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1.
J Oral Maxillofac Surg ; 79(6): 1287-1291, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33582038

RESUMEN

Erdheim-Chester Disease (ECD) is a rare non-Langerhans cell histiocytosis characterized by histiocytic infiltration of multiple organ systems, including the bony skeleton, central nervous system, cardiovascular system, lungs, and kidneys. Manifestations of the disease are highly variable, ranging from focal disease to multisystem involvement. Oral manifestations are exceedingly rare, with only 10 known reports of ECD involving the jaws. The objective of this case report is to highlight the radiographic, clinical, and histological features of ECD involving the maxillofacial complex. A 35-year-old male admitted for sepsis secondary to pyelonephritis and suspected diabetes insipidus received an extensive workup for ECD versus IgG4 disease versus lymphoma. The oral-maxillofacial surgery service was consulted for biopsy of maxillary lesions noted to have increased activity on positron emission tomography. Intraoral biopsy yielded the characteristic histopathological features of ECD, confirming the diagnosis. We compare the clinical, radiographic, and microscopic features of ECD with past findings, contributing to the profile of this rare disease.


Asunto(s)
Enfermedad de Erdheim-Chester , Adulto , Biopsia , Enfermedad de Erdheim-Chester/diagnóstico por imagen , Histiocitos , Humanos , Masculino , Tomografía de Emisión de Positrones , Radiofármacos
2.
J Autoimmun ; 113: 102491, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32565049

RESUMEN

Cell specific and cytokine targeted therapeutics have underperformed in systemic lupus erythematosus (SLE). Mesenchymal stem cells (MSCs) have emerged as a novel therapy to address the dysregulation in autoimmune diseases but also have limitations. Human gingiva derived MSCs (GMSCs) are superior in regulating immune responses. Here, we demonstrate that the adoptive transfer of GMSCs homes to and maintains in the kidney and has a robust therapeutic effect in a spontaneous lupus nephritis model. Specifically, GMSCs limits the development of autoantibodies as well as proteinuria, decreases the frequency of plasma cells and lupus nephritis histopathological scores by directly suppressing B cells activation, proliferation and differentiation. The blockage of CD39-CD73 pathway dramatically abrogates the suppressive capacities of GMSCs in vitro and in vivo and highlights the significance of this signaling pathway in SLE. Collectively, manipulation of GMSCs provides a promising strategy for the treatment of patients with SLE and other autoimmune diseases.


Asunto(s)
Encía/citología , Nefritis Lúpica/terapia , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas/inmunología , 5'-Nucleotidasa/antagonistas & inhibidores , 5'-Nucleotidasa/metabolismo , Animales , Antígenos CD/metabolismo , Apirasa/antagonistas & inhibidores , Apirasa/metabolismo , Linfocitos B/inmunología , Linfocitos B/metabolismo , Diferenciación Celular/inmunología , Proliferación Celular , Células Cultivadas , Técnicas de Cocultivo , Modelos Animales de Enfermedad , Femenino , Proteínas Ligadas a GPI/antagonistas & inhibidores , Proteínas Ligadas a GPI/metabolismo , Humanos , Nefritis Lúpica/inmunología , Activación de Linfocitos , Ratones , Células Plasmáticas/inmunología , Células Plasmáticas/metabolismo , Cultivo Primario de Células , RNA-Seq , Transducción de Señal/efectos de los fármacos , Transducción de Señal/inmunología , Análisis de la Célula Individual
3.
J Oral Maxillofac Surg ; 75(9): 1915-1920, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28390759

RESUMEN

The calcifying odontogenic cyst is a rare developmental odontogenic lesion with a distinguishing cystic lining containing "ghost" epithelial cells. The variation in clinical, radiographic, and histologic findings makes the treatment decision difficult for these lesions. There are very few reports on treatment, with enucleation and curettage being the standard surgical method of choice for the cystic type and excision of the tumor for the solid type. A 2-stage surgical approach consisting of initial decompression with tube placement followed by a secondary procedure of enucleation and curettage is common for other large odontogenic cysts, such as dentigerous and odontogenic keratocysts. To the authors' knowledge, this is the first case managed with an intended 2-stage approach in the form of decompression followed by enucleation and curettage.


Asunto(s)
Neoplasias Maxilares/cirugía , Quiste Odontogénico Calcificado/cirugía , Adulto , Biopsia , Legrado , Descompresión Quirúrgica , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Maxilares/diagnóstico por imagen , Quiste Odontogénico Calcificado/diagnóstico por imagen , Tomografía Computarizada por Rayos X
4.
Implant Dent ; 26(3): 405-411, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28125517

RESUMEN

PURPOSE: This study examined (1) if cone-beam computed tomography (CBCT) can determine relative differences in bone mineral density distribution using clinical images of patients' mandibular bone and (2) if the relative differences can be used to detect the effects of sex and age on bone mineral density distribution. MATERIALS AND METHODS: Sixty-six clinical CBCT images from patients (36 females and 30 males) of 3 age groups (40, 50, and 60 years) were identified. Alveolar (AB) and basal cortical bone (CB) regions were digitally isolated. A histogram of gray levels, which are proportional to degrees of bone mineralization, was obtained from each region. Mean, variability (SD and coefficient of variation), and percentage differences of gray level parameters between AB and basal CBs were computed. RESULTS: Significant sex differences in gray level variability were observed within the postmenopausal age group (P < 0.042). CONCLUSION: These findings suggest that clinical CBCT images can be a valuable tool in providing information on bone quality, which is an important criterion for optimum planning for dental implant placement.


Asunto(s)
Proceso Alveolar/diagnóstico por imagen , Densidad Ósea , Tomografía Computarizada de Haz Cónico/métodos , Implantación Dental Endoósea , Mandíbula/diagnóstico por imagen , Planificación de Atención al Paciente , Adulto , Calcificación Fisiológica , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
6.
J Oral Maxillofac Surg ; 70(2): 378-83, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22079063

RESUMEN

PURPOSE: To evaluate the efficacy of using a single lag screw combined with an arch bar in the management of anterior mandibular fractures and to compare this method with the traditional application of 2 lag screws. MATERIALS AND METHODS: We designed and implemented a randomized clinical trial and enrolled a sample of patients with anterior mandibular fractures. Twenty adult male patients were randomly divided into 2 equal groups according to the number of lag screws used for fracture fixation after securing the occlusion with intermaxillary fixation. In group A, the fractures were treated using 2 lag screws. In group B, the fractures were treated using a single lag screw and an arch bar on the teeth, spanning the fracture line. Clinical and radiographic evaluations were used to evaluate the efficacy of each fixation method immediately and at 2 and 4 months postoperatively. RESULTS: The clinical examination showed stable fixation with no mobility or infection in all cases. One patient in group A showed a slight occlusal discrepancy that was managed with occlusal adjustment. The pretraumatic occlusal relationship of all other patients was re-established. Postoperative radiographs showed properly reduced fracture segments with gradual bone healing. No significant difference was noted (P > .05) between the 2 groups in the development of postoperative complications. CONCLUSIONS: The use of 1 lag screw in conjunction with an arch bar across the fracture line is rigid and stable enough to manage anterior mandibular fractures without the need for supplemental intermaxillary fixation. The use of a single lag screw offers several advantages compared with the traditional use of 2 lag screws. These advantages include decreased cost, use of materials, healing time, and risk of associated morbidity.


Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas/instrumentación , Fijación de Fractura/instrumentación , Fracturas Mandibulares/cirugía , Adolescente , Adulto , Mentón/inervación , Equimosis/etiología , Edema/etiología , Estudios de Seguimiento , Curación de Fractura/fisiología , Humanos , Técnicas de Fijación de Maxilares/instrumentación , Masculino , Maloclusión/etiología , Persona de Mediana Edad , Osteotomía/métodos , Dolor Postoperatorio/etiología , Parestesia/etiología , Complicaciones Posoperatorias , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento , Adulto Joven
7.
J Oral Implantol ; 36(1): 69-74, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20218871

RESUMEN

A variety of techniques and materials has been used to provide the structural base of bone and soft tissue support for dental implants. Alveolar bone augmentation techniques include different surgical approaches such as guided bone regeneration, onlay grafting, interpositional grafting, distraction osteogenesis, ridge splitting, and socket preservation. In the case presented, a technique was used to augment the alveolar bone three-dimensionally with autologous "bone rings" and immediate implant placement in a 1-stage procedure following teeth extraction. Bone rings (circular osteotomies) were outlined at the symphysis area using trephine burs, and a central osteotomy for implant placement was done before its removal. The rings were then removed and sculptured to fit the extraction socket; this was followed by screwing the implant through the ring, gaining its primary stability from the prepared basal bone.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Alveolo Dental/cirugía , Mentón/cirugía , Prótesis Dental de Soporte Implantado , Femenino , Humanos , Persona de Mediana Edad , Extracción Dental
8.
Anesth Prog ; 66(2): 103-110, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31184944

RESUMEN

Ludwig's angina (LA) is a gangrenous cellulitis of the neck that spreads via continuity of the fascial planes. Treatment of LA includes aggressive antibiotic therapy as well as surgical drainage in many cases. The most common cause of infection is odontogenic and can be due to both aerobic and anaerobic bacteria. Signs and symptoms of LA include bilateral cervical swelling, dysphagia, drooling, neck tenderness, elevation and posterior distension of the tongue, restricted neck movement, trismus, dyspnea, and stridor, which can result in difficult airway management. Proper preoperative assessment of patients with LA should include identifying features that may cause difficulties with mask ventilation, direct laryngoscopy, and intubation. Alternative methods of ventilation should be considered and immediately accessible, including a plan on how and when they would be used in the event that a patient cannot be mask ventilated or intubated. Marking external anatomical airway landmarks prior to manipulating the airway can save vital time if an emergent airway becomes necessary.


Asunto(s)
Manejo de la Vía Aérea , Anestésicos , Angina de Ludwig , Humanos
9.
Anesth Prog ; 66(4): 202-210, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31891296

RESUMEN

Historically, patients who developed malignant hyperthermia had an extremely high rate of mortality. Today, if treated appropriately, patients who experience an episode of malignant hyperthermia will most likely survive. This dramatic decrease in mortality associated with malignant hyperthermia is due to several factors, including an increased understanding of the disease, improved diagnostic and monitoring equipment, and the development of lifesaving pharmacologic agents. This article presents the very likely case of acute malignant hyperthermia in a 24-year-old man with special needs, who presented for restorative dentistry under general anesthesia in the outpatient clinic of The Ohio State University's College of Dentistry.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Anestesia General , Reparación de Restauración Dental , Hipertermia Maligna , Adulto , Instituciones de Atención Ambulatoria , Personas con Discapacidad , Humanos , Masculino , Hipertermia Maligna/diagnóstico , Hipertermia Maligna/etiología , Ohio , Adulto Joven
11.
Artículo en Inglés | MEDLINE | ID: mdl-26972423

RESUMEN

OBJECTIVE: Transconjunctival approach to the lower one-third of the orbit is commonly used to avoid transcutaneous incisions when surgical access is needed. A lateral canthotomy is used in conjunction with this approach if increased lateral exposure is required. A major disadvantage to lateral canthotomy is difficulty in resuspension of the lateral canthal tendon, which can lead to unaesthetic outcomes. The present report describes two cases of lateral tarsal incision or, as we decided to call it, the "lateral tarsotomy" technique. This simple approach is used to increase lateral access to the orbit without the need for lateral canthotomy. STUDY DESIGN: Two patients presented with internal orbital wall trauma that required repair; access was achieved with a transconjunctival approach in conjunction with lateral tarsotomy. The patients were followed up at 1 week, 1 month, and 3 months to document the development of possible unaesthetic and poor functional outcomes. RESULTS: Excellent cosmetic results were observed, with no noticeable deformity at the tarsotomy site. There was no evidence of ectropion, entropion, scleral show, and visible scars. CONCLUSIONS: The above results suggest that the lateral tarsotomy approach is a practical alternative to lateral canthotomy when increased lateral exposure is required.


Asunto(s)
Párpados/cirugía , Fracturas Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Estética , Femenino , Humanos , Masculino , Fracturas Orbitales/diagnóstico por imagen , Tomografía Computarizada por Rayos X
12.
Oral Maxillofac Surg Clin North Am ; 24(1): 25-38, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22284395

RESUMEN

Although anatomy often seems static, the continual innovation of new surgical techniques and approaches, in reality, make it a dynamic field. The first essential principal of any surgery is the comprehensive knowledge of the anatomic area and its physiology. This assertion is especially true in functional and or cosmetic nasal surgery.


Asunto(s)
Nariz/anatomía & histología , Nariz/cirugía , Rinoplastia/métodos , Estética , Humanos , Planificación de Atención al Paciente
14.
Tissue Eng Part A ; 18(5-6): 665-75, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21981405

RESUMEN

The ability of recombinant human bone morphogenetic protein 2 on absorbable collagen sponge (rhBMP2/ACS) to regenerate bone in segmental defect has been well characterized. However, clinical results of rhBMP2/ACS constructs in secondary reconstruction of large mandibular and craniofacial defects have not been consistent. We hypothesized that rhBMP2 delivery triggers an endogenous response in the soft tissues surrounding the defect, in the form of expression of BMP2 and vascular endothelial growth factor (VEGF). Such osteogenic response will occur only after immediate, as opposed to delayed, rhBMP2 delivery, suggesting a new explanation to the difference in bone regeneration between the two settings. A 35-mm segmental bone and periosteum defect was created on one side of the mandible in 16 dogs divided in three groups. Group 1 (Gp1, n=6) ACS was loaded with 8 mL of rhBMP2 (0.2 mg/mL). In Gp2 (n=5) the same dose of rhBMP2/ACS was delivered into the defect 4 weeks after surgery. In Gp3 (control; n=5) the defect was reconstructed using ACS loaded with 8 mL of buffer only (devoid of rhBMP2). Tissues were collected after 12 weeks of reconstruction in all groups. Direct measurement of physical dimensions of regenerates and bone morphometry was performed to evaluate bone regeneration. The mRNA expression of both BMP2 and VEGF in the soft tissue surrounding the defect was evaluated using real-time quantitative PCR. Both BMP2 and VEGF proteins were quantified in immunostained sections. Immunoflurescence colocalization of BMP2 and acetylated low density lipoprotein (AcLDL) was done to detect the source of BMP2. Immediate delivery yielded better bone regeneration. Both BMP2 and VEGF mRNA expression was upregulated only in Gp1 (+7.3, p=0.001; +1.53, p=0.001, respectively). BMP2 protein was significantly higher in the immediate reconstruction group; however, VEGF protein was undetected in the examined sections. Immediate delivery of rhBMP2 seemed to induce endogenous release of BMP2 from the surrounding soft tissues, an effect that was lacking in delayed delivery and may explain the variability of clinical results associated with BMP2 use. Colocalization of BMP2 and endothelial cells (ECs) suggested that ECs could be the source of endogenous BMP2.


Asunto(s)
Proteína Morfogenética Ósea 2/farmacología , Regeneración Ósea/efectos de los fármacos , Anomalías Craneofaciales/tratamiento farmacológico , Fracturas Mandibulares/tratamiento farmacológico , Animales , Proteína Morfogenética Ósea 2/biosíntesis , Anomalías Craneofaciales/patología , Modelos Animales de Enfermedad , Perros , Relación Dosis-Respuesta a Droga , Regulación de la Expresión Génica/efectos de los fármacos , Humanos , Lipoproteínas LDL/metabolismo , Fracturas Mandibulares/patología , Periostio/metabolismo , Periostio/patología , Factores de Tiempo , Factor A de Crecimiento Endotelial Vascular/biosíntesis
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