The Importance of Using Physical Tridimensional Models for the Management and Planning of Extended Osseous Odontogenic Lesions

(1) Surgical intervention becomes crucial in situations in which lack of action would cause a decrease in quality of life for the patient. As healthcare professionals, our next objective is to reduce patient fear perception. This work’s aim is to illustrate how physical tridimensional models can serve not only as confidence boosters for the patient, but also as a valid tool to aid both the clinician and the fostering of a patient–doctor relationship. (2) An example case managed using a stereolithographic model in the pre-surgical planning stage is presented in which surgical planning was carried out by analysis of radiographic investigations combined with a tridimensional resin model derived from the patient’s x-ray exam. (3) Successful enucleation, surgical debridement, and stable follow-up shows the effectiveness of the applied surgical protocol, confirming that planification using a physical representation of the tridimensional exam aids in the correct surgical management of said lesions. (4) The effectiveness o101f the surgical act itself as well as the follow-up showing ossification of the bony lesion and absence of relapse of a highly recurrent lesion confirms the effectiveness of the tools used for this surgical intervention.

Breaks, bends and holes

A 14 year old boy presented with lower limb deformities and bone pain since 8 months. He was severely wasted, stunted with tachypnea, pallor, genu-valgum, widened wrists and rachitic rosary. Workup revealed end-stage-renal-disease with metabolic acidosis, anaemia, hypocalcemia and secondary hyperparathyroidism. Scannogram of both lower limbs showed evidence of rickets, fractures and a lytic lesion in the lower end of the right femur suggestive of osteitis-fibrosa-cystica (OFC). The case depicts how one should evaluate a lytic bony lesion taking into consideration the complete clinical and biochemical picture and that OFC is not uncommon in adolescence in the presence of unchecked hyperparathyroidism. The child was treated with iron therapy, oral bicarbonate, oral vitamin D, erythropoietin and advised renal replacement therapy.

A HISTOPATHOLOGICAL STUDY OF LIMB LESIONS: RETROSPECTIVE STUDY AT RIMS, RANCHI

Limb lesions of skin, soft tissue and bone are commonly encountered. They include a multitude of non neoplastic, benign and malignant diseases ranging from lipoma to brosarcoma and from epidermal cyst to squamous cell carcinoma. An insight of the pattern of various limb diseases in relation to site, age, and type of lesion assists in better comprehension of differential diagnosis for histopathologists. A retrospective study of histopathologically diagnosed cases of Material & Methods: 47 limb lesion patients from June 2020 to May 2021 was undertaken. A total 47 cases included 28 male and 19 female, Results: 55% of cases belong to age group 21 to 50 years. 13 (28%) cases were of upper extremity and 34 (72%) from lower extremity. 15 (34%) cases were non-neoplastic, 13 (28%) were benign lesion and rest 19 (38%) were malignant lesions. Lower limb lesions are more common than Conclusion: upper limb lesions. Squamous cell carcinoma is the most common malignant neoplasm and lipoma is the most common benign disease of extremity. Pyogenic granuloma and epidermal cyst were found to be the most common non-neoplastic extremity lesions. Fibrosarcoma was the most common type of sarcoma observed in 9% cases. Chronic osteomyelitis was the most common bony lesion.

Multi-Modality Imaging of Craniofacial Fibrous Dysplasia with Orbital Complications and Histopathology Correlation-A case report and short review of literature

Craniofacial fibrous dysplasia [CF-FD] with orbital complications is a known but rare entity. This is a multi-modality imaging Case Report of extensive CF-FD in a 31-year-old male with right eye pain, swelling, and redness, along with histopathology correlation. In this patient, the CT scan demonstrates the classic ground glass bony appearance in great detail and helps with the diagnosis of FD, while excluding other bony pathology. The patient’s corroborative MRI brain with and without contrast and MRI brain perfusion images are presented to further characterize this pathology along with its orbital and ocular complications. Given the significant mass-effect on the ocular structures, the patient underwent orbital surgery with removal of as much of the lesion as possible. On macroscopic pathology evaluation, the affected bone was rubbery and gritty when sectioned. Microscopically, remnant fragments of woven bone of various size and shapes were seen with lack of an osteoblast rim. The bony fragments had a characteristic curvilinear, trabecular, and/or branching pattern. Post-surgical imaging demonstrated improvement in the mass-effect on orbital structures and proptosis, along with residual bony lesion.

Extensive titanium mesh invasive cranial fibrous dysplasia

Background: Craniofacial fibrous dysplasia (FD) is a benign lesion. It presents as bony swelling. Even after complete excision, it has a tendency to recur due to some residual lesion in normal bone. Recurrence at same site is common, but it recurs in bone. We are reporting a rare case of recurrent FD engulfing titanium mesh. Case Description: A 22-year-old girl, who underwent frontal FD excision and reconstruction using titanium mesh surgery 2 years back, came with complaint of progressive bony swelling at same site for 1 year. CT head confirmed bony lesion involving mesh, frontal air sinus. She underwent complete excision of lesion and cranioplasty using bony cement. Biopsy confirmed recurrence of FD and invasion of titanium mesh. Conclusion: Recurrence of FD, involving cranioplasty titanium mesh, is extremely rare. It suggests local invasiveness of lesion. Recurrence can be prevented by excision of lesion with free bony margins.

“Central Giant Cell Granuloma of Maxilla- A Case Report”

Central giant Cell granuloma (CGCG) formerly called giant cell reparative granuloma is a benign bony lesion and etiology is unclear. It occurs most commonly in mandible and also occur in maxilla. 1%-7% of all benign lesions of jaws are central giant cell granuloma. It affects children and adults. it is usually a slow growing lesion, fast growing lesions also reported. The fast growing CGCG has an aggressive behavior mimicking a malignant lesion through it has the innocent histological appearance. CGCG sometimes resemble a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination. Histological examination confirms as CGCG. The case described here involved maxilla which was treated with surgical curettage. The patient has been followed up for 11/2 years with no post operative complications and no recurrence. Keywords: Central giant cell granuloma, maxilla, benign, jaw

A rare coexistence of central giant cell granuloma and parathyroid adenoma: Case report

Central giant cell granuloma is a reparative bony lesion characterised by abundant multinucleated giant cells within a sea of spindle shaped mesenchymal stromal cells. Giant cells are scattered throughout the fibrovascular connective tissue stroma containing hemorrhage. Its coexistence with parathyroid adenoma is very rare. Brown tumour is a close differential in this scenario. Herein we present the case of a central giant cell granuloma of maxilla and parathyroid adenoma diagnosed almost during the same time in a 58 years old male.

Aggressive Central Giant Cell Granuloma in the Posterior Region of Mandible – A Case Report

Central giant cell granuloma (CGCG) is an uncommon, benign, intraosseous bony lesion of the mandible and maxilla which is variably aggressive in nature. The incidence of an aggressive and recurrence nature is greatest in a female with a ratio of 2:1. Based on the clinical and radiographic features, Central giant cell granuloma can be classified as aggressive and non-aggressive lesions. Here we report a case of central giant cell granuloma in the posterior mandibular molar region which was aggressive in nature. The clinically and radiographically swelling was evaluated with displaced tooth, pain, cortical expansion, and root resorption. The treatment varies according to the nature of the lesion, this case was treated by conservative excision with continuity of the mandible. Key words: Aggressive, central giant cell granuloma, osteolytic lesion.

In-house 3D-printed surgical guides for osseous lesions of the lower jaw: an experimental study

Background The accuracy of computer-assisted biopsies at the lower jaw was compared to the accuracy of freehand biopsies. Methods Patients with a bony lesion of the lower jaw with an indication for biopsy were prospectively enrolled. Two customized bone models per patient were produced using a 3D printer. The models of the lower jaw were fitted into a phantom head model to simulate operation room conditions. Biopsies for the study group were taken by means of surgical guides and freehand biopsies were performed for the control group. Results The deviation of the biopsy axes from the planning was significantly less when using templates. It turned out to be 1.3 ± 0.6 mm for the biopsies with a surgical guide and 3.9 ± 1.1 mm for the freehand biopsies. Conclusions Surgical guides allow significantly higher accuracy of biopsies. The preliminary results are promising, but clinical evaluation is necessary.

Patella Osteomyelitis Mimicking Sinding-Larsen and Johansson Apophysitis: A Pitfall Not to Miss

Background. Diagnosis of bony infection remains difficult during childhood. Osteomyelitis of the patella (OMP) is rare and produces few symptoms and no fever. A high level of suspicion is needed to avoid missing this uncommon type of bone infection. Methods/Results. We report an acute osteomyelitis of the patella treated by joint and patella puncture aspiration followed by antibiotics in a 12-year-old healthy boy. Clinical and radiological findings, orthopedic follow-up, and clinical outcome are presented. Conclusion. Making a diagnosis of acute osteomyelitis of the patella can be challenging especially in the pediatric population, as it produces few specific symptoms with mostly nonspecific biologic anomalies. The paucity in specific signs and symptoms, accompanied by the rare occurrence, often leads to incorrect initial diagnosis, such as overuse injury or apophysitis. Clinical examination with high suspicion for patella infection is key. Radiological exams including MRI are the main components of the adequate imaging studies. Computed tomography may be an excellent addendum to better visualize any bony lesion within the patella. Bone aspiration or biopsy is essential to confirm the diagnosis and offers a first step in the treatment of this infection, which can then be successfully treated with a normal course of antibiotics.