An orthodontic bracket embedded in the medial pterygoid surface: a case report

Trismus caused by migration of orthodontic archwire into the infratemporal fossa: a case report

INTRODUCTION

Soft tissue injuries are known complications of orthodontic treatment. Most of the injuries are mild, but severe complications can arise from deeper penetration or dislodgement of brackets and other foreign bodies into the surrounding tissues of the oropharynx and infratemporal fossa.

PATIENT CONCERNS

The patient, accompanied by his parents, presented to the Children's Emergency Department with the concern of gradual limitation of mouth opening and eventual trismus, which occurred over a span of 2 weeks.

CLINICAL FINDINGS

The patient presented with trismus and slight discomfort at the left cheek region. He reported a history of gradual limitation to his mouth opening 2 weeks prior. He was wearing upper and lower fixed orthodontic appliances and the left distal end of the maxillary archwire was found to have migrated into the left infratemporal fossa.

PRIMARY DIAGNOSES

Left medial pterygoid muscle inflammation, or bleeding and haematoma formation, or infection within the infratemporal region.

INTERVENTIONS

The maxillary archwire was removed in the Children's Emergency Department and a computed tomography (CT) scan performed subsequently confirmed the diagnosis of left medial pterygoid muscle inflammation. The patient was started on an intravenous (IV) antibiotic and a 2-day course of IV dexamethasone to reduce the muscle inflammation.

OUTCOME

By the second day, the patient was able to achieve a mouth opening of 6 mm, and by the second week, the mouth opening had returned to normal.

CONCLUSION

The potential risk of soft tissue injury and complications from orthodontic treatment is generally mild and limited. Soft tissue injuries can be avoided with careful management by the operator with the proper precautions taken. Clinicians should be familiar with the surrounding soft tissue anatomy and be aware of the potential for more severe complications and provide management or referral to the appropriate specialty accordingly.

Effects of Accidental Swallowing of Orthodontic Appliance on Gastrointestinal Tract and Airway: An Evidence-Based Review of Case Reports

Background:

Contemporarily, the use of innovative orthodontic appliances or their components has increased for safer, quicker results, and more comfort of the patient. But, researchers rarely highlight the potential demerits of accidental ingestion of these appliances. Thus, the present study aimed to investigate the evidence-based literature on the accidental swallowing of these appliances and their effect on the gastrointestinal tract (GIT) and airway.

Method:

An electronic search was performed on PubMed, Medline, Scopus, The Cochrane Library, and EMBASE until April 11, 2021. Methodological quality and synthesis of case series and case report tool (MQCC) was applied to determine the quality of these case reports and series. The outcome variable was to assess its effect on airway and GIT, and methods of removal of these foreign bodies. Meta-analysis was not performed as the study included case reports and case series in which no control groups were present.

Results:

Out of 113 case reports and series, 29 articles were included in this systematic review. Only 31% of articles have satisfied the MQCC scale and maintained as high-quality case reports, 43% of articles were medium to high quality, and 26% designated as low quality.

Conclusions:

Eighty percent of the accidental ingested orthodontic appliances that pass uneventfully through the gastrointestinal system require a fiber-rich diet and laxatives. A total of 10% to 20% lacerates oral, pharyngeal, and gastrointestinal mucosa result in pain, bleeding requires laryngoscope, endoscopically and laparoscopy with use of Magill’s forceps. Only 1% of cases have presented with a high morbidity and mortality alarming for surgical removal of ingested component. Thus, the precautions to be taken to overcome such incidences are tying silk thread to activation key, use of recent bonding method, use of contrast colors of removable appliances as the color merges with mucosal color, and operator position should be 7 O′ clock.

Challenges, limitations, and solutions for orthodontists during the coronavirus pandemic: A review

INTRODUCTION

Orthodontic patients worldwide missed appointments during the early months of the coronavirus disease 2019 (COVID-19) pandemic. A significant problem with this virus is its high transmission power. Asymptomatic patients can transmit the virus. The aim of this review is to examine orthodontic emergencies and the necessary strategies and measures for emergency and nonemergency treatment during the coronavirus pandemic.

METHODS

The following databases were comprehensively searched: PubMed, MEDLINE, Scopus, and Google Scholar. Up-to-date data released by major health organizations such as the World Health Organization and major orthodontic associations involved in the pandemic were also evaluated.

RESULTS

Few studies were conducted on managing orthodontic offices or clinics during the pandemic, and most are not of high quality. Appropriate communication is the most important issue in managing orthodontic patients, particularly virtual counseling. Many orthodontic emergencies can be managed in this way by patients themselves. Most studies recommend using the filtering facepiece 2 masks, equivalent to N95 masks for non-COVID-19 patients undergoing aerosol-generating procedures and all suspected or confirmed COVID-19 patients in orthodontic visits.

CONCLUSIONS

At this time, there are no definitive clinical protocols supported by robust evidence for orthodontic practice during the COVID-19 pandemic. Orthodontists should not rush to return to routine orthodontic work and should follow state guidelines. Nonemergency orthodontic visits should be suspended during the severe acute respiratory syndrome coronavirus 2 pandemic in high-risk areas. Resuming orthodontic procedures during the pandemic requires paying special attention to screening, performing maximum efforts to reduce aerosol generation, using appropriate personal protective equipment, having proper ventilation, and fully adhering to sterilization and disinfection principles.

An Ingested Orthodontic Wire Fragment: A Case Report

Accidental ingestion or inhalation of foreign bodies has been widely documented, including incidents which occur whilst undertaking dental treatment. Most ingested objects pass through the gastrointestinal tract (GIT) spontaneously, but approximately 10%-20% need to be removed endoscopically and 1% require surgery. This case reports a complication arising from the accidental loss of an archwire fragment during maxillary archwire placement. It describes the immediate and subsequent management, including the use of radiographs to track the passage of the fragment through the gastro-intestinal tract. This case stresses the vigilance that dentists must take to prevent inhalation or ingestion of foreign bodies and the consequences of time-delays when management decisions are needed.