Right Angle Of Mandible Research Articles

A case of idiopathic First Bite Syndrome responding to carbamazepine

AbstractFirst Bite Syndrome (FBS) is a painful condition which classically presents as severe pain in the pre‐auricular region, initiated on the first bite of a meal. It is usually associated with a history of upper neck surgery or tumour of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises from damage to, or resection of, the cervical sympathetic trunk resulting in loss of sympathetic innervation to the parotid salivary gland. Idiopathic FBS has been reported only a handful of times in the literature. We present the case of a 51‐year‐old male, urgently referred to the Department of Oral Medicine, with a 3‐week history of severe, sharp, unilateral pain from the right angle of mandible, intensity described as ‘20/10', occurring only on the first bite of eating. This would diminish over 2 min. Clinical examination revealed tenderness over the right condylar neck and angle of mandible only. FBS was suspected and the patient immediately started on carbamazepine. An urgent MRI displayed no abnormalities of the temporomandibular joints, PPS, trigeminal nerve or parotid gland. Restorative Dentistry review confirmed no odontogenic or occlusal cause and on review, 4 months later the patient reported complete resolution of symptoms on 200 mg of carbamazepine three times daily. This case highlights the importance of taking a thorough pain history. Patients with symptoms of FBS and no history of surgery to the neck should have an MRI to rule out parotid gland or PPS tumour. Carbamazepine can be successful in treating idiopathic FBS and can resolve symptoms completely.

Management of Central Giant Cell Granulomas of the Jaws: An Unusual Case Report with Critical Appraisal of Existing Literature.

Central giant cell granuloma (CGCG) is an uncommon, benign but aggressive osteolytic neoplasm of the craniomaxillofacial region, histologically characterized by an abundance of evenly distributed multinucleated giant cells within a sea of spindle-shaped mesenchymal stromal cells, scattered throughout the fibrovascular connective tissue stroma containing areas of hemorrhage. A rapid diagnostic assessment, together with an adequate histopathologic verification, is essential to improve the management and the prognosis of this locally destructive lesion. A rare case of a large destructive CGCG involving the entire right angle of mandible, causing extensive bony resorption, and buccal, medial as well as inferior border cortical expansion with multiple perforations, in a young child is presented. It was treated successfully by enucleation and aggressive curettage followed by peripheral ostectomy preserving the continuity of the mandible. Two adjunctive measures were employed; first, chemical cauterization of the residual bony walls to prevent possible recurrence, for which this tumor is notorious, and second, placement of fresh autologous platelet-rich fibrin within the bony defect to hasten bone fill and reossification, thus obviating the need for a bone graft.

Pimary hyperparathyroidism as central giant cell granuloma of the jaws: Pre- and post-treatment pattern of clinical and radiographic presentation

Introduction: The parathyroid glands regulate serum calcium and phosphorous levels by its secretion and maintenance, within physiological limits, of its hormone parathormone (PTH). Hyperparathyroidism is a metabolic disorder resulting from excessive secretion of parathyroid hormone. Hyper secretion might occur either due to a primary pathology in the glands (or) due to secondary causes. Central giant cell lesions occur in jaw bones. Case Report: A 20­year­old boy reported with complaints of swelling in left maxilla. Intra orally swelling extended from left upper canine till left upper second premolar and caused expansion of the cortical plates. Intra oral radiograph and orthopantomograph showed a poorly defined radiolucent lesion in between left upper canine and left upper 1st premolar with multiple cystic cavities in the region of the symphysis, left body and right angle of mandible. The radiographs of long bones showed osteoporosis. Serum alkaline phosphatase level was raised. Histopathology was reported as central giant cell granuloma. Nuclear scan of parathyroid showed a functioning parathyroid adenoma. The swelling in left maxilla regressed on its own after the adenoma of the parathyroids was excised. Conclusion: Timely diagnosis of parathyroid adenoma results in total regression of intra oral swelling and further progression of osteoporosis and fractures of long bones can be prevented.

Ectopic parapharyngeal meningioma: diagnosis of a rare entity on FNAC

Meningioma is a tumour most commonly located intracranially that may rarely extend extracranially. Ectopic meningioma presenting as parapharyngeal mass is a rare entity. We report a case of an 18-year-old female who presented with a complaint of swelling below the right angle of mandible associated with difficulty in swallowing for the last 3 months. The swelling measured 1.5 × 1 cm and was firm, fixed, non-pulsatile, non-transilluminant and non-tender. Computer tomography revealed a heterogenous enhancing mass with foci of calcification in parapharyngeal space without any intracranial component. Intraoral fine needle aspiration cytology was performed. A cytological diagnosis of spindle cell lesion of neural origin with the closest possibility of meningioma was rendered. Excision biopsy confirmed the diagnosis of ectopic parapharyngeal meningioma. It is important for clinicians and pathologists to be aware of this entity at the unusual site.