Styloid process elongation and temporomandibular disorders: a pilot study in the Albanian population.

INTRODUCTION: Patients with an elongated styloid process (SP) presented related symptoms as deep neck pain, foreign body sensation in the throat, pain on turning the head, and odynophagia. These symptoms are the source of misdiagnosis of this syndrome since these clinical manifestations are like those of temporomandibular disorders (TMD). This study aimed to investigate a possible correlation between the TMD and elongation of the SP. MATERIALS AND METHODS: The case-control study included 60 participants between 25-60 years of age and was carried out at University Dental Clinic, Department of Maxillo-Facial Surgery, Tirana, Albania during the period November 2020 - March 2021. The study group consisted of 30 patients diagnosed with TMD (21 females and 9 males) and the control group consisted of 30 individuals without TMD (18 females and 12 males). The diagnosis of TMD was performed according to Research Diagnostic Criteria for Temporomandibular Disorders axis I and the SP measurement was performed by a single experienced examiner. The normal range of SP length was considered 20-30 mm. RESULTS: SP >30mm was found in 86.67% of patients with TMD group and 43.33% of individuals of the control group. There was a significant difference between the TMD group and the control group in regards to SP length (p <0.001). CONCLUSIONS: There is a significant association between the elongation of the SP and TMD. Dental clinicians should recognize the morphological changes in the length of SP on the panoramic radiographs, which could be a hint in the proper diagnosis of TMD.

Transfusion of Fresh Frozen Plasma in Critically Ill Patients: Effective or Useless?

BACKGROUND: Fresh frozen plasma (FFP) is widely used in critically ill patients to correct the deficiency of coagulation factors or increased INR. AIM: In the present study we aimed to evaluate the outcome of the freshly frozen plasma use as prophylaxis in ICU patients before an invasive procedure. METHODS: The study was conducted at Central Anaesthesiology and Intensive Care Service UHCT "Mother Theresa", Tirana. 136 patients were enrolled with coagulopathy with no bleeding before the invasive procedure, from June 2016 to December 2016. A group of 75 patients underwent a median volume of 12.5 ml/kg FFP given, and 61 had no transfusion. Data were collected on demographics, the severity of illness measured by APACHE III scores, INR, medication use, hemodynamic data. RESULTS: From 136 patients with coagulopathy with no bleeding who underwent planned invasive interventions, 75 [55%] received FFP, vs 61 [45%] p = 0.04 who did not receive. Overall, the median FFP dose was 12.5 ml kg-1. Median INR level in FFP and non-FFP groups was respectively 3.1 (1.9-4.8) and 3.5 (1.8-5.2). INR was corrected in 24 of 75 (32%) of those who received a transfusion. The frequency of minor bleeding episodes was 9.3% in transfused patients vs 4.9% in the non-transfused group. Patients who developed an onset of acute lung injury were more frequent in the FFP group. No allergic transfusion complications were observed. Also, the median length of hospital stay [LOS] was 3.05 days vs 2.91 days and mortality rate 8.2% vs 6.5% with no significant difference between two groups. CONCLUSIONS: Freshly frozen plasma transfusions are often unnecessarily administered during an inadequate correction of the deficiencies of coagulation factors. When comparing a liberal FFP transfusion strategy vs restrictive other clinical trials are required to asses which one is the best to adopt in intensive care settings.