Necrotizing ulcerative periodontitis associated with severe congenital immunodeficiency in aprepubescent subject: clinical findings and response to intravenous immunoglobulin treatment

Common variable immunodeficiency (CVID) is a rare multifactorial congenital disease of genetic origin caused by an impairment in the secretion of specific immunoglobulins. It manifests systemically through recurrent respiratory infections, gastrointestinal disorders and autoimmune diseases. Oral manifestations may include gingivitis and lichenoid lesions with Wickham's striae. The treatment for CVID is supported by using intravenous infusion of immunoglobulins (IVIG) that allows for control of the disease and avoidance of recurrent opportunistic infections. This report presents a case of necrotizing ulcerative periodontitis (NUP) in a young patient with CVID, and correlates his periodontal status with systemic conditions before and after IVIG administration during 1 year of evaluation.     

Orofacial manifestations in primary immunodeficiencies: common variable immunodeficiencies

The orofacial manifestations of 15 patients with Common Variable Immunodeficiencies (CVID) arc reported. Aphthous-like ulceration, pseudomembranous candidosis and/or enamel hypoplasia were observed in 11 patients. Four patients had no orofacial lesions.     

Restoration of facial symmetry in a patient with bell palsy using a modified maxillary complete denture: a case report

Permanent facial paralysis can be devastating for a patient. Modern society's emphasis on appearance and physical beauty contributes to this problem and often leads to isolation of patients embarrassed by their appearance. Lagophthalmos with ocular exposure, loss of oral competence with resultant drooling, alar collapse with nasal airway obstruction, and difficulties with mastication and speech production are all potential consequences of facial paralysis. Affected patients are confronted with both a cosmetic defect and the functional deficits associated with loss of facial nerve function. In this case history report, a modified maxillary complete denture permitted a patient with Bell palsy to carry on daily activities with minimal facial distortion, pain, speech difficulty, and associated emotional trauma.     

Two-stage total prosthetic reconstruction of temporomandibular joint in severe and recurrent ankylosis

ABSTRACT: Temporomandibular joint ankylosis is a devastating condition for the patient associated with both functional disability and aesthetic deformities. Various techniques have been described in the literature to overcome this problem; however, there is still a high risk of reankylosis in patients undergoing multiple temporomandibular joint operations, severe heterotopic ossification, and fibrosis of the soft tissues.This study includes 5 patients with severe and recurrent ankylosis. Two-stage reconstruction with excision of the bony mass and placement of a distraction device in the first stage, followed by gradual distraction of soft tissues, and placement of a total joint prosthesis in the second stage were performed in all patients. The 2-step approach helps to overcome the fibrosis and adhesions in the soft tissues and allows placing an implant with a higher ramus component. This approach seems to be a useful and effective technique for the management of such patients with high risk of reankylosis.     

(vi) Management of periprosthetic infection in total hip arthroplasty

Total hip arthroplasty (THA) is one of the most commonly preferred orthopaedic procedures. Although the rate of deep infection after primary hip arthroplasty is relatively low, the economic burden, associated morbidity and mortality make it potentially devastating. Because of an ageing population will need an increasing number of arthroplasties, prevention, diagnosis and treatment of infection must be optimised in order to reduce both direct and indirect costs to patients and healthcare systems.     

Cauda equina syndrome: principles of management

Cauda equina syndrome (CES) is a devastating condition for quality of life which may lead to permanent loss of bladder, bowel and sexual function with associated neurological pain affecting the patient, their family and relationships. It is a time-sensitive syndrome, requiring rapid and effective assessment, diagnosis and treatment if the best possible outcome for the patient is to be achieved. Assessment and diagnosis should be undertaken as an emergency. Surgery when it is required must be performed at the earliest opportunity. Nevertheless, despite optimal medical care, many patients with CES will suffer long-term symptoms with significant disability, which is often hidden for the rest of their lives.     

(vii) Management of periprosthetic fractures in the lower limb

The incidence of periprosthetic fractures is rising significantly as more replacement arthroplasties are performed. They are a potentially devastating complication associated with high morbidity and mortality. Their management is a sub-specialty in itself. This article outlines the principles of the management of periprosthetic fractures of the lower limb.     

Noma (cancrum oris) associated with oral myiasis in an adult

Noma is a devastating oro-facial necrotic condition affecting debilitated subjects. Oral myiasis is an infectious disease caused by deposition of larval flies in oral wounds and lesions. Oro-facial noma-myiasis association has not been previously reported in the literature. The aim of this paper is to report a case of noma associated with myiasis in a 65-year-old Brazilian male.     

Clinical treatment of ectodermal dysplasia: a case report.

Ectodermal dysplasia is both physically and emotionally devastating to patients. With proper restorative intervention, the quality of life can be improved for patients with ectodermal dysplasia. This case report outlines a method of restoring function and esthetics for a 14-year-old boy with ectodermal dysplasia. It is important that these patients be treated at an early age to aid in their social interactions.     

Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap

The mandibular defects caused by mandibulectomies can involve esthetic and functional sequelae in patients. The fibula presents positive aspects and can be used as an option for mandibular reconstruction after tumor resections or extensive traumas. Furthermore, this retrospective study of the patients who have passed through a mandibular reconstruction with a microvascular fibular flap over the last 17 years describes the experience of the Oral and Maxillofacial SurgeryService at the ErastoGaertner Hospital, Curitiba/PR. The use of this flap type has a complication rate of 32.3%, which includes the fixation material exposure, flap resorptions, fistulas, pathological fractures, tumor recurrence, infections, seromas, and thrombocytopenia. Most of them are associated with patients who have received radiotherapy and/or chemotherapy. These data suggest a high frequency of complications when a reconstruction plate fixation is used. Minor complications are usual and they should not be overlooked because they can lead to devastating consequences.     

Short-range shotgun wounds to the face.

To efficiently treat short-range shotgun wounds to the face, it is imperative to have a basic understanding of the causes, pathogenesis, probable extent of initial injury, primary treatment principles, and secondary reconstruction problems associated with these injuries. This paper deals with these basic principles in an attempt to provide a guide to the treatment of these devastating injuries.     

Ectodermal dysplasia: dental management and benefits, a case report

AIM: This case report describes a method of restoring function and aesthetics in a 9-year-old girl with ectodermal dysplasia with 15 years follow-up. Ectodermal dysplasia is both physically and emotionally devastating to patients. It is important that they are treated at an early age to help their social interaction. With proper dental intervention, the quality of life can be improved for patients with ectodermal dysplasia.     

Total joint replacement: a consideration for antimicrobial prophylaxis

Infection is the principal and most devastating complication of total joint replacement, resulting in long periods of hospitalization, staggering costs, loss of the implant, disastrous physical impairment, and even death. Staphylococcus aureus and Staphylococcus epidermidis account for more than 50% of late infections. Animal studies have shown that joint implants are at a high risk of becoming infected via a metastatic hematogenous route during transient bacteremias. Because cephalosporins have been established as the perioperative and intraoperative agents of choice to prevent infections related to total joint replacement, oral cephalosporins are the drugs of choice to minimize the potential for the metastatic infection of prosthetic joints associated with transient dental bacteremias. Clindamycin is preferred for patients who are allergic to the cephalosporins or who may have a cross-allergy between penicillin and the cephalosporins.     

Bisphosphonates and their clinical implications in endodontic therapy

This review gives an overview of the factors that may play a role in the development of osteonecrosis of the jaw in patients treated with bisphosphonates (BPs) and undergoing nonsurgical endodontic treatment as well as some recommendations for its prevention. BPs are a widely prescribed group of drugs for diverse bone diseases. The occasional but devastating adverse effect of these drugs has been described as bisphosphonate‐related osteonecrosis of the jaw (BRONJ). As this condition is debilitating and difficult to treat, all efforts should be made to prevent its occurence in patients at risk. The main triggering event is considered to be dental extraction. Even though nonsurgical endodontic treatment appears to be a relatively safe procedure, care remains essential. After an overview of this class of drugs, the clinical presentation, epidemiology and pathogenesis of BRONJ, as well as the possible risk factors associated with its development after nonsurgical endodontic treatment will be described. Finally, several strategies will be proposed for the prevention of BRONJ during nonsurgical endodontic treatment.     

Dental treatment of patients with neurodegenerative disease

Neurodegenerative disorders are among the most challenging and devastating illnesses in medicine. A heterogeneous group of chronic and progressive diseases, they include Alzheimer's, Parkinson's, and Huntington's diseases. Dentists faced with patients affected by one of these disorders are confronted with the major problems of cognition, mobility, and behaviour, as well as of dental maintenance. While treatment of patients with progressive neurodegeneration remains daunting, increased knowledge of the aetiology and pathogenesis of these diseases has provided new opportunities and a new understanding of their treatment needs. In this article, we briefly describe the effects of ageing on the brain, and introduce two of the major neurodegenerative disorders, Alzheimer's and Parkinson's diseases. The dental problems associated with these conditions include a decrease in oral hygiene, difficulty in controlling and retaining dentures, and purposeless chewing. Medications can result in xerostomia and consequent root caries and recurrent decay. Where possible, individuals with neurodegenerative disorders should always be treated by the same dentist.     

An orbital apex fracture resulting in multiple cranial neuropathies

Fractures of the orbital apex are rare after trauma, but can be devastating if associated with indirect traumatic optic neuropathy and a permanent visual defect. Computed tomography plays an important role in the diagnosis and classification of these fractures, but optimal treatment is controversial. We describe an isolated fracture of the orbital apex in a 15-year-old boy resulting in indirect traumatic optic neuropathy and palsies of cranial nerves III, IV and VI after a blunt injury to the face.     

Electrocautery-ignited endotracheal tube fire: case report.

The risk of fire in the airway associated with laser surgery is well known, but there are reports of endotracheal tube fires ignited by electrocautery, particularly during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially devastating consequences. Surgeons undertaking these procedures should be aware of this complication and be familiar with measures to avoid them. We present a case report of an electrocautery-ignited endotracheal tube fire during an elective tracheostomy, which resulted in the patient's death.     

Complications in children's orthopaedics: avoiding late deformity in paediatric fracture surgery

Paediatric orthopaedic surgery can be an unfamiliar and challenging field with the potential for devastating consequences. This article discusses late deformity associated with humeral supracondylar fractures and slipped capital femoral epiphysis (SCFE). Common complications include loss of fixation, mal-reduction, avascular necrosis and growth disturbance. Many cases result in reoperation and revision surgery associated with significant morbidity. We discuss the risk factors, aetiology, tips to avoid them and management options based on current evidence.     

Teaching dental students how to deliver bad news: S-P-I-K-E-S model

Delivering bad news has traditionally been associated with life-threatening illness, the imminence of death, or communicating about the death of a loved one to a family member. The delivery of bad news in dentistry is rarely about life-threatening circumstances. However, the impact of the bad news such as the loss of an anterior tooth can be devastating for the patient. This article outlines the S-P-I-K-E-S protocol and discusses the teaching aims and methodology in applying the model in an undergraduate dental program in Ireland.     

Blindness after Le Fort I osteotomy: a possible complication associated with pterygomaxillary separation.

INTRODUCTION: Visual loss after Le Fort I osteotomy is a devastating complication the mechanism of which is not always clear. METHODS: A case report of blindness following Le Fort I osteotomy is presented. The literature on the various skull base complications associated with Le Fort I osteotomies is reviewed and the mechanisms of these complications discussed. CONCLUSION: The radiological findings in this case are similar to those previously reported. They strongly support the hypothesis that an adverse transmission of forces associated with pterygomaxillary separation via the sphenoid bone to the intra- and extracranial portions of the skull base is the main reason for injury to the optic and other cranial nerves as well as to the branches of the carotid artery.