Aim: Verrucous carcinoma is a progressive lesion of obscure etiology with high recurrence rate. It seems to have significant risk for progression of this disease entity to squamous cell carcinoma. Various treatment modalities have been advocated but poor response to treatment have been reported. We present our experience management of Verrucous Carcinoma with long term results in Central India population. Methods & Materials: This study was observational and prospective randomized included 52 patients during the period of 2012 to 2015. All the patients were randomly divided into two groups. In group A, 26 (52) patients of OVC were treated with surgical treatment consisting wide local surgical excision with 1cm safe margin and management of cervical lymph nodes with Supraomohyoid neck dissection. In Group B, 26 (52) were treated with only local wide excision. All the patients were followed up for 10 to 18 months. Results: 4 (26) patients in group A were showing positive cervical metastasis in the histopathological examination among. There was no recurrence in 1 year of follow up. 7 (26) patients in group B had recurrence in the form of cervical nodal metastasis. All 7 patient were reoperated and extended supraomohyoid neck dissection was performed along with wide local surgical excision of recurred lesion and fallowed up for18 months. 3 out of 7 (42.85%) resected specimen had invasive carcinoma. Mostly the initial T2 & T3 size lesion showed recurrence & malignant transformation.. Distant metastasis not evident in both the groups. Conclusion: In view of high recurrence and malignant transformation rate of verrucous carcinoma, we advocate the surgical strategy for the management of verrucous carcinoma same as that of squamous cell carcinoma.

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Branchial cleft cysts typically present as a unilateral, fluctuant soft tissue swelling that are mostly localised deep to the anterior border of sternocleidomastoid in the lateral aspect of the neck at the junction of its upper third and lower two third. Diagnosis is usually straightforward and can be made clinically however FNAC facilitates diagnosis.Unusually they can mimic as an abscess or metastatic node and less commonly present at an unusual location. We encountered 3 cases where patients presented with neck swelling either with unusual presentation or atypical location or inconclusive FNA. This report describes a series of patients in which the diagnosis of branchial cysts was not straightforward and posed a diagnostic challenge.

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There have been a few establishments to prove the hypothesis, that oral infection has influences in cardiovascular health of an individual. Among many chronic dental infections, periodontal infections in particular have been said to have an impact on various cardiovascular diseases, including atherosclerosis, fatal and non-fatal myocardial infarctions, venous thrombosis, peripheral artery disease and stroke. Various studies including epidemiological, novel research approaches, direct and indirect immunological and microbiological studies have been performed to confirm or eliminate this association. This article reviews the discussions to whether periodontal infection and its influence in cardiovascular disease are, in fact relevant or is a mere coincidence.

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AIM: The objective of the present study was to screen for hearing loss and to document the importance of using Transient Evoked Otoacoustic Emissions as a screening tool for hearing loss. MATERIAL AND METHODS: The descriptive study was conducted during the period August 2012 to July 2014 in a tertiary care health center. A study group consisting of 500 infants were subjected to TEOAE at 24-72 hours after birth. For pass cases no further testing was done. For refer cases repeat TEOAE testing was done at 15-30days, failing which such infant was subjected to Brainstem Evoked Response testing within 3 months to confirm hearing loss. RESULT: Five hundred infants were screened by TEOAE's after 24 hours of birth. 29 infants had refer result for 1st TEOAE hearing screen and for these infants repeat TEOAE screen was done at 15-30 days of age. On repeat TEOAE testing, 1 infant gave refer result. Then 19 infants including 18 high risk babies and 1 well baby were subjected to BERA testing within 3 months. On testing with BERA only 5 infants showed hearing loss. Hence the prevalence of hearing loss of 2 per thousand was detected in well babies and 22.2 per hundred in high risk babies. Hence substantiating the need to develop a method for screening infants for hearing loss. CONCLUSION: Hence the use of Transient Evoked Otoacoustic Emissions as initial screening test provides as easy, cost effective and quick method to detect infants with hearing loss.

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AIM: To find the prevelance and Incidence of head and neck cancer cases of other total body malignancies in our Cancer Centre. MATERIALS & METHODS: This is a retrospective analysis which was done in curie Manavata Cancer Centre in northern Maharashtra from 14^th May 2007 to 30^th November 2014. Total cases operated were 14368 out of which 2017 were head and neck cancers. RESULTS: Incidence of Head & Neck cancer cases in our 7 years study was around 14.03% of other total body malignancies. Males are more affected by Head & Neck cancer for around 82.01% than females contributing which is around 17.9%. Oral cavity malignancies contribute around 76.6% out of all head & neck cancer cases. Tongue cancers are more commonly affected which is around 33.4% followed by Buccal mucosa which is 29.77%. The mortality rate is high in buccal mucosa (32.35%) followed by tongue (27.4%). CONCLUSION: This retrospective study hopes to quantify and analyze the spectrum of Head and neck cancer out of the other total body malignancies. A tremendous effort is needed to identify such high prevelance, generate awareness and establish treatment modalities to meet this challenging statistical analysis.

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Ameloblastoma is a benign but locally invasive tumour of odontogenic epithelial origin with several histological variants. Basal cell ameloblastoma is the rarest histological subtype with only a few cases reported till date. It shows remarkable similarity to basaloid squamous cell carcinoma (BSCC), cutaneous basal cell carcinoma (BCC) and solid-type adenoid cystic carcinoma (ACC). This report describes an interesting case of basal cell ameloblastoma of the left maxilla in a 37 year old man. He had undergone enucleation of a maxillary lesion 2 years back without a pre-operative tissue diagnosis, which was later established to be an ameloblastoma. The tumor recurred after 6 months and was managed by a standard partial (infrastructure) maxillectomy. We review the literature on this rare entity with emphasis on the appropriate treatment modality.

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Salivary duct carcinoma (SDC) is a rare and high-grade malignant tumor that arises predominantly in a major salivary gland and bears a striking histological resemblance to high grade ductal adenocarcinoma of breast. The sarcomatoid SDC is a rare subtype that comprises of both epithelial and sarcomatoid components. The authors describe a case of sarcomatoid SDC of parotid gland. Its histological features have been discussed. The patient was treated by total parotidectomy with wide local excision of the involved skin and ipsilateral neck dissection followed by adjuvant radiotherapy.

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Background: The purpose of this study was to compare the efficacy of bupivacaine and lignocaine for the surgical removal of mandibular impacted third molars. The study focused on pain experience and analgesic consumption. Materials and Methods: Forty patients, aged between 18-45yrs, were selected each with bilateral mandibular third molar indicated for extraction under local anesthesia. The mean age of the patients was 24 years and the ratio of males to females was 23 to 17. All patients randomly received lignocaine 2% with adrenaline 1:200,000 for one extraction and bupivacaine 0.5% with adrenaline 1:200,000 for the other sided extraction. Results: The visual analog and global pain scores for both groups were outlined. There was no significant difference between bupivacaine and lidocaine for intra-operative pain experience. Conclusion: There were no signs or symptoms of central nervous system or cardiovascular system toxicity in this study and the routine use of bupivacaine in oral surgery would appear to be a safe and effective method of producing adequate surgical analgesia and an increased post-operative pain free period.

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Botryoid odontogenic cyst (BOC) is considered a rare multilocular variant of the lateral periodontal cyst, usually involves the mandibular premolar-canine area, followed by the anterior region of the maxilla. A 42-year-old male patient with botryoid odontogenic cyst (BOC) was treated by surgical removal. BOC have been widely regarded as variants of the lateral periodontal cyst. The conservative enucleation of the BOC is the treatment of choice, a significant recurrence rate has been reported for BOC. An extended post-surgical follow-up is necessary for a patient who has been diagnosed with BOC.

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Different patterns of malignant change may occur in pleomorphic adenoma; carcinoma ex-pleomorphic adenoma is one such malignant entity.Although in most instances, the features of malignant transformation are evident, some very well-differentiated cancers such as myoepithelial carcinoma or cancers that exhibit morphologically limited nuclear atypia may be somewhat challenging to diagnose. A 45 year old man presents to us with a recurrent swelling over the upper lip for ten years. It had been excised twice during this period; the histopathology being consistent with pleomorphic adenoma. This time, however, there was a co-existent ipsilateral submandibular swelling. He underwent wide local excision of upper lip swelling with primary reconstruction of lip defect and supraomohyoid neck dissection.Diagnosis of myoepithelial carcinoma could only be made by histopathological examination of the resected specimen. Myoepithelial differentiation of tumor cells was established by showing positivity for CK7 and SMA. To the best of our knowledge, this is the first case of myoepithelial carcinoma arising in a recurrent pleomorphic adenoma in the upper lip.

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Trauma to the mid-facial region commonly causes ocular injuries of varying degrees. Majority of the patients suffer injury to the eye who have sustained trauma to the mid-facial region. Orbital contusion or fractures have been reported in as many as 30% of the cases and approximately 15% have decreased vision. Only 2 ocular emergencies require treatment within minute's I.e.: chemical burns of the eye and central retinal artery occlusion. Apart from these there is adequate of time for thorough history taking and examination. Isolated orbital blow-out fractures will have an associated eye injury in up to one third of patient. Both prospective and retrospective studies of patients who have sustained bifacial fractures indicate that as many as 20% may sustain serious ocular injury that warrants ophthalmological referral.

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Angioleiomyoma is a benign tumor that arises from smooth muscle. It is rare in the head and neck area and less than 1% occur in the nasal cavity with 38 cases reported so far. The only way to make the diagnosis is the histologic examination. The treatment of choice is surgical excision and it is curative. Occurrence of this type of neoplasm in the nasal cavity is extremely exceptional and has rarely been described in the literature. We present a new case of angioleiomyoma in the nasal cavity and a review of the literature

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Odontomas are developmental anomalies of the dental tissues that may interfere with the eruption of the associated tooth. These lesions are generally asymptomatic and are usually detected on routine radiographs. Morphologically odontomas can be classified as complex, when present as irregular masses containing different types of dental tissues, or as compound if there is superficial anatomic similarity to even rudimentary teeth – the denticles. The present report describes the surgical management of a case of compound odontoma in 11-year-old boy who presented with a complaint of missing tooth in maxillary anterior region. After the lesion was surgically removed under local anesthesia, histopathological examination confirmed the diagnosis of compound odontoma.

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Calcifying Cystic Odontogenic Tumor (CCOT) constitutes 1% of all jaw cysts and considered as one of the rarest odontogenic lesions. It's a group of odontogenic entities which exhibits variety of clinical and biological behaviors. Even after many classifications and sub classifications COC remains a tough nut to crack for clinicians and pathologists. According to recent WHO classification of 2005 it has been reclassified as a tumor due to its diverse nature. Ameloblastomatous Proliferating type is very rare variant of CCOT which is not widely described in literature. This Clinicopathological conference presents one such case in young female patient and also discuss in detail about the differential diagnosis and management of such cases.

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Platelet-rich fibrin (PRF) or leucocyte- and platelet-rich fibrin (L-PRF) is a second-generation PRP where autologous platelets and leucocytes are present in a complex fibrin matrix to accelerate the healing of soft and hard tissue. A platelet-rich fibrin (PRF) membrane containing bone growth enhancing elements can be stitched over the wound or a graft material or scaffold is placed in the socket of an extracted tooth at the time of extraction. The socket is then directly closed with stitches or covered with a non-resorbable or resorbable membrane and sutured. It is known that platelets are involved in the process of wound healing through blood clot formation and release of that promote and maintain the wound healing. In this article we have discussed a case treated with PRF after surgical removal of mandibular third molar.

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Aim: To find the role of PET-CT scan in management of locally advanced head & neck cancers. Materials & Methods: A prospective study was performed in 21 patients suffering from locally advanced head & neck cancers reporting to our centre from January 2014 to December 2015. All the patients who had T3- T4 lesions with metastatic lymph node disease were included in the study. They underwent PET-CT scan and the results were tabulated to check whether there was distant metastasis thereby altering the clinical staging of the disease. Results: Out of 21 patients, who under PET-CT scan, 9(42.8%) patients had distant metastasis to various organs. 8(38%) patients had more than one metastatic lymph nodes and 4(19%) patients had locally advanced disease with only one metastatic lymph nodal involvement. Conclusion: Though incidence of distant metastasis is less than 10 % in head and neck cancers, sometimes the clinician fail to identify the distant metastasis due to non-availability of PET-CT scan equipment or due its financial cost when the patient is not affordable. But appropirate steps must be taken based on the clinical symptoms of the patients which must not be ignore by the surgeon and PET-CT scan needs to be done which can change the whole treatment management of the patient.

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Mucoepidermoid carcinoma (MEC) is a malignant epithelial neoplasm composed of both mucus secreting cells and epidermoid-type cells. Mucoepidermoid carcinoma arising from mucous glands of maxillary sinus is extremely rare and accounts for 13% of all malignancies occurring in maxillary sinus. While the high-grade MEC is a highly aggressive tumor, its low-grade counterpart usually demonstrates a more benign nature. However, both local recurrence and an aggressive clinical course have been reported to occur even with low-grade tumors. We report a case of low grade mucoepidermoid carcinoma of the maxillary sinus who presented to us with a recurrence 20 years after undergoing a total maxillectomy and post-operative adjuvant radiotherapy. The patient was successfully managed with wide excision of the tumor.

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