Myofibroma of the body of mandible: A case report of a solitary lesion.

Myofibromas are rare benign lesions and are often found as solitary entities. The treatment of the lesion is complete excision and the recurrence is rare. A 56-year-old female presented to the Oral and Maxillofacial Surgery clinic for further evaluation and management of a solitary lesion of the right body of the mandible that was first noticed incidentally by her referring dentist. An incisional biopsy was first performed in the clinic with the diagnosis of myofibroma. The patient was then treated with complete excision of the lesion and extraction of the adjacent teeth. The final biopsy report confirmed the initial diagnosis of myofibroma. Intraosseous solitary lesion of the mandible is a rare lesion with a handful of reported cases. Uniquely, the diagnosis of myofibroma in this 56-year-old is the oldest reported case of myofibroma. There are distinct histopathological features of the lesion that distinguishes this entity from other closely resembling lesions.

Role of alloplastic reconstruction of the temporomandibular joint in the juvenile idiopathic arthritis population.

We present outcomes following total joint replacement of the temporomandibular joint (TMJ) in adolescent and young adult patients with juvenile idiopathic arthritis (JIA), and discuss a multidisciplinary treatment model. A retrospective review was performed of patients presenting to the University of North Carolina Oral and Maxillofacial Surgery Service (Chapel Hill, NC) from 2016- 2018 who underwent unilateral or bilateral total replacement of the TMJ for a diagnosis of end-stage joint disease secondary to JIA. Inclusion criteria included diagnosis by a rheumatologist, presentation to our department in adolescence (under 18 years of age), surgical intervention in adolescence or young adulthood (under 25 years of age), and documentation of preoperative and postoperative pain, maximum incisal opening (MIO), and quality of life measures. A database was created and data were then analysed both qualitatively and quantitatively. Five patients met the inclusion criteria. All achieved MIO of more than 35mm with a mean improvement of 24mm, and were able to tolerate a regular diet. All preoperative pain had essentially been eliminated. All patients reported a considerable improvement in quality of life. To our knowledge, this is the first report to document a series of paediatric and young adult patients with JIA who required total replacement of the joint for end-stage joint disease. To our knowledge, it is also the first to describe the use of a collaborative clinic of oral and maxillofacial surgeons, neuroradiologists, dental radiologists, orofacial pain specialists, paediatric rheumatologists, and paediatric nurse practitioners, to care for these patients.

Ultrasound versus magnetic resonance imaging of the temporomandibular joint in juvenile idiopathic arthritis: a systematic review.

A systematic review of published articles on ultrasound (US) and magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) in juvenile idiopathic arthritis (JIA) was performed to answer the question "What is the sensitivity and specificity of US as compared to MRI in diagnosing acute and chronic joint changes in patients with JIA?" The most recent evidence was sought in published articles via a search of the PubMed, Ovid, and Embase databases. Article appraisal was performed by two reviewers. Nineteen articles reporting prospective or ambispective studies comparing US to MRI in TMJ imaging were found. Six of these articles were specific to JIA patients. The heterogeneity of these articles made comparison difficult. Of the acute and chronic changes assessed (disk displacement, joint effusion, bony deformity), only joint effusion was appropriately assessed by multiple authors, with US having a sensitivity of 0-72% and specificity of 70-83% as compared to MRI. There was a paucity of studies specific to JIA, with many studying adult, non-rheumatic patients. This systematic review found that dynamic imaging with high-resolution US improves sensitivity and specificity compared to static, low-resolution US. Additionally, there is evidence to suggest that US imaging following a baseline MRI can increase US sensitivity and specificity and may have a future role in disease surveillance.

Quality of life: patient-reported outcomes after total replacement of the temporomandibular joint.

Since publication of the UK guidelines on total replacement of the temporomandibular joint (TMJ) in 2008 by the British Association of Oral and Maxillofacial Surgeons (BAOMS), pain scores, mouth opening, and diet have been used as markers of success. We have looked at quality of life (QoL) as another. We analysed the data from a single surgeon on patients who had had joints replaced and devised a questionnaire to find out about the subjective, functional, psychological, and social aspects of TMJ disease. A total of 18 patients who had the same operation were included (mean (range) age 50 (33 - 73) years, mean (range) follow up 30 (18 - 48) months). Jaw function and facial aesthetics had improved, and patients needed less analgesia. Overall, they reported a better QoL with improvements in mood and social interaction, and the activities of daily life were easier. The NHS uses QoL questionnaires to measure success in fields such as orthopaedic surgery, but currently we know of no nationally accepted questionnaire that measures success after total replacement of the TMJ.

Eagle's syndrome after fracture of the elongated styloid process.

A case is reported of a patient presenting to clinic after a sudden spontaneous 'cracking' sensation in the jugulo-digastric region. This proved, following clinical and radiological investigation, to be a fractured elongated styloid process(ESP). This extraordinary presentation of Eagle's syndrome has not previously been published.

Psychological characteristics of women who require orthognathic surgery: comparison with untreated controls.

Improvement in appearance is an important motivation for orthodontic treatment and orthognathic surgery, and two possible underlying causes are objective physical abnormalities, or the patient's personality type that leads them to concentrate on their appearance and request unnecessary interventions. Questionnaires that measure personality traits were given to 30 women who required orthognathic operations, and a control group of 30 other women. Traits measured were: satisfaction with the appearance of the face, head, and body; tendency to compare their appearance with that of others; the extent to which they are aware of their appearance and how they thought they should look; sense of self identity; depression; anxiety; and self-esteem. The only difference between patients and controls was that patients were more dissatisfied with their facial appearance than the others. Orthognathic patients were psychologically normal except that they had more dissatisfaction with their facial appearance. As this was the only difference, it is likely that their desire for operation was caused by a genuine physical abnormality rather than a perceived exaggerated aesthetic problem. It seems, therefore, that any patient who seeks orthognathic treatment because they have a personality that causes them to dwell on their appearance (which may lead them to hold unrealistic expectations of intervention) are screened out of the process before they begin treatment.

Effect of 1- and 10-day administration of tepoxalin on minimum alveolar concentration of isoflurane and sevoflurane in dogs.

Analgesics given preoperatively have the potential to decrease the amount of inhalant anesthetics required intraoperatively (i.e., to decrease the minimum alveolar concentration, or MAC, for the inhalant). Tepoxalin is an NSAID approved for the treatment of arthritis in dogs in the United States and, hence, could be administered to patients undergoing anesthesia. In this study, administration of a single dose or a 10-day course of tepoxalin did not affect the MAC for isoflurane or sevoflurane.

Ultra-high resolution array painting facilitates breakpoint sequencing.

OBJECTIVE: To describe a considerably advanced method of array painting, which allows the rapid, ultra-high resolution mapping of translocation breakpoints such that rearrangement junction fragments can be amplified directly and sequenced. METHOD: Ultra-high resolution array painting involves the hybridisation of probes generated by the amplification of small numbers of flow-sorted derivative chromosomes to oligonucleotide arrays designed to tile breakpoint regions at extremely high resolution. RESULTS AND DISCUSSION: How ultra-high resolution array painting of four balanced translocation cases rapidly and efficiently maps breakpoints to a point where junction fragments can be amplified easily and sequenced is demonstrated. With this new development, breakpoints can be mapped using just two array experiments: the first using whole-genome array painting to tiling resolution large insert clone arrays, the second using ultra-high-resolution oligonucleotide arrays targeted to the breakpoint regions. In this way, breakpoints can be mapped and then sequenced in a few weeks.

Preliminary assessment of skeletal stability after sagittal split mandibular advancement using a bioresorbable fixation system.

We studied skeletal stability during the first year after mandibular advancement and fixation with bioresorbable self-reinforced poly-L-lactide (SR-PLLA) screws in 11 patients by cephalometric measurements. We compared these with a cohort of 11 patients, in whom titanium screws were used for fixation. We found no significant difference between the two groups in the median preoperative cephalometric values and the median changes after operation. There was also no significant difference between the two groups regarding the median extent of relapse 1-year after operation. We conclude that bioresorbable SR-PLLA screws are comparable to metallic screws for fixation of bone after sagittal split mandibular advancement.

A multisite case report on the clinical use of sevoflurane in dogs.

The purpose of this report was to evaluate the clinical safety and efficacy of sevoflurane as an inhalant anesthetic in dogs. Subjective and objective data from 196 clinical cases utilizing sevoflurane as the maintenance anesthetic was collected at three sites. After preanesthetic evaluation, the attending anesthesiologist assigned the dogs to one of the following six anesthetic protocols: protocol 1, oxymorphone premedication and thiopental induction; protocol 2, oxymorphone/acetylpromazine premedication and thiopental induction; protocol 3, xylazine/butorphanol premedication and thiopental induction; protocol 4, opioid premedication and propofol induction; protocol 5, optional premedication and mask induction with sevoflurane in oxygen; and protocol 6, optional premedication and optional induction. The average quality of induction, maintenance, and recovery was good to excellent in all protocols. The three most common side effects during maintenance and recovery were hypotension, tachypnea, and apnea. Sevoflurane produces anesthesia in dogs comparable to the other inhalation anesthetics currently used (i.e., halothane and isoflurane) for diagnostic or therapeutic procedures.

Pharmacokinetics of phenylbutazone and its metabolite oxyphenbutazone in miniature donkeys.

OBJECTIVE: To describe the pharmacokinetics of phenylbutazone and oxyphenbutazone after IV administration in miniature donkeys. ANIMALS: 6 clinically normal miniature donkeys. PROCEDURE: Blood samples were collected before and 5, 10, 20, 30, 45, 60, 90, 120, 180, 240, 300, 360, and 480 minutes after IV administration of phenylbutazone (4.4 mg/kg of body weight). Serum was analyzed in triplicate by use of high-performance liquid chromatography for determination of phenylbutazone and oxyphenbutazone concentrations. The serum concentration-time curve for each donkey was analyzed separately to estimate model-independent pharmacokinetic variables. RESULTS: Serum concentrations decreased rapidly after IV administration of phenylbutazone, and they reached undetectable concentrations within 4 hours. Values for mean residence time ranged from 0.5 to 3.0 hours (median, 1.1 hour), whereas total body clearance ranged from 4.2 to 7.5 ml/kg/min (mean, 5.8 ml/kg/min). Oxyphenbutazone appeared rapidly in the serum; time to peak concentration ranged from 13 to 41 minutes (mean, 26.4 minutes), and peak concentration in serum ranged from 2.8 to 4.0 mg/ml (mean, 3.5 microg/ml). CONCLUSION AND CLINICAL RELEVANCE: Clearance of phenylbutazone in miniature donkeys after injection of a single dose (4.4 mg/kg, IV) is rapid. Compared with horses, miniature donkeys may require more frequent administration of phenylbutazone to achieve therapeutic efficacy.

The use of halothane gas to identify turkeys prone to developing pale, exudative meat when transported before slaughter.

Halothane screening has been used in the swine industry to identify animals susceptible to stress and prone to developing pale, soft, exudative (PSE) meat. This study evaluated the ability of halothane to identify stress-susceptible turkeys prone to developing PSE meat when reared to market age and transported before slaughter. Male Nicholas turkeys (n = 1,286) were exposed to 3% halothane for 5 min at 4 wk of age in two trials. Birds were classified as halothane sensitive (HAL+) or halothane nonresponder (HAL-), in which HAL+ birds showed signs of muscle rigidity in the legs upon removal from halothane gas, and HAL- birds showed no stiffness response. Approximately 3.5% (45) of the turkeys were HAL+. All HAL+ birds and an equal number of HAL- birds were grown until 20 wk of age. Immediately prior to slaughter, all birds were transported in coops on a flatbed trailer for 2 h and then immediately slaughtered upon arrival at the processing plant. Breast muscle pH (0, 1.5, and 24 h postmortem) and L* value (1.5 h and 24 h postmortem) were measured on the fillets. Drip loss and cook loss were also determined on marinated and nonmarinated breast fillets from each carcass. There were no significant mean differences in any parameter measured between the HAL+ and HAL- turkeys. However, the HAL+ turkeys had a greater percentage of fillets with L* values >51 compared with the HAL- turkeys. These results suggest that either halothane response is only a limited predictor of PSE meat in turkeys or that transportation is not an appropriate stressor to induce the PSE condition.

The development of pale, exudative meat in two genetic lines of turkeys subjected to heat stress and its prediction by halothane screening.

Previous research has indicated that seasonal-type heat stress (HS) can contribute to the development of pale, soft, exudative (PSE) meat in fast-growing turkeys and that halothane exposure may identify stress-susceptible animals. This study evaluated the ability of halothane screening to identify stress-susceptible birds prone to developing pale, exudative meat when reared to market age. Two lines of turkeys (n = 292), one selected for rapid overall growth (BODY) and the other for large breast muscle yield (BREAST), were exposed to 3% halothane for 5 min at 2 to 4 wk of age and were raised together until 16 wk of age. Approximately 10% of both BODY and BREAST birds were sensitive to halothane. Between 16 and 20 wk, all of the halothane sensitive (HAL+) and half of the halothane nonresponders (HAL-) were exposed to an HS environment of 30 to 36 C (night/day), whereas the other half of the HAL- birds were kept at an ambient temperature of 13 to 21 C (night/day). All birds were slaughtered at 20 wk of age, and samples were collected for pH, L* value, drip loss, cooking loss, and shear value. The BREAST strain had 5% greater breast percentage than the BODY strain, and there were no differences in ready-to-cook yields between any treatments. The HAL+ HS birds had significantly lower muscle pH (0 h) and significantly higher L* values at 2 h postmortem compared with HAL- HS birds in the BREAST strain; however, there was no difference in L* value at 24 h postmortem. The HAL- HS birds had significantly lower muscle pH (0 h and 2 h) and significantly higher L* values at 2 h postmortem compared with HAL- controls in the BODY strain. The HAL- HS BREAST birds had significantly higher drip loss than HAL- controls. No differences in shear value were found among any treatments. The incidence of PSE (2-h L* values >52) was significantly higher in HAL+ HS birds (34.7%) compared with HAL- HS birds (13.4%). These results suggest that halothane sensitivity early in life is associated with HS susceptibility and the development of pale meat when birds are slaughtered at market age. These results also suggest that halothane screening may be better at predicting the development of PSE meat during HS in the strain selected for large breast yield rather than rapid overall growth.