Excisional biopsy and radiotherapy for management of an olfactory neuroblastoma in an axolotl (Ambystoma mexicanum)

CASE DESCRIPTION A 4-year-old sexually intact male leucistic axolotl (Ambystoma mexicanum) was presented with a 2-week history of dysrexia and difficulty swallowing. CLINICAL FINDINGS Physical examination revealed a 1-cm-diameter intraoral mass on the rostral aspect of the palate and swelling of the left nasal fossa. Local invasion into the left nasal fossa was suspected during oral examination. The lesion was marginally excised, and an incompletely excised olfactory neuroblastoma was diagnosed histologically. Five weeks later, physical examination revealed persistent erythema, delayed healing of the rostral portion of the palate, and a mild facial deformity associated with a white mass in the nasal cavity. TREATMENT AND OUTCOME 6 weeks after excision, adjuvant electron (6-MeV) beam radiotherapy was initiated for treatment of the incompletely excised olfactory neuroblastoma and likely presence of a recurrent mass. The protocol consisted of 4 weekly fractions of 8 Gy each (total, 32 Gy) with the axolotl under anesthesia. No acute adverse radiation effects were noted following radiotherapy. The oral erythema resolved after the third session. No recurrence was observed 2 months after treatment, and the owners reported no abnormal signs at home. The axolotl died 3.5 months after radiotherapy was completed (8 months after marginal excision of the tumor) secondary to an environmental management failure. Postmortem histologic evaluation showed no evidence of neoplasia. CLINICAL RELEVANCE In axolotls, olfactory neuroblastoma should be considered in the differential diagnosis of intraoral palatal masses. This report describes the first application of radiotherapy for treatment of an olfactory neuroblastoma in an axolotl.

Pharyngeal Airway Space Dimensions and Hyoid Bone Position in Various Craniofacial Morphologies

Objective: To assess the relationship of pharyngeal airway dimensions and the position of the hyoid bone in several craniofacial morphologies among Nepali adults. To assess the relationship between dimensions of the pharyngeal airway and position of the hyoid bone and compare gender dimorphism. Materials and Methods: The cross-sectional observational research comprised lateral cephalograms of 150 subjects aged 16 to 30 years. Samples were separated into three sagittal craniofacial morphological groups based on the ANB (A point, nasion, B point) angle and into gender groups. Different parameters (linear and angular) for measuring dimensions of the pharyngeal airway and position of the hyoid bone were assessed. An ANOVA test and a Pearson correlation test were performed. Results: Dimensions of the pharyngeal airway were largest in skeletal Class III when compared to skeletal Class I and Class II subjects, with a lower pharyngeal airway space and the length of the nasal fossa being significantly larger. The hyoid bone was anteriorly and inferiorly placed in Class III skeletal subjects. Males had greater pharyngeal airway dimensions and a hyoid bone positioned more inferiorly and anteriorly. The nasal fossa length had a strong positive correlation with the hyoid bone position vertically. Conclusion: There were differences in the dimensions of the pharyngeal airway and position of the hyoid bone in various craniofacial morphologies among Nepali adults. Gender dimorphism was observed in both dimensions of the pharyngeal airway and the position of the hyoid bone.

Accidental nasal fossa perforation during endodontic treatment - Case report

Fracture of an endodontic instrument within the root canal system can occur due to incorrect use of instruments, and clinicians are confronted with a few removal options when considering this situation. The purpose of this article is to present the removal of a fractured endodontic file from the periapical region of the right upper central incisor, that caused a nasal floor perforation and otorhinolaryngological symptoms, with the aid of a dental operating microscope (DOM) and cone bean computed tomography (CBCT). Success was achieved when the fragment was visible and removed from the nasal fossa. The standardized techniques of removal or bypassing fracture file were not effective, and success was obtained with the aid of CBCT that made possible the visualization of the broken file inside the nasal fossa.

Large Rhinolith Mimicking Atypical Odontogenic Pain: Case Report and Brief Review of the Literature

Rhinoliths are rare calcified entities in the nasal fossa, frequently originating around a nidus near the midway point in the inferior meatus, where the passage is the narrowest. They can be clinically asymptomatic and undetected for years. In this study, we present a rare case of large rhinolith mimicking atypical odontogenic pain in a 40-year-old Caucasian female in the left nasal cavity. The lesion was detected in the CBCT and removed uneventfully.

Evaluation of cone beam computed tomography imaging in placed dental implants: comparison between multiplanar reconstruction and parasagittal images / Avaliação de imagens de tomografia computadorizada de feixe cônico em implantes instalados: comparação entre reconstrução multiplanar e imagens parassagitais

This study aimed to compare multiplanar reconstruction (MPR) to parasagittal images of cone-beam computed tomography (CBCT) for localizing placed dental implants concerning adjacent anatomical structures (nasal fossa floor, maxillary sinus, inferior alveolar canal and nasopalatine canal).The CBCT exams of 164 placed implants were analyzed. All tomographic images were imported to Imaging Studio software to create parasagittal image templates. The images were randomized and analyzed by two oral and maxillofacial radiologists who classified whether or not there was perforation of the anatomical structure in question.According to Kappa coefficient of agreement, the results including, all anatomical structures for inter-observer assessment was 0.81 and for intra-observer assessment, 0.79 for observer one and 0.89 for observer two. For each anatomical structure, the agreement ranged from 'substantial' to 'almost perfect' (nasal fossa floor 0.72, nasopalatine canal 0.92, maxillary sinus 0.81, and inferior alveolar canal 0.81). Based on our findings, there was substantial to almost perfect agreement when comparing MPR and parasagittal images of CBCT regarding of implant position relationship with anatomical structures. Since both modalities did not differ in implant position, and the MPR represents the complete and original volume that enables analysis in three dimensions, they can be the first-choice imaging modality to analyze placed dental implants.

COMPARATIVE EVALUATION OF THE NASOPHARYNGEAL SOFT TISSUE CHARACTERISTICS BETWEEN IDEAL OCCLUSION AND CLASS III MALOCCLUSION IN DAKSHINA KANNADA POPULATION

Introduction :Because of the close relationship between the pharynx and the dentofacial structures, a mutual interaction is expected to occur between the pharyngeal structures and the dentofacial pattern. The aim of this study was to assess and compare the nasopharyngeal characteristics in adults with Ideal occlusion and Class III malocclusion in Dakshina Kannada population. Materials and Methods: The study sample consisted of 64 patients with Class III malocclusion and 96 subjects with Ideal Class I molar relation randomly selected from the patients visiting the department of orthodontics of various dental colleges in Dakshina Kannada district. Lateral cephalograms were manually traced, linear and area measurements were determined to dene the airway characteristics. Independent means t tests and Pearson correlation analysis were used to evaluate sexual dimorphism and the correlations among the variables. Results: Nasal fossa length, lower pharyngeal dimension, and upper adenoid width were greater in the Class III malocclusion group. The cranial base showed signicant correlation with nasal fossa length in the Class III malocclusion group. Lower pharyngeal dimension was increased in Class III malocclusion group compared to Ideal Class I occlusion. Sexual dimorphism was also found within Ideal Class I occlusion and Class III Malocclusion groups. Conclusions : From analysing the data it was found that the nasopharynx in Class III malocclusion patients in Dakshina Kannada was characterised by an increased lower pharyngeal dimension, upper adenoid width, nasal fossa dimension and also smaller cranial base length.

Maxilectomia parcial por Degloving en cáncer - nasosinusal Partial maxillectomy by Degloving in sinonasal cancer

Introducción: Los tumores de Senos paranasales y cavidad nasal representan el 0.2% de todos los cánceres; son más frecuentes en hombres y predominantemente unilateral; los tipos histológicos más comunes son el Carcinoma escamocelular y los carcinomas de glándulas salivales menores, dentro del cual, se encuentra el carcinoma adenoideo quístico. Las bases del tratamiento para las lesiones resecables combinan radioterapia y cirugía radical cuyo abordaje puede ser endoscópico, abierto (ej. degloving mediofacial) o la combinación de ambos. Objetivo: Describir un abordaje por degloving para la realización de una maxilectomía parcial y presentarlos resultados de nuestra experiencia clínica en un paciente con una masa en fosa nasal con diagnóstico de carcinoma adenoideo quístico. Diseño: Reporte de caso Materiales y métodos: Se presenta el caso de un varón de 57 años, quien consultó por epistaxis intermitente en fosa nasal izquierda de un año de evolución, con nasosinuscopia que mostró una lesión abombada en tercio medio de cornete inferior y piso de fosa nasal y una lesión violácea en paladar óseo a nivel paramediano izquierdo; identificándose histopatológicamente como carcinoma adenoideo quístico patrón tubular y adenoideo, estadificado como T3N0M0. Se consideró la realizaciónde maxilectomía parcial por abordaje de degloving mediofacial. Resultados: La estancia hospitalaria postquirúrgica fue de 3 días y no presentó complicaciones ni recurrencia hasta la fecha. Conclusiones: El abordaje con degloving mediofacial y maxilectomía parcial, permite resecar el tumor nasosinusal en bloque con márgenes amplios; y la reconstrucción con prótesis, una rápida rehabilitación de la función masticatoria y de resonancia fonatoria.Introduction: Tumors of nasal cavity and paranasal sinuses represent 0.2% of all cancers; they are more common in men and presentation is predominantly unilateral; the most common histological types are the squamous cell carcinoma and carcinoma of minor salivary glands, within which, adenoid cystic carcinoma is located. The basis of treatment for resectable lesions combine radiotherapy and radical surgery whose approach may be endoscopic or open (e.g. midface degloving) or a combination of both. Objective: To describe an approach by degloving to perform a partial maxillectomy and present the results of our clinical experience in a patientwith a mass in left nasal fossa with histopathological diagnosis of Adenoid Cystic Carcinoma. Design: Case report. Materials and methods: We present a case of a 57 year old man, with a history of intermittent epistaxis from the left nasal fossa during a year, whose nasoscopy showed a bulging lesion on the middle third of the inferior turbinate and nasal fossa floor and a purplish lesion on bony palate at paramedian left level; it was identified histologically as adenoid cystic carcinoma with tubular and adenoid pattern, staged as T3N0M0. It was considered to perform a partial maxillectomy by midfacial degloving approach. Results: The postoperative hospital stay was 3 days and there were not any complications or recurrence to date. Conclusions: The approach to midface degloving and partial maxillectomy allows en-bloc resection of sinonasal tumor with wide margins; and prosthetic reconstruction gives a rapid rehabilitation of masticatory function and phonation resonance.

Papiloma Invertido, importancia de la Tomografía Computarizada y Resonancia Magnética en el diagnóstico y extensión // Inverted Papilloma, the importance of Computed Tomography and Magnetic Resonance in diagnosis and extension

Demostrar la importancia de la Tomografía computarizada (TC) y Resonancia Magnética (RM) en el diagnóstico, extensión y seguimiento de los pacientes con papiloma invertido (PI). Paciente femenino de 64 años, con antecedentes de sinusitis alérgica recurrente, que consulta por obstrucción nasal bilateral a predominio izquierdo, asociada a rinorrea purulenta y rinolalia de cinco meses de evolución. Se le realiza TC y RM de Macizo Cráneo facial (MCF). La TC demuestra formación de densidad de partes blandas ubicada en fosa nasal y seno maxilar derecho que se extiende hacia celdillas etmoidales bilaterales, seno frontal y seno esfenoidal derecho. La RM evidencia lesión expansiva sólida ubicada sobre seno maxilar derecho, que se extiende excavando la pared interna del mismo hacia fosa nasal homolateral. El PI es una neoplasia nasal que se caracteriza por su crecimiento invertido hacia el estroma. Es un tumor benigno que presenta una incidencia anual del 1 % promedio por cada 100.000 habitantes. La TC es el método imagenológico de elección para el diagnóstico de PI, siendo también útil en la valoración de la extensión en la fase preoperatoria. El diagnóstico de certeza lo determina la histopatología. La RM representa un método de gran utilidad en el seguimiento postoperatorio. AbstractDemonstrating the importance of Computed Tomography (CT) and Magnetic Resonance (MRI) in the diagnosis, extension and follow-up of patients with inverted papilloma (IP) of a 64-year-old female patient with a history of recurrent allergic sinusitis who consults for bilateral nasal obstruction and left predominance associated with purulent rhinorrhea and rhinolalia of five months of evolution. CT and MRI of CranioFacial Massif (CFM) were performed. CT demonstrated soft tissue density formation located in the nasal fossa and right maxillary sinus extending to bilateral ethmoidal cells, frontal sinus and right sphenoid sinus. MRI showed solid expansive lesion located on the right maxillary sinus, extending through its inner wall to the homolateral nasal fossa. IP is a nasal neoplasm that is characterized by its inverse growth towards the stroma. It is a benign tumor that presents an annual incidence of 1% average per 100,000 inhabitants. CT is the imaging method of choice for the diagnosis of IP, and it is also useful in assessing extension in the preoperative phase. A thorough diagnosis is determined by histopathology. MRI represents a very useful method in postoperative follow-up.