The Role of Dental Arch Dimensions and Impacted Third Molars on Mandibular Anterior Segment Crowding.

OBJECTIVES: This study aimed to investigate the potential impact of arch dimensions and unerupted third molars on mandibular anterior segment crowding. MATERIALS AND METHODS: This study included a total of 240 subjects with an average age of 18 years seeking orthodontic treatment. Panoramic radiographs, alginate impressions, and study models were taken for measurements. This study utilized the Ganss ratio to calculate the ratio of retromolar space to the width of the crown of the third molar, along with other measurements such as intercanine and intermolar widths, arch perimeter, and arch length to assess dental arch dimensions. RESULTS: We found that the Ganss ratio and angle B values on both the right and left sides were significantly different between the noncrowding and crowding groups, suggesting a potential role for third molars in mandibular anterior segment crowding. Additionally, there was an increase in angle A on both sides in the crowding group, indicating a more acute angle between the anterior teeth. This study also observed a reduction in the retromolar space on the third molars in the crowding group, further supporting the potential role of third molars in mandibular anterior segment crowding. CONCLUSION: The findings of our study provide substantial evidence to suggest that third molars may contribute to mandibular anterior segment crowding. These findings highlight the importance of carefully evaluating dental arch dimensions and the presence of third molars when assessing and treating mandibular anterior segment crowding.

Camptodactyly Caused by an Anomalous Origin of the Flexor Digitorum Superficialis Tendon: A Case Report and Review of the Literature.

Camptodactyly is a flexion contracture of the proximal interphalangeal joints and is known as an isolated malformation that affects 1 in 300 in the population and can be inherited as an autosomal dominant trait with variable expression. A 17-year-old female was referred to the Clinic of Plastic Surgery, University Clinical Center of Kosovo, Prishtina, for the first time with camptodactyly of the little finger in the right hand. She was presented with a progressive flexion contracture of the proximal interphalangeal joint greater than 110 degrees of her right little finger. According to our observations from outpatient consultations, we concluded that the case of camptodactyly in the little finger in the flexible form (>110 degrees), which underwent surgical treatment, presented excellent result. Therefore, we think that the surgical technique used in our case report will contribute to treating this complicated deformity.

Effects of Lower Third Molar Angulation and Position on Lower Arch Crowding.

UNLABELLED: The role of the third molars in lower arch crowding has been debated for more than a century. OBJECTIVES: The aim of this study was to determine the relationship between lower arch crowding and the presence of angulation and position of lower third molar. METHODS AND MATERIALS: The measurements of the dental arch were made in 120 subjects aged 16 to 21 years, with average age to 18 years. The subjects were divided into two groups: Class I normal occlusion comprised 35 male and 25 female with mean age 18.87years, whereas Class I crowding comprised 27 males and 33 females with mean age 18.5 years. The dental pantomogram (DPT) were used to calculate the ratio of retromolar space (Ganss ratio), angulation of third molar to second molar and third molar to the base of the mandible. RESULTS: The results showed that measurements of Ganss ratio, third molar angulation to the base of the mandible, and third molar to second molar inclination, was statistically significant between crowded and normal groups. CONCLUSION: It can be concluded that there was a strong relationship between angulation and position of third molars and lower arch crowding. Key words: Third molars, angulation, lower arch, crowding

Partially Divided Flexor Tendon Injuries: Should They Be Repaired or Not?

The correct management of partially divided flexor tendon injuries is still controversial. Opinions vary regarding whether partially divided flexor tendon injuries should be repaired. Flexor tendon injuries are common because the tendons lie close to the skin. The tendons are therefore exposed to injuries like lacerations and crush injuries, and occasionally they can rupture from where they are joined to the bone. Tendon injuries are the second most common hand injuries in orthopedic patients.

New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events.

Despite the discovery and application of many parenteral (unfractionated and low-molecular-weight heparins) and oral anticoagulant vitamin K antagonist (VKA) drugs, the prevention and treatment of venous and arterial thrombotic phenomena remain major medical challenges. Furthermore, VKAs are the only oral anticoagulants used during the past 60 years. The main objective of this study is to present recent data on non-vitamin K antagonist oral anticoagulants (NOACs) and to analyze their advantages and disadvantages compared with those of VKAs based on a large number of recent studies. NOACs are novel direct-acting medications that are selective for one specific coagulation factor, either thrombin (IIa) or activated factor X (Xa). Several NOACs, such as dabigatran (a direct inhibitor of FIIa) and rivaroxaban, apixaban and edoxaban (direct inhibitors of factor Xa), have been used for at least 5 years but possibly 10 years. Unlike traditional VKAs, which prevent the coagulation process by suppressing the synthesis of vitamin K-dependent factors, NOACs directly inhibit key proteases (factors IIa and Xa). The important indications of these drugs are the prevention and treatment of deep vein thrombosis and pulmonary embolisms, and the prevention of atherothrombotic events in the heart and brain of patients with acute coronary syndrome and atrial fibrillation. They are not fixed, and dose-various strengths are available. Most studies have reported that more advantages than disadvantages for NOACs when compared with VKAs, with the most important advantages of NOACs including safety issues (ie, a lower incidence of major bleeding), convenience of use, minor drug and food interactions, a wide therapeutic window, and no need for laboratory monitoring. Nonetheless, there are some conditions for which VKAs remain the drug of choice. Based on the available data, we can conclude that NOACs have greater advantages and fewer disadvantages compared with VKAs. New studies are required to further assess the efficacy of NOACs.

Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits.

BACKGROUND: The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU) on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs]) following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and biomechanical evaluations of tendon adhesions. METHODS: We used 32 adult male European rabbits (Oryctolagus cunniculus) weighing from 2.5 to 3.5 kg. The study was performed on the deep flexor tendons of the second and third digits of the right hind paws of the rabbits; thus, a total of 64 tendons were examined in this study. RESULTS: Based on the results achieved in our experimental study, the load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared with subgroup 2a in which tendons were surgically repaired and treated with 5-FU. CONCLUSIONS: The load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared to subgroup 2a in which the tendons were surgically repaired and treated with 5-FU. Therefore, these results revealed a decrease in adhesion formation in the subgroup that was treated with 5-FU due to increased resistance to tendon adhesions during their excursion through the tendon sheath, which in this case required greater traction force.

Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012.

BACKGROUND: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. MATERIALS AND METHODS: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. RESULTS: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. CONCLUSION: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.

Biomechanical properties of the sciatic nerve following repair: effects of topical application of hyaluronic acid or tacrolimus.

UNLABELLED: Recovery following nerve repair can be evaluated based on electrophysiological and morphological assessments of biomechanical properties. This study compared the effects of topical hyaluronic acid (HA), tacrolimus (FK-506) or saline administration on the biomechanical properties of the sciatic nerve at 12 weeks after nerve repair. MATERIALS AND METHODS: Eighteen male European rabbits (Oryctolagus cuniculus) (weight from 2.5 to 3 kg) were randomly assigned to one of the following experimental groups (six animals per group): Saline, HA, or FK-506. The non-transected left leg was used as a control group (eighteen sciatic nerves). Biomechanical assays were performed and statistically analyzed. RESULTS: The average maximal load, elastic limit load, maximal stress, and elastic limit strain of the control group were significantly different (P<0.001) from those of all three experimental groups. Moreover, the other examined parameters (i.e., maximal displacement, elastic limit stress, and maximal strain) were significantly different between the control group and all three experimental groups (P<0.0001). However, no significant differences in any of the biomechanical parameters were observed between the experimental groups (P>0.05). At 12 weeks after nerve repair, Saline, HA, and FK-506 groups displayed average maximal stress values that were 72.6%, 77.38%, and 73.8% of those in the control group (100%), respectively. CONCLUSION: The biomechanical properties of the HA and FK-506 groups were similar to those of the saline group at 12 weeks after nerve repair.

Electrophysiological and functional evaluation of peroneal nerve regeneration in rabbit following topical hyaluronic acid or tacrolimus application after nerve repair.

AIMS AND OBJECTIVES: To investigate and compare the effects of hyaluronic acid (HA), tacrolimus (FK-506) and saline on peripheral nerve regeneration in vivo after topical application at the site of nerve repair. MATERIALS AND METHODS: In the present study, 48 adult male European rabbits (Oryctolagus cuniculus), ranging in weight from 2.5 to 3 kg, were randomly assigned to three experimental groups: Group I (saline), Group II (HA) and Group III (FK-506). After transection and immediate repair of the right sciatic nerve of each rabbit, the nerve repair sites were wrapped with an absorbable gelatin sponge soaked that contained saline, HA and FK-506 in Groups I, II and III, respectively. The left hind leg was used as a control. To evaluate the effects of HA and FK-506 on nerve regeneration, electrophysiological measurements were acquired at 6 and 12 weeks after nerve repair and toe-spreading index (TSI) experiments were conducted at 4, 8 and 12 weeks after nerve repair. RESULTS: Motor nerve conduction velocity (MNCV) was improved in Groups II and III compared to Group I, but no differences between Groups II and III were observed. After 12 weeks, however, the MNCV in Groups I, II and III was 40.04%, 51.16% and 50.42%, respectively, of that in the control group (100%). In addition, at 12 weeks, Grade 4 TSI scores were observed in Groups II and III. CONCLUSION: Electrophysiological analyses and functional evaluations based on the TSI indicate that HA and FK-506 exert similar, positive effects on nerve regeneration that are superior to those observed in response to saline treatment.

Application of topical pharmacological agents at the site of peripheral nerve injury and methods used for evaluating the success of the regenerative process.

Traumatic injuries of the peripheral nerves are very common. Surgical repair of the damaged nerve is often complicated by scar tissue formation around the damaged nerve itself. The main objective of this study is to present the recent data from animal experimental studies where pharmacological topical agents are used at the site of peripheral nerve repair. Some of the most commonly topical agents used are tacrolimus (FK506), hyaluronic acid and its derivatives, and melatonin, whereas methylprednisolone and vitamin B12 have been used less. These studies have shown that the abovementioned substances have neuroprotective and neuroregenerative properties though different mechanisms. The successes of the regenerative process of the nerve repair in experimental research, using topical agents, can be evaluated using variety of methods such as morphological, electrophysiologic, and functional evaluation. However, most authors agree that despite good microsurgical repair and topical application of these substances, full regeneration and functional recovery of the nerve injured are almost never achieved.

Pediatric burns in University Clinical Center of Kosovo from 2005-2010.

OBJECTIVE: The objective of this study was to determine the incidence and cause of burns in children of our population. METHODS: This was a retrospective study that included 399 patients with burns, younger than 15 years old who were admitted to the Department of Plastic Surgery, University Clinical Center of Kosovo, between 1 January 2005 and 31 December 2010. The patients were categorized into the following three age groups: infants and toddlers (0-2 years), early childhood (3-6 years), and late childhood (7-15 years). Arithmetic median and standard deviation were calculated from statistical parameters for gender and age; the differences between the three age groups were measured with one-way analysis of variance (ANOVA). A p value of <0.05 was considered statistically significant. RESULTS: During the study period 2005-2010, in our population, burns in children were predominant in boys with 257 cases or 64.4%, while 142 patients were girls or 35.5% The difference between the three age groups related to the causes of burns was statistically significant: p<0.000 for electrical burns and p<0.002 for burns caused by pyrotechnic devices. CONCLUSION: A high rate of childhood burns in Kosovo induces hospital admissions and prolonged hospital stays.

A retrospective study of 572 patients with hand burns treated at the Department of Plastic Surgery Kosovo during the period 2000-2010.

Hands participate in everyday human activities and they are the most vulnerable parts of a human body. The objective of this study is to understand the common causes of hand burns, the methods of surgical interventions, duration of hospitalization and distribution of hand burns in 11 year period regarding the age. This is a retrospective study that included 572 patients with hand burns treated at the Department of Plastic Surgery Kosovo during the period 2000-2010. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Data processing was done with the statistical package InStat 3. From statistical parameters were calculated structural index, arithmetic median and standard deviation. Data testing is done with X (2) test and the difference is significant if P<0.05. The Ministry of Health of our country should make efforts to organize training for health workers about treatment for minor burns in order to reduce the number of referral patients from other primary (Familiar Medicine) and secondary centers (regional Hospitals).

Surgical Treatment of 55 Patients with Pressure Ulcers at the Department of Plastic and Reconstructive Surgery Kosovo during the Period 2000-2010: A Retrospective Study.

Objective. The objective of this study is to determine the incidence of PUs, the distribution of PUs, common injuries contributing to the occurrence of PUs in patients admitted to the Department of Plastic and Reconstructive Surgery Kosovo for surgical interventions of PUs, localization of PUs in body, the topical treatment of pressure ulcers before surgical intervention, the methods of surgical interventions, number of surgical interventions, duration of treatment, complications, and mortality. Materials and Methods. This study includes 55 patients with PUs treated surgically in 2000-2010 period in the Department of Plastic and Reconstructive Surgery Kosovo. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Data processing was done with the statistical package In Stat 3. From statistical parameters arithmetic median and standard deviation were calculated. Data testing is done with χ (2)-test and the difference is significant if P < 0.05. Conclusion. Despite preventive measures against PUs, the incidence of Pus remains high.

A retrospective study of 22 patients with necrotising fasciitis treated at the University Clinical Center of Kosovo (2005-2010).

Necrotising fasciitis (NF) is a destructive invasive infection of skin, subcutaneous tissue and deep fascia. The aim of the study is to determine the causative agents of NF, its localisation, predisposing factors and comorbid conditions, duration of treatment and distribution of NF in different age groups and over the years. We conducted a retrospective study including 22 patients with NF from 2005 to 2010 in the University Clinical Center of Kosovo. The data were collected and analysed from the archives and protocols of the University Clinical Center of Kosovo. The average age of patients was 56·9 years. In eight cases or 36·4% of total patients studied, NF was caused by monobacterial agents with a predominance of Pseudomonas aeruginosa (five cases or 22·7% of total infections). Polybacterial agents were responsible for NF infection in other 14 cases (63·6%). Majority of the patients had other comorbidities like diabetes, trauma and prior history of surgical interventions. Diabetes was present in 17 patients or 77·3%. The remaining five patients (22·7%) had previous trauma and recent surgical intervention. Average length of treatment was 43 days. The hospital mortality rate in our case series was 22·6%. Early identification and diagnosis of NF significantly improves outcome and reduces mortality.