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1.
Johanna Snäll Jyrki Törnwall Anna Liisa Suominen Hanna Thorén 《Oral and maxillofacial surgery》2018,22(2):129-134
Purpose
To clarify pre- and postoperative C-reactive protein (CRP) levels in patients with facial fractures and to investigate the influence of perioperatively administered dexamethasone on postoperative CRP levels.Patients and methods
Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone (Oradexon®), whereas patients in the control group received no glucocorticoid. The analysis included patients who had CRP measured pre- and postoperatively.Results
A total of 73 adult patients with facial fractures were included in the final analysis. Mean CRP level was elevated preoperatively and the level increased further after surgery. However, postoperative CRP rise was significantly impeded by dexamethasone (p?<?0.001), regardless of gender, age, treatment delay, site of fracture, surgical approach, and duration of surgery. CRP rise halved on the 1st postoperative day when dexamethasone was used. In addition, dexamethasone resulted in a CRP decrease on the 2nd postoperative day, whereas the CRP rise continued in the control group.Conclusions
CRP rise is a normal body response after facial fracture and surgery that can be markedly reduced with dexamethasone. CRP changes should be considered with caution if perioperative dexamethasone is used.2.
H. Jagadish Chandra B. H. Sripathi Rao A. P. Muhammed Manzoor A. B. Arun 《Journal of maxillofacial and oral surgery》2017,16(4):445-452
Background
Odontogenic infections range from peripheral abscess to superficial and deep infections leading to severe infections in head and neck region. This study was aimed to assess bacterial isolates responsible for orofacial infection of odontogenic origin and their drug susceptibility patterns so as to provide better perceptive for the management of odontogenic infections.Methods
The study was made in a selected cohort of patients, irrespective of age and gender having moderate and severe orofacial infections of odontogenic origin admitted to Yenepoya University Hospital. Pus samples were collected and identification of bacteria was performed by 16S rRNA gene sequencing. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method.Result
A total of 37 study subjects were included, with bacterial isolation rate of 31 (83.7 %). The mean age presented of all patients was 40.62. Of all, 24 (64.9 %) were males. Staphylococcus aureus, Enterobacter claocae subsp. dissolvens, Klebsiella quasipneumoniae subsp. similipneumoniae, Staphylococcus aureus subsp. anaerobius and Klebsiella pneumoniae subsp. ozaenae were the most prevalent isolates. Result showed that 58.6 % of the isolates were resistant to gentamicin, 52.5 % for ampicillin, 51.3 % for piperacillin; least resistant being 18.9 % for azithromycin.Conclusion
High prevalence of bacterial isolates was found, Staphylococcus aureus being the dominant. Most of the bacteria were resistant to different classes of antibiotics. Appropriate antibiotics should be given based on the bacterial isolates, culture sensitivity and clinical course of the disease.3.
Background
The aims of this study were to investigate the immunolocalization of ezrin and its relationship with the podoplanin expression in keratocystic odontogenic tumors.Material and Methods
The immunohistochemical expressions of ezrin and podoplanin by odontogenic epithelium were evaluated in keratocystic odontogenic tumors using monoclonal antibodies.Results
Our results showed strong cytoplasmic ezrin and membranous podoplanin expressions in basal epithelial layer of all keratocystic odontogenic tumors. The cytoplasmic and membranous ezrin expressions were also detected in suprabasal epithelial layers of tumors. Statistically significant difference between cellular immunolocalization of ezrin and podoplanin odontogenic epithelium were found by Wilcoxon’s test (p < 0.05). No correlation between both proteins in keratocystic odontogenic tumors was detected by Spearman test.Conclusions
These results suggest that ezrin and podoplanin may contribute to the expansive growth and local invasiveness of keratocystic odontogenic tumors. Additionally, as both proteins were overexpressed by odontogenic epithelium, their possible roles need to be further explored in benign odontogenic tumors.4.
5.
Masaya Akashi Kazuhiro Tanaka Junya Kusumoto Shungo Furudoi Kohkichi Hosoda Takahide Komori 《Journal of maxillofacial and oral surgery》2017,16(1):58-64
Introduction
Odontogenic foci can rarely cause intracranial infection. Hematogenous spread is considered to be the most important pathophysiological mechanism of intracranial infection of odontogenic origin. To investigate the oral origin of intracranial infections, oral surgeons should understand the underlying mechanisms by which oral bacteria spread to the central nervous system. However, there have been very few reports of intracranial infection resulting from odontogenic infection.Case reports
The authors report the cases of a 64-year-old man, a 68-year-old man, and a 64-year-old woman whose brain abscesses perhaps have arisen from odontogenic foci, because other sources of intracranial infection such as endocarditis and maxillary sinusitis were not found. Bacteriological examination of brain abscess specimens identified Staphylococcus aureus in case 1, Streptococcus constellatus, Fusobacterium nucleatum, and Parvimonas micra in case 2, and Lactobacillus catenaformis, Porphyromonas gingivalis, and F. nucleatum in case 3. All suspected causal teeth had no obvious signs of acute inflammation in all three cases.Conclusions
Oral surgeons should understand these characteristics of odontogenic brain abscess, in which the potentially causal odontogenic foci often lack acute symptoms. If other origins of infection are not found, it would be better to eliminate the potentially causal odontogenic foci for improvement of oral hygiene, however, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated.6.
Nils Heim Valentin Wiedemeyer Rudolf H. Reich Markus Martini 《Journal of cranio-maxillo-facial surgery》2018,46(12):2220-2226
Introduction
Odontogenic infections and subsequent developing abscess remain to be a potentially life-threatening event, due to septicemia, airway compression and spreading into sensitive anatomic tissues. C-reactive proten (CRP) and white blood cell (WBC) count are routinely blood-measured indicators for inflammation. Are CRP-levels and WBC-count predictive factors of the developement of odontogenic abscess?Methods
A 4-year retrospective study evaluated hospital records of 218 patients, diagnosed and inpatiently treated for acute odontogenic abscess. They received surgical incision, drainage and intravenous antibiotics. CRP-levels and WBC-counts were measured preoperativly.Results
218 subjects were enrolled in this study. Patients hospitalized 10 days or more showed significantly higher CRP-levels (p = < 0.001) and WBC-counts (p = 0.006) on admission day than patients with lower LOS. CRP-levels of patients with LOS from 7–9 days were significantly lower (p = 0.47) than in people hospitalized 10 days or more. Abscess focus in the mandible shows significantly higher WBC-counts (p = 0.014). Multiple space infections present a significantly higher CRP (p = 0.003) and WBC (p < 0.001) on admission day.Discussion
According to the presented data, CRP-levels and WBC-count can be regarded as predictive factors for LOS (length of stay in hospital) in patients with long term hospitalization (CRP:7–9 days and > 10 days; WBC: > 10 days). Further WBC and CRP are suitable to predict multiple space infections and localisation of the abscess (WBC) in certain limits.Conclusion
In predicting the developement of odontogenic abscess, CRP is more capable in providing exact statements regarding the LOS. However, WBC-counts are more suitable in predicting multiple space infections and localization of infection. 相似文献7.
Eduardo Luis de Souza Cruz Ana Karla da Silva Tabosa Aline Semblano Carreira Falcão Talita Tartari Lucas Machado de Menezes Edmar Tavares da Costa José Thiers Carneiro Júnior 《Oral and maxillofacial surgery》2017,21(1):21-26
Purpose
Keratocystic odontogenic tumor (KCOT) is an aggressive benign tumor and the management by complete enucleation followed by cryotherapy maintains the inorganic bone matrix, resulting in better repair and reduces the rates of recurrence. A refrigerant spray with a propane/butane/isobutane gas mixture has been pointed to as an alternative to liquid nitrogen, because the device is easy to handle and contain within the cavity, providing better control and lower risk of injury to the adjacent soft tissue. Thus, the aim of this study was to evaluate the outcome of enucleation followed by cryosurgery using a refrigerant spray of this gas mixture in ten patients diagnosed with KCOT.Method
The biggest lesions received a prior treatment consisting of marsupialization to decrease the tumor size. During the surgeries, the lesions were removed by enucleation and the surgical site was sprayed with the gas mixture.Results
Wound dehiscence was observed in all cases, which healed by the second intention. The mean follow-up period was 64.3 months (range 24–120 months). Eight of the ten patients showed no evidence of clinical or radiographic recurrence. Pathologic fractures and infections were not observed.Conclusions
The results obtained suggest that enucleation followed by cryosurgery is an effective therapy for managing KCOT.8.
Raúl González-García Manuel Moreno-Sánchez Carlos Moreno-García Leticia Román-Romero Florencio Monje 《Journal of maxillofacial and oral surgery》2018,17(2):228-232
Objective
Arthroscopy of the temporomandibular joint (TMJ) has become a well-standardized non-invasive procedure for the treatment of TMJ internal derangement (ID). Since the last 1980s, no clinical application for arthroscopy of the inferior compartment has been established because of the intrinsic difficulty of the technique and the believing of the absence of clinical relevance for treatment of ID.Methods
We report on a particular case in which arthroscopy of the inferior joint compartment together with the examination of the upper joint space was performed in a patient with ID of the TMJ. A 1.9 mm scope was used, while the technique for entering the inferior compartment is presented.Results
The presence of intense synovitis, fibrous adhesion, and pseudowall were observed in the inferior joint compartment, thus leading to the hypothesis of the more than likely influence of the status of the synovial lining within this space in the persistence of symptoms in recalcitrant patients with ID.Conclusion
We believe that this new insight could lead surgeons to a more complete use of this non-invasive procedure for the treatment of this entity.Level of Evidence
4/5.9.
Johanna Snäll Jyrki Törnwall Anna Liisa Suominen Hanna Thorén 《Oral and maxillofacial surgery》2017,21(2):241-246
Purpose
We investigated leukocyte changes in facial fracture patients undergoing surgery. Of specific interest was the effect of perioperative dexamethasone on leukocyte changes.Methods
Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone, whereas patients in the control group received no glucocorticoid. All patients received antibiotics until postoperative days 7–10. Leukocyte count was measured on postoperative days 1 and 2. Clinical infections were observed during the follow-up.Results
A total of 110 adult patients were included in the study. Postoperative leukocytosis was found in 91.2% of patients receiving dexamethasone and in 67.9% of controls. Dexamethasone was associated strongly with leukocyte rise (p < 0.001) on both postoperative days. Transoral surgery and younger age (≤40 years) showed significant associations with leukocytosis on the first postoperative day (p = 0.002). In regression analyses, dexamethasone associated with leukocytosis most significantly (p < 0.001). No association was found with infections.Conclusions
Dexamethasone use was the most significant predictor of leukocyte rise. As a drug response, perioperative dexamethasone caused sixfold postoperative leukocytosis. High-dose dexamethasone-induced leukocytosis may confuse the clinical decision-making especially in assessment of early infections.10.
Ra’ed M. Ayoub Al-Delayme Shefaa H. Alnuamy Firas Taha Hamid Tariq Jassim Azzamily Salah AbdulMahdy Ismaeel R. Sammir M. Hadeel Jafaar Nabeel R. Shwan Shahad Jamal Alfalahi Alaa Yasin 《Journal of maxillofacial and oral surgery》2017,16(1):43-47
Objective
The objective of this study was to determine average improvement during the rest and active mouth opening after ultrasound guided platelets rich plasma injection in the tempromandibular superior joint space for the patients complaining from non-reducing disk displacement.Patients and Methods
Thirty-four patients with non-reducing disk displacement underwent guided ultrasound injection of platelet rich plasma to the upper joint space. The extent of maximal mouth opening, chewing efficiency, sound intensity of the TMJ, and tenderness of the TMJ and the masticatory muscles at rest, motion and mastication were thoroughly assessed at the beginning of the study and scheduled for next follow-up at 1st, 3rd, and 6th months.Results
Injection with platelets rich plasma was significantly more effective in improvements of the extent of maximal mouth opening, statistics result demonstrated a significant reduction in the VAS values of pain at rest, motion and mastication compared to the baseline VAS values.Conclusion
PRP injection to the upper temporomandibular joint space provided improvement in signs and symptoms of patient with non-reducing disk displacement of the temporomandibular joint.11.
Objectives
To determine the prevalence of odontogenic maxillary sinus pathologies and their relationship with periapical pathologies in the maxillary posterior teeth using cone-beam computed tomography (CBCT).Method
Maxillary posterior CBCT scans of consecutive patients aged 20–77 years were evaluated retrospectively. Patients with at least one maxillary posterior tooth were included. Patients with edentulous maxillae or having one or more maxillary implants were excluded. Finally, 461 CBCT images were evaluated. Demographic data, such as age and sex, and pathologic findings of the right and left maxillary sinuses and adjacent teeth were recorded. Statistical analyses were performed using the Chi square test and binary logistic regression.Results
The prevalence of right and left odontogenic maxillary sinusitis was 59.5 and 64 %, respectively. Maxillary sinus pathology was more common in males, and there was no relationship with age. Regarding the maxillary sinus pathology, 64 % had mucosal thickening, 19 % had partial opacification, 5 % had total opacification, and 12 % had polypoidal mucosal thickening. Right and left maxillary sinus pathologies were approximately twice as prevalent in patients with periapical pathology in at least one maxillary posterior tooth. Periapical pathologies in the right maxillary first molar and left maxillary first and second molars significantly increased the risk of maxillary sinus pathology with odds ratios of 2.53, 1.83, and 3.12, respectively.Conclusions
Odontogenic maxillary sinus pathologies were present in >50 % of the study population. Periapical pathologies in the maxillary first and second molar teeth significantly increased maxillary sinus pathologies.12.
Background
The objective of this study was to evaluate the reproducibility and validity of patients’ mouth opening measurements in a research setting.Methods
Firstly, 68 patients made repeated self-measurements of mouth opening using a cardboard scale (Therabite Range of Motion Scale – TRMS). Secondly, 80 patients enrolled in a clinical trial on morbidity after lower third molar surgery, made daily assessments during the postoperative week. Patients’ measurements were then compared to gold-standard clinicians’ measurements.Results
Reliability of patients’ measurements was excellent with an intraclass correlation coefficient of 0.92. The patient’s measurements correlated well with the gold-standard clinician’s measurements, both for the first 68 patients (Pearson’s rho ranging from 0.86 to 0.90, p < 0.0001) as well as for the 80 patients enrolled in the clinical trial (rho = 0.82, p < 0.0001 at day 2, rho = 0.83, p < 0.0001 at final visit).Conclusions
TRMS can be used by patients to produce reproducible and valid mouth opening measurements.13.
Sanjay Roy Chowdhury K. Rajkumar Tushar Deshmukh 《Journal of maxillofacial and oral surgery》2017,16(1):96-100
Introduction
Access osteotomies provide direct exposure to inaccessible areas of the deep part of craniofacial skeleton for treating pathologies involving vital structures. The use of maxillary swing approach for gaining wide access to the nasopharynx, infratemporal fossa, parapharyngeal space, middle fossa of skull base. Though the maxillary swing requires transfacial incision for wide exposure but with careful handling the scar is minimum and this approach can be used in young people.Materials and Methods
Surgical resection is carried out following preoperative embolization of the involved feeder vessels. Total 16 cases were considered for this study.Results
This article highlights cases successfully treated in our institution, the mention of complications associated with the cases along with management.Conclusion
Maxillary swing is a good approach for getting access to the deep pathologies like JNA.14.
Vinay V. Kumar P. C. Jacob Moni A. Kuriakose 《Journal of maxillofacial and oral surgery》2016,15(4):449-455
Background
In patients with reconstructed mandibles using free fibula flaps, management of soft tissues around implants supporting dental rehabilitation, is often a clinical problem.Aim
The aim of this paper is to describe a new technique, namely "Sub-periosteal dissection and denture-guided epithelial regeneration (SD-DGER)", as a method of peri-implant soft tissue management in these patients.Materials and methods
The technique consists of performing a subperiosteal dissection with creation of buccal and lingual flaps. These flaps form the buccal and lingual vestibule. Implants are placed and an interim denture is immediately loaded onto the implants to guide the regenerated epithelium. A keratinized mucosal layer is formed on the bare fibula bone in six months time.Results
This technique was successful in producing fixed keratinized epithelial tissue around implants in patients with mandibles reconstructed using the free fibula flap in patients who did not undergo radiotherapy.Conclusion
The sub-periosteal dissection with denture guided epithelial regeneration is a predictable form of peri-implant soft tissue management in selected patients with reconstructed jaws.15.
Background
Submental flap is a useful aid in maxillofacial reconstruction. For intraoral usage the hairs in male patients will create some problems.Materials and Methods
In a retrospective study, patients in whom submental flap had been used for reconstruction of orofacial region between 2007 and 2013, in the Mashhad University, Ghaem Hospital, were included. The ways in which the problem of hairs was solved in male patients were evaluated.Results
There were 42 patients in whom submental flap was used for orofacial reconstruction. Sixty percent were males. Three ways had been used for management of intraoral hairs: radiotherapy (9 patients), second surgery (2 patients) and flap de-epithelialization (13 patients).Conclusion
Deepithelialized variant of submental flap is the best option when submental flap is used for oral cavity reconstruction in male patients. Flap thickness, age, race and postoperative radiotherapy can have strong influence on this strategy.16.
Ling Gao Wenhao Ren Shaoming Li Jingjing Zheng Lingfa Xue Yaoxiang Xu Qibo Wang Jianzhong Song Zhichao Dou Minzhan Zhou Wenlin Xiao Keqian Zhi 《Oral Radiology》2018,34(3):251-256
Objectives
Bone quality comprises bone mineral density and trabecular microstructure. The aim of this study was to explore the effectiveness of cone-beam computed tomography (CBCT) in evaluating bone quality of large odontogenic cystic lesions after decompression using CBCT and BoneJ software, and to determine whether secondary definitive surgery can be guided using CBCT data.Methods
Twenty-seven patients with large odontogenic cystic lesions treated by decompression were evaluated by CBCT. Medical history and perioperative details were analyzed.Results
The \(\Delta\)CT values for all patients with cystic lesions decreased after decompression, with no differences for age, sex, and histology (p?>?0.05). Bone volume fraction and trabecular number of new cancellous bone (0.012%, 0.17/mm3) were lower than those of normal cancellous bone (0.189%, 0.47/mm3) (p?<?0.05), while new cancellous bone trabecular separation (11.344?±?2.556 mm) was stronger than normal cancellous bone trabecular separation (4.833?±?2.232 mm) (p?<?0.05). There were no differences in trabecular thickness between new cancellous bone (3.812?±?1.593 mm) and normal cancellous bone (4.598?±?3.573 mm) (p?=?0.746). The \(\Delta\)CT values of five patients with favorable osteogenesis were ??72, ?86, ??86, ?47, and ??55, those of three patients with moderate osteogenesis were ??107, ?120, and ??71, and those of two patients with poor osteogenesis were ??165 and ??127 during secondary definitive surgery.Conclusions
CBCT is considered beneficial for evaluating bone quality of large odontogenic cystic lesions after decompression, while providing potentially useful information for referral to secondary definitive surgery.17.
Serhat Sezgin Metin Sencimen Aydin Gülses Fevzi Erdemci Mustafa Ayna İsmail K. Gider Onder Ongoru Tuncer Cayci 《Oral and maxillofacial surgery》2016,20(3):273-279
Aim
The aim of this study is to assess the effects of triester glycerol oxide (TGO) on cutaneous wound epithelization process.Material and methods
Fifty-four male Wistar rats were divided into 2 groups of 27 rats each: control(C) and TGO (PX). The groups have been divided into three subgroups which included nine rats each regarding the wound excision on the 3rd, 7th, and 10th days, respectively. The specimens were evaluated according to histological properties and hydroxyproline levels.Results
Seventh day examination showed that PX and control groups present the same score. HP levels in the control group were significantly lower compared to PX groups.Conclusion
TGO have positive effects on wound epithelization process by increased collagen synthesis.18.
Sameep Kadakia David Chan Yadranko Ducic Ricardo Cristobal Moustafa Mourad 《Oral and maxillofacial surgery》2017,21(1):7-11
Objective
We analyzed patients with advanced parotid malignancy requiring proximal facial nerve exposure undergoing mastoidectomy versus lateral temporal bone resection to determine differences in local and distant recurrence.Study design
The study design is a case series with chart review.Setting
The setting is in Tertiary care practice in Fort Worth, Texas from January1998 to January 2014.Subjects and methods
The study included 120 patients with advanced parotid malignancy, 82 males between 19 and 87 years, and 38 females between 26 and 83 years. Patients with no overt bone involvement were treated with parotidectomy and mastoidectomy for exposure of the proximal facial nerve, and patients with clinically suspected (radiographic imaging or clinical fixation) bone involvement were treated with parotidectomy and lateral temporal bone resection. Follow up ranged from a minimum of 18 months to 11 years following surgery.Results
Sixty patients were treated with mastoidectomy and 60 were treated with lateral temporal bone resection. In patients treated with mastoidectomy, 13 had local recurrence and 7 had distal recurrence. In patients treated with lateral temporal bone resection, 2 had local recurrence while 9 had distant recurrence. Statistical analysis revealed that patients treated with mastoidectomy developed local recurrence (p = 0.0022) more commonly than those treated with lateral temporal bone resection. There was no significant difference in distant recurrence between both groups (p = 0.5949).Conclusions
Patients with advanced parotid malignancy should be treated aggressively with parotidectomy and lateral temporal bone resection regardless of bone involvement due to increased risk of local recurrence in those treated with mastoidectomy alone.Level of evidence
Level of evidence is a 4 case series.19.
Kirti Chaudhry Dutt Sukhvinder Bindra Meenakshi Awana Manjit Talwar Gurvanit Lehl 《Journal of maxillofacial and oral surgery》2017,16(2):145-151
Introduction
Leiomyoma is a rare tumor of smooth muscle origin with a very low incidence in the maxillofacial region. Intraosseous occurrence of oral leiomyoma is even rare with involvement of mandible followed by maxilla.Aim
The purpose of this paper is to present a case of intraosseous leiomyoma of the left mandibular angle region with the review of literature describing this rare entity. The paper also highlights the need to include this entity in differential diagnoses of jaw lesions.Material and Method
An extensive search of literature was carried out on the Medline-Pubmed and Google Scholar database using the keywords leiomyoma, maxilla, mandible, oral and palate to thoroughly search and collect all the reported cases of intraosseous leiomyoma.Result
To the best of our knowledge till date only 22 cases of intraosseous leiomyoma have been reported in the maxillomandibular region we represent the 23rd case of the intraosseous leiomyoma in a 36 year old male patient.Conclusion
Though uncommon but it is known to occur in the jaws therefore intraosseous leiomyoma should be included in the list of differential diagnoses of radiolucent lesion of mandible and maxilla.20.
Anshul Rai Adesh Shrivastava Manal M. Khan 《Journal of maxillofacial and oral surgery》2017,16(1):127-130