Atypical clinical features of post COVID-19 mucormycosis: A case series.

OBJECTIVES: This case series aims to evaluate patients affected with post COVID-19 mucormycosis from clinical presentation to surgical and pharmacological treatment to improve the disease prognosis. MATERIAL AND METHODS: This case series was conducted at a specialized surgery hospital in Baghdad Medical City for over 10 months. Fifteen cases who had mild to severe COVID-19 infections followed by symptoms similar to aggressive periodontitis, such as mobility and bone resorption around the multiple maxillary teeth, were included in this case series. RESULTS: All patients did not receive COVID-19 vaccination; seven had a history of diabetes mellitus type 2, another five patients had a history of diabetes-like syndrome during the COVID-19 infection, and the remaining three patients had no history of any systemic diseases. No intracranial involvement was seen in all patients, and bilateral sinus involvement was seen in three patients. CONCLUSION: Being highly suspicious of all patients affected with COVID-19 is highly recommended to avoid the complications of the late diagnosis of mucormycosis. In addition, our knowledge and methods in diagnosing and treating classical mucormycosis should be modified regarding post COVID-19 mucormycosis.

Evaluation of crestal sinus floor elevations using versah burs with simultaneous implant placement, at residual bone height ≥ 2.0 _ < 6.0 mm. A prospective clinical study.

PURPOSE: To evaluate the efficacy of Versah drills in breaching the maxillary sinus floor while keeping the membrane intact, as well as measure the implant stability (primary stability at the time of implant placement by the osseous densification of the residual bone height (RBH) of ≥ 2.0 _ < 6.0 mm, and secondary stability after 6 months of osseous healing period). METHODS: This prospective clinical study, which included twenty crestal sinus floor elevations, was conducted on 17 patients (10 males and 7 females, ages 29 to 70 years). The sinus membrane integrity was clinically checked at the time of osseodensification sinus lifting and confirmed by CBCT after sinus augmentation and implant insertion. Time of operation has been recorded from the first drill to implant installation. Primary implant stability was measured using an Osstell beacon at the time of implant placement, and secondary stability was measured after 6 months of osseous healing. RESULTS: The mean of secondary stability in the current study is significantly higher than the mean of primary stability (P ≤ 0.011), which was 74.22 ± 8.11 and 69.85 ± 9.74, respectively, in RBH 3.81 mm as a mean. There was no clinical evidence of membrane perforation or complication reports, and the average operation time was 11.2 ± 1.85 min. CONCLUSION: The current study found that at highly atrophic posterior maxilla with a residual bone height of ≥ 2.0 _ < 6.0 mm, osseodensification using Versah drills was effective in crestal sinus elevation with no membrane perforation, which was confirmed by cone-beam CT scan postoperatively, and showed higher primary and secondary implant stability.

Differences Between Impression Stone Pouring and Digital Pouring in Fully Guided Dental Implant Surgery: A Prospective Clinical Study.

Modern clinical protocols in implantology aim to reduce the duration and discomfort of the surgical phase while preserving excellent treatment results. The purpose of this study is to evaluate the clinical differences between impression stone pouring and impression digital pouring required for surgical guide fabrication in fully guided dental implant surgery. This study was conducted for partially edentulous patients with straightforward cases who did not require bone or soft tissue augmentation. Forty dental implants were installed in 14 patients (age range: 25-70 y) at the Dental Implant Unit, Oral and Maxillofacial Surgery Center, Gazi Alhariri Teaching Hospital, Medical City, Baghdad. The dental implants were guided into the most prosthetically suitable position using a surgical guide. Twenty of them were guided by conventional impression stone pouring to create the surgical guide, whereas the other 20 implants were installed using digital pouring for the dental impression to fabricate the surgical guide. The mean for impression stone pouring in regard to angular deviation of 4.33±3.435 degree, the depth difference was 1.29±0.90 mm and entry point deviation 0.99±0.84 mm. In contrast, the mean for digital pouring in regard to angular deviation of 3.34±2.10 degree, depth difference was 0.89±0.67 mm and entry point deviation was 0.83±0.61 mm. This study revealed that there was no significant difference between the 2 groups regarding all 3 variables at a P-value of 0.05. Neither biological nor mechanical complications occurred.

Outcome Assessment for Surgical Reconstruction of Mandibular Continuity Defects.

ABSTRACT: Mandibular continuity defects are associated with multiple functional and esthetic problems. Nonvascularized bone grafting is one of several surgical corrective techniques for such defects with good success predictability. This retrospective clinical study reviewed the outcome of this technique when applied in its 2 protocol variations while minimizing the effect of as many confounding factors as possible through the application of strict eligibility criteria. The surgical records of 16 patients constituted the final sample: 10 patients in the one-stage and 6 patients in the two-stage reconstruction groups. It was found that mandibular reconstruction with nonvascularized bone graft is a good first option as well as a viable alternative in the absence of free flap procedure facilities. Patients' initial expectations should be a crucial factor in deciding the appropriate surgical treatment protocol form the early planning stage. Standardizing success parameters in such cases could further improve objectivity and allow for multi-center research data pooling with reduced effect of heterogeneity featuring these complex injuries.

The Impact of Blast Implosions and Bullet Injury on Maxillary Air Sinus.

BACKGROUND: Successive waves and generations of terrorists attacked the Iraqis in the years following the fall of the regime in Iraq in 2003, after the US invasion of the country under the pretext of weapons of mass destruction. Hence, the Iraqi people enrolled in ongoing war with these armed groups which led to massive casualties due to blasts and missile injuries.Mechanism of blasts injury can be classified into primary, secondary, tertiary, and quaternary. While bullet injuries can be classified into low and high-energy injuries, the type and severity of the injury will influence the type of management, together with facilities available in the authors' hospitals.In this study the authors aim to compare between the effects of blast implosions and penetrating missiles on the maxillofacial air containing cavities, specifically the maxillary sinuses. PATIENTS AND METHODS: Twenty-eight patients (26 male patients [92.85%] and 2 [7.14%] female patients) with maxillary sinus wall fractures were admitted to the authors' maxillofacial surgery Department in the Hospital of specialized surgeries/Baghdad Medical city from July 2014 to November 2016. RESULTS: Seventy-six percent of the total bullet injuries affect the left side of the face, while shell injuries tend to affect the right side of the face by 60% than the left side.Direct maxillary sinus injuries constitute 76.9% of the injuries caused by bullets, while it constitutes only 40% of shell injuries. CONCLUSION: Bullet injuries are associated with more severe comminuted fractures in addition to involvement of multiple neighboring bones and this may lead to extensive bone loss, while postoperative complications and infection are more common with improvised explosive devices injuries.

Efficacy of the LED Red Light Therapy in the Treatment of Temporomandibular Disorders: Double Blind Randomized Controlled Trial.

BACKGROUND: Temporomandibular dysfunction syndrome (TMD) is a common disease among dental patients. It occurs as a consequence of malfunction of the tempromandibular and/or surrounding facial muscles. LED red light therapy is not been well established, and it is important to find out the role of this technique in the treatment of temporomandibular disorders. AIM OF THE STUDY: To evaluate the efficacy of the LED red light in the treatment of the tempromandibular dysfunction syndrome. MATERIAL AND METHODS: Fifty students of the College of Dentistry/University of Baghdad with myofacial pain associated with Tempromandibular Disorder volunteered to participate in this study and be evaluated during both treatment and follow-up periods. They were 40 (80%) females and 10 (20%) males. Patients were divided into 2 groups: Group A treated by TenDlite® Medical Device model 204 with a LED's of wavelength 660 nm (red light) and Group B given placebo (no treatment at all) by just putting the TenDlite device near the tender points without battery and turning ON the device. RESULTS: The changes in the pain value and number of the tender muscles in both groups were highly significant, only placebo group less but with no significant differences. CONCLUSIONS: This study showed that red LED therapy could be useful in improving patient's symptoms regarding pain, clicking, and number of tender muscles. In addition, this study showed the importance of the psychological part of treatment of those patients. This trial is registered with TCTR20190406002.

Evaluation the Efficacy of Hilotherm Cooling System in Reducing Postoperative Pain and Edema in Maxillofacial Traumatized Patients and Orthognathic Surgeries.

Surgical treatment in patients with facial bone surgeries governs a meaningful extent of tissue trauma prompting prevalent postoperative portents of pain, facial swelling, and inconvenience. Beneficial effects of local cold therapy following surgery, facial swelling, pain, and inflammation have been discussed. The aim of study is to evaluate the efficacy of hilotherm cooling system in reducing postoperative pain and edema in patients following maxillofacial trauma and orthognathic surgeries.A clinical prospective study was done in the postoperative period for patients with facial trauma or those subjected to orthognathic surgery, 34 patients divided randomly into 2 groups; study group treated with the hilotherm cooling system and control group without. Facial swelling was quantified by 5 linear distances (A, B, C, D, and E). Pain was reported on day 1, 2, and 7 postoperatively. Satisfaction with cooling therapy at day 7 following surgery was recorded. The means of swelling variation in study group were less than in control group with highly significant difference (P < 0.01) except in (line D) which is from tragus to the chin most prominent point where it was significant. Pain scores in control group were higher than in study group with highly significant difference (P < 0.01) except at 7th day which was not significant (P > 0.05). All patients in the study group were very satisfied.

Mandibular war injuries caused by bullets and shell fragments: a comparative study.

PURPOSE: Is to compare the patterns, severity, and management of the high- and low-velocity mandibular war injuries managed at Al Shaheed Gazi Al-Hariri Hospital in Baghdad Medical City, Iraq, during a 2-year period. METHODS: Forty-one patients with a history of mandibular war injuries treated by our maxillofacial team were reviewed during a period of 2 years (2015-2017). All patients were treated in the Maxillofacial Unit of the Hospital of Specialized Surgeries in Baghdad Medical City. RESULTS: A 2-year retrospective study evaluated 41 patients with mandibular war injuries with a total of 94 fractures (comminution represents 79.06% of the bullet injuries, while it is only 62.74% with IED injuries). Management of these injuries was varied according to the severity of the injuries and resources available. Close reduction was used in 72.72% of the linear fracture cases, whereas open technique was used in 56.6% of the comminuted fractures. CONCLUSIONS: Bullet injuries were associated with a higher number of mandibular comminuted fractures, in addition to more extensive bone loss. While shell injuries of IED (improvised explosive devices), on the other hand, were associated with higher infection rate and more postoperative complication.

The First Patient Report of Tongue Abscess Among Iraqi Population.

Tongue abscess is a serious clinical entity which scarcely affects the tongue. It should be treated urgently to prevent airway obstruction or dissemination of infection to a more deep or distant area of the body. This article presented the first clinical report of tongue abscess in Iraq which discussed its clinical presentation, diagnosis, and treatment with a review of literature.