Role of TNF-alpha and its receptors in pericoronitis.

The classic stimulus for cellular cytokine production is bacterial lipopolysaccharide (endotoxin). It was therefore hypothesized that tumor necrosis factor-alpha (TNF-alpha) may be responsible for pericoronitis. TNF-alpha and its receptors were detected by immunohistochemical staining in third molar pericoronitis in ten patients and ten healthy control samples. The percentage of TNF-alpha positive cells was high in pericoronitis (p = 0.0317). TNF receptors TNF-R1 and TNF-R2 were found in macrophage- and fibroblast-like cells, vascular endothelial cells in post-capillary venules, and basal epithelial cells in pericoronitis, but were only weakly expressed in controls. Increased expression of interleukin-1beta and vascular cell adhesion molecule-1 was found as a biological indicator of TNF-alpha ligand-receptor interaction. Explanted tissues acquired destructive potential upon TNF-alpha stimulation, whereas TNF-alpha blockers controlled it in inflamed tissues. These findings suggest that, in pericoronitis, inflammatory and resident cells produce and respond to potent pro-inflammatory cytokine TNF-alpha, with pathogenic and potential therapeutic relevance.

Thermographic imaging of postoperative inflammation modified by anti-inflammatory pretreatment.

PURPOSE: The aim of this study was to assess the usefulness of thermography in detecting the postoperative inflammatory reaction after third molar removal. PATIENTS AND METHODS: Thermographic images (NovaTherm; Novamedix Ltd, Hampshire, England) of both cheeks were obtained on the first and seventh postoperative days after removal of impacted mandibular third molars under local anesthesia in 30 patients (15 men, 15 women). The unoperated contralateral side served as a control. One of the following pretreatments was given immediately before the operation: diclofenac (Voltaren; Novartis, Espoo, Finland) 150 mg orally (rapid-release 50 mg and prolonged-release 100 mg, n = 15), diclofenac 100 mg orally (prolonged-release) and 50 mg intramuscularly (n = 11), or placebo (n = 4). RESULTS: The postoperative skin surface temperature on the operated side was significantly higher than that on the unoperated side. The thermal difference was 0.9 degrees C +/- 0.1 degrees C on the first postoperative day and declined significantly by the seventh day to 0.3 degrees C +/- 0.1 degrees C (both P < .001). The thermal difference in patients receiving diclofenac preoperatively was significantly smaller (0.8 degrees C +/- 0.1 degrees C at day 1 and 0.2 degrees C +/- 0.1 degrees C at day 7) than in patients receiving placebo (1.6 degrees C +/- 0.1 degrees C at day 1 and 0.8 degrees C +/- 0.3 degrees C at day 7, P < .001). However, with equal doses of diclofenac, the combination of rapid-release and prolonged-release tablets orally was more effective in reducing skin temperature than an orally administered prolonged-release tablet combined with intramuscular injection (P < .001). CONCLUSION: Thermography is a suitable method to measure the inflammatory reaction related to third molar removal. Thermal changes are significant and are decreased by the nonsteroidal anti-inflammatory drug diclofenac.

Effect of preoperative single doses of diclofenac and methylprednisolone on wound healing.

Anti-inflammatory drugs should impair wound healing, which may explain why they have been used to only a limited extent to relieve pain. If they are to have maximal effect they must be started before the operation. In the present study, single doses of the non-steroidal anti-inflammatory agent diclofenac or of diclofenac and the corticosteroid methylprednisolone were given before operation, and the effects on wound healing after operative extraction of third molars were recorded. Patients developed 18 postoperative complications (5%), the most common of which was alveolar osteitis (n = 14), followed by bleeding (n = 3) and infection (n = 1). Pretreatment with diclofenac alone or in combination with methylprednisolone did not result in a notable increase in the incidence of complications as compared to placebo.

Blindness after maxillofacial blunt trauma. Evaluation of candidates for optic nerve decompression surgery.

Clinical and computerized tomography (CT) findings in 10 patients with post-traumatic blindness after maxillofacial blunt trauma were evaluated as potential candidates for optic nerve decompression surgery. The total number of blind eyes was 14. All patients suffered from midfacial fractures (isolated zygomatic fracture in 4 and Le Fort fracture in 6 cases) predominantly caused by road traffic accidents. CT scanning and clinical findings allowed location of damage to the optic nerve region in all patients. The most common CT finding was swelling of the optic nerve. Fracture in the optic canal wall was seen in only 3 cases. The clinical situations characteristic of this type of injury make diagnosis and early surgical intervention difficult. It was concluded that two of the 10 patients might have benefitted from optic nerve decompression.

Effective postoperative pain prevention through administration of bupivacaine and diclofenac.

The efficacies of bupivacaine and lidocaine together with a preoperatively administered single-dose oral combination of normal- and sustained-release preparations of diclofenac in preventing postoperative pain after third molar removal were compared in a double-blind crossover study. Bilaterally impacted lower third molars were removed in two sessions. Each patient was given one type of local anesthetic on one session and the other in the second. Pain was recorded using a visual analog scale. When the diclofenac combination (150 mg) was given before the operation, postoperative analgesia was better with bupivacaine plus diclofenac than with lidocaine plus diclofenac. Twenty-five out of 40 patients preferred bupivacaine to lidocaine for local anesthesia. It is possible to achieve effective postoperative pain prevention by combining bupivacaine and preoperative normal- and sustained-release preparations of diclofenac.

Preoperative intravenous diclofenac for postoperative pain prevention in outpatients.

Fifty patients undergoing a standard removal of an impacted lower third molar were given a single dose of 75 mg sodium diclofenac or saline (placebo) intravenously before operation, on a double-blind basis. Pain was measured postoperatively by means of a visual analogue scale hourly for the first 8 h and during the first and second days after operation. Administration of diclofenac resulted in greater pain relief than administration of placebo for the first 3 h after surgery, whereafter the treatments did not differ. The results suggest that intravenous preoperative diclofenac may be useful in some clinical situations but generally it probably offers little benefit over the corresponding oral treatment.

A comparison of diclofenac with and without single-dose intravenous steroid to prevent postoperative pain after third molar removal.

The efficacy of 40 mg of methylprednisolone given intravenously before operation in combination with orally administered rapid-release and sustained-release diclofenac preparations in preventing postoperative pain after third molar removal was studied. The administration of methylprednisolone and diclofenac resulted in greater pain relief than did administration of diclofenac alone.

Postoperative pain prevention by a single-dose formulation of diclofenac producing a steady plasma concentration.

The preoperative single-dose oral administration of a combination of rapid- and slow-release diclofenac (Voltaren, Ciba-Geigy, Basel, Switzerland) preparation in a placebo-controlled trial proved to be more effective in postoperative pain prevention following third molar removal than the combination of intramuscular diclofenac and an oral depot formula.

Maxillofacial fractures sustained in bicycle accidents.

The present report is an analysis of 93 patients (52 male; 41 female) treated in 1981-1983 for maxillofacial fractures sustained in bicycle accidents. These accidents accounted for 7.1% of all facial bone fractures treated during the same period. Most accidents were single vehicle accidents (88%) and took place during the summer months. Of the patients, 65% had mandibular fractures, 35% had midface fractures and 5% had fractures in both the middle and lower thirds of the face. Condylar fractures were by far the most common of the mandibular fractures (67%)--a result which differs from studies concerning the profile of mandibular fractures in general. The majority of the middle third fractures were zygomatic (65%). Multiple injuries were diagnosed in 38% of the cyclists and other head injuries were the most common associated injury. Mean hospitalization of the in-patients (38%) was 4.1 days and the average sick leave was 14 days. The results of the study indicate that the use of protective helmets should be strongly recommended to cyclists, although most commercially available helmets do not protect the whole facial area and especially not the chin.