ORBITAL BLOWOUT FRACTURES: A RETROSPECTIVE STUDY WITH LITERATURE REVIEW.

Blowout fractures of the orbit are relatively common injuries of the viscerocranium. However, there is still no general consensus on the optimal timing and method of treatment. This article gives a comprehensive review of the pathology of the fracture, process of diagnosis, management and follow-up, including results of a retrospective study done in the Department of Maxillofacial and Oral Surgery, Dubrava University Hospital, Zagreb, in which we collected and analyzed medical records of 91 patients treated for blowout fractures in our institution over a period of three years. Our study showed that the patients admitted to our department more than 48 hours from the injury were more than 4 times likely to develop a complication that would require additional treatment. In other words, of our 91 patients, those admitted to our department in the first 48 hours from the injury had a more than 4 times lower rate of complications, likely due to early recognition of the injury with early intravenous antibiotic and corticosteroid administration, multidisciplinary treatment, and early recognition of candidates for emergency and early surgical treatment. The results of our study show the importance of treating blowout fractures in a tertiary care facility with expertise on the subject.

Anatomical Variations of the Bifid Mandibular Canal on Panoramic Radiographs in Citizens from Zagreb, Croatia.

BACKGROUND: The bifid mandibular canal (BMC) is an anatomical variation with reported prevalence ranging from 0.08 to 65%. Identifying anatomical variations of mandibular canal is very important in order to prevent possible complications during oral surgical and other dental procedures. OBJECTIVES: The aim of this study was to determine the prevalence and to classify the morphology of BMCs using digital panoramic radiographs. MATERIAL AND METHODS: A retrospective study was conducted that included 1008 digital panoramic radiographs (412 female and 596 male) used to identify the type of BMC. Panoramic radiographs were analyzed by three oral surgeons and one dentist, and BMCs were classified into six different types, 4 types according to Langlais et al. (types 1-4), and two new types (types 5 and 6) described by authors. RESULTS: The prevalence of BMC was 4.66% (n=47), with no significant differences in gender between BMC types (P=0.947; χ2=0.74). The prevalence of type 1 BMC was 0.79% (n=8), type 2 2.08% (n=21), type 3 0.30% (n=3), type 4 0% (n=0), type 5 0.89% (n=9) and type 6 0.60% (n=6). CONCLUSION: This study revealed a relatively high prevalence of BMCs among Zagreb citizens. Furthermore, two new types of BMCs were described. These results stress the importance of a careful and thorough radiographic analysis prior to each invasive procedure in the mandible.

Regression analysis of the symptoms.

Stomatopyrosis of 'burning mouth' syndrome, in a narrower sense of definition, is a condition characterized by sensation of burning and heating in mouth, despite its normal mucosa. This research has been directed towards treatment of stomatopyrosis, putting emphasis on the implementation of psychopharmacotherapy and psychotherapy. The research was conducted on altogether 120 respondents suffering from stomatopyrosis. The respondents were divided into two equal groups: each one comprising 60 members. All the respondents were treated by means of a standard topical therapy. All the patients were assessed clinically and by means of psychological tests measuring depression and anxiety four times: once before the treatment, after one month, after two months and after four months since the beginning of the treatment. The acquired data were afterwards statistically processed. Our research led to the conclusion that stomatopyrosis occurs with elderly people, primarily women. Regarding their occupation, majority of the respondents were clerks, followed by retirees. The burning sensation in mouth was present with all the respondents, the dominating site being the lips, while the nature of sensation was reported as mostly unbearable. Anxiety, tension and stress tend to aggravate the symptoms. When grading the symptoms on VAS, i.e. visual analogous scale, the subjective assessment of symptoms was marked as 7-8 cm, which shows a high degree of burning sensation. According to our study, the quantity of saliva, which was at the beginning of the research slightly decreased, normalized after the treatment. Apart from the clinical investigation of stomatopyrosis, we applied Depression and Anxiety questionnaires. During the therapy, the results of the depression test have shown a decrease in depression (from 56.7% to 0.00%), which is particularly apparent in the group treated by autogenic training and in the first group of respondents, i.e. the one treated with antidepressants. The Anxiety tests have shown a higher percentage and intensity of anxiety with men (62.5%, as opposed to women - 32.5%) in the beginning, which has dropped to 7.5% with men during the treatment and 8.8% with women. Clinical presentation of stomatopyrosis has also apparently improved. This improvement in clinical symptoms and psychological condition of patients is statistically significant. On the basis of our research, we have concluded the following: the comorbidity of stomatopyrosis with the phenomena of anxiety and depression proves that, among other factors, there is a psychogenic aetiology of this disease. Further research should provide answers to the questions whether stomatopyrosis is a psychosomatic or a conversive disorder Antidepressants and anxiolytics have an important role in the therapy of stomatopyrosis. Autogenic training, which is a psychotherapeutic anxiolytic technique, is a therapy of choice for stomatopyrosis, which contributes not only to the elimination of oral complaints, but to the emotional rehabilitation of the patients as well.

Unilateral cleft lip/palate children: the incidence of type 6 septal deformities in their parents.

BACKGROUND: The overall incidence of pathological septal deformity has been found to be significantly higher in unilateral cleft lip/palate (UCLP) children than in control children. Of the seven types of septal deformity according to Mladina's classification, type 6 has been found to be the most frequent in UCLP children, occurring in only 3.7% of the control children. OBJECTIVE: To investigate the incidence of type 6 septal deformity in the parents of UCLP children. PATIENTS AND METHODS: UCLP children (N=62) and their parents (N=91) were examined for type 6 septal deformities. RESULTS: Type 6 was found in at least one parent of a UCLP child in 58% of cases. However, it was not found in the parents whose UCLP children did not show a type 6 septal deformity. CONCLUSION: Type 6 septal deformity is almost a rule in children suffering from UCLP. Type 6 was not seen in the parents whose UCLP children did not show a type 6 septal deformity. There is a morphogenetic predisposition for the development of CLP in children whose parents carry a type 6 septal deformity.

[Expert medical witness testimony of maxillofacial injuries]. / Vjestacenje ozljeda maksilofacijalne regije.

The basic principles of expert medical witness testimony of the maxillofacial region are described. The specific anatomic characteristics of the region are emphasized, especially in view of the fact that face is the most exposed part of the human body. Post-traumatic deformities of the maxillofacial region involve soft tissues of the face and mouth as well as bony structures of the viscerocranium and teeth. Endured physical pain, lessening of life activities, disfigurement and requirement of assistance by third person are separately described as an important part of expert medical witness testimony of the maxillofacial region. The number of lawsuits raised against physicians has significantly increased in the past several years, more often in cases where the patients are dissatisfied with the results of cosmetic surgery, especially when these procedures are performed on the face.

[Surgical treatment of lower jaw pseudoarthrosis as a result of fracture non-treatment following tooth extraction]. / Kirursko lijecenje pseudoartroze donje celjusti kao posljedice nelijecenog prijeloma nakon vadenja zuba.

Fracture of the lower jaw following tooth extraction is a rare and severe complication, occurring most often in the preangular region following third molar extraction. When left untreated, pseudoarthrosis can occur. Symptoms show a wide variance, including pathologic mobility, pain and infection, as well as sometimes trismus before and following surgical treatment. The possible complications of pseudoarthrosis may be malnutrition, jaw deformity and long-term disability. Treatment options range from prescription of a soft diet in case of simple fracture to surgical treatment by open reduction and internal fixation. A case is presented where a 47-year-old male suffered from painful perimandibular swelling and complained of "instability" of the lower jaw as well as hypoesthesia in the area of the left mental nerve. Case history revealed that he had had extraction of the lower left second molar (tooth 37) four months before. Following clinical and radiographic examination he was diagnosed with non-diagnosed and/or non-treated lower jaw fracture. The patient was surgically treated using an oseosynthetic plate to ensure stability. The postoperative protocol showed satisfactory results. Bone growth in the fracture line was recorded in the follow up. However, due to the four-month period of pseudoarthrosis and infection, the plate was removed much later than it would have been the case if surgical treatment had been performed immediately following the fracture. The delayed diagnosis of this fracture demonstrates the necessity of radiologic control when a fracture is suspected following tooth extraction. When a patient shows symptoms inconsistent with those following tooth extraction, surgical consultation is recommended.