Treatment of chronic ear disease. Topical ciprofloxacin vs topical gentamicin

OBJECTIVE

To determine and compare the therapeutic efficiency of ciprofloxacin hydrochloride and gentamicin sulfate in the treatment of chronic ear disease.

DESIGN

Prospective randomized study.

SETTING

Academic tertiary medical center.

PATIENTS

Consecutive referred sample of 44 patients with chronic suppurative otitis media randomized into two groups.

INTERVENTIONS

Ciprofloxacin hydrochloride (200 mg/mL) was administered to the first group (composed of 24 patients), while the second group (composed of 20 patients) received gentamicin sulfate (5 mg/mL) locally, five drops three times a day for 10 days.

RESULTS

In the ciprofloxacin group, 21 (88%) of the 24 patients with suppurative chronic otitis media were cured. On the other hand, only six (30%) of the patients in the gentamicin group were cured. The rest of the patients showed no clinical or bacteriological improvement.

CONCLUSIONS

To our knowledge, this is the first study to compare the efficiency of two topical otic preparations in the treatment of chronic ear disease. The results show that topical ciprofloxacin preparation is more efficacious and efficient than topical gentamicin for the treatment of chronic otitis media in the acute stage.

Two booster dose hepatitis B virus vaccination in patients with leukemia

The aim of this study was to interpret the antibody response to hepatitis B (HB) vaccination following a two booster dose schedule in 94 acute lymphoblastic leukemia (ALL) patients. All patients were between 1-16 years of age with negative hepatitis B virus (HBV) serology and normal hepatic function. Fifty patients were vaccinated with Engerix B vaccine, and 44 patients were vaccinated with GenHevac B vaccine, with a schedule of 0, 1, 6 and 0, 1, 2, as well as booster doses, in 12 and 6 months respectively. A second booster was given as a fifth dose to 16 unresponsive patients in each vaccine group, 3 and 6 months after the first booster for Engerix B and GenHevac B vaccines respectively. Dosage was 20 microg HbsAg for all patients. Seroconversion rates with protective level antibody were 35.1% (n=33/94). The figures were 32.1% (n=16/50) and 38.6% (n=17/44) for Engerix B and GenHevac B vaccines, respectively. Seroconversion rate in patients younger than 10 years old was found to be higher (39.11%) than older patients (24%), but this was not statistically significant. This study indicates that one third of the leukemic children undergoing maintenence chemotherapy responded to HB vaccine with protective titers of anti-HBs. We recommend HB vaccination especially in developing countries.

Evaluation of children with myelodysplastic syndrome: importance of extramedullary disease as a presenting symptom

Thirty-three children diagnosed with primary myelodysplastic syndrome (MDS) in a single institution over an 8 year period were evaluated with special emphasis on children who presented with extramedullary disease (EMD). EMD was present at diagnosis in 12 (36%) of the 33 children with MDS. Three patients with juvenile myelomonocytic leukemia (JMML) and 2 patients with chronic myelomonocytic leukemia (CMML) presented with pleural effusion. Pericardial effusion was present in 3 of these patients, two of whom also had thrombosis. Pyoderma gangrenosum, relapsing polychondritis were the initial findings in another two cases with JMML. Lymphadenopathy (n=1), gingival hypertrophy (n=2), orbital granulocytic sarcoma (n=1) and spinal mass (n=1) were the presenting findings in 5 patients with refractory anemia with excess of blasts in transformation. Since high-dose methylprednisolone (HDMP, 20-30 mg/kg/day) has been shown to induce differentiation and apoptosis of myeloid leukemic cells in children with different morphological subtypes of acute myeloid leukemia in vivo and in vitro, 25 children with de novo MDS were treated with combined HDMP and cytotoxic chemotherapy. Dramatic improvement of EMD and decrease in blast cells both in the peripheral blood and bone marrow were obtained following administration of short-course HDMP treatment alone as observed in children with AML. HDMP, combined with low-dose cytosine arabinoside and mitoxantrone were used for the remission induction. Remission was achieved in 8 (80%) of 10 children who presented with EMD and in 9 (60%) of 15 children without EMD. Long-term remission (>6 years) was obtained in 4 (two with JMML and two with CMML), three of whom presented with EMD. In conclusion EMD can be a presenting finding in childhood MDS as observed in adults. In addition, the beneficial effect of HDMP combined with more intensive chemotherapy should be explored as alternative therapy in children with MDS not suitable for bone marrow transplantation.

Effect of atorvastatin on ocular blood flow velocities in patients with diabetic retinopathy

AIM

To investigate blood flow velocities in the ophthalmic and central retinal arteries (CRAs) in patients with diabetic retinopathy before and after atorvastatin treatment.

METHODS

45 patients with type 2 diabetes were included in this double-blind, placebo-controlled study. The patients with diabetes were divided into three subgroups: group 1 (n = 15) included patients with non-proliferative diabetic retinopathy (NPDR); group 2 (n = 15) had patients with proliferative diabetic retinopathy (PDR); and group 3 (n = 15; placebo group) included 8 patients with NPDR and 7 patients with PDR. The patients in groups 1 and 2 (atorvastatin group) received 10 mg atorvastatin daily for 10 weeks. Pre-treatment and post-treatment serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride were recorded before and after treatment. Ocular blood flow velocities of the ophthalmic artery and CRA were evaluated by colour Doppler imaging before and after treatment in each group.

RESULTS

The baseline haemodynamic parameters were similar between atorvastatin and placebo groups (p>0.05 for both). Atorvastatin significantly decreased serum levels of total cholesterol, low-density lipoprotein cholesterol and triglycerides in groups 1 and 2 compared with pretreatment levels (p<0.001 for both). The mean peak systolic flow velocities (PSVs) of the ophthalmic artery in group 2, and the mean PSV and resistive indices of the CRA in groups 1 and 2 decreased significantly after atorvastatin treatment (p<0.05 for both), whereas the mean end diastolic flow velocity of the ophthalmic artery and CRA did not change (p>0.05). There was no significant difference in ocular blood flow velocities in the placebo group (p>0.05).

CONCLUSION

Atorvastatin may have a role in reducing diabetic retinal complications, with improvement in vascular resistance and decrease in the mean PSVs of the ophthalmic artery and CRA. However, further studies with large numbers of patients are needed to obtain the long-term results of this drug.

Benefit of high-dose methylprednisolone in comparison with conventional-dose prednisolone during remission induction therapy in childhood acute lymphoblastic leukemia for long-term follow-up

Eight-year event-free survival (EFS) was evaluated in 205 patients with acute lymphoblastic leukemia (ALL), to consider the efficacy of high-dose methylprednisolone (HDMP) given during remission induction chemotherapy between 1 and 29 days. The St Jude Total XI Study protocol was used after some minor modifications in this trial. Patients were randomized into two groups. Group A (n = 108) received conventional dose (60 mg/m(2)/day orally) prednisolone and group B (n = 97) received HDMP (Prednol-L, 900-600 mg/m(2) orally) during remission induction chemotherapy. Complete remission was obtained in 95% of the 205 patients who were followed-up for 11 years; median follow-up was 72 months (range 60-129) and 8-year EFS rate was 60% overall (53% in group A, 66% in group B). The EFS rate of group B was significantly higher than of group A (P = 0.05). The 8-year EFS rate of groups A and B in the high-risk groups was 39% vs 63% (P = 0.002). When we compared 8-year EFS rate in groups A and B in the high-risk subgroup for both ages together </=2 or >/=10 years, it was 44% vs 74%, respectively. Among patients in the high-risk subgroup with a WBC count >/=50 x 10(9)/l, the 8-year EFS was 38% in group A vs58% in group B. During the 11-year follow-up period, a total of 64 relapses occurred in 205 patients. In group A relapses were higher (39%) than in group B (23%) (P = 0.05). These results suggest that HDMP during remission-induction chemotherapy improves the EFS rate significantly for high-risk patients in terms of the chances of cure.

Accuracy of the London atlas, Willems, and Nolla methods for dental age estimation: a cross-sectional study on Eastern Turkish children

OBJECTIVES

This study aimed to estimate the dental age (DA) using the London Atlas, Willems, and Nolla methods and to compare their accuracies.

METHODS

The DA was estimated using the aforementioned methods on panoramic radiograms of a total of 919 Eastern Turkish patients aged 6-14 years, of whom 459 were female and 460 were male. The overestimation and underestimation values were determined in relation to the chronological age (CA) values. The paired t test was used to compare the mean DA and CA values. Multiple regression analysis was used to derive gender-specific formulations for the three methods.

RESULTS

The most accurate method for estimating the DA was the Willems method (mean prediction error 0.80), followed by the London Atlas (mean prediction error 0.83) and Nolla (mean prediction error 0.89) methods. Statistically significant differences were found only between the Willems and Nolla methods.

CONCLUSION

All three methods can be used for DA estimations of Eastern Turkish children.

CLINICAL RELEVANCE

Willems was the most suitable method for this patient sample. However, the London Atlas method may be preferred due to its practicability and comparable accuracy.

Effects of topical otic preparations on hearing in chronic otitis media

Most of the topical otic preparations have been shown to cause ototoxicity. In this study ciprofloxacin hydrochloride, a relatively new topical agent, and gentamicin sulfate were studied in two groups of 20 patients with chronic otitis media. Patients were randomly selected to receive either ciprofloxacin (200 microg/ml) or gentamicin sulfate (5 mg/ml) locally, five drops three times a day for 10 days. Clinical response was seen in 20 of 20 patients in the ciprofloxacin group compared with 6 of 20 patients in the gentamicin group. Audiometric evaluation revealed no significant ototoxic effect in either group. In fact, hearing thresholds were slightly better than pretreatment levels in both groups.

Extraction and physicochemical characterization of broiler (Gallus gallus domesticus) skin gelatin compared to commercial bovine gelatin

Gelatin was extracted from broiler (Gallus gallus domesticus) skins and analyzed to compare its physicochemical properties with those of commercial bovine gelatin. The average yield of broiler skin gelatin was 6.5% on a wet weight basis. Broiler skin gelatin had more α1-and α2-chains than β-chain and contained high molecular weight (γ-chain) polymers. Glycine was the dominant amino acid in broiler skin gelatin (20.26%), followed by proline (Pro) (15.12%) then hydroxyproline (Hyp) (11.36%). Compared to commercial bovine gelatin, broiler skin gelatin had less total imino acids (Pro and Hyp) but a higher (33.65 vs. 31.38°C) melting temperature (P < 0.01). The differences in physical properties between the broiler and commercial bovine gelatins appeared to be associated with differences in their amino acid composition and molecular weight distribution. The sensory evaluation results revealed that broiler skin gelatin could be a potential alternative to commercial bovine gelatin, useful in various food products.

Assessment of prevalence and volumetric estimation of possible Stafne bone concavities on cone beam computed tomography images

OBJECTIVES

Our study aimed to determine the prevalence and volumetric estimates of Stafne bone cavities (SBC) on cone beam computed tomography (CBCT) images.

METHODS

This retrospective study, which involved the CBCT images of 1141 men and 1260 women with an age range of 10-90 years, aimed to determine the prevalence of SBCs and to calculate their volumes using the semi-automatic segmentation method.

RESULTS

A total of 15 SBCs were diagnosed in 14 patients. Among the detected SBCs, 7.14% were found in a female patient and 92.86% were found in 13 male patients. Of the total number of SBCs, 6.67% were anteriorly located and 93.33% were posteriorly located. Bilateral SBCs had a prevalence of 0.04%; unilateral posterior SBCs 0.54% and anterior SBCs 0.04%. The mean SBC volume was calculated as 338.05 mm³.

CONCLUSIONS

The results of our study showed that SBC is a rare anomaly. In contrast to two-dimensional imaging techniques, CBCT allows a precise determination of SBCs' pattern of impact on adjacent bony structures, relationship with the mandibular canal and dimensions.

Some factors influencing milk somatic cell count of Holstein Friesian and Brown Swiss cows under the Mediterranean climatic conditions

Abstract. The aim of this study was to determine the influencing factors on somatic cell count (SCC) in the milk of Holstein Friesian (HF) and Brown Swiss (BS) cows raised on three dairy farms under the Mediterranean climatic conditions in Turkey. For a two-year period, farms were visited monthly to measure daily milk yield (DMY) and collect milk samples from each cow during the morning and evening milking. Total of 1 429 SCC readings from 67 HF and 16 BS cows were analyzed by using repeated measures. Breed (P<0.01), lactation number (LN) (P<0.01), milking time (MT) (P<0.05), lactation month (LM) (P<0.01) and the interactions of breed-LM (P<0.05), herd-LM (P<0.01) and LN-LM (P<0.01) effects on SCC were statistically significant as did the co-variable DMY effect (P<0.01). The effect of herd and herd-MT interactions on SCC were statistically insignificant (P>0.05). The SCC means for BS and HF cows were 5.464±0.060 (291 072 cells/ml) and 5.654±0.029 (450 817 cells/ml), respectively. The SCC mean for morning milking (338 065 cells/ml) was 25 850 cells/ml lower than that of evening milking. The LN4 had the highest SCC mean (490 908 cells/ml) and was statistically different from those of LN1 (P<0.01) and LN2 (P<0.05). The SCC level was the highest in the first LM (601 174 cells/ml) and this level then decreased in the later months. Possible reasons for the difference in SCC means between the breeds are different resistance mechanisms against mastitis, different morphological conformations of udders and different milk yields between these two breeds. The insignificant differences found among herds show the similarities of management, milking hygiene and barn conditions. In order to decrease SCC in milk and increase udder health, some precautions need to be taken like improving milking management, hygiene and barn conditions, milking the cow at uniform intervals, feeding the cows after the milking and applying a mastitis control program.

Myelodysplastic syndrome (MDS) associated with increased hemoglobin F and trisomy 8: presentation of a patient

A 7.5 year old boy with myelodysplastic syndrome (MDS) of CMML type associated with trisomy 8 and elevated hemoglobin F (Hb F) value is presented. Hematological evaluation of the patient revealed that the Hb was 10 g/dl, MCV 110 FL, platelets 58 X 10(9)/l, WBC 5.4 X 10(9)/l with 24% atypical monocytes. Karyotype analysis revealed 47, XY, +8. Hb F value was 21% which was distributed heterogeneously among red cells. PCR amplified cDNA copies of circulating reticulocyte mRNA were used to measure the relative amounts of alpha-, beta-, and gamma- globin. There was marked increases in both alpha/beta mRNA ratio (20%) and gamma/(gamma+beta) mRNA ratio (35%) in the patient compared to normal subjects. The study indicated that increased transcription of alpha and gamma genes are partly responsible for the elevation of Hb F in MDS.

Closure vs non-closure of peritoneum at caesarean section: evaluation of pain

We evaluated the effect of closure or non-closure of parietal and visceral peritoneum during caesarean section (CS) on post-caesarean pain and analgesic requirement. A total of 94 primigravidas planned for elective CS were prospectively enrolled into closure (n = 46) and non-closure (n = 48) groups. Analgesia was provided by a patient-controlled analgesia pump (PCA) postoperatively. Pain was evaluated using a visual analogue scale (VAS) and verbal rating scale (VRS). Total dose of analgesics administered through PCA and times of analgesia demand and additional analgesics were also assessed. VAS and VRS scores were similar between the groups. The total dose of analgesics administered were similar (p = 0.095) between groups, however the mean number of analgesic demand (p = 0.020) and the additional analgesics (p < 0.001) were higher in the closure group. As a conclusion, the closure or non-closure of the peritoneum does not have any impact on postoperative pain intensity, however the analgesia demand and additional analgesia requirement decreases with non-closure.

Is it possible to estimate volume of bone defects formed on dry sheep mandibles more practically by secondarily reconstructing section thickness of cone beam computed tomography images?

OBJECTIVES

The purpose of this study was to evaluate the effect of section thickness on volume estimations of bone defects scanned using cone beam computed tomography (CBCT).

METHODS

25 bone defects were prepared on sheep mandibles and scanned using a KaVo 3D eXam (KaVo Dental, Biberach, Germany) CBCT device. Section thickness of images were reconstructed at 0.25, 0.5, and 0.75 mm to estimate the volume of these defects using the semiautomatic segmentation method. The volume averages obtained using microcomputed tomography and Archimedes' method served as reference values. The estimated volumes at each section thickness were compared with the actual volumes using the Friedman test. The accuracy of volume estimation was determined by the percentage error with respect to the reference values, and the mean absolute error (MAE) was calculated.

RESULTS

Volumetric values of bone defects obtained with CBCT at section thicknesses up to 0.5 mm were compatible with the actual volumes (p > 0.05). The percentage errors at section thicknesses of 0.25, 0.5, and 0.75 mm were -5.4%, -7.3%, and -13.1%, respectively. The mean absolute errors were 13.6 mm³, 15.7 mm³, and 18.2 mm³, respectively.

CONCLUSIONS

The section thickness values of CBCT images can be increased to a reasonable level to obtain accurate volume estimation results and save time. The semiautomatic segmentation method can be used reliably for volume estimations of bone defects.

Evaluation of trabecular bone microstructure of mandibular condyle in edentulous, unilateral edentulous and fully dentate patients using cone-beam computed tomography

BACKGROUND

The aim of this study was to compare the trabecular bone microstructure of the mandibular condyle in edentulous, unilateral edentulous (Kennedy Class II), and fully dentate patients.

MATERIALS AND METHODS

The study used the cone-beam computed tomography (CBCT) images of 17 fully dentate (34 condyles), 16 edentulous (32 condyles), and 17 unilateral edentulous patients (34 condyles) aged 19 to 80 years. The trabecular bone microstructure of the mandibular condyle was evaluated on 8 consecutive cross-sectional images of these patients. In the microstructure analysis, structural model index (SMI), ellipsoid factor (EF), bone volume fraction (BV/TV), trabecular thickness (Tb.Th) and trabecular seperation (Tb.Sp) were measured.

RESULTS

There was no significant difference between the mean SMI, BV/TV, EF and Tb.Th microstructure values of each group (p = 0.243, p = 0.095, p = 0.962, p = 0.095, respectively). However, there was significant difference in terms of mean Tb.Sp between the groups (p = 0.021). The trabecular structure in all three groups was more rod-shaped. No correlation was found between age factor and microstructure values.

CONCLUSIONS

Considering the in vivo microstructure analysis of CBCT images, it can be said that teeth loss does not have a significant effect on the microstructure parameters excluding Tb.Sp of mandible condyles and does not affect mandibular condyle trabecular endurance.

Cell free fetal DNA in the plasma of pregnant women with preeclampsia

OBJECTIVE

Insufficient cytotrophoblast invasion to the myometrium is associated with preeclampsia, especially with the early-onset preeclampsia (before 34 gestational weeks). Several investigations have marked changes in the concentration of cell free fetal DNA in the maternal circulation of women with preeclampsia. However, these studies were not performed for early or late preeclampsia subgroups individually. The present authors planned to determine the levels of the cell free both fetal and maternal DNA in the maternal circulation in early preeclampsia subgroup and compare it with normotensive control cohort.

MATERIALS AND METHODS

A total of 16 women; eight of these with preeclampsia and eight normotensive control cohorts with singleton male pregnancy between 28 and 32 gestational weeks were included in the study. Real-time PCR analysis was performed for determining the circulating cell free DNA levels.

RESULTS

Cell free fetal DNA concentrations were higher in early preeclamptic women than control subjects. The authors found no statistically significant difference in each levels of maternal and total DNA between hypertensive and normotensive groups.

CONCLUSIONS

The present findings suggest that the levels of cell free fetal DNA in maternal circulation were higher in pregnancies which are complicated with early preeclampsia than normotensive controls.

Determination of IL-17, BCL-3 and IκBζ expression levels in the gingival crevicular fluid of psoriasis patients

The purpose of this study was to determine the levels of IL-17, Bcl-3 and IκBζ gene expression in the gingival crevicular fluid (GCF) of psoriatic and healthy individuals and to compare the clinical periodontal parameters in the patient and control groups. A total of 10 psoriasis patients and 2 healthy patients in the control group were included in the analysis for IL-17, Bcl-3, and IκBζ gene expression in the GCF. Periodontal health, gingival index, plaque index, and mobility (using a periotest device) levels were compared between the groups. While considering the down-expressed patients, the expression level of the Bcl-3 gene showed the most variability among the genes studied in psoriasis disease. IL-17 gene expression levels were significantly higher and up-regulated in all patients compared to the control group. In addition, when comparing IL-17 with Bcl-3, IL-17 gene expression was notably high in all patients except patients 4, 9 and 10. The highest expression levels of the IκBζ gene were observed in the patient sample, except for patients 7 and 8. While plaque index, gingival index, and pocket depth parameters were higher in the psoriasis group, there was no significant difference between the two groups (p = 0.257, p = 0.390, p = 0.240, respectively). In the periotest (mobility) parameter, while the mean value was higher in the psoriasis group significantly (p = 0.030), clinically mean values of two groups were in the same grade according to Miller mobility index. The IκBζ gene showed notable high expression levels in psoriasis patients. It was concluded that psoriasis may be associated with periodontitis. CLINICAL TRIAL REGISTRATION NUMBER: NCT06408454-05/06/2024. NAME OF THE TRIAL REGISTER: Interleukin- 17 (IL-17), Bcl-3, and NF-kappa-B Inhibitor Zeta (IκBζ) Expression Levels in the Psoriasis Patients.

Juvenile rheumatoid arthritis presented with thrombocytopenia

Leukopenia and thrombocytopenia are rare findings in systemic onset juvenile rheumatoid arthritis (S-JRA), and if present, bone marrow (BM) examination is necessary to exclude malignant diseases. We report here a 13.5-year-old boy with S-JRA who had severe thrombocytopenia and mild leukopenia, without arthritis, at the onset of the disease. BM was hypercellular with increased numbers of myeloid precursors and megakaryocytes. After treatment with acetylsalicylic acid, leukocyte and platelet counts returned to normal levels, and after two months chronic arthritis developed.

The current overview of the devices of temporary anchorage placed on the palatal bone: CBCT study

Temporary anchorage devices (TADs) are frequently applied to different anatomic areas with different protocols to increase skeletal effects and anchorage in orthodontic treatment planning. It has been reported in many literatures that primary stability for orthodontic TADs is significant for long-term survival rate. For this reason, different areas of the palatal region, which has many indications, have been widely used in the studies. In this evaluation where bone quality and thickness are important, density, bone thickness, and fractal dimension (FD) on cone beam computed tomography (CBCT) will provide more predictable clinical results. The aim of this study was to evaluate bone thickness, density, and FD in the palatal region of the first, and second premolars, and first molars. There was a remarkable difference (p < 0.05) between the parameters of FD, thickness and density of bone in the identified areas in the palatal region. In terms of thickness and FD, the 1st premolar region had significantly higher values than the other regions (p < 0.05). In terms of density, the values in the right 1st molar and right 1st premolar regions were significantly higher (p < 0.05). The 1st premolar region is an ideal site for placement of palatal TADs. CBCT-assisted preliminary evaluation of FD value, bone density, and thickness may increase clinical success when selecting the location of TADs to be applied to the palatal bone.

The frequency and etiology of anemia among children 6-16 years of age in the southeast region of Turkey

The frequency and etiology of anemia were investigated in 2,913 children between six and 16 years of age in Sanliurfa, in the southeast region of Turkey. Anemia was found in 142 (7.8%) children in the 6-11 years of age group, and in 16 (1.5%) in the 12-16 years of age group; in total, in 158 (5.4%) children. Causes were iron deficiency in 93 (58.9%) children, beta-thalassemia heterozygosity in 10 (6.3%) children, chronic disease that causes anemia of inflammation in 30 (19.0%) children, and intestinal parasitic infections in 17 (10.8%) children. In eight (5.1%) children, the cause of anemia could not be determined. The study's results showed that iron deficiency anemia and chronic and parasitic disease are important problems in schoolchildren of Sanliurfa, while beta-thalassemia and hemoglobinopathies have less importance.

Variation of Mandibular Canal Branching Related to Anatomical Regions in Mandible: A Radiographic Study Without Contrast

PURPOSE

Screening mandibular canal branches and awareness of these possible canal branches is vital for patient safety and surgical success. The aim of this study was to evaluate the prevalence and localization of mandibular canal branching (MCB).

METHODS

This is an institutional and retrospective cohort study of patients who presented for evaluation of cone beam computed tomography (CBCT) between 2019 and 2020. The prevalence of MCB and the related foramina was estimated according to anatomical regions. Predictor variables were gender, age, anatomical region, and side of branches. Outcome variable of the study was MCB. Thus, multiple correspondence analysis was performed to determine the relationships between the categories of the variables, as well as between variables.

RESULTS

CBCT images were obtained from 180 patients (n = 360 hemimandible; 90 males, 90 females). MCB was observed in 130 (72.2%) of 180 patients (mean age = 38.2 ± 11.8 years). MCB was observed in 63 (48.5%) males and 67 (51.5%) females, and the prevalence of MCB did not differ significantly according to gender (P = .618). MCB was mostly observed in the molar region (69 branches, 34.3%). Foramina were detected in 60 of 248 branches (24.19%) and were mostly observed in the retromolar region (28 foramina, 46.7%). "Quadrafid" branching was detected in 2 females (1.11%). Female patients aged 19-38 years were more prone to have MCB in molar and retromolar regions. MCB was more likely to occur bilaterally. There was also a high positive correlation among the MCB, side, and anatomical regions.

CONCLUSIONS

MCB is not a rare anatomical variation, and even quadrafid branching can be observed in the hemimandible. CBCT images should be examined carefully for possible MCB to minimize postoperative complications during dental surgery.