Cleft lip and palate: the multidisciplinary management

Patients with cleft lip and palate usually face a multitude of problems, esthetic compromise being the most noticeable, malocclusion, missing teeth, oronasal fistula, speech and hearing pathology are also present in most cleft patients; this necessitates a multidisciplinary treatment across various medical and dental specialties that extends from birth to adulthood but in separate stages. A protocol for the treatment of cleft patients should followed by the healthcare providers, and coordination amongst them is a major contributor to success in cleft treatment

Prevalence of apical periodontitis and quality of root canal treatment in an adult Palestinian sub-population

The aim of this study was to determine the prevalence of apical periodontitis and the technical quality of root canal fillings in a Palestinian sub-population. The panoramic radiographs of 258 patients [142 females, 116 males] attending dental clinics in 2010 were examined to identify the presence of apical lesions associated with any remaining teeth, excluding third molars. The technical quality of root canal fillings was also evaluated by assessing apical extension from the radiographic apex. The panoramic radiographs were taken by a well-trained radiology assistant and evaluated by a radiologist and an endodontist. Statistical analysis was performed with the chi-square test with a significant level set at P < 0.05%. Of 6482 teeth examined radiographically, 978 [15.1%] had radiographic signs of apical periodontitis [AP]. The prevalence of AP was 8.3% in teeth without filled roots and 59.5% [509/ 855] in root canal-treated teeth. The prevalence of AP and endodontic treatment increased with age and differed significantly [p < 0.05] between males and females. The majority [74.5%] of root canal fillings was performed inadequately, and most [77.2%] inadequate fillings were > 2 mm short of the radiographic apex. The presence of AP was correlated significantly with poorly executed root canal fillings [p < 0.05]. The present study found a high prevalence and incidence of AP in association with root-filled teeth. The technical quality of many root canal treatments was unacceptable

Vigorous pelvic traction as an adjuvant therapy in FBSS

Failed back surgery syndrome [FBSS] is a condition where there is a failure to improve satisfactorily following back surgery for herniated discs, stenosis and instability. The syndrome is difficult to treat due to the variability of pain generators. Eighteen patients were evaluated in a prospective study. All had post-operative enhanced magnetic resonance imaging which showed no surgically treatable lesions and no infection but all had variable degrees of epidural fibrosis [EDF]. Vigorous pelvic traction [VPT] was applied twice a week for 4 weeks and patients followed up 3 months post-traction. The mechanical and physiological effects of VPT on the tethering fibrous bands and surroundin 9 structures is the concept of this study. The aim of therapy was focused on the reduction of pain and the enhancement of function. The results showed a definite improvement in many clinical parameters in 16 [88.88%] patients. In conclusion, patients with surgically repairable problems cannot benefit from anything but surgery. However, there is a group for whom surgery is not an option and another group in those where surgery is an alternative but not necessarily one that must be pursued. In both groups, a comprehensive programme of spinal rehabilitation including VPT may be beneficial

Evaluation of carotid endarterectomy in post cerebral stroke patients with significant carotid artery lesions

This study was carried out to evaluate the results of carotid endarterectomy after recovery from prior stroke due to a significant carotid artery lesion. Thirty-seven patients with prior for cerebral stroke were included [26 males: 11 females, mean age = 64.5 years]. All patients had good functional recovery with minimal residual deficits. A corresponding significant carotid stenosis [> 70%] was present in 32 patients [86%] and an unstable ulcerated plaque in 5 patients [14%]. Carotid endarterectomy was done 30 days to 6 months post-stroke. Risk factors included smoking [73%], hypertension [68%], diabetes mellitus [57%], coronary artery disease [35%] and hyperlipidemia [41%]. Mean follow up was 18 months [range 6-37 months]. There was one postoperative death as a result of intraoperative stroke and another from myocardial infarction resulting in a combined perioperative stroke/mortality of 5.4%. No other neurological events were encountered during the rest of the follow up period. Complications related to the procedure included reactionary hemorrhage [2.7%], hoarseness of voice [5.4%], and transient ramus mandibularis palsy [2.7%]. This experience supports the benefit of carotid endarterectomy in post-stroke patients with significant carotid artery lesions. It is a safe and reliable procedure in preventing recurrent stroke in this group of patients