Candan Efeoglu

Malnutrition due to bisphosphonate-related osteonecrosis of the jaw in a chronic dialysis patient: case report

Abstract Adequate nutrition is imperative for a successful outcome in dialysis patients. Excellent oral hygiene and an efficient mastication can help to correct several metabolic and endocrine disturbances as well as delay initiation of dialysis in patients with chronic renal failure. However, concerns exist about the risk of malnutrition and protein depletion. On the other hand, intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws. This complication occurs either spontaneously or after minor dento-alveolar surgery including extraction of teeth. A malnourished dialysis patient who showed the typical clinical features of bisphosphonate-related osteonecrosis of the jaw (BRONJ) without any obvious radiological changes in his panoramic radiograph is reported. To minimize the risk of BRONJ, patients initiated on bisphosphonates should optimize routine dental care and have their baseline oral health evaluated by both clinical and radiographic examinations before initiation of bisphosphonate therapy.

A stepped approach for the management of symptomatic internal derangement of the temporomandibular joint

BackgroundInternal derangement is the clinical and pathological condition of disc displacement of the temporomandibular joint. Management of these cases involve conservative and surgical treatment options. Minimally invasive surgical procedures namely arthrocentesis and arthroscopy are promising techniques in the management of internal derangement. However patient selection algorithms, indications for minimally invasive procedures and details of the techniques should be further studied for safe and cost effective management of these cases.This manuscript aims to retrospectively analyze the significance of a stepped surgical treatment approach (arthrocentesis under local anaesthesia as the first line of treatment, followed by arthroscopic lysis and lavage under general anaesthesia in unresolving cases) of internal derangement with or without osteoarthritis.MethodsThis is a retrospective cohort study. Case notes of 1414 patients that were managed with a standard protocol were reviewed. Appropriate inclusion and exclusion criteria were set. Thirty-three patients were eligible for inclusion. Parameters recorded were pain-free inter-incisal opening, spontaneous pain, pain on function, difficulty on chewing, and perceived disability on jaw movements. Pre-operative and post-operative (at the end of the follow up period) pain free maximum interincisal opening values were compared with paired t test and the subjective parameters were evaluated with Chisquare analysis. Treatment outcome and success rate according to American Association of Oral and Maxillofacial Surgeons were descriptively shown.ResultsInterincisal opening values increased, and the number of patients with severe or medium rated subjective parameters were reduced at discharge. These improvements were found to be statistically significant. Clinical (Wilkes) staging of internal derangement pre-operatively and at discharge remained either unchanged or was lower. Treatment outcome and success according to American Association of Oral and Maxillofacial Surgeons criteria was 94%.ConclusionThe stepped approach for the management of symptomatic internal derangement with or without osteoarthritis is a successful treatment strategy with favourable therapeutic outcomes.

The effect of teeth in mandibular fracture lines

BACKGROUND/AIM The decision to retain or extract teeth in the line of mandibular fractures has been a subject of debate in the scientific literature, and there is a need for further evidence to clear this issue. Thus, the aim of this study was to investigate the effects on healing of teeth in the line of mandibular fractures in order to contribute to the field. MATERIAL AND METHODS The case notes of 100 patients with teeth in the line of 106 mandibular fractures were reviewed. Open reduction and rigid internal fixation (ORIF) was used if elastic intermaxillary reduction failed to achieve a satisfactory occlusion and/or anatomical reduction in the fragments as assessed by orthopantomogram (OPG) and clinical examination. The remaining cases had maxillomandibular fixation (MMF) with an arch bar and bridle wire. RESULTS Three of the 106 teeth involved in the fracture lines healed with complications. In the cases where the teeth had been removed prior to fracture treatment, or in cases of delayed extractions, no complications were noted. CONCLUSION The factors which should be considered for removal include the condition of the teeth and alveolar bone, the timing and the type of treatment. This decision should be made on an individual basis considering potential risks to avoid complications.

Odontojen enfeksiyon ile karışan kemik içi yerleşimli mandibuler hemanjiom

Hemangioma is a neoplasm that is rarely seen in the oral cavity. The most commonly affected facial bones are the mandible, the maxilla and the nasal bones. A case of intraosseous hemangioma, adjacent to a lower molar with periodontitis is presented. The involved tooth and the lesion were excised under local anesthesia. Histopathological examination did not reveal cellular atypia or mitotic activity. The differential diagnosis of radiolucent periapical lesions is discussed with emphasis on radiographic appearance. Intraosseous hemangioma of the mandible is a very rare pathology and this case has unique aspects like the misleading presentation, the age and sex of the patient. Removal of the involved tooth and a complete enucleation of the central hemangioma were sufficient for the treatment of this case, and there were no clinical or radiological signs of recurrence three years after the operation.

Temporomandibuler Eklem Artrosentezinin İlginç Bir Komplikasyonu: Olgu Sunumu

Bu olgu sunumunda, artrosentezin teknik detaylarinin irdelenmesi ve 22 yasindaki bir bayan hastada gelisen nadir bir komplikasyonun bildirilmesi amaclanmistir. Hastanin sol temporomandibuler eklemindeki (TME) periyodik kilitlenme ve agri semptomlarini tedavi edebilmek icin artrosentez uygulanmistir. Artrosentez islemi sirasinda, ortaya cikan agri ve basinc duyusunu ortadan kaldirmak icin uyguladigimiz, intraartikuler lidokain enjeksiyonununu takiben artrosentez islemine devam edilmis ve sonrasinda, ayni taraftaki nervus lingualis ve nervus alveolaris inferiorde bir saat sϋren anestezi izlenmistir. Kontrolleri devam eden hastada kalici bir komplikasyon izlenmemistir. Olgumuzda, kanϋllerin ϋst eklem bosluguna yerlestirilmesi sirasinda eklem kapsϋlϋnϋn medyal duvarinda istemeden bir perforasyon olusturuldugu ve bunun sonucunda, serum fizyolojik ve lokal anestezik maddenin infratemporal fossaya yayilmasiyla ekleme yakin komsuluktaki nervus mandibulariste anestezi gelistigi dusunulmustur. Bildigimiz kadariyla artrosenteze bagli olarak gelisen boyle bir komplikasyon daha once bildirilmemistir. Atrosentez sirasinda ekstravasasyona (irrigasyon sivisinin eklem kapsulunun disina sizmasina) engel olmak veya en az seviyede kalmasini saglamak, istenmeyen anestezi veya yumusak doku odemine bagli olarak havayolunun daralmasi gibi komplikasyonlara engel olmak acisindan onem tasimaktadir.

Aktinik şelitis tedavisinde 5-fluorourasıl (5-fu) kullanımı: derleme ve iki olgunun sunumu

Actinic (solar) cheilitis is an epithelial precancerous lesion with a predilection of lower lip rather than upper lip. Clinically they may be undistinguishable from squamous cell carcinomas. Therefore actinic cheilitis should not be left untreated and the effected area should be protected from exposure to excess sun light. Two patients complaining of chronic ulcers and burning sensation on their lower lips were referred to the oral surgery clinic. Clinical examination revealed keratotic areas and superficial ulcers on lower lip vermillion. Patients’ history and the clinical findings led us to a clinical diagnosis of actinic cheilitis in both cases. The diagnoses were confirmed histopathologically, treatment was with topical 5-FU and one of the cases is still under our review. Clinical appearance of actinic cheilitis can be similar to lip carcinomas and there is the risk of transformation to squamous cell carcinoma. For this reason it is imperative that a biopsy is taken promptly to confirm the diagnosis. Recurrence is possible after treatment and this necessitates regular review appointments. Patient compliance is a must, and to improve this, treatment options should be discussed with the patient and their preferences should be considered. OZET Aktinik (solar) selitis daha cok alt dudakta gorulen epitelyal prekanseroz bir olusumdur. Klinik olarak, skuamoz hucreli karsinomdan ayrilmasi guc olabilir. Bu nedenle aktinik selitis tedavisiz birakilmamali ve etkilenen bolge gunes isigindan korunmalidir. Alt dudaklarinda iyilesmeyen yara ve yanma sikayeti olan 2 olgu, Agiz Dis Cene Hastaliklari ve Cerrahisi Anabilim Dali klinigine basvurmuslardir. Muayenede alt dudak vermilyonlarinda iyilesmeyen yuzeyel ulserler ve keratotik alanlar iceren lezyonlar saptanmistir. Her iki olgunun da hikayeleri ve klinik muayeneleri sonucunda aktinik selitis on tanisi konmustur. Tanilar histopatolojik tetkikle dogrulandiktan sonra topikal 5-FU tedavisi uygulanmis olup, olgulardan birinin kontrolleri halen devam etmektedir. Aktinik selitisin klinik gorunumu dudak karsinomuna benzeyebilecegi gibi, skuamoz hucreli karsinoma donusme riski de bulunmaktadir. Bu nedenle klinik taninin dogrulanmasi icin en kisa surede biyopsi alinmalidir. Tedavi sonrasinda nuks ihtimali oldugundan hastalarin duzenli araliklarla kontrolu onem tasir. Tedavide hasta uyumunu ve memnuniyetini onemsemek gerekir ki, bu nedenle olasi tedavi secenekleri hakkinda hasta bilgilendirilmeli ve tedaviye tercih edilen yontem ile baslanmalidir. Anahtar kelimeler: Aktinik selitis, selitis, 5-fluorourasil