Pregnancy epulis is a common and benign vascular tumor that reaches 5% of pregnant women; it respects adjacent structures, such as bone, teeth, and sinus mucosa. This paper reports a rare case of ...extensive pregnancy epulis with alveolar bone lysis, tooth displacement, and sinusal floor lysis. A 23-year-old pregnant woman with 23 weeks of amenorrhea was referred to the Department of Oral and Maxillofacial Surgery with a large maxillary mass and spontaneous bleeding, causing difficulty in speaking and swallowing. Due to the rapid development, the stage of pregnancy, and the need for a sure diagnosis of a benign lesion, a surgical excision was performed. After 1 month, the patient recovered from swallowing and speaking. Pregnancy epulis can be locally aggressive and involve alveolar bone. Biopsy allows to confirm the diagnosis. Surgery during pregnancy or birth waiting should be well ponderated in correlation with the size of the tumor and the delay to birth.
Foramen of Huschke is a bone defect with wide clinical symptoms which ca can be responsible for severe complications. Clinical history and imaging are unspecific, it is therefore essential to ...recognize and treat the pathology related to the persistence of this foramen, to avoid destruction of the TMJ, chronic pain or OBJECTIVE: The aim of this review was to summarise the clinical manifestations and complications of persistent foramen of Huschke in adult patients, through a review of the cases reported in the literature.
A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to November 2022 to identify studies and case reports concerning clinical manifestations and complications of persistent foramen of Huschke in adult patients, with the key words "foramen of Huschke" or "foramen tympanicum".
74 papers where firstly identify, and 21 were selected. This correspond to 46 patients with the additional case from our department. Symptoms mostly reported consisted of otitis (63%, 29/46), otorrhea (28.26%, 13/46), and masticatory tinnitus (19.57%, 9/46). Diagnosis was priority made by CT-scan (95.65%, 44/46). Surgery was the most performed treatment (28.26%, 13/46). In our case, the use of FLUOBEAM® NIR camera was help-full for TMJ surgery.
Persistent foramen of Huschke should be suspected in the presence of otitis, otorrhea and masticatory tinnitus. Knowledge of this anatomical variation could help to treat certain pathology like TMJ disorders or TMJ septic arthritis.
The γ isoform of protein kinase C (PKCγ), which is concentrated in a specific class of interneurons within inner lamina II (IIi) of the spinal dorsal horn and medullary dorsal horn (MDH), is known to ...be involved in the development of mechanical allodynia, a widespread and intractable symptom of inflammatory or neuropathic pain. However, although genetic and pharmacological impairment of PKCγ were shown to prevent mechanical allodynia in animal models of pain, after nerve injury or reduced inhibition, the functional consequences of PKCγ activation alone on mechanical sensitivity are still unknown. Using behavioural and anatomical approaches in the rat MDH, we tested whether PKCγ activation in naive animals is sufficient for the establishment of mechanical allodynia. Intracisternal injection of the phorbol ester, 12,13‐dibutyrate concomitantly induced static as well as dynamic facial mechanical allodynia. Monitoring neuronal activity within the MDH with phospho‐extracellular signal‐regulated kinases 1 and 2 immunoreactivity revealed that activation of both lamina I–outer lamina II and IIi–outer lamina III neurons, including lamina IIi PKCγ‐expressing interneurons, was associated with the manifestation of mechanical allodynia. Phorbol ester, 12,13‐dibutyrate‐induced mechanical allodynia and associated neuronal activations were all prevented by inhibiting selectively segmental PKCγ with KIG31‐1. Our findings suggest that PKCγ activation, without any other experimental manipulation, is sufficient for the development of static and dynamic mechanical allodynia. Lamina IIi PKCγ interneurons have been shown to be directly activated by low‐threshold mechanical inputs carried by myelinated afferents. Thus, the level of PKCγ activation within PKCγ interneurons might gate the transmission of innocuous mechanical inputs to lamina I, nociceptive output neurons, thus turning touch into pain.
Combining intracisternal injection of both phorbol ester and a specific antagonist to the γ isoform of PKC reveals that PKCγ activation within the medullary dorsal horn leads to facial static and dynamic mechanical allodynia in naïve rats. Thus, the level of PKCγ activation within the inner lamina II PKCγ interneurons that receive innocuous mechanical inputs, might gate the transmission of such inputs to lamina I, nociceptive output neurons, and thus the transformation of touch into pain.
: Dental cellulitis management is no longer a simple procedure, as more and more patients are needing long-time hospitalization, several surgeries and intensive care follow-up. This prospective study ...seeks to highlight criteria that can split patients with severe odontogenic infection into two groups: those with simple evolution and those for whom complex management is necessary.
: In this observational study, all patients considered with a severe odontogenic infection (which necessitated hospital admission, intravenous antibiotics and general anaesthesia) were enrolled between January 2004 and December 2014 from Clermont-Ferrand University Hospital (France). They were split into two groups: those who needed one surgical intervention with tooth extraction and collection drainage combined with probabilistic antibiotic to treat infection and those who need several surgeries, intensive care unit follow-up or tracheotomy to achieve healing.
: 653 patients were included, of which 611 (94%) had one surgery, 42 (6%) had more than one surgery before healing. Penicillin allergy (
< 0.001), psychiatric disorders (
= 0.005), oropharyngeal oedema (
= 0.008), floor oedema (
= 0.004), fever (
= 0.04) and trismus (
= 0.018) on admission were the most relevant predictors of complex evolution. A conditional inference tree (CTREE) illustrated the association of prognostic factors and the need of multiple surgery.
: Besides clinical symptoms of severity, complications of severe odontogenic infection are predicted by measurables and objectives criteria as penicillin allergy, mandibular molar, C-reactive protein level, psychiatric disorders and alcohol abuse. Their specific association potentialize the risks. IRB number: CE-CIC-GREN-12-08.
Background
Prospective evaluation of the results of volumetric modulated arc therapy (VMAT) for sinonasal cancer compared to 3D conformal radiation therapy (3DCRT).
Materials and Methods
We ...prospectively evaluated 34 patients (pts) treated with postoperative VMAT with simultaneous integrated boost (SIB; RapidArc) from 2011 to 2015. These pts were retrospectively compared with 24 pts treated with 3DCRT from 2003 to 2011. The two sets were not significantly different on sex, mean age, tumor site, stage, histology. Efficacy and toxicity were evaluated.
Results
Median follow‐up was 45 months (range: 6‐143 months). Three‐year overall survival was 85.2% in VMAT‐SIB versus 65.2% in 3DCRT (P = .02). Three‐year local control was 81.2% in VMAT‐SIB versus 62.5% in 3DCRT (P = .04). There was a reduction of acute (<0.09) and late (0.03) ocular toxicity of grade ≥ 2 for pts with VMAT‐SIB.
Conclusion
VMAT significantly improved local control and overall survival in sinonasal cancer with lower rate of toxicity.
The advent of digital medical imaging, medical image analysis and computer vision has opened the surgeon horizons with the possibility to add virtual information to the real operative field. For oral ...and maxillofacial surgeons, overlaying anatomical structures to protect (such as teeth, sinus floors, inferior and superior alveolar nerves) or to remove (such as cysts, tumours, impacted teeth) presents a real clinical interest.
Through this work, we propose a proof-of-concept markerless augmented reality system for oral and maxillofacial surgery, where a virtual scene is generated preoperatively and mixed with reality to reveal the location of hidden anatomical structures intraoperatively. We devised a computer software to process still video frames of the operating field and to display them on the operating room screens.
Firstly, we give a description of the proposed system, where virtuality aligns with reality without artificial markers. The dental occlusion plan analysis and cusps detection allow us to initialise the alignment process. Secondly, we validate the feasibility with an experimental approach on a 3D printed jaw phantom and an ex-vivo pig jaw. Thirdly, we evaluate the potential clinical benefit on a patient.
this proof-of-concept highlights the feasibility and the interest of augmented reality for hidden anatomical structures visualisation without artificial markers.
•Limited data exist to guide the delineation for PORT of parotid and submandibular gland cancers.•Radiographic-anatomy, natural history of these cancers and their extension pathways are ...described.•Are included the risk of local tumor spread, perineural invasion risks and regional spread.
Intensity-modulated radiotherapy has been widely used routinely in recent past years for post-operative radiotherapy of salivary gland cancers Because of the sharp dose fall off outside of target volumes with IMRT, each volume must be strictly and rigorously defined, as the areas not specifically included in the target volume will not be treated to a therapeutic dose. The selection and delineation of these volumes is complex and requires extensive knowledge of parotid and submandibular gland cancer radiographic-anatomy, natural history and extension pathways (including local tumor spread, PNI risks and regional spread), which are detailed in the present article.
We report a case of a needlefish jaws retained near the C5-C6 joint that was associated with chronic pain and inflammation and seen confirmed by FDG-PET scan. Two unsuccessful surgeries using an ...anterior approach were complicated by vascular and nerve injuries. We used image-guided surgery with a posterior approach.
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.
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