A serious complication in the temporomandibular region due to insufficient follow-up.

The aim of this case report is to point out follow-up insufficiency as a contributing factor of ankylotic development after condylar fractures as well as the significance of clinicians' familiarity with this complication and its prevention. Condylar fractures require close follow-up due to the potential emergence of delayed and distressing complications, such as ankylosis, regardless of their proper initial treatment. Regular follow-up for a minimum of 18 months is of crucial importance for the prevention of ankylosis. The clinician's contribution in alerting his patients could be considerable, given he or she is aware of the development of this complication. The case of a 17-year-old patient with bilateral condylar fractures and a mental fracture is presented. He was successfully treated with mental osteosynthesis and intermaxillary fixation. Strict instructions for kinesiotherapy were given and constant re-examinations were made, but the patient's compliance was poor. This resulted in his readmission 2 years later with a great limitation of mouth opening (0.5 cm), demanding more serious surgical procedures. Follow-up insufficiency could be identified as a contributing factor to traumatic temporomandibular joint ankylosis. Intense surveillance and harmonious collaboration is dictated from both the clinician and patient to prevent any untoward development.

Maxillofacial injuries sustained during soccer: incidence, severity and risk factors.

A very popular sport worldwide, soccer generates a great number of maxillofacial injuries, mainly fractures, resulting in esthetic or functional problems. The aim of this retrospective study was to contribute to the knowledge of soccer-related maxillofacial injuries, and call attention to the risk factors that favor these injuries. A total of 108 patients, who attended hospital because of maxillofacial injuries during soccer within a period of 8 years, were included in this study. The relationship of the patients with soccer, the type, the site, the severity, the mechanism of the injuries and the applied treatment were analyzed. The injured were all males, and were principally amateurs. Around 89.8% of the patients suffered maxillofacial fractures while 10.2% presented only soft tissue injuries; 13.9% had multiple fractures; 50% of the maxillofacial fractures concerned the zygomatic complex and 38.2% the mandible where the majority occurred at the angle. The prevailing mechanism was the direct impact of players. Head to head impact outnumbered. Elbow to head impact caused contusions of the temporomandibular joint. Kick to head impact was the main cause of multiple fractures. The treatment of fractures was mainly surgical (68.2%). These findings support the fact that maxillofacial injuries sustained during soccer tend to be severe, demanding surgical treatment. The mandibular angle is in danger due to the usual existence of impacted and semi-impacted third molars. There should be a preventive intervention on the above contributors, and mainly coaches and sports physicians should be properly informed about the specificity of the maxillofacial injuries.

Air entrapment in the cervicofacial region due to injury.

Air entrapment in the soft tissues of the cervicofacial region is a benign entity occasionally developing after a fracture of the facial bones or ribs. Characteristic clinical findings of air entrapment are the sudden onset of edema and crepitation of the respective region. Possible complications are respiratory obstruction or contamination of the mediastinum. Treatment includes precautionary administration of antibiotics. In regard to the region of injury, air may enter the anterior cranial fossa where it compresses the brain, resulting in pneumocephalus, which may cause meningitis as an imminent complication. After a fracture at the zygomatic or nasal bones, subcutaneous emphysema may result in the middle third of the face. It is also possible for air to penetrate into the retrobulbar fat and damage the eye. In other cases, air traverses the parapharyngeal space and causes pneumomediastinum. Moreover, after a fracture at the mandible, it is possible that air passes through the floor of the mouth and the submandibular area to the deep tissue layers again causing pneumomediastinum. Alternatively, after rib fracture, air could follow an upward course, resulting in subcutaneous emphysema of the thoracocervicofacial region. In this article, patients who suffered from air entrapment were categorized into four groups, and the methods used to diagnosis and treat these patients are presented.

Effects of propranolol or paracetamol on lidocaine concentrations in serum and tissues.

PURPOSE: The goal of this study was to determine the interaction of lidocaine after paracetamol or propranolol administration. MATERIALS AND METHODS: Group A rats received a mixture of cold lidocaine and (14)C lidocaine into the masseter muscle. Group B rats received lidocaine and paracetamol 7.5 mg/kg orally, whereas group C received lidocaine intramuscularly and propranolol 1.5 mg/kg orally. Five consecutive doses were administered. The levels of these drugs were estimated in serum and the total concentration and the percent protein binding of lidocaine in tissues (liver and mandible) were determined. The rats were killed 2 hours after the last dose. RESULTS: The results suggest that lidocaine concentrations in serum were significantly increased after either paracetamol or propranolol administration. Additionally, the combined therapy of propranolol and lidocaine resulted in a significant decrease in the total concentration and the percent protein binding of lidocaine in tissues. CONCLUSIONS: The coadministration of lidocaine with paracetamol or propranolol interferes with the metabolic profile, resulting in pharmacokinetic interactions that may be significant for the determination of the correct dose of lidocaine in clinical applications.