Traumatic displacement of maxillary permanent incisor into the nasal cavity

PURPOSE

The purpose of this paper was to describe a case of unviable alveolar repositioning of an intruded tooth into the nasal cavity and to bring the subject of intrusive tooth injury among patients with dentoalveolar fractures to the attention of trauma surgeons.

PATIENT

A 26-year-old male was involved in a car accident and crashed his mouth against the dashboard due to sudden deceleration. Intraoral examination revealed an anterior maxillary dentoalveolar fracture and absence of the central maxillary incisors, right lateral maxillary incisor, and left maxillary canine. Computed tomography showed a dislocated tooth in the nasal cavity. The "missing" left maxillary canine was easily recovered from the floor of the left nostril.

CONCLUSIONS

Because complete dislocation of a tooth can cause a frontal sinus abscess, an airway complication, a respiratory tract obstruction, and a complicated lung abscess or sinusitis, anytime a tooth is not accounted for after a dentoalveolar trauma, the possibility that it has been fully intruded should be considered. Computed tomographic scan should be a routine diagnostic study in all cases with associated missing anatomical structures in the oral and maxillofacial region. The need to involve the dental professional in the initial assessment of dental trauma in emergency rooms in hospitals is important in order to identify how many teeth might be missing after dental trauma and to correctly reposition the avulsed teeth when possible.

Comparison of survival outcomes between ameloblastic carcinoma and metastasizing ameloblastoma: A systematic review

PURPOSE

To investigate and compare the demographic data, occurrence of recurrence and metastasis, and survival prognosis between ameloblastic carcinoma (AC) and metastasizing ameloblastoma (MA), based on appropriate and currently accepted eligible diagnostic criteria, in a systematic review of the literature.

METHODS

An electronic search was undertaken, last updated in December 2021. Eligibility criteria included publications having enough clinicopathological information to confirm the diagnosis of these tumors.

RESULTS

Seventy-seven publications reporting 85 ACs and 43 MAs were included. Both tumors were more frequent in mandible and showed different clinical profiles regarding patients' sex and age. There was no difference in the estimated cumulative survival between patients diagnosed with these tumors. Metastases mainly affected the lungs, followed by cervical lymph nodes. The mean time between the first metastasis and the last follow-up was higher for MA (p = 0.021). In addition, MA patients remained alive longer than AC patients after the first metastasis diagnosis (p = 0.041). Considering only the cases that metastasized, a higher ratio of AC patients died in comparison to MA patients (p = 0.003). The occurrence of recurrence was associated with a conservative primary treatment with both AC (p < 0.001) and MA tumors (p = 0.017). Multiple recurrent events were associated with conservative primary therapies with MA (p < 0.001) but not with AC (p = 0.121).

CONCLUSION

In addition to some demographic differences, ACs that metastasize present a worse prognosis than MA. As conservative procedures are associated with multiple recurrent events, this treatment modality should be avoided for both tumors.

Assessment of hematologic parameters before and after bimaxillary orthognathic surgery

PURPOSE

The purpose of the study was to evaluate changes of hematologic parameters in bimaxillary surgery.

METHODS

Fifty-three patients were prospectively evaluated and divided into groups based on the surgical procedure and sex (predictor variables). Hemoglobin, red blood cells, hematocrit, and platelet were the primary outcome variables, operation time the secondary outcome, and the patients' age and weight the other variables.

TRIAL REGISTRATION

NCT02364765 (U.S. National Institutes of Health, clinicaltrials.gov).

RESULTS

There was statistically significant difference between all hematologic parameters before and after surgery, for both men and women, and for all surgical groups. There was a positive correlation between operative time and the decrease (in %) of the hematologic parameters. Linear regression analysis suggested that the Hb values decrease 0.083 % for every minute increase in the operation time, and 0.066, 0.066, and 0.010 % for RBC, Hct, and platelet count, respectively. There was a negative correlation between weight and all hematologic parameters. Correlations between age and hematologic parameters were not statistically significant. Almost all correlations between age, weight, sex, and the surgery group and the hematologic parameters were considered as very weak. Only one patient was transfused.

CONCLUSIONS

It is suggested that operation time and patient's weight play a bigger role than patient's age and sex in the decrease of hematologic parameters after bimaxillary surgery.

Migration of tip knife blade through middle-third facial tissues

PURPOSE

The aim of this paper is to report a case of knife aggression with a spontaneous migration of a tip blade lodged in deep tissues 6 months after trauma.

PATIENT

An 18-year-old woman that was a victim of impalement injury with a knife by her boyfriend on the glabella region with a blade fracture and tip lodging into middle-third facial tissues.

RESULTS

After conservative management of a knife tip, a spontaneous migration occurred with its exposition on the zygomatic area, possibly due to a functional treatment to improve mouth opening.

CONCLUSION

Fracture of knife blade with a tip retained deeply into the tissues is considered foreign body, and its removal must be considered. Nevertheless, the basis for this removal takes account the cost-benefit ratio, and if a conservative management was chosen, the clinical and radiological accompanying is mandatory to prevent and to treat its possible complications.

An expanded odontogenic myxoma in maxilla

Odontogenic myxomas are considered to be a benign odontogenic tumor with locally aggressive behavior, non-metastasizing neoplasm of the jaw bones. It derives from the dental mesenchyme or periodontal ligament. Despite the benign nature of these lesions, there is a high rate of local recurrence after curettage alone and in certain cases requires adequate resection. This paper describes a case of a large odontogenic myxoma in the maxilla, emphasizing a discussion on the differential diagnosis related to radiological findings and the surgical treatment.

Pyodermatitis-pyostomatitis vegetans: a case report and systematic review focusing on oral involvement

BACKGROUND

Pyodermatitis-pyostomatitis vegetans (PPV) is a rare mucocutaneous disease characterized by multiple pustules and it is considered a marker for inflammatory bowel disease (IBD). The oral manifestations of this condition are referred to as pyostomatitis vegetans (PSV).

PURPOSE

To investigate which features could help in establishing the diagnosis of PSV, with or without cutaneous lesions, based on information retrieved from all cases of PSV described in the literature. A case of PV from the authors was also included in the analysis.

METHODS

An electronic search was undertaken, last updated in August 2022. Inclusion criteria included publications reporting cases of PSV, with the diagnosis confirmed by the pathological examination of oral or skin lesions, and presence of IBD.

RESULTS/CONCLUSIONS

Sixty-two publications with 77 cases of PSV and an associated IBD were included. Features that are helpful in establishing the diagnosis of PSV are snail track appearance of oral lesions, an associated IBD (which is not always symptomatic), evidence of intraepithelial clefting on microscopic examination of oral lesions, and peripheral blood eosinophilia. A gold standard for the management of PSV does not exist and high-level evidence is limited. There is no established therapeutic protocol for PSV and management primarily consists of topical and/or systemic corticosteroids, antirheumatic drugs (sulfasalazine, mesalazine), monoclonal antibody (infliximab, adalimumab) immunosuppressives (azathioprine, methotrexate), antibiotics (dapsone), or a combination of these. The risk of recurrence of oral lesions is considerable when the medication dose is decreased or fully interrupted.

Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis

OBJECTIVES

Acute as well as chronic pain syndromes are common after whiplash trauma and exercise therapy is proposed as one possible intervention strategy. The aim of the present systematic review was to evaluate the effect of exercise therapy in patients with Whiplash-Associated Disorders for the improvement of neck pain and neck disability, compared with other therapeutic interventions, placebo interventions, no treatment, or waiting list.

CONTENT

The review was registered in Prospero (CRD42017060356) and conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search in PubMed, Scopus and Cochrane from inception until January 13, 2020 was combined with a hand search to identify eligible randomized controlled studies. Abstract screening, full text assessment and risk of bias assessment (Cochrane RoB 2.0) were conducted by two independent reviewers.

SUMMARY

The search identified 4,103 articles. After removal of duplicates, screening of 2,921 abstracts and full text assessment of 100 articles, 27 articles that reported data for 2,127 patients were included. The included articles evaluated the effect of exercise therapy on neck pain, neck disability or other outcome measures and indicated some positive effects from exercise, but many studies lacked control groups not receiving active treatment. Studies on exercise that could be included in the random-effect meta-analysis showed significant short-term effects on neck pain and medium-term effects on neck disability.

OUTLOOK

Despite a large number of articles published in the area of exercise therapy and Whiplash-Associated Disorders, the current evidence base is weak. The results from the present review with meta-analysis suggests that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with Whiplash-Associated Disorders.