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Oral submucous fibrosis (OSMF) is a potentially malignant disorder, characterized by alteration in the connective tissue stroma. Its association with oral squamous cell carcinoma (OSCC) has been recognized and conferred a special status as a distinct disease entity with improved prognosis as compared to conventional squamous cell carcinoma. Such cases of concomitant presentation of OSMF and OSCC have not yet been defined, leading to ambiguity regarding the evaluation. The concomitant occurrence of OSMF-OSCC is associated with histopathological features, unlike OSMF, yet similar to an aggressive presentation of OSCC. An indepth evaluation of the connective tissue, along with other tumor characteristics such as tissue hypoxia, inflammatory cell population, neoangiogenesis, and stromal cells fortify the possibility of these cases of concomitance being as aggressive, if not more, as compared to conventional OSCC. Thus, recognizing such cases along with the evaluation of probable prognostic indicators is necessary to improve the current understanding of tumorigenesis and progression in concomitant cases of OSMF-OSCC.

Background Separation of the epithelial lining from the underlying connective tissue wall has been a frequently observed and unique feature in odontogenic keratocysts (OKC), but not in other odontogenic cysts nor neoplasms. No study on OKC has been reported evaluating the role of type VII Collagen, the anchoring fibrils, which function in stabilising the epithelial structure. The purpose of this study was to assess the role of type VII collagen in the fragility of the epithelium leading to a high recurrence rate in OKCs. Material and Methods Immunohistochemical staining with Abcam® Monoclonal Mouse Anti-Collagen VII Antibody [LH7.2] (used at a dilution of 1:200) on 30 tissues of OKC. The chi-square test was applied to confirm the statistical significance between the control and test groups. The frequencies of the pattern of distribution for the staining characteristics of collagen VII were calculated in the OKC samples. Results Out of the 30 OKC samples 22 (73.3%) showed negative staining for type VII Collagen. Among the infected cases, 7 showed a positive basement membrane staining and one of the non-infected OKC showed positive basement membrane staining. However, none of the syndrome associated or recurrent OKCs showed any evidence of type VII collagen reactivity. Conclusions Considering the distribution of type VII collagen in OKCs it can be concluded that type VII collagen expression is altered in OKCs, leading to destabilisation of the epithelium connective tissue interface thus rendering the epithelium-connective tissue interface fragile. Key words:Type VII Collagen, Odontogenic Keratocyst, Basal Lamina, Immunohistochemistry.

Zoonotic filarial infections particularly dirofilariasis have been reported worldwide. The route of transmission to human beings is vector-borne through mosquitoes. Increased mosquito activity subsequent to global warming has influenced the transmission of dirofilarial infection in many geographic regions, including Asia. Dirofilariasis presents as mucocutaneous and pulmonary infections. Dirofilarial infections rarely manifest in the oral and perioral region and can pose to be a diagnostic challenge to clinicians. We report the first case of oral dirofilariasis in Goa, India.

Background Oral submucous fibrosis (OSMF) is a potentially malignant disorder dominantly noted in South East Asian countries. A prevalence rate of 0.2% to 0.5% has been reported in India, with about 7% to 13% transforming to oral squamous cell carcinoma (OSCC). Authors have stated that cases of OSMF-OSCC may have a better prognosis compared to conventional OSCC, thus recognizing the former as a distinct clinicopathologic entity. Objective To explore and understand microenvironmental alterations in cases of OSMF-oral epithelial dysplasia (OED) and OSMF-OSCC. Methods All cases were staged using the Khanna and Andrade system for OSMF. Epithelial evaluation was achieved using World Health Organization grading for OED and Anneroth's histopathologic assessment for OSCC. Stromal evaluation included quantification and qualification of the inflammatory cell infiltrate and a comparison in both groups. Cases of OSMF with OSCC were further subjected to evaluation using Masson's trichrome and immunohistochemistry for CD-105, TGF-β, and CD-163. Results Cases of OSMF-OED and OSMF-OSCC demonstrated divergent and contrasting stromal features. Based on the demographic and clinical data along with stromal features of OSMF-OSCC, an entity such as concomitant OSMF-OSCC was identified and defined. These cases demonstrated distinct and contrasting stromal alterations, indicative of a relatively poorer prognosis than previously postulated. Conclusions The microenvironmental changes, reported herewith are significant owing to their digression from the conventional stroma as is seen and expected to persist in OSMF. The possibility of a better prognosis remains uncertain and the findings of this study warrant further investigation. Thus, a cautious approach must be exercised toward concomitant cases of OSMF-OSCC.

Aim of the study : Despite advances in surgical and radiotherapy techniques, the presence of lymph node metastasis drastically decreases the survival rate of patients with primary oral squamous cell carcinoma (OSCC). Thus the accurate pathological staging of the neck is critical. Desmoglein 3 (DSG3), a desmosomal cadherin protein is said to be highly expressed in head and neck squamous cell carcinoma (HNSCC) and in metastatic cervical lymph nodes, but absent in non-invaded nodes. With an aim to improve the sensitivity of tumour cell detection, we investigated the potential of DSG3 as an immunohistochemical marker for the detection of occult lymph node metastasis in patients with primary OSCC. Material and methods : Forty-seven lymph node specimens from 10 patients who underwent neck dissection for primary OSCC were immunostained with DSG3. Results : The DSG3 positivity was noted in the six positive lymph nodes. However, when using DSG3 as an immunohistochemical marker, no additional micrometastatic deposits were evident in the histologically negative nodes. Interestingly, tumour marker DSG3-positive macrophages could be identified within the subcapsular sinuses, medullary sinuses, and the interfollicular areas. Conclusions : Our findings suggest that although DSG3 is overexpressed in HNSCC, it is not specific and may not prove to be a potent immunohistochemical marker to detect micrometastasis. The role of tumour marker-positive macrophages within the lymph nodes needs to be investigated further.

Objectives – Routine histopathological grading for salivary gland mucoepidermoid carcinoma (MEC) have failed to prognosticate these tumors, resulting in poor post-surgical outcomes. In developing countries, the lack of technologically advanced infrastructure curtails, efficient treatment modalities. This study aimed at determining if MUC4β can characterize salivary gland MEC and serve as a practical and inexpensive method to prognosticate salivary gland MEC. Materials and methods – Fifteen cases of archived paraffin embedded tissue blocks of mucoepidermoid carcinomas were reassessed for histopathological grading using Healey's system, modified by Batsakis and Luna and immunohistochemically evaluated for expression of MUC4β. Statistical analysis (Kappa statistics and Spearman's rho correlation coefficient) was performed to assess inter-observer reproducibility and to correlate the expression of MUC4β with the histopathological grade of the tumor. Results MUC4β expression is related to tumor differentiation in an inverse relationship. Two cases of high grade MEC were the exception to this rule. Conclusion Our study revealed that MUC4β alone cannot serve as a reliable prognostic marker due to its divergent tumor suppressor and oncogenic pathway. The role of MUC4β needs further evaluation and research so as to potentiate therapeutics depending upon its context dependent function, as a cancer marker or an oncogenic factor., Cancer Research; Dentistry; Oncology; Salivary gland cancer; Mucoepidermoid carcinoma; MUC4; Prognosis

Background: The significance of the tumor microenvironment (TME) as a modulator of tumor behavior was acknowledged by Hanahan and Weinberg in 2011 as the emerging hallmarks and enabling characteristics of the hallmarks of cancer. Subsequently, the role of inflammation, in conferring aggressiveness to a tumor, was regarded as a fundamental process in the evolution of the TME. Tumor-associated macrophages (TAMs) are distinctly polarized inflammatory cells and key shapers of a protumorigenic microenvironment. Aims: The aim of the study was to evaluate the distribution of TAMs and the expression of CD-163 as a marker to evince tumor aggressiveness, in oral squamous cell carcinoma (OSCC). Settings and Design: A retrospective institutional study was approved by the institutional ethics committee, and random sampling was carried out. Cases fulfilling the inclusion criteria were subjected to S(site), T(tumor), N( node), M( metastasis), P(pathology) STNMP staging along with immunohistochemical evaluation of CD-163. Methods: Samples for this study included 58 archival cases of OSCC. Demographic details were recorded, and the STNMP stage ascertained, following which, each case was reevaluated histopathologically for the invasive front. Cases with sufficient stroma and demonstrating the invasive front were further subjected to immunohistochemical evaluation of CD-163 for TAMs. The density of CD-163-positive cells was assessed by three pathologists, independently, in a double-blinded evaluation using Image-J©. Statistical Analysis: Descriptive data were evaluated and analyzed statistically using Spearman's/Pearson's correlation tests based on the distribution of data. Results: The density of TAMs was noted to be directly proportional to the STNMP stage. In addition, a strong positive, statistically significant correlation was noted between the density of TAMs and tumor size, nodal status and STNMP stage. Conclusion: The crucial role of the tumor microenvironment must be considered when evaluating OSCC. TAMs prove to be a reliable marker for assessing tumor aggressiveness and could aid in improved prognostication of OSCC, while also being potential targets for therapy.

Oro-facial-digital syndrome is a group of rare heterogeneous hereditary disorders characterized by abnormalities of the oral cavity, face and digits, along with varying degrees of mental retardation. Currently, Oro-facial-digital syndrome has been classified into 14 types and two additional unclassified variants have been proposed. Amongst the various variants described, Oro-facial-digital syndrome type I is the most common. We report an interesting subclinical sporadic case of Oro-facial-digital syndrome type I in a 21-year-old female patient. Interestingly, our patient presented with a few novel hitherto unreported clinical findings like midline pits in the philtrum area and a hamartomatous proliferation of tissue in the anterior maxillary alveolar gingival region. This case report highlights the importance of prudent histopathological-clinical correlation, which can direct the flow of clinical investigations leading to the detection and diagnosis of unsuspected conditions as learned in this case. We would also like to emphasize that comprehensive examination of new born for structural abnormalities of the orofacial region is crucial to early diagnosis of syndromes and subsequent referral for further evaluation and management.

Background: With the increasing prevalence of type 2 diabetes mellitus (DM), there is a need to assess if the elevated salivary glucose levels provide an environment conducive to the growth of cariogenic microorganisms specifically Streptocooccus mutans and Lactobacillus acidophilus. Materials and Methods: Forty-five patients were divided into three groups consisting of patients with type 2 DM with caries, patients with type 2 DM without caries and age-matched healthy nondiabetic individuals (control). Saliva samples were subjected to semiautomatic salivary glucose estimation by the glucose oxidase-peroxidase method, using the Tulip glucose estimation kit. Swabs were immediately inoculated onto Mitis Salivarius Bacitracin agar and Man Rogosa Sharpe agar. Results: In Group A, statistically significant positive correlation was found between S. mutans and salivary glucose (r = 0.858) as well as L. acidophilus and salivary glucose (r = 0.853). In Group B, a statistically significant positive correlation was found only between S. mutans and salivary glucose (r = 0.705) and not between L. acidophilus and salivary glucose (r = 0.387). The control group did not show a statistically significant correlation. Conclusion: It is established that salivary glucose levels reflect the diabetic state of an individual. The salivary glucose level predicted a 1.7 times higher caries susceptibility in a diabetic, as shown by results in this study. Salivary glucose causes an increase in the cariogenic load in diabetic patients, thus warranting a modification of the Keyes triad.

India is considered to be the oral cancer capital of the world. Oral squamous cell carcinoma is a multifactorial disease with tobacco and alcohol being considered major risk factors. However, there is a growing incidence of nonhabit (i.e., the absence of tobacco or alcohol) associated oral cancer. Difference is noted in demographics, site predilection, grade, and stage while comparing habit associated and nonhabit associated oral carcinoma. This warrants a need for a greater understanding of carcinogenesis without a known carcinogen. This case adds to the sparse existing scientific literature on oral cancer in nonhabitues and reviews the possible etiopathogenic mechanisms underlying the disease process.

Background: Tobacco in any form is genotoxic to the oral epithelium and manifests as tobacco-associated mucosal lesions, some of which are OPMDs with a propensity for progression into OSCC (2-17%). The aberrations in the count and morphology of micronuclei in exfoliative cytological preparations have been demonstrated in all forms of oral tobacco usage and OLP independently. The more extensive these aberrations, the greater the possibility of undergoing malignant change. This study focused on assessing the extent of micronuclear damage in tobacco-habitues with OLP, thus placing them in a higher risk group as compared to non- habitues with OLP. Aim and Objectives: To evaluate the frequency of micronucleated exfoliative cells in oral lichen planus and to evaluate the effect of tobacco on the frequency of micronuclei in these patients. Material and Methods: Patients were divided into 3 groups: OLP with habit, OLP without habit and healthy controls. Exfoliated cells were obtained from the lesion, smeared on slides, stained by Papanicolaou's method and 1000 cells per slide evaluated for micronuclei according to the Tolbert et al criteria. Statistical Analysis: A statistically significant result was obtained using ANOVA and Bonferroni tests. Result: The genetic damage and increased potential for malignant transformation in OLP is compounded in tobacco habitues evidenced by the increase in the number of micronuclei. Conclusion: The Micronucleus Index was observed to be three-fold greater in tobacco habitues with OLP as compared to non-habitues with OLP.

Adenomatoid odontogenic tumor (AOT) is a benign non-invasive odontogenic lesion with slow growth potential and exceptionally low recurrence rate. This case report highlights an unusual case of an aggressive adenomatoid odontogenic tumor associated with impacted deciduous and permanent canines presenting in a 14 year old male in the anterior mandible.

Masseter muscle hypertrophy is a rare condition of unknown cause, which is important due to growing cosmetic concern. A hypertrophied masseter may cause prominent mandibular angle, alter facial lines and characteristic square configuration of face, which may be unacceptable to the patient. Several treatment options reported for masseter hypertrophy, which range from conservative treatment options to invasive surgical procedure. The botulinum therapy offers good results but it's expensive and requires repeated injections with the chances of antibodies development. However, surgical treatment though invasive provides quick and permanent treatment for masseter muscle hypertrophy. The present case reports surgical management of young male patient with masseter hypertrophy due to cosmetic reasons.

Background: Ameloblastoma is a benign slow growing tumor of odontogenic origin composed of epithelial cells that resemble enamel forming cells namely the ameloblasts however these lesional cells do not differentiate to produce enamel. They are locally aggressive and can cause severe abnormalities of the face and jaw. Aim: This study aimed to correlate the incidence and recurrence rates of ameloblastoma to the different clinical and histopathological parameters. Methods: A study on ameloblastomas in the Goan population for 16 years (1999–2014) was carried out. Archived documented data of surgically treated cases of ameloblastomas were used in this study. Results: It was revealed that out of 52 cases of ameloblastomas, a male preponderance was seen. Age predisposition was seen to favor the third-fourth decade, the most common site was the posterior aspect of lower jaw for new and recurrent cases. Conclusion: The study highlights, the possible etiological role of location influencing the incidence and recurrence rates of ameloblastomas.

Background: Pleomorphic adenoma (PA) accounts for 45–74% of all the salivary gland neoplasms, of which 40–70% are present in minor salivary glands. Studies have depicted variations in histological typing and classification of these tumors. Its pleomorphism is attributed to the cytological differentiations of the epithelial components and the diverse stromal components. Biochemical investigations of saliva have revealed “mucins” to be its main component. Mucins reflect in their composition, the functional state of the mucosa, both in health and disease. Many reviews on histochemical classification and identification have been put forward to explain the intricacies of mucins; however, no attempts have been made to classify salivary gland tumors based on their mucin profiles and assess its prognostic significance. Thus, this study was executed to analyze the clinical, histopathological and histochemical behavior of PA of minor salivary glands and decipher a correlation. Materials and Methods: Twenty-six diagnosed cases of PA of minor salivary glands and five controls of normal minor salivary glands of the hard palate were included in the study. Blocks were retrieved, sectioned and stained with hematoxylin and eosin (H and E) stain as well as combined Alcian blue (AB)-periodic acid-Schiff (PAS) stains. Results: The stained slides revealed an array of epithelial and stromal patterns and varying heterogeneity of mucin expression of normal and neoplastic minor salivary glands. Conclusion: The study elucidated the role of mucins in tumorigenesis and its prognostic implications.

The resection of oral cavity tumor and malignancies often causes functional disabilities like deglutition and articulation. Maxillectomy is a very common surgical procedure carried out for the management of benign and malignant tumors of maxilla. Irrespective of the procedure, there is a common end result that is the defect. Several soft tissue flaps can be used for reconstruction of maxillectomy defect. Keeping the parameters of reconstruction in mind it is ideal to reconstruct the maxillary defect with either the free flaps or the regional flaps. Of all regional flaps, the temporalis myofascial flap (TMF) provides a high degree of reliability, vascularity, adequate bulk, and proximity to the defect in the oral and maxillofacial region.

Context: Odontogenic tumors (OTs) represent a rare subset of pathologies of the oral and maxillofacial region. The classification of OTs has undergone several changes over the years due to a lack of uniform international identification criteria. The histomorphological similarity and the many variations in behavioral patterns elaborated by these lesions warrant research. Aims: Using the update from the fourth edition of the World Health Organisation Classification of Head and Neck Tumors (2017), this dental institution carried out an epidemiological study on OTs in the state of Goa (India) and compared the data obtained with similar studies on OTs done within India. Materials and Methods: The clinical and pathological data of OTs from August 1996 to December 2016 was retrieved from the oral and maxillofacial pathology department archives, belonging to the lone dental college and hospital in the state of Goa, India. Demographic data such as frequency, age, gender, and site along with pathological subtype was analysed. Statistical Analysis Used: Descriptive analysis (i.e. frequency of age, gender, and location), Chi-Square Test and Fischer Exact test. Results: The relative frequency of OTs was 2.61% of all oral biopsied specimens. The most common OT encountered was ameloblastoma (57.9%). The posterior aspect of the mandible was the most favored site (77.2%). The frequency of OTs decreased after the fourth decade. An overall marginal male predilection (55%) was seen. Conclusions: This study contributes to the establishment of a comprehensive loco-regional epidemiological database on OTs in India, aiding research on their aetio-pathogenesis and diagnosis.

Extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL) is a rare Epstein-Barr virus associated lymphoma seen predominantly in Asian population with a 5 years survival rate ranging from 10% to 75% depending on the stage of presentation. In this case report, we describe an unusual presentation of ENKTCL, which in its early stages was clinically misdiagnosed as buccal space infection and later on histologically as inflammatory myofibroblastic pseudotumor owing to manifold reasons. Postoperative biopsy specimen showed characteristic feature of ENKTCL both histologically and immunophenotypically. This case report underlines the importance of adequate sampling and the unusual presentation of ENKTCL nasal type with oral manifestations.

Oral squamous cell carcinoma (OSCC) is the sixth most common human malignancy. According to World Health Organization, oral cancer has been reported to have the highest morbidity and mortality and a survival rate of approximately 50 % at 5 years from diagnosis. This is attributed to the subjectivity in TNM staging and histological grading which may result in less than optimum treatment outcomes including tumour recurrence. One of the hallmarks of cancer is aerobic glycolysis also known as the Warburg effect. This glycolytic phenotype (hypoxic state) not only confers immortality to cancer cells, but also correlates with the belligerent behaviour of various malignancies and is reflected as an increase in the expression of lactate dehydrogenase 5 (LDH-5), the main isoform of LDH catalysing the conversion of pyruvate to lactate during glycolysis. The diagnostic role of salivary LDH in assessing the metabolic phenotype of oral cancer has not been studied. Since salivary LDH is mainly sourced from oral epithelial cells, any pathological changes in the epithelium should reflect diagnostically in saliva. Thus in our current research, we made an attempt to ascertain the biological behaviour and aggressiveness of OSCC by appraising its metabolic phenotype as indirectly reflected in salivary LDH activity. We found that salivary LDH can be used to assess the aggressiveness of different histological grades of OSCC. For the first time, an evidence of differing metabolic behaviour in similar histologic tumour grade is presented. Taken together, our study examines the inclusion of salivary LDH as potential diagnostic parameter and therapeutic index in OSCC.

Context: Trigeminal neuralgia is as a chronic, debilitating condition, which can have a major impact on quality of life. There are few reports of trigeminal neuralgia in oriental populations. Objectives: To evaluate the retrospective data of the patients diagnosed with idiopathic trigeminal neuralgia and to understanding the disorder in the Indian populace. Methods: The retrospective data of 72 patients with typical idiopathic trigeminal neuralgia regarding age of onset, gender, site of involvement, clinical presentations and treatment received during three years of the follow up was collected and analyzed. Results: In the present retrospective study, the mean age was 54.9 years; female to male ratio was 2.13:1; rural to urban ratio 1.76:1 with 62.5% suffered trigeminal neuralgic pain on the right side. Carbamazepine was found to be highly effective in 60.8% of the cases on long-term basis with maintenance doses. Other treatment modalities were employed in more refractory cases including add-on of gabapentin, which relieved the symptoms for an additional duration of 13±3months. The neurolytic alcohol bloc was given in 30% of patients who stopped responding to combination of carbamazepine and gabapentin and relieved pain for a mean duration of 17.25±2.95 months. Twenty three percent of the patients (23%) required peripheral neurectomy. Conclusions: Carbamazepine was found to be highly effective in trigeminal neuralgia. Other treatment modality includes add-on of gabapentin, neurolytic alcohol blocs and peripheral surgical intervention in more refractory cases. Only limited cases needed further neurological consideration. Key words:Trigeminal neuralgia, carbamazepine, gabapentin, alcohol bloc, peripheral neurectomy.

Background: Salivary diagnostics promise an easily accessible, non-invasive approach for analyzing and monitoring various oral diseases including cancer. Objectives: This study was undertaken to establish the baseline salivary lactate dehydrogenase (LDH) levels in healthy controls and to discern the effect of smokeless tobacco (SLT) on the diagnostic efficacy of salivary LDH. Materials and Methods: Thirty-seven systemically and periodontally healthy individuals in the age group of 19-27 years without any deleterious habit and oral lesion participated in this study. After explaining the procedure to the participants, unstimulated whole saliva was collected by spit method under sterile conditions. Baseline LDH activity was measured spectrophotometrically. After evaluating baseline activity, 1 ml of saliva was mixed with 1 g of SLT and incubated at 37°C. LDH activity was measured at different time intervals. Results: The median value of baseline LDH levels at rest was 338 IU/L. The gender-based variation in LDH activity was found to be non-significant. Exposure of whole saliva to SLT resulted in an initial increase followed by reduction in the LDH activity. Conclusion: This study provides additional rationale for the use of salivary LDH as a biomarker to investigate the aggressiveness and biological nature of oral pathological conditions. Interpretation of changes in salivary LDH activity should be done with caution in individuals habituated to tobacco use.

Objective: To evaluate the diagnostic performance of X (Barr body [BB]) and Y (F body [FB]) chromosomes observed in dental pulp tissue for gender determination of an individual. Materials and Methods: The study was carried out on 100 teeth (50 male and 50 female), which were indicated for extraction. The teeth were sectioned at various intervals (within 12 h to 49 days post-extraction), and the pulpal tissue was obtained. Two slides for each pulp tissue were prepared, one for 5% Quinacrine dihydrochloride stain (FB) and the other for Hemotoxylin and Eosin stain (BB). The slides were then observed under the fluorescent microscope for FB and under the light microscope for the BB respectively. Results: Gender determination from human pulp is possible up to 7 weeks. The percentage of FB and BB decrease gradually as the time interval increases. Further, an equation was derived from the data based on the canonical discriminant function coefficients. Conclusion: The determination of gender based on a joint search for the presence or absence of X (BB) and Y (FB) Chromosome is a reliable and cost-effective technique.

Hemangiomas are benign vascular neoplasms characterized by an abnormal proliferation of blood vessels. They may occur in any vascularized tissue including skin, subcutaneous tissue, muscle, and bone. Intraosseous hemangiomas are uncommon, constituting less than 1% of all osseous tumors. The most frequent sites are the calvaria and the vertebral column. Involvement of the facial bones is rare and occurs most commonly in the maxilla, mandible, and nasal bones. In literature, only 20 cases of zygomatic involvement have been reported. We report a case of an intraosseous hemangioma of the zygoma with the history and physical findings of slowly growing, bony, hard tumor causing facial and ocular deformity. The typical clinicopathologic and radiologic findings helped to set up the correct diagnosis. Early recognition and excision are recommended to preserve facial contour. Operative blood loss is minimal, and there is no need for preoperative angiography.