Treatment of masseteric hypertrophy with botulinum toxin : a report of two cases

Masseter muscle hypertrophy is a rare condition of unknown cause which is important in the differential diagnosis of head and neck masses, located in the cheek. Several treatment options reported for masseter hypertrophy, which range from simple pharmacotherapy to more invasive surgical reduction. Botulinum toxin type A is a powerful neurotoxin which is produced by the anaerobic organism Clostridium botulinum and when injected into a muscle causes interference with the neurotransmitter mechanism producing selective paralysis and subsequent atrophy of the muscle. Injection of botulinum toxin type A into the masseter muscle is generally considered a less invasive modality and has been advocated for cosmetic sculpting of the lower face. Botulinum toxin type A injection is considered to be a beneficial treatment modality in masseter muscle hypertrophy patients. The aim of this article is to report two cases of masseteric muscle hypertrophy which were treated with botulinum toxin type A injection. Marked changes in facial feature were achieved 3 months after the procedure

Comparison of the planimetry and point-counting methods for the assessment of the size of the mandible cysts on orthopantomograms

Objective: The purpose of this study is to compare the computer-assisted planimetry and point-counting methods in evaluating the sizes of the mandibular cysts with respect to their agreement and the time required to analyze. Study Design: The surface areas of 46 mandibular cyst lesions on orthopantomograms were estimated using the point-counting and computer-assisted planimetry methods. Three observers evaluated the outlined areas twice, using the point-counting (PC) and computer-assisted planimetry (CAP) methods with an interval of two weeks. In the planimetry technique, digitalized images and ImageJ software were used to measure the surface area of the half mandibles and cysts. The grids were superimposed over the same images and the number of points hitting the interested structures was counted for the point-counting technique. The projection area fraction (PAF) of the cysts within the mandible was estimated using the obtained values by means of the two techniques. Intraclass correlation coefficient was used to assess the level of agreement between the two methods. Inter-rater reliability analysis using the Kappa statistic was performed to determine consistency among raters. Results: CAP and PC techniques showed consistent intra-observer values in all observers. Intraclass correlation between CAP and PC measurements of first, second and third observers were found to be 0.9986, 0.9988 and 0.9994 respectively. The durations of PC technique was 32% higher than the CAP technique. Conclusion: PC and CAP methods were seemed to show sufficient agreement to be used interchangeably. The main disadvantage of the PC analysis is it takes more time than CAP method

Use of a Simple Appliance to Prevent Mucosal Irritation by the Distractor Rod during Vertical Distraction: Case Report

Patient discomfort due to the excessive length of the distractor rod is one of the disadvantages of alveolar distraction osteogenesis. Although this seems to be a minor complication, it can cause severe mucosal irritation on the opposite arch, and uncontrolled forces can lead to the loosening of the screws and the inactivation of the distractor. The purpose of this case report is to introduce an acrylic appliance that is very useful in avoiding the mucosal irritation caused by the long distractor rod. The appliance is simple, effective, and easy to fabricate

Effects of polyglecaprone 25, silk and catgut suture materials on oral mucosa wound healing in diabetic rats : an evaluation of nitric oxide dynamics

Objectives: The purpose of this study is to investigate the effects of monocryl (Polyglecaprone 25), silk and catgut suture materials on wound healing in diabetic rats and to evaluate NO (nitric oxide) dynamics. Study desing: Fourty-eight male Wistar-Albino rats weighting 220-270 g were used in this study. The rats were categorized into 2 groups, as control group (n=24) and streptozotocin (STZ) induced diabetic group (n=24). For each group, incision wounds were created on the inner cheeck mucosa of the animals and wounds were closed primarily with three different types of sutures. These materials were sized 3-0 monocryl (polyglecaprone 25), silk and catgut sutures swaged on. Excisional biopsies were performed at 2nd, 7th, 14th and 21st day (2 rats per day) from the initial surgical procedure. Effects of these suture materials on wound healing and NOS (nitric oxide synthase) activities were compared immunohistochemically in the study. eNOS and iNOS (Endothelial and induced nitric oxide synthase) activities were classified as mild (+), moderate (++) and severe (+++). Results: Mild eNOS activities were seen in both diabetic and control groups at 2nd day specimens. Activities of silk and catgut were similar both in diabetic and control groups at 14th day, this activity in monocryl was mild. 21st day specimens revealed that monocryl has mild eNOS activity than silk and catgut sutures. iNOS activities in diabetic group were greater than control groups and the degrees of the activity in monocryl, silk and catgut sutures were mild, severe and moderate at the 7th day. At the 14th day there was no iNOS activity in diabetic monocryl group. Conclusion: All of the materials have the potential capacity to be well tolerated however monocryl seemed to have more benefical effects on wound healing in diabetic subjects

Horizontal Alveolar Distraction of the Mandibular Canine Regions for Implant Placement

Horizontal alveolar augmentation by distraction osteogenesis is an alternative method for reconstructing atrophic alveolar bone. A 65-year-old woman with atrophy of the alveolar rim in the anterior lower jaw, which had inadequate width for implant placement, was presented. Under general anesthesia, vertical and horizontal osteotomies of the buccolabial cortical bone were performed in the canine regions bilaterally. Modified horizontal distraction devices were stabilized to the mandible. Distraction proceeded from the seventh postoperative day at a rate of 0.450 mm twice a day for 6 days. After 3 months, distraction osteogenesis occurred and increased the alveolar width from 2 to 7 mm. Two implants were placed in the distracted areas. Marginal bone resorbtion around the implants was not observed 12 months after implant placement

A comparison of injection pain with articaine with adrenaline, prilocaine with phenylpressin and lidocaine with adrenaline

Objective: The objective of the present study was to investigate the pain on injection of articaine with adrenaline, prilocaine with phenylpressin, and lidocaine with adrenaline. Study Design: The study sample was comprised of 497 consecutively seen patients received 497 maxillary buccal infiltration injections or inferior alveolar block injections of 4% articaine with 1: 200.000 adrenaline, 3% prilocaine with 1.08mcg phenylpressin, or 2% lidocaine with 1: 100.000 adrenaline. Immediately after the injection, patients were asked to rate their injection pain on a six-point scale. Results: There were no significant differences among the anesthetic solutions for injection pain. Patients usually reported mild or no injection pain for all of anesthetic administrations. Conclusion: Under the conditions of this study that lidocaine with adrenaline, articaine with adrenaline and prilocaine with phenylpressin seemed to be similar for pain on injection and they could be quite painless

Biomechanical comparison of plating techniques for fractures of the mandibular condyle

We compared the biomechanical behaviour of various rigid internal fixation techniques for treatment of fractures of the mandibular condylar process. Fifteen sheep hemimandibles were used to evaluate three bicortical plating techniques. A custom-made 3-point biomechanical test model was used for the samples. Each group was tested with compression forces by an Instron Lloyd LRX machine. The resistance to forces (N) that caused displacements of 1.75 and 3.50 mm were compared using the Instron software programme and displacement graphics. There were no significant differences among the three groups for displacements of 1.75 and 3.50 mm. Our study showed that the titanium miniadaptation plates, minicompression plates, and the absorbable miniplates did not differ significantly in their biomechanical behaviour. (C) 2006 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved

Fixation of vertically distracted segment with dental implants after breakage of distraction device: case report

Distraction osteogenesis is an efficient method to augment the mandibular alveolar process for dental implants. Complications of this procedure include fracture of the basal bone, breakage of distractor, wound dehiscenses, undesirable soft tissue changes, and defective movement of the transported segment. We report a case of breakage of the distractor after mandibular alveolar vertical distraction osteogenesis. Mandibular alveolar vertical distraction osteogenesis was applied to 53-year-old woman for prosthetic rehabilitation. Fracture of the distraction device occurred on the 13th day of the activation phase. Radiographic examination revealed the fracture of the distractor rod and lingually displaced alveolar segment. Lingually displaced segment was successfully advanced to the desired position, and fixed to the basal bone using dental implants before the maturation of the distracted bone. We consider that this technique is eligible for the management of these kind of complications

Comparison of lidocaine metabolism for different anesthesia techniques in rabbits with liver disease

Objective. This study was designed to investigate the serum lidocaine concentrations (SLC) after local infiltration anesthesia (IA) and mandibular anesthesias (MA) in rabbits with carbon tetrachloride (CCl4)-induced chronic liver damage (CLD)