Severe unilateral scissor bite and bimaxillary protrusion treated by horseshoe Le Fort I osteotomy combined with mid-alveolar osteotomy

This report describes an orthognathic surgical case employing horseshoe Le Fort I osteotomy (HLFO) combined with mid-alveolar osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) for a patient with severe unilateral scissor bite and bimaxillary protrusion. A female patient (aged 26 years, 2 months) presented with a chief complaint of dysmasesis caused by scissor bite on the right side. The clinical examination revealed difficulty in lip closure and a convex profile. Overerupted right maxillary premolars and molars and lingual tipping of the right mandibular premolars and molars were indicated before treatment. After 3 months of presurgical orthodontic treatment, two-jaw surgery involving a combination of HLFO with mid-alveolar osteotomy and BSSRO was performed. A good interdigitation in the right side was established by superior-posterior-medial movement of the dento-alveolar segment of the maxilla. Next, both the maxilla and mandible were moved superiorly and posteriorly to correct the improper lip protrusion, thereby improving the patient''s profile. Our results suggest that this new orthognathic surgery technique—achieved by combining HLFO with mid-alveolar osteotomy and BSSRO—is effective for adult patients exhibiting severe unilateral scissor bite and bimaxillary protrusion.     

Current treatment of Crimean–Congo hemorrhagic fever in children

Crimean–Congo hemorrhagic fever (CCHF) is a fatal viral hemorrhagic fever and is usually transmitted to humans by tick bite, or exposure to infected blood or tissues of infected livestock or humans. Although children can be infected with the CCHF virus, infection is unusual in the younger age group. Early diagnosis and treatment of CCHF infection is critical to the survival of patients and the control of the disease. In this article, we underline current therapeutic approaches to CCHF infection in children.     

Development of computerized masticatory force measurement system

Purpose: The aim of this study was to assess the Maximum Voluntary Bite Force (MVBF) in Indian population with normal occlusion and after treatment of mandibular angle fracture.

Materials and methods: This paper discusses the development of a sensor fork with modified load cell and computer-based bite force measuring system that generates force profile on the computer. This is a powerful diagnostic tool in response to the needs of dentists seeking an accurate way to dynamically measure occlusion.

Results: This study was carried out to evaluate the maximum voluntary bite force generated by the patients after the treatment of mandibular angle fracture. The in vivo measurements were repeated on the following day, week and two months later. The measurements of the device were highly repeatable.

Conclusion: This development provides the cost effective and handy equipment for bite force measurement further, if again sensor thickness reduced, we will be able to get more close results of forces that are exactly generated during the mastication process. Our study shows a significant difference in mean bite force efficiency between the all the treatment weeks and increased with time at α?=?0.05 level. The gender difference was statistically significant in the male and female.     

咀嚼肌肌腱-腱膜增生症的研究进展

咀嚼肌肌腱-腱膜增生症(MMTAH)是一种咀嚼肌肌腱及腱膜慢性进行性增生所导致的疾病,可有张口受限、方面型等表现,通常从青春期开始,进展缓慢,患者少有不适主诉,一般难以发现.自2000年被日本学者报道以来,其他国家也陆续有研究者针对该疾病发表报告及研究.临床上一般采用手术的方法进行治疗,疗效较好.本文将从其命名、诊断、...     

Transdermal fentanyl patch versus standard analgesia in postoperative oral submucous fibrosis patients: a triple blinded,randomised control trial

Severe pain experienced by patients with oral submucous fibrosis (OSMF) compromises their physiotherapy and negatively affects the surgical outcome and the patient’s compliance. The main aim of this study was to develop a protocol for pain control in the management of OSMF postoperatively. This was a prospective, parallel with active control, double-arm, triple-blinded, randomised control trial (RCT) with 48 OSMF patients, randomised into two groups - Group A (control, n = 25): received non-opioid analgesics (NSAIDs) and Group B (cases, n = 23): received transdermal fentanyl patches (TFP). Pain and interincisal opening were measured on postoperative days 1, 3, 5, 7, 9, and 15, and on the1^st and 3^rd postoperative months. Quality of Life (QoL) was assessed preoperatively, on the 15^th day postoperatively, and 3^rd month postoperatively, and compliance was documented postoperatively on the 9^th day. The transdermal fentanyl patch was found to have statistically significantly more effect in controlling severe pain during active mouth opening exercises, and thus significantly increased the patients’ compliance. Although there was increased mouth opening and QoL in the fentanyl group, the differences were statistically insignificant. Our study recommends the use of TFP for better pain control and compliance in postoperative OSMF patients.     

Anterior and posterior neck muscle activation during a variety of biting tasks

Bruxism may be involved in the aetiology of myofascial neck pain. The objective of this study was to test the hypothesis that anterior and posterior neck muscles co-contract during jaw clenching. Ten test subjects developed different feedback-controlled submaximum bite forces in a variety of bite-force directions by means of bite-force transducers. The electromyographic activity of the sternocleidomastoid and supra/infrahyoidal muscles, and of the semispinalis capitis, semispinalis cervicis, and multifidi muscles was recorded by use of surface electrodes and intramuscular wire electrodes, respectively. For normalization of electromyography data, maximum voluntary contraction tasks of the neck muscles were conducted in eight different loading directions. The results confirmed co-contraction of the neck muscles in the range of 2-14% of the maximum voluntary contraction at a bite force ranging from 50 to 300 N. Significant activity differences were observed as a result of the different force levels and force directions exerted by the jaw muscles. Long-lasting tonic activation of specific neck muscles triggered by the jaw-clenching tasks was also detected. These findings support the assumption of a relationship between jaw clenching and the activity of the neck muscles investigated. The low level of co-contraction activity, however, requires further study to elucidate possible pathophysiological interactions at the level of single motor units.     

Characterization of the early local immune response to Ixodes ricinus tick bites in human skin

Little is known about the immunomodulation by tick saliva during a natural tick bite in human skin, the site of the tick‐host interaction. We examined the expression of chemokines, cytokines and leucocyte markers on the mRNA levels and histopathologic changes in human skin biopsies of tick bites (n=37) compared to unaffected skin (n=9). Early tick‐bite skin lesions (<24 hours of tick attachment) were characterized by a predominance of macrophages and dendritic cells, elevated mRNA levels of macrophage chemoattractants (CCL2, CCL3, CCL4) and neutrophil chemoattractants (CXCL1, CXCL8), of the pro‐inflammatory cytokine, IL‐1β, and the anti‐inflammatory cytokine, IL‐5. In contrast, the numbers of lymphocytes and mRNA levels of lymphocyte cell markers (CD4, CD8, CD19), lymphocyte chemoattractants (CXCL9, CXCL10, CXCL11, CXCL13, CCL1, CCL22), dendritic cell chemoattractants (CCL20), and other pro‐ (IL‐6, IL‐12p40, IFN‐γ, TNF‐α) and anti‐inflammatory cytokines (IL‐4, IL‐10, TGF‐β) did not differ from normal skin. With longer tick attachment (>24 hours), the numbers of innate immune cells and mediators (not significantly) declined, whereas the numbers of lymphocytes (not significantly) increased. Natural tick bites by Ixodes ricinus ticks initially elicit a strong local innate immune response in human skin. Beyond 24 hours of tick attachment, this response usually becomes less, perhaps because of immunomodulation by tick saliva.     

Finger opening in an overarm throw is not triggered by proprioceptive feedback from elbow extension or wrist flexion

 Accuracy in an overarm throw requires great precision in the timing of finger opening. We tested the hypothesis that finger opening in an overarm throw is triggered by proprioceptive feedback from elbow extension or wrist flexion. The hypothesis was tested in two ways: first, by unexpectedly perturbing elbow extension or slowing wrist flexion and determining whether changes occurred in finger opening, and second, by measuring the latency from the start of these joint rotations to the start of finger opening. Subjects threw balls fast and accurately from a sitting or standing position while joint rotations were recorded with the search-coil technique. Elbow extension was unexpectedly blocked near the start of forward motion of the hand by a rope attached to the wrist that passed through a catch mechanism located behind the subject. In spite of a slowing or complete block of elbow extension, and in some cases a replacement of elbow extension by elbow flexion, finger opening always occurred and at the same latency as for normal throws. Wrist flexion was slowed in seven of eight subjects when subjects changed from throwing with a light ball (14 g, 70 mm diam.) to a heavy ball (210 g, 65 mm diam.). For the first throw with the heavy ball, this slowing was neither fully anticipated by the subject nor compensated for by the changed proprioceptive feedback associated with the slowing. Consequently, the timing of finger opening was unchanged and (to the surprise of the thrower) the ball went high. Furthermore, in unperturbed throws with tennis balls, the latency from onset of wrist flexion or elbow extension to onset of finger opening was too short for either to have triggered finger opening (across subjects means were 4 ms for wrist flexion and 21 ms for elbow extension). In additional analysis, no relation was found between the time of onset of earlier occurring rotations at the shoulder and the time of onset of finger opening. We concluded that, although a role for all proprioceptive feedback in triggering finger opening cannot be disproved by these experiments, it can be ruled out for feedback arising from elbow extension and wrist flexion, and it seems unlikely for feedback arising from events occurring very early in the throw. The more likely possibility is that finger opening in an overarm throw is triggered by a central command based on an internal model of hand trajectory. Received: 6 July 1998 / Accepted: 16 October 1998     

机械通气及大黄在抢救毒蛇咬伤致呼吸衰竭的应用

目的探讨毒蛇咬伤致急性呼吸衰竭治疗措施。方法选择毒蛇咬伤致呼吸衰竭患者46例,治疗方法：①机械通气治疗：患者出现呼吸困难或者呼吸浅慢时,及时气管插管行机械通气。上机模式为辅助／控制通气或同步间歇指令通气,注意观察患者胸廓起伏情况及肺部体征,动态监测脉搏血氧饱和度、X线胸片及血气分析,并视病情变化调整通气参数,使其逐渐达到脱机标准;②生大黄20g＋清水250ml水煎15min,管饲,qd,连用3～5d;③常规治疗：伤口切开排毒及药物局部封闭,及早足量应用抗蛇毒血清等。结果患者住院时间6～20天,平均（13．4±5．2）d。通气时间〈48h者28例（60．9％）,48～72h者12例（26．1％）,〉72h者6例（13．0％）。治愈44例（95．7％）,死亡2例（4．3％）。死亡者均是就诊时合并多器官功能障碍者。结论机械通气联合大黄、抗蛇毒血清等集柬治疗是抢救毒蛇咬伤致呼吸衰竭有效的方法。