Application of modified mucogingival surgery in the treatment of gingival recession / 口腔疾病防治

@#With the increasing demand for beauty, the treatment of gingival recession has become a common request among patients. Clinically, gingival recession is mainly treated by surgery. The common surgical methods include free gingival grafting, pedicled flap technology and double flap technology (subepithelial connective tissue transplantation combined with coronally advanced flaps). If patients with indications are selected, satisfactory surgical results will be obtained. However, there are still some shortcomings in the above mentioned methods, such as the root coverage effect not being satisfactory. In recent years, researchers have put forward some improved schemes to minimize the shortcomings of the above methods to treat different degrees of gingival recession. A gingival unit graft containing gingival papilla and free gingiva can improve the blood supply of the recipient area and improve the effect of root coverage. It can obtain better root coverage for slight retraction, widening of the angular gingiva and deepening of the vestibular sulcus, but there may be issues with inconsistent color and shape of the gingiva after surgery, as well as poor aesthetic effects. Modified coronally advanced flaps, flaps prepared by the technique of half-thickness, full-thickness and half-thickness, and modified coronally advanced envelope flap technology are designed with the most serious retraction teeth as the center in the case of multiple gingival retractions, both of which can improve the effect of root covering. Tunnel technology and modified tunnel technology, without severing the gingival papilla and tunneling the gingival flap to accommodate the graft, can effectively reduce tissue damage and promote wound healing. This paper reviews the literature and summarizes the outcome of the modified surgery techniques in the treatment of gingival recession. These treatment options for gingival recession are proposed with the aim of improving clinical work, and some suggestions for the treatment of gingival recession to achieve a stable root coverage effect are put forward. In the future, the development direction of mucogingival surgery is to reduce trauma and have a stable curative effect.

Tumor inflamatorio de Pott en escolar de 7 años: a propósito de un caso

El tumor inflamatorio de Pott (PPT) es una osteomielitis del hueso frontal con un absceso subperióstico concomitante, principalmente secundario a sinusitis frontal complicada. Es infrecuente, pero puede tener consecuencias fatales debido a su alta asociación con complicaciones intracraneales. Presentamos el caso de una escolar de 7 años sin antecedentes, que consulta en el Servicio de Urgencia por un cuadro de 5 semanas de rinorrea mucopurulenta derecha y aumento de volumen frontal progresivo, habiendo recibido antibioticoterapia sin respuesta. Se realizan neuroimágenes que confirman el diagnóstico de rinosinusitis aguda fronto-etmoidal complicada con absceso subperióstico frontal compatible con PPT, asociado a un absceso epidural. Se manejó con antibiótico endovenoso prolongado y aseo quirúrgico mediante craniectomía por abordaje bi-coronal con drenaje de ambas colecciones y reconstrucción de base de cráneo con colgajo de pericráneo, evolucionando favorablemente. El diagnóstico del tumor inflamatorio de Pott es clínico y radiológico, siendo el aumento de volumen frontal el signo cardinal. La tomografía computarizada es útil para establecer el diagnóstico diferencial con otras entidades y la resonancia magnética permite con mayor sensibilidad y especificidad detectar complicaciones intracraneales. El tratamiento es médico y quirúrgico mediante antibioticoterapia endovenosa y aseo quirúrgico oportuno.

Pott's inflammatory tumor is an osteomyelitis of the frontal bone with a concomitant subperiosteal abscess, mainly secondary to complicated frontal sinusitis. It is rare entity but may have fatal consequences due to its high association with intracranial complications. We present the case of a healthy 7-year-old girl who presented to the emergency department with a 5-week history of mucopurulent right rhinorrhea and progressive forehead swelling without response to oral antibiotic therapy. Neuroimaging confirms the diagnosis of acute frontoethmoidal rhinosinusitis complicated with frontal subperiosteal abscess compatible with PPT and an epidural abscess. She received prolonged intravenous antibiotics for six weeks and surgical treatment with craniectomy by bi-coronal approach with drainage of both collections and reconstruction of the skull base with pericranial flap, progressing favorably. The diagnosis of Pott's inflammatory tumor is clinical and radiological. The increased frontal volume is the cardinal sign, and computed tomography is the image of choice, which is also helpful in establishing the differential diagnosis with other entities. Magnetic resonance imaging is practical, given its greater sensitivity and specificity to detect intracranial complications. Treatment is imperative and is based on adequate antibiotic therapy and prompt surgical debridement.

Orbital subperiosteal abscess secondary to osteomyelitis in a patient with chronic sinusitis

Objective@#To report a case of orbital subperiosteal abscess in a diabetic elderly patient.@*Methods@#This is a case report.@*Results@#A 65-year-old diabetic female consulted for a two-month history of poor vision on both eyes and a palpable mass on the left brow area. The patient previously underwent functional endoscopic sinus surgery and was treated for postoperative systemic infection and several complications including sinusitis, mastoiditis, trigeminal neuralgia, bacterial meningitis, and otitis media. On presentation, best-corrected visual acuity was noted to be no light perception on the right eye and 20/400 on the left eye. She had a relative afferent pupillary defect on the right eye, ophthalmoplegia on both eyes, and inferior displacement and proptosis of the left globe. Magnetic resonance imaging showed subperiosteal abscess on the left superior orbital rim with intraorbital extension. The patient underwent surgery and the culture from the drained abscess yielded Pseudomonas aeruginosa and Enterobacter cloacae. Pathologic examination of the orbital bone sample revealed osteomyelitis.@*Conclusion@#Osteomyelitis of the orbital bone leading to subperiosteal abscess is a complex, multifactorial disease requiring rapid diagnosis and treatment. Complete resolution of the infection must be achieved to decrease the morbidity and mortality of the patient.

Orbital Cellulitis In A Pediatric Population - Experience From A Tertiary Center

Objective: To describe our experience in treating children afflicted with orbital cellulitis. Methods: A retrospective analysis of hospital records of children afflicted with orbital cellulitis was conducted between 2005-2018. Clinical, laboratory and radiology characteristics as well as management, microbiological data, and outcomes were collected. Results: Of the 94 patients, painful restriction of ocular motility was observed in 37.2% and proptosis in 34%, whereas, only 18% of the children presented with both classical signs. Children aged older than 9 years presented with markedly elevated inflammatory markers i.e., leukocytosis and C-reactive protein (CRP). Only a minority (12, 12.4%) required functional endoscopic sinus surgery. Conclusion: Our data support the general approach that orbital cellulitis should be initially managed conservatively with close monitoring; since, only a minority of patients require surgical intervention.

Traditional and modified tunnel technique for the treatment of maxillary anterior teeth gingival recession / 口腔疾病防治

Objective @#To compare the clinical effect of the tunnel technique (TUN) and vestibular incision subperiosteal tunnel access (VISTA) combining connective tissue grafts (CTGs) on recovering the exposed root surface in a case of gingival recession over the upper anterior teeth and then to provide clinical evidence for gingival recession treatment. @*Methods@# A case of gingival recession (Miller I type) over teeth 13-14 and 22-23 was treated using different techniques bilaterally. 22-23 were treated by a TUN combined CTG transplantation,while teeth 13-14 were treated by a VISTA technique combined with CTG transplantation. The gingival retraction height (GRH), gingival retraction width (GRW), keratinized gingival width (KW), root coverage aesthetic score (RES) and visual analog scale (VAS) were measured after operation. @*Results @#The effect of post-operation were ideal and complete ginglval recovering were achieved, the postoperative effects of the two methods were stable, GRH and GRW decreased, and KW increased. RES was 10. The VAS score of VISTA combined with CTG transplantation was 6, which was higher than that of TUN+CTG. @*Conclusion@#Gingival recession can be treated by TUN+CTG or VISTA+CTG with ideal prognosis. VISTA with an additional incision facilitates the operative procedure but leads to less comfort.

Orbital cellulitis: early intervention saves vision

Orbital cellulitis describes an infection involving the soft tissues posterior to the orbital septum including the fat and muscle within the bony orbit. This condition is associated with severe sight and life-threatening complications. Distinguishing it from preseptal cellulitis is difficult, but important. Acute sinusitis is the commonest predisposing factor. Clinical findings alone are not specific enough to distinguish between preseptal and post septal orbital cellulitis. Early diagnosis using CT orbit is important to rule out complications such as orbital cellulitis, subperiosteal abscess. The most common location of subperiosteal abscess is the medial wall of the orbit. Transnasal endoscopic drainage of the abscess is a functional and minimally invasive technique and is the treatment of choice at present. Early diagnosis and intervention are mandatory to prevent the visual loss and life-threatening complication.Here, the authors describe a 2 months old infant with orbital cellulitis and medial subperiosteal abscess and treated with transnasal endoscopic drainage of the subperiosteal abscess.

Actualización en Implantes Subperiósticos: Ranc-Implants Presentación de un Caso Clínico y Revisión de la Literatura / Innovations in Subperiosteal Dental Implants: Ranc-Implants. Case Report and Literature Review

RESUMEN: Los implantes subperiósticos (ISP) han sido relegados poco a poco en favor de los implantes endóseos debido a la aparición de implantes cortos, técnicas all-on-4, elevaciones sinusales, lateralizaciones y transposición del nervio dentario inferior, colocación de implantes en arbotantes anatómicos en el maxilar superior y de modernas técnicas de regeneración óseas. El objetivo del presente artículo es el de realizar una revisión de la evolución que han ido experimentando los ISP desde su invención en 1943, así como exponer una actualización de estos, los Ranc-Implants, mediante la presentación de un caso clínico. Los Ranc-Implants suponen una alternativa viable en casos de atrofias severas de los maxilares que, en otros casos, requerirían procedimientos de regeneración óseos avanzados para la inserción de implantes convencionales.

ABSTRACT: Subperiosteal implants (ISP) have slowly been downgraded, in favor of endosseous implants, short implants, all-on-4 techniques, sinus elevations, lateralization and transposition of the inferior alveolar nerve, anatomical buttresses in the maxilla, as well as modern bone regeneration techniques. The aim of this article is to review the evolution of ISPs since their invention in 1943, and present an update of these techniques, Ranc-Implants, by presenting a clinical case. Ranc-Implants represent a viable alternative in cases of severe atrophy of the jaws that, in other cases, would require advanced bone regeneration procedures for the insertion of conventional implants.

Lateral alveolar ridge augmentation procedure using subperiosteal tunneling technique: a pilot study / 대한악안면성형재건외과학회지

BACKGROUND: In this research article, we evaluate the use of sub-periosteal tunneling (tunnel technique) combined with alloplastic in situ hardening biphasic calcium phosphate (BCP, a compound of β-tricalcium phosphate and hydroxyapatite) bone graft for lateral augmentation of a deficient alveolar ridge. METHODS: A total of 9 patients with deficient mandibular alveolar ridges were included in the present pilot study. Ten lateral ridge augmentation were carried out using the sub-periosteal tunneling technique, including a bilateral procedure in one patient. The increase in ridge width was assessed using CBCT evaluation of the ridge preoperatively and at 4 months postoperatively. Histological assessment of the quality of bone formation was also carried out with bone cores obtained at the implant placement re-entry in one patient. RESULTS: The mean bucco-lingual ridge width increased in average from 4.17 ± 0.99 mm to 8.56 ± 1.93 mm after lateral bone augmentation with easy-graft CRYSTAL using the tunneling technique. The gain in ridge width was statistically highly significant (p = 0.0019). Histomorphometric assessment of two bone cores obtained at the time of implant placement from one patient revealed 27.6% new bone and an overall mineralized fraction of 72.3% in the grafted area 4 months after the bone grafting was carried out. CONCLUSIONS: Within the limits of this pilot study, it can be concluded that sub-periosteal tunneling technique using in situ hardening biphasic calcium phosphate is a valuable option for lateral ridge augmentation to allow implant placement in deficient alveolar ridges. Further prospective randomized clinical trials will be necessary to assess its performance in comparison to conventional ridge augmentation procedures.

Celulitis orbitaria complicada por absceso subperióstico debido a infección por Streptococcus pyogenes / Orbital cellulitis complicated by subperiosteal abscess due to Streptococcus pyogenes infection

Resumen: Introducción: La celulitis orbitaria es una enfermedad infecciosa muy frecuente en la edad pediátrica que puede provocar el desarrollo de severas complicaciones. Los principales microorganismos involucrados son Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis, que juntos corresponden al 95% de los casos. También se pueden presentar Streptococcus beta hemolíticos y microorganismos anaerobios, que corresponden a menos del 5% de los casos. Se presenta un caso poco frecuente de celulitis orbitaria complicada por absceso subperióstico ocasionado por Streptococcus pyogenes (estreptococo beta hemolítico del grupo A). Caso clínico: Paciente masculino de 9 años de edad con antecedente de trastorno por déficit de atención e hiperactividad desde los 5 años de edad. Inició su padecimiento actual por presentar eritema en canto externo del ojo derecho; posteriormente, aumento de volumen periorbicular con limitación de apertura palpebral, progresión a proptosis, dolor a los movimientos oculares y secreción conjuntival purulenta. Los estudios de imagen subperióstico reportaron absceso y preseptal derecho con celulitis extraocular. Se inició manejo empírico con antibióticos, drenaje quirúrgico y cultivo del material purulento. De este, se aisló Streptococcus pyogenes. Conclusiones: Debido a la implementación de los esquemas de vacunación desde la década de los 90 contra H. influenza y S. pneumoniae, los casos por estos patógenos han disminuido, provocando que nuevas bacterias tomen su lugar como causantes de la infección. La importancia de considerar a S. pyogenes como etiología de celulitis orbitaria radica en la rápida progresión para la formación de abscesos, así como los pocos casos descritos en la literatura.

Abstract: Background: Orbital cellulitis is an infectious disease that is very common in pediatric patients, in which severe complications may develop. Etiological agents related to this disease are Haemophilus influenzae B, Staphylococcus aureus, Streptococcus pneumoniae and Moraxella catarrhalis, which correspond to 95% of cases. Moreover, Streptococcus beta hemolytic and anaerobic microorganisms may also be present corresponding to < 5% of the cases. We present an uncommon case of cellulitis complicated by sub-periosteal abscess caused by Streptococcus pyogenes (Group A beta hemolytic streptococcus). Case report: A 9-year-old male patient with a history of deficit disorder and hyperactivity since 5 years of age. His current condition started with erythema in the external edge of the right eye, increase in peri-orbicular volume with limitation of eyelid opening, progression to proptosis, pain with eye movements and conjunctival purulent discharge. Image studies reported subperiosteal abscess and preseptal right with extraocular cellulitis. The patient started with empirical antibiotic treatment, surgical drainage and culture of purulent material from which Streptococcus pyogenes was isolated. Conclusions: Due to the implementation of vaccination schemes against H. influenza and S. pneumoniae since the 90s, the cases by these pathogens have decreased, causing new bacteria to take place as the cause of the infection. The importance of considering S. pyogenes as an etiology of orbital cellulitis is the rapid progression to abscess formation, and the few cases described in the literature.

Managing Subacute Subperiosteal Hematoma with High Intraocular Pressure: A Case Report

Subperiosteal haematoma of the orbit is an uncommon complication of maxillofacial trauma, hence easily missed. It usually presents subacutely with proptosis and diplopia. In our case, the subperiosteal haematoma is complicated with high intraocular pressure, necessisating measures to reduce the intraocular pressure. Unresponsive to only medical treatment, surgical evacuation was carried out in this patient. Removal of the clot finally relieved the intraocular pressure and simultaneously improved the proptosis and the cumbersome diplopia.

Subperiosteal Drainage versus Subdural Drainage in the Management of Chronic Subdural Hematoma (A Comparative Study)

Introduction: Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate. Materials and Methods: The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 January 2014 with a total of 30 patients in both treatment groups. Results: Overall, there were no statistically significant difference in terms of patient general characteristics, pre-operative and post-operative symptoms, Markwalder grades, postoperative hematoma volume and recurrence, mortality and functional outcome at discharge and at three month follow-up between both groups. Albeit not achieving statistical significance, we observed a lower rate of surgical complication especially for post-operative intracranial hematoma with placement of the SPD system. Conclusions: Our study concludes that both treatment methods proved to be highly effective in the treatment of CSDH. However, with a lower overall surgical complication rate, treatment with single burr-hole craniostomy, irrigation and placement of the SPD system can be considered a treatment of choice for the management of symptomatic CSDH.

Osteoneogenesis on Subperiosteal Orbital Hematoma in a 10-Year-Old Boy

PURPOSE: We report the first case in Korea of rapid bone formation on a subperiosteal orbital hematoma after trauma. CASE SUMMARY: A 10-year-old boy who was in the intensive care unit after trauma showed proptosis and ocular movement limitation of the right eye associated with subperiosteal hematoma. On ocular examination, 3 mm of proptosis and limitation of right eye movement were observed; however, visual acuity was not decreased. At 1 month after the trauma, orbital computed tomography (CT) showed new bone formation at the margin of the hematoma border although the size of the hematoma decreased. The patient underwent hematoma and bony tissue removal using anterior orbitotomy approach. A new bone was formed between the orbital border and hematoma from the anterior orbital margin to the orbital apex. During pathological examination, woven bone tissue with fibrotic tissue was observed in the hematoma wall. One year after surgery, the patient's proptosis and limitation of ocular movement disappeared without any evidence of new bone formation. CONCLUSIONS: Waiting for spontaneous absorption of orbital subperiosteal hematoma is usually recommended unless there is significant functional impairment. However, as in our case, new bone formation could occur during a short period of less than 1 month; imaging follow-up is necessary in patients having intensive care or showing delayed absorption of a hematoma.

Subperiosteal Osteoid Osteoma of the Knee: Case Report

Osteoid osteoma, a frequent lesions of bone, is usually intraosseous but occasionally subperiosteal. We describe the case of a 19-year-old male with knee pain caused by subperiosteal osteoid osteoma. Radiologic evaluation was performed with radiographic, computed tomography (CT), ultrasonographic (US) and magnetic resonance imaging (MRI). But the preoperative diagnosis of osteoid osteoma was delayed because of unusual imaging findings and atypical symptom. After excisional biopsy, histological examination confirmed the diagnosis of osteoid osteoma. The lesion was treated successfully with CT-guided radiofrequency ablation.

Case Report: Progression of Pre-Septal Cellulitis to Orbital Subperiosteal Abscess despite Intravenous Broad-Spectrum Antibiotics in a Child

We report a case of a 7-year-old girl who initially presented with painless right eyelid swelling with full extra-ocular movement (EOM). She was treated with intravenous broad-spectrum antibiotics for preseptal cellulitis but her condition worsened. An urgent magnetic resonance imaging (MRI) of the brain and orbit showed orbital abscess, subperiosteal abscess in the medial orbital wall and evidence of sinusitis in the anterior ethmoidal air cells. She underwent Endoscopic Orbital Decompression (EOD) surgery on day 4 of presentation and her condition improved remarkably. We report a case of orbital abscess with subperiosteal abscess in the medial orbital wall. This case highlights the possibility of progression of orbital cellulitis despite administration of a broad-spectrum antibiotic.

Two Cases of Acute Mastoiditis with Subperiosteal Abscess

The incidence of mastoiditis in pediatric age has consistently increased over the last two decades due to increase of antibiotic-resistant bacteria. Compared to young patients, occurrence of acute otitis media complications such as acute mastoiditis and subperiosteal abscess is relatively low in adults. Various treatments for acute mastoiditis with subperiosteal abscess such as tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage have avoided the morbidity and necessity of mastoid surgery. Recently, many studies have indicated mastoidectomy only in cases of severe complications or failure of disease improvement after antibiotic treatment and myringotomy. In this report, we present two cases of successful treatment of subperiosteal abscess and discuss the management of acute mastoiditis with subperiosteal abscess in both child and adult.

Biomechanical properties of the complete mandibular subperiosteal implant under different bite loads / 医用生物力学

Objective To investigate biomechanical properties of the complete mandibular subperiosteal implant under four different bite loads, and provide some references for the personalized implant design in clinical cases. Methods Based on the three-dimensional model of human mandible, two kinds of matching complete mandibular subperiosteal implants, meshy base (implant 1) and zonary base (implant 2), were established, respectively. Stress distributions of both the two implants under four different bite loads were calculated and compared. Results The maximum stress of implant 1 was 230.42 MPa under the load Ⅳ and that of implant 2 was 311.11 MPa under the load Ⅰ. The stress distributions and maximum stress showed that the implant with meshy base had better resistance to the vertical loads, while the implant with zonary base had better resistance to the horizontal loads. Conclusions Rational arrangement for the number of posts and the distance between posts can effectively control the stress of implants. Posts should be placed in a vertical direction with the alveolar bone to avoid amplifying the horizontal component. In addition, posts should be well bounded to the bases, so that the stress on the bottom of posts won’t be at a high level. The complete denture should be guaranteed to contact at several spots during centric, protrusive and lateral bites to keep occlusion balance and decrease the maximum tensile stress on the contact surface.

Subperiosteal Ganglion Cyst of the Distal Radius: A Case Report

Subperiosteal ganglion is a cyst that develops from periosteum with cortical erosion. There have been several case reports and most common location is the tibia. Only seven cases of subperiosteal ganglion of the upper extremity have been reported. We report a case of subperiosteal ganglion at distal radius without communication of the wrist joint in a 41-year-old woman. Excision of the cyst and adjacent periosteum were performed without evidence of recurrence.

Clinical features and management of posttraumatic subperiosteal hematoma of the orbit.

Traumatic subperiosteal hematoma (SpH) usually presents late, after the initial trauma. It is generally seen in young males. Computed tomography is the best mode of imaging and helps to rule out orbital fracture or associated subdural hematoma. We present the clinical features and management of four patients seen at the orbit clinic with SpH. Management is based on time of presentation, visual acuity and any communicating bleed. The prognosis of traumatic SpH is excellent if treated with an individualized patient approach.

Sequential Management of Pierre Robin Sequence: Case Report

Simultaneous Subperiosteal and Subdural Abscesses Occurred as Complications of Acute Sinusitis

Acute sinusitis is a common medical problem which can result in serious complications if it is not managed appropriately. The most common complication of acute sinusitis is orbital complication, followed by intracranial complications. Concomitant involvement of the orbit and the brain as complications of acute sinusitis is very rare. We were presented with a case of a 27-year-old woman who suffered from subperiosteal abscess in the orbit and subdural abscess in the frontal area. Endoscopic sinus surgery, drainage of the subperiosteal abscess through eyebrow incision and drainage of the subdural abscess through craniotomy were performed. The postoperative course was uneventful, and the patient was free of ocular and neurologic symptoms at the eight month follow-up.