ABSTRACT
BACKGROUND AND OBJECTIVES: Posttraumatic carotid-cavernous sinus fistula is a rare complication of maxillofacial trauma and is seldom discussed in the literature. Motor vehicle accidents, falls, and other crush injuries contribute to the incidence of basilar skull fractures and the formation of fistulae. When injuries occur in the vessel wall, the carotid artery has the potential to fill the low-pressure cavernous sinus. The symptoms include chemosis, proptosis, pulsating exophthalmos, diplopia, ophthalmoplegia, orbital pain, audible bruits, and blindness. METHODS AND MATERIALS: The conventional treatments include carotid ligation and embolization. These techniques have often proved to be ineffective. A new method--the occlusive balloon technique--has been developed and is described in this article. A clinical case is used to illustrate the procedure. RESULTS AND/OR CONCLUSIONS: Utilization of balloon catheters provides a minimally invasive technique to treat patients, without significant morbidity or mortality. The procedure is found to be successful and predictable.
Subject(s)
Carotid-Cavernous Sinus Fistula/etiology , Maxillofacial Injuries/complications , Accidental Falls , Accidents, Traffic , Adolescent , Carotid-Cavernous Sinus Fistula/classification , Carotid-Cavernous Sinus Fistula/therapy , Cerebral Angiography , Conjunctival Diseases/etiology , Diplopia/etiology , Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/methods , Exophthalmos/etiology , Humans , Male , Minimally Invasive Surgical Procedures , Ophthalmoplegia/etiology , Skull Fracture, Basilar/complications , Treatment OutcomeABSTRACT
Dentists attempt to overcome patients' fears by using various oral, intramuscular, intravenous, and inhalational anxiolytic agents. This article discusses the use of oral midazolam as an alternative to oral diazepam in the management of the pediatric patient.
Subject(s)
Anesthesia, Dental/methods , Conscious Sedation/methods , Dental Care for Children/methods , Hypnotics and Sedatives/administration & dosage , Midazolam/administration & dosage , Administration, Oral , Child , Child, Preschool , Dental Anxiety/prevention & control , Diazepam/administration & dosage , Flumazenil/pharmacology , GABA Modulators/pharmacology , HumansABSTRACT
A 55-year-old woman developed chronic infections of the maxillary sinuses with osteomyelitis resulting in extensive bone destruction and atrophy from a failed subperiosteal implant. After surgical removal of the subperiosteal implant, extensive debridement of the maxilla, and long-term antibiotic therapy, maxillary reconstruction was initiated. A Le Fort I osteotomy and downgraft was performed, and a posterior iliac bone graft was harvested and grafted to reconstruct the severely atrophic maxilla. In a later surgical procedure, maxillary and mandibular implants were placed. Implant-retained overdentures were fabricated to restore function and esthetics.
Subject(s)
Alveolar Ridge Augmentation/methods , Dental Implantation, Endosseous/methods , Maxillary Diseases/surgery , Alveolar Bone Loss/etiology , Alveolar Bone Loss/rehabilitation , Alveolar Bone Loss/surgery , Bone Transplantation/methods , Dental Implantation, Subperiosteal/adverse effects , Dental Prosthesis, Implant-Supported , Denture, Overlay , Female , Humans , Ilium/transplantation , Maxillary Diseases/complications , Maxillary Diseases/etiology , Maxillary Diseases/rehabilitation , Middle Aged , Osteotomy, Le Fort , ReoperationABSTRACT
Lesch-Nyhan syndrome is a rare anomaly consisting of a deficiency in the production of hypoxanthine phosphoribosyltransferase that leads to the overproduction of purine and the accumulation of uric acid. Major manifestations include mental retardation and self-destructive behavior resulting in self-mutilation through biting and scratching. Because no medical treatment exists to alleviate the symptoms of self-mutilation, direct dental intervention is the only way these behaviors can be affected. A unique case of this type involving two male identical twins is reported.
Subject(s)
Diseases in Twins , Lesch-Nyhan Syndrome/physiopathology , Self Mutilation/surgery , Tooth Extraction , Child , Humans , Lip/injuries , Male , Tongue/injuriesABSTRACT
Osteomas of the jaws are well-defined lesions that can present as an isolated finding or as part of a syndrome (e.g., Gardner's syndrome). The etiology of peripheral osteomas is somewhat controversial. Trauma has been implicated by several authors, and osteoma is presented here as a rather striking lesion with well-defined traumatic origins.
