Proinflammatory cytokines levels in patients with temporomandibular joint disorder undergoing arthroscopy.

PURPOSE: Biomarkers represent objective indicators of normal processes, pathology, or responses to therapeutic intervention. The purpose of this study is to evaluate the levels of proinflammatory cytokines in synovial fluid of the temporomandibular joint (TMJ) and to investigate whether there is a correlation between elevated levels and disease progression. MATERIALS AND METHODS: This is a prospective study that included patients who were diagnosed with internal derangement according to magnetic resonance imaging and were classified according to Wilkes's classifications. After failing to improve with conservative treatment, they were referred for TMJ arthroscopy. During arthroscopy, synovial fluid was collected for biomarker analyses that included the investigation of levels of proinflammatory cytokines: tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and vascular endothelial growth factor (VEGF). The Mann-Whitney U test was used for differences between subgroups for TNF-α, IL-6, and VEGF. RESULTS: During the study period, 22 patients presented with a TMJ disorder and met the criteria of the study. There was a statistically significant correlation between the levels of VEGF, TNF-a, and osteoarthritis (P < 0.05). There was also a statistically significant correlation between TNF-a levels and a higher degree of chondromalacia (P = 0.019). CONCLUSION: An increase in inflammatory cytokines coupled with chondromalacia propose a more aggressive degenerative disease.

Craniofacial Injuries Seen Among Electric-Motorized Bicycle Riders.

The popularity of electric-motorized bicycles (E-bikes) has increased dramatically over the past few years. As a result, E-bike--associated injuries are quickly becoming a substantial issue. The aim of the present study was to evaluate the epidemiology and general nature of these injuries, with special attention to craniofacial trauma. This was a retrospective study of 84 E-bike riders who suffered from trauma and treated at our level 1 trauma center between the years 2014 and 2018. The information consisted of demographics, characteristics of injury, Injury Severity Score, and number of hospitalization days.Regarding craniofacial trauma, the mean age was 22.7 years. Data about helmet usage was missing. The most common cause of injuries in maxillofacial region, was falling (80%). The most prevalent injury in the maxillofacial region was fractures of the zygomatic complex with the orbit (33%) and soft tissue lacerations.There is little data regarding craniofacial trauma attributed to electric-motorized bicycle accidents. In Israel there are a lot of young adults and teenagers that use E-bikes as an economical solution for mobility. Education regarding road behavior and the proper use of protective measures such as wearing a helmet can reduce significantly overall injuries and cranio-facial trauma in particular.

Endoscopically Assisted Open Reduction and Internal Fixation of Sub-Condylar Fractures: Debunking Some of the Myths.

Endoscopically assisted open reduction and internal fixation has cumulate advantages over both open and closed techniques. Even though, this approach had not become popular. The study intended to summarize the outcomes and complications from the first 12 consecutive cases of sub condylar fractures that treated by endoscope and trans-buccal trocar. All patients experienced improvement in mouth opening. No postoperative malocclusion was noticed. The learning curve was assessed subjectively regarding the use of the endoscope and objectively by operating time reduction. The significant decrease in operating time and the ease of handling the endoscope were already noticed after the 5th operation. The mean time for endoscopically assisted open reduction and internal fixation in our study was 180 minutes, which was the same as for external approaches open reduction and internal fixation for sub-condylar fracture cases. No special designed instruments except an endoscope and a trans-buccal trocar were used. We can conclude that the learning curve for this technique is not as steep as it was thought to be, and it can be mastered after a relatively small number of operations. There is no difference in mean operation time comparing to external approaches. No need for special designed instruments.

A novel treatment of temporomandibular joint arthritis as a complication in familial Mediterranean fever-literature review and a case report.

OBJECTIVES: Articular involvement in familial Mediterranean fever (FMF) ranges between 40 and 70% of the patients. Involvement of temporomandibular joint (TMJ) in FMF is very rare, and only a few cases have been reported in the literature. There are no specific guidelines for treatment. We hereby present a new treatment for TMJ inflammation in FMF. MATERIALS AND METHODS: A literature search was performed using PubMed according to the following criteria: key terms included in the search were FMF arthritis, TMJ involvement in FMF patients, and arthroscopy in FMF patients. All keywords were included both as medical subject headings (MeSH) terms and text words. Selections were limited to the English language. RESULTS: Literature search yielded four reported cases of TMJ involvement in FMF patients. The four cases were treated differently, with no clear guidelines for management of TMJ involvement. Our patient suffered from painful swelling and redness over the involved TMJ area and severe trismus. She was treated by arthroscopic lysis and lavage of her TMJ followed by aggressive physiotherapy resulting to improvement of her mouth opening. CONCLUSIONS: The adverse effect of TMJ arthritis in FMF patients can be avascular necrosis and destruction of the mandibular condylar head. TMJ arthroscopy allows lysis and lavage of the joint with minimal operative and postoperative complication, resulting with satisfactory results. Thus, in case of TMJ arthritis in FMF, we recommend TMJ arthroscopy as soon as possible, following aggressive physiotherapy in order to gain normal mouth opening. CLINICAL RELEVANCE: FMF rates have been described among the Mediterranean and Middle Eastern population ranging from 1:5 to 1:3; thus, TMJ involvement due to the disease is not so rare in this region, and a clear treatment protocol is needed.

Lipoid proteinosis unveiled by oral mucosal lesions: a comprehensive analysis of 137 cases.

OBJECTIVES: Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by deposits of hyaline material within skin and mucous membranes of the upper aerodigestive tract, especially the vocal cords. We aimed to investigate possible associations between oral LP (oLP) manifestations and demographic data and extra-oral lesions. MATERIAL AND METHODS: Cases of oLP were collected following a systematic search of Medline's PubMed and Google Scholar (1948-2014). We added four new cases. Demographic data, consanguineous marriage status, oral lesion site(s), and related symptoms were analyzed for potential associations. RESULTS: A total of 137 patients with oLP lesions were analyzed. Parental consanguinity status was known for 52 patients, and the parents were not related in 38 (73%) of them. The tongue was the most commonly affected oral site (68%), and it was associated with significantly more affected family members (P = 0.002). The palate and gingiva were the least involved sites (25 and 6%, respectively): the former had a tendency to be affected in younger patients and the latter in older ones. Patients with palatal and labial lesions had significantly less skin scarring (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Extra-oral manifestations are easily recognizable and they can lead to early and accurate diagnosis of LP. In spite of early voice manifestations, diagnosis of LP might be obvious only later in life and usually sought due to presence of oral lesions. CLINICAL RELEVANCE: The diagnosis of oLP with obscure extra-oral signs is challenging, with dental surgeons playing a key role in its establishment.

Coronectomy of the mandibular third molar: a retrospective study of 185 procedures and the decision to repeat the coronectomy in cases of failure.

PURPOSE: A prevalent complication associated with mandibular third molar extraction is inferior alveolar nerve (IAN) injury. This study evaluated the success rate of coronectomy and, in the event of failure of the procedure, retreatment. PATIENTS AND METHODS: One hundred seventy-three patients underwent 185 coronectomy procedures of the mandibular third molar to prevent IAN injury. The coronectomy was performed along the cementoenamel junction. Residual roots were trimmed 3 to 4 mm below the crest margin. No pulp treatment was performed and the roots were left vital. A postoperative orthopantogram was recorded immediately after the procedure or at follow-up 1 month later. Two additional orthopantographic views were taken at 6- and 12-month follow-up appointments. Statistical analyses were performed to assess differences in root migration, pain, wound healing and failure by age, gender, and time elapsed from coronectomy. Statistical data were considered significant at a P value less than .05. RESULTS: Statistical differences in the migration of residual roots from 6 to 12 months were found. Migration of the roots was found in younger patients. In a total of 10 cases of failure, 4 were treated with repeat coronectomy. The other 6 cases were treated with reoperation (ie, removal of residual roots). CONCLUSION: Immediate postoperative radiographic imaging is recommended, as well as, follow-up evaluation 12 months after surgery. In addition, repeat coronectomy is recommended for cases in which enamel retention is diagnosed to prevent residual roots from becoming infected.

Operation room tool handling and miscommunication scenarios: an object-process methodology conceptual model.

OBJECTIVE: Errors in the delivery of medical care are the principal cause of inpatient mortality and morbidity, accounting for around 98,000 deaths in the United States of America (USA) annually. Ineffective team communication, especially in the operation room (OR), is a major root of these errors. This miscommunication can be reduced by analyzing and constructing a conceptual model of communication and miscommunication in the OR. We introduce the principles underlying Object-Process Methodology (OPM)-based modeling of the intricate interactions between the surgeon and the surgical technician while handling surgical instruments in the OR. This model is a software- and hardware-independent description of the agents engaged in communication events, their physical activities, and their interactions. The model enables assessing whether the task-related objectives of the surgical procedure were achieved and completed successfully and what errors can occur during the communication. METHODS AND MATERIAL: The facts used to construct the model were gathered from observations of various types of operations miscommunications in the operating room and its outcomes. The model takes advantage of the compact ontology of OPM, which is comprised of stateful objects - things that exist physically or informatically, and processes - things that transform objects by creating them, consuming them or changing their state. The modeled communication modalities are verbal and non-verbal, and errors are modeled as processes that deviate from the "sunny day" scenario. Using OPM refinement mechanism of in-zooming, key processes are drilled into and elaborated, along with the objects that are required as agents or instruments, or objects that these processes transform. The model was developed through an iterative process of observation, modeling, group discussions, and simplification. RESULTS: The model faithfully represents the processes related to tool handling that take place in an OR during an operation. The specification is at various levels of detail, each level is depicted in a separate diagram, and all the diagrams are "aware" of each other as part of the whole model. Providing ontology of verbal and non-verbal modalities of communication in the OR, the resulting conceptual model is a solid basis for analyzing and understanding the source of the large variety of errors occurring in the course of an operation, providing an opportunity to decrease the quantity and severity of mistakes related to the use and misuse of surgical instrumentations. Since the model is event driven, rather than person driven, the focus is on the factors causing the errors, rather than the specific person. This approach advocates searching for technological solutions to alleviate tool-related errors rather than finger-pointing. Concretely, the model was validated through a structured questionnaire and it was found that surgeons agreed that the conceptual model was flexible (3.8 of 5, std=0.69), accurate, and it generalizable (3.7 of 5, std=0.37 and 3.7 of 5, std=0.85, respectively). CONCLUSION: The detailed conceptual model of the tools handling subsystem of the operation performed in an OR focuses on the details of the communication and the interactions taking place between the surgeon and the surgical technician during an operation, with the objective of pinpointing the exact circumstances in which errors can happen. Exact and concise specification of the communication events in general and the surgical instrument requests in particular is a prerequisite for a methodical analysis of the various modes of errors and the circumstances under which they occur. This has significant potential value in both reduction in tool-handling-related errors during an operation and providing a solid formal basis for designing a cybernetic agent which can replace a surgical technician in routine tool handling activities during an operation, freeing the technician to focus on quality assurance, monitoring and control of the cybernetic agent activities. This is a critical step in designing the next generation of cybernetic OR assistants.