Bilateral synovial cysts of the temporomandibular joint.

Synovial cysts very rarely affect the temporomandibular joint (TMJ). On review of the literature, there are 29 reported cases of unilateral synovial cysts of the TMJ. We present a case of bilateral synovial cysts occurring at the TMJs.

Multiple myeloma presenting as mandibular pain.

INTRODUCTION: Multiple myeloma (MM) is a systemic malignancy of plasma cells defined by monoclonal production of circulating immunoglobulins. Bone pain is a presenting feature in the majority of cases. Treatment may involve intravenous use of bisphosphonates, chemotherapy or haematopoietic stem cell transplantation. Here, we illustrate a first presentation of MM in a patient with mandibular pain and discuss radiographic, diagnostic and treatment challenges of orofacial issues in patients with MM. CASE REPORT: A 69-year-old lady presented to an emergency oral surgery clinic with a month-long history of unilateral left-sided pain in her jaw. Examination revealed a buccolingual swelling of 2cm diameter in the lower left premolar region. Radiographic images demonstrated a 2cm lytic lesion in her mandible corresponding with the symptomatic region. Aspiration of the lesion was performed and histological analysis indicated an abundance of atypical plasma cells. Subsequent biopsy revealed sheets of plasmacytoid cells suggesting evidence of a plasmacytoma. Skeletal survey, bone marrow biopsy and serum analysis confirmed the presence of MM. DISCUSSION: MM, although a systemic malignancy, can present via a variety of orofacial manifestations. The presence of a lytic lesion on plain radiographs should alert the dental practitioner to the possibility of the diagnosis. Treatment of orofacial bone pain may respond to intravenous bisphosphonates but care must be taken to avoid osteonecrosis of the jaw. CONCLUSION: This case is an important reminder of the potential oral presentations of MM and underlines the importance of radiographic evaluation in patients with atypical symptoms and presentations.

Catecholamine-o-methyltransferase polymorphisms are associated with postoperative pain intensity.

OBJECTIVES: single nucleotide polymorphisms (SNPs) in the genes for catecholamine-O-methyltransferase (COMT), µ-opioid receptor and GTP cyclohydrolase (GCH1) have been linked to acute and chronic pain states. COMT polymorphisms are associated with experimental pain sensitivity and a chronic pain state. No such association has been identified perioperatively. We carried out a prospective observational clinical trial to examine associations between these parameters and the development of postoperative pain in patients undergoing third molar (M3) extraction. METHODS: psychologic and clinical parameters were measured prospectively in a single homogeneous cohort of 100 patients undergoing M3 extraction. We genotyped the patients for SNPs within GCH1, COMT, and µ-opioid receptor 1. Primary outcome was the occurrence of pain, 3 months after surgery. Other outcomes included pain measures in the early postoperative period and the week after surgery. RESULTS: seven patients (7/98; 7.1%) had persistent pain. Patients with and without persistent pain were similar in terms of perioperative demographic, psychological, and clinical parameters. The proportion who reported adequate postoperative analgesia was greater amongst those with the GG genotype for either rs4818 or rs6269 than those without (P<0.0001). The rare forms of COMT SNPs rs4818 and rs6269 were associated with postoperative pain of lesser intensity at rest (P=0.02, 0.03 respectively) and on movement (P=0.02, 0.01, respectively). The number of days until analgesia was not required during the first postoperative week was associated with GCH1 SNPs (rs8007267, P=0.05; rs3783641, P=0.01; rs10483636, P=0.002). DISCUSSION: we report an early demonstration of a COMT SNP association with a clinically meaningful pain outcome after elective surgery.

Stability of dental implants in grafted bone in the anterior maxilla: longitudinal study.

We aimed to assess the stability over time of dental implants placed in grafted bone in the maxilla using resonance frequency analysis, and to compare the stability of implants placed in grafted and non-grafted bone. Data were collected from 23 patients (15 test and 8 controls) in whom 64 implants (Brånemark system, Nobel Biocare, Göteborg, Sweden) were placed in accordance with the two-stage surgical protocol. In the test group 36 fixtures were placed in grafted bone, and in the control group 28 fixtures were placed in non-grafted bone. Resonance frequency analysis was used to assess the test sites at implant placement and abutment connection. The mean (SD) implant stability quotient (ISQ) for test sites at the time of implant placement was 61.91 (6.68), indicating excellent primary stability, and was 63.53 (5.76) at abutment connection. ISQ values at abutment connection were similar for test and control sites. Implants placed in grafted bone compared favourably with those in non-grafted bone, and showed excellent stability.

Dental and maxillofacial abnormalities following treatment of malignant tumours in children.

There is a wide range of malignant tumours with an embryonic origin that can affect children in their early childhood including Rhabdomyosarcoma, Osteosarcoma, Chloroma, Retinoblastoma and neuroblastoma. Different protocols have been developed over the past years to treat these tumours and different combinations of radiotherapy, surgery and chemotherapy were used. This improved the survival rate considerably. This treatment has a marked effect on growth of soft and hard tissues in the affected regions of the head and face, leading to facial and dental abnormalities that become evident with growth. The great effect of radiotherapy and chemotherapy on craniofacial skeletal growth should be considered in all cases undergoing treatment for tumours. The resulting dental and maxillofacial abnormalities should be expected in all cases and its management require involvement of different members of the medical team including maxillofacial surgeon, restorative dentist, orthodontist, psychologist, dietician, speech therapist, the patient and the parents in order to achieve maximum results. This paper presents four patients who underwent radiotherapy and chemotherapy for treatment of embryonic tumours and discusses the main side effects of the treatment.