All that can be Hidden Behind the Clinical Appearance of Odontogenic Abscesses. Oversight or Error? - Presentation of Two Cases

Ovim se radom želi upozoriti na važnost iscrpnoga kliničkog pregleda, dijagnostičke obradbe i dobroga poznavanja patologije usne šupljine kako se ne bi dogodilo pogrješno liječenje i gubitak dragocijena vremena. Prvi pacijent R. J., tridesetπest godina, dolazi zbog perimandibularnog otoka i trizmusa desne strane lica u OB Karlovac, ORL odjel. Tu mu se dva puta učini ekstraoralna incizija pod sumnjom odontogenog apscesa. Dolaskom oralnoga kirurga u bolnicu i uvidom u stanje usne šupljine pacijent se dogovorno premješta u KKL»U KB “Dubrava”. Pregledom se intraoralno našao ispod jezika jasan ulkus desno te golem infiltrat gotovo cijele prednje dvije trećine jezika. Palpacijom se nađu fiksirane metastaze u regiji dva i tri veličine 50 milimetra. Nakon prikaza, na onkološkom konziliju indicira se samo iradijacija. Na kontroli, nakon πest mjeseci, vidljiva je djelomična regresija bolesti. Drugi pacijent I. J., tridesettri godine, dolazi u ambulantu oralne kirurgije pod sumnjom palatinalnog apscesa od gornjih lijevih molara. Gornja lijeva šestica se trepanira, a suspektni apsces dva puta incidira. U tijeku šest mjeseci uopće nije bilo regresije bolesti pa se pacijent upućuje u KKL»U KB “Dubrava”. Tamo mu se učini citopunkcija, biopsija, CT maksile te se utvrdi da se radi o mukoepidermoidnom karcinomu tvrdoga nepca. Nakon preoperativne pripreme pacijentu se učini parcijalna resekcija gornje čeljusti. Terapija pacijenta je u tijeku. Ta dva slučaja govore da se jasno moraju znati uzročnici različitih oteklina u području glave i vrata i da, ako se radi o odontogenoj upali, ona na odgovarajuću terapiju reagira za kratko vrijeme.The aim of this study was to show the importance of a detailed clinical examination, diagnostic analysis and good knowledge of the pathology of the oral cavity, in order to avoid erroneous treatment and loss of precious time. The first patient, R. J., a 36-year-old man, was admitted to the ENT Department of the General Hospital, Karlovac, because of a perimandibular swelling and trismuss of the right side of the face. Because an odontogenic abscess was suspected extraoral incision was performed on two occasions. After the arrival of an oral surgeon to the hospital and examination of the oral cavity the patient was transferred to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava. During an intraoral examination an ulcer was detected beneath the tongue on the right side and a massive infiltrate of almost the whole of the anterior two thirds of the tongue. Immovable metastasis was detected by palpation in regions two and three, 50 millimetres in size. After consultation at an oncological Meeting irradiation only was indicated. A check-up six months later showed partial regression of the disease. The second patient, K. J., a 33 year-old man, came to the Out-patient Department of Oral Surgery with suspected palatinal abscess of the upper left molar. The upper left six was trepanated and the suspect abscess incidirated twice. For a period of six months no regression occurred and consequently the patient was sent to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, where cytopuncture, biopsy, CT of the maxilla were performed which confirmed mucoepidermoid carcinoma of the hard palate. After preoperative preparation partial resection of the upper jaw was performed. Therapy is presently in course. These two cases indicate the need to know the causative agents of swellings in the area of the head and neck, and if odontogenic inflammation is the case it quickly responds to appropriate therapy

Uncommon Clinical Appearance and Localisation of Carcinoma of the Upper Lip - Case Presentation

U radu se prikazuje neobična klinička slika i lokalizacija karcinoma gornje usnice. Pacijentica K. A., sedamdesetčetiri godine, dolazi u ambulantu za oralnu medicinu radi gnojnog infiltrata u gornjoj usnici sa sumnjom na ubod kukca. Uputi se u ambulantu za oralnu kirurgiju gdje se učini incizija i drenaža te se postavi dijagnoza piogenoga granuloma. Kako promjena u međuvremenu od mjesec-dva ne prolazi već postaje sve tvrđa i vidljivija, i vestibularno i labijalno, naruči se na ekciziju. U međuvremenu pacijentica odlazi na Kliniku za dermatovenerologiju zbog bazocelularnih promjena na licu. U tijeku ekscizija promjena lica učini se i površna biopsija s kožne strane usnice te se dobije PHD nalaz planocelularnoga karcinoma. Pacijentici se na klinici za dermatovenerologiju savjetuje radioterapija promjene, no pacijentica se ponovno javlja u ambulantu oralne kirurgije. Zbog sumnje u površno uzet nalaz promjene i eventualne zamjene s mioblastomom zrnatih stanica, učini se ekscizija promjene u cijelosti te se dobije identičan PHD nalaz planocelularnoga karcinoma. Tada se pacijentica dogovorno premjesti u KKLČU KB “Dubrava” gdje se učini proširena ekscizija, te se PHD-om utvrdi da je promjena u predhodnom zahvatu ekscidirana u cijelosti.The study presents the uncommon clinical appearance and localisation of carcinoma of the upper lip. A 74-year-old female patient was referred to the Outpatient Department of Oral Medicine because of a purulent infiltrate in the upper lip which was thought to be an insect bite. She was referred to the Outpatient Department of Oral Surgery where an incision was performed and drainage, and piogenic granuloma diagnosed. As the lesion had not healed after two months, but on the contrary had become harder and more visible, both vestibularly and labially, an excision was planned. In the meantime, however, the patient had attended the Clinic of Dermatovenerology because of basocellular lesions on the face, and during excision of the facial lesions a surface biopsy was performed from the skin side of the lip, and the PHD finding showed planocellular carcinoma. At the Clinic of Dermatovenerology the patient was recommended to undergo radiotherapy of the lesions. However, the patient returned to the Out-patient Department of Oral Surgery. Because of the suspicion that the biopsy had been too superficial and because of the possibility of eventual confusion with a mioblastoma, complete excision of the lesion was performed and an identical PHD finding was obtained of planocellular carcinoma. The patient was then transferred to the Department of Maxillofacial Surgery, University Hospital Dubrava, where an extended excision was performed, and the PHD confirmed that the lesion had been completely excised in the previous procedure

Uncommon Metastasis of Melanoma of the Face after Sixteen Years - Case Presentation

U radu prikazujemo slučaj neobična metastaziranja melanoma lica u limfni čvor vrata nakon šesnaest godina. Pacijent M. Š., četrdeset godina, javlja se oralnom kirurgu zbog povećanoga limfnoga čvora desne strane regije jedan. S obzirom na činjenicu da ima dosta nesaniranih zuba i sijevajuću bol na desnoj strani lica, dolazi na pregled zbog sumnje na odontogeni limfadenitis. Anamnestički se utvrdi da je pacijent prije šesnaest godina u desnoj nazolabijalnoj brazdi operirao melanom. Pregledom se nađe postoperativni ožiljak na desnome obrazu, tvrd, bezbolan i pomičan limfni čvor veličine dva centimetra u regiji jedan, te dosta nesaniranih zuba. Pacijent se uputi prvo na citopunkciju čvora kojom se je utvrdilo da se radi o metastazi melanoma. Nakon učinjene preoperativne pripreme, učini se radikalna disekcija vrata desne strane te se izvade svi zubi koji nisu bili za sanirati. U PHD pripravku nađe se samo jedan pozitivan limfni čvor. Pacijent se uključi u protokol za melanom te se po kliničkim smjernicama učine sve pretrage. Budući da su svi pacijentovi nalazi uredni, za sada nije potrebna nikakva druga terapija. Slučaj prikazuje da ni takve situacije ne možemo zanemariti u diferencijalnoj dijagnostici povećanih limfnih čvorova vrata.We present the case of unusual metastasis of a facial melanoma in a lymph node of the neck, after sixteen years. A 40-year-old male patient was referred to the oral surgeon because of an enlarged lymph node on the right side, region one. Due to the fact that he had a number of untreated teeth and radiating pain on the right side of the face he was admitted for examination with suspected odontogenic lymphadenitis. From the case history it was learnt that the patient had had an operation for melanoma in the right nasolabial cheek sixteen years previously. An examination revealed a postoperative scar on the right cheek, which was hard and painless, and a lymph node, two centimetres in size in region one, and also several untreated teeth. The patient was first sent for cytopuncture of the node, which showed metastasis of the melanoma. For preoperative preparation radical dissection was performed of the right side of the neck and all teeth extracted which could not be treated. Only one positive lymph node was found In the PHD specimen. The patient was included in the protocol for melanoma and all tests were carried out according to clinical guidelines. As all findings are presently normal no further therapy is necessary. The case shows that even in such situations we cannot disregard enlarged lymph nodes of the neck in differential diagnostics

All that can be Hidden Behind the Clinical Appearance of Odontogenic Abscesses. Oversight or Error? - Presentation of Two Cases

Ovim se radom želi upozoriti na važnost iscrpnoga kliničkog pregleda, dijagnostičke obradbe i dobroga poznavanja patologije usne šupljine kako se ne bi dogodilo pogrješno liječenje i gubitak dragocijena vremena. Prvi pacijent R. J., tridesetπest godina, dolazi zbog perimandibularnog otoka i trizmusa desne strane lica u OB Karlovac, ORL odjel. Tu mu se dva puta učini ekstraoralna incizija pod sumnjom odontogenog apscesa. Dolaskom oralnoga kirurga u bolnicu i uvidom u stanje usne šupljine pacijent se dogovorno premješta u KKL»U KB “Dubrava”. Pregledom se intraoralno našao ispod jezika jasan ulkus desno te golem infiltrat gotovo cijele prednje dvije trećine jezika. Palpacijom se nađu fiksirane metastaze u regiji dva i tri veličine 50 milimetra. Nakon prikaza, na onkološkom konziliju indicira se samo iradijacija. Na kontroli, nakon πest mjeseci, vidljiva je djelomična regresija bolesti. Drugi pacijent I. J., tridesettri godine, dolazi u ambulantu oralne kirurgije pod sumnjom palatinalnog apscesa od gornjih lijevih molara. Gornja lijeva šestica se trepanira, a suspektni apsces dva puta incidira. U tijeku šest mjeseci uopće nije bilo regresije bolesti pa se pacijent upućuje u KKL»U KB “Dubrava”. Tamo mu se učini citopunkcija, biopsija, CT maksile te se utvrdi da se radi o mukoepidermoidnom karcinomu tvrdoga nepca. Nakon preoperativne pripreme pacijentu se učini parcijalna resekcija gornje čeljusti. Terapija pacijenta je u tijeku. Ta dva slučaja govore da se jasno moraju znati uzročnici različitih oteklina u području glave i vrata i da, ako se radi o odontogenoj upali, ona na odgovarajuću terapiju reagira za kratko vrijeme.The aim of this study was to show the importance of a detailed clinical examination, diagnostic analysis and good knowledge of the pathology of the oral cavity, in order to avoid erroneous treatment and loss of precious time. The first patient, R. J., a 36-year-old man, was admitted to the ENT Department of the General Hospital, Karlovac, because of a perimandibular swelling and trismuss of the right side of the face. Because an odontogenic abscess was suspected extraoral incision was performed on two occasions. After the arrival of an oral surgeon to the hospital and examination of the oral cavity the patient was transferred to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava. During an intraoral examination an ulcer was detected beneath the tongue on the right side and a massive infiltrate of almost the whole of the anterior two thirds of the tongue. Immovable metastasis was detected by palpation in regions two and three, 50 millimetres in size. After consultation at an oncological Meeting irradiation only was indicated. A check-up six months later showed partial regression of the disease. The second patient, K. J., a 33 year-old man, came to the Out-patient Department of Oral Surgery with suspected palatinal abscess of the upper left molar. The upper left six was trepanated and the suspect abscess incidirated twice. For a period of six months no regression occurred and consequently the patient was sent to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, where cytopuncture, biopsy, CT of the maxilla were performed which confirmed mucoepidermoid carcinoma of the hard palate. After preoperative preparation partial resection of the upper jaw was performed. Therapy is presently in course. These two cases indicate the need to know the causative agents of swellings in the area of the head and neck, and if odontogenic inflammation is the case it quickly responds to appropriate therapy

‘Design-in’ Faults - the Reason for Serious Drawbacks in High Capacity Bucket Wheel Excavator Exploitation

This paper describes the failure analysis results of undercarriage and superstructure vital subassemblies, which led to periodical stoppage and eventually total collapse of the bucket wheel excavator (BWE) SchRs 1760, once the machine with the highest theoretical capacity operating on the overburden excavation in open pit mine “Kolubara” - Serbia. It is conclusive that the main cause of two wheel bogie structural failure, described as case 1, is its insufficient strength during the action of lateral forces which are dominantly applied during the BWE curve travel. Case 2 analyses the support structure of portal tie-rods failure which was the consequence of superposition of the negative effects caused by inadequate shaping and dimensioning of the support assembly for given load conditions, as well as influences of defects of the metal weld structure. Both of the described failures are caused by the design-in faults

Učestalost humanog papilomavirusa 16 i Epstein-Barrova virusa kod bolesnika s oralnim karcinomom pločastih stanica

It has been suggested that certain viruses such as human papillomaviruses (HPV) and Epstein-Barr virus (EBV) might have a role in oral squamous cell carcinoma (OSCC). However, results of the published studies are controversial and are dependent on the geographic distribution and methods of sampling and sample analysis. The aim of this study was to determine the prevalence of HPV 16 and EBV in OSCC patients. In 24 patients with OSCC (mean age 59.6±8.8) and 30 controls (mean age 49.1±8.3), 5 mL of blood was collected to determine the prevalence of EBV by serologic methods. In addition, swabs were obtained to analyze the presence of HPV 16 and EBV by use of polymerase chain reaction. Statistical analysis was performed by use of Mann Whitney test, χ2-test and Spearman correlation test. The results of this study showed that there were no significant differences between OSCC patients and control subjects according to the presence of EBV or HPV 16. Therefore, it can be concludedČini se kako određeni virusi poput humanih papilomavirusa (HPV) i Epstein-Barrova virusa (EBV) mogu imati ulogu u nastanku karcinoma pločastih stanica u usnoj šupljini (OPCK). Ipak, rezultati objavljenih istraživanja na tu temu su kontroverzni i ovise o geografskoj distribuciji i metodama uzimanja uzoraka odnosno raščlambi uzoraka. Cilj ovoga istraživanja je bio odrediti učestalost HPV 16 i EBV u osoba s OPCK. U 24 osobe s OPCK (srednje dobi 59,6±8,8) i u 30 kontrolnih ispitanika (srednje dobi 49,1±8,3) je uzeto 5 mL krvi kako bi se odredio EBV serološkim metodama. Uz to su uzeti i brisevi kako bi se odredila prisutnost HPV 16 i EBV uz pomoć reakcije lančane polimeraze. Statistička analiza je napravljena pomoću Mann-Whitneyeva testa, χ2-testa i Spearmanova korelacijskog testa. Rezultati ovoga istraživanja pokazuju kako nije bilo znakovitih razlika između osoba s OPCK i kontrolnih ispitanika s obzirom na prisutnost HPV 16 ili EBV. Može se zaključiti kako ovi virusi u našoj populaciji oboljelih od OPCK vjerojatno nemaju veliku ulogu

‘Design-in’ Faults - the Reason for Serious Drawbacks in High Capacity Bucket Wheel Excavator Exploitation

This paper describes the failure analysis results of undercarriage and superstructure vital subassemblies, which led to periodical stoppage and eventually total collapse of the bucket wheel excavator (BWE) SchRs 1760, once the machine with the highest theoretical capacity operating on the overburden excavation in open pit mine “Kolubara” - Serbia. It is conclusive that the main cause of two wheel bogie structural failure, described as case 1, is its insufficient strength during the action of lateral forces which are dominantly applied during the BWE curve travel. Case 2 analyses the support structure of portal tie-rods failure which was the consequence of superposition of the negative effects caused by inadequate shaping and dimensioning of the support assembly for given load conditions, as well as influences of defects of the metal weld structure. Both of the described failures are caused by the design-in faults

Validation of the number of buckets on the working device of a bucket wheel

The method for validation of the number of buckets on the working device of a bucket wheel excavator from the aspect of dynamic behaviour of the system, partially presented in this paper, was developed on the basis of the original spatial reduced dynamic model of the bucket wheel excavator with two masts, which enables modal analysis and analysis of the dynamic response of the system for continuous variation of constructional parameters and parameters of excitation. The set of 16 seemingly acceptable solutions, all of which satisfied the rigid design restrictions which were: (a) use of the same bucket wheel drivetrain, (b) preservation of the theoretical capacity, (c) possibility of the excavation of soil of the fourth category and (d) preservation of the superstructure centre of gravity position, was analyzed. On the basis of limiting vertical and lateral accelerations, derived from dynamic coefficients prescribed by the code DIN 22261-2, of the bucket wheel centre, which for a proper geometrically-designed bucket wheel excavator structure represents a well grounded indicator of its dynamic behaviour, 14 out of 16 analyzed solutions were discarded, yielding the set of possible solutions to only 2, the originally designed one (with 17 buckets) and the solution with 20 buckets installed on the bucket wheel

Temporary Leaning of the Gas Oil Storage Tank Structure During Bottom Sanation

The design concept of temporary leaning of the gas oil storage tank bearing structure used during substitution of the worn out section of the bottom plates in the zone of the central column support is presented in the paper. On the basis of comparative analysis of the results obtained using finite element structural calculations of the designed state and the state of the central column leaning on the temporary supports, it was determined that by the implementation of the temporary support, the stress-strain state of the bearing structure, which corresponds to the designed stress-strain state of the construction, is obtained. Besides, the strength proof of the structure of temporary support including its welded joint to the central column is also presented in the paper

Evaluation of Sentinel Node Biopsy in Oral Carcinomas

It is still a matter of debate whether sentinel node biopsy might replace neck dissection in patients with clinically negative neck lymph nodes who suffer from oral squamous cell carcinoma. In 30 patients (26 male, 4 female, average age 59.4 years) with oral squamous cell carcinoma we performed ultrasound guided punction of the lymph nodes which were lymphoscintigraphically seen together with histopatological analysis of the dissected node. Sentinel lymph node was seen in 93% cases. By use of lymphoscintigraphy sentinel node was verified in 23 patients. Ultrasound guided punction showed presence of regional disease in 10% of cases, whereas sentinel biopsy revealed 23 of the converted necks. Histopathological findings were positive in 33% of our patients. The results of this study revealed that sentinel biopsy did not reveal 27% of the patients with positive neck histopathology. In conclusion, sentinel node biopsy should be performed in selective cases as in some localizations it is easier to perform neck dissection in comparison to the sentinel node biopsy