Airway emergency after dental extraction.

Life-threatening airway emergencies and uncontrolled haemorrhage following dental extractions is rarely encountered. Inappropriate handling of dental luxators may lead to unexpected traumatic events resulting from penetrating or blunt trauma to the surrounding soft tissues and vascular damage. Bleeding during or after surgery usually resolves spontaneously or with local haemostatic interventions. Pseudoaneurysms are rare occurrences secondary to blunt or penetrating trauma usually produced by arterial injury leading to extravasation of blood. The rapidly enlarging haematoma with risk of spontaneous pseudoaneurysm rupture is an airway and surgical emergency necessitating urgent intervention. The following case highlights the importance of appreciating the potential complications associated with extractions in the maxilla, significant anatomical relationships and recognizing the clinical signs of a threatened airway.

Abiotrophia defectiva bacterial endocarditis complicated by an infective intracranial mycotic aneurysm - The need for aggressive odontogenic source control.

Abiotrophia defectiva or nutritionally variant streptococci (NVS) was first described in 1961 as a rare cause of infectious endocarditis (IE). It is distinct to the Streptococcus genus, pleomorphic, and demonstrates variable Gram-staining characteristics due to poor growth in culture media requiring extended incubation or 16S rRNA sequencing in culture negative situations.1 NVS has also been implicated in the pathogenesis of culture-negative endocarditis. In comparison with other causes of endocarditis, it has the ability to secrete exopolysaccharide and adheres to fibronectin in the extracellular matrix of endovascular structures.2 NVS is associated with significant morbidity and mortality, higher rates of multisystem complications ranging from pancreatic abscess, intracranial aneurysms, osteomyelitis, and valvular destruction, despite sensitivity to antibiotics.

Salivary microRNA miR-let-7a-5p and miR-3928 could be used as potential diagnostic bio-markers for head and neck squamous cell carcinoma.

BACKGROUNDS: MicroRNAs (miRNA) are a class of non-protein-coding RNAs that have significant biological and pathological functions. The importance of miRNAs as potential cancer diagnostic biomarkers is gaining attention due to their influence in the regulation of cellular processes such as cell differentiation, proliferation and apoptosis. The aim of this study was to identify significant miRNAs from saliva as potential diagnostic biomarkers in the early diagnosis and prognosis of head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: Five differentially expressed miRNAs (miR-7703, miR- let-7a-5p, miR- 345-5p, miR- 3928 and miR- 1470) were selected from Next Generation Sequencing (NGS) miRNA data generated from our previous study using saliva of 12 HNSCC patients and 12 healthy controls. Their differential expressed miRNAs were subsequently validated by RT-qPCR using saliva samples from healthy controls (n = 80) and HNSCC patients (n = 150). Total RNA was isolated from 150 saliva samples of HNSCC patients and was transcripted into cDNA by TaqMan MicroRNA Reverse Transcription Kit. Using quantitative RT-PCR analysis, salivary miRNAs were identified in HNSCC patients (n = 150) and healthy controlled cases (n = 80). T-tests were used to compare the differences among the various clinical variants. RESULTS: On average 160 ng/µl was isolated from 500 µl of saliva. Overall, a good correlation observed between the HNSCC and some of miRNAs expression levels. Salivary miR-let-7a-5p (P<0.0001) and miR-3928 (P< 0.01) were significantly down regulated in saliva of HNSCC patients relative to age and sex-matched healthy controls. A number of salivary miRNAs (miR-let-7a-5p and miR-3928) were correlated with lymph node metastasis (p = 0.003, p = 0.049) and tumour size (p = 0.01, p = 0.02), respectively. However, our preliminary analysis showed no significant differences in salivary miR-1470, miR-345-5p or miR-7703 expression between patients and healthy controls. Most notably, our analysis showed that salivary miR-let-7a-5p and miR-3928 expression levels have significant sensitivity and specificity to distinguish between patients with HNSCC and healthy controls. CONCLUSION: This study concluded that salivary miR-let-7a-5p and miR-3928 has the potential to be novel non-invasive biomarkers for early detection and prognosis of HNSCC.

Investigation of Sustained BMP Delivery in the Prevention of Medication-Related Osteonecrosis of the Jaw (MRONJ) in a Rat Model.

Medication-related osteonecrosis of the jaw (MRONJ) poses an ongoing challenge for clinicians and researchers. Currently, there is a lack of preventative measures available for at-risk patients undergoing tooth extractions, especially those with prior bisphosphonate treatment due to osteoporosis or bone metastasis diagnoses. Here, these issues are addressed using a preventative tissue engineering strategy against MRONJ development. This study evaluates the efficacy of a poly(ethylene glycol)-heparin hydrogel as a tool for the delivery of arginylglycylaspartic acid (RGD) and recombinant human bone morphogenic protein-2 (rhBMP-2). Three groups of skeletally mature rats each receive two doses of intravenous zoledronic acid prior to surgery and undergo extraction of the right first mandibular molar with gingival closure. Experimental groups either have the sockets left empty, filled with hydrogel minus rhBMP-2, or filled with hydrogel plus rhBMP-2. Eight weeks postoperatively specimens are analyzed using radiological, histological, and scanning electron microscopy (SEM) techniques. µCT analysis shows increased bone formation with hydrogel/rhBMP-2 delivery compared to the empty socket. Hydrogel-treated groups display increased presence of osteocytes and increased osteoclastic action compared to the empty sockets. These results represent the first step toward improved delivery of rhBMP-2 and a potential MRONJ preventative for patients undergoing bisphosphonate treatment.

Clear cell carcinoma, not otherwise specified/hyalinising clear cell carcinoma of the salivary gland: The current nomenclature, clinical/pathological characteristics and management.

Clear cell carcinoma, not otherwise specified (NOS)/hyalinising clear cell carcinoma (HCCC) is a rare entity in salivary gland tumour. The aim of the research is to review the current concepts and characteristics of this carcinoma. The clinical and pathological data of the disease obtained from literature and two original cases were analysed. Overall, 152 cases were reviewed up to the year 2014. The carcinomas were noted often in woman, in the seventh decade of life, located in oral cavity and as early-stages cancers. On pathological examination, they were characterized by tumour cells having clear cell morphology with hyalinised stroma. Immunohistochemical studies revealed that the carcinoma is positive for cytokeratin and negative for myoepithelial differentiation. EWSR1-ATF1 fusion is specific for the carcinoma. Also, 9% of the reported cases had local nodal metastasis, with 6 cases demonstrating distant metastases at presentation. On follow-up, 22% of patients had recurrent or with persistent diseases after surgery. The time for the first recurrence could be as long as 24 years. Risk factors for recurrence include advanced stage at diagnosis and metastases at presentation. To conclude, HCCC is a low grade malignancy but have the potential for local metastases, recurrence, distant metastases and cancer-related death.

Management of dental trauma by general practitioners.

BACKGROUND: Patients who sustain dental trauma commonly present to their general practitioner (GP) or the emergency department, especial-ly to seek help after hours. It is important, therefore, for medical practitioners to correctly diagnose and manage these patients. OBJECTIVE: The purpose of this paper is to familiarise GPs with different presentations of dental-related trauma, and a brief management plan for each condition. DISCUSSION: Time is of the utmost importance when dealing with trauma in the dentition. Initial management of dental trauma, primarily by GPs working in rural or remote areas, can have a significant impact on the prognosis of oral hard and soft tissues.

Penetrating injuries to the orbit despite safety equipment.

Penetrating injuries to the orbit are uncommon but may have catastrophic consequences ranging from blindness, cerebral damage to death. Apparently similar injuries but with a slight difference in the anatomic pathway may have minimal morbidity. Prevention by the use of full safety equipment is recommended. This case report shows that full safety equipment may not prevent injury.

Management of the node-positive neck in oral cancer.

Surgery continues to play a prominent role in the management of patients with loco-regionally advanced squamous cell carcinoma of the upper aerodigestive tract. Most evidence supports the use of comprehensive neck dissection for node-positive disease and suggests that planned neck dissection following definitive radiation therapy and chemoradiation therapy is unnecessary in the great majority of patients with node-positive neck disease who exhibit a complete response. Evidence for less aggressive therapy is much less compelling in patients with bulky adenopathy. For such patients, there is growing enthusiasm for selective or even super-selective neck dissection for surgical salvage. Finally, when cervical disease is so advanced as to involve the carotid artery, evidence continues to portend a dismal prognosis.