Nasopalatine Duct Cyst (NPDCs) Case Study

Nasopalatine Duct Cyst (NPDCs) Case Study Abstract Incisive canal cyst or Nasopalatine duct cysts (NPDCs) are the most common non-odontogenic cysts of the maxilla. These developmental NPDC are usually asymptomatic and are discovered during routine radiological examination done for some other diagnosis. A cone-beam computed tomography (CBCT) is a valuable tool to localize a cyst within the nasopalatine canal. CBCT enables analysis of the dimension of the NPDC, analysis of the involvement of neighboring anatomical structures and assists in treatment planning. Histopathology shows non-keratinized epithelium with pseudostratification, ciliation with neuro-vascular bundle in the capsular wall. Surgical approach with enucleation of the cyst is the treatment of choice. Since these lesions show diagnostic dilemma in clinical and radiological study, the definitive diagnosis is made by histopathology. Our case report shows nasopalatine duct cyst in a 27 year old male patient along with brief literature review. Keywords: Nasopalatine duct cyst, Non-odontogenic , Trauma, Anterior maxilla. INTRODUCTION Various synonyms were used previously in the literature for NPDC as cystis canalis nasopalatini, cystis canalis incisive, is the most common non-odontogenic cyst occurring in the oral cavity. Most common site will be midline palate around the incisive foramen from debris of nasopalatine duct’s epithelium. It was first described by Meyer in 1914, in the past, known as the fissured cyst, now according to the WHO classification it is defined as a non-odontogenic, developmental, epithelial cyst of maxilla. In most of cases, it develops in the midline of the palate near the incisive foramen.1  During fetal development the duct gradually narrows until one or two central clefts are finally formed on the midline of the upper maxilla. The nasopalatine neurovascular bundle is located within the duct, and emerges from its intrabony trajectory through the nasopalatine foramen.2 Etiology is still debatable, as some say it may arise from a vestigial organ (nasal-vomer Jacobson organ) present in some inferior mammals. Various triggering factors for cyst development are infection (38 %), trauma (16 %), minor salivary mucus retention, inflammatory stimulus resulting in the abnormal growth of the remnant cells, derived from the fusion of the primary palatal of the first branchial arch. It is a developmental cyst.3 The case report here was in a dilemma whether it was a residual cyst or incisive canal cyst. Many nasopalatine duct cyst were diagnosed during routine periapical or occlusal radiographs.4 The definite diagnosis of the cyst should be basedon clinical, radiological and histopathologic findings. Hence, we report a case of nasopalatine duct cyst in a 33year old male patient, along with a review of literature. CASE REPORT A 27 years old male patient reported in the Department with the chief complaint of swelling in the upper front tooth region since 3 months. Pain was insidious in onset with swelling gradually increased to the present size. Patient gave the history of trauma with extraction of his upper front tooth 3 months back. Extraorally there was no abnormality and no lymphadenopathy detected. Intraoral examination revealed a swelling in the incisive papilla region. Swelling was measuring 1.5 cm x 1.5 cm in the midline of the hard palate and extended posteriorly to the mesial aspect of upper canine. CBCT of the maxilla was advised. Axial, sagittal and coronal sections were obtained; lateral sections along the arch and buccolingual sections were made and assessed to make the following report: CBCT of maxilla showed missing 11, 21 and a radiolucent lesion in anteriormaxilla. A well-defined unilocular radiolucent lesion seen in the anterior maxilla in11, 21, region.(Fig 1). The lesion extends from the incisive canal opening to the floor of nasal fossa superoinferiorly, from labial to palatal cortical plate labiopalatally and from 12 to 22 regions. (Fig 2) The lesion is roughly oval in shape, measures about 13 mms mesiodistally, 13 mms supero-inferiorly, 12 mms laterally. The lesion is bordered by very thin sclerotic margin except for few areas. The lesion is uniformly radiolu cent within, has caused expansion, thinning and perforation of labial cortical plate in particular, also caused perforation of the floor of nasal fossa. On the basis of clinical and radiographic evidence of incisive canal cyst was made. It was decided to enucleate the cyst under general anesthesia. Prior to surgery all preliminary investigations were done and results were within normal range. Cyst was enucleated (Fig 3,4) and specimen was sent for histopathological examination for the confirmation of provisional diagnosis. Microscopic examination revealed non keratinized stratified squamous epithelium of variable thickness with moderate inflammatory infiltrate in the connective tissue wall with few areas of pseudostratified epithelium. Capsular wall shows endothelial lined capillaries, muscular arteries, nerve fiber bundles/neurovascular bundles are seen in the connective tissue wall with areas of hemorrhage and peripheral vital bone is seen.(Fig 5,6) These histological features, in conjunction with the site of the lesion, suggested incisive canal cyst. DISCUSSION Usually it is difficult to distinguish normal incisive canal and foramen from small NPDC which is associated with vital tooth. It is more difficult when it is associated with non-vital tooth to differentiate from radicular cyst and existing NPDC. Some clinicians follow the thumb rule that radiolucency of the incisive canal measuring less than 0.6 cm in diameter should not be considered cystic in the absence of other symptoms.5 The exact etiology of NPDC is of uncertain origin but idiopathic or secondary to trauma, bacterial infections, or mucous retention has been shown with peak incidence between the fifth and the sixth decades of life. NPDC is the most common non-odontogenic cyst of the gnathic bones, representing up to 1% of all maxillary cysts. Etiology of present case is idiopathic with no history of trauma or infections. NPDC has high predilection for male which is synchronizing with our case. NPDC mainly manifest during fourth to sixth decades of life, but our patient was 27 years old and very few cases have been reported in the third decade of life.6 As far as pathogenesis concerned, it was previously thought that the NPDCs originated from the trapping of epithelium during fusion of the embryological processes. This concept has been discarded, and currently NPDC is thought to develop from the epithelial remnants of the nasopalatine ducts present within the incisive canals (canals of Stenson).7 Patients may be asymptomatic, with the lesion being detected on routine radiographs, however many will present with one or more symptoms. Complaints are often found to be associated with an infection of a previously asymptomatic nasopalatine duct cysts and consist primarily of swelling, drainage and pain.8 Our patient was presented with swelling on the midline of the palate without pain or drainage. The mean size of the NPDC variesfrom 6 to 17 mm,9 whereas our case showed a swelling that is 1.5 Ãâ€" 1.5mm. Even though definitive diagnosis of a nasopalatine cyst is more easily made on plain film so the advanced imaging modalities such as computed tomography and magnetic resonance imaging are being used to differentiate this entity from other lesions.5 Radiographically, NPDC are wellà ¢Ã¢â€š ¬Ã¢â‚¬Ëœcircumscribed round, ovoid or heart-shaped radiolucency in the anterior maxilla.10 The radiographic diameter of our case was 13 Ãâ€" 13 mm. The differential diagnosis should concern the supernumerary tooth appearing in this area- the mesiodens in the follicular cyst and also it should concern the primary cyst, the giant-cell granuloma, the ostitis with the palatal fistula and also naso-palatine and palatal-sinus connections.2 Histologically, the type of cystic epithelium varies according to the location involved (palatine, nasal, or intermediate). A squamous cell epithelium is almost always observed, although ciliary respiratory epithelium can be seen when the lesion is located higher up or nasally. Some cases rarely show the combination of squamous cell epithelium with ciliary respiratory epithelium as seen in the present case suggesting intermediate to palatal and nasal epithelial origin.7 Surgical enucleation was considered as the choice of treatment. The present case had typical clinical, radiographic, and histopathological features of a nasopalatine duct cyst. CONCLUSION Nasopalatine duct cysts occur in approximately 1% of the population with mean age of 42.5 years. The lesions may be asymptomatic or may manifest as swelling, pain, and drainage from the hard palate. A well-circumscribed, round, ovoid or heart-shaped radiolucency is seen on radiograph. Cone-beam computed tomography easily visualizes the radio-transparency on the midline, with well-defined sclerotic margins, and informs of the exact location of the lesion. In addition, it facilitates planning of the best surgical approach.

Gender Issues in Special Education Essay

While it is obvious to researchers that males and females are disproportionately served by special education programs, the reasons for the gender bias are not clear. Boys and girls are known to â€Å"comprise equal proportions of the school-aged population;† nevertheless, boys are known to â€Å"account for approximately two-thirds of all students served in special education (Gender as a Factor in Special Education Eligibility, Services, and Results). † Is it because the educational policies of most states of America prefer to send off more boys than girls for special education programs? Or, are there essential differences between boys and girls to account for the gender gap in special education? The present research evaluates the answers to these questions for education professionals to attempt to bridge the gender gap in special education. Are there gender differences to account for the gender gap in special education? Studies on disability have by and large emphasized on commonalities among persons with disabilities instead of addressing gender based differences. This is the reason why there is little known about the different experiences and characteristics of boys and girls with disabilities (Gender as a Factor). It is interesting to note that the problem of the gender gap in special education does not exist in the United States alone. Studies have addressed this topic in relation to the disabled populations in the United Kingdom, Norway, and Canada as well. As a matter of fact, researchers have also noted the differences between the learning needs and academic achievements of boys and girls in the regular classroom. The differences among boys and girls in the regular classroom allow us to infer that boys and girls are, indeed, different in terms of their educational needs and achievements. Hence, the gender gap in special education may exist for a genuine reason. Chapman (2006) writes: Sitting in the same classroom, reading the same textbook, listening to the same teacher, boys and girls receive very different educations. In fact, upon entering school, girls perform equal to or better than boys on nearly every measure of achievement, but by the time they graduate high school or college, they have fallen behind. However, discrepancies between the performance of girls and the performance of boys in elementary education leads some critics to argue that boys are being neglected within the education system. Across the country, boys have never been in more trouble: They earn 70 percent of the D’s and F’s that teachers dole out. They make up two thirds of students labeled â€Å"learning disabled. † They are the culprits in a whopping 9 of 10 alcohol and drug violations and the suspected perpetrators in 4 out of 5 crimes that end up in juvenile court. They account for 80 percent of high school dropouts and attention deficit disorder diagnoses. This performance discrepancy is notable throughout Canada. In Ontario, Education Minister Janet Ecker said that the results of the standardized grade 3 and grade 6 testing in math and reading showed, â€Å"†¦ persistent and glaring discrepancies in achievements and attitudes between boys and girls. † In British Columbia, standardized testing indicates that girls outperform boys at all levels of reading and writing and in Alberta testing shows that girls, â€Å"†¦ significantly outperform boys on reading and writing tests, while almost matching them in math and science. † However, the American Association of University Women published a report in 1992 indicating that females receive less attention from teachers and the attention that female students do receive is often more negative than attention received by boys. In fact, examination of the socialization of gender within schools and evidence of a gender biased hidden curriculum demonstrates that girls are shortchanged in the classroom. Furthermore, there is significant research indicating steps that can be taken to minimize or eliminate the gender bias currently present in our education system. If teachers are, indeed, responsible for giving more attention to boys than the girls, this may very well be a reason why boys are more often referred to special education programs than the girls. Even so, the academic achievement of girls tends to be higher than that of the boys in most regular classrooms. Therefore, there may be no reason to blame the teachers for referring more boys than the girls to special education programs. Vaishnav (2002) writes that boys are more likely to act out in class than the girls simply because boys tend to be more active while girls tend to be more passive. Furthermore, girls are more likely to be compliant, and this attitude on their part can be misleading because girls may be hiding their disabilities behind their compliance. Even so, it is noteworthy that the gender gap in special education varies from school district to school district in the United States. Among the emotionally disturbed children in Milwaukee, for example, only fifty five percent are boys. In Kansas City, on the other hand, almost ninety percent of the students diagnosed as emotionally disturbed are males. In the schools of Massachusetts, males are â€Å"slightly more likely than girls to be identified with hearing or vision problems,† and one and a half times more likely to be identified as mentally retarded (Vaishnav). What is more, males are twice more likely than girls to be labeled with learning disabilities, and â€Å"more than three times as likely to be called emotionally disturbed (Vaishnav). † Are state policies responsible for the gender gap in special education? Data on the gender gap in special education reveals that boys are overrepresented in special education regardless of school district and state. Nonetheless, it is noteworthy that the school districts in Massachusetts, on average, refer students for special education programs according to the following ratio for male to female students: 7:3 (â€Å"District Rates: Students with Disabilities by Race and Gender,† 2004). Perhaps this ratio is based on a state policy that requires more males to be referred for special education programs. Indeed, there are three typical reasons cited for the gender gap in special education, one of which is the â€Å"bias in special education referral and assessment procedures (Tschantz & Markowitz, 2003). † The other reasons include the biological and behavioral differences between male and female students. Even so, the reason that points to blatant discrimination in special education requires the collection of data from states to reveal the actual gender gap in special education in different states and school districts. By knowing that the gender gap in a certain state is wider than the gap in another state, for example, we may very well be able to identify the state policies that may be responsible for the difference (Tschantz & Markowitz). Coutinho & Oswald (2005) have conducted a study on state policies with regards to special education. According to the researchers, states that either have a high or low proportion of students assigned to special education programs are more likely to identify more males than females for these programs. Seeing that the law of the United States does not demand school authorities to refer more males than females for special education programs, the authors recommend that all states must collect data to analyze the gender gap in special education. The data that is collected thus would allow researchers to examine where the problem truly lies. Is it because the teachers are referring more males than females because they observe the differences in the classroom? Or, is it because certain school districts prefer to send off more males than females to the special education classroom? The authors further note that the educators may very well be biased in their implementation of identification and referral policies. Hence, a â€Å"vigorous, systematic evaluation† is a necessity in the identification of the real reasons for the gender gap in special education (Coutinho & Oswald). Analysis of the Findings and Conclusion Sanders (2002) confirms the conclusion of Chapman that there is a difference between the levels of attention received by boys and girls in schools. Some of the reasons for the differences are pointed out by the author as the following: (1) The ratio of boys to girls taking the highest level Advanced Placement Test in Computer Science is 9:1; (2) Eighty five percent of girls from eighth to the eleventh grade report that they have been sexually harassed in school, while the percentage is lower for males; (3) All except one of the school shootings in recent years had been committed by white male students; and (4) The average boy in eleventh grade writes at the level of the average girl in eighth grade. Perhaps, therefore, we must agree with the fact that there is a difference in the learning needs and academic achievements of boys and girls also in the regular classroom. The difference between boys and girls in the regular classroom helps us to understand that the gender gap in the special education programs is perhaps a genuine one. However, there is very little research on the differences between males and females with regard to disabilities. This is the reason why researchers are as yet unclear about the real meaning of the gender gap in special education. Research in future must focus on the differences between males and females with regard to disabilities. Only then shall we conclude with certainty that there is a genuine gender gap in special education, perhaps because there are more disabled boys than disabled girls. Vaishnav’s analysis of the reason for the gender gap in special education is very important, seeing that girls are definitely more passive while boys are certainly more active in the classroom. This is the reason why educators find it easier to identify emotionally disturbed boys. Males are also more likely to show their learning disabilities more easily than the females, for the simple reason that boys act out in class more often than the girls. Females may hide their disabilities from their teachers through their passivity and compliance. This analysis carries an important lesson for teachers: perhaps teachers should learn to identify learning disabilities and emotional disturbance in girls by a different method altogether. Psychological, including IQ testing, should definitely help. Research has also suggested that boys are twice more likely than girls to be identified as gifted students (Chapman). If psychological, including IQ testing, is made mandatory for all students, however, the gender gap may very well be bridged. Lastly, it is important to note that researchers have not yet found differences in state policies with regards to the gender gap in special education. There is no state policy that clearly asks for boys to be referred in greater numbers to special education programs. Nevertheless, there are differences among states with respect to the gender gap. Besides, our research on Massachusetts shows that most school districts maintain an average ratio of boys to girls that are referred to special education programs. Even though research would not identify the reason for this average ratio, Countinho & Oswald are correct to conclude that thorough data collection would allow us to analyze the gender gap more easily. By knowing exactly where the gender gap widens or contracts, educational researchers would be able to study the specific school district policies that relate to the same. This would allow them to identify the real reasons for the gender gap in school education, and why it widens or contracts in certain states or school districts as compared to the others. Regardless of limited research on the real reasons of the gender gap in special education, educators are required to pay equal attention to girls and boys in their classrooms. This is, perhaps, the most important lesson to be learned from the present research. After all, by paying more attention to boys, teachers may be negatively impacting the lives of countless gifted girls. Similarly, there may be countless learning disabled girls who may benefit from special education programs even though their teachers have not identified them as learned disabled. Equal opportunity in education is of the essence. Psychological testing, including IQ testing, is certainly expected to help educators along the way. References Chapman, A. (2006). Gender Bias in Education. Research Room. Retrieved Nov 25, 2007, from http://www. edchange. org/multicultural/papers/genderbias. html. Coutinho, M. J. , & Oswald, D. (2005, Jan 1). State variation in gender disproportionality in special education: findings and recommendations. Remedial and Special Education. District Rates: Students with Disabilities by Race and Gender. (2004, Oct 1). Massachusetts Department of Education. Retrieved Nov 25, 2007, from http://www. doe. mass. edu/InfoServices/reports/enroll/sped05/rg. pdf. Gender as a Factor in Special Education Eligibility, Services, and Results. Retrieved Nov 25, 2007, from http://www. iteachilearn. com/uh/meisgeier/statsgov20gender. htm. Sanders, J. (2002, Nov 1). Something Is Missing from Teacher Education: Attention to Two Genders. Phi Delta Kappan. Tschantz, J. , & Markowitz, J. (2003, Jan). Gender and Special Education: Current State Data Collection. Quick Turn Around. Retrieved Nov 25, 2007, from http://www. nasdse. org/publications/gender. pdf. Vaishnav, A. (2002, Jul 8). Some Say Boys Singled Out for Wrong Reasons. The Boston Globe.

Business Regulation Law

When conducting business whether it is local and global, big or small organizations have to abide by state and federal laws. Depending on the nature of the business different organization has to comply with certain laws and regulations. For example, retailers like Wal-Mart, Target and Kroger have to comply with the Department of Labor and a manufacturing company like LM Fiberglass and Toyota would have to comply with the Environmental Protection Agency and Occupational Safety and Health Administration (OSHA). When an organization do not comply with the state and federal regulation the company can face fines or become caught up in major litigation, costing the company major expenses. In this memo I will identify common tort and risk found in the organization of Alumina, and describe different measures to manage risk. Some common torts found at Alumina are negligence, defamation/slander/libel, Freedom of Information Act (FOIA), and strict liability is tort liabilities uncovered. Alumina Violation Alumina is an aluminum maker base in the United States and has operation in eight countries. The aluminum maker is on Lake Dira in the state of Erehwon. Alumina is under the jurisdiction of region six under the Environmental Protection Agency. A few years ago Alumina was found in violation with the Environmental Protection Agency for environmental discharge norms in an Environmental Protection Agency compliance evaluation. The PAH levels were above prescribe limits. Alumina was order to clean up the problem in which they complied too quickly. Because of this incident Alumina has maintain a good compliance record. Recently a resident name Kelly Bates claims that Alumina continuous contamination of Lake Dira with pollutants. Bates threatens to file a suit against the company for punitive damages and recovery damages. She believes that the incident that occurred several years ago is the cause of her daughter’s leukemia. Tort Liability A tort is a â€Å"civil wrong that is an interference with someone’s person or property such that an injury results† (Jennings, 2006, p. 367). Torts can be categorized as intentional torts, torts of negligence, and strict liability torts. Intentional torts are those that result in a harm not accidental. Torts of negligence are accidental harms that result from a failure to act appropriately in a given situation. Strict liability torts assign absolute liability and offer very few defenses. Defamation of Character A company or a person reputation is a valuable asset. The tort of defamation of character requires that a plaintiff prove that: the defendant made an untrue statement about the plaintiff or the statement was intentionally published by a third party (Cheeseman, 2010). Written False statements are referred to as libel and verbal statement are referred to as slander. Bates made a libel statement in the newspaper about Alumina and the violation that occurred years ago. This defamation can have a negative effect on the company. Alumina can lose business with a bad reputation and once the reputation has gone sour it is hard to reclaim the good name. Freedom of Information Act A local news reporter and Kelly Bates approached the EPA to obtain environmental audit reports that documented Alumina violation of the Clean Water Act. Bates requested the documents under the Freedom of Information Act; this act was enacted in Congress in 1966 to the American public great access to the Federal Government records (Federal Communication Commission, 2010) . The Company chooses to release partial audit information from the violation from years ago. Alumina has the right to withhold informational this qualifies under the Confidential Business Information, which is available under exemption four of the Freedom of information Act. Strict liability Negligence and Strict liability Negligence, the most common tort, is explained as conduct that falls below standards of behavior established by the law for the protection others against unreasonable risk harm (Cheeseman, 2010). In this case of negligence Bates must prove that Alumina had a duty to keep the PAH levels contained. In a case Alumina breaches that duty by not staying in compliance with the EPA regulation several years ago. Bates assumes that the consumption of the water cause the harm of her daughter to have leukemia. In response Alumina chose to conduct an independent site study for new violations. The reports come back good the PAH levels were well below the standard. After releasing a partial audit report Bates has threaten to file a lawsuit against Alumina of personal injury to recover compensation and punitive damages. Alumina negligent conduct of â€Å"serious violation of environmental laws five years ago is the cause of her daughter leukemia,† alleged by Bates (Business Regulations Simulation, 2010). The best resolution for this situation is mediation by a neutral third party, by choosing this options Alumina can provide Bates with a confidential settlement. The settlement includes that Alumina provides Bates with reimbursement of medical expenses for her daughter treatment a lump sum for future treatments and a college fund set aside if her daughters recovers from the leukemia (Business Regulations Simulation, 2010). Although tort liability is founded on intended harm strict liability is attached even though the defendant has been reasonable. In the Article titled â€Å" The American Influence on Canadian Tort Law† author Allen M. Linden states â€Å" One person may be require to compensate another for injury or damages even though the loss was neither intentionally or negligently inflicted. If Alumina had taken the case to court, the company would have been in a long litigation process costing the company thousands and even millions of dollar. The mediation process is half the cost of a court trial and there is no guarantee that the jury would agree with Alumina even though the company may have had proof that the allegation against the company was false. The jury tends to side with the victims. Preventative, Detective, and Corrective Measures In an organization it will be hard to prevent allegation against the company, but the company needs to prepare for such issues when they arise. A preventative plan should be put into place. The company should make it a priority that the employees of the company aware of the rules and regulations of the state and federal laws. The company should be aware of the competitors who have violated any government regulations and improve their process so that the company will not violate the same regulations as the competition. Health risk that may be exposes to the staff, customers, and other should be included in the document also. Conclusion Alumina has to abide by state and federal rules these laws are in place to improve environmental safety. The agency that regulates Alumina was the Environmental Protection Agency this agency enforces environmental laws. Alumina has to be aware and comply with the state and federal regulations at all-time or it can affect the business a great deal. Maintaining a positive image in the community is also important when a crisis occurs the support of the community can be a big help in determine issues. The decision mage by Alumina were wise, the company took the right approach to maintain its good name in the community and the competitive market and save cost on litigation.

The Eight Photos By John Thomson s Illustrations Of China...

Jiangnan Yao Prof. Franziska Seraphim TA: Lia Atanat HIST1006 Feb. 16th, 2016 The eight photos I chose were arranged in a particular order. The first four were selected from the Globetrotter’s Japan while the other four photographs were chosen from John Thomson’s Illustrations of China and Its People: A Series of Two Hundred Photographs. Moreover, the photos on the left side depicted the traditional Asian people and places, in contrast with those on the right side, which seemed to be more â€Å"modern† due to some western elements presented in the pictures. These eight photos well represented the themes that are recurring in the three albums: Asians in traditional dress doing menial labor without the presence of technology,†¦show more content†¦The two scenes were beautiful in a natural, traditional and exotic way, which was different from Yokohama’s beauty of modernity in picture 2 and 4. Yokohama was one of the seven treaty ports opened by the Kanagawa Treaty in 1854 and Harris Treaty in 1858. Under the i ntimidation of America’s steam-and-coal warships, Japan had no choice but ended its â€Å"close-country policy† and gave the U.S., later also Britain, the Netherlands, Russia, and France, the access to the seven treaty ports. After a decade, when the â€Å"globetrotter† tourists visited Japan and pressed the camera shutter, we can see how those treaty ports, especially Yokohama, were influenced by the West. Picture 2 depicted a main street of Yokohama. On the left side of the street was a printing office while on the right side of the street, there was a Cigar store. Cigar was clearly not a native product of Japan, but something introduced from the West. Another noteworthy detail was that the shop signs of the two stores were both written in English instead of Japanese. Picture 4 was a portrait of a railway station. Train was a symbol of technology development and signified Japan was stepping outside of the Biological Old Regime and start to use steam and fuel a s the source of energy. In addition, in the middle of the picture stood a lampstand. It indicated the use of electricity, and gave viewer a