According to the 3rd edition of the international
classification of headache disorders (ICHD3 2013),
Trigeminal Neuralgia (TN) is classified into two types:
1. Classical TN, purely paroxysmal 2. Classical TN
with concomitant persistent facial pain. In this article,
the authors describe a 47 year-old, male with unilateral,
severe, recurring, electric shock-like pain involving left
lower jaw, teeth and gingiva. Diagnosis of classical TN
of the left 3rd division of the trigeminal nerve was made.
The patient was treated with pharmacotherapeutic agents
but without relief. Magnetic resonance imaging (MRI)
of the brain showed medial vascular compression of left
trigeminal pontine root entry zone caused by superior
cerebellar artery. A microvascular decompression (MVD)
surgery was done at the left trigeminal pontine root entry
zone resulting in good relief of pain. This article highlights
the differential diagnoses to be considered with TN and
also emphasize the difference between the two types of
the TN according to ICDH3 (2013). It also highlights the
difference between classical TN purely paroxysmal with
and without vascular compression by imaging techniques
and their differing treatment modalities, which therefore
should be reflected in future ICDH classification.
There is significant amount of research done
on Oral Squamous cell carcinoma (OSCC). One research
technique is immunohistochemical (IHC) analysis using
whole sections. With little availability of OSCC tissues
high throughput analysis such as Tissue Microarray
(TMA) are capable of efficient analysis of small samples.
However, the results become questionable if the tumor
exhibits high degree of heterogeneity as TMA cores might
not accurately represent the whole section. Aim: The aim
of this study is to determine the optimal number of TMA
cores required to provide an accurate representation of
the whole section with IHC analysis in OSCC. Materials
and Methods: Twenty tissue samples stained with
anti-p53 antibody were scanned at 40x magnification.
Three to six virtual cores of size 0.6 mm, 1.0 mm and
1.5 mm were drawn on the scanned slides. H-scores
were obtained for both whole sections and cores using
NuclearQuant (3DHistech, Budapest, Hungary) software
after eliminating non-tumour cells and artifacts manually.
The correspondence between the cores and whole sections
were calculated using intra-class correlation and one
sample t-test. Results: Good correlation was obtained
with just a single core of 0.6mm (0.826). Subsequent
increase in core number and size resulted in improved
correlation coefficient and smaller confidence interval.
Conclusion: Three TMA cores of 0.6 mm would be the
most optimal, as not only was there very strong correlation
with the whole tissue section, the extra core will also be
able to act as confirmation if the results of the first 2 cores
are in doubt.
The prevalence of oral mucosal lesions in elderly
population is 22.8% to 61.6%. Conventional oral
examination (COE) is usually carried out to detect oral
mucosal lesions (OML). However, new diagnostic aids
have been introduced to improve OML detection. This
study aimed to determine the utility of autofluorescence
(AF) imaging in detecting OML from normal oral mucosa
and its anatomic variation among institutionalised elderly
Malaysian when compared with COE. Fifty subjects
randomly selected from 9 nursing homes and COE and AF
imaging using VELscope Vx, (LED Dental, Vancouver,
British Columbia, Canada) were carried out. Sensitivity,
specificity, positive (PPV) and negative predictive value
(NPV) and accuracy of AF imaging were calculated.
From the study, fifteen subjects had normal oral mucosa,
15 anatomic variations and 36 lesions were identified.
The sensitivity and specificity of AF imaging were 100%
and 70% whereas the PPV and NPV were 80% and 100%
respectively. The accuracy of AF imaging was 86.37%
when compared to COE. In conclusion AF imaging was
able to detect OML and differentiate them from normal
oral mucosa. However it has limited usefulness in
differentiating between these lesions. This study however,
was able to detail the AF imaging profile of normal oral
mucosa, its normal variants and some common reactive or
infective lesions which can be used in future OML studies
as comparison to oral potentially malignant lesions.