Optimizing donor site analgesia after bone harvest from iliac crest.

At Queens Medical Centre, Nottingham, alveolar bone grafts (ABG) for patients with cleft lip and palate (CLP) were performed by two surgeons following the same surgical protocol, but with different postoperative iliac crest donor site analgesia: surgeon A used a donor site bolus of levobupivacaine, whilst surgeon B used a donor site epidural catheter (EC) infusing levobupivacaine. A healthcare evaluation was conducted in two phases to establish the effectiveness of analgesia for CLP patients undergoing ABGs. Data were collected prospectively in 2016 and 2018. Cleft patients postoperative to ABG were included. Outcome measures were pain scores at 2, 4, 6, 12, and 24 hours, time to mobilization, and time to food intake. Mean pain scores at the first evaluation were <1 out of 10 for all time points, except 24 hours (score 2.0 for bolus, 1.8 for EC). There was no statistically significant difference between the groups for any of the outcomes measured. As EC conferred no advantage, surgeon B changed to bolus administration and a second evaluation was performed. The mean pain score for the second evaluation was 1.7 and higher pain scores were more common with lower doses of levobupivacaine. The data suggest that bolus injection can produce safe, effective pain control provided an adequate dose is given.

Rose-trellis periosteal release in oral mucosal advancement flaps in pigs.

The aims of this study were to find out whether scoring in a rose-trellis pattern improved the stretch of mucoperiosteal flaps more than conventional scoring in the horizontal plane, and to consider its application in the closure of oroantral communications. Sixteen sections of cadaveric porcine buccal mucoperiosteum were removed from the molar region of the maxilla and mandible. A three-sided flap was raised in the subperiosteal plane, excised, and pinned to a cork board with the periosteal side facing upwards. Eight samples were scored in the horizontal plane (control) using lines perpendicular to the line of simulated advancement, and eight in a rose-trellis or criss-cross pattern. Scoring using a rose-trellis pattern yielded a mean increase in stretch of 24.3% (p=0.0003) when compared with the conventional method. Buccal advancement flaps are widely used to close oroantral communications, and scoring of the mucoperiosteum facilitates the stretching of the tissue over the defect. To be successful, defects should be fully closed to prevent contamination, and closure should be tension-free. In this study, scoring in a rose-trellis pattern increased the stretch of the tissue sample more than scoring in the horizontal plane. The rose-trellis technique therefore could aid the effective closure of oroantral communications.

[Odontogenic myxoma recurring after 11 years: case report and observations on this unusual neoplasm]. / Mixoma odontogeno recidivato dopo 11 anni. Descrizione del caso clinico e considerazioni su una neoplasia rara.

Odontogenic myxoma is usually a benign neoplasm, although it has the ability to infiltrate surrounding tissues thus becoming locally invasive. Furthermore, it has a moderately high recurrence rate and can sometimes display a really aggressive behaviour. An unusual case of a 48-y-old woman in whom odontogenic myxoma recurred 11 years after excision of the primitive lesion is reported. Although rare, the possibility of malignant evolution led us to consider which was the most appropriate management of both the neoplasm and the recurrence. A careful assessment of the clinical, radiographical, tomographical, histological and, if necessary, immunohistochemical features of the lesion allows a distinction to be made between lesions that are only locally invasive and the rarer, more dangerous aggressive lesions. In the first case we suggest that, where possible, a conservative treatment should be preferred, followed by close monitoring of the lesion over time. Since odontogenic myxoma is limited to the facial bones, excision may be uselessly disfiguring, above all in young patients. More aggressive surgical treatment should be reserved for lesions for which there is a strong suspicion of malignant transformation.

[Mouth diseases and dental materials: potential for study with cytofluorometry]. / Flogosi orali e materiali dentari: potenzialità di studio tramite citofluorimetria.

BACKGROUND: The potential dental materials have of inducing mouth diseases is well known, and various methods have been developed to investigate this phenomenon. Among these there are histological studies of the pulp and periodontium exposed to dental materials, both in vivo and in vitro in humans and animals. Other studies are based on the clinical observation of the effects induced by dental materials. Aim of the paper is to evaluate the use of flow cytometry to analyse crevicular fluid to study its content in terms of inflammatory cells and inflammation mediators. METHODS: Samples of crevicular fluid were collected by aspiration using a bevelled needle mounted on a 5 ml syringe from patients without periodontitis and with periodontitis and multiple heterogeneous dental restorations. This method was adopted since it allows to place the cells of the fluid in suspension. Part of the fluid was analysed by cytology and part by flow cytometry. RESULTS: In the patients without periodontal disease cytological examination revealed the presence of desquamated epithelial cells and colonies of cocci, rods and spirochaetae. In the patients with periodontal disease the same examination revealed, besides the above, the presence of inflammatory cells. Flow cytometry confirmed the findings of cytological examination, thus proving to be an effective method for studying crevicular fluid. CONCLUSIONS: This method allows to identify specific inflammatory cells or mediators of inflammation in crevicular fluid and may therefore prove to be very useful in the study of alterations induced by some dental materials at the level of the gingival sulcus.

Enfuvirtide: a new class of antiretroviral therapy for HIV infection.

Enfuvirtide is the first of a new class of antiretroviral agents recently approved for the treatment of human immunodeficiency virus (HIV)-1 infection. Present available data suggest that enfuvirtide may be a promising agent for the control of HIV infection in patients who have previously received reverse transcriptase inhibitor and protease inhibitor regimens and who are either intolerant to such drugs and/or who have gone into virological failure. Perhaps the greater limitation to the clinical use of enfuvirtide is the cost, limiting its use in the developing world.