Odontomas are rare pathological abnormalities which may occur at any age. It is most unusual to observe an odontoma together with supernumerary teeth, more particularly if this is found in conjunction with an osteoma. This report emphasizes the underlying pathology of a case co-incidentally encountered in a 14 year old patient whose main complaint was of a painful 85 tooth. An incisional biopsy of the area revealed the presence of mineralized tooth-related tissue resembling a complex odontoma. In conjunction with the radiographic evidence, which confirmed the presence of complex and compound odontomas as well as a number of small osteomas, a provisional diagnosis of Gardner's syndrome was made. The syndrome is a rare autosomal disease that is difficult to treat. If a dentist suspects a patient may present with Gardner's syndrome, the patient should be referred immediately for further medical management.

AIM: To determine the prevalence, aetiological factors and demographic data of patients presenting with injuries sustained from maxillofacial trauma over a six month period at Zithulele Hospital MATERIALS AND METHODS: In a retrospective, descriptive study, data collected and analysed included records of all patients who had suffered maxillofacial trauma, their demographics, clinical features and the aetiology. The radiographic records were assessed by a maxillofacial surgeon and a radiologist for a diagnosis as well as gaining opinions regarding the types of fractures observed. RESULTS: A total of 239 patients sustained maxillofacial trauma. The most common aetiological factor was interpersonal violence (55%) followed by road traffic accidents (16%), falls (10%), animals (4%) and other causes (2%). The male to female ratio was 2.6:1 and the 18-24 years age group endured the most trauma. A total of 210 (88%) patients sustained soft tissue injuries while 29 (12%) experienced hard tissue injuries, with 39 fractures diagnosed. A total of 165 maxillofacial radiographs were assessed, 37% were diagnostically acceptable, 56% had poor diagnostic value and 7% had no diagnostic value. CONCLUSION: Maxillofacial trauma is prevalent in rural parts of South Africa. Males aged 18-24 years are frequent victims, with interpersonal violence being the major aetiology.

A comparison of radiation doses to selected vital organs in the maxillo-facial region at three different settings on the Galileos® cone-beam computed tomography (CBCT) machine in the Wits Dental Hospital was conducted with the courtesy of the Department of Medical Physics of the Charlotte Maxeke Johannesburg Academic Hospital. The study made use of the RANDO® phantom and TLD- 100 detector chips which provided detailed mapping of the dose distribution from the Galileos CBCT machine. Sixty-two Sanford® lithium fluoride dosimeters- (TLD- 100) were irradiated using a calibrated known x-ray source after having undergone a recommended annealing cycle. The data showed acceptable consistency in the results. Association between the different imaging modalities was further investigated using Kruskal-Wallis equality-of-populations rank test and Chi-squared test. A p-value of <0.05 was considered statistically significant. Since there do not appear to be major differences between the radiation doses for the different settings of the Galileos CBCT machine, the authors recommend the use of the combined setting at all times for optimum image quality.

Two cases of sialoliths. a.) A 32 year-old female, referred to the Wits Oral Health Centre by a private periodontist who suspected a stone in the submandibular duct. The patient experienced a sharp stabbing pain beneath the right side of her chin, exacerbated on eating. Intraoral palpation of the duct revealed nothing. Panoramic and scanning radiography confirmed a small radiopaque sialolith near the angle of the mandible, measuring 6.43mm in diameter. Sialography determined it was wedged within the genu of the duct. Surgical access was difficult, possibly leading to removal of the entire gland. As the pain had subsided, the patient will be monitored over the following few months. b.) A fifty two year-old male patient with a three year history of pain and swelling on the right side of his face. Previous medical consultations failed to diagnose the cause. Intraorally a creamy-white, bony-hard lesion was visible, perforating through the sublingual mucosa. Various radiographs confirmed the presence of a giant sialolith, measured on cone-beam scan at 25 x 26mm. Excisional biopsy easily shelled out the stone The resultant cavity was marsupialized and the defect sutured. Possible causes of Sialolithiasis, the various imaging modalities and alternative treatment options are discussed.

A 32 year-old male patient, who had previously presented with all the signs and symptoms of scleroderma,was referred to a dental clinic in 2013 for removal of a lower left canine tooth that was traumatising his lower lip. His face showed tight skin with loss of wrinkling resulting in the classical "mask-like" facies. Both the sclera and intraoral soft tissues were pale, suggestive of some form of anaemia. Telangiectasia was noted in the lower lip which, together with the soft palate, was fibrosed. Mild restriction of mouth opening was noted. The patient was fully dentate but exhibited poor oral hygiene. The lower left canine was labially displaced, non-carious and firm. A panoramic radiograph showed severe resorption of the ramus, angle and body of the mandible as well as of the roots of the posterior mandibular teeth. The condyles were relatively unaffected. Multiple carious teeth were noted. The periodontal spaces appeared relatively normal. Both submandibular glands showed calcification and it appeared that there were undisplaced bilateral pathological fractures distal to the wisdom teeth. No radiological evidence of caries or periodontal disease was detected on the 33, which was extracted to relieve the patient of pain and discomfort. Healing was uneventful.

Pseudo-ankylosis of the temporo-mandibular joint (TMJ) refers to a persistent restricted mandibular hypomobility resulting from a pathologic condition outside the TMJ. Ankyloses may be acquired or congenital. Most congenital ankyloses are extracapsular (pseudo- ankyloses), while most of the acquired ankyloses (true ankyloses) are intracapsular. An extremely rare form of extracapsular ankylosis is bony pterygomandibular fusion, few cases having been reported in the literature. To our knowledge, a case with two separate ipsilateral extracapsular ankylosis sites together with bilateral intracapsular ankylosis has never been reported. This paper considers the case of a 24 year-old patient who had been unable to open his mouth for six years. There was neither a history of trauma nor one of recurrent infection. The patient presented with a slight facial asymmetry with deviation of the mandible towards the right. CT scans confirmed the diagnosis of a complex pseudoankylosis, characterised by unilateral bony fusions between the lateral pterygoid plate and the medial aspect of the ramus, coronoid process and zygoma together with bilateral intracapsular ankyloses. The patient underwent surgery for ostectomy of the pterygomandibular fusion and a bilateral coronoidectomy. Comments on a paediatric case with bilateral bony pterygomandibular fusions are also included.

A 14 year-old Black female was referred for management of an asymptomatic swelling in her right maxilla. The lesion measured 3cm across, was localised lateral to the right ala of the nose, felt bony hard in some areas and soft in others, and was continuous with the maxillary buccal plate. It occupied the right anterior vestibule but there was no palatal expansion. A panoramic radiograph showed a radiopaque lesion surrounded by a radiolucent periphery, but a lack of clarity prompted a computed tomographic scan. The latter revealed two separate lesions, one buccal and one palatal. The buccal lesion showed a well-defined radiolucency containing a radiopaque mass while the palatal lesion showed a small cystic area attached to the neck of an impacted tooth. Differential diagnoses of calcifying odontogenic cyst, adenomatoid odontogenic tumour or ameloblastic fibro-odontoma and dentigerous cyst or odontogenic keratocyst were considered for the two lesions respectively. Enucleation of the buccal lesion and removal of the impacted tooth together with the overlying cyst presented no problem. Histologically the lesions were respectively diagnosed as a calcifying odontogenic cyst and a dentigerous cyst. Histological features are briefly described together with an historical review of the calcifying odontogenic cyst which has evoked much interest and controversy over the past five decades.

A 32 year-old male patient who was HIV positive presented at the Wits Oral Health Centre complaining of a large swelling of the left submandibular region of three years' duration. The swelling was non-tender, soft and doughy on palpation and appeared to be crossing the midline. Bilateral sub-mandibular and submental lymphadenopathy was present. Intraorally the lesion caused considerable elevation of the floor of the mouth and impaired the flow of saliva. Fluid from the lesion was aspirated and the patient sent for MRI examination. These images revealed a multilocular cystic lesion causing disruption of the mylohyoid muscle. The aspirate consisted of a thick, bloody fluid which tested positive for salivary amylase. A provisional diagnosis of plunging ranula was made. The multilocular nature of the lesion seen on MRI prompted a more extensive surgical approach in order to prevent recurrence. Consequently the sublingual gland was removed via an intraoral approach while the multilocular cyst was dissected by means of a submandibular approach in order to effect complete removal. Microscopic examination of the submitted specimen confirmed the clinical diagnosis of a plunging ranula.

Cylindrospermopsis raciborskii (Woloszynska) Seenayya et Subba Raju (Ordem Nostocales) é uma das espécies formadoras de florações mais prejudiciais no Brasil. Entender a dinâmica populacional dos diferentes morfotipos de C. raciborskii (reto e espiralado) pode auxiliar a previsão de condições favoráveis à proliferação e ao estabelecimento dessa espécie potencialmente produtora de saxitoxinas e cilindrospermopsina. O objetivo deste estudo foi avaliar os efeitos de duas diferentes intensidades luminosas e temperaturas na velocidade de crescimento e na morfologia dos tricomas de morfotipos reto e espiralado. Para tanto, foram utilizadas duas linhagens de C. raciborskii, não produtoras de toxinas, sendo uma com tricoma espiralado (ITEP31) e outra com tricoma reto (ITEP28), cultivadas em câmaras climáticas sob condições controladas em meio BG-11. Duas intensidades luminosas, 30 e 90 µmol.m-2.s-1 , foram combinadas com temperaturas de 21 e 31 °C e avaliadas as velocidades de crescimento e modificações morfológicas. Os morfotipos responderam de maneiras diferentes às temperaturas e intensidades luminosas. As linhagens investigadas, independentemente do morfotipo, apresentaram maiores velocidades de crescimento em intensidade luminosa e temperatura altas. A condição de temperatura baixa e intensidade luminosa alta prejudicaram o desenvolvimento de ambas as linhagens. Variações na morfometria celular, bem como a ausência de acinetos para ambas as linhagens, estiveram relacionadas às condições de temperatura baixa (21 °C). O morfotipo espiralado apresentou grande plasticidade fenotípica, alterando a morfologia do tricoma ao longo de sua curva de crescimento. Apesar de a análise com ferramentas moleculares não sustentar a separação dos morfotipos em espécies distintas, devem-se considerar as diferentes respostas ecofisiológicas entre os mesmos como conhecimento de extrema importância no controle populacional desses organismos potencialmente tóxicos.

Cylindrospermopsis raciborskii (Woloszynska) Seenayya et Subba Raju (Ordem Nostocales) is one of the most troublesome bloom-forming species in Brazil. Understanding the population dynamics of the different morphotypes of C. raciborskii (straight and coiled) could assist in the prediction of favourable conditions for the proliferation of this potentially toxin-producing species. The aim of the present study was to assess the effects of two different light intensities and temperatures on the growth rate and morphology of the trichomes of the straight and coiled morphotypes. For such, two non-toxin producing strains of C. raciborskii were used - one with a coiled trichome (ITEP31) and another with a straight trichome (ITEP28). The strains were cultured in BG-11 medium in a climatic chamber under controlled conditions. Two light intensities (30 and 90 µmol.m-2.s-1 ) were combined at temperatures of 21 and 31 °C and the growth rate and morphological changes were analysed. The morphotypes responded differently to the different temperatures and light intensities. Both strains exhibited faster growth velocities when submitted to higher light intensity and temperature. The lower temperature and higher luminosity hampered the development of both strains. Variations in cellular morphology and an absence of akinetes in both strains were related to the lower temperature (21 °C). The coiled morphotype demonstrated considerable phenotype plasticity, changing the morphology of trichome throughout its growth curve. Although molecular analysis does not sustain the separation of the morphotypes as distinct species, their different eco-physiological responses should be considered further knowledge of extreme importance for the population control of these potentially toxic organisms.