Postoperative Antibiotics May Be Unnecessary in Pediatric Patients Hospitalized With Minor Odontogenic Infections.

BACKGROUND: Antibiotic overuse is a growing concern in health care. For pediatric odontogenic infections, the necessity of postoperative antibiotics lacks clear, evidence-based guidelines. PURPOSE: The purpose of this study was to compare treatment outcomes between pediatric patients hospitalized with vestibular space odontogenic infections who received postoperative antibiotics and those who did not. STUDY DESIGN, SETTING, SAMPLE: This ambispective cohort study was conducted at the Baruch Padeh "Tzafon" Medical Center, Poriya, Israel (January 2010-December 2015 for retrospective and November 2018-December 2019 for prospective). The sample included 522 pediatric patients (<15 years) hospitalized for odontogenic infections requiring surgical intervention. Patients with nonodontogenic infections, compromised immune systems, or infections involving deeper spaces were excluded. PREDICTOR/INDEPENDENT VARIABLE: The primary predictor was postoperative antibiotic management (administration vs no administration), decided at hospital admission. MAIN OUTCOME VARIABLE(S): The primary outcome variable was hospital length of stay (LOS), categorized as short (1 to 2 days) or extended (≥3 days). LOS was chosen as a proxy for recovery time and symptom resolution, reflecting the overall efficacy of the treatment approach. COVARIATES: Demographic, clinical, and laboratory data were collected. ANALYSES: Descriptive statistics, Student t-tests, χ2 tests, and multivariable logistic regression were used (P < .05). RESULTS: Of 522 patients (411 control, 111 study), mean LOS was similar between groups: 1.7 ± 0.91 days (control) versus 1.67 ± 0.9 days (study) (P = .76). Short stays were not significantly different (90.99 vs 87.10%, P = .32). Multivariable analysis showed no association between withholding antibiotics and extended stay (OR = 0.92, 95% CI: 0.45 to 1.89, P = .82), but identified age (OR = 1.11, 95% CI: 1.02 to 1.21, P = .02) and initial white blood cell count (OR = 1.08, 95% CI: 1.01 to 1.15, P = .03) as predictors of extended stay. CONCLUSION AND RELEVANCE: Withholding routine postoperative antibiotics in pediatric patients with odontogenic infections does not significantly impact length of hospital stay. While length of stay is not a direct measure of clinical outcome, it serves as a proxy for recovery. This approach may contribute to antibiotic stewardship efforts without compromising patient care, though future studies with direct clinical outcome measures are needed to confirm these findings.

Pediatric Maxillofacial Infections During COVID-19: What Have We Learned?

BACKGROUND: The coronavirus (COVID-19) pandemic significantly affected health care systems worldwide, and the field of dentistry is no exception. Odontogenic infections in pediatric patients pose unique challenges to treatment and diagnosis. PURPOSE: The purpose of this study was to evaluate the incidence, characteristics, and treatment of pediatric maxillofacial odontogenic infections during COVID-19 compared to pre-COVID-19. STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study included all pediatric patients (0-18 years old) who visited the emergency department (ED) at Tzafon Medical Center, Israel, between March 2020 and February 2021 (COVID-19), or between March 2018 and February 2020 (pre-COVID-19), and were diagnosed with maxillofacial odontogenic infections. Patients with missing demographic data and patients who did not complete the medical examination were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The exposure variable was the date of presentation, categorized as COVID-19 or pre-COVID-19. MAIN OUTCOME VARIABLE(S): The main outcome variables were the proportion of patients diagnosed with odontogenic infections, hospitalization rate, treatment methods, and length of hospital stay. COVARIATES: Covariates included patient demographics, involved dentition and associated spaces, and the administration of antibiotics before ED arrival. ANALYSES: The Fisher exact test and Pearson's χ2 test were applied to assess differences in categorical variables. The Wilcoxon rank-sum test was used for independent variables. A logistic regression model was used to predict outcome variables. P values were two-tailed, and statistical significance was defined as P < .05. RESULTS: The study sample comprised 471 patients: 357 (76%) in the pre-COVID-19 period and 114 (24%) during COVID-19. The relative risk of visits to the ED out of total oral and maxillofacial ED visits was lower during COVID-19 (relative risk = 0.65, P = .0001). The hospitalization rate increased from 72% (257 patients) pre-COVID-19 to 86.8% (99 patients) during the COVID-19 period (P = .001). Length of hospital stay during COVID-19 was significantly shorter than pre-COVID-19 (P < .001). CONCLUSION AND RELEVANCE: The findings of this study reveal a significant reduction in odontogenic infection incidents referred to the ED during the pandemic. This implies that many of these incidents can be successfully treated in community health care settings without referral to the ED.

The Modified Caldwell-Luc Approach for Treating Odontogenic Maxillary Sinusitis Without Need for Functional Endoscopic Sinus Surgery: A Retrospective Study.

BACKGROUND: Odontogenic maxillary sinusitis is a common inflammatory condition resulting from the violation of the Schneiderian membrane by conditions arising from the dentoalveolar unit, which includes teeth, their supporting structures, and adjacent tissues. This study aims to evaluate a modified surgical approach for treating this condition. PURPOSE: The purpose of this study is to measure the frequency of retreatment of maxillary sinusitis of odontogenic origin following treatment with a modified Caldwell-Luc approach, which involves accessing the maxillary sinus through the canine fossa without creating a counter-opening in the inferior nasal meatus. STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study included 82 cases (83 sinuses) with odontogenic sinusitis treated surgically with the modified Caldwell-Luc technique at the Department of Oral and Maxillofacial Surgery, Poriya Medical Center, between 2014 and 2021. Patients with nonodontogenic sinusitis were excluded. PREDICTOR VARIABLE: Anatomic findings defined as the presence or absence of ostiomeatal complex abnormalities and oroantral communication, as identified through clinical examination and computed tomography imaging. MAIN OUTCOME VARIABLES: The need for retreatment, defined as the requirement for functional endoscopic sinus surgery (FESS) due to persistent signs and symptoms of maxillary sinusitis after the modified Caldwell-Luc procedure, including facial pain/pressure, nasal congestion, purulent nasal discharge, or radiographic evidence of persistent sinus opacification on computed tomography scan, lasting more than 4 weeks despite appropriate medical management. COVARIATES: Covariates included demographic data (age, sex [male/female as identified at birth]), smoking status, etiologies of odontogenic sinusitis, and surgical conditions. ANALYSES: Descriptive statistics, Cox proportional hazards regression was used to compute hazard ratios (HRs). Kaplan-Meier survival analysis was performed to estimate the probability of remaining FESS-free over time. The level of statistical significance was set at P < .05. RESULTS: The sample was composed of 82 patients (83 sinuses) with a mean age of 52.3 years (SD 13.5), and 47 (56.6%) were male. Dental implantation and sinus augmentation procedures were the most common etiologies of odontogenic sinusitis (50.6%). The median follow-up time was 6.03 months (IQR: 2.57 to 10.93 months). The incidence rate of FESS requirement was 2.64 per 100 person-months of follow-up. The FESS-free frequency was 89.2% (95% CI: 80.4 to 94.4%). The Kaplan-Meier analysis estimated the probability of remaining FESS-free at 12 months to be 89.1% (95% CI: 79.8 to 94.4%). Patients with ostiomeatal complex abnormalities had an HR of 2.25 (95% CI: 0.47 to 10.84, P = .31) for requiring FESS, while those with oroantral communication had an HR of 1.85 (95% CI: 0.46 to 7.39, P = .38). CONCLUSION AND RELEVANCE: The modified Caldwell-Luc procedure was effective in treating the majority of odontogenic sinusitis cases. FESS may be necessary in a small percentage of cases with persistent symptoms. Further research is needed to identify predictors for FESS requirement. Of note, we recommend that oral and maxillofacial surgery surgeons review sinusitis cases with a FESS surgeon before performing the modified Caldwell-Luc procedure creating the opportunity for simultaneous or closely timed procedures when necessary.

Exploring the relationship between cycle threshold values and oral manifestations in COVID-19: a comprehensive overview.

OBJECTIVE: This cross-sectional study aimed to compare oral manifestations between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-positive and SARS-CoV-2-negative patients and to examine associations between oral symptoms, Ct values of E and N SARS-CoV-2 viral genes, and the implications of low Ct values indicating a high viral load, which is a predictive factor for the outcome of COVID-19. METHODS: A total of 353 participating patients were aged ≥18 years with clinical manifestations of COVID-19 infection and tested for SARS-CoV-2 carriage at the medical center, by reverse transcriptase polymerase chain reaction (RT-PCR). All patients filled out an anonymous digital questionnaire regarding oral and general symptoms and overall medical health.  Results: A significant association was found between SARS-CoV-2 carriage and dry mouth, unpleasant taste and changes in taste (p < 0.001); for example, 37.4% of the 147 SARS-CoV-2- positive participants had a dry mouth, compared to 18.9% of the 206 SARS-CoV-2- negative participants. Oral blisters were experienced by patients with an E gene Ct value of 10-20 (50%) or 21-30 (50%) (p = 0.041). Bad breath, dry mouth, unpleasant taste and changes in taste were mostly present in participants whose Ct values of both E and N genes were between 21 and 30.  Conclusions: This study found significant associations between low Ct values of E and N SARS-CoV-2 viral genes and high viral load, indicating that Ct values can serve as predictive factors for COVID-19 outcomes. The findings suggest that while oral symptoms are present, the Ct values and associated high viral loads are more critical indicators of disease severity and prognosis.

Human oral mucosa-derived neural crest-like stem cells differentiate into functional osteoprogenitors that contribute to regeneration of critical size calvaria defects.

BACKGROUND AND OBJECTIVE: Regeneration of large bony defects is an unmet medical need. The therapeutic effect of fully developed bony constructs engineered in vitro from mineralized scaffold and adult stem cells is hampered by deficient long-term graft integration. The purpose of the present study was to investigate the regenerative capacity of a bony primordial construct consisting of human oral mucosa stem cells (hOMSC)-derived osteoprogenitors and absorbable Gelfoam® sponges. METHODS: Gingiva and alveolar mucosa-derived hOMSC were differentiated into osteoprogenitors (Runx2 and osterix positive) and loaded into Gelfoam® sponges to generate primordial hOMSC constructs. These were implanted into critical size calvaria defects in the rat. Defects treated with human dermal fibroblasts (HDF) constructs; Gelfoam® sponges and untreated defects served as controls. RESULTS: After 120-day post-implantation defects treated with hOMSC constructs, HDF constructs and gelatin and untreated defects exhibited 86%, 30%, 21%, and 9% of new bone formation, respectively. Immunofluorescence analysis for human nuclear antigen (HNA), bone sialoprotein (BSP), and osteocalcin (OCN) revealed viable hOMSC-derived osteoblasts and osteocytes that formed most of the cell population of the newly formed bone at 30 and 120 days post surgery. Few HNA-positive HDF that were negative for BSP and OCN were identified together with inflammatory cells in the soft tissue adjacent to new bone formation only at 30 days post implantation. CONCLUSION: Collectively, the results demonstrate that primordial in vitro engineered constructs consisting of hOMSC-derived osteoprogenitors and absorbable gelatin almost completely regenerate critical size defects in an immunocompetent xenogeneic animal by differentiating into functional osteoblasts that retain the immunomodulatory ability of naïve hOMSC.

Quality of Life After Class III Repair Orthognathic Surgery: Five-Year Retrospective Study.

OBJECTIVE: To evaluate the effect of orthognathic surgery on the long-term quality of life of patients with presurgical skeletal Class III and to identify its strongest effect-whether esthetic, social, or functional. MATERIALS AND METHODS: In this retrospective cohort study, the subjects were patients after orthognathic surgery for repairing skeletal Class III. Fifty-five patients who had undergone orthognathic surgery from 2013 to 2018 in the oral and maxillofacial surgery department participated in this study. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery. RESULTS: The rate of esthetic improvement in orthognathic surgery patients was 88%. More than four-fifths (81.8%) of the patients reported improvement in their personal and social self-esteem and confidence. Finally, 40.7% of the patients reported functional improvement. No significant differences between male and female patients were found. All but one of the patients recommended orthognathic surgery for patients with similar problems. One in six (17.3%) patients was dissatisfied with the nasal appearance after the surgical procedure, while almost a quarter (21.8%) reported worsening of their mouth opening, and 25.4% reported worsening of TMJ (Temporo-Mandibular Joint) symptoms. Analysis of the results revealed no statistically significant pattern connecting preoperative overjet or overbite measures with satisfaction rates. CONCLUSIONS: In this study, patient satisfaction with the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance, mouth opening, and TMJ complaints.

Oral myopericytoma: a rare pediatric case report and a review of the literature.

BACKGROUND: Myopericytoma is a rare mesenchymal neoplasm with perivascular myoid differentiation that arises most commonly in middle adulthood. The lesion generally involves the subcutaneous tissue of distal extremities. Myopericytoma of the oral cavity is extremely rare. Herein we report a case of oral myopericytoma in a pediatric patient, who was treated via a conservative approach with a follow up of 8 years. The case is followed by a literature review. To our knowledge this is the first documented case of oral myopericytoma affecting a patient of such a young age. CASE PRESENTATION: A 6 years old boy was referred to the maxillofacial surgery department for the evaluation of a solitary growth of the right maxillary buccal and palatal gingiva. Histology and immunohistochemistry confirmed the diagnosis of myopericytoma. CONCLUSIONS: Our patient was treated by local excision with no recurrence in 8 years of follow up. Conservative approach should be considered for the treatment oral myopericytoma especially in young patients in tooth bearing areas.

Polymorphous Low-Grade Adenocarcinoma: A Proposed Reconstruction Protocol Based on Past Surgical Experience.

BACKGROUND: To propose a reconstructive protocol based on surgical management experience of polymorphous low-grade adenocarcinoma (PLGA) and the location of the primary lesion. METHODS: Data on the surgical management and the reconstructive technique of 14 histologically conformed patients with PLGA, all treated by the same surgeon, were analyzed and evaluated. RESULTS: Mean follow-up period in our series was 6.2 years. Mean age at diagnosis was 55.5 years and female to male ratio was 2.2:1. The most common presenting sign was a nonpainful lump or mass in an intraoral location. Most patients were managed by wide local excision and reconstruction method varied from primary closure to the use of radial forearm graft. Recurrence appeared in one of the patients in this series, while 2 required further radiation therapy. A protocol for reconstruction of intraoral patients with PLGA is suggested based on our analysis. CONCLUSION: Surgical management is the gold standard for PLGA treatment. Neck dissection is recommended only in patients with presurgery fine-needle aspiration confirmed lymph node involvement. The reconstruction depends mainly on location and size of the primary lesion.

Trend and Demographic Characteristics of Maxillofacial Fractures in Level I Trauma Center.

AIM: The aim of this study was to analyze the pattern and treatment of craniomaxillofacial injuries in the northern part of Israel, within a Jewish majority and large Arab minority population. PATIENTS AND METHODS: A 5-year retrospective study evaluated patients treated for craniomaxillofacial fractures. Fracture cause, type, site, and patient demographics were evaluated. RESULTS: Patient age ranged from 1 to 94 years with an average age of 36.7 years; 52% of the victims were Jews and 48% Arabs. There was male predilection in both sectors (78.3% vs 21.7%). The main site of injury was the zygomatic bone (33.5%) followed by nasal bone, orbital, mandible, frontal sinus, and maxillary fractures. The main etiology of injuries was falls (45.4%) with significantly more falls reported by females (52.1% vs 43.2% in males). Motor vehicle accidents caused injuries more frequent in males. Arabs experienced CMF fractures at a younger age compared to Jews (27.8 and 44.8 average age, respectively). In the elderly, the trend reversed where Jews were more prone to craniomaxillofacial fractures. CONCLUSIONS: Compared to their weight in the population, the Arab sector experiences more craniomaxillofacial injuries. The Jewish elderly population tends to reside in nursing homes where they are more susceptible to accidental falls, whereas young Arab males are more exposed to motor vehicle accidents and interpersonal violence. Falls were the main cause of injuries particularly in women. This may reflect the women's fear of reporting domestic violence. We believe that increased government investments in infrastructures and education will lower the incidence of craniomaxillofacial trauma and balance the gap between both sectors and sexes.

Pediatric maxillofacial trauma: Epidemiologic study between the years 2012 and 2015 in an Israeli medical center.

BACKGROUND/AIM: Trauma is the leading cause of morbidity and mortality in the pediatric population worldwide, and Israel is no different in this aspect. Of these injuries, craniofacial trauma is a significant cause of morbidity in the pediatric population. The high occurrence of pediatric trauma is possibly related to a lower perception for the hazards that surround them, combined with the restless and adventurous nature that is typical of children. The aim was to perform a retrospective, epidemiological study on facial trauma in children examined in the emergency room in order to analyze the different patterns in pediatric maxillofacial trauma, to emphasize this data and educate those involved in preventing and treating children's injuries. MATERIALS AND METHODS: The database of pediatric maxillofacial trauma patients younger than 18 years registered at the Department of Oral and Maxillofacial Surgery at the Baruch Padeh Medical Center, Poriya during a period of 4 years (2012-2015) was reviewed and examined. The data collected were analyzed for each year separately and then comparisons and cross sections were made. RESULTS: This study examined 3034 files of pediatric maxillofacial and head trauma patients aged under 18. The comparison of frequency of the injuries between seasons reveals more injuries occur in the summer and 69.3% of the injuries occurred in boys. Average age was 6.5 years, with the most prevalent group being 0-5 years. The most common type of injury was blunt head trauma followed by facial lacerations and dental injuries. Most (84.5%) of the injuries occurred outside the education system. The number of injuries at the Arab villages was higher than in the Jewish villages. CONCLUSION: There is a marked difference in the injured children population with an increase incidence in the Arab child population and children under the age of 6.

[PRIMARY AND SECONDARY HYPERPARATHYROIDISM PRESENTING AS BROWN TUMOR].

INTRODUCTION: Hyperparathyroidism (HPT) may lead to the formation of osteolytic lesions with giant granulomas. Giant cell lesions associated with HPT are known as brown tumor and represent an end stage complication of HPT. Brown tumors affect the mandible, clavicles, ribs and pelvis. Maxillary involvement is rare. We present two cases of brown tumor: the first is a case of primary HPT involving the maxilla and the second case is secondary HPT involving the mandible. Differential diagnosis, work up and methods of management of the jaw lesions are discussed.

Hypotensive anesthesia versus normotensive anesthesia during major maxillofacial surgery: a review of the literature.

Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia.

Sialendoscopy enhances saliva production of parotid glands in primary Sjögren syndrome patients.

OBJECTIVE: Primary Sjögren syndrome (pSS) is a chronic systemic autoimmune disorder that harms exocrine glands located mainly in the oral and ocular regions. pSS patients often complain about pain and mouth dryness. The aim of this retrospective study was to evaluate the influence of parotid glands' sialendoscopy on salivary flow in pSS patients and to assess the tissue characteristics of the parotid glands during the sialendoscopy procedure. METHOD AND MATERIALS: Twenty-six pSS patients (52 glands) treated with sialendoscopy for their parotid glands between the years 2017 and 2019 were included. The unstimulated whole saliva (UWS) flow rate was obtained 2 weeks before intervention (T1) and 3 months post intervention (T2). For 20 patients, UWS was measured 6 months post intervention (T3); and for 11 patients, UWS was measured 12 months post intervention (T4). Patients were asked about their oral quality of life before and after sialendoscopy. RESULTS: UWS was significantly higher at T2, T3, and T4 compared to T1 (P = .002, P = .01, and P = .04 respectively). In total, 22 patients (84.6%) reported substantial improvement of their oral quality of life at T2. Of the 52 glands, 33 (63.5%) exhibited avascularity in the walls of the Stensen duct, 33 (63.5%) had strictures, and in 8 (15.4%) mucus plugs were present. No major complications were observed in this study except for one patient who suffered from duct perforation, which during follow-up was spontaneously healed. CONCLUSION: This study indicates a positive effect of sialendoscopy on salivary flow rate and oral quality of life in pSS patients. Sialendoscopy should be considered as a vital tool in treating pSS patients. (Quintessence Int 2023;54:234-240; doi: 10.3290/j.qi.b3609681).

Controlling postoperative pain after third molar extraction with a dexamethasone and articaine injection: a double-blind randomized controlled trial.

OBJECTIVES: To evaluate the benefits of submucosal administration of a dexamethasone and articaine mixture on postoperative pain after mandibular third molar extraction. METHOD AND MATERIALS: This was a double-blind randomized controlled pilot trial of consecutive patients requiring surgical removal of mandibular third molars. Immediately post extraction, the surgeon administered a submucosal injection. The surgeon was masked to the content of the injection, which contained either a mixture of 10 mg dexamethasone and 68 mg articaine ("study group") or the same volume of saline only ("control group"). Pain severity was assessed by questionnaire (postoperative symptom severity [PoSSe] scale) 7 days after the procedure. RESULTS: Sixty subjects were enrolled. Patients in the study group had significantly lower PoSSe pain intensity scores than subjects in the control group (P = .004). The combined postoperative PoSSe pain score was significantly lower in the study group than in the control group (P = .016). There was no significant difference in pain duration between the two groups (P = .237). CONCLUSION: Submucosal injection of dexamethasone/articaine solution after surgical extraction of mandibular third molars is effective in reducing pain intensity.

A mucoadhesive patch loaded with freeze-dried liposomes for the local treatment of oral tumors.

Oral cancers affect millions of people globally, with increasing incidences among adults aged 35 and above. Poor drug uptake by lesions in the oral cavity following systemic administration, as well as limited localized treatment modalities for oral tumors, result in poor patient quality of life and high mortality. Here, we describe a solid, dissolvable, bioadhesive alginate patch containing freeze-dried doxorubicin-loaded liposomes as a local treatment for oral tumors located on the tongue. By varying the alginate-to-liposome ratio in the mucoadhesive patch, we could control the degree of bioadhesion to the tongue and the release profile of the drug-loaded liposomes from the matrix. In vitro, exposing squamous cell carcinoma (SCC) to the alginate mucoadhesive patch or tablet resulted in dose-dependent cancer-cell death. In vivo, the efficacy of the local treatment was demonstrated in mice bearing orthotopic SCC tumors in the tongue. The bioadhesive patch, applied directly above the lesion, significantly reduced the tumor size and treatment-associated side effects compared to implanted patches or systemic drug administration. This study demonstrates that local bioadhesive therapies are effective in treating cancers of the oral cavity.

Deep convolution neural network for screening carotid calcification in dental panoramic radiographs.

Ischemic stroke, a leading global cause of death and disability, is commonly caused by carotid arteries atherosclerosis. Carotid artery calcification (CAC) is a well-known marker of atherosclerosis. Such calcifications are classically detected by ultrasound screening. In recent years it was shown that these calcifications can also be inferred from routine panoramic dental radiographs. In this work, we focused on panoramic dental radiographs taken from 500 patients, manually labelling each of the patients' sides (each radiograph was treated as two sides), which were used to develop an artificial intelligence (AI)-based algorithm to automatically detect carotid calcifications. The algorithm uses deep learning convolutional neural networks (CNN), with transfer learning (TL) approach that achieved true labels for each corner, and reached a sensitivity (recall) of 0.82 and a specificity of 0.97 for individual arteries, and a recall of 0.87 and specificity of 0.97 for individual patients. Applying and integrating the algorithm in healthcare units and dental clinics has the potential of reducing stroke events and their mortality and morbidity consequences.

Acute dental malocclusion associated with lateral pterygoid muscle partial tear: Case Report and literature review.

BACKGROUND: The article presents a rare case of acute malocclusion produced by a unilateral partial tear of the lateral pterygoid muscle and an up-to-date literature review of the pathology. CLINICAL PRESENTATION: A 37-year-old female was examined; her chief complaints were pain on the right side of the temporomandibular joint (TMJ) area and mastication impairment associated with major occlusal modifications and anterior open bite. After magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) of the TMJ and subsequent MRI for soft tissue, the final diagnosis was a partial right lateral pterygoid muscle tear. CONCLUSION: The case shows the value of combined imaging in temporomandibular disorders (TMD) and the importance of soft tissue evaluation in addition to articular examination, as the primary pathology might lie outside the joint. The authors' review of the current literature did not hitherto reveal a similar case.

The association between carotid calcium on dental panoramic radiographs and coronary calcium score on chest computerized tomography.

OBJECTIVES: Coronary artery calcium measured by CT predicts future coronary events. Similarly, carotid artery calcium on dental panoramic radiographs has been associated with increased cardiovascular events. Pre-procedural assessment of candidates for valve replacement in our institution includes panoramic radiographs and chest tomography. We aimed to assess the association of carotid calcium on panoramic radiographs with coronary artery calcium on chest tomography. METHODS: Paired pre-procedural panoramic radiographs and chest tomography scans were done in 177 consecutive patients between October 2016 and October 2017. Carotid calcium was quantified using NIH's ImageJ. Coronary artery calcium was quantified by the Agatston score using Philips Intellispace portal, v. 8.0.1.20640. RESULTS: Carotid calcium maximal intensity, area and perimeter were higher among patients with high coronary artery calcium. Non-zero carotid calcium was found in half of patients with high coronary artery calcium, doubling prevalence of low coronary artery calcium. CONCLUSION: Carotid calcium identified in panoramic radiographs was associated with high coronary artery calcium. Awareness of carotid calcium recognized by dental practitioners in low-cost, low radiation and commonly done panoramic radiographs may be useful to identify patients at risk of coronary disease with potential future cardiovascular events.

The use of the temporalis myofascial flap in oral cancer patients.

PURPOSE: The purpose of this article is to present our experience using the simple, reliable, and predictable temporalis myofascial flap (TMF) in rehabilitation and reconstructive surgery in cancer patients who are older and whose health is compromised in a way that precludes the use of microvascular free flaps. PATIENTS AND METHODS: Our series includes 10 patients (8 men and 2 women), ranging in age from 62 to 85 years (mean, 73.4 years). A full-thickness anteroinferiorly based TMF was used in 5 patients for palatal reconstruction, 3 patients for buccal lining reconstruction, and 2 patients for reconstruction after resection of facial skin and buccal mucosa. RESULTS: The TMF survival rate in this study was excellent, with an 80% success rate (2 minor complications). Complications included 1 case of a partial distally necrotic flap that resolved after local debridement and did not require further flap manipulation and 1 case of transient, spontaneously resolved facial nerve (temporal branch) palsy and limited mouth opening (<20 mm), which also resolved after judicious physiotherapy. CONCLUSIONS: The TMF was found in this study to have a fairly low complication rate, was relatively easy to use, and had a predictable outcome. The proximity and reliability of the myofascial flap make it a favorable and highly recommended candidate for oral and maxillofacial reconstructive surgery in elderly patients, who usually have relatively poor recovery potential and decreased physiologic reserves.

Surgical approach to impacted mandibular third molars--operative classification.

PURPOSE: The aim of the present study is to suggest a convenient way to classify the position of the impacted third mandibular molar relative to the mandibular canal and to suggest indications for the use of each surgical approach for mandibular third molar extraction. MATERIALS AND METHODS: The presented new typing system, Third Molar Classification (TMC), is a simple and easy-to-apply method for the surgical management of mandibular third molars and can be extended for any ectopic or impacted mandibular tooth. There are 3 major types of third molar positions. The second type is subdivided further into 2 subtypes. In the present study, 9 patients with high-risk mandibular third molars were treated according to the present classification and are presented and discussed. Patients typed as TMC IIb were treated with a sagittal split osteotomy approach and patients typed as TMC III were treated with an extraoral approach. RESULTS: The operative classification was successfully implemented in very rare cases of deeply impacted mandibular third molars. In 3 of 9 cases (33%) minor complications included some degree of hypoesthesia using the extraoral approach; these complications resolved spontaneously without the need for any intervention. CONCLUSIONS: The present study describes the use of a new surgical classification system for treatment planning in all types of mandibular third molar extractions. We believe that the present classification could help the oral and maxillofacial surgeon in decision-making and limit the possible risks that are present when attempting to extract impacted mandibular third molars.