Rayees Ahmad Sheikh

Abstract

Early detection and preventing the progression of potentially malignant disorders (PMDs) help in decreasing the incidence and improving the survival of those who develop oral cancer. The content of DNA and RNA is more in dysplasia and in situ carcinoma than the normal surrounding oral epithelium, the use of in vivo staining, by means of toluidine blue dye, is based on the fact that it is an acidophilic dye that selectively stains acidic tissue components such as DNA and RNA. Toluidine blue staining is considered to be sensitive in identifying early oral and oropharyngeal premalignant and malignant lesions. The results of the clinical evaluation, the toluidine blue test and histology, were compared in order to calculate the sensitivity (true-positivity) and specificity (true-negatives). According to the clinical examination, sensitivity was 53% while for toluidine blue staining, it reached 88.4% (p = 0.0007). Specificity was 76% for the clinical examination and 73.6% for toluidine blue staining (p = 0.79). The positive predictive value for clinical examination was 78.9% and 82% for toluidine blue staining (p = 0.85). The negative predictive value for clinical examination was 50% and 82.3% for toluidine blue staining (p = 0.0073). Our observations suggest that toluidine blue can act as a helpful adjuvant for biopsy in clinically suspicious lesions. So that toluidine blue negative lesions need not to be subjected to biopsies thus saving time and resourses. We conclude, toluidine blue stain could be a useful aid for clinically suspicious lesions in order to establish whether the lesions are at high risk of progression to malignancy and to contribute to an early diagnosis of oral and oropharyngeal cancer. Further studies with larger sample sizes have to be done to make the use of toluidine blue more widespread.   Keywords: Toluidine blue (TB), Dysplasia, Premalignant lesions.

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Abstract

Approximately 25-40% of the total schwannomas, are head and neck Schwannomas, they may originate from nerve sheath of the peripheral, cranial or autonomic nerves. We report a case of Schwannoma of right side Submandibular region in a 25 year old female with no significant dental, personal or medical history. Schwannomas are slowly progressive benign lesions, the patient presents with a mass or swelling that is growing in size slowly. The lesions are usually painless non-tender, smooth swelling beneath the mucosa with no changes in the overlying skin. An Ultrasound revealed well circumscribed hypoechoic solid lesion with internal vascularity. The lesion on T1 weighted MRI images exhibits homogenous isointensity and on T2 weighted MRI images exhibits heterogenous hyperintensity on contrast enhanced T1 MRI images it exhibits salt and pepper type of enhancement. The diagnosis of Schwannoma is confirmed histopathologically by showing the presence of Antoni type A cells and Antoni type B cells, nuclear palisading, whirling of cells and Verocay bodies. This tumor may have originated from an autonomic nerve of the submandibular gland.   Keywords: Schwannomas, Submandibular region, MRI.

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Abstract

Finding two mesiobuccal root canals named MB1and MB2 in maxillary first molar is not uncommon. Mesio-buccal-2 (MB2) canal orifice located palatally to the mesio buccall orifice and buccally as well as mesially to palatal orifices. A complete understanding of MB2 root canal morphology can contribute to the successful outcome of root canal treatment. This study conducted on CBCT scans with age ranged from 15 to 60 years which was further divide into group I (15-30 years), group II (30-45 years) and group III (45-60 years).Unilateral as well as bilateral prevalence of MB2 canal in maxillary first molar in both the genders and prevalence of MB2 canal in maxillary first molar in accordance with age were determined. Results showed overall prevalence of MB2 canal in maxillary first molar was 60.7%. In age wise distribution, group II showed greater prevalence than group I and group III showed least prevalence than others. The results were statistically significant between age groups. There was no statistical significance obtained between gender and quadrant wise. Conventional diagnostic aids such as radiographs play an important role in assessment of complex root canal morphologies. These modalities, however, do not provide detailed information of the complexity as a result of their inherent limitations. Shifting from 2D radiographic techniques to 3D radiographic techniques provides better visualization and location of these small and difficult structures. Keywords: CBCT, Mesiobuccal, Canal, First molar.

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