This is a rare case report of a patient around 11 years with the complaint of extra mouth who reported to the hospital for removal of that extra mouth. On examination there was accessory oral cavity with small upper and lower lips, seven teeth and saliva was drooling out. Under general anesthesia crevicular incision from 32 to 43 was put and labial gingiva with alveolar mucosa was reflected completely and bone exposed to lower border of mandible. There were seven teeth resembling lower permanent anterior teeth in the accessory mouth, which was excised with the accessory lips. 41 extracted and osteotomy carried out extending the incision from the extracted site and osteotomy carried out. Dermoid cyst both below and above the mylohyoid muscle and rudimentary tongue found and excised and the specimen sent for histopathological examination. The wound was closed and uneventful healing noted to the satisfaction of the patient. This is a rare and interesting case which has been documented.

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The term LASER is an acronym for 'Light Amplification by the Stimulated Emission of Radiation'. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.

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The classical features of superior orbital fissure syndrome arise due to compression of all or some anatomical structures passing through the fissure. A conservative approach is advocated in this condition unless there is a bony impingement of the neuronal structure and/or simultaneous compression of optic nerve leading to blindness or diminished vision. This paper reports three cases of this rare complex and also presents a review of literature.

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This case report presents a 22-year-old girl with class III malocclusion due to maxillary deficiency. The patient was referred for presurgical orthodontics; however, she rejected the surgery. This case was treated by means of Tongue appliance and slow palatal expansion, followed by lower fixed appliance, reverse chin cup, and upper fixed appliance. Tongue appliance and slow palatal expansion were used at the beginning of the treatment. After 6 months, reverse chin cup and lower fixed appliance were added. Six months later reverse chin cup was removed and upper fixed appliance was mounted. Positive overbite and over jet were achieved after 24 months of active treatment. Nasolabial angle also showed improvement. Nonsurgical treatment of adult class III patients is a difficult procedure; however, this patient was treated nonsurgically.

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Platelet-rich growth factor is an innovative regenerative therapy used to promote hard and soft tissue healing. It involves the application of autologous platelet-leukocyte-rich plasma containing growth factors and thrombin directly to the site of treatment. It is the intrinsic growth factors released by activated platelets which are concentrated in a topical gel formula. Clinically, it is an affordable treatment with potentially broad spectrum of applications in maxillofacial surgery especially in the treatment of complex or refractory wounds. The present article reviews its various applications not only in the specialization of oral and maxillofacial surgery but also in regenerative medicine.

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Introduction: We have evaluated efficacy of diclofenac sodium as pre-emptive analgesia agent in a prospective triple blind placebo controlled randomized clinical trial in a patients undergoing third molar impaction surgery. Materials and Methods: Randomization of groups was done by randomization software and two groups were constituted one group receiving placebo pre operatively and then the drug for next five days while the other group was given diclofenac sodium pre operatively and then for five days. Results: Results were achieved with help of measurement of outcome variables like postoperative tenderness, swelling and trismus on a visual analogous scale (VAS) and other personalized scale. Collected data shows that there is a significant reduction in the score of postop tenderness in experimental group (P = 0.00), while there is a minimal difference between score of postoperative swelling and tenderness (P > 0.04). Conclusion: So, we can conclude that use of diclofenac sodium as a preemptive analgesic agent is beneficial for better pain control in third molar impaction surgery.

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Epidermoid and dermoid cysts represent less than 0.01% of all oral cavity cysts. We describe a rare case of large epidermoid cyst in floor of mouth, with an oral as well as submental component resembling plunging ranula reported in the literature from India. We present a case of a 16-year-old girl with complaints of a mass in sublingual region, difficulty chewing, and dysphagia for about 5 months. Fine-needle aspiration cytology showed keratin flakes and proteinaceous material. Contrast-enhanced CT oral cavity was done and showed 7.0 × 5 × 4.5 cm well-circumscribed non-enhancing cystic mass extending into the floor of the mouth. On examination, a firm swelling was noticed in the submental area, extending down to the thyroid notch. The patient underwent surgical removal of the mass. On histopathology, acidophilic stratum corneum and basophilic dot like staining of stratum granulosum, which is the hallmark of an epidermoid cyst, were seen.

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Objectives: The aim of this study was to evaluate the incidence and etiology of maxillofacial fractures and also to evaluate different treatment modalities. Study design: The sample consisted of 1,038 patients, with maxillofacial injuries treated at our center from June 2006 to June 2011. Cause, type, site of injury, gender, age and treatment given to them, all these parameter are evaluated. Conclusion: The results of this study exhibit that road traffic accidents is the main reason for maxilla facial injuries followed by fall from height.Maxillofacial injuries are more frequent in male than in female. The mandible was most frequently involved facial bone. The miniplate osteosynthesis was the most widespread of the fixation technique but conservative management of the fractured bone also has a significance importance in treatment modalities.

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Hypokalemic periodic paralysis is a rare genetic disorder characterized by recurrent attacks of skeletal muscle weakness with associated hypokalemia which is precipitated by stress, cold, carbohydrate load, infection, glucose infusion, hypothermia, metabolic alkalosis, anesthesia, and steroids. We encountered one such incidence of prolonged recovery after general anesthesia, which on further evaluation revealed a case of hypokalemic paralysis. The key to successful management of such a patient was vigilant pre-operative evaluation, perioperative monitoring, and aggressive treatment of hypokalemia when it occurs.

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Purpose: To compare the efficacy of locking plates to non-locking plates in the osteosynthesis of mandibular fractures on the basis of clinical parameters. Materials and Methods: A prospective randomized clinical trial was conducted at the Faculty of Dental Science, CSMMU (formerly King Georges Medical College), Lucknow, to treat consecutive mandible fractures. The patients were randomly divided into two groups. The patients underwent osteosynthesis-group 1 with 2.4-mm locking titanium plates and group 2 with 2.7 mm non-locking titanium plates. The cause of trauma, the number of days from injury to surgery, average age, gender, and site distribution were all reviewed. The assessment of the patients was done at 1, 3, and 6 weeks and 3 months using the clinical parameters. Results: A total of 12 patients with mandibular fractures met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as infection, paraesthesia, hardware failure, and mobility between the fracture segments. A statistically significant difference was found between pain and swelling from the previous follow-up visit in groups 1 and 2. In locking group, pain decreases significantly at 3 ^rd week, 6 ^th week, 12 ^th week from 1 ^st week and pain was absent after 3 week. In non-locking group, pain decreases significantly at 3 ^rd week, 6 ^th week and 12 ^th week from 1 ^st week but pain was present till 12 ^th week. Pre-operative swelling was present only in case of non-locking group. Swelling was present in 66.7% of non-locking group and 0% in locking group. After one week swelling was absent in 100% patients at 3 ^rd , 6 ^th and 12 ^th week. Swelling was considerably decreased in locking group as compared to the non-locking group. Conclusion: These findings show that the use of locking plates in mandibular fracture was efficacious enough to bear the masticatory loads during osteosynthesis of the fracture. The locking plates provide the advantage of a greater stability, with clinical results almost similar to those seen with non-locking plate osteosynthesis.

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This study was done to find out the role of topiramate therapy in infraorbital nerve paresthesia after miniplate fixation in zygomatic complxex fractures. A total 2 cases of unilateral zygomatic complex fracture, 2-3 weeks old with infra orbital nerve paresthesia were slected. Open reduction and plating was done in frontozygomaticregion. Antiepileptic drug tab topiramate was given in therapeutic doses and dose was increased slowly until functional recovery was noticed.

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Hemangiomas are lesions that are not present at birth. They manifest within first month of life, exhibit a rapid proliferative phase, and slowly involute to non-existent. Hemangiomas of the oral cavity are not common pathological entities, but the head and neck are common sites. Furthermore some time histologically lymphatic channels may be evident in hemangiomas, and then it will be categorized according predominant component, e.g.; hemangiolymphangiomas or lymphangiohemangiomas, vice versa is true for lymphangiomas. Most true hemangiomas involute with time, but 10-20% of true hemnagioma in completely involute and required post- adolescent ablative treatment. In the present article we are reporting a case of hemangiolypmangiomas of left buccal mucosa in an 18-year-old male patient. We have also reviewed various treatment modalities and their clinical implication.

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Background and Objectives: Maxillofacial trauma is commonly associated with other injuries, predominantly head injuries. The predictors of outcome in such concomitant injuries have been studied the least. The present study aims at the evaluation of types of injury, management and outcome of patients sustaining maxillofacial trauma and concomitant cranial injuries. Materials and Methods: A retrospective study was carried out in the department of anesthesiology and intensive care. A case series of 129 patients was evaluated who were admitted in ICU (Intensive Care Unit) with maxillofacial trauma and head injuries. The data was then compiled systematically and analyzed using SPSS windows and value of P< 0.05 was considered significant and P< 0.001 as highly significant. Results: Among the 129 patients, majority of them had roadside accidents (RSA > 90%) and male gender predominance with male to female ratio of 5 : 1. Fracture maxilla and nasal bones were the most commonly encountered injuries (51.93%) followed by mandibular fractures (39.53%) and fracture of zygomatic bones (28.68%). Eighty five patients (65.90%) required mechanical ventilation, tracheostomy was needed in 29 (22.48%) patients and 81 (62.8%) patients were operated for head injuries as well. Majority of the victims were aged between 15 and 40 years. Conclusions: Maxillofacial trauma and cranial injuries are common among young males and so is the nature of injuries, that is, RSA. Besides facial injuries, head injuries are important determinant of outcome in such patients. Timely resuscitation and surgical interventions at specialized centers are of prime importance as far as a better prognosis is concerned in such injuries.

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Background : Ophthalmic injuries commonly occur in patients with facial fractures. This study was set up to determine the incidence of ophthalmic injuries as assessed by an ophthalmologist, in patients who had sustained maxillofacial fractures. Objective: To determine the incidence of ophthalmic injuries in maxillofacial fractures in Indian population. Materials and Methods : A study of 136 patients who had sustained facial trauma sufficient to lead to a facial bone fracture was undertaken and the patients received a comprehensive examination by an ophthalmologist and an orthoptist within one week of injury. All the patients sustaining confirmed maxillofacial fractures were examined by an ophthalmologist for any associated ocular injury. The ophthalmic injuries were classified into three categories-mild, moderate, severe. Results : Ninety-three patients (68.3%) examined sustained eye injuries of various types. Of these, 61.2% were temporary or minor, 29.03% were moderate, and 9.6% were serious. The highest incidence was found in association with mid face fractures, i.e., 95.7%. Fifty-seven patients sustained 176 minor ophthalmologic injuries; 27 patients suffered moderately; 33 had severe ophthalmic injuries. Nine patients sustained severe eye injuries. Conclusion: It is suggested that all traumas to the face, particularly above the level of the mouth, require a careful eye examination, including an estimation of visual acuity of each type.

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Background: The purpose of this study was to classify various types of non-neoplastic and neoplastic lesions presenting as sinonasal mass and characterize their clinico-pathological profile in a tertiary care center in the state of Uttarakhand. Materials and Methods: This was a prospective study where 110 cases of sinonasal masses were included over a period of 12 months. Clinico-pathological study was carried out in these cases. A provisional diagnosis was made after clinical assessment and radiologic investigations, but final diagnosis was made after histopathologic examination. Observations: The number of non-neoplastic lesions were more than the neoplastic lesion, 60% versus 40% respectively. In the neoplastic group, 19.8% and 23.76% patients presented with benign and malignant lesion, respectively. The incidence was more predominant in the age group of 11-20 years (22.72%) with male to female ratio of 1.08:1. In our study, among non-neoplastic lesions the occurrence of sinonasal polyps was highest seen in 80.30% cases. In neoplastic lesions, angiofibroma was most common benign lesion seen in 35% cases. Carcinoma nasal cavity was the commonest malignant lesion seen in 45.83% cases. In 3.63% patients, clinical and radiologic diagnosis was not correlated with histopathologic diagnosis. Only two cases required immuno-histocytochemistry to confirm the final diagnosis. Conclusion: We concluded that for proper evaluation of a sinonasal mass, clinical, radiologic, and histopathologic evaluation should be carried out conjointly in all the cases. Histopathology always gives a confirmatory diagnosis but in few cases immuno-histocytochemistry becomes the ultimate diagnostic technique for correct and timely intervention.

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Coronoid hyperplasia is a rare disorder, which effectively is a mechanical problem associated with limited mouth opening. In some cases, enlarged coronoid pushes the zygoma forward causing facial asymmetry. This article looks at the case of a 15-year-old boy reporting in OPD of Government College of Dentistry, Indore, with chief complaint of facial asymmetry. Transzygomatic approach was taken to get proper access to the enlarged coronoid. Coronoidectomy was performed which significantly reduced facial asymmetry. Postoperative healing was uneventful and recurrence was not reported.

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Primary Non Hodgkin s Lymphoma (NHL) usually arises within the lymphnodes, but 20-30% account for extra nodal sites. Oral cavity, as a primary extra nodal site for NHL, is relatively rare and diverse in presentation, response to therapy and prognosis. We report a 14 year old adolescent girl who presented with multiple gingival swellings, the most prominent one being in the right anterior maxilla. Gingival biopsy showed NHL- diffuse large B cell type. Child was completely cured with chemotherapy and now she is in complete remission and under regular follow up.

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Purpose: The aim of this investigation was to evaluate whether the addition of the platelet derived growth factor type BB (PDGF-BB) to a collagen matrix applied on a titanium mesh would favor healing and resorption onto the grafted bone. A histologic and radiographic study of two different groups (test and control) was performed. Designs: A surgical procedure was performed on 8 pigs to obtain 16 bilateral mandibular alveolar defects. All the defects were then reconstructed with a mixture of autogenous bovine bone using titanium mesh positioning. Two groups, with a total of 16 defects were created: The first to study collagen sponge and PDGF-BB and the second to control collagen only. The collagen matrix was positioned directly over the mesh and soft tissue was closed without tensions onto both groups without attempting to obtain primary closure. Possible exposure of the titanium mesh as well as the height and volume of the new bone was recorded. Results: New bone formation averaged about 6.68 mm in the test group studied; the control group had less regenerated bone at 4.62 mm. Conclusion: PDGF-BB addition to the collagen matrix induced a strong increase in hard and soft tissue healing and favored bone formation, reducing bone resorption even if the mesh was exposed.

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In this study we are describing an unusual case of the boundary fence (6 inch long) penetrating through the skull vault and lodging into the middle cranial fossa. A 10 years old male child fell onto his house fence while playing on the terrace. The metal fence penetrated through the scalp, parietal bone, midbrain and the midface, fracturing the parietal and the midfacial bones. CT-scans were obtained to view the trajectory and the position of the fence. The amount of midbrain injury was also accessed. The degree of morbidity vis-à-vis the type of injury was surprisingly low. Safe access to the fence was made through a bicoronal incision and modified bifrontal craniectomy to retrieve the lodged portion of the fence. These kind of penetrating injuries are rare considering the thickness of the vault. Proper preoperative planning and team approach is required for the safe surgical removal of the objects.

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Teratoma of the maxilla is a rare entity. Congenital intraoral teratoma occurs in 1:4000 births. It is a benign tumor, although malignancy has been described in adults. A 10-year-old male child with this condition is described in this report. This case illustrates a huge mass on the right side of the maxilla. The mass was excised under general anesthesia. Histopathologically, it consisted of all three layers of embryonic elements with predominantly fibrous tissue. Postoperative result was uneventful and no recurrence was detected after 2 years.

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Objectives: Study included 20 patients with diagnosis of fascial space infections of odontogenic origin to assess efficacy of serum CRP levels as monitoring tools for determining severity of infections, hospital stay and efficacy of treatment. Materials and Methods: Blood samples taken on Day 0, 4 and 8 for measuring serum levels of marker. Simultaneously clinical parameters like swelling size, pain etc. were also recorded on Day 0, 4 and 8 and appropriate treatment given to each patient. Correlation between markers and parameters was found using regression and paired t- test. Results: Statistical analysis found strong correlation between lab. values of markes and parameters used to measure severity of infection. Also CRP is significant marker for hospital stay (P<.01). Interpretation and Conclusion : Prospective analysis indicates CRP can be effective marker for determining severity of infection, treatment efficacy and hospital stay. Duration of antibiotic usage, intensive unit care, use of nutritional supplements becomes more rationale. Markers also make treatment cost effective and help protecting patients from side effects of excess drug usage.

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Branchial fistulae are formed due to the abnormal persistence of the embryonic branchial clefts. Complete branchial fistula with internal and external opening is extremely rare. We report a rare case of complete second arch branchial fistulae in a 7-year-old boy, which was confirmed by a fistulogram. The tract was completely excised and the patient was successfully treated.

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Parotid gland involvement in tuberculosis is rare. We present a case of middle aged male presenting with parotid swelling for 1 year and diagnosed to have parotid tuberculosis on fine needle aspiration cytology. A brief review of radiological findings in tuberculous parotitis is discussed which can help in correct interpretation and timely diagnosis, and thus avoiding unnecessary parotidectomies.

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Augmentation of the floor of the maxillary sinus is an extremely important technique for posterior site development in the maxilla prior to implant placement. A number of techniques have been suggested and used in the past to deal with membrane perforations such as suturing the membrane, application of fibrin sealants oxidized regenerated cellulose and collagen membranes. The most important aspect of sinus grafting is the integrity of the sinus membrane solely to confine the graft. If membrane tears are not taken care of, graft material can extravasate into the antrum and block the ostium. The fast-resorbing membranes are not good enough to form bone as their integrity is lost before woven bone forms. The novel technique demonstrates the use of a slow-resorbing membrane not only for perforations, but even in circumstances where the sinus is devoid of a membrane, thus bypassing the waiting period for schnederian membrane regeneration prior to grafting.

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