Pratheba.

T CRRI

DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY

SPECIAL CASE - 1
DEMOGRAPHIC DATA:
Name: Mr karthick.M
Age: 31 years
Sex: Male
Address: 91, Thanthalperyar Stret,
Bhavani,
Erode
Phone no: 9994612394
Occupation: catering
Income: ₹12,000/-monthly
Religion: Hindu
HISTORY:
Chief complaint and duration: Patient complaints of swelling in left buccal mucosa for past
2years.
History of present illness: History reveals that patient has swelling which frequently occurs &
subsides for past 2 years.He brushes once a day using tooth brush and paste. He drinks R/o
water.
Past medical history:
Hypertension - No history of hypertension
Diabetic mellitus - No history of diabetic
Tuberculosis - No history of tuberculosis
Jaundice- No history of jaundice
Bleeding disorder- No history of bleeding disorder
Gastric ulcer- No history of gastric ulcer
Drug allergy -No history of drug allergy
Asthma-No history of asthma
Trauma-No history of trauma
Hospitalization-No history of hospitalization
Past dental history :
Patient had visited the private dental clinic before 2 months for consultation.
Personal habits:
1. Habits
Diet - He takes mixed diet.
Brushing - He brushes once a day using brush.
Tobacco and chewing- No habit of tobacco chewing.
Smoking - No history of smoking.
Alcohol - No history of alcohol consumption.
2. Marital status - He is married and his wife
is alive and apparently healthy. He has one son and one daughter and they are alive and
apparently healthy.
3. Family history - His father and mother are alive and apparently healthy.
CLINICAL EXAMINATION:
GENERAL EXAMINATION:
A. Built - He is well built
Nourishment - He is well nourished
Height - 167cm
Weight - 90kg
B. Anemia - No signs of anemia.
Jaundice - No signs of jaundice.
Cyanosis - No signs of cyanosis.
Clubbing of fingers - No signs of clubbing.
Pedal edema - No signs of pedal edema.
C. VITAL SIGNS:
Temperature - 97°F
Blood pressure - 124/80 mm of hg
Pulse rate - 70beats/min
Respiratory rate - 14cycles/ min
D. EXAMINATION OF SYSTEMIC ORGANS:
Central nervous system :
•Patient is well oriented to time, place, person
•No slurring of speech
• No blurring of vision
Cardiovascular system :
•No dyspnea on exertion
•No chest pain after excercise
•No ankle edema
Respiratory system :
• No dyspnea
•No hemoptysis
•No cough/sputum
•No wheezing
•No weight loss
Gastric intestinal system :
• Bowel movement is normal
•No vomiting and diarrhoea.
•No gastric acidity.
Urinary system :
•Micturition normal
•No burning sensation
Lymphnode examination :
•Submandibular lymph nodes are not palpable.
LOCAL EXAMINATION:
EXTRA ORAL
1. Facial appearance: Face is apparently symmetrical. Macules are present in upper 1/3rd of
Face and middle 1/3rd of face.
2.Examination of Temporomandibular Joint:
He is able to open his mouth upto 3 finger breath.
No tenderness on palpation
No clicking sound on auscultaion
No deviation on mouth opening
3.Examination of Muscles of Mastication :
No tenderness on palpation
Protrusive, retrusive and lateral movements
4.Lymph Node Examination : Submandibular lymphnodes are not palpable.
INTRAORAL EXAMINATION
1.Teeth
Clinically all teeth present
2. Dental Caries - Initial - 17,46
3.Mobility - Nil
4. Calculus/stains - Generalised calculus present. Generalised brownish extrinsic stains in
present.
5.Occlusion - Class 1 molar relation on both side.
6. Attrition - Nil
Abrasion - There is no abrasion seen.
Erosion - There is no erosion seen.
7.Gingiva -
a. Color : Appears greyish pink in colour.
b.Bleeding on probing: Generalised bleeding on probing.
c. Pocket formation : No pocket formation seen
d.Gingival recession: localized gingival recession present
8. Alveolar Mucosa: appears reddish pink in color.No growth/ ulcer /
sinus present.
9. Labial Mucosa : appears reddish pink in colour, Normal frenal attachment. No growth/ ulcer /
sinus present.
10. Buccal Mucosa :reddish pink swelling seen on left buccal mucosa.
11. Tongue : All surfaces appears normal. No growth/sinus/ ulcer present .
12. Floor of oral cavity : Appears reddish pink in color. Submandibular, sublingual duct
opening is not Palpable.No growth /ulcer/sinus is present.
13. Palate: No growth/ulcer/sinus is present.
14. Intraoral lesion:
Inspection - on intraoral examination,small, round swelling measued 3X3cm
seen in relation to the left side of Buccal mucosa, in relation to maxillary first molar extending
anteriorly to area of Buccalmucasa in relation to 15, 16 to posteriorly in relation to 16,17.
Superiorly in relation to gingival margin of 15,16 to inferiorly occlusal plane of maxilla
 Palpation – On palpation the Inspectory findings are confirmed.The
number,site,size and colour are confirmed. On palpation, Pus discharge on left parotid duct
orifice and is tender.
.
CASE SUMMARY:
A 31 year old male patient Mr. Karthick from Erode complaints of swelling in
left buccal mucosa for past 2years. Patient has swelling which frequently occurs & subsides for
past 2 years.He brushes once a day using tooth brush and paste. He drinks R/o water.on
intraoral examination,small, round swelling measued 3X3cm seen in relation to the left side of
Buccal mucosa, in relation to maxillary first molar extending anteriorly to area of Buccalmucasa
in relation to 15, 16 to posteriorly in relation to 16,17. Superiorly in relation to gingival margin of
15,16 to inferiorly occlusal plane of maxilla.On palpation the Inspectory findings are
confirmed.The number,site,size and colour are confirmed. On palpation, Pus discharge on left
parotid duct orifice and is tender.
DIFFERENTIAL DIAGNOSIS:
1.sialolithiasis
2.sjogren's disease
PROVISIONAL DIAGNOSIS :
Considering the swelling on left buccal mucosa and pus discharge on left parotid duct
orifice, it could be a case of sialadenitis.
INVESTIGATION:
Ultrasonogram: USG has to be performed for confirming the diagnosis of sialadentitis
CLINICAL DIAGNOSIS:
“BACTERIAL SIALADENITIS OF LEFT PAROTID GLAND”
TREATMENT PLAN:
1. Tab.augmentin-625mg b.i.d for 5 days
2. Tab.zerodol.sp b.i.d for 5 days
3. Tab.metronidazole-400mg t.i.d for 5 days
4. Tab.pantoprazole -40mg b.i.d for 5 days
5. Cap.vit.B complex b.i.d for 5 days
 i

REVIEW OF LITERATURE

Bacterial sialadenitis:

Introduction:
A salivary gland infection is also called sialadenitis and is caused by bacteria or viruses.
 A salivary stone or other blockage of the salivary gland duct can contribute to an acute
infection.

Chronic inflammation of a salivary gland can cause it to stop functioning.

Case report 1:

Laliytha Kumar Bijai, Venkatesh Jayaraman, and Ravi David Austin, "Chronic Bacterial
Sialadenitis-A Case Report." Oral Surgery, Oral Medicine, Oral Radiology 1, no. 1 (2013): 1-5.
doi:
10.12691/oral-1-1-1.

On extra oral examination, inspection revealed facial asymmetry due to a single diffuse swelling
on left middle and lower third of the face. The swelling extends 3 cm away from commissure of
lips anteriorly to left ear lobeposteriorly, 1 cm above left tragus superiorly to inferior border of
mandible inferiorly.On intraoral examination, inspection revealed inflamed parotid duct orifice on
left side. On palpation, pus discharge evident on milking of left parotid duct orifice and is tender.
Ultrasonogram (USG) of left parotid gland reveals hetrogeneous echogenicity with multiple
small cystic areas with increase in vascularity in left parotid.Parotid gland was enlarged on left
side with measures of 40X17 mm as comparing to right side parotid gland with dimensions of
29X11 mm.

Based on the history, clinical examination and investigations the case was diagnosed as chronic
bacterial sialadenitis. The differential diagnosis considered was viral sialadenitis, buccal node
lypmadenopathy, tuberculous lymphadenitis, pleomorphic adenoma, and myositis ossificans.

Case report : 2

Shirish Degwekar,Manoj Chandak, and Shivlal Rawlani,”Acute submandibular sialadentitis”

Clinical examination revealed that spherical shape swelling was present and that measured 4-3
cm in diameter. Swelling extending from 1 cm below lower border of mandible to upper border of
thyroid cartilage. Swelling has well-defined and regular border, surface was smooth and skin
over the swelling was red and shiny. It was tender on palpation but temperature was not raised.
Consistency of swelling was soft and rubbery and fluctuation was present but it was not fixed to
overlying skin. Other intraoral findings were grossly carious lower left second molar and fracture
crown with right and left first molar. Considerable deposition of sub- and supragingival calculus
and stains was noticed. Missing teeth were upper right and left molars.
When swelling is seen at the side of neck, it is important to formulate the differential diagnosis
since this would help further evaluation of the condition and management of the patient. After
considering all clinical findings following entities were considered in differential diagnosis - acute
submandibular sialadenitis and benign swelling of neck.
Case report :3
Parotid sialolithiasis and sialadenitis in a 3-year-old child: a case report and review of the
literature
Nur Eliana Ahmad Tarmizi, Suhana Abdul Rahim, …Lum Sai Guan

A 3-year-old Malay boy presented with 5 days history of painful right cheek swelling, which was
gradually increasing in size.Examination revealed a firm swelling at the right parotid region
extending to the right cheek, measuring 3 × 3 cm. It was tender and warm on touch; the
overlying skin was not inflamed . There was no trismus and hydration was good. Oral cavity
examination noted pus discharge from the right Stensen duct opening.CT scan of the neck
performed showed diffuse homogenous swelling of the right parotid gland and right masseter
muscle.There was a tubular-shaped hyperdense lesion measuring 10 mm in length within the
distal part of parotid duct, consistent with a parotid ductal calculus.There was no stricture of the
duct noted, and no other calculi or abscess collection was seen in the enlarged parotid gland.
On the basis of history clinical presentation a provisional diagnosis of acute sialadenitis and
and sialectasis secondary to parotid duct sialolithiasis was given.

Discussion:
A 31 year old male patient Mr. Karthick from Erode complaints of swelling in left buccal
mucosa for past 2years. Patient has swelling which frequently occurs & subsides for past 2
years.He brushes once a day using tooth brush and paste. He drinks R/o water.on intraoral
examination,small, round swelling measued 3X3cm seen in relation to the left side of Buccal
mucosa, in relation to maxillary first molar extending anteriorly to area of Buccalmucasa in
relation to 15, 16 to posteriorly in relation to 16,17. Superiorly in relation to gingival margin of
15,16 to inferiorly occlusal plane of maxilla.On palpation the Inspectory findings are
confirmed.The number,site,size and colour are confirmed. On palpation, Pus discharge on left
parotid duct orifice and is tender.Considering he clinical presentations and other relaed clinical
history findings, the case was provisionally diagnosed as bacterial sialadenitis.
 SPECIAL CASE - 2
DEMOGRAPHIC DATA:
Name: Mr Rasu
Age: 61 years
Sex: Male
Address: 61 - Andhiyur, pudhu kaddu,
Gandhinagar, Andhiyur(tk).
Phone no: 9791723060
Occupation: labour
Income: ₹700/day
Religion: Hindu
HISTORY:
Chief complaint and duration: Patient complaints of missing of all teeth for past 1 year.
History of present illness: History reveals that patient had difficulty in chewing food.He drinks
river water.
Past medical history:
Hypertension - No history of hypertension
Diabetic mellitus - No history of diabetic
Tuberculosis - No history of tuberculosis
Jaundice- No history of jaundice
Bleeding disorder- No history of bleeding disorder
Gastric ulcer- No history of gastric ulcer
Drug allergy -No history of drug allergy
Asthma-No history of asthma
Trauma-No history of trauma
Hospitalization-No history of hospitalization
Past dental history :
Patient had visited our dental clinic before 1 year for extraction.
Personal habits:
1. Habits
Diet - He takes mixed diet.
Brushing - He rinse his mouth using drinking water.
Tobacco and chewing- He had a habit of tobacco chewing for past 15 years.
Smoking - He had a habit of smoking for past 15 years.
Alcohol - He had a habit of alcohol consumption for past 20 years.
2. Marital status - He is married and his wife
is alive and apparently healthy. He has two daughter and they are alive and apparently healthy.
3. Family history - Her father and mother died due
to natural cause.
CLINICAL EXAMINATION:
GENERAL EXAMINATION:
A. Built - He is well built
Nourishment - He is well nourished
Height - 160cm
Weight - 58kg
B. Anemia - No signs of anemia.
Jaundice - No signs of jaundice.
Cyanosis - No signs of cyanosis.
Clubbing of fingers - No signs of clubbing.
Pedal edema - No signs of pedal edema.
C. VITAL SIGNS:
Temperature - 97°F
Blood pressure - 130/80 mm of hg
Pulse rate - 70beats/min
Respiratory rate - 16cycles/ min
D. EXAMINATION OF SYSTEMIC ORGANS:
Central nervous system :
•Patient is well oriented to time, place, person
•No slurring of speech
• No blurring of vision
Cardiovascular system :
•No dyspnea on exertion
•No chest pain after excercise
•No ankle edema
Respiratory system :
• No dyspnea
•No hemoptysis
•No cough/sputum
•No wheezing
•No weight loss
Gastric intestinal system :
• Bowel movement is normal
•No vomiting and diarrhoea.
•No gastric acidity.
Urinary system :
•Micturition normal
•No burning sensation
Lymphnode examination :
•Submandibular lymph nodes are not palpable.
LOCAL EXAMINATION:
EXTRA ORAL
1. Facial appearance: Face is apparently symmetrical.Macules are present in upper 1/3rd of
Face and middle 1/3rd of face and lower 1/3rd of face.
2.Examination of Tempero Mandibular Joint:
He is able to open his mouth upto 3 finger breath.
No tenderness on palpation
No clicking sound on auscultaion
No deviation on mouth opening
3.Examination of Muscles of Mastication :
No tenderness on palpation
Protrusive, retrusive and lateral movements
4.Lymph Node Examination : Submandibular lymphnodes are not palpable.
INTRAORAL EXAMINATION
1.Teeth
Clinically all teeth missing.
2. Dental Caries - Nil
3.Mobility - Nil
4. Calculus/stains - Nil
5.Occlusion - Nil
6. Attrition - Nil
Abrasion - Nil
Erosion - Nil
7.Gingiva -
a. Color : Appears greyish pink in colour.
b.Bleeding on probing: Nil
c. Pocket formation : Nil
d.Gingival recession: Nil
8. Alveolar Mucosa: appears reddish pink in color.No growth/ ulcer /
sinus present.
9. Labial Mucosa : appears reddish pink in colour, Normal frenal attachment. No growth/ ulcer /
sinus present.
10. Buccal Mucosa :whitish patch seen on left buccal mucosa
11. Tongue : All surfaces appears normal. No growth/sinus/ ulcer present .
12. Floor of oral cavity : Appears reddish pink in color. Submandibular, sublingual duct
opening is not Palpable.No growth /ulcer/sinus is present.
13. Palate: No growth/ulcer/sinus is present.
14. Intraoral lesion:
Inspection - on intraoral examination,well-defined whitish patch of size 1.5cm in
diameter is seen on left buccal mucosa,extending apically from 2.5cm away form left commisure
mucosa,4cm away from left pterygomandibular raphe,the surface of the lesion appears
smooth,typical cracked mud appearance.
Palpation – On palpation the Inspectory findings are confirmed.The
number,site,size and colour are confirmed. On palpation, the lesion is non-tender,non-
scrappable. With no evident of secondary malignancies changes.
CASE SUMMARY:
A 60 year old male patient Mr. Rasu from Erode complaints of missing of all
teeth. Patient had difficulty in chewing food. He drinks river water.He had a habit of tobacco
chewing for past 15 years.On intraoral examination,well-defined whitish patch of size 1.5cm in
diameter is seen on left buccal mucosa,extending apically from 2.5cm away form left commisure
mucosa,4cm away from left pterygomandibular raphe,the surface of the lesion appears
smooth,typical cracked mud appearance.On palpation, the lesion is non-tender,non-scrappable.
DIFFERENTIAL DIAGNOSIS:
1.lichen planus
2.Hyperplastic candidiasis
3. Hairy leukoplakia
4. Lichenoid reaction
PROVISIONAL DIAGNOSIS :
Considering the lesion well-defined whitish patch which is non-tender and non-
scrappable, it could be a case of leukoplakia.
INVESTIGATION:
Biopsy : Biopsy has to be performed for confirming the diagnosis of leukoplakia
CLINICAL DIAGNOSIS:
“HOMOGENOUS LEUKOPLAKIA OF LEFT BUCCAL MUCOSA”
TREATMENT PLAN:
1.Elimination of habit
The proved pharmacological replacement of tobacco cessation are:
Bupropion - 150 mg twice daily for 2 weeks.
Varenicline - 0.5 mg daily for 3 days, 0.5 mg bid for 4 days, and then I mg bid for 11 weeks.
2.Tab.antoxid - twice daily for 10 days.

REVIEW OF LITERATURE

Leukoplakia:
Leukoplakia is the development of thickened and white patches over tongue, inner part of
cheeks or other parts of oral cavity.
Homogeneous leukoplakia:Homogeneous leukoplakia may look like a flat white patch in your
mouth. The patch surface may be smooth, wrinkled or have ridges. This leukoplakia is typically
benign, meaning it usually doesn’t become oral cancer. It’s more common than non-
homogeneous leukoplakia.
Non-homogeneous leukoplakia: Non-homogeneous leukoplakia may cause irregular or odd-
shaped white or red patches in your mouth. The patches may be flat or have raised surfaces.
Studies show that non-homogenous leukoplakia is seven times more likely to become
cancerous than the homogenous type.

Case report 1:
Dr. Arif Mohiddin - “LEUKOPLAKIA IN THE ORAL CAVITY :- CASE REPORT”

A53-year-old male patient reported to the outpatient department, with

a complaint of white patch on the right anterior buccal mucosa. examination revealed
homogenous grayish white plague on the right anterior buccal mucosa measuring 3.5cmx
2.5cm . The surface showed cracked mud appearance and on palpation the lesion left as raised
and rough. The lesion was non tender and non scrapable. The patient was had tobacco habit. A
provisional diagnosis of leukoplakia was considered. Incisional biopsy revealed histological
features shows hyperplastic stratified squamous epithelium with intraepithelial inflammatory cell
infiltration consistent with leukoplakia . Diagnosis of leukoplakia was derived based on the
history and clinical examination
Treatment:
Complete excision of the lesion was performed and the histological report was again consistent
with leukoplakia.

Follow up:

The patient was followed up once in five months to check recurrence.

The patient did not reveal any signs of recurrence even after one year.

Case report 2:

Rakhi Chandak,Shirish Degwekar,Manoj Chandak,Shivlal Rawlani, Rahul Bhovate - “Oral

Leukoplakia - A Clinical Presentation”

A 35 years of old male patient was referred toDepartment of oral medicine and radiology with a
chief complaint of mild discomfort in lower anterior region of iaw since one month. Patient
noticed white patch at same site. He had the habit of tobacco chewing since zu vears and
keeping guid in lower labial vestibule of iaw The patient's medical history was unremarkable.
Clinical examination revealed slightly elevated thicker and whitish patch that was well
denned and nas a leathery appearance with surface fissures, extending from lower right canine
region to left canine region.On the basis of history clinical presentation a provisional diagnosis
of leukoplakia was given.
Management:
Avoid aggravating habits e.g. quit smoking, tobacco chewing, alcohol intake.
Removal of chronic irritants such as-sharp cusps of teeth.
Treatment modality for leukoplakia is Surgical excision, or CO2 laser - excision or vaporisation.
Possible other options - retinoids (acitretin or isotretinoin), photodynamic therapy.
Lifelong follow-up is recommended whether or not the disorder has been treated

Case report 3:
K. Tupakula Pavan, Ankita Kar, S. Reddy Sujatha, B. K. Devi Yashodha, Nagaraju Rakesh, V.
Shwetha-“Bilateral oral leukoplakia: A case report”

On clinical examination, no abnormalities were detected extraorally. Inspection of the lesion

intraorally revealed an irregular whitish plaque on the right buccal mucosa at the line of
occlusion, measuring approximately 1 cm × 2 cm at its greatest diameter ]. The lesion extends
anteriorly 1 cm away from the commissure of the lip up to 4 cm short of retromolar trigome
region posteriorly, superiorly 3 cm below the upper buccal vestibule, and inferiorly 4 cm short of
lower buccal vestibule. The boundaries of the lesion appeared to be well defined.Similarly, an
irregular whitish plaque was noted on the left buccal mucosa at the line occlusion, measuring
approximately 1.5 cm × 1.5 cm at its greatest diameter .The lesion extends anteriorly 1 cm away
from the commissure of the lip and extending 4.5 cm short of retromolar trigome region
posteriorly.On palpation of both the lesions, all inspectory findings were confirmed with respect
to size, shape, and extent. The lesions were non scrapable and nontender.Based on the history
and clinical examination, a provisional diagnosis of bilateral homogeneous leukoplakia was
considered.
Management:
Patient motivation and counseling with respect to tobacco cessation was done.
Consumption of carotenoids (β‐carotene, lycopene); Vitamins A, C, and K; and fenretinide,
bleomycin, and photodynamic therapy have shown significant regression of the lesion.
Surgical approaches encompass conventional surgery, electrocauterization, laser ablation, or
cryosurgery. Conventional surgical procedures entail excision of the lesion.It can be
accompanied with or without the placement of skin graft or any other dressing material.

Discussion:

A 60 year old male patient Mr. Rasu from Erode complaints of missing of all teeth. Patient had
difficulty in chewing food. He drinks river water.He had a habit of tobacco chewing for past 15
years.On intraoral examination,well-defined whitish patch of size 1.5cm in diameter is seen on
left buccal mucosa,extending apically from 2.5cm away form left commisure mucosa,4cm away
from left pterygomandibular raphe,the surface of the lesion appears smooth,typical cracked mud
appearance.On palpation, the lesion is non-tender,non-scrappable.Considering he clinical
presentations and other relaed clinical history findings, the case was provisionally diagnosed as
Homogeneous leukoplakia.