Numerous biochemical datas support the noxious role of anti-inflammatory drugs on immune response. Those observations are often put forward for unfavorable evolution of odontogenic infection but has ...never been really proven in clinic. The aim of this study is to try to clarify this role based on the collection of the clinical course of odontogenic infections over a 10-year analysis period.
The investigators implemented a prospective observational study. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. Clinical and pharmacological data were collected at admission, during hospitalization until discharged home. The population was first separated into two groups patients with or without anti-inflammatory drugs on admission, then on four groups (non-steroidal anti-inflammatory drugs, corticosteroids drugs, both and none on admission). Analysis were performed each time by univariate analysis, multivariate analysis and propensity score matching.
Six hundred and fifty-three patients were included in the study, 329 (50%) patients report orally anti-inflammatory treatment before presenting to hospital, 50 (7.6%) received corticosteroids, 242 (37%) received NSAIDs and 37 (5.6%) both. Evolution is worsening for patients under anti-inflammatory drugs in term of hospitalization in ICU (p=0.016), number of surgeries (p=0.003), risk of tracheotomy (p=0.036), duration of hospitalization (p=0.005) and spaces involved by the infection (p<0.001). When separating patients into 4 groups, dysphonia and odynophagia are more frequent for patients under corticosteroid and NSAID (35.14%, p<0.001), mediastinal erythema is more frequent for patients under corticosteroid (16%, p=0.004), fever is more frequent for patients under NSAID (35.5%, p=0.032), pain is higher for patients under corticosteroids (p=0.024). But, in order to reduce bias, linked to factors of gravity, a regression weighted by propensity scores was performed and any group of patients is different from the others.
Patients under anti-inflammatory drugs have more severe dental infection on admission and their complex evolution seems to be linked to the severity of infection on admission.
Most patients with severe odontogenic infections are successfully treated with large spectrum probabilistic antibioc therapy, drainage of the collections and tooth treatment or extraction and are ...discharged home before antibiotic sensitivity results were available. The investigators hypothesized whether bacteriological sampling should be systematically performed in the management of patients with severe odontogenic infections. Methods: The investigators implemented a prospective observational study. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. The predictor variable was the results of bacteriological sampling, culture and sensitivity. The outcome variable was antibiotic therapy adaptation according to antibiotic sensitivity results.
The sample was composed of 653 patients; 386 (59%) were male and 267 (41%) female, with a mean age of 37 years (range 18–88); 378 (58%) patients had been receiving oral antibiotics before admission to hospital, for a mean duration of 4.1 days (range 1 – 30). About 535 (81.9%) patients had swabs taken during surgery. Microorganisms were observed in 477 (89.1%) patients but in 377 (70.5%) they were polymorphic oropharyngeal flora. After culture, at least one antibiogram was obtained for 91 (17%) patients and the results led to antibiotic therapy being adapted in 23 (4.3%) patients.
The results suggest that bacteriological analysis had an impact on evolution in less than 5% of patients. Future studies will focus on the patients for whom the bacteriological analysis is essential.
Basal cell carcinomas with symptomatic perineural invasion are rare entities. We report the case of a 60year-old man (with a grafted kidney), surgically treated in 2007 for a sclerodermiform basal ...cell carcinoma infiltrating the left nostril. Five years later, a painful left hemifacial hypoesthesia associated with an ulcus rodens of the nasolabial fold appeared. A biopsy confirmed a recurrence. MRI showed an enhancement of the trigeminal ganglion. The patient had a trigeminal perineural invasion secondary to a cutaneous basal cell carcinoma. He received a local intensity-modulated radiotherapy alone (70Gy in 33 sessions), administered from the skin tumour to the skull base. Three years after the end of treatment, the patient is in radiological and clinical remission, with partial recovery of the hypoesthesia. Evolution was marked by iterative corneal ulcers and decreased visual acuity. Modalities of treatment by surgery and/or radiation therapy and complications are poorly described in the literature.
Les carcinomes basocellulaires avec invasion périneurale symptomatique sont rares. Nous rapportons le cas d’un homme âgé de 60ans, greffé rénal, traité chirurgicalement en 2007 pour un carcinome ...basocellulaire infiltrant et sclérodermiforme de l’aile narinaire gauche. Cinq ans plus tard, une hypoesthésie douloureuse de l’hémiface gauche et un ulcus rodens du sillon nasogénien sont apparus. La biopsie a confirmé une récidive. Il a été retrouvé sur l’IRM un réhaussement pathologique au niveau du ganglion de Gasser posant le diagnostic d’invasion périneurale du trijumeau par le carcinome basocellulaire cutané. Le patient a reçu une radiothérapie exclusive avec modulation d’intensité de 70Gy en 33 séances au niveau de la tumeur jusqu’en base de crâne. Trois ans après la fin de traitement, le patient était en situation de rémission radiologique et clinique, avec une récupération partielle de l’hypoesthésie. L’évolution a été marquée par des ulcères de cornées itératifs et une diminution de l’acuité visuelle. Les modalités du traitement par chirurgie et/ou irradiation et leurs complications sont peu décrites dans la revue de la littérature.
Basal cell carcinomas with symptomatic perineural invasion are rare entities. We report the case of a 60year-old man (with a grafted kidney), surgically treated in 2007 for a sclerodermiform basal cell carcinoma infiltrating the left nostril. Five years later, a painful left hemifacial hypoesthesia associated with an ulcus rodens of the nasolabial fold appeared. A biopsy confirmed a recurrence. MRI showed an enhancement of the trigeminal ganglion. The patient had a trigeminal perineural invasion secondary to a cutaneous basal cell carcinoma. He received a local intensity-modulated radiotherapy alone (70Gy in 33 sessions), administered from the skin tumour to the skull base. Three years after the end of treatment, the patient is in radiological and clinical remission, with partial recovery of the hypoesthesia. Evolution was marked by iterative corneal ulcers and decreased visual acuity. Modalities of treatment by surgery and/or radiation therapy and complications are poorly described in the literature.
The gold standard management of mandibular fractures is open reduction and osteosynthesis associated with intermaxillary fixation. The use of intermaxillary fixation screws for 20 years has ...considerably reduced the number of intermaxillary fixation with arch bars. The aim of our review was to identify current indications and contraindications of each technique.
We present a short history and compare the two techniques with recently published assets, drawbacks, and complications.
The indications of intermaxillary fixation screws are uni- or bifocal fractures without or with minimal displacement. Their use is contraindicated in any other type of fracture, which should still be treated with arch bar fixation.
La référence de prise en charge en traumatologie mandibulaire est l’ostéosynthèse à foyer ouvert associée à un blocage maxillo-mandibulaire (BMM). L’utilisation depuis une vingtaine d’années des vis ...de blocage a réduit considérablement le nombre de BMM sur arcs. Le but de cette revue de la littérature est d’identifier les indications et contre-indications actuelles de chaque technique.
Après un bref historique, cette mise au point compare ces deux techniques, leurs avantages, leurs inconvénients et complications retrouvés dans la littérature récente.
Les indications des vis de blocage se résument aux fractures unifocales ou bifocales non ou peu déplacées. Toutes les autres fractures représentent des contre-indications à leur usage et doivent encore être traitées avec un blocage sur arcs.
The gold standard management of mandibular fractures is open reduction and osteosynthesis associated with intermaxillary fixation. The use of intermaxillary fixation screws for 20years has considerably reduced the number of intermaxillary fixation with arch bars. The aim of our review was to identify current indications and contraindications of each technique.
We present a short history and compare the two techniques with recently published assets, drawbacks, and complications.
The indications of intermaxillary fixation screws are uni- or bifocal fractures without or with minimal displacement. Their use is contraindicated in any other type of fracture, which should still be treated with arch bar fixation.
Les ostéomyélites cervico-faciales à Actinomyces naeslundii sont des infections granulomateuses chroniques rares. La symptomatologie clinique est peu spécifique. Le diagnostic est confirmé par les ...examens bactériologiques et anatomopathologiques. Le traitement associe une antibiothérapie prolongée et un traitement chirurgical agressif visant à éliminer tous les tissus nécrosés. Nous rapportons l’observation d’un patient, âgé de 24 ans, pris en charge pour une ostéomyélite à Actinomyces naeslundii et à Streptoccocus alpha-hémolytique de la branche montante de la mandibule, apparue après avulsion de la 48.
The Actinomyces naeslundii cervicofacial osteomyelitis is a rare chronic infection. The clinical symptoms are nonspecific. The diagnosis is established by the bacteriological and histological examinations. Treatment associates antibiotherapy and surgery to remove all the necrosed tissues. We report the case of a 24-year-old patient with an associated Actinomyces and Streptococcus osteomyelitis of the right rising branch of the mandible, after wisdom tooth extraction.
PDF
