Interesting Cases

Case Story 1.
Ludwig’s Angina A 47 years old Female patient came to the department of Dentistry in T S Misra Medical College, Lucknow with Chief complaint of reduced mouth opening with swelling and pain over chin region from last 4-5 days. After clinical and radiographic ( Digital OPG) examination it was found that right mandibular first molar is decayed with periapical pathology, restricted mouth opening ( 20 mm) , raised floor of the mouth leading to difficulty in breathing. The case was diagnosed as Ludwig’s Angina (Infection involving sub mental, sub mandibular and sub lingual spaces). In acute condition this may lead to chocking of airway and can lead to death. All necessary blood investigations were done and case was planned for incision & Drainage. Extraction of right mandibular first molar followed by Extraoral incision and drainage at submental region was done under local anesthesia by Dr Manish Dubey. Approximately 10 ml pus was collected and sent to the microbiology lab for culture and sensitivity test. Corrugated rubber drain placed for 24 hours. Patient was admitted in hospital for 7 days. After 7 days of Intravenous medication patient was discharged with satisfactory result (No swelling , no pain, with 35 mm of mouth opening.)

Case Story 2.
A 52 years old lady came to the Department of Dentistry in T S Misra Medical College, Lucknow with chief complaint of difficulty in Chewing food and changed facial appearance due to her missing teeth from last 4-5 years. After clinical examination it was found that only 3-4 teeth were present in her mouth that too were mobile and not in a condition to support any fixed prosthesis. She was advised for implant supported denture but due to financial issues she agreed for complete denture prosthesis with soft liner. As per treatment plan her remaining teeth were extracted, Maxillary and Mandibular ridges were inspected for any preprosthetic surgery, if required. After healing of extraction sockets, primary impression was made followed by denture base fabrication, border moulding, secondary impression, occlusal rims, jaw relations, try in and finally insertion of complete denture with soft liner. The purpose of soft liner is to provide a smooth and cushion like surface to the alveolar ridges that would help in mastication. Patient was totally satisfied with this prosthesis. The complete procedure was done within a week after healing of extraction sockets. Patient smiled with her teeth after 5 years with improved facial appearance.

Case Story 3.
Premature twins survive against odds in TSM Medical College & Hospital, Lucknow In a miraculous show of endurance, twin baby boys weighing just 960 gm and 1120 gm during their premature birth have survived after a stormy clinical course of neonatal care at TSM hospital. Born to Savitri and Mukesh Kumar from ograpur, Unnao, who were married for 2 years, the preterm were conceived and were born prematurely through an emergency caesarean section at 28 weeks of gestation, were barely larger than a human hand and were very precious for the family. They required artificial breathing support and were quickly transferred to the neonatal intensive care unit (NICU). The twin babies were born on June 6th this year. Sheltered under radiant warmer cover with polyocclusive sheet, circuits, central lines, probes, dressings and eye pads,. One of them was put on ventilator as well as multiple blood transfusions and plan to give surfactant to expand their tiny immature lungs, as they were struggling to breathe. Dr. Rohit Agarwal, who led a team of doctors including Dr. Arvind Shukla, Dr. Abdullah and nursing staff at the hospital for ensuring the twins’ incredible survival, said the babies, had infection in blood and their heart functions and pumping was poor. As their gut was immature and could not be fed, the babies were put on total parenteral nutrition (TPN), supplying all essential nutrients by blood. Dr. Rohit said, regular screening of heart and brain is being performed to rule out any bleeding in the brain. “As the brain was immature, the babies used to forget to breathe. Medically, the condition is called apnea of prematurity,” he added. The baby boys completing the clinical course in NICU since 6th of June and currant weights are 1210 gm and 1480 gm. Their brain is structurally normal and eyes are developing normally. It is a long and tough journey for the doctors looking after the twins. “At the best of centers, only 20-30 % of such babies are born with this weight. The possibility of healthy survival is low due to infection and various prematurity related problems, he further added. “We are grateful to the doctors and the hospital for their care and help including financial support. We had full faith in the doctors and TSM Hospital, our babies have survived even when the chances of survival were less,” said Mukesh Kumar, the father. Dr Rohit, senior consultant, added, “the fact is that immature preterm babies in developing countries not only have a chance, but also the right to survive and live a normal life. Sophisticated neonatal care and teamwork could make this happen. Infect, survival of such immature preterm babies may be a daunting task, but not impossible.” ..

Case Story 4
Patient name:Neha Yadav 22/F came to the dept of dentistry in TS Misra medical college with chief complaint of pain and pus discharge from right lower back tooth region from last 6 months..also complaint of ugly scar at right side of face with a big mole.. she wanted to get rid of that scar and pus discharge problem.. After clinical and radiographic examination found decayed and chronic periapical pathology in right maxillary and mandibular first molar ..infected right mandibular first molar leading to extraoral pus discharge through sinus tract and necrosed skin As per treatment, extraction of molar teeth with fistulectomy procedure done under local Anesthesia ..A second stage scar revision surgery done after 20 days to remove preexisting scar ..

Case Story 5
Interesting Case Surgical Oncology A 80 years old man admitted with constipation, distension of abdomen & vomiting 3 days in July 2017. Clinically he had an abdominal mass left side, USG and CECT abd confirmed spleen flexure mass. As patient developed features of intestinal obstruction his colonoscopy was deferred and he was explored on 10.07.2017, a10 x 10 x 8 cm growth was found at splenic flexure with no ascitis, no hepatic metastasis or regional LN. Tumor was excised gut continuity restored and diverting and ileostomy was done. Patient developed wound infection and dehescence. He was managed conservatively. Ileostomy was closed on 23rd August 2017. Histopathology was gastro intestinal stromal tumour. Now patient is done well, He is on regular follow up and 300 mg imatinib daily x 3 years.