Ocular injuries among oral and maxillofacial surgeons: Have high risk or not? An overview of a two-centered experience.

BACKGROUND: Oral and maxillofacial surgeons are occupationally exposed to ocular injuries via bodily fluid (ie, blood or saliva), which can carry substantial latent risks, both bacterial and viral. The aim of this study was to determine the prevalence of ocular injury and infection among oral and maxillofacial surgeons during outpatient procedures. METHODS: Data were collected from a consecutive series of 500 surgeries conducted by 26 resident surgeons via a questionnaire. Responses were categorized into two groups: Group I did not indicate an eye injury, and Group II did indicate an eye injury. RESULTS: Of 500 procedures, 161 resulted in ocular injuries, a rate of 32.2 injuries per 100 person-procedures. Educated participants experienced eye injuries at a significantly higher rate than those who were uneducated (23.33% vs. 15.11%; P=0.022). Those not using eye protection experienced eye injuries at a significantly higher rate than those using eye protection (23.32% vs. 2.33%; P<0.001). Of all eye injuries, 14.28% required medical management. Incidents were reported at a rate of 10.56%, higher in those with multiple injuries. CONCLUSION: These findings demonstrate major inadequacies and breaches of the present eye/face protection protocols. Because the number of clinical studies on ocular injuries during oral and maxillofacial surgerical procedures is limited in the literature, each additional study can be important for promoting awareness among professionals, so that serious morbidity can be prevented.

Ultrastructural evaluation of intramuscular applied botulinum toxin type A in striated muscles of rats.

BACKGROUND: Botulinum toxin type A (BTX-A) is clinically utilized for therapeutic and cosmetic purposes in maxillofacial surgery as well as many other medical specialties. There is no sufficient ultrastructural research about BTX and it is controversial whether BTX-A causes muscle degeneration to some extent, in the course of therapy. The aim of this study was to evaluate the histological effects of BTX-A when injected into masseter and gluteal muscles. MATERIALS AND METHODS: A total of 30 male Sprague-Dawley rats were used and randomly divided into experimental (n =15) and control groups (n =15). Masseter and gluteal muscles were injected with a single dose of BTX-A in normal saline (0.5 U/0.1 ml), or 0.1 ml of normal saline, in the experimental and control groups, respectively. After 12 weeks all the rats were sacrificed. Gluteal, masseter muscles, and the sciatic nerves of the rats were prepared and electron microscopic, and light microscopic evaluation was performed on semi-thin sections cut from Epon embedded tissues and stained with toluidine blue. Quantitative parameters such as muscle fiber thickness and qualitative assessments including sarcosomal (striated muscle mitochondria) deformation, glycogen content, features of the triad structures and the intensity of connective tissue around the muscle fibers, and endoneurial and perineural tissue around nerve fibers were evaluated microscopically. We paired BTX- A (+) and BTX-A (-) samples statistically. Independent Samples t-test was used for the statistical analysis. RESULTS: Muscle fiber's diameter was significantly decreased in BTX-A (+) group (p <0,001). Atrophic changes in the myofibrils were characterized by a decrease in the myofibrillar diameter and changes in the sarcomere structure, and were prominent in the BTX-A (+) group. Also, some other changes like dilatation in the sarcoplasmic reticulum cisternae, mitochondrial swelling, and clearing of mitochondrial cristae associated with degeneration, were detected. No morphologic difference in the sciatic nerve fibers was detected, and myelin sheaths of axon structures were intact in both groups. CONCLUSION: BTX-A-induced muscular changes that are predominantly related to atrophy instead of degeneration. Although predominantly related to atrophy, our degeneration related findings suggest that further studies are needed focusing on detecting BTX-A effects on a cellular level. Hippokratia 2016, 20(4): 292-298.

Evaluation of potential salivary acetaldehyde production from ethanol in oral cancer patients and healthy subjects.

BACKGROUND: Acetaldehyde has been implicated as a major factor in oral carcinogenesis associated with alcohol consumption. In this study, saliva samples from oral cancer patients and healthy individuals were incubated in vitro with ethanol in order to investigate factors which can influence salivary acetaldehyde production. MATERIALS AND METHODS: A total of 66 individuals (40 males and 26 females, mean age 52 years) participated in the study. Participants were classified into three groups: Group 1 (oral cancer patients [n = 20]); Group 2 (poor dental health status [n = 25]) and Group 3 (good dental health status [n=21]). Every patient chewed a 1g piece of paraffin chewing gum for 1 minute then saliva samples were collected from all individuals. After in vitro incubation of the samples with ethanol, the levels of salivary acetaldehyde production was measured by head space gas chromatography. Kruskal-Wallis and Mann-Whitney tests and Spearman's Correlations analysis were performed for statistical analyses. RESULTS: The salivary acetaldehyde production was significantly higher (p <0.0001) in both group 1 and group 2 when compared to group 3. However, there was no significant difference between group 1 and group 2. Poor dental health status, infrequent oral hygiene habits and dental visits, smoking and presence of a dental prosthesis were significant parameters for increased levels of salivary acetaldehyde production from alcohol. The evaluation of salivary acetaldehyde production after in vitro incubation with ethanol may be useful for early detection of oral cancer. CONCLUSION: According to the results of this study, the significantly higher levels of salivary acetaldehyde production in oral cancer patients and individuals with poor dental health status may suggest a possible link between increased salivary acetaldehyde production and oral cancer. Improved oral hygiene can effectively decrease the level of salivary acetaldehyde production in oral cavity. Hippokratia 2014; 18 (3): 269-274.

Displacement of a maxillary third molar into the buccal space: anatomical implications apropos of a case.

A few cases of accidental displacement of molars into adjacent anatomical spaces, such as the infratemporal fossa, the pterygomandibular space, the maxillary sinus, or the lateral pharyngeal space, during surgical interventions have been reported. This report describes the displacement of a maxillary third molar into the buccal space and discusses the anatomical implications.

Treatment results and prognostic factors in oral tongue cancer: analysis of 80 patients.

Treatment results and prognostic factors for 80 patients with oral tongue cancer admitted to Istanbul University Oncology Institute between 1987 and 2000 were retrospectively analysed. The patients were treated by surgery and postoperative or curative radiotherapy. Median age was 55 (22-93) out of which 41 patients (51%) were male and 39 (49%) were female. One patient (1%) had stage I disease, 28 patients (36%) stage II, 18 patients (23%) stage III and 32 patients (40%) stage IVA disease. Nineteen patients (24%) were medically inoperable or refused surgical treatment, so were treated with curative radiotherapy to a total dose of 70Gy (group A). The remaining 61 patients (76%) were treated with surgery and postoperative external beam radiotherapy (group B). The median follow-up time was 44 months. The 5-year overall and loco-regional disease-free survival rates were 42% and 46%, respectively. The 5-year overall survival rates were 16% in group A and 49% in group B (P=0.0002). The 5-year disease-specific survival rate was 23% in group A while in group B it was 49%; the difference was statistically significant (P=0.02). Combined treatment improves overall and disease-free survival in patients with stage II, III and IVA oral tongue cancer. In patients who are not candidates for surgery, the effect of radiotherapy may be increased with the use of brachytherapy.