Evaluation of Dentoalveolar Trauma in Children and Adolescents: a Modified Classification System and Surgical Treatment Strategies for Its Management.

OBJECTIVE: To retrospectively analyze dentoalveolar trauma in pediatric patients, propose a modified classification, and delineate an approach for its urgent care from the surgeon's perspective. PATIENTS AND METHODS: Clinical records of patients, attended at the 'A. and P. Kyriakou' Children's Hospital Department of Oral and Maxillofacial Surgery from 2000 to 2015, were retrieved and data were analyzed. RESULTS: A total of 365 cases of dentoalveolar trauma, affecting 363 children and adolescents (221 males and 142 females), with an age range from 1 to 15 years, were treated in the authors' department. The most common injury mechanism was falls. The trauma was graded as class II in most patients (41.65%). The anterior maxilla was injured in the majority of the patients (78.35%). In 230 patients (63%) the trauma involved the primary dentition. Two hundred eighty-nine of the patients were treated with local anesthesia on an emergency basis, while in the rest 76 patients general anesthesia was considered mandatory. CONCLUSIONS: Accurate diagnosis, timely treatment, and follow-up are critical for the management of dentoalveolar trauma in pediatric patients. A modified more detailed and severity-specific classification and guidelines for its surgical management may assist practitioners in decision making and effective treatment planning.

Surgical management of head and neck vascular anomalies in children: a retrospective analysis of 42 patients.

OBJECTIVE: This article aimed to present a series of surgically treated head and neck vascular anomalies during a 12-year period, highlighting the epidemiology, diagnostic approach, indications for surgery, and final clinical outcome. STUDY DESIGN: The medical records of all patients with head and neck vascular anomalies, surgically treated at our department from 1998 to 2010, were reviewed retrospectively. RESULTS: A total of 42 patients with 46 vascular anomalies were identified. Patients' diagnoses included vascular tumors, hemangiomas mainly (18 cases), and various vascular malformations (26 cases). All patients were submitted to surgical treatment (excision-resection) to resolve main clinical symptoms (ulceration, bleeding, impaired mastication and feeding, airway obstruction) and/or esthetic issues. Recurrence was noted in 3 patients. CONCLUSION: Accurate differential diagnosis based on history, physical examination, and imaging, is the key to optimal treatment. Surgical intervention is warranted for small to moderately extended lesions to avoid complications and/or esthetic concerns and psychosocial distress.

Lymphatic malformations in children and adolescents.

PURPOSE: This article aimed to present a series of surgically treated lymphatic malformations of the cervicofacial region in a population of children and adolescents during a 13-year period. METHODS: The medical records of all children and adolescents with cervicofacial lymphatic malformations, treated surgically at our department from 1998 to 2011, were reviewed retrospectively. RESULTS: Eighteen patients with 20 lymphatic malformations located within the soft tissues of the cervicofacial region were identified. All patients were submitted to surgical treatment (excision or resection with conventional scalpel or radiosurgery) to address complications (ulceration, bleeding, impaired mastication and feeding, airway obstruction) and/or aesthetic issues. Recurrence was noted in 2 of our patients. CONCLUSIONS: Accurate diagnosis based on history, clinical examination, and adequate imaging techniques is the key to the optimal treatment of cervicofacial lymphatic malformations; surgical intervention remains the treatment of choice for these lesions.

Comparison of lateral thermal injury and healing of porcine skin incisions performed by CO2-laser, monopolar electrosurgery and radiosurgery: a preliminary study based on histological and immunohistochemical results.

BACKGROUND: Despite the wide application of lasers and electrosurgery in dermatology, the pertinent literature provides conflicting data regarding the lateral thermal injury (LTI) associated with these instruments and its effects on wound healing. This study aims to quantitate the LTI produced by CO(2)-laser, monopolar electrosurgery (MES), and radiosurgery (MRS) and determine its effects on the healing process (re-epithelialization and inflammatory response) of incisional wounds. METHODS: Five adult swine of similar weight (22.8-25 kg) were submitted to standardized full-thickness incisions on the lateral abdominal skin by the above instruments (at settings similar to those used in clinical practice) and scalpel (control group). Full-thickness specimens from the surgical site were harvested immediately afterwards and 48 hours later (days 1 and 3). The animals were euthanized by intravenous administration of propofol and pentobarbital. All specimens were formalin fixed, paraffin embedded, cut, and stained with hematoxylin-eosin to quantitate the extent of LTI and inflammatory infiltration. Sections of day 3 were stained with the MIB-1 monoclonal antibody to detect Ki-67 as a marker of epithelial cell proliferation adjacently to the incisions. RESULTS: LTI was most extensive in the CO(2)-laser-group but did not differ significantly between MES- and MRS-groups. Immunohistochemistry ascertained significantly greater epithelial cell proliferation in the CO(2)-laser-group. Inflammatory infiltration was significantly greater in the CO(2)-laser-group, when compared with the controls but did not differ significantly between the MES/MRS and control groups. CONCLUSION: CO(2) laser incisions exhibit more extensive LTI, epithelial cell proliferation, and inflammatory response. Confirmation of these findings requires a greater sample.

Evaluation of lateral thermal damage and reepithelialization of incisional wounds created by CO2-laser, monopolar electrosurgery, and radiosurgery: a pilot study on porcine oral mucosa.

OBJECTIVE: This study aims to compare lateral thermal damage (LTD) produced by CO(2)-laser, monopolar electrosurgery (MES), and radiosurgery (MRS) and its effects on the reepithelialization of oral mucosa incisional wounds. STUDY DESIGN: Five adult swine were submitted to standardized incisions at the tongue and gingiva by MES, MRS, CO(2)-laser and scalpel. Full-thickness specimens were harvested sequentially on days 1 and 3. All specimens were formalin fixed, paraffin embedded, cut, and stained with hematoxylin-eosin to quantify LTD extent. Sections of day 3 were stained for Ki-67 to assess epithelial proliferation at the incision margins. A multiple linear regression model and an analysis of variance were used to determine the correlation of each instrument with LTD extent and Ki-67 expression respectively. RESULTS: LTD was most extensive in the CO(2)-laser but did not differ between the MES and MRS groups. No statistically significant differences regarding reepithelialization were noted among the investigated instruments. CONCLUSIONS: CO(2)-laser produced more extensive LTD, without evident impact on reepithelialization.