D. Blinder

Oral manifestations of sarcoidosis.

OBJECTIVE To report two new cases of sarcoidosis of the buccal mucosa and to analyze the literature on oral manifestations of sarcoidosis. STUDY DESIGN Oral lesions with histologic features of sarcoidosis were analyzed according to their location and appearance. RESULTS Analysis of 45 cases of oral sarcoidosis (43 from the literature and the 2 new presented cases) revealed 12 lesions in the jaws, 10 in the buccal mucosa, 6 in the gingiva, 5 in the lips, 5 in the floor of the mouth, 4 in the tongue, and 3 in the palate. Sarcoidosis in the jaw was located in the alveolar bone and presented as an ill-defined radiolucency. Submucosal nodules were observed in sarcoidosis affecting the buccal mucosa, palate, and lip. Swelling was the main manifestation in the gingiva. In the floor of the mouth, sarcoidosis presented as ranula and that of the tongue as induration. In most of the cases, the lesions in the buccal mucosa, gingiva, and tongue were the first clinical manifestation of the disease. CONCLUSION Oral sarcoidosis lesions should be considered in the differential diagnosis of oral soft tissue swellings and jaw lesions.

Electrocardiographic changes in cardiac patients having dental extractions under a local anesthetic containing a vasopressor

PURPOSE This study attempted to identify which group of cardiac patients is most at risk when dental extractions are performed under a local anesthetic with a vasopressor. PATIENTS AND METHODS Forty cardiac patients who had dental extractions under local anesthesia were connected to a Holter monitor for 24 hours, starting an hour before the procedure. The electrocardiogram was analyzed for the number of premature beats, ST depression, and cardiac rhythm. A mean rate was calculated for the first 2 hours after injection of the local anesthetic and for the subsequent 22 hours. The preoperative electrocardiogram was compared with the electrocardiogram performed 1 week before treatment. RESULTS Electrocardiographic changes were observed in 15 patients (37.5%), and all occurred during the first 2 hours after injection of the local anesthetic. Of the 15 patients, eight were being treated with digoxin. CONCLUSIONS Cardiac patients being treated with digoxin had more electrocardiographic changes after administration of a local anesthetic than other cardiac patients. When the local anesthetic contained a vasopressor, there was a greater incidence of tachycardia but less arrhythmia or ST depression.

Surgical considerations in cases of large mandibular odontomas located in the mandibular angle

The surgical treatment of two large, complex odontomas of the angle of the mandible is described. It is recommended that the surgeon consider excision by an intraoral, lingual approach when indicated. The advantages, indications, and possible complications of this approach are discussed.

Electrocardiographic changes in cardiac patients undergoing dental extractions under local anesthesia

PURPOSE The purpose of this study was to identify which group of cardiac patients is most at risk when dental extractions are performed under local anesthesia. PATIENTS AND METHODS Forty cardiac patients who had dental extraction under local anesthesia (Mepivacain HCl three percent) were connected to a Holter monitor for 24 hours starting 1 hour before the procedure. Of the 40 patients, 24 had coronary artery disease, 12 had valvular disease, 3 were being treated with antiarrhythmic drugs, and 1 had malignant arterial hypertension. Sixteen patients were being treated with digoxin. The electrocardiogram was analyzed for the number of premature beats, ST depression, and cardiac rhythm. A mean rate was calculated for the first 2 hours after injecting the local anesthetic and surgical procedure, and for the subsequent 22 hours. RESULTS All electrocardiographic changes occurred during the first 2 hours after injecting the local anesthetic. When the mean rate of that period was compared with the remaining 22 hours, new pathologic signs of arrhythmia, tachycardia, or ST depression were seen in 14 patients (35%). Of these, 12 were being treated with digoxin. CONCLUSION Patients being treated with digoxin for atrial fibrillation or congestive heart failure are more prone to complications during dental extractions under local anesthesia than other cardiac patients.

Metastatic basal cell carcinoma presenting in the oral cavity and auditory meatus: A case report and review of literature

Basal cell carcinoma is a common neoplasm of the skin which rarely metastasizes. A rare case of metastatic basal cell carcinoma to the mandibular alveolar ridge and to the auditory meatus is described. The pertinent literature since 1977 is reviewed and the possible pathways of metastatic spread are discussed.

Intraoral vertical ramus osteotomy: a simple method to prevent medial trapping of the proximal fragment.

Intraoral vertical ramus osteotomy (IVRO) is a useful surgical procedure for mandibular setback in patients with mandibular prognathism or mandibular asymmetry. IVRO has some intraoperative complications, such as the medial trapping of the proximal segment. Several techniques have been described to overcome this problem, but none can prevent it. This technical report describes a method that prevents the medial trapping of the proximal segment during IVRO.

Conversion disorder after maxillofacial trauma and surgery

Three cases of conversion disorder are reported: one after orthognathic surgery and two after facial trauma. Two of the cases involved facial anesthesia and one case involved facial palsy. It was thought to be important to bring this phenomenon to the attention of oral and maxillofacial surgeons, to consider its management, and to define the patients with a high risk of developing conversion disorder. The prognosis is dependent on the circumstances of the onset of the disorder, the premorbid psychologic health of the patient, and how rapidly treatment is prescribed.

Sinus floor augmentation with simultaneous implants placement in the severely atrophic maxilla

Dental implant placement associated with augmentation of the sinus floor in the severely atrophic maxilla can be performed in 1- or 2-surgical stages, depending on the height of the residual alveolar bone. A minimum of 4 to 5 mm of residual alveolar bone height is recommended for a 1-stage surgical procedure. The present study describes a 1-stage procedure in cases where the residual alveolar bone height in the posterior maxilla was 1 to 2 mm. A total of 55 hydroxyapatite-coated dental implants were inserted in 20 grafted sinuses of 20 patients. No case presented any difficulty in achieving initial stabilization and parallelism. No perforation of the sinus membrane or clinical complications of the sinuses were evident. Prior to exposure, radiographic evaluation revealed bone consolidation and a close bone-implant relation. At second-stage surgery, there was no clinical evidence of crestal bone loss around the implants. All implants were clinically osseointegrated. All patients received fixed implant-supported prosthesis. The mean follow-up was 26.4 months (range 15 to 39 months). There was no implant loss after loading. The following surgical modifications are essential: a wide lateral window opening, the use of a bone mill to homogenize the bone graft, meticulous condensation, and clinical measurements to ensure implant parallelism.

Idiopathic submandibular abscesses in children

Idiopathic submandibular abscesses are often observed in young children and the report concerns 31 children treated over a period of 3 years. Their origin is unknown. As all these abscesses were lymph node abscesses in the submandibular region, it is assumed that they are due to minor oral and nasal cavity traumatic lesions secondarily infected. Antibiotic treatment and surgical drainage resulted in quick resolution and recurrences were never observed.