Local vs general anaesthesia in the development of neurosensory disturbances after mandibular third molars extraction: A retrospective study of 534 cases.

BACKGROUND: The choice of the anaesthetic modality is one of the primary steps during planning of third molar surgery. The aim of the present study was to compare the risk of developing neurological injures of the inferior alveolar nerve (IAN) and lingual nerve (LN) in patients treated for wisdom teeth removal under general anaesthesia (GA) with a group treated under local anaesthesia (LA). MATERIAL AND METHODS: This is an observational retrospective, unicentric study; between September 2013 and September 2014, 534 patients underwent third molar surgery, 194 (36,3%) under GA and 340 (63,7%) under LA by the same oral surgeon. Difference in the incidence of IAN and LN injures between groups have been statistically analyzed with Fisher exact test and estimated odd ratio for development of such complications has been calculated. RESULTS: In GA patients the incidence of IAN and LN injures was 4.6% and 2.1%, respectively while in the LA group it was and 0.3% and 0%, respectively. A significant difference in IAN and LN involvement between groups was observed (IAN lesion: Fisher exact test, p<0.001; LN lesions: Fisher exact test, p<0.05). The estimated odd ratio for development of IAN injures after GA was 16.49 (95% CI: 2.07-131.19) and was not calculable for LN injures because no cases were observed in the LA group. CONCLUSIONS: Since GA is a perioperative variable that seems to significantly increase the risk of developing IAN and LN lesions, when treating patients that request GA, they must be adequately informed that an higher incidence of post-surgical sensory disturbances is expected.

Epidemiology and variables involved in dental abscess: survey of dental emergency unit in Trieste.

OBJECTIVES: The objective of this epidemiologic study was to estimate the healing time of acute dental abscesses and to evaluate the main variables involved in the healing process itself. SUBJECTS AND METHODS: Among a sample of over 24 000 patients visited at the emergency dental unit, 688 subjects were diagnosed with dental abscess and enrolled in the study. Case histories of all patients were collected to investigate the clinical course and healing time of dental abscess according to anamnestic and diagnostic data and therapeutic management. A multiple logistic regression model was performed to evaluate the association of each variable with the healing time required for dental abscess. RESULTS: Variables associated with increased healing time were spring seasonality at admission, pyretic state, trismus, involvement of multiple anatomic spaces, and spontaneous drainage. Moreover, administration of some, but not all, classes of antibiotics was also associated with an increased healing time. CONCLUSIONS: The knowledge of variables involved in healing time for dental abscess is crucial in the optimization of managing such infections in terms of cost-benefit ratio. This would represent a valuable way to ensure a shortened and more effective healing.

Peripheral neurological damage following lower third molar removal. A preliminary clinical study.

AIM: Type of impaction and site of nerve are important risk factors of neurological damage following the lower third molar removal. The purpose of this study was to evaluate the peripheral damage of lingual and lower alveolar nerves in relation to tooth angulation and radiographic proximity to the alveolar canal. METHODS: Sixty-seven consecutive patients (41 women and 26 men, mean age 29.97+/-14.35 years) underwent lower wisdom teeth extraction and were clinically evaluated over a one year period, checking any evidence of peripheral damage of the lower alveolar or lingual nerves. Tooth angulation and presence or absence of spongy bone between the mandibular canal and the root apex were considered; so, the patients were assigned twice to two groups: G1A (third molar in axis); G2A (third molar angulated); G1B (third molar apex adjacent to the mandibular canal); G2B (spongy bone between root apex and canal). The extraction was carried out according to a standardised technique without raising and retracting of a lingual flap. The follow-up checks were at one week, 1, 3, 6, 12 months and until any problem was solved. Statistical analysis was carried out using chi2 test. RESULTS: A total of two cases of temporary damage to the lingual nerve (1 case in G1A and 1 in G2A; 2 cases in G2B) and 3 cases to the lower alveolar nerve (3 cases in G2A; 1 in G1B and 2 in G2B) were discovered. No statistical differences were found. Symptoms cleared up within a maximum period of 5 months. CONCLUSION: Tooth angulation and proximity to lower alveolar canal were not related to alveolar or lingual damage; the conservative surgical technique seems to be an important factor in preventing neurological complications.

Buccal-masseteric mycotic abscess as a consequence of dental procedures.

Trismus may represent an external sign of masticatory or lateral pharyngeal abscess that in rare cases is the consequence of pathogen action by micro-organisms introduced in deep tissues after inferior alveolar block. The case presented shows a buccal-masseteric mycotic abscess following restorative procedure involving inferior alveolar anesthesia on the same side. A 49-year-old woman was referred to the Dental Clinic (University of Trieste) complaining of a progressive inability to open her mouth since one week associated to a hemifacial edema in the right parotid region. The symptoms initially started one week before. Infection developed after restorative procedures performed 10 days before on the same side. Based on clinical signs and cultural exam findings, a buccal-masseteric mycotic abscess was found and magnetic resonance (MR) was performed to assess its localization and extension. Initial pharmacological therapy with piperacillin/tazobactam administered intravenously, was replaced by appropriate antimycotic therapy on the basis of sensitivity test to antibiotics. Infection resolution was obtained but complete absence of facial asymmetry occurred after 5 months only. Introduction of micro-organisms during anesthetic alveolar block is a documented source of infection and may occur after dental procedure involving inferior alveolar anesthesia. Complete medical history, cultural exam with sensitivity test to antibiotics and RM or computed tomography (CT) images, are necessary to perform an adequate treatment plan and to administer a correct therapy. Presence of trismus, accompanied by pain or facial edema after dental procedure or during dental or perioral infections has to be carefully considered by clinician to diagnose as soon as possible a deep spaces infection and to avoid serious or life-threatening complications.

Masson's pseudoangiosarcoma, alias intravascular papillary endothelial hyperplasia, in dissecting aortic aneurysm caused by cystic medionecrosis.

This report describes a 25-year-old man who died due to extensive cystic medionecrosis of the aortic wall complicated by both an acute and an ancient dissection. The very unusual finding of an intravascular papillary endothelial hyperplasia, also known as Masson's pseudoangiosarcoma, in the dissected wall is reported given its resemblance to a hemangiosarcoma.

Suicide by hara-kiri: a series of four cases.

The authors describe four cases of suicide by hara-kiri. This very painful form of suicide consists of self-inflicting a wound in the abdomen using a sharp instrument. It was first reported in 988 A.D. in the East but has now become rare in both the East and West. These four cases occurred over a 40-year period in the Trieste and Bari medicolegal area. In two of our cases the victims were afflicted with mental illness, whereas the other two suffered from depression. In cases of death by hara-kiri, it is important to establish a differential diagnosis between suicide and homicide; the presence of trial wounds (inflicted by the victim as a form of practice to overcome any hesitation before stabbing the abdomen with the cutting weapon) can prove very helpful.

Suicide using a hand grenade.

The authors describe an unusual case of suicide that required particular attention to establish whether the victim was murdered, was preparing a terrorist attack or had committed suicide. Examination of the corpse and the crime scene, as well as testimonies, led the authors to determine the real cause of death, namely, an unusual method of suicide.

Aorto-oesophageal fistula and intestinal infarction secondary to volvulus following ingestion of foreign bodies in a schizophrenic patient.

We present a case of death caused by voluntary ingestion of non-organic foreign bodies observed at the Institute of Legal Medicine of the University of Trieste. The victim was a young schizophrenic patient whose death, at first giving rise to suspicions of murder by another psychiatric patient, was found to be caused by an uncommon chronic permanence of foreign bodies at different locations of the digestive tract which suddenly evolved into a series of simultaneous lethal complications as yet never described. The case also raised the issue of possible responsibilities of the subject's healthcare providers.

Determination of the time of death in a homicide-suicide case using flow cytometry.

The study of the biologic processes involved in determining the postmortem interval also can be useful for determining the time of death. In this instance, we investigated the time of death in a case of homicide-suicide using circumstantial findings and thanatochronological and flow cytometric data. The flow cytometric data confirmed the time of death as calculated from the police investigations. This method has proven more reliable than thanatochronological techniques and can be used to supplement these observations. This case indicates that the use of flow cytometry "on the spot" is useful and reliable; however, more evidence is needed to support this new, although to date very sound, method of investigation.

Diatom test with Soluene-350 to diagnose drowning in sea water.

The authors tested the Soluene-350 method to detect diatoms in three cases of sea water drowning. The negative results obtained in all three cases prompted us to re-test the method on samples of fresh water and sea water microalgae. The experiment showed that the siliceous frustule of sea water diatoms is solubilized by Soluene-350 while that of fresh water diatoms is resistant to the treatment. The method, which is effective in cases of drowning in fresh water, should therefore be used with caution in sea water drowning.

Is flow cytometric evaluation of DNA degradation a reliable method to investigate the early postmortem period?

The time of death can be established by determining the length of the postmortem interval. Many methods have been proposed to achieve this goal. Flow cytometric evaluation of DNA degradation seems to be reliable for the first 72 hours after death. Our study evaluated the correspondence of the corruption process between in vitro and corpse tissues. We chose spleen tissue to perform our investigation because it is rich in nucleated cells. Results showed a precise correspondence between the two kinds of samples in the time period between 24 and 36 hours. The period from 36 to 72 hours is characterized by a much looser correspondence than that found in the first period. After the first 72 hours, DNA denaturation is massive and does not allow useful cytofluorimetric readings. The spleen does not seem to be the most suitable organ for this type of investigation because it tends to colliquate very rapidly. We therefore are evaluating other organs to identify a more suitable tissue source for the investigation of longer postmortem period using flow cytometry.

Radiographic magnification in the diagnosis of traumatic lesions of the hyoid-larynx complex.

This paper proposes the use of radiographic magnification to detect the effects of neck traumas. This technique, both fast and economical, has proved to be particularly useful in all those cases where post mortem examinations failed to detect valid evidence of lesions of the hyoid-larynx complex. This is the case with corpses in an advanced stage of putrefaction where death occurred as a result of pressure or when a soft object is placed between the victim's neck and the assailant's hands. The radiological study was performed "on site" on four cases of medicolegal interest and its potential was confirmed.

[Traffic-related injuries in children at Trieste, 1984-1986]. / Lesioni da traffico nel bambino a Trieste 1984-86.

Traffic-related injuries to children are poorly known in our country, in spite of their role in mortality and morbidity. Being that they are rather different from those reported in the adults, their study is useful in identifying risks and elaborating prevention strategies. This paper reports epidemiologic and clinical data on 1050 children under 16, referred to our hospital because of road traffic accidents. The study has been prospectively carried out during 1984-86; injuries severity was assessed according to the Abbreviated Injury Scale. Incidence rates resulted to increase with the age, highest values being observed for 15 year old children, due to motorcycle use. Patterns and severity of the injuries were significantly different according to the age and the group of injured subjects. Younger children as pedestrians and 14-15 y.o. motorcyclists resulted to be more involved than car passengers and bicyclists. At a telephone inquiry after 6-12 months sequelae resulted in 20-40% out of 482 children, according to different AIS Score.

A fatal case of accidental cerebral injury due to power drill.

An unusual fatal case of an accidental craniocerebral penetrating wound due to a power drill is described. A 25-year-old man fell from a stepladder while perforating a ceiling with a drill to arrange the lights for New Year's Day. During the fall the drill penetrated the right upper jaw, passed through the orbit, the ethmoid and the sphenoid bones, tearing the left internal carotid artery, the left cavernal sinus, and the left base nuclei. Death was due to inhalation of blood and atelectasis. The skin wound was an atypical puncture wound similar to bullet entrance wound.