A proposed protocol for correlation between bone density in hemimandibular hyperplasia radiography and histopathological findings - A retrospective study

The role of low-dose computed tomography (LDCT) in surgical planning can be assessed based on the correlation among bone density (BD/HU), radiographic values, and the histopathological appearance of hyperplastic overgrowth in mandibular condyles (hemimandibular hyperplasia/osteochondroma). The aim of this study was to evaluate the correlation between LDCT indices of bone-density measurements in surgical planning and histopathological specimens. The patients incuded in this study underwent detailed radiological evaluation as preparation for further clinical procedures. Excised condyles were evaluated in terms of bone density index using LDCT, and then histopathologically to investigate the accuracy of surgical procedures and set the basis for future surgical planning. An index value between both condyles' bone densities represented the relative difference between the healthy condyle and the side with hemimandibular hyperplasia (HH). Patients with unilateral condylar hyperplasia (UCH) showed a statistical correlation between condyle heads with increased bone density (BD) and scintigraphic (SCI) values (p < 0.001). On the other hand, correlation between BD and histopathological studies alone was significant (p < 0.001). With the increase in BD measured in HU in UCH condyles, the overall value of fibrous cartilage layer thickness decreased (p < 0.001). Furthermore, histopathological evaluation indicated that increased bone density on the UCH side resulted in increased total thickness (p > 0.001). The proposed index measurements in the mandibular condyles based on LDCT/BD can be used to estimate the degree of required surgical resection. Results from LDCT radiographic studies correlate with histopathological specimens more than scintigraphy.

The CBCT Retrospective Study on Underwood Septa and Their Related Factors in Maxillary Sinuses-A Proposal of Classification

Introduction. The presence of bone septum in the maxillary sinus is one of the most common anatomical findings. So-called Underwood septa (US) are an atypical bone formation in the maxillary sinuses. Mostly they are quite easily found in CBCT studies and have major importance in sinus lift procedures in dental surgery. Furthermore, the shape, location, and size of the bony septa are important in each maxillary sinus surgery. Material and methods. A retrospective study of 120CBCT scans from the authors' own database was conducted. Results. Approximately 37.5% of each CBCT was associated with the occurrence of US, while just 25% had a full septum, and a total of only 14 patients had a half septa. More females have US, while healthy pneumatized maxillary sinus is most commonly found (82.22%). There is no correlation between the occurrence of silent sinus syndrome (p = 0.174), mucosal thickening (p = 0.325), or retention cyst formation (p = 0.272). Most sinuses are without any opacification in CBCT evaluation (91.11%), while other syndromes are not statistically relevant. Conclusions. It seems that the occurrence of Underwood septa is not statistically related to any clinical, radiological, or pathological condition within the sinus (p > 0.05). Furthermore, a more full or partial appearance of US was found in female patients.

Anatomical and Surgical Implications of the Usage of Bichat Fat Pad in Oroantral Communication, Maxillary, Palatal, and Related Surgeries-Narrative Review

The buccal fat pad, also called the Bichat's fat pad (BFP), is an encapsulated fat mass located in the cheek. This type of specialized fat mass can be used both as a pedicular or free graft in various surgeries and approaches. Due to its easy access from the oral cavity approach, it is commonly used for oroantral and palatal fistula closure. The knowledge of its anatomy and surrounding tissues plays a role in its mobilization and suturing onto the desired defect in the palatal or maxillary region. The BFP is mostly associated with the primary approach used for a fistula or bone surgery. Alternatively, the procedure can be performed with a single approach incision, which does not compromise the appearance or the function of the operating or adjacent areas. The most important inclusion criteria for BFP usage and surgical limitations are highlighted. The BFP is used for multiple purposes in reconstructive and oncology surgery and also has its use in esthetic and facial contouring procedures. The amount, volume, and shape of the BFP are mostly associated with the scope of their usage. The aim of the following narrative review is to present the surgical and anatomical implications of fat pads in maxillary and palatal surgeries.

Physical Conditions Prevailing in the Nasal and Maxillary Sinus Cavities Based on Numerical Simulation

Background and Objectives: This paper presents a unique study that links the physical conditions in the nasal passage with conditions that favour the development of bacterial strains and the colonization of the mucous membranes of the nose and paranasal sinuses. The physical parameters considered were air flow, pressure, humidity, and temperature. Materials and Methods: Numerical models of the human nose and maxillary sinus were retrospectively reconstructed from CT images of generally healthy young subjects. The state-of-the-art numerical methods and tools were then used to determine the temperature, humidity, airflow velocity, and pressure at specific anatomical locations. Results: The results were compared with optimal conditions for bacterial growth in the nose and sinuses. Conclusions: Temperature, humidity, air velocity, and pressure were shown to play critical roles in the selection and distribution of microorganisms. Furthermore, certain combinations of physical parameters can favour mucosal colonisation by various strains of bacteria.

The Temporary Mental Nerve Paresthesia as an Outcome of Dentigerous Cyst Removal during Preparation for Dental Implant Placement: A Case Report

The usage of xenograft material is widely used in almost all oral cavity bone defects for regenerative and reconstructive purposes. The presented xenograft usage in the following care report enabled good bone defect healing and enabled the preservation of affected premolars. It is quite common to use any possible variations of bone materials to ensure bone defect improved healing. In some cases, the scope of surgeries requires the removal of each cyst within close proximity to various nerves and vessels. The inferior alveolar, infraorbital, lingual, and mental nerves are those most commonly adjacent to most operating sites in jaw bones. The usage of some additional materials such as collagen sponges, bone substitutes, resorbable membranes, or other additional materials are useful in each bone defect reconstruction but should be handled with care, as described in the following case. Before planning their usage, it is important to perform each surgery with close cone beam computed tomography imaging, which is very helpful to establish the scope of each lesion and the proximity of vital structures. There are a lot of factors that might influence any possible nerve damage, especially the different nerve anatomical variations. Even factors including the subperiosteal preparation and compression of adjacent tissues might influence later nerve function. When the lesion is expanding through the buccal cortical plate and when soft tissue fluctuation is present, some special care is needed. Similar to the presented case, a limitation in crushing, blowing, or any irritation of nerve fibers improves later postoperative outcomes. When the wound and surrounding tissues are handled with care, a limited possibility of any damage or paresthesia can occur. When the nerve itself is damaged or cut, loss of function can be permanent. Immediately after or even prophylactic prescription 1–2 days before the surgery of Vitamin B with NSAIDs (Non-steroidal anti-inflammatory drugs) (or other additional supplementary medicaments can improve nerve function in time. Possible nerve damage can be divided into many etiological factors. A quite different situation arises when the nerve is pulled in by the cyst growth into the cyst wall. The presented case report describes the outcomes of a cyst removal from the mandibular basis and treatment modalities.

Bacterial complications in patients with coronavirus infection, new diagnostic and therapeutic possibilities

We present the case of a young patient who developed pneumonia during the COVID-19 outbreak. The course of the disease with involvement of interstitial lung tissue atypical for bacterial infections, the picture of infection markers could indicate SARS-CoV-2. The patient was tested by PCR method on admission with negative results. Due to the atypical follow-up of the disease, suggesting a severe course of SARS, PCR testing of the material collected by BAL was performed BIOFIRE® FILMARRAY® Pneumonia plus Panel (bioMérieux). Legionella pneumophilla and coronavirus genetic materials were found. We conclude that in the described case there was a bacterial co-infection, paved by virus infection. The similar radiological picture of the two cases of pneumonia, as well as the similar infectious response in the blood, specific for atypical infections, may pose a problem in the differential diagnosis. The study was able to confirm the bacterial etiology of pneumonia and introduce targeted treatment. The patient was discharged from the hospital. We believe that in any case of pneumonia of non-bacterial etiology, extending the diagnosis with a PCR pulmonary panel allows early and effective treatment of patients. In the treatment of patients with pulmonary interstitial lesions in the course of virus infections, one should always keep in mind the possibility of atypical co-infections.

Methods of Definitive Correction of Mandibular Deformity in Hemimandibular Hyperplasia Based on Radiological, Anatomical, and Topographical Measurements-Proposition of Author's Own Protocol

In order to fully evaluate and establish the degree of bone overgrowth, various radiological studies are essential in the careful planning of the amount of surgical excision. In the presented paper, the authors use self-designed anatomo-topographical reference points for planning the surgeries. Routine panoramic radiographs and low-dose computed tomography based on anatomical landmarks help in measuring the proportions of mandibular bone overgrowth with the following preoperative anatomical landmarks: (Go-Go), (Go(Right)-Gn), (Go(Left)-Gn), and (Me−Gn). Measurements taken at selected points and landmarks (gonion-gnathion/gnathion-menton) are easy to conduct. In the authors’ proposal, the main key factor is total chin correction, which is necessary in cases of severe overgrowth; when F0 > C and Go-Gn>, there is >7 mm of vertical bone overgrowth, and the mandibular canal is positioned <5 mm from the inferior mandibular border—MIB. Larger overgrowths (>7 mm) have a greater outcome on the final symmetry than smaller overgrowths. As no guidelines are known, the authors present their own proposal.

Expression of Apoptosis-Related Biomarkers in Inflamed Nasal Sinus Epithelium of Patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)—Evaluation at mRNA and miRNA Levels

In chronic upper respiratory tract diseases, increased cell proliferative activity is observed, which is coordinated by BCL-2 proteins and small non-coding RNAs. This study aimed to determine the expression of critical apoptosis markers at the mRNA and miRNA levels in patients with chronic rhinosinusitis with nasal polyps (CSRwNP). The study group consisted of ten patients with CSRwNP and ten healthy subjects. To detect in situ apoptosis in the maxillary sinus mucosa, TUNEL staining was performed. The expression of transcripts was determined by RT-qPCR and included the detection of markers associated with cell survival and apoptosis, i.e., BAX, p53, p21, CASP3, CASP9, c-MYC, CCND1, BRIC5, and APAF1. Levels of miR-17-5p, miR-145-5p, miR-146a-5p, and miR-203a-3p were also measured by RT-qPCR. The obtained results indicated increased apoptosis determined by a TUNEL assay in CSRwNP patients and accompanied by an increased expression of BAX, P21, P53, CASP3, CASP9, c-MYC, and APAF-1 transcripts and decreased mRNA levels of BCL-2 and BIRC5. Furthermore, the nasal sinus epithelium of patients with CSRwNP showed increased levels of miR-203a-3p while also showing a decreased expression of miR-17-5p and miR-145-5p. Our results showed that pro-apoptotic transcripts detected at mRNA and miRNA levels might be involved in the pathogenesis of chronic sinusitis with polyps. The identification of those key molecular mediators may be applicable for the specific diagnostic and/or development of targeted therapies for chronic sinusitis with polyps.

The pH Value as a Factor Modifying Bacterial Colonization of Sinonasal Mucosa in Healthy Persons

OBJECTIVE

The aim of the present study is to determine and compare the range of pH value in nasal and sinus cavities in vivo regarding the presence of bacteria colonizing sinonasal mucosa among healthy subjects.

METHODS

The nasal pH value measurement using a portable pH meter (Dx-pH System, Restech) and the microbiological culture swab were taken from beneath the middle turbinate and in the sinus cavity in 39 healthy subjects during maxillary bone corrective osteotomy with the Le Fort I technique.

RESULTS

The mean pH value (independently of sex, P = .441) in the healthy sinus cavity was statistically higher than in the nasal middle meatus: 7.96 (SD ± 0.29) versus 7.83 (SD ± 0.30) (P = .032). Forty-eight strains of bacteria were cultured from sinus maxillaries cavities-aerobic 36.8%, aerobic and anaerobic 52.6%, anaerobic only 10.5%-and 23 strains from the nasal meatus-aerobic 25%, aerobic and anaerobic 75%. A statistically significant correlation was found between the type and location of 8 microorganisms, especially Propionibacterium acnes, identified only in the sinus cavities.

CONCLUSIONS

Differences in the pH value between the middle nasal meatus and the maxillary sinus are characteristic of healthy subjects and could be associated with the diverse bacterial flora. The role of bacteria Propionibacterium acnes seems to be crucial for the pH range and sinus flora in healthy subjects.

Technical aspects of nasal cavity surgery through the Le Fort I down-fracture approach: An otolaryngologist's point of view based on 90 patients' experience

BACKGROUND

The downfracture access to septoand turbinoplasty during maxillary osteotomy may be recommended in many cases. One or both of these laryngological interventions may be necessary when, after the patient's clinical evaluation, either an impaired function of nasal breathing or a deviated septum are present. The main postsurgical risk of the procedure is the destabilization of the cartilaginous septum position and its relation to adjacent anatomical structures, a change in the shape of the nose and the presence of a supratip break.

OBJECTIVES

In this paper, the authors present their own experience in intranasal procedures, the relevant surgical techniques and possible complications, based on their own clinical findings and on a literature review.

MATERIAL AND METHODS

The general aim of the study was to describe the key points and differences between septoand turbinoplasty performed classically and during Le Fort I osteotomy based on 90 orthognathic surgery patient cases. The procedures have been evaluated and compared regarding their advantages and disadvantages.

RESULTS

Intraoperative downfracture of the maxilla facilitates the performance of various subsequent procedures in the regions of the nasal cavities and sinuses. Due to a very convenient access to the nasal cavities, it is possible to perform septoor turbinoplasty in patients with nasal airway breathing problems, a deviated septum, and in others.

CONCLUSIONS

A combined effort of an otolaryngologist and a maxillofacial team improves the overall nasal breathing with a limited amount of complications. Endoscopy with low-dose computed tomography (CT) is a valuable diagnostic tool for measuring any breathing improvements in nasal capacity. Objective patient nasal breathing problems should be always investigated.

Immune disorders in sepsis and their treatment as a significant problem of modern intensive care

Despite the great advances in the treatment of sepsis over the past 20 years, sepsis remains the main cause of death in intensive care units. In the context of new possibilities of treating sepsis, a comprehensive response of the immune system to the infection, immunosuppression, in particular, has in recent years gained considerable interest. There is vast evidence pointing to the correlation between comorbid immunosuppression and an increased risk of recurrent infections and death. Immune disorders may impact the clinical course of sepsis. This applies in particular to patients with deteriorated clinical response to infections. They usually suffer from comorbidities and conditions accompanied by immunosuppression. Sepsis disrupts innate and adaptive immunity. The key to diagnose the immune disorders in sepsis and undertake targeted immunomodulatory therapy is to define the right biomarkers and laboratory methods, which permit prompt "bedside" diagnosis. Flow cytometry is a laboratory tool that meets these criteria. Two therapeutic methods are currently being suggested to restore the immune homeostasis of sepsis patients. Excessive inflammatory response may be controlled through extracorporeal blood purification techniques, in large part derived from renal replacement therapy. These are such techniques as high-volume haemofiltration, cascade haemofiltration, plasma exchange, coupled plasma filtration and adsorption, high-absorption membranes, high cut-off membranes. The main task of theses techniques is the selective elimination of middle molecular weight molecules, such as cytokines. Pharmacotherapy with the use of such immunostimulants as interleukin 7, granulocyte-macrophage colony-stimulating factor, interferon gamma, PD-1, PD-L1 and CTLA-4 antagonists, intravenous immunoglobulins may help fight immunosuppressive immune disorders.

The presence of bacterial microcolonies on the maxillary sinus ciliary epithelium in healthy young individuals

OBJECTIVE

The aim of this cross-sectional in vitro study was to evaluate the mucosal surfaces of healthy maxillary sinuses, explore different forms of bacterial microorganism colonies present on the mucous membrane, and determine a mucosal surface area they occupy.

METHODS

Samples of the maxillary sinus mucosa were collected from 30 healthy patients (M = 11; F = 19). The material was obtained during the Le Fort I osteotomy performed during corrective jaw surgery. The morphological and morphometric analysis of sinus mucosa and bacterial film that was grown on it was performed using scanning electron microscopy (SEM) as well as imaging software.

RESULTS

Scanning electron microscopy analysis showed the presence of different bacterium and bacteria-like structures in all the analyzed samples. In most cases, the bacterial film was mostly composed of diplococci-like and streptococci-like structures on the mucosa of the paranasal sinus. In any case, the mucous layer did not cover the whole lining of the evaluated sample. Each colony consists of more than 20 single bacterial cells, which has grown in aggregates.

CONCLUSIONS

Under the conditions of normal homeostasis of the body, the maxillary sinuses present diverse bacterial colonization. The bacteria are dispersed or concentrated in single microcolonies of the biofilm on the border of the mucous covering the ciliary epithelium. There is no uniform layer of the biofilm covering the mucosa of the maxillary sinuses. Because the biofilm is detected on healthy individuals sinus mucosa, the clinical question if it may become pathogenic is unclear and require an explanation.

Risk factors involved in orofacial cleft predisposition - review

Clefts that occur in children are a special topic. Avoiding risk factors, and also an early diagnosis of cleft possibility can result in minimizing or avoiding them. If on the other hand when clefts occur they require a long-term, multistage specialized treatment. Etiology of clefts seems to be related to many factors. Factors such as genetic, environmental, geographic and even race factors are important. Identification of risk factors can lead to prevention and prophylactic behaviors in order to minimize its occurrence. Exposure to environmental factors at home and work that lead to cleft predisposition should not be disregarded. It seems that before planning a family it would be wise to consult with doctors of different specializations, especially in high-risk families with cleft history in order to analyze previous lifestyle. Clefts are very common in hereditary facial malformations and are causing a lot of other irregularities in the head and neck region. In this paper after a brief papers review authors present socio-geographic, environmental and also work place related factors that are influencing pregnant women condition and should be taken under serious consideration.