Oral complications associated with metal ion release from oral piercings: a systematic review.

PURPOSE: This systematic review explored dental complications associated with metal ion release from oral piercings using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. METHODS: Item retrieval from October 2022 to December 2022 from databases, such as Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Scopus and Web of Science, using predefined search terms was undertaken by two independent reviewers. Data were extracted and risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. From 1509 identified studies, 25 were included for analysis. RESULTS: Of the 25 studies, 20 included both clinical examination and questionnaire-based data. The remaining five studies were deemed low quality based on the Joanna Briggs Institute criteria. The average time piercings were worn ranged between 5 and 48 months. Most studies did not investigate complications from metal ion release. Only two studies examined the direct effects of metal ion release and showed that metal ions may cause hypersensitivity reactions and mucosal changes. Other soft tissue complications were reported, with gingival recession noted in 16 out of 25 studies, especially due to lip piercings. Studies reporting other complications were as follows: swelling (9), pain (8), infection (6), bleeding (6), inflammation (5), alterations to speech, eating and/or swallowing (5), changes to taste or metallic taste (5), and mucosal changes (4). Ten studies reported tooth chipping from tongue piercings. CONCLUSION: Oral piercings leach metal ions into surrounding tissues which may cause local mucosal changes. Furthermore, oral piercings cause damage to both soft and hard oral tissues, particularly gingival recession for lip piercings and tooth chipping for tongue piercings. Thus, to prevent such adverse injuries, dental professionals should discourage patients against oral piercings.

Emergency Facial Injuries in Athletics.

Dental and oral injuries are a common occurrence in sport. Initial evaluation should always begin with an assessment of the patient's airway, breathing, circulation, as well as identification of associated injuries. Tooth avulsions are the only true dental emergency. Oral lacerations frequently do not require repair; however, special attention should be paid to lip lacerations involving the vermillion border. Most tooth and oral lacerations can be treated on the field with urgent referral to a dentist.

An approach to a repeated self-biting tongue injury in a toddler.

BACKGROUND: Children with tongue injuries often visit the pediatric emergency department. The vast majority of cases can be conservatively treated, while some injuries require operative repair. The aim of this article was to demonstrate a "back-to-basics" approach to a refractory bifid tongue injury in a toddler. CASE DESCRIPTION: A 1-year-old toddler with a tongue injury was unsuccessfully treated three times within a week by a surgeon in another specialty; all reconstructions were mucosal only. The case was then referred to our maxillofacial unit for proper management. On examination, the recurrent injury seemed to occur because of the patient's self-biting habit. We performed the fourth reconstruction of the tongue muscles and mucosa, and because of no dental prosthetic laboratory available in our hospital, we used transparent adhesive drapes fixed by resorbable sutures to cover the patient's anterior teeth instead of bite guards. The toddler was fed via a nasogastric tube for 1 week under 2-day antibiotic prophylaxis and routine oral care. The patient was discharged without any complications 1 week later. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The causes of repeated orofacial injuries should be identified and require particular attention to establish a proper treatment. For intraoral injuries in pediatric patients, self-biting habits should not be overlooked. The application of materials in an operating theater can help the treating clinicians improve the treatment outcomes.

Lip Laceration and Vermilion Border Repair.

Lacerations to the face and lips are commonly seen in the emergency setting from dog bites, falls, and blunt trauma (motor vehicle crash, strike with an object, etc.). Lip lacerations, especially involving the vermilion border, can be most challenging and deforming, especially when greater than 25% of the lip is involved. These lacerations require preciseness for a good cosmetic outcome. Lips are a highly visible facial structure and consist of 3 layers: skin, muscle, and oral mucosa. They are used for speech, food consumption, and tactile sensation (Lammers & Scrimshaw, 2019; Lent, 2020).

Tratamento de lesão traumática em UTI: relato de caso / Treatment of traumatic injury in the ICU: case report

O objetivo desse trabalho é relatar um caso clínico de tratamento de úlcera traumática labial utilizando protetor bucal em paciente internado em uma Unidade de Terapia Intensiva. Paciente do sexo feminino diagnosticada com uma doença neurodegenerativa apresentou uma lesão de aspecto ulcerado, de aproximadamente 12 mm na mucosa do lábio inferior. O diagnóstico foi de úlcera traumática decorrente de espasmos musculares involuntários em face. O tratamento proposto foi instalação de protetor bucal confeccionado a partir de uma moldeira pré-fabricada de EVA (etil-vinil-acetato) borrachóide associado à medicação tópica a base de corticosteroide sobre a lesão. Após 5 dias foi observada cicatrização completa da úlcera, dispensando o uso do dispositivo. Nos dias seguintes de internação não foram observadas novas lesões. O protetor bucal instalado mostrou-se efetivo no afastamento do tecido traumatizado de novos traumas, protegeu os tecidos não lesionados e proporcionou qualidade de vida e segurança à paciente. Este relato reforça a importância da Odontologia na assistência do paciente crítico... (AU)

The objective of this work is to report a clinical case of treatment of traumatic lip ulcers using mouth guard in a patient admitted to an Intensive Care Unit. Female patient diagnosed with a neurodegenerative disease presented with an ulcerated lesion, of approximately 12 mm in the mucosa of the lower lip. The diagnosis was a traumatic ulcer resulting from involuntary muscle spasms in the face. The proposed treatment was the installation of a mouthguard made from a prefabricated EVA (ethyl vinyl acetate) rubber mold associated with topical corticosteroid medication on the lesion. After 5 days, complete healing oh the ulcer was observed, dispensing with the use of the intraoral device. In the following days of hospitalization, no new injuries were observed. The installed mouthguard proved to be effective in removing traumatized tissue from new traumas, protecting uninjured tissues and providing quality of life and safety to the patient. This report reinforces the importance of Dentistry in the care of critical patients... (AU)

A Strategy for Integrative Reconstruction of Midface Defects Using an Extended Forehead Flap.

Background: Midface reconstruction is challenging because the structures and deformities involved are complicated. In this study, we present a strategy for integrally reconstructing nasal and midface defects, including hair-bearing defects, using extended forehead-expanded flaps. Methods: From 2015 to 2018, a total of 22 patients with midface defects underwent reconstruction with extended forehead-expanded flaps. The far end of the expanded flap, which included scalp hair, was used to cover the upper lip defect (Type 1). In cases with large perioral defects (Type 2), we designed two separate supratrochlear artery flaps, one with a shorter pedicle for nasal reconstruction and the other with a longer pedicle for partial reconstruction. The pedicle of the longer flap was saved for upper lip recovery after pedicle interruption. Results: Among the 22 patients (13 male and 9 female), 17 were caused by burns and 5 by trauma. Nineteen patients had Type 1 defects, and three had Type 2 defects. The average postoperative follow-up was 17.6 ± 4.3 months. Patient satisfaction was excellent in most patients. Conclusions: Our extended forehead flap strategy can achieve aesthetic recovery of nasal and perioral defects with a single expansion treatment. The expanded flap can be flexibly designed to fit diverse midface defects.

Comparison of three fixation methods for orotracheal intubation in 95 adults.

BACKGROUND: The present study aimed to compare three fixation methods for orotracheal intubation. METHODS: Through literature retrieval, the effects of the adhesive/twill tape method, fixator method, and adhesive/twill tape-fixator alternation method on patients with tracheal intubation in the intensive care unit (ICU) were compared. RESULTS: The fixator and alternation methods were more effective in protecting the tongue mucosa and teeth. The alternation method was superior to the other two methods in maintaining the position of the endotracheal intubation. However, the difference in facial and lip injuries between the three methods was not statistically significant. CONCLUSION: The fixator method can significantly reduce intraoral injury and is more suitable for older people with weak tongue mucosa and loose teeth. These are worth popularizing among a wider group.

Repair of cutaneous and mucosal upper lip defects using double V-Y advancement flaps.

BACKGROUND: The repair and reconstruction of the upper lip defects should focus on the important anatomical landmarks of the upper lip. In this investigation, double V-Y advancement flaps were used to simultaneously repair the cutaneous and mucosal defects of the upper lip. It was especially suitable for young patients with tight skin and high-risk scar hyperplasia in the donor sites. OBJECTIVE: The objective was to examine the surgical outcomes following the simultaneous repairation of upper lip mucocutaneous defects using double V-Y advancement flaps. METHODS: A retrospective review of all patients with defects near the vermilion border who underwent double V-Y flaps repair from July 2014 to November 2018 was performed. Transverse V-Y advancement flaps were used to repair the cutaneous defects and longitudinal V-Y advancement flaps to repair the mucosal defects. RESULTS: Fifteen patients (six males, nine females) were retrospectively reviewed. Defects spanning the vermilion border ranged from 0.8 × 0.5 to 2.5 × 1.5 cm2 . Follow-up was for 3 months or longer. There were no perioperative complications or visible postoperative scars, and major anatomic landmarks were preserved and reconstructed. All patients were satisfied with the aesthetic outcome. CONCLUSION: Double V-Y advancement flaps are suitable for the repair of superficial mucocutaneous defects smaller than 50% of the lateral upper lip, especially for younger patients with tight skin.

Triangular Fossa Graft for Philtral Reconstruction After Facial Burns: A 34-Year Experience.

BACKGROUND: Upper lip burns and skin grafts used for the resulting deformities all contract, leading to distortion of regional tissues and producing a flattened upper lip devoid of normal anatomic landmarks. Absence of the philtral contour draws attention to the upper lip and can accentuate other reconstructive inadequacies. Philtral restoration requires a 3-dimensional reconstruction capable of resisting contractile forces to restore and maintain normal relationships between the upper and lower lips. METHODS: This was a 34-year retrospective review of a single surgeon's experience using a composite triangular fossa graft from the ear for philtral reconstruction. Ten patients were identified and analyzed using records of follow-up examinations, long-term clinical evaluations, and photographic documentation. RESULTS: Five males and 5 females were identified with 2- to 34-year follow-up. Age at operation ranged from 14 to 52 years. Percent total body surface area ranged from less than 1% to greater than 90%. Previous upper lip grafts prior to the auricular graft included 5 full-thickness skin grafts and 5 split-thickness skin grafts. No significant complications were noted. All patients were satisfied with the end aesthetic result and donor site morbidity. CONCLUSIONS: A triangular fossa composite graft restores and preserves the philtral dimple and corrects the obvious visible deformity of a featureless upper lip. Addition of tissue loosens the lip transversely, and the cartilage component provides a consistent and predictable upper lip position. This results in improved projection, a concave shape to the upper lip, and a better relationship with the lower lip. Restoration of this anatomic landmark creates a more normal-appearing upper lip and helps to minimize the negative impact of other abnormalities in this vitally important area. The overall improvement in total facial appearance can be profound.

Binky Bites and Other Oronasal Pressure Injuries.

Initial examination and exploration of childhood injuries may not lead to an obvious explanation of abuse. Although abusive oronasal injuries have been described, ones including nasal destruction are rare. We describe 4 children abused using implements that ultimately were thought to have caused significant nasal tissue destruction. In 2 of the cases, a forced pacifier placement was implicated in causing pressure injuries. In the other 2 cases, gags were part of the children's injuries. All 4 children had other findings of abuse and neglect.

Upper Lip Reconstruction With Modification for Creating a Philtrum With Single-Stage Full-Thickness Skin Graft in Burned Face Injury.

BACKGROUND: The philtrum plays an important role in determining the shape and form of the upper lip and creates individual identity. Postburn scar contracture in this area often leads to severe functional and aesthetic disfigurement. In this report, we present a novel method of philtrum reconstruction using full-thickness skin grafts (FTSGs) after burn injury. METHODS: Between August 2011 and October 2017, 8 patients with postburn philtrum deformity who underwent FTSG for replacement of the whole upper lip unit with a silastic tube for creation of the philtral dimple were included. A review of photographic documentation was used to evaluate the aesthetic results. RESULTS: The size of FTSG ranged from 4 × 9 to 6 × 17 cm. No patient had immediate postoperative complications, such as hematoma, infection, or necrosis. The crests of the ridges preserved their height and length, and the dimple remained visible after an average follow-up of 30.4 months (range, 3-69 months). All patients were satisfied with both functional and aesthetic results. CONCLUSIONS: This technique of single-stage reconstruction of the upper lip and philtrum with FTSG and silastic tube produced favorable results in the formation of the philtral ridges and the dimple. Through thoughtful preoperative design, meticulous scar release, and skin grafting, satisfactory functional and aesthetic results are achievable.

Complex Reconstruction of Nose and Upper Lip after Assault.

A 21-year male, farmer by profession, was admitted in Plastic Surgery Department via outpatient department, with amputation of nose and upper lip with the knife during resistance against robbery attempt. He was having the blockage of the right side of nostril and difficulty in mouth opening. Upper lip vermilion and mucosal reconstruction with the bilateral facial artery musculo-mucosal (FAMM) flap and moustache reconstruction was done with visor flap. Split thickness skin graft (STSG) was done over the donor site. Division and insetting of visor flap was done after two weeks. After three months, all three nasal layers were reconstructed. The inner lining was reconstructed with the turn down flap, L-strut from rib cartilage, and the outer lining with forehead flap.

Review of Risk Assessment of Major Anatomical Variations in Clinical Dentistry: Accessory Foramina of the Mandible.

Most of the studies of the mandible's anatomical variations have presented the authors' speculations, and only a limited number has provided evidence that demonstrated the actual complications injury to the variant structures caused. To our knowledge, no study has evaluated the risks associated with these variant anatomical structures' injury. We reviewed articles that described clinical cases of the injury to, and anatomical studies of, three anatomical variants of the mandible-the accessory mental, lingual, and retromolar foramina-with which dentists are relatively familiar and that are mentioned often in the context of implant and third molar surgeries, to describe risk assessment methods with which to evaluate potential complications preoperatively. Only a limited number of the clinical reports of injury to the mandible's accessory foramina were available. The potential severe complication of injury of the accessory mental foramen (AMF) is sensory disturbance of the lower lip. Risk of neurosensory disturbance of lower lip can be assessed by AMF/MF ratio and positional relations to the MF. Potential severe complication of injury of the lingual foramen is bleeding and hemorrhage in the oral cavity's floor. Risk of bleeding can be assessed by diameter and positional relation between the mental spine/mylohyoid line. A risk assessment of the retromolar foramen could not be made because of inadequate data. We hope the risk assessments suggested will encourage dentists to predict intraoperative/postoperative complications caused by damaging the mandible's accessory foramina. Clin. Anat. 32:672-677, 2019. © 2019 Wiley Periodicals, Inc.

Mucocele oral provocada por mordida acidental: relato de caso / Oral mucocele caused by accidental bite: case report / Mucocele bucal causada por la mordedura accidental: reporte de caso

Mucocele é definida como fenômeno de retenção ou extravasamento de muco. A mucocele oral é provocada por traumatismos mecânicos, que comprimem e vedam o ducto das glândulas salivares menores, impossibilitando a secreção de saliva, mesmo sua produção continuando a ocorrer, fazendo com que haja aumento de volume da glândula e ducto envolvidos. Existem várias modalidades de tratamento que incluem excisão cirúrgica da lesão, laserterapia, criocirurgia, escleroterapia, micromarsupialização, injeção intralesional de corticosteroide ou agente esclerosante, além da regressão espontânea. A remoção cirúrgica convencional das mucoceles utilizando um bisturi é considerada a opção mais comum e requer a ressecção completa da lesão e glândulas salivares menores associadas para diminuir o risco de recidiva. O presente trabalho relata um caso de excisão cirúrgica de mucocele em mucosa labial inferior causada por mordida acidental, realizada em paciente atendido na clínica de Odontologia do Centro de Saúde Odontominas, Patos/PB. Diante disso, discute sobre o diagnóstico e as diferentes terapias (cirúrgicas e não cirúrgicas) para o tratamento de mucocele. Após a remoção cirúrgica da lesão, os resultados se mostraram satisfatórios, com pós-operatório indolor, sem edema ou quaisquer outras queixas por parte do paciente. Não houveram recidivas ou aparecimento de novas lesões. A remoção completa da mucocele e glândulas salivares acessórias, bem como a ausência de recidivas, caracterizou o sucesso na abordagem do caso(AU)

Mucocele is defined as a phenomenon of retention or extravasation of mucus. The oral mucocele is caused by mechanical trauma, which compress and seal the duct of the minor salivary glands, preventing the secretion of saliva, even their production while continuing to occur, so that there is an increase of volume of the gland and ductus involved. There are several treatment modalities which include surgical excision of the lesion, laser therapy, cryosurgery, sclerotherapy, micromarsupialização, intralesional injection of corticosteroids or sclerosing agent, besides spontaneous regression. The conventional surgical removal of mucoceles using a scalpel is considered the most common option and requires a complete resection of the lesion and minor salivary glands associated to decrease the risk of recurrence. The present study reports a case of surgical excision of salivary mucocele in lower labial mucosa caused by accidental bite, held in patient in the clinic of Dentistry of the Centro de Saúde Odontominas, Patos/PB. In addition, discusses the diagnosis and the different therapies (surgical and non surgical procedures) for the treatment of mucoceles. After the surgical removal of the lesion, the results were satisfactory, with post-operative pain, without edema or any other complaints on the part of the patient. There were no recurrences or appearance of new lesions. The complete removal of the mucocele and ancillary salivary glands, as well as the absence of relapse characterized the success in the approach of the case(AU)

Mucocele es definido como un fenómeno de retención o extravasación de moco. El mucocele oral es causado por el trauma mecánico, que comprimir y sellar el conducto de las glándulas salivales menores, evitando la secreción de saliva, incluso su producción mientras continúa produciéndose, por lo que hay un aumento de volumen de la glándula y el ductus involucrados. Existen varias modalidades de tratamiento que incluyen la escisión quirúrgica de la lesión, la terapia con láser, la criocirugía, la escleroterapia micromarsupialização, inyección intralesional de corticoides o agente esclerosante, además de la regresión espontánea. La extirpación quirúrgica convencional de los mucoceles utilizando un escalpelo es considerada la opción más común y requiere una resección completa de la lesión y de glándulas salivales menores asociados a disminuir el riesgo de recurrencia. El presente estudio se reporta un caso de escisión quirúrgica del mucocele salival en la mucosa labial inferior causada por la picadura accidental, celebrada en pacientes en la clínica de Odontología del Centro de Saúde Odontominas, Patos/PB. Además, discute el diagnóstico y las diferentes terapias (procedimientos quirúrgicos y no quirúrgicos) para el tratamiento de los mucoceles. Después de la extirpación quirúrgica de la lesión, los resultados fueron satisfactorios, con dolor post-operatorio, sin edema o cualquier otras quejas por parte de la paciente. No hubo recidivas o la aparición de nuevas lesiones. La extracción completa del mucocele y glándulas salivares accesorias, así como la ausencia de recidiva caracteriza el éxito en el método del caso(AU)