Complications of total temporomandibular joint replacement: a systematic review and meta-analysis.

The aim of this systematic review was to determine the most prevalent complications resulting from total temporomandibular joint (TMJ) replacement. An electronic search was performed using the Embase, LILACS, MEDLINE (via PubMed), SciELO, Scopus, and Web of Science databases up to June 2022. Prospective and retrospective clinical studies on patients who underwent TMJ replacement were included. Two reviewers performed the study selection, data extraction, and individual risk of bias assessment using the Joanna Briggs Institute Critical Appraisal Tools. The pooled prevalence of each complication was calculated through a proportion meta-analysis using the random-effects model. Twenty-eight studies met the eligibility criteria and were included in the review. All of the eligible studies had a low risk of bias. The results of the meta-analysis revealed that the most prevalent complication was paresis or paralysis of the facial nerve branches (7.8%; 95% confidence interval (CI) 2.6-15.1%, I2 = 94.5%), followed by sensory alterations (1.8%; 95% CI 0.6-4.9%, I2 = 88.8%), heterotopic bone formation (1.0%; 95% CI 0.1-2.5%, I2 = 75.8%), and infection (0.7%; 95% CI 0.1-1.6%, I2 = 22.7%). In conclusion, TMJ replacement has a low prevalence of complications, and most of them can be managed successfully.

Quantitative bone imaging biomarkers to diagnose temporomandibular joint osteoarthritis.

Bone degradation of the condylar surface is seen in temporomandibular joint osteoarthritis (TMJ OA); however, the initial changes occur in the subchondral bone. This cross-sectional study was performed to evaluate 23 subchondral bone imaging biomarkers for TMJ OA. The sample consisted of high-resolution cone beam computed tomography scans of 84 subjects, divided into two groups: TMJ OA (45 patients with TMJ OA) and control (39 asymptomatic subjects). Six regions of each mandibular condyle scan were extracted for computation of five bone morphometric and 18 grey-level texture-based variables. The groups were compared using the Mann-Whitney U-test, and the receiver operating characteristics (ROC) curve was determined for each variable that showed a statically significance difference. The results showed statistically significant differences in the subchondral bone microstructure in the lateral and central condylar regions between the control and TMJ OA groups (P< 0.05). The area under the ROC curve (AUC) for these variables was between 0.620 and 0.710. In conclusion, 13 imaging bone biomarkers presented an acceptable diagnostic performance for the diagnosis of TMJ OA, indicating that the texture and geometry of the subchondral bone microarchitecture may be useful for quantitative grading of the disease.

The nervous and prenervous roles of serotonin in Echinococcus spp.

Serotonin (5-hydroxytryptamine, 5-HT) is an important neuroactive and morphogenetic molecule in several metazoan phyla, including flatworms. Serotoninergic nervous system studies are incomplete and 5-HT function/s are unknown in Echinococcus spp., the flatworm parasites that cause hydatid disease. In the present work, we searched for genes of the serotoninergic pathway and performed immunocytochemical and functional analyses of 5-HT in Echinococcus spp. Bioinformatic analysis using the recently available Echinococcus multilocularis and Echinococcus granulosus genomes suggests the presence of genes encoding enzymes, receptors and transporters participating in 5-HT synthesis, sensing and transport in these parasites. However, some components of the pathway could not be identified, suggesting loss or divergence of parasite homologous genes. The serotoninergic neuroanatomy study performed by confocal scanning laser microscopy on different E. granulosus stages showed an increasing level of complexity when the protoscolex develops towards the adult stage and a progressive diminution when the parasite develops towards the metacestode stage. The role of 5-HT as a neurotransmitter in E. granulosus was evaluated by determining the effect of this substance on protoscolex motility. The addition of 5-HT to protoscoleces induced a significant increase in motility for short time periods. Preincubation with 100 µM citalopram, a known 5-HT transporter inhibitor, abolished the 5-HT-induced increase in motility, indicating that the effect could be mediated by a 5-HT transporter. Incubation of protoscoleces with 5-HT for time periods of several days induced a progressive differentiation towards the metacestode stage. The results indicate that 5-HT could have nervous and prenervous roles during Echinococcus spp. development. Taking into account the important roles of 5-HT in parasite biology and the divergence of 5-HT pathway genes with respect to human counterparts, the serotoninergic system could be considered as an amenable drug target against hydatid disease.

Pulse oximetry index: a simple arterial assessment for patients with venous disease.

OBJECTIVE: To provide additional safety data comparing ankle brachial pressure index (ABPI) and pulse oximetry (Lanarkshire Oximetry Index, LOI) as measures of arterial circulation in patients with venous disease of the leg. METHOD: A total of 107 (195 legs) attending hospital leg ulcer clinics participated in this prospective open study. We attempted to measure brachial and foot arterial pressures in all patients using both the handheld Doppler method (ABPI) and pulse oximeter method (LOI). Features of patients with limbs in which either the ABPI or LOI could not be assessed were documented. ABPI and LOI values were compared, and agreement between the two assessment methods was assessed. RESULTS: We found the LOI measurement to be a simpler technique than Doppler ABPI measurement, with an endpoint less prone to the subjective variability associated with the Doppler method. Of the 195 legs assessed,we obtained LOI in 10 in which an ABPI could not be recorded. LOI could not be recorded in only one leg. There was a linear association (p<0.001) and fair agreement (kappa=0.303) between LOI and ABPI in the 184 legs in which both ratios could be measured. There was no evident tendency for LOI to read either low or high compared with ABPI. CONCLUSION: Pulse oximetry LOI is a simple alternative to Doppler ABPI in the screening of patients for arterial disease that could be a contraindication to, or require modification of, compression therapy. It can be measured in some legs that cannot be assessed by Doppler ultrasound.

Efficacy of several anti-tick treatments to prevent the transmission of Rickettsia conorii under natural conditions.

The efficacy of several anti-tick treatments to prevent the transmission of Rickettsia was evaluated under natural conditions of tick pressure in a kennel. Only Amitraz (Preventic) provided total control on transmission (no dogs were infected), whereas with Frontline, Advantix, or Scalibor, the rate of infection varied among the dogs.

Allergic contact dermatitis in venous leg ulcer patients.

Our aim was to determine the frequency and nature of contact sensitivity in venous leg ulcer patients in Lanarkshire. We performed patch testing with the European standard series, antimicrobials and medicaments on 200 patients referred to our leg ulcer clinics. Positive patch tests were found in 136 (68%) patients. Multiple allergies occurred in 102 (51%). The most frequent allergen groups were fragrances (30.5%), antimicrobials (19.5%), topical excipients (19.5%), rubber accelerators (13.5%) and topical corticosteroids (8%). We also found a high prevalence of positive patch tests to Intrasite gel (9.5%) and Hioxyl cream (8.5%), medicaments which are commonly used to treat leg ulcers in our area. Contact sensitivity is common in venous leg ulcer patients and has important implications for patient management. The allergens involved vary depending on local nursing practice. We suggest that all venous leg ulcer patients be patch tested with a locally relevant patch test series.

Unusual CT appearance in an odontogenic keratocyst of the mandible: case report.

An expansile lesion in the body of the left mandible had high attenuation (225 HU) on nonenhanced CT scans. Histologic examination revealed an odontogenic keratocyst with no evidence of mineralization or calcification within the lesion. The high attenuation was considered to be due to highly concentrated protein of thick, viscous keratin in the lumen of the keratocyst.

Biomechanical evaluation of occipitocervical fixation devices.

Human cadaveric occipitocervical specimens were implanted with three types of instrumentation. The devices were tested biomechanically under three modes of loading to determine the stiffness of spinal constructs and the failure mechanisms of the constructs under extreme flexion. The devices tested were the AXIS Fixation System (with custom plate), the Y-Plate, and the Luque rectangle. No significant differences in stiffness among the devices were found under compression and flexion. The stiffnesses of the plate systems were statistically higher than the Luque rectangle in extension and torsion. In extreme flexion, the plate systems failed by fracture of the C2 pedicles. Modern plate systems, for occipitocervical fixation, provide more stiffness and stability than traditional wiring techniques. This study provides surgeons with information on the relative merits of modern plate and screw systems compared with traditional rod and wire constructs.

Iodoflex and Iodosorb in the treatment of venous leg ulcers.

This article reviews the use of Iodoflex and Iodosorb in chronic venous leg ulcers. A description of prevalence and quality of life issues is given. Application and method of use of Iodoflex and Iodosorb in venous leg ulcers is then detailed along with relevant clinical evidence. A case study describes the use of Iodoflex in a difficult-to-heal venous leg ulcer.

Use of rotational tomography for assessing internal resorption.

The authors describe the use of tomography, a relatively simple and well-established radiographic technique, for determining the buccolingual extent of internal resorptive lesions. The procedure may be a useful adjunct in selected cases to determine whether root canal therapy for the treatment of internal resorption followed by restoration of the tooth is likely to be successful.

In vivo, thyroid and lens surface exposure with spiral and conventional computed tomography in dental implant radiography.

OBJECTIVE: To compare the surface dose exposure to the lens of the eye and the thyroid gland received by patients undergoing spiral and conventional computed tomography (CT) examinations during dental implant pretreatment evaluation in critical radiosensitive structures of the maxillofacial region. STUDY DESIGN: Two groups of 10 patients each had a dental implant CT examination performed, with 5 patients in each group having maxillary and 5 having mandibular examinations. One group was examined with conventional CT and the other with spiral CT. Seven examination parameters were standardized to both types of examinations. Lithium fluoride thermoluminescent dosimeters were placed over the thyroid gland, lateral orbit, and infraorbital foramen of each patient to measure the surface dose. The Wilcoxon rank sum test was used to compare doses, with statistical significance set at P <.05. RESULTS: For the maxillary examination, there was a 57.4% reduction in the surface dose at the lateral orbit, 47% at the infraorbital foramen, and 60.8% at the thyroid when spiral CT was used instead of conventional CT with the same parameters. Similarly, for the mandibular examination, there was a 57.4% reduction at the lateral orbit, 60% reduction at the infraorbital foramen, and 70.9% at the thyroid. All the dose reductions were statistically significant at P <.05. CONCLUSION: The use of spiral CT for preimplant evaluation reduces the surface absorbed dose in certain critical structures of the maxillofacial region compared with conventional CT.

The cleansing of superficial traumatic wounds.

Patients with skin injuries account for 15% of accident and emergency (A&E) admissions (Leaman, 1991). Although there is evidence to suggest that wound cleansing is not always necessary (Thomlinson, 1987), no diagnostic test exists to allow healthcare practitioners to identify whether the bacterial load in the wound is capable of causing infection (Chrisholm, 1992). For this reason, all wounds in A&E should undergo some form of cleansing to decrease the bacterial inoculum in the wound to levels that can be managed by host defences (Chrisholm, 1992). Heyworth (1997) postulates that successful management of the contaminated wound must remove contaminants while inflicting minimal injury to tissue. This article reviews the research on the preparation and cleansing of superficial lacerations. Wound closure and indications for oral antibiotics will not be discussed.

Pulse oximetry: a new tool to assess patients with leg ulcers.

The objective of the study was to investigate pulse oximetry as a guide to assessing patients with leg ulcers before treatment. Graduated elastic compression is the treatment of choice for uncomplicated venous leg ulcers, but is contra-indicated in patients with significant arterial disease. The standard assessment of arterial insufficiency by Doppler ultrasound ankle branchial pressure index (ABPI) has shortcomings which prompted this investigation of pulse oximetry as a possible additional, or alternative, method of assessment of patients with leg ulcers, prior to treatment with compression. The study, carried out on a population of patients attending hospital leg ulcer clinics, was designed to evaluate pulse oximetry assessment in the selection and monitoring of patients with venous leg ulceration leading to a prospective controlled study of ulcer healing in groups of patients with reduced and normal ABPI, selected for compression therapy by pulse oximetry criteria. Outcome measurement required follow-up of patients selected for compression therapy by pulse oximetry to record time to healing and rate of healing of leg ulcers. Results from the study show a fair correlation between the toe-finger oximetry index (TFOI) and Doppler ABPI. There is no difference between ulcer healing in patients with reduced and normal ABPI selected for treatment on the basis of pulse oximetry maximum compression pressure (MCP). In conclusion, pulse oximetry is an aid to the selection of patients who will benefit from compression therapy, but would be excluded on the basis of Doppler ABPI.

The management of a patient with lymphoedema of the legs.

Lymphoedema is a much under-publicised condition, yet it affects many people. Janice Bianchi and Marie Todd outline the implications of the condition and examine the treatment options of a typical case study.

The management of leg ulcers in a patient with B cell cutaneous lymphoma.

Some patients suffer the consequences of skin ulceration more severely than others. Patients with B cell cutaneously lymphoma are one such group and this article reviews their special needs.

Cortical photostimulation with filtered visible light as a treatment for rheumatoid arthritis.

Not all extraocular photoreceptors in the human brain have been identified or their functions determined. The efferent and afferent fibres between the orbital frontal cortex and the hypothalamus cannot be overlooked in the context of the neuro-endocrine-immune feedback loop. It is suggested here that there are extraocular photoreceptors in the orbital frontal cortex, conceivably crucial for immunoregulation. The orbital frontal cortex of 7 volunteers with rheumatoid arthritis (RA) was photostimulated through the roof of the orbits with filtered visible light in sessions of 12, 14 and 16 minutes for a period of 6 weeks. Within 5 weeks, a significant decrease in the rheumatoid factor titres of 6 subjects was observed together with marked clinical improvement in 4 cases.