Association of Postoperative Nausea and Vomiting Incidence With Neutrophil-Lymphocyte Ratio in Ambulatory Maxillofacial Surgery.

PURPOSE: Postoperative nausea and vomiting (PONV) constitutes an important factor in ambulatory surgery. The mechanisms of the antiemetic action of potent anti-inflammatory corticosteroids, which are used extensively for the treatment of PONV, as well as the association between PONV and inflammation, have not been investigated sufficiently. We aimed to establish the association between the neutrophil-lymphocyte ratio (NLR) and postoperative antiemetic administration, as well as to investigate whether the NLR would be a biomarker for PONV. MATERIALS AND METHODS: The anesthesia records of American Society of Anesthesiologists (ASA) physical status I or II patients who underwent ambulatory routine oral surgery under general anesthesia were evaluated after we obtained ethical approval from the faculty ethics committee. A 5-point scale was used to score PONV. Metoclopramide (Metpamid, Istanbul, Turkey) was used as the first choice in patients who had a PONV scale score of 1 or higher. Data regarding metoclopramide administration during extubation and discharge periods were analyzed. Sixty-four patients were randomized and enrolled in the study with an NLR less than 2 (group I, n = 37) or an NLR greater than 2 (group II, n = 27), and metoclopramide administration was evaluated in each case. The association between the NLR and metoclopramide administration was analyzed statistically by a descriptive statistical method in detecting frequencies; the χ2 test was used in comparison of the groups and the t test in independent groups. RESULTS: The metoclopramide administration frequency for PONV was 5.4% in group I and 96.3% in group II. The metoclopramide administration frequency in group II was statistically higher than that in group I (P < .001). CONCLUSIONS: We are of the opinion that the NLR can be easily calculated with data obtained from the complete blood count and could be a marker for PONV. Antiemetic prophylaxis could be given after evaluation of the NLR. However, we suggest that this result should be supported with further prospective studies using larger series.

Preauricular pilomatricoma: An uncommon entity in a dental pediatric patient.

INTRODUCTION: Pilomatricomas are benign follicular skin appendage tumors, commonly occurring in children and young adults. Most patients admit to dermatologists to seek treatment and are well known by them; however, dental professionals, especially pediatric dentists are not familiar with these tumors. PRESENTATION OF CASE: This report presents a 16-year-old female with preauricular pilomatricoma, located beneath the overlying skin of the temporomandibular region. Clinical examination revealed an asymptomatic lump, the overlying skin revealed no abnormalities. Patient was unaware of the lesion. DISCUSSION: Pilomatricomas are commonly encountered in the maxillofacial region, although not considered in differential diagnosis by dental professionals. They usually present as, asymptomatic, subcutaneous masses; although symptomatic cases have been reported. In literature, common differential diagnosis for head and neck pilomatricoma includes sebaceous cyst, ossifying hematoma, giant cell tumor, chondroma, dermoid cyst, foreign body reaction, degenerating fibroxanthoma, metastatic bone formation, and osteoma cutis. We are of the opinion that temporomandibular joint disease should also be considered in differential diagnosis for preauricular pilomatricoma. CONCLUSION: Pediatric dentists should be aware of the condition and consider it in the differential diagnosis of pediatric conditions involving the temporomandibular joint.

Florid osseous dysplasia in a middle-aged Turkish woman: A case report.

Florid osseous dysplasia (FOD) is an uncommon, benign, cemento-osseous lesion of the jaws. The etiology of FOD is still unknown. It is often asymptomatic and may be identified on routine dental radiographs. The classic radiographic appearance of FOD is amorphous, lobulated, mixed radiolucent/radiopaque masses of cotton-wool appearance with a sclerotic border in the jaws. In our case the lesion was found incidentally on routine periapical radiographs taken for restored teeth and edentulous areas. For further and detailed examination, a panoramic radiograph and cone-beam computed tomograph (CBCT) were taken. The panoramic radiograph and CBCT revealed maxillary bilateral and symmetrical, non-expansile, well-defined, round, radiopaque masses in contact with the root of the maxillary right second molar and left first molar teeth. Our aim in presenting this case report was to highlight the importance of imaging in diagnosis of FOD.

Ultrasound evaluation of masseter muscle changes in stabilization splint treatment of myofascial type painful temporomandibular diseases.

OBJECTIVES: To detect whether stabilization splint (SS) treatment of painful myofascial type temporomandibular diseases (TMD) changes the masseter muscle morphology using ultrasound (US). STUDY DESIGN: Thirty-five patients with painful myofascial TMD receiving SS treatment were studied. Masseter thickness, length, internal echo-fibrillary structure and vascularization were evaluated using gray-scale and power Doppler US just before and 3 months after the SS application. Visual analog scale (VAS) and mouth opening measurements were used to measure the outcome of treatment. RESULTS: A significant shortening in the masseter muscle length (R: -3.67 mm, P: .010; L: -3.97 mm, P: .005) and thickness (R: -0.93 mm, P: .005; L: -0.90 mm, P: .016) was noted. No change in the internal echo-fibrillary structure or vascularization was detected. A significant decrease in VAS scores (Median: 5-0.5 P < .05) and mouth opening (42.77 ± 7.86 mm to 38.69 ± 6.21, P < .05) was also detected. CONCLUSION: SSs modify and reduce the dimensions of masseter muscle.

Use of pedicled buccal fat pad in the closure of oroantral communication: analysis of 75 cases.

OBJECTIVE: This report evaluates the use of pedicled buccal fat pad for closure of oroantral communications. METHOD AND MATERIALS: Seventy-five patients were treated with pedicled buccal fat pad. Fifty-two were treated immediately after tooth extractions. The remaining 23 had chronic oroantral communication and were treated similarly after irrigation of the maxillary sinus with saline for 7 days. RESULTS: The 6-month follow-up revealed uneventful healing in all of the patients. Though partial necrosis of the flap was observed in three patients, this did not effect the final healing. Total necrosis of the flap was not noted. CONCLUSION: The use of pedicled buccal fat pad is an acceptable and reliable alternative in acute or chronic oroantral communications management and may even be used as a first treatment choice by experienced surgeons.

Impacted tooth in mandibular fracture line: treatment with closed reduction.

PURPOSE: Most mandibular fractures occur because of blunt trauma. In some cases, the mandible can be weakened by the presence of an unerupted or impacted tooth. The fate of this tooth in the fracture line and its effects on bone healing remain an important outcome event. MATERIALS AND METHODS: In this study, we analyzed the records of 117 patients with a total of 121 fractures having an unerupted tooth remaining in the fracture line who were treated and followed by the Dental Faculty of Ankara University between 1986 and 1996. All were open fractures, and none of the patients had a history of an acute inflammatory episode related to the unerupted tooth before the injury. Intermaxillary fixation was used in all cases. RESULTS: Three of the patients subsequently required open reduction with internal fixation. The unerupted tooth was not extracted in any patient. The fixation was maintained for an average of 45 days and followed up for 3 months. No complications were encountered. CONCLUSION: According to these results, we suggest that asymptomatic impacted teeth in the fracture line of uncomplicated mandible fractures do not cause delayed healing when treated with closed reduction.

The reconstruction of oral defects with buccal fat pad.

QUESTIONS UNDER STUDY: 1) To evaluate the success of buccal fat pad used in the reconstruction of oral defects, 2) to clarify its indications and size limitations, 3) to identify risk factors if there were any. METHODS: In this prospective clinical study, buccal fat pad was used in 26 patients with different indications which included 5 defects resulting from tumour excisions, 3 maxillary cysts, 3 secondary maxillary cyst defects and 15 oro-antral communications. All defects were in the maxilla with a maximum size of 5x 3 cm. Patients were evaluated for signs of flap epithelialisation, infection, fistulae recurrence and facial contour deficiency. RESULTS: The epithelialisation process was completed after 3 to 4 weeks without any complications in 22 patients. However, partial dehiscence of the graft occurred in 2 patients with large maxillary defects. We also observed serious bleeding during the operation of one of our cases. Because of the small fistula, 1 patient was re-operated. CONCLUSION: The results of this series support the view that the use of buccal fat pad is a simple, convenient, and reliable method for the reconstruction of small to medium-sized oral defects.

Histomorphometric evaluation of the effect of doxycycline on the healing of bone defects in experimental diabetes mellitus: a pilot study.

PURPOSE: Bone healing is impaired in diabetes mellitus, particularly due to increased collagen breakdown. Recently, tetracyclines have been used to treat experimental bone defects because they have anticollagenolytic properties, and positive effects on the healing process have been obtained. The objective of this study was to develop a computer-assisted histomorphometric technique to quantitatively determine the amount of regenerating bone within experimental bone defects in a diabetic rodent model. MATERIALS AND METHODS: This study examined the effects of systemic doxycycline administration on the healing of tibial bone defects in healthy albino rats and in experimentally induced diabetic rats. Twenty-four female albino rats were assigned to 4 groups: diabetic, diabetic plus doxycycline, control, or control plus doxycycline. The standardized bone defects were histomorphometrically examined 10 and 30 days postoperatively. Histomorphometric analysis of the amount of new bone formation was performed using the Zeiss Vision image analysis program KS 400 (Kontron Elektron GmbH, Eching, Germany). RESULTS: At 10 days of healing, the diabetic groups exhibited inferior healing compared with the control groups in terms of the amount of new bone formation within the defects. However, the effect of doxycycline administration to the diabetic and control groups was not statistically different. At 30 days of healing, there were no statistically significant differences between the amount of newly formed bone in any of the groups. CONCLUSIONS: This study found that doxycycline administration did not significantly alter the amount of new bone formation during the healing of bone defects in control and diabetic rats.