P177 A SHOT TO THE HEART

We report the case of a 50–year–old man who, during a wild bird hunt, was accidentally fired with a shotgun loaded with pellets which hit the chest, the neck and the face of the hunter. The patient was taken to the emergency room, tachypnoic and suffering from chest pain, systolic blood pressure was 150/70 mmHg, SpO2 88%, analgesic therapy, liquids administration and O2 therapy were performed with moderate response. On physical examination there was a reduced vesicular murmur in middle field on the right, no heart murmurs; noticeable edema of face and neck soft tissues and absence of evident jugular turgor. The ECG showed sinus rhythm, HR 100/min, morphology at the limit for ST slightly rigid in the inferior site. He underwent a total body CT in which a shotgun pellet was found located at the heart base near the right atrium, with associated pericardial fluid, with a maximum thickness of about 10 mm, with blood density. A shotgun pellet was also found in the apical segment of the right upper lung lobe with associated parenchymal ground glass (the pellet site of passage) without pneumothorax and pleural effusion. CT also showed multiple hunting pellets in the soft tissues of the face and of the neck without significant lesions. The echocardiogram confirmed the presence of circumferential pericardial effusion of mild degree, but progressively worsening, mainly represented along the cardiac apex and the inferolateral wall, but without signs of cardiac tamponade (right atrium within limits, absence of significant Doppler variation in blood flow across cardiac valves). The hospital where the patient arrived was at a distance of 30 minutes from the cardiac surgery, therefore the patient was urgently transferred to the cardiac surgery room of the hub (distance of 30 minutes). Fortunately, the patient maintained hemodynamic stability and arrived in the operating room with good blood pressure, but with a pre–tamponade effusion. The man quickly underwentcardiac surgery, the pericardial effusion was drained and the responsible breach was found in at the atrio–caval junction and successfully sutured. The patient was discharged in the 6th day and currently is in good clinical condition.

Diagnosis of Lingual Atrophic Conditions: Associations with Local and Systemic Factors. A Descriptive Review

Atrophic glossitis is a condition characterised by absence of filiform or fungiform papillae on the dorsal surface of the tongue. Consequently, the ordinary texture and appearance of the dorsal tongue, determined by papillary protrusion, turns into a soft and smooth aspect.

Throughout the years, many factors, both local and systemic, have been associated with atrophic glossitis as the tongue is currently considered to be a mirror of general health. Moreover, various tongue conditions were wrongly diagnosed as atrophic glossitis. Oral involvement can conceal underlying systemic conditions and, in this perspective, the role of clinicians is fundamental.

Early recognition of oral signs and symptoms, through a careful examination of oral anatomical structures, plays a crucial role in providing patients with a better prognosis.

Prescriptions of NSAIDs to patients undergoing third molar surgery : an observational, prospective, multicentre survey

BACKGROUND AND OBJECTIVES

Surgical extraction of an impacted third molar is generally followed by acute post-operative pain that has been shown to be primarily inflammatory. Thus, use of NSAIDs in this context is appropriate and has been shown to be effective. Several drugs are employed for this purpose, but no information exists on the reasons why preference is given to one rather than another. The principal objective of this study was to evaluate the pattern of administration of NSAIDs in patients undergoing surgery for impacted third molar extraction. The study also aimed to collect information on the efficacy, onset and duration of the analgesic effect of routinely prescribed NSAIDs and to assess the duration of treatment with these drugs and their tolerability.

METHODS

This was an observational, multicentre, prospective survey. A total of 616 patients (38% male and 62% female) from the Italian Stomatology Clinics of the Universities of Bologna, Brescia, Cagliari, Chieti, Pavia, Pisa, Siena and Varese and from the Department of Oral and Maxillo-Facial Surgery of Semmelweis University, Budapest, were eligible for the study. Patients were evaluated over the 7 days following surgical extraction. NSAIDs were prescribed according to the normal prescribing habits of the centre and physician involved. The main outcomes of interest in the survey were the efficacy, onset and duration of analgesic effect, duration of therapy, and tolerability of the NSAIDs prescribed.

RESULTS

Nimesulide was the most prescribed NSAID (68%), followed by diclofenac, ketoprofen and ibuprofen. Because of the low proportion of patients receiving other NSAIDs, these patients were considered a single treatment group for evaluation purposes. Nimesulide, especially when given before patients started experiencing pain after surgery, was more effective than other NSAIDs in reducing the severity of pain on the day of surgery, in delaying the time to maximum intensity of pain, in providing complete pain relief and in prolonging the duration of analgesic effect on the day of surgery. These results are consistent with the known anti-inflammatory and analgesic actions of nimesulide and with the important role of inflammation in the onset of pain after this type of surgery.

CONCLUSION

These results confirm nimesulide as an effective reference drug for the treatment of post-operative dental pain and show that it has a positive benefit/risk profile in this setting.

[Microcystic lateral parodontal cyst. Report of a case]

The lateral periodontal cyst (LPC) is an odontogenetic lesion of the maxillary bone representing about 0.8% of maxillary cystic lesions. It starts in the lateral periodontal area of a vital erupted tooth. Clinical symptoms are generally absent. Its diagnosis usually can be made on the basis of an occasional radiographic examination which shows an osteolytic monoloculate lesion with defined outlines. The botryoid cyst is a variation of LPC and is radiographically different and more aggressive than the common LPC. A clinical case of LPC which allows to make histopathological and clinical considerations on these cystic lesions is described.

[Idiopathic osteosclerosis in jaw bones. Clinical statistic study on a population of Sardinian origin]

BACKGROUND

Idiopathic Osteosclerosis are localized, non-expansive and asymptomatic areas of bone radio-opacity, whose aetiology is unknown. The aim of this study was to assess its frequency, and distribution according to its location and to patients' age and gender, in a sample of patients native in Sardinia.

METHODS

697 consecutive clinical records of patients who underwent odontological treatment at the Department of Odontostomatologic Sciences at Cagliari University, over a 10-year period were studied. The panoramic radiographs attached to the clinical records were examined and searched for all cases that showed radio-opacity areas in maxillary bones that could be identified as idiopathic osteosclerosis (IO).

RESULTS

By examining orthopantomographies we have located 58 IOs. We found no significant differences between the sexes; average age was 37.8 years. The mandible has proved to be the most affected site (98.2%) in the first molar tooth region (34.5%), followed by the premolar teeth region (25.9%) and of the second molar tooth (15.5%). The lesions examined had an average diameter of 8.8 mm.

CONCLUSIONS

IO frequency has proved to be slightly higher than that reported in other articles, though remaining significantly lower than the values reported in Eastern populations. From the clinical point of view, IOs have been identified as sporadic radiographic findings without any real pathological relevance, except for one case in which the lesion caused nervous compression and dental retention, so that it was necessary to administer specific treatment.

A new technique for the study of periapical bone lesions: ultrasound real time imaging

AIM

This study describes the use of a real time-ultrasound imaging technique (echography) for the study of periradicular lesions.

METHODOLOGY

Twelve patients with periapical lesions of endodontic origin, diagnosed with conventional clinical and radiographic examination, were examined further using echography at the site of the diagnosed lesions. Each lesion was echographically characterized and described by an expert echographist together with an endodontist. Once the major echographic features were identified, information on the size of the lesion, its content, and its vascular supply was obtained and recorded. A tentative differential diagnosis between a cyst and a granuloma was made based on the data.

RESULTS

In all cases it was possible to obtain an echographic image. It was also possible to measure the lesions, to evaluate their content and to view their vascularization in different regions of the mouth.

CONCLUSIONS

Ultrasound real time imaging is a promising diagnostic technique in endodontology, but further work is required to refine the process.

[Fibrous dysplasia of the maxillofacial bones. Clinical considerations]

OBJECTIVE

After a wide survey of the literature, the results of a clinical-statistic study carried out on twelve cases of maxillo-facial bones fibrous dysplasia, diagnosed and treated at the Oral and Maxillo-Facial Surgery Department of the II University of Naples, are reported. EXPERIMENTAL ASSAY: Retrospective study.

MATERIALS AND METHODS

All the patients examined showed fibro-osseus lesions involving the mandible in eight cases, the maxilla in three cases and the frontal bone in one case. Seven patients were females and five males, aged between nine and seventy-two years. The surgical treatment was carried out on eleven patients: four cases were treated by complete surgical excision of the fibro-osseous lesions and seven cases by a conservative removal of the portion of the lesion contributing to the bone deformity.

RESULTS AND CONCLUSIONS

All cases examined involved maxillo-facial skeleton structures as a sole localization, confirming that the polyostotic forms are more infrequent than the maxillary monostotic ones. The distribution of the cases according to age classes and lesion localization showed a higher incidence of fibrous dysplasia in the third decade of life and a clear predilection for the mandible. The observation of active lesions in old age shows that the disease may evolve also after the growth. The cases treated by radical excision of the lesions have not been followed from relapse; on the contrary three of the seven cases treated by conservative excision relapsed after a few years.

[Enteral nutrition in maxillofacial oncology]

The authors present a review regarding knowledge of malnutrition in maxillofacial oncology. The causes of nutritional deficit in head and neck tumor derived from metabolic alteration, consequent to the presence neoplasia and antineoplastic therapy. They analyze how to evaluate clinical status in malnutrition patients and they show different therapeutic strategy. The authors emphasise advantages and disadvantages of EN and TPN and present their nutritional forms, based on the EN, analyzing the characteristics.

[Experience with a rigid fixation device in maxillofacial surgery using shape-memory clips]

BACKGROUND

A device of alloy with shape-memorising effect (SME) was utilized in the surgical correction of maxillo-facial fractures. Nitinol, an alloy of equal atomic parts nickel and titanium, is a metal with the unusual property of shape memory. This alloy may be easily bent when cooled in its lower temperature phase and it resumes its original shape when heated in its higher temperature phase. A lot of useful properties of nitinol alloy, such the ability to convert heat energy into mechanical energy, as the biocompatibility and bioinertness, as the anti corrosive stability and high mechanical strength, suggest that it can be useful in the surgical fixation of maxillofacial bone injuries.

METHODS

The fixing device of alloy with SME, the indications and the techniques of osteosynthesis and some cases have been discussed by the authors.

RESULTS AND CONCLUSIONS

The results of this study showed that the surgical treatment of maxillo-facial bone fractures by devices of shape memory alloys is simple, ensures a good stability of fracture surfaces, reduces the time period of operative procedures and of patients rehabilitation, allowing rapid bone healing.

[The departmental concept in the therapy of facial dysmorphisms. A preliminary note on the psychological aspects]

The authors describe the work carried out with the intention of map and border in simple and repeatable way the risk of dissatisfaction in the patient candidates to cosmetic and oro-maxillo-facial surgery. It represent the first of a series of notes which propose to characterize patients with problems tied to the organization of the individuality in which, the discrepancy among expectations and obtained result, lead in the more serious cases, to a real crisis of identity or a depressed state of varied entity.

[A critical note on bioceramics]

In this note I, the authors point out the uncertainty and confusion which exists in the bioceramics field. They then list the calcium phosphate biomaterials today in use.

[Clinico-statistical observations on 292 cases of salivary gland pathologies]

292 cases of salivary gland diseases have been observed and treated at the Oral and Maxillo-Facial Surgery Department of the Faculty of Medicine II Naples University. The statistical results concerning age, sex, localization, histological characteristics and therapy are analysed and compared with other references.

[Submandibular sialadenectomy. Our experience]

The authors analyze 102 personal cases of submaxillary gland excision. They describe their epidemiological and clinical features and make a comparison with the data already published on the same subject.