Congenital Nasopharyngeal Teratoma with a Cleft Palate: Case Report and a 7 Year Follow Up

Teratomas are benign tumors containing cells from ectodermal, mesodermal and endodermal layers. They occur in about 1 in every 4,000 births and most commonly in the sacrococcygeal region, followed by the ovaries. Congenital epignathus teratomas are rare embryological neoplasms localised in the region of head and neck. An epignathus is found in approximately 1:35,000–1:200,000 live births. This accounts for 2–9% of all teratomas. Size and location of the neoplasm in the oronasopharynx is variable. Teratomas are partly undiagnosed at the time of birth. They may exist with an intracranial extension or as small polyps. Large epignathi can lead to difficult management during and after birth. We present a case of a female infant with a combination of nasopharyngeal teratoma and a cleft palate with successful multidisciplinary management via a staged surgical approach. The epignathus presented as a huge mass extending out of the mouth of the infant girl. On the day of birth debulking of the extraoral portion of the tumor, followed by intraoral extirpation and cleft palate repair at a later stage, was performed. The results of the histopathological examination confirmed diagnosis of a congenital teratoma.     

Kimura’s Disease: Report of a Case & Review of Literature

Kimura’s disease is an uncommon allergic disorder of unknown etiology affecting sporadic populations. A male patient in his third decade presented with a swelling in his left facial region. His investigations showed a raised eosinophil count. The lesion was excised surgically. He was put on a short term steroid therapy. Biopsy revealed it as Kimura’s disease. Subsequent follow-ups have been satisfactory with no recurrences.     

Jacob’s disease: Report of a case

Purpose: Jacob’s disease (JD) is an uncommon disorder that presents as pseudojoint formation between the enlarged mandibular coronoid process and the zygoma, resulting in mouth opening limitation (MOL). Intraosseous lipoma (IOL) usually presents in the long bone, but it is very rare in the mandible. The authors present a rare case of JD and coexisting IOL in the same anatomical area and discuss diagnosis and surgical intervention. Clinical presentation and intervention: The patient was a 39-year-old Korean female with MOL. Magnetic resonance imaging showed a large lobulated mass with fat-specific signal intensity. A combined extraoral and intraoral approach was used to resect the large mass. Histopathologic examination revealed a degenerated lipomatous tumor replacing the marrow cavity, with cartilaginous cap formation on the articular surface. Conclusion: Postoperatively, the patient showed uneventful healing and resolution of MOL.     

Warthin’s Tumor of Bilateral Parotid Glands: A Case Report

Bilateral Warthin’s tumours of parotid constitute a small proportion of all salivary gland tumours. We present a case report of surgical management of a prototype case.     

Histochemistry and Immunohistochemistry Evaluation of the Abrikossoff’s Tumour of the Tongue: a Case Report

Abrikossoff’s tumour is a rare benign soft tissue neoplasm that can occur in any part of the body, including the orofacial region. The tumour is usually benign, but there are reports of cases in which the tumour shows a locally aggressive behaviour, malignancy, and distant metastases. The aetiology is unknown, since several studies have shown that different cells are involved. In the present case, a 36-year-old Dominican woman was referred to the Department of Oral and Maxillofacial Surgery in Policlinico Federico II, Naples with a circumscribed lesion and sessile nodule on the dorsum of the tongue measuring about 17 mm in diameter. The treatment consisted of an excisional biopsy performed on the basis of the diagnostic hypothesis of Abrikossoff’s tumour, which was confirmed by histopathological analysis and histochemistry and immunohistochemistry evaluation. Abrikossoff’s tumour is an uncommon neoplasm which must be carefully diagnosed considering all the histological and clinical aspects in order to be treated correctly.Key words: Granullar Cell Tumour, Soft Tissue Neoplasm, Tongue     

Management of Oro-Nasal Fistula Using Andrew’s Bridge: A Case Report

Oro-nasal fistula is the most common complication following the surgical closure of the cleft palate. Retention is the paramount factor in the successful prosthodontic habilitation of cleft palate patients. Various precision attachments have provided us with the opportunity to make the prosthesis fixed removable type; giving a double advantage to the patient i.e. comfort through fixed type and easy maintenance through removal type. This case report describes a case of oro-nasal fistula habilitated with an obturator attached to Andrew’s bridge, which had good retention and esthetics.     

A Large Sialolith Perforating the Wharton’s Duct: Review of Literature and a Case Report

Sialolithiasis accounts for the most common cause of diseases of salivary glands. The majority of sialoliths occur in the submandibular gland or the Wharton’s duct. This article discusses review of literature, predisposing factors, signs and symptoms, diagnostic methods and various modalities available for the management of sialolithiasis. This case report presents a case of sialolith of a large size in the left Wharton’s duct, which was explored and removed via an intra-oral approach.     

A Case Report of Focal Epithelial Hyperplasia (Heck’s disease) with PCR Detection of Human Papillomavirus

Focal epithelial hyperplasia or Heck’s disease, is a rare viral infection of the oral mucosa caused by human papillomavirus. The frequency of this disease varies widely from one geographic region to another. In Caucasians there have been only few cases reported. This paper reports a case of focal epithelial hyperplasia and demonstrates the association with HPV subtype 32 through polymerase chain reaction (PCR) and sequencing of PCR products. A 7-year-old Caucasian girl was admitted to our clinic for investigation of multiple oral mucosal lesions in the mouth. Lesion was excised under local anesthesia without any complication. The lesion was diagnosed as focal epithelial hyperplasia according to both clinical and histopathological features. Dental staff should be aware of these kind of lesions and histopathological examination together with a careful clinical observation should be carried out for a definitive diagnosis.     

Case Report—A Pair of Monozygous Twins Discordant for Cleft Lip and Palate

Abstract

The effects of cleft lip and palate on facial growth and dental occlusion are reported for a pair of genetically identical twins only one of which has a cleft of lip and palate. Mandibular growth and arch form are similar for both patients but downward growth of the maxilla has been less for the cleft twin and the maxilla is contracted compared with that of the normal twin.     

Eagle's Syndrome Caused by Traumatic Fracture of a Mineralized Stylohyoid Ligament—Literature Review and a Case Report

Eagle's Syndrome is the common name for a series of clinical symptoms arising from an elongated styloid process of the temporal bone. The syndrome is named for Watt W. Eagle, M.D., who described its occurrence in a series of articles beginning in 1937. Common presentations of Eagle's Syndrome are a post-tonsillectomy, nerve irritation and an impingement on either the external or internal carotid artery. The styloid process is the first section of the stylohyoid chain, formed by the stylohyoid ligament. Sections of this structure have the ability to mineralize, forming a rigid segment. This mineralized segment is then subject to fracture due to traumatic injury. The literature is reviewed for examples of traumatic fracture of the mineralized stylohyoid ligament, and a clinical case is presented.     

Prosthodontic Rehabilitation in Sjogren’s Syndrome with a Simplified Palatal Reservoir: Two Year Follow Up

Sjogren's syndrome is a distinct clinical condition which includes xerostomia, ocular dryness, rheumatoid arthritis and other connective tissue disorders. Major oral problems reported by such patients include high caries rate, burning of oral mucosa, early tooth loss, increased tooth wear, poor tolerance for dentures and repeated failure of dental restorations. Prosthodontic therapy for this unique patient group is challenging and neglected due to the limited number of abutments, loss of vertical dimension and poor occlusion. Two year follow up of a patient of Sjogren's syndrome, rehabilitated by a combination of fixed and removable prostheses with a simplified palatal salivary reservoir is presented. Though the patient felt an improvement in quality of life due to the prosthesis, slurred speech and frequent reservoir refilling remained problems.     

A New Approach for Management of Kennedy’s Class I Condition Using Dental Implants: A Case Report

Replacement of multiple missing teeth mainly in the Kennedy’s class I and class II condition is a challenge for the clinician and the patient in terms of retention, masticatory efficiency, esthetics, comfort and importantly economics. Here, a case using implants in the distal denture bearing area with ball attachments and fabricating a cast partial denture over it utilizing the best of all benefits has been presented.     

The Development of a Regional Cleft Lip and Palate Database—A Preliminary Report

Abstract

The development of a regional cleft lip and palate database since its inception in 1988 is described. The method of data collection is outlined together with difficulties found and improvements it is hoped to achieve—both in the method of data collection and, ultimately, in the standard of care provided.     

Comparison of Outcome of Modified Millard’s Incision and Delaire’s Functional Method in Primary Repair of Unilateral Cleft Lip: A Prospective Study

Background

Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another. No one technique of cleft lip repair consistently produces ideal aesthetic and functional results.

Objectives

This study was conducted to compare the outcomes attained using two different designs of skin incision used for surgical correction of unilateral cleft lip.

Materials and Methods

Modified Millard’s incision and Delaire’s functional method techniques were performed and evaluated on 18 patients who received primary unilateral cleft lip repair. Soft-tissue measurements of the lip and nose were recorded preoperatively. Analysis was based on postoperative assessment of the white roll, vermilion border, scar, Cupid’s bow, lip length, and nostril symmetry and appearance of the alar dome and base. Chi-square and Fisher exact test, Student t test (two tailed, independent) and Student t test (two tailed, dependent) were used for statistical analysis of study parameters at 5 % level of significance.

Results

Preconceptions that one particular technique was better suited to certain preoperative cleft anatomical forms were not proven statistically. The outcome of our surgical methods was good and suggested quantitative changes with progressive diminution of asymmetry of the cleft and non cleft sides.

Conclusion

Lip length improvement was better in case of modified Millard’s incision. The Delaire’s functional method of cleft lip repair results in improved nasal symmetry due to correction of the abnormal insertions of the underlying musculature.

     

Parapharyngeal Ganglioneuroma of Hypoglossal Nerve in a 4?Year Old Girl: a Rare Case Report

Parapharyngeal ganglioneuroma of hypoglossal nerve is very rare benign tumor arising from sympathetic nervous system producing mass and functional effect. We present a rare case in 4 year old girl with history of swelling and odynophagia in left side of neck. Extensive clinical, immunohistochemistry, and imaging of the swelling confirmed the diagnosis of ganglioneuroma after surgical excision.     

Relationship of children’s salivary microbiota with their caries status: a pyrosequencing study

Purpose

Different dental caries status could be related with alterations in oral microbiota. Previous studies have collected saliva as a representative medium of the oral ecosystem. The purpose of this study was to assess the composition of oral microbiota and its relation to the presence of dental caries at different degrees of severity.

Materials and methods

One hundred ten saliva samples from 12-year-old children were taken and divided into six groups defined in strict accordance with their dental caries prevalence according to the International Caries Detection and Assessment System II criteria. These samples were studied by pyrosequencing PCR products of the 16S ribosomal RNA gene.

Results

The results showed statistically significant intergroup differences at the class and genus taxonomic levels. Streptococcus is the most frequent genus in all groups; although it did not show intergroup statistical differences. In patients with cavities, Porphyromonas and Prevotella showed an increasing percentage compared to healthy individuals. Bacterial diversity diminished as the severity of the disease increased, so those patients with more advanced stages of caries presented less bacterial diversity than healthy subjects.

Conclusion

Although microbial composition tended to be different, the intragroup variation is large, as evidenced by the lack of clear intragroup clustering in principal component analyses. Thus, no clear differences were found, indicating that using bacterial composition as the sole source of biomarkers for dental caries may not be reliable in the unstimulated saliva samples used in the current study.     

Gingivitis Artefacta—A Case Report of a Patient Undergoing Orthodontic Treatment

Abstract

Objectives: There is evidence to suggest that clinicians are reluctant to refer orthognathic patients for psychological evaluation due to fear of the patient reacting badly to the suggestion. The aim of this study was to assess orthognathic patients’ perceptions of referral to a psychiatrist/psychologist using a previously developed patient-centred questionnaire.

Methods: The study was divided into two parts. Stage 1 (presented previously) involved developing the questionnaire using qualitative methodology and stage 2 involved distribution of the questionnaire to 63 orthognathic patients. This paper describes the findings of stage 2.

Setting: UCLH Foundation Trust.

Results: The majority of patients viewed referral to a psychiatrist/psychologist positively (95.2%), the main benefits being having someone neutral to talk to who could explain and prepare them for treatment. Patients said they would prefer the referral to be made by the clinician they are most familiar with and to see the psychiatrist/psychologist on a one-to-one basis (79.4%) in an environment they are familiar with. The main perceived drawback of seeing a psychiatrist was the inconvenience of an additional visit.

Conclusions: Fear of the patient reacting badly to being referred to a mental health professional appears to be unfounded in this study of patients from a large teaching hospital and should not prevent clinicians referring patients whom they think would benefit from this.