Intraoral Swelling Research Articles

Management of a Periodontally Compromised Grade III Mobile Tooth Associated with Pyogenic Granuloma

With current advancements in the field of dentistry, the dental treatments today are focused more on conserving the tooth and supporting the concept of “nothing serves better than the natural tooth itself.” This case report presents a multidisciplinary treatment approach adopted in retaining a Grade III mobile periodontally compromised permanent maxillary left central incisor in a 32-year-old female patient who reported to the Department of Periodontics and Oral implantology with the chief complaint of intraoral swelling, pus discharge, bleeding gums, and tooth mobility in the upper front tooth region. At 1-year follow-up, the tooth was periodontally stable and functional.

Developing confidence in oral and maxillofacial dental core trainees: a national review of the trainee experience

This study considers the confidence of dental core trainees (DCTs) as they mature and progress through their first six months in an oral and maxillofacial surgery (OMFS) training post. Trainees have different incentives for embarking on a year in OMFS: to develop additional skills before settling into general dental practice; as a step towards specialty training; and to help decide about their career direction. Traditionally, an OMFS year has been associated with creating well-rounded and confident clinicians. We surveyed 123 DCTs at three stages over a six-month period to monitor their confidence in 10 clinical domains: assessing dentofacial infection, mandibular fractures, midface fractures, intraoral/extraoral swellings, airway risks, intraoral/extraoral lesions (benign/malignant), CT/MRI scans, and performing intraoral/extraoral suturing. The study demonstrates an increase in trainee confidence across all domains over the first six months of an OMFS post, with a particularly significant increase in the assessment of dentofacial infection, mandibular/midface fracture, and both intraoral and extraoral lesions and swellings.

Pleomorphic adenoma of the minor salivary gland in buccal mucosa: A case report

Pleomorphic Adenoma (PA) is the most common tumor of the salivary gland, arising mostly from the parotid gland while small percentage from the minor salivary gland. The most common sites of pleomorphic adenoma of the minor salivary glands are the palate, followed by lips. The buccal mucosa or cheek is a rarely affected site by PA of the minor salivary glands. Here, we present a case report of PA of the buccal mucosa, presented with intraoral swelling, complete surgical excision was done with a follow up of 3.5-years.

Conservative Lateral Approach for Pleomorphic Adenomas of Parotid Gland Involving the Parapharyngeal Space-A Case Series.

The aim of this paper is to present and discuss the symptoms, clinical signs, diagnostic methods and a conservative surgical approach to large parotid pleomorphic adenomas arising from deep lobe and extending to the parapharyngeal space. In this case serieswe are describing four such cases which presented with painless swelling of different sizes in the parotid region along with intraoral swelling. Detailed diagnostic workup which included computed tomography scan, fine needle aspiration biopsy and magnetic resonance imaging was undretaken for confirmingthe diagnosis. Complete excision of the tumour via transcervical and transparotid approach without mandibulotomy and aftersecuring local neurovascular structures was performed in all cases. This conservative lateral approach reduces the likelihood of complications. All the four patients were discharged without any complications and a proper follow up was done.

Sinonazal Tümörlerden Düşük Dereceli Tübülopapiller Adenokarsinomu: Tanı ve Takip

Low grade tubulopapillary adenocarcinoma is one of the rare sinonasal tumors. A 65-year-old male patient was admitted to our clinic with painless intraoral and extraoral swelling and speech disorder. Radiological examination of the patient revealed a lesion suggesting malignancy. The area of the lesion spread from the left maxillary area to the maxillary sinus, nasal cavity, zygomatic bone and the base of the eye, causing resorption of the bones in the regions. As a result of biopsy, the lesion was diagnosed as well-differentiated low-grade tubulopapillary adenocarcinoma. The patient was referred to the oncology department of the medical faculty and the radiotherapy was started by the medical faculty board, indicating that it was not suitable for surgical treatment. After 1.5-year follow-up, the patient was re-biopsied and diagnosed as poorly differentiated tubulopapillary adenocarcinoma. We think that the aggressive lesion may show heterogeneous differentiation as a possible reason for the differentiation between the two biopsies.

Airway Management in Huge Ranula

Airway management in the presence of a large intraoral swelling is always challenging. We report a young boy with a huge ranula occupying the entire oral cavity and protruding from the mouth. Our planned and strategic approach in a resource-limited setting included prior consultation with the ENT surgeon for aspiration of swelling if needed before intubation. Good topical airway anaesthesia followed by gentle videolaryngoscopy resulted in successful airway management.

Delayed hypersensitivity reaction to orodispersible budesonide in a case with eosinophilic esophagitis

BackgroundEosinophilic esophagitis (EoE) is a chronic inflammatory disease that has been known since the early 1990s. Swallowed topical corticosteroids (STC) belong to the therapeutic cornerstones. We describe a delayed hypersensitivity reaction to Jorveza®, a newly developed orodispersible budesonide tablet licensed for the treatment of eosinophilic esophagitis.Case presentationA 32-year-old Caucasian woman with EoE was newly treated with Jorveza®. Hours after the first intake, she felt a “strange pruritus” in the throat. This sensation worsened with each subsequent intake. On day 4 she developed oral mucosal symptoms (paresthesia of the tongue, sore and an itchy throat). Intraoral, throat and facial swellings, but no systemic reaction were observed. Patch testing using two commercial test series as well as the orodispersible budesonide tablet revealed a strong sensitization, proving a T cell mediated allergy to budesonide.ConclusionsOrodispersible budesonide is increasingly prescribed for the treatment of eosinophilic esophagitis. The development of oropharyngeal symptoms after initiating should alert the treating physician to the possibility of a hypersensitivity reaction.

Neurofibromatosis ‐1 diagnosed from an intraoral swelling – a case series

The neurofibromatoses [NF 1, NF 2 and schwannomatosis] are a group of genetic disorders that lead to the development of nervous system tumours and have diverse dermatologic, neurologic, ophthalmic, skeletal and vascular effects. The most common is NF 1 (Neurofibromatosis 1) also known as von Recklinghausen's disease, which is one of the most common human genetic diseases. Oral manifestations of NF 1 are reported in 72% of cases and in one of our cases precipitated attendance at a general dental practitioner (GDP), subsequent diagnosis and genetic screening for family members. This disease may go undiagnosed due to its variable expressivity of symptoms. The pivotal importance of a GDP in the discovery and early referral to an oral or oral and maxillofacial surgeon for further investigation and diagnosis of this condition is highlighted. Knowledge of the most common features of neurofibromatosis can facilitate the speedy referral and subsequent diagnosis of generalized neurofibromatosis, local surgical management of benign neoplasms and long term management of its other clinical features. Dentists should be aware of the classic symptoms of this condition and of their role in long-term care in view of the risk of local recurrence and malignant transformation.

The Shrinkage Pattern of Odontogenic Cyst After Surgical Decompression

Aim: This study was designed to evaluate the shrinkage pattern of odontogenic cyst after surgical decompression clinically and radiographically. Subjects and Methods: Twenty-eight patients were selected from those attending the outpatient clinic of the Department of Oral and Maxillofacial Surgery, Sayed Galal University Hospital with cystic lesions, larger than 3 cm on 2D-Panorama. Clinical examination was made to all patients as: Facial disfigurement, Intra-oral swelling and Sinus tract. Preoperative and after 3, 6 months postoperatively cone beam CT for every patient to determine extension of the cystic lesion, Proximity to the vital structures, Multi or uni-cystic lesion and Volumetric measurement of cystic lesion. All readings were recorded and analyzed statistically. Results: The mean volumetric analysis was 21.21 ± 7.69 cm3 at base line (pre surgery), 13.96 ±5.25 cm3 after 3 months and 8.80± 4.03 cm3 after 6 months which was statistically significant. Conclusion: Decompression is an effective treatment of odontogenic cysts, leading to a high percent reduction of the lesion area

Diagnostic imaging of a Rare Intraosseous Mandibular Schwannoma using Cone Beam Computed Tomography – A case report

Intraosseous schwannoma is a very rare (<1%), slow-growing, benign tumor of Schwann cells. The mandible is the most common site for intraosseous schwannoma. Here, we report the case of a 35-year-old female reported with extraoral and intraoral swelling with bicortical expansion on the left side of the mandible for the past 6 months. Two-dimensional imaging modalities (intraoral periapical radiograph, orthopantomogram, and occlusal radiograph) showed giant well-defined false multilocular radiolucency appearance in the left body of the mandible and external root resorptions of the premolars and molars. Aspiration was non-productive. Cone-beam computed tomography (CBCT) study showed a bicortical expansile unilocular hypodense lesion in continuity with the widened mandibular canal suggesting a tumor of neural tissue origin. Radiological diagnosis of intraosseous schwannoma was given and histopathological examination after an excisional biopsy confirmed the same. The postsurgical phase was uneventful and the patient is under follow-up. This article highlights the importance of three-dimensional modality like CBCT in narrowing the diagnosis of such rare clinically misleading presentations

Immunophenotyping for Diagnosis of Oral Lesions: Is It an Important Tool?

Aims: To report two cases of onco-hematologic diseases diagnosed by oral biopsy and subsequent flow cytometry immunophenotyping.
 Presentation of Case: Case 1: A 36-year-old woman, HIV +, referred to the Hospital Dentistry Center presenting an extensive, ulcerated and painless lesion in the left maxilla involving teeth #24, #25, #26 and #27. A fine needle aspiration and incisional biopsy were performed and one sample was sent to anatomopathological analysis and other to immunophenotyping. Immunophenotyping revealed 31.2% of aberrant plasma cells with phenotype suggestive of plasmablastic lymphoma.
 Case 2: 62-year-old male patient attended Hospital Emergency presenting extra and intraoral swelling on the left side of maxilla. Fine needle aspiration and incisional biopsy were performed, followed by pathological analysis and immunophenotyping. Immunophenotyping revealed 40.7% of large mature B cells with phenotype suggestive of diffuse large B-cell lymphoma. Both patients presented histopathological and immunophenotyping results leading to the same diagnosis. After definitive diagnosis, both patients underwent antineoplastic treatment through cycle of chemotherapy.
 Conclusion: Immunophenotyping is a well-established method for the diagnosis of onco-hematologic diseases and has been shown to be effective for the rapid diagnosis of oral tumors.

Antibiotics Are Recommended, for the Urgent Management of Pulpal- and Periapical-Related Dental Pain and Intraoral Swelling, Only When There Is Systematic Involvement

Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. Lockhart PB, Tampi MP, Abt E, etal. J Am Dent Assoc 2019;150(11):906-921.e12. The American Dental Association. Systematic review with meta-analysis of data.

Pleomorphic Adenoma of the Anterior Hard Palate: A Rare Case Report

Pleomorphic adenoma (PA) is a benign tumor of the salivary glands that has components of both epithelialand mesenchymal origin. The most common site for the PA is the parotid or submandibular glands. On rareoccasions, the tumor may arise from the minor salivary glands and present as an intraoral swelling overthe hard palate or lip. But the anterior hard palate is not the commonest site for PA. We report the case of a42-year old man who came with a complaint of a swelling in the anterior region of the hard palate and laterdiagnosed as pleomorphic adenoma based on histopathological examination.

Periradicular Cystic Enucleation and PRF Grafting Following Apicoectomy in Trichotillomania Patient- A Case Report

Diagnosis and treatment planning of untreated traumatised anterior teeth specially in children with psychiatric disorders or special health care needs is a challenge to paediatric dentist, that too in non-pharmacological means is a difficult task. Most of the time when these patients report with such complaint, it is already too late. This could be due to unintentional reasons like lack of parent awareness or patient’s response at the time of insult. All these factors bypass the time of conservative and minimal invasive treatment approaches. Ultimately, delayed treatment of trauma to anterior region exposes pulp and infection progress to periradicular region with cystic changes. Here, in this case report, the non-pharmacological management of periradicular cyst enucleation, followed by apicoectomy and Platelet Rich Fibrin (PRF) grafting was done in a 15-year-old female patient with obsessive compulsive disorder i.e., Trichotillomania (TTM) under local anaesthesia. Symptoms and intraoral swelling was resolved postoperatively in follow-up visits.

Retrospective study for performing high condylar shaving as preservative treatment of mandibular condyle osteochondroma

PurposeThe aim of this study was to evaluate the efficiency of conservative condylectomy with articular disc repositioning for the treatment of temporomandibular joint (TMJ) condylar osteochondroma.Patients and methodsSeven adult patients with unilateral TMJ condylar osteochondroma were involved in this study, four patients were male and three patients were female. Their ages ranged from 27 to 45 years with a mean of 35 years. All patients were evaluated preoperatively both clinically and radiographically. All the clinical and radiographic parameters were performed immediate, 1, 3, and 6 months postoperatively.ResultsThe visual analog pain scale revealed no pain after 6 months follow-up periods in all patients. Regarding to occlusal disturbances, during the period of follow up only two cases (case no. 2 and no. 7) suffered from slight occlusal disturbances after 1 month. All cases had no occlusal disturbances at the end of 6 months follow-up period. There was improvement in mouth opening (the interincisal distance was found to be 38 mm 6 months postoperatively). No extraoral or intraoral swelling was detected in the region of condyle in all cases at the end of 6 months postoperatively. No obvious deviation of the mandible was detected during mouth opening in all cases through the follow-up period. All the treated patients had satisfactory facial symmetry during the postoperative follow-up period. Radiographic evaluation revealed that the treated condyle had normal configuration in all cases and fits properly within the extent of glenoid fossa and there was no evidence of recurrence of the lesion nor any evidence of condylar resorption in any of the operated cases.ConclusionA conservative condylectomy with articular disc repositioning is considered as an option for treatment of the TMJ condylar osteochondroma.

”Myxoma of the Jaws”: Report of an atypical presentation and review of literature

Oral lesions of myxomatous origin are relatively rare and include nerve sheath myxomas, soft tissue myxomas, oral focal mucinosis, and odontogenic myxomas. These lesions have a common histologic appearance of abundant myxoid ground substance. A 61-year-old edentulous female presented with nasal stuffiness since the past 4 months. Clinical examination revealed an asymptomatic intraoral swelling in the edentulous maxillary ridge which had ulcerated. Plain film radiography and CT showed an expansile osteolytic lesion involving the right maxillary sinus. A partial maxillectomy was performed and direct microscopy showed a predominant embryonic mesenchymal stroma with fibroblasts and calcifications suggestive of a myxoma. The central myxoma is hypothesized to originate from the odontogenic apparatus due to its almost exclusivity to the jaw bones. However, when a central myxoma occurs in an edentulous jaw at an age when the odontogenic apparatus is apparently nonfunctional, explaining the genesis of this unique tumor based on present understanding becomes difficult. We present one such case while reviewing the existing literature on the present concepts of pathogenesis.

Fibrous hamartoma of infancy (FHI) of the parotid region in a 3-year-old female presenting as a huge parapharyngeal tumor: A very rare case presentation

Introduction: Fibrous hamartoma of infancy (FHI) is a rare, benign tumor arising from the lower dermis and subcutaneous tissue. It usually occurs in children below two years of age and is often misdiagnosed as being of malignant nature. It most commonly effects the lower extremities, very rarely involves the head and neck region, and is commonly found in males. Microscopically, it is a poorly circumscribed and non-capsulated tumor comprising of interlacing fascicles of pale eosinophilic myofibroblasts and stellate shaped fibroblasts with island of mature adipocytes. Case Report: We report a very rare case of FHI of parotid gland in a 3-year-old female child, posing a diagnostic difficulty for management. The site, size, and age of presentation of the tumor were unique. This tumor is common in males but our case was a female child. Our patient presented with involvement of the parotid, submandibular and upper neck area with a huge size of around 7 × 8 cm which was causing mild swallowing difficulty due to intraoral swelling in the child. Cytopathology from the lesion demonstrated spindle cell lesion, the differential diagnosis of which is often malignant in pediatric age group. We took a biopsy for confirmatory diagnosis and after histopathological diagnosis of FHI proceeded with complete surgical excision. Conclusion: Treatment of choice for these benign tumors is complete surgical excision, with excellent prognosis.

Anesthetic management of large tongue swelling in neonate and children: A series of four cases

Management of neonatal airway is difficult due to its anatomical and physiological changes. The presence of intraoral pathology causes anticipated difficult intubation during the management of infant and children airway. Bleeding, difficult in visualizing the airway, and enlarged upper respiratory structures make airway management challenging for anesthesiologist. There is a risk in the postoperative period also for airway patency. In these case series, we described the management of difficult airway with large intraoral swelling.

ODONTOGENIC KERATOCYST ASSOCIATED WITH THIRD MOLAR IN MAXILLARY SINUS

A 20-year-old white male patient was admitted to the hospital complaining about intraoral swelling, spontaneous secretion drainage at superior left molar, throbbing pain, local pressure, parageusia, and halitosis 3 months ago. The intraoral physical examination revealed bulging in between teeth 25 to 27 causing slight facial asymmetry. The computed tomography showed ectopy of tooth 28 associated to cystic-like unilocular bone rarefaction, filling in great extension of the left maxillary sinus. The maxillary sinus was accessed through Caldwell-Luc technique followed by the decompression and cyst excision, and the material removed was referred for histopathologic examination. Microscopically, an epithelium-lined pathologic cavity was observed, being 6 to 8 cells thick. The epithelium demonstrated a well-developed basal layer of palisade cells with polarized, hyperchromatic nuclei. The luminal surface was corrugated and contained parakeratin and, thus, diagnosis of odontogenic keratocyst was established. The patient is under follow-up for 4 months without recurrence.

INFLAMMATORY ODONTOGENIC CYSTS IN THE RIGHT JAW. DIAGNOSIS, TREATMENT, AND 3 YEARS OF FOLLOW-UP

Inflammatory odontogenic cysts may arise from the development or proliferation of residual odontogenic epithelium remaining from an extracted tooth. A 76-year-old male patient sought treatment with mild pain and intraoral swelling in the right mandibular region. The clinical examination evidenced a great asymptomatic expansion of the vestibular and lingual cortices covered by normal color mucosa in the posterior region of the edentulous right mandible. On the radiographic examination, a single, well-delineated radiolucent area with sclerotic and slightly multilocular borders extended from the right lower canine region to the mandibular ramus. As a treatment, a biopsy was performed initially and then a decompression cannula was placed. After the result of the histopathologic examination of the inflammatory odontogenic cyst, the decompression cannula was maintained for 18 months until regression of the cystic lesion. Subsequently, enucleation was performed. The patient is being followed up with radiographic control.