Implications of Dabigatran, a direct thrombin inhibitor, for oral surgery practice.

Direct thrombin inhibitors, specifically orally administered dabigatran etexilate, are emerging as alternatives to warfarin for anticoagulation in the management of atrial fibrillation and venous thromboembolism. The risk associated with bleeding events while taking dabigatran has been documented in multiple randomized controlled trials, but to date, no studies have focused on the risk of bleeding after dental extraction. Extraction of teeth is one of the most common surgical procedures and may cause significant bleeding, so a thorough understanding of the pharmacology of anticoagulant medications is required to prevent complications. With the increasing use of direct thrombin inhibitors, the safe management of patients taking these anticoagulants must be delineated. This review compares dabigatran and warfarin, especially in terms of their effects on dental and oral surgery practice, and examines best management of these patients in light of the existing literature.

Concomitant removal of mandibular third molars during sagittal split osteotomy minimizes neurosensory dysfunction.

PURPOSE: Inferior alveolar nerve (IAN) injury is 1 of the most important postoperative complications after sagittal split osteotomy (SSO). The purpose of our study was to investigate the effects of the presence or absence of a mandibular third molar on the neurosensory recovery of the IAN after SSO. MATERIALS AND METHODS: A prospective cohort study enrolled a sample composed of patients who underwent SSO to correct mandibular deformities. The primary predictor variable was the status of the mandibular third molar at the time of SSO and it was divided into two levels, present at the time of SSO (Group I) or absent at the time of SSO (Group II). The primary outcome variable was neurosensory recovery of the IAN, assessed using the Medical Research Council scale, functional sensory recovery, and subjective evaluation. Neurosensory status was measured 3 times (preoperatively and 3 and 6 months postoperatively). Appropriate bivariate and multivariate statistics were computed, and the level of statistical significance was set at P < .05. RESULTS: A total of 120 SSOs were performed in 60 patients. Group I included 64 SSOs (mean patient age ± SD 19.3 ± 8.0 years) and group II, 56 SSOs (mean patient age 24.9 ± 10.0 years). The Medical Research Council scale scores showed that the presence of third molars during SSO was associated with a statistically significant decreased incidence of neurosensory disturbance of the IAN at 3 and 6 months postoperatively (all P < .01). Functional sensory recovery was achieved more frequently in group I, but this difference remained significant only at 3 months after adjusting (P = .01). A "normal sensation" was subjectively reported more frequently in group I at 3 and 6 months postoperatively (P ≤ .05). CONCLUSIONS: The presence of third molars during SSO minimizes postoperative neurosensory disturbance of the IAN.

An Unusual Case of Mandibular Squamous Cell Carcinoma in Intimacy with an Impacted Wisdom Tooth.

Squamous cell carcinoma is the most common head and neck malignancy. It can occur in the mandible or maxilla without a preexisting oral mucosal lesion. Often, the clinical and radiographic presentation of SCC directs the clinician to favour malignancy over other pathological conditions. However, SCC may also mimic an infectious condition and therefore can pose a diagnostic challenge even for the most experienced clinicians. Herein, we report a case of mandibular squamous cell carcinoma in a 53-year-old male who presented with symptoms of right facial swelling, trismus, pain, and right-sided lip paresthesia. The patient underwent a surgical removal of the presumed infected third molar of the right mandible, but histopathological analysis of the associated soft tissue unexpectedly yielded squamous cell carcinoma. Given the biopsy-proven diagnosis, the patient received a mandibular resection of the tumor followed by primary reconstruction with a fibular free flap. Patients presenting with symptoms mimicking odontogenic infections should receive vigilant attention by clinicians with regard to the disease history, clinical signs, radiographic evidence, and decision for histopathological analysis. This is especially true in the context of impacted dentition, where malignancy must be considered when formulating a differential diagnosis.

A review of compressive ulnar neuropathy at the elbow.

OBJECTIVE: To review the anatomy, etiology, and symptoms associated with compressive ulnar neuropathy at the elbow and to discuss the diagnosis and treatment of this condition. DATA SOURCE: The following were searched for information relevant to cubital tunnel syndrome: MEDLINE, WorldCat, and Index to Chiropractic Literature. RESULTS: Cubital tunnel syndrome is the second most common nerve compression syndrome of the upper extremity. Clinical features of this syndrome are described along with electrodiagnostic techniques that can be used to provide evidence concerning the probable location, character, and severity of the lesion affecting the ulnar nerve. Conservative treatment of cubital tunnel syndrome is recommended for patients with intermittent symptoms and without changes in cutaneous sensation or muscle atrophy. CONCLUSION: A definitive diagnosis can best be made using clinical tests along with nerve conduction studies and electromyography, conservative treatment can be effective in treating this neuropathy in mild cases; in moderate or severe cases, surgery may be necessary.

Delays in treatment of oral cancer: a review of the current literature.

OBJECTIVE: This review aims to update the reader as to the current issues surrounding the delay in treatment of oral cancer. STUDY DESIGN: We searched Medline/PubMed and the Cochrane database. English-language publications were included. Paired reviewers selected articles for inclusion and extracted data. The strength of the evidence was graded as high, moderate, or low. RESULTS: Eighteen studies met our inclusion criteria. The majority of the studies were retrospective case-control studies (55%). CONCLUSIONS: Patient delay continues to be the greatest contributor to overall delay in treatment of head and neck cancers, with an average delay of 3.5 to 5.4 months. In addition, the average professional delay is approximately 14 to 21 weeks. Cumulatively, the amount of delay may be causative for the late stage at which head and neck cancers are diagnosed and subsequently treated.

Helping anesthesiologists understand facial fractures.

Injuries to the oral and maxillofacial region are commonly encountered, and the appropriate management of patients with these injuries frequently requires the expertise of an anesthesiologist. Injuries to this region may involve any combination of soft tissue, bone, and teeth. Injuries to these structures often produce anesthesia-related challenges, which must be overcome to achieve optimal outcomes. This article addresses the common challenges faced by anesthesiologists specific to patients with facial fractures.