Potential complications and precautions in vertical alveolar distraction osteogenesis: a retrospective study of 40 patients.

The aim of this retrospective study was to analyse the outcome of 44 cases of vertical alveolar distraction osteogenesis (ADO) and to investigate the complications, precautions, and treatment associated with ADO. The 44 alveolar distractions were performed on 40 patients. Extraosseous distraction was used in all cases. Complications associated with the intraoperative, postoperative, distraction, and consolidation periods were recorded and evaluated. Intraoperative complications were noted in two patients (4.5%) where fracture of the basal bone was evident. Three (6.8%) complications were recorded postoperatively, and 12 (27.3%) complications were recorded during the activation period. During the consolidation period, 4.5% of the patients (n = 2) were affected. The total prevalence of complications was 43.2% (n = 19), and the success rate of the ADO was 95.5%. Most complications occurred in the anterior mandibular region. Although complications associated with vertical ADO were not rare, the use of this procedure for maxillofacial defects results in satisfactory outcomes. Early diagnosis and management of related complications are crucial for increasing the success rate of ADO procedures.

Maxillary tuberosity reconstruction with transport distraction osteogenesis.

Severe bone loss due to pathology in the maxillary tuberosity region is a challenging problem both surgically and prosthetically. Large bone grafts have a poor survival rate due to the delicate bony architecture in this area and presence of the maxillary sinus. Our case presentation describes a new technique for reconstructing severe bony defect in the maxillary tuberosity with horizontal distraction osteogenesis in a 45-year-old man. A 4 × 6 × 3 cm cyst was discovered in the left maxillary molar region and enucleated. Three months postoperatively, the area had a severe bone defect extending to the zygomatic buttress superiorly and hamular notch posteriorly. Three months later, a bone segment including the right upper second premolar was osteotomised and distracted horizontally. The bone segment was distracted 15 mm distally. After consolidation, implants were placed when the distractor was removed. A fixed denture was loaded over the implants after 3 months. Complete alveolar bone loss extending to the cranial base can be reconstructed with transport distraction osteogenesis. Distalisation of the alveolar bone segment adjacent to the bony defect is an easy method for reconstructing such severe defects.

Treatment of trigeminal neuralgia with bupivacaine HCL using a temporary epidural catheter and pain pump: preliminary study.

OBJECTIVES: Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe paroxysmal pain in the face. The treatment for trigeminal neuropathic pain disorder continues to be a major therapeutic challenge, as relief provided by medical therapy generally decreases over time. When medical therapy fails either due to poor or diminishing responses to drugs or to unacceptable side effects, peripheral intervention or surgical management of TN should be considered. STUDY DESIGN: Fourteen patients (eight men and six women) who were not responsive to further medical treatment and who were diagnosed with TN previously at other health centres were selected for treatment. For this purpose, the affected nerve was infused with 60 mL (1 mL h(-1)) of 0.5% bupivacaine HCl with a pain pump via an temporary epidural catheter. Patient's visual analogue scores (VAS) were recorded on the fifth preoperative day and on postoperative day 5, 2 weeks, 1, 3, 6 and 9 months. RESULTS: There was a significant difference between mean preoperative and postoperative VAS value at day 5, 2 weeks, 1, 3, 6 and at the end of 9 months ((68.85 ± 1.43) (13.57 ± 6.68) (11.43 ± 6.70) (14.29 ± 6.52) (20.71 ± 6.41) (20.71 ± 6.41) and (21.43 ± 6.10) respectively; ∗P<0.05). Two of 14 patients did not show any pain relief. CONCLUSIONS: Continuous administration of 60 mL of 0.5% bupivacaine HCl at 1 mL h(-1) with a pain pump and epidural catheter can be used as a transition treatment for patients with side effects from high-dose antiepileptic drugs and for patients awaiting neurosurgery or individuals who refuse cranial surgery. It should not be considered as an alternative treatment of neurosurgical approaches, such as MVD, which has a definite long-lasting results.

Management of arsenic trioxide necrosis in the maxilla.

Historically, pulp-necrotizing agents were commonly used in endodontic treatments. They act quickly and devitalize the pulp within a few days. However, they are cytotoxic to gingiva and bone. If such an agent diffuses out of the cavity, it can readily cause widespread necrosis of gingiva and bone, which can lead to osteomyelitis of the jaws. Although the use of arsenic trioxide can cause severe damage to surrounding tissues, producing complications, it is still used in certain areas in the world. This article presents and discusses two cases of tissue necrosis and their surgical management. These cases showed severe alveolar bone loss in the maxilla, which affected the patients' quality of life and limited the restorative possibilities. As dentists, we should be aware of the hazardous effects of arsenic trioxide and should abandon its use. Because of its cytotoxicity, there is no justification for the use of arsenic trioxide in the modern dental practice.