Mentonian paresthesias (Roger's sign) are associated with bone metastases (it is not paraneoplastic but direct infiltration). In this case what you describe is an oral tumor growing locally and infiltrating the mandibular canal, I believe.

Faced with a patient presenting with an ulcerovegetating lesion on the mandibular gingiva at the level of the molar region of 5 months of evolution, the appearance of hypoesthesia in the mentonian region requires ruling out:

Diagnosis of sarcoidosis with "on the scale" facial paralysis.

Herpes virus infection in immunosuppressed patient.

Diagnosis of carcinoma with infiltration of the mandibular canal.

Ramsay Hunt syndrome type 2

Ramsay Hunt Syndrome Type 2 is estimated to account for 12% of all facial nerve paralysis. It occurs in both immunocompetent and immunocompromised individuals with immunocompromised patients often having more severe disease presentation. RHS may occur in any age group with cases reported in patients ranging in age from 3 months to 82 years. The affected ganglion is responsible for the movements of facial muscles, the touch sensation of a part of ear and ear canal, the taste function of the frontal two-thirds of the tongue, and the moisturization of the eyes and the mouth. The syndrome specifically refers to the combination of this entity with weakness of the muscles activated by the facial nerve. In isolation, the latter is called Bell's palsy. However, as with shingles, the lack of lesions does not definitely exclude the existence of a herpes infection. Even before the eruption of vesicles, varicella zoster virus can be detected from the skin of the ear.

[The neuropathy of marginal mandibular branch of the facial nerve].

To analyze the diagnosis, treatment and rehabiltation of patients with marginal mandibular branch of the facial nerve (MMB). We have collected 6 patients (mean age 40 [33.8; 44] years) with isolated lesion of MMB that innervates the depressor labii inferioris and chin muscle. The illness duration without any improvement was 35 [13; 44] days. Diagnosis and treatment were carried out according to the special algorithm developed and implemented at the N.V. Sklifosovsky Research Institute of Emergency Medicine. With needle myography of the muscle that lowers the lower lip, the change in the ratio of the maximum amplitudes of the interference pattern (MAIP) in all patients exceeded 15%, and in 2 cases it was more than 90%. Comparing with the healthy face side, a change of the MAIP ratio less than 90% was considered as the biomarker of favorable prognosis, with conservative treatment recommendations, e.g. the set of exercises with targeted effects on depressor labii inferioris. With regular exercises, patients noted positive dynamics of restoring the symmetry of the smile in 1-2 months of the disease, full recovery - in 4-5 months. In case of exercises rejection, there was no positive dynamics. A change in the MAIP ratio more than 90% or the absence of motor unit potentials was considered as the biomarker of an unfavorable outcome and an indication for surgical treatment. After surgical treatment, the improvement occurred within 4-5 months. In conservative treatment group, there were no positive changes even with regular exercises. The diagnosis of an isolated lesion of MMB is established clinically using a protocol of step-by-step assessment of facial muscle function, and tactics is determined by needle myography with depressor labii inferioris. Even with favorable myographic predictors, spontaneous recovery may not occur, exercises with a targeted effect on the depressor labii inferioris are required, and in the presence of unfavorable predictors, surgical treatment is reccomended.

InternalMed_Harrison

involving the maxillary and mandibular divisions of the trigeminal nerve (e.g., maxillary sinusitis, neuroma, and leukemic infiltrate) is distinguished from ordinary toothache by the neuropathic quality of the pain. Occasionally, phantom pain follows tooth extraction. Pain and hyperalgesia behind the ear and on the side of the face in the day or so before facial weakness develops often constitute the earliest symptom of Bell’s palsy. Likewise, similar symptoms may precede visible lesions of herpes zoster infecting the seventh nerve (Ramsey-Hunt syndrome) or trigeminal nerve. Postherpetic neuralgia may follow either condition. Coronary ischemia may produce pain exclusively in the face and jaw; as in typical angina pectoris, this pain is usually reproducible with increased myocardial demand. Aching in several upper molar or

Bell's palsy

One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus. The major differences in this condition are the presence of small blisters, or vesicles, on the external ear, significant pain in the jaw, ear face, and/or neck and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete). Reactivation of existing herpes zoster infection leading to facial paralysis in a Bell's palsy type pattern is known as Ramsay Hunt syndrome type 2. The prognosis for Bell's Palsy patients is generally much better than for Ramsay Hunt Syndrome Type 2 patients. Treatment Steroids have been shown to be effective at improving recovery in Bell's palsy while antivirals have not. In those who are unable to close their eyes, eye protective measures are required. Management during pregnancy is similar to management in the non-pregnant.

Bell's palsy

One study found that 45% of patients are not referred to a specialist, which suggests that Bell's palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. Other conditions that can cause similar symptoms include herpes zoster, Lyme disease, sarcoidosis, stroke, and brain tumors. Differential diagnosis Once the facial paralysis sets in, many people may mistake it as a symptom of a stroke; however, there are a few subtle differences. A stroke will usually cause a few additional symptoms, such as numbness or weakness in the arms and legs. And unlike Bell's palsy, a stroke will usually let patients control the upper part of their faces. A person with a stroke will usually have some wrinkling of their forehead.

Neurology_Adams

Bell’s palsy may be bilateral, but only rarely is the involvement on the two sides simultaneous. The truly contemporaneous appearance of bilateral facial paralysis (facial diplegia) is most often a manifestation of the Guillain-Barré syndrome (GBS) and may also occur in Lyme disease and rarely, with HIV infection. There are numerous other causes of bilateral facial palsy, all of them infrequent. Keane (1994) listed the idiopathic (now presumably mainly viral) variety, GBS, and meningeal infiltration by tumor as the most common causes, but also found 2 cases of syphilis among 43 patients. The bilateral syndrome has been reported in approximately 7 of every 1,000 patients with sarcoidosis, although our impression is that it is more frequent. When acute in onset and associated with parotid gland swelling from sarcoidosis, it has been referred to as uveoparotid fever, or Heerfordt syndrome. In typical cases of sarcoidosis, the paralysis on each side tends to be temporally separated by

InternalMed_Harrison

Pterygopalatine Clinical Manifestations The onset of Bell’s palsy is ganglion fairly abrupt, with maximal weakness being attained by 48 h as a general rule. Pain behind the ear may precede the paralysis for a day or two. Taste sensation may be lost unilaterally, and hyperacusis may be present. In some cases, there is mild cerebrospinal fluid lymphocytosis. Magnetic resonance imaging (MRI) may reveal swelling and uniform enhancement of the geniculate ganglion and facial nerve and, in some cases, entrapment of the swollen nerve in the temporal bone. Approximately 80% of patients recover within a few weeks or months. Electromyography may be of some prognostic value; evidence of denervation after 10 days indicates there has been axonal degeneration, that there will be a long delay (3 months as 2648 Pathophysiology In acute Bell’s palsy, there is inflammation of the facial nerve with mononuclear cells, consistent with an infectious or immune cause. Herpes simplex virus (HSV) type 1 DNA was

InternalMed_Harrison

Isolated sensory loss over the chin (mental neuropathy) can be the only manifestation of systemic malignancy. Rarely, an idiopathic form of trigeminal neuropathy is observed. It is characterized by numbness Nasopharyngeal carcinoma Trauma Guillain-Barré syndrome Sjögren’s syndrome Collagen-vascular diseases Sarcoidosis Leprosy Drugs (stilbamidine, trichloroethylene) Idiopathic trigeminal neuropathy and paresthesias, sometimes bilaterally, with loss of sensation in the territory of the trigeminal nerve but without weakness of the jaw. Gradual recovery is the rule. Tonic spasm of the masticatory muscles, known as trismus, is symptomatic of tetanus (Chap. 177) or may occur in patients treated with phenothiazines. (Fig. 455-2) The seventh cranial nerve supplies all the muscles concerned with facial expression. The sensory component is small (the nervus intermedius); it conveys taste sensation from the anterior Trigeminal Neuralgia, Bell’s Palsy, and Other Cranial Nerve Disorders

Heerfordt syndrome

Diagnosis In patients that have already been diagnosed with sarcoidosis, Heerfordt syndrome can be inferred from the major symptoms of the syndrome, which include parotitis, fever, facial nerve palsy and anterior uveitis. In cases of parotitis, ultrasound-guided biopsy is used to exclude the possibility of lymphoma. There are many possible causes of facial nerve palsy, including Lyme disease, HIV, Melkersson–Rosenthal syndrome, schwannoma, and Bell's palsy. Heerfordt syndrome exhibits spontaneous remission. Treatment Treatments for sarcoidosis include corticosteroids and immunosuppressive drugs. Prevalence In the United States, sarcoidosis has a prevalence of approximately 10 cases per 100,000 whites and 36 cases per 100,000 blacks. Heerfordt syndrome is present in 4.1 to 5.6% of those with sarcoidosis.

Massive mandibular destruction and alveolar nerve infiltration without lower lip paresthesia in primary intraosseous carcinoma: report of two cases and critical appraisal of diagnostic criteria.

To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal of one of the WHO diagnostic criteria. Both patients had radiographic and histopathologic findings showing massive mandibular destruction as well as the involvement of the inferior alveolar nerve, without lip or chin paresthesia. Patients were treated through hemimandibulectomy followed by reconstruction through fibula free flap and forearm flap. Lip and/ or chin paresthesia are rather frequent in metastatic and salivary gland tumors but not in primary tumors of the jaws. Reasons for such a discrepancy are mostly unknown. A few hypotheses are put forward here. It is the opinion of the authors that most of the diagnostic criteria for solid type PIOC are acceptable. However, the criterion "absence of ulcer formation on the overlying mucosa" mainly depends on the dimension of the tumor at diagnosis.

Human mouth

all the lower teeth (inferior dental plexus). The oral mucosa of the gingiva (gums) on the facial (labial) aspect of the maxillary incisors, canines and premolar teeth is innervated by the superior labial branches of the infraorbital nerve. The posterior superior alveolar nerve supplies the gingiva on the facial aspect of the maxillary molar teeth. The gingiva on the palatal aspect of the maxillary teeth is innervated by the greater palatine nerve apart from in the incisor region, where it is the nasopalatine nerve (long sphenopalatine nerve). The gingiva of the lingual aspect of the mandibular teeth is innervated by the sublingual nerve, a branch of the lingual nerve. The gingiva on the facial aspect of the mandibular incisors and canines is innervated by the mental nerve, the continuation of the inferior alveolar nerve emerging from the mental foramen. The gingiva of the buccal (cheek) aspect of the mandibular molar teeth is innervated by the buccal nerve (long buccal nerve).

Facial Nerve Anatomy and Clinical Applications -- Clinical Significance -- Lower Motor Neuron Lesions after the Nerve Exits from the Brainstem

After its exit from the brainstem, clinical features of lower motor neuron lesions depend on which branches of the facial nerve are affected. If the motor axons of the facial nerve are affected, the result is facial muscle weakness. Damage to the nerve to stapedius results in hyperacusis; damage to the greater petrosal branch manifests as loss of lacrimation, and damage to the chorda tympani results in loss of taste from the anterior two-thirds of the tongue as well as the loss of function of the sublingual and submandibular salivary glands. Causes of lower motor neuron lesions beyond the brainstem include infections such as the herpes simplex virus (Bell's Palsy), varicella-zoster virus (Ramsay-Hunt syndrome), Lyme disease, and HIV, inflammatory conditions such as sarcoidosis, demyelinating conditions such as Guillain Barre Syndrome, vascular conditions such as hemifacial spasm due to neurovascular compression, trauma such as temporal bone fractures, and neoplasms (both benign and malignant). [14] [1] [2]

Retrocuspid papilla

Retrocuspid papilla (RCP) is a small elevated nodules mostly behind the lower canine teeth in humans(Fig.1,2). It is sometimes associated with reactive arthritis. Epidemiology The RCP are first reported in 1947 and 1965. In a Swedish population it was first reported 1994. Among 1150 consecutively examined patients aged 20 –75 years, 10 showed RCP. Among 2000 biopsy cases from 1989 - 1992 in Department of Oral Pathology Lund University, 15 biopsies met the criteria of RCP. Clinical appearance The lesions are bilaterally situated in the attached gingiva or close to the border of the mucosa lingual to the two mandibular canines (Fig.1). However, they could in a few individuals also be seen simultaneously in the molar region and on the lingual side (Fig.2). They were 2–3 mm wide and high and covered with normal mucosa. Their tips were erected or could be folded down, mimicking the entrance of a periodontal abscess, but no duct was present.

[Diagnosis and treatment of facial palsy].

The topographic diagnosis of facial nerve lesions is based on the symptoms that accompany paralysis, allowing lesions to be located in the protuberance, pontocerebellar angle, facial channel or trajectory distal to the stylomastoid foramen. Most cases of peripheral facial palsy have no apparent cause (idiopathic, or Bell's, peripheral facial palsy). However, facial palsy can sometimes be a manifestation of neuroborreliosis, multiple sclerosis, diabetes, HIV infection or neurinoma. Neurophysiologic studies complement physical examination to establish a prognosis; after the fifth day axonal degeneration related to incomplete recovery can be recognized. Magnetic resonance identifies nerve lesions but is useful only in atypical cases. Prednisone 1 mg/kg over 5 days, with gradual weaning, is the most widely accepted treatment for Bell's palsy. Acyclovir is indicated in Ramsay-Hunt syndrome. Early surgical decompression in cases with poor prognosis is not generally considered beneficial. Cases of permanent facial palsy have serious consequences, particularly because facial expression is altered.

[Neuropathy of the chin associated with neoplasms. Presentation of 5 cases and a review of the literature].

Mental neuropathy is a paraneoplastic syndrome characterized by hypoesthesia or anesthesia in the area of mental nerve inervation. Its ethyology is not well known, and in some cases would be secondary to metastasis in the mandible, meningeal carcinomatosis or infiltration of the ganglion of Gasser. We report five new cases; three of them we have studied the presence of circulating antibodies against nervous tissue of ganglion of Gasser, and it was negative in all of them. Likewise we have reviewed the literature.

Odontogenic myxoma

Patients afflicted with an odontogenic myxoma generally notice a painless, slowly enlarging expansion of the jaw with possible tooth loosening or displacement. As the tumor expands, it frequently infiltrates adjacent structures. Maxillary lesions frequently enter the sinuses while mandibular tumors often extend into the ramus. Diagnosis Radiographically, odontogenic myxomas appear most commonly as multilocular radiolucencies with ill-defined borders, though unilocular cyst-like tumors can occur, especially when associated with impacted teeth or when discovered in childhood. Ideally, the septa that cause the multilocular feature are thin and straight, producing a tennis racket or stepladder pattern. In reality, the majority of the septa visible in the tumor are curved and coarse, causing a "soap bubble" or "honeycomb" appearance, though locating one or two straight septa can aide in the diagnosis of this tumor.

First_Aid_Step1

B . Ataxic GAAit. CN V motor lesion Jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle. CN X lesion Uvula deviates away from side of lesion. Weak side collapses and uvula points away. CN XI lesion Weakness turning head to contralateral side of lesion (SCM). Shoulder droop on side of lesion (trapezius). The left SCM contracts to help turn the head to the right. CN XII lesion LMN lesion. Tongue deviates toward side of lesion (“lick your wounds”) due to weakened tongue muscles on affected side. Facial nerve lesions Bell palsy is the most common cause of peripheral facial palsy A . Usually develops after HSV reactivation. Treatment: corticosteroids +/– acyclovir. Most patients gradually recover function, but aberrant regeneration can occur. Other causes of peripheral facial palsy include Lyme disease, herpes zoster (Ramsay Hunt syndrome), sarcoidosis, tumors (eg, parotid gland), diabetes mellitus.

[The incorporation of acyclovir into the treatment of peripheral paralysis. A study of 45 cases].

The relation between use of acyclovir and facial nerve palsy prognosis was studied. In a randomised study, steroids or steroids + acyclovir (oral doses for Bell's palsy, and intravenous doses for Ramsay Hunt's syndrome) were given to 45 patients with facial palsy. There was a significant reduction of sequelae in patients treated with acyclovir in the group of Ramsay Hunt's syndrome (n = 15) (p less than 0.05). There were no significant differences in the group of Bell's palsy (n = 30) (p greater than 0.05), treated with acyclovir compared with steroids.

Dental follicle

Clinical features The dentigerous cyst is often found in areas where unerupted teeth are found. These areas, in decreasing order of frequency, are mandibular third molars, maxillary third molars and maxillary canines. The cyst may grow to a large size, replace the tooth with which they are associated, or hardly cause resorption of adjacent tooth roots. Diagnosis Clinical and radiographic assessments are required to diagnose dentigerous cysts. A cyst is present when the follicular space exceeds 5mm from the crown. However, it is possible that keratocysts and ameloblastomas mimic the radiographical appearance of follicular cysts. Aspiration can be used to differentiate the lesions. Treatment - Marsupialization This procedure is partial removal of associated tooth. The advantage of this procedure is that it maintains the vitality of teeth and is less invasive. The disadvantage is that it required substantial after care and heals very slowly. - Enucleation

InternalMed_Harrison

Laboratory Evaluation The diagnosis of Bell’s palsy can usually be made clinically in patients with (1) a typical presentation, (2) no risk factors or preexisting symptoms for other causes of facial paralysis, (3) absence of cutaneous lesions of herpes zoster in the external ear canal, and (4) a normal neurologic examination with the exception of the facial nerve. Particular attention to the eighth cranial nerve, which courses near to the facial nerve in the pontomedullary junction and in the temporal bone, and to other cranial nerves is essential. In atypical or uncertain cases, an ESR, testing for diabetes mellitus, a Lyme titer, angiotensin-converting enzyme and chest imaging studies for possible sarcoidosis, a lumbar puncture for possible Guillain-Barré syndrome, or MRI scanning may be indicated. MRI often shows swelling and enhancement of the facial nerve in idiopathic Bell’s palsy (Fig. 455-3).

Cysts of the jaws

Odontogenic cysts have histologic origins in the cells of the dental structures. Some are inflammatory while others are developmental. Radicular cyst is the most common (up to two thirds of all cysts of the jaws). This inflammatory cyst originated from a reaction to dental pulp necrosis. Dentigerous cyst, the second most prevalent cyst, is associated with the crown of non-erupted tooth. Odontogenic keratocyst This lesion may be associated with the Nevoid basal cell carcinoma syndrome. Buccal bifurcation cyst which appears in the buccal bifurcation region of the mandibular first molars in the second half of the first decade of life. Eruption cyst; a small cyst in the gingiva as a tooth erupts, forming from the degenerating dental follicle Primordial cyst; previous thought to be a unique entity. Most primordial cysts have proven to be Keratocystic odontogenic tumors Orthokeratinized odontogenic cyst; a variant of the Keratocystic odontogenic tumor

[Heerfordt's syndrome remitting without corticosteroid therapy].

A 25-year-old woman presented with low-grade fever, uveitis, and bilateral swelling of the parotid glands. Her older sister had a history of sarcoidosis. A chest X-ray film showed bilateral hilar lymphadenopathy. The low-grade fever persisted after admission. Ga scintigraphy showed abnormal uptake in the parotid glands and hilar lymph nodes bilaterally. Sarcoidosis was diagnosed histologically after epithelioid cell granulomas without caseous necrosis were found in a specimen obtained by transbronchial biopsy. Heerfordt's syndrome was the final diagnosis. Six days after admission, left facial and left trigeminal nerve paralysis developed. The symptoms remitted without steroid therapy and, as of eight months after discharge there had been no evidence of recurrence.

Nevoid basal-cell carcinoma syndrome

Signs and symptoms Some or all of the following may be seen in someone with Gorlin syndrome: Multiple basal-cell carcinomas of the skin Odontogenic keratocyst: Seen in 75% of patients and is the most common finding. There are usually multiple lesions found in the mandible. They occur at a young age (19 yrs average). Rib and vertebrae anomalies Intracranial calcification Skeletal abnormalities: bifid ribs, kyphoscoliosis, early calcification of falx cerebri (diagnosed with AP radiograph) Distinct faces: frontal and temporoparietal bossing, hypertelorism, and mandibular prognathism Bilateral ovarian fibromas 10% develop cardiac fibromas Cause Mutations in the human homologue of Drosophila patched (PTCH1), a tumor suppressor gene on chromosome 9, were identified as the underlying genetic event in this syndrome. Diagnosis Diagnosis of NBCCS is made by having 2 major criteria or 1 major and 2 minor criteria.

Numb chin syndrome: A reflection of malignancy or a harbinger of MRONJ? A multicenter experience.

Numb chin syndrome (NCS) or mental neuropathy (MN) is a disorder characterized by sensory neuropathy on the distribution of the inferior alveolar nerve or mental nerve. The most frequent causes are of odontogenic origin (infections, wrong therapies). Other etiologies are related to primary tumor, metastasis, osteoradionecrosis and medication-related osteonecrosis of the jaw (MRONJ). The aim of this study is to highlight the clinical importance of NCS as one of the first symptoms of cancer or as consequence of drug therapy. The present study was conducted from 2010 to 2016 by recruiting patients who present NCS as one of the symptoms, having excluded those in which it depends on a clear odontogenic cause, on systemic degenerative diseases or metabolic disorders. Data collection included suspected diagnosis at the time of presentation of the symptom, final diagnosis, mandibular localization, treatment performed and diagnostic delay between the first medical examination and the definitive diagnosis. This study included 29 patients in which NCS had not a clear odontogenic cause. NCS was the first symptom of malignancy in 11 cases and the clinical sign of metastasis in 4 cases. In a single patient, it was the first symptom of an immune-mediated disease. In the remaining 13 patients, NCS represented the symptom of MRONJ. NCS can be the first symptom of malignancy, especially in patients with a previous history of cancer, but also a prodromal sign of MRONJ. It should be recognized in order to require deeper examinations for early diagnosis of the disease.

Metastasis in the mandible involving gingiva: An intriguing case with a perplexing pathology.

Oral metastasis, although rare, tends to involve jawbones, particularly the posterior region of the mandible, and involvement of oral soft tissues, even when less likely, is most often seen on the gingiva and tongue. Clinically, the soft-tissue masses tend to mimic pyogenic granuloma, peripheral giant cell granuloma or an epulis and thus are difficult to diagnose and identify. The jaw bone is preferred by prostate carcinoma as a metastatic target. Prostate malignancy, which is more common in Western countries than in India, may be adenocarcinomas or carcinomas. Oftentimes, metastatic lesions develop in the alveolar region and are a cause for tooth mobility, yet, they tend to be detected only after extraction of the affected tooth. In such cases, the symptomatic presentation therefore, is vague and indicative of tooth mobility secondary to periodontal pathology unless, a detailed history and follow-up is done. We report a case of a male patient who presented to our department with a proliferative, painful, swelling postextraction of the left first molar region, and the lesion was seen at the extraction site as well as in the mandibular anterior tooth region. The swelling was associated with palpable lymph nodes. Orthopantomogram showed an irregular, radiolucent lesion extending from the lower left central incisor to the left first molar region in the mandibular alveolus. Incisional biopsy tissue came with provisional diagnosis of osteomyelitis or squamous cell carcinoma as the patient was a habitual bidi smoker for more than 20 years. Histologically, it was an undifferentiated tumor with tumor cells seen in deep connective tissue with a lack of lineage differentiation. An undifferentiated malignant tumor represents either a metastasis of unknown origin or a primary neoplasia without obvious cell line of differentiation. Immunohistochemistry (IHC) of undifferentiated tumors helps to categorize them into small round blue cell tumors or large cell tumors. The oral pathologist was perplexed as there was no mention of any other malignancy in the patient's history, which, however, was noted by the surgeons few days later. Hence, initially, a hematopoietic malignancy was suspected which was ruled out by IHC, and later, staining with cytokeratin 7 (CK7), CK-high molecular weight and P63 confirmed prostate metastases as all three were negative.

Actinomyces bovis

Role in disease Clinical presentation and diagnosis Lumpy jaw (actinomycosis) in cattle can present itself in two main ways. One is as soft-tissue abscesses in the mouth and on the tongue. The other explains its common name, lumpy jaw, as A. bovis bacteria infect the mandibular bone, causing osteomyelitis and the formation of periosteal new bone, giving it the classical lumpy jaw appearance. It is caused by sharp objects, such as coarse feed materials or sticks, causing penetrative lesions in the mouth when ingested or by complication of periodontitis. Deeper lesions are required to cause infections in the bone, while shallower lesions are more likely to cause mouth abscesses. The bony lumps are usually not painful and can develop over weeks to months, causing facial distortion, dyspnea, and occasionally loose teeth. The abscesses within the bony lumps or soft tissue commonly consist of purulent granulation tissue, often gritty in texture, surrounded by a fibrous capsule.

Periradicular burkitt's lymphoma: a report of 2 cases from Nigeria and review of the literature.

This article reports two cases of periradicular Burkitt's lymphoma from Nigeria, to emphasize the difficulties in differentiating the early lesion from other periradicular lesions with similar clinical and radiological findings Case 1, is a 4-year-old boy who presented with a one-month history of a painless, hard, posterior mandibular swelling (right), which was causing loosening and displacement of deciduous teeth (84 and 85). Histopathological examination of periradicular tissues from extracted tooth (85), confirmed the diagnosis of early periradicular B urkitt's lymphoma. Case 2, is a 6-year-old boy who presented with one-week history of a loose, extruded right mandibular first molar tooth (46) and an exfoliated left mandibular first molar tooth (36). After two weeks of follow-up, the patient developed bilateral mandibular swelling at the molar region, as well as peri-orbital and bilateral pedal oedema. Incisional biopsy of the oral lesion at the region of exfoliated left first mandibular molar (36) was useful for histopathological diagnosis of early Burkitt's lymphoma of the jaw. In the face of limited diagnostic tools such as clinico-radiological assessment, cytology or incisional biopsy for incipient periradicular lesions, a high index of suspicion of Burkitt's lymphoma of the jaw may be helpful in early diagnosis and treatment of a lesion, presenting in a child as periradicular radiolucency or mixed radiolucency and radiopacity, with associated loosening and displacement of teeth.

Orofacial granulomatosis: clinical study of 20 patients.

The objective of this study was to analyze the clinical features of a series of patients with orofacial granulomatosis (OFG). Twenty patients diagnosed with OFG at Bellvitge Hospital (Barcelona, Spain) from 1985 to 2010 were included in the study. All of our patients (9 men and 11 women, median age 48.1 years) presented with labial swelling. Six patients presented with recurrent orofacial swelling, 12 with permanent swelling, and 2 with progressive swelling. Fissured tongue was observed in 9 cases, and 2 patients presented with recurrent episodes of peripheral facial paralysis. The median follow-up time was 65.1 months, ranging from 4 to 300 months. None of our patients developed sarcoidosis or Crohn disease. In the south of Europe, OFG does not appear to be as frequently associated with Crohn disease as in northern Europe. Although several treatments may achieve transient control of the orofacial swelling, there is no curative treatment for OFG and some patients may develop embarrassing lesions.

[Ramsay-Hunt syndrome associated to unilateral recurrential paralysis].

Varicella herpes zoster (VZV) virus reactivaction can produce multiple neuropathies of the cranial and cervical region being the peripheral facial paralysys the most common one. We report one case of Ramsay-Hunt syndrome with eruption of vesicles on left auricular pinna and face besides facial palsy which associated to ipsilateral laryngeal or recurrential paralysis nonexisting previously. Our patient was treated by oral aciclovir (800 mg, 5 times daily) for 1 week. 3 months later she returned to Emergencies due to another cause and the ENT exploration showed a recovery in the mobility of the left cord but it persisted the affectation of VII pair, specially the inferior branch or cervicofacial. It is advised that the larynx should be examined in all cases of herpes zoster that involve the head and neck.

Human tooth development

Primary dentition starts on the arrival of the mandibular central incisors, usually at eight months, and lasts until the first permanent molars appear in the mouth, usually at six years. The primary teeth typically erupt in the following order: (1) central incisor, (2) lateral incisor, (3) first molar, (4) canine, and (5) second molar. As a general rule, four teeth erupt for every six months of life, mandibular teeth erupt before maxillary teeth, and teeth erupt sooner in females than males. During primary dentition, the tooth buds of permanent teeth develop below the primary teeth, close to the palate or tongue.

[Isolated mandibular B-cell lymphoma revealed by inferior alveolar nerve anesthesia].

Mandibular lymphomas are rare and most often revealed by painless swelling. The authors report the case of a mandibular lymphoma revealed by an isolated lesion of the inferior alveolar nerve evolving for eight months. A 41-year-old male patient was followed for left mandibular pain, with progressive hypoesthesia of the left inferior alveolar nerve. The radiological assessments remained normal during eight months. Then a vestibular tumor developed in front of tooth 34. The biopsy revealed a B-cell lymphoma. No other localization was found. The patient was in complete remission two years after polychemotherapy. Our observation is unusual in its clinical presentation. Mandibular lymphomas most often present as a painless swelling, sometimes ulcerated in the mouth. They are very rarely diagnosed after an isolated hypoesthesia of V3. Lymphomas are the second most frequent head and neck lymphomas after epidermoid carcinomas, but the frequency seems to be increasing. In almost all the cases, they present as B-cell tumours of the DLBCL subtype in the WHO classification. Mandibular localizations account for only 0.6% of the cases. They are often misdiagnosed as a dental problem. The complete remission rate after chemotherapy ranges from 60 to 80% at one year. Nevertheless, the prognosis remains bad with a survival rate of only 50% at five years.

Herpes esophagitis

Herpes esophagitis is a viral infection of the esophagus caused by Herpes simplex virus (HSV). While the disease most often occurs in immunocompromised patients, including post-chemotherapy, immunosuppression with organ transplants and in AIDS, herpes esophagitis can also occur in immunocompetent individuals. Signs and symptoms People with herpes esophagitis experience pain with eating and trouble swallowing. Other symptoms can include food impaction, hiccups, weight loss, fever, and on rare occasions upper gastrointestinal bleeding as noted in the image above and tracheoesophageal fistula. Frequently one can see herpetiform lesions in the mouth and lips. Diagnosis