Cone-beam-computed tomography evaluation of mandibular nutrient canals in patients with periodontal diseases.

Background and Aim: The aim of this study was to evaluate radiographically the prevalence of mandibular nutrient canals (NCs) in patients with/without periodontal bone loss with aging and to correlate the number of NCs with the severity of bone loss using cone-beam-computed tomography (CBCT). Patients and Methods: CBCT examinations of 208 patients were evaluated retrospectively of all patients, 114 had periodontal bone loss, whereas 94 patients were control subjects. Alveolar bone loss investigations were performed according to the Progressive Rate Index. Results: NCs were observed in 55% of the control group and 86% of the periodontitis patients. NCs were more prevalent in the elderly age group with periodontal bone loss. In the study group, the NCs were statistically more frequent than in the control subjects (P > 0.05). Conclusion: Statistical analysis showed a significant difference between the age groups and the prevalence of NCs increased in patients with periodontal alveolar bone loss with aging (P < 0.05).

Internal herniation with fatal outcome: herniation through an unusual apertura between epiploic appendices and greater omentum.

Internal hernia is an unusal cause of intestinal obstruction. Herniation related to epiploic appendix is a very rare entity. We herein report a case of internal herniation due to an adhesion between epiploic appendixes and the greater omentum. A 71-year-old woman complaining of abdominal pain and intermittent nausea was operated on with the pre-operative diagnosis of intestinal obstruction. Three epiploic appendixes of the left side of the transverse colon and the corresponding part of the greater omentum had created a tunnel and a loop of small bowel 25 cm in length was strangulated. No resection was required after releiving the strangulation. However, the patient died due to massive myocardial infarction in the postoperative period. Internal herniation must be included in the differential diagnosis of patients with acute abdomen or intestinal obstruction. A high index of suspicion with prompt surgical intervention may be the key to the reduction of morbidity and mortality.

Total subcutaneous fistulectomy combined with Karydakis flap for sacrococcygeal pilonidal disease with secondary perianal opening.

OBJECTIVE: Flap techniques have been performed with success in the treatment of pilonidal disease. However, some complex cases such as perianal pilonidal disease need special attention. We describe a modification of a well-known flap technique for secondary perianal pilonidal disease and its early results. PATIENTS AND METHOD: Total subcutaneous fistulotomy combined with Karydakis flap was performed on 14 patients. An elliptical incision, described by Karydakis, was made while not including the perianal opening. Both sides of the elliptical incision were deepened down to the gluteal muscle and postsacral fascia. At the level of subcutaneous tissue, attention was directed to the secondary perianal opening. A fine probe was inserted through the perianal skin pit, and the connection site between the fistula and the cyst was observed. A small circular skin incision was made around the probe and the fistula tract was totally excised using electrocautery together with the main cyst. The flap was prepared as described by Karydakis. Before suturing the flap to the other side, perianal subcutaneous tissue was sutured with a fine absorbable material, then, the flap was sutured with 4/0 polypropylene. RESULTS: One patient developed seroma. Neither early failure in wound healing nor recurrence was observed at a mean of 16.2 months (range 4-36 months) follow-up. CONCLUSION: Total subcutaneous fistulectomy plus Karydakis flap as a single-stage procedure is an effective surgical modality for sacroccocygeal pilonidal disease with secondary perianal opening.

Epiploic appendicitis in inguinal hernia sac presenting an inguinal mass.

Inguinal hernia sometimes surprises surgeons with its unexpected content. Epiploic appendagitis in hernia sac is a very rare entity. We report a 60-year-old male patient with a painless inguinal mass. Surgical exploration showed a 4-cm mass beneath the external oblique aponeurosis that consisted of a hernia sac containing an inflamed and remarkably swollen appendix epiploica of the sigmoid colon secondary to torsion. The patient recovered after the resection of epiploic appendix and a tension-free hernia repair.