Synovial chondromatosis: a case series and review of the literature.

This case series reviews 2 patients worked up and treated for unilateral synovial chondromatosis of the temporomandibular joint (TMJ). The first was a 58-year-old female evaluated and treated for synovial chondromatosis of the left TMJ using an arthrotomy of the joint to remove the cartilaginous and osteocartilaginous nodules. The second is a 63-year-old male who was evaluated and treated for synovial chondromatosis of the right TMJ with the removal of extracapsular masses and an arthrotomy with intra-joint removal of nodules. Six-year radiographic follow-up demonstrated no recurrence of the pathology in his case. The cases are reviewed in this article, along with a current review of the literature.

Dental implants at sites of focal high and mixed density osseous lesions: Treatment strategies.

FOCUSED CLINICAL QUESTION: Under what circumstances may a clinician consider dental implant placement at a site exhibiting a focal high or mixed density (HMD) osseous lesion radiologically? SUMMARY: Some conditions and pathologic entities exhibiting high and mixed density radiological appearance pose low risk for dental implant failure or complications following implant surgery. However, other lesions represent contraindications to implant placement, and implant surgery at such sites can result in severe morbidity. CONCLUSION: Potential implant sites exhibiting focal HMD osseous lesions/conditions present varying levels of risk. In most cases, optimal management will include advanced imaging of the site, multidisciplinary consultations, and detailed informed consent to assure full understanding of procedural risks, benefits, and complications. Currently, clinical recommendations rely on case reports, opinion, and usual practice (level 3 evidence). The strength of each recommendation provided in this report is categorized as level C.

The Role of Dental Occlusion Ties to Achieve Stable Maxillomandibular Fixation During Temporomandibular Joint Replacement.

Dental occlusion ties (Minne Ties®) are a new example of the concept of an oral zip tie used to establish maxillomandibular fixation (MMF). Each tie uses a blunt introducer that is easily passed between embrasures and fed through a self-locking, unidirectional clasp. Five to six ties are used to establish MMF. They are fast, easy to use, and relatively safe because there are no sharps or wires associated with their use. The authors report their experience using this MMF method for temporomandibular joint replacement surgery, where over the last 2 years, over 65 collective cases have been completed using this method.

Traumatic Facial Tattoo Injuries From Gunpowder and Ammunition: A Case Series.

BACKGROUND AND OVERVIEW: Gunpowder inclusion injuries are rare occurrences in the civilian sector but are more frequently encountered in the military setting. The authors report a case series of 3 active duty military service members treated by an Army hospital's Oral & Maxillofacial Surgery service for the removal of embedded gunpowder particles so as to avoid traumatic tattooing. CASE DESCRIPTION: Three otherwise healthy active duty military service members were treated for gunpowder inclusion injuries incurred while conducting live fire training exercises at a state-side military installation between 2018 and 2019. All 3 males presented with injuries of the same etiology: Their weapons malfunctioned, and while visually inspecting the action, a round exploded close to the face. This peppered the face with gunpowder particles that were both superficially and deeply embedded. Treatment focused on individual removal using fine forceps. The patients were followed up and healed quickly without any complications, specifically without traumatic tattooing from the gunpowder injuries. CONCLUSION AND PRACTICAL IMPLICATIONS: Gunpowder inclusion injuries should be addressed quickly to remove the particles before epidermal healing occurs, thus avoiding the complication of traumatic tattooing. This surgical team recommends meticulous fine forceps removal as the treatment of choice for larger particles.

Temporomandibular Joint Pain Presentation of Myocardial Ischemia.

Cardiovascular disease is a leading cause of death worldwide. We report a case of myocardial infarction for which temporomandibular joint (TMJ) pain was the sole presenting initial symptom. A 28-year-old man presented to a dental clinic reporting TMJ pain. He was an active duty infantry solider in the US Army who was otherwise healthy and in excellent physical condition. He reported a 3-week history of intense throbbing to his left TMJ, specifically during physical activities and weight lifting. On examination by his general dentist, his blood pressure, heart rate, respiratory rate, and temperature were unremarkable. His maximal incisal opening was more than 45 mm without pain and demonstrated deviation, crepitus, and a full range of excursive movements without restrictions or provocation of pain. A hard night guard appliance was fabricated, and muscular physical therapy instructions were given, because his symptoms were thought to be related to muscle-related pain, possibly related to bruxism. He was referred to the oral and maxillofacial surgery (OMS) department for further evaluation and a second opinion. Before his appointment, he collapsed during physical training in cardiac arrest. He was brought to the emergency department and successfully resuscitated. He was found to have an 80% occlusion of his left anterior descending artery that was treated with a 1-vessel coronary artery bypass graft. After his cardiac surgery, he was seen and evaluated by OMS, and his TMJ symptoms had completely resolved. During the differential diagnosis of orofacial pain, clinicians should consider nonfacial sources of pain, especially referred cardiac pain that can mimic TMJ, odontogenic, and myofascial pain.