Actinomycosis is a chronic granulomatous infection caused by Actinomyces species which may involve only soft tissue or bone or the two together. Actinomycotic osteomyelitis of maxilla is relatively rare when compared to mandible. These are normal commensals and become pathogens when they gain entry into tissue layers and bone where they establish and maintain an anaerobic environment with extensive sclerosis and fibrosis. This infection spreads contiguously, frequently ignoring tissue planes and surrounding tissues or organ. The portal of entry may be pulpal, periodontal infection, and so forth which may lead to involvement of adjacent structures as pharynx, larynx, tonsils, and paranasal sinuses and has the propensity to damage extensively. Diagnosis is often delayed and is usually based on histopathology as they are cultured in fewer cases. The chronic clinical course without regional lymphadenopathy may be essential in diagnosis. The management of actinomycotic osteomyelitis is surgical debridement of necrotic tissue combined with antibiotics for 3–6 months. The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula is rare. Hence, we present a 50-year-old female patient with chronic sclerosing osteomyelitis of maxilla which presented as oroantral fistula with suppurative and sclerotic features.

The results of the present study demonstrated that ART proved to be effective in reducing the prevalence of HIV-related oral lesions.

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A 33-year-old male patient reported with a chief complaint of swelling below tongue since 8 months. The swelling started as a small nodule and gradually increased to present size. There was history of pain since 2 months, which aggravated on lifting tongue and on swallowing.The medical history was noncontributory and there was no history of trauma, tooth pain or preceding inflammation and no constitutional symptoms like fever, weight loss.Extraoral examination was unremarkable and on intraoral examination, a solitary well circumscribed swelling was present on anterior floor of mouth and lingual to lower anteriors. The size of swelling was 1 x 1.5 cm [Table/ Fig-1].The surface was smooth with no visible pulsations and no secondary changes. It was firm in consistency, tender, non-fluctuant, non-compressible, non-reducible and mobile. The oral hygiene status was good with no evidence of stains, calculus, carious lesions and apparently normal gingivoperiodontal status. The mandibular anterior teeth on percussion and palpation were normal and were vital. A provisional diagnosis of minor salivary gland tumour was made, with differential diagnosis of mucous retention cyst, ranula, lymphangioma, haemangioma, lipoma, and ectopic lymphnode.Diascopy test was not done because of anatomy and FNAC did not yield any aspirate. Intraoral periapical radiograph with respect to mandibular anterior teeth and mandibular topographical occlusal view showed no abnormality [Table/ Fig-2]. MRI revealed patchy area of signal abnormality in floor of mouth, infero-medial to attachment of geniohyoid muscle. Mildly hypointense on T1 and T2 image was appreciated with an impression of malignancy from minor salivary gland [Table/ Fig-3]. Mild diffuse restriction was noted on Diffuse weighted image (DWI). Complete surgical profile was advised in which no abnormality was detected. Correlating clinical, radiographic and MRI findings, odontogenic lesion was ruled out and working diagnosis of minor salivary gland tumour was arrived. Excisional biopsy of the lesion was performed under local anaesthesia [Table/ Fig-4] and the specimen was subjected to histopathological examination.On microscopic examination, there were cavernous vascular spaces, solid spindle cells attached to vessel walls and vacuolated epitheloidendothelial cells [Table /Fig-5,6]. The lesion was well circumscribed, highly cellular with vascular proliferation and slit like spaces 7]. There were few lymphocytes and eosinophils. Larger thin walled vessels with RBCs and areas of hemorrhage were also appreciated. The lesion did not show any cellular atypia and was well circumscribed without infiltration to surrounding structures. Histopathological diagnosis of vascular lesion i.e., spindle cell haemangioma was given. Immunohistochemistry (IHC) was done for the markers CD-34 and CD-31 for evaluation of origin of these spindle cells which were triple positive. Pericytes with surrounding blood vessels, split like vascular spaces lined by endothelial cells were positive for CD-34 and cells in ...

Diffuse Large B Cell Lymphomas (DLBCL) encompasses a heterogeneous group of tumors that together constitute the commonest of all Non Hodgkin Lymphoma (NHL) and the proclivity of DLBCL to oral cavity is unknown. They mostly arise from soft tissues as asymptomatic lesions, mostly without 'B' symptoms and involvement of jaw bones is uncommon. Most studies and case reports of oral DLBCL's are based on, manifestation of primary extra-nodal disease or a component of a disseminated disease process involving regional lymph nodes. Many investigators have proposed that patients with this cell type who maintain a complete response for 24 consecutive months are cured because late relapses seldom occur. With advances in treatment modalities, many patients with NHL become long-term survivors and the risk of relapses or second tumors are of growing concern. We present a case of DLBCL which relapsed after five years of initial lesion in a 41 year old female patient and presented as a nonspecific bilateral anterior maxillary radiolucency. DLBCL usually express pan-B markers with small percentage expressing T-cell markers. Few rare cases of DLBCL have shown CD3 expression, which is a most sensitive T-cell marker which was focally expressed in the present case.

Rhino-orbital-cerebral zygomycosis is a potentially lethal, opportunistic, fungal infection with protean manifestations, rapid progression, unpredictable course and high mortality. It is associated with angioinvasion and infarction, usually observed in diabetic ketoacidosis, immuno-compromised states and rarely reported in an apparently normal host. We present a case of an18-year-old patient with a chronic, painful, non healing ulcer with necrotic margins over the right side of the face which extended to both orbits involving eyes within a period of 1.5 month. Later he developed severe headache, decreased vision, inability to speak, seizures and status epilepticus with fatal outcome. Awareness of its occurrence in normal patients with prompt diagnosis and appropriate management may improve the outcome and decrease mortality.

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