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

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.

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.

Factors Contributing to the Spread of Odontogenic Infections : A prospective pilot study

Objectives: Spreading odontogenic infections (SOI) are the commonest type of serious infections encountered in the orofacial region. A prospective multi-centre study was conducted in the West of Scotland to investigate the contributing role of social, systemic and microbial factors in the pathogenesis of SOI. Methods: Twenty-five patients with severe odontogenic infections were recruited over a period of six months. At admission, clinical assessment included temperature rise, haematological and biochemical investigations. Demographic data, social and past medical histories were obtained. Microbiology samples were collected to identify causative microorganisms and the clinical management of each infection was recorded. Results: Most infections were associated with teeth or roots. Eighty percent of the patients were tobacco smokers and 72% came from deprived areas. Five patients were intravenous drug users, four admitted chronic alcohol abuse, six had underlying systemic disorders and two were at high risk of malnutrition. A raised C-reactive protein at admission was a useful indicator of the severity of infection. Inappropriate prior antibiotic treatment in the absence of surgical drainage was common. Microbiology results showed a predominance of strict anaerobes, notably anaerobic streptococci, Prevotella and Fusobacterium species. Conclusion: SOIs remain surprisingly common and our present pilot study showed a particular association with social deprivation and tobacco smoking. Further elucidation of the role of malnutrition in SOI would be of interest. Molecular characterisation of the microflora associated with SOI may help to highlight whether bacterial factors play a role in converting a localised dentoalveolar abscess into a serious, spreading odontogenic infection

Factors Contributing to the Spread of Odontogenic Infections: A prospective pilot study

Objectives: Spreading odontogenic infections (SOI) are the commonest type of serious infections encountered in the orofacial region. A prospective multi-centre study was conducted in the West of Scotland to investigate the contributing role of social, systemic and microbial factors in the pathogenesis of SOI. Methods: Twenty-five patients with severe odontogenic infections were recruited over a period of six months. At admission, clinical assessment included temperature rise, haematological and biochemical investigations. Demographic data, social and past medical histories were obtained. Microbiology samples were collected to identify causative microorganisms and the clinical management of each infection was recorded. Results: Most infections were associated with teeth or roots. Eighty percent of the patients were tobacco smokers and 72% came from deprived areas. Five patients were intravenous drug users, four admitted chronic alcohol abuse, six had underlying systemic disorders and two were at high risk of malnutrition. A raised C-reactive protein at admission was a useful indicator of the severity of infection. Inappropriate prior antibiotic treatment in the absence of surgical drainage was common. Microbiology results showed a predominance of strict anaerobes, notably anaerobic streptococci, Prevotella and Fusobacterium species. Conclusion: SOIs remain surprisingly common and our present pilot study showed a particular association with social deprivation and tobacco smoking. Further elucidation of the role of malnutrition in SOI would be of interest. Molecular characterisation of the microflora associated with SOI may help to highlight whether bacterial factors play a role in converting a localised dentoalveolar abscess into a serious, spreading odontogenic infection