Prevalence and pattern of maxillofacial injuries associated with domestic violence: A retrospective study at a major trauma center.

BACKGROUND/AIM: This study aimed to analyze the frequency and pattern of maxillofacial injuries associated with domestic violence. MATERIALS AND METHODS: Medical records of victims of domestic violence between May 2016 and May 2023 were scrutinized retrospectively. The following data were analyzed: gender and age, history of previous abuse, hospital admission, pregnancy, type of facial injuries, anatomical location of injuries, side of injuries, concomitant injuries, mechanism of impact, treatment modality, and history of drug and alcohol abuse. RESULTS: Seventy-eight patients were included, comprising of 75 (96.2%) women and 3 (3.8%) men. Domestic violence was an etiology of 2.7% of all maxillofacial injuries. The mean age was 27.06 ± 5.5 years. 33.3% of cases had a history of previous domestic violence. The assailant was drug addicted in 47.4% of cases. The attacker was the current partner of the victim in 79.5% of the victims. Soft tissue injuries were found in 96.1% of cases. Maxillofacial fracture was observed in 52.6% of victims among which zygoma was the most common (16.7%) followed by the nose and mandible (15.4%). Isolated fracture was observed in 85.3% of patients and 71.8% of the injuries were observed on the left. Concomitant injuries were present in 51.3% of patients with arms/hands being the most frequent (48.7%). Punch (67.9%) constituted the majority of the mechanism of impact. Based on the statistical analysis, punches resulted in significantly higher soft tissue contusion (p = .046), and injuries that required no intervention were significantly higher in punched victims (p = .002). CONCLUSION: Maxillofacial soft tissue injuries with or without isolated fracture on the left side of the zygoma, mandibular angle, or nose in association with arms/hands injuries in young adult women could be clues of domestic violence. Appropriate care such as preventive programs for drug or alcohol abuse should be implemented to reduce domestic violence, thereby reducing these injuries.

Recent advances in metal nanoparticles to treat periodontitis.

The gradual deterioration of the supporting periodontal tissues caused by periodontitis, a chronic multifactorial inflammatory disease, is thought to be triggered by the colonization of dysbiotic plaque biofilms in a vulnerable host. One of the most prevalent dental conditions in the world, periodontitis is now the leading factor in adult tooth loss. When periodontitis does develop, it is treated by scraping the mineralized deposits and dental biofilm off the tooth surfaces. Numerous studies have shown that non-surgical treatment significantly improves clinical and microbiological indices in individuals with periodontitis. Although periodontal parameters have significantly improved, certain bacterial reservoirs often persist on root surfaces even after standard periodontal therapy. Periodontitis has been treated with local or systemic antibiotics as well as scaling and root planning. Since there aren't many brand-new antibiotics on the market, several researchers are currently concentrating on creating alternate methods of combating periodontal germs. There is a delay in a study on the subject of nanoparticle (NP) toxicity, which is especially concerned with mechanisms of action, while the area of nanomedicine develops. The most promising of them are metal NPs since they have potent antibacterial action. Metal NPs may be employed as efficient growth inhibitors in a variety of bacteria, making them useful for the treatment of periodontitis. In this way, the new metal NPs contributed significantly to the development of efficient anti-inflammatory and antibacterial platforms for the treatment of periodontitis. The current therapeutic effects of several metallic NPs on periodontitis are summarized in this study. This data might be used to develop NP-based therapeutic alternatives for the treatment of periodontal infections.

Effect of blood contamination on marginal adaptation of cold ceramic and MTA angelus: a scanning electron microscopic study.

BACKGROUND: This study aimed to assess the effect of blood contamination on marginal adaptation of cold ceramic (CC) and mineral trioxide aggregate (MTA) Angelus using scanning electron microscopy (SEM). METHODS: This in vitro experimental study was conducted on 24 extracted single-rooted human teeth. After cleaning and shaping, the root canals were filled with lateral compaction technique. The apical 3 mm of the roots was cut, and cavities with 3 mm depth were created at the apex. The teeth were randomly assigned to two group (n = 12) for the application of CC and MTA Angelus as retrograde filling materials. CC and MTA Angelus were prepared by mixing the powder with blood, and applied in the cavities. After 24 h, their marginal adaptation to the canal walls was assessed by SEM. Data were statistically analyzed by t-test (alpha = 0.05). RESULTS: The mean marginal gap was 8.98 µm in the CC, and 16.26 µm in the MTA Angelus group; this difference was statistically significant (P < 0.001). CONCLUSIONS: The present in vitro study revealed that following complete blood contamination of powder, CC showed significantly superior marginal adaptation than MTA Angelus as shown by SEM assessment.

Epibulbar solitary myofibroma in an elderly patient: a case report.

A 93-year-old male patient presented with abrupt expansion of an old epibulbar mass at the temporal area of the left eye. He had a medical history of previously treated laryngeal cancer with surgery and radiotherapy. The tumor, despite being firmly attached to the underlying sclera, was excised completely and histopathological examinations revealed a solitary myofibroma. The patient had a 4-month uneventful follow-up with excellent wound healing. Solitary myofibroma may be a differential diagnosis for epibulbar masses in elderly patients.

Huge heterotopic brain cyst of the orbit: report of a case and its management.

Heterotopic brain tissues are a group of extracerebral neuroglial tissues. Heterotopic brain tissue in the orbit remains a rare clinical entity. This article presents a 7-year-old male child who presented with severe globe displacement, proptosis, and vision loss in the right eye. The orbital imaging showed a huge orbital cystic mass displacing the globe. The cyst was excised entirely from the orbit. The histopathological investigations revealed the presence of a cystic lesion containing brain tissue that was immune reactive for S-100 and glial fibrillary acidic proteins. The diagnosis was confirmed to be heterotopic brain tissue due to the lack of visible bony defect. The relevant literature was also reviewed.

Facial and Abducens Nerve Palsies Following COVID-19 Vaccination: Report of Two Cases.

A broad spectrum of neurological side effects has been reported after immunisation for COVID-19, including functional neurological disorders, cerebral vascular events, cerebral venous thrombosis, intracerebral haemorrhage, neuroleptic malignant syndrome, cranial nerve palsies, and otologic manifestations. Multiple cranial neuropathies have also been reported following vaccination in which involvement of VII nerve is the most prevalent, followed by the VI, III, and IV nerves. We describe two male patients, one with with facial nerve palsy and the other with abducens nerve palsy following COVID-19 vaccination. The patient with facial nerve palsy received the AstraZeneca vaccine 2 days before the symptoms began. In contrast, the patient with the abducens palsy had received his first dose of the Sinopharm vaccine 7 days previously. Both patients demonstrated a gradual recovery within the next 2 months. Further studies are required to investigate the proper relationship between cranial nerve palsies and vaccinations.

Intraconal Orbital Hidrocystoma in an Infant.

ABSTRACT: Intraconal orbital hidrocystoma is a very rare entity. Herein, a 6-month old boy with an intraconal apocrine hidrocystoma will be reported. The patient presented with a left-sided mild proptosis and significant anisometropic hypermetropia. Clinical examinations revealed choroidal folds and optic disc blurring in the left eye. Orbital MRI disclosed an intraconal well-defined cystic lesion that was hypointense in T1 and hyperintense in T2 weighted images. The lesion was excised completely through a lateral orbitotomy and diagnosed histologically as an apocrine hidrocystoma. Excepting partial improvement of anisometropia, other clinical signs were improved after surgery.

Congenital Four Eyelid Ectropion Associated With Clefting Anomaly.

An infant with congenital 4 eyelid ectropion associated with cleft lip and palate developed exposure keratopathy. He underwent skin grafting of the upper eyelids and lateral canthal reconstruction. Ectropion and signs of exposure keratopathy improved. Congenital eyelid ectropion is a rare disorder. Surgical repair can successfully correct the condition.

Trichloroacetic acid 10% injection for treatment of conjunctival inclusion cysts.

Purpose: To evaluate the effect of intra-lesional injection of Trichloroacetic acid (TCA) 10% in patients with conjunctival inclusion cysts.Methods: This prospective case series study included all patients with conjunctival inclusion cyst who were referred to our referral center from August 2016 to August 2018. All patients received TCA 10% injection into the conjunctival cyst, and outcomes of the intervention were evaluated at least 6 months later.Results: Ten patients with mean age of 24 ± 17.6 (range 6-65) years including three children received TCA 10% injection into the conjunctival cyst. We included 6 anophthalmic and 4 ophthalmic cases. All patients were treated successfully and no recurrence of the lesion was observed in any case. Mean follow up duration was 18.1 ± 8.3 (range 6-28) months.Conclusion: Intra-lesional injection of TCA 10% is a safe, simple, and effective treatment in patients with conjunctival inclusion cysts including ophthalmic cases and anophthalmic cases, both in adults and in children. This concentration may avoid ocular surface complications.

Superficial Orbital Rim Osteoma.

A 29-year old woman presented with 2 small and firm subcutaneous nodules on the anterior aspect of the left inferonasal orbital rim. Orbital computed tomography scan showed small well-circumscribed exophytic masses of bone density on frontal process of maxillary bone. The patient refused any surgical intervention in this stage. After 5 years masses demonstrated a significant growth and she requested to do surgery. Complete surgical excision was performed and histopathological diagnosis was consistent with an ivory-typed osteoma. The patient was tumor-free in a 2-year follow up. Orbital osteoma may present as subcutaneous nodules on orbital rim, which can be eradicated by surgical excision of the tumor.

Orbital, Periorbital, and Intracranial Emphysema Caused by Compressed Air Injury in a 5-Year-Old Child.

A 5-year-old boy was accidentally injured by a compressed air blast to his right eye and developed periorbital and subconjunctival emphysema and proptosis subsequently. CT scan showed periorbital subcutaneous and intraorbital emphysema around the right eye, as well as intracranial and cervical emphysema without frank fractures in orbital bones. He was examined under sedation, and the subconjunctival air was aspirated. He was also prophylactically treated with topical and systemic antibiotics to prevent infection. Emphysema was resorbed entirely within 3 weeks. In conclusion, compressed air injury can occur in a child and manifest with orbital and periorbital emphysema without any detectable fracture and any clear entrance site and may need emergent management to save the vision or upper respiratory airways.

Optic Disc Deformation and Orbital Bone Erosion Secondary to a Huge Neglected Orbital Cavernous Hemangioma.

Cavernous hemangioma (CH) is the most common benign tumor of the orbit which can expand the bony orbit by gradual growth of a large tumor. In this article, the authors report a 28-year-old man presented with a longstanding unilateral proptosis secondary to a huge orbital CH which also caused optic disc deformation and bone erosions in the adjacent orbital walls. The optic disc deformities resolved after the tumor removal.

Mesenchymal Chondrosarcoma of the Orbit Attached to the Optic Nerve.

Mesenchymal chondrosarcoma (MCS) is a rare tumor in the orbit. Although optic nerve displacement is a common finding in intraorbital MCS, optic nerve tissue involvement in tumor has rarely been reported in huge tumors associated with intracranial extension. Herein the authors report a patient with MCS involving optic nerve tissue without intracranial extension. A 59-year-old woman with a 2-month history of progressive proptosis and normal vision presented to us. Computed tomography revealed a clearly outlined heterogeneous mass with calcified foci in its center, which was attached to the optic nerve, magnetic resonance imaging showed the mass to be isointense to gray matter on T1- and T2-weighted images. She underwent lateral orbitotomy and partial tumor excision. Histopathologic study confirmed MCS. She refused exenteration till 1 year but the tumor recurred and her vision decreased to no light perception. Then exenteration was performed with obtaining free margin and she is now free of tumor after 6 months without radiotherapy or chemotherapy. Mesenchymal chondrosarcoma must be differentiated from more common calcified tumors attached to optic nerve like meningioma.

A new surgical technique for excision of orbital cavernous hemangioma: a 15-year experience.

PURPOSE: To present a new surgical technique for excision of orbital cavernous hemangiomas (CHs). METHODS: This retrospective case series study included patients with orbital CH who were operated from 2001 to 2016 at our referral center. Epidemiologic data, symptoms, signs, and images were reviewed from patients' files with at least one year of follow-up. Surgical results and complications were documented. We used the "index finger dissection" technique without grasping the tumor for release of adhesions and its removal. RESULTS: We included 60 patients with orbital CH consisting of 36 (60%) female and 24 (40%) male patients with mean age of 40 ± 12.1 (range 9-66) years. The main complaint was proptosis with average size of 5.3 ± 2 millimeters. The surgical approach was lateral orbitotomy in 49 (81.7%) patients, medial transcutaneous in seven (11.7%) patients, inferior transconjunctival in three (5%) patients, and simultaneous lateral and medial orbitotomy in one (1.6%) patient. All tumors were removed intact; complications included ptosis in one subject, lower lid retraction in one case, and diplopia in two patients, all of which improved before 2 months. No optic nerve damage occurred. CONCLUSION: The "index finger dissection" technique without grasping the tumor for excision of orbital CH, via any external approach to the tumor, is a safe technique with minimal complications.

Efficacy of tightening of orbicularis oculi muscle in patients with functional nasolacrimal duct obstruction.

PURPOSE: To evaluate the efficacy of tightening of lateral portion of orbicularis oculi muscle in patients with functional nasolacrimal duct obstruction (FNLDO). METHODS: This is an interventional cross-section study for evaluation of effect of orbicularis oculi tightening procedure in patients with FNLDO. Patients with unexplained epiphora, open lacrimal system in syringing and evidences of lacrimal pump weakness in lacrimal scintigraphy underwent surgery. In this procedure, a stripe of preseptal and pretarsal orbicularis muscle was dissected, slightly resected and secured to the periosteum of lateral orbital rim. Each subject completed a questionnaire about the intensity of epiphora before surgery and 1, 3 and 6 months after surgery. Furthermore, fluorescein dye disappearance test (FDDT) was performed before surgery and repeated in the follow-up visits. At last visit, the pre- and post-operative data were analyzed and compared. RESULTS: Fifteen eyes of 12 patients (5 males and 7 females) with the mean age of 56.7 years included in the study. Severity of epiphora and tearing effect on daily life were significantly improved following the operation. FDDT result was improved significantly after 1 month follow-up in all eyes (15 eyes), at 3 months follow-up in 80% of eyes (12 eyes) and at the end of the 6th month in 66.7% of eyes (10 eyes). Subjective and objective success rates were 87% and 80%, respectively. No significant complications or side-effects were observed. CONCLUSION: Tightening of lateral portion of preseptal and pretarsal orbicularis muscle seems an effective, safe, and easy procedure to decrease epiphora in patients with FNLDO.

Psychogenic unilateral pseudoptosis.

Conversion disorders are among common psychological problems. Pseudoptosis is an uncommon presentation of this category of disorders. Herein, the authors report 2 cases of psychogenic pseudoptosis. The first case is a 21-year-old man who presented with sudden onset of ptosis in his OS 2 weeks previous. The patient reported episodes of left upper eyelid drooping during the last 7 months. The second case is a 10-year-old girl with ptosis onset 6 months previously, after a viral conjunctivitis. In both patients, specific presentations in favor of nonorganic ptosis were observed; all neurological and paraclinical evaluations were normal, and considerable familial or social stressors were found. Both patients received psychological treatment, and no recurrence was observed afterward.

Blepharoptosis Associated With Third Cranial Nerve Palsy.

PURPOSE: To evaluate the demographics and outcomes of management for blepharoptosis associated with third cranial nerve palsy at a tertiary eye center. METHODS: This retrospective cross-sectional and interventional study was performed on hospital records of patients with ptosis associated with third cranial nerve palsy who were referred to Labbafinejad Medical Center from January 1999 to January 2009. The authors evaluated age, sex, laterality, severity of involvement, etiology, clinical findings, and treatment modalities and outcomes in patients with blepharoptosis due to third cranial nerve palsy over a 10-year period. RESULTS: Of a total of 45 subjects, 25 cases (55.6%) were males and 20 subjects (44.4%) were females. Mean age of enrolled subjects was 21.1 ± 15.5 years. Etiologies included trauma in 21 (46.7%), congenital in 16 (35.6%), and other causes in 8 (17.7%) cases. Overall, 18 of 45 patients (40%) underwent ptosis surgery: of these, 15 (83.3%) subjects improved with one procedure, whereas 3 (16.7%) subjects required more than one operation. For initial ptosis surgery, 5 (27.7%) patients underwent levator resection and 13 (72.3%) cases underwent frontalis sling; all second and third procedures were frontalis sling. One-step, 2-step, and 3-step ptosis surgery was accomplished in 15 (83.3%), 1 (5.6%), and 2 (11.1%) patients, respectively. Eventually, an open visual axis was attained in all cases following 1-3 operations. CONCLUSIONS: Trauma was the most common cause of ptosis associated with third cranial nerve palsy in the current series. Surgical management of ptosis in patients with third nerve palsy may be challenging but most subjects achieve good results following appropriate and stepwise surgical plans.

Clinical and Radiologic Characteristics of Inferior Rectus Muscle Sheath Entrapment in Orbital Blowout Fracture.

Blowout fracture is a common condition in the oculoplastics clinic. One of the indications for its repair is entrapment of the inferior rectus muscle within the fracture site. Herein, the authors present 3 patients of inferior rectus muscle sheath entrapment without entrapment of the muscle itself. The outcome of treatment was excellent in all patients. The aim of this report is to present the special clinical and radiologic findings in such patients.

Tear condition following unilateral ptosis surgery.

PURPOSE: To evaluate changes in tear film condition following unilateral ptosis surgery. METHODS: This interventional case series includes patients with unilateral blepharoptosis scheduled for ptosis surgery with no prior history of eye disease and surgery over a 2-year period. Tear film evaluation before surgery were performed, which included Schirmer test with and without anesthesia, and tear break up time (TBUT). Ptosis surgery included levator resection and frontalis sling. The previously mentioned tests were repeated 1, 3, and 6 months after surgery. Subjective symptoms related to dry eye also evaluated before and after surgery. RESULTS: A total of 83 patients including 46 (55.4%) male subjects with mean age of 26.2 ± 16.2 years were enrolled in the study. The most common cause of ptosis was congenital in 77 (92.8%) patients. Surgical intervention included levator resection in 56 (67.5%) cases and frontalis sling procedure in 27 (32.5%) cases. The result of surgery was good in 47 (56.6%) patients while under- and overcorrection were observed in 32 (39.8%) and 3 (3.6%) patients, respectively. Schirmer's test with and without anesthesia and TBUT after surgery revealed a decrease in tear quantity and quality after surgery with time. Patients who had subjective complaints from dryness after surgery only had shorter TBUT among the objective signs. CONCLUSIONS: Ptosis surgery can decrease the quantity and quality of tears in operated eyes. Since some of these patients may need other types of operations in future, such as refractive or cataract surgery, evaluation of the tear condition before further surgery is prudent.

Free-floating pyogenic granuloma of the lacrimal sac.

The authors report a 13-month-old girl with chronic dacryocystitis, and history of three times probing and once inferior turbinate infracture. She underwent dacryocystorhinostomy due to failure of previous procedures. During surgery a free floating reddish mass was extracted from the lacrimal sac. Histopathologic examination revealed the mass to be a pyogenic granuloma.