Biomedical subjects

Saravanan Ram

Publications and source records attributed to Saravanan Ram.

7 recordsLinked to original sources

PubMed2007

Four oral motor disorders: bruxism, dystonia, dyskinesia and drug-induced dystonic extrapyramidal reactions.

This article reviews four of the involuntary hyperkinetic motor disorders that affect the orofacial region: bruxism, orofacial dystonia, oromandibular dyskinesia, and medication-induced extrapyramidal syndrome-dystonic reactions. It discusses and contrasts the clinical features and management strategies for spontaneous, primary, and drug-induced motor disorders in the orofacial region. The article provides a list of medications that have been reported to cause drug-related extrapyramidal motor activity, and discusses briefly the genetic and traumatic events that are associated with spontaneous dystonia. Finally, it presents an approach for management of the orofacial motor disorders. The contraindications, side effects, and usual approach for medications and injections are covered. An overview of the indications, contraindications, and complications of using botulinum toxin as a therapeutic modality is discussed briefly.

Basal Ganglia Diseases↗

PubMed2006

Multicentric peripheral ossifying fibroma.

Peripheral ossifying fibroma (POF) is a common solitary gingival growth thought to arise from the periodontal ligament. Though the etiology of POF remains unknown, some investigators consider it an inflammatory or reactive process, while others suggest it is a neoplastic process. In this report, we present and discuss a unique case of multicentric POF, affecting the maxillary and mandibular gingiva of a 49-year-old Caucasian female with meticulous oral hygiene and routine dental care. Though biopsy samples from multiple sites revealed similar histopathologic features, consistent with POF, the fact that there was a multicentric presentation is a unique phenomenon for this lesion. Multicentric lesions presenting in the oral and maxillofacial region are not typical, but have been observed in conditions associated with known genetic mutations, such as nevoid basal cell carcinoma syndrome (multiple odontogenic keratocysts), multiple endocrine neoplasia type II (multiple neuromas), neurofibromatosis (multiple neurofibromas) and Gardner syndrome (multiple neoplasms). This case is the first one to demonstrate that there may be a multicentric variant of POF that has not been previously recognized, and given the clinical presentation and multifocal nature of disease, the lesions in this patient are likely the result of genetic mutation(s) that predisposes to gingival soft tissue overgrowths containing mineralized product.

Female↗

PubMed2006

Using oral medications, infusions and injections for differential diagnosis of orofacial pain.

Chronic orofacial pain is a rapidly evolving and challenging field that deals with the management of pain originating from neurogenic, osseous, muscular, or vascular structures of the head and neck. The challenge lies in the accurate diagnosis of orofacial pain conditions, which may be difficult to differentiate in many clinical situations. As pain cannot be "seen" or precisely located or its intensity measured with any device, clinicians must rely heavily on the patient's own description of type, duration and location of pain, and thus, history plays a crucial role in diagnosis. Advances in neuroscience, pharmacology, and pain management have made medications one of the primary therapeutic modalities in the management of pain including orofacial pain conditions. Despite this, these medications will not help patients if the origin and nature of pain is not accurately diagnosed. Hence, diagnosis is critical for successful management of orofacial pain conditions. Experience and knowledge of practice in pain management have led clinicians to devise several clinical diagnostic tests using medications in various forms (topical, oral, injections, intravenous infusions) to differentiate certain orofacial pain disorders where the nature of pain is unclear and the presentation of pain is at multiple sites. Although the diagnostic tests are not 100 percent accurate, they are very effective in many clinical scenarios, especially in orofacial pain conditions. Topical medications such as anesthetics and anti-inflammatories, oral medications such as anti-inflammatory drugs and skeletal muscle relaxants, injections such as local anesthetics and corticosteroids, and vapocoolant sprays are some examples of the modalities used by clinicians to manage orofacial pain conditions. These medications may also be used for diagnostic tests to aid in accurate diagnosis of some orofacial pain conditions. In addition, there are special cases where medications such as triptans, carbamazepine and indomethacin may be used as diagnostic tests to confirm diagnosis of migraines, neuralgias, or stabbing headaches, respectively. Based on the concept of using medications to predict which treatment would be best for certain pain conditions or to aid in better diagnosis, diagnostic intravenous infusions of lidocaine, morphine, and ketamine have been studied to test the response to adjuvant analgesics and oral dextromethorphan. Paradoxically, taking the patients off their current medications can be of diagnostic significance in conditions like medication overuse headache and serotonin selective reuptake inhibitor-induced clenching. In summary, this paper focuses on the use of medications in different forms as useful diagnostic tests for differential diagnosis of orofacial pain conditions that are difficult to diagnose or are refractory to past or current treatment.

Adrenal Cortex Hormones↗

PubMed2004

Pseudo bilateral tonsilloliths: a case report and review of the literature.

Tonsilloliths are very rare concretions found in the tonsillar crypt. They are usually single and unilateral, but occasionally may be multiple or bilateral. Small concretions in the tonsils are common, but well formed giant unilateral or bilateral tonsilloliths are extremely uncommon. Only two cases of bilateral tonsilloliths have so far been reported in the literature. A case of unilateral tonsillolith, mimicking bilateral tonsilloliths taken with the orthopantogram (OPT) in a 57-year-old Malaysian Indian female with squamous cell carcinoma of the oral cavity is described. Although the OPT is a reliable and standard panoramic X-ray unit used in dentistry, superimposition of a lesion involving one side of the jaw creates a pseudo or ghost image on the contralateral side leading to a misdiagnosis of bilateral lesions. This report highlights that tonsilloliths, though rare, should be considered in the differential diagnosis of radiopaque masses involving the mandibular ramus, and that investigations such as CT scan or MRI may be required to differentiate pseudo or ghost images from true bilateral pathologies.

Calculi↗

PubMed2004

Cannon's disease: clinical and diagnostic implications: a case report.

Cannon's disease or white sponge naevus is a relatively rare genetically determined skin disorder. It is inherited as an autosomal dominant trait that displays a high degree of penetrance and expressivity. This article describes cases of Cannon's disease in a mother and her son.

Adult↗

PubMed2004

Osteoma of the condyle as the cause of limited-mouth opening: a case report.

Osteoma is a benign tumour consisting of mature bone tissue. It is an uncommon lesion that occurs mainly in the bones of the craniofacial complex. Only a few cases involving the condylar process have been reported. An osteoma of the left condyle causing limited mouth-opening in a 32-year-old Malaysian Chinese female is reported here to alert the practitioner to consider this lesion as a diagnostic possibility in instances of trismus or limited-mouth opening.

Adult↗

PubMed2003

Oral candidosis in non-Hodgkin's lymphoma: a case report.

Though oral candidosis is an opportunistic fungal infection that commonly affects immunocompromised patients, little is known of its occurrence as a complication of Non-Hodgkin's lymphoma. This paper reports a case of oral candidosis in a 20-year-old Indonesian woman with this lymphoproliferative disease. She presented with acute pseudomembranous candidosis on the dorsum and lateral borders of the tongue, bilateral angular cheilitis and cheilocandidosis. The latter is a rare clinical variant of oral candidosis, and the lesions affecting the vermilion borders presented as an admixture of superficial erosions, ulcers and white plaques. Clinical findings were confirmed with oral smears and swabs that demonstrated the presence of hyphae, pseudohyphae and blastospores, and colonies identified as Candida albicans. A culture from a saline rinse was also positive for multiple candidal colonies. Lip and oral lesions were managed with Nystatin. The lesions regressed with subsequent crusting on the lips, and overall reduction in oral thrush. As Non-Hodgkin's lymphoma is a neoplastic disease that produces a chronic immunosuppressive state, management of its oral complications, including those due to oral candidosis, is considered a long-term indication.

Adult↗