Bifid mandibular canals: CBCT assessment and macroscopic observation.

PURPOSE: The bifid mandibular canal is an anatomical variation, which causes anesthetic failure and surgical accidents occasionally. The purpose of this study is to observe the prevalence and anatomical location of bifid mandibular canals, providing clinical value in reducing the occurrence of surgical accidents and postoperative complications. METHODS: A total of 321 outpatients were selected in this study. Their CBCT images were observed, and the prevalence of bifid mandibular canals as well as the composition ratios of each branch type was evaluated according to the classification of Naitoh. The bifid mandibular canals and their branches' diameter, length, horizontal distance to the buccal/lingual wall of the mandible, and vertical distance to the mandibular alveolar ridge were measured. Furthermore, 194 dry adult mandibles from the Department of Oral Anatomy and Physiology of Tianjin Medical University were observed to evaluate the prevalence and the average diameter of retromolar foramina. RESULTS: Of all the 321 patients, 84 (26.17%) cases of bifid mandibular canals and 105 (16.36%) sides of unilateral bifurcation were observed. Based on Naitoh's classification, the retromolar canals were the most common types (46.67%), followed by the forward canals (40.00%), the dental canals (10.48%) and the buccolingual canals (2.86%). In 194 dry adult mandibles, 23 cases (11.86%) and 29 sides (7.47%) of retromolar foramina were found and the average diameter of retromolar foramina was 0.94 ± 0.30 mm. CONCLUSION: More than a quarter of the population has the bifid mandibular canal, which is a potential factor of the onset of surgery accidents. CBCT is an effective method to identify the branches of mandibular canals. Preoperative CBCT examination can help reduce various postoperative complications.

Three-dimensional assessment of the temporal bone and mandible deformations in patients with congenital aural atresia.

OBJECTIVE: To investigate the deformations of temporal bone and mandible combined with congenital aural atresia. METHODS: A total of 158 patients with congenital aural atresia were included in the study. The raw CT data of the temporal bone was imported into MIMICS v 12 and threshold dissection, region growing and three-dimensional (3D) calculation were used to calculate 3D models. The 3D characteristics of the temporal bone and upper part of mandible were assessed. RESULTS: The tympanic part of the temporal bone was all undeveloped. Of all the patients included, 14 patients were found to have severe maxillofacial malformations. Among them, 2 cases have floating arch, 4 cases have interrupted arch, 5 cases have mandibular processes hypoplasia and 3 cases have interrupted arch combined with severe maxillary malformation. Ten of the 14 patients were suffered from dysplasia of the mastoid part of the temporal bone as well. CONCLUSION: Maxillofacial malformations may sometimes coexist with congenital aural atresia. Otolaryngologists should not neglect the coexisted maxillofacial malformations and give timely referral to maxillofacial surgeons.

Absceso alveolar agudo en pacientes mayores de 19 años. Municipio Unión de Reyes / Acute alveolar abscess in patients elder 19 years old. Municipality Union de Reyes

Introducción: frecuentemente las infecciones de la cavidad bucal son el resultado del deterioro que provoca la caries con exposición de la pulpa dental. Una higiene dental descuidada o inadecuada, y complicaciones asociadas a enfermedades periodontales, son otras de las causas, que pueden incidir en la aparición de procesos infecciosos. Objetivo: caracterizar el comportamiento del absceso alveolar agudo en los pacientes mayores de 19 años en la consulta de urgencia estomatológica del poblado de Alacranes, Municipio Unión de Reyes. Materiales y Métodos: se realizó un estudio observacional descriptivo en pacientes mayores de 19 años, del área de Alacranes municipio Unión de Reyes. El universo de estudio estuvo constituido por los pacientes que acudieron a la consulta de urgencia estomatológica, de enero de 2011 a enero 2012. Con previo consentimiento informado la muestra la constituyó 135 pacientes, con patológica de absceso alveolar agudo, teniendo en cuenta las variables: edad, sexo, etiología y complicaciones. Los datos obtenidos fueron registrados en una base de datos y se procesaron estadísticamente. Resultados: los grupos de 20-29 años y el sexo masculino fueron los más afectados, con 38 % y 54.8 %, respectivamente. La causa fundamental fue la caries dental con un 91.8 %. La celulitis facial resultó la complicación más frecuente. Conclusiones: la etiología más usual del absceso alveolar agudo fue la caries dental. Los pacientes afectados que no recibieron una puntual asistencia sufrieron complicaciones (AU).

Introduction: frequently, oral cavity infections are due to the deterioration caused by caries with dental pulp exposition. An inadequate and careless dental hygiene and complications associated to periodontal diseases are other reasons the may lead to the occurrence of infectious processes. Objective: Characterise the behaviour of the absceso alveolar acute in the greater patients of 19 years in the query of urgency estomatológica of the populated of Alacranes, municipality Union de Reyes. Materials and Methods: a descriptive, observational study was carried out in patients elder 19 years old, in the health area Alacranes, municipality Union de Reyes. The studied universe was formed by the patients assisting to the dentist emergency consultation from January 2011 to January 2012. With previous informed consent, the sample was formed by 135 patients with acute alveolar abscess, taking into account the following variables: age, sex, etiology and complications. The obtained data were recorded in the database and statistically processed. Results: the most affected groups were the 20-29 years-old group and the male sex, with 38 % and 54.8 % respectively. Dental caries was the main cause with 91.8 %. Facial cellulitis was the most frequent complication. Conclusions: dental caries was the most usual etiology of the acute alveolar abscess. The affected patients who did not receive opportune health care suffered complications (AU).

[Orthodontic treatment need in school-age children in the Leningrad region].

Epidemiology of dentoalveolar anomalies is undoubtedly important, but in terms of the organization of orthodontic care, greater interest are data on the needs in this type of treatment. In a situation of limited manpower and resources for the provision of orthodontic care information about needs in orthodontic treatment allows you to define a group of patients with the primary need for orthodontic treatment, and to identify priorities to optimize the organization of orthodontic care in the region. Such data can be obtained by using the Dental Aesthetics Index (DAI) and Index of Orthodontic Treatment Need (IOTN). The aim of the study was to analyze the epidemiology of various forms of dentoalveolar anomalies school-age children of Kirishi district of Leningrad region, as well as their needs in orthodontic treatment in accordance with objective evaluation indices. The study involved 734 pupils of Kirishi lyceum №1 of Leningrad region. Analysis of the prevalence of dentoalveolar anomalies, as well as needs in the orthodontic treatment was conducted in three age groups: I mixed dentition period (6-9 years), II mixed dentition period (10-13 years), and permanent dentition (14-17). To determine the needs in the orthodontic treatment were used two most common international index (DAI and IOTN). In Kirishi district of Leningrad region dentoalveolar anomalies were found in 88.8% of children of school age, which is in accordance with the indices and IOTN DAI needs in orthodontic treatment is 38.8% and 54.5%, respectively. In order to reduce unnecessarily high load volume medical institutions orthodontic profile, optimize utilization of financial resources, as well as reducing social tension it is recommended to introduce the practice of doctors-orthodontists methodology for determining the needs in orthodontic treatment by objective indices.

ICD-10 coding in otorhinolaryngological malformations: Analyses of 2342 Q-diagnoses.

INTRODUCTION: The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) includes more than 14,400 codes. The aim of this study was to study the prevalence and demographics of otorhinolaryngological congenital malformations in an outpatient clinic based of the ICD-10 Q-diagnoses used for congenital malformations, deformations and chromosomal abnormalities. MATERIALS AND METHODS: Electronic hospital records covering six years (2007-2013) were searched to identify all patients with ICD-10 Q-diagnosis. RESULTS: 2342 patients were identified. Malformations of the face and neck were most prevalent (30%). The gender distribution was equal except malformations of tongue, mouth and pharynx, where 70% of the patients were male. CONCLUSIONS: There seems to be a significant excess of ICD-10 codes for otorhinolaryngological malformations. Ten most common otorhinolaryngological malformation codes cover more than 94% of the diagnoses. In addition, the illogicalities and the possibility of coding by diagnosis, symptoms or clinical findings makes the coding suboptimal for the purposes it was originally created for. Malformations of the nose and larynx are rare compared to other anatomic localizations. The age at diagnosis of branchial cysts differs significantly from all other congenital malformations supporting the theory of cystic transformation of cervical lymph nodes.

[Naso-ethmoido-maxillary protrusion (NEMP): a specific dysmorphosis]. / La pro-naso-ethmoïdo-maxillie (PNEM) : une dysmorphose spécifique.

Naso-ethmoido-maxillary protrusion (NEMP) is a rare dental and facial dysmorphosis, with excessive growth of basicranium, ethmoid, maxillary, and nasal bones. The clinical presentation includes nasal and upper lip protrusion, telecanthus, a class 2 malocclusion with maxillary protrusion and exoclusion. The craniofacial field is increased in Delaire's analysis. Contrary to isolated maxillary protrusion secondary to membranous ossification dysfunction, NEMP is a constitutional anomaly resulting from an excessive primary growth of the chondrocranium. The therapeutic management of NEMP should take into account these specificities.

[Congenital piriform aperture stenosis and odontogenic disorders]. / Sténose congénitale de l'orifice piriforme et troubles de l'odontogenèse.

PURPOSE: We had for objective to assess odontogenic disorders associated to a congenital piriform aperture stenosis and to study their various presentations. METHODS: Twelve patients presenting with a congenital piriform aperture stenosis, 1 week to 3 months of age, were retrospectively included from 1998 to 2008. All patients underwent an initial CT scan to evaluate the temporary dental germs. RESULTS: Deciduous dental germs were abnormal in 75% of the cases. Thirty-three percent had a single median maxillary central incisor. DISCUSSION: The concept of solitary median maxillary central incisor syndrome makes for a more pathophysiological approach of this type of disease, with various clinical presentations, corresponding to various levels of severity of a same pathological process.

Binder syndrome.

UNLABELLED: Patients with chondrodysplasia punctata (CDP) usually present with Binder-type features, and often CDP is misdiagnosed as Binder syndrome. This study reviewed the management and outcome of patients with Binder syndrome and CDP in a multidisciplinary setting. METHODS: The notes and radiographs of the patients managed at the Australian Craniofacial Unit with a multidisciplinary setting since 1976 were reviewed, and data were collected on patient demographics, associated medical and surgical problems, subsequent management, and complications. RESULTS: Seventy-seven patients were treated over the 30-year period (5 patients were lost to follow-up); of the remaining 72 patients, 60 (83%) had Binder syndrome, and 12 (17%) were patients with CDP. Forty were males, and 32 were females, with an age range of 6 months to 47 years. Thirteen patients (18%) had a strong family history, and 65 patients (90%) have so far undergone surgical correction, and of those, 35 (54%) have completed their treatment, the longest follow-up time being 18 years. The mean number of surgical procedures was 2.4, and 18 patients (28%) had postoperative complications, which included partial necrosis of the maxilla, osteomyelitis of the mandible, facial nerve and inferior alveolar nerve neuropraxia, nasal bone graft exposure, and cellulitis. DISCUSSION: Because of the phenotypic characteristics shared by both Binder syndrome and CDP, it is most likely that Binder syndrome is not a syndrome, nor is it an entity, but most likely to be an "association." We would advocate that these patients should be managed in a multidisciplinary setting.

Binder phenotype: associated findings and etiologic mechanisms.

Binder phenotype (BP), or maxillonasal dysostosis, consists of 6 characteristics: arhinoid face, abnormal position of nasal bones, intermaxillary hypoplasia/malocclusion, reduced/absent anterior nasal spine, atrophy of nasal mucosa, and absence of frontal sinus. The purposes of this study were (1) to review the characteristic facial findings, other malformations, and diagnoses in 8 patients with BP; (2) to compare these patients to those in the literature; and (3) to discuss developmental mechanisms, including genetic and environmental factors, involved in this facial defect. An initial 24 cases of BP were identified from the Iowa Registry of Congenital & Inherited Disorders during the period of 1998 to 2008. Chromosome analysis performed in all 24 cases revealed the following: trisomy 21, trisomy 18, and mosaic trisomy 18. Of the 24 patients, 8 met the specific diagnostic characteristics of BP. All 8 patients were evaluated in the genetics clinic at University of Iowa Children's Hospital, having diagnoses of vitamin K epoxide reductase deficiency, Xp22.3 deletion with chondrodysplasia punctata, Stickler syndrome, fetal warfarin syndrome, Robinow syndrome, and unknown etiology. This study, unlike those in the literature, ascertained cases through a population-based active surveillance registry and therefore may better represent the incidence of BP (∼1 per 18,000). Most cases were sporadic with a recognizable pattern of malformation, highlighting that chromosomal, genetic, and exogenous factors may cause BP. Of 8 cases remaining after exclusion of chromosome syndromes, 3 cases had in common the involvement of the vitamin K-dependent metabolic pathway, which likely represents a significant pathogenetic mechanism of BP. Clinical characterization of BP, as in these cases, may allow further understanding of other causative developmental mechanisms.

Follow-up: orthognathic surgery. Is there a future? A national survey.

BACKGROUND: The authors recently documented a significant decrease in orthognathic surgical cases performed by both plastic and oral surgeons in Ohio over a recent 5-year period. The main reason noted was related to third-party reimbursement. This is a potentially serious issue that may affect the quality of health care for patients with dentofacial deformities. Therefore, an expanded survey was conducted to determine whether this was indicative of a national trend. METHODS: A three-page questionnaire was sent nationally to plastic surgeons and oral surgeons who were members of the American Society of Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons, respectively. Surveys requested information regarding changes in the number of orthognathic operations over a 5-year period (1999-2003) and reasons for these changes. RESULTS: Of the 3273 surveys sent, 883 were returned, representing an overall response rate of 27 percent. Of the 883 returned, 771 (87.3 percent) were completed by oral surgeons and 112 (12.7 percent) were completed by plastic surgeons. The majority surveyed (70.0 percent) noted a decrease in the number of orthognathic procedures performed over a 5-year period, and 443 (77.3 percent) stated that the decrease was attributable to problems with insurance. Professional reimbursement per hour was calculated based on data collected from consecutive operations performed at the authors' institution. These data demonstrated that reimbursement per hour is significantly lower when orthognathic surgery procedures were compared with other standard plastic surgery operations. CONCLUSIONS: Orthognathic surgery may rapidly be becoming a cosmetic procedure. This has the potential of creating a two-tier system whereby only those who can afford it will undergo orthognathic correction.

Interdisciplinary approach to oral health for persons with developmental disabilities.

The aim of this interdisciplinary study was to survey the oral health among persons with developmental disabilities (PDD), and to evaluate the impact of the routine referral process at a regional center in Los Angeles, California. This study evaluated the subjects' oral health, access to care, oral health behaviors, and adherence to referrals. The study recruited 102 subjects (74% were African American or Hispanic). Among them, 24% reported brushing their teeth less than once a day, and 68% had dental insurance. The prevalence of leukoplakia was 4% and the prevalence of temporomandibular joint (TMJ) clicking and pain were 11% and 9%, respectively. Their decayed, missing, filled (DMF) equaled 14 points with 7 missing teeth. The subjects' DMF index was poorer compared to the general population. The routine referral process was not effective in improving the subjects' access to dental care. More sophisticated referral systems need to be developed for this population.

Anormalidades dentofaciais em pacientes portadores de fissuras labiopalatais no Estado do Ceará / Dentafacial abnormalities in patients with clefts labiopalatal in the State of Ceará

O objetivo desta dissertação foi caracterizar as anormalidades dentofaciais de indivíduoscom fissura labiopalatal atendidos pelo SUS no estado do Ceará entre 2004 e 2007. A dissertação é apresentada com uma introdução e revisão de literatura sobre o tema. Segue-se com a descrição detalhada da metodologia utilizada e o artigo que inclui os resultados. A amostra incluiu 117 pacientes de 6 a 37 anos de idade cadastrados no CEO-Centro em Fortaleza, unidade de referência do estado. Foi investigado o perfil demográfico e socioeconômico, aspectos hereditários e familiares dos sujeitos. O tipo de padrão facial e maloclusão foram determinados por exames radiográficos e análise demodelos dentários. Além disso, foram investigados o tipo, localização e grupo de fissuras. Para análise da maloclusão foram empregadas a Classificação de Angle, registro de mordida aberta, mordida cruzada e apinhamento dentário (6 a 12 anos de idade) e o Índice de Estética Dental (DAI) (idade (...) 13 anos). A idade média dos pacientes foi de 14,7 (...) 7,4 anos, com predomínio da cor parda (76 por cento), renda familiar de 1 a 3 salários mínimos (73,5 por cento), baixa escolaridade dos pais e classe econômica D (56,4 por cento). A fissura transforame unilateral foi a de maior prevalência (60,6 por cento), sendo observada uma freqüência de 39,3 por cento de tabagismo materno durante a gestação e a ocorrência de 21,4 por cento de fissuras labiopalatais na família. Na faixa etária de 6 a 12 anos,observou-se uma freqüência de anormalidade oclusal de 41,1 por cento e 50 por cento para molares e caninos, além de uma alta prevalência de mordida cruzada anterior (60,7 por cento), apinhamento superior (69,6 por cento) e inferior (66,1 por cento). Todos aqueles com idade (...) 13 anosforam classificados como maloclusão muito grave ou incapacitante. Em ambas faixas etárias as características de anormalidade oclusal foram heterogêneas entre os indivíduos com fissuras pré-forame incisivo e com fissuras transforame incisivo. Indivíduos portadores de fissuras labiopalatais usuários do SUS no Ceará necessitam de atenção especializada para tratamento de deformidades dento-faciais.

[Incidence of dentofacial deformities in the Specialty Hospital of the Instituto Mexicano del Seguro Social]. / Incidencia de deformidades dentofaciales en un Hospital de Especialidades.

OBJECTIVE: To report the incidence and classification of dentofacial deformities from the Maxillofacial Department at the Specialty Hospital at the 21st Century National Medical Center of the Mexican Institute of Social Security in Mexico City. A descriptive, retrospective and transversal study was carried out. MATERIAL AND METHODS: Clinical files from 120 patients were reviewed from May 1997 to May 1998 with the purpose of classifying and determining the types of maxillofacial deformities and also to report whether these deformities were corrected by orthognatic surgery. RESULTS: One hundred twenty clinical files were reviewed and dentofacial deformities were found in 47 (39%). All patients were treated with orthognatic surgery. Surgical treatment was often combined (orthodontia and surgery). CONCLUSIONS: Regardless of the type of dentofacial deformities, an individualized treatment protocol must be designed for each patient. It is important to list the priorities and needs of the patients in order to find appropriate solutions, in regard to their importance.

[Remote effects of the Chernobyl accident: evaluation of the maxillodental status of the children]. / Otdalennye posledstviia Chernobyl'skoi katastrofy: otsenka sostoianiia zubocheliustnoi sistemy detei.

Examinations of children exposed to the Chernobyl factor showed deterioration of the maxillodental status, presenting as a decrease in the incidence of normal-for-age status in comparison with children from the control group. The incidence of dental abnormalities in children whose parents participated in the Chernobyl accident aftermath is increased by 240,09%. The determination of remote effects of the Chernobyl accident for the health status of Russian children requires a differentiated approach and deserves a special study.

An 8-year assessment of maxillofacial prosthetic patients treated in a Department of Prosthetic Dentistry.

The Department of Prosthetic Dentistry at the University of the Witwatersrand, Johannesburg, serves as a referral centre for maxillofacial prosthetic patients from the surrounding general hospitals and local private clinics. This places a time and financial constraint on the department. The aim of this study was to establish the number of new patients seen annually, the causative factors associated with the various types of defects, the treatment provided and the cost per patient in terms of clinical hours and prosthesis fees. The data were taken from the records of patients treated in the maxillofacial prosthetics clinic during an 8-year period, from January 1991 to December 1998. The total number of new patients was calculated and the data were collated according to the year in which treatment commenced. Results were tabulated according to the number of new cases in each group, the aetiology of the defects, prosthetic treatment provided and the costs in terms of clinical hours and prostheses. The results of this study indicate that there is a need for a specialised Maxillofacial Prosthetic Unit. Although the present fee schedule needs to be revised, there is still a need for a substantial amount of state subsidy.

[The morphological status of the maxillodental system in children living in an area contaminated by radionuclides as a result of the accident at the Chernobyl Atomic Electric Power Station]. / Morfologicheskoe sostoianie zubocheliustnoi sistemy detei, prozhivaiushchikh v raione, zagriaznennom radionuklidami v rezul'tate avarii na ChAES.

The present study has been done in the framework of federal programme "Children of Chernobyl" with the aim to determine spread and structure of dental jaw abnormalities in children born and living in the radiation polluted regions after Chernobyl accident in 1986. 183 children have been examined in Donskoi town of Tula Province with the polluted soil by Cs-137 up to 5 Ci/km. All the examined children were divided into 2 groups: group 1--born in 1980-1986 and group 2--born in 1987-1994. It was determined that 76.5% of children have dental jaw system abnormalities. The most spread ones were occlusion abnormalities in combination with teeth abnormalities (28.9% cases) while the state of dental jaw system corresponding to the age standard was 2 times rarer in children born after the Chernobyl accident.