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    Table of Contents - Current issue
January-April 2019
Volume 23 | Issue 1
Page Nos. 1-165

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From the Editor's Desk p. 1
T Smitha
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President's Message p. 2
B Veerendra Kumar
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Hon. Secretary's Message p. 3
Nadeem Jeddy
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Hon. Treasurer's Message p. 4
S Ratheesh Kumar Nandan
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Delineating the scope of oral pathology and microbiology: Present scenario and future prospects Highly accessed article p. 5
Bhuvan Nagpal
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Prof. (Dr.) R R Paul p. 8
Mousumi Pal
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Extracellular matrix in invasion and metastasis of oral squamous cell carcinoma p. 10
K Vinod Kumar, KN Hema
Oral squamous cell carcinoma is a common cancer in developing countries with highly invasive and metastasis credentials. The Lymphnode metastasis in oral squamous cell carcinoma is regarded as the factor that decides on disease survival of patients. Steps have been made towards research in the field of Oral squamous cell carcinoma for better understanding of the molecular events involved in invasion and metastasis. Recently, the role of Extracellular matrix (ECM) of oral squamous cell carcinoma in invasion and metastasis has gained interest, as ECM is known to actively contribute in events that regulate transcriptional controls and cell signalling mechanisms involved in invasion and metastasis. Understanding such contributing role of ECM may pave way for newer methodologies in early detection, prevention and therapeutic strategies for oral squamous cell carcinoma.
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Kamino bodies p. 17
Deepak Venkatesh, T Smitha
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Oral epithelial dysplasia: Classifications and clinical relevance in risk assessment of oral potentially malignant disorders Highly accessed article p. 19
Kannan Ranganathan, Loganathan Kavitha
After more than a decade, the World Health Organization (WHO) published the revised grading system for oral epithelial dysplasia in 2017. The revised classification has changes reflecting our evolution of understanding of the dysplastic process. Although the WHO 2017 three-tier grading system is the gold standard for histological diagnosis of oral potentially malignant disorders, it has certain limitations. Suggestions to overcome these limitations include the use of clinical determinants and molecular markers to supplement the grading system. It has also been suggested that a two-tier system may be more reproducible and clinically translatable for better management. These advances in the understanding of epithelial dysplasia are very important globally and for us in the Indian subcontinent, given the prevalence of habits (tobacco/areca nut) and burden of oral cancer in this part of the world. The following review traces the evolution of the grading system of dysplasia, its relevance and clinical utility.
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Identification of Candida albicans using different culture media and its association in leukoplakia and oral squamous cell carcinoma p. 28
Vivek Gupta, Khare Abhisheik, Shreedhar Balasundari, Niranjan K Devendra, Kalim Shadab, Mahendra Anupama
Context: Candida, leukoplakia and oral squamous cell carcinoma. Aims: The aim of the present study has assessed the association of Candida albicans with normal control group, leukoplakia and oral squamous cell carcinoma lesions of the oral cavity by using cornmeal broth +5% milk and milk serum liquid culture media. Settings and Design: Thepresent study comprised of total 80 patients,which included, 30 patients of Leukoplakia, 30 patients of oral squamous cell carcinoma and normal control group comprised of 20 healthy individuals who were not having any relevant medical, dental and habit history. Subjects and Methods: Saliva and Biopsy was taken from clinically suspected leukoplakia and oral squamous cell carcinoma lesions for the confirmation of histopathological diagnosis. Saliva samples were inoculated for fungal growth in Sabouraud Dextrose Agar, and culture-positive samples had undergone for the germ tube test. Germ tube-positive samples were further taken for chlamydospore production in milk serum and cornmeal broth +5% milk media separately at 8 and 16 h. Statistical Analysis Used: Chi-square test, Fischer extract test. Results: In the normal control group, no fungus growth was found; however, leukoplakia and oral squamous cell carcinoma showed fungus growth with positive germ tube test and chlamydospore formation; the result also showed rapid and quantitatively more chlamydospore formation in cornmeal broth +5% milk in comparison to serum milk culture media. There was no growth of Candida in mild and moderate form of leukoplakia. Whereas in a severe form of leukoplakia, there was more quantitative chlamydospore growth in cornmeal broth +5% milk liquid media. Conclusions: In this study, we have tried to compare the efficacy of cornmeal broth +5% milk and milk serum for the identification of C. albicans. Both the culture media were able to promote the growth of chlamydospore in C. albicans. Among different grades of leukoplakia, the growth of C. albicans was seen in severe dysplastic patient only while mild and moderate dysplasia showed no Candidal growth.
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Prognostic efficiency of clinicopathologic scoring to predict cervical lymph node metastasis in oral squamous cell carcinoma p. 36
Sangeetha Keloth Nayanar, Jaya Prasad Tripathy, Karthickeyan Duraisamy, Sajith Babu
Background: The extent of involvement of cervical lymph nodes is known to be the most important prognosticator in oral squamous cell carcinoma (SCC) that significantly affects the survival rate of patients. The clinical, radiological and pathological factors that can predict cervical lymph node metastasis are yet to be ascertained clearly, which poses a challenge for the surgeon to determine the extent of neck dissection. Aim: This study aims to identify the clinical and histopathologic predictors of lymph node metastasis among patients with oral SCC and to devise a scoring system based on those predictors to aid in better clinical decision-making regarding the extent of neck dissection. Setting: Malabar Cancer Centre, a specialized tertiary cancer care center in Kerala, India. Methods: A retrospective review of 160 patient records and biopsy slides collected and preserved between June 2014 and May 2016. Conclusion: The clinicopathologic parameters such as site of cancer (P = 0.03), histologic differentiation (P = 0.03), shape of rete pegs (P = 0.002), pattern of invasion (P = 0.0001) and depth of invasion >3 mm (P = 0.016) were significantly associated with the risk of lymph node metastasis. The risk score devised based on these predictors serves as an efficient tool in aiding clinical decision-making regarding the extent of neck dissection.
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Expression of p63 in tooth germ, dentigerous cyst and ameloblastoma p. 43
Rolly Gupta, Minal Chaudhary, Swati Patil, Chinar Fating, Alka Hande, Hema Suryawanshi
Context: To assess the role of p63, a p53 homolog, in the cytodifferentiation (odontogenesis) and oncogenesis of odontogenic epithelium. Aim: The present study aimed to compare the expression pattern of p63 in the epithelium of tooth germ, dentigerous cyst (DC) and ameloblastoma (AB). Materials and Methods: Tissue specimens of thirty tooth germs, thirty ABs and thirty DCs were examined by immunohistochemistry for the expression of p63. Results: p63 labeling index (LI) was observed in descending order in epithelial cells of ABs, tooth germs and DCs. p63 LI was statistically nonsignificant among all the three groups. ABs revealed the highest p63 expression, but, surprisingly, tooth germs showed higher expression than DCs. Conclusion: p63 plays a role in the cytodifferentiation and proliferation of odontogenic epithelial cells irrespective of the tissue (normal developing or lesional tissue). This implies that p63 cannot be used as a diagnostic marker. However, our results indicate p63 overexpression as a mark of increased proliferation. Thus, it can be stipulated that p63 can be used as a prognostic marker in odontogenic lesions with more aggressive and invasive phenotype. Our results also suggest the differential function of p63 in both developing and lesional odontogenic tissues, which, however, depends on p63 isoform predominantly being expressed. Therefore, identification of p63-predominant isoform in a particular lesion is more important than the presence or absence of p63. Consequently, we suggest the performance of polymerase chain reaction analysis along with immunohistochemical evaluation in further studies.
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Mucin-4: A novel marker for oral cancer p. 49
Moulshree Kohli, Animesh Kumar Shivam, Puneet Ahuja, Jahnobi Dutta
Background: Mucins are high-molecular-weight glycoproteins and are implicated in diverse biological functions. MUC4, a member of transmembrane mucin family, is expressed in airway epithelial cells and body fluids such as the saliva, tear film, ear fluid and breast milk. In addition to its normal expression, an aberrant expression of MUC4 has been reported in a variety of carcinomas. Till date, very few studies have discussed about MUC4 expression in normal and cancerous oral mucosa. Aim: The aim of the study is to evaluate the expression of MUC4 in varying grades of oral squamous cell carcinoma (OSCC) and also to analyze its role played in oral carcinogenesis. Materials and Methods: Formalin-fixed paraffin-embedded tissues of five cases of normal tissue, ten cases of well-differentiated OSCC, ten cases of moderately differentiated OSCC and ten cases of poorly differentiated OSCC were retrieved from the archives of the department, and MUC4 antigen was immunohistochemically localized. Statistical Analysis: The result was subjected to statistical analysis using Pearson's Chi-square test and one-way analysis of variance. Results: About 70% of OSCC were stained positive with MUC4 antigen. Maximum intensity of staining was noted in well-differentiated OSCC. A steady decrease in MUC4 staining was noted with the increase in histological grading of OSCC. Conclusion: The findings of the study suggest that MUC4 plays a vital role in the pathogenesis of OSCC and can be regarded as a novel marker for OSCC.
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Role of cell block technique as a novel diagnostic approach in odontogenic cysts and ameloblastomas of the jaw region p. 54
Sabarad Pallavi, Abdulla Riaz, Pillappa Chethana, Prabhu Vishnudas
Background: Fine-needle aspiration cytology (FNAC) involves puncturing a lesion for microscopic analysis. Smears are prepared using aspirated material for cytology and for cell block (CB) preparation. FNAC is a preoperative technique and does not provide sufficient information for precise diagnosis, and the risk of false diagnosis or intermittent diagnosis always exists. To overcome the deficiencies of FNAC, the CB technique (CBT) is considered a novel innovative technique for odontogenic lesions. The present study is carried out to evaluate the efficacy of CBT in diagnosing odontogenic cystic lesions and ameloblastoma of the jaw and comparing it with aspiration cytology and histopathology. Methods: In this prospective study, 17 patients with clinical diagnosis of odontogenic cysts and ameloblastoma are obtained. FNAC smears and CBs are prepared and compared with cytology and histopathology. Results: A total of 17 cases of odontogenic cysts and ameloblastoma are divided into seven odontogenic keratocyst (OKC), three dentigerous cysts, three radicular cysts and four ameloblastoma. In seven cases of OKC, five cases (71.4%) are showing positive features and two cases (28.6%) are showing negative features. Three dentigerous and three radicular cysts are showing three positive CB features (66.7%) and three negative features (33.3%). Among four cases of ameloblastoma, two cases (50%) are showing positive CB features and two cases (50%) are showing negative features. Conclusion: CB is a novel diagnostic technique in oral pathology for odontogenic cysts, tumors, metastatic tumors and bony lesions. Compared to FNAC, it gives accurate diagnostic architecture and apparent histopathological features. This technique can be used alternative to FNAC.
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Immunohistochemical study of α-smooth muscle actin expression in oral leukoplakia and oral squamous cell carcinoma p. 59
A Smitha, Kavita Rao, HS Umadevi, T Smitha, HS Sheethal, MA Vidya
Context: It is important to evaluate the role of stromal myofibroblasts (MFs) in carcinogenesis and also as a predictive marker for lymph node (LN) metastasis at the invasive front of oral squamous cell carcinoma (OSCC). Aims: To demonstrate the expression of α-smooth muscle actin (α-SMA) by MFs in the tissues of oral leukoplakia (OL) with dysplasia and OSCC. To record and compare the distribution of MFs in OSCC with LN metastasis and without LN metastasis. Settings and Design: Fifty paraffin-embedded tissue blocks with 10 cases of normal oral mucosa, 10 cases of OL with dysplasia and 30 diagnosed cases of OSCCs were studied. Subjects and Methods: The samples were subjected to heat-induced antigen retrieval method followed by staining using primary mouse monoclonal antibodies against α-SMA and visualized using super sensitive polymer–HRP detection system. Statistical Analysis: Descriptive statistical analysis and ANOVA test were used for statistical analysis. Results: There was no α-SMA expression in normal oral mucosa or in OL with dysplasia. All tissues of OSCC were positive for α-SMA expression. The difference in the expression between OL with dysplasia and OSCC was statistically significant (P < 0.05). The mean α-SMA count of OSCC with LN metastasis is significantly greater than in the OSCC without LN metastasis (P = 0.001). In OSCC without LN metastasis, focal and spindle patterns were predominant and in OSCC with LN metastasis network pattern was more. Conclusion: α-SMA expression by MFs in OSCCs indicates its role in tumor growth and invasion. The mean α-SMA count was found to correlate with tumor invasiveness and locoregional LN metastasis.
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Cytokeratin and fibronectin expression in orthokeratinized odontogenic cyst: A comparative immunohistochemical study p. 65
Kirti Kureel, Aadithya B Urs, Jeyaseelan Augustine
Background: The orthokeratinized odontogenic cyst (OOC) is a rare developmental jaw cyst. It is crucial to distinguish it from keratocystic odontogenic tumor (KCOT) in all parameters including clinical behavior, immunohistochemical (IHC) profile and prognosis. This study aimed to analyze the IHC expression of cytokeratins and fibronectin in OOC, epidermoid cyst and dermoid cyst (EDC/DMC), dentigerous cyst (DC) and KCOT in order to explicate the pathogenesis of OOC. Materials and Methods: Twenty-five cases of all study groups were incubated with CK10, CK13, CK19 and fibronectin antibodies and staining was assessed in the basal, intermediate and surface layers of epithelium. All the data were analyzed by SPSS software. Nonparametric Chi-square test and Spearman's correlation test were applied. Results: The overall expression pattern of CK10, CK13 and CK19 was similar and resembled each other in the study groups of OOC and EDC. The immunoexpression was almost akin to each other in DC and KCOT. Conclusion: It was inferred from the results that the IHC profile of OOC is different from DC and KCOT and closer to EDC.
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Antiadherence and antimicrobial property of herbal extracts (Glycyrrhiza glabra and Terminalia chebula) on Streptococcus mutans: An in vitro experimental study p. 73
Neha Bhadoria, Mohit K Gunwal, Hema Suryawanshi, Snehal S Sonarkar
Background: Herbal agents are used for treating different forms of diseases since decades. In the current study, the antiadhesive property of herbal extracts has been evaluated using Glycyrrhiza glabra (GG) and Terminalia chebula (TC) herbal extracts on Streptococcus mutans. Materials and Methods: The plant extracts (GG and TC) were powdered in mechanical grinder. Ten gram of each plant extract in powder form was placed in porous bag or thimble. The extract was placed in a round-bottom flask and was transferred into clean preweighed universal tubes. The yield strength of the extract was calculated. The antiadherence property of the herbal extract was evaluated using glass surface adherence test. Statistical Analysis: The statistical analysis was done using one-way analysis of variance followed by post hoc Tukey's test. Results: Both herbal extracts have significant antiadhesive and antimicrobial activity against S. mutans, however, high antiadherence property was seen with TC than GG. Conclusion: Both the plant extracts exhibit inhibitory activity against S. mutans. However, TC had more clinically significant results than GG, but it was found statistically insignificant.
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Neutrophil: Lymphocyte ratio and oral squamous cell carcinoma: A preliminary study p. 78
Rashmi G S Phulari, Rajendrasinh S Rathore, Arpan K Shah, Samarth S Agnani
Introduction/Background: It is well-established that host response plays a vital role in the determination of biological behavior of tumors. Inflammatory response against tumors has been a focus of research in recent years. There has been extensive research regarding inflammatory reaction in oral squamous cell carcinoma (OSCC) in tissue specimens. However, there is no much data regarding systemic inflammatory response in OSCC. It was recently reported that an elevated neutrophil:lymphocyte ratio (NLR) may correlate with aggressive biological behavior in various malignancies including head-and-neck tumors. Thus, the study was undertaken with the aim of evaluation of NLR in peripheral blood of patients suffering from OSCC. Materials and Methods: The research was a prospective, case–control study. Hundred patients suffering from OSCC and 100 healthy individuals were included in the study, after obtaining informed consent. NLR was determined from the differential leukocyte count obtained from complete blood count in each case. Comparison of NLR was made among two groups. Results: The mean value of absolute neutrophil count was found to be significantly higher in OSCC cases than in controls (P < 0.01). The mean value of NLR in OSCC was found to be 2.84, and in controls, it was 1.95. This difference was found to be statistically significant (P < 0.001). Conclusion: NLR and other hematological parameters may serve as surrogate marker for potential aggressive behavior of OSCC and may help in prognostic prediction of these cases.
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Loss of CDKN2A and CDKN2B expression is associated with disease recurrence in oral cancer p. 82
VG Deepak Roshan, MS Sinto, Bipin T Vargees, S Kannan
Background: Loco-regional recurrence is one of the major reasons for poor prognosis of oral squamous cell carcinoma (OSCC). However, till date, no feasible molecular marker is available to predict the risk of recurrence in OSCC patients. Aim: To evaluate the cell cycle regulatory genes expression and its association with the risk of recurrence in oral cancer patients. Materials and Methods: Transcript level expressions of 47 cell cycle regulatory genes were analyzed in 73 OSCC tumors from buccal mucosa and tongue, 26 adjacent normal samples using real-time polymerase chain reaction. TaqMan low-density array data were analyzed using the DataAssist™ v 3.01. Significantly altered genes within the tumor samples and samples showing recurrence (re-appearance of disease during the follow-up in cases having complete response to initial treatment assessed after 3 months of the treatment) were identified. Further, Kyoto Encyclopedia of Genes and Genomes pathway analysis and The Cancer Genome Atlas (TCGA) online data analysis portal were used to analyze interacting protein and pathways significantly associated with the altered gene. Results: CCNA1, CCNB2, CCND2, CCNE1, CCNF, CDC2, CDK6, CHEK1, and TGFA found to significantly alter in the tumor sample of oral cancer patients, and down-expression of CDKN2A and CDKN2B found to associate with the recurrence of disease in oral cancer patients. TCGA data also showed the loss of CDKN2A and CDKN2B significantly associated with recurrence in head and neck cancer patients. Conclusion: CDKN2A and CDKN2B expression analysis can be used as the prognostic marker for the oral cancer patients. The present method of data analysis helps overcome the limitations and complications of high throughput techniques and thereby increases the opportunity of employing molecular markers in routine clinical management of OSCC.
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Epidemiological profile and clinical characteristics of oral potentially malignant disorders and oral squamous cell carcinoma: A pilot study in Bidar and Gulbarga Districts, Karnataka, India p. 90
G Kiran Kumar, Mohammed Abidullah, Lena Elbadawi, Siraj Dakhil, Hani Mawardi
Background: Clinical scenarios of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) vary between geographical districts within the same country. This could be attributed to common habits and other cultural factors, such as excessive consumption of tobacco products, leading to higher prevalence of tobacco-related lesions of the oral cavity. A better understanding of their pattern and behavior in each particular region may help in devising strategies for prevention and treatment. Aims and Objectives: The aim of the study is to assess the epidemiological profile and clinical characteristics of OPMD and OSCC among population in and around Bidar and Gulbarga districts of Karnataka, India. Materials and Methods: This was a retrospective, chart review study in the districts of Bidar and Gulbarga, Karnataka, India. Medical records of patients with clinical and histopathological diagnosis of OPMD or OSCC who attended a private dental school in Bidar and 20 private dental clinics in the districts of Bidar and Gulbarga between 2010 and 2017 were included in the study. Collected data were analyzed using Statistical Package Social Sciences software, version 20.0. Results: There were a total of 630 patients, with males representing 69.52% (n = 438; ratio of 2.28:1) of cases and mean age of 42.64 years. 375 (59.52%) patients had a diagnosis of OPMD with the most common subtype of oral submucous fibrosis (185/375; 49.33%) followed by leukoplakia (110/375; 29.33%) and lichen planus (80/375; 21.33%). Buccal mucosa was the most commonly affected site (33.01%). Of 630 patients, 255 (40.48%) had OSCC, with tongue being the most common site (36.86%). Conclusion: This study revealed for the first time that OPMD and OSCC are widespread in the districts of Bidar and Gulbarga. The available knowledge on the prevalence of these lesions could help in educating patients and implementing preventive measures by health-care providers to improve overall survival. Long-term follow-up studies are needed to better understand the disease pattern.
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p53 polymorphism and association of human papillomavirus in oral submucous fibrosis and oral squamous cell carcinoma: A case–control study p. 97
Kaveri Hallikeri, Krishna Burde, Venktesh Anehosur, Bhushan B Kulkarni, Shivaprakash V Hiremath
Introduction: The tumor-suppressor p53 protein is inactivated by the human papillomavirus (HPV) E6 oncoprotein, causing polymorphism of the p53 at codon 72 of exon either proline (Pro) or arginine (Arg). Specific allele predisposition has been reported in the literature. The association between the p53 allele and HPV types has been reported. We analyzed the association between p53 polymorphism at codon 72 and HPV 16 and 18 genotypes in control, oral submucous fibrosis (OSF) and oral squamous cell carcinoma (OSCC). Materials and Methods: Of the total 90 cases, biopsy tissues of all groups (30 cases of OSF, OSCC and control each) were collected to extract DNA. Polymerase chain reaction was used to detect HPV 16 and 18 and alleles of codon 72 in p53 were evaluated in all the samples. Results: In control, OSF and OSCC samples showed the presence HPV 63.3%, 33.3% and 60%, respectively. In OSF, HPV 16 and 18 was detected in four and four cases, respectively, whereas in OSCC, HPV 16 and 18 was detected in ten and nine cases, respectively. In all three groups, predominantly, Arg/Arg protein was present followed by Pro/Pro and Arg/Pro. Among the control, Arg/Arg type protein was frequently seen followed by Arg/Pro, Pro/Pro in the presence of HPV. OSF and OSCC were associated homologous genes in the presence of HPV. Conclusion: The definite association between p53 codon 72, polymorphism and HPV 16 and 18 was seen in OSCC with low frequency in OSF. Frequency of homozygous genotype is at high risk in the presence of HPV 16 and 18 in developing OSCC.
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Effect of amygdalin on oral cancer cell line: An in vitro study p. 104
D Sireesha, Basireddy Siva Reddy, Bernard Ajay Reginald, Meda Samatha, Firoz Kamal
Background: Recently, studies have concentrated on complementary medicine in treating a large number of diseases, including cancer. Unfortunately, many of these treatment methods do not provide a permanent solution, and even if they do, many do not have a scientific corroboration. A shift toward alternative medicine and natural methods is being preferred to reduce if not counter the toxic effects of the drugs that are used to treat such diseases. Studies have shown that amygdalin is a natural plant product to have an anticarcinogenic effect on many types of cancers. However, the effect of amygdalin on oral cancers has not been studied, and hence, the present study aimed to evaluate the anticarcinogenic effect of amygdalin extracted from apricots and almonds on human oral cancer cell lines. Materials and Methods: Oral cancer cell lines (KB cell line) were used in the present study. Ethanolic extracts of apricots and almonds were prepared using Soxhlet extraction method. The antiproliferative and cytotoxic activity on KB cell line was evaluated using 3-(4,5-dimethylthiazol-2-YL)-2,5-diphenyltetrazolium bromide assay. Results: Both the extracts exhibited cytotoxic and antiproliferative activity on KB cell lines. While almonds exhibited maximum efficacy at 50 μg/mL, apricots extract required 100 μg/mL concentrations. Conclusion: Ethanolic extracts of amygdalin from almonds and apricots were effective as an antiproliferative agent which caused apoptosis in oral cancer cell line.
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Estimation of expression of beta-human chorionic gonadotropin levels through progression of disease from normal to epithelial dysplasia to malignancy p. 108
Jaya Singh, Uma Swaminathan, P Sharada, Jyoti B Alur, Pritha Chowdhury, Ujjwal Mrinal
Background: Gonadotropins have been extensively studied in trophoblastic and nontrophoblastic tumors of breast, gastric, bladder, parathyroid, renal cell and cervical carcinomas, with a significant increase in tissue expressions. Serum levels of beta-human chorionic gonadotropin (β-hCG) and its tissue expression were found more in oral squamous cell carcinoma (OSCC) patients with a significant diagnostic and prognostic value. No such study has been done on oral epithelial dysplasia (OED). Aims and Objective: To evaluate the expression of β-hCG in OED and the feasibility of using this marker for early diagnosis and to see its progression from normal to dysplasia to malignancy. Materials and Methods: The study population consisted of thirty histologically confirmed cases of OED and thirty cases of OSCC. Fifteen normal tissues were also included in the study. All the tissue samples were subjected to immunohistochemical (IHC) staining using antimouse β-hCG antibody. Results: The IHC expression of β-hCG was completely negative in normal cases (Group 1 [n = 15]), whereas 13 (43.3%) cases of OED (Group 2 [n = 30]) and 13 cases (43.3%) of OSCC (Group 3 [n = 30]) showed diffuse cytoplasmic staining in dysplastic surface epithelium and epithelial islands of OSCC. This difference was statistically significant with P = 0.007. Conclusion: We conclude that the expression of β-hCG increased from normal mucosa to dysplasia to OSCC, suggesting that it is involved in the early stage of carcinogenesis and progression of the disease.
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Application of cone beam computed tomography in facial soft tissue thickness measurements for craniofacial reconstruction p. 114
Manasa Anand Meundi, Chaya Manoranjini David
Context: The paradigm shift from two- to three-dimensional imaging has marked the beginning of a new era in diagnosis. Newly developed cone-beam computed tomography (CBCT) designed specifically to visualize maxillofacial pathologies is being used in forensic investigations also. Facial reconstruction is a specialized forensic technique to identify the deceased from the unknown skull. It is dependent on population-specific facial soft tissue thicknesses. Aims: This study aims to propose the mean dataset of facial soft tissue thickness for South Indian population by utilizing CBCT. It also aims to evaluate the sex and racial differences in the values if any. Settings and Design: This descriptive study was conducted on CBCT scans of South Indians. Materials and Methods: Eighty CBCT scans of South Indian adults aged 18–80 years were selected. Facial soft tissue thickness measurements at 34 craniometric landmarks were carried out. Statistical Analysis: Descriptive statistics was done. Student's t-test estimated the differences of soft tissue thickness between the sexes; bilateral measurements and also racial differences. Tukey's honest significant difference test was used for multiple comparisons among Indian studies. Results: Males had thicker soft tissue than females in most of the landmarks. Differences in the bilateral soft tissue thicknesses were negligible. Indians had thicker facial tissues than the Koreans and CBCT was found efficient in measuring soft tissue thickness. Conclusion: The present study provides facial soft tissue thickness dataset using CBCT which will be useful in forensic facial reconstructions of South Indian population as well as in maxillofacial and plastic reconstructive surgeries.
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Oral microbiome: Unveiling the fundamentals p. 122
Priya Nimish Deo, Revati Deshmukh
The oral cavity has the second largest and diverse microbiota after the gut harboring over 700 species of bacteria. It nurtures numerous microorganisms which include bacteria, fungi, viruses and protozoa. The mouth with its various niches is an exceptionally complex habitat where microbes colonize the hard surfaces of the teeth and the soft tissues of the oral mucosa. In addition to being the initiation point of digestion, the oral microbiome is crucial in maintaining oral as well as systemic health. Because of the ease of sample collection, it has become the most well-studied microbiome till date. Previously, studying the microbiome was limited to the conventional culture-dependent techniques, but the abundant microflora present in the oral cavity could not be cultured. Hence, studying the microbiome was difficult. The emergence of new genomic technologies including next-generation sequencing and bioinformatics has revealed the complexities of the oral microbiome. It has provided a powerful means of studying the microbiome. Understanding the oral microbiome in health and disease will give further directions to explore the functional and metabolic alterations associated with the diseased states and to identify molecular signatures for drug development and targeted therapies which will ultimately help in rendering personalized and precision medicine. This review article is an attempt to explain the different aspects of the oral microbiome in health.
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Prevalence of malignant melanoma in anatomical sites of the oral cavity: A meta-analysis p. 129
Diksha Singh, Pragya Pandey, Manish Kumar Singh, Shailesh Kudva
Oral malignant melanoma (OMM) is a very rare disease entity accounting <1% of all other melanomas. Till date, no comprehensive meta-analysis has been conducted regarding the prevalence of malignant melanoma in the oral cavity. Therefore, the present meta-analysis was conducted to update on the prevalence of malignant melanoma in anatomical sites of the oral cavity. Literature search was performed to congregate reports of last 10 years using databases, such as PubMed and ScienceDirect. The search strings used were “palate,” “buccal,” “gingiva,” “gum,” “maxillary,” “mandibular,” “lip,” “tongue,” “melanoma,” “oral melanoma,” “malignant melanoma,” “prognosis,” “risk factors,” “noncutaneous” and “diagnosis” of OMM by combining terms using the Boolean operators. MedCalc 16.4.3 software was used for the analysis. “Random effects model” was used in the analysis due to significant heterogeneity in the studies. Proportion method was used to analyze the prevalence. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to report the analysis. Out of 130 studies screened, 19 were included in the meta-analysis and a total of 1323 patients were included. The median age of the patients was found to be 61.87 ± 7.78 years (confidence interval 53.8–67 years). All the screened studies showed significant heterogeneity in gender as well as tumor sites (P < 0.0001). Palate (34.29%) was the most commonly affected site in OMM patients. Overall, the results of the meta-analysis suggest that palate is the most prevalent site in OMM. Furthermore, OMM is high in patients between the fifth and sixth decade of life with a male predominance.
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Solitary plasmacytoma of mandible: A rare entity p. 136
Samatha Chittemsetti, Venkateswara Rao Guttikonda, Taneeru Sravya, Praveen Kumar Manchikatla
Plasmacytoma is a discrete, unifocal, monoclonal neoplastic proliferation of the plasma cells. It may present as one of the three distinct clinical entities: multiple myeloma (MM), solitary plasmacytoma of bone and extramedullary plasmacytoma. Solitary bone plasmacytoma accounts for 3% of all plasma cell neoplasms with approximately 50% of the cases transforming into MM. It is frequently seen in vertebrae and secondarily in long bones. Its presence in jaws is extremely rare and when it is seen, retromolar area, angle and ramus of the mandible are most common sites of occurrence. A comprehensive clinical, radiological, histological and immunohistochemical features of solitary plasmacytoma of the mandible in a 46-year-old female patient is reported.
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Clear cell odontogenic carcinoma: Case report of a deceptive pathology p. 140
Sneha Upadhyay, Jyoti D Bhavthankar, Mandakini S Mandale, Bhagyoday Barewad
Clear cells are associated with numerous physiological and pathological conditions. Odontogenic cysts and tumors can arise from physiological clear cells like rests of dental lamina. One such clear cell neoplasm is clear cell odontogenic carcinoma (CCOC) that is associated with aggressive clinical behavior, metastasis and low survival rate. With <80 cases reported so far, it is a rare entity. Initially described as a clear cell odontogenic tumor considering it as a benign but invasive neoplasm, it was later termed as CCOC owing to its infiltrative nature with a marked tendency for local recurrence, regional nodal spread and possible distant, mainly pulmonary, metastasis. Reported here is a case of CCOC affecting mandible of a 55-year-old female along with its immunohistochemical workup.
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Histopathological evaluation of a rare fulminant case of contemporaneous mucormycosis, aspergillosis and actinomycosis p. 144
Aadithya B Urs, Jeyaseelan Augustine, Shivani Singh
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Forensic application of frontal sinus measurement among the Indian population p. 147
Nikita B Gadekar, Vijayalakshmi S Kotrashetti, Jagadish Hosmani, Ramakant Nayak
Aim: Studies have been done in diversified population, demonstrating the uniqueness of frontal sinus; data related to the Indian population are less. Thus, the present study was aimed to determine the frontal sinus measurement and to assess its forensic application in the Indian population. Materials and Methods: A total of 400 individuals with Indian origin (21–30 years) were included in the study. The digitized posteroanterior skull radiographs were obtained and was transferred to Adobe® CS4 extended to measure the dimensions of frontal sinus and orbit for 12 parameters. Statistical Analysis: A descriptive statistical analysis was performed. Results: The descriptive statistics showed the presence of bilateral frontal sinus in 87.7% and bilateral absence in 8.0% of the individuals and the absence of left and right frontal sinus in 3.3% and 1%, respectively. Maximum population showed high asymmetry index (64.7%); the right side frontal sinus (height, 59.3% and width, 40.8%) was superior to the left side in both males and females. The partial septa among the Indian population were absent for maximum population (55.2%), and supraorbital cells of the frontal sinuses were present on both sides among the Indian population. Conclusion: The observation of the present study suggests that the frontal sinus is highly asymmetrical and unique to the individual and hence can be effectively used in personal identification method in forensic anthropology.
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Sexual dimorphism p. 152
B Sivapathasundharam, Manoj Prabhakar
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In Response to: Sexual dimorphism p. 153
Ganganna Kokila, Wakambam Monalisa, Hidangmayum Denish Sharma, Pillai Arun Gopinathan, Okram Manoranjan Singh, Shubha Kumaraswamy
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Estimation of serum sialic acid in oral submucous fibrosis and oral squamous cell carcinoma p. 156
Samatha Chittemsetti, Praveen Kumar Manchikatla, Venkateswararao Guttikonda
Background and Objectives: Sialic acid (SA) N-acetyl neuraminic acid is a negatively charged 9-carbon monosaccharide, commonly attached to the nonreducing residues of carbohydrate chains of glycoconjugates by glycosidic linkage. SA is widely distributed in glycoproteins (GPs) of cell membrane. The alterations in GPs start at an early stage of tumorigenesis. Hence, the aim of the present study is to evaluate the levels of serum SA in normal individuals, in patients with oral submucous fibrosis (OSMF), oral squamous cell carcinoma (OSCC), and compare the levels with respect to the clinical staging and histological grading. Materials and Methods: A total of 90 individuals were selected for the purpose of the study. Thirty cases of clinically diagnosed and histopathologically confirmed cases of OSMF and OSCC each were included. A control group of 30 age and gender-matched individuals with no systemic diseases were selected. Serum levels of SA were measured based on the reaction between SA and ninhydrin. The absorbance was read using a spectrophotometer. Results: Serum SA levels were significantly increased in OSMF, OSCC patients as compared with controls. When multiple comparison was done using post hoc Tukey test, there is a statistically significant difference between clinical staging and histopathological grading of OSMF and OSCC (P < 0.05). Conclusion: The serum SA levels in OSMF and OSCC patients were increased as compared with controls suggesting that, it can be used as a reliable biomarker for prognostic evaluation, and also give a clue about the amount of tumor burden in the individual.
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Comparative evaluation of micronuclei in exfoliated oral epithelial cells in potentially malignant disorders and malignant lesions using special stains p. 157
Neha Gupta, Apurva Rakshit, Sandhya Srivastava, Hema Suryawanshi, Pramod Kumar, Rupali Naik
Introduction: Micronuclei (MNs) are extranuclear cytoplasmic DNA bodies which are induced in cells by numerous genotoxic agents that damage chromosome. The MN assay in exfoliated buccal cells is a useful and minimally invasive method for monitoring genetic damage. Aim: The aim of present study was to detect and assess MNs in oral exfoliated cells in patients diagnosed with leukoplakia with dysplasia, oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) using special stains and to determine the most appropriate staining technique for the evaluation of MNs along with a comparative evaluation of MNs with histological grading Materials and Methods: The study was conducted in the Department of Oral Pathology and Microbiology, CDCRI, Rajnandgaon, and a total of 45 subjects were included in the study who were subsequently divided into three groups (15 each). Four smears were obtained from each subject which were taken from the lesional tissue and stained simultaneously. Analysis: The results were analyzed via Statistical Package for the Social Sciences, version 23.0 (SPSS). Results: The results confirmed the association of MNs with genotoxic agents and showed an elevated number in OSCC followed by OSMF and leukoplakia. The frequency also increased with the severity of the lesion. Besides this, Papanicolaou (PAP) stain was found to be the most suitable stain for detection of MNs. Conclusion: Based on the above pretext, we can conclude that PAP stain was the most suitable stain for valuation of MNs and that the MN assay holds promise as a specific biomarker of genotoxicity, for screening of oral cancer and can be used as a prognostic indicator.
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Assessment of morphological parameters associated with neural invasion in oral squamous cell carcinoma p. 157
M Manjula, Punnya V Angadi, NK Priya, Seema Hallikerimath, Alka D Kale
Aims: Neural invasion (NI) is a form of tumor spread distinct from lymphatic and vascular invasion. It has been correlated with aggressive behavior, disease recurrence and increased morbidity and mortality. Despite the importance of NI as a prognostic indicator, the mechanism and associated factors are poorly understood. Hence, the aim of this study was to determine morphological parameters associated with NI in oral squamous cell carcinoma (OSCC). Methodology: One hundred and five archival specimens of patients with primary OSCC who underwent surgical excision and radical neck dissection were included in the study. The presence of NI was analyzed in slides and correlated with clinical as well as morphological parameters using univariate and multivariate analysis. Results: NI was identified in 31 cases (29%) of OSCC. NI was significantly associated with tobacco habit, lymphovascular invasion and positive surgical margins. Multivariate analysis further emphasized these factors to be significant risk factors for NI. Peri-NI and intra-NI significantly associated with the size of the tumor, while the distance of invasion was associated with advanced stage. Conclusion: NI is associated with multiple morphological parameters and its identification may have a significant impact on the management and prognostic evaluation of OSCC.
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Association of matrix metalloproteinase 2 and matrix metalloproteinase 9 gene polymorphism in aggressive and nonaggressive odontogenic lesions: A pilot study p. 158
Devu Aloka, SK Padmakumar, Sanish Sathyan, Maria Sebastian, Moinak Banerjee, VT Beena
Context: The exact factors that determine the biological behavior of odontogenic lesions have not been thoroughly established yet. The influence of the matrix metalloproteinases (MMPs) on the clinical behavior of these lesions was recently brought to light. Aims: We did a pioneer study to investigate the association of MMP9 (rs3918242 [−1562 C/T] and rs17576) and MMP2 (rs243865 [−1306 C/T] and rs865094) gene polymorphisms and aggressiveness of ameloblastomas, keratocystic odontogenic tumors (KCOT) and dentigerous cysts (DC). Settings and Design: A case–control study conducted in the Department of Oral Pathology and Microbiology, Government Dental College, Trivandrum and Human Molecular Genetics Laboratory, Rajiv Gandhi Institute of Biotechnology and Poojappura, Trivandrum, Kerala. Subjects and Methods: DNA from the blood samples of histopathologically proven ameloblastoma (n = 15), KCOT (n = 11) and DC (n = 13) patients were extracted using standard protocols. Primers were designed based on the functionality and relevance for polymerase chain reaction (PCR). PCR products were analyzed by PCR-restriction fragment length polymorphism and sequencing. Statistical Analysis Used: Chi-square analysis was done to assess the association of gene polymorphisms among the cases and controls. Results: Ameloblastomas showed a higher frequency of mutant allele (T = 0.43; P = 0.05) of MMP9 rs3918242 (−1562C/T) compared to the control population. All the cases showed a statistically significant difference in the distribution of genotype (P = 0.046) and allele (P = 0.03; odds ratio [OR] = 2.06 [1.08–3.95]) frequency of MMP2 rs2438659 (−1306C/T). KCOT samples also showed a significant association in distribution of both genotype (P = 0.01) and allele (P = 0.01 with an OR at 3.42 [1.31–8.92]) frequency, on comparison with control population. Conclusions: MMP2 rs243865 polymorphism has a plausible role in increasing the aggressiveness of ameloblastomas and KCOT compared to that of the control population. Furthermore, MMP9 rs3918242 polymorphism may contribute to the aggressive behavior of ameloblastomas.
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An immunohistochemical evaluation of podoplanin expression in oral leukoplakia and oral squamous cell carcinoma to explore its potential to be used as a predictor for malignant transformation p. 159
A Aiswarya, Rakesh Suresh, Mahija Janardhanan, Vindhya Savithri, Thara Aravind, Lisha Mathew
Background: Oral leukoplakia (OL) is a potentially malignant disorder with increased risk for the development of oral squamous cell carcinoma (OSCC). Many cases of OSCC arise from the malignant transformation of preexisting OL. However, the risk of progression into OSCC and the possible prediction of malignant potential of OL remain inconclusive. Recent studies have shown that podoplanin, a mucin-like transmembrane glycoprotein specifically expressed in lymphatic endothelial cells, is expressed in various neoplasms including OSCC, indicating its possible biologic role in tumor cells. In this study, an evaluation of podoplanin expression in OL and OSCC has been carried out to assess its potential role as a biomarker to predict the possibility of malignant transformation in OL cases. Aims and Objectives: To assess the usefulness of podoplanin as a potential biomarker for predicting the risk of malignant transformation in OL, by comparing its immunohistochemical expression in OL and OSCC. Materials and Methods: Archival paraffin-embedded blocks of 25 OL cases with varying grades of dysplasia and 30 OSCC cases showing its varying grades were selected. Sections were subjected to immunohistochemical staining for podoplanin and compared with the control group for evaluation of results in the three groups. Results: A statistically significant increase in podoplanin expression was observed from normal mucosa through OL to OSCC. In the OL cases, the podoplanin staining score progressively increased from mild dysplasia to carcinoma in situ, whereas in OSCC, well-differentiated group showed the maximum expression of podoplanin. Conclusion: The progressive increase in podoplanin expression through the increasing grades of dysplasia in OL is suggestive of an increased risk for malignant transformation with increased expression of podoplanin in OL cases. A high podoplanin expression in the well-differentiated OSCC may indicate a vital role for podoplanin in the early stages of tumorigenesis.
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The prevalence of developmental anomalies among school children in Southern district of Andhra Pradesh, India Highly accessed article p. 160
Brijesh Krishna Bandaru, Prasanth Thankappan, Surapaneni Ratheesh Kumar Nandan, Rajesh Amudala, Sudarshan Kumar Annem, Arvind Babu Rajendra Santosh
Background: The developmental anomalies of oral cavity are malformations affecting dental and oral tissues. Anomalies of teeth can be associated with primary, mixed or adult dentitions. Anomalies are the results of perturbations in the developmental stages of tissues which may be influenced by genetic and/or environmental factors. Aim and Objectives: The primary objective of this study was to estimate the prevalence of oral and dental anomalies among school attending children in Chittoor and Kadapa districts of Andhra Pradesh. The secondary objective of this study was to compare occurrence of anomalies based on the age stratification to denote primary, mixed and adult dentitions. Materials and Methods: A total of 5000 school children, aged 3–15 years were invited to participate in the study. Information regarding age, sex, level of school education, brushing and hygiene habits were collected using a questionnaire. Intra- and extra-oral examinations were conducted by trained dental surgeons. Clinical data were collected by a single examiner and the details of these anomalies were recorded on the data sheet of the study. The obtained data were statistically analyzed using Chi-square test. Results: Overall prevalence of developmental anomalies was 11.40% and documented 14 types of anomalies. The prevalence of documented anomalies is as follows: tongue-tie 197 (3.90%), dental fluorosis 171 (3.40%), high frenal attachments 156 (3.10%), cusp of Carabelli 14 (0.30%), supernumerary teeth 11 (0.20%), microdontia 4 (0.10%), congenitally missing teeth 4 (0.10%), lip pits 3 (0.08%), fusion 2 (0.04%), retained deciduous teeth 2 (0.04%) and one case of angular cheilitis, cleft lip and cleft palate, talon cusp, amelogenesis imperfecta (0.02%). The prevalence of dental anomalies was 18.10% in 3–5 years, 52.30% among 6–12 years and 29.6% in 13–15 years. Chi-square test was statistically significant (P = 0.003). Conclusions: Tongue-tie was the most frequent oral tissue developmental anomaly and fluorosis was the most common developmental anomaly affecting dental tissue. The prevalence rate of the study was compared with studies published from other geographical regions in India. The variations in the reported prevalence of developmental anomalies are probably related to genetic and environmental conditions.
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Detection and comparison of microsatellite marker D9S1747 with clinical stages and grades of oral squamous cell carcinoma p. 161
Deepa Babji, Ramakant Nayak, Kishore Bhat, Vijayalakshmi Kotrashetti, Harsha Babaji, Manohar S Kugaji
Background: One of the main characteristics of oral squamous cell carcinoma (OSCC) is genetic alteration in specific target regions. Allelic imbalance in tumor suppressor genes is the key event in OSCC which is associated with loss of heterozygosity mostly on chromosome 9p21 locus which includes p16 marker. p16 (D9S1747) is a microsatellite marker which detects early changes in OSCC. To redefine more clearly the role of D9S1747 (p16 microsatellite marker) and its expression in OSCC, the study was designed with the aim to check the detection of D9S1747 in OSCC and to compare the same with histopathological grades and tumor node metastasis staging. Materials and Methods: Forty cases of paraffin-embedded tissue section which was histologically confirmed as OSCC and 10 cases of normal tissues were retrieved from the archives. DNA was extracted from the tissue sections and subjected for polymerase chain reaction to detect p16 microsatellite marker D9S1747. Data were analyzed using Chi-square test and Fisher's exact test. Results: Twenty-seven cases (67.5%) showed p16 microsatellite marker positivity for OSCC. It was observed that 44.4%, 51.9% and 3.7% p16 microsatellite markers were positive in Stage 1, Stage 2 and Stage 4 OSCC cases, respectively. p16 microsatellite marker positivity was found in 77.8%, 22.2% and 0% for well-differentiated, moderately differentiated and poorly differentiated OSCC cases, respectively. Conclusion: The observations of the present study revealed D9S1747 marker as an early event in OSCC, and this can be used as a prognostic marker.
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A retrospective study of clinicopathological features of oral squamous cell carcinoma with and without oral submucous fibrosis p. 162
Swetha Acharya, Sartaz Rahman, Kaveri Hallikeri
Context: Oral submucous fibrosis (OSF) is strongly associated with areca nut usage; the existence of OSF in patients with oral squamous cell carcinoma (OSCC) is an indicator of areca nut-induced carcinogenesis. As areca nut follows a discrete molecular path for oral carcinogenesis, this could be the basis why OSCC patients with OSF are different and are currently projected to constitute a distinct clinicopathologic entity. Aim: This study aims to analyze and compare the demographics, risk factors and clinicopathologic features of OSCC patients with and without OSF. Materials and Methods: A retrospective review of OSCC cases treated in the institution from 2008 to 2013 was done. Sixty OSCC of buccal mucosa were selected, of which 30 were with concomitant OSF and 30 without OSF. Demographics, risk factors and clinicopathological features were studied. The data were analyzed by SPSS-20 software, using the Pearson Chi-square, Fisher's exact and Mann–Whitney U-tests. Results: OSCC cases with OSF were younger (mean age 40.5 vs. 54 years) compared to those without OSF (P < 0.05). Risk factors and other clinicopathological parameters did not differ between the two groups. There was significant difference in the two groups with regard to tumor differentiation (P = 0.000). Tumors in OSCC with OSF were more likely to be well differentiated. Conclusion: Although majority of OSCC patients with OSF were young with a better grade of tumor differentiation, other clinicopathologic features having prognostic significance did not differ significantly between the two groups. Therefore, OSCC arising in background OSF as a distinct entity is uncertain.
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Osteochondroma condyle: A journey of 20 years in a 52-year-old male patient causing severe facial asymmetry and occlusal derangement p. 162
Mounabati Mohapatra, CS Banushree
Mandibular condylar osteochondroma (OS) is a rare lesion though most common benign tumor of the axial skeleton. OSs are slow-growing tumors originating from the cortex of the bone resulting in facial asymmetry, temporomandibular dysfunction and occlusal derangement. We present an extremely rare case of OS of the mandibular condyle in a 52-year-old male patient who presented to our hospital with gradual deviation of the lower jaw, difficulty in opening the mouth and chewing the food for 20 years with clinicoradiological and pathological correlation.
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Sarcomatoid squamous cell carcinoma of mandible: A report of two cases p. 163
Bansuri Jigar Shah, Jagdish Vishnu Tupkari, Tabita Joy
Spindle cell neoplasms comprise a diverse collection of benign and malignant tumors. These tumors are uncommon in the oral cavity, accounting for <1% of all tumors of oral region. Sarcomatoid squamous cell carcinoma (SSCC), also known as spindle cell carcinoma or Lane's tumor, is a rare and peculiar biphasic malignant neoplasm that occurs mainly in the upper aerodigestive tract. It is a variant of squamous cell carcinoma which has spindled or pleomorphic tumor cells which simulate a true sarcoma, but are epithelial in origin. It is an unusual aggressive variant that frequently recurs and metastasizes, reinforcing the importance of its correct diagnosis. We report two cases of SSCC with immunohistochemical findings.
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Multiple supernumerary teeth in a nonsyndromic association: Rare presentation in three siblings p. 163
Madhuri Alankar Sawai, Mohammad Faisal, Saleha Mansoob
Multiple supernumerary teeth is an infrequent developmental alteration. It can affect any area of the dental arches. They are usually reported with several syndromes such as Gardner's syndrome, Cleidocranial dysplasia, Ehler Danlos syndrome, Down's syndrome, etc. Rarely, is it observed in a non-syndromic association. A familial finding of multiple supernumerary teeth is even rarer. Detection of supernumerary teeth is a coincidental finding and is usually detected on radiographs. The article presented here reports the presence of multiple supernumerary teeth without associated syndrome in three siblings of a family which is a very rare finding. It also stresses on the importance of clinical and radiographic diagnosis and the value of thorough medical and dental history.
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Forensic odontology as a humanitarian tool p. 164
T Smitha, HS Sheethal, KN Hema, R Franklin
Humanitarian forensic action is the application of skills of forensic science in a conflicts or disasters as a humanitarian action. Forensic odontologist promote forensic odontology and forensic science principles to caseworks with the purpose of preventing human right violation by human identification, age estimation and where ever dental evidence is involved. Forensic odontologist is involved in all phases of disaster victim identification. According to Disaster Victim Identification Guide, if a positive match is found using dental identification it can be trusted as a standalone identifier. Dental structures are well protected and the hardest structure of the body. They resist decomposition and high temperatures and are the last one to disintegrate after death. Dental hard tissue provide abundant information in disaster victim identification, missing and unidentified persons, child abuse and neglect, domestic violence and sexual abuse with bite mark evidence, age estimation of unaccompanied minors, border control and human trafficking. The present article highlights the role of forensic odontologist in human identification for the purpose of preventing human rights violation.
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Analysis of enamel rod end pattern for personal identification p. 165
J Naziya, S Sunil, P Jayanthi, R Rathy, RK Harish
Background: Microscopically, groups of enamel rods run in unique direction, which differ from adjacent group of enamel rods and results in forming different patterns of enamel rod endings on tooth surface. These are called as tooth prints and they help in personal identification in forensic odontology. Aims and Objectives: The aim of the present study is to analyze the enamel rod end pattern on the tooth surface for personal identification and to analyze the familial inheritance of enamel rod end pattern. Materials and Methods: In the present study, 100 different families were considered for the analysis of tooth print pattern. In each family, four members were present. The maxillary central incisor, canine and first premolar were selected. Enamel rod end pattern was recorded using acetate peel technique and analyzed using Verifinger® standard SDK version 6.7 software. Statistical Analysis: Data analysis was performed using the SPSS software. Contingency coefficient statistical analysis was used for the comparison of tooth print pattern in incisors, canines and premolars based on age and gender. P < 0.05 was considered statistically significant. Results: The present study showed that a tooth print is composed of combination of eight distinct subpatterns, namely wavy branched, wavy unbranched, linear branched, linear unbranched, whorl open, whorl closed, loop and stem-like pattern. Wavy branched pattern was found to be the most predominant pattern in incisors, canines and first premolars in our study. Familial tendency of tooth print pattern in incisors, canines and premolars was noticed in 65%, 66% and 52% of the families, respectively. Conclusion: Tooth prints are unique to an individual and can be used as a valuable inexpensive tool in forensic odontology for personal identification.
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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007