Haemophilia

The laboratory findings in haemophilia will be as follows.

APTT (activated partial prothrombin time) -prolonged

PT (prothrombin time)-normal

BT (bleeding time)-normal [1] or increased [2]

Factor VIII-C- low

Factor VIIIR:Ag [von Willebrand factor] and factor VIIIR:RCo [Ristocetin cofactor]-normal

Ref:

1. Crispian Scully, Roderick A. Cawson Medical problems in dentistry page 142 5th Ed. 
2. https://www.cdc.gov/ncbddd/hemophilia/diagnosis.html

Oral Erythroplakia

Erythroplakia is a clinical term for a potentially malignant fiery red lesion that cannot be attributed to any particular condition.

Signs and Symptoms

Lesions are usually asymptomatic and isolated, and commonly appear on the floor of the mouth, tongue, soft palate and buccal mucosa. Lesions may appear as smooth, velvety, granular or nodular plaques, often with clear margins.

Antimicrobials used in dentistry

Chemotherapy is the use of chemicals to destroy or inhibit the growth of cells. Two broad classes of chemotherapeutic agents are used in pharmacology: 

1. antimicrobials and 
2. anticancer drugs. 

The basis of antimicrobial chemotherapy is a differential sensitivity of the patient and microbe cells to the action of the drug. The drug may affect a structural component of the target cell which is not found in the patient, for example, the bacterial cell wall. Alternatively, a chemotherapeutic agent may inhibit a metabolic pathway peculiar to the microbe cells, for example, synthesis of folate.

Parotid Fistula

     Normally there is one opening of the parotid gland which is located in buccal vestibule opposite the upper 2nd molar tooth.

     Parotid fistula is a patent tract connecting a parotid gland or duct to the exterior apart from the parotid duct opening.

Photo 1. Pre-operative picture of parotid fistula with leakage of serous fluid from the fistulous tract and scarring of surrounding area (red circle) [1]

     Parotid fistula may be of two types

    1. Glandular: It arises directly from gland. It shows minimal discharge during rest or eating.

2. Ductal: It arises from duct. It shows profuse discharge during eating.

Parotid fistula may be extra oral or intraoral.

Extraoral fistulas are seen in the preauricular region or near the angle of mandible (see photo 1 and 2).

Photo 2. showing discharge of serous fluid from the right cheek in the angle of mandible region [2]

Causes
1. After superficial parotidectomy.
2. After drainage of parotid abscess.
3. After biopsy or Trauma.
4. Post surgical

Clinical Features
1.  Discharging fistula in the parotid region of the face, and discharge is more during eating.
2. Tenderness and induration.
3. Trismus if it gets infected

     Diagnosis
1.  Sialography to find out the origin of the fistula whether from the parotid gland or duct or ductules.
2. Fistulogram or CT fistulogram.
3. Culture of discharge if infection is suspected
4. MRI to assess soft tissues involvement

    Treatment
Ø Surgical stripping of the fistula tract
Ø Anticholinergics in post-operative period- Hyoscine bromide (Probanthine) reduce discharge
Ø Immediate post surgical fistulas can close spontaneously in such cases
Ø Newman Seabrock's operation: used for removal of anomalous arotid fistula
Ø If there is stenosis at the orifice of the Stenson's duct, papillotomy at the orifice may help.
Ø Total conservative parotidectomy is done in failed cases conserving the facial nerve
 

Ref:

1. Parotid fistula secondary to suppurative parotitis in a 13-year-old girl: a case report
2. Parotid Fistula : Report of Two Cases and Literature Review Introduction

Injections Techniques

Darsogluteal Intramuscular Injections