Treatment of Cervicofacial Actinomycosis: A report of 19 cases and review of literature

Objectives: Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis. Study design: A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature. Results: The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 – 4 weeks, being shorter than the 3 – 52 weeks reported in the literature. Conclusion: When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 – 4 weeks is generally efficient. Key words:Actinomycosis, actinomyces, actinomycosis treatment, cervicofacial infection, actinomycosis diagnosis, head and neck infection.     

Peripheral fibroma/fibrous epulis with and without calcifications. A clinical evaluation of 204 cases in Singapore

Peripheral fibroma/fibrous epulis accounts for the great majority of localised gingival swellings as was substantiated by various reports in the literature. A study was undertaken to investigate the clinical features of a series of 204 localised fibrous gingival swellings received by the Histopathology Laboratory, Department of Oral Surgery, National University of Singapore. The female patients were more affected than the male patients and the lesions occurred predominantly among the Chinese. The lesions were mainly pedunculated and most commonly occurred in anterior maxilla. The recurrence rate was about 10.3%. In conclusion the results obtained in this study were overall in agreement with those of other authors.     

A 20-year study of dentists' and dental hygienists' assessment of dental caries lesions in bite-wing radiographs

Epidemiological data reveal that the prevalence of dental caries in western countries has decreased in recent decades. The aim of this study was to investigate how dentists and dental hygienists assess dental caries lesions in bite-wing radiographs between 1983 and 2003. All dentists and dental hygienists in Public Dental Health in Uppsala County were offered to take part in the study. The participants assessed manifest and initial caries lesions in eight bite-wing radiographs from three patients individually. An X-ray viewer and binoculars were used. The assessments were repeated in the same radiographs every five years, a total of five times, between 1983 and 2003. In the different test occasions 80-103 dentists and 11-48 dental hygienists participated. The registration of dental caries changed between 1983 and 2003. The number of manifest lesions registered by dentists decreased between 1983 and 1988, but were stable after 1988. Dental hygienists showed no changes in the registration of manifest lesions during the study. Initial lesions registered by dentists and dental hygienists increased between 1988 and 1998. Assessments of initial caries lesions displayed a wider range than manifest lesions. Increasing age and more years in the profession resulted in fewer registered initial caries lesions. Dental hygienists had a tendency to register less caries than dentists. In conclusion, the result of the study indicate that inclusion of initial caries lesions in epidemiological reports should lead to a reduction in reliability. The changes in assessments of manifest caries lesions that took place in the 19805s should be considered when epidemiological data are evaluated.     

Distribution of oral tumors in Nigerian children based on biopsy materials examined over an 11-year period

A survey of biopsied lesions of patients aged 0-16 yr who presented with oral swellings at the Lagos University Teaching Hospital over a period of 11 yr was conducted to determine the pattern of presentation of these lesions in 203 Nigerian children, 123 boys and 80 girls. 21% of the lesions were fibro-osseous lesions. There were more non-odontogenic than odontogenic tumors and very few salivary gland tumors.     

Periapical actinomycosis: report of a case and review of the literature

Abstract This case of periapical actinomycosis presented the clinical picture of chronic periapical inflammation. The diagnosis was based on the histological examination of the periapical lesions suggesting the necessity for routine histological examination. Although root canals provide a primary port of entry the Actinomyces organisms into the periapical tissue, periapical actinomycosis, is considered extremely rare. This may be due to the omission of routine histological examination of periapical lesions and the clinical behavior of the disease. The large number of cases reported during the last decade indicates that periapical actinomycosis is more frequent than what it is believed and this is important in the daily dental practice.     

A case-control study of plasma ascorbate and acute necrotizing ulcerative gingivitis

Data from animal studies and from studies of patients with acute necrotizing ulcerative gingivitis (ANUG) have provided suggestive evidence for an association between ascorbate deficiency and disease risk. Further, there is biological plausibility for such an association, due to the role of ascorbate in collagen synthesis and leukocyte function. A case-control study of plasma ascorbate and ANUG was performed on 60 patients with a history of ANUG infection and 60 age-race-sex-matched controls. No cases had had active lesions for at least two months prior to their vitamin assay to avoid any potential reduction of dietary intake of ascorbic acid due to the presence of painful mouth lesions. According to results obtained by use of a modification of the 2,4-dinitrophenylhydrazine method for determination of total plasma ascorbate, the mean and standard error of the mean of plasma ascorbate for all ANUG cases was 0.07 +/- 0.006 mmol/L; the mean for all controls was 0.10 +/- 0.006 mmol/L. Paired differences in plasma ascorbic acid concentrations between cases and controls were significantly different from zero (p less than 0.001). The unadjusted relative risk (RR) of ANUG as obtained by conditional logistic regression for subjects whose plasma ascorbic acid concentration was at or below the median value for controls, relative to subjects with higher values, was 7.3 (90% confidence interval, 3.0 - 17.4; one-sided p value less than 0.001). Patients with a history of ANUG ingested a daily average of 1.2 +/- 0.2 servings of dietary ascorbic acid, as compared with a daily average of 1.9 +/- 0.2 servings for healthy controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

The use of cefadroxil in the treatment of acute orofacial infections

The role of a new semi-synthetic cephalosporin, cefadroxil, was assessed in 20 patients presenting with acute orofacial infections. The patients were observed over a period of three days and clinical effects of the antibiotic therapy were noted. Where possible microbiological culture of fluid aspirated from swellings was performed and the bacteria were identified and tested in vitro with cefadroxil. The results indicate that cefadroxil may be considered an alternative antibiotic in the treatment of acute orofacial infections.     

Signs of temporomandibular disorders in tinnitus patients and in a population-based group of volunteers: results of the Study of Health in Pomerania

The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18-71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological 'Study of Health in Pomerania' (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann-Whitney U-tests. Sixty per cent of the tinnitus patients and 36.5% of the control subjects exhibited more than two symptoms of TMD (P = 0.004). Tinnitus patients had significantly more muscle palpation pain (P < 0.001), temporomandibular joint (TMJ) palpation pain (P < 0.001), and pain upon mouth opening (P < 0.001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1.6 for one to three painful muscles and OR = 2.53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2.99), listlessness (OR = 2.0) and frequent headache (OR = 1.84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.     

Evaluation of the therapeutic effect of levamisole in treatment of recurrent aphthous stomatitis

Abstract Recurrent aphthous stomatitis is a chronic, painful, ulcerative disease of the oral mucosa, which affects up to 60 % of the population. No effective cure or treatment is available. Levamisole is a drug reported to restore deficient immunologic states to normal and to reduce the incidence and severity of recurrent aphthous stomatitis. Sixty-five patients with attacks of recurrent aphthous stomatitis which recurred at least every 2 months were entered in a double-blind evaluation of the therapeutic effect of levamisole on their disease. Fifty-seven completed the double-blind study by taking the supplied medication for six recurrences of their aphthous lesions. Forty-two of those completing the double-blind study entered an open study to evaluate the long-term effects of levamisole on recurrent aphthous stomatitis. Each patient took the supplied medication at the onset of each recurrence of their aphthous lesions. They were examined and evaluated at each recurrence of their lesions. The levamisole was supplied in 50-mg tablets and taken by mouth at a dosage of 150 mg daily for 3 days. Pregnant patients were excluded from the study. A reduction in the duration of the aphthous lesions from 10.7 days to 6.07 days was obtained in the double-blind study by the group taking levamisole. The placebo group had a reduction from 10 to 8.62 days. The reduction in the duration of the lesions continued in both groups in the open study. No reduction was noted in the days between recurrences of the lesions in the double-blind or open study. No changes were noted in the RBC, WRC, differential white count, hemoglobin or hematocrit. Nineteen patients (33%) experienced side effects to levamisole. The most frequent reported were nausea, dysgeusia and hyperosmia.     

Role of FNAC in the diagnosis of intraosseous jaw lesions

Background

FNAC of intraosseous jaw lesions has not been widely utilized for diagnosis due to rarity and diversity of these lesions, limited experience and lack of well established cytological features. Aim of the study was to determine the role of FNAC in the diagnosis of intraosseous jaw swellings.

Material and Methods

42 patients underwent FNAC over a period of 7 years (2007-2013), of which 37 (88.1%) aspirates were diagnostic. Histopathology correlation was available in 33 cases and diagnostic accuracy of FNAC was calculated.

Results

Lesions were categorized into inflammatory 3, cysts/hamartomas 15 and neoplasms 19. Mandibular and maxillary involvement was seen in 21 and 16 patients respectively. Of these, benign cysts and malignant lesions were commonest, accounting for 27% lesions (10 cases) each. One case of cystic ameloblastoma was misdiagnosed as odontogenic cyst on cytology. Overall, sensitivity and specificity of FNAC were 94.7% and 100% respectively with a diagnostic accuracy of 97.3%. Definitive categorization of giant cell lesions, fibro-osseous lesions, odontogenic tumors and cystic lesions was not feasible on FNAC.

Conclusions

FNAC is a simple, safe and minimally invasive first line investigation which can render an accurate preoperative diagnosis of intraosseous jaw lesions, especially the malignant ones in the light of clinic-radiological correlation. Key words: Jaw swellings, intraosseous, FNAC.     

Periapical actinomycosis: A follow-up study of 16 surgically treated cases

Abstract Clinical features of 16 immunocytochemically verified and surgically treated cases of periapical actinomycosis were evaluated. A. israelii was demonstrated in 13, A. propionica in 10, and A. naeslundii in 6 biopsy specimens. More than one of these species were present in 9 lesions. All cases had a long and complicated clinical history accompanied by fistulation and destruction of cortical bone plates. During a mean follow-up period of 28 months after periapical surgery, only 1 clear failure was found. The results indicated that periapical actinomycosis is more common than previously believed and that these infections can be controlled by ordinary periapical surgery.     

原发性三叉神经痛患者负性情绪调查及影响因素分析

目的:调查原发性三叉神经痛患者焦虑、抑郁负性情绪,分析患者负性情绪的影响因素。方法:采用回顾性分析方法,收集2018年1月~2020年1月医院收治的原发性三叉神经痛患者165例,采用焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression,SDS)调查患者的焦虑、抑郁情绪,一般临床资料量表调查患者的临床资料,比较不同临床资料患者SAS和SDS评分差异,多元线性逐步回归分析患者负性情绪的影响因素。结果:调查的165例原发性三叉神经痛患者中平均SDS评分(51.01±5.86)分,抑郁发生率为48.48%;平均SAS评分为(48.11±5.33)分,焦虑发生率为61.21%。年龄越大、疼痛部位越多、病程越长、VAS评分越高、每次疼痛时长越长、发作频率越频繁的原发性三叉神经痛患者SAS评分越高,疼痛部位越多、病程越长、VAS评分越高、每次疼痛时长越长、发作频率越频繁的原发性三叉神经痛患者SDS评分越高,差异有统计学意义(P<0.05)。最终疼痛部位、病程、VAS评分、每次疼痛时长、发作频率进入回归方程,解释原发性三叉神经痛患者SAS评分、SDS评分的程度R~2分别为0.425和0.478。结论:原发性三叉神经痛患者多伴有焦虑和抑郁负性情绪,双支或者多支病变、病程长、疼痛重、疼痛频繁且持续时间长的患者更易出现负性情绪。     

Pulmonary Actinomycosis of Periodontal Origin

A case of pulmonary actinomycosis of periodontal origin is presented. Microbiologic testing including culture and typing of multiple systemic and oral lesions revealed the presence of Actinomyces naeslundii and A viscosus in all sites. In addition, biopsies demonstrating branching filamentous forms and “sulfur granules” were found in exudates from the lungs, submandibular region and left quadrants of the oral cavity. Seeding of tooth-associated materials containing Actinomyces sp into the pulmonary field may have resulted in this case of pulmonary actinomycosis. Therapy of the pulmonary and periodontal infections was completed and the patient is maintaining satisfactory health 18 months later.     

MR imaging of tumor-like swelling in the submandibular region

Tumor-like swellings in the submandibular region were evaluated in seven patients with MR imaging. Two cases of pleomorphic adenoma and two of sialoadenitis were selected as examples of submandibular gland lesions, while a plunging ranula, dermoid cyst and lymphadenitis were selected as examples of extraglandular lesions. The pleomorphic adenoma was connected with the remaining gland on T1-weighted images. The sialoadenitis showed changes in the size, signal intensity and homogeneity of the submandibular gland itself. On the other hand, extragland lesions showed zonal interpositions between the lesion and the submandibular gland, which showed either low or high signal intensity on T1-weighted images. On T1-weighted images, the intensity of all of the lesions was either lower than or the same as the normal submandibular gland. On the other hand, all lesions showed higher signal intensity, ranging from slight to very high on T2-weighted images. Sharp margins were seen in all lesions except one sialoadenitis. The sialoadenitis showed inflammatory infiltration into the surrounding tissue. A homogeneous internal pattern was observed in the case of cystic lesions, while an inhomogeneous internal pattern was noted in the pleomorphic adenoma and in the inflammatory lesions. Gd-DTPA enhanced the T1-weighted images in three cases. Pleomorphic adenoma and lymphadenitis were enhanced inhomogeneously, whereas the ranula was not enhanced.     

Comparison of the effectiveness of arthrocentesis in acute and chronic closed lock: analysis of clinical and arthroscopic findings

The objective of this study was to investigate the effectiveness of temporomandibular joint arthrocentesis in acute and chronic closed lock patients. Eighteen patients with closed lock of the temporomandibular joint (TMJ) were treated with fine needle fiber arthroscopic observation following arthrocentesis. Maximal mouth opening (MMO) and intensity of pain (VAS) were evaluated at pretreatment and each posttreatment appointment (one week, one month, three months following treatment). The clinical and arthroscopic findings were analyzed categorizing two groups into: good (A) and poor (B) groups. At pretreatment there was no significance relative to age or the mean MMO and VAS between the groups, but the mean of duration of the symptoms in group B was significantly longer than in group A (P < 0.03). Group B showed more severe synovitis, adhesions, and chondromalacia than group A (P < 0.01). Results suggest that arthrocentesis is more effective in closed lock of short duration where there is less severe synovitis, adhesions, and chondromalacia.     

Oral manifestations of non-Hodgkin's lymphoma in HIV-infected patients

The incidence of non-Hodgkin's lymphomas (NHL) in patients infected with human immunodeficiency virus (HIV) is relatively high. However, there have been few reports on the clinical and histopathological features of oral manifestations of NHL in these patients. The lesions reported so far were all tumorous swellings with or without ulceration, as in non-HIV-infected patients. In this report 3 cases are presented of HIV-infected patients with solitary, primary oral NHL. These lesions showed a striking resemblance to acute, necrotizing gingivitis, a common finding in these patients, thus making the diagnosis more difficult.     

Developing confidence in oral and maxillofacial dental core trainees: a national review of the trainee experience

This study considers the confidence of dental core trainees (DCTs) as they mature and progress through their first six months in an oral and maxillofacial surgery (OMFS) training post. Trainees have different incentives for embarking on a year in OMFS: to develop additional skills before settling into general dental practice; as a step towards specialty training; and to help decide about their career direction. Traditionally, an OMFS year has been associated with creating well-rounded and confident clinicians. We surveyed 123 DCTs at three stages over a six-month period to monitor their confidence in 10 clinical domains: assessing dentofacial infection, mandibular fractures, midface fractures, intraoral/extraoral swellings, airway risks, intraoral/extraoral lesions (benign/malignant), CT/MRI scans, and performing intraoral/extraoral suturing. The study demonstrates an increase in trainee confidence across all domains over the first six months of an OMFS post, with a particularly significant increase in the assessment of dentofacial infection, mandibular/midface fracture, and both intraoral and extraoral lesions and swellings.     

Angio-oedema in dentistry: management of two cases using C1 esterase inhibitor

Angio-oedema is a rare condition; it may be a hereditary or acquired form. It results from biochemical defects which cause excessive activation of the complement cascade and result in deep swellings in the skin and alimentary tract, called angio-oedema.These swellings are painful rather than itchy and not associated with urticaria, which helps to differentiate angio-oedema from allergic reactions. Even mild trauma can give rise to swelling, which may be life-threatening in the oral region. Management of two cases, one hereditary and the other acquired angio-oedema, are reported to demonstrate the use of C1 esterase inhibitor prophylaxis. CLINICAL RELEVANCE: It is important that patients giving a history of angio-oedema are thoroughly investigated and, in discussion with the patient's medical team, appropriate prophylactic measures are taken to prevent swelling.     

Actinomycotic ulcer of the oral mucosa: an unusual presentation of oral actinomycosis

Although the oral mucosa is often the site of entry of actinomyces into the deeper tissues, actinomycosis in the oral mucosa is extremely rare. Actinomycotic lesions are usually described as either single or multiple abscesses or indurated masses with hard fibrous walls and soft central loculations. Actinomyces israelii is the principal cause of human actinomycosis. We present a rare case of actinomycosis caused by Actinomyces odontolyticus; it presented primarily as a long-standing ulcer of the oral mucosa mimicking a squamous cell carcinoma.     

Joint tenderness, jaw opening, chewing velocity, and bite force in patients with temporomandibular joint pain and matched healthy control subjects

AIMS: To evaluate the effect of temporomandibular arthralgia on mandibular mobility, chewing, and bite force. METHODS: Twenty female patients (ages 19 to 45 years) with unilateral temporomandibular joint (TMJ) pain during chewing (49 +/- 27 mm on a 100-mm visual analog scale) and provocation, as well as TMJ tenderness, were studied. The TMJ conditions were classified as disc derangement disorders (n = 9), osteoarthritis (n = 7), and inflammatory disorders (n = 4). The patients were compared with matched healthy volunteers without orofacial pain or tenderness. Exclusion criteria were the presence of fewer than 24 teeth or malocclusion. The methods used were (1) algometric assessment of the pressure pain threshold (PPT) over the TMJ; (2) clinical recordings of maximum jaw opening; (3) computerized kinematic assessment of maximum vertical distance, velocity, and cycle duration during chewing of soft gum; and (4) measurement of unilateral molar bite force. RESULTS: The mean (+/- SD) PPT in the patients' painful side (69 +/- 20 kPa; P = .000001) was significantly lower than in the control subjects (107 +/- 22 kPa). Jaw opening was also significantly less (P = .00003) in the patients (42 +/- 9 mm) than in the controls (52 +/- 4 mm). Chewing cycle duration and maximum closing velocity were significantly different (P < or = .03) in the patients (948 +/- 185 milliseconds and 142 +/- 46 mm/s, respectively) versus the controls (765 +/- 102 milliseconds and 173 +/- 43 mm/s, respectively), and bite force was significantly lower (P = .000003) in the patients (238 +/- 99 N) than in the controls (394 +/- 80 N). Both bite force and jaw opening in patients were significantly correlated (P < or = .02) with PPT (r = 0.53 and 0.63, respectively). CONCLUSION: These systematic findings supplement results from acute pain experiments and confirm indications from unspecified patient groups that the clinical presence of long-standing TMJ pain is associated with marked functional impairment. This impairment might be a result of reflex adaptation and long-term hypoactivity of the jaw muscles.