A Rare Complication of Maxillary Third Molar Extraction

The removal of tuberosity post extraction of the maxillary third molar is a very rare complication and there has not been ample discussion in the literature. Forceful extraction of a maxillary third molar can lead to soft and hard tissue loss. Various techniques have been used for the management of such defects such as local flaps, free soft tissue flaps, free bone flaps, and even tissue engineering. We present a case report of a large post-traumatic defect of maxillary tuberosity caused by forceful extraction of the maxillary third molar, which was managed conservatively by secondary healing, and the patient is on regular follow-up.

Clinical and histological comparison of healing by steel scalpel, diode laser, and radiofrequency in palatal wound: An animal study

Background

Wound healing following periodontal soft tissue procedures can differ owing to different techniques, the feasibility of which can be determined through detailed macroscopic and microscopic observations.

Aims

This study aimed to clinically and histologically evaluate palatal wound healing in rats by secondary intention after excision using a steel scalpel, diode laser, and radiofrequency.

Materials and Methods

An excision was made in the edentulous anterior maxilla of 42 4-month-old male Wistar rats weighing 289-428 g. Part of the connective tissue was left in the surgical area to observe the dynamics of secondary intention wound healing. Three experimental groups were established: the steel scalpel, an 810-nm diode laser at a power output of 1.5 W in continuous mode, and a monopolar radiofrequency in a fully rectified waveform at 15 W. Clinical and histological analyses were performed on days 2, 4, and 7. Hemostasis, changes in body weight, defect size, epithelial gap, and inflammatory infiltration were evaluated.

Results

The epithelial gap closed completely in all groups on day 7. Bleeding occurred significantly more in the scalpel group (P < 0.001). No significant changes were observed in body weight between the groups. Macroscopically, the mean wound area decreased over time in all groups. Wound healing was significantly slower in the laser group on day 2 and in the radiofrequency group on days 4 and 7 (P < 0.001). Microscopically, the laser created the cleanest wound area, with minimal inflammatory infiltration and no thermal injury. More damage occurred in the connective tissue of the radiofrequency group. Wound healing was observed on day 7 in all groups.

Conclusions

Palatal wound healing with secondary intention yielded different outcomes in a rat model when different techniques were used. However, almost complete healing was observed in all wounds, which highlights the importance of the soft tissue left in the surgical area. Wound healing in periodontal soft tissue procedures is not compromised by different techniques, as long as the clinician has sufficient knowledge and experience.

Surgical Outcomes Following Mohs Micrographic Surgery for Basal Cell Carcinoma on the Distal Third of the Nose

OBJECTIVE

The primary aim of this study is to determine a quantifiable difference in surgical outcomes between local skin flap, full thickness skin graft (FTSG), and secondary intention (SI) following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) on the distal third of the nose.

METHODS

A retrospective chart review of 66 MMS defects on the distal third of the nose performed by a single surgeon between June 2019 to June 2020 was completed. Clinical images of MMS defects and postoperative scars at six months were recorded and measured by the Vancouver Scar Scale (VSS). Pearson Chi-square and Fisher's Exact tests were utilized to determine the relationship between the main predictor variables and VSS.

RESULTS

Of the 66 patients retained, 52 were deemed to have low VSS (77.61%), 11 had medium VSS (16.42%) and three had high VSS (4.48%). Of the 52 patients with low VSS, 40 underwent local flap (76.92%), nine underwent FTSG (17.31%), and three healed by SI (5.77%). Of the 11 patients with medium VSS, two underwent local flap (18.15%), nine underwent FTSG (81.82%), and zero healed by SI. Of the three patients with high VSS, zero underwent local flap or SI, while all three underwent FTSG (100%). Bivariate analysis demonstrated that repair type employed was associated with VSS at six months (p<0.0001) with patients treated with local skin flap having better outcomes.

CONCLUSION

Our data illustrate that local skin flaps might result in a lower VSS at six months compared to FTSG or SI, therefore offering superior surgical outcomes in the treatment of BCC on the distal third of the nose.

Non-Healing Burn Wound Treatment With A Sterile Silicone Gel

Treatment of burn wounds can be complicated due to fluid and electrolyte loss and the increased chance of infectious complications. Silicone-based products have become increasingly used for non-healing wound treatment, but no study has specifically addressed its potential on burn patients. The purpose of this study was to compare the use of sterile silicone gel with conventional medication in improving the healing of burn wounds. Between November 2019 and March 2020, 12 patients with mid-deep and deep burn wounds were included in the present study (average TBSA approximately 29%, range 13-51%). Patient average age was 49 years (range 29-67 years), 7 were male. In each patient two clinically similar areas were identified and treated every 48 hours with topical application of silicone gel in the form of Stratamed® (Group 1) and conventional medication (Group 2). All the cases healed without requiring skin grafting. No secondary wound infection nor allergic reactions were found. The mean days from commencing the treatment to 95% re-epithelialization in Groups 1 and 2 were 5.4 and 12.5, respectively. Culture samples were negative for common pathogens. Silicone gel has shown to be particularly effective in speeding up the re-epithelialization process. The protective film formed by the silicone helps to reduce possible infectious complications. Finally, silicone gel is easy to apply and associated with greater pain control during medication.

Residual Breast Sarcoma Left to Heal by Secondary Intention Following Wide Local Excision: An Unorthodox Approach to a Rare Malignancy

Breast sarcomas remain a rare malignancy and are noted to portend a particularly dismal prognosis. Due to their high rates of recurrence, a surgical excision with negative margins remains the preferred treatment modality. Nevertheless, their sparse prevalence often poses a diagnostic conundrum. In this report, we chronicle the case of a 46-year-old female with a recurrent breast sarcoma that was treated with wide local excision. Interestingly, no flap reconstruction, skin graft surgery, or primary wound closure was performed, and the resultant wound was left to heal by secondary intention. The patient continues to do well to date, with no postoperative complications.

Application of secondary intention for the restoration of the apical triangle after Mohs micrographic surgery

BACKGROUND

Restoring the apical triangle (AT) to maintain the symmetry of the face after Mohs micrographic surgery can be challenging. We have applied secondary intention (SI) after partial closure in cases with large defects.

OBJECTIVE

To compare the cosmetic results between immediate closure (IC) and SI.

METHODS & MATERIALS

We retrospectively reviewed 24 patients (IC group: n = 15, SI group: n = 9). To evaluate the symmetry, the comparative ratio (CR; area of the AT of the involved side/area of the normal contralateral side) was calculated.

RESULTS

The defects were significantly larger in the SI group than in the IC group (588.89 ± 346.53 mm² vs. 252.87 ± 196.52 mm², p < .01). While there was no statistically significant difference in average CR, the standard deviation was higher in the SI group (0.95 ± 0.08 vs. 0.93 ± 0.31, p = .3359), indicating the difficulty in predicting the results of SI healing. The average visual analog scale score evaluated by two dermatologists was higher in the IC group, albeit without a significant difference (8.23 ± 0.96 vs. 7.78 ± 1.52, p = .5267).

CONCLUSION

SI after partial closure can be an option for large defects in the AT area.

Structured zinc oxide dressing for secondary intention wounds

OBJECTIVE

Inexpensive methods for more rapid healing of secondary intention wounds are sought. This pilot study measured the wound healing rate for a new zinc oxide structured dressing technique.

METHOD

In this study, we included the three patients with the largest wounds with onset during a one month period. A 3-ply gauze was cut and placed in the centre of each wound, leaving a 3-5mm rim of the wound exposed to the zinc gauze. The central gauze was soaked with 0.9% saline solution and the entire wound area was covered with 3 layers of Unna zinc oxide dressing. The central gauze size was modified to fit as the wound healed and the size changed. The wound was photographed at each visit and wound areas were obtained using best-fit ellipses.

RESULTS

The average wound closure rate is reported in the three wounds as 21.73mm² per day. The scalp wound healed at a rate of 21.45mm² per day.; the spider bite wound healed at a rate of 28.92mm² per day; and the thigh wound healed at a rate of 14.81mm² per day.

CONCLUSION

Healing rates for the zinc gauze method exceed those previously reported for full-thickness wounds healing by secondary intention. Additional study of the new technique with more patients is needed before conclusions relevant to clinical practice can be made.

Overview of nasal soft tissue reconstruction: keeping it simple

The authors provide an overview of nasal soft tissue reconstruction and of the senior author's practice. Nasal soft tissue reconstruction is a challenging endeavor as the nose is one of the most prominent and complex facial features. A multitude of surgical repair options exist, which can make the decision-making process unnecessarily complicated. It is advisable that the reconstructive surgeon become facile with a handful of surgical techniques versus trying to master many techniques.