This study compares the operational difficulty and patient-related outcomes of removing a dental implant or tooth root displaced into the maxillary sinus. The study was conducted on 19 patients [median age, 22 years; female, 8 (42.11%)] whose dental implants or tooth roots remained in the maxillary sinus for over 6 months. Nine patients had dental implants in their maxillary sinuses (Group 1), and 10 had tooth roots migrated into the maxillary sinus during tooth extraction (Group 2). All patients were operated on under local anesthesia. The maxillary sinus was accessed by opening a lateral bone window osteotomy on the sinus wall (Caldwell-Luc technique). Age, gender, operation time, smoking habit, duration after displacement, displacement region, operational difficulty reported by the surgeon and patient-related outcomes such as pain, swelling, postnasal drip, and nasal obstruction were collected retrospectively. The mean age was 43.47 years. The mean age of the patients in the Group 2 was significantly lower (P = .037). There was no statistically significant relation between the operational difficulty in groups. However, there was a statistically significant difference in operation time between groups. The mean total operation time for Groups 1 and 2 were 66.22 minutes and 35.4 minutes, respectively (P = .001). Patient-related outcomes such as pain after the operation, nasal obstruction, postnasal drip and facial swelling were not different between groups (P > .05). It was determined that the operation time for removing the dental implants from the maxillary sinus was longer than the tooth root. However, operational difficulty and patient-related outcomes were similar.

Abstract Background/Aims In Scotland, unlike other parts of the UK, tocilizumab is accessible from the time of GCA diagnosis, subject only to a 12-month stopping rule. The aim of this study was to evaluate the results of treatment with tocilizumab in patients diagnosed via the NHS Lanarkshire GCA Fast Track Pathway, including safety, tolerability, and relapse rates. Methods We conducted a retrospective analysis of consecutive patients commenced on tocilizumab for GCA in NHS Lanarkshire between January 2020 and August 2024. For all patients, tocilizumab was added to glucocorticoids for an intended duration of 12 months as per SMC recommendations. The prednisolone dose was usually tapered over 26-52 weeks, depending on GCA phenotype, comorbidities and tolerance. Relapses were defined by recurrence of signs or symptoms of GCA, positive ultrasound scan (when previously negative), or positive PET-CT, +/- rise in inflammatory markers. Relapses were treated per BSR recommendations. The follow-up period after finishing tocilizumab extended to the date of data analysis in August 2024. Patients discharged from rheumatology were assumed to remain in remission in the absence of re-referral, hospital attendance for GCA symptoms, or prednisolone prescription in primary care. Results 63 patients started tocilizumab during the selected period. Mean (SD) age was 73.0 (7.4) years, 38/63 (60.3%) were female. 61/63 GCA diagnoses were confirmed by USS or TAB; 50/63 were cranial GCA, 4/63 extra-cranial LVV, and 9/63 mixed phenotype. Median (IQR) time from diagnosis to starting tocilizumab was 1 (1,5) months. Decisions to start tocilizumab were supported by relapsing GCA (n = 15), refractory GCA (n = 9), visual manifestations (n = 11), and steroid side effects (n = 7). 39/63 completed the course, 9/63 discontinued before 12 months (14.3%), and 15/63 remain on treatment. Reasons for early discontinuation were death (n = 1), malignancy (n = 3), and adverse reactions (n = 5; bowel perforation, neutropenia, recurrent infections, rectal bleeding, facial swelling). One patient developed scalp necrosis on tocilizumab and was treated as a relapse. The 39 patients who completed 12 months of tocilizumab were subsequently followed up for mean (SD) 18 (13) months (range 0-42). Three patients had possible relapse post-tocilizumab, at 6, 9 and 12 months, each manifesting as non-specific headache and minor CRP rise, with negative ultrasound scans. Only one patient developed definite relapse, 9 months after finishing tocilizumab, with conversion from initial cranial to extra-cranial LVV, confirmed on ultrasound. Of 30 patients with ≥12 months follow-up post-tocilizumab, 21 are in relapse-free drug-free remission (4=relapse, 1=low-dose prednisolone, 2=died, 2=missing). Conclusion Tocilizumab was well tolerated by most patients. While these results come from a single centre, low relapse and high drug-free remission rates may point towards favourable effects of early treatment. Outcomes in Scotland, where access to tocilizumab is less restrictive, may provide useful insights for clinicians elsewhere in the UK. Disclosure A. Ciechomska: None. A. Melville: None. J.E. Dale: None. K. Donaldson: None.

Large B-cell lymphoma (LBCL) with interferon regulatory factor 4 (IRF4) rearrangement (LBCL-IRF4) is a rare subtype of LBCL, with a high prevalence in Waldeyer's ring as well as the neck, head and gastrointestinal lymph nodes. A patient with 2-month clinical symptoms of nasal obstruction and facial swelling was reported in this short review. A nasal endoscopy examination revealed a neoplasm in the inferior nasal meatus. Both CT and enhanced MRI showed that a soft tissue occupied the nasolacrimal duct, with bone destruction, and extended into the left nasal cavity and left lacrimal gland area. Then, a biopsy of the neoplasm in the inferior nasal meatus was performed. HE staining results showed that neoplastic cells presented diffuse growth patterns, abundant cytoplasm, vacuole shape, lightly stained nuclei, and irregular nuclear membrane. Immunohistochemistry staining results revealed MUM1(+), Bcl- 6(+), CD20(+), CD79α(+), and CD10(+). FISH analyses detected positive IRF4 rearrangement. LBCL-IRF4 was diagnosed in the patient. The patient received treatment with four cycles of R-CHOP and two times of rituximab, followed up for 2 years, and finally got complete remission. For the first time, we summarize the imaging and pathological features, drug treatment, and curative effect of LBCL-IRF4 in the nasolacrimal duct.

Abstract An HIV-positive male with advanced infection presented with chronic multiple small facial swellings without fever. A biopsy of the lesions revealed an HIV-related opportunistic infection.

There have been only 24 documented occurrences of the extremely uncommon giant cell tumour of the parotid gland. We report an additional case of a female patient in her late 40s who presented with a 2.5-year history of right-sided face swelling in the preauricular region. Fine-needle aspiration suggested the possibility of a primary giant cell tumour of the parotid, which was confirmed by histopathology, revealing a biphasic population of mononuclear stromal cells and osteoclast-like giant cells. There was no metastatic lesion in the cervical lymph node. No associated carcinomatous component was found. Immunohistochemistry was positive for haematopoietic, monocytic-lineage and mesenchymal markers while it was negative for epithelial and myoepithelial markers.

What is your diagnosis? Facial swelling in a dog.

Systemic lupus erythematosus (SLE) is an intricate autoimmune disorder with diverse clinical presentations, encompassing various cutaneous manifestations. This case report describes a diagnostically challenging occurrence of acute cutaneous lupus erythematosus (ACLE) exhibiting a toxic epidermal necrolysis (TEN)-like rash in a 28-year-old female already diagnosed with SLE. The patient's rapid progression from itching to maculopapular skin eruptions involving the face, extremities, and torso within days, coupled with facial puffiness and systemic symptoms, presented a clinical conundrum. Histopathological findings of epidermal hyperkeratosis, acanthosis, and a subcorneal neutrophilic abscess guided the exclusion of other conditions, emphasizing the distinctive features of TEN-like ACLE. The patient exhibited a favorable response to pulse methylprednisolone, mycophenolate mofetil, and hydroxychloroquine.

ABSTRACTBackgroundMalignancy involving the salivary glands is a rare occurrence; of these malignancies occurring in the salivary glands, the majority are associated with the parotid glands. Lymphoma is a rare occurrence in the parotid glands and salivary glands in general, and the majority of these are non‐Hodgkin lymphoma (NHL). Hodgkin lymphoma (HL) is exceptionally rarely encountered in the parotid gland in the paediatric population and consequently can often be overlooked when considering differential diagnoses.Method12‐year‐old patient was referred to the local oral and maxillofacial surgery department with a 1‐month history of left‐sided facial swelling affecting the pre‐auricular region. A CT scan and ultrasound were completed, which showed a large mass affecting the left parotid gland, and an ultrasound‐guided biopsy established a diagnosis of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) of the left parotid gland.ResultsThe patient subsequently underwent treatment with chemotherapy only, receiving 3 cycles of CVP—cyclophosphamide, vincristine, and prednisolone—over a 1‐month period. Repeat imaging demonstrated an incomplete response to CVP. As a result of this, the patient received 4 cycles of R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) over a 2‐month period. The patient showed a complete response to this and, following 36 months of follow‐up, has experienced no recurrence of disease.ConclusionHodgkin lymphoma—and particularly NLPHL—of the parotid gland is a rare occurrence, but it is vital that this remains part of the differential diagnosis when confronted with a swelling in the pre‐auricular region.

Three cases of benign ossifying proliferations of the ventral mandible were diagnosed in a 22-month-old female Malayan tapir (Tapirus indicus), a 12-year-old male Malayan tapir, and a 19-month-old male okapi (Okapi johnstoni) at the Denver Zoo Conservation Alliance. The cases each presented with a firm, nonpainful mandibular swelling that would wax and wane in size and were minimally progressive radiographically. Positive reinforcement training, which included scratch down and station standing techniques, was used to obtain serial radiographs. Radiographs revealed mild periosteal proliferation ventral to cheek teeth with no tooth root involvement. A biopsy of the juvenile tapir's mandibular swelling confirmed benign ossifying exostosis. The other two animals did not have biopsies performed and their diagnoses were presumed to be the same as the juvenile tapir's due to similar radiographic findings. The clinical appearance of these lesions can resemble malignant diseases such as osteomyelitis, tumors, or dental maleruptions of ungulates. However, the lesions in the juvenile okapi and female Malayan tapir were found to be unrelated to adult tooth eruption, and the male Malayan tapir was an adult with complete permanent dentition. The mandibular swellings persist in both the okapi and adult tapir cases, respectively, four and two years after identification of each. No further histopathology has been performed in the three cases and the juvenile tapir was lost to follow-up. To the authors' knowledge, this is the first report of ossifying exostosis in a Malayan tapir and suspect diagnosis in an okapi. Benign ossifying exostosis should be a differential diagnosis for facial swellings in ungulates and further investigation including histopathology and long-term follow-up is warranted.

Aim: Cystic hygroma is a congenital malformation of the lymphatic system. Surgical excision is the treatment of choice, but injection of sclerosing agent into the cyst is an alternative procedure. The aim of this study was to report a case with successful outcome with using sclerosing agent intralesional bleomycin injection despite of surgery. Materials and methods: Mr. X; a baby boy hailing from Cumilla with the complaints of right sided facial swelling since birth in the pediatric outpatient department of a tertiary eye hospital in 2018. On basis of clinical examination and radiological imaging he was diagnosed as right sided ptosis due to cystic hygroma involving right eyelid, orbit and hemi facial portion of face. Visual acuity was fixation and following at birth. After neuro surgical evaluation he was treated by applying intralesional Bleomycin injection (.3-.6 mg/Kg) at 6 sessions. Primary size of the lesion was 10.6X7.2cm. In each follow up his size of facial swelling was dramatically reduced with time. After completing six sessions in 2023 his lesion was significantly reduced to (2.5X1cm) and his vision is 6/60 in right eye and 6/6 in left eye. Now he was given to patching therapy to treat the stimulation deprived amblyopia. Results: Excellent result was observed after applying Inj Bleomycin of 6 sessions .The swelling was reduced in size and no significant complication was observed. Conclusion: Intralesional bleomycin injection is effective, safe and useful for the treatment of cystic hygroma with low complication rates. J.Natl.Inst.Ophthalmol. 2023; 6(2):67-72

Necrotizing fasciitis (NF) is a soft tissue infection that is primarily characterized by fast spread along the fascial planes and adjacent cutaneous tissues. Cervico-facial necrotizing fasciitis (CNF) usually presents with severe intense pain with a polymicrobial odontogenic source. Early diagnosis with aggressive management, usually involving appropriate antibiotic selection, surgical debridement, and wound care, is key to achieving a good outcome. Management of CNF requires a multidisciplinary approach and poses several challenges in resource-constrained settings, especially in developing countries. This problem is further compounded by the late presentation and uncontrolled and indiscriminate use of herbal medications in the tropics. A 65-year-old Ghanaian woman with no known comorbidity reported to the Accident and Emergency Unit of Sunyani Teaching Hospital with a chief complaint of recurrent toothache for two years and left facial swelling of 1-week duration. On physical examination, she was chronically ill, febrile (39.5°C), and anicteric but not pale. There was a soft, fluctuant, tender swelling involving both submandibular and submental areas with increased local temperature. The swelling also extended to the anterior cervical and anterior chest walls, which were overlaid with necrotic skin. Overlying such diseased skin was also prevalent over the mammary glands. Following the clinical diagnosis of NF spread, debridement was performed, and appropriate antibiotic therapy with daily wound care management was instituted. This continued until the patient's general condition improved, and good wound healing with the formation of granulation tissue was observed. The patient was subsequently referred to a tertiary facility for skin graft. Early presentation, prompt diagnosis, and aggressive surgical and medical care are key in achieving good outcomes of NF in resource-constrained developing nations.

Facial puffiness caused by dengue fever; two female returning travelers from Laos, and India in the COVID-19 era

Craniofacial fractures pose complex medical and surgical challenges. Prolonged wound healing complicates surgical reconstruction, highlighting the need for methods to enhance tissue healing. This research evaluated the effects of photobiomodulation (PBM) therapy on edema, trismus, and pain following mandibular fracture surgery. This study was approved by the Kasturba Hospital and Kasturba Medical College Institutional Ethics Committee (IEC: 219/2022). Thirty-two participants were signed up and split into two groups, one receiving PBM. Ten 660 nm LEDs with an energy density of 9 J/cm2, Power density (irradiance) of 50 mW/cm2, and nine 905 nm LEDs with an energy density of 13.5 J/cm2, power density (irradiance) of 75 mW/cm2. With a total power of 235 mW, the total dose was 42.3 J, a spot Size of 3.8 cm2, and pulsed at 156 Hz. The mandibular body and angle area were irradiated from the outer skin surface of the Jaw region. The therapy lasted for 3 min and was given for 4 consecutive days starting from the day after surgery. The present study evaluates pain thresholds using an algometer. The facial swelling was measured at two distinct points, the ear's tragus to the labial commissure (T-LC) and the outer canthus of the eye to the mandible's angle (OC-AM), using a ruler. Mouth opening was measured for trismus using a vernier calliper. There was no significant reduction in pain (-0.34 vs. -0.09; p = 0.079) or edema (T-LC: 2.44 vs. 2.13; p = 0.771, OC-AM 2.31 vs. 0.69; p = 0.185) in the PBM-treated group compared to the control group. However, trismus reduction was significantly better in the PBM group (-3.25 vs. -1.31; p < 0.001). In summary, a specific PBM protocol can effectively reduce trismus during recovery from mandibular fractures, with the potential for future optimization to address pain and edema.

Severe headache and physical findings in the face and neck area may imply serious intracranial pathology and warrant further investigations including laboratory tests and imaging. We present two migraine cases with unusual trigeminovascular cutaneous findings (i.e., periorbital bruising and facial swelling). Recognition of these rare manifestations of migraine may help the clinician in differential diagnosis and prevent unnecessary investigations. A pathophysiological discussion of these signs is provided.

Background: Myiasis, the infestation of live human tissue by dipterous larvae, is a rare condition in modern clinical practice but can present with severe complications in vulnerable individuals. Chrysomya bezziana, the Old World screwworm fly, is an obligate parasite known to cause aggressive tissue destruction, particularly in tropical regions. Case Presentation: We present a rare and severe case of extensive palatal necrosis caused by Chrysomya bezziana in a 62-year-old immunocompromised patient from a rural area. The patient presented with facial swelling, halitosis, and a necrotic lesion in the palate, initially misdiagnosed as a fungal infection. Direct examination revealed numerous live larvae within the necrotic tissue. Imaging studies ruled out deeper craniofacial involvement. Management included mechanical debridement, systemic antibiotics, and antiparasitic therapy, followed by reconstructive surgery. Conclusion: This case highlights the importance of considering myiasis in differential diagnoses of orofacial necrosis, especially in endemic regions and among immunocompromised or neglected populations. Early recognition and appropriate intervention are crucial to prevent extensive tissue damage and systemic complications.

Hyaluronic acid versus amniotic membrane in wound healing and bone regeneration in extraction sockets - A randomized controlled trial.

Antibiotic use in the dental field, especially in pediatric dentistry, should be carefully considered, taking into account resistance and side effects. This review aims to provide a general overview of antibiotic use and dosage in pediatric dentistry. Indications for antibiotic prescription include symptoms of systemic infection such as fever (≥ 38°C), lymphadenitis (cervical lymph node swelling and tenderness), facial swelling (especially spreading around the eyes), cellulitis, soft tissue infections (risk of deep infection and sepsis), severe localized infection or high risk of infection after invasive dental procedures such as acute pulpitis, severe periapical abscess spreading to soft tissues, persistent or worsening infection despite drainage, and prophylactic antibiotic use in immunocompromised patients. Antibiotic use for simple dental caries, no signs of infection after root canal treatment, prophylactic use after simple tooth extraction, and viral infections is unnecessary. The first-choice antibiotic in dentistry is amoxicillin; its dosage should be adjusted according to the infection symptoms and body weight in children. Furthermore, amoxicillin-clavulanate, clindamycin, metronidazole and azithromycin can be prescribed depending on the type of infection and the patient’s allergies. Excessive and inappropriate antibiotic use can contribute to antibiotic resistance. Pediatric dentists should receive continuous education and stay updated on periodic revisions to antibiotic use and dosage guidelines.

Abstract INTRODUCTION Angiotensin-converting enzyme inhibitors (ACEIs) are known to cause drug-induced angioedema, though involvement of the gastrointestinal tract is rare. Bowel angioedema results from fluid leakage into the intestinal wall and can be challenging to diagnose, especially in patients with underlying conditions like Crohn’s disease, where overlapping symptoms may occur. Isolated bowel angioedema, although uncommon, poses diagnostic difficulties and requires careful evaluation, particularly when managing patients with complex abdominal diseases. CASE REPORT We present a 32-year-old Caucasian woman with well-controlled Crohn’s disease and hypertension, managed with Risankizumab and Lisinopril. She experienced a year of episodic abdominal pain, nausea, and vomiting, leading to repeated steroid tapers and a change in biologic therapy. She was hospitalized after a two-day period of worsening symptoms and presented hypotensive (85/55 mmHg) and tachycardic, though improved with IV fluids. Initial imaging revealed significant small bowel wall thickening and free fluid in the abdomen, raising suspicion for a Crohn’s flare. However, following the discontinuation of Lisinopril, the patient experienced rapid improvement within 24 hours. Repeat imaging confirmed resolution of bowel edema, and endoscopy and colonoscopy performed showed no abnormalities. She was diagnosed with ACEI-induced intestinal angioedema, which had been misinterpreted as Crohn’s disease.Discussion: Visceral angioedema due to ACEI is often recognized by systemic signs like facial or upper airway swelling, but when it presents with isolated bowel involvement, diagnosis can be challenging. This case highlights the importance of considering ACEI-induced bowel angioedema in patients with Crohn’s disease, as misdiagnosis may result in inappropriate treatment, such as escalation of biologic therapy. ACEI-induced bowel angioedema can occur at any time after initiating the medication and should be suspected in patients with unexplained gastrointestinal symptoms, especially if imaging shows bowel thickening. Recognizing this condition early is crucial to avoid unnecessary interventions. CONCLUSION This case emphasizes the need for clinicians to be aware of ACEI-induced bowel angioedema as a rare but significant Crohn’s mimicker. Failure to recognize this condition can lead to unwanted treatments and complications. Timely diagnosis and discontinuation of the offending agent can result in rapid symptom resolution, preventing further unnecessary interventions and improving patient outcomes. Figure 1: Figure 1 A and B is the initial CT A/P, showing the bowel edema and the free fluid. contrast showed extensive marked small bowel wall thickening with free fluid adjacent to the cecum and in the pelvis. Figure 2: Figure 2 A and B is the CTE showing substantial improvement with only mild bowel wall thickening and mural hyperenhancement involving a short segment of the small bowel.

BackgroundThird molar surgery is associated with various postoperative complications (PC). Different strategies, including the application of platelet-rich fibrin (PRF), have been implemented to reduce PC. Digital technologies have proven useful in objectively assessing postoperative facial swelling. This study aimed to evaluate the effect of PRF on reducing facial swelling after lower third molar surgery using a 3D face scanner.MethodsA randomized split-mouth clinical trial was set up and 32 patients (18 to 32 years), requiring extraction of both mandibular third molars, were recruited at the Oral Surgery Clinic of the Magna Graecia University of Catanzaro. The primary predictive variable was the application or not of PRF plugs and membranes in the post-extraction socket. Primary outcome variable was facial swelling recorded with a face scanner preoperatively (T0), after three (T1) and seven (T2) days. Qualitative and quantitative data analysis were conducted following an automated and standardized imaging analysis workflow using the 3D Slicer software. Secondary outcome variables were trismus, recorded by measuring the maximum buccal opening with a caliper, pain, recorded using a visual analogue scale (VAS), and duration of the surgery. Descriptive and bivariate analysis were performed by setting the significance level = 0.05.ResultsAll patients exhibited a significant increase in facial swelling at T1, followed by a subsequent reduction from day 3 to day 7, with a slight persistence of edema observed on the seventh day. No significant data emerged from the statistical analysis conducted. Linear differences in PRF group reported improved values of postoperative swelling only in the T1-T2 and T0-T2 phases of analysis. Volumetric differences favored PRF group compared with control group in all phases. VAS was lower in PRF group only at T2, compared with control group.ConclusionsApplication of PRF in post-extraction sockets showed effectiveness in reducing facial swelling. Its advantages, including accessibility, cost-effectiveness, and absence of adverse reactions, make it an optimal treatment choice in reducing post-surgical sequelae.

Central vein stenosis (CVS) is a complication primarily affecting chronic hemodialysis patients, frequently resulting in vascular access dysfunction and decreased dialysis efficacy. While CVS has a variable mortality rate, its impact on dialysis access is profound, including arm edema, facial swelling, and venous hypertension. We describe the prevalence, clinical presentation, and treatment outcomes of CVS for vascular access in hemodialysis patients. We conducted a prospective observational study from July 2023 to June 2024, on patients undergoing maintenance hemodialysis (MHD) at a tertiary care center in South India who had CVS detected by CT Venography. Demographic information, comorbidity, access type, stenosis location, clinical presentation, treatment, and outcome data were collected and analyzed. Of the 152 patients on MHD, 20 (13.1%) had CVS. Of them, 7 patients were on tunneled catheter and 13 were on AVF. Arm edema (47%) was the most common symptom, followed by face swelling (29%) and prolonged bleeding (11%) from arteriovenous fistula post dialysis. The brachiocephalic vein (BCV) was the most common site of stenosis in 65% of patients. Angioplasty was performed in (N = 9) nine patients with a primary success rate of 66% and a six-month patency of 44.4%. In the remaining eleven (N = 11) four patients (20%) transitioned to CAPD, three (15%) had new access of which two had femoral catheter inserted and other one had new AVF creation done and two (10%) continued dialysis via same access. Mortality occurred in two patients (10%) due to pulmonary edema. The Prevalence of CVS in our study population was 13.1%. Six-month primary patency rate among those who underwent intervention was 44.4%. Vascular access had to be terminated in 55%.