The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document provides information on vascular anomalies including hemangiomas and vascular malformations. It begins with an introduction and historical background. It then discusses classification systems for vascular lesions and specific types such as hemangiomas, vascular malformations, and other congenital vascular tumors. Diagnosis and management are mentioned. Key points include hemangiomas demonstrating endothelial cell hyperplasia while malformations have normal endothelial turnover, as well as classifications differentiating vascular tumors from malformations. Complications are also summarized.
Vascular lesions in the head and neck regionsاسامه عائض
This document provides an overview of vascular lesions, including a classification system and guidelines for diagnosis and treatment. It distinguishes between vascular tumors and malformations, and describes specific conditions like infantile hemangioma. Diagnostic tools include MRI, ultrasound and biopsy. Treatment options depend on whether a lesion is a tumor or malformation, as well as its location and flow. Medical therapies include steroids and laser treatment, while surgical options range from excision to resection or reconstruction. The document aims to establish best practices for managing diverse vascular lesions.
The document discusses naso-orbito-ethmoidal (NOE) fractures, which involve the central upper midface region. It describes the anatomy and classification of NOE fractures. Markowitz classification system categorizes NOE fractures into 5 types based on the status of the central bony fragment and involvement of the medial canthal tendon. Type I and II fractures involve a single or displaced central fragment with an intact tendon. Type III fractures have comminution beneath the tendon. Imaging such as CT is important for diagnosis.
This document discusses giant cell lesions of the jaws. It begins by defining giant cells and describing their origin from monocytes and macrophages. Giant cell lesions are then classified as inflammatory/reactive, metabolic, or neoplastic. Central giant cell granuloma, aneurysmal bone cyst, and traumatic bone cyst are discussed as examples of inflammatory/reactive lesions. Cherubism and brown tumor of hyperparathyroidism represent metabolic giant cell lesions. Osteoblastoma is provided as an example of a neoplastic giant cell lesion. Clinical, radiographic, histologic, and treatment details are outlined for many of the conditions.
This document provides information on vascular lesions of the head and neck. It discusses the classification of hemangiomas and vascular malformations. Hemangiomas are benign tumors that proliferate rapidly after birth and then slowly involute over time. In contrast, vascular malformations are present at birth and grow proportionally with the patient. The document describes different types of vascular malformations including venous, capillary, lymphatic and provides details on their clinical presentation and characteristics. Complications of hemangiomas are also outlined.
The document discusses controversies surrounding odontogenic keratocysts (OKCs). It covers the history and terminology of OKCs, their etiology and pathogenesis, clinical and radiographic features, histopathology, treatment and recurrence rates. There is ongoing debate around whether OKCs should be considered cysts or tumors due to their locally aggressive behavior and high recurrence rates. The document also explores theories on malignant transformation of OKCs and biomarkers that may help predict their biological potential.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
Maxillary sinus diseases are presented by Dr. Vishal Modha. The maxillary sinus is the largest paranasal sinus located within the maxilla bone. It develops embryologically from the lateral nasal wall and grows postnatally. The maxillary sinus anatomy includes thin bony walls that are vulnerable to trauma and contain important structures. Mucociliary drainage flows from the maxillary sinus ostium to the nasal cavity. Common maxillary sinus diseases include acute or chronic sinusitis, which can result from dental infections, trauma, or nasal obstruction and cause symptoms like facial pain and nasal congestion. Radiographs and CT scans may reveal mucosal thickening or opacification in sinusitis. Treatment involves antibiotics,
The document provides information on vascular anomalies including hemangiomas and vascular malformations. It begins with an introduction and historical background. It then discusses classification systems for vascular lesions and specific types such as hemangiomas, vascular malformations, and other congenital vascular tumors. Diagnosis and management are mentioned. Key points include hemangiomas demonstrating endothelial cell hyperplasia while malformations have normal endothelial turnover, as well as classifications differentiating vascular tumors from malformations. Complications are also summarized.
Vascular lesions in the head and neck regionsاسامه عائض
This document provides an overview of vascular lesions, including a classification system and guidelines for diagnosis and treatment. It distinguishes between vascular tumors and malformations, and describes specific conditions like infantile hemangioma. Diagnostic tools include MRI, ultrasound and biopsy. Treatment options depend on whether a lesion is a tumor or malformation, as well as its location and flow. Medical therapies include steroids and laser treatment, while surgical options range from excision to resection or reconstruction. The document aims to establish best practices for managing diverse vascular lesions.
The document discusses naso-orbito-ethmoidal (NOE) fractures, which involve the central upper midface region. It describes the anatomy and classification of NOE fractures. Markowitz classification system categorizes NOE fractures into 5 types based on the status of the central bony fragment and involvement of the medial canthal tendon. Type I and II fractures involve a single or displaced central fragment with an intact tendon. Type III fractures have comminution beneath the tendon. Imaging such as CT is important for diagnosis.
This document discusses giant cell lesions of the jaws. It begins by defining giant cells and describing their origin from monocytes and macrophages. Giant cell lesions are then classified as inflammatory/reactive, metabolic, or neoplastic. Central giant cell granuloma, aneurysmal bone cyst, and traumatic bone cyst are discussed as examples of inflammatory/reactive lesions. Cherubism and brown tumor of hyperparathyroidism represent metabolic giant cell lesions. Osteoblastoma is provided as an example of a neoplastic giant cell lesion. Clinical, radiographic, histologic, and treatment details are outlined for many of the conditions.
This document provides information on vascular lesions of the head and neck. It discusses the classification of hemangiomas and vascular malformations. Hemangiomas are benign tumors that proliferate rapidly after birth and then slowly involute over time. In contrast, vascular malformations are present at birth and grow proportionally with the patient. The document describes different types of vascular malformations including venous, capillary, lymphatic and provides details on their clinical presentation and characteristics. Complications of hemangiomas are also outlined.
The document discusses controversies surrounding odontogenic keratocysts (OKCs). It covers the history and terminology of OKCs, their etiology and pathogenesis, clinical and radiographic features, histopathology, treatment and recurrence rates. There is ongoing debate around whether OKCs should be considered cysts or tumors due to their locally aggressive behavior and high recurrence rates. The document also explores theories on malignant transformation of OKCs and biomarkers that may help predict their biological potential.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
Maxillary sinus diseases are presented by Dr. Vishal Modha. The maxillary sinus is the largest paranasal sinus located within the maxilla bone. It develops embryologically from the lateral nasal wall and grows postnatally. The maxillary sinus anatomy includes thin bony walls that are vulnerable to trauma and contain important structures. Mucociliary drainage flows from the maxillary sinus ostium to the nasal cavity. Common maxillary sinus diseases include acute or chronic sinusitis, which can result from dental infections, trauma, or nasal obstruction and cause symptoms like facial pain and nasal congestion. Radiographs and CT scans may reveal mucosal thickening or opacification in sinusitis. Treatment involves antibiotics,
This document provides an overview of surgical approaches to the temporomandibular joint (TMJ). It discusses several extraoral and intraoral approaches, including the preauricular, endaural, postauricular, coronal, retromandibular, and intraoral vestibular approaches. For each approach, it highlights considerations for exposure and visibility of the joint, avoidance of neurovascular structures, and postoperative aesthetics. Complications are also briefly mentioned. Detailed anatomical descriptions and illustrations are provided to demonstrate the surgical planning and exposure for different approaches.
The document discusses several types of odontogenic tumors that can occur in the jaws. It focuses on describing ameloblastoma, adenomatoid tumor, and calcifying epithelial odontogenic tumor. Ameloblastoma is a benign but locally aggressive tumor arising from odontogenic epithelium. It commonly presents as a painless swelling in the mandible and radiographs show multilocular radiolucency. Histologically there are follicular or plexiform patterns. Adenomatoid tumor is a rare benign tumor associated with impacted teeth. Calcifying epithelial odontogenic tumor is a rare, locally aggressive tumor that can be mistaken for carcinoma, presenting with calcified masses visible on radiographs.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Benign odontogenic and non odontogenic tumoursAbhishek Roy
This document provides information on various benign odontogenic tumors of the jaws. It begins by classifying these tumors into three categories based on their histological composition. It then discusses specific tumor types in more detail, including their clinical features, radiographic appearance, histology, treatment and prognosis. The tumors covered include ameloblastoma (solid/multicystic, unicystic and peripheral subtypes), calcifying epithelial odontogenic tumor, and adenomatoid odontogenic tumor. For each tumor, the summary highlights their defining characteristics and typical presentation.
Naso-orbital-ethmoid (NOE) fractures: Management principles, options and rec...Dibya Falgoon Sarkar
Naso-orbital-ethmoid fractures involve the nasal bones, ethmoid bone, lacrimal bone, maxilla, and frontal bone. They are complex injuries that can damage the lacrimal apparatus and cause complications like epiphora. Diagnosis involves CT scans and clinical exams. Management principles include early repair, precise fixation to restore anatomy, and grafting of bone defects. Potential complications include telecanthus, enophthalmos, and cerebrospinal fluid leaks.
This document discusses fibro-osseous lesions, which replace normal bone with fibrous tissue containing newly formed mineralized structures. It describes several types of fibro-osseous lesions including fibrous dysplasia, cemento-osseous dysplasias like periapical cemental dysplasia, and fibro-osseous neoplasms like ossifying fibroma. For each type, it covers definitions, clinical features, radiographic appearances, differential diagnosis, and treatment approaches.
Haemangiomas and vascular malformations can be classified into two groups: haemangiomas and vascular malformations. Haemangiomas are common tumors in infancy that exhibit rapid growth and slow regression during childhood. Vascular malformations are present at birth and never regress, comprised of abnormally formed blood vessels. Common types of vascular malformations include slow-flow malformations (capillary, lymphatic, venous) and fast-flow malformations (arterial, arteriovenous fistulae, arteriovenous malformations). Diagnostic imaging and clinical presentation can help distinguish between haemangiomas and vascular malformations and their subtypes. Treatment depends on the specific diagnosis and may include observation, medications, laser therapy,
This document provides classifications and descriptions of various odontogenic tumors. It discusses the clinical presentation, radiographic features, histopathology, treatment, and prognosis of different tumor types including ameloblastoma, calcifying epithelial odontogenic tumor, clear cell odontogenic carcinoma, primary intraosseous squamous cell carcinoma, odontoma, and odontogenic myxoma. It provides detailed information on subtypes, locations, patient demographics, recurrence rates after various treatments, and other characteristics of these tumors.
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
This document summarizes fibro-osseous lesions (FOLs), which are characterized by the replacement of bone by a benign connective tissue matrix displaying varying degrees of mineralization. FOLs include fibrotic dysplasia, cemental lesions arising from the periodontal ligament, and fibro-osseous neoplasms. Fibrotic dysplasia is caused by a GNAS1 gene mutation and can be monostotic (single bone) or polyostotic (multiple bones). Polyostotic fibrotic dysplasia can occur with skin pigmentation and endocrine disorders. Treatment depends on symptoms and may include observation, medication such as bisphosphonates, surgical remodeling, or radical excision.
This document discusses condylar fractures of the mandible. It begins by providing background on condylar fracture development, anatomy, surgical anatomy, blood supply, nerve supply and muscle attachments. It then covers the etiology, associated injuries, mechanisms of injury and various classification systems for condylar fractures. The document outlines the diagnosis process including history, clinical examination and radiographic imaging. It concludes by discussing treatment approaches, focusing on the aims of surgery and indications for conservative versus surgical management.
The document discusses the management of jaw tumors, including diagnosis, treatment planning, and surgical excision principles. Diagnosis involves history, examination, biopsy, and imaging. Treatment planning considers tumor factors like location, size, and histology. Surgical excision modalities range from conservative enucleation to more aggressive resection, depending on the tumor's aggressiveness, location, size, and duration. The goal is to completely remove the tumor while preserving adjacent structures.
Central Giant Cell Granuloma :
WHO has defined it as an intraosseous lesion consisting of cellular and fibrous tissue that contains multiple foci of hemorrhage, aggregation of multinucleated giant cells and occasionally trabaculae of woven bone
Etiology JAFFE (1953): considered this lesion to be a local reparative reaction of bone, possibly to intramedullary hemorrhage or trauma, hence the term reparative giant cell granuloma was accepted.
Charles A Waldron & W G Shafer (1966) suggested trauma be an important etiological factor in the initiation of the CGCG of the jaws
Thoma K H (1986) suggested that the lesion may be due to capillary injury caused by defective wall due to some type of trauma
J V Soames and J C Southam (1997) suggested that it could be a reaction to some form of hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) :
Suggested that
Response to previous traumatic or inflammatory episodes.
This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones
CLINICAL PRESENTATION
Found predominantly in children and young adult
It has a female predilection (2:1)
Most commonly affected site is the anterior portion of the jaws, with an increased frequency of occurrence in the mandible
Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination
Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion
Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular.
The defect is usually well delineated
The lesion may vary from a 5×5mm incidental radiographic findings to a destructive lesion greater than 10cm in size.
radiographic findings
A small unilocular lesion may be confused with periapical granuloma or cysts.
multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories
- Non-aggressive lesion
- Aggressive lesion
The non aggressive lesion makes up most cases and exhibit few or no symptoms, they demonstrate slow growth and do not show cortical perforation or root resorption of teeth involved in the lesion. The aggressive lesions are characterized by pain, rapid growth, cortical perforation and root resorption and show marked tendency to recur when compared with non aggressive typeSoft spongy, brownish to reddish friable tissue of various size.
A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated
This document discusses various types of pseudocysts and true cysts found in the body. It begins by defining the key differences between a true cyst and a pseudocyst. Pseudocysts are lined by granulation and/or fibrous tissue rather than an epithelial cell layer. The document then classifies and describes different types of pseudocysts including traumatic bone cysts, aneurysmal bone cysts, and developmental cysts. It provides details on the etiology, location, patient demographics, clinical presentation, radiographic features, histopathology and treatment for each type.
This document discusses mandibular condylar fractures, including:
1. It provides an overview of the etiology, classification, clinical features, diagnosis, and management of mandibular condylar fractures.
2. Treatment protocols for geriatric and pediatric patients are also discussed.
3. The indications and contraindications of closed and open reduction and fixation techniques for condylar fractures are analyzed in detail.
This document discusses the use of tongue flaps in reconstructive surgery. It provides a brief history of tongue flaps dating back to 1909. Various types of tongue flaps are described, including posterior based dorsal flaps, anterior based dorsal flaps, transverse dorsal tongue flaps, perimeter flaps, and dorsoventral flaps. Indications for tongue flaps include moderate sized oral defects, defects exposing bone, and repairs after cancer resections. Four case studies are presented demonstrating the use of different tongue flap techniques for reconstructing posterior palatal, maxillary, and anterior palatal defects. Tongue flaps are concluded to be a reliable and versatile option for oral reconstruction with over 100 years of successful use and minimal
What are Vascular Anomalies?
Hemangioma
Rendu Osler Weber Disease
Sturge Weber syndrome
Lymphangioma
Cystic Hygroma
Hemangiomas: lesions demonstrating endothelial hyperplasia.
Vascular Malformations : lesions with normal endothelial turnover.
A hemangioma is a benign and usually self-involuting tumor of the endothelial cells that line blood vessels, and is characterised by increased number of normal or abnormal vessels filled with blood.
May be present at Birth or arise during early childhood.
This document provides an overview of genioplasty procedures. It begins with an introduction to genioplasty and anatomy. It then discusses preoperative evaluation including facial analysis, cephalometric evaluation, and chin classifications. Next, it covers various techniques for correcting chin deformities including osseous genioplasty procedures like horizontal osteotomy with advancement or reduction, and alloplastic genioplasty. It concludes with a brief discussion of complications. The document provides detailed information on evaluating patients, planning procedures, and technical aspects of different genioplasty techniques.
Vascular malformations are abnormalities of blood or lymph vessel development that are present at birth. They do not involute or proliferate over time like hemangiomas, but rather grow proportionally with the patient. There are several types of vascular malformations classified by flow rate and vessel type, including low-flow venous and lymphatic malformations which appear blue and compressible or as translucent cysts, respectively. In contrast, hemangiomas are benign tumors consisting of rapidly growing clusters of blood vessels that proliferate in infancy before slowly involuting over several years.
Hemangiomas and Vascular Malformations /certified fixed orthodontic courses b...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides an overview of surgical approaches to the temporomandibular joint (TMJ). It discusses several extraoral and intraoral approaches, including the preauricular, endaural, postauricular, coronal, retromandibular, and intraoral vestibular approaches. For each approach, it highlights considerations for exposure and visibility of the joint, avoidance of neurovascular structures, and postoperative aesthetics. Complications are also briefly mentioned. Detailed anatomical descriptions and illustrations are provided to demonstrate the surgical planning and exposure for different approaches.
The document discusses several types of odontogenic tumors that can occur in the jaws. It focuses on describing ameloblastoma, adenomatoid tumor, and calcifying epithelial odontogenic tumor. Ameloblastoma is a benign but locally aggressive tumor arising from odontogenic epithelium. It commonly presents as a painless swelling in the mandible and radiographs show multilocular radiolucency. Histologically there are follicular or plexiform patterns. Adenomatoid tumor is a rare benign tumor associated with impacted teeth. Calcifying epithelial odontogenic tumor is a rare, locally aggressive tumor that can be mistaken for carcinoma, presenting with calcified masses visible on radiographs.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Benign odontogenic and non odontogenic tumoursAbhishek Roy
This document provides information on various benign odontogenic tumors of the jaws. It begins by classifying these tumors into three categories based on their histological composition. It then discusses specific tumor types in more detail, including their clinical features, radiographic appearance, histology, treatment and prognosis. The tumors covered include ameloblastoma (solid/multicystic, unicystic and peripheral subtypes), calcifying epithelial odontogenic tumor, and adenomatoid odontogenic tumor. For each tumor, the summary highlights their defining characteristics and typical presentation.
Naso-orbital-ethmoid (NOE) fractures: Management principles, options and rec...Dibya Falgoon Sarkar
Naso-orbital-ethmoid fractures involve the nasal bones, ethmoid bone, lacrimal bone, maxilla, and frontal bone. They are complex injuries that can damage the lacrimal apparatus and cause complications like epiphora. Diagnosis involves CT scans and clinical exams. Management principles include early repair, precise fixation to restore anatomy, and grafting of bone defects. Potential complications include telecanthus, enophthalmos, and cerebrospinal fluid leaks.
This document discusses fibro-osseous lesions, which replace normal bone with fibrous tissue containing newly formed mineralized structures. It describes several types of fibro-osseous lesions including fibrous dysplasia, cemento-osseous dysplasias like periapical cemental dysplasia, and fibro-osseous neoplasms like ossifying fibroma. For each type, it covers definitions, clinical features, radiographic appearances, differential diagnosis, and treatment approaches.
Haemangiomas and vascular malformations can be classified into two groups: haemangiomas and vascular malformations. Haemangiomas are common tumors in infancy that exhibit rapid growth and slow regression during childhood. Vascular malformations are present at birth and never regress, comprised of abnormally formed blood vessels. Common types of vascular malformations include slow-flow malformations (capillary, lymphatic, venous) and fast-flow malformations (arterial, arteriovenous fistulae, arteriovenous malformations). Diagnostic imaging and clinical presentation can help distinguish between haemangiomas and vascular malformations and their subtypes. Treatment depends on the specific diagnosis and may include observation, medications, laser therapy,
This document provides classifications and descriptions of various odontogenic tumors. It discusses the clinical presentation, radiographic features, histopathology, treatment, and prognosis of different tumor types including ameloblastoma, calcifying epithelial odontogenic tumor, clear cell odontogenic carcinoma, primary intraosseous squamous cell carcinoma, odontoma, and odontogenic myxoma. It provides detailed information on subtypes, locations, patient demographics, recurrence rates after various treatments, and other characteristics of these tumors.
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
This document summarizes fibro-osseous lesions (FOLs), which are characterized by the replacement of bone by a benign connective tissue matrix displaying varying degrees of mineralization. FOLs include fibrotic dysplasia, cemental lesions arising from the periodontal ligament, and fibro-osseous neoplasms. Fibrotic dysplasia is caused by a GNAS1 gene mutation and can be monostotic (single bone) or polyostotic (multiple bones). Polyostotic fibrotic dysplasia can occur with skin pigmentation and endocrine disorders. Treatment depends on symptoms and may include observation, medication such as bisphosphonates, surgical remodeling, or radical excision.
This document discusses condylar fractures of the mandible. It begins by providing background on condylar fracture development, anatomy, surgical anatomy, blood supply, nerve supply and muscle attachments. It then covers the etiology, associated injuries, mechanisms of injury and various classification systems for condylar fractures. The document outlines the diagnosis process including history, clinical examination and radiographic imaging. It concludes by discussing treatment approaches, focusing on the aims of surgery and indications for conservative versus surgical management.
The document discusses the management of jaw tumors, including diagnosis, treatment planning, and surgical excision principles. Diagnosis involves history, examination, biopsy, and imaging. Treatment planning considers tumor factors like location, size, and histology. Surgical excision modalities range from conservative enucleation to more aggressive resection, depending on the tumor's aggressiveness, location, size, and duration. The goal is to completely remove the tumor while preserving adjacent structures.
Central Giant Cell Granuloma :
WHO has defined it as an intraosseous lesion consisting of cellular and fibrous tissue that contains multiple foci of hemorrhage, aggregation of multinucleated giant cells and occasionally trabaculae of woven bone
Etiology JAFFE (1953): considered this lesion to be a local reparative reaction of bone, possibly to intramedullary hemorrhage or trauma, hence the term reparative giant cell granuloma was accepted.
Charles A Waldron & W G Shafer (1966) suggested trauma be an important etiological factor in the initiation of the CGCG of the jaws
Thoma K H (1986) suggested that the lesion may be due to capillary injury caused by defective wall due to some type of trauma
J V Soames and J C Southam (1997) suggested that it could be a reaction to some form of hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) :
Suggested that
Response to previous traumatic or inflammatory episodes.
This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones
CLINICAL PRESENTATION
Found predominantly in children and young adult
It has a female predilection (2:1)
Most commonly affected site is the anterior portion of the jaws, with an increased frequency of occurrence in the mandible
Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination
Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion
Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular.
The defect is usually well delineated
The lesion may vary from a 5×5mm incidental radiographic findings to a destructive lesion greater than 10cm in size.
radiographic findings
A small unilocular lesion may be confused with periapical granuloma or cysts.
multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories
- Non-aggressive lesion
- Aggressive lesion
The non aggressive lesion makes up most cases and exhibit few or no symptoms, they demonstrate slow growth and do not show cortical perforation or root resorption of teeth involved in the lesion. The aggressive lesions are characterized by pain, rapid growth, cortical perforation and root resorption and show marked tendency to recur when compared with non aggressive typeSoft spongy, brownish to reddish friable tissue of various size.
A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated
This document discusses various types of pseudocysts and true cysts found in the body. It begins by defining the key differences between a true cyst and a pseudocyst. Pseudocysts are lined by granulation and/or fibrous tissue rather than an epithelial cell layer. The document then classifies and describes different types of pseudocysts including traumatic bone cysts, aneurysmal bone cysts, and developmental cysts. It provides details on the etiology, location, patient demographics, clinical presentation, radiographic features, histopathology and treatment for each type.
This document discusses mandibular condylar fractures, including:
1. It provides an overview of the etiology, classification, clinical features, diagnosis, and management of mandibular condylar fractures.
2. Treatment protocols for geriatric and pediatric patients are also discussed.
3. The indications and contraindications of closed and open reduction and fixation techniques for condylar fractures are analyzed in detail.
This document discusses the use of tongue flaps in reconstructive surgery. It provides a brief history of tongue flaps dating back to 1909. Various types of tongue flaps are described, including posterior based dorsal flaps, anterior based dorsal flaps, transverse dorsal tongue flaps, perimeter flaps, and dorsoventral flaps. Indications for tongue flaps include moderate sized oral defects, defects exposing bone, and repairs after cancer resections. Four case studies are presented demonstrating the use of different tongue flap techniques for reconstructing posterior palatal, maxillary, and anterior palatal defects. Tongue flaps are concluded to be a reliable and versatile option for oral reconstruction with over 100 years of successful use and minimal
What are Vascular Anomalies?
Hemangioma
Rendu Osler Weber Disease
Sturge Weber syndrome
Lymphangioma
Cystic Hygroma
Hemangiomas: lesions demonstrating endothelial hyperplasia.
Vascular Malformations : lesions with normal endothelial turnover.
A hemangioma is a benign and usually self-involuting tumor of the endothelial cells that line blood vessels, and is characterised by increased number of normal or abnormal vessels filled with blood.
May be present at Birth or arise during early childhood.
This document provides an overview of genioplasty procedures. It begins with an introduction to genioplasty and anatomy. It then discusses preoperative evaluation including facial analysis, cephalometric evaluation, and chin classifications. Next, it covers various techniques for correcting chin deformities including osseous genioplasty procedures like horizontal osteotomy with advancement or reduction, and alloplastic genioplasty. It concludes with a brief discussion of complications. The document provides detailed information on evaluating patients, planning procedures, and technical aspects of different genioplasty techniques.
Vascular malformations are abnormalities of blood or lymph vessel development that are present at birth. They do not involute or proliferate over time like hemangiomas, but rather grow proportionally with the patient. There are several types of vascular malformations classified by flow rate and vessel type, including low-flow venous and lymphatic malformations which appear blue and compressible or as translucent cysts, respectively. In contrast, hemangiomas are benign tumors consisting of rapidly growing clusters of blood vessels that proliferate in infancy before slowly involuting over several years.
Hemangiomas and Vascular Malformations /certified fixed orthodontic courses b...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Vascular tumors and malformations are common skin lesions in infants and children. This document discusses several types of vascular tumors: infantile hemangiomas, congenital hemangiomas, kaposiform hemangioendothelioma, and pyogenic granuloma. Infantile hemangiomas are the most common tumor of infancy, appearing as red lesions that grow rapidly during the first year of life and slowly involute over subsequent years. Congenital hemangiomas are fully developed at birth and do not undergo postnatal growth. Kaposiform hemangioendothelioma is a rare but locally aggressive vascular tumor. Pyogenic granuloma is a small red papule that grows rapidly to form a
This document discusses the case of a 12-year-old boy who presented with sudden severe headache, vomiting, right-sided weakness and difficulty speaking. Imaging revealed an aneurysm at the bifurcation of his internal carotid artery. The document then provides background information on intracranial aneurysms in pediatric patients, noting they are rare but can occur in unusual locations compared to adults. Risk factors also differ, with few of the common adult risk factors applying to children. The document outlines treatment approaches for different types of pediatric aneurysms and notes management aims to treat the cause while minimizing risk given children's developing physiology. In this case, the team opted for microsurgical clipping and decompressive craniectomy to address the boy's int
Infantile and congenital hemangiomas managment.pptxMohammad Daboos
This product discuss the definitions, theories, pathogenisis, pathology and methods of diagnosis of Infantile and Congenital hemangiomas, and explain when and how to treat both infantile and Congenital Hemangiomas. In addition to describe hemangioma in espicial sites as [parotid, GIT and Hepatic Hemangioma] So, i advice all pediatric, plastic, and dermatologist to revise this lecture and update his knowledge.
vascular anomalies of newborn,approach to infantile hemangiomaDr Praman Kushwah
The document discusses vascular anomalies in newborns, focusing on infantile hemangiomas. It provides classifications for vascular tumors and malformations, and describes key features of infantile hemangiomas including risk factors, pathogenesis, clinical presentations, growth cycles, potential complications, and risk factors for life-threatening complications. Infantile hemangiomas typically arise postnatally, demonstrate endothelial proliferation, and can involve the superficial dermis, deep dermis, or both. Aggressive early treatment may be needed for hemangiomas near the airway or eyes to prevent functional impairment.
Craniofacial anomalies /certified fixed orthodontic courses by Indian dental ...Indian dental academy
Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
This document discusses various types of vascular anomalies. It begins by providing historical context for how vascular anomalies were classified. It then summarizes the current biologic classification system introduced in 1982, which distinguishes between vascular tumors and malformations. For vascular tumors, it describes infantile hemangioma and its life cycle phases. It also discusses other types of vascular tumors like congenital hemangiomas and kaposiform hemangioendothelioma. For vascular malformations, it lists the main types classified by predominant vessel type. Diagnosis and management approaches are summarized for different vascular anomalies.
Vasoformative disorders are distinct type of lesions that covers benign, lesions of intermediate malignancy and malignant disorders along with syndromes. very useful for oral path, oral medicine and as well as general pathology and residents.
The document discusses genetics, genetic disorders, and stem cell research. It defines dominant, recessive, and co-dominant alleles and how they control traits. It also defines single-gene, multifactorial, and chromosomal genetic disorders. It discusses the pros and cons of fetal stem cell research, with pros being stem cells' potential and cons being the ethical issues around using embryonic stem cells.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The spectrum of childhood neoplasms – Evaluation of 161 cases in surgical pat...Apollo Hospitals
Although major cause of childhood morbidity and mortality in the developing world is still malnutrition and infections, pediatric neoplasms are also rising in number. Although pediatric neoplasms occur infrequently, they present a challenging diagnostic and therapeutic problem. Unfamiliarity with these conditions may lead to the erroneous diagnosis and unnecessary aggressive therapy. This was a retrospective analysis of 161 cases of pediatric tumors, both benign and malignant, in surgical pathology department excluding neurosurgery, cardiothoracic, and hemato-lymphoid malignancies (age group 0–12 years) encountered over a period of 5 years: January 2004–December 2008. The clinical, radiological, and therapeutic data were obtained from patients’ case paper records. Pattern of childhood tumors was studied with a focus on tumor incidence, age and sex distribution, demographic pattern, and histological type.
This document discusses challenges in diagnosing disorders related to dysmorphology and genetics in pediatric patients. It notes that an accurate diagnosis can be difficult due to genetic heterogeneity, environmental factors, incomplete family histories, and other issues. The document emphasizes the importance of a thorough clinical examination, family history, and integrating multiple sources of data to establish a diagnosis. It also discusses how early diagnosis can provide benefits by informing clinical management and prognosis.
GENETICS & MALOCCLUSION - II /orthodontic courses by Indian dental academy Indian dental academy
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Nephroblastoma also known as Wilms tumor, is the most common renal malignancy affecting one in 10,000 children <15 years old
Children with bilateral disease are diagnosed at an earlier age (median age, girls at 31 months and boys at 24 months): Patients with associated congenital anomalies are also diagnosed at an earlier age
Accounts for 6-7% of cases of childhood cancer in the developed world and 12% in South Africa
In Tanzania the prevalence is 6.7% ( Mgaya E et al., 2000), “third from leukemia and lymphoma” (Shakilu J, 2017)
The overall survival rate of nephroblastoma approaches 90% in the developed world but in developing countries the survival rates are much less and in some sub-Saharan countries it is only 40% at 8 months after diagnosis
These may occur in 1% of infantile kidneys but typically regress during childhood
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Nephrogenic rests normally occur in 1% of newborn kidneys and regress early in childhood: in contrast, they are present in 35% of kidneys with unilateral Wilms tumor and almost 100% of kidneys with bilateral disease
Has been associated with loss of function mutations of a number of tumor suppressor and transcription genes
These include mutations of the WT1, p53, FWT1, and FWT2 genes and at the 11p15.5 locus
Histologically, the classic favorable histology Wilms tumor is comprised of three cell types:
Blastemal cells – Undifferentiated cells
Stromal cells – Immature spindle cells and heterologous skeletal muscle, cartilage, osteoid or fat
Epithelial cells – Glomeruli and tubules
Grossly, Wilms tumors are usually well-circumscribed and have a pseudo-capsule
Histologically, Wilms is divided into "Favorable" and "Unfavorable" histologies
"Favorable" Histology: 90% of Wilms tumors will demonstrate "favorable" histology which generally has a better prognosis
Most children with Wilms tumor present with an abdominal mass or swelling without other signs or symptoms
The definitive diagnosis of Wilms tumor is made by histologic confirmation at the time of either surgical excision or biopsy
Stage I indicates the tumor was completely contained within the kidney without any breaks or spillage outside the renal capsule and no vascular invasion
Stage II would be a tumor that has grown outside the kidney
Stage IIIunresectable tumor
Stage IV-Metastasis
Stage V-bilateral kidney
Surgery is the main treatment
Embryonic stem cells – Promises and IssuesTania Jabin
Introduction, Embryonic Stem Cells, Promises of Embryonic Stem cell research, Figure: The Promise of Stem Cell Research, Issues in Embryonic Stem cells - New embryonic stem cell lines from frozen embryos Informed consent for donation of materials for stem cell research Waiver of consent Consent from gamete donors Confidentiality of donor information Ethical concerns about oocyte donation for research (1. Medical risks of oocyte retrieval, 2. Protecting the reproductive interests of women in infertility treatment, 3. Payment to oocyte donors, 4. Informed consent for oocyte donation).
1) The document discusses the potential uses and benefits of stem cell research, including curing diseases like Alzheimer's, blood disorders, and birth defects.
2) It argues that stem cells can be used to generate organs and tissues to treat diseases. Stem cells may also reverse neural birth defects.
3) The conclusion is that the government should fund stem cell research because it could help cure many diseases and reduce waiting times for organ transplants. Researchers have also found ways to obtain stem cells without using embryos.
1) The document discusses how stem cells can potentially cure or treat various diseases and medical conditions like Alzheimer's, blood disorders, birth defects, and help generate organs.
2) It provides arguments for how stem cells have reversed neural defects in mice and could do the same for humans, in addition to being used to generate blood, bone marrow, heart, kidney, liver and lung cells/tissues.
3) The conclusion is that the government should fund stem cell research as it could find cures for diseases and reduce wait times for organ transplants, and stem cells don't need to come from embryos.
This case report describes a 74-year-old male patient diagnosed with Gorlin-Goltz syndrome based on presenting with over 50 basal cell carcinomas on his face, chest, and back as well as a family history of similar lesions in his brother. Gorlin-Goltz syndrome is a rare autosomal dominant disorder characterized by basal cell carcinomas, jaw cysts, and skeletal abnormalities caused by mutations in the PTCH gene. The patient underwent surgical excision of basal cell carcinomas on his face. Regular screening was recommended due to risks of additional cancers and basal cell carcinomas associated with this syndrome.
Similar to Hemangiomas and vascular malformations/ oral surgery courses (20)
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
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3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
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Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
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Indian Dental Academy
Leader in continuing dental education
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skype:indiandentalacademy
+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Training: ISO/IEC 27001 Information Security Management System - EN | PECB
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Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
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You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
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Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
2. J. B. Mulliken and J. Glowacki, “Hemangiomas and vascular
malformations in infants and children: a classification based on
endothelial characteristics,” Plastic and Reconstructive Surgery, vol. 69,
no. 3, pp. 412–422, 1982.
A. N. Haggstrom, B. A. Drolet, E. Baselga et al., “Prospective study of
infantile hemangiomas: demographic, prenatal, and perinatal
characteristics,” Journal of Pediatrics, vol. 150, no. 3, pp. 291–294, 2007.
P. E. North, M. Waner, and M. C. Brodsky, “Are infantile hemangiomas of
placental origin?” Ophthalmology, vol. 109, no. 4, pp. 633–634, 2002.
Y. Yu, A. F. Flint, J. B. Mulliken, J. K. Wu, and J. Bischoff, “Endothelial
progenitor cells in infantile hemangioma,” Blood, vol. 103, no. 4, pp.
1373–1375, 2004.
www.indiandentalacademy.com
3. J. Chang, D. Most, S. Bresnick et al., “Proliferative hemangiomas:
analysis of cytokine gene expression and angiogenesis,” Plastic and
Reconstructive Surgery, vol. 103, no. 1, pp. 1–9, 1999.
M. L. Calicchio, T. Collins, and H. P. Kozakewich, “Identification of
signaling systems in proliferating and involuting phase infantile
hemangiomas by genome-wide transcriptional profiling,” American
Journal of Pathology, vol. 174, no. 5, pp1638–1649, 2009.
L. C. Chang, A. N. Haggstrom, B. A. Drolet et al., “Growth
characteristics of infantile hemangiomas: implications for management,”
Pediatrics, vol. 122, no. 2, pp. 360–367, 2008.
www.indiandentalacademy.com
4. F. Ronchese, “The spontaneous involution of cutaneous vascular tumors,”
The American Journal of Surgery, vol. 86, no.4, pp. 376–386, 1953.
S. J. Orlow, M. S. Isakoff, and F. Blei, “Increased risk of symptomatic
hemangiomas of the airway in association with cutaneous hemangiomas in
a “beard” distribution,” Journal of Pediatrics, vol. 131, no. 4, pp. 643–
646, 1997.
D. Metry, G. Heyer, C. Hess et al., “Consensus statement on diagnostic
criteria for PHACE syndrome,” Pediatrics, vol. 124, no. 5, pp. 1447–1456,
2009.
A. N. Haggstrom, B. A. Drolet, E. Baselga et al., “Prospective study of
infantile hemangiomas: clinical characteristics predicting complications
and treatment,” Pediatrics, vol. 118, no.3, pp. 882–887, 2006.
www.indiandentalacademy.com
5. N. M. Bauman, D. K. Burke, and R. J. H. Smith, “Treatment of massive or
life-threatening hemangiomas with recombinant α2a-interferon,”
Otolaryngology—Head and Neck Surgery, vol. 117, no. 1, pp. 99–110, 1997
J. Perez, J. Pardo, and C. Gomez, “Vincristine—an effective treatment of
corticoid-resistant life-threatening infantile hemangiomas,” Acta
Oncologica, vol. 41, no. 2, pp. 197–199, 2002.
E. Pope, B. R. Krafchik, C. Macarthur et al., “Oral versus highdose pulse
corticosteroids for problematic infantile hemangiomas: a randomized,
controlled trial,” Pediatrics, vol. 119, no. 6, pp. e1239–e1247, 2007.
L. M. Buckmiller, C. L. Francis, and R. S. Glade, “Intralesional steroid
injection for proliferative parotid hemangiomas,”International Journal of
Pediatric Otorhinolaryngology, vol. 72, no. 1, pp. 81–87, 2008.
www.indiandentalacademy.com
6. At the end of the journal club, the learner should be
able to describe
1.What are Hemangiomas
2.Classification of Hemangiomas
3.Etiology and Pathogenesis of Hemangiomas
4.Diagnosis of Hemangiomas
5.Treatment planning of Hemangiomas
www.indiandentalacademy.com
7. Introduction
Vascular anomalies are congenital lesions of abnormal
vascular development.
Previously referred to as vascular birthmarks.
In 1982, Mulliken and Glowacki classified vascular
anomalies into 1.Hemangiomas
2.Vascular malformations
www.indiandentalacademy.com
8. Hemangiomas - are tumors identified by rapid
endothelial cell proliferation.
Vascular malformations –result from anomalous
development of vascular plexus.
Malformations are further divided into (differences in
biologic and radiographic behavior)
slow-flow and
fast-flow lesions
www.indiandentalacademy.com
10. Hemangioma Vascular malformation
• vascular tumors
that are rarely apparent at
birth.
• grow rapidly during
the first 6 months of life
• involute with time
• do not necessarily infiltrate
but can sometimes be
• they are present at birth
• slow growing
•do not involute with time
• infiltrative,
and destructive.
www.indiandentalacademy.com
11. Hemangiomas are further categorized into two types:
“infantile”
“congenital”
www.indiandentalacademy.com
12. most common tumor in infancy
occur in approximately 10% of the population.
Risk factors include
female sex,
prematurity,
Low birth weight
www.indiandentalacademy.com
13. They consist of rapidly dividing endothelial cells.
Because their growth is attributed to hyperplasia of
endothelial cells, they are classified as, and are the
most common, vascular tumors.
www.indiandentalacademy.com
15. The pathogenesis of infantile hemangiomas remains
unclear, although two theories have been proposed.
The first theory suggests that hemangioma endothelial
cells arise from disrupted placental tissue embedded in
fetal soft tissues during gestation or birth.
Markers of hemangiomas have been shown to coincide
with those found in placental tissue.(P.E.N orth,
M.Waner and M.C.Brodsky,2002).
www.indiandentalacademy.com
16. Glucose transporter 1 (GLUT1), a glucose transporter
normally expressed in the microvascular endothelia of
blood-tissue barriers such as placenta.
It was recently described as a specific marker for
hemangioma as it is absent in other vascular lesions such
as malformation, RICH (rapidly involuting congenital
hemangioma) and NICH (non-involuting congenital
hemangioma).
www.indiandentalacademy.com
17. This is further supported by the fact that they are found more
commonly in infants following chorionic villus sampling,
placenta previa, and preeclampsia.
(A.N.Haggstrom, B.A.Drolet, E.Baselga et al.,2007).
www.indiandentalacademy.com
18. A second theory arose from the discovery of endothelial
progenitor and stem cells in the circulation of patients with
hemangiomas.
The development of hemangiomas in animals from stem
cells isolated from human specimens supports this theory.
However, infantile hemangiomas most likely arise from
hematopoietic progenitor cells (from placenta or stem cell)
in the appropriate milieu of genetic alterations and
cytokines.
www.indiandentalacademy.com
19. Abnormal levels of matrix metalloproteinases (MMP-9)
and proangiogenic factors (VEGF, b-FGF, and TGF-
beta) play a role in hemangioma pathogenesis.
www.indiandentalacademy.com
20. Infantile hemangiomas present shortly after birth.
Most often as well-demarcated, flat, and erythematous red
patches.
At this stage, hemangiomas may be
confused with other red lesions of birth,
but rapid proliferation and vertical growth
will trigger the diagnosis .
Hemangiomas do not spread outside their original anatomic
boundaries.
www.indiandentalacademy.com
22. Hemangiomas follow a predictable course with three
distinct developmental phases:
proliferation
quiescence
involution
www.indiandentalacademy.com
23. Proliferation - rapid growth can lead to exhaustion of
blood supply resulting ischemia, necrosis, ulceration, and
bleeding.
Quiescence - typically lasts from 9 to 12 months of age.
Involution - marked by graying of the overlying skin and
shrinking of the deeper components.
www.indiandentalacademy.com
24. Historical reports suggest that involution of 50%,
70%, and 90% of the hemangioma occurs by 5, 7,
and 9 years of age with some variability.
At the final stages of involution, a fibrofatty
protuberance may remain.
www.indiandentalacademy.com
26. Focal hemangiomas
• localized, unilocular lesions which adhere to the phases
of growth and involution.
• Multifocal hemangiomatosis also exists, and infants
with greater than 5 lesions should be ruled out for any
visceral involvement.
www.indiandentalacademy.com
27. Segmental hemangiomas
• more diffuse plaquelike and can lead to untoward
functional and aesthetic outcomes.
• The limb and face are common locations for disease.
Head and neck lesions frequently coincide with the
distribution of the trigeminal nerve.
• A beard-like distribution is associated with a
subglottic hemangioma 60% of the time (S.J.Orlow,
M.S.Isakoff, F.Blei,1997)
www.indiandentalacademy.com
28. Patients with segmental hemangiomas should also
undergo investigation to rule out PHACES syndrome
(D.Metry, G.Heyer, C.Hess et al.,2009)
•Posterior fossa brain malformations
• Hemangiomas of the face
• Arterial cerebrovascular anomalies,
•Cardiovascular anomalies
• Eye anomalies
• Sternal defects or supraumbilical raphe.www.indiandentalacademy.com
29. The diagnosis of a hemangioma is best made by
Clinical history and physical exam
Doppler ultrasound or MRI.
www.indiandentalacademy.com
30. Medical management (N.M.Bauman, D.K.Burke
and R.J.H.Smith,1997)
Corticosteroids,
interferon, and vincristine
Surgical management
excision,
laser treatment
both.
www.indiandentalacademy.com
31. Numerous studies demonstrating the success of
propranol have beeen followed.
In fact, over ninety percent of patients have dramatic
reduction in the size of their hemangiomas as early as
1-2 weeks following the first dose of propranolol .
Dosing for propranolol in treating hemangiomas is
recommended to be 2-3mg/kg separated into two or
three-times-a-day regimens.
www.indiandentalacademy.com
33. These doses are dramatically below the
concentration employed for cardiovascular
conditions in children.
Thus, reported side effects of propranolol for
hemangiomas have been minimal.
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34. Vascular malformations are rare vascular anomalies
composed of inappropriately connected vasculature.
Any blood vessel type, or a combination thereof, can
be affected in a vascular malformation.
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35. The most common vascular malformations include
lymphatic malformations(LMs)
capillary malformations (CM),
venous malformations (VMs) and
arteriovenous malformations (AVMs)
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36. Vascular malformations do not regress and continue
to expand with time.
Periods of rapid growth, infiltration, and soft tissue
destruction will spur therapeutic approaches that
depend upon the malformation involved.
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37. Lymphatic Malformations
Dilated lymphatic vessels with inappropriate
communication, lined by endothelial cells and filled
with lymphatic fluid.
Their incidence is approximated to be 1 in 2000 to
4000 live births (J.A.Perkins, S.C Manning,
R.M.Tempero et al.,2010)
macrocystic (single or multiple cysts >2 cm3),
microcystic (<2 cm3), or
mixed
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38. Macrocystic LMs present as
a soft, fluid-filled swelling beneath normal or
slightly discolored skin.
Intracystic bleeding or a mixed lymphatic venous
malformation may result in blue discoloration of the
overlying skin.
Microcystic LMs
soft and noncompressible masses with an overlying
area of small vesicles involving the skin or mucosa.
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39. Macrocystic lymphatic malformation
(LM) of right neck in toddler.
Microcystic lip LM displaying
mucosal vesicles.
Microcystic LM in older patient with
bone involvement and mandibular
hypertrophywww.indiandentalacademy.com
40. The etiology of Lymphatic Malformation is unclear.
Although most are congenital, there have been reports of LM
occurring after trauma or infection.
Receptors involved in the formation of lymphatic vascular
channels, such as VEGFR3 and Prox-1, may play a role in the
development of this disease.
(K. A. Pavlov, E. A. Dubova, A. I. Shchyogolev, and O.
D.Mishnyov, “Expression of growth factors in endotheliocytes
in vascular malformations,” Bulletin of Experimental Biology
and Medicine, vol. 147, no. 3, pp. 366–370, 2009).
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41. Approximately half of the lesions are present at birth
and 80–90% by 2 years of age.
Local infections approximating the course of
lymphatic drainage will cause LM to swell, protrude,
and sometimes become painful.
This is a hallmark of a LM versus other vascular
anomalies that do not present in this fashion.
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42. LM can occur anywhere on the body, and symptoms are
determined by the extent of disease.
Most LMs are found in the cervicofacial region and
extend to involve the oral cavity or airway, especially
when mixed or microcystic.
Symptoms often include pain, dysphagia, odynophagia,
impaired speech, or in severe cases, airway obstruction.
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43. When involving the skeletal framework in this area,
LMs often cause osseous hypertrophy leading to
dental or extremity abnormalities.
These malformations can usually be diagnosed
Physical examination
MRI is used to confirm diagnosis.
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44. An ideal option for treatment of LM does not exist.
Macrocystic lesions are more amenable to treatment
and have a better prognosis.
Swelling from acute infection is best controlled with a
short course of systemic steroids and antibiotics.
Definitive treatment is delayed until resolution.
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45. LM may be detected on prenatal ultrasound and may
require special interventions during delivery.
The EXIT (ex utero intrapartum treatment) procedure
provides good airway control of the infant if
compromise is suspected to occur at birth.
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46. Sclerotherapy is frequently employed for lymphatic
malformations, especially if deep seated and difficult
to access surgically.
Several agents have been utilized for lymphatic
malformations including ethanol, bleomycin, OK-
432, and doxycycline.
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47. Complications
Include skin breakdown, pain, and swelling.
Severe swelling can occur at times and may lead to
airway obstruction requiring intensive care .
Risks to local nerves are also real but usually result
in only transient loss of function.
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48. Capillary malformations (CMs) are sporadic lesions
consisting of dilated capillary-like channels.
They occur in approximately 0.3% of children.
CMs can present on any part of the body, but are
mostly found in the cervicofacial region.
They are categorized depending on their locations.
Medial CM
Lateral lesions
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49. Medial CM
gradually lighten with time and eventually disappear.
they are referred to as stork bites on the nape of the
neck and angel kisses on the forehead.
Lateral lesions
commonly referred to as port-wine stains,
have a more protracted course
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51. Pathogenesis of isolated capillary malformations is
unknown.
A genomewide linkage analysis has identified a locus
on chromosome 5q associated with familial disease.
A rare autosomal dominant inherited disease
consisting of a combination of CM and arteriovenous
malformations (AVM) is associated with a loss-of-
function mutation in RASA1 gene (L.M.Boon,
J.B.Mulliken and M.Vikkula,2005).
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52. CMs present at birth as flat, red or purple, cutaneous
patches with irregular borders.
They are painless and do not spontaneously bleed.
Lateral CMs, or portwine stains, usually involve the
face and present along the distribution of the
trigeminal nerve.
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53. • CMs tend to progress with time as the vessel ectasia
extends to involve deeper vessels to the level of the
subcutaneous tissues.
• This causes the lesion to become darker in color, as well
as more raised and nodular (K.C.Tark, D.H.Lew and
D.W.Lee,2011)
• Although they are mostly solitary lesions, CM may exist
as a part of a syndrome.
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54. Sturge-Weber syndrome (SWS) and is characterized by
CM in the region of the ophthalmic branch of the
trigeminal nerve,
leptomeningeal angiomatosis, and
choroid angioma.
Symptoms
intractable seizures,
mental retardation, and
glaucoma.
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55. Klippel-Trenaunay Syndrome (KTS)
This syndrome consists of a combination of multiple
lymphatic, venous, and capillary abnormalities.
Diagnosis is usually made by physical examination
alone.
An MRI of the brain as well as an annual
ophthalmological exam is warranted when suspicion
for SWS is present.
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56. The mainstay of treatment for CM is laser therapy.
The argon, potassium-titanyl-phosphate (KTP)
lasers, and 755nm laser have also been utilized in
more advanced lesions.
Surgical excision is also an option in lesions not
amenable to laser therapy.
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57. Venous malformations (VMs) are slow-flow vascular
anomalies composed of ectatic venous channels.
These aberrant venous connections lead to venous
congestion, thrombosis, and gradual expansion of
these lesions.
The incidence of VMs is approximately 1 in 10,000.
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58. There are inherited forms of VMs, the cause of which
has been localized to chromosome 9p.
Recently a loss-of-function mutation was discovered
on the angiopoetin receptor gene TIE2/TEK in many
solitary and multiple sporadic venous malformations.
Upregulation of several factors including tissue
growth factor beta (TGF-beta) and basic fibroblast
growth factor (beta-FGF) has been discovered in
patients with venous malformations (K.A.PAVLOV,
E.A.Dubova, A.I.Shchyogolev,2009).
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59. Venous malformations are often visible at birth but
may present as a deep mass.
Protrusion may be the only presenting symptom.
They are known to grow proportionately with the
child with sudden expansion in adulthood.
Rapid growth may occur during puberty, pregnancy,
or traumatic injury.
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60. VM can be either well localized or extensive.
The overlying skin may appear normal or possess a
bluish discoloration.
With more cutaneous involvement, the lesions appear
darker blue or purple.
Upper aerodigestive involvement is common, and VM
are particularly evident when mucosa is affected.
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62. VM can occur anywhere in the body but often are
found in the head and neck where they involve the
oral cavity, airway, or cervical musculature.
MRI is the imaging modality of choice when
diagnosing VM and offers superior delineation of
disease for treatment planning.
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63. Surgery
Nd : YAG laser therapy, and
sclerotherapy
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64. Arteriovenous malformations (AVMs) are congenital
highflow vascular malformations composed of
anomalous capillary beds shunting blood from the
arterial system to the venous system.
They are often misdiagnosed at birth as other
vascular lesions because of the delay in presentation
of characteristic signs of the malformation.
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65. Puberty and trauma trigger the growth of the lesion and
manifestation of its troublesome symptoms.
They are infiltrative causing destruction of local tissue
and often life-threatening secondary to massive bleeding.
Extracranial AVMs are different from their intracranial
counterpart and are found in several areas in the
cervicofacial region.
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66. A defect in vascular stabilization is thought to cause
AVM, but it remains unclear whether these lesions
are primarily congenital in origin.
Most AVM, are present at birth, but there are several
case reports of these lesions presenting after trauma
in adults.
Defects in TGF-beta signaling and a genetic two-hit
hypothesis are the prevailing theories to the
pathogenesis.
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67. Diagnosis of AVM is based upon clinical examination
and imaging.
A growing hypervascular lesion presents as a slight blush
at birth.
The distinguishing characteristics of an AVM will be
palpable warmth, pulse, or thrill due to its high vascular
flow .
The overlying skin may have a well-demarcated blush
with elevated temperature relative to adjacent skin.www.indiandentalacademy.com
68. The natural course of AVM is
early quiescence,
late expansion, and
ultimately infiltration and destruction of local soft
tissue and bone.
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69. Common sites for occurence are the midface, oral
cavity, and limbs .
Oral lesions can present early due to
gingival involvement,
disruption of deciduous teeth, and
profuse periodontal bleeding.
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70. Although both focal (small vessel) and diffuse lesions
exist, AVMs are by far the most difficult vascular
anomaly to manage due to the replacement of normal
tissue by disease vessels and very high recurrence
rates.
Imaging is essential in identifying the extent of AVM.
MRI may be useful, but MRA and CTA can give a
superior outline of these lesions.
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71. embolization,
surgical extirpation, or
a combination of these modalities.
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72. In general, surgical management of AVMs require
preoperative supraselective embolization,
judicious removal of tissue, and
complex reconstructive techniques.
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73. Vascular anomalies embody a myriad of blood
vessels abnormalities that are thought to occur
perinatally.
Correct diagnosis is imperative for appropriate
treatment.
Treatment of vascular anomalies is complex and often
involves multiple disciplines and therapeutic options.
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74. Etiology, diagnosis
and treatment of
vascular anomalies
were described in detail.
Histopathology of
the anomalies was
not explained .
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