Invasive rhino maxillary lesions / dental implant courses

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

CASE REPORTS

CASE - 1
 Chief complaint
 History of presenting
illness
• Painful swelling – ulcer - pus-discharge -
oro antral fistula – parasthesia -
unable to close L eye.
• Painful ulcer in the L upper front
region of mouth since 20 days.

 Extra - Oral
examination
• Firm, diffuse mass on the L
anterior maxilla.

 Intra - Oral examination
• Ulcer with bone denudation.www.indiandentalacademy.com

PROVISIONAL DIAGNOSIS
DEEP FUNGAL INFECTION
 Acute duration.
 Sudden & rapidly progressed
C/F.
 Extensive bone denudation.
 Scrapable white patches.
POSITIVE FINDINGS

DIFFERENTIAL DIAGNOSIS
 Osteomyelitis.
 SCC of nasal / sinus origin.
 Adenocarcinoma.
 Gummatous necrosis of syphilis.
 Tuberculous ulcer.
 Extranodal NK T- cell lymphoma.
 Wegener’s disease.
• Auluck A. Maxillary necrosis by mucormycosis. A case report and literature review.
Med Oral Patol Cir Bucal 2007;12:E360-4.
• Wood NK, Goaz PW. Differential Diagnosis of Oral and Maillofacial Lesions.5th
ed, 2006. Mosby, St.Louis.

 Blood investigation
 Hb - 12g%
 WBC – 12,200 cells/cm
 RBC – 4.5 cells/cm
 BT – 1 min 45 sec
 CT - 3 min 25 sec
 Platelet – 1.4lakhs/cm
 ESR 1 hr - 6 mm
 Blood sugar (R) 330mg%
 Urine sugar - +++
 Serum creatinine – 1.4 gm%
 Polymorph – 66%
 Lymphocyte – 29%
 Eosinophil – 08%
 Basophil – Nil
 Monocyte - Nil
DC

 Radiological investigation
• Destruction of L max. process.
• Opacification of the L max. sinus &
nasal fossae.

 CT Scan
• Bone erosion of the L lamina papyracea
with soft tissue thickening of the lateral nasal
& medial canthal areas
• L nasal cavity and sinus soft tissue
thickening of the septum, nasal floor &
lateral wall .
Coronal view Axial view

 Histopathology
• Long aseptate branching hyphae
FINAL DIAGNOSIS :-RHINO - MAXILLARY -
ORBITAL

Case - 2
 Chief complaint
 History of
presenting
illness
 Medical history
• Pain - headache - nasal congestion - pus
discharge - oro nasal fistula - fever.
• Pain on the L mid face region since 1 month.
• + ve diabetic history.www.indiandentalacademy.com

 Extra – Oral
examination
• L sub-mandibular LN’S – palpable, mobile,
firm & tender.

 Intra – Oral examination

PROVISIONAL DIAGNOSIS
RHINO – MAXILLARY
MUCORMYCOSIS
POSITIVE FINDINGS
 Acute onset & rapid progression.
 + ve diabetic history.
 Bone necrosis.
 Diffuse swelling of hard palate.

DIFFERENTIAL DIAGNOSIS
 Other deep fungal infection.
Osteomyelitis.
 SCC of nasal / sinus origin.
 Adenocarcinoma.
 Wegener’s granulomatosis.
 Inverted papilloma.
• Auluck A. Maxillary necrosis by mucormycosis. A case report and literature review.
Med Oral Patol Cir Bucal 2007;12:E360-4
• Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions.5th
ed, 2006. Mosby, St.Louis.
• Kirtane MV, Pai PS. Nasal Polyposis. Bombay Hosp J. 1999;41(4).

 Hb - 11g%
 WBC – 12,200 cells/cm
 RBC – 3.5 cells/cm
 BT – 1 min 45 sec
 CT - 4 min 15 sec
 Platelet – 1.2 lakhs/cm
 ESR 1 hr – 5 mm
 Blood sugar (R) - 260 mg%
 Urine sugar - ++
 Serum creatinine – 1.2 gm%
 Blood investigation
DC
 Polymorph – 66%
 Lymphocyte –
29%
 Eosinophil – 05%
 Basophil – Nil
 Monocyte - Nil

 Radiological investigations
PNS viewOcclusal view
OPGIOPA

 CT Scan
Coronal view Axial view
•Soft tissue dense mass – L max. sinus
with destruction of medial wall of max.
sinus & extn into L nasal cavity deviating
the nasal septum to R side.
• Destruction of alv. process of
maxilla & hard palate on L side

 Microbiological
investigation
• +ve β - hemolytic streptococci

 Nasal endoscopy
 Excisional biopsy
• Polypoidal pedunculated
mass in the L middle
meatus

 Histopathological investigation
• Presence of numerous inflammatory cells

INFLAMMATORY
SINO - NASAL POLYP
OF THE LEFT
NOSTRIL
 FINAL DIAGNOSIS

DISCUSSION
 Polyps are pearly white painless, prolapsed,
pedunculated parts of mucosa.
 Origin :- Antral or Ethmoidal.
 Antral polyps are usually unilaterally & may cause
bone erosion.
 Aetiopathogeneis :- Hypersensitivity reaction,
mediated by mast cell degranulation.
 P.Philip Gross (1950) reported a case of nasal polyp
extending through the hard palate.
 J.L.Esquivel (1968) reported a case of nasal polyps in
maxillary sinus.•Kirtane MV, Pai PS. Nasal Polyposis. Bombay Hosp J. 1999;41(4).
•Churchill, Livingstone. Tumors of the upper jaw. 1993.

CONCLUSION

 Kirtane MV, Pai PS. Nasal Polyposis.
Bombay Hosp J. 1999;41(4).
 Centeno RS et al. CT Scanning in Rhinocerebral
Mucormycosis and Aspergillosis. Radiology.
1981;140:383-9.
 Nasal polyps in maxillary sinus. Report of a
case. OOO vol 26. Issue 5, Nov 1968 pg-685-7.
 Nasal polyp extending through the hard palate.
OOO vol 3. Issue 2, Feb 1950 pg-198-200.
 Auluck A. Maxillary necrosis by mucormycosis.
A case report and literature review. Med Oral
Patol Cir Bucal 2007;12:E360-4.
REFERENCES

 Greenberg MS, Glick M. Burket’s Oral
Medicine; Diagnosis & Treatment. 10th
ed. 2003.
BC Decker; Ontario.
 Wood NK, Goaz PW. Differential Diagnosis of
Oral and Maxillofacial Lesions. 5th
ed, 2006.
Mosby, St.Louis.
 Rajendran R, Sivapathasundaram ed. Shafer’s
Textbook of Oral Pathology. 5th
ed. 2006.
Elsevier; New Delhi.
 Ghom AG. Textbook of Oral Medicine. 2005.
Jaypee Brothers; New Delhi.
REFERENCES

Invasive rhino maxillary lesions / dental implant courses

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