Thymoma with immunodeficiency with multiple recurrent oral herpetic infections.

Thymomas with immunodeficiency (formerly Good's syndrome) are a rare acquired disease of combined T- and B-cell immunodeficiency accompanying a thymoma. Recurrent opportunistic infections associated with disorders of both humoral and cell-mediated immunity frequently accompany this rare primary, adult-onset immunodeficiency. This is a report of a case of a thymoma with immunodeficiency in a 65-year-old male patient who developed recurrent oral herpetic infections. He consulted us about recurrent vesiculo-ulcerative lesions on his tongue, lower lip, and buccal mucosa. Results of laboratory examinations indicated hypogammaglobulinemia accompanied by diminished B cells in the peripheral blood, which is consistent with the characteristic features of a thymoma with immunodeficiency. After a diagnosis confirming herpes simplex virus infection, systemic antiviral therapy was administered, which was effective for his vesiculo-ulcerative lesions at follow-up. When an intractable infection accompanied by a thymoma is encountered, increased awareness about the clinical and immunological profiles of this primary immunodeficiency may help in its early diagnosis, thereby preventing mortality.

Clinical comparison of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative discomfort after third molar surgery.

OBJECTIVE: The aim of the study was to compare the effect of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative pain, swelling, and trismus occurring after impacted mandibular third molar surgery. METHOD AND MATERIALS: A total of 78 patients (aged 18 to 35) with asymptomatic, unilateral, impacted mandibular third molar, and without any systemic disease were included in this study. Patients were divided into three groups randomly (control, dexamethasone, and triamcinolone acetonide). In the experimental groups, dexamethasone and triamcinolone acetonide were injected into submucosa at about 1 cm above the surgical area submucosally. The control group of patients did not take any drug submucosally but the same surgical procedure was applied. Pain evaluation was performed by visual analog scale (VAS). Swelling was measured using a flexible standard ruler measuring the dimensions of the axes between certain points on the face. For trismus evaluation, maximum mouth opening was measured. Measurements taken on the preoperative, and on postoperative first, third, and seventh days were compared with each other and statistically evaluated. RESULTS: There were statistically significant differences between the control and experimental groups on the different days of the postoperative period. The effect of triamcinolone acetonide on pain started on the first day postoperatively and the effect of triamcinolone acetonide on trismus and pain was better than other groups at the third and seventh days. However, there was no statistically significant difference between the effects of dexamethasone and triamcinolone acetonide regarding postoperative complications. CONCLUSION: The submucosal injection of dexamethasone or triamcinolone acetonide might be an effective treatment for postoperative discomfort occurring following impacted mandibular third molar surgery, and triamcinolone acetonide could be applied as an alternative to dexamethasone.

Maxillary ameloblastoma mimicking an oroantral fistula.

BACKGROUND: The aim of this current report is to present an unusual case of a maxillary ameloblastoma mimicking an oroantral fistula. CASE REPORT: A left subtotal maxillectomy via Weber-Ferguson-type incision was performed. The patient tolerated the procedure well, the postoperative course was uneventful, and the patient was discharged 3 days after surgery with a mild paraesthesia of the right infraorbital nerve distribution. The infraorbital nerve paraesthesia has resolved 5 months after resection. The patient has been followed-up for 3 years without recurrence. DISCUSSION: Ameloblastoma is a well-known pathology of the maxillofacial region. However, unusual manifestations of this tumor can represent a serious challenge for diagnosis.

Histological evaluation of the changes in temporomandibular joint capsule and retrodiscal ligaments following autologous blood injection.

INTRODUCTION: In recent years injection of autologous blood into the temporomandibular joint (TMJ) has been reintroduced as a treatment of chronic recurrent TMJ dislocation. The effects of this treatment on components of the TMJ is not fully understood. The purpose of this article is to evaluate the effects of autologous blood on TMJ capsule and the retrodiscal ligament. MATERIAL AND METHODS: A total of 16 healthy adult country bred pig were used in this study. Autologous blood were injected into the upper joint space (4 ml) and around the capsule of TMJ unilaterally (1 ml). This procedure was then repeated on the opposite side only by using 5 ml of 0.9% saline. TMJ capsules and retrodiscal ligaments were examined four weeks following the injections. RESULTS: Histological examination of TMJs injected with autologous blood revealed fibrotic changes in 81.25% of the retrodiscal ligaments and 56.25% of the capsular areas. Whilst no changes were seen in the retrodiscal ligaments nor in the capsules of TMJs injected with saline alone. CONCLUSION: There is little published clinical data on the use of autologous blood injection and as such the mechanism of action is still unclear. The rate of induction of fibrosis within the retrodiscal ligaments in this study were similar to previously reported studies and case series. However, further studies to evaluate the mechanism of this safe and simple technique are needed.

Clinical study on the closure of extraction wounds of partially soft tissue-impacted mandibular third molars.

OBJECTIVE: When a mandibular third molar is partially impacted in the soft tissue, it must be determined whether the extraction wound should be left partially open or completely closed. We hypothesize that a blood clot preserving a surgical wound with easily cleanable surfaces by primary closure and drain application would postoperatively minimize dry socket and/or alveolitis development. METHOD AND MATERIALS: Twenty patients requiring bilateral extraction of partially soft tissue-impacted mandibular third molars in a vertical position were included in the study. The existence of dry sockets, alveolitis, pain, facial swelling, and trismus were evaluated on the second, fifth, and seventh days of the postoperative period. RESULTS: On the second day, pain, trismus, and swelling were higher in the drained group; however, pain reduced progressively in the drained group over time. There were no cases of dry sockets or alveolitis except for a single patient on the seventh day in the drained group over the 7-day study period. On the other hand, in the secondary closure group, the number of dry sockets was 8 (40%) on the second day. The number of alveolitis was 10 (50%) on the fifth day and 4 (20%) on the seventh day. CONCLUSION: Closed healing by drain insertion after removal of partially soft tissue-impacted third molars produces less frequent postoperative dry sockets and/or alveolitis development than occurs with open healing of the surgical wound. In cases with a risk of alveolitis development (lack of oral hygiene, immunocompromised patients, etc), it can be avoided with the "kiddle effect" and related undesired complications by implementing closed healing with drain insertion.

Histomorphometric analysis of new bone obtained by osteogenic periosteal distraction in ovariectomized rabbits.

OBJECTIVE: The aim of this study was to evaluate the effects of estrogen deficiency on newly formed bone obtained by osteogenic periosteal distraction histomorphometrically. STUDY DESIGN: Thirty-six female rabbits were divided into 2 groups. The experimental group underwent a bilateral ovariectomy and a sham operation was applied to the control group to equalize the stress of ovariectomy surgery. Four weeks postoperatively, a gradual distraction of the mandibular corpus was performed. RESULTS: In the experimental group, callus formation was delayed and the new bone was less mineralized; conversely, when histomorphometric measurements were compared statistically, there were no significant differences between the ovariectomized and sham-operated subgroups in the mean extent of newly formed bone tissue. CONCLUSIONS: Although osteoporosis caused by the lack of estrogen has negative effects on osteogenic periosteal distraction (OPD), these negative effects do not appear to present a contraindication to OPD.

The evaluation of the effects of hyperbaric oxygen therapy on new bone formation obtained by distraction osteogenesis in terms of consolidation periods.

OBJECTIVE: The aim of this study was to evaluate the effect of hyperbaric oxygen therapy on new bone formation obtained by distraction osteogenesis in long- or short-term consolidation periods. MATERIALS AND METHODS: Twenty-four rabbits were used. The animals were divided into two groups of 12 animals each, and vertical mandibular distraction osteogenesis was performed. Hyperbaric oxygen therapy was administered in the first group. Each group was subdivided into two subgroups according to the 30- and 60-day consolidation period. The acquired bone amounts were compared according to their radiographic density and histopathology. RESULTS: Histopathologically, in the experimental group, callus formation was increased and the new bone was more mineralized. According to the radiographic densitometry analyses, there were no statistically significant differences between the 30-day consolidated subgroups of the experimental group and the 60-day consolidated subgroup of the control group (p = 0.873). CONCLUSION: Hyperbaric oxygen therapy can be used to increase the quality and the quantity of bone and to decrease the maturation time which may shorten the consolidation period of vertical distraction osteogenesis. CLINICAL RELEVANCE: The effect of hyperbaric oxygen therapy on vertical distraction osteogenesis procedure according to consolidation periods has been determined. Hyperbaric oxygen therapy may increase the quality and the quantity of bone and shorten the consolidation period.

Ex vivo produced oral mucosa equivalent by using the direct explant cell culture technique.

OBJECTIVE: The aim of this study is the histological and immunohistochemical evaluation of ex vivo produced oral mucosal equivalents using keratinocytes cultured by direct explant technique. MATERIAL AND METHODS: Oral mucosa tissue samples were obtained from the keratinized gingival tissues of 14 healthy human subjects. Human oral mucosa keratinocytes from an oral mucosa biopsy specimen were dissociated by the explant technique. Once a sufficient population of keratinocytes was reached, they were seeded onto the type IV collagen coated "AlloDerm" and taken for histological and immunohistochemical examinations at 11 days postseeding of the keratinocytes on the cadaveric human dermal matrix. RESULTS: Histopathologically and immunohistochemically, 12 out of 14 successful ex vivo produced oral mucosa equivalents (EVPOME) that consisted of a stratified epidermis on a dermal matrix have been developed with keratinocytes cultured by the explant technique. CONCLUSION: The technical handling involved in the direct explant method at the beginning of the process has fewer steps than the enzymatic method and use of the direct explant technique protocol for culturing of human oral mucosa keratinocyte may be more adequate for EVPOME production.

Histomorphometric analysis of different latency periods effect on new bone obtained by periosteal distraction: an experimental study in the rabbit model.

OBJECTIVES: The aim of this study was to evaluate the effects of latency period on the bone formation after periosteal distraction. For this purpose, a rabbit model was developed and histologic and histomorphometric analyses were conducted. STUDY DESIGN: Periosteal distractors were custom designed and built from stainless steel. Rabbits were divided into 2 groups of 18 each according to the duration of latency period. In group 1, the latency period was 7 days, and in group 2 it was 1 day. Distraction was performed by activating the distractor 0.25 mm twice per day. A periosteal distraction of 7.0 mm was achieved after a distraction period of 10 days. Both groups were divided to 3 subgroups according to the rabbits being killed on the 15th, 30th, or 60th day of the consolidation period. Histologic and histomorphometric analyses were performed to evaluate the bone formation. RESULTS: In the histologic evaluation, new bone formation was observed on the lateral side of the mandible of all the rabbits. Histomorphometric measurements revealed that the mean area of newly formed bone formation was 2.62 cm(2) in group 1 and 3.26 cm(2) in group 2. CONCLUSIONS: Periosteal distraction osteogenesis is a viable method in acquired and congenital alveolar ridge defects, resulting in new bone formation. Newly formed bone can be obtained by periosteal distraction osteogenesis applying different latency periods.

Oral metastasis of the mediastinal germ cell tumor (yolk sac).

A yolk sac tumor is a rare malignant tumor of germ cell origin. It most commonly arises from the testes and ovaries in young adults, but extragonadal sites of origin are reported in 10% to 15% of the cases. Yolk sac tumors are malignant, tend to recur locally, and may present with widespread metastases at the time of diagnosis. Involvement of the head and neck is uncommon. In this study, we present the case of a 23-year-old man presenting with mandibular and adjacent gingival metastasis of a mediasatinal yolk sac tumor. Thus, the patient has already undergone chemotherapy; no additional treatment was provided. In this case report, clinical and histopathologic features of the oral metastases of a yolk sac tumor were briefly discussed.

Osteoma of the mandibular condyle: report of a case with 5-year follow-up.

Osteomas of the mandibular condyle are rare. An unusual case of an osteoma occurring in the mandibular condyle of a 22-year-old man with mandibular deviation and malocclusion is reported; this represents the 14th documented case in the English language literature. The tumor was resected with condylectomy. Postoperatively, mandibular deviation was minimized.

Treatment of temporomandibular joint ankylosis with temporalis superficial fascia flap.

Temporomandibular joint (TMJ) ankylosis is characterized by the formation of bony or fibrous mass, which replaces the normal articulation and limitation of mouth opening. This study aims to determine the efficacy of arthroplasty and interpositional fascia flap in the treatment of unilateral and bilateral TMJ ankylosis in three young adult men. Our operative protocol for unilateral and bilateral TMJ ankylosis entailed resection of ankylotic mass, intraoral ipsilateral and bilateral arthroplasty, interpositional tissue transfer to the TMJ with temporalis superficial fascia flap, maxillomandibular fixation, and early mobilization and aggressive physiotherapy. Early postoperative initial exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions. The temporalis superficial facia flap is an autogenous graft that has the advantages of close proximity to the TMJ minimal surgical morbidity, and successful clinical results. It was found to be a valuable option for TMJ ankylosis reconstruction.

An analysis of maxillofacial fractures: a 5-year survey of 157 patients.

The purpose of this study was to review retrospectively the outcomes for 157 patients treated for maxillofacial fractures between 1994 and 1999 at one military hospital in Turkey. Significant data were collected according to age, gender, time of injury, type of facial injuries, cause of injury, treatment methods, and postinjury and postoperative complications. Fractures resulting from gunshot wounds were excluded in this study. Fractures were examined in two groups according to the type of fracture, i.e., isolated or combined. Methods of fixation with closed or open reduction were used to treat the fractures. Fixation was performed with miniplates, compression plates, microplates, reconstruction plates, and wires for open reduction, and stabilization was performed with arch bars for closed reduction. Complications were recorded in two groups, i.e., postinjury and postoperative complications. There were 151 male patients (96.18%) and 6 female patients (3.82%). The patients ranged in age from 15 to 62 years (mean, 22.8 years). In our study, it was determined that the most significant causes of maxillofacial fractures were traffic accidents (69 cases, 43.95%) and fighting (42 cases, 26.75%). Most fractures were in the mandible (161 fractures). It was observed that most of the mandibular fractures were in the body (49 fractures, 30.43%) and condylar (42 fractures, 26.09%) regions. Of the 223 maxillofacial fractures, 63.68% (142 fractures) were treated with closed reduction and 36.32% (81 fractures) were treated with open reduction. Postinjury complications included infections (local infection or osteomyelitis), nerve injuries (alveolaris inferior, facial, lingual, and infraorbital nerves), and a salivary gland fistula, and postoperative complications included infection, facial asymmetry, and malocclusion.

Premaxillary distraction osteogenesis with an individual tooth-borne appliance.

Distraction osteogenesis defines a technique of bone generation and osteosynthesis by the distraction of native preexisting bone. The technique offers a promising treatment alternative for patients with maxillary hypoplasia and a retrognathic mandible. In this case report, the steps in the treatment of an 18.2-year-old girl with premaxillary hypoplasia and anterior crossbite are described. The patient was treated with a distraction osteogenesis technique, and premaxillary advancement was performed using an individual tooth-borne distraction device. The surgical operation consisted of a classical segmental maxillary osteotomy carefully respecting the palatal periosteum. The distractor was cemented in the mouth after the surgical procedures. The patient was observed during a seven-day latency period, after which the device was activated 0.5 mm every 12 hours. The anterior crossbite was eliminated in one week, and the treatment was finished with fixed orthodontic appliances.

Evaluation of oral or rectal midazolam as conscious sedation for pediatric patients in oral surgery.

This study was undertaken with a view to determine the acceptance and treatment possibilities of midazolam, depending upon its oral and rectal application for pediatric patients requiring an oral surgery procedure (tooth extraction) and having a pretreatment behavioral score of 1 or 2 according to the Frankl Scale. Oral (0.5 mg/kg) and rectal (0.35 mg/kg) midazolam was compared in view of acceptance of the mode of treatment and local anesthesia, level of amnesia, and adverse effects. Although oral or rectal midazolam application has similar characteristics in respect to ease of working, the oral midazolam application should generally be preferred because it is more easily accepted by pediatric patients.

Hereditary gingival fibromatosis and expression of Ki-67 antigen: a case report.

BACKGROUND: Hereditary gingival fibromatosis (HGF) is a fibrotic enlargement of the gingiva. The mechanism that leads to the accumulation of abnormal amounts of gingival tissue in HGF is still unknown. The aim of this report was to present the clinical and histopathologic characteristics of a patient with gingival fibromatosis and to evaluate the proliferation of HGF fibroblasts. METHODS: We examined the proliferation rate of fibroblasts in this case by using Ki-67 immunohistochemical staining and compared the rate to fibroblasts of non-fibromatosis gingival tissues from 5 healthy patients serving as controls. RESULTS: There were no Ki-67-positive cells in the lesional tissue, and the control gingiva revealed no immunostaining. The number of Ki-67 antigen-positive epithelial cell nuclei was observed to be low in the basal cell layers of hyperplastic gingival epithelia, similar to the control group. CONCLUSIONS: In the present case, there was no increase in the proliferation rate of lesional fibroblasts observed by Ki-67 immunohistochemical staining as a proliferation marker; only the epithelium was stained. It seems likely that the underlying mechanism of HGF may be an increase in the biosynthesis of collagen and glycosaminoglycans rather than cell proliferation.