SUMMARYHerpes zoster is a localised disease caused by reactivation of the varicella zoster virus that enters the cutaneous nerve endings during an earlier episode of chicken pox, travels to the dorsal root ganglia, and remains in latent form. The condition is characterised by occurrence of multiple, painful, unilateral vesicles and ulceration, and shows a typical single dermatome innervated by single dorsal root or cranial sensory ganglion. Involvement of three or more dermatomes is known as disseminated zoster and seen in immunocompromised individuals. Complications of herpes zoster include ocular sequelae, bacterial superinfection of the lesions, meningoencephalitis and postherpetic neuralgia. The incidence of herpes zoster increases with age and immunosuppression, therefore prompt management is necessary to avoid morbidity and mortality in these individuals. We present two case reports of herpes zoster, one involving the maxillary and mandibular branches of the trigeminal nerve while the other involves all branches of the trigeminal nerve. BACKGROUND

Background. Oral submucous fibrosis is a chronic, insidious oral mucosal condition affecting the most parts of the oral cavity with high malignant transformation rate triggered by areca nut chewing, nutritional deficiencies, immunologic processes, and genetic predisposition. OSF causes significant hematological abnormalities resulting in anemia and a decrease in serum iron levels. Aim. The aim of this study was to estimate the hemoglobin and serum iron levels among patients with oral submucous fibrosis and to compare the values with healthy subjects. Materials and Methods. In this hospital-based study 30 diagnosed patients of OSMF and 15 healthy individuals were included, and the values of hemoglobin and serum iron levels were estimated using Sahli's and Ferrene methods. Results. OSMF patients showed significantly lower levels of hemoglobin and serum iron when compared with the healthy subjects. Conclusion. The findings of the study emphasizes on the assessment of hemoglobin and serum iron for patients with oral submucous fibrosis. Also iron therapy should be instituted concomitantly with the initial diagnosis which helps to cease the further progression of the condition. Further extensive studies are indicated to understand the correlation between OSMF and iron deficiency.

Brown tumours are classic bony lesions that arise as a result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. They are erosive bony lesions caused by rapid osteolysis and peritrabecular fibrosis, resulting in a local destructive phenomenon. Facial skeleton is involved in about 2% of all cases of which the mandible is frequently affected. A 35-year-old female who was diagnosed with osteomalacia and brown tumour in posterior mandible as the sign of secondary hyperparathyroidism secondary to vitamin D deficiency is presented.

SummaryMesiodens, a common supernumerary tooth, is found in the midline in anterior maxilla between the incisors. Its occurrence as multiples is termed as 'mesiodentes'. Double mesiodentes, a rare phenomenon, is seldom reported in literature and show a plethora of manifestations as described in the case report. They may not be apparent clinically, necessitating the use of imaging modalities and require careful evaluation to prevent complications. This paper presents a report of six double mesiodentes cases with negative family history for supernumerary teeth and absence of any syndromes. This is an effort to educate dentists about signs, symptoms, complications and management of mesiodentes.BMJ Case Reports 2011; doi:10.1136/bcr.07.2011.4420 2 of 5 mesiodens. 5 However, very little literature is available on cases of double supernumerary teeth as they do not occur frequently.The aetiology of supernumerary teeth is not known. The literature reports three theories concerning the cause of mesiodentes but this subject remains controversial. It was originally postulated that mesiodentes represented a phylogenetic relic of extinct ancestors who had three central incisors known as phylogenetic reversion (atavism). 4 6 A second theory known as dichotomy suggests that the tooth bud is split to create two teeth, one of which is the mesiodens. Supporters of this theory believe that dichotomy represents complete gemination, which also occurs frequently in the anterior maxilla. 4 7 The third theory, involving hyperactivity of the dental lamina, is the most widely supported. According to this theory, remnants of the dental lamina or palatal offshoots of active dental lamina are induced to develop into an extra tooth bud, which results in a supernumerary tooth. Thus, the localised and independent hyperactivity of the dental lamina is the most accepted cause for the development of supernumerary teeth. 3 4 The observation that supernumerary teeth are more common in family members suggests heredity as an aetiologic factor; however, it does not follow a simple Mendelian pattern. It has been suggested that environmental factors might have infl uence on genetic susceptibility 2 8 which could probably be a cause for negative family history in our case series.In the present report all six patients were males. This suggests that males are predominantly affected by mesiodentes as discussed by Asaumi et al (M: F =2.8:1) 9 . Roychoudhury et al 10 in their retrospective study of 30 cases of mesiodens found male preponderance of 1.5:1.Supernumerary teeth are classifi ed according to their morphology and location. In the permanent dentition, there are four different morphological types: conical, tuberculate, supplemental and odontoma. 11 12 Case 1 presented with both mesiodentes as tuberculate type, while in cases 4, 5 and 6 both were of conical variety. In case 3 both mesiodentes were supplemental but case 2 was unique in morphology as one mesiodens was tuberculate and other one conical.In some subjects, mesiodens erupt normally, but us...

Introduction: Patients with cancer suffer from a wasting syndrome associated with anorexia/cachexia. Anorexia is associated with a marked loss of appetite and/or an aversion to food. Cachexia is associated with loss of body mass and is often associated with weakness, fatigue leading to poor quality of life. It has been observed in those individuals with oral submucous fibrosis (OSMF), a premalignant condition, are generally thin and there seems to be a relation between loss of appetite and consumption of areca nut in these individuals.Aims: Evaluation of cachexia in OSMF patients based on the criteria given for defining cachexia by group of scientists and clinicians in the cachexia consensus conference. Materials and methods:Twenty OSMF cases (group I) and 20 healthy individuals with areca nut chewing habit (group II) were assessed for body mass index (BMI), hemoglobin and serum albumin level. Their fatigue and anorexia scores were calculated by using structured questionnaires.Results: Correlation between fatigue and anorexia was statistically significant for OSMF group but was statistically not significant in group II. Comparisons of BMI, hemoglobin, fatigue and anorexia between two groups were statistically not significant, however, serum albumin was found to be statistically significant. Conclusion:From the present study it can be concluded that the early process of cachexia begins during the progression of OSMF. The areca nut chewing practice associated with OSMF may play some role in this context.

An intranasal tooth (INT) is an ectopic tooth erupting into the nasal cavity. It is a rare clinical entity. Ectopic and supernumerary teeth may be present in many regions of maxillofacial skeleton. Ectopic teeth may be supernumerary, deciduous or permanent. The clinical manifestations of intranasal tooth are quite variable and they may cause a variety of symptoms and complications. Their clinical and radiographic presentations are classical, posing little challenge to the diagnostician. The identification of such teeth can be important since they have potential to cause considerable morbidity. Here, we describe a case of intranasal tooth along with possible etiopathogenesis, clinical and radiographic features, differential diagnosis, potential complications and treatment modalities.

Objectives: To evaluate the effect of OSMF on the eustachian tube function and to correlate it with various grades of the disease. Study Design: Twenty OSMF patients (40 ears) and 20 healthy controls (40 ears) were evaluated for eustachian tube function by eustachian tube function test, tympanometry and audiometry. Results: The audiometric and tympanometric analysis showed no significant differences in hearing abilities of OSMF patients and controls and between various grades of OSMF, indicating no hearing impairment. However, eustachian tube function test revealed a statistically significant difference in eustachian tube function in OSMF patients and controls. Further, there was a significant increase in severity of dysfunction with increase in severity of disease. Conclusions: From the present study it is evident that the subjective function of Eustachian tube may be affected by disease process. But, probably the amount of deviation found in function of the eustachian tube is non contributing to cause a conductive hearing loss. Key words:Oral submucous fibrosis, eustachian tube function, tympanometry.

The results of this study suggest that evaluation of serum leptin level can provide status of cachexia in oral squamous cell carcinoma patients.