1/11. guideline of surgical management based on diffusion of descending necrotizing mediastinitis.BACKGROUND: Descending necrotizing mediastinitis resulting from oropharyngeal abscess, is a serious, life-threatening infection. Exisiting strategies for surgical management, such as transcervical mediastinal drainage or aggressive thoracotomic drainage, remain controversial. methods: Four patients, (three males and one female) were treated for descending necrotizing mediastinitis resulting from oropharyngeal infection. Two had peritonsillar abscesses, while the others experienced dental abscess and submaxillaritis. Descending necrotizing mediastinitis received its classification according to the degree of diffusion of infection diagnosed by computed tomography. mediastinitis in two cases, (Localized descending necrotizing mediastinitis-Type I), was localized to the upper mediastinal space above the carina. In the others, infection extended to the lower anterior mediastinum (Diffuse descending necrotizing mediastinitis-Type IIA), and to both anterior and posterior lower mediastinum (Diffuse descending necrotizing mediastinitis-Type IIB). The spread of infection to the pleural cavity occurred in three cases. RESULTS: The surgical outcome concerning each of the patients was successful. Radical cervicotomy (unilateral in three patients, bilateral in the other) in conjunction with mechanical ventilation with continuous postoperative positive airway pressure, was performed in all cases. tracheostomy was established in three patients and pharyngostomy in two. The two descending necrotizing mediastinitis-Type I cases were successfully managed with transcervical mediastinal drainage. The descending necrotizing mediastinitis-Type IIA case received treatment through transcervicotomy and anterior mediastinal drainage through a subxiphoidal incision. The patient with descending necrotizing mediastinitis-Type IIB required posterior mediastinal drainage through a right standard thoracotomy followed by left minimal thoracotomy. CONCLUSIONS: The mediastinal infection, the extent of which has been accurately determined by computed tomograms, necessitates radical cervicotomy followed by pleuromediastinal drainage. Situations where infection has spread to posterior medisatinum, particularly when it reaches in the level of the carina (descending necrotizing mediastinitis-type I), may not always require aggressive mediastinal drainage. In comparison, diffuse descending necrotizing mediastinitis-Type IIB demands complete mediastinal drainage with debridement via thoracotomy. Subxiphoidal mediastinal drainage without sternotomy may provide adequate drainage in diffuse descending necrotizing mediastinitis-Type IIA.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/11. Possibilities of preventing osteoradionecrosis during complex therapy of tumors of the oral cavity.In recent years, there has been a dramatic increase in the number of tumors of the head and neck. Their successful treatment is one of the greatest challenges for physicians dealing with oncotherapy. An organic part of the complex therapy is preoperative or postoperative irradiation. Application of this is accompanied by a lower risk of recurrences, and by a higher proportion of cured patients. Unfortunately, irradiation also has a disadvantage: the development of osteoradionecrosis, a special form of osteomyelitis, in some patients (mainly in those cases where irradiation occurs after bone resection or after partial removal of the periosteum). Once the clinical picture of this irradiation complication has developed, its treatment is very difficult. A significant result or complete freedom from complaints can be attained only rarely. attention must therefore be focussed primarily on prevention, and the oral surgeon, the oncoradiologist and the patient too can all do much to help prevent the occurrence of osteoradionecrosis. Through coupling of an up-to-date, functional surgical attitude with knowledge relating to modern radiology and radiation physics, the way may be opened to forestall this complication that is so difficult to cure.- - - - - - - - - - ranking = 110.62731727985keywords = oral cavity, cavity (Clic here for more details about this article) |
3/11. oral manifestations of congenital neutropenia or Kostmann syndrome.Infantile congenital agranulocytosis or Kostmann syndrome is a rare hereditary kind of severe neutropenia. The typical symptoms, which appear since the first days of life, are abscesses located on various parts of the body: ear, cutis, lung and oral cavity. These abscesses are due to an almost total disimmunity typical of the neutropenia. The aim of this article is to describe the most typical signs of this pathology in the oral cavity, reporting a case observed in our department in Florence, italy. On the basis of the personally observed case and of the review of the literature, it is possible to consider, as a characteristic finding in Kostmann syndrome, a typical very serious periodontal pathology, which is similar to the prepubertal periodontitis in deciduous dentition. At the age of 19 years the patient showed a dramatic compromise of the masticatory function. It is obvious that the lack of response of the host can obstruct the interaction between the host and the microbic flora, because the lack of neutrophils increases the susceptibility of the patient to every kind of infection, even to periodontitis. A periodontal prophylaxis, since the very first observations, followed by a rigorous maintenance with frequent and regular professional hygienic treatments could be effective in controlling the effects of periodontal disease and could reduce the tragic evolution. We need to recognise that it could be hard to monitor the oral situation correctly in these patients, as they have a continuously poor systemic condition. Finally in these cases the rehabilitative therapy is very problematical.- - - - - - - - - - ranking = 55.313658639927keywords = oral cavity, cavity (Clic here for more details about this article) |
4/11. Oral post-surgical complications following the administration of bisphosphonates given for osteopenia related to malignancy.BACKGROUND: This case report seeks to illustrate the clinical consequences of the administration of bisphosphonate therapy to prevent osteopenia secondary to malignancy in one patient. methods: A 69-year-old white female with a history of breast cancer with metastasis presented with pain in the upper left quadrant and periodontal pocketing of at least 6 mm in each of the four quadrants of the oral cavity. One week following surgery on the lower right region, lingual bone exposure was noted, and several attempts at achieving healing over the course of 15 months proved unsuccessful. RESULTS: Upon referral to a surgeon at the louisiana State University Medical Center, new orleans, louisiana, a potential causative factor was finally identified. The drug zoledronic acid, a bisphosphonate given for prevention of osteoclastic activity of bone metastasis, secondary to breast cancer, was identified as the possible cause of inhibition of healing, most likely from regional vascular insufficiency. The drug was immediately discontinued. The patient is healing very slowly with the aid of hyperbaric therapy; she has been unable to achieve smoking cessation, which is deterring thorough healing of the exposed bony area on the lower right lingual side. CONCLUSIONS: physicians and dentists alike must become increasingly aware of impaired oral healing following the use of bisphosphonates given for malignancy-related osteopenia. A dental exam should be performed before bisphosphonate therapy, as recommended for radiation therapy related to malignancy.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/11. Differences between florid osseous dysplasia and chronic diffuse sclerosing osteomyelitis.Florid osseous dysplasia (FOD) is confused in the literature with chronic diffuse sclerosing osteomyelitis. Two cases of each condition are presented to demonstrate the differences between them. In FOD, there are multiple lobulated sclerotic masses in several quadrants of the jaws, usually in black females. In some cases, the sclerotic masses are exposed to the oral cavity, resulting in a secondary osteomyelitis. Periapical cemental dysplasia is often found in association with FOD. Chronic diffuse sclerosing osteomyelitis is a primary inflammatory condition of the mandible. patients have cyclic episodes of unilateral pain and swelling. The affected region of the mandible exhibits a diffuse opacity with poorly defined borders. Although women are affected more often than men, black persons are not particularly susceptible.- - - - - - - - - - ranking = 27.656829319963keywords = oral cavity, cavity (Clic here for more details about this article) |
6/11. Masticator space abscess complicating removal of suspension wires: case report.Masticator space abscesses have been reported more frequently in recent years. They are usually secondary to extractions of the first and second mandibular molar teeth. The use of antibiotics has changed the presentation and clinical course of these abscesses, masking the symptoms and resulting in secondary infection by resistant organisms. Therefore, selection of appropriate antibiotics is important, but surgical intervention remains the cornerstone of treatment. Suspension wires are being used widely in the treatment of midface fractures. These wires may extend from the zygomatic arch or frontal bone through the masticator space into the oral cavity to attach to arch bars. A case of masticator space abscess resulting from the removal of suspension wires is reported, and the relevant literature is reviewed. Suggestions are made for preventing and treating this complication.- - - - - - - - - - ranking = 27.656829319963keywords = oral cavity, cavity (Clic here for more details about this article) |
7/11. Alveolar pyogenic granuloma: review and report of a case.A large exophytic bone-resorbing lesion was discovered in the oral cavity of an institutionalized 33-year-old male. An excisional biopsy under general anesthesia was performed. Frozen and permanent histologic sections confirmed a reactive gingival fibroma consistent with a pyogenic granuloma. This lesion is unusual in that it attained a very large size and caused marked remodeling of the alveolar bone of the mandible. Of interest as well, this highly vascular lesion was found to have numerous feeding vessels from the alveolar bone. A retained tooth root was encountered within the lesion, presumably the etiologic factor producing this lesion. A differential diagnosis is presented and discussed. The lesion should be of particular interest to otolaryngologists who deal with intraoral lesions and their treatment, since it illustrates an extreme presentation of a totally benign process.- - - - - - - - - - ranking = 27.656829319963keywords = oral cavity, cavity (Clic here for more details about this article) |
8/11. Recurrent trismus: twenty-year follow-up result.The authors encountered an unusual case of recurrent trismus in a patient who had oral synechia, cleft lip and palate, digital anomalies, and external genital anomaly. Mandibular movement was severely restricted by congenital soft-tissue adhesion in the retromolar region. Despite aggressive surgical efforts and postoperative manipulations, limitation of mouth opening recurred soon after each operation. Furthermore, congenital and postoperative soft-tissue adhesion resulted in severe subsequent jaw deformities, which needed combined maxillary and mandibular advancement.- - - - - - - - - - ranking = 3.1837754709727keywords = mouth (Clic here for more details about this article) |
9/11. oral manifestations of sarcoidosis.OBJECTIVE: To report two new cases of sarcoidosis of the buccal mucosa and to analyze the literature on oral manifestations of sarcoidosis. STUDY DESIGN: Oral lesions with histologic features of sarcoidosis were analyzed according to their location and appearance. RESULTS: Analysis of 45 cases of oral sarcoidosis (43 from the literature and the 2 new presented cases) revealed 12 lesions in the jaws, 10 in the buccal mucosa, 6 in the gingiva, 5 in the lips, 5 in the floor of the mouth, 4 in the tongue, and 3 in the palate. sarcoidosis in the jaw was located in the alveolar bone and presented as an ill-defined radiolucency. Submucosal nodules were observed in sarcoidosis affecting the buccal mucosa, palate, and lip. Swelling was the main manifestation in the gingiva. In the floor of the mouth, sarcoidosis presented as ranula and that of the tongue as induration. In most of the cases, the lesions in the buccal mucosa, gingiva, and tongue were the first clinical manifestation of the disease. CONCLUSION: Oral sarcoidosis lesions should be considered in the differential diagnosis of oral soft tissue swellings and jaw lesions.- - - - - - - - - - ranking = 6.3675509419454keywords = mouth (Clic here for more details about this article) |
10/11. Sequestration of the alveolar bone by invasive aspergillosis in acute myeloid leukemia.Compared to non-invasive aspergillosis, invasive aspergillosis in the region of the mouth, jaw and face has rarely been reported. It occurs particularly often in the presence of haematological oncological illness. The case of a patient suffering from acute myeloid leukemia is described; he contracted invasive aspergillosis of the lungs and the alveolar processes in the course of chemotherapeutic treatment. All the alveolar processes in the region of the premolars and molars were demarcated and had to be removed by sequestrectomy. The therapy of invasive aspergillosis should be carried out within the framework of intensive interdisciplinary treatment. In addition to systemic and local antimycotic therapy, the debridement of necrotic hard and soft tissue was necessary.- - - - - - - - - - ranking = 3.1837754709727keywords = mouth (Clic here for more details about this article) |
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