Biomedical subjects
Publications and source records attributed to S L Bahn.
This article discusses the more practical and safer oral prophylactic antibiotic regimens recently approved by the American Heart Association and the American Dental Association. The new guidelines are strongly supported by the scientific data combined with an appreciation of the substantial logistic and financial barriers to parenteral prophylactic antibiotic administration to dental outpatients.
Improvements in our understanding of the methods of mandibular invasion by malignancies and refinements in the biomechanical analysis of mandibular osteotomies led us to modify our standard operative procedure for this disease process. Over a 10 year period, we performed rim mandibulectomy to treat oral cavity malignancies with mandibular involvement. This retrospective analysis of 38 patients comparing rim mandibulectomy with the traditional segmental mandibulectomy has demonstrated equivalent local control rates between rim mandibulectomy and segmental resection (75 and 64 percent, respectively). Patients with rim mandibulectomies were more satisfied with their postoperative appearance, and some were able to wear lower dentures if well motivated. In performing the rim mandibulectomy, we found that smooth, curved osteotomies without step-offs resulted in a technically simple operation that was biomechanically sound and had a low complication rate. Rim mandibulectomy, because it is based on sound pathologic principles and does not disrupt the mandibular arch, is an operation that adequately resects the tumor without compromising the cancer operation or the patient.
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A case report of a rare oral lesion termed giant cell hyaline angiopathy is presented. The clinical, radiographic, and histopathologic appearances are discussed, together with a successful mode of antibiotic treatment. The absence of vasculitis and foreign bodies and the therapeutic efficacy of antibiotics suggest that angiopathy may not be the appropriate term.
The natural history of necrotizing sialometaplasia as a self-healing process makes it essential for the surgeon and the pathologist to distinguish this entity from carcinoma. Seventeen of the 39 early cases were initially misdiagnosed as malignant. Occasionally, residual glands can be trapped in mucous lakes, giving the appearance of mucoepidermoid carcinoma. An awareness of the entity and adequate clinicopathologic correlation should lead to a correct diagnosis. A limited biopsy specimen may create a problem in diagnosis and may necessitate more adequate tissue for proper evaluation. Necrotizing sialometaplasia can present as an ulceration or a swelling beneath the mucosa, either of which can be painless or painful with radiation of pain to the ear, eye, or pharynx. Lesions presenting as a swelling will either convert to an ulceration or heal spontaneously, never forming an ulcer. The most commonly involved area is the palate (79 percent), but any area where glandular oral mucosa is present can be involved. The male-to-female ratio is 3:1, and it shows no predilection for race. The etiology of the disease remains unknown, but it may be associated with tobacco, alcohol, the use of dentures, and local trauma. Most investigators seem to favor an ischemic basis. Lesions heal spontaneously without treatment, and the only invasive procedure required is a biopsy.
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Oral infections caused by gram-negative anaerobes are now recognized more frequently than in the past because of improved culturing techniques. A case of B melaninogenicus infection secondary to a fractured mandible, in which the organisms were both clinically resistant and insensitive on culture to penicillin, is presented. The organism was also shown to produce beta-lactamase. Clindamycin is appropriate dosage resulted in diarrhea, which precluded its continuation. Erythromycin therapy was curative in this case. In all cases in which the clinical course does not reflect the expected reasonable response to the appropriate antibiotic therapy, bacterial resistance to a drug should be considered, and laboratory testing for resistance and sensitivities should be performed.
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Circumstantial evidence has strongly implicated dental manipulation as an etiologic factor in the development of infective endocarditis. The introduction of human oral streptococci via the oral cavity in rabbits with vegetative cardiac lesions yields a 94 per cent incidence of infective endocarditis, if the number of inoculated organisms is above a threshold level of 10(7).
Dentin dyslasia is a rare autosomal dominant hereditary variant of dentinogenesis imperfecta. The primary defect is mesodermal and involves the dentin. Two types (Type I and Type II) of dentin dysplasia have been described previously. The current case presents radiographic findings which include characteristics common to both types. It is proposed that either a third type (Type III) be recognized or the variability of the developmental defect precludes definitive subclassification.
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