tissue, resembling the dental papilla. The islands showed a peripheral rim of columnar similar to the inner enamel epithelium. The center of the islands revealed a loosely arranged spindle-shaped epithelium identical to stellate reticulum. The patient is undergoing regular clinical and radiographic follow-up; after 6 years, no recurrence was observed. A 27-year-old male was referred to a Brazilian School of Dentistry, in November 2016, complaining about a slowly progressive asymptomatic swelling on the right side of the posterior mandible. The medical history was unremarkable. Upon intraoral examination, the right lower buccal vestibule was obliterated due to the expansion of the buccal cortical plate. The extraoral examination showed slight facial asymmetry. Panoramic radiographs showed a large unilocular radiolucent lesion with well-defined borders involving the unerupted 48 teeth. An incisional biopsy was performed. Microscopically, hematoxylin and eosin sections presented strands, cords, and nests of odontogenic epithelium supported by a primitive-looking myxoid connective tissue, resembling the dental papilla. The islands showed a peripheral rim of columnar similar to the inner enamel epithelium. The center of the islands revealed a loosely arranged spindle-shaped epithelium identical to stellate reticulum. The patient is undergoing regular clinical and radiographic follow-up; after 6 years, no recurrence was observed.

LIP ABSCESS FORMATION SECONDARY TO HYALURONIC ACID SOFT TISSUE FILLERS

The number of esthetic soft tissue filler treatments has rapidly increased, along with an increase in complications associated with such treatments. This study presents a case of a 62-year-old woman who received an injection of hyaluronic acid to the nasolabial fold and lips, and developed a painful lesion in the lip a year after injection. Extraoral examination presented a pustule in the inferior lip. The surrounding area was also hot, erythematous, and soft to the touch. Based on the patient´s history, the diagnosis was an abscess secondary to the filler. The area was decontaminated, and the abscess was drained. To prevent a recurrence, cephalexin 2g daily for seven days was prescribed. There was no recurrence at 17 months. Abscesses following soft tissue filler treatment usually occur two weeks after treatment, but less commonly, they can occur months or years after injection procedure. The number of esthetic soft tissue filler treatments has rapidly increased, along with an increase in complications associated with such treatments. This study presents a case of a 62-year-old woman who received an injection of hyaluronic acid to the nasolabial fold and lips, and developed a painful lesion in the lip a year after injection. Extraoral examination presented a pustule in the inferior lip. The surrounding area was also hot, erythematous, and soft to the touch. Based on the patient´s history, the diagnosis was an abscess secondary to the filler. The area was decontaminated, and the abscess was drained. To prevent a recurrence, cephalexin 2g daily for seven days was prescribed. There was no recurrence at 17 months. Abscesses following soft tissue filler treatment usually occur two weeks after treatment, but less commonly, they can occur months or years after injection procedure.

EXUBERANT OSTEOSARCOMA OF THE POSTERIOR MANDIBLE

A 25-year-old male sought out dental services complaining of painful swelling in the posterior mandible and paresthesia of the lower lip for two months. The extraoral examination revealed an exuberant left-side facial asymmetry, with no palpable cervical lymph nodes. Intraorally, a swelling on the posterior buccal vestibule was observed. Imaging exams showed an extensive ill-defined osteolytic lesion in the posterior mandible. The patient was submitted to an incisional biopsy and microscopically, pleomorphic cells of osteoblastic appearance deposited in the hypercellularized connective tissue. The final diagnosis was primary osteosarcoma of the mandible. After four sessions of chemotherapy and five months of evolution, with aggressive progression, he underwent a left hemi-mandibulectomy surgery, performed by the Head and Neck team. The patient is still undergoing chemotherapy. It is important to note the dentist's role in the early diagnosis of osteosarcoma of the jaws, contributing to the improvement in the patient's quality of life. A 25-year-old male sought out dental services complaining of painful swelling in the posterior mandible and paresthesia of the lower lip for two months. The extraoral examination revealed an exuberant left-side facial asymmetry, with no palpable cervical lymph nodes. Intraorally, a swelling on the posterior buccal vestibule was observed. Imaging exams showed an extensive ill-defined osteolytic lesion in the posterior mandible. The patient was submitted to an incisional biopsy and microscopically, pleomorphic cells of osteoblastic appearance deposited in the hypercellularized connective tissue. The final diagnosis was primary osteosarcoma of the mandible. After four sessions of chemotherapy and five months of evolution, with aggressive progression, he underwent a left hemi-mandibulectomy surgery, performed by the Head and Neck team. The patient is still undergoing chemotherapy. It is important to note the dentist's role in the early diagnosis of osteosarcoma of the jaws, contributing to the improvement in the patient's quality of life.

The Impact of Professional Oral Hygiene in Orthognathic Surgery.

Oral hygiene represents a fundamental element with regard to outcomes in oral and maxillofacial surgery. Both basic hygiene that the patient must perform daily at home and obviously professional hygiene aimed at preventing any complications in the surgical field. Patients undergoing orthognathic surgery in our Department of Maxillofacial Surgery in Ancona, in a total number of 137 in the period studied (2016-2021), were divided into 2 groups: period 1, (2016-2018) and period 2 (2019-2021). The division into 2 groups derives from the establishment of a professional oral hygiene protocol established starting from January 2019 and put into practice by dental hygienists. The protocol consists of preoperative counseling and above all very precise instructions in the postoperative so as to optimize the oral hygiene process, assist in the best possible wound healing and reduce possible postoperative complications. Anamnestic, cephalometric data, measurements of the distances between certain landmarks for the evaluation of facial edema, patient-referred pain, accurate intraoral and extraoral physical examination both pre and postoperative, and complications were collected for each patient. The main goal of the study authors set is to evaluate the effective impact of professional oral hygiene in the pre and postoperative management of patients undergoing orthognathic surgery, taking into account parameters, such as facial edema and pain, and using evaluation scales, making a comparison with the data reported in the 3 years before and after the establishment of the protocol applied by the authors.

CLINICAL PATHOLOGIC CONFERENCE CASE 1: A MULTILOCULAR RADIOLUCENCY OF THE RIGHT MANDIBLE

CLINICAL PATHOLOGIC CONFERENCE CASE 1: A MULTILOCULAR RADIOLUCENCY OF THE RIGHT MANDIBLE

Https://scholarhub.ui.ac.id/jdi/vol30/iss1/6/

Ramsay Hunt syndrome (RHS) is a disease that is caused by the varicella-zoster virus and is characterized by severe ear pain, auricular vesicular eruptions, and peripheral facial paralysis. Objective: The aim of this case report is to provide information about the clinical findings and treatment process of RHS, which is a rare case and may have oral findings and stress the importance of early diagnosis. Case Report: A 60-year-old male patient had previously consulted an otolaryngologist and a family physician with complaints of vesicular eruptions in the right ear auricle and on the mandible. The patient in whom a diagnosis could not be established presented to the Department of Oral and Maxillofacial Radiology after exacerbated lesions. White plaque-like and ruptured vesicular lesions were observed in the intraoral examination. All vesicular lesions were on one side of the face, and the patient was referred to the dermatology clinic with the diagnosis of RHS. Facial paralysis fully recovered in a short time after early diagnosis and treatment. It should be kept in mind that there may also be oral findings in RHS, and a patient’s intraoral and extraoral examination findings should be evaluated together. Conclusion: Early diagnosis and treatment are highly important in preventing complications such as permanent facial paralysis, vestibulocochlear dysfunction, and hearing loss

Glandular Odontogenic Cyst in the Anterior Mandible: A Case Report of a Conservative Approach and a Recurrence Detection

The glandular odontogenic cyst (GOC) is considered a rare developmental cyst, with an odontogenic origin and both epithelial and glandular characteristics, with less than 200 reported cases in the literature. In the present case, a 29-year-old man was referred for evaluation of an asymptomatic slow-growing swelling in the anterior region of the mandible, with one-year history. The patient's medical history did not reveal any systemic alteration. The extraoral examination did not show enlargement of the facial contour and the intraoral examination showed vestibular and lingual swelling. Panoramic radiography and CT scan revealed a well-defined unilocular radiolucent lesion involving the inferior incisors and canines bilaterally. Histopathological analysis revealed multiple cysts lined by stratified epithelium with varying thickness and characteristics, in addition to duct-like structures filled with PAS-positive amorphous material, suggestive of GOC. Conservative treatment was performed through surgical curettage, peripheral ostectomy of the surgical site and apicectomy of the teeth involved in the lesion. There was one recurrence, which was detected in postoperative follow-up, leading to a new surgical approach. Fifteen months after the second procedure, no signs of recurrence were identified, and bone neoformation within the surgical site occurred, supporting that a conservative approach for the treatment of GOC is viable.

Single-visit regenerative endodontic procedure of necrotic immature lower permanent molar with acute apical abscess

Regenerative endodontic procedures (REPs) of immature teeth with necrotic pulp and apical pathosis focus on passive chemomechanical debridement and usually require multiple visits to enhance the antibacterial effect by placing intracanal medications. However, different case reports showed a favorable clinical and radiographic outcome in single-visit REPs of necrotic immature teeth with symptomatic apical periodontitis or chronic apical abscess. To the best of our knowledge, there are no published reports of single-visit REPs on cases with acute apical abscess. Therefore, this case report aimed to present a successful REP performed in a single visit for immature lower molar with necrotic pulp and acute apical abscess. A 9-year-old female patient referred for the management of the lower right molar (#46), with the chief complaint of localized moderate pain with cold drinks in the lower right molar for 1 week. The extraoral clinical examination revealed no significant findings. Intraorally, tooth #46 revealed a deep occlusal caries, with normal response to palpation, mild pain on percussion, and moderate pain to the cold test. The radiographic examination showed deep occlusal caries approaching the pulp, and periapical radiolucency related to the distal root. It was diagnosed as symptomatic irreversible pulpitis with symptomatic apical periodontitis. After accessing the pulp chamber, the radicular pulp on the mesial root was vital, while necrotic in the distal root. Therefore, vital pulp therapy was done for the mesial root, and REPs initiated for the distal root with intracanal medicament placement. However, the patient failed to show up in the scheduled visit to complete the treatment. The father refused to bring her as she was asymptomatic, and he was afraid of the COVID-19 pandemic situation. One month later, she presented to the clinic with pain and facial swelling in the lower right area of her face. Clinical examination revealed extra- and intraoral swelling related to tooth #46 (i.e., acute apical abscess) with severe pain on palpation and percussion. The patient’s parents insist to finish the treatment or extract the tooth on the same visit. Hence, a single-visit REP was done. After 20 months, clinical and radiographic examinations showed that the tooth became asymptomatic, responded to sensibility tests, and the periapical pathosis healed. It was concluded that regenerative endodontic treatment can be done in single visit in cases with acute apical abscess. It should be considered in cases of poor complaint, difficulty in accessing dental care, or pandemic curfew.

COMPREHENSIVE MANAGEMENT OF ORAL FRAILTY IN MULTIPLE SYSTEMIC DISEASES GERIATRIC PATIENT

ABSTRACTBackground Oral frailty is an important geriatric syndrome characterized by decreases in oral function that coincides with declines in cognitive and physical function. Objective: The aim of this case report is to describe the comprehensive management of oral frailty in a medically compromised geriatric patient prior to cardiovascular surgery. Case: A 64-year-old male patient complained of pain in swallowing and sore mouth since two days before. He had multiple systemic diseases, including infective endocarditis, acute kidney injury, type II diabetes mellitus, thrombocytopenia, and electrolyte-fluid imbalance. Extra-oral examination showed lymphadenitis, icteric sclera, and dry-exfoliative lips. Intra-oral examination revealed tongue depapillation, frothy saliva, and dry mucosa with poor oral hygiene. The scraped-off white plaque leaving erythematous area was found on the dorsal and ventral tongue, buccal mucosa, and hard palate. Irregular multiple major ulcers, surrounded by erythema, well-demarcated with yellowish concave base, and covered by thick yellowish-green sputum at the soft palate to the uvula. The diagnosis was exfoliative cheilitis, aphthous-like ulcer, acute pseudomembranous candidiasis, and moderate xerostomia. A D-E-N-T-A-L questionnaire was used to evaluate oral frailty, and the cumulative result was seven. Case Management: The patient was treated with 100% petroleum jelly, 0.12% chlorhexidine digluconate mouthwash, and chlorine dioxide-zinc mouthwash three times a day. The oral lesions showed significant improvement after one week of treatment. Conclusion: Appropriate therapy for oral lesions and eliminating the infection could be considered to minimize the long-term effect of oral frailty. The comprehensive management of oral frailty could be beneficial for improving the quality of life. Keywords: Geriatric, Oral frailty, Oral lesion, Systemic disease

Management of Garre’s osteomyelitis of the mandible with utility of cone beam computed tomography: A case report

Garre’s osteomyelitis or proliferative periostitis is a chronic osteomyelitis condition in young individuals. It is many times correctly diagnosed in a later stage due to less chances of clinical encounter by dental professionals. This is a report of a case of proliferative periostitis in a 9 year old boy who came with a chief complaint of painful swelling in the right lower third of the face for the past 1 month. On extraoral examination, there was a localized swelling over the right side of the mandible in the posterior aspect without any secondary changes. On palpation, it was felt hard in consistency and non-tender. There was a mild expansion of the lingual and buccal cortex in the region of 46. CBCT imaging was done which showed laminated appearance of new periosteal bone formation in the inferior border of the mandible and along the buccal cortex. Endodontic management of 46 and antibiotic therapy was given to the patient.

Management of keratocystic odontogenic tumor in the maxillary sinus of 12-year-old children: A case report

Objective: Keratocystic odontogenic tumor (KCOT) is a benign intraosseous tumor of odontogenic origin, making up the third most common odontogenic cyst. KCOTs arise from the remnants of dental lamina or the basal cells of the overlying oral epithelium. KCOTs are characterized by an aggressive behaviour with a relatively high recurrence rate, especially if they are associated with syndromes. Treatment of KCOTs include marsupialization, saucerization, 
 Methods: A 12-year-old child patient was referred to the Specialist Clinic of Oral and Maxillofacial Surgery, Cipto Mangkusumo Hospital. On physical examination, facial asymmetry, a fixated swelling and lump in right maxilla from the second molar to canine with tenderness were observed. A complete history was taken and clinical examination followed by complete enucleation with sulcular flap from 12 region until 18 regions was performed. The diagnosis was maxillary dentigerous cyst based on histopathological result after the operation. 
 Results: The medical history was not significant and patient was in a generally good condition with no fever, nausea, pain, or difficulty in breathing. Extra oral examination showed facial asymmetry and visible lump in the right region of the maxilla.
 Conclusion: The diagnosis of maxillary KCOT expanding to maxillary sinus can be achieved with adequate datas; history, clinical, and histopathological examinations. Careful surgical approach and proper treatment decision is crucial to avoid complications according to individual case of each patient, especially in children.

Ortho-Surgical Management of An Adult Patient with Gummy Smile

Aim: This case report represents the clinical management of a Skeletal Class II adult patient with gummy smile treated by Orthognathic surgery. Background: Vertical maxillary excess (VME) is the most common skeletal deformity in Skeletal Class II which is treated by Anterior Maxillary Osteotomy (AMO) and Gummy Smile is the characteristic feature of VME in which the anterior part of maxilla is superiorly repositioned. Case Description: A 19-year-old patient reported our clinic with the complaint of forwardly placed upper front teeth. On extra oral examination, she had convex profile with posterior divergence and interlabial gap of 10mm and everted upper lip. The patient had a gummy smile of 8mm. Intra orally, she had Class II canine relationship on both sides with missing irt 16, 36, 46. Cephalometric values showed Class II skeletal base with protrusive upper and lower incisors and acute nasolabial angle. Initially orthodontic treatment was done and extraction of upper first premolars was planned during surgery. AMO was done with superior impaction of 4mm and posteriorly by 6mm. After 4 weeks of post surgery, the settling of occlusion using intermaxillary elastics was done. At the end of the treatment, the patient had Class I canine relationship on both sides with Skeletal Class I and overjet and overbite was 2mm. The patient gummy smile was reduced to 4mm which was accepted by the patient. Fixed retention was given in both the arches. The total treatment time was around 30 months. Conclusion: The proper diagnosis and appropriate treatment planning is the main key to achieve stable results in Orthodontics. An interdisciplinary approach with the orthodontist and surgeon will lead to achieve stable, functional and esthetic results.

Double mandible coronoid process: a very unusual feature.

The double coronoid process (DCP) is a very unusual feature in patient. The literature, which briefly describes just only one case. Being this a very unusual feature, the aim of the paper is to describe the finding, discuss the anatomic, radiological, and clinical characteristics of a DCP. A 61-year-old-woman with no significant medical history, extraoral and intraoral examination was unremarkable. Following panoramic radiography (PR) for assessment of periodontal support and pre-implant planning suspicious radiopaque area in the mandibular notch on the left side was observed. Cone-Beam Computed Tomography (CBCT) and Magnetic resonance imaging (MRI) were subsequently performed. No signs and symptoms of syndromes or medical records with a relevant contribution to the DCP existence and the patient denied any type of facial trauma. CBCT image showed the structure found on the PR was indeed a DCP and it was not superimposed on the mandibular notch area, MRI was performed to investigate soft tissue components and temporomandibular joint (TMJ) or other alterations. DPC is extremely rare with the only case reported in the literature within the same comparison parameters. In this case images revealed the muscles, articular surfaces and articular disc were well preserved, and no other alterations were found.