1/16. Heat-induced segmental necrosis after reaming of one humeral and two tibial fractures with a narrow medullary canal.In three cases referred to our clinic (a simple fracture of the humeral shaft, a simple, closed fracture, and a wedge fracture of the mid-third of the tibia), bone necrosis had resulted from excessive heat produced by reaming extremely narrow medullary cavities (5-5.5 mm diameter) with the 9 mm front-cutting reamer as part of a reamed nailing procedure. In any one case, different degrees of damage can occur from the metaphysis to the diaphysis. Based on the clinical course and the histological evaluation, we postulate that heat-induced damage can be divided into four degrees of severity (0-3): Grade 0: no damage; no devascularization, no heat-induced damage. Grade 1: The heat damaged zone is cut away during subsequent reaming, the only damage is devascularization. Grade 2: The damaged zones are not eliminated by subsequent reaming. The bone is devascularized and heat damaged. Grade 3: The entire cross section of the bone including the periosteum is devitalized by exposure to excessive heat. Depending on the severity of additional damage to the soft tissues, grave consequences are to be expected and further operations are unavoidable. The effects of heat-induced damage are particularly critical in the presence of infection (cases 2 and 3). The fundamental aspects and the extent of heat necrosis will be discussed. After discussion with the AO Technical Commission on the cause of heat-induced necrosis, we would recommend the following preventive measures: 1. preoperative measurement of the smallest diameter of the medullary cavity in two planes. 2. reaming with the standard instrumentation (9 mm) only if the medullary cavity has a diameter of at least 8 mm at its narrowest point. 3. Extremely narrow cavities should first be reamed manually or an alternative to nailing should be sought. 4. It is strongly recommended that only sharp reamers be used in such cases and blunt or damaged reamers replaced.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/16. Aseptic bone necrosis in Japanese divers.Medical examination was performed on the divers in Ohura for 7 years from 1969 to 1972. Aseptic bone necrosis was found in 268 of 450 divers (59.5%). Men with over 5 years of experience in diving were highly affected (more than 54.4%). These bone lesions were found most frequently in the proximal end of the femur and the humerus. There was a significantly higher incidence of bone lesions in the men who dived over 30 meters. In the group of men with one or more bone lesions, 73.1% were known to have been treated for bends. The bone, once exposed to a certain compression of air, would have a tendency to develop bone lesions even after cessation of diving. Type A2 (linear opacity) led to the structural failure of the joint surface of the femur and the humerus. Histopathological study was carried out on the sections of bone obtained from three autopsy cases and four operated cases. Formation of air bubbles in the bone marrow cavity seemed to be the most important as the cause for the occurrence of aseptic bone necrosis, and local circulatory disturbance might be the most responsible for the progression of the bone lesion.- - - - - - - - - - ranking = 0.5keywords = cavity (Clic here for more details about this article) |
3/16. Localized alveolar bone necrosis following the use of an arsenical paste: a case report.AIM: To describe some toxic effects of arsenic trioxide in the mouth, to condemn its continued use, and present a case in which a tooth was preserved despite significant bony destruction. SUMMARY: A case is presented in which severe alveolar bone necrosis resulted from leak-age of an arsenical devitalization paste into the periodontium.The tooth was root canal treated before root amputation, and restored with a cuspal coverage restoration. The tooth was observed to be symptomless and functional at the one-year follow-up. KEY learning POINTS: * arsenic and its compounds have no place in contemporary endodontics. * dentists should protect their patients by avoiding the use of arsenic-containing materials and refusing to use products whose constituents are not known. * Localized bone necrosis may not require tooth extraction. Depending on the severity of the case, the tooth may be preserved by a combination of endodontic, periodontal,prosthodontic and maintenance therapies.- - - - - - - - - - ranking = 0.53012082733888keywords = mouth (Clic here for more details about this article) |
4/16. Sinonasal osteocartilaginous necrosis in cocaine abusers: experience in 25 patients.BACKGROUND: cocaine-induced lesions may cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate that mimics the clinical picture of other diseases. methods: From January 1991 to September 2001 25 patients with cocaine-induced midline destructive lesions were observed at the Department of Otorhinolaryngology of the University of Brescia. The diagnosis was based on physical and endoscopic evaluation, routine blood and urine analysis, radiological findings, and repeated biopsies of the nasal mucosa. serum was analyzed by the antineutrophilic cytoplasmic antibody (ANCA) test using indirect immunofluorescence and by enzyme-linked immunosorbent assay for antibodies against proteinase 3 and myeloperoxidase. RESULTS: Septal perforation was present in all 25 patients, 16 of which (68%) also had partial destruction of the inferior turbinate. Hard palate reabsorption was observed in only six patients (24%); in two of these patients, the lesion also extended to the soft palate. Fourteen patients (56%) were positive by the immunofluorescence test (nine patients had a P-ANCA and five patients a C-ANCA pattern). Four patients (16%) with the P-ANCA pattern and all patients with the C-ANCA pattern also tested positive for anti-proteinase 3 antibodies. CONCLUSION: Any sinonasal inflammation involving the midline that persists or remains refractory to treatment may be the first manifestation of potentially lethal drug addiction. cocaine abuse should be considered in the differential diagnosis of destructive lesions of the nasal cavity even in the presence of a positive ANCA test.- - - - - - - - - - ranking = 0.5keywords = cavity (Clic here for more details about this article) |
5/16. Avascular necrosis of the hamate: a case report with reference to the hamate blood supply.Avascular necrosis of the hamate bone has not previously been reported. In this case the proximal fragment of the fractured hamate underwent avascular necrosis and prolonged healing. In an attempt to explain this sequela, angiography of the cadaver carpus followed by dissection of intact wrists and a study of enzyme-cleaned hamates showed that their wedge-shaped proximal segments were mostly enveloped by a distal extension of the midcarpal joint cavity and thus totally dependent on intraosseous nutrition. Consequently, the segment is at risk when a fracture line transects the body proximal to the base of the wedge. Clinically, this condition resulted in persistent discomfort and limitations of motion. A postinjury bone scan of the wrist indicated avascular changes in the proximal third of the hamate, and a delayed union was followed by later revascularization and a more normal scan image.- - - - - - - - - - ranking = 0.5keywords = cavity (Clic here for more details about this article) |
6/16. mastoid cells myiasis in a Saudi man: a case report.We report here the case of myiasis of the mastoid cells in a 50-year old Saudi farmer. Eight larvae of suspected Calliphorid fly were extracted from his right mastoid at examination in the clinic. The larvae almost ate into his brain, using their powerful screw-shaped mouth parts. It is the first report of Calliphorid larvae affecting the mastoid cells from saudi arabia. The epidemiological and clinical implications of this finding are discussed below.- - - - - - - - - - ranking = 0.53012082733888keywords = mouth (Clic here for more details about this article) |
7/16. Management of arsenic trioxide necrosis in the maxilla.Historically, pulp-necrotizing agents were commonly used in endodontic treatments. They act quickly and devitalize the pulp within a few days. However, they are cytotoxic to gingiva and bone. If such an agent diffuses out of the cavity, it can readily cause widespread necrosis of gingiva and bone, which can lead to osteomyelitis of the jaws. Although the use of arsenic trioxide can cause severe damage to surrounding tissues, producing complications, it is still used in certain areas in the world. This article presents and discusses two cases of tissue necrosis and their surgical management. These cases showed severe alveolar bone loss in the maxilla, which affected the patients' quality of life and limited the restorative possibilities. As dentists, we should be aware of the hazardous effects of arsenic trioxide and should abandon its use. Because of its cytotoxicity, there is no justification for the use of arsenic trioxide in the modern dental practice.- - - - - - - - - - ranking = 0.5keywords = cavity (Clic here for more details about this article) |
8/16. Extensive maxillary sequestration resulting from mucormycosis.mucormycosis is an invasive and potentially lethal infection caused primarily by fungi of the order mucorales. An ulcer or extraction in the mouth can be the port of fungal invasion, particularly when the patient is immunocompromised. Early recognition and aggressive treatment have reduced the mortality and morbidity. We present a case of oral mucormycosis with extensive maxillary osteonecrosis that is of interest because the patient ignored the initial warning signs and was rescued from the fulminating stage by thorough debridement and medical treatment.- - - - - - - - - - ranking = 0.53012082733888keywords = mouth (Clic here for more details about this article) |
9/16. Aseptic necrosis of the hamate: a case report.The case of a 25-year-old man with osteonecrosis of the hamate is reported. He had pain and swelling in his right wrist. The diagnosis was accomplished with plain radiographs as well as with MRI. The case was treated surgically that included resection of the necrotic bone. The occured cavity was filled with autogenous cancellous bone graft. In addition, capito-hamate arthrodesis was performed. Histopathological examination following the operation demonstrated avascular necrosis of the hamate. The arthrodesis was obtained four months after the operation.- - - - - - - - - - ranking = 0.5keywords = cavity (Clic here for more details about this article) |
10/16. cocaine associated with onlay bone graft failure: a clinical and histologic report.This patient report presents an unusual onlay bone graft failure following local cocaine application. Three months after the bone grafting procedure performed in the anterior maxilla for bone volume augmentation, the bone graft was totally exposed in the oral cavity as a result of the rubbing of cocaine on the gingival tissue that covered the bone graft. A histologic view of the removed bone fragment presented not only an area of necrosis but also ample spaces filled with necrosis material and resorption areas. Dental practitioners need to be aware of this phenomenon because such patients often do not report the use of drugs, particularly cocaine.- - - - - - - - - - ranking = 4.8708038823211keywords = oral cavity, cavity (Clic here for more details about this article) |
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