Postoperative radiographs after open reduction and internal fixation of the mandible: are they useful?

Mandibular fractures are common in oral and maxillofacial departments in the UK. The aim of this study was to find out the national practice in preoperative and postoperative radiographic investigations for fractured mandibles and to audit their diagnostic capacity, including specificity and sensitivity to short-term complications. The audit took place over a 4-month period and involved 100 patients across the Northern region. Ninety percent of patients were reviewed up to discharge and five of these patients developed a short-term postoperative complication. The postoperative radiograph was diagnostic in only one of the five cases. Overall, postoperative radiographs had a sensitivity of 20% and a specificity of 5% in their ability to predict short-term postoperative complications.

Fascia lata interpositional arthroplasty in the treatment of temporomandibular joint ankylosis caused by psoriatic arthritis.

A patient with bilateral temporomandibular joint ankylosis, secondary to psoriatic arthritis, was treated by interpositional arthroplasty using fascia lata autogenous grafts. Despite gross limitation of mandibular movements prior to operation, radiological and functional recovery was complete at 2 years.

Proteus syndrome. A case report of a hamartomatous syndrome with severe mandibular hemihypertrophy.

Proteus syndrome is a rare congenital hamartomatous malformation that is characterized by a wide range of deformities, including craniofacial deformities. Skin and skeletal developmental malformations are common and may assume tremendous proportions. The syndrome is often mistaken for other, more commonly recognized conditions, including neurofibromatosis. The soft-tissue masses in Proteus syndrome are not nerve tumors but are usually hamartomatous proliferations. The case report describes its varied manifestations, which include significant craniofacial dysmorphism, and discusses the differential diagnosis and management.

Oxypentifylline in the management of recurrent aphthous oral ulcers: an open clinical trial.

OBJECTIVE: The purpose of this study was to determine the efficacy of oxypentifylline in the treatment of recurrent oral aphthous ulcers and to compare the results with those of previous studies. STUDY DESIGN: A 6-week open trial and a patient survey regarding pain were conducted at the Oral and Maxillofacial Surgery Unit, City General Hospital, Carlisle. Twenty-four patients (11 male and 13 female) were selected from sequential referrals involving complaints of recurrent oral ulcers. A 2-week pretrial period was used to record data pertaining to the occurrence, duration, and pain associated with ulcers. A 4-week period of treatment with oxypentifylline (400 mg administered orally 3 times daily) was followed by an assessment of improvement at the end of 6 weeks. RESULTS: The results were comparable to those of previous studies, with positive responses seen in 63.6% of male patients and 61.5% of female patients. However, recurrence of ulcers was noted in all patients once the drug was discontinued. This was attributed to the small size of the patient sample studied and to the relatively short duration of treatment. No significant side effects were noted. CONCLUSIONS: Double-blind, controlled studies are indicated for a definitive assessment of the efficacy of oxypentifylline in the management of recurrent oral aphthous ulcers. The encouraging results of this study support the suggestion that the use of oxypentifylline be considered in refractory cases of recurrent oral aphthous ulcers.

Naso-orbital fracture leading to orbital cellulitis, and visual loss as a complication of chronic sinusitis.

A case is reported of a 26-year-old man, who after sustaining a fracture involving the nasal complex and left infra-orbital margin developed orbital cellulitis and a sub-periosteal abscess. This resulted in complete loss of vision in that eye. A pre-existing sinusitis was the source of the infection.

Fine needle aspiration cytology in maxillofacial surgery--experience in a district general hospital.

101 fine needle aspirations of 82 head and neck masses in 72 patients performed in one maxillofacial unit over a 5-year period were studied retrospectively. Satisfactory reports were obtained for 69 masses. Fifty six (81.2%) were confirmed histologically and 13 (18.8%) by clinical follow up of at least 6 months' duration. The sensitivity was 96.7% and specificity 100% with a positive predictive value of 100%. No complications were recorded. Provided the unsatisfactory specimens are correctly recognised this technique provides a useful aid in the management of head and neck masses.

Reaction of superoxide radicals with glycosaminoglycan chloramides: a kinetic study.

Hypochlorous acid and its acid-base counterpart, hypochlorite ions, produced under inflammatory conditions, may produce chloramides of glycosaminoglycans, perhaps through the binding of myeloperoxidase directly to the glycosaminoglycans. The N-Cl group in the chloramides is a potential target for reducing species such as Cu(I) and superoxide radicals. Laser flash photolysis has been used here to obtain, for the first time, the rate constants for the direct reaction of superoxide radicals with the chloramides of hyaluronan and heparin. The rate constants were in the range 2.2-2.7 × 10(3)M(-1)s(-1). The rate constant for the reaction with the amino acid taurine was found to be much lower, at 3.5-4.0 × 10(2)M(-1)s(-1). This demonstration that superoxide anion radicals react directly with hyaluronan and heparin chloramides may support the mechanism first proposed by M.D. Rees et al. (Biochem. J.381, 175-184, 2004) for an efficient fragmentation of these glycosaminoglycans in the extracellular matrix under inflammatory conditions.

One-electron oxidation and reduction of glycosaminoglycan chloramides: a kinetic study.

Hypochlorous acid and its acid-base counterpart, hypochlorite ions, produced under inflammatory conditions, may produce chloramides of glycosaminoglycans, these being significant components of the extracellular matrix (ECM). This may occur through the binding of myeloperoxidase directly to the glycosaminoglycans. The N-Cl group in the chloramides is a potential selective target for both reducing and oxidizing radicals, leading possibly to more efficient and damaging fragmentation of these biopolymers relative to the parent glycosaminoglycans. In this study, the fast reaction techniques of pulse radiolysis and nanosecond laser flash photolysis have been used to generate both oxidizing and reducing radicals to react with the chloramides of hyaluronan (HACl) and heparin (HepCl). The strong reducing formate radicals and hydrated electrons were found to react rapidly with both HACl and HepCl with rate constants of 1-1.7 × 10(8) and 0.7-1.2 × 10(8)M(-1)s(-1) for formate radicals and 2.2 × 10(9) and 7.2 × 10(8)M(-1)s(-1) for hydrated electrons, respectively. The spectral characteristics of the products of these reactions were identical and were consistent with initial attack at the N-Cl groups, followed by elimination of chloride ions to produce nitrogen-centered radicals, which rearrange subsequently and rapidly to produce C-2 radicals on the glucosamine moiety, supporting an earlier EPR study by M.D. Rees et al. (J. Am. Chem. Soc.125: 13719-13733; 2003). The oxidizing hydroxyl radicals also reacted rapidly with HACl and HepCl with rate constants of 2.2 × 10(8) and 1.6 × 10(8)M(-1)s(-1), with no evidence from these data for any degree of selective attack on the N-Cl group relative to the N-H groups and other sites of attack. The carbonate anion radicals were much slower with HACl and HepCl than hydroxyl radicals (1.0 × 10(5) and 8.0 × 10(4)M(-1)s(-1), respectively) but significantly faster than with the parent molecules (3.5 × 10(4) and 5.0 × 10(4)M(-1)s(-1), respectively). These findings suggest that these potential in vivo radicals may react in a site-specific manner with the N-Cl group in the glycosaminoglycan chloramides of the ECM, possibly to produce more efficient fragmentation. This is the first study therefore to conclusively demonstrate that reducing radicals react rapidly with glycosaminoglycan chloramides in a site-specific attack at the N-Cl group, probably to produce a 100% efficient biopolymer fragmentation process. Although less reactive, carbonate radicals, which may be produced in vivo via reactions of peroxynitrite with serum levels of carbon dioxide, also appear to react in a highly site-specific manner at the N-Cl group. It is not yet known if such site-specific attacks by this important in vivo species lead to a more efficient fragmentation of the biopolymers than would be expected for attack by the stronger oxidizing species, the hydroxyl radical. It is clear, however, that the N-Cl group formed under inflammatory conditions in the extracellular matrix does present a more likely target for both reactive oxygen species and reducing species than the N-H groups in the parent glycosaminoglycans.

Langerhans cell histiocytosis in an adult.

We describe an unusual case of a 31-year-old man who presented with generalised pain in his jaw after referral by his general dental practitioner. Langerhans histiocytosis was diagnosed and treatment started with azathioprine.

Trismus: or is it tetanus? A report of a case.

Tetanus is a life-threatening infection that is rare in the developed world. Trismus and dysphagia are the most common presenting symptoms, and thus oral and maxillofacial surgeons may be involved in the early stages of evaluation of the patient. Early diagnosis helps initiate prompt management and referral for intensive therapy. This article is a case report of severe generalized tetanus with a discussion of its diagnosis, pathophysiology, and management.