Eosinophilic granuloma within the jaws may radiographically mimic other benign odontogenic cysts and tumors, and different protocols have been suggested in the literature for treating eosinophilic granuloma of the jaws. Forty-one lesions of eosinophilic granuloma, diagnosed in 25 patients, were reviewed retrospectively, and data were collected regarding age, gender, ethnic origin, location, symptoms, clinical appearance, radiographic features, treatment, and recurrence. The lesions were found in youngsters (18.1 +/- 4.7 years of age), mostly in the posterior parts of the mandible, and the most common presenting symptom was pain (92%), often accompanied by swelling. Approximately one half of the lesions were radiographically well defined without ossification. All patients were treated by enucleation (with or without peripheral ostectomy) and radiotherapy; 7.3% lesions recurred during follow-up (9.3 +/- 4.6 years). In addition, the different treatments suggested in the literature for eosinophilic granuloma of the jaws were reviewed.

Adolescent↗

PubMed1999

Burkitt's lymphoma of the oral cavity in Israel.

The clinical presentation of Burkitt's lymphoma in the maxillofacial area is variable. The objective of this study is to review and analyse all cases of Burkitt's lymphoma with oral or maxillofacial involvement diagnosed in our department. A retrospective review of patients with Burkitt's lymphoma in the facial area between the years 1978 and 1997 was undertaken. The patients, 8 male and 5 female, were from 7 to 50 years old (mean 15.3 years). Six patients were Stage I and 7 were Stage II. Five had abdominal involvement and 2 lymph node involvement besides the maxillofacial presentation. Three tumours were in the mandible, 3 in both mandible and maxilla, 2 in the palate, and 5 in the maxilla alone. In 5 patients the tumour presented as a facial swelling, in 3 as an exophytic mass, in 2 as an ulcer, 1 case presented as a hyperplastic lesion, and 2 were periapical lesions. Complaints included pain (7), swelling (5), and sensory disturbance (2). EBV titres were positive in 4 patients. Abdominal involvement was only seen in patients under 12 years old. All patients were treated with chemotherapy, while adjuvant radiotherapy was indicated in 3 cases. Follow-up of 1-20 years revealed a 2-year survival rate of 61.5%. It seems that the Israeli disease is between that of the African and American types, when considering age distribution.

Adolescent↗

PubMed1999

The effect of smoking and periodontal treatment on salivary composition in patients with established periodontitis.

BACKGROUND: The purpose of this study was to evaluate the effect of smoking on the periodontal status and the salivary composition in subjects with established periodontitis before and after periodontal therapy. METHODS: Our study group included 26 healthy subjects, 12 smokers and 14 non-smokers with established periodontitis. Clinical measurements and non-stimulated whole saliva were obtained and analyzed at baseline and after scaling and root planing. Smokers presented at baseline with significantly greater probing depth (4.16+/-0.26) compared to non-smokers (3.52+/-0.32) which was statistically significant (P = 0.0268); likewise, baseline clinical attachment level was greater in smokers (4.49+/-0.31 compared to non-smokers 3.87+/-0.13; P = 0.0620). Mean plaque index was also greater in smokers compared to non-smokers (0.86 and 0.65, respectively; P = 0.0834). Baseline pretreatment sodium values were significantly greater in non-smokers (14.36 mEq/l compared to 9.31 mEq/l in smokers; P = 0.0662); likewise non-smokers exhibited 50% greater salivary calcium levels (6.04 mg/100 ml compared to 4.32 mg/100 ml in smokers; P = 0.0133). RESULTS: Post-treatment probing depth and clinical attachment level were not different between smokers and non-smokers; this in spite of significant difference in plaque index in smokers (0.35 compared to 0.13 in non-smokers; P = 0.0135). Post-treatment, smokers had reduced calcium concentration (3.58 mg/100 ml compared to 5.11 mg/100 ml in non-smokers; P = 0.0438). Treatment affected albumin level in smokers only, consequently non-smokers had significantly greater salivary albumin concentration (1.1 mg/100 ml compared to 0.38 mg/100 ml in smokers; P = 0.0274). CONCLUSIONS: Subjects with established periodontitis exhibited elevated concentrations of salivary electrolytes and proteins. Within this study group, smokers exhibited greater disease level but reduced sodium, calcium, and magnesium concentrations. Smokers responded favorably to treatment. The clinical improvement eliminated the differences in salivary composition.

Adult↗

PubMed1999

Surgically-assisted orthopedic protraction of the maxilla in cleft lip and palate patients.

Fourteen children, aged 8 to 13 years, with unilateral or bilateral cleft lip and palate, were treated by an incomplete Le Fort I osteotomy without down-fracturing the maxilla, followed by traction of the maxilla by face mask for twelve weeks. Our results revealed a mean maxillary forward movement of 7.2 mm after three weeks of traction, followed by a retention period of nine weeks for callus maturation. There was an associated minor downward movement of the maxilla that caused a slight increase in the lower facial height, which improved the facial esthetics of the patients. The advantages of this method are: i) it allows for early skeletal advancement of the maxilla with new bone formation in the osteotomy line, ii) there is no need for inter-maxillary fixation of young patients and no need for rigid fixation of the maxilla by miniplates that can damage teeth buds and roots at this age, and iii) it can be used in young patients to improve esthetic appearance, an important factor in the psychological development of adolescents.

Adolescent↗

PubMed1998

Life-threatening complications and irreversible damage following maxillofacial trauma.

Trauma remains one of the principal causes of mortality in the western world, especially among young adults. The most serious immediate life-threatening complication following maxillofacial trauma is airway obstruction. The onset can be sudden, as with foreign body aspiration, or following soft-tissue damage that can lead at a later stage to airway-compromising oedema. The medical literature regarding facial trauma appears to support the hypothesis that maxillofacial trauma alone is rarely life threatening, or will not lead to life-threatening conditions unless associated with airway compromise. There are some causes of life-threatening complications following trauma to the maxillofacial region such as massive bleeding or undiagnosed cervical spine injury. However, there are some situations that may cause irreversible damage unless immediate operation is undertaken. The almost complete lack of reports dealing with death or irreversible damage in trauma involving the maxillofacial region prompted us to review and analyse the importance of immediate intervention following trauma to the maxillofacial region, in order to treat life-threatening complications and prevent irreversible damage.

Adolescent↗

PubMed1998

Metastatic follicular thyroid carcinoma to the maxilla.

We present a unique case of metastatic follicular thyroid carcinoma to the hard palate and the maxillary sinus, a case that to our knowledge has not been reported before. Various malignant tumours that metastize to the maxilla are reviewed, and the therapeutic approach to follicular thyroid carcinoma metastasis to that area is also discussed. Follicular thyroid carcinoma should be included in the list of tumours that metastasize to the maxilla.

Brachytherapy↗

PubMed1998

Radiological features of primary intra-osseous carcinoma of the jaws. Analysis of the literature and report of a new case.

OBJECTIVES: To analyse the clinical and radiological features of primary intra-osseous carcinoma of the jaws (PIOC). MATERIAL AND METHODS: Twenty-four cases (23 from the literature and one new case) of PIOC were reviewed. RESULTS: Patient's age at time of diagnosis ranged from 4-76 years, (mean 50 years). Male to female ratio was 1.7:1. Most lesions (79%) were in the mandible and of these, 95% were in the posterior area, approximately 70% of the maxillary lesions were in the anterior region and crossed the midline. In 87% of the cases PIOC was radiolucent; the remainder were mixed radiolucent-radiopaque lesions. The radiological borders were defined but none corticated in 57% of the cases and diffuse in 43%. The lesion was unilocular in 61% and not loculated in 35%. CONCLUSIONS: The variable radiological features of PIOC and its deceptive resemblance to odontogenic cysts and other tumours of the jaws suggests that despite its rarity, PIOC should be considered in the differential diagnosis of radiolucent lesions in the jaws.

Adolescent↗

PubMed1997

[Facial trauma: characteristics and therapy].

This department was established 35 years ago. Since then, many patients with facial trauma, both soldiers and civilians, have been treated and extensive experience has been accumulated. From 1990 to 1995, 487 patients with facial trauma (18.6% of the patients in the department) where hospitalized and treated. 88.5% suffered from injuries which included facial bones, and the others from soft tissue injuries only. We summarize our experience, analyzing both the demographic and clinical characteristics of the injuries and the treatment administered. Based on our experience and the current literature, we present an overview of the issue.

Facial Injuries↗

PubMed1997

Cervicofacial actinomycosis: a diagnostic challenge.

Actinomycosis was first described as a clinical entity over 100 years ago. However, the fundamental characteristics of this entity have not been fully discussed, and major questions remain unanswered, such as the highly diversified pathogenicity of the phenomenon according to numerous published case reports and clarification of solid diagnostic criteria. Even the frequency of cervicofacial actinomycosis occurrence is unclear; some authors consider it to be rare and others to be common. We present 11 cases examined and treated in our department within the last 14 years along with a review of the literature. Diagnostic problems are emphasized, and a comprehensive overview of the entity is suggested.

Actinomycosis, Cervicofacial↗

PubMed1997

Traumatic bone cyst resembling apical periodontitis.

Among the pseudocysts of the jaws, the traumatic bone cyst is known as an asymptomatic lesion often noted unintentionally during routine radiographic examinations. The lesion neither devitalizes the teeth within its borders, nor does it cause resorption of their roots. The well-demarcated traumatic bone cyst often projects into the intraradicular septa and hence has been described as having scalloped borders. The following presentation is of a traumatic bone cyst that resembled periodontal pathology in its appearance.

Alveolar Bone Loss↗

PubMed1997

Impaired glucose-induced insulin response in transgenic mice overexpressing the L-phosphofructokinase gene.

The selective impairment of glucose-induced insulin secretion in NIDDM can be attributed to defects in the glucose-signaling system. An alteration in the activity of phosphofructokinase (PFK), a key enzyme in the glycolytic pathway, may play a role in the abnormal glucose-induced insulin secretion. In this study, we evaluated insulin secretion in transgenic (Tg) mice overexpressing the liver-type subunit of phosphofructokinase (PFKL). Three independently derived Tg-PFKL lines showed random and postprandial hyperglycemia with diminished acute insulin response following intravenous glucose tolerance load. Isolated islets of Tg-PFKL mice exhibited a shift to the right of the glucose insulin dose curve. However, the maximal insulin secretory capacity, as well as the potentiation effect by arginine, were retained. PFK activity in Tg-PFKL islets was increased by 30-70%, because of the overexpression of PFKL. Conceivably, a selective overexpression of the PFKL isoform in Tg-PFKL mice altered the enzymatic properties of the tetrameric PFK and thereby affected glucose metabolism. A similar phenomenon was previously observed in transfected PC12-PFKL cells. The data show that overexpression of PFKL in transgenic mice was associated with diminished glucose-induced insulin response and suggest a mechanism to explain the role of beta-cell PFK activity in glucose-induced insulin secretion.

Age Factors↗

PubMed1997

Complications of miniplate osteosynthesis in the treatment of mandibular fractures.

Miniplate osteosynthesis with 2.0-mm screws is being increasingly utilized in the treatment of mandibular fractures, midface fractures, zygomatic fractures, orthognathic surgery, and in craniomaxillofacial surgery. It enables better anatomic reduction, better stability of fracture lines, quick recovery and return of function. To examine complications related to its use, data were compiled from the preoperative, immediately postoperative, and 6-months' postsurgery examinations of 143 patients with isolated mandibular fractures. Sixteen of the patients (11.2%) presented with postoperative complications that were related to the miniplate system. The authors' experience and data support the theory that the complication rate is related more to the surgical approach and technique than to the time elapsed between injury and operation.

Adolescent↗

PubMed1997

Incidence and type of cervical spine injuries associated with mandibular fractures.

The incidence of facial fractures accompanied by spinal injuries, while low, is of significant concern to the craniomaxillofacial surgeon. There are conflicting reports on the association between facial fractures and concomitant spinal damage. This retrospective study of 424 patients with mandibular fractures examines the relationship of mandibular fractures and concomitant spinal injuries. The incidence of concurrent mandibular and cervical fractures was 2.6%, predominantly associated with motor vehicle accidents. The purpose of this study is to examine the incidence of cervical spine injury associated with mandibular fractures, in order to improve the diagnosis and treatment of spinal injury associated with mandibular fractures.

Accidents, Traffic↗

PubMed1997

Preoperative prophylaxis for C1 esterase-inhibitor deficiency in patients undergoing oral surgery: a report of three cases.

C1-inhibitor deficiency, or hereditary angioedema, is a genetic disorder characterized by recurrent circumscribed, nonpruritic, nonpitting subepithelial edema. Minor trauma to the tissue, such as tooth extraction, can trigger life-threatening laryngeal edema. The use of fresh frozen plasma and/or danazol before treatment prevents angioedema attacks. A critical review of the treatment regimen and prophylaxis for C1-inhibitor deficiency is presented, and three new cases are described.

Adult↗