[Dizziness and nausea following implant placement]. / Duizeligheid en nausea na het plaatsen van implantaten.

A patient suffered from episodes of dizziness and nausea immediately after the placement of 4 implants in his edentulous maxilla. During the treatment implant drills and osteotomes had been used. During the following 6 months, the complaints disappeared gradually. The presentation fitted the not very well-known diagnosis traumatic labyrinthine concussion. Before treating patients with oral implants in the maxilla, it is necessary to inform them about this potential invalidating complication. The complication can be prevented by using a screw-type bone spreader, which renders the use of a surgical hammer unnecessary.

[Cheek paresthesia by an osteosarcoma]. / Paresthesie van de wang door een osteosarcoom.

A 21-year-old woman was referred by the dental practitioner to an oral surgeon concerning a hard elastic swelling of the left cheek in combination with local paresthesia. Histopathologic and radiographic examination revealed an osteosarcoma in the left segment of the maxilla. Subsequently, the patient was referred to a medical centre for head and neck oncology. The treatment consisted of 3 courses neoadjuvant chemotherapy, followed by radical surgical resection of the tumor, and 3 courses adjuvant chemotherapy. One year after treatment, there was no sign of local tumor recurrence or metastases. An osteosarcoma is a malignant tumor of bone forming cells. About 10% of osteosarcomas are appearing in the head and neck region, primarily in the mandible and the maxilla. The treatment of choice is adequate surgical removal. Treatment with (neo)adjuvant chemotherapy seems to have additional benefit, but this needs further research.

[A patient with glossopharyngeal neuralgia: a (un)known trap]. / Een patiënt met glossofaryngeusneuralgie: een (on)bekende valkuil.

A man visited the dentist regularly during the past 6 years with a complaint about severe pain. Treatment met with uneven success. The patient now complained about severe, radiating pain which resulted from contact between the tongue and the bridge. The teeth that seemed to be involved were inspected and, after diagnostic testing, restoratively and endodontically treated. When the pain persisted, an oral and maxillofacial surgeon was consulted; the surgeon diagnosed the problem as a glossopharyngeal neuralgia. The neuralgia was treated with carbazamzepine, after which the pain diminished. Pain that seems to be pulpitis pain may be caused by a neuralgia, in this case a glossopharyngeal neuralgia. Triggers for the pain can be swallowing, chewing, talking, coughing or yawning. Although the incidence is low, when pain persists after initial treatment, a (glossopharyngeus) neuralgia should be seriously considered.

Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months.

Insertion of endosseous implants in the atrophic maxilla is often complicated because of lack of supporting bone. Augmentation of the floor of the maxillary sinus with autogenous bone graft has been proven to be a reliable treatment modality, at least in the short term. The long-term clinical and radiographic outcome with regard to the grafts, the implants and satisfaction of the patients with their implant-supported overdenture was studied in 99 patients. The sinus floor was augmented with bone grafts derived from the iliac crest (83 subjects, 162 sinuses, 353 implants), the mandibular symphysis (14, 18, 37), or the maxillary tuberosity (2, 2, 2). Before implant installation, the width and height of the alveolar crest were increased in a first stage procedure in 74 patients, while in the other 25 patients augmentation and implant installation could be performed simultaneously (width and height of the alveolar crest >5 mm). Perforation of the sinus membrane occurred in 47 cases, which did not predispose to the development of sinusitis. Loss of bone particles and sequestration were observed in one (diabetic) patient only, in whom a dehiscence of the oral mucosa occurred. A second augmentation procedure was successful in this patient. Symptoms of transient sinusitis were observed in 3 patients. These symptoms were successfully treated with decongestants and antibiotics. 2 other patients developed a purulent sinusitis which resolved after a nasal antrostomy. In all cases, the bone volume was sufficient for implant insertion. 32 of 392 inserted Brånemark implants (8.2%) were lost during the follow-up. After the healing period of the bone grafts, no sinus pathology was observed. The patients received implant-supported overdentures (72 patients) or fixed bridges (27 patients). Overall, the patients were very satisfied with the prosthetic construction. We conclude that bone grafting of the floor of the maxillary sinus floor with autogenous bone for the insertion of implants is a reliable treatment modality with good long-term results.

[Interface between dentistry and otorhinolaryngology]. / Raakvlakken tussen tandheelkunde en KNO-heelkunde.

In this paper some relevant pathological aspects on the interface of dentistry and ENT surgery are discussed. A major part of the field of ENT surgery is not available for direct inspection and/or evaluation. Therefore, ENT pathology is often overseen or not detected at an early stage. Because of frequent patient-dentist contact, also in healthy patients, dentists can play an important role in early detection of ENT pathology. The combination of specific anatomic knowledge of the ENT region and a proper anamnesis are potent tools for a dentist to suspect ENT pathology, even in not easily accessible areas like the hypopharynx and oesophagus.

Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants.

Placement of endosseous implants in the atrophic maxilla is often limited because of a lack of supporting bone. A technique to augment the floor of the maxillary sinus with autogenous bone graft seems to be a new reliable treatment modality. The morbidity and complication rate of augmentation of the maxillary sinus floor was studied in 75 patients. The sinus floor was augmented with iliac crest (n = 65, 128 sinuses, 276 implants), mandibular symphysis (n = 8, ten sinuses, 21 implants), or maxillary tuberosity grafts (n = 2, two sinuses, two implants). The width of the alveolar crest had to be reconstructed in 52 patients, while in the other 23 patients augmentation and implantation were performed simultaneously. Perforation of the sinus membrane occurred in 45 patients, but this did not predispose them to the development of sinusitis. Loss of bone particles and sequesters were observed in one (diabetic) patient only, in whom a mucosal dehiscence occurred. A second augmentation procedure was successful. Symptoms of transient sinusitis were observed in two of the seven patients with a predisposition for sinusitis. These symptoms were successfully treated with decongestants and antibiotics. One patient developed a purulent sinusitis which resolved after a nasal amrostomy. The bone volume was sufficient for insertion implants in all patients. Twenty of 299 patients (6.7%) in whom Brånemark implants had been inserted were lost to follow-up (mean, 32 months); no sinus pathology was observed. The patients received implant-supported overdentures (58 patients) or fixed bridges (17 patients) and experienced no complaints with regard to the grafts or implants. We conclude that the morbidity and complication rate of bone grafting of the floor of the maxillary sinus floor with autogenous bone is low.

Maxillary sinus function after sinus lifts for the insertion of dental implants.

PURPOSE: The influence of bone augmentation of the floor of the maxillary sinus for the insertion of dental implants on sinus function has not been well investigated. In this study, the influence of the sinus lift on the development of maxillary sinus pathology was evaluated using generally accepted diagnostic criteria. MATERIAL AND METHODS: A group of 45 patients in whom a sinus lift procedure had been performed were evaluated for sinus pathology 12 to 60 months after bone transplantation and implant insertion, using a questionnaire, conventional radiographic examination, and nasoendoscopy. RESULTS: Postoperative maxillary sinusitis was detected in two of five patients with a predisposition for sinusitis, but in none of the other 40 patients. The occurrence of iatrogenic sinus membrane perforations during surgery was not related to the development of postoperative sinusitis in patients with healthy sinuses. CONCLUSION: The occurrence of postoperative chronic sinusitis appears to be limited to patients with a predisposition for this condition. These predisposing factors need to be considered when evaluating patients for sinus lift procedures.

[Angioedema due to medication treatment]. / Angio-oedeem door medicijngebruik.

Patients with hypertension can be treated by inhibition of angiotensin-converting enzyme (ACE). A major side-effect of the use of ACE-inhibitors is the development of a life threatening dyspneu by angioedema of oropharyngeal and laryngeal tissue. This severe complication is caused by interaction of ACE-inhibitors with prostaglandin and bradykinin metabolisms. Minor manifestations of angioedema can be followed by severe reactions. It is wise to stop ACE-inhibitors immediately.

[Peripheral facial nerve palsy]. / Perifere nervus facialis-paralyse.

There are different etiological factors concerning the acute peripheral facial nerve palsy. In the majority of the cases, however, no etiological factor can be found. These cases are called idiopathic facial palsy or Bells palsy. Perhaps local anaesthetics could play a role as an etiological factor. By means of a case-report this form of facial nerve palsy will be discussed.