Mortality associated with odontogenic infection!

Odontogenic causes are the most common source for spreading maxillo-facial infections. These infections can develop into life threatening events. However a fatal outcome is fortunately rare and is generally associated with an immunocompromised status. This case report highlights a spreading maxillo-facial infection, which resulted in massive haemorrhage from the subclavian vein into the pleural cavity and subsequent death of a young fit male patient.

The Brain laryngeal mask. An alternative to difficult intubation.

We report the case of a young man undergoing fixation of bilateral mandibular fractures, where the anaesthetist was unable to intubate. A Brain laryngeal mask was employed, thus enabling surgery to proceed. This relatively new device enabled the airway to be safeguarded whilst preserving reasonable surgical access for the attachment of Erich arch bars and a four hole osteosynthetic bone plate. The surgical and anaesthetic procedures are summarised. The laryngeal mask is described and its performance and limitations are discussed. We believe this to be the first report of mandibular fracture fixation performed with a Brain laryngeal mask in situ.

Lip numbness--sometimes a sinister symptom.

Loss of sensation in the lower lip is a common symptom. Frequently, it can be ascribed to orosurgical procedures carried out in the region of the inferior alveolar nerve or its mental branch. Additionally, trauma, haematoma or acute infections may be the cause of the problem. Neoplasms, an excess of endodontic paste and some drugs are less frequently responsible. Three patients are described, in whom impaired sensation in the lip was the presenting symptom. In two of the cases, local factors were found to which this complaint could be ascribed. Further investigation, however, revealed that disease elsewhere was the underlying cause.

Histological analysis of parotid and submandibular glands in chronic alcohol abuse: a necropsy study.

A quantitative histological analysis of the major salivary glands was carried out at necropsy in 28 alcoholics and in a series of age and sex matched controls. The findings were related to the different types of histologically diagnosed liver disease present. Significant quantitative changes of salivary gland structure were noted in cirrhosis but not in other forms of alcoholic liver disease. In cirrhotic subjects the parotid contained proportionally more adipose but less acinar tissues than in controls. The submandibular gland showed a proportional increase in adiposity and reduction in fibrovascular tissues but no noticeable reduction in its acinar proportional volume. Neither grossly detectable parotid enlargement nor acinar hypertrophy, a feature which has previously been noted as characteristic of alcoholic sialadenosis, were evident in this series. These findings provide little structural support for the reportedly increased secretory capacity of salivary glands in chronic alcohol abuse.

A quantitative study of histological changes in the human parotid gland occurring with adult age.

Parotid samples from 63 'sudden death' necropsies of both sexes, aged 17-90 years, were collected after exclusions for chronic illness or medications. Advancing age was accompanied by acinar atrophy and ductal irregularities. The adipose content varied widely at all ages but, together with fibrovascular tissue, tended to increase with age. Stereological analysis demonstrated a linear reduction of acinar proportional volume amounting to 30% over the age range. Females tended to have more adipose tissue and less fibrous tissue than males. These structural age changes resemble those of other salivary glands, but unlike the latter are not accompanied by age-dependent functional impairments. This suggests a greater acinar secretory efficiency or larger secretory reserve volume in the parotid than in other glands. The frequent high levels of parotid adiposity encountered suggest this feature is not pathological nor necessarily a reliable indicator of nutritional or hormonal diseases, excluded from the present study.