Left Maxillary Region Research Articles

Ewing’s Sarcoma Presenting in the Paranasal Sinus – A Case Report

Abstract Rationale: The aim of this study is to raise awareness among dentists regarding a potential outcome associated with the rapid growth of facial swellings. Patient Concerns: We present a case of Ewing’s sarcoma (ES) in a 23-year-old male who presented with a rapidly progressive swelling in the left maxillary region over six weeks. Diagnosis: There was no significant intraoral dental finding other than a missing left upper first molar. Panoramic imaging initially suggested chronic sinusitis, but the swelling persisted despite treatment. A subsequent cone-beam computed tomography (CBCT) scan revealed a soft-tissue tumour affecting multiple sinuses, confirmed by an open biopsy as a small round cell tumour. Immunohistochemistry was used for precise diagnosis due to biopsy sample limitations and tumour variability. Treatment: The patient’s case was reviewed by our institution’s tumour board. One month after diagnosis, chemotherapy began with alternating drugs for a total of 6 cycles. Outcomes: A follow-up Positron Emission Tomography (PET)/Computed Tomography (CT) scan after two months of chemotherapy showed resolution of the hypermetabolic mass on the left side without evidence of metastatic disease. The patient is currently under regular follow-up. Take-Away Lessons: Dentists should be vigilant for rapidly expanding oral or facial swellings. Early and accurate diagnosis can improve clinical management and survival rates for ES patients.

Barodontalgia during hyperbaric oxygen therapy of an 8-year-old male: A case report

Barodontalgia, barometric pressure-induced dental pain, may occur during hyperbaric oxygen (HBO2 ) therapy due to pressure changes. This case report presents an 8-year-old male patient with barodontalgia. The patient declared a severe toothache during HBO2 therapy. The diving medicine specialist referred the patient to the dental clinician immediately. On clinical examination, the pain was thought to be caused by caries lesions of the deciduous teeth in the left maxillary molar region. Tooth extraction was suggested. After extraction, the patient continued hyperbaric oxygen therapy sessions without any pain. The patient was recommended for an intraoral and radiographic examination session one week after the extraction. In conclusion, caries lesions and faulty restorations should be examined before hyperbaric oxygen therapy sessions. Even though barodontalgia is a rare phenomenon, dental examination is essential to avoid these kinds of pain-related complications. All carious lesions and defective restorations must be treated, if necessary. Removal of faulty restorations and management of inflammation as part of the treatment is suggested before exposure to pressure changes.

Tumor odontogénico adenomatoide. Reporte de un caso clínico

The Adenomatoid Odontogenic Tumor (AOT) is an uncommon benign neoplasm, characterized by slow and progressive growth, in most cases asymptomatic. It is an intraosseous pathology, which can be follicular or extrafollicular, with the follicular type being the most common. It occurs in both men and women, with a predilection for the female sex. Histologically, it is composed of odontogenic epithelium organized in different histoarchitectonic patterns, embedded in a stroma of mature fibroconnective tissue. We describe the clinical case of a 25-year-old female patient with increased volume in the left anterior maxillary region, extending to the base of the nose, causing deviation of the midline to the right and having one year of evolution.

Mixed Type Basal Cell Carcinoma Treated with Excision and Defect Closure Using Advancement Flap: A Case Report

Background: Basal cell carcinoma (BCC) is a localized malignant tumor in the basal layer of the epidermis thought to be the result of prolonged sun exposure and associated with gene mutations in most cases. Although rarely metastazises, BCC can cause high levels of morbidity due to its locally destructive nature. There are several modalities for managing BCC, and the defect caused by the lesion can reconstructed by local flap.
 Case presentation: We present a 55-year-old woman with a chief complaint of a blackish lump on the left maxillary region, growing bigger, and frequent episodes of bleeding. The lesion was excised and followed by histopathological examination, which revealed mixed subtype BCC. Closure of the defect with an advancement flap was performed with favorable results.
 Conclusion: Surgical excision is the best option for managing BCC, while a skin flap is preferred to close defects for lesions on the cheek.

Maxillary Sinus Epidermoid Cyst: A Case Report.

The preoperative diagnosis of a paranasal epidermoid cysts (EC) is challenging and is frequently mistaken. We present the case of a patient who developed a swelling on the left side of the face. The clinical examination showed a fixed and poorly defined swelling in the left maxillary region, with a slightly painful bulge in the upper vestibular peri-gingival area. A computed tomography (CT) scan showed a well-encapsulated expansive hypodensity that filled the left maxillary sinus. Magnetic resonance imaging (MRI) revealed a mass hypo-intense on T1-weighted images, high intense on T2-weighted images, hyperintense on diffusion-weighted images, and had a low apparent diffusion coefficient with no contrast uptake observed after the injection of Gadolinium. Surgical excision under general anesthesia was considered. A combined approach using an endoscopic sinus and Caldwell-Luc approach was performed and the histopathological examination confirmed the diagnosis of an EC. In conclusion, the preoperative imaging, including CT scans and MRI, aids in diagnosing ECs and differentiating them from other sinus tumors. Postoperative follow-up involving endoscopic surveillance and CT scans is crucial to monitor for potential recurrence.

Reconstruction of the Atrophic Ridge with Staged approaches with the Autogenous Bone Block and Dental Implant: Case Reports and Literature Review

<p>Dental implant is a common choice for rehabilitation of edentulous areas in modern dentistry. However, alveolar bone destruction due to severe periodontitis, trauma, or other pathological conditions may compromise implant placement in an idea position. Ridge augmentation with autogenous bone blocks can be used to reconstruct the deficiency of the alveolar bone. This article reviewed about the relevant literatures and reported two cases of severe ridge atro¬phy using staged approaches with ridge augmentation using autogenous bone block grafting and implant placement for reconstruction. Case 1 showed alveolar bone destruction caused by severe periodontitis at left maxillary region, which was augmented with the autogenous bone block harvested from mandibular symphysis in combination with FDBA and collagen membrane. Case 2 presented alveolar ridge deficiency after tooth extraction due to severe periodontitis. Ridge augmentation was performed using autogenous bone block harvested from the mandibular ramus along with FDBA and collagen membrane. Both cases showed increased bone volume after ridge augmentation. Implants were successful and presented stable bone level for a follow up period at least one year after implant surgery. The literature review and case reports suggest that with appropriate case selection, careful treatment, and regular maintenance, using autogenous block bone grafts harvested from the mandibular symphysis or ramus for ridge augmentation and implant placement can achieve predictable outcomes.</p> <p> </p>

A giant peripheral ossifying fibroma-A case report

Peripheral ossifying fibroma (POF) is a reactive lesion of the gingiva which predominantly affects women and is usually found anterior to the maxillary molars. POF is usually a fibroma of the gingiva which shows some areas of calcification or ossification. According to literature, POF is a separate clinical entity rather than a transitional form of pyogenic granuloma or irritation fibroma. Surgical excision is the treatment of choice for POF, though the recurrence has been reported in many cases. We present a case of large POF arising from alveolar mucosa in left maxillary edentulous region in 57 years old female patient.

Barodontalgia during hyperbaric oxygen therapy of an 8-year-old male: a case report

Barodontalgia, barometric pressure-induced dental pain, may occur during hyperbaric oxygen therapy due to pressure changes. This case report represents an 8-year-old male patient with barodontalgia. The patient declared a severe toothache during hyperbaric therapy. The diving medicine specialist referred the patient to the dental clinician immediately. Upon clinical examination, the pain was thought to be caused by caries lesions of the deciduous teeth in the left maxillary molar region. Tooth extraction was suggested. After extraction, patient continued hyperbaric oxygen therapy sessions without any pain. Patient was recommended for a session to intraoral and radiographic examination one week after the extraction. In conclusion, caries lesions and faulty restorations should be examined before hyperbaric oxygen therapy sessions. Even though barodontalgia is a rare phenomenon, dental examination is essential to avoid these kinds of pain-related complications. All carious lesions and defective restorations must be treated, if necessary. Removal of faulty restorations, and management of inflammation as part of the treatment is suggested before being exposed to pressure changes.

Benigni mešoviti tumor male pljuvačne žlezde

Introduction: The most common major salivary gland neoplasm is the Pleomorphic adenoma. Only 10% of the pleomorphic adenoma occur in minor salivary glands. 42.8% to 68.8% of cases with intraoral lesion occurs in the palate. Here we present a rare case of a pleomorphic adenoma masquerading as a lesion of odontogenic origin. Case report presents a male patient who reported with a chief complaint of swelling in the upper left tooth region since 3 months. Panoramic radiograph revealed shadow of a soft tissue swelling in the left maxillary posterior region with destruction and resorption of the alveolar process. Radiographic differential diagnosis of benign odontogenic/non-odontogenic cysts or tumours, benign minor salivary gland tumours were considered. Excisional biopsy was carried out and the lesion was removed in total up to the periosteum and the overlying mucosa and sent for histopathologic examination, which suggested pleomorphic adenoma. Conclusion: Pleomorphic adenoma is a benign neoplasm which has excellent prognosis with a cure rate of more than 95%. However, periodic long term follow up is mandatory.

Maxillary Ridge Split with Simultaneous Implant Placement – A Case Report

Inadequate alveolar ridge width often poses difficulty in implant placement. Such ridges require a combination of techniques in placing implants. One such technique is the ridge split technique which helps the expansion of the ridge with or without greenstick fracture of cortical plates. Before placing implants the width of the alveolar ridge can be effectively restored utilising the modified ridge splitting approach employing autologous bone grafts. This case report describes the ridge splitting and placement of a dental implant in the left maxillary central region followed by guided bone regeneration. Ridge expansion was done in relation to 21 and osteotomy was prepared to the desired depth. After proper treatment planning implant measuring 3.5 mm in diameter and 11.5 mm in length was placed. Four months later final cementation was done with PFM crown. The ridge split technique with the immediate implant placement resulted in minimal resorption of alveolar bone along with maximum expansion of the bone. The sequential surgical and restorative techniques were combined into one successful protocol whose steps are well elaborated in this case report.

Modified Band and Loop Appliance for Retention of Periodontal Dressing on Denuded Bone: A Case Report

Intraoral lacerations without gape heal spontaneously, whereas lacerations gaping open need to be managed with primary closure or advancement flap. Fall injury leading to a laceration over the left maxillary vestibular region extending till the alveolar ridge with avulsed tooth where primary closure was not possible was planned for debridement followed by periodontal dressing. Due to the lack of retentive area, modified band and loop appliance with a T-loop was fabricated and used for the retention of periodontal dressing for the healing of denuded bone following trauma.

Management of A Case of Fibro-epithelial Hyperplasia of Gingiva

ABSTRACT:
 Fibroepithelial hyperplasia/fibroma is an exophytic growth which occurs due to any reactive or chronic inflammatory condition of the gingiva by plaque, calculus, overhanging margins, trauma and dental appliances. These can cause discomfort to the patient and often causes difficulty in oral hygiene maintenance. This case report presents a case of a fibro-epithelial hyperplasia in a 37 years old female, who presented with a localized diffuse type of gingival enlargement in the left maxillary posterior teeth region. Based on clinical and histopathological evaluation the diagnosis of fibro-epithelial hyperplasia was made. The patient was then kept on regular follow-up and no recurrence of the lesion could be appreciated till date.

Two third’s tumour – A case report

Adenomatoid odontogenic tumour (AOT) is a rare, uncommon, benign odontogenic tumour that constitutes approximately 3% of all odontogenic tumors. It usually occurs in the second or third decade of life with female prediction. AOT commonly occurs in anterior maxilla. An accurate diagnosis should be established through clinical, radiographical and pathological correlations to differentiate AOT from other conditions. In this article we report a case of follicular AOT in 13-year-old female patient with swelling in left maxillary anterior region.

Effect of Osseodensification on Bone Density and Crestal Bone Levels: A Split-mouth Study

Dental implants have become a popular alternative in the oral and maxillofacial rehabilitation after the introduction of the concept of osseointegration. A poor density bone can negatively influence the bone to implant contact (BIC) and delay osseointegration. Various osteotomy techniques and drilling procedures have been used to increase stability in low-density bone. But they have been associated with limitations such as trauma to the surrounding bone and difficulty in controlling the technique. Osseodensification has recently been developed. Densifying burs are specifically designed burs which help in preserving the bone by condensing the bone by rotating in the noncutting direction. Split-mouth study was conducted on a total of 10 patients wherein implants were placed in the same patient bilaterally in maxillary posterior region where the left maxillary posterior region received implants through sequential osteotomy technique and the right maxillary posterior region received implants through a series of new multifluted tapered burs (Densah™). A cone-beam computed tomography (CBCT) was taken preoperatively, immediately after implant placement, and 3 and 6 months after implant placement. The bone density and crestal bone levels were measured. Results were analyzed by student's paired "t" test and Man-Whitney U test. There is no statistical difference between the levels of the crestal bone between an osseodensified site as compared to a conventional osteotomy site. The width of the residual bone increases after osseodensification and remains in the increased dimension for 3 months and continues at 6 months. Thus, it can be concluded that osseodensification leads to bone expansion. The radiographic bone density adjacent to the implant is significantly increased after ossedensification and the bone there remains relatively dense over a period of 6 months aiding in a primary stability and eventual good osseointegration.

Central odontogenic fibroma of maxilla: A case report

Central odontogenic fibroma is a rare mesenchymal odontogenic neoplasm with a prevalence of 0.1 of all odontogenic tumors. Herein we present a case of a 63-year-old female with swelling in the left posterior maxillary region which was later diagnosed as a central type of odontogenic fibroma. A painless swelling was noted in the left maxillary tuberosity area. Orthopantamogram was advised which revealed a unilocular lesion with a mixed radiopaqueradiolucent appearance. This was associated with a spherically dense radiopaque mass in the left maxillary sinus region. A provisional diagnosis of the calcifying epithelial odontogenic tumor was made. An incisional biopsy was done and the specimen was sent for histopathological evaluation. The microscopic examination revealed inactive-looking odontogenic islands in the background of mature connective tissue stroma. Few foci of calcifications were also noted. After contemplating all the histological features a final diagnosis of central odontogenic fibroma was given. This case emphasizes the importance of histopathological examination of the unusual and rarely observed central odontogenic fibroma which can be missed due to similarities with other entities.nbsp

Adenomatoid odontogenic tumor: “Quiet but not Quiet” – A rare case report

The adenomatoid odontogenic tumor (AOT) is a hamartomatous benign neoplasia of odontogenic origin. It appears to be, mostly prevalent in young female patients, mostly during the second decade of life. The maxillary region is most affected when compared to the mandible. Its presentation is slow-growing, asymptomatic, and quiet but not quite a lesion. It is related to canines which are unerupted. Here, we report a case of the AOT in the left maxillary region of a female patient aged 13 years. We approached with a surgical enucleation resulting in an excellent outcome.

ATYPICAL SINUSITIS IN A PATIENT ON ANTI-RESORPTIVE MEDICATION: A CASE REPORT

<h3>BACKGROUND</h3> Skeletal complications and bone loss resulting from giant cell tumor (GCT) of the bone are uncommon.¹ However, GCT can be locally aggressive and lead to surgical resection. Antiresorptive medications are used in these patients to reduce the risk of complications. <h3>CASE REPORT</h3> A 50-year-old male patient presented to the Oral Medicine clinic at the University of Florida College of Dentistry with the chief complaint of discomfort and swelling in the left maxillary region. The patient had been on various antiresorptive medications including Zometa. Clinical examination demonstrated an intraoral fistula on the left side of the maxilla in the non-keratinized gingiva. After correlation with the patient's medical history, medication-related osteonecrosis of the jaw (MRONJ) was suspected. A complete opacification and dystrophic calcification within the left maxillary sinus were noted on cone beam computed tomography. There were disruptions of the posterior and anterior walls of the maxillary sinus. The radiographic findings were consistent with chronic sinusitis with possible fungal infection. The possibility of MRONJ or a malignant neoplasm was also included. Histopathologic analysis revealed chronic inflammation and polypoid tissue with viable reactive bone. After endoscopy and histopathologic evaluation, the patient was prescribed 300 mg chlorhexidine and sodium chloride solution. <h3>DISCUSSION/CONCLUSIONS</h3> There are reports of sinus involvement with MRONJ if the radiograph shows unilateral mucoperiosteal thickening, sinus opacification, and fistula formation. These findings may mimic sinusitis. The patient had these radiographic findings as well as discontinuity of the sinus boundaries.

Surgical Management of a Giant Compound Odontoma with 52 Denticles and Impacted Canine in the Maxilla of a Non-syndromic Child: A Case Report

Supernumerary tooth (ST) refers to any tooth or odontogenic structure that is formed excess of usual number for any given region of the dental arch. The treatment of ST usually involves surgical removal to avoid further complications to the developing dentition. This report presents a rare case of a giant compound odontoma that was observed in the left maxillary region of a 10-year-old child during routine dental examination. Surgical removal of the compound odontoma was performed in the dental setting under Nitrous oxide sedation. In total, 52 denticles were removed from the left maxillary region. Additionally, exposure, bonding, and orthodontic traction was performed in the contralateral impacted maxillary canine. Both surgical procedures were successful and well tolerated by the patient with adequate behavior management technique.

Calcifying epithelial odontogenic tumour at an unusual site - A case report

Calcifying epithelial odontogenic tumour (CEOT), also known as Pindborg tumour, is a rare benign odontogenic tumour of locally aggressive behaviour forming 0.4–3.0% of all intraosseous tumours and 1% of all odontogenic tumours. CEOT is traditionally described as a rare, benign, locally-invasive, and slow-growing odontogenic neoplasm of exclusively epithelial tissue of origin. The most frequent location is the mandibular premolar and molar area, less frequently the lesion is found in the maxilla in the ratio 3:1, typically in the fourth to fifth decades of life with no gender predilection. It usually starts as a painless swelling and is often concurrent with an impacted tooth. The present case highlight the occurrence of CEOT in a younger individual on the unusual site i.e. in the left maxillary canine and premolar region as a painless swelling. This article also attempts to briefly emphasize the concepts of CEOT with the review of literature. Keywords: Calcifying epithelial odontogenic tumour, Pindborg tumour, Odontogenic tumour, Odontogenic neoplasm, Calcification.

A cocktail of rarities: Case report and a petite review of concomitant hypo-hyperdontia

A teenager with swelling in the left maxillary canine region exhibited an atypical combination of three rare sporadic anomalies of teeth. The clinical and radiographic evaluation revealed an unerupted odontoma, an impacted maxillary left deciduous supernumerary canine, an impacted maxillary left permanent canine, and the bilateral absence of mandibular lateral incisors. The findings led to the diagnosis of a non-syndromic case of concomitant hypohyperdontia. Only a small number of cases of hypo-hyperdontia have agenesis of mandibular lateral incisors and odontomas, but none have deciduous supernumerary canines. The authors thus bring a new combination of hypohyperdontia cases. This case report also discusses the treatment options of hypo-hyperdontia and the consequences of delaying treatment.