Nitin Bhola

Posterior maxillary odontogenic cysts associated with impacted or ectopic third molars are uncommon and present diagnostic and surgical challenges because of their proximity to the maxillary sinus, nasal cavity and vital neurovascular structures. This case series describes four patients (age range 18–74 years) who presented with cystic lesions of the posterior maxilla linked to third molars. Clinical presentations ranged from incidental radiographic findings to long-standing swelling and recurrent sinus-related symptoms. All lesions were managed by complete surgical enucleation with extraction of the associated tooth, performed via intraoral or Caldwell-Luc approaches under general anaesthesia. Histopathological examination established the definitive diagnoses: infected dentigerous cyst, orthokeratinized odontogenic cyst, odontogenic keratocyst and dentigerous cyst secondary to iatrogenic intrusion. Postoperative recovery was uneventful in every case, with no clinical or radiographic evidence of recurrence at follow-up intervals of 3–24 months. A practical treatment algorithm is proposed to assist surgeons in selecting the appropriate approach according to lesion size, sinus involvement and suspected histopathological type. Accurate preoperative imaging, preferably cone-beam computed tomography, combined with meticulous enucleation and mandatory histopathological confirmation remain essential for favourable outcomes.

Background: Plasmablastic lymphoma (PBL) is an unusual and aggressive form of non-Hodgkin lymphoma that most frequently occurs in immunosuppressed patients, especially those suffering from HIV infection. The association between PBL and the oral cavity is very rare, and the clinical features may mimic odontogenic and epithelial tumors, which causes a delayed diagnosis. Here, we describe an extremely rare case of localized PBL involving the anterior mandible in an HIV-infected patient clinically resembling carcinoma of the lower anterior alveolus. Case presentation: A 43-year-old man, HIV positive, Indian origin, with progressive enlargement of painful swelling over chin area for three months was seen. Examination showed a hard swelling with hypopigmented skin over the lower anterior chin area. Intraorally, there was presence of a nodular, erythematous, pebble like appearance of the mucosa in the edentulous anterior mandibular region, without any ulcerations. No cervical lymphadenopathy could be palpated. Clinically, the provisional diagnosis was made as carcinoma of the lower anterior alveolus, with lymphoma and Kaposi sarcoma being the differentials. Contrast-enhanced computed tomography scan showed a destructive mass with destruction of the anterior mandible and involvement of the surrounding soft tissue areas. Histopathology showed diffuse sheets of plasmablast-like cells. Immunohistochemistry showed MUM-1 and CD45 positivity and CD20 and PAX-5 negativity and high ki67 proliferation index (80–85%). Thus, the diagnosis of plasmablastic lymphoma was confirmed. The staging showed Stage IE extranodal disease without any significant lymphadenopathy and systemic symptoms. The patient was put on antiretroviral and systemic chemotherapeutic treatment. Conclusions: This case demonstrates the difficulty in making a diagnosis for plasmablastic lymphoma mimicking a localized mandibular mass, similar to an oral squamous cell carcinoma. The differential diagnosis must include lymphoma in cases where there is an unusual mandibular swelling, especially when there is an underlying immunocompromised status. Imaging, histopathologic, and immunohistologic studies are crucial in making an early diagnosis and appropriate management of the disease. This case report illustrates the significance of a multidisciplinary management strategy for an unusual oral malignancy.

Osteomyelitis is an uncommon but serious infection of the maxilla, often associated with dental infections, maxillary sinusitis, or systemic conditions tha

Background/Objectives: Oral squamous cell carcinoma (OSCC) often presents at an advanced stage; therefore, the early detection of precursor lesions is crucial. However, the risk assessment of precursor lesions such as oral epithelial dysplasia (OED) remains challenging because of the subjectivity of histopathological grading. We aimed to identify molecular markers that enhance the diagnostic accuracy and prognostic stratification of OSCC and explore the differences in the molecular characterization of OED and OSCC using a few selected markers. Methods: A two-step diagnostic workflow was applied: (1) FISH evaluation of EGFR amplification and CDKN2A deletion to distinguish OED from OSCC and identify EGFR-dependent tumors, and (2) HRAS immunohistochemistry performed exclusively in EGFR-negative OSCCs to stratify EGFR-independent cases. Fluorescence in situ hybridization (FISH) was used to assess seven EGFR/cell cycle-related genes (CCND1, CDKN2A, EGFR, PIK3CA, PTEN, TP53, and 1p36 locus) in 117 formalin-fixed paraffin-embedded samples (66 OED and 51 OSCC) and 10 normal mucosa samples. HRAS expression was evaluated using immunohistochemistry (IHC) in 36 EGFR amplification-negative OSCCs samples. Results:EGFR amplification was frequent in OSCC, whereas CDKN2A deletion was common in OED. The EGFR-amplified/ CDKN2A-intact profile showed high specificity for OSCC and improved diagnostic performance (area under the curve = 0.77) when combined with the Ki-67 labeling index. It also predicted poor disease-free survival (hazard ratio [HR] = 5.08, p = 0.016) and overall survival (HR = 6.10, p = 0.047). Among EGFR-negative OSCCs, HRAS overexpression was associated with advanced-stage disease and a poor prognosis (HR = 6.15, p = 0.043). Conclusions:EGFR amplification was frequent in OSCC, and CDKN2A deletion was prevalent in OED, supporting their use as molecular markers for differential diagnoses. FISH for EGFR/CDKN2A and HRAS IHC can stratify OSCC by diagnosis and prognosis, enabling practical molecular subclassification, including EGFR-negative cases.

Background: Orocutaneous fistula is a challenging postoperative complication often encountered in head and neck reconstruction, typically resulting from surgical site dehiscence, infection, or compromised flap vascularity. While the pectoralis major myocutaneous flap has historically been a reliable option for reconstruction, its failure—though uncommon—can lead to persistent fistula formation. This case highlights the effective use of combined local tissue rearrangement and free anterolateral thigh flap for successful secondary reconstruction following pectoralis major myocutaneous flap failure. Case presentation: A 31-year-old Indian male patient, previously treated with composite resection and pectoralis major myocutaneous flap reconstruction for carcinoma of the buccal mucosa, presented with orocutaneous fistula due to pectoralis major myocutaneous flap dehiscence and partial necrosis. Conservative wound care failed to achieve closure. The patient underwent secondary reconstruction using local tissue rearrangement and a free anterolateral thigh flap. Postoperative recovery was uneventful, with successful closure of the fistula and restoration of orofacial continuity. Conclusion: This case underscores the importance of timely secondary intervention using free tissue transfer and local flap adjustment in managing orocutaneous fistula following pectoralis major myocutaneous failure. The combined approach provided durable closure and functional restoration, offering a viable option in complex salvage scenarios.

Background Oral submucous fibrosis (OSMF) is a debilitating oral disease, causing progressive loss of vascularity in the diseased mucosa, resulting in epithelial atrophy. Therefore, this pilot study aimed to use intralesional pentoxifylline to increase blood supply to the local tissues, helping in eliminating or reducing the severity of OSMF. Aims and Objectives To comparatively evaluate the effectiveness of the combination of intralesional pentoxifylline and dexamethasone with pentoxifylline and dexamethasone alone in assessing the mouth opening, burning sensation, and USG parameters. The USG parameters included submucosal thickness, echoicity, and blood vascularity. The pilot study results were compared among the three study groups, in terms of increase in mouth opening, reduction in burning sensation, and the above-mentioned USG parameters. Methods Patients were categorized randomly into Group I (n = 05), Group II (n = 05), and Group III (n = 05): Group I, intralesional dexamethasone 4 mg/ml, Group II, Intralesional PTX 1 mg/ml, while in Group III, combination of both drugs was administered, biweekly for 3 months along with active physiotherapy. Ultrasonography and colour Doppler were done pre- and post-treatment. Results The increase in mouth opening in Group III was 115%, and in Group II that was 63.46% as compared to Group I 19.28% after 26th dose. The results of various parameters considered in this study were overall better in combination group as compared to other two groups. Conclusion This regimen will improve quality of life, function, and patient compliance along with down staging of Grade of OSMF. Trial registration number: CTRI/ 2020/09/027836.

An uncommon entity in the class of malignant neuroectodermal nasal tumors is the olfactory neuroblastoma, which originates in the roof of the nasal cavity from the olfactory epithelium. It is often mistaken by clinicians for a nasal polyp because it presents with indistinct features such as nasal obstruction and secondary sinus disease. Olfactory neuroblastoma has been observed to cause morbidity by distant metastasis, invasion through the cribriform plate, and secondary meningitis in most instances. It exhibits a range of biologic activities, from slow growth accompanied by long-term patient survival to a very aggressive malignancy with extensive metastases. We report the incidence of a rare case in which a patient, previously operated on and irradiated for squamous cell carcinoma of the maxilla, developed an olfactory neuroblastoma with orbital protrusion.