The Treatment Options of Dens Invaginatus: Report of 2 Cases

Invaginacija zuba je razvojna anomalija koja nastaje uvlačenjem površine zubnoga zametka prije kalcifikacije zuba. Autori prikazuju dva slučaja invaginacije zuba s različitim periapikalnim patološkim komplikacijama u djece, kao provedene terapijske postupke. Opisani slučajevi su djeca u dobi između 12 i 16 godina. Oblik dijagnosticirane invaginacije zuba klasificiran je prema Schulzu i Brandu. Oba su slučaja zabilježena u djece na trajnim gornjim zubima. Komplikacije su nastale izraštajem zubnoga zametka, a manifestirale su se otečenošću u području morfološki promijenjena zuba. U slučaju 1 napravljena je ekstirpacija zubne pulpe uz obilno lokalno krvarenje. Instrumentima za endodontsko zbrinjavanje pripremljen je endodontski prostor te je privremeno napunjen preparatom kalcijeva-hidroksida kroz razdoblje od 10 dana. Bolse javila prvi dan nakon terapije, a nakon toga je nestala kao i otečenost čeljusti u području tretirana zuba. Nakondesetoga dana privremeno punjenje je uklonjeno, a korijenski kanali definitvno napunjeni pastom i gutaperkom postupkom lateralne kondenzacije. U slučaju 2 klinički je opažena otečenost i fluktuacija u vestibularnom području. Načinjena je incizija s drenažom te primijenjena sustavska terapija antibiotikom. Nakon završene terapije zub s invaginacijom je izvađen. Patohistološki nalaz potvrdio je folikularnu cistu. Nakon kirurškoga tretmana nedostatak kosti koji je nastao tretiran je Bio-Oss spongiozom i membranom. Periapikalne komplikacije zahtijevaju ranu dijagnozu i brz endodontski tretman kako bi se spriječile sve komplikacije koje mogu nastati.Dens invaginatus is a developmental variation thought to arise as a result of invainatio in the surface of the tooth crown before calcification has occurred. The authors described two cases of dens invaginatus accompanied by different periapical complications in children, as wel as the therapy methods used. The two children were between the ages of 12 and 16 years. The type of dens invaginatus was classified according to Schulze and Brand. Both cases had dens invaginatus on their permanent teeth in the maxilla. The complications occurred while the teeth were growing, and they were accompanied by swelling in the region of the dens invaginatus. In Case 1, pulp extripation was accompanied by profuse pulp chamber bleeding. Intraradicular instrumentation was adapted to conform with the existent morphological deviation of the endodontic space. The root canal was temporally filled with calcium hydroxide for a period of 10 days. The pain disappeared on the first day and the swelling gradually reduced. On the tenth day, the temporary root filling was replaced, and the root canals were dilled using the lateral condensation with standardized gutta percha points and paste. In Case 2, the clinical examination found fluctuation in the vestibular region. An intraoral incision with drainage was performed and antibiotic treatment continued. When the odontogenic infection has been controlled, the dens invaginatus tooth was surgically extracted.Pathohistological finding of the periradicular cyst confirmed the diagnosis of a follicular cyst. Given the significant size of the post-surgical bone defect, it required corresponding treatment with Bio-Oss spongiosa block and membrane for GBR. The periapical complications required early diagnostic and endodontic treatment to prevent further difficulties at a later stage

Mesiodens in a 14-Month-Old Child

Meziodens je prekobrojni zub smješten između gornjih središnjih inciziva. Njegova je čestoća u trajnoj denticiji između 0,5-2%, ameziodens mliečne denticije izrazito je rijetka pojava. Prikazan je slučaj meziodensa u četrnaestmjesečne djevojčice.Mesiodens is supernumerary tooth between maxillary central incisors. The prevalence of mesiodens in permanent dentition is 0.5 2% and in primary dentition even more rare. The case of mesiodens in a 14-month-old female child is shown

Application of Tomographic Methods in the Diagnosis of Pathological Changes of the Jaw

The aim of this study was to evaluate the frequency of specific diagnostic methods used for diagnosis of oral pathologies. The sample consisted of 198 patients (98 man and 100 women) with formulated diagnosis, confirmed postoperatively by histopathological verification. In 74.7% of subjects only X-ray diagnostic examination was used. Both X-ray and computed tomography (CT) examinations were used in 18.7% of subjects. Magnetic resonance imaging (MRI) wasn’t performed in any subject. In 6.6% of subjects neither X-ray nor CT was performed. The study reported on statistically significant differences in the distribution of specific diagnostic methods according to age groups (p=0.026). Also, there was statistically significant differences in the distribution of diagnostic methods according to diagnostic groups (p=0.053). In the group of 37 subjects, in whom both X-ray and computed tomography were used, the majority had carcinomas, followed by fractures and inflammatory cysts

Utjecaj hormonskog statusa na termografski nalaz kod raka dojke

The aim of this study was to investigate the association of infrared imaging findings and hormone receptor (estrogen and progesterone) status in breast cancers. The study was carried out at Department of Surgical Oncology and Department of Pathology, Sestre milosrdnice University Hospital Center, in collaboration with licensed infrared thermography experts. The study involved 75 female patients with invasive breast tumors. Thermography findings were compared with different immunohistochemical findings (hormone status positive or negative). Seventy-five female patients aged 36 to 86 years, mean age 64±11.36 years, were examined. The tumor itself and the breast containing the tumor were statistically significantly warmer (p<0.001) than the healthy breast in all study patients. There was no statistically significant difference (p>0.05) between patients with positive and those with negative estrogen receptors. Unlike all previously published results of various thermographic studies, results obtained in this study on the hormone receptor status analyzed and its impact on thermographic findings indicated that estrogen negative tumors had a higher maximum and average temperature than estrogen positive tumors. It was also observed that estrogen negative tumors had lower impact on warming of the entire breast, and that maximum and average temperature of the affected breast was higher in estrogen positive tumors. Arithmetic means of maximum and average tumor temperatures were statistically significantly higher for progesterone negative tumors compared with progesterone positive tumors (p<0.05). Thermographic findings correlated with the specific hormonal status of breast invasive tumors, which reflects the biological behavior of tumors as well as their clinical variables.U ovom istraživanju analizirao se utjecaj hormonskog receptorskog statusa, tj. estrogenskih (ER) i progesteronskih (PR) receptora na termografski nalaz kod bolesnica s karcinomom dojke. Rad je napravljen u KBC “Sestre milosrdnice” na Zavodu za onkološku kirurgiju i Zavodu za patologiju u suradnji s licenciranim stručnjacima za termografiju sa Zavoda za termodinamiku, toplinsku i procesnu tehniku Fakulteta strojarstva i brodogradnje u Zagrebu. Istraživanje je obuhvatilo 75 prijeoperacijski termografski snimljenih bolesnica s invazivnim tumorom dojke, starosti 36-86 godina, prosječne dobi 64±11,36 godina. Rezultati istraživanja su pokazali da je dojka s tumorom statistički značajno toplija (p<0,001) u odnosu zdravu dojku kod svih bolesnica. Nije bilo statistički značajne razlike (p>0,05) između bolesnica s pozitivnim u odnosu na one s negativnim estrogenskim receptorima. Za razliku od svih prethodno objavljenih rezultata različitih termografskih istraživanja invazivnih tumora dojke i utjecaja hormonskog receptorskog statusa na termografske nalaze, iz rezultata dobivenih u ovom istraživanju može se primijetiti da su ER- tumori imali višu maksimalnu i prosječnu temperaturu u odnosu na ER+. Primjetno je da su ER- tumori imali manji utjecaj na zagrijavanje cijele dojke, kao i to da je maksimalna i prosječna temperatura cijele dojke bila viša u ER+ tumorima. Aritmetičke sredine za maksimalne i prosječne temperature tumora statistički su značajno više kod progesteronski negativnih tumora u usporedbi s progesteronski pozitivnim tumorima (p<0,05). U zaključku, za razliku od ranijih termografskih istraživanja, rezultati termografske analize invazivnih tumora dojke u ovom istraživanju pokazali su da postoji razlika po utjecaju na termografske nalaze s obzirom na status hormonskih receptora. Ove rezlike ukazuju na danas dokazane različite imunohistokemijske, patohistološke i biološke osobine tumora dojki s obzirom na status hormonskih receptora

Rekonstrukcija defekata skalpa i kalvarije

Defects of the scalp and calvaria most frequently occur as a result of invasive growth of intra- or extracranial malignant or benign tumors, or as a result of trauma. During a five-year period, from 2004 to 2008, 21 patients (12 men and 9 women) underwent reconstructive surgery for scalp and calvaria defects at the Department of Plastic Surgery, “Dubrava” University Hospital. The patients were divided into groups with regard to the etiology of the defect, size, depth, reconstruction technique, number of surgical procedures, complications and duration of hospitalization. Different local flaps were successfully used for reconstruction of small and medium-sized defects of the scalp and calvaria, while large defects were reconstructed using free microvascular flaps. Successful treatment of the scalp and calvaria defects depends on accurate indication and the choice of an appropriate reconstruction technique.Defekti skalpa i kalvarije najčešće su posljedica invazivnog rasta intra- ili ekstrakarnijalnih zloćudnih ili dobroćudnih tumora ili traume. Tijekom petogodišnjeg razdoblja, od 2004. do 2008. godine, u Klinici za plastičnu kirurgiju KB Dubrava 21 bolesnik (12 muškaraca i 9 žena, srednja dob - 61 godina) bio je podvrgnut rekonstrukcijskom kirurškom zahvatu zbog defekata sklapa i kalvarije. Bolesnici su podijeljeni u skupine s obzirom na etiologiju defekta, veličinu, dubinu, reksontrukcijski postupak, broj kirurških zahvata, komplikacije i trajanje hospitalizacije. Za male i srednje velike defekte skalpa i kalvarije uspješno su korišteni različiti lokalni režnjevi, a za velike defekte slobodni mikrovasularni režnjavi. Uspjeh zbrinjavanja ovih defekata skalpa i kalvarije ovisi o pravilnoj indikaciji i izboru adekvatne kirurške tehnike za rekonstrukciju

Rekonstrukcija defekata skalpa i kalvarije

Defects of the scalp and calvaria most frequently occur as a result of invasive growth of intra- or extracranial malignant or benign tumors, or as a result of trauma. During a five-year period, from 2004 to 2008, 21 patients (12 men and 9 women) underwent reconstructive surgery for scalp and calvaria defects at the Department of Plastic Surgery, “Dubrava” University Hospital. The patients were divided into groups with regard to the etiology of the defect, size, depth, reconstruction technique, number of surgical procedures, complications and duration of hospitalization. Different local flaps were successfully used for reconstruction of small and medium-sized defects of the scalp and calvaria, while large defects were reconstructed using free microvascular flaps. Successful treatment of the scalp and calvaria defects depends on accurate indication and the choice of an appropriate reconstruction technique.Defekti skalpa i kalvarije najčešće su posljedica invazivnog rasta intra- ili ekstrakarnijalnih zloćudnih ili dobroćudnih tumora ili traume. Tijekom petogodišnjeg razdoblja, od 2004. do 2008. godine, u Klinici za plastičnu kirurgiju KB Dubrava 21 bolesnik (12 muškaraca i 9 žena, srednja dob - 61 godina) bio je podvrgnut rekonstrukcijskom kirurškom zahvatu zbog defekata sklapa i kalvarije. Bolesnici su podijeljeni u skupine s obzirom na etiologiju defekta, veličinu, dubinu, reksontrukcijski postupak, broj kirurških zahvata, komplikacije i trajanje hospitalizacije. Za male i srednje velike defekte skalpa i kalvarije uspješno su korišteni različiti lokalni režnjevi, a za velike defekte slobodni mikrovasularni režnjavi. Uspjeh zbrinjavanja ovih defekata skalpa i kalvarije ovisi o pravilnoj indikaciji i izboru adekvatne kirurške tehnike za rekonstrukciju

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

Surgical Treatment of Pathologic Fractures in Patients with Metastatic Tumors

The study presents results in treatment of pathologic fractures of long bones of all patients who underwent surgery in the last 10 years in our hospital. The study cohort comprised 133 consecutive patients divided in two groups who underwent surgery of long bone fractures caused by metastatic tumor or trauma. We used resection, open reduction and plating with bone cement application for pathologic fracture and some cases of femoral shaft fractures were stabilized with intramedullary nailing. Proximal femoral fractures were treated with hip arthroplasty or dynamic hip screw. There were 2 amputations performed: one case of pathologic fracture of tibia and one case of humeral fracture. The present study compares results between two group of patients. We noted: age, gender, fracture site, choice of the surgical procedure, hospital stay, need for analgesia after surgery, postoperative complications, and reached level of physical activity after surgery. The mean survival rate was 8.1 months. Seventeen patients experienced postoperative complications. We also found statistically significant improvement in functional scores (MSTS and TESS) in surgically treated patients with pathologic fractures. There are many different techniques of surgical treatment of pathologic fractures caused by skeletal metastases including arthroplasty or a combination of internal fixation combined with polymethyl methacrylate (PMMA) that provides immediate fixation and stability. The present study showed that surgical treatment of pathologic fractures caused by skeletal metastases in vast majority of cases provides bone healing after pathologic fracture, with signifficant improvement of physical activity and rehabilitation in the investigated group