Clinical and Radiological Correlation with Surgery of Third Mandibular Impacted Molars

Overview:Tooth extraction is one of the most common procedures in dentistry and oral maxillofacial medicine. Vigilant investigation of the condition and an accurate preoperative assessment, planning, evaluating indications and contraindications, is needed in all the cases. The objective: The aim of this study is to evaluate the role of radiographic examinations in diagnosis and surgery planning of lower third molar extraction. Materials and methods: Review of literature; on pubmed, medline, embase, sciencedirect, and the Cochrane library, using key words of impacted molars, third molars, mandibula, alveolar, dentistry, oral maxillofacial. Results: During dental and oral maxillofacial daily clinical practice is quite often to face impacted third lower molars, a condition that can lead to a close relation with important anatomical structures. Radiographic examinations are useful in the diagnosis and subsequently in the surgery planning and must submit to principle of justification and optimization. Intraoral radiography and orthopantomography hardly permit to evaluate the buccal or lingual position of the inferior alveolar nerve so to better predict the risk of complications. There are some radiographic signs that suggest the necessity to perform a more accurate radiographic investigation that provides a three-dimensional view of the images. The three-dimensional radiographic methods, by means of sagittal, frontal and axial views, are used to determine anatomical location, proximity, and possible contact of the third molar with the mandibular canal, blood vessels and nerves branches. The beginning of Cone Beam Computed Tomography (CBCT) has reduced the equipment cost but then again above all the radiation exposure for the patients. Conclusions: In the past few years three-dimensional reconstructive technologies were introduced: besides advantages, in addition to the potential benefit in the reduction of complications related to the patient, also resides in the different approach of the surgeon: stress and duration of dental and oral maxillofacial surgical procedures significantly is reduced because the respective medical specialist know exactly the position of anatomical structures. This information will help the surgeon to determine a possible post-operative paresthesia and plan the better surgical technique. Keywords: Impacted molars, third molar, surgery, inferior alveolar nerve, OPT, CBCT DOI: 10.7176/ALST/95-04 Publication date: November 30th 202

Trigeminal Nerve Injuries in Correlation with Daily Dental and Maxillofacial Medicine

Oral and maxillofacial medicine is in close relation with trigeminal nerve, and such daily dental procedures, impacted teeth, dental implants placement, oral and oral maxillofacial medicine including trauma, even injection of local anesthesia can damage trigeminal nerve. Auspiciously, most nerve injuries will undergo natural recovery, with small portion of cases resulting in permanent sensory deficits. Many patents suffering trigeminal nerve problems, present at family medicine doctors as well, or direct to medical specialist like dentist, oral maxillofacial medical specialists, neurologist or neurosurgeons as well.Subsequently, early assessment and diagnosis, often involving multidisciplinary team optimize recovery in respect of time and minimize the complication. Keywords: Trigeminal nerve, oral, maxillofacial, medicine, damage, assessment, recovery DOI: 10.7176/ALST/95-07 Publication date: November 30th 202

Ectopic Thyroid Tissue and Management Approach: Surgical vs Conservative

From embryology it well known that thyroid gland is the first endocrine gland to develop in the body, starting by the end of third week post conception. The thyroid gland originates from primitive pharynx and the neural crests. Surgeons should have a complete understanding of embryonic development of thyroid and parathyroid gland, as well as knowledge of possible congenital abnormalities of thyroid dysgenesis that is characterized by thyroid ectopia, as may impact medical assessment and the surgical procedures approach and prevention of possible complications. Surgical vs conservative management approach should be well evaluated and proper professional decision upon patient case should be taken, upon patient consensus. Thyroid ectopia is a rare disease, and according to most studies and respective database it is estimated with prevalence about 1 per 100 000–300 000 people, rising to 1 per 4000–8000 patients with thyroid disease. This paper focuses on surgical approach of lingual ectopic tissue of thyroid of a 32 years old women. Keywords: Thyroid, endocrine, location, embryology, ectopic, surgeon DOI: 10.7176/ALST/93-05 Publication date: April 30th 202

Management Approach of Cholangiocarcinoma of Middle Third Bile Duct

Background: Prognosis of middle third cholangiocarcinoma according of recent studies remains poor. However, identifying survival predictors, mentioned a few; stage and patients age, still should take place in clinical practices especially for minor medical facility centers. Case presentation: A 75 years old lady, was assessed and diagnosed with middle third cholangiocarcinoma, patients underwent from laboratory workup; where SGOT, SGPT were almost threefold elevated, as well Total bilirubin, direct and indirect, were four to tenfold higher than normal levels. CRP as well was seen tenfold higher than normal levels. MRCP was seen dilated of biliary ducts, dilatation of common hepatic duct, narrowing of common hepatic and ductus choledochus that goes with cholangiocarcinoma aspect. Thickness of junction lumen with solid mass 7 mm, infiltrates totally the wall that created the blockage, with increased of contrast intake, no infiltration of pancreas head is seen. Closeness of mass with the vena porta There were seen two lymph nodes less than 1 cm in gastro hepatic ligament. No infiltration of inferior vena cava, common pancreatic ductus normal. No infiltration of superior mesenteric vena. After multidisciplinary consultation and patient’s decision informed consent was completed, personalized patients’ treatment was performed, surgical intervention, biopsy and then adjuvant chemotherapy was applied, with a 3-year survival and quality life was achieved. Conclusions: even in advanced cases of highly malignant cases like cholangiocarcinoma, even most of authors and surgeons agree in low survival rate according to study data, we should create a personalized strategy treatment of each patient in order to increase survival and quality of life as well Keywords: Cholangiocarcinoma, surgical, chemotherapy, personalized treatment DOI: 10.7176/ALST/93-06 Publication date: April 30th 202

Management Approach to Thyroid Cancer in Albania

Thyroid cancer is a cancer that starts in the thyroid gland. In Albania, thyroid cancer is rare disease, according to available data, which are not solid and up to date data, referred to 2014 to a paper named “Actualities in the Diagnosis and Treatment of Thyroid Cancer in Albania” by D. Gjergji et al., data from Clinic of General Surgery, UHC “Mother Theresa” in Tirana and the Registry of the Department of Pathology during the period 2004 – 2011, there were suspected 262 patients with thyroid tumors and only 42 of them or 16 % were diagnosed with thyroid cancer. Treatment depends on the type of thyroid cancer. Surgery is most often done, the entire thyroid gland is usually removed and if is suspected that cancer has spread to lymph nodes in the neck, these will also be removed. Radiation therapy may be done with or without surgery and it may be performed by; aiming external beam x-ray radiation at the thyroid or taking radioactive iodine by mouth. If the cancer does not respond to surgery or radiation, and has spread to other parts of the body, chemotherapy and targeted therapy are applied. The importance of screening, early diagnosis and there proper treatment possess still challenges in Albania, so better national health  programs must be developed in order to offer a better health care service to this medical problem. Keywords: Thyroid cancer, risk factors, diagnosis, treatmen

Magnetic resonance imaging findings in primary lymphoma of the liver: a case report

<p>Abstract</p> <p>Introduction</p> <p>Primary lymphoma of the liver is an extremely rare finding, with the few such cases reported in the literature to date describing indeterminate imaging findings, being focused more on computed tomography. To the best of our knowledge, there is no prior report describing magnetic resonance imaging scan findings with such a lesion. In the case reported here, magnetic resonance imaging gave us the opportunity to ascertain the correct diagnosis, confirmed by histopathology, thus avoiding unnecessary surgery or other treatments. Although this condition is rare, knowledge of magnetic resonance imaging findings will be invaluable for radiologists and other medical subspecialties that may face such cases in the future in helping to provide adequate management for affected patients.</p> <p>Case presentation</p> <p>A focal lesion was incidentally detected by ultrasound in a 75-year-old asymptomatic Albanian man being treated for benign hypertrophy of prostate. Chest and abdomen computed tomography scans did not reveal any abnormal findings besides a solid focal lesion on the right lobe of the liver and a mild homogenous enlargement of the prostate gland. Subsequently, magnetic resonance imaging of the upper abdomen was performed for better characterization of this lesion. Our patient was free of symptoms and his laboratory test results were normal.</p> <p>Conclusions</p> <p>The magnetic resonance imaging scan results showed some distinctive features that helped us to make the correct diagnosis, and were thus very important in helping us provide the correct treatment for our patient.</p