Identifying inflicted injuries in infants and young children.

Child physical abuse is a common cause of pediatric morbidity and mortality. Up to half of all children presenting with abusive injuries have a history of a prior suspicious injury, suggesting a pattern of repeated physical abuse. Medical providers are responsible for identifying children with suspicious injuries, completing mandated reporting to child protective services for investigation, and screening for occult injuries and underlying medical conditions that can predispose to injuries. Early identification of inflicted injuries appropriate evaluations may serve as an opportunity for life-saving intervention and prevent further escalation of abuse. However, identification of abuse can be challenging. This article will review both physical exam findings and injuries that suggest abuse as well as the evaluation and management of physical abuse.

Effects of Anesthetic Choice on the Incidence of Transcranial-Motor Potential-Induced Oral Trauma.

Transcranial motor-evoked potentials (TcMEPs) play an integral role in assessing motor tract function in surgical procedures where motor function is at risk. However, transcranial stimulation creates a risk for oral trauma. Several studies have reported on distinct factors that can influence the rate of TcMEP-induced oral trauma, but little is known about how an anesthetic regimen can influence this rate. In this retrospective review, we investigated the incidence of oral injury under total intravenous anesthesia (TIVA) and balanced anesthesia in 66,166 cases from 2019 to 2021. There were 295 oral injuries in our sample, yielding an incidence of 0.45%, which is in line with ranges reported in the literature. A total of 222 of the injured patients were sedated with balanced anesthesia, while the remaining 73 were under TIVA anesthetics. This difference in distribution was statistically significant (p < 0.0002). Our findings suggest TIVA is associated with lower risk of oral trauma when TcMEPs are monitored, thereby improving patient safety.

Ultrasound imaging for evaluation of impalement-related injuries to the oral cavity in pediatric patients: a case series study.

BACK GROUND: An impalement-related injury to the oral cavity is common in pediatric patients at emergency department. A computed tomography evaluation is not always suitable in these cases. Herein, we aimed to present oral sonography findings from six pediatric patients presenting with impalement-related injury to the oral cavity. CASE SERIES: All included patients were younger than 4 years and sustained injuries with a toothbrush, chopstick, water gun, and fork to the tonsils, submandibular gland area, uvula, and under the tongue. CONCLUSION: Ultrasound imaging appeared useful in helping diagnose impalement-related injuries lateral to the midline.

Buccal Fat Pad Injury-Delayed Presentation.

COVID-19 pandemic has been a major challenge for health care services all around the world. With increasing COVID-19 cases and lockdown enforcement, there has been a significant delay in the presentation of patients in the emergency department; also the fear in people of contracting COVID-19 from the hospital is an additional factor. The following case report describes such an incidence of delay in presentation of buccal fat pad injury patient to the emergency department.

Oropharyngeal Bleeding Due to Cannabidiol Oil Vape Use.

Vaping has become an increasingly popular alternative to smoking in recent years. We present a rare and unusual case of upper airway bleeding caused by inhalation of a cannabidiol (CBD) oil-based vape due to a chemical burn. There are no case reports of this injury in the literature, and we discuss the clinical presentation, diagnosis and our management of this potentially life-threatening injury. A 27-year-old man presented to the accident and emergency department after using a CBD oil vape. After one inhalation of the CBD oil vape, the patient experienced immediate onset pain in the oropharynx, dyspnoea, expectoration of blood and hoarseness. The patient had used a CBD oil vape four hours earlier that evening for the first time, which was procured from an unregulated online source. The patient was referred to the Ear, Nose and Throat (ENT) team where the examination of oropharynx identified a posterior pharyngeal bleeding point. Flexible nasal endoscopy was undertaken showing profound erythema and inflammation throughout the oropharynx and posterior pharyngeal wall. The mucous membranes had been detached leaving an exposed bleeding submucosa. The patient was commenced on three cycles of back-to-back adrenaline nebulisers (1:1000 adrenaline in 5ml of 0.9% NaCl), 6.6mg dexamethasone intravenously and hydrogen peroxide gargles (5ml of 3% hydrogen peroxide in 10ml of water) three times a day. There were early involvement and review of the airway by the anaesthetic and intensive care teams, which was deemed safe at the time. A plan was made for a definitive airway if bleeding reoccurred. Upper airway bleeding can present as a rare form of vape-induced injury and should be considered part of the differential diagnosis particularly in those using CBD oil vapes. History taking is pertinent and patients should be questioned on the specific vape liquids used. Airway stabilisation is the priority with early involvement of the multi-disciplinary team including anaesthetists, intensive care specialists and ENT surgeons.

Association between levels of sports participation and oral injuries among combat athletes / Associação entre níveis de participação no esporte e lesões orais em atletas de combate / Asociación entre niveles de participación en el deporte y lesiones orales en atletas de combate

ABSTRACT Introduction Oral injuries are common traumas in combat sports due to the aggressive nature of both offense and defense. Sports mouth guards are made to reduce the risk of traumatic face and jaw injuries and concussions during sports activities. Objective The objective of this study was to determine the prevalence of oral injuries in combat sports and to examine the association between participation levels and percentage of injury occurrence. Methods One hundred and eight participants (mean age: 22.42 ± 2.162 years) who were involved in sparring events were recruited. Data were collected using a questionnaire consisting of 22 questions about the demographic profile of the athletes, their injury experience and type of injuries sustained, awareness and use of mouth guards in sports activities. Descriptive analysis, Chi-square test, and one-way analysis of variance (ANOVA) were applied for data analysis. Results Almost 77% of participants had experienced oral injuries during sports activities and nearly 90% were aware that oral injuries can be reduced by using mouth guards. In addition, 52.7% of participants complained that the mouth guard is not comfortable to use during sports activities. Findings revealed a significant moderate association between levels of participation and number of oral injuries ( p = 0.013). One-way ANOVA showed a significant mean difference in the rate of oral injury for the four levels of participation groups F (3, 104) = 6.21, p = 0.011. Post-hoc comparisons using the Bonferroni test indicated a significant mean difference between university-state levels ( p = 0.033) and university-national levels ( p = 0.028). Conclusion This study revealed that higher levels of participation in sports have a higher risk of injury. It was also found that the discomfort of using a mouth guard can be reduced if the coaches make the athletes wear proper mouth guards that follow the recommended specifications. Level of evidence IIIb; Case control study.

RESUMO Introdução As lesões orais são traumas comuns nos esportes de combate, devido à natureza agressiva tanto do ataque quanto da defesa. Os protetores bucais esportivos são feitos para diminuir o risco de lesões traumáticas na face e na mandíbula; e também de concussão durante as atividades esportivas. Objetivo Este estudo teve como objetivo determinar a prevalência de lesões orais em esportes de combate e examinar a associação entre níveis de participação e a porcentagem de ocorrência de lesões. Métodos Foram recrutados cento e oito participantes (média de idade: 22,42 ± 2,162 anos) envolvidos em eventos de combate. Os dados foram coletados por meio de um questionário composto por 22 perguntas sobre o perfil demográfico dos atletas, sua experiência com lesões e tipo de lesões sofridas, conhecimento e uso de protetores bucais em atividades esportivas. A análise descritiva, o teste do qui-quadrado e a análise de variância (ANOVA) foram aplicados para análise dos dados. Resultados Quase 77% dos participantes sofreram lesões orais durante atividades esportivas e quase 90% estavam cientes de que as lesões orais podem ser reduzidas com o uso de protetores bucais. Além disso, 52,7% dos participantes reclamaram que o protetor bucal não é confortável para uso durante as atividades esportivas. Os achados revelaram associação moderada significativa entre níveis de participação e número de lesões orais (p = 0,013). A ANOVA unilateral mostrou uma diferença média significativa na taxa de lesão oral nos quatro níveis dos grupos de participação F (3, 104) = 6,21, p = 0,011. As comparações post-hoc usando o teste de Bonferroni indicaram diferença média significativa entre os níveis universitário-estadual (p = 0,033) e os níveis universitário-nacional (p = 0,028). Conclusão Este estudo revelou que níveis mais altos de participação no esporte representam maior risco de lesões. Verificou-se também que a sensação de desconforto ao usar protetor bucal pode ser reduzida se os treinadores fizerem com que os atletas usem protetores bucais adequados, que sigam as especificações recomendadas. Nível de evidência IIIb; Estudo Caso-Controle .

RESUMEN Introducción Las lesiones orales son traumas comunes en los deportes de combate, debido a la naturaleza agresiva tanto del ataque como de la defensa. Los protectores bucales deportivos son hechos para disminuir el riesgo de lesiones traumáticas en el rostro y en la mandíbula; y también de concusión en las actividades deportivas. Objetivo Este estudio tuvo como objetivo determinar la prevalencia de lesiones orales en deportes de combate y examinar la asociación entre los niveles de participación y el porcentaje de ocurrencia de lesiones. Métodos Fueron reclutados ciento ocho participantes (promedio de edad: 22,42 ± 2,162 años) involucrados en eventos de combate. Los datos fueron colectados a través de un cuestionario compuesto por 22 preguntas sobre el perfil demográfico de los atletas, su experiencia con lesiones y tipo de lesiones sufridas, conocimiento y uso de protectores bucales en actividades deportivas. El análisis descriptivo, el test de chi-cuadrado y el análisis de varianza (ANOVA) fueron aplicados para el análisis de los datos. Resultados Casi 77% de los participantes sufrió lesiones orales durante las actividades deportivas y casi 90% tenía conocimiento de que las lesiones orales pueden ser reducidas con el uso de protectores bucales. Además, 51,7% de los participantes reclamaron que el protector bucal no es confortable para uso durante las actividades deportivas. Los hallazgos revelaron asociación moderada significativa entre niveles de participación y número de lesiones orales (p = 0,013). El ANOVA unidireccional mostró una diferencia promedio significativa en la tasa de lesión oral en los cuatro niveles de grupos de participación F (3,104) = 6,21, p = 0,011. Las comparaciones post hoc usando el test de Bonferroni indicaron una diferencia promedio significativa entre los niveles universitario-estatal (p = 0,033) y los niveles universitario-nacional (p = 0,028). Conclusión Este estudio reveló que niveles más altos de participación en el deporte representan mayor riesgo de lesiones. Se verificó también que la sensación de incomodidad al usar protectores bucales adecuados puede reducirse si los entrenadores hacen con que los atletas usen protectores bucales adecuados, que sigan las especificaciones recomendadas. Nivel de evidencia IIIb; Estudio Caso-Control.

Oral injuries in children less than 24 months of age in a pediatric emergency department.

BACKGROUND: Oral injuries in young children may indicate physical abuse. The prevalence of oral injuries in young children presenting to the emergency department is unknown. These data would assist providers in making decisions about the need for further abuse evaluation. OBJECTIVE: To determine the prevalence of oral injuries, associated chief complaints and characteristics, and frequency of abuse evaluations in children younger than 24 months presenting to a pediatric emergency department (PED). PARTICIPANTS AND SETTING: Twelve pediatric emergency medicine physicians consecutively enrolled children younger than 24 months in a tertiary care PED. METHODS: We performed a prospective observational study. Enrolled patients underwent a complete oral examination. Providers recorded patient demographics, type of chief complaint, oral injury details, developmental ability, and the presence of an abuse evaluation. RESULTS: Oral injuries occurred in 36/1303 (2.8%, 95% CI 1.9-3.8%) and were more common in patients with traumatic (26/200, 13%) versus medical chief complaints (10/1,103, 0.9%) (p < .001). Of patients with oral injuries (36), 78% were mobile and 72% had traumatic chief complaints. Nine (25%) children with oral injuries were evaluated for abuse. Oral injuries in children 0-11 months old were more likely to be evaluated for abuse than children 12-24 months old (70.0% vs. 7.7%, p < .001). CONCLUSIONS: The prevalence of oral injuries in children <24 months old presenting to a PED was low. Most occurred in mobile children and in children with traumatic chief complaints. Younger, non-mobile children with oral injuries had a higher likelihood of having an abuse evaluation.

Involvement of transient receptor potential vanilloid 2 in intra-oral incisional pain.

OBJECTIVE: To examine whether transient receptor potential vanilloid 2 (TRPV2) contributes to the changes in intra-oral thermal and mechanical sensitivity following the incision of buccal mucosa. MATERIALS AND METHODS: Buccal mucosal pain threshold was measured after the incision. Changes in the number of TRPV2-immunoreactive (IR) trigeminal ganglion (TG) neurons which innervate the whisker pad skin and buccal mucosa, changes in the number of isolectin B4-negative/isolectin B4-positive TRPV2-IR TG neurons which innervate the whisker pad skin and the buccal mucosa, and the effect of peripheral TRPV2 antagonism on the pain threshold of incisional whisker pad skin and buccal mucosa were examined after these injuries. RESULTS: Buccal mucosal pain hypersensitivities were induced on day 3 following the incision. The total number of TRPV2-IR TG neurons and the number of isolectin B4-negative TRPV2-IR TG neurons which innervate the whisker pad skin and buccal mucosa were increased. Buccal mucosal TRPV2 antagonism completely suppressed the heat and mechanical hypersensitivities, but not cold hypersensitivity. TRPV2 antagonist administration to the incisional whisker pad skin only partially suppressed pain hypersensitivities. CONCLUSION: The increased expression of TRPV2 in peptidergic TG neurons innervating the incisional buccal mucosa is predominantly involved in buccal mucosal heat hyperalgesia and mechanical allodynia following buccal mucosal incision.

Oral lacerations during motocross: A case report.

Motocross is a high-risk sport that can cause serious injuries including oral injuries. However, mouthguard use is not mandatory in motocross. This report describes a case of an oral laceration with exposure of bilateral inferior alveolar nerves as a result of a motocross accident in which the patient was not wearing a mouthguard.

Oral injuries in children presenting to a Japanese pediatric emergency room.

BACKGROUND: Oral injuries are common among children, but studies on oral injury according to the presence of foreign objects in the mouth are limited. The aim of this study was to compare injury patterns and their effects in children presenting to a Japanese pediatric emergency room (ER) with and without foreign objects in the mouth. METHODS: Children who were brought to the ER at Tokyo Metropolitan Children's Medical Center with oral injuries between 1 January 2011 and 31 December 2012, were included. Information regarding mechanism of injury, object related to injury, required procedure, and disposition (i.e. placement after ER evaluation: hospitalization or discharge) was collected. Injured subjects with and without foreign objects in the mouth were compared. RESULTS: Three hundred and nineteen subjects were included in analysis. Median age was 26 months. Labial mucosa, tongue, buccal mucosa, and teeth were major locations of injury. Tumble (i.e. fall from standing) was the leading mechanism of injury (50%). Seventy-one subjects (22%) were holding foreign objects in the mouth when injury occurred. A toothbrush was the most common object (31%). Subjects with foreign objects in the mouth were more likely to injure the posterior parts of the mouth, and to require imaging (P = 0.04) and hospital admission (P < 0.001). This was also the case for children with injury due to tumble. CONCLUSIONS: Tumble (i.e. fall from standing) was the most common mechanism of injury. Furthermore, requirement for medical resources increased if children had foreign objects in their mouth. Preventive measures should focus on educating parents about the dangers associated with children moving around while holding objects in the mouth.

Impalement oral injury: Ultrasonic scalpel is the best tool to cut off a toothbrush.

BACKGROUND/AIM: Penetrating injuries to the oral cavity involving a toothbrush are relatively common among children. Sometimes general anesthesia is recommended. Although the handle prevents adequate mask ventilation in the induction of anesthesia, it is unknown what is the best tool to cut it preventing complications. The aim of this study was to evaluate the optimal tool to cut off the toothbrush handle. MATERIALS AND METHODS: Six anesthesiologists participated in this study. We attached a triaxial acceleration sensor to the tip of the toothbrush to virtually measure force toward the wound. Each participant cut off the handle of the toothbrush using 3 tools: Gluck rib shears (GRS: cutting horizonal); Sklar Coryllos rib shears (SCRS: cutting vertical); and an ultrasonic scalpel (USS). Acceleration and time required to cut the toothbrush were measured. Each anesthesiologist evaluated the usability of each tool on a 5-point scale. RESULTS: The USS showed the longest mean time (GRS, 1.78 ± 1.01 s; SCRS, 7.30 ± 4.58 s; USS, 28.13 ± 13.41 s), lowest 3-dimensional acceleration (GRS, 2.15 ± 0.69 G; SCRS, 2.13 ± 0.57 G; USS, 1.01 ± 1.07 G), and highest mean score for usability. CONCLUSION: The USS appeared preferable to rib shears for cutting off toothbrush handles, even though it takes longer.

Amiloidosis bucal / Oral amyloidosis

A amiloidose é uma doença complexa rara de difícil diagnóstico que ocorre devido à deposição de substância amilóide no meio extracelular. Ao ser diagnosticado na cavidade bucal, deve-se monitorar o paciente a fim de avaliar possíveis complicações sistêmicas da doença. Diante disso, o objetivo do presente estudo é relatar um caso de amiloidose oral em uma paciente do gênero feminino de 72 anos de idade. Baseado nos sinais clínicos observados, a hipótese diagnóstica foi de fibroma traumático. Após realização de biópsia e exame histopatológico, o diagnóstico foi de amiloidose oral, o que foi confirmado com a coloração do espécime com o reagente vermelho congo. Depósitos de amilóide foram encontrados no tecido conjuntivo, na avaliação através da luz polarizada, que apresentou birrefringência. Tal achado foi preocupante, já que a amiloidose geralmente acomete diversos tecidos levando a comprometimentos sistêmicos. Por essa razão a paciente foi encaminhada a procurar atendimento médico. No entanto, houve abandono do tratamento e a mesma veio a óbito 6 meses após o diagnóstico da doença. Lesões orais aparentemente simples podem revelar doenças raras e de difícil tratamento. O diagnóstico preciso e acompanhamentos médicos são fundamentais na sobrevida do paciente(AU)

Amyloidosis is an uncommon complicated disease of a difficult diagnosis occurring due to the amyloid substance depot in the extracellular medium. Being diagnosed in the oral cavity, the patient must to be supervised to assess the potential systemic complications of disease. The aim of present paper was to present a case of oral amyloidosis in a female patient ages 72 presenting with traumatic fibroma. After performance of a biopsy and the histopathological examination, the diagnosis was the presence of amyloidosis, confirmed with the help of the sample using Congo red reactant. Amyloid depots were found in the conjunctive tissue which under the polarized light showed birefringence. This finding was worrying since the amyloidosis involves different tissues leading to systemic complications. Thus, the patient was oriented to search medical care; however she abandons treatment dying 6 months after diagnosis of the disease. The apparently single oral injuries may to reveal uncommon diseases and of difficult treatment. The precise treatment and the medical supervision are essential in the patient's survival(AU)

La amiloidosis es una enfermedad compleja, rara, de difícil diagnóstico, que ocurre debido al depósito de sustancia amiloidea en medio extracelular. Al ser diagnosticada en la cavidad bucal, el paciente debe tener supervisión médica para evaluar las posibles complicaciones sistémicas de la enfermedad. El objetivo del presente estudio fue presentar un caso de amiloidosis bucal en un paciente del género femenino de 72 años de edad. Basados en las señales clínicas observadas, la hipótesis diagnóstica fue de un fibroma traumático. Después de la realización de una biopsia y del examen histopatológico, el diagnóstico fue de amiloidosis, confirmado con la coloración del espécimen con el reactivo rojo congo. Los depósitos de amiloide fueron encontrados en el tejido conjuntivo, que con la luz polarizada presentó birrefringencia. Tal hallazgo fue preocupante, ya que la amiloidosis afecta diversos tejidos, lo que puede provocar complicaciones sistémicas. Por esa razón la paciente fue orientada a buscar atención médica. Sin embargo, abandonó el tratamiento y falleció 6 meses después del diagnóstico de la enfermedad. Lesiones bucales aparentemente simples pueden revelar enfermedades raras y de difícil tratamiento. El diagnóstico preciso y la supervisión médica son fundamentales para la sobrevida del paciente(AU)

Oral injury and the use of mouth guards. Soccer, rugby, basketball player in Japanese high school / 体力科学

The use of mouth guards in contact sports effectively prevents oral injuries and preserves oral structures. Many contact sports in which a high impact collision could easily cause oral injury do not require athletes to use mouth guards. We discuss the circumstance of oral injury and awareness concerning the use of mouth guards in Japanese high school soccer and rugby and basketball teams.<BR>During an interview, each athlete was asked a series of questions concerning their history of oral injury while participating in sports and actual circumstances of using a mouth guard.<BR>The incidence of oral injuries was 32.3% in soccer, and 56.5% in rugby, 46.6% in basketball while 0.8% of athletes possessed some type of mouth guard in soccer, 24.1% in rugby and 1.3% in basketball. Although 81.8% of soccer athletes and 81.2% of basketball athletes thought mouth guards were unnecessary, only 26.2% of rugby athletes shared this opinion. Many athletes playing soccer and basketball had insufficient knowledge about mouth guards, and were not interested in preventing oral injury. Due to the diversity of sports that can produce oral injury, it is recommended that mouth guards be worn by all individuals participating in rugby, soccer and basketball.