Compatibility of Clinical and Histopathological Diagnosis of Oral Lesions in Iranian Patients

Objective: To determine compatibility between clinical diagnosis and the pathological reports of biopsies from oral lesions. Material and Methods: In this descriptive study, 1146 clinical files of patients referring to Tabriz Faculty of Dentistry from 2004 to 2016 were retrieved and evaluated. The kappa coefficient was calculated for each file for compatibility of clinical and pathological diagnosis. Results: In relation to clinical (40.2%) and pathological (39.2%) diagnosis, irritational lesions of soft tissues exhibited the highest frequency. In 72.3% of cases, the clinical and pathological diagnosis were compatible and in 27.7% of cases these diagnosis were not compatible. The highest compatibility rates were detected for irritational lesions of soft tissues (81.5%) and mucocutaneous lesions (76.9%). There was no compatibility for osseous malignant tumors, inflammatory tissues, granulation tissues, metastatic lesions and hematologic disorders. Conclusion: Approximately one-third of clinical and histopathological diagnosis were not compatible. Therefore, to reach a correct diagnosis, the clinical, radiographic and histopathological views should be evaluated simultaneously.

Effect of Pharyngeal Pack on Postoperative Nausea and Throat Pain in Patients Undergoing Rhinoplasty

Objective: To evaluate the effect of pharyngeal pack on postoperative throat pain and nausea in rhinoplasty patients. Material and Methods: Twenty-eight patients were randomly selected and divided into two groups (n=14). The participants were randomly divided into two groups: G1 - the pharyngeal pack was used (Intervention group) and G2: not used (Control group). Both groups were anesthetized by the same protocol. Throat pain was measured by visual analog scale and nausea by presence / absence. Fischer's exact test, ANOVA, Friedman and Wilcoxon test were used. Results: There was no significant difference in mean pain and presence or absence of nausea between the two groups (p>0.05). But there was a significant difference in mean pain and the presence or absence of postoperative nausea with the intervals (p<0.05). Mean pain had a significant difference 2 hours postoperatively with other times, 6 hours postoperatively with 24 and 72 hours postoperatively, and 24 hours postoperatively with 72 hours (p<0.05). There was no significant difference in the presence or absence of postoperative nausea, between 2 hours and 6 hours postoperatively (p>0.05). The presence or absence of postoperative nausea had a significant difference between 2 hours postoperatively with 24 and 72 hours postoperatively and 6 hours postoperatively with 24 and 72 hours postoperatively (p<0.05). There was no significant difference in nausea between 24 hours and 72 hours postoperatively (p>0.05). Conclusion: None of the two groups were significantly superior in terms of reduction of pain and nausea, but because of the possible effectiveness of the pharyngeal pack in preventing aspiration of objects and tissues during the operation, the use of pharyngeal pack is recommended in patients.

Effect of 2% Nasal Mupirocin Ointment on Decreasing Complications of Nasotracheal Intubation: A Randomized Controlled Trial.

INTRODUCTION: In oral and maxillofacial surgeries, nasotracheal intubation is carried out to increase the surgeon's access to the oral cavity. During nasotracheal intubation the risk of trauma is higher than that in orotracheal intubation as there is passage of the tube through the mucosa of the nasal tract due to which bacteria might get transported into the trachea. AIM: To evaluate the effect of 2% nasal mupirocin ointment before and after nasotracheal intubation on decreasing the complications of intubation for oral and maxillofacial surgeries. MATERIALS AND METHODS: In the present single blinded randomised controlled clinical trial, 44 patients were randomly assigned to two equal groups. A sterile swab was used, eight to 10 hours before nasotracheal intubation, to take a sample for culturing from the vestibule of nostrils and the anterior septum of the patients. In Group 1, 2% nasal mupirocin ointment was applied to the vestibules of both nostrils and the anterior septum. In Group 2, no intervention was carried out. After general anaesthesia and extubation, microbial cultures were prepared from the 4 cm distal end of the tube and antibiogram test was carried out. Also, the patients were compared in terms of the severity of nasal bleeding, the ease of breathing through the nose after nasotracheal intubation. Data were analysed with suitable statistical tests. RESULTS: In the mupirocin group, 27.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but no S. aureus was detected at the distal end of nasotracheal tube after extubation. In the control group, 18.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but there was no change in the number of S. aureus counts at the distal end of nasotracheal tube (p-value<0.001). After extubation, in the mupirocin and control groups, 18.2% and 22.7% of the subjects, respectively, exhibited severe bleeding (p-value=0.001). In the mupirocin and control groups, 86.4% and 59.1% of the subjects had easy extubation, respectively (p-value=0.044). In the mupirocin and control groups, 9.1% and 63.7% of the subjects immediately after regaining consciousness and 9.1% and 54.6% three hours after extubation had difficulty in breathing, respectively (p-value=0.001). CONCLUSION: Use of mupirocin before nasotracheal intubation decreased the complications of nasal intubation in addition to decreasing the risk of colonization of S. aureus and other gram-negative bacteria.

The effect of ameloblastoma and keratocystic odontogenic tumor on the displacement pattern of inferior alveolar canal in CBCT examinations.

Background. The inferior alveolar canal should be examined as a significant anatomical landmark, particularly in the posterior body and ramus of the mandible, for dental and surgical procedures. In the present study, the effects of two pathological lesions, ameloblastoma and keratocystic odontogenic tumor, on canal displacement were investigated. Methods. This study had a single-blinded design. Twenty-six patients with lesions in the mandible referred to Imam Reza Hospital, Tabriz, Iran, were studied in two equal groups (13 patients with a histopathological diagnosis of ameloblastoma and 13 with a histopathological diagnosis of odontogenic keratocyst). After confirming the initial incisional biopsy and pathological report, cone beam computed tomography (CBCT) of lesions larger than 3 cm mesiodistaly and those involving the mandibular posterior body and ramus were included in the study. Two maxillofacial surgeons in association with an oral and maxillofacial radiologist examined three points on CBCT images to determine the mandibular canal position relative to the lesions from the lingual and buccal aspects. Results. The results of statistical analyses showed that in ameloblastoma, the inferior alveolar canal had been displaced more buccally in the ramus area (point A) (84.6%) but in the distal region (point C), the displacement was less buccal (41.6%). The canal was displaced buccally in 53.8% of cases at point A and in 46.2% of cases at point C in KOT lesions. Finally chi-squared test did not show any statistically significant differences between these two lesions. Conclusion. The results of this study showed no relationship between these lesions and the displacement of the mandibular canal.

Comparison of the influence of two flap designs on periodontal healing after surgical extraction of impacted third molars.

BACKGROUND AND AIMS: Impacted lower third molar is found in 90% of the general population. Impacted lower third molar surgery may result in periodontal complications on the distal surface of the adjacent second molar. The aim of this study was to evaluate the effect of flap design on the periodontal status of the second molar after lower third molar surgery. MATERIALS AND METHODS: Twenty patients, with an age range of 18-26 years, participated in the present study. The inclusion criteria consisted of the presence of bilateral symmetrical impacted third molars on panoramic radiographs. The subjects were randomly divided into two groups. The impactions on the left and right sides were operated by Szmyd and triangular flaps, respectively. Postoperative management and medications were similar for both groups. The subjects were evaluated at two-week, one-month, and six-month postoperative intervals by a surgeon who was blind to the results. Data was analyzed by t-test using SPSS 11 software. RESULTS: There were no significant differences in clinical attachment loss, pocket depth, bone level, plaque index, and free gingival margin between the two flaps (p>0.05). CONCLUSION: The results of the present study did not show any differences in pocket depth, clinical attachment level, bone level and FGM (free gingival margin) between the two flap designs under study.

Evaluation of Glove Damage during Dental Procedures among Dental Specialists in Tabriz.

BACKGROUND AND AIMS: Dental practitioners are prone to occupational risk of infection. This can be prevented in part by wearing gloves. However, for this to be effective, gloves should be intact during the entire course of dental procedure. Leaky surgical latex gloves have been seen in 0.9% of cases before use. As much as 1.9% of latex gloves have been reported to be damaged during dental procedures. In this study, we decided to assess glove damage during dental procedures among dental specialists in Tabriz. MATERIALS AND METHODS: Thirty-six dental specialists were selected for this study. Each practitioner received 40 pairs of intact powdered latex gloves. Upon the completion of dental procedures, the gloves were retrieved and any tears were evaluated separately for right and left hands. Data was analyzed using chi-square test. RESULTS: 159 punctures were detected in 144 gloves (5%) out of 2880 unpaired gloves used by practitioners. They noticed the tear(s) in 60 cases (2%), however, 99 cases (3%) of tear(s) were not noted during the procedure. The highest rate of glove damage was observed in the prosthodontists' group (12.3%), which was statistically significant comparing to other groups (p=0.048). The lowest rate of the damage was observed in the oral surgeons' group (2%) which showed no significant difference (p=0.134). The highest rate of punctures in the gloves was observed in the first and second fingers of the non-dominant hand. CONCLUSION: The damage to 5% of the gloves is highly significant, with a potential role in occupational hazards. The higher rate of leaks in the prosthodontists' group compared to other groups demands for greater prudence in this field. The high rate of leaks in the first and second fingers of the non-dominant hand requires more attention to this area during daily practice.