Etiology, pattern, and treatment of nose fractures: A 10-year cross-sectional cohort retrospective study.

BACKGROUND: Determining the etiology, epidemiology, pattern, and treatment of nasal bone fractures and the associated soft tissue injuries in a population will be beneficial for the prevention, rapid and correct diagnosis, and adequate management of this pathology in order to minimize postoperative complications. PATIENTS AND METHODS: This study retrospectively evaluated the patients admitted and treated for nasal bone fractures in a university clinic of oral and maxillofacial surgery in Romania over a 10-year period. Following statistical analysis, evaluation and correlation of the monitored variables, a P value < 0.05 was considered statistically significant. RESULTS: Nasal bone fractures had the highest incidence among men (88.30%), aged 20-29 years (33.33%), with no education (33.33%), interpersonal violence being the main cause in this category of patients (P = 0.004; P = 0.005; P = 0.005). In urban environment (55.9%), nasal bone fractures through aggression and road traffic accidents were predominant, while in rural areas (44.10%), those caused by domestic accidents and animal attacks prevailed (P = 0.551). Nondisplaced (81.10%), closed (85.60%) and involving the nasal septum fractures (51.35%) were preponderant. Hematoma was the most frequent associated soft tissue injury (86.49%), its incidence being increased in the case of displaced (P = 1.000) and open fractures (P = 0.692). The most frequent treatment method was close nasal reduction (CNR) + closed septoplasty (51.35%). The most frequent complication was malunion (7.2%), secondary to CNR without septoplasty (P = 0.037). CONCLUSIONS: The main etiology of nasal bone fractures was interpersonal violence, which mainly affected men, aged 20-39 years, with a low level of education, living in urban areas. Implementing laws to fight interpersonal aggression and increase the education level of the population would lead to a considerable reduction in the incidence of this pathology. Patients treated by CNR + closed septoplasty and ORIF had the best postoperative evolution. Immediate septoplasty in the case of associated septal fractures significantly decreased the rate of postoperative complications.

Odontogenic inflammatory lesions in patients with type 2 diabetes mellitus: A prospective study of 128 cases.

BACKGROUND: Diabetes mellitus is one of the most widely spread systemic diseases worldwide. It is characterized by hyperglycemic status with major multiorgan impact. With regard to the oral cavity, the relationship between diabetes mellitus and periodontal disease is well-known, although other dental diseases have been neglected. AIMS: The aim of this study was to assess the characteristics of type 2 diabetes mellitus patients and correlate it with the inflammation of the marginal and apical periodontium and the status of the underlying disease. SUBJECTS AND METHODS: The current prospective study analyzed 128 patients with type 2 diabetes mellitus, in terms of marginal as well as apical periodontal involvement. The patients presented voluntarily for evaluation and treatment of oral diseases and their oral health status was established based on clinical and imaging examinations. Biological samples were collected when necessary to determine mycotic diseases. The clinical characteristics of each patient were recorded in a study sheet, and the data were centralized in electronic format using Microsoft Excel. The statistical values of the assessed cases were calculated with a two decimal accuracy, using the Chi-Square, Mann-Whitney and Student t tests. RESULTS: The results obtained evidenced an incidence of apical periodontal infection of approximately 50%, with a slightly higher value for patients with decompensated diabetes mellitus compared to those with compensated diabetes mellitus. CONCLUSIONS: The results obtained show a higher incidence of apical periodontal infections, regardless of the compensation level of type 2 diabetes mellitus.

Clinical patterns and characteristics of midfacial fractures in western romanian population: a 10-year retrospective study.

BACKGROUND: The aim of this study was to identify the clinical pattern of midfacial fractures and concomitant associated injuries in our geographical area, as well as to correlate them in order to determine the type of fracture with the highest incidence of associated injuries. MATERIAL AND METHODS: A 10-year retrospective evaluation of midfacial fractures was performed in 379 patients. RESULTS: Zygomatic complex fractures had the highest incidence (n=242, 50%). The majority of the fractures were complete (n=561, 92.42%), closed (n=473, 84.16%) and without displacement (n=454, 80.78%) regardless of the location of the fracture line ( p=0.014). All patients had at least one associated soft tissue injury (n=379, 100%). The most frequent associated injury was hematoma (n=308, 73.51%). Hematomas were predominant in the case of single fractures, while lacerations and excoriations were prevalent in the case of multiple fractures ( p=0.000). CONCLUSIONS: Following trauma of the midface, patients with soft tissue hematomas will most probably have an underlying fracture with a single trajectory, while patients with lacerations will most probably have concomitant multiple bone fractures.

Midfacial fractures: A retrospective etiological study over a 10-year period in Western Romanian population.

INTRODUCTION: Midfacial fractures are extremely important oral and maxillofacial problems because they take varied forms and are frequently accompanied by major long-term esthetic or functional complications. Their etiology and epidemiology vary significantly in the literature, and the main causes are varied by population. The aim of this study is to identify the main traumatic etiology of midfacial fractures, along with the main categories of affected patients in our geographical area, in order to establish the need for measures that can prevent fractures in the future. MATERIALS AND METHODS: We conducted a retrospective study over a 10-year period in 379 patients. Data were extracted from the patients' charts, and the following variables were taken into consideration: sex, age, environment of origin, education level, and traumatic etiology. RESULTS: Midfacial fractures most frequently affected the 20-29 years age group (31.93%), male sex (n = 333, 87.86%, M:F = 7.23:1), patients from urban areas (n = 206, 54.35%), and patients without education (46.70%). The most frequent etiology was interpersonal violence (44.85%), followed by fall trauma (16.62%) and road traffic accidents (15.30%). Statistical correlations evidenced that urban environment favors midfacial fractures caused by interpersonal violence and road traffic accidents or sports injuries, while in rural areas, domestic accidents and animal attacks are predominant (P = 0.000). CONCLUSIONS: The overwhelming incidence of interpersonal violence in our population is currently a major public health problem. Implementing laws and initiating national programs for the prevention of interpersonal violence would lead to a considerable reduction of midfacial fractures in the Western Romanian population.

Odontogenic cervical necrotizing fasciitis, etiological aspects.

INTRODUCTION: Cervical necrotizing fasciitis is a rare but very severe infection that affects the soft-tissues of the cephalic extremity. Cervical necrotizing fasciitis most frequently occurs secondarily to inflammatory odontogenic disorders and represents the most severe infection of maxillofacial spaces, with a high lethal potential. MATERIALS AND METHODS: In this study, we selected 55 patients with confirmed cervical necrotizing fasciitis of odontogenic origin, treated in the Clinic of Oral and Maxillofacial Surgery in Cluj-Napoca during January 1996-December 2012. RESULTS: In the majority of cases, the disease evolved without the presence of associated systemic disorders (60% [45.49-72.69]), the rest of the patients having 1-4 types of systemic disorders; type 2 diabetes mellitus was the most frequent type of underlying systemic disorder. From the appearance of the first symptoms until the presentation for treatment, a time interval of 2-30 days elapsed. During this time period, 78.18% (95% confidence interval [CI] [65.49-89.06]) of the patients received antibiotic treatment, but without results. Mandibular molars were the most frequent starting point of the disease, and the submandibular space was the first affected by the disease, 47.27% (95% CI [32.76-61.79]). Bacteriological exams showed that facultatively aerobic/anaerobic G + bacteria were the most frequently identified (72.22% [58.21-83.60]). CONCLUSION: The odontogenic lesions of the lower molars, complicated by submandibular space infections, are the most frequent starting point of odontogenic cervicofacial necrotizing fasciitis. Delayed surgical treatment and strict antibiotic therapy play an important role in favoring the development of odontogenic necrotizing fasciitis.

Carcinoma ex-pleomorphic adenoma -- a giant tumor.

Pleomorphic adenoma is one of the most frequent tumors that involve the parotid gland. The tumor constantly increases in dimension if not cured in due time and may become malignant. A case of a patient suffering from a carcinoma ex-pleomorphic adenoma that had a 20-year-evolution and reached impressive dimensions is presented. The tumor holds the second place worldwide among the largest carcinoma ex-pleomorphic adenoma in terms of size and the ninth place worldwide among the most voluminous parotid tumors ever surgically excised, as far as we know. Nevertheless, the regional invading character of the tumor in this particular case has been limited, without generating local lymph node invasion or metastases.

Maxillary odontogenic sinusitis, complicated with cerebral abscess--case report.

Maxillary sinus inflammation, when untreated or incorrectly treated, may extend locoregionally, the remaining paranasal sinuses being the first affected anatomical structures. This is why the understanding of the inflammatory pathology of the maxillary sinus, and particularly of the complications it can generate, is extremely important. The purpose of this presentation is to point out that inflammations of the paranasal sinuses are susceptible to develop complications in certain conditions and threaten the patient's life due to the proximity of vital structures. This is the case of a 16 years old male patient who developed a left maxillary and frontal sinusitis, complicated with cerebral abscess. Early detection, multidisciplinary approach and proper indication of surgical treatment, as well as early suspicion of complication, especially in young male adolescents, are extremely important.

[Septic metastases of suppuration of odontogenic origin]. / Metastazele septice ale supuratiilor de origine odontogena.

The infections of odontogenic origin, set in the soft tissues region of the viscerocranium are among the most frequent conditions specific to this anatomical level. A distinct category among these, represented by the conditions with diffuse character, may have serious forms, developing systemic septic metastases. The current paper displays a study approaching seven cases of odontogenic diffuse infections with metastases at distance. The ways in which the septic metastases appeared, as well as the topic and general prescribed treatment have been analyzed. The expanding at distance of the suppuration occurred at those patients who were suffering from cervical necroziting fasciitis associated to some immunodepressing conditions. Out of the 7 patients involved in the study, 4 were suffering from uncompensated diabetes and obesity. All those 7 patients had septic conditions localized in mediastinal region, and in 3 cases hepatic septic affections were observed. The best treatment possible for these conditions proved to be the surgical one associated with that concerned with the sustenance of the general state of health, the rebalancing of the homeostatic constants and the antibacterial one. The post-surgical evolution in case of 5 patients was a good one, in case of 2 patients being unfavourable because of the appearance of the multiorganic insufficiency and of death.

[Clinical study of sinus grafts and implants integration, in the posterior maxilla]. / Studiu clinic privind integrarea grefelor sinusale si a implanturilor in regiunea maxilara posterioara.

UNLABELLED: In this study we have tried to evaluate the degree of integration for endosinusal grafting and implant placement in the posterior maxilla. MATERIAL AND METHOD: We included in our study a number of 136 patients with sinus lift surgery. We have established the stability of the implants using the periotest. RESULTS: The presence of the antral septum favoured the sinus membrane to tear, the results of our study are obvious (23.46%). Aloplastic materials for sinus grafting is our first choice because the results are comparable with the cases in wich we used autografts, and the advantage is that we don't need a second surgery place. Implant insertion after sinus grafting integration, increases the rate of succes in sinus grafting and implant insertion compared with sinus grafting and implant insertion made in the same operative step.