Cosme Gay-Escoda

Morbidity associated with removal of the submandibular gland

Postoperative complications in 206 submandibular gland excisions, excluding those resulting from benign or malignant tumours, carried out during a 15-year period were reviewed. Most patients (62%) had sialolithiasis. Coexistence of sialolithiasis and nephrolithiasis was documented in 5.5% of cases. Early postoperative complications (particularly infection) developed in 14.6% of the cases, whereas late complications appeared in 25.3% of the cases (residual inflammation in Whartons duct 7.3%). Neurological complications were observed in 16% of the cases. In 7 cases (3.4%) several nerves were involved and almost always the hypoglossal nerve. In 37.4% of the cases, these lesions resolved spontaneously in a mean period of 4 months. In those cases with a permanent neurological deficit, the facial nerve was the most often affected (7.7%) followed by the hypoglossal (2.9%) and the lingual nerve (1.4%). A single case of gustatory sweating (Freys) syndrome was observed.

Diagnosis and treatment of branchial cleft cysts and fistulae. A retrospective study of 183 patients

A retrospective analysis of 183 patients undergoing surgical treatment for branchial cleft cysts and fistulae between 1970 and 1990 was carried out. There were 148 (80.8%) cases of branchial cleft cysts and 35 (19.2%) cases of branchial cleft fistulae. In patients with branchial cysts, the most frequent clinical presentation consisted of a left-sided, painless, cervical mass. Patients with a branchial fistula presented with persistent mucous discharge from a skin opening in the neck. The introduction of ultrasonography, computed tomography, and magnetic nuclear resonance imaging has improved the accuracy of traditional radiologic methods such as parotid sialography and fistulography. Complete excision under general anesthesia is the treatment of choice, and the procedure is associated with a low incidence of local complications and neurologic sequelae. The overall recurrence rate was 4.9% after a follow-up of 2 years.

Lingual nerve protection during surgical removal of lower third molars : A prospective randomised study

A prospective randomised study was designed to evaluate the efficacy of protecting the lingual nerve by subperiosteal insertion of a retractor in 300 patients. All operations were performed under local anaesthesia and only one molar was removed at a time. In one group, the lower third molar was removed with protection of the lingual nerve and in another group, without protection. Molars which did not need to be sectioned were excluded from the study. The position of the molar, the degree of surgical difficulty and patient gender and age were also recorded. The results indicate 1.33% incidence of temporary lingual nerve dysaesthesia--this being low in comparison with other studies. No permanent disturbances were found. The intergroup percentage difference was not significant. It is suggested that routine application of a lingual protecting instrument during surgical removal of a third molar is not necessary in the hands of an experienced surgeon.

Mediastinitis from odontogenic infection: Report of three cases and review of the literature

Descending necrotizing mediastinitis secondary to dental infection occurs infrequently. The diagnosis of this condition is difficult and often a surgical approach is delayed due to initial clinical improvement after antimicrobial therapy. An incorrect evaluation of this apparent improvement may result in fatal mediastinitis and septic shock. We report 3 cases of mediastinitis of odontogenic origin. In one patient, a nonproductive cough was the first sign of thoracic involvement. A total of 25 similar cases of mediastinitis from odontogenic infection have been collected from the literature in the last 15 years. Some features have to be emphasized, such as the polymicrobial flora, the higher prevalence in males, and the high mortality rate of approximately 44%.

Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars

The aim of this study was to demonstrate the efficacy of methylprednisolone, as a single 40-mg dose, injected into the masseter muscle upon completion of extraction of impacted lower third molars. A prospective, randomized cross-over study was made of 35 healthy patients. The difficulty of extraction was similar in all cases. The study group received 40 mg of methylprednisolone injected into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound. The control group received no intramuscular corticoid. Evaluations were made of postoperative pain, trismus and swelling. Oral aperture was measured, along with the following distances for the assessment of swelling: tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye, before and 2 and 7 days after surgery. The patients administered methylprednisolone showed superior results after surgery in terms of oral aperture, pain and all the facial swelling parameters, with statistically significant differences versus the controls (p<0.05). The results obtained show that 40 mg of methylprednisolone injected into the masseter muscle in the immediate postoperative period reduces swelling, trismus and pain.

Postoperative complications in smoking patients treated with implants: a retrospective study.

PURPOSE To identify the risk of complications (eg, implant loss, infection, peri-implantitis, and mucositis) in a group of patients treated with osseointegrated implants and to assess the effect of smoking on this risk. MATERIALS AND METHODS A retrospective cohort study of patients treated in the Unit of Implantology, University of Barcelona Faculty of Dentistry was performed. All patients had already undergone prosthetic treatment, and the minimal follow-up time after implant surgery was 6 months. RESULTS A total of 295 patients fulfilled the inclusion criteria; 56.9% were women and 43.1% were men. They received a total of 1,033 implants. There were 209 complications (32 cases of implant loss, 2 cases of infection, 70 cases of peri-implantitis, and 105 cases of mucositis). The smoking habit was associated with an increased risk of complications (P = .008). CONCLUSION Smokers had an increased risk of complications, including infection, implant loss, mucositis, and peri-implantitis, compared with nonsmoking patients.

Eruption disturbances of the first and second permanent molars: Results of treatment in 43 cases ☆ ☆☆

Impaction or retention of first and second permanent molars is an uncommon condition with diverse therapeutic approaches. To ascertain the success rate of different treatment possibilities, a retrospective study was made of 25 patients with a total of 43 permanent molars with eruption disturbances. In most cases, the nonerupted teeth were mandibular second molars (65%), followed by maxillary second molars (21%). Their position, degree of impaction (inclusion), clinical features, repercussion on the neighboring teeth, type of treatment, and outcome were evaluated. Infraocclusion was often associated with malposition of neighboring teeth, as well as extrusion and infraocclusion of opposing teeth. Due mostly to a delay in the diagnosis of the condition, an acceptable final position of the nonerupted molar was obtained in only 8 of 13 conservatively treated second molars. In order to prevent this situation, radiographic examination (ideally during the early mixed dentition period) and early diagnosis of eruption disturbances of permanent first and second molars are recommended, particularly when considering that these anomalies are associated with a high rate of occlusal disturbances that may require orthodontic correction.

Eminectomy associated with redirectioning of the temporal muscle for treatment of recurrent TMJ dislocation.

Fourteen patients with recurrent dislocation of the temporomandibular joint underwent surgical operation which consisted of Myrhaugs (1951) technique (resection of the articular tubercle and eminence). In 12 of these 14 cases, Myrhaugs technique was associated with redirectioning of the temporal muscle (Ullik and Zenkers (1961) technique). The simultaneous performance of both surgical procedures has been extremely useful in achieving a definite cure of recurrent dislocation of the temporomandibular joint.

In vivo low-density bone apposition on different implant surface materials

During osseointegration, new bone may be laid down on the implant surface and/or on the old bone surface; the former is known as contact osteogenesis and the latter as distance osteogenesis. Implant surface topography and material composition affect this process. The present study evaluates Ca and P apposition onto three different dental implant material surfaces (carbon monoxide (CO) ion implantation on Ti6Al4V, sand blasting and acid etching on commercially pure titanium and untreated Ti6Al4V) on the mandibles of beagles after healing periods of 3 and 6 months. Energy dispersive spectroscopy is useful for identifying low-density bone relative to surrounding mature bone, allowing for discrimination of the osteogenesis source. Low-density bone was only found at the apical end; there was none on the surface of untreated implants. Low-density bone arising from mature bone towards the implant at month 3 (i.e. distance osteogenesis) was only present on the CO ion implanted samples, due to the modification of the surface nano-topography and the chemistry and structure of the material.

Hemodynamic changes during the surgical removal of lower third molars.

PURPOSE This study was conducted to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molars, and to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. PATIENTS AND METHODS A prospective study was made of 80 normotensive individuals (40 females and 40 males, mean age, 27 years [range, 18 to 67 years]) seen in the Service of Oral Surgery in the context of the Masters Degree Program in Oral Surgery and Implantology, School of Dentistry, University of Barcelona, for surgical extraction of the lower third molars. Local anesthesia comprised 4% articaine with vasoconstrictor (adrenalin 1:100.000). The following parameters were monitored in each of the surgical interventions: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SaO(2)). Finally, tests of patient anxiety (Corahs Dental Anxiety Scale and Kleinknechts Dental Fear Scale) were carried out, and the degree of pain experienced during the surgical procedure was assessed by means of a visual analog scale. RESULTS The females showed higher levels of anxiety. The most anxious patients had the lowest BP values and the highest HR, although the differences did not reach statistical significance. The variations in BP and HR during surgical extraction of the molars were within normal limits. In the case of BP, no significant changes were recorded; the highest mean SBP and DBP values were observed at the time of ostectomy and/or tooth sectioning. The lowest HR values were recorded at baseline, before the start of the surgical procedure, whereas the highest values were obtained during incision and flap raising. The SaO(2) values showed no significant changes and were lower at the start of the surgical procedure. CONCLUSIONS Most of the cardiovascular changes induced by the surgical extraction of molars were within normal ranges, considering the anxiety and stress induced by surgery. We consider it essential to avoid pain and minimize patient anxiety to ensure safe clinical practice.