Temporomandibular Joint: Approach to the Intermediate Space by Triangulation With Transillumination Reference.

Arthroscopy of the temporomandibular joint is a minimally invasive surgical procedure. Nowadays, 3 levels are described depending on the complexity. Level I involves a single puncture with an anterior irrigating needle for outflow. Level II involves a double puncture using triangulation in order to be able to perform minor operative maneuvers. Subsequently, it is possible to progress to Level III and perform more advanced techniques, through multiple punctures, involving the arthroscopic canula and 2 or more working cannulas. However, in cases of advanced degenerative pathology or re-arthroscopy, it is common to observe advanced fibrillation, severe synovitis, adhesions, or articular obliteration which makes conventional triangulation difficult. On these cases, we propose a simple and effective technique that facilitates approach to the intermediate space by means of triangulation with transillumination reference.

Elective neck dissection in early-stage oral squamous cell carcinoma--does it influence recurrence and survival?

BACKGROUND: This study investigates the influence on survival and regional control rates of neck dissection therapy at the time of surgery of the primary tumor in early stages of squamous cell carcinoma (SCC) of the oral cavity. METHODS: A series of 154 patients with pT1N0M0 and pT2N0M0 intraoral carcinomas was analyzed retrospectively. Neck dissection was associated with tumor ablation in 87 patients (56.5%), although 67 patients (43.5%) were treated with local resection exclusively. Survival and relapse rates were studied with the Kaplan-Meier curves and the log-rank test for univariate analysis and Cox proportional model for multivariate analysis (p < .05). RESULTS: Regional recurrences occurred in 25 cases (16.2%), 7 cases (8%) with primary neck dissection and 18 cases (26.8%) with local excision alone. Neck dissection therapy was a significant prognostic factor for recurrences and survival (p < .05). The 5-year regional control rate was of 92.5% for patients with elective lymph node ablation versus 71.2% for patients without primary neck dissection. Neck dissection was also significant for recurrences in stage I and for survival and recurrences in stage II. Neck dissection therapy also showed independent prognostic value in the Cox analysis. CONCLUSIONS: In patients with intraoral carcinomas, elective neck treatment should be considered even in cases with a small primary tumor and negative clinical examination because of the high incidence of occult nodal metastases and the tendency to regional recurrences.

Subperiosteal abscess of the orbit: an unusual complication of the third molar surgery.

Few procedures in oral surgery show severe complications with the potential to result in life-threatening problems. Subperiosteal orbital abscess is an extremely rare but transcendent complication arising spontaneously or after dental surgery. This report describes a case of subperiosteal abscess of the orbit in a 57-year-old man that occurred following the uneventful extraction of the left maxillary third molar. In the emergency department, proptosis and extraocular muscle dysfunction were marked but no decrease in visual acuity was observed. Echography, computed tomography scan, and magnetic resonance imaging allowed distinction from other types of orbital inflammation. Surgical drainage confirmed the diagnosis. In this patient, orbital abscess was probably caused by extension of the infection to the pterygopalatine and infratemporal regions progressing next to the inferior orbital fissure. This report highlights the difficulty in the clinical diagnosis of this complication.

Dentin dysplasia type I treated with onlay bone grafting, sinus augmentation, and osseointegrated implants.

Dentin dysplasia is a defect of dentin development that was classified by Shields as type I and type II. The teeth in dentin dysplasia type I are characterized by normal enamel and abnormal dentin in the crown and root. For that reason, this disorder is characterized by dental caries, early exfoliation of the teeth and, consequently, maxillomandibular bony atrophy. In this report, we present a case of a young girl affected by dentin dysplasia type I, treated with a combination of onlay bone grafting and a sinus lift technique to accomplish implant placement. This case showed that onlay autogenous grafting and a sinus lift technique are well-tested methods of bony augmentation and can be useful in patients with congenital dentin defects, such as dentin dysplasia.