Trans-implant treatment of chronic recurrent maxillary sinusitis via dynamic implants with an internal port: Experience with 31 cases.

This study was performed to test a protocol for trans-implant treatment of chronic recurrent maxillary sinusitis (CRS), via implants with an internal removable sealing screw. The appropriate indications for treatment, optimal number of treatment sessions, and general schedule of treatment and follow-up were assessed. This was a retrospective study of 31 patients with CRS who were managed with trans-implant lavage. Of these patients, 28 (referred for a sinus elevation procedure) underwent a simultaneous implantation procedure and treatment of the sinusitis. Three patients received treatment for sinusitis via an already existing implant. The suggested sinusitis treatment protocol includes the drainage of pus through the punctured sinus floor and three sessions of antral irrigation/lavage, four cone beam computed tomography scans, and four transnasal endoscopic observations. The suggested combined protocol includes the simultaneous evaluation of the implant status and the sinusitis treatment results on days 30 and 60 after surgery. Of the 31 patients, 28 (90%) had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) up to day 30 postoperative. Follow-up nasal endoscopy demonstrated no evidence of active sinus disease. Twenty-seven implants were well-osseointegrated and were still in use for prosthetic purposes. In one case, the implantation failed because of poor bone quality. For the remaining 30 cases, both clinical and radiological results showed stability of the implants and no CRS recurrence during the whole follow-up period. The dental implant with an internal central port and an integral sealing screw may be used for drainage, irrigation, observation, and further treatment of the maxillary sinus in cases of CRS.

Complications of traditional and modern therapeutic salivary approaches.

The morbidity following traditional surgery of the salivary glands is well documented and includes postsurgical complications such as the Frey's syndrome, complete or partial facial nerve damage, facial scarring, greater auricular nerve numbness, sialocoeles and salivary fistula. The avulsion of the salivary duct, secondary strictures, gland swelling, salivary fistulas and perforations (false rout), traumatic ranulas, and the lingual nerve paraesthesia are the main endoscopy-related complications. In general, the rate of postsurgical complications after modern advanced minimally invasive surgical interventions is significantly lower compared with traditional surgery of the salivary glands. However, such comparisons cannot be performed because up-to-date traditional and minimally invasive surgical techniques are applied to different salivary disorders. Combinations of various minimally invasive techniques are also possible. There is no clear borderline between "traditional" and "modern" surgery of the salivary glands. It is appropriate to write about gradual replacement of old techniques with newer ones, and this process has no traffic lights.

[Minimal invasive implantology].

Endoscopic surgery has changed the philosophy and practice of modern surgery in all aspects of medicine. It gave rise to minimally invasive surgery procedures based on the ability to visualize and to operate via small channels. In maxillofacial surgery, our ability to see clearly the surgical field opened an entirely new world of exploration, as conditions that were once almost impossible to control and whose outcome was uncertain can be now predictably managed. in this article we will descripe the advantage of using the oral endoscope during the dental implantology procedure, and we will describe a unique implant which enable us in combination with the oral endoscope to create a maxillary sinus lift with out the need of the major surgery with all of its risks and complication.

Minimal surgery for parotid stones: a 7-year endoscopic experience.

The results of endoscope-assisted parotid surgery are presented as a minimally invasive alternative to parotidectomy for large parotid stones. From 1999 to 2007, 70 patients with parotid sialoliths were treated by minimally invasive surgical techniques in three specialist centres. At surgery a combination of sialoendoscopic and ultrasound examination was used to locate the stone within the duct. The calculus was released by incising the duct through a pre-auricular approach (40 patients) or by direct transcutaneous incision over the stone (27 patients). Four patients were treated using other minimally invasive procedures. Local anesthesia was used in 22 patients and general anesthesia in 48. The average follow-up was 25.5 months with two patients lost to review. In 3 patients treatment had long-term complications (persistent stone fragment; obstructive symptoms due to a fibrous stricture; a visible scar on the cheek). In one patient, endoscopy was abandoned due to stricture. 85 stones were retrieved successfully from 69 patients. The average size of the stones was 7.2 mm. There were no cases of facial nerve weakness or salivary fistula. The data suggest that endoscopic-assisted surgery is a viable alternate to adenectomy for the treatment of large or recalcitrant parotid stones.

Calcifications simulating sialolithiasis of the major salivary glands.

Calcifications found in routine and normal radiographs of the oral and facial region may turn out to be an interesting diagnosis. Although most of the radiopacities may be sialoliths, other differential diagnoses must not be exempted, such as calcified lymph nodes, phleboliths and other vascular calcifications, tuberculosis of lymph nodes or of the salivary gland itself. Several cases are presented which simulated pathological calcifications of the orofacial region and were diagnosed primarily as sialoliths, but further examinations revealed other pathology. These cases together with several suggested diagnostic modalities are discussed in this paper.

Sialadenitis following radioiodine therapy - a new diagnostic and treatment modality.

OBJECTIVES: To explore the usage of salivary gland endoscope technique as a diagnostic tool as well as a novel treatment modality for sialadenitis following radioiodine therapy. SUBJECTS AND METHODS: Fifteen patients suffering from sialadenitis of the major salivary glands after I131 therapy for thyroid carcinoma underwent a single procedure of sialoendoscopy under local anesthesia. RESULTS: All the patients were free of sialadenitis after one sialoendoscopy procedure with no complications accompanied. CONCLUSIONS: Sialoendoscopy is an efficient technique with low morbidity as well as a relatively simple surgical method for diagnosing and treating sialadenitis induced by radioiodine therapy for thyroid cancer patients.

Penetrating grease gun injury in the face.

We present the case of a sailor who sustained a penetrating grease gun injury to his face, and the challenging subsequent series of events.

[Future therapy strategies for salivary gland impairment].

Saliva offers many modalities, mainly protecting the oral tissues by maintaining a local healthy environment. Several conditions cause salivary gland secretion impairment, in which irradiation therapy to the head and neck cancer patients is one of the most rigorous, leading to major decline in quality of life. At present, conventional therapy provides a limited answer for this situation. In the last two decades, several strategies had been proposed to overcome this problem. These approaches can be divided into three branches: 1. Preventing salivary gland damage before irradiation therapy. 2. Protecting the secretory parenchymal tissue during the course of irradiation and, 3. Trying to regenerate salivary gland function after irradiation damage has already occurred. These attitudes may provide future beneficial modalities to salivary gland dysfunction especially in patients were salivary gland function is diminished.

[Nerve injury following implant placement: prevention, diagnosis and treatment modalities].

Nerve injury is a well-known complication following oral and maxillofacial surgery. Direct trauma, inflammation and infection are postoperative neural disturbances main causes. The most inflicted nerves associated with endosseous implant placement are those innervating the mandible: the inferior alveolar nerve, the mental nerve and the lingual nerve. Evaluation of the nerve injury characteristics and severity as early as possible has always imposed a great challenge for clinicians. We demonstrate a reliable yet simple way of dealing with this kind of problem in conjunction with comparing preoperative and postoperative sensation of the chin, the tongue and the lower lip. On the other hand, it is considerably important to take preventive measures for such injuries by using appropriate radiographic images. If a nerve damage has occurred, best prognosis is to be expected by early and appropriate treatment. It is imperative to treat such injuries in four months following the injury, otherwise a permanent nerve damage may occur. Further investigation of nerve damage risks following implant placement should be performed in order to enable patient to decide whether having implants dependent rehabilitation or choosing an alternative.

Harnessing the osseointegration principle for anchorage of fingernail prostheses.

On the basis of this preliminary report series of patients, it seems that the achievement of fixed anchorage for nail prostheses is feasible using the process of osseointegration, the use of standard dental implants, and abutment and maxillofacial rehabilitation laboratory to build the superstructure system. The osseointegrated procedure is relatively simple, cost-effective, and less time-consuming compared with other reconstruction techniques. Using local anesthesia and day-care facilities the operative time was only 35 minutes for the first stage and 15 minutes for the second stage. The attachment should be lifelong, as in the face. Loosening and infection are infrequent.

Autologous blood injection for treatment of recurrent temporomandibular joint dislocation.

OBJECTIVE: The purpose of this study was to reintroduce a rather simple, safe, minimally invasive, and rapid alternative procedure for the treatment of recurrent dislocation of the condyles. STUDY DESIGN: Subjects were 3 patients (5 joints) who suffered from recurrent condyle dislocation. The technique consisted of visually identifying a line from tragus to the eye angle. Then the articular fossa point was identified in this line, 10 mm anteriorly to tragus and 2 mm below the line. A 19-gauge needle was inserted at the articular fossa point. After injection of saline in the superior compartment, 5 cc of autologous blood drawn from the cubital fossa was injected (4 cc in the superior compartment and 1 cc in the pericapsular tissue). After this an elastic bandage was applied and left for the first 24 hours. Patients were advised to constrain their mandibular motion and to eat only soft foods for a week. They received cephalosporin antibiotics and nonsteroidal anti-inflammatory drugs for 7 days. A week after the procedure, supervised physiotherapy was started and the patients were encouraged to increase their mandibular opening to 40 mm. RESULTS: Postoperative recoveries were uneventful. Dislocation of condyles did not reoccur; however, patient no. 3 experienced an episode of unilateral subluxation. At follow-up all patients presented with normal mouth opening. CONCLUSION: Bleeding resulted from the introduction of a needle for injection in the pericapsular tissue. Blood coming from this wound, associated with autologous blood injected in the superior compartment, generates a bed for fibrous tissue formation in the region, creating a limitation of mandibular movement, thus ceasing dislocation of the condyles. Temporomandibular joint autologous blood injection is a simple procedure performed on an outpatient basis that we advise as an alternative treatment for patients with recurrent dislocation of the condyles.

Diagnosis and treatment of strictures and kinks in salivary gland ducts.

PURPOSE: This article describes the use of sialoendoscopy for diagnosis and treatment of strictures and kinks in the major salivary glands ducts. PATIENTS AND METHODS: Thirty-four salivary glands with obstruction were diagnosed as having ductal kinks or strictures. Strictures were diagnosed by sialography and sialoendoscopy, kinks were diagnosed mainly by sialography, whereas endoscopy was used to rule out other pathology and to locate the kink. There were strictures in 25 salivary glands (14 male and 11 females; aged 25 to 60 years), 14 in the parotid and 11 in the submandibular gland, and kinks in 9 salivary glands (5 males 4 females; aged 40 to 55 years). Seven kinks were found in the submandibular gland and 2 in the parotid. Treatment of strictures was performed by dilatation procedures with saline under pressure, balloon techniques, and forced manipulation. After these procedures, a polyethylene stent was inserted for 2 weeks. Kinks were treated by advancement ductoplasty and balloon contouring to overcome the acute angle. RESULTS: Twenty of 25 cases of stricture became completely asymptomatic in a follow-up of 8 to 36 months after treatment. In 4 cases, further revisional dilatation was needed, and in 1 case treatment failed and the gland had to be removed. All 9 cases of kinks became completely asymptomatic in a follow-up of 6 to 24 months after treatment. CONCLUSION: Strictures and kinks should be considered when salivary gland obstruction is present without sialolithiasis.

Povidone-iodine related burns.

Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in patients placed in the lithotomic position undergoing gynaecologic or urologic operations, the burn being on the buttocks, and in those undergoing orthopaedic operations, the burn being on the extremities and under a tourniquet. The basic mechanism involves irritation coupled with maceration and pressure. If the betadine solution has not been allowed to dry and has been trapped under the body of the patient in a pooled dependent position, such as the buttocks or under a tourniquet, the solution may irritate the skin and result in a skin burn. The irritation coupled with pressure leads to a situation analogous to that seen in the development of an acute accelerated decubitus ulcer; irritation, maceration, friction and pressure compounding each other to result in a skin burn or superficial ulcer in the skin. Our experience with three illustrative patients who presented with various burns following exposure to povidone-iodine (betadine) is described below.

Pediatric sialolithiasis.

Pediatric sialolithiasis is a rare condition. This article characterizes 15 cases in children between 5 and 14 years of age. The diagnoses of this condition were made with routine radiograph and ultrasound, as well as with sialography whenever possible. Sialoendoscopy was performed as a diagnostic and treatment modality. Thirteen of the 15 affected children were boys, and 12 of 15 cases occurred in the submandibular gland. We were able to diagnose 67% by our imaging methods; the remainder were diagnosed by clinical examination.

Minimally invasive orthognathic surgery: endoscopic vertical ramus osteotomy.

The endoscopic procedure for placement and activation of a distraction device for mandibular advancement has been previously reported. The purpose of this study was to demonstrate the feasibility of endoscopic exposure, dissection and osteotomy for mandibular set-back. Two cadaver and three anesthetized minipigs were used in this study. Access to the mandibular ramus was achieved through a 2.0 cm submandibular incision. The dissection was carried sharply to the mandible and completed in the subperiosteal plane. Visualization was achieved using a 2.7 mm diameter endoscope (Karl Storz, Germany). Landmarks were identified and a custom-made retractor was inserted into the sigmoid notch. A vertical ramus osteotomy was created (bilaterally) from the sigmoid notch to the mandibular angle. The mandible was set back (average 6 mm) and fixed using 2.0 mm diameter, bicortical screws. Live animals were sacrificed three weeks postoperatively. The mandibles were examined clinically and radiographically to verify proper osteotomy position and clinical union. In all animals, exposure, accurate identification of landmarks, osteotomy placement and screw fixation were achieved. In the live animals (n=3), union between the proximal and distal segments was documented by clinical and radiographic examination. This study demonstrates the feasibility of the EVRO procedure for mandibular set-back in a minipig model.