Modified Difficult Index Adding Extremely Difficult for Fully Impacted Mandibular Third Molar Extraction

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Pyomyositis of the Sternocleidomastoid Muscle after Tooth Extraction: A Case Report

Pyomyositis is a primary bacterial infection of the striated muscle. The sternocleidomastoid muscle (SCM) is rarely involved in pyomyositis because of its excellent blood supply from the branches of the external carotid artery. In this study, we present the report of a 67-year-old male with an uncommon case of pyomyositis of the sternocleidomastoid muscle who had been taking methylprednisolone and isoniazid for rheumatoid arthritis and latent tuberculosis, respectively. The infection in the SCM occurred after the drainage of an abscess in the left submandibular and sublingual space that appeared after extraction of a tooth. Although pyomyositis of the head and neck area is rare, it can lead to severe complications, and even death, if treated improperly. It is also known that patients with reduced immunity are susceptible to these infections. Therefore, if cervical edema or redness is observed in immunocompromised patients, a more intensive clinical and radiographic examination is recommended for differential diagnosis of pyomyositis.ope

Differential Diagnosis and Treatment of Septic Arthritis in the Temporomandibular Joint: A Case Report and Literature Review

Septic arthritis of the temporomandibular joint (TMJ) is an uncommon disease caused by microbial pathogens through hematogenous infection, local spread, or iatrogenic infection. As the symptoms have an insidious onset, the early stage of septic arthritis is often confused with other diseases. A 49-year-old man was referred for increasing preauricular pain, swelling, and restricted mouth opening. He had been initially diagnosed as having a conventional temporomandibular joint disorder and trigeminal neuralgia and had been treated for the same. Imaging studies including panoramic view, lateral tomography, computed tomography with contrast enhancement, and magnetic resonance imaging were performed. Erosive bone change with displacement of the involved condyle, diffuse swelling of adjacent soft tissue, and fluid collection in the joint space were noted. Needle aspiration of the joint space and bacterial culture confirmed the diagnosis of septic arthritis of the TMJ and he was treated with antibiotic therapy and surgical drainage. Clinicians should always consider the diagnosis of septic arthritis of the TMJ in patients with preauricular pain or swelling.ope

Progressive Hemifacial Atrophy After Implant Placement in Patients Taking Immunosuppressive Agents

Progressive hemifacial atrophy (PHA) is a rare disorder characterized by acquired unilateral facial atrophy. This disease mainly affects the skin and the craniofacial tissue below forehead. It also involves dermatomes of the fifth cranial nerve. Atrophy of subcutaneous tissue, fat, muscle and osseocartilaginous structures were seen. It resulted in a sunken hemifacial appearance. Although epidermal cutaneous tissue was minimally involved, the tongue, gingiva, teeth, and palate may also be affected. The purpose of this study is to report a case of progressive hemifacial atrophy in a patient taking immunosuppressive drugs after implant and sinus graft surgery.ope

Clinical and microbiologic investigation of an expedited peri-implantitis dog model: an animal study

BACKGROUND: Animal studies are pivotal in allowing experimentation to identify efficacious treatment protocols for resolution of peri-implantitis. The purpose of this investigation was to characterize an expedited dog peri-implantitis model clinically, radiographically, and microbiologically. METHODS: Eight hound dogs underwent extractions (week 0) and implant (3.3 × 8.5 mm) placement with simultaneous surgical defect creation and ligature placement for induction of peri-implantitis (week 10). Ligatures were replaced at 6 weeks (week 16) and removed after 9 weeks (week 19) when supporting bone loss involved approximately 50% of the peri-implant bone. Microbial samples from the defects and healthy control implant sites collected at week 19 were analyzed utilizing a microarray. Clinical measures of inflammation were obtained and radiographic bone loss was measured from periapical radiographs. Radiographic depth and width measurements of bony defect were repeated at weeks 10 (baseline), 16, and 19. Canonical analysis of principal coordinates was used to visualize overall differences in microbial abundance between peri-implantitis and healthy implants. RESULTS: This accelerated disease protocol led to intrabony defect creation with a mean depth and width of 4.3 mm and 3.5 mm, respectively after 9 weeks of ligature placement. Microbial identification revealed 59 total bacteria in peri-implant sites, 21 of which were only present in peri-implant sites as compared to healthy controls. Overall microbial beta diversity (microbial between-sample compositional diversity) differed between peri-implantitis and healthy implants (p = 0.009). CONCLUSIONS: Within the limitations of this study, this protocol led to expedited generation of peri-implant defects with a microbial profile indicative of a shift to disease and defect patterns conducive to regenerative treatment. However, the possibility of potential spontaneous resolution of lesions due to the lack of a chronicity interval as compared to chronic disease models need to be further clarified and considered during preclinical peri-implantitis model selection.ope

Orthognathic surgery of temporomandibular disorders

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Effect of a vertical incision on postoperative swelling after an impacted mandibular third molar extraction: two cases with split-mouth designed magnetic resonance imaging analysis

This study examined the effects of a vertical incision on postoperative edema after third molar extraction. The study design was that of a comparative split-mouth approach. Evaluation was performed via magnetic resonance imaging (MRI). Two patients with homogeneous bilateral impacted mandibular third molars were enrolled. These patients underwent facial MRI within 24 hours after simultaneous extraction surgery. Modified triangular flap and enveloped flap incisions were made. Postoperative edema was evaluated by MRI and was assessed according to anatomical space. The two pairs of homogeneous extractions demonstrated that vertical incisions were associated qualitatively and quantitatively with extensive postoperative edema. The edema associated with these incisions spread toward the buccal space, beyond the buccinator muscle. In conclusion, a vertical incision with mandibular third molar extraction was related to edema in the buccal space and the fascial space, which contributed to clinical facial swelling. Copyright © 2023 The Korean Association of Oral and Maxillofacial Surgeons.ope

The relationship between mandibular asymmetry and temporomandibular joint disc displacement on MRI

Purpose: This study was aimed to investigate the relationship between the mandibular asymmetry and the internal derangement of temporomandibular joint. Materials and methods: One hundred and sixty eight patients had been assessed through clinical examinations, panoramic radiographs and magnetic resonance imagings (MRIs), were selected. The samples were classified into three subgroups according to the severity of the mandibular asymmetries in the panoramic radiographs and the status of TMJ discs on the MRI were compared among each groups. Results: In an apparent asymmetry group, there was a significant difference in the number of temporomandibular disk displacement without reduction between the long and short side (66.7%, 18/27 joints on the short side) when the ratio of condylar process and coronoid process was used (p<0.05), but there was no statistically significant difference when the ratio of condyle and ramus was used. Conclusion: The probability of the disc displacement without reduction was higher at the side with relatively shorter condylar process on the panoramic radiograph, and also it might be more effective to use ratio of condylar process and coronoid process in the assessment of mandibular asymmetry. Therefore, a careful assessment on the temporomandibular disorders is necessary to diagnose and establish the treatment plans for the patients with a mandibular asymmetry and the panoramic radiograph can be used effectively on that way.ope

Progression of periapical cystic lesion after incomplete endodontic treatment.

We report a case of large radicular cyst progression related to endodontic origin to emphasize proper intervention and follow-up for endodontic pathosis. A 25 yr old man presented with an endodontically treated molar with radiolucency. He denied any intervention because of a lack of discomfort. Five years later, the patient returned. The previous periapical lesion had drastically enlarged and involved two adjacent teeth. Cystic lesion removal and apicoectomy were performed on the tooth. Histopathological analysis revealed that the lesion was an inflammatory radicular cyst. The patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. Although the patient had been asymptomatic, close follow-ups are critical to determine if any periapical lesions persist after root canal treatment.ope

Bony window approach for a traumatic bone cyst on the mandibular condyle: a case report with long-term follow-up

Traumatic bone cyst (TBC) occurs preferentially on the mandibular symphysis and body, but rarely on the mandibular condyle. When TBC occurs in the condylar area, it can usually be related with or misdiagnosed as a temporomandibular joint disorder. A 15-year-old female patient visited the Temporomandibular Joint Clinic with a 5-year history of pain and noise localized in the left temporomandibular joint. On imaging, a well demarked oval-shaped radiolucent lesion was observed on the left condyle head. The patient underwent cyst enucleation and repositioning of the bony window on the lateral cortex of the affected condyle head under the impression of subchondral cyst or TBC; however, no cystic membrane was found. The bone defect resolved and showed no recurrence on the serial radiographic postoperative follow-up for 43 months after surgery.ope