Self-mutilation of the lower lip in a child with dystonia secondary to megalencephalic leukoencephalopathy treated with botox injections: a case report.

PURPOSE: We report the case of a 10-year old boy who had been diagnosed with megalencephalic leukoencephalopathy several years earlier. Because of the patient's oral dystonic activity, a traumatic, nonhealing, chronic ulcer had developed on his lower lip. MATERIALS AND METHODS: Botox-A was injected into the mentalis, orbicularis oris, and bilateral masseter muscles. RESULTS: The patient showed decreased dystonia and gradual complete healing of the traumatic ulcer of the lower lip. CONCLUSIONS: The treatment of patients with self-mutilation to the lips will often be difficult. Traditionally, patients have been treated with various medications, oral appliances, and even tooth extraction. The results of the present case report suggest that Botox should be considered as a possible first-line strategy, along with oral appliances.

Oral rehabilitation of a 12-year-old patient diagnosed with a central giant cell granuloma using a fibula graft and an implant-supported prosthesis: a clinical report.

This clinical report describes the oral rehabilitation of a 12-year-old boy with a central giant cell granuloma of the mandible. He underwent en bloc resection of a central giant cell granuloma, free vascularized fibula reconstruction, implant placement, and prosthesis fabrication. The multidisciplinary approach successfully restored function and esthetics. Considerations regarding the extensive surgical and prosthetic rehabilitation of a young adult with remaining growth are discussed.

Simultaneous intranasal procedures to improve chronic obstructive nasal breathing in patients undergoing maxillary (le fort I) osteotomy.

PURPOSE: The aim of this study was to evaluate the safety and efficacy of septoplasty and inferior turbinate reduction, carried out through a Le Fort I osteotomy as part of the correction of a dentofacial deformity, designed to improve nasal breathing in patients who reported pre-existing nasal airway obstruction and had documented septal deviation and inferior turbinate hypertrophy. PATIENTS AND METHODS: A validated outcomes instrument, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, was used to objectively assess the extent of clinical nasal obstruction both before and after septoplasty and inferior turbinate reduction performed at the time of Le Fort I down-fracture. The study group comprised 43 consecutive patients scheduled for orthognathic surgery (including Le Fort I osteotomy) over a 12-month period who complained of chronic nasal obstruction and were found (by an independent otolaryngology evaluation) to have septal deviation and inferior turbinate hypertrophy unresponsive to medical therapy, who met the inclusion criteria, and who agreed to the procedures (septoplasty and turbinate reduction). The data collected included age, gender, health and social history, type of dentofacial deformity, concomitant surgical procedures, and any associated postoperative complications. RESULTS: For the 43 study patients, significant improvement in nasal breathing was documented (by NOSE scores) at 3 months (P < .001) after the procedures (Le Fort I osteotomy, septoplasty, and inferior turbinate reduction). Comparison of the 3-month and 6-month NOSE scores showed maintenance of improved nasal breathing with further improvement that did not demonstrate statistical significance. CONCLUSIONS: The findings of this study indicate that simultaneous management of the maxillary jaw deformity (Le Fort I osteotomy) and intranasal pathology (septoplasty and reduction of inferior turbinates) were effective for the symptomatic relief of nasal airway obstruction. The complication rate for the intranasal procedures completed simultaneously with a Le Fort I osteotomy was minimal and not dissimilar to the rates reported for each procedure performed as an isolated event.

The role of automated external defibrillators in dental practice.

Dental practices are seeing an increasing number of elderly and medically compromised patients, making it likely that staff will be called upon to respond to medical emergencies in the office, including cardiac arrest. Out-of-hospital cardiac arrests account for nearly half of all cardiovascular deaths in the United States. In adult cardiac arrest victims, the most frequent cause of sudden cardiac arrest is ventricular dysrhythmia, either ventricular tachycardia or ventricular fibrillation. The survival rate for sufferers of out-of-hospital cardiac arrests is a dismal 1% to 5% to hospital discharge. A majority of people who survive to discharge sustain significant morbidity. Untreated ventricular fibrillation degenerates into asystole, which is often refractory to resuscitative efforts and represents a terminal event. The development and availability of the automated external defibrillator (AED) represents a promising advance in the pre-hospital early defibrillation of victims of sudden cardiac arrest in a variety of settings, often remote from hospitals or EMS personnel. Given the medically compromised segment of the population treated in many dental practices today, it is imperative that dental practitioners and allied health providers become trained in the recognition and prompt initiation of emergency care, including basic life support with early defibrillation. The AED is becoming more accessible, with increasingly widespread availability, training in its use and relative ease of operation, making the goal of increased survival one in which dental health professionals can play a part.

Peripheral primitive neuroectodermal tumor associated with the anterior mandible: a case report and review of the literature.

Neuroectodermal tumors may arise in many places throughout the body including the diverse tissues of the head and neck. The primitive neuroectodermal tumor is a predominately neural, nonepithelial neoplasm similar to Ewing sarcoma. This article describes an 18-year-old female patient with a highly malignant peripheral primitive neuroectodermal tumor located in the soft tissue anterior to the mandibular symphysis. The clinical and radiographic presentation as well as the histopathology and immunohistochemistry of this rare entity is discussed. A review of the literature with respect to this tumor, as well as the current management of this tumor, is presented.