Mucocele

U ambulanti oralne kirurgije gotovo se danomice susrećemo sa salivarnim cistama. Liječimo ih kirurškim putem - izljuštivanjem ili marsupijalizacijom. Smatrali smo vrijednim te promjene raščlaniti klinički, patohistološki i patogenetski. Postoje dva tipa salivarnih cisti: retencijske ciste (histološki žlijezda slinovnica s dilatiranim izvodnim kanalićima obloženima krupnim stanicama sa saćastom citoplazmom) i ekstravazacijske ciste (šuplja tvorba ispunjena staničnim detritusom i bakterijama, obložena cilindričnim i višeslojnim epitelom). Mukokele su obložene stijenkom granulacijskoga tkiva i sadržavaju eozinofilni hijalini materijal. Raspoređene su po cijeloj sluznici usne šupljine, ali najviše na donjoj usnici. Najčešće nastaju mehaničkim ozljedama izvodnih kanala malih žlijezda slinovnica i retencijom. Promjera su oko 1,5 cm. Izazivaju laganu cijanozu područja i plavkasto-bijelo prosijavanje koje nastaje kao posljedica sužavanja krvnih žila i tanke stijenke mukokele. Retrospektivno smo analizirali patohistološke nalaze s kliničkom dijagnozom “mukokela” u razdoblju od 1. siječnja 1995. do 31. prosinca 2000. godine. U tome razdoblju ukupno je operirano 9047 osoba. Od 1358 nalaza koji su poslani na patohistološku raščlambu (PHD) 89 je klinički dijagnosticirano kao mukokele. Od 89 navedenih lezija u samo je 72 slučaja patohistološki potvrđena dijagnoza mukokela. Razlike u spolu nisu bitno utjecale na nastanak mukokela, a prema istraživanju nalazimo da se mukokele javljaju u svim dobnim skupinama, no ipak češće u mladih ljudi u drugom i trećem desetljeću života. Mukokele su najvećim dijelom bile na donjoj usnici, 83,3% u našem istraživanju. Ostale mukokele bile su u sublingvalnom prostoru, na obraznoj sluznici i u vestibulumu usne šupljine. Prema patohistološkom opisu zaključili smo da su 23 mukokele bile retencijskoga tipa, a dvije su bile ekstravazacijske promjene.In the Out-Patient Department of Oral Surgery we daily come across salivary cysts which we treat surgically - by scaling or marsupialisation. We considered that it would be helpful to analyse these changes clinically, histopathologically and pathogenetically. There are two types of salivary cysts: retention cysts (histologically a salivary gland with dilated secretory canals lined with large cells with honeycomb cytoplasm) and extravasation cysts (a hollow mass filled with cellular detritus and bacteria, coated with cylindrical and stratified epithelia). Mucocele are coated with a lining of granulation tissue and contain eozinophyllic hyaline material. They occur throughout the whole of the mucous membrane of the oral cavity, although the majority are on the lower lip. They most frequently occur because of mechanical injury to the secretory canals of the small salivary glands and retention. They are approximately 1.5 cm in diameter. They cause slight cyanosis of the area and bluish-white surface which occurs as a result of the narrowing of the blood vessels and thin walls of the mucocele. We retrospectively analysed histopathological findings with a clinical diagnosis “mucocele” during the period 1 January 1995 to 31 December 2000. During that period a total number of 9047 people were operated. Of 1358 findings sent for histopathological analysis (PHD), 89 were clinically diagnosed as mucocele. Of these 89 lesions in only 72 cases was the diagnosis of mucocele confirmed histopathologically. Differences in gender did not essentially have an effect on the occurrence of mucocele, and according to the results of the investigation we found that although mucocele occurs in all age groups, it is more frequent in younger people during the second and third decade of life. In our investigation mucocele were largely located on the lower lip, 83.3%. Other mucocele were located in the sublingual space, on the mucous membrane of the cheek and in the vestibulum of the oral cavity. According to the histopathological description we concluded that 23 mucocele were of retention type and two extravasation lesions

Dental Implants In Medically Compromised Patients

Terapija djelomične ili potpune bezubosti zubnim usadcima danas ima znatnu ulogu u oralnoj rehabilitaciji bolesnika, sve je češća, a za očekivati je da će u budućnosti biti u još većem porastu zajedno i u skladu s razvojem ostalih polja medicine. Unatoč tomu, svi gorljivi zagovornici ugradnje zubnih usadaka i implantološki entuzijasti ipak svoje djelovanje moraju znati kontrolirati i ispravno usmjeriti kroz prizmu poznavanja fizioloških i patofizioloških zbivanja u svakoga pacijenta, bio on potpuno zdrav ili pod utjecajem nekoga patološkog poremećaja, kako bi postignuli njegovo konačno opće i oralno zdravlje. Mnogo je medicinski kompromitiranih pacijenata koji traže implantološku terapiju u svrhu svoje oralne rehabilitacije. Smatramo da još danas nisu potpuno razjašnjene smjernice za pre i postimplantološkom terapijom takvih pacijenata i zato nepotpuno jasne stomatolozima praktičarima i oralnim kirurzima. Svrha ovoga izlaganja jest prikazati kritičku procjenu dosadašnjih stajališta i literature te dati jasne i znanstveno utemeljene smjernice za implantološku terapiju u takvih pacijenata. Bit će razjašnjene dosadašnje spoznaje utjecaja najčešćih sustavskih i lokalnih bolesti, poremećaja i stanja na terapiju zubnim usadcima, kao što su poremećaji i promjene u metabolizmu kosti (osteomalacija, osteopenija, osteoporoza, osteoradionekroza) i kod starenja bolesnika, diabetes mellitus, kserostomija, stanja nakon radioterapije u području čeljusti, ektodermalne displazije, kardiopulmonalne bolesti, pušenje, hipotireoza, autoimune bolesti (sklerodermija, Chronova bolest...), Parkinsonova bolest te hematološke bolesti (anemije, leukemije, poremećaji hemostaze...) i stanja uzrokovana raznim medikamentima (kortikosteroidima, citostaticima, fenitoinom, blokatorima kalcijevih kanala...). Specifični patofiziološki aspekti utjecaja navedenih stanja na sam proces oseointegracije i njihovih potencijalnih daljnjih mogućih utjecaja na zubne usatke bit će potanko razjašnjeni u svrhu njihove moguće i što jednostavnije primjene u svakodnevnoj praksi svakog kliničara koji se bavi zubnom implantologijom. U skladu s time izložit ćemo naše smjernice za pre i poslijeoperativnim tretmanom implantiranih medicinski kompromitiranih pacijenata.Today, therapy of partial or complete edentulousness by dental implants plays an increasingly significant role in the oral rehabilitation of patients, and is expected in the future to further increase in accordance with the development of other medical fields. However, all ardent advocates of dental implants and implantological enthusiasts, must know how to control and direct their activity through the prism of physiological and pathophysiological events in each patient, regardless of whether he/she is entirely healthy or effected by some pathological disorder, having in view his/her general and oral health. Many medically compromised patients seek implantological therapy for the purpose of their oral rehabilitation. We are of the opinion that today guidelines for pre and post implantological therapy of such patients have still not been entirely clarified, and consequently are not completely clear to dental practitioners and oral surgeons. The purpose of our presentation is to give a critical assessment of opinions and literature to date, and to give clear and scientifically founded guidelines for implantological therapy in such patients. Current knowledge will be discussed on the influence of the most frequent systemic and local diseases, impairments and conditions on therapy by dental implants. They include disorders and changes in bone metabolism (osteomalacia, osteopenia, osteoporosis, osteoradionecrosis) and ageing of the patient - diabetes mellitus, xerostomia, conditions in the area of the jaw following irradiation, ectodermal dysplasia, cardiopulmonary disease, smoking, hypothyrosis, autoimmune diseases (sclerodermia, Chron’s disease), Parkinson’s disease and haematological diseases (anaemia, leukaemia, haemostasis disorders....) and conditions caused by various medications (corticosteroids, cytostatics, phenitoin, blockers of calcium canals....). Specific pathophysiological aspects of the influence of the aforementioned conditions on the process of osseointegration and their possible effect on dental implants, will be explained in detail for the purpose of their possible and more simple application in the daily practice of every clinician engaged in dental implantology. Accordingly, we will present our guidelines for pre and post surgical treatment of implanted, medically compromised patients

Treatment of Acute Odontogenic Inflammation in National Health Care

Akutna odontogena upala najčešća je bolest zbog koje bolesnici dolaze u ambulantu oralne kirurgije. U većini slučajeva pomoć se može i treba pružiti u ambulantama primarne zdravstvene zaštite. Svrha našega istraživanja bila je utvrditi na koji način neki opći stomatolozi liječe akutne odontogene infekcije i zašto upućuju bolesnika s akutnom odontogenom oteklinom u ambulantu oralne kirurgije. Prospektivno ispunjavajući anketne listiće za 38 nasumce odabranih bolesnika, koji su zbog otekline odontogene etiologije došli u ambulantu oralne kirurgije Klinike za kirurgiju lica, čeljusti i usta KB “Dubrava”, došli smo do sljedećih podataka. Stomatolozi su uputili 79% bolesnika, liječnici opće prakse l3%, a 8% bolesnika došlo je samoinicijativno. Dvije trećine svih bolesnika uputili su žene stomatolozi prosječne dobi 38 godina, a preostale su uputili muški stomatolozi prosječne dobi 41 godinu. Žene stomatolozi najčešće ordiniraju samo antibiotike, 60% u našoj anketi, 20%, njih šalju bolesnike bez ikakve terapije ili poslije trepanacije i ordiniranja antibiotika. Muški stomatolozi u 40% slučajeva šalju bolesnike bez ikakve terapije ili samo ordiniraju antibiotike, a najmanje ih učini trepanaciju i ordinira antibiotike, 20%. Najstariji stomatolozi, prosječne dobi 43 godine, ne provode nikakvu terapiju; samo antibiotike ordiniraju stomatolozi prosječne dobi 39 godina, a trepaniraju zube i ordiniraju antibiotike najmlađi, prosječne životne dobi 34 godine. Najčešća obrazloženja zbog čega su uputili bolesnika u našu ambulantu jesu: ne smije ništa raditi jer je otečen, alergija na lijekove, ne smije se dati injekcija jer je otečen i nemam instrumente. Trećini pacijenata nije dana nikakva terapija prije nego što su ih uputili u našu ambulantu. Samo je u 18% slučajeva učinjena trepanacija i ordinirani su antibiotici. Najzastupljeniji način liječenja, u ovom istraživanju, jest samo ordiniranje antibiotika (53%). Prije upućivanja pacijenata, nije učinjena ni jedna intraoralna incizija. U 2/3 upućenih mi smo učinili intraoralnu inciziju, a samo je 13 % opravdano upućeno u našu ustanovu jer im je rađena ekstraoralna incizija, i to 3 ambulantno i 2 hospitalno. Rezultati ove ankete pokazuju neprihvatljiv odnos nekih stomatologa prema liječenju akutnih odontogenih oteklina. Zato se nameće potreba da se intenzivira dodiplomska nastava i uspostavi trajna izobrazba stomatologa primarne zdravstvene zaštite o problemu liječenja akutne odontogene upale te za podizanje kakvoće primarne stomatološke službe kako bi se smanjio nastanak odontogenih upala, njihovih komplikacija i potrebe za hospitalizacijom takvih bolesnika.Acute odontogenic inflammation is the most frequent disease because of which patients come to the Out-Patient Clinic of Oral Surgery. In the majority of cases help can, and should, be ensured in the dental surgeries of National Health clinics. The object of our investigation was to determine how and in what way, some dentists treat acute odontogenic infections and why they refer patients with acute odontogenic swelling to the Out-Patient Clinic of Oral Surgery. We arrived at the following data by prospectively completing a questionnaire for 38 patients, selected at random, who had come to the Out-Patient Clinic of Oral Surgery, Clinic for Maxillofacial and Oral Surgery, University Hospital Dubrava, because of swellings of odontogenic aetiology. Of these patients, 79% were referred by dentists, 13% general practitioners and 8% came on their own initiative. Two-thirds of the patients were referred by female dentists, mean age 38 years, while the remaining patients were referred by male dentists, mean age 41 years. Female dentists most frequently prescribe only antibiotics, 60% in our questionnaire, and 20% refer patients without any therapy at all or after trepanation and prescribed antibiotics. In the same way in 40% of cases male dentists refer patients without any therapy at all or only prescribed antibiotics, and only 20% perform trepanation and prescribe antibiotics. The oldest dentists, mean age 43 years, do not carry out any therapy at all, and antibiotics are only prescribed by those aged around 39 years, and trepanation of the tooth and antibiotics are prescribed by the youngest dentists, mean age 34 years. The most frequent explanation for referring patients to our Out-Patient Department are: “cannot do any work because of the swelling”, allergy to medications, “cannot give an injection because of the swelling” and “does not have the instruments”. One third of the patients did not receive any kind of therapy prior to being referred to our Department. Trepanation and antibiotics were performed in only 18% of cases. In this investigation the most frequent method of treatment was the application of antibiotics (53%). Not one intraoral incision was performed prior to being referred to our Department. We performed intraoral incision in two-thirds of the patients and only 13% were justifiably referred to our Department because extraoral incision had been performed, i.e. three in out-patient departments and two in hospital. The results of this questionnaire indicate the unacceptable attitude of some dentists towards treatment of acute odontogenic swellings. Thus, there is clearly a need for more intense undergraduate teaching and permanent training of the national health dentist on the problem of treating acute odontogenic inflammation, and for raising the quality of national health dental care with the object of reducing the occurrence of odontogenic inflammations and their complications, and the need for hospitalisation of such patients

Number of the Dentinal Tubules as a Function of Cavity Dept

Svrha ovog istraživanja je utvrditi postoji li razlika između broja i promjera otvora eksponiranih dentinskih tubula te udjela površine otvora eksponiranih dentinskih tubula od ukupne površine poprečnog presjeka humanoga koronarnog dentina s obzirom na udaljenost prema caklinsko-dentinskom spojištu i pulpi. Scanning elektronsko-mikroskopska usporedbena raščlamba provedena je na 60 uzoraka humanoga koronarnog dentina razdijeljenih u tri skupine prema udaljenosti između pulpe i caklinsko-dentinskog spojišta. promatran je dentin na tri razine u području središnje fisure: 1. poprečni rez koronarnoga dentina, 1 mm ispod caklinsko-dentinskoga spojišta 2. poprečni rez koronarnoga dentina na polovini razmaka između caklinsko-dentinskoga spojišta i pulpne komore 3. poprečni rez koronarnoga dentina 1 mm iznad krova pulpne komore Izbrojeni su vidljivi dentinski tubulusi unutar kvadrata površine 50 µm x 50 µm. Dobiveni broj podijeljen je s 2500 da bi se dobio N/µm2 i pomnožen s 1.000.000 da bi se dobio N/mm2). Prosječan broj otvora eksponiranih dentinskih tubula na prvoj razini je 96000/mm2, na drugoj razini 27100/mm2, te na trećoj 58.300/mm2. Jednosmjernom raščlambom varijance dobiven je omjer MStretman/MS pogrješka 305,22, koji je veći od F 0,99 (2,57) 4,98. Rezultati upućuju da postoji statistički znatna razlika broja i promjera otvora eksponiranih dentinskih tubula i veličine površine koju zauzimaju sve tri promatrane skupine uzoraka.The aim of this study was to determine if there is any defference between the number of exposed dentinal tubules on the cross section of the coronal dentine. By scanning electron microscopy comparative observation was carried out on 60 specimens of human coronal dentine, divided into 3 groups, in relation to the distance from the enamel-dentine junction and the pulp. Coronal dentine in the region of the central fissure was observed on three levels: 1. Cross section of the coronal dentine, 1 mm from the enamel-dentine junction. 2. Cross section of the coronal dentine, half-distance between the enamel-dentine junction and the pulp. 3. Cross section of the coronal dentine, 1 mm from the roof of the pulp chamber. Openings of the exposed dentinal tubules were counted in a square size 50 x 50 µm of the dentinal surface. The number was divided by 2500 to obtain the number of the openings of the dentinal tubules in the square micrometer (N/µm2). This number was multiplied by 106 to obtain the number of the openings of the dentinal tubules in the square millimeter (N/mm2). The mean number of the openings of the dentinal tubules on the first level was 9600/mm2, on the second level 27100/mm2 and on the third level 58300/mm2. Using the one-way analysis of variance was found ratio MStreatment/MSerror 305.22, that was greater than F 0.99 (2.57) 4.98. The results showed that there is significant statistical difference in the number of exposed dentinal tubules between all three groups of specimens

Sudbina zuba u prijelomnoj pukotini donje čeljusti

The mandibular fracture line with involved teeth, because of the presence of periodontal ligament, is always in communication with the oral cavity and therefore may allow the spread of infection. Moreover, such a tooth may lose blood supply due to damage of apical blood vessels and in the case of pulp necrosis the tooth is a source of infection. Methods of sensitivity testing of teeth are based on pain and it is difficult to distinguish the pulp vitality (a function of vascularisation) and the pulp sensitivity (a function of innervation). If the injury causes an interruption of the pulp vascularisation it will lead to the death of pulp tissue including the nerve, and if only the injury of the nerve occurs, the vitality of the pulp is not endangered. The aim of this investigation was to evaluate the sensitivity of teeth involved in jaw fracture line as well as to determine the number of denervated teeth and the time period in which reinnervation or revitalisation will occur. 50 patients with mandibular fractures were prospectively analyzed, 39 out of 50 patients had a tooth involved in the fracture line. There were 63 fractures in 39 patients, with 84 teeth involved in fracture line; 48 out of 84 teeth involved in the mandibular fracture line were initially seemingly avital and their reinnervation was followed up. Six weeks after the injury 31% of teeth involved in the jaw fracture were reinnervated, and a year after the injury 81% of teeth were reinnervated. No reinnervation occurred later than one year following injury. One year after the injury 84% of incisors, 75% of canines, 83% of premolars, and 80% of molars were reinnervated. During the second and the third year after the injury no reinnervation occurred but the devitalisation of initially denervated teeth is possible. The pulp is vitally stable one year after injury. Denervated teeth should not be considered as avital and should not be treated if neither clinical nor radiological signs of devitalisation are present. If sensitivity testing is the only criterion for tooth treatment and/or extraction, i.e., if we do not take into consideration the clinical and radiological criteria of devitalisation, 95% of false avital, i.e. only denervated teeth would be considered devitalised and unnecessary treated or extracted.Prijelomna pukotina u kojoj je zub komunicira preko parodontne pukotine s usnom šupljinom, što predstavlja ulazna vrata infekciji. Osim toga, takav zub može izgubiti opskrbu krvlju zbog oštećenja apeksnih žila pa u slučaju nekroze pulpe postaje izvor infekcije. Metode ispitivanja “vitaliteta” zuba osnivaju se na boli tako da dolazi do nerazlikovanja vitaliteta koji je funkcija vaskularizacije pulpe i senzibiliteta koji je funkcija inervacije. Ako ozljeda uzrokuje prekid vaskularizacije pulpe doći će do smrti pulpnog tkiva uključujući i živac, a ako dođe samo do ozljede i ispada funkcije živca, vitalitet pulpe nije ugrožen. Cilj ovog rada bio je ispitati promjene “vitaliteta”, tj. senzibiliteta zuba u prijelomnoj pukotini donje čeljusti i utvrditi u kojem broju i u kojem vremenskom razdoblju će doći do normalizacije senzibiliteta zuba ili do devitalizacije. Prospektivnom analizom obrađeno je 50 bolesnika s prijelomom donje čeljusti. Zub u prijelomnoj pukotini imalo je 39/50 bolesnika. Analizirano je 39 bolesnika s ukupno 63 prijeloma i 84 zuba u prijelomnoj pukotini, od čega je 48 bilo inicijalno “avitalno”. Mjesec i pol nakon ozljede reinervirano je 31%, a godinu dana nakon ozljede 81% inicijalno “avitalnih” zuba u prijelomnoj pukotini. Godinu dana nakon ozljede reinervirano je 84% sjekutića, 75% očnjaka, 83% pretkutnjaka i 80% kutnjaka. Tijekom druge i treće godine ne dolazi do reinervacije, ali moguća je devitalizacija denerviranih zuba. Pulpa zuba je vitalno stabilna godinu dana poslije ozljede. Denervirani zub ne treba smatrati devitaliziranim i ne treba ga liječiti i/ili ekstrahirati ako nema kliničkih ili radioloških znakova devitalizacije. Kad bi ispitivanje senzibiliteta bilo jedini kriterij za ekstrakciju, tj. kad ne bismo uvažavali kliničke i radiološke kriterije devitalizacije, 95% lažno avitalnih, tj. samo denerviranih zubi proglasili bismo devitaliziranima i nepotrebno ih liječili ili ekstrahirali

Influence of Different Etching Times on Dentin Surface Morphology

The aim of this study is to investigate the influence of different etching times on demineralized dentin surface morphology using scanning electron microscopy and qualitative line microanalysis of chemical structure. Two sample groups, consisting of 30 first premolar teeth in each group, were established. Teeth were cut at the half-distance between the enamel-dentin junction and the pulp. The first group of specimens was etched for 10 seconds and the second group for 30 seconds. 37% ortophosphoric acid was used. SEM (scanning electron microscopy) was utilized to observe the following parameters: number and diameter of dentinal tubules, dentinal and intertubular dentinal surface percentage, appearance of the dentin surface porous zone containing smear layer and demineralized residual collagen particles with dentin demineralization products in acid globules, and dissolved peritubular dentin cuff. After calculating measurements of central tendency (X,C, Mo, SD), Kolmogorov-Smirnov and Student t-test were performed to confirm the quantitative results, and the c²-test was run to produce qualitative data. In contrast to the 10-second etching time, the increased etching time of 30 seconds resulted in the following findings: (1) an increased number of dentinal tubules (p<0.05), (2) an increase in dentinal tubule diameter (p<0.05), (3) an increase in dentinal tubule surface percentage (p<0.001), (4) a decrease in intertubular dentinal surface percentage (p<0.001), (5) appearance of dentin surface porous zone containing smear layer and demineralized residual collagen particles with dentin demineralization products in acid globules (p< 0.001), and (6) completely dissolved peritubular dentin cuff (p<0.001). Therefore, different etching times using the same phosphoric acid concentration result in different morphological changes in demineralized dentin surface. Moreover, based on a comparison with current studies, prolonged etching time causes morphological changes to dentin surface. Such changes, have, in turn, negative effects on the dentin hybridization process

Biological Bases of Dentin Hybridization

The aims of this study were threefold: (1) to characterize and quantify the number, diameter and surface area of exposed dentinal tubules on the cross section of the human coronal dentin; (2) to determine if any such differences in these properties arise in relation to the distance from the dentinoenamel junction; and (3) to evaluate whether such differences can influence dentin hybridization. To accomplish these aims, scanning electron microscopy comparative observation was carried out on 60 prepared human premolars, which were divided into three groups of 20 samples each. The three sample groups were cut as follows: (1) in the central fissure region, one millimeter from the enamel-dentine junction; (2) halfway between the enamel-dentine junction and the pulp; and (3) one millimeter from the roof of the pulp chamber. Using one-way analysis of variance (one-way ANOVA) and a regression linear model, the data enumerated below were obtained. First, the mean number of the tubule openings was 19600/mm2 on the first level, 32400/mm2 on the second and 42300/mm2 on the third. The mean tubule diameter on the first level was 0.67 mm, 1.52 mm on the second and 2.58 mm on the third. Finally, exposed tubules on the first level occupied 2.79% of of total dentinal surface area, 23.90% on the second, and 87.78% on the third level. Therefore, significant statistical differences (p<0.01) between all three groups of the specimens for all three properties were observed, as well as positive correlation between the dentin depth and each of these properties. This indicates that the dentin structural variety, which ultimately determines adhesion to dentine, involves a complex interaction between biological material (dentin) and the particular adhesion system applied

Ambulatory oral surgery: 1-year experience with 11 680 patients from Zagreb district, Croatia

Aim To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Methods Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. Results The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P < 0.001) and intraoral incisions (P < 0.001) were performed among male patients, whereas significantly more alveolectomies and apicoectomies were performed among female patients (P < 0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas. Conclusion The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health

Mucoepidermoid Carcinoma Misdiagnosed as Palatal Odontogenic Infection: An Overview on the Differential Diagnosis of Palatal Lesions

Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authors’ knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MEC’s differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list

A Large Cheek Hematoma as a Complication of Local Anesthesia: Case Report

Hematom je među rjeđim komplikacijama pri davanju lokalnog anestetika. Najveća incidencija aspiracije krvnog sadržaja tijekom primjene svih infiltracijskih i provodnih tehnika lokalne anestezije u oralnoj kirurgiji vezana je za tubernu i provodnu anesteziju na donji alveolarni živac. Prikazujemo do sada zdravog dječaka u dobi od 8 i pol godina kod kojega se pojavio veliki hematom obraza nakon rutinski aplicirane infiltracijske anestezije u gornjoj čeljusti. Najprije je pogrešno liječen pod dijagnozom tipa 1 alergijske reakcije, a zatim nije bila uspješna ni lokalna terapija heparinskom kremom. Konačno su u liječenje uvrštene ključna incizija i drenaža inficiranog hematoma. Shvatiti da je hematom moguća komplikacija, rano prepoznati njegovu kliničku sliku i odabrati odgovarajuće liječenje, vrlo je važno za siguran i brz ishod.Hematoma is among less frequent complications which occur following local anesthesia. The posterior superior alveolar nerve block and inferior alveolar nerve block are known to be accompanied with a higher incidence of positive aspiration compared to all infiltration and block anesthesia techniques in oral surgery. We present the case of an otherwise healthy 8-year-old boy who experienced a large cheek hematoma after a routine infiltration anesthesia in the maxilla. Firstly, he was mistakenly treated under the diagnosis of type1 allergic reaction. Subsequently, the topical therapy for an evident, large hematoma was unsuccessful. Ultimately, incision of the infected hematoma and antibiotic therapy were crucial for its resolution. Early recognition of clinical signs of hematoma is of utmost importance for the surgeon in order to treat the patient adequately