Is amelogenesis imperfecta an indication for renal examination?

BACKGROUND: The term 'amelogenesis imperfecta' (AI) describes a diverse group of hereditary conditions primarily affecting the quality and/or quantity of dental enamel. CASE REPORT: This paper describes a case in which hypoplastic AI with delayed/failure of eruption of the permanent teeth was shown to be associated with renal calcification. CONCLUSION: Given the importance of the renal involvement, the authors suggest that paediatric dentists consider referring all children with this dental phenotype for renal ultrasound examination.     

Sarcoidosis presenting as an isolated facial swelling--an unexpected diagnosis?

Sarcoidosis is a rare chronic granulomatous disease of unknown aetiology that primarily affects individuals between 30 and 50 years of age. It is usually characterized by the presence of non-caseating, granulomatous, epithelioid tissue at the sites affected with involvement of lymphoid tissue. Sarcoidosis confined to lymph nodes, salivary glands and other tissue in the head and neck is uncommon and usually indicative of a more generalized systemic process. Within the differential diagnosis of isolated masses associated with the head and neck, sarcoidosis is indeed rare. We report a case of systemic sarcoidosis presenting as a small localized facial swelling. The report illustrates that other symptoms, albeit mild, may direct the clinician to a provisional diagnosis of generalized sarcoidosis. CLINICAL RELEVANCE: Within the differential diagnosis of isolated facial swellings, sarcoidosis is extremely uncommon. However, clinicians should consider the diagnosis, especially in the presence of other, albeit mild, symptoms.     

Masseteric–facial nerve anastomosis for early facial reanimation

ObjectiveEarly repair of facial nerve paralysis when cortical neural input cannot be provided by the facial nerve nucleus, is generally accomplished anastomozing the extracranial stump of the facial nerve to a motor donor nerve. That is generally the hypoglossus, which carries a variable degree of morbidity. The present work aims to demonstrate the effectiveness of the masseteric nerve as donor for early facial reanimation, with the advantage that harvesting is associated with negligible morbidity.MethodsBetween October 2007 and August 2009, 7 patients (2 males, 5 women) with unilateral facial paralysis underwent a masseter–facial nerves anastomosis with an interpositional nerve graft of the great auricular nerve. The interval between the onset of paralysis and surgery ranged from 8 to 48 months (mean 19.2 months). All patients included in the study had signs of facial mimetic muscle fibrillations on electromyography. The degree of preoperative facial nerve dysfunction was grade VI following the House-Brackmann scale for all patients.ResultsAt the time of the study, all the patients with a minimum follow-up time of 12 months after the onset of mimetic function had recovered facial animation. Facial muscles showed signs of recovery within 2–9 months, mean 4.8 months, with the restoration of facial symmetry at rest. Facial movements appeared while the patients activated their chewing musculature. Morbidity related to this intervention is only the loss of sensitivity of earlobe and preauricular region.ConclusionThe present technique seems to be a valid alternative to classical hypoglossal–facial nerve anastomosis because of similar facial nerve recovery and lower morbidity.     

Is a fractured mandible an emergency?

We retrospectively audited the records of 708 patients who presented with the diagnosis of fractured mandible between January 2009 and July 2013 at the Queen Elizabeth Hospital, Birmingham. We assessed the different factors that may have altered their outcomes, and found that delay before definitive fixation caused no harm in either the short or the long term.     

How do I manage an acute injury to the facial nerve?

Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Damage to the upper trunk can result in eye complications with the risk of exposure keratitis. Numerous factors influence the therapeutic strategy: the cause of the injury, the time elapsed since injury, functional impairment, and the likelihood of recovery. We discuss the management of an acute injury to the facial nerve and focus on the surgical options.     

Is bleeding on probing a reliable clinical indicator of peri-implant diseases?

Bleeding on probing (BOP) is regarded as an indispensable diagnostic tool for evaluating periodontal disease activity; however, its role in peri-implant disease is more intricate. Much of the confusion about the interpretation originates from drawing parallels between periodontal and peri-implant conditions. BOP can originate from two forms of probing in implants: traumatic or pathologic induction. This, in addition to the dichotomous scale of BOP can complicate diagnosis. The objective of this commentary is to discuss the following: 1) the value of BOP as a diagnostic tool for peri-implant diseases; 2) the reasons it should be distinct from value for diagnosing periodontal and peri-implant diseases; and 3) the current best evidence on how to implement it in daily clinical practice. A comprehensive bleeding index is proposed for evaluating and monitoring peri-implant conditions. BOP should be used in addition to other parameters such as visual signs of inflammation, probing depth, and progressive bone loss before a peri-implant diagnosis is established.