Jaw Osteomyelitis as a Complication of Sickle Cell Anaemia in Three Omani Patients : Case reports and literature review

Sickle cell anaemia (SCA) is a common haemoglobinopathy among people from the Middle East, the Afro-Caribbean region, the Mediterranean and East India. While osteomyelitis of the long bones is a welldocumented complication of SCA, there are few documented cases of SCA patients presenting with jaw osteomyelitis. We report three SCA patients with chronic jaw osteomyelitis who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, between 2009 and 2013. Two of the patients had osteomyelitis of the mandible and the third had osteomyelitis of the maxilla. In addition, a brief review of the literature is presented focusing on the clinical presentation, diagnosis and management of jaw osteomyelitis among patients with SCA

Complications of Third Molar Extraction: A retrospective study from a tertiary healthcare centre in Oman

Objectives: This retrospective study aimed to investigate complications associated with the extraction of third molars at a tertiary healthcare centre in Oman. Methods: All consecutive patients who underwent extraction of one or more impacted third molars under general anaesthesia at Sultan Qaboos University Hospital, Muscat, Oman, between January 2007 and December 2017 were included. Age, gender, indication for extraction, teeth removed, procedure and complications were recorded. Results: A total of 1,116 third molars (56% mandibular and 44% maxillary) were extracted and the majority (67.7%) were from female patients. The mean age at extraction was 24 ± 5 years and most patients (77.7%) were 20‒29 years old. The intraoperative and postoperative complication rates were 3.7% and 8.3%, respectively. The intraoperative complications included tuberosity fracture (1.2%), root fracture (1.1%), bleeding (0.7%), soft tissue injury (0.5%) and adjacent tooth damage (0.2%). Postoperative complications were sensory nerve injuries (7.2%), swelling/pain/trismus (0.6%) and dry socket (0.5%). Nerve injury was temporary in 41 patients and permanent in four cases. A statistically significant relationship was observed between those aged 30‒39 years and dry socket (P = 0.010) as well as bone removal and all postoperative complications (P = 0.001). Conclusion: Most complications resulting from third molar extractions were minor and within the reported ranges in the scientific literature. However, increased age and bone removal were associated with a higher risk of complications. These findings may help to guide treatment planning, informed consent and patient education.Keywords: Third Molar; Tooth Extraction; Complications; Lingual Nerve; Inferior Alveolar Nerve; Oman

Erdheim-Chester Disease Presenting as Bilateral Facial Masses: A case report and review of literature

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis with unknown etiology. It is recently recognized to be neoplastic with genetic mutations affecting the mitogen-activating protein kinase (MAPK) pathway. We here present a case of a 49-year-old female who initially presented in 2012 with bilateral facial masses to a tertiary care center. These were removed but later recurred over a period of ten years. She then presented with xanthelasmas, bone lesions, secondary infertility due to hypothalamic hypogonadism, diabetes insipidus, and Hashimoto’s hypothyroidism. The facial masses were biopsied, and they showed classic morphological features in the form of diffuse infiltration by foamy histiocytes, with scattered Touton type of giant cells, patchy lymphocytic infiltrates, and dense fibrosis. The presented ECD case is particularly interesting due to the recurrent bilateral facial masses.  To the best of our knowledge, this is the first documented case in Oman.  The patient is stable and is being followed up in the clinic. Keywords: Erdheim-Chester disease, Langerhans cell histiocytosis

Dental and Anaesthetic Challenges in a Patient with Dystrophic Epidermolysis Bullosa

Epidermolysis bullosa is a group of rare genetic disorders characterised by skin and mucous membrane fragility and systemic manifestations of variable severity. We report a case of dystrophic epidermolysis bullosa in an 18-year-old male patient who presented to the Department of Oral Health at Sultan Qaboos University Hospital, Muscat, Oman, in 2015 with recurrent dental pain and infections. Due to the poor dental status of the patient and anticipated operative difficulties due to microstomia and limited mouth opening, the patient underwent full dental clearance under general anaesthesia. This article discusses the dental and anaesthetic challenges encountered during the management of this patient and provides a brief literature review

Temporomandibular Joint Ankylosis as a Complication of Neonatal Septic Arthritis : Report of two cases

Temporomandibular joint (TMJ) ankylosis as a complication of neonatal septic arthritis is rarely reported in the literature. We report two clinical cases of unilateral TMJ ankylosis occurring in paediatric patients subsequent to neonatal septic arthritis. The first case was a 15-month-old male infant who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in May 2010. According to the published English scientific literature, he is the youngest person yet to be diagnosed with this condition. The second case was a five-year-old female who presented to the Al-Nahda Hospital, Muscat, Oman, in October 2011. Both cases presented with facial asymmetry and trismus. They subsequently underwent gap arthroplasty and interpositional temporalis muscle and fascia grafts which resulted in an immediate improvement in mouth opening. Postoperatively, the patients underwent active jaw physiotherapy which was initially successful. Both patients were followed up for a minimum of two years following their surgeries

Modified Le Fort I Osteotomy and Genioplasty for Management of Severe Dentofacial Deformity in β-Thalassaemia Major: Case report and review of the literature

β-thalassaemia major is an autosomal recessive form of haemoglobinopathy that is characterised by complete lack of production of the β-chains resulting in multiple complications that include severe anaemia, failure to thrive and skeletal abnormalities. Facial deformities induced by β-thalassaemia major are rare and are very challenging to treat from a surgical point of view. We report a 33-year-old female patient with β-thalassaemia major who presented to the Dental & Maxillofacial Surgery Department, Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with gross dentofacial skeletal deformity contributing to her psychosocial issues. The facial deformity was corrected surgically by excision of the enlarged maxilla, modified Le Fort I osteotomy and advancement genioplasty. This case highlights the pre-operative preparation, surgical management, encountered complications and treatment outcome within 24 months of follow-up.Keywords: Beta-Thalassaemia; Thalassaemia Major; Cooley's Anemia; Le Fort Osteotomy; Genioplasty; Dentofacial Deformities; Case Report; Oman

Maxillary Artery Pseudoaneurysm as a Complication of Maxillofacial Injuries: Report of three cases and literature review

Traumatic maxillary artery pseudoaneurysm is an uncommonly reported complication in the field of oral and maxillofacial surgery. It is usually discovered incidentally, either early after trauma or weeks-to-months later. Quick recognition and prompt management are essential to avoid devastating consequences. In this paper, we report three uncommon cases of maxillary artery pseudoaneurysm recognised during the surgical management of maxillofacial injuries in Muscat, Oman. All cases presented as sudden brisk bleeding during the intraoperative surgical repair and were subsequently diagnosed and successfully managed by endovascular embolisation with platinum coils. This case report highlights the clinical presentation, diagnosis and management of maxillary artery pseudoaneurysm, in addition to a brief review of the literature.Keywords: Maxillofacial Injuries; Maxillary Artery; Pseudoaneurysm; Mandibular Condyle; Angiography; Therapeutic Embolization; Case Report; Oman

A Triad of Temporomandibular Joint Ankylosis, Mandibular Retrognathia and Severe Obstructive Sleep Apnoea: Case report

The surgical management of paediatric patients with temporomandibular joint (TMJ) ankylosis, mandibular retrognathia and obstructive sleep apnoea (OSA) is challenging. We report a nine-year-old boy who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with complaints of limited mouth opening, loud snoring and excessive daytime sleepiness. He was diagnosed with TMJ ankylosis, mandibular retrognathia and severe OSA. The patient initially underwent mandibular distraction and, subsequently, release of the TMJ ankylosis and rib graft reconstruction. The overall patient outcome was successful, with improvement in OSA-related symptoms, good facial symmetry and adequate mouth opening. Keywords: Temporomandibular Joint Disorders; Temporomandibular Ankylosis; Retrognathia; Obstructive Sleep Apnea; Case Report; Oman

Mucormycosis of the Jaw after Dental Extractions: Two Case Reports

Mucormycosis is a rare opportunistic fungal infection, which is mainly reported to occur in patients with immunocompromised conditions such as uncontrolled diabetes mellitus and leukaemias. In this paper, two cases of mucormycosis are reported after dental extractions. The first case of mucormycosis occurred in the maxilla and mandible of a 14 year old male patient undergoing chemotherapy for acute myeloid leukaemia. The second case occurred in the mandible of a 49 year old male patient with a recently diagnosed type-2 diabetes mellitus, presenting with ketoacidosis and underlying undiagnosed acute lymphoblastic leukaemia. The outcome of these reported cases of mucormycosis was favourable after comprehensive surgical and medical management

Minor Oral Surgery Procedures in Patients Taking Warfarin : A 5-year retrospective study at Sultan Qaboos University Hospital, Sultanate of Oman

Objectives: Minor oral surgery (MOS) procedures in warfarinised patients carry the risk of post-operative bleeding. The aim of this study was to conduct a retrospective analysis and to describe the profile of warfarinised patients who underwent MOS procedures at Sultan Qaboos University Hospital. Methods: A retrospective study of 124 warfarinised patients (41 men and 83 women), who had a pre-operative international normalised ratio (INR) of ≤ 3.5 and underwent different MOS procedures under local anaesthesia, without discontinuation of their warfarin therapy, was carried out over a 5-year period from January 2004 to December 2008. Results: Ninety (72.6%) patients had simple dental extractions, 26 (21%) surgical extractions, 6 (4.8%) soft tissue biopsies and 2 (1.6%) had apicectomies with cyst enucleations. Local measures were applied in all patients, which included the use of oxidizing regenerated cellulose haemostatic agent (Surgicel) and suturing. A total of eight patients (6.5%), five who had surgical extractions and three who had simple extractions, bled enough post-operatively to require a return to hospital. All cases of post-operative bleeding were managed conservatively by repacking the bleeding site with haemostatic agent and re-suturing without the need for hospital admission. Conclusion: Minor oral surgery procedures can be safely conducted in warfarinised patients without interruption of warfarin regimen when the pre-operative INR is ≤ 3.5 and appropriate local haemostatic measures are used.