Maxillary ameloblastoma mimicking an oroantral fistula

Background

The aim of this current report is to present an unusual case of a maxillary ameloblastoma mimicking an oroantral fistula.

Case report

A left subtotal maxillectomy via Weber–Ferguson-type incision was performed. The patient tolerated the procedure well, the postoperative course was uneventful, and the patient was discharged 3 days after surgery with a mild paraesthesia of the right infraorbital nerve distribution. The infraorbital nerve paraesthesia has resolved 5 months after resection. The patient has been followed-up for 3 years without recurrence.

Discussion

Ameloblastoma is a well-known pathology of the maxillofacial region. However, unusual manifestations of this tumor can represent a serious challenge for diagnosis.     

Management of a fused central incisor in association with a macrodont lateral incisor: a case report

Fusion is developmental anomaly of the dental hard tissue and is defined as the joining of 2 developing tooth germs resulting in a single large tooth structure. Different treatment methods can be used according to the requirements of the situation. The purpose of this case report was to present the multidisciplinary treatment of a patient who had a permanent maxillary left central tooth fused with a supernumerary incisor and a macrodont permanent maxillary right lateral incisor. In the radiographic evaluation, it was determined that the fused tooth had 2 separate roots. The supernumerary tooth was extracted after hemisection, and endodontic treatment was performed on the remaining portion. The distal side of the macrodont lateral incisor was recontoured, and the right central incisor was reshaped with a strip crown to provide aesthetic appearance and to gain space for the alignment of teeth. Following the restoration of the incisors, orthodontic treatment was provided.     

Anatomic evaluation of maxillary sinus septa: Surgery and radiology

The anatomical structure of the maxillary sinus is fundamental to maxillofacial surgery. The presence of septa, located at the inner surface of the maxillary sinus, increases the risk of sinus membrane perforation during sinus elevation for dental implant surgery. The aim of this study was to evaluate the anatomy of maxillary sinus septa.Data in this study was obtained from a total of 205 cases. One hundred and seventy‐seven patients were partially edentulous (PE) whereas 28 patients had no teeth. Dental computerized tomography (dental CT) was used in the assessment of 410 sinus segments (205 left and 205 right segments). The prevalence of sinus segments with septa was found to be 145/410. Septa were detected in 91 of the 177 PE cases. There were a total of 26 septa in 18 of the 28 completely edentulous (CE) cases. A total of 165 septa were detected in these segments. The prevalence of septa was 46.4% (26/56) in the CE, and 39.2% (139/354) in the PE segments. Thirty septa were found in the anterior, 110 in the middle and 25 in the posterior region. All detected septa were located mediolateral direction. Their relative position: lateral, middle or medial were also noted. The height measurements of the septa varied amongst the different positions. In view of the fact that septa of various heights and courses can develop in all parts of the maxillary sinus, timely and adequate assessment of the inner aspect of the maxillary sinus is essential to avoid complications during sinus augmentation procedures. Clin. Anat. 22:563–570, 2009. © 2009 Wiley‐Liss, Inc.     

Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: anatomical and surgical aspects

The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury.     

Magnetic Resonance Angiography in Glomus Arteriovenous Malformation of the Cervical Spine

Conventional magnetic resonance imaging (MRI) and spine magnetic resonance angiography (MRA) demonstrated a glomus-type intradural arteriovenous malformation of the upper cervical region of the spine in a 24-year-old woman. Gadolinium-enhanced, three-dimensional, phase-contrast angiography displayed the nidus and feeders of the arteriovenous malformation. The clinical features of the two most common types of spinal arteriovenous malformations (dural arteriovenous fistula and glomus intradural arteriovenous malformation) are reviewed. Conventional MRI and spine MRA may obviate the need for performing total spinal myelography in patients suspected of having spinal arteriovenous malformations.     

Multidisciplinary treatment of "twinned" permanent teeth: two case reports

Twinned teeth usually appear in the anterior region of the dental arch. Besides orthodontic malocclusions, such as protrusion, crowding, or diastema, they also cause esthetic problems. Different treatment methods can be used according to the requirements of the situation. This article reports multidisciplinary treatment of 2 patients whose maxillary central teeth were twinned with supernumerary incisors. The twinned tooth was reshaped following endodontic treatment in 1 of the patients and orthodontic treatment was performed with edgewise mechanics. In the second case, however, it was determined that the twinned tooth had 2 separate roots. There was also another supernumerary lateral incisor in the dental arch that increased the severity of the crowding. The twinned tooth was hemisected and the other supernumerary tooth was extracted. The patient wore a removable appliance for initial tooth movements and treatment was finished with fixed appliances.     

Bone mineral density in pediatric patients with meningomyelocele

Purpose

The aim of this study was to determine the bone mineral density (BMD) and the factors leading to reduction in BMD in children diagnosed with meningomyelocele.

Methods

A total of 31 patients with meningomyelocele (mean (SD) age, 8.5 (3.9) years; 51.6 % were females) and 22 healthy children were included. BMD of femoral neck and spinal L1–L4 levels and markers for bone metabolism were recorded.

Results

BMD of femoral neck (p?=?0.001) and spinal L1–L4 (p?=?0.01), serum calcium (p?=?0.031), and urinary deoxypyridinoline (p?=?0.015) levels were significantly lower in patients than in controls. Mobilization was significantly reduced in lumbar (p?=?0.001) and thoracic (p?=?0.002) level meningomyelocele compared to controls, while a significant positive correlation was noted between BMD of spinal L1–L4 and mobility (r?=?0.58, p?=?0.015).

Conclusions

Our findings suggest a decrease in BMD in meningomyelocele patients being associated with osteoporosis rather than nutritional and hormonal factors and the negative impact of higher levels of lesion on the mobility.

     

Flap and incision design in implant surgery: clinical and anatomical study

Objectives  The protection of microcircular support which is essential for healing gains importance if implant surgery is considered to affect the blood flow. The aim of the study is to establish the artery territories supplying the blood into the oral mucosa in the cadavers and to demonstrate the mucosal delivery pattern and to evaluate the effects of different incision types on the healing in the patients having the implant application. Materials and methods  The study was planned in two stages as cadaver and clinical investigations. In cadaver investigation, all intra oral vascular territories were shown in ten specimens. The arterial structure and mucosal vascularity of the area were assessed microscopically and macroscopically. With the obtained data, the clinic results were established by making the crestal incision only for Group 1 (n = 30); both crestal and vertical releasing incisions for Group 2 (n = 30) were planned. Results  The results were established anatomically and clinically. In all cases, vascular territories of the mucosa in the maxilla and mandible were evaluated. In stereo microscopic assessment, although vestibule and oral mucosa had rich anastomoses, the crestal line had avascular features. There was no complication in the soft tissues of the cases, performed the vertical releasing incision during the healing period after 8-week follow-up. Conclusion  The vascular richness of the oral mucosal area enables the sufficient healing in the areas of applied flap. According to the alveolar anatomical pattern and the amount of the soft tissue over it, the incisions may be applied horizontally and/or vertically.     

A Neisseria gonorrhoeae immunoglobulin A1 protease mutant is infectious in the human challenge model of urethral infection.

Many mucosal pathogens, including Neisseria gonorrhoeae, produce proteases that cleave immunoglobulin A (IgA), the predominant immunoglobulin class produced at mucosal surfaces. While considerable circumstantial evidence suggests that IgA1 protease contributes to gonococcal virulence, there is no direct evidence that N. gonorrhoeae requires IgA1 protease activity to infect a human host. We constructed a N. gonorrhoeae iga mutant without introducing new antibiotic resistance markers into the final mutant strain and used human experimental infection to test the ability of the mutant to colonize the male urethra and to cause gonococcal urethritis. Four of the five male volunteers inoculated with the Iga- mutant became infected. In every respect-clinical signs and symptoms, incubation period between inoculation and infection, and the proportion of volunteers infected-the outcome of human experimental infection with FA1090iga was indistinguishable from that previously reported for a variant of parent strain FA1090 matching the mutant in expression of Opa proteins, lipooligosaccharide, and pilin. These results indicate that N. gonorrhoeae does not require IgA1 protease production to cause experimental urethritis in males.