Odontogenic carcinoma is rare group of malignant epithelial odontogenic neoplasms with characteristic clinical behavior and histological features, which requires an aggressive surgical approach. The pathogenesis of this rare group remains still controversial and there have been many varied opinions over the classification of this rare group of lesions. As there have not been many reviews on odontogenic carcinoma, the existing knowledge is mostly derived from the published case reports. This review is discussing the pathogenetic mechanisms and is updating the knowledge on nomenclature system of less explored odontogenic carcinomas. This review might throw light on the pathogenesis and nomenclature system of odontogenic carcinoma and this knowledge may be applied therapeutically.

Oral cancer is the most common cancer diagnosed in Indian men and is the leading cause of cancer deaths. It is considered as a multistep and multifactorial disease. Besides accumulation of genetic mutations, numerous other carcinogens are involved. In this category, viral and chemical carcinogens are well studied and documented. However, in the oral cavity, the role of microbiota in carcinogenesis is not known. Microbial populations on mouth mucosa differ between healthy and malignant sites, and certain oral bacterial species have been linked with malignancies, but the evidence is still weak in this respect. Nevertheless, oral microorganisms inevitably up-regulate cytokines and other inflammatory mediators that affect the complex metabolic pathways, and may thus be involved in carcinogenesis. Poor oral health associates statistically with prevalence of many types of cancer such as pancreatic and gastrointestinal cancer. This review presents possible carcinogenesis pathway involved in bacterial carcinogenesis, commonly implicated bacteria in oral carcinogenesis, and their role in cancer therapeutics as well.

Metastatic lesions to the oral region are uncommon and account for approximately 1% of all malignant oral tumors. In 25% of the cases, oral metastases are found to be the first sign of the metastatic spread; and in 23% of the cases, it is the first indication of an undiscovered malignancy at a distant site. Metastases to oral soft tissues are even less frequent than jaw bones. Because of its rarity, the clinical presentation of a metastatic lesion in the oral cavity can be deceiving, leading to a misdiagnosis of a benign process; therefore, in any case where the clinical presentation is unusual, especially in patients with a known malignant disease, a biopsy is mandatory. Here, we are presenting a rare case of multiple secondary tumors in the attached gingiva in an otherwise apparently healthy patient with no other symptoms of the primary tumor. It subsequently led to the diagnosis of Pancoast tumor (bronchoalveolar carcinoma) metastasizing simultaneously to multiple sites in the oral cavity and bilateral adrenal glands.

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Supernumerary tooth is a developmental anomaly and has been argued to arise from multiple etiologies. These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. They can cause a variety of complications in the develo­ping dentition. Supernumerary teeth can present in various forms and in any region of the mandible or maxilla, but have a predisposition for the anterior maxilla. Here is the presentation of a case of unusual location of supernumerary teeth located in between mandibular first and second molar region bilaterally.How to cite this article: Dhull KS, Dhull RS, Panda S, Acharya S, Yadav S, Mohanty G. Bilateral Mandibular Paramolars. Int J Clin Pediatr Dent 2014;7(1):40-42.

A 61-year-old male patient came to the Department of Oral and Maxil lofacial Surgery, with complaints of painful, non healing extraction site in relation to right upper posterior teeth region, of 3 months duration. Patient's history revealed that there was pain in right maxillary first molar tooth region since the last 4 months. Due to the ignor ance of the local physician and lack of optimum medical care, the patient had undergone repeated extractions of regional teeth and biopsy of local soft tissue, which revealed non specific infection with lots of inflammatory cells. The patient was referred to us for further evaluation and treatment. On clinical examination, a large area of exposed bone which extended from right maxillary first premolar to second molar region [Table/ Fig-1] was found. Laboratory investigation revealed fasting blood sugar-350 mg/dl, postprandial blood sugar -470 mg/dl and elevated neutrophil and total leucocyte counts. Panoramic radiograph demonstrated diffuse radiolucencies extending from the periapical region of right maxillary second molar to left premolar region, with interradicular bone loss [Table/ Fig-2]. Although clinically there was unilateral exposure of bone on the right side, the radiological features suggested diffuse radiolucencies in the left maxilla. Therefore, a provisional diagnosis of extensive bilateral maxillary osteomyelitis which was complicated with diabetes was made. A swab from the junction area of exposed bone and mucoperiosteum site was taken and it was sent for culture and antibiotic sensitivity. The patient was referred to an endocrinologist for controlling his blood sugar. The culture report revealed E.coli growth and the bacteria was resistant to most of the commonly used antibiotics, except amikacin and gentamycin. After the patient was stable, sequestrectomy under general anaesthesia was planned. Mucoperiosteal flap was reflected and necrotic bone pieces from deeper site were taken and sent for culture sensitivity. A wide area of necrotic bone, starting from right side second molar to left side second premolar region, was found. With slightest pressure from periosteal elevator, the premaxilla and right side posterior part of the maxilla got downfractured and came out [Table/ Fig-3]. Almost entire palatal bone from right side and most part on left side (upto first molar) had to be removed because of necrosis. Buccally, root of the zygoma, anterolateral wall of the maxillary sinus (upto infraorbital foramen) on right side, left anterolateral wall of maxillary sinus and pyriform fossa on both sides were also found to be necrosed. So, they were excised, as was evident in post operative panoramic radiograph [Table /Fig-4]. Antral packs were given with ribbon gauge soaked in soframycin and brought to vestibule through a separate stab incision. The patient was given inj. Amikacin 250mg i.m. 12 hourly and inj. clindamycin 600 mg i.v. 8 hourly for seven days. Ryles tube feeding was started from immediate postoperative day and it was kept for seven days, to avoid sec...

Endemic to South India and Sri Lanka, Rhinosporidiosis is a chronic granulomatous infection caused by an agent of uncertain taxonomy: Rhinosporidium seeberi. Although it commonly manifests as a proliferative nasal lesion, many cases of Rhinosporidiosis have been reported where it has appeared as an extranasal lesion. The reported extranasal sites include the eye, ear, trachea, and parotid duct. However, the involvement of the parotid duct is quite rare, even among extranasal sites. The case presented is an adult female from the non-endemic zone of East India with a proliferative mass in the parotid duct. Although Rhinosporidiosis was not taken into consideration in the clinical differential diagnosis, eventual histopathological diagnosis confirmed Rhinosporidiosis. As this appears to be the second case of Rhinosporidiosis in the parotid duct in East India in 4 years, we encourage clinicians to be flexible in the differential diagnosis of proliferative growth in the parotid duct, even in those from non-endemic areas.

This systematic review and meta-analysis aims to address whether age can be a determinant of overall survival (OS), disease-free survival (DFS), recurrence, distant metastasis (DM) and second primary (SP) in surgically treated oral and oropharyngeal squamous cell carcinoma (OOPSCC). A total of 4981 cases and 44254 controls from 25 comparative observational studies were included in the analysis. A significantly better OS (matched subgroup analysis: OR 1.64; 95% CI 1.31–2.04, overall analysis: OR 1.48; 95% CI 1.09–2.01) was observed in young patients compared to older adults, with heterogeneity ranging from moderate to severe. Worse DFS (unmatched subgroup analysis OR 0.43; 95% CI 0.27–0.68) was observed in young patients compared to older adults with minimal to moderate heterogeneity. The frequency of recurrence (OR 1.49; 95% CI 1.10–2.02) and DM (OR 1.83; 95% CI 1.10–3.03) was significantly higher in the young patients, as found in unmatched and matched subgroup analysis, with the least heterogeneities. Young age can be considered as an independent prognostic factor for recurrence and distant metastases in OOP-SCC. Larger and methodologically robust observational studies with longer follow-up are needed to establish the definitive role of age as an independent prognostic factor on OS and DFS in OOPSCC.