An unusual case of 177 pieces of mandibular compound odontoma: 10-year follow-up.

Odontomas are benign and the most common odontogenic tumors. They are classified as compound or complex odontomas according to their radiological and histological features. They have slow growth potential and compound odontoma is more common. Since they are generally asymptomatic they may reach in excessive sizes. In our case we would like to present a case with a large (177 denticles) compound odontoma in mandible.

The use of botulinum toxin-a in the treatment of muscular temporomandibular joint disorders.

INTRODUCTION: Botulinum toxin has been used mainly in the treatment of muscular temporomandibular joint disorders (TMD) and hyperactivity of the masticatory muscles. It is used also as a therapeutic option to relieve pain and help in functional recovery from dental, oral and maxillofacial surgery. The aim of our study was to investigate the efficacy of botulinum toxin injection in the treatment of muscular TMD. MATERIALS AND METHODS: Of the 200 temporomandibular joint patients who applied for treatment, 25 patients with muscular dysfunction of the origin were included in the study. This patient group received drug, drug - physical therapy, occlusal splint therapy and botulinum toxin. These treatments were performed step by step. Botulinum toxin was applied, in accordance with reflex measurement in electromyography guidelines to nine patients whose results were not success from the other treatments had not been successful. Measurements were taken of bite force, pain and mouth openness. RESULTS: Sixteen patients were treated with drug-physical therapy-occlusal splint therapy, and botulinum toxin treatment was found to be successful in the case of nine patients. No side effects were observed at six months follow-up. CONCLUSION: Botulinum toxin injection for the treatment of muscular temporomandibular joint disorder is a viable treatment option in the case of patients who do not respond to conservative treatment methods.

A dual-purpose guide for optimum placement of dental implants.

Correct placement of implants is a requirement for implant treatment. The use of computed tomography and precise surgical guides is required when inadequate bone support is anticipated. This article describes the fabrication and use of an acrylic resin dual-purpose guide for radiographic evaluation of recipient sites and implant placement, which uses internally stacked stainless steel surgical guide channels. The drill guides are machined to allow consecutive surgical drills to be used without changing the implant angulation during surgery.

Intraoperative management of the thyroid gland in laryngeal cancer surgery.

OBJECTIVE: To determine if it is necessary to perform a hemithyroidectomy routinely with all total laryngectomies or if it should be reserved for selected cases. DESIGN: A retrospective analysis of 215 cases who had been operated on due to laryngeal cancer in our clinic between 1985 and 1999. SETTING: In only 182 cases, hemithyroidectomy and isthmectomy were performed together with laryngeal surgery. Of these, 98% were male. Their ages ranged between 42 and 70 years. The tumour was located in the supraglottic region in 93 (51%) and in the glottic region in 24 (13%) cases. In 65 cases (36%), the tumour was transglottic. Twenty cases of transglottic tumours (31%) and 3 cases of glottic tumours (12.5%) were found to have subglottic extension. METHODS: Total laryngectomy with unilateral or bilateral neck dissection and hemithyroidectomy on the tumour side plus isthmectomy were performed on all patients. On the pathologic specimens, subglottic extension was measured anteriorly and posteriorly from the free edges of the vocal cords. The specimens were stained with hematoxylin and eosin and examined under a light microscope. MAIN OUTCOME MEASURES: With glottic and transglottic carcinomas, the need for thyroidectomy may be based on the intraoperative assessment of the thyroid gland. In subglottic carcinomas, a hemithyroidectomy should routinely be performed. There may be no need to perform thyroidectomy in all total laryngectomy cases. RESULTS: The thyroid gland was invaded by squamous cell carcinoma in only 2 cases (1%). Both of these cases were transglottic tumours staged as T3 and T4 and had a subglottic extension more than 1 cm. CONCLUSIONS: We recommend routine hemithyroidectomy and isthmectomy during total laryngectomy only in cases with subglottic extensions more than 1 cm or thyroid cartilage invasion with tumour. In the other cases, assessment of extralaryngeal invasion and thyroid gland invasion by the tumour will determine whether thyroidectomy should be performed.

Choanal polyp of sphenoidal origin.

Sphenochoanal polyp is a rare entity which originates in the sphenoid sinus cavity and extends into the choana via the ostium. It presents in a similar manner to the more common antrochoanal polyp. Radiological examination is necessary to differentiate between these two types. We present a case of sphenochoanal polyp and review the clinical, radiological and pathological features. The role of endoscopic sinus surgery is emphasised.

The effect of intraoperative colonic lavage with NG-nitro-L-arginine methyl ester (L-NAME) on anastomotic healing in the presence of left-sided colonic obstruction in the rat.

The effect of intraoperative colonic lavage with NG-nitro-L-arginine methyl ester (L-NAME) on the healing of colonic anastomosis in the presence of a left-sided obstruction in the rat was investigated. Left-sided colonic obstruction was created in 144 Wistar rats. The obstruction site was excised 24h later and anastomosis was performed after either no irrigation or colonic lavage with either saline, povidone iodine (PI), short-chain fatty acids (SCFA), L-NAME, or glutamine, in 24 animals each. Animals were killed on days 3 and 6, and a 4-cm colonic segment with the anastomosis at the center was excised. Bursting pressure (BP) and hydroxyproline (HP) content were measured. In the saline, PI, and SCFA groups, BP was higher (P < 0.05, P < 0.05, and P < 0.001, respectively) and HP concentration was similar compared with controls. Both the BP and HP concentrations were higher in the glutamine group compared with controls (P < 0.001). BP was lower (P < 0.05) and HP concentration was similar in the L-NAME group compared with the control group. Colonocyte nutrition and tissue perfusion are the mainstays of anastomotic healing. Intraoperative colonic lavage with L-NAME suppresses colonic anastomotic healing in the presence of a left-sided obstruction.

Abdominal stab wounds: the role of selective management.

OBJECTIVE: To investigate the role of a selective approach to the operative treatment of abdominal stab wounds. DESIGN: Retrospective study. SETTING: University hospital, Turkey. SUBJECTS: 387 patients with stab wounds of the abdomen, who presented between January 1992 and January 1995. INTERVENTIONS: After local exploration of the wound, 200 patients in whom the wound had penetrated the peritoneum, underwent diagnostic peritoneal lavage. The lavage fluid was examined for white cells, red cells, and amylase and alkaline phosphatase activity. The severity of the injury was evaluated with the penetrating abdominal trauma index (PATI). MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The main complications were wound infection (n=15), wound dehiscence (n=5), pneumonia (n=3) and renal failure (n=1). Five patients died. The median hospital stay was 6.1 days when patients were operated on, and 1.5 days when they were not. CONCLUSIONS: We managed to minimise the number of negative and unnecessary laparotomies. We emphasise that the selective approach may easily be applied in teaching hospitals.

Ileocolic invagination in adult due to caecal carcinoma.

In adult invagination, the leading point is usually an organic lesion. It is mostly a benign lesion in enteric, ileocolic and ileocaecal invaginations, however in colocolic invaginations the leading point is often malign. In our patient we diagnosed an ileocolic invagination due to a caecal tumour, evidenced by CT (Computerized tomography) and colonoscopy. Right hemicolectomy and ileotransversostomy were performed.