Cooperation of the maxillofacial and plastic surgeon in reconstructive surgical procedures in gunshot injury - a case report.

Lower and middle face defects resulting from gunshot wounds often cause severe functional and cosmetic deformities. The purpose of this case report is to refer to our experiences in the treatment of facial gunshot trauma associated with attempted suicide that resulted in a complex facial injury. The goal of the treatment of complex facial injuries is a proper reconstruction of the hard and soft tissue defects and sufficient rehabilitation of the relevant functions, such as speech, nutrition and appearance. A close cooperation of the maxillofacial and plastic surgeon is essential to achieve a satisfactory outcome.

Aggressive periodontitis.

AIM: Horizontally impacted mandibular molars may cause loss of bone, and development of periodontal pockets on the distal root surface of adjacent second molars. The reported patient was confirmed to have aggressive periodontitis. The aim of this presentation is to describe a novel view of a complex treatment approach to promote periodontal healing in a patient. MATERIAL AND METHODS: Our study presents the results of a patient with generalized aggressive periodontitis, horizontally impacted left third mandibular molar, and a second molar with a deep periodontal pocket. The treatment concept was recommended based on the idea of "one-stage treatment". The removal of the third molar was followed by deep scaling and root planing, and the xenogenic grafting material was placed on the bone defect. The flap completely covered the wound. The patient received systemic antibiotics. RESULTS: The probing pocket depth was 9 mm before surgical treatment and 0-2 mm 1, 5, and 10 years postoperatively. The radiographic bone level was 50 % before surgery and 100 % after the surgical approach. CONCLUSION: This presentation with a 10-year follow-up describes the implementation of one-stage treatment management to promote periodontal healing in a patient via full-mouth periodontal and surgical therapy (Fig. 4, Ref. 33).

Hyaluronic acid application vs arthroscopy in treatment of internal temporomandibular joint disorders.

AIMS: The goal of this study was to compare the treatment outcome after two different treatment modalities in cases of disc displacement of the temporomandibular joint diagnosed via magnetic resonance technique, namely surgical procedure in form of arthroscopic lysis and lavage vs. hyaluronic acid superior joint space application. MATERIALS AND METHODS: Magnetic resonance imaging was performed before and one year after treatment. Simultaneously, pre- and post-treatment visual analogue scales and maximal mouth opening distance were documented. RESULTS: In our study, out of the total of 145 patients who were initially diagnosed with magnetic resonance imaging to have internal derangements and treated with arthroscopic lysis and lavage or hyaluronic acid application, we observed progression of internal derangement in 27 cases (18.6 %), improvement in 37 cases (25.5 %) and stationary state in 81 patients (55.9 %). Both treatment methods significantly improved the followed maximal mouth opening distance and visual analogue scale, as confirmed upon the 12­month follow-up examination. Maximal mouth opening was 4.7mm for hyaluronic acid application and 12.2mm for arthroscopic lysis and lavage (p<0.005). The mean visual analogue scale values decreased from 6.2 to 2.1 for hyaluronic acid application and from 6.9 to 1.2 for arthroscopic lysis and lavage (p<0.005). CONCLUSION: Our study shows that both arthroscopic lysis and lavage and hyaluronic acid injections are effective and safe in the treatment of disc displacement in the temporomandibular joint (Tab. 3, Ref. 30).

Therapeutic effects of arthrocentesis in treatment of temporomandibular joint disorders.

OBJECTIVE: Analyse, compare and evaluate the effects of the treatment arthrocentesis with a control group of non-steroid drugs treated patients. MATERIAL AND METHODS: 1752 out-patients (1293 females, 459 males) were examined within the years 2013-2017. We evaluated the following criteria: gender, age, visual analog scale for pain (VAS), inter-incisal distance and reducing intake of orally administered analgesics. RESULTS: The pain level of the group of patients with arthrocentesis had stabilized at mark 2.5 on the pain scale, unlike in the control group after treatment with non-steroidal anti-inflammatory drugs, pain had stabilized at mark 9 on the pain scale. The inter incisal distance amongst the first group was 37 mm and in the control group only 27 mm, after completed treatment. The amount of applied analgesics in the group with arthrocentesis decreased to 100 mg daily, while in the control group, the dose was adjusted to 700 mg daily. CONCLUSION: In the observed study, arthrocentesis was effective in reducing pain, amount of analgesics per day and improving the mobility of temporomandibular joint (TMJ). The results of this study we use in the ongoing project, that focuses on progressive and innovative methodology of endoscopically assisted arthrocentesis. (Tab. 4, Fig. 5, Ref. 39).

Biodegradable versus titanium plates and screws for paediatric facial skeleton fractures.

OBJECTIVE: The use of biodegradable materials represents a new option in the treatment of paediatric facial skeleton fractures. The benefits of a resorbable system include reductions in time for long-term stability, diminished immobilisation period, and elimination of painful procedures for implant removal. The resorption of the material did not influence bone repair and growth. Bioresorbable plates and screws get completely excreted through physiological routes. MATERIAL AND METHODS: The age of the patients ranges from that of pre-schoolers till 18 years. The mean age of boys and girls was 12.18 (range 4-18 years) and 13.59 (range 5-18 years), respectively. RESULTS: During the ten-year period, 168 children and adolescents, 136 boys and 32 girls, were treated. The conservative treatment was performed in 67 patients (39.9 %). Open surgical reduction was performed in 101 patients (60.1 %). Bioresorbable plates were applied in 44 patients (43.6 % of surgically treated). CONCLUSION: The implementation of biodegradable osteosynthetic materials is optimal for the treatment of fractures of the middle third of the facial skeleton, lower part of the upper third of the facial skeleton, mandibular body and parasymphysis (Tab. 3, Fig. 3, Ref. 31).

Is the prevalence of the medication-related osteonecrosis of the jaws underestimated, evaluation in oncological and non-oncological disease.

OBJECTIVES: The purpose of this study was to evaluate the prevalence of medication-related osteonecrosis of the jaw in Slovak population and compare the literature findings, whether the prevalence of MRONJ is underestimated. BACKGROUND: Antiresorptive drugs significantly increase quality of life, although during therapy, or in post-treatment period, osteonecrosis of the jaws might occur as a severe adverse effect. Medication-related osteonecrosis of the jaws (MRONJ) is a severe problem that has been observed in the past few years. METHODS: This multi-centric study evaluates the prevalence in Slovak population, assesses the values from 4 largest centres of maxillofacial surgery in Slovakia (1166 patients with MRONJ) and provides the comparison of literature review. RESULTS: Between 2010-2015, there was increasing number of newly diagnosed patients with MRONJ (1166 overall MRONJ patients) annually, except 2012 (mean growth of 123.88 %). This finding was supported by a statistical analysis of the rising tendency of prevalence in literature, where there was a significant difference in prevalence of non-oncologic patients before and after 2010 t(15) = 2.725, p = 0.016. The 6-year prevalence was 1.34 % in population with antiresorptive drugs intake, for osteoporosis 0.47 %, for breast cancer 4.10 %, prostate cancer 3.99 % and multiple myeloma 21.26 %. CONCLUSION: This study considers that there is a significant rising tendency of MRONJ in non-oncological patients, what could be caused by underestimation of the risk for development MRONJ in these patients. There should be a better cooperation and information among dentists and doctors indicating the antiresorptive treatment and strong emphasis on primary prevention before the initial treatment even in non-oncological patients (Tab. 5, Fig. 7, Ref. 69).

p-ERK involvement in the neuroprotection exerted by ischemic preconditioning in rat hippocampus subjected to four vessel occlusion.

Global brain ischemia-reperfusion causes delayed cell death in hippocampal CA1 (cornus ammonis 1) pyramidal neurons after reperfusion. Ischemic tolerance evoked by preconditioning (IPC) represents a phenomenon of CNS adaptation to any subsequent ischemia. This paper was designed to describe changes in the mitogen-activated protein kinases (MAPK) protein pathways of the hippocampal area following by IPC. Ischemia was induced by a 4-vessels occlusion (4VO) and the rats were preconditioned by a non-injurious ischemia. Apoptotic markers were used to follow the degeneration process. Western blot and immunohistochemistry identified p-ERK (phosphorylated extracellular signal-regulated protein kinase) and p38 proteins in injured hippocampal areas. P-ERK quantification increased after IPC and reached the highest level at 24 hours after ischemia. Interestingly, neuroprotection induced by IPC lead to the opposite effect on MAPK/p38, where the level was lowest at 24 hours after ischemia. Taken together, the present study clearly demonstrates that p-ERK takes part in complex cascades triggered by IPC in the selectively vulnerable hippocampal region. In addition, paper describes a crosstalk between p-ERK and p-p38 which occurs after preconditioning maneuver in 4VO model of global ischemia.