Central giant cell granuloma of the jaws-long-term clinical and radiological outcomes of surgical and pharmacological management.

OBJECTIVES: To compare long-term results of different treatment modalities in central giant cell granuloma of the maxillofacial-skeleton. Primary resection may result in major defects. Alternative treatments include pharmacological agents. As yet there has been no consensus on the use of the variety of treatment options, and few studies have reported clarifying long-term results. MATERIALS AND METHODS: This retrospective study on 22 patients with 25 lesions evaluated clinical, radiological and histological features, treatment preformed and lesion recurrence. Success was defined as regression/calcification and failure as recurrence, progression or un-responsiveness. RESULTS: Of the presenting patients, 77% were under age 40. Lesion prevalence was higher in the anterior mandible and left posterior maxilla. Most cases exhibited pain, tooth-mobility or mucosal-expansion. The appearance was predominantly unilocular in the maxilla and multilocular in the mandible, which also exhibited higher prevalence of cortical perforation. Up to 80% of lesions were classified as aggressive. Intralesional steroids/calcitonin were used in 7 cases. Mean follow-up was 39.8 months. Two cases showed recurrence. In 71% of the cases treated pharmacologically, calcification/regression were observed. CONCLUSIONS: Our analysis indicates better outcomes using a combined approach, including both pharmacological and surgical treatments in large aggressive lesions. Pharmacological treatment resulted in decreased size or well-defined lesions, thus reducing the need for extensive bone resection. Dual treatment with corticosteroids and calcitonin showed no superior outcomes, but a larger cohort should be assessed. CLINICAL RELEVANCE: There are several protocols for treatment of central-giant-cell-granuloma lesions, but most are not fully established. It is important to report results that contribute to the establishment of proven protocols. This report attempts to establish the relevance of the combined approach: pharmacological treatment followed by surgical resection.

The Relation Between Morphometric Features and Susceptibility to Mandibular Angle Fractures.

The study was aimed to determine possible relations between skeletal morphologic parameters to mandibular angle fractures. Retrospective study of 100 patients suffering from mandibular fractures and treated in the Rambam Health Care Campus between the years 2013 and 2017 was conducted. Predictor variable was facial skeletal morphologic features as derived from the measurements. Outcome variable was mandibular angle fractures. About 42 patients suffered from angle fractures. Gonial angle (131.3° versus 118.1°), condylar neck width (8.3 mm versus 6.8 mm sagittaly and 7.1 mm versus 5.8 mm horizontally), and wisdom tooth prevalence and impaction were positively correlated to the fracture. Ramus height (48.3 mm versus 53.4 mm) was negatively correlated to angle fractures. Many reports in the literature show positive relations between impacted 3rd molars and angle fractures, yet only sporadic reports describe relations between facial fractures and facial features. Our results showed the predictable positive relation between angle fractures and 3rd molar prevalence and impaction. Yet surprisingly, we found unequivocal significant positive correlation between angle fractures to gonial angle and condylar neck width and negative correlation to ramus height. Based on the correlation to the gonial angle and ramal height, it is concluded that enlarged anterior vertical growth is a predictor for angle fractures, as are condylar neck width, and wisdom teeth.

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.

Lemierre's syndrome from odontogenic infection: Review of the literature and case description.

Lemierre's syndrome (LS) is a rare potentially fatal sequel of head and neck infection, classically described as thrombophlebitis of the internal jugular vein (IJV) with cervical space infection extending into the thorax. Our objective was to answer the clinical question: "Does Lemierre syndrome (LS) from odontogenic infection differ from nonodontogenic LS in regard to clinical sequence, treatment, and survival." We reviewed the literature on the management of LS over the last two decades, with a focus on LS from odontogenic infection. Such a case is presented in order to portray the clinical sequence. Only 10 cases met the inclusion criteria (including the case presented). The recorded data were analyzed in comparison to large case series reviewing LS. Our data reflect the moderate differences in regard to IJV thrombosis and bacteriogram. There is an overall rise in published LS cases in the last 20 years. Odontogenic infection leading to LS is scarce, yet with survival rates similar to nonodontogenic LS. Repeated surgical interventions and aggressive wide spectrum antibiotic therapy remain the treatment of choice.

Secondary bone grafting of the cleft maxilla following reverse quad-helix expansion in 103 patients.

INTRODUCTION: The main points to consider in secondary alveolar bone grafting (ABG) of cleft patients are age at the time of surgery, the type of bone graft, and pre/postorthodontic expansion of the upper jaw. PURPOSE: The aim of this study is to evaluate the reverse quad-helix (RQH) expander device. Does RQH improve the surgical procedure before ABG? We will evaluate the outcome of the procedure, duration of the operation, hospitalization time, satisfaction of the surgeon with this procedure and the success of the bone graft in the long-term. PATIENTS AND METHODS: We reviewed the medical records of 103 cleft patients who underwent secondary bone grafting at our institution between 2001 and 2012. All patients were treated presurgically with a RQH appliance to expand the cleft area. The following data were recorded for each of the patients: Unilateral/bilateral cleft, surgery time, hospital stay, success/failure, and follow-up. CONCLUSION: Presurgical orthodontic application of the RQH expander in the cleft area enabled improved anterior expansion rather than posterior expansion. This technique improves access for surgery and bone grafting, the use of RQH facilitates the improved manipulation of the nasal mucosa via direct view due to the wide separation of the alveolar segments in the cleft area. Furthermore, this gap enables improved access for the bone grafting procedure, shortens the surgery time and provides stable maxillary transverse correction.

In vitro antibacterial evaluation of flowable restorative materials.

OBJECTIVES: The microgap at the tooth-restoration interface is inevitable and may allow bacterial penetration that could lead to failure. The purpose of this in vitro study was to assess the antibacterial potential of 4 flowable composite restorative materials. METHOD AND MATERIALS: The antibacterial potential of Aeliteflo (Bisco), Filtek Flow (3M ESPE), Tetric Flow (Ivoclar Vivadent), and Dyract Flow (Dentsply) was tested against Streptococcus mutans. Agar diffusion test (ADT) and direct contact test (DCT) were the methods used. For ADT, wells were punched in S mutans-inoculated plates. The materials were placed in the wells and polymerized. Inhibition zones were measured after 48 hours' incubation at 37 degrees C. In the DCT, 8 samples of each tested material were placed on the side walls of wells in a 96-microtiter plate and polymerized. A suspension of S mutans was placed on the surface of each sample. Bacterial growth was monitored by optical density changes at 650 nm every 30 minutes for 16 hours. The experiment was repeated after the samples were aged in phosphate-buffered saline for 1 and 7 days. RESULTS: In both tests, only Dyract Flow showed inhibition of S mutans growth. Except for Dyract Flow samples, aged samples did not statistically differ in S mutans inhibition when compared to their 1-hour control counterparts. Dyract Flow samples lost their S mutans inhibitory potential after 24 hours. CONCLUSION: The flowable composites tested do not possess effective long-term antibacterial ability.