Assessment of the changes in the dimensions of the soft palate following orthognathic surgery in class three patients

Statement of Problem: Adaptation of the soft palate and its morphological alterations do occur to some extent after different surgical strategies of class III patients including mandibular setback, maxillary advancement and bimaxillary surgery. The precise changes in soft palate morphology are not well understood yet

Purpose: The aim of this study was to conduct a detailed cephalometric evaluation of the alterations taking place in position and morphology of the soft palate after treatment of class III skeletal deformity via different surgical procedures [i.e. mandibular setback, maxillary advancement, bimaxillary surgery]

Materials and Method: 120 consecutive patients who were diagnosed as having skeletal class III deformity were evaluated. All patients included in this study were adults who had completed their growth and had cephalograms within a month prior to operation [T1] and 1 month to 9 months post-surgery [T2] taken in the natural head position. Patients were divided according to the type of surgery undertaken in three groups: group 1 combination of mandibular and maxillary [bimaxillary], group 2 [mandibular setback] and group 3 [maxillary advancement] surgery. Soft palate length, depth and thickness were evaluated at both T1 and T2 in each group. The results were compared by paired t and oneway ANOVA tests

Results: Soft palate length increased significantly in groups I and III [p <0.05]. Soft palate depth changed significantly in group II [p <0.05]. Soft palate thickness did not changed in any groups [p >0.05]

Conclusion: Soft palate morphology was changed after class III surgeries. Palatal length was increased after maxillary advancement or bimaxillary surgery whereas its depth was increased after mandibular setback or bimaxillary surgery

Prevalence of odontogenic deep head and neck spaces infection and its correlation with length of hospital stay

Statement of Problem: As the duration of hospital stay could be an indicator of the severity of infection [Including odontogenic sources]; defining related variables could be very helpful in the treatment process. All clinical and paraclinical variables related to sever head and neck infections of odontogenic origin have not been fully evaluated

Purpose: This study was designed to identify the potential risk factors associated with increasing hospital stay in patients with deep head and neck spaces infections of odontogenic origin

Materials and Method: A total of 297 patients admitted to Shiraz Khalili hospital [1996-2006] with head and neck spaces infection were retrospectively identified by a medical chart view. Data concerning patient demographics, source and location of infection, culture results, and treatment modalities were evaluated. Linear regression techniques were used to explain the relationship between patient admission characteristics and duration of hospitalization

Results: A total of 34.3% [n=102] of the patients had head and neck spaces infections of odontogenic origin. The most common location of infection was submandibular space [32%], followed by masseter space [22%] and Ludwig's angina [20%]. Culture results showed non-hemolytic streptococcus as the most common microorganism with the prevalence of 61.6%.The most frequent signs and symptoms were swelling and pain. The results showed a higher percentage of hospital admissions for the middle socioeconomic status [58.8%]. Variables such as high weight, blood sodium level less than 135, preexisting disease and increasing in blood mean cell volume [MCV] were associated with longer hospital stay. Only 1 [0.9%] death was reported as the result of these infections

Conclusion: Odontogenic infections were a common source of deep head and neck spaces infection resulted in longer hospital stay. Paying particular attention to the variables that lead to longer hospital stay could be very important in formulating the treatment plan and reducing complications

Chronic multifocal inflammation of the alveolar bone mimicking malignancy: a case report

Chronic inflammation of the alveolar bone is a great clinical and radiologic mimic, which merits recognition by the clinician and pathologist. The patient can thus be reassured of the proper early treatment and a favorable prognosis. Occasionally, it is difficult to differentiate inflammatory lesions from malignant tumors. The aim of this report is to present a case with an inflammatory lesion mimicking malignant condition. We report a 19-year-old male complaining of rapid onset gingival swelling of the right side of both jaws and looseness of the right upper molar teeth in 20 days. Based on the acute onset of the gingival hyperplasia, severe looseness of the affected teeth especially in the maxilla, and the patient's age, multifocal rapid growing malignant condition was not ruled out. The lesion was misdiagnosed as a malignant condition by clinical and radiographic examination. The whole body bone scan showed no significant increased uptake in the right oral cavity compatible with no active bony pathology. The surgical pathology findings of the lesion showed severe chronic inflammation with surface epithelial hyperplasia. The initial diagnosis of the lesion was malignant condition but it was ruled out by bone scan and histological appearance

Clonazepam for the management of anxiety associated with oral surgery: a randomized double-blind controlled trial

Statement of Problem: Anxiety is one of the most common challenges which affect both the patient and the surgeon throughout dental procedures. Thus, there has been growing interest in the application of sedatives in dentistry

Purpose: This study evaluated the efficacy of clonazepam in reducing anxiety prior to oral surgery

Materials and Method: The participants of this, randomized controlled trial, study included 60 patients who referred to the Department of Oral and Maxillofacial Surgery, Shiraz University of Medical Sciences. They were randomly allocated to either a single 2 mg dose of Clonazepam or a placebo one hour prior to the surgery. The participants and the outcome assessors were blind to the intervention. Levels of anxiety were recorded using Visual Analogue Scale [VAS] and measuring blood pressure [BP], pulse rate and arterial oxygen saturation percentage. After collecting the data, the Chi-square test was run and then the data was analyzed

Results: The participants in the treatment and control groups were matched for age, sex, education, marital status and employment status [p >0.05]. All anxiety determinants [VAS, BP, pulse, and oxygen saturation rates] changed significantly one hour after the administration of clonazepam [p <0.05]

Conclusion: Clonazepam is an effective anxiolytic drug with minimal side effects which can be used to reduce anxiety in dental patients

Recurrent ameloblastoma of the mandible: two cases report

Six cases of ameloblastoma were treated by enucleation and peripheral osteoctomy during 1992-2001. Histologically, desmoplastic reaction, epithelial cells with severe fibrous, and keratin formation in the acanthomatous follicles were seen. The disorder was in the mandible in five cases, and in the maxilla in one case. Two cases were male and four were female, and the age at surgery was between 20 to 28 years. For all cases, a uniform surgical protocol was applied. The lesions were removed primarily by enucleation with peripheral ostectomy. There was recurrence in two cases. An enbloc resection was done for the first case and a radical resection with titanium bone plate reconstruction for the second case. The patients did not have any problem, bone grafting being recommended for the first case as soon as possible. Based on our knowledge, the procedure was successful in approximately 70% of cases, but more radical surgery methods may be recommended in the initial surgery

Comparison of ibuprofen, celecoxib and tramadol in relief of pain after extraction of mandibular third molar teeth

The ultimate goal of oral health care providers is not only to restore function, but also to relieve pain. This study was undertaken to compare the analgesic efficacy of ibuprofen, celecoxib and tramadol in patients after extraction of mandibular third molar teeth. Forty one patients entered our study and were randomly divided into three groups. Group 1 received ibuprofen [600 mg] and groups 2 and 3 received celecoxib [200 mg] and tramadol [100mg] respectively, 8 hours and one hour before extraction of mandibular third molar teeth. The patients reported their pain severity in a questionnaire four and eight hours after the tooth extraction. To evaluate the side effects of the drug, the patients were asked to report if they had any problem using the drug. Fourteen patients received ibuprofen, 15 celecoxib and 12 tramadol for relief of pain. The pain severity in ibuprofen group, 4 and 8 hours after tooth extraction was less than celecoxib, and was less in these two groups when compared to tramadol group but no significant difference was found between the three groups. No undesirable side effects were reported in ibuprofen and celecoxib groups, but side effects such as headache, nausea, vomiting, oral dryness, drowsiness, tremor and vertigo were observed in the tramadol group. All patients who used tramadol were not satisfied from the drug while it had disturbed their daily activities. Regarding the very little side effects of celecoxib and its desirable analgesic effects, it can be administered as one of the analgesic drugs of choice in dentistry

[Mandibular incisive canal in panoramic view]

One of the anatomic structures in mental interforaminal area is mandibular incisive canal [MIC]. Due to the lack of sufficient emphasis in anatomic texts and limited ability of conventional radiographies to depict it, this structure is not fully recognized or considered by dentists in planning treatment. Ignorance of this canal can lead to post-surgical complications in this region. The aim of this study was the assessment of radiographic appearance of mandibular incisive canal in panoramic view. In this cross-sectional study, 2324 panoramic views of patients [1117 males, 1207 females] with the mean age of 18 to 70 years were inspected for presence of MIC. Digital photographies were obtained from those radiographic views containing MIC. Then panoramic views with good visible MIC were selected in the study. A data sheet containing age, sex, visibility, extension of the canal in each side, and distance between MIC and inferior border of mandible was completed. An approximate course of MIC was determined and drawn. Chi-square test and SPSS- 11.5 software were used to analyze the data. In 883 cases [38%] of panoramic radiographies, MIC was visible, and 277 of them [11.9%] displayed MIC with good visibility. In 19% of cases MIC was detected in right side, and in 14% of cases it was detected in left side. In rest of the cases [67%] canals were visible on both sides. Based on Chi-square test, good visibility of the canals in men was significantly more than in women. Because less than 50% of panoramic views with good quality and standard protocol could depict incisive canal of the lower jaw, use of other more reliable methods such as C.T or tomography should be recommended in case of necessity

[Assessment of anatomical relationship between impacted lower third molar tooth and mandibular canal in panoramic view of men and women between ages 20-70 years old]

Background: It is likely that the inferior alveolar nerve injury occurs following the removal of the lower third molars due to the anatomic proximity. So preoperative radiographic assessments are necessary to determine the position of the mandibular canal. Radiography is the most standard technique for assessing the anatomic relationship between the third molars and the mandibular canal. Panoramic view can help to determine the relationship and position of the mandibular canal to the mandibular third molar

Materials and Methods: 664 panoramic radiographs of the individuals aged 20-70 years who showed 1128 impacted third molars were assessed. Photos of these panoramic images were obtained with a digital camera in similar conditions. The incidence of proximity of the root tips of the third molars and mandibular canal [in range of 2 and 3 mm] was detected. Four radiological signs [deflected roots, diversion of the canal, interruption of the cortical white line of the canal and the narrowing at the canal] were recorded in both sides and in different ages

Results: From 1128 impacted mandibular third molars, %79.3 had 2 roots and %20.7 had one root. In the teeth the roots of which had a distance with the mandibular canal, the proximity was observed in females more than in males. There was no significant relationship between proximity and age. In 558 teeth, one or both roots were superimposed over the mandibular canal. In those cases, there was no statistically significant relation between superimposition and age and sex. Deflection of the root and interruption of the white line of the canal were observed in the right side more than the left side. Diversion of the canal was seen more in the LT side. Narrowing of the canal showed no difference among the patients

Conclusion: In the present research, in significant cases of impacted third molars [in both gender and in both sides] there are radiographical signs for proximity of the mandibular canal and the root of impacted third molars, which increases the risk of inferior alveolar nerve injury