Category Archives: Case Report

Non Syndromic Congenital Agenesis of Multiple Permanent Teeth: Case Series and Recent Literature Review

DOI: 10.2478/amma-2022-0013

Introduction: Hypodontia refers to the congenital absence of less than six teeth. This absence may be unilateral or bilateral. Though the congenital agenesis of bilateral mandibular/ maxillary incisors has often been reported in literature, however, the congenital absence of bilateral mandibular and maxillary incisors, as well as the mandibular second molar- giving rise to a total of six missing permanent teeth in an apparently healthy individual has not been reported earlier.
Case presentation: This case series presents two cases of a 10- and 11-year-old children with presence of retained deciduous anterior in both arches with absence of permanent successors and also aims to review the literature regarding etiology, clinical implications and management in such cases.
Conclusions: It is essential that practitioners monitor the developing dentition with establishment of a proper review schedule. Non-eruption of the permanent tooth more than one year later than expected, or even after six months following the emergence of the contralateral tooth, warrants a high degree of suspicion. A multidisciplinary team, including pediatric, restorative and orthodontic specialists, is advised. In addition, prior to formulation of any treatment plan, due consideration to the general issues such as the patient’s systemic and oral health, motivation and expectations should be given.

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Use of the continuous glucose monitoring system in the management of hypoglicemia in Insulin autoimmune syndrome

DOI: 10.2478/amma-2022-0011

Background: Insulin autoimune syndrome (IAS), also known as Hirata’s disease, is a rare cause of spontaneous hyperinsulinemic hypoglicemia characterised by the presence of autoantibodies directed against human insulin (IAA).
Case Report: A 48-year-old Caucasian female patient with IAS was studied in two different periods, for 7 days each, using a continuous monitoring system (CGM) under various treatment regimens, i.e diet modification and corticosteroids therapy.
Discussions: The use of CGM in autoimmune hypoglycemia is encouraged and must be taken into consideration in order to prevent episodes of hypoglicemia. Including of IAS and quantification of IAA in differential diagnosis in patients with hypoglicemia episodes and negative imaging results can prevent patients from going through unnecessary procedures.

 

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Abdominal wall metastases due to a squamous cell carcinoma of the lung: case report and literature review

DOI: 10.2478/amma-2022-0010

Introduction: At the time of diagnosis, most patients with lung cancer are in an inoperable stage, with distant metastases. Most often, these patients have metastases to the brain, adrenal glands, liver, or bones. This article presents the case of a patient with non-small-cell lung cancer (NSCLC) metastases in the abdominal wall.
Case presentation: A 67-year-old patient came to our service reporting the existence of a tumor 5 cm in diameter, located at the level of the abdominal wall, without other clinical symptoms. Surgical excision of the tumor was performed. The postoperative evolution was favorable, with the patient discharged on the third postoperative day. Histological examination of the resected specimen revealed metastasis of squamous cell carcinoma of the lung.
Conclusions: The appearance of a tumor in the abdominal wall of patients with NSCLC may raise the suspicion of metastasis at this level.

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Pier Abutment: Bridge the gap with Non rigid connector – A clinical case report

DOI: 10.2478/amma-2022-0008

Pier abutment is defined as a freestanding abutment with edentulous space on both sides. This case report described the rehabilitation of a patient who presented to the department with the primary complaint of missing teeth and difficulty in mastication. Intraoral examination revealed missing right maxillary canine and the second premolar, with the lone standing first premolar acting as a pier abutment. To reduce the stress transferred to the abutment and prosthetic assembly, a non-rigid (Tenon-mortise) connector was used in the case, with a keyway (mortise) distal to the pier abutment and a key (Tenon) mesial to the distal pontic.

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Chest wall secondary chondrosarcoma caused by malignant degeneration of an enchondroma: case report and literature review

DOI: 10.2478/amma-2022-0006

Introduction: Enchondromas are benign tumors originating in the cartilaginous tissue of the hyaline gristle, rarely located in the chest wall. They sometimes undergo a sarcomatous transformation, becoming secondary chondrosarcomas.
Case presentation: We present the case of a 53-year-old patient who, following a chest computed tomography scan performed after a thoracic trauma, was diagnosed with an osteolytic tumor at the chondrocostal junction of rib 4. Surgery was performed, with partial straight resection of ribs 3–5. Histopathological examination of the resection piece identified the existence of a chest wall chondrosarcoma on the background of malignant degeneration of an enchondromatosis lesion. The postoperative evolution was favorable, and the patient was discharged on the eighth postoperative day.
Conclusion: In patients with even asymptomatic chest wall enchondromas, periodic clinical evaluation of these lesions is required, given their risk of malignant degeneration.

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Rehabilitation of maxillary arch with attachment-retained reinforced single complete denture

DOI: 10.2478/amma-2022-0003

Introduction: Fracture of maxillary complete denture is a common problem for dentists and denture wearers, occurring especially when it is opposing mandibular natural teeth or fixed and implant-sustained restorations; to prevent it, various methods and materials are available.
Case presentation: This case is of a patient losing his old maxillary removable partial denture due to the mobility of the frontal abutments. Considering the age of the patient and the status of the mandibular arch, completely restored and having a mix of natural teeth, fixed and implant-sustained restorations, the functional and esthetic rehabilitation of the maxillary arch, and also the long-term resistance of the denture, are a serious prosthetic challenge. An association between ball attachments, metal-casted reinforcement and masking agents for both are described, underlying their role in the treatment’s succes.
Conclusion: The age and health status of the patient and the situation of the mandibular arch imposed the construction of a functional, strong and stable maxillary denture; the technique described in this article offers a good functional and esthetical result and benefits the patient, even if the implant-prosthetic therapy is not available.

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Maturogenesis of an immature necrotic tooth with an extensive perirapical lesion using platelet rich fibrin

DOI: 10.2478/amma-2022-0001

Introduction: Earlier, treatment of immature necrotic tooth focussed only on surgical endodontic management and apexification procedures. Regenerative endodontic therapies have called for a paradigm shift in management of such cases. Prognosis becomes challenging though at times due to chronicity of infection, inadequate disinfection of canal space and cytotoxic nature of irrigants used hindering the survival of the apical stem cells.
Case presentation: This report highlights the management of a long-standing case of an immature necrotic tooth with an extensive periapical lesion in a 12 year old male patient. The protocol of regenerative endodontic procedure using platelet rich fibrin (PRF) was followed. Follow up visits at 1week, 3months and 12 months revealed a successful clinical and radiological outcome leading to progressive maturogenesis of the tooth.
Conclusion: The case report favours the possibility of stem cells of apical papilla being viable even in chronic periapical lesions. Hence conservative approach involving regenerative endodontic therapies should always be sought for as first line of treatment in such cases.

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Ulnar-basilic arteriovenous fistula with multilocular gigantic aneurysmal dilatation: a case report

DOI: 10.2478/amma-2021-0035

Introduction: Arteriovenous fistula dysfunction has been associated with a range of problems such as thrombosis, stenosis, dilatation, and infection.
Case presentation: We present the case of a 64-year-old patient with chronic kidney disease on hemodialysis and with aneurysmal dilatation of the ulnar-basilic arteriovenous fistula, having an increased risk of rupture. A temporary dialysis catheter is placed in the left femoral vein, an aneurysmal basilic vein is ligated at the anastomosis, aneurysmal dilatation is emptied by compression, and a right radiocephalic arteriovenous fistula is performed. The patient undergoes hemodialysis on the second day and subsequently three times a week for six weeks until the new arteriovenous fistula develops. He returns for aneurysmal sac resection.
Conclusion: The purpose of this paper is the presentation and management of a 15-year-old ulnar-basilic arteriovenous fistula with multilocular aneurysmal development and an imminent rupture.

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Prosthodontic Management of Dentate Maxillectomy Patient: A Clinical Case Report

DOI: 10.2478/amma-2021-0038

Patients with minor defects of the alveolar ridge and hard palate can easily be treated by surgical closure, while patients with larger defects are more amenable to prosthetic restoration. The case report describes the rehabilitation of a dentate maxillectomy patient with a definitive closed hollow bulb cast partial obturator. A tripod retainer design was chosen for direct retention in the case. The tripod design consisted of a T-bar clasp placed on the left first central incisor and two embrasure clasps with buccal retention and palatal bracing components between the right first & second premolar and right first & second molar. A complete palate major connector was designed to ensure uniform distribution of functional load across tissues. The remaining teeth, the palate, and the rest provided support for the prosthesis. Prosthetic rehabilitation of the defect with a definitive obturator thus seals tissue openings in the palate, improves deglutition, speech, mastication, aesthetics, and significantly improves quality of life.

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Adenosquamous and squamous cell carcinoma of the pancreas: two histopathological variants of ductal adenocarcinoma

DOI: 10.2478/amma-2021-0025

Introduction: Primary squamous cell carcinoma (SCC) and adenosquamous carcinoma of the pancreas are rare malignancies for which diagnostic and treatment strategy are challenging. In this paper we present a literature review of these tumors based on two case reports.
Case presentation: In the first case, a 55-year-old male presented with an inoperable pancreatic head/body junction tumor. Endoscopic ultrasound-guided fine needle aspiration was practiced, and histopathological examination revealed a squamous cell carcinoma of the pancreas. After exclusion of any another tumor, the diagnosis of cT4N0M0-staged primary pancreatic SCC was made. The patient is under treatment with gemcitabine and oxaliplatin. The second case is represented by a 73-year-old patient in which imagistic examinations highlighted a cystic mass of the pancreatic body. Following coporeo-caudal splenic-pancreatectomy and histopathological-proved diagnosis of adenosquamous carcinoma, the patient started chemotherapy but died at 11 months after surgery. Both tumor components displayed positivity for markers which prove ductal (cytokeratin19, maspin) and squamous differentiation (p63, cytokeratin5/6) same as vimentin, as indicator of epithelial mesenchymal transition (EMT).
Conclusions: SCC and adenosquamous carcinoma of the pancreas are aggressive malignancies which prognosis remains highly reserved. These tumors might be variants of ductal adenocarcinomas which are dedifferentiated through EMT phenomenon.

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