Coronectomy of the mandibular third molar: a prospective study of 20 procedures

Oral surgeon in private practice, Plovdiv, Bulgaria, Oral and maxillofacial surgeon, Department of Oral Surgery, Faculty of Dental Medicine, Medical University, Plovdiv, BulgariaSummary Coronectomy is a surgical procedure designed to avoid the risk of iatrogenic neurological injury to the inferior alveolar nerve (IAN). The aim of this study was to evaluate success rate of coronectomy. Material and methods: Twenty patients underwent 20 coronectomy procedures of impacted mandibular third molar with close proximity to IAN evaluated on preoperative radiographs. The procedure was performed under mandibular nerve block. Follow-up appointments were perform at 1 week, 1, 6 months. Results: No patients developed IAN injury and no cases of root exposure were found. Eighteen wounds healed primary. In two cases the socket opened and healed secondary. No one root fragments were removed. Conclusion: Coronectomy of wisdom teeth is a safe technique - effective alternative to extraction, when the wisdom tooth shows radiographic signs of close proximity of the IAN to the root

Jaw cysts at children and adolescence : a single-center retrospective study of 152 cases in southern Bulgaria

One hundred fifty two cysts of the upper and lower jaw were examined at patients up to 18 years old treated in the Clinics of Maxillo-Facial Surgery, University Hospital, Plovdiv, Bulgaria for the period 1998 - 2007. Patients were distributed in four age groups (up to 4 years old, from 5 to 9 years old, from 10 to 14 years old, from 15 to 18 years old). Both sexes were constantly affected (52% male, 48% female). The biggest number cystic lesions were found in the third age group (48.7%). The mandible was preferable localization of the lesions (69.7%). Dentigerous cysts predominated (61.8%) - more affected was third age group (31.6%). Radicular cysts were observed two times less (31.6%) - more affected were third (15.8%) and fourth (12.5%) age groups. The most frequently observed clinical symptom was presence of painless swelling (59.9%). The operative interventions were carried out predominantly under general anesthesia (81.6%) by intraoral approach (97.4%). The extraoral surgical approach was preferred in four cases only - three in third and one in fourth age groups. © Medicina Oral S. L

Manual lymphatic drainage techniques reduces postoperative facial swelling after third molar surgery

Department of Oral surgery, Faculty of dental medicine, Medical University, Plovdiv, BulgariaSummary Manual lymphatic drainage (MLD) is an unique manual intervention pioneered by Emil and Estrid Vodder. The aim of this study was to investigate whether the application of MLD, in case of surgically removal of impacted third molars, can efficiently diminish postoperative swelling. Material and methods: Sixty patients with mandibular third molars, that required surgical removal, were divided into two equal groups: MLD group (30 patients) and control group (30 patients). Each patient underwent lower third molar extraction. MLD was performed on the neck region, using Vodder’s method, once a day - immediately after extraction, until the suture removal. Swelling was evaluated prior to operation, on the first, third and seventh postoperative day with the objective method - a linear measurement. The six landmarks of measurement were as follows: tragus-lip junction, traguspogonion, mandibular angle-external corner of eye, mandibular angle-ala nasi, mandibular angle-lip junction, mandibular angle-median point of chin. Results: All lines demonstrated a significant reduction of swelling in the MLD group compared to the control group. Conclusion: MLD is an efficient method for managing postoperative swelling after the removal of impacted third mandibular molars

Cysts of the Jaws: a Clinical Study of 621 Cases

Svrha rada: Ciste u čeljusti mnogo su češće nego u drugim kostima zbog razvojnih, odontogenih, rezidualnih te epitelnih tkiva u tom području. Ovo je istraživanje imalo zadatak da klinički i epidemiološki analizira pacijente sa cističnim lezijama liječene na Maksilofacijalnoj klinici Sveučilišne bolnice u Plovdivu, u Bugarskoj. Ispitanici i postupci: Pregledana je 621 cista u jednoj čeljusti kod 594 pacijenta - odontogene ciste činile su 97,1%±0,67%. Rezultati: Radikularne ciste bile su najčešći oblik ciste u čeljusti (435 cista - 70,1%), a zatim su slijedile dentigerozne (146 cista - 23,5%) kao najčešće u prvom i drugom desetljeću života. Rezidualnih cista bilo je 112 (18%). Prosječna dob pacijenata bila je 35,3±0,73 godine. Ciste su bile češće u gornjoj negoli u donjoj čeljusti (t = 2,33; P < 0,05). Radikularne ciste uglavnom su zahvaćale alveolarni greben gornje čeljusti (204 ciste ili 46,9% svih radikularnih cista). Zaključak: Dentigerozne ciste razvijale su se češće u donjoj čeljusti (106 cista ili 72,6% svih dentigeroznih cista), posebice u tijelu mandibule (89 cista ili 61%).Objective: Cysts occur in the jaws more commonly than in any other bone due to the presence of developmental, odontogenic, residual, epithelial tissue. The present study aimed at providing a clinical and epidemiological analysis of patients with cystic lesions, treated at the Clinics of Maxillo-Facial Surgery, University Hospital, Plovdiv, Bulgaria. Material and Methods: Six hundred twenty one cysts of the jaws in 594 patients were examined. The odontogenic cysts were 97.1%±0.67%. The radicular cysts were the most common type of jaw cysts (435 cysts, 70.1%), dentigerous cysts (146 cysts, 23.5%) were the most common in the first and the second decades. The residual cysts were 112 (18%). The average age of patients with jaw cysts was 35,30±0,73 years. Results: Jaw cysts were more frequent in the maxilla in comparison with mandible (t=2.33; Р<0.05). The radicular cysts more frequently involved the alveolar bridge of the upper jaw (204 cysts of 435 radicular cysts, 46.9%). Conclusion: The dentigerous cysts developed more frequently in the lower jaw (106 cysts of 146 dentigerous cysts, 72.6%), especially in the mandible body (89 cysts, 61%)

BROWN TUMOR AT THE JAW IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM DUE TO CHRONIC RENAL FAILURE

Brown tumors are bony lesions caused by rapid osteoclastic activity, which rare involved jaws. Renal osteodystrophy (ROD) is associated with different pathogenetic mechanisms – disorder of calcium-phosphate metabolism, impaired metabolism of vitamin D, increased parathyroid activity that lead to extreme concentrations of parathormone. The authors report two cases of jaw enlargement in patients received haemodialysis with excessive increase values of alkaline phosphatase and parathormone in serum. The patients were treated surgically with corrective procedures in maxillo-facial area.ROD of the jaws could be severe complication in dialysis patients with end stage of CKD if no appropriate care aimed at correction or prevention of parathyroid hyperfunction was applied to them

Malignant fibrous histiocytoma of the lower lip: A case report

Malignant fibrous histiocytoma (MFH) represents the diagnosis that is still commonly used by both patients and physicians although in 2002., the World Health Organization (WHO) declassified MFH as a formal diagnostic entity, renaming it as an undifferentiated pleomorphic sarcoma not specifying it further. MFH is extremely rare in the oral cavity. The aim of this article was to describe a newly diagnosed case of primary MFH in a 78-year-old male presented after 4-months history of rapidly increasing swelling of lower lip. Histopathology of the lesion showed highly malignant cell infiltration with epithelioid/spindle cell type morphology. Immunohistochemical study was positive for vimentin (++), S-100 protein (++) and negative for desmin and cytokeratin. The authors discussed the possibilities of immunohistochemical study and necessity of individual treatment plan in patients with MFH, comparing their point of view with other studies

Assault-related maxillofacial injuries:the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration

Objective. The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study. Study Design. Demographic and injury data were recorded for each patient who was a victim of an assault. Results. Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures. Conclusions. Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study

European Maxillofacial Trauma (EURMAT) project:a multicentre and prospective study

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries