Aspiration of a tooth in facial trauma is a known complication. There have been few reports on the consequences of maxillofacial trauma, especially when the patient is intubated. We report on two complicated cases of multiple teeth aspiration and their removal in intubated patients. A special technique using flexible bronchoscopy with simultaneous tracheotomy was used for safe and successful removal of aspirated teeth. We suggest that simultaneous tracheostomy is a safe and effective method for removal of a bronchial foreign body in maxillofacial traumatized patients.

Peripheral odontoma arising in the extraosseous soft tissues is rare and if not removed early, may enlarge over time and eventually erupt in the oral cavity.A 15-year-old girl presented with "denticles on the gingiva". During the intraoral examination, seven small tooth-like structures were found. These were exposed in the anterior left gingiva between the permanent maxillary lateral incisor and canine teeth, and the left first premolar was absent. Radiographic examination revealed irregular tooth-like structures without evidence of bone involvement.The lesion was surgically removed, and the specimens were analyzed histopathologically. The diagnosis of compound odontoma was established.This is the twelfth reported case of peripheral odontoma in the gingiva and the first one that erupted in the oral cavity.

Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) presents with necrotic bone in the mouth in the setting of BP exposure. It has been studied in cancer patients taking high-dose BP, but BRONJ has also been noted in patients taking lower-dose BP for osteoporosis. The purpose of this study was to characterize the phenotypes and outcomes in a large series of patients with osteoporosis and BRONJ in the setting of BP exposure. We conducted a retrospective case series. The sample was composed of subjects with BRONJ and osteoporosis. Subjects with a history of BP treatment for myeloma or metastatic cancer to the bones were excluded. Descriptive statistics were computed for the study variables. Ninety-one cases of BRONJ met the inclusion criteria. Subjects had a median age of 71 years and were predominantly female (94.5 %). The median time of BP exposure was 60 months (range 2-120). Most subjects were treated with alendronate (82.4 %). The mandible was involved more frequently (58.2 %) than the maxilla (37.3 %). Subjects commonly (65.9 %), but not universally, reported pain. For subjects with treatment outcome data (n = 0), most reported improvement (80.0 %). Although BRONJ is an uncommon condition, the absolute number of cases is fairly large due to the very large number of patients taking BPs for osteoporosis. The findings of this study confirm that BRONJ primarily affects the mandible, a substantial minority present without pain, and patients typically improve with treatment.

The aim of this study was to evaluate the relationships of selected facial measurements with mesio-distal crown widths and dental arch dimensions in individuals with normal occlusions. A cross-sectional study was conducted on 276 subjects with Angle's Class I normal occlusions. Three-dimensional images of the face and dental casts were captured and analyzed using stereophotogrammetric systems. Significant correlations were found between the sagittal facial variables and both upper and lower dental arch dimensions and to lesser degree with the horizontal and vertical variables. The values of correlation coefficients calculated between facial and dental crown measurements ranged from .01 to .50 for upper teeth and .01 to .49 for lower teeth. The values of correlation coefficients between facial and upper dental arch dimensions ranged from .01 to .55 and those between facial and lower dental arch dimensions ranged from .01 to .60. A principal components analysis showed that the sagittal dimensions, face height, nose, labial fissure, binocular widths were positively associated with dental arch dimensions and mesio-distal crown diameters in males. On the other hand, only the sagittal variables were associated with dental dimensions in females. The results of this study confirm that positive associations exist between facial and dental arch dimensions. These relationships should be taken into consideration when attempts are made to modify dental arch size as part of orthodontic treatment. Moreover, these relationships are also relevant to prosthodontists involved with selecting tooth sizes that display optimal functional balance with the craniofacial structures.

To analyze the clinical effect of Le Fort I osteotomy approach associated with endoscope for the resection of juvenile nasopharyngeal angiofibroma.Three patients with juvenile nasopharyngeal angiofibroma, stage II b, were retrospectively analyzed. All of them underwent Le Fort I osteotomy approach associated with endoscope between 2004 and 2009. All patients were followed up at first, third, sixth months and one year after surgery. Two years later, endoscopic examination and CT scan were performed, to analyze the clinical effect.All three patients had total removal of tumor and no postoperative complications. No tumor recurrence was found 2 years after operation, and no face deformity. The tooth articulation was recovered, these patients could eat hard diet, although one patient had lose a little teeth sensation.Le Fort I osteotomy had good clinical effect, if associated with endoscope, it could get a good surgical exposure, and can do well in the treatment on juvenile nasopharyngeal angiofibroma, even intruded into pterygopalatine and infratemporal fossa.

Costello syndrome is a rare multiple congenital anomaly syndrome caused by heterozygous germline HRAS mutations, which is characterized by intellectual disability, growth retardation, distinctive facies, loose skin, cardiomyopathy and a preposition to malignancies. Although teeth abnormalities have been encountered in nearly two-thirds of the patients in literature, the evaluation tended to be limited to the extent which can be obtained from physical examination. We investigated detailed craniofacial, oral and dental findings in four patients with Costello syndrome. In this study, images reconstructed by multi-detector row computed tomography (MDCT) were used as substitutes for dental cast study and panoramic and lateral cephalometric radiograph studies to evaluate dental arches, tooth size, relationships between craniofacial and dental structures, and hypodontia. All four patients showed true/relative macrocephaly with facial bone hypoplasia and gingival hypertrophy. Occlusal attrition, malocclusion, small dental arches, microdontia, and convex face were noted in three patients. In addition, one patient showed dental caries, conic tooth and gingivitis, and another patient showed hypodontia. Our study suggests that craniofacial and dental abnormalities are common in Costello syndrome patients and comprehensive dental care should be provided from early infancy. To our knowledge, this is the first study of thorough craniofacial and dental evaluation by using MDCT in Costello syndrome. MDCT is a useful tool for precise evaluation of craniofacial and oral manifestations in patients with congenital anomaly/intellectual disability syndromes.

Dipeptidyl peptidase-like protein 6 (DPP6), a member of the dipeptidyl aminopeptidase family, plays distinct roles in brain development, but its expression in embryonic Meckel's cartilage and tooth germs development is unknown. We analyzed the expression pattern of DPP6 in Meckel's cartilage and tooth germs development using in situ hybridization. DPP6 was detected in different patterns in Meckel's cartilage and tooth germs during mouse facial development from 11.5 to 13.5 days post-coitus (dpc) embryos. The expression pattern of DPP6 suggests that it may be involved in mandible and tooth development.

Some cases in orthognathic surgery present with large discrepancies between the skeletal pattern and the occlusion. If there is little or no sagittal dental discrepancy, but the mandibular basal bone is prognathic, surgical correction can be critical. We describe a two-step procedure to treat these patients. The first step is to adapt the lower alveolar bone to the position of the chin. Distraction osteogenesis in the anterior dentoalveolar mandibular region carries the lower incisors to the same level as the chin. A one-tooth space is opened in the distraction area to obtain a full negative over-jet. Bimaxillary osteotomy can be used to correct class III dentoskeletal malocclusion. Five patients aged 20-40 years have been operated on during the last 2 years. The first step creates harmony between the chin and lower lip, together with a negative over-jet and a true prognathic profile. The class III malocclusion is corrected with a bimaxillary osteotomy. Our two-step plan achieves good occlusion and profile in patients with severe discrepancies between their occlusion and the position of the chin. Dental implants can then be inserted into the gaps left by distraction, which results in a third bicuspid on each side of the mandible.

OBJECTIVES:

To answer the clinical research question: in patients with myofascial pain, are there any differences in the surface electromyography (sEMG) activity of muscles of the painful and nonpainful sides that can be detected by commercially available devices?

METHODS:

The study sample (N = 39; 64%F, mean age 35.7 ± 15 years) consisted of patients seeking for temporomandibular disorders Temporomandibular Disorders (TMD) treatment and meeting Research Diagnostic Criteria for TMD (RDC/TMD) diagnosis of myofascial pain, with pain referred only in muscles on one side. They underwent sEMG of jaw muscles to record levels of standardized sEMG activity at rest, as well as during maximum clenching on teeth for the four investigated muscles, viz., bilateral masseter and temporalis. The existence of differences between sEMG values of muscles of the painful and nonpainful sides during the standardization test (i.e., clenching on cotton rolls) at rest and during clenching on teeth was assessed.

RESULTS:

At the study population level, differences between the sEMG values of muscles of the painful and nonpainful sides were not significant in any conditions, viz., either at rest or during clenching tasks. At the individual level, the difference between the sEMG activity of painful and nonpainful sides was very variable.

CONCLUSIONS:

The above findings were not supportive of the existence of any detectable difference in sEMG activity between jaw muscles of the painful and nonpainful sides in patients with unilateral myofascial pain. Centrally mediated mechanism for pain adaptation may explain these findings, and the role of sEMG as a diagnostic tool for muscle pain needs to be carefully reconceptualized.

Abstract

Background:

Congenital insensitivity to pain with anhidrosis (CIPA) is a congenital autonomic sensory neuropathy. In southern Israel, there are many patients with this disease. We here tried to characterize the different infections acquired by children with CIPA.

Methods:

We collected all the available data about CIPA patients in southern Israel in the year 1991-2005, including the lesion types, area in the body where the infection occurs, and the treatment given.

Results:

The current study included 30 children with CIPA, out of 44 known CIPA patients in southern Israel (68.2%). A total of 382 different episodes of infections, fever, orthopedic lesions, and jaw and mouth lesions led our patients to our outpatient clinic or resulted in hospitalization.

Conclusion:

We found that children with CIPA mainly have infections of the skin and skeleton, and that the most frequent pathogen is Staphylococcus aureus. We also found that a fair amount of these pathogens are resistant to conventional treatment regimens.