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Context: Recent studies show that enzymatic contents of the neutrophil granules have a remarkable ability to modulate the tumor microenvironment by causing apoptosis of T-lymphocytes which leaves the host's cell-mediated immunity at stake. The preoperative neutrophil to lymphocyte ratio (NLR) is considered to be an indicator of the immune status of the patients with oral squamous cell carcinoma (OSCC), which will thereby help in predicting the course of the disease. Aims: The aim is to assess the NLR and histopathological prognostic factors pertinent to infiltration of the surrounding structures and correlate them with the clinical prognostic outcomes of OSCC. Settings and Design: This retrospective study involved the retrieval of formalin-fixed, paraffin-embedded, hematoxylin, and eosin-stained sections of 55 cases of OSCC from the departmental archives from 2006 to 2014. Subjects and Methods: Grading of each case was done by Bryne's grading system. The preoperative complete blood counts, relevant case history, and clinical data of the patients involved in the study were collected from the institutional medical records. The NLR was calculated by dividing the serum neutrophil count by the serum lymphocyte count. Statistical Analysis Used: The median NLR was compared between the controls and OSCC cases using Wilcoxon-signed rank test, and the Kaplan-Meier survival analysis was carried out to predict the survival and recurrence status of OSCC. Results: Higher NLR was seen in lymph node and margin-involved cases and also in patients who had tumor recurrence. Kaplan-Meier survival analysis showed that the mean survival dropped from 26 to 4.5 months when NLR ≥5 ( P = 0.052). Conclusion: Neutrophil-to-lymphocyte ratio can be used as a prognosticator of survival, recurrence, lymph node status, and margin status in OSCC.

Gingival recession is an aesthetic and functional problem requiring surgical management in most cases. Adequate gingival health is a prerequisite to maintain plaque control during orthodontic treatment. This case report described management of gingival recession before orthodontic treatment using a novel surgical method. Here, authors presented a case of 27-year-old female patient reported to the Department of Periodontics for management of gingival recession in the lower front tooth region. The patient was diagnosed with Miller’s Class II gingival recession on mandibular right central incisor. Vestibular depth and width of attached gingiva was found to be inadequate at the recession site. The case was managed with epithelial embossed connective graft. The recipient site was prepared using envelope technique and internal vestibular deepening was performed before placing the graft. Complete root coverage, adequate vestibular depth and width of attached gingiva were obtained postoperatively. Due to high aesthetic demand of the patient, orthodontic therapy was instituted six months following root coverage and patient could maintain good oral hygiene during orthodontic treatment. Results of surgical treatment were maintained till two years follow-up. Careful selection of surgical technique could enhance thickness and width of attached gingiva and retain vestibular depth at the recipient site. Successful case management enabled the patient to maintain gingival health during orthodontic treatment.

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