Diode Laser in the Management of Foliate Papillitis - Two Case Reports

The human tongue consists of various kinds of papillae which form its characteristic morphology. Among these papillae, the foliate papillae may become enlarged and inflamed causing a condition called as foliate papillitis. The treatment of this disease includes relieving all causes of trauma such as sharp teeth, ill-fitting dentures, etc., to the region. However, for several patients, the symptoms of foliate papillitis remain even after the conservative treatment is done. For two of these patients, we have used IMDSL dental diode laser of 980 nm to ablate the enlarged foliate papillae to relieve the symptoms of pain. Both the patients were recalled after one month during which time they were free of symptoms with total healing of the ablated site. One year later, during follow-up, both the patients remained symptom free. We believe this is the first time that diode laser has been used for the treatment of foliate papillitis.

Palatal flap in bilateral inferior partial maxillectomy

Maxillectomy is done for a variety of disease conditions. Reconstruction following maxillectomy is done to restore the form and function. One of the important goals that are to be achieved in reconstruction is the separation of the oral and nasal cavities. In this article, we report the use of palatal flap by preserving the descending palatine artery during bilateral inferior partial maxillectomy, for separating the nasal cavity from the oral cavity. This technique eliminates the need for an obturator or another free or local flap for this purpose.

Conservative Approach for Treatment of Isolated Mandibular Fractures, the Adaptations During COVID 19 Pandemic

Background

The ongoing COVID 19 pandemic brought about a sudden disruption to the way medical services are rendered in our country. Management of maxillofacial injuries, especially isolated mandibular fractures by surgical methods, became near impossibility because of the restrictions and other concerns related to the pandemic.

Methods

The individuals who suffered isolated mandibular fracture because of trauma were included, to undergo conservative treatment methods with adaptations for the pandemic. Individuals with multiple bone fractures were excluded, and the selected patients were given the choice to opt out from this treatment plan. We followed a more conservative approach with adaptations, which we have discussed in this article.

Result

The fracture healing for all the patients was as expected, and none of our team members got infected with this virus from exposure to patients.

Conclusion

The adaptations helped in limiting the possible exposure of patients, relatives and health care providers to the virus and addressed other pressing concerns related to this pandemic. We present the guideline that we formulated in our unit, which we used to manage the patients who reported to us with isolated mandibular fractures during the ongoing pandemic.

Coronoidoplasty in TMJ ankylosis treatment

A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was malnourished, with developing facial asymmetry. He was diagnosed with right side temporomandibular joint ankylosis. We planned for surgical removal of the ankylotic mass. But we modified the treatment protocol. Instead of doing coronoidectomy after aggressive excision of the ankylotic mass as advocated by Kaban, we did a 'coronoidoplasty' after aggressive excision of the ankylotic mass. Coronoidotomy or coronoidectomy is one of the rungs in the treatment ladder that is followed in surgical management of temporomandibular joint ankylosis. But one of the postoperative complications after coronoidectomy is the open bite. The difficulty to close the mouth becomes more pronounced when bilateral coronoidectomy is done. However, 'coronoidoplasty', as we have done for this patient retains the action of the temporalis muscle on the mandible in closing the mouth, yet removes the mechanical interference of the coronoid process. Postoperatively the patient was able to clench his teeth well, chew properly and there was no open bite.

Current therapeutic protocols for chronic granulomatous fungal sinusitis

BACKGROUND

The treatment of chronic granulomatous fungal sinusitis (CGFS), a rare form of invasive fungal sinusitis, is controversial.

AIM

To assess the response to postoperative antifungal therapy in patients with CGFS and suggest an effective treatment protocol.

METHODOLOGY

Clinical records of patients with CGFS who had undergone excisive surgery followed by antifungal therapy were reviewed to assess current disease status.

RESULTS

Fourteen male and 4 female patients were diagnosed with CGFS, based on typical histopathological and fungal smear/ culture results. Aspergillus flavus was isolated from 88.9% cases. Stage 1 patients had resectable sinonasal disease, stage 2 had additional spread to orbit/palate and stage 3 had extensive disease. Follow-up ranged from 6 months to 8 years. Residual disease was seen in all but one patient who received amphotericin B as first line therapy and in none of those who received itraconazole or voriconazole. Even those who received azoles as second line therapy were disease free at last follow-up.

CONCLUSION

Surgery followed by itraconazole or voriconazole for Stage 1 and 2 disease and voriconazole for stage 3 disease is recommended for a good outcome. Amphotericin B is not recommended as first line therapy for CGFS.

An unusual injury from a toothbrush: a case report

The use of toothbrushes has significantly improved oral hygiene. However, if brushing of the teeth is not done judiciously, it could result in severe trauma to the soft tissues of the oral cavity. This is particularly true in the young age group, since children tend to be very playful while brushing their teeth. This article describes the case report of a child who sustained a penetrating injury while brushing his teeth. A detailed plan for the management of such injuries is also presented.

Malignant melanoma of the oral cavity

Oral malignant melanoma is a rare disease. The common sites of its occurrence are the palate and gingiva with the maxillary arch being affected 80% of the time. Because of their presence at relatively obscure areas in the oral cavity, most of the malignant melanomas of the oral cavity are diagnosed at a late stage. These lesions are associated with poor prognosis. The dental clinician must therefore carefully examine the head, neck, and oral cavity, and any pigmented lesion that may exhibit growth potential must be biopsied. This article describes a case of malignant melanoma that was present in the oral cavity and briefly reviews the relevant literature that explains the nature of this lesion.

Primary oral tuberculosis : Report of two cases

Oral lesions of tuberculosis though uncommon, are seen in both the primary and secondary stages of the disease. In secondary tuberculosis, the oral manifestations may be accompanied by lesions in the lungs, lymph nodes, or in any other part of the body and can be detected by a systemic examination. Primary oral tuberculosis may present as a diagnostic challenge for the clinician. Here we report two patients with primary tuberculosis in the oral cavity who presented to the dental department, were diagnosed and referred for medical management.