Epidemiology of maxillofacial trauma in the elderly: A European multicenter study.

INTRODUCTION: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more). MATERIALS AND METHODS: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS). RESULTS: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (P<.005). Concomitant injuries were observed in 27.3% of patients. Falls were associated with the absence of concomitant injuries. The ninth decade (P<.05) and a high FISS score (P<.005) were associated with concomitant body injuries too. CONCLUSIONS: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.

Management of mandibular condylar fractures in patients with atrophic edentulous mandibles.

INTRODUCTION: Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. METHODS: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. RESULTS: A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. CONCLUSIONS: The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.

Use of botulinum neurotoxin A in uncontrolled salivation in children with cerebral palsy: a pilot study.

This study investigated the safety and efficacy of botulinum neurotoxin type-A (BNT-A) injections into the salivary glands for treatment of sialorrhea in children with cerebral palsy (CP) and assessed the clinical factors that affect treatment outcome. The parotid and submandibular glands of nine CP patients were injected with BNT-A 1.4 U/kg in each parotid gland, and 0.6 U/kg in each submandibular gland. All children had neurological disorders. Gross motor function classification system levels ranged from I to V. All children had moderate to severe intellectual disability. A telephone interview with one parent determined response to treatment. Drooling intensity and frequency were measured with the drooling severity and frequency scale. After BNT-A treatment, the patients were followed up for 6 months using self-assessed rating scales for drooling intensity, discomfort and treatment effect (drooling impact scale). All parents reported an improvement in sialorrhea in the first week. Drooling was very intensive at baseline, and moderate 2 weeks after treatment. Maximum response occurred at 2-8 weeks. The use of BNT-A in uncontrolled salivation in children with CP can be considered acceptable and effective. Malocclusion and anterior salivation are closely related clinical characteristics and should be taken into account when planning treatment.

Dynamics of nitrate and nitrite content during storage of home-made and small-scale industrially produced raw vegetable juices and their dietary intake.

The influence of storage conditions on nitrate and nitrite contents, pH, and total viable bacterial count of raw vegetable juices was studied. Three different types of juices from an Estonian small-scale producer and five different types of home-made juices were analysed. Analyses were performed immediately after opening the commercial juice packages and immediately after preparation of a home-made juice. Additionally, samples were taken after open storage of a juice at the refrigerator and ambient temperatures during 24 and 48 h. The biggest changes in nitrate and nitrite contents were found during storage of carrot, beetroot and radish juices. During 48 h of storage at ambient temperature, the mean increases of nitrite content in home-made carrot, beetroot and radish juices were from 0.1 to 187, from 2.1 to 578, and from 0.5 to 259 mg l(-1), respectively. In the case of commercial lightly pasteurized products, the biggest increase of nitrite content, from 3.2 to 11 mg l(-1), was found in red beetroot juice. After 48 h of storage at refrigerator temperature, the changes of nitrite and nitrate were smaller. In the case of consumption of 300 ml of home-made carrot juice, with a nitrate and nitrite content of 64 and 110 mg l(-1), respectively, stored for 24 h at ambient temperature, the average intake was 8% and 846% of the acceptable daily intake of nitrates and nitrites, respectively. After consumption of 50 ml of the same carrot juice by children (1-2 years of age) the average intake of nitrates and nitrites was 7% and 733% of the acceptable daily intake, respectively.

Mandibular ameloblastoma: a 28-years retrospective study of the surgical treatment results.

AIM: The aim of this study was to analyse the long-term treatment results of mandibular ameloblastomas over a 28-year period and determine the most appropriate method of management of these tumours. METHODS: Sixteen patients with a diagnosis of mandibular ameloblastoma treated in our Department between January 1977 and December 2004 were selected for this retrospective study. Data included gender, age at surgery, symptoms, tumour type, size and site of lesion, radiological findings, primary surgical methods, complications, recurrences, and follow-up period. RESULTS: There were eight male and eight female patients. Their age ranged from 15 to 74 years (average 43.4 years). The dominant symptom was facial deformity (9 cases). From analysis of ortopantomographs or radiographs, four cases were unilocular and 12 cases were multilocular, and its size ranged from 2 to 11 cm. Observation time varied from 5 to 27 years after treatment. Histologically prevalence of follicular type was observed. The treatment selected was segmental resection in three cases (18.6%), a resection with bone margin in six cases (37.5%) and conservative treatment by means of enucleation was carried out in seven patients (43.8%). Recurrences were observed in three patients. All these cases have been primarily treated through conservative surgical technique, i.e., by enucleation. CONCLUSION: In summary, conservative treatment enucleation should be used only in the treatment of unicystic ameloblastoma, while the radical approach, resection with some safe margin, should be the first choice in the treatment of solid, multicystic mandibular ameloblastoma to avoid recurrence.

Nitrate in leafy vegetables, culinary herbs, and cucumber grown under cover in Estonia: content and intake.

The content of nitrate in leafy vegetables, culinary herbs, and cucumber was determined during the years 2006-2008. All samples of Estonian origin, except white cabbage, were grown under cover. Seasonal differences in nitrate concentrations were observed in lettuce and spinach. Nitrate concentrations in lettuce were 22% and those in spinach were 24% higher in winter crops compared with samples collected in summer. The mean nitrate level was 3023 mg kg(-1) for fresh lettuce and 2337 mg kg(-1) for spinach. On average, 11.6% of fresh lettuce and spinach samples nitrate concentration exceeded the maximum level specified in European Commission Regulation No. 1881/2006. The mean levels were 999 mg kg(-1) for imported iceberg lettuce and 1287 mg kg(-1) for frozen spinach, which are below the maximum European Commission limits. Parsley, dill, basil, thyme, and rucola contained high concentrations of nitrate from mean levels of 2134 mg kg(-1) for parsley up to 8150 mg kg(-1) for rucola. Mean nitrate concentrations ranged from 382 to 1115 mg kg(-1) for white cabbage and Chinese cabbage, respectively. The per capita mean daily intake of nitrates related to the consumption of leafy vegetables, culinary herbs, and cucumber for the whole Estonian population was 31.3 mg day(-1), which comprised 14.2% of the acceptable daily intake (ADI).

Impact of food processing and storage conditions on nitrate content in canned vegetable-based infant foods.

The nitrate and nitrite contents were determined in canned vegetable-based infant foods of five varieties. Furthermore, changes in nitrate content during industrial processing were studied. Samples were taken from raw materials, homogenized mixtures, and final products after sterilization, and then analyzed for nitrate and nitrite content by high-pressure liquid chromatography. Processing steps preceding heat treatment, such as vegetable peeling and washing, decreased the nitrate concentrations in the range of 17 to 52%. During processing, the nitrate content in canned infant foods decreased 39 to 50%, compared with nitrate concentration in the raw-vegetable mixture. The final nitrate concentration in infant foods depends mainly on the initial nitrate content of the raw-vegetable mixture. The effect of storage time (24 and 48 h) and temperature (4 to 6 degrees C and 20 to 22 degrees C) on nitrate and nitrite content in opened canned infant-food samples was studied. After 24 h of storage at refrigerated and room temperatures, the mean nitrate content increased on average by 7 and 13%, and after 48 h of storage by 15 and 29%, respectively. The nitrite content in all analyzed samples was below the quantification limit. Storage requirements of industrial manufacturers must be followed strictly. Opened can foods, stored under refrigerated conditions, have to be consumed within 2 days, as recommended by manufacturers. The infant-food producers must pay more attention to the quality of raw materials. Nitrate content analyses should be added as compulsory tests to the quality assurance programs.

Polycyclic aromatic hydrocarbons (PAHs) in meat products and estimated PAH intake by children and the general population in Estonia.

The concentrations of benzo[a]pyrene and 11 other polycyclic aromatic hydrocarbons (PAHs) were analysed from 322 commercial, cured meat products and 14 home-grilled meat samples as part of the Estonian food safety monitoring programme during 2001-2005. The maximum acceptable concentration of 5 microg kg(-1) for benzo[a]pyrene was exceeded in 3.4% of samples. The highest PAH concentrations were detected in home-grilled pork samples. Using of disposable grilling unit resulted in 1.6 times higher PAH concentrations compared to the traditional wood-burning grill. The average intake of benzo[a]pyrene and sum of 12 PAHs from meat products was estimated for children (age 1-16 years) on the basis of an individual food consumption questionnaire and, for the general population, based on national food consumption data. The highest total PAH concentrations detected were 16 microg kg(-1) in smoked meat and ham, 19 microg kg(-1) in smoked sausage and 6.5 microg kg(-1) in smoked chicken samples. Since smoking and grilling are prevalent meat-cooking methods in Estonia, the impact of meat products is assessed to be significant in overall PAH intake.

Nitrates and nitrites in vegetables and vegetable-based products and their intakes by the Estonian population.

The content of nitrates were determined in 1,349 samples of vegetables and ready-made food in 2003-2004 as a part of the Estonian food safety monitoring programme and the Estonian Science Foundation grant research activities. The results of manufacturers' analyses carried out for internal monitoring were included in the study. The highest mean values of nitrates were detected in dill, spinach, lettuce and beet root. The mean concentrations were 2,936, 2,508, 2,167 and 1,446 mg kg(-1), respectively. The content of nitrites in samples was lower than 5 mg kg(-1). In total, the mean intake of nitrates by the Estonian population was 58 mg day(-1). The mean content of nitrates in vegetable-based infant foods of Estonian origin was 88 mg kg(-1). The average daily intake of nitrates by children in the age group of 4-6 years was 30 mg. The infants' average daily intake of nitrates from consumption of vegetable-based foods was 7.8 mg.

Nitrites, nitrates and N-nitrosoamines in Estonian cured meat products: intake by Estonian children and adolescents.

The contents of nitrate, nitrite and N-nitrosoamines in commercial cured meat products on the Estonian market were determined for 2000-01 and 2003-04 as part of the Estonian food safety monitoring programme and the Estonian Science Foundation grant research activities. The maximum permitted levels of residual nitrites and nitrates were not exceeded in the samples analysed. However, a great variation in the content of nitrate, nitrite and N-nitrosoamines was found for all the products. The concentrations of these compounds in domestic cured meat products showed a decrease from year to year. The mean intake of nitrate, nitrite and N-nitrosoamines by Estonian children (n=346) from cured meat products was calculated on the basis of individual intake data. The mean daily intake of nitrates was 1.7 mg, that of nitrites was 0.83 mg and that of N-nitrosoamines was 0.073 microg. In the 2000-01 study, the calculated nitrite intake exceeded the acceptable daily intake by up to 140% for 1-6-year-old children and up to 105% in 2003-04.