A simple technical innovation to prevent needle stick injuries among dental professionals.

OBJECTIVE: Dental healthcare personnel face the potential danger of being exposed to infectious patients while administering local anesthesia injections during dental operations. This could lead to unintentional transfer of infectious diseases from patients to physicians. Although safety measures such as the One-hand-scoop technique and the use of safety syringes, plastic needle cap holders, and needles with safety caps are in place, there have been instances of needle stick injuries reported in clinics. This might be due to the lack of adherence to conventional safety measures or the impracticality of safety techniques and safety syringes. This article aims to demonstrate the utilization of dental tweezers, specifically London College tweezers or dental forceps, for the secure recapping of needles, eliminating the requirement for extra equipment or devices. SUBJECTS AND METHODS: After obtaining ethical approval (Approval No.: 024-01-2024) from the College of Dentistry, Dar Al Uloom University, 67 dental professionals, with consent for participation in the study, were included. They were requested to use dental tweezers/London College tweezers and dental extraction forceps such as maxillary anterior, mandibular anterior, and maxillary bayonet root forceps individually to recap the local anesthetic needles. The efficacy of these techniques was evaluated against the one-hand scoop technique for its ease, convenience, and reliability in preventing needle stick injuries. RESULTS: The evaluation of dental professionals regarding the ease of using dental tweezers to recap needles, compared to the one-hand scoop technique (p=0.592), maxillary bayonet root forceps (p=0.746), mandibular anterior forceps (p=0.380), and maxillary anterior forceps (p=0.808), did not yield statistically significant results. The assessment of the procedural simplicity of the one-hand scoop technique showed a satisfaction rate of over 40%, whereas the application of dental tweezers resulted in a satisfaction rate of 30%. However, the use of dental tweezers for needle recapping resulted in a satisfaction rate of over 50%, compared to a satisfaction rate of 30% for the one-handed scoop technique. CONCLUSIONS: There is no statistically significant difference in the assessment of the efficacy of dental tweezers and the one-hand scoop technique, bayonet root forceps, mandibular anterior forceps, maxillary anterior forceps, and dental tweezers for the needle capping technique. Therefore, dental forceps can be used instead of the one-handed scoop approach. The needle recapping procedure outlined in our study, aimed at preventing needle stick injuries, is simple to implement, and all dental specialties have convenient access to the required instruments.

Perspectives and challenges in lip rejuvenation: a systematic review.

OBJECTIVE: There is an abundance of information on facelifts, blepharoplasties, rhinoplasty, and other cosmetic surgical procedures for the upper third of the face, but little is known about perioral lip rejuvenation. The aim of this article is to examine the existing literature on lip rejuvenation and perioral procedures related to lip rejuvenation. Additionally, this article aims to highlight the importance of addressing perioral areas alongside lip rejuvenation procedures, rather than solely focusing on lip rejuvenation. We also discussed the extensive procedures and materials used for lip rejuvenation, such as hyaluronic acid, botulinum toxin A, abobotulinum, onabotulinum, incobotulinum, prabobotulinum, fat grafts, silicone fillers, human collagen, collagen stimulating procedures such as derma pens and derma rolls, radiation frequency, stem cells, and plasma therapy, as well as the underlying factors that contribute to varying success rates. MATERIALS AND METHODS: A thorough literature search was done using PubMed, Cochrane, Ebsco search, Google Scholar, Scopus, and Web of Science for the articles pertaining to facial and lip cosmetic surgeries 1995-2020. Keywords for the search included anatomy of the face, facial aging, perioral areas, lip rejuvenation, botox, grafts, facelift, plastic surgery, stem cell therapy, plasma treatment, and cosmetic surgery. RESULTS: 37 articles met the study criteria. 14 out of 37 studies included procedures for lip and perioral region rejuvenation. The remaining 23 studies either involved lip procedures alone or lip procedures in conjunction with facial cosmetic procedures. Lip rejuvenation with perioral enhancement with hyaluronic acid gel demonstrated a 94.3% improvement on the lip fullness scale (LFS) one month after re-treatment. The amalgamation of lip and perioral region rejuvenation produces a synergistic effect. Whereas, sole lip rejuvenation procedures showed short-term results with less patient satisfaction, calling for secondary lip rejuvenation procedures. It was also observed that hyaluronic acid was the most commonly used agent for lip rejuvenation procedures with minimal or no side effects. CONCLUSIONS: In conjunction with perioral rejuvenation, lip rejuvenation procedures produce more aesthetically appealing results. However, any cosmetic surgical or non-surgical procedure is limited by the nature and composition of the products used. The use of FDA-approved products for rejuvenation is strongly advised to avoid undesirable side effects. Further extensive research is required on the long-term outcomes and adverse effects of stem cell transplants, such as tumor development.

An unusual cervical swelling in a child.

Congenital thymic cysts are rare benign lesions, frequently seen in the neck and mediastinum, but because of their infrequent occurrence and similarity to other more common cystic swellings, their preoperative diagnosis is not considered. Congenital thymic cysts although rare should be considered in the differential diagnosis of cervical and mediastinal cystic swellings in children. This is a case report of a multilocular cervical thymic cyst in a child.

A case of Turcot's Syndrome in a child with malignant transformation.

Turcot's syndrome or the glioma polyposis syndrome is a rare variant of the polyposis syndrome and it is characterized by colonic polyposis and central nervous system neoplasm typically a glioblastoma or a medulloblastoma. We present a case of Turcot's syndrome in a child with malignant transformation.

Congenital Morgagni's hernia in infants and children.

Morgagni's hernia is an uncommon type of diaphragmatic hernia in the pediatric age group. Out of 52 children with different types of congenital diaphragmatic hernia that we have treated, 5 (9.6%) had Morgagni's hernia. There were 2 infants and 3 children including one with Down's syndrome. All suffered from repeated attacks of chest infection, and only after a chest X-ray was the diagnosis of Morgagni's hernia suspected. In 2 cases this appeared as an opacity in the anterior mediastinum adjacent to the pericardium; diagnosis was confirmed by barium enema in one and a CT-scan in the other. The remaining 3 cases showed anterior herniation of bowel loops on chest X-ray which was bilateral in one. This bilaterality was confirmed pre-operatively by CT scan. Associated anomalies were present in all cases, including 2 with malrotation. All patients were treated surgically via a transabdominal approach. Our study shows a relative high frequency of Morgagni's hernia in our patients and, although late-presenting Morgagni hernias are relatively benign, it can cause significant morbidity. This calls for early diagnosis and early referral for surgery. Chest X-ray is to be strongly advocated in children with repeated attacks of chest infection.

Intrauterine torsion of a wandering spleen presenting as an abdominal cystic swelling.

Wandering spleen is a rare clinical condition that presents commonly with splenic infarction secondary to torsion. Intrauterine torsion of a wandering spleen, however, is extremely rare. An unusual case of intrauterine torsion of a wandering spleen presenting as an abdominal mass is reported.

Congenital spigelian hernia and cryptorchidism: cause or coincidence?

Congenital spigelian hernia (SH) is very rare in the pediatric age group. This is a report of two cases of SH in 1-week and 3-month-old male infants. A review of the literature revealed only 35 cases of SH in children younger than 17 years of age, bringing the total including our 2 cases to 37. There were 25 males and 12 females, a ratio of 2.1:1. Their ages ranged from 6 days to 17 years (mean 4.52 years). The hernia was situated on the right side in 13, the left side in 19, and was bilateral in 4. In one case the side of the hernia was not mentioned. In 29 cases the hernia was spontaneous while in 5 it was caused by trauma. In 3 children the hernia developed postoperatively, in 2 following repair of a congenital diaphragmatic hernia and in 1 following excision of a mediastinal neuroblastoma. Two children presented with a strangulated SH. Eleven of the 35 previously reported children had associated conditions; in 5 there was an ipsilateral undescended testis (UDT). Our two infants with SH also had an ipsilateral UDT. The significance of this association is discussed.

Congenital pyloric atresia and junctional epidermolysis bullosa: a report of two cases.

The association between epidermolysis bullosa (EB) and congenital pyloric atresia (CPA) is rare, but is known distinct clinical entity with autosomal recessive inheritance. The outcome of such an association was universally fatal. This is a report of two newborns with EB and CPA, associated with additional aplasia cutis congenita in one case. One patient was treated postoperatively with phenytoin and survived. Aspects of the diagnosis, pathogenesis, and management are also discussed.

Intrathoracic gastric volvulus in infancy.

Intrathoracic gastric volvulus is a very rare surgical emergency. Early diagnosis and treatment are of great importance to prevent gastric gangrene and perforation or gastric obstruction and dilation, which may lead to cardiorespiratory arrest. We report two infants who presented with intrathoracic gastric volvulus. This was associated with recurrent diaphragmatic hernia in one and congenital paraoesophageal hernia in the other. Aspects of diagnosis and treatment are also discussed.

An unusual anterior mediastinal mass in a child with B-thalassemia major.

This case report describes the delayed appearance of Morgagni's hernia in a 5 year old child with B-Thalassemia major to present as an anterior mediastinal mass. The progressive enlargement of the liver resulted in herniation of the left lobe of the liver through the already congenitally present Morgagni's hernia leading to its enlargement. The report also emphasizes the fact that a previously normal chest x-ray should not preclude the diagnosis of Morgagni's hernia. Morgagni's hernia should also be included in the differential diagnosis of anterior mediastinal masses in children.

Pneumoperitoneum and free meconium without gastrointestinal perforation in a neonate.

A newborn was referred to our hospital because of poor feeding and abdominal distension and was found to have pneumoperitoneum on abdominal x-ray. At operation there was free intraperitoneal air with no free fluid in the peritoneal cavity. In addition there was free air and meconium retroperitoneally on the left side but there was no evidence of gastrointestinal perforation. This case is rare and unique in that no demonstrable cause for the free air and free meconium could be demonstrated.

Congenital paraesophageal hernia in infancy and childhood.

OBJECTIVES: Congenital paraesophageal hernia is a rare condition in the pediatric age group. The symptomatology of these patients is usually non-specific in the form of repeated attacks of chest infection and/or recurrent attacks of vomiting but can be associated with serious complications such as intrathoracic gastric volvulus. METHODS: Between 1989 and 1997, 6 children with paraesophageal hernia were treated at our hospital. RESULTS: Six children (4 males and 2 females) were treated for congenital paraesophageal hernia. Their age at presentation ranged from 2 days to 21/2 years (mean 1.3 years). Two presented with recurrent chest infection, while 3 others had recurrent attacks of vomiting with fullness and pain in the epigastrium in one of them. One of our patients presented acutely immediately after birth with respiratory distress while another was found to have intrathoracic gastric volvulus. Chest x-ray was suggestive of paraesophageal hernia in all of them but the diagnosis was confirmed by Barium swallow and meal. Intraoperatively there was a hernial sac in all of them. The surgical treatment consisted of excision of the hernial sac after reducing the stomach and tightening of the crura of the esophageal hiatus. Nissen's fundoplication was added in 3 patients, but in one of them this was dismantled because of tight repair. Anterior and fundal gastropexy was added in one patient, while 2 had tightening of the crura only. CONCLUSION: Congenital paraesophageal hernia, although rare in the pediatric age group, can present acutely with respiratory distress or intrathoracic gastric volvulus. Physicians caring for these patients should be aware of such a presentation and complication and paraesophageal hernia should be included in the differential diagnosis of children with repeated attacks of chest infection and/or vomiting. The rarity of this condition in children makes it difficult to evaluate the true necessity of adding an antireflux procedure in these patients. We feel some form of gastropexy may be a more appropriate procedure to be added to the repair.