Vitamin D receptor gene polymorphisms (Apa1 and Taq1) in temporomandibular joint internal derangement/osteoarthritis in a group of Turkish patients.

Genetic variations might play a role in susceptibility to temporomandibular joint internal derangement (TMJ-ID) and osteoarthritis of the joint (TMJOA). Vitamin D receptor (VDR) polymorphisms have been shown to be associated with disc degeneration-linked pathologies, particularly osteoarthritis (OA). The aim of this study was to evaluate whether VDR polymorphisms present susceptibility to TMJ-ID/TMJOA. The study included 49 unrelated TMJ-ID patients with OA (31.7 ± 7.9) that were grouped and evaluated as having anterior disk displacement with reduction (ADDwR, n = 24) (31.58 ± 8.25) and without reduction (ADDwoR, n = 25) (31.8 ± 7.53) and 70 healthy controls (28.22 ± 5.9). DNA was extracted from blood samples using the standard proteinase K/phenol-chloroform method. Apa1 and Taq1 polymorphisms were investigated using a polymerase chain reaction-based restriction fragment length polymorphism assay. When TMJ-ID patients, ADDwR cases and ADDwoR cases versus healthy controls were compared, Apa1 Aa genotype compared to AA genotype had odds ratios of 1.65, 1.79 and 1.64 respectively (p > 0.05). In TMJ-ID women versus healthy women Aa genotype had 2.06 fold (p = 0.15) odds compared to AA genotype. Taq1 results showed that in TMJ-ID patients and ADDwoR cases the Tt genotype had odds ratios of 0.63 and 0.44 fold (p > 0.05) respectively. In TMJ-ID women the Tt and tt genotypes had odds ratios of 0.53 and 0.73 (p > 0.05). Combined VDR genotypes revealed that AATT had a 3.3 fold (p = 1.21) odds ratio while AATt had a 2.0 fold odds ratio (p = 0.29) (OR 0.59, 95% CI 0.23-1.49, p = 0.26) compared to AaTt. Although our results do not confirm susceptibility of VDR polymorphisms to TMJ-ID/TMJOA ,this relation needs to be further evaluated in a large cohort study.

Oncologists awareness about bisphosphonate related osteonecrosis of the jaws.

OBJECTIVE: To evaluate the oncologists thoughts about the positive and adverse effects of bisphosphonates, drug holiday and the awareness about BRONJ. METHODS: A written questionnaire was sent to 7 hospitals, which have oncology facilities in Ankara, Turkey. Results were evaluated as percentages. Chi Square and Kruskal Wallis H test was used to analyze the data. RESULTS: A total of 53 oncologists replied to the questionnaire. BRONJ is the most seen complication (66%) due to bisphosphonates usage. Temporary suspension of the drug (52.8%) is the best treatment choice for this complication. Oncologists usually prefered dentist consultatation (39.6%). CONCLUSIONS: A good cooperation of oncologists and dentists is very important to prevent BRONJ.

Efficacy of immediate postoperative intramasseteric dexamethasone injection on postoperative swelling after mandibular impacted third molar surgery: A preliminary split-mouth study.

OBJECTIVE: To evaluate the efficacy of immediate intramasseteric injection of dexamethasone on postoperative oedema. METHODS: The prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Ankara University, Ankara, Turkey, in July 2012, and comprised patients aged 15-32 years who presented for the removal of bilateral vertical impacted mandibular third molar teeth.The right and left impacted third molars of each patient were randomly allocated into study and control groups. The impacted teeth in the study group were extracted with surgical bone removal, and 2ml of 8mg/2ml dexamethasone was injected into the ipsilateral masseter muscle immediately after suturing.In the control group, dexamethasone was replaced with 2ml of sterile saline solution. Postoperative facial oedema was measured with a tape scale by calculating the distance between several facial landmarks on postoperative day 2. SPSS 15 was used for data analysis. RESULTS: The mean age of 20 patients was 21.35±4.18 years, and there were 9(45%) patients between 15-20 years of age, while 11(55%) were 21-32 years. IN terms of gender, 9(45%) patients were male and 11(55%) were female. Postoperative oedema was significantly reduced in the study group compared to the control group (p<0.05). CONCLUSIONS: Immediate intramasseteric injection of dexamethasone was effective in reducing postoperative oedema after mandibular impacted third molar surgery.

Detecting Gram-positive anaerobic cocci directly from the clinical samples by multiplex polymerase chain reaction in odontogenic infections.

PURPOSE: Gram-positive anaerobic cocci (GPAC) can be isolated as pathogens from odontogenic infections. Culturing GPAC is time consuming and labor intensive. The objectives of the present study were to examine the utility of polymerase chain reaction (PCR) in directly detecting the presence of GPAC in clinical samples obtained from patients with odontogenic infections and to compare the distribution of GPAC in infected and healthy tissue. MATERIALS AND METHODS: In the present case-control study, the infected tissue from patients and oral mucosal swabs from healthy control subjects were subjected to anaerobic culture and direct PCR analysis for the presence of GPAC. The McNemar, chi-square, and Fisher exact tests and kappa analysis were used for the statistical analyses. P < .05 was regarded as significant. RESULTS: The patient group included 13 men and 14 women, including 9 patients diagnosed with granulation of tooth extraction, 6 with impacted tooth follicles, 4 with peri-implantitis, 3 with abscesses, 2 with epithelial cysts, 2 with infected cysts, and 1 with an oroantral fistula. The control group included 14 men and 12 women. All the patient and control samples contained at least 1 GPAC. The groups did not differ by method of determining GPAC presence, but more microorganisms were detected when clinical samples were directly used for PCR analysis than when cultured bacteria were used (P = .001). CONCLUSIONS: The presence of GPAC in infected tissue cannot be directly related to the development of odontogenic infections. PCR performed directly on clinical material is a sensitive and specific method that can detect GPAC and save time.

Postoperative analgesia in impacted third molar surgery: the role of preoperative diclofenac sodium, paracetamol and lornoxicam.

OBJECTIVE: The aim of this study was to compare the postoperative analgesic effects of preoperative intravenous (i.v.) paracetamol, diclofenac sodium and lornoxicam (nonsteroidal anti-inflammatory drugs). SUBJECTS AND METHODS: Sixty patients with impacted third molar who underwent surgical removal were randomly allocated into three groups: group P (n = 20), group D (n = 20) and group L (n = 20). Group P received preoperatively 1 g paracetamol i.v., group D 75 mg diclofenac sodium i.m. and group L 8 mg lornoxicam i.v. Postoperative pain intensity, additional consumption of analgesics postoperatively and postoperative complications were compared among groups. RESULTS: The groups were comparable for pain scores (p > 0.05). Maximum pain scores were recorded in postoperative 4th h in all groups (group L 22, 14-44 mm; group P 24, 13-43 mm; group D 14, 10-24 mm, p = 0.117). Patients experienced high satisfaction scores which were comparable among groups (group L 85, 75-100 mm; group P 87, 70-95 mm; group D 84, 77-98 mm, p = 0.457). CONCLUSION: Preoperative intramuscular diclofenac, intravenous paracetamol and lornoxicam effectively decreased the pain scores. The patients were satisfied with the three postoperative pain management regimens.

Prevalence and prediction of difficult intubation in maxillofacial surgery patients.

PURPOSE: The failure to maintain a patent airway after the induction of general anesthesia is a major concern for anesthesiologists. For securing the airway, tracheal intubation using direct laryngoscopy remains the method of choice in most cases. However, direct laryngoscopic intubation is difficult in 1% to 4%, and impossible in 0.05% to 0.35%, of patients who have seemingly normal airways. This study sought to determine the prevalence of difficult intubation in maxillofacial surgery patients, and to evaluate the usefulness of various predictive tests for difficult intubation. PATIENTS AND METHODS: This study was conducted on 208 patients undergoing maxillofacial surgery. During the preoperative visit, patients were examined in terms of the test of Mallampati et al (Can Anaesth Soc J 32:429, 1985), thyromental distance, sternomental distance, and interincisal distance. Direct laryngoscopic grading, as defined by Cormack and Lehane (Anesthesia 39:1105, 1984), was recorded for each patient. An intubation of "no difficulty" was noted when the tube was inserted into the fully visualized larynx with little effort on the first attempt. RESULTS: Intubation was possible in all patients. Combinations of different predictive tests resulted in higher sensitivity. Among all test types, that of Cormack and Lahene was thought to exhibit the highest sensitivity and positive predictive values when used alone. The prevalence of difficult intubation in our group of maxillofacial surgery patients was 15.4%. It may be concluded that a combination of predictive variables can be used to improve sensitivity. CONCLUSIONS: We demonstrated that combining the Mallampati test with other instruments of measurement resulted in higher sensitivity than when either test was used alone.

Prospective short term comparison of outcomes after single or double puncture arthrocentesis of the temporomandibular joint.

Our aim was to compare the single puncture technique for arthrocentesis of the temporomandibular joint (TMJ) with the double puncture technique and to evaluate the short-term effects of a single puncture. Forty patients were randomly divided into two groups: the first was treated by single puncture, and the second with double puncture, arthrocentesis. During the one-month follow-up period the visual analogue and verbal scales for pain, maximal mouth opening, and satisfaction were evaluated within each group and between the two groups. Both groups recorded significant improvements compared with the baseline values in almost all outcome variables. There were no significant differences between the groups. Arthrocentesis of the TMJ was successful with both techniques.

Combined surgical-orthodontic rehabilitation of cleidocranial dysplasia: 5 years follow-up.

Cleidocranial dysplasia (CD) is an autosomal dominant syndrome which is characterized by several skeletal malformations such as non-closed fontanelles, skeletal abnormalities of the maxilla and mandible and absence of clavicles. Mid-facial hypoplasia and mandibular prognathism are mostly seen jaw abnormalities in CD. In this study, the combined orthodontic-surgical treatment of a patient with CD with class III malocclusion and multiple unerupted primary and deciduous teeth is presented.

Response of ramus following vertical lengthening with distraction osteogenesis.

Vertical lengthening of the mandibular ramus is considered to be one of the least stable surgical procedures in the management of musculoskeletal maxillofacial deformities. The aim of this study was to evaluate the response of the mandibular ramus following vertical lengthening by means of distraction osteogenesis. This study included eight non-syndromic adult patients with temporomandibular joint ankylosis. The vertical height deficiency of the mandibular ramus and the ramus/condyle unit on the affected side were simultaneously reconstructed by transportation of a bone segment using distraction osteogenesis following gap arthroplasty. Lateral and posteroanterior (PA) cephalograms taken postoperatively before active distraction, at the completion of distraction and 6, 12, 24 months after distraction, were compared to evaluate the changes of the ramus height. In all cases the vertical ramus and ramus/condyle unit height loss were successfully reconstructed by distraction osteogenesis. There was no relapse in the amount of height gained by distraction osteogenesis at the 24 months follow-up review (p>0.05). Acute one stage vertical lengthening of the mandibular ramus is considered to be one of the least stable musculoskeletal procedures with relapse being a significant adverse outcome. In this clinical study gradual vertical lengthening of the ramus through ramus/condyle unit distraction osteogenesis has maintained the initial vertical ramus height gained for 24 months.

Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis of the mandible.

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of Staphylococcus that is resistant to certain antibiotics, such as methicillin, oxacillin, penicillin, and amoxicillin. This nosocomial pathogen has become a great threat in hospitals globally. Up to 40% of the normal population carries S. aureus in the anterior nares, and this rate is often higher in hospitalized patients and their attendants. This case report presents a patient with serious MRSA osteomyelitis of the mandible demonstrating purulent discharge. The patient failed to recover despite prolonged postoperative treatment and the administration of several antibiotics. There was a resulting nonunion along with chronic MRSA infection. The treatment protocol involved a multimodal approach with parenteral clindamycin infusion, local rifampicin irrigation, and intermaxillary fixation of the jaws.