Surgical Treatment of Neuralgia as a Result of Ossification of the Mental Orifice

Prikazan je slučaj bolesnika s osteomom donje čeljusti koji je svojim rastom izazivao kompresiju mentalnoga živca i neuralgiformne boli. Intraoralnim pregledom nisu nađeni koštani deformiteti čeljusti, a dijagnoza je potvrđena rentgenskim nalazom, što govori da se radi o enostozi ili središnjem osteomu. U prikazu je opisana i operativna tehnika eksterne dekompresije kojom je epineuralna ovojnica živca oslobođena od pritiska nastalog rastom benigne koπtane tvorbe. Šest mjeseci nakon zahvata pacijent je bio bez simptoma, s normalnim senzibilitetom u donjoj čeljusti i urednim rentgenskim nalazom.A case of a patient with osteoma of the lower jaw is presented. Osteoma caused compression of the mental nerve and neuralgiform pain. During an intraoral examination, osseous deformity of the mandibula was not found. Diagnosis was confirmed by X-ray, which showed enostosis or a central osteoma. The presentation describes the surgical technique of external decompression by which the nerve epineural integument is released from the pressure caused by the benign osseous formation. Six months after the surgery the patient had no symptoms and had normal sensibility in the lower jaw and no irregularities

All that can be Hidden Behind the Clinical Appearance of Odontogenic Abscesses. Oversight or Error? - Presentation of Two Cases

Ovim se radom želi upozoriti na važnost iscrpnoga kliničkog pregleda, dijagnostičke obradbe i dobroga poznavanja patologije usne šupljine kako se ne bi dogodilo pogrješno liječenje i gubitak dragocijena vremena. Prvi pacijent R. J., tridesetπest godina, dolazi zbog perimandibularnog otoka i trizmusa desne strane lica u OB Karlovac, ORL odjel. Tu mu se dva puta učini ekstraoralna incizija pod sumnjom odontogenog apscesa. Dolaskom oralnoga kirurga u bolnicu i uvidom u stanje usne šupljine pacijent se dogovorno premješta u KKL»U KB “Dubrava”. Pregledom se intraoralno našao ispod jezika jasan ulkus desno te golem infiltrat gotovo cijele prednje dvije trećine jezika. Palpacijom se nađu fiksirane metastaze u regiji dva i tri veličine 50 milimetra. Nakon prikaza, na onkološkom konziliju indicira se samo iradijacija. Na kontroli, nakon πest mjeseci, vidljiva je djelomična regresija bolesti. Drugi pacijent I. J., tridesettri godine, dolazi u ambulantu oralne kirurgije pod sumnjom palatinalnog apscesa od gornjih lijevih molara. Gornja lijeva šestica se trepanira, a suspektni apsces dva puta incidira. U tijeku šest mjeseci uopće nije bilo regresije bolesti pa se pacijent upućuje u KKL»U KB “Dubrava”. Tamo mu se učini citopunkcija, biopsija, CT maksile te se utvrdi da se radi o mukoepidermoidnom karcinomu tvrdoga nepca. Nakon preoperativne pripreme pacijentu se učini parcijalna resekcija gornje čeljusti. Terapija pacijenta je u tijeku. Ta dva slučaja govore da se jasno moraju znati uzročnici različitih oteklina u području glave i vrata i da, ako se radi o odontogenoj upali, ona na odgovarajuću terapiju reagira za kratko vrijeme.The aim of this study was to show the importance of a detailed clinical examination, diagnostic analysis and good knowledge of the pathology of the oral cavity, in order to avoid erroneous treatment and loss of precious time. The first patient, R. J., a 36-year-old man, was admitted to the ENT Department of the General Hospital, Karlovac, because of a perimandibular swelling and trismuss of the right side of the face. Because an odontogenic abscess was suspected extraoral incision was performed on two occasions. After the arrival of an oral surgeon to the hospital and examination of the oral cavity the patient was transferred to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava. During an intraoral examination an ulcer was detected beneath the tongue on the right side and a massive infiltrate of almost the whole of the anterior two thirds of the tongue. Immovable metastasis was detected by palpation in regions two and three, 50 millimetres in size. After consultation at an oncological Meeting irradiation only was indicated. A check-up six months later showed partial regression of the disease. The second patient, K. J., a 33 year-old man, came to the Out-patient Department of Oral Surgery with suspected palatinal abscess of the upper left molar. The upper left six was trepanated and the suspect abscess incidirated twice. For a period of six months no regression occurred and consequently the patient was sent to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, where cytopuncture, biopsy, CT of the maxilla were performed which confirmed mucoepidermoid carcinoma of the hard palate. After preoperative preparation partial resection of the upper jaw was performed. Therapy is presently in course. These two cases indicate the need to know the causative agents of swellings in the area of the head and neck, and if odontogenic inflammation is the case it quickly responds to appropriate therapy

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

Uncommon Clinical Appearance and Localisation of Carcinoma of the Upper Lip - Case Presentation

U radu se prikazuje neobična klinička slika i lokalizacija karcinoma gornje usnice. Pacijentica K. A., sedamdesetčetiri godine, dolazi u ambulantu za oralnu medicinu radi gnojnog infiltrata u gornjoj usnici sa sumnjom na ubod kukca. Uputi se u ambulantu za oralnu kirurgiju gdje se učini incizija i drenaža te se postavi dijagnoza piogenoga granuloma. Kako promjena u međuvremenu od mjesec-dva ne prolazi već postaje sve tvrđa i vidljivija, i vestibularno i labijalno, naruči se na ekciziju. U međuvremenu pacijentica odlazi na Kliniku za dermatovenerologiju zbog bazocelularnih promjena na licu. U tijeku ekscizija promjena lica učini se i površna biopsija s kožne strane usnice te se dobije PHD nalaz planocelularnoga karcinoma. Pacijentici se na klinici za dermatovenerologiju savjetuje radioterapija promjene, no pacijentica se ponovno javlja u ambulantu oralne kirurgije. Zbog sumnje u površno uzet nalaz promjene i eventualne zamjene s mioblastomom zrnatih stanica, učini se ekscizija promjene u cijelosti te se dobije identičan PHD nalaz planocelularnoga karcinoma. Tada se pacijentica dogovorno premjesti u KKLČU KB “Dubrava” gdje se učini proširena ekscizija, te se PHD-om utvrdi da je promjena u predhodnom zahvatu ekscidirana u cijelosti.The study presents the uncommon clinical appearance and localisation of carcinoma of the upper lip. A 74-year-old female patient was referred to the Outpatient Department of Oral Medicine because of a purulent infiltrate in the upper lip which was thought to be an insect bite. She was referred to the Outpatient Department of Oral Surgery where an incision was performed and drainage, and piogenic granuloma diagnosed. As the lesion had not healed after two months, but on the contrary had become harder and more visible, both vestibularly and labially, an excision was planned. In the meantime, however, the patient had attended the Clinic of Dermatovenerology because of basocellular lesions on the face, and during excision of the facial lesions a surface biopsy was performed from the skin side of the lip, and the PHD finding showed planocellular carcinoma. At the Clinic of Dermatovenerology the patient was recommended to undergo radiotherapy of the lesions. However, the patient returned to the Out-patient Department of Oral Surgery. Because of the suspicion that the biopsy had been too superficial and because of the possibility of eventual confusion with a mioblastoma, complete excision of the lesion was performed and an identical PHD finding was obtained of planocellular carcinoma. The patient was then transferred to the Department of Maxillofacial Surgery, University Hospital Dubrava, where an extended excision was performed, and the PHD confirmed that the lesion had been completely excised in the previous procedure

Clinical and Radiographic Investigation of Bone Defect Following the Application of ß Tricalcium Phosphate - Report of Two Cases

Cijeljenje koštanih defekata čeljusti s rekonstrukcijom ili bez nje do danas daje samo razmjerno zadovoljavajuće rezultate. Veliki koštani defekti popunjavaju se različitim vrstama koštanih usadaka (autologni, homologni, ksenogeni i aloplastični). Idealan koštani usadak poticao bi stvaranje nove kosti, stvorio bi čvrstu vezu s podlogom i sam bi nakon ugradnje poprimio značajke kosti. U radu je prikazano cijeljenje koštanih defekata čeljusti nakon cistektomije u dva pacijenta. Cistični su defekti po veličini bili na granici zadovoljavajućeg cijeljenja preko krvnog ugruška, pa je za rekonstrukciju uporabljen chronOSTM. To je aloplastični usadak koji bi trebao pripomoći cijeljenju koštanoga defekta. ChronOSTM prema dosadašnjim referentnim istraživanjima pokazuje vrlo dobru biokompatibilnost, dobra mehanička svojstva, resorptivan je i oseoinduktivan. Praćenje pacijenata je kliničko i radiološko. Radiološki su pacijenti obrađeni preoperativno, postoperativno i šest mjeseci nakon operacije. Svi ortopantomogrami standardizirani su bakrenim kalibracijskim klinom radi mikrodenzitometrijskih mjerenja gustoće kosti.The healing of bone defects with or without reconstruction today is relatively satisfactory. Large bone defects of the jaw, so far, have been filled with various types of bone implants (autologous, homologous, xenogenic and alloplastic). The best implant will be after implantation in bone defects, would stimulate the formation of bone, form and firm conection with the base and have the characteristics of bone. The investigation included two patients with large bone defects after removal of jaw cysts. To fill the bone defects we used bone substitute Chron OSTM . Chron OSTM is syntetic ß tricalcium phosphate. It is an alloplastic bone implant. Previous investigations showed that Chron OSTM is osteoconductive, resorbable and highly biocompatible with compressive strength similar to the compressive strength of cancellous bone. Results are presented on the basis of clinical followup and X-ray performed preoperativly, postoperativly and after six months. The patients were screened using panoramic X-rays standardised with copper stepwedge. Using microdensitometric method all the measured values were expressed in the equivalents of actual copper stepwedge thickness

Comparison of the Bond Strengths of Zinc Phosphate, Glass-Ionomer, and Compomere Cement for Dowel Cementation

Unatoč dosad mnogim provedenim istraživanjima, ne postoji jedinstvena ocjena koji je cement najbolji za cementiranje konfekcijskih kolčića. Svrha rada bila je ispitati i usporediti retenciju konfekcijskih kolčića cementiranih s trima različitim vrstama cemenata: cink-fosfatnim, stakleno-ionomernim i kompomernim. Prikupljeno je 30 zuba i endodontski preparirano do dubine od 7 mm i ISO promjera 140. Podijeljeni su u 3 skupine od 10 uzoraka. S pomoću triju navedenih vrsta cemenata u njih su cementirani kolčići od čelične žice. Pošto se je cement stvrdnuo, izmjerena je vlačna sila potrebna za izvlačenje kolčića iz korijenskoga kanala. Za cink-fosfatni cement iznosila je 175±33,17 N, za stakleno-ionomerni 235,5±46,93 N, a za kompomerni 275,63±96,42 N. Kolčići cementirani kompomerom imaju znatno jaču retenciju od kolčića cementiranih cink-fosfatnim ili stakleno-ionomernim cementom. Stakleno-ionomerni cement mnogo jače retinira od cink-fosfatnoga cementa. Prednosti cink-fosfatnog cementa jesu manja osjetljivost na pogrješke u radu i razmjerna jeftinoća, te još uvijek u mnogim kliničkim okolnostima ostaje cement izbora.In spite of numerous previous studies, there is no final conclusion on which type of cement is the best for dowel cementation. The purpose of this study was to compare the retention of dowels cemented with three different cement types: zinc phosphate, glass-ionomer, and compomere. Thirty teeth were divided into 3 groups, root-canals were prepared to ISO 140, to 7 mm depth and dowels were cemented. After 40 hours the tensile force needed to dislodge the dowels was recorded. For zinc phosphate it was 175±33.17 N, for glass-ionomer 235.5±46.93 N, and for compomere 275.63±96.42 N. The dowels cemented with compomere had significantly higher tensile strength than those cemented with zinc phosphate or glass-ionomer cement. Glass-ionomer cement had significantly higher tensile strength than zinc phosphate cement. The advantages of zinc-phosphate are its low price and simple usage. Thus, in many clinical situations it may be the cement of choice

Efficiency of Polylactide/Polyglycolide Copolymers Bone Replacements in Bone Defects Healing Measured by Densitometry

Healing of bone defects is the most frequent cause of failure in surgical treatments of an odontogenic ostitic processes. The aim of this study was to determine successfulness in healing of bone defects after implantation of alloplastic co-polymer-polyglycol bone implant. A group of 45 cases with periradicular ostitic processes were examined. The densitometric measurements were taken from radiovisiographic dental x-ray images. Patients were observed throughout a period of one year. The results obtained were analyzed and presented graphically. Thirty-eight patients (84%) were treated successfully, and seven patients (16%) showed unsuccessful healing of the bone defects. The results obtained indicate that polyglycol copolymer bone implants can be successfully used in a treatment of odontogenically caused bone defects. Their fundamental advantage is a slow biodegradation, which ensures a more suitable area for the apposition of a new bone in the defect, simple application in clinical work and the possibility of a mutual combination of all three available forms

Postextraction pain treatment possibilities

Postekstrakcijska bol je komplikacija koja se javlja nakon vađenja zuba. Najčešće nastaje u molarnoj regiji donje čeljusti. U ovome radu uspoređene su dvije metode liječenja postekstrakcijske boli: konzervativna i kirurško - konzervativna metoda. Svrha rada bila je odrediti najdjelotvorniji način liječenja te komplikacije. Istraživanje je provedeno na trideset pacijenata sa simptomima postekstrakcijske boli. Petnaest pacijenata liječeno je konzervativnom metodom, a petnaest kirurško - konzervativnom metodom. Pacijenti su klinički praćeni do prestanka simptoma. Dobiveni rezultati pokazuju da je kirurško - konzervativna metoda liječenja djelotvornija jer u kraćem vremenu smiruje simptome boli.Postextraction pain or alveolitis sicca dolorosa is a complication which appears after tooth extraction, usually in the molar region of the lower jaw. In this paper two methods were compared: conservative and surgical-conservative method. The research was carried in order to establish which method is more advantageous and more effective. The pain treatment lasted for one year. Thirty patients were treated and each of them were separately conducted during three weeks after the treatment. Fifteen patients were submitted to conservative therapy, and fifteen others to surgical-conservative therapy. The results (tables and charts) show that both methods are effective and that both methods lead to symptom termination. However, surgical- conservative method appeared to be more effective, because in the first seven days after the therapy, approximately 75% of the patients no longer had alveolitis symptoms

All that can be Hidden Behind the Clinical Appearance of Odontogenic Abscesses. Oversight or Error? - Presentation of Two Cases

Ovim se radom želi upozoriti na važnost iscrpnoga kliničkog pregleda, dijagnostičke obradbe i dobroga poznavanja patologije usne šupljine kako se ne bi dogodilo pogrješno liječenje i gubitak dragocijena vremena. Prvi pacijent R. J., tridesetπest godina, dolazi zbog perimandibularnog otoka i trizmusa desne strane lica u OB Karlovac, ORL odjel. Tu mu se dva puta učini ekstraoralna incizija pod sumnjom odontogenog apscesa. Dolaskom oralnoga kirurga u bolnicu i uvidom u stanje usne šupljine pacijent se dogovorno premješta u KKL»U KB “Dubrava”. Pregledom se intraoralno našao ispod jezika jasan ulkus desno te golem infiltrat gotovo cijele prednje dvije trećine jezika. Palpacijom se nađu fiksirane metastaze u regiji dva i tri veličine 50 milimetra. Nakon prikaza, na onkološkom konziliju indicira se samo iradijacija. Na kontroli, nakon πest mjeseci, vidljiva je djelomična regresija bolesti. Drugi pacijent I. J., tridesettri godine, dolazi u ambulantu oralne kirurgije pod sumnjom palatinalnog apscesa od gornjih lijevih molara. Gornja lijeva šestica se trepanira, a suspektni apsces dva puta incidira. U tijeku šest mjeseci uopće nije bilo regresije bolesti pa se pacijent upućuje u KKL»U KB “Dubrava”. Tamo mu se učini citopunkcija, biopsija, CT maksile te se utvrdi da se radi o mukoepidermoidnom karcinomu tvrdoga nepca. Nakon preoperativne pripreme pacijentu se učini parcijalna resekcija gornje čeljusti. Terapija pacijenta je u tijeku. Ta dva slučaja govore da se jasno moraju znati uzročnici različitih oteklina u području glave i vrata i da, ako se radi o odontogenoj upali, ona na odgovarajuću terapiju reagira za kratko vrijeme.The aim of this study was to show the importance of a detailed clinical examination, diagnostic analysis and good knowledge of the pathology of the oral cavity, in order to avoid erroneous treatment and loss of precious time. The first patient, R. J., a 36-year-old man, was admitted to the ENT Department of the General Hospital, Karlovac, because of a perimandibular swelling and trismuss of the right side of the face. Because an odontogenic abscess was suspected extraoral incision was performed on two occasions. After the arrival of an oral surgeon to the hospital and examination of the oral cavity the patient was transferred to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava. During an intraoral examination an ulcer was detected beneath the tongue on the right side and a massive infiltrate of almost the whole of the anterior two thirds of the tongue. Immovable metastasis was detected by palpation in regions two and three, 50 millimetres in size. After consultation at an oncological Meeting irradiation only was indicated. A check-up six months later showed partial regression of the disease. The second patient, K. J., a 33 year-old man, came to the Out-patient Department of Oral Surgery with suspected palatinal abscess of the upper left molar. The upper left six was trepanated and the suspect abscess incidirated twice. For a period of six months no regression occurred and consequently the patient was sent to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, where cytopuncture, biopsy, CT of the maxilla were performed which confirmed mucoepidermoid carcinoma of the hard palate. After preoperative preparation partial resection of the upper jaw was performed. Therapy is presently in course. These two cases indicate the need to know the causative agents of swellings in the area of the head and neck, and if odontogenic inflammation is the case it quickly responds to appropriate therapy

Examination of the Retention of Sm-Co5 and Nd-Fe-B Magnets

U planiranju retencije jedna od najvažnijih zadaća jest konstrukcijom, veličinom i oblikom retencijskih elemenata omogućiti prijenos sila koje opterećena tkiva mogu prihvatiti bez oštećenja. Magneti izrađeni od biokompatibilnih materijala upotrebljavaju se sve češće kao suvremena sredstva retencije potpunih i djelomičnih protetskih nadomjestaka te resekcijskih proteza. Svrha je rada ispitati čimbenike o kojima ovisi jakost retencijske sile Sm-Co5 i Nd-Fe-B magneta. Uzorci su podijeljeni u dvije skupine: 28 parova Sm-Co5 magneta te 28 parova Nd-Fe-B magneta. Visine mjerenih magneta bile su 2; 2,5 i 3 mm. Svaki se je uzorak sastojao od skupine s lateralnom silom i skupine bez djelovanja lateralne sile. Vrijednosti sile izmjerene su s pomoću uređaja za mjerenje magnetne retencijske sile koji omogućuje mjeriti retencijske sile raznih kombinacija permanentnih magneta i feromagnetnih materijala. Rezultati su prikazani grafički i u tablicama. Temeljni čimbenici koji utječu na veličinu retencijske magnetne sile jesu: vrsta magneta, veličina, njihova međusobna udaljenost i postojanje lateralnih sila. Dobivene vrijednosti prikazuju koje se veličine i debljine magnetnih parova moraju upotrijebiti za željenu silu retencije.When planning retention one of the most important tasks is to ensure that the construction, size and form of the retentive elements enable the transfer of forces which the loaded tissues can accept without damage. The use of magnets fabricated from biocompatible materials is becoming increasingly used as a means of retention for total and partial prosthetic replacements and resectional prostheses. The purpose of this study was to examine factors on which the strength of retentive forces Sm-Co5 and Nd-Fe-B magnets depend. The samples were divided into two groups: 28 pairs of Sm-Co5 magnets and 28 pairs of Nd-Fe-B magnets. The heights of the measured magnets were 2, 2.5 and 3 mm. Each sample consisted of a group with lateral force and a group without lateral force. The force values were measured by means of a device for measuring magnetic retentive forces, which enables the measurement of retentive forces of different combinations of permanent magnets and ferromagnetic materials. The results are presented in figures and tables. The basic factors that influence the magnitude of the retentive magnetic force are the type of magnet, size, their mutual distance and the presence of lateral forces. The values obtained indicate which sizes and thickness of the magnetic pairs should be used for the desired force of retention