Fotios Tzermpos

Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patients previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patients medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.

Function of blood monocytes among patients with orofacial infections

Few data are available on the significance of the integrity of the innate immune system among patients with orofacial infections. This was assessed in the present study. Peripheral blood mononuclear cells (PBMCs) were isolated from 23 patients with orofacial infections before surgical debridement and from 12 healthy volunteers. PBMCs were stimulated with bacterial endotoxin (LPS) and with Pam3Cys. Concentrations of interleukin (IL)-1β, IL-6 and tumor necrosis factor-alpha (TNFα) were estimated in supernatants by an enzyme immunoassay. Concentrations of estimated cytokines released from PBMCs of healthy volunteers and of patients did not differ. Intensity of cytokine release after stimulation was related with the time until complete resolution of the infection (p: 0.046). It is concluded that adequate functions of blood monocytes are associated with favorable outcome after surgery for orofacial abscesses. It seems, however, that impairment of monocyte function predisposes to infection persistence.

Management of Intraosseous Vascular Malformations of the Jaws in Children and Adolescents: Report of 6 Cases and Literature Review.

ABSTRACT Background Intraosseous vascular malformations represent a rare clinical entity of the facial skeleton. The purpose of the current study was to present our experience in a Greek paediatric population and propose guidelines for the treatment of these jaws anomalies in children and adolescents. Methods A retrospective study (from 2009 to 2014) was performed to investigate the features and management of the intraosseous vascular anomalies in a Greek paediatric population. Results Six patients aged between 6 and 14 years were treated for intraosseous vascular malformations (4 venous and 2 arteriovenous) of the jaws. Five lesions were located in the mandible and one in the maxilla. In four lesions with pronounced vascularity superselective angiography, followed by embolization was performed. Individualized surgical treatment, depending on the size and vascularity of the lesions was applied in 4 patients. Conclusions The intraosseous vascular malformations of the jaws may escape diagnosis in paediatric patients. A multidisciplinary approach is important for their safe and efficient treatment. Embolization is recommended for extended high-flow lesions, either preoperatively or as a first-line treatment, when surgery is not feasible without significant morbidity.

Segmental sandwich osteotomy of the posterior mandible in pre-implant surgery - A systematic review.

Background The rehabilitation of the atrophic posterior mandible with dental implants often requires bone augmentation procedures. The aim of the present study is the systematic review of the literature concerning the success rate of Segmental Sandwich Osteotomy (SSO) of the posterior mandible in pre-implant surgery. Material and Methods Systematic review of all clinical cases and clinical studies of SSO of the posterior mandible in pre-implant surgery with a minimum follow-up of 6 months after implant loading was performed, based on specific inclusion and exclusion criteria. The search strategy involved searching the electronic databases of MEDLINE, EMBASE, COCHRANE LIBRARY, Clinical Trials (www.clinicaltrials.gov) and National Research Register (www.controlled-trials.com), supplemented by a manual search, in August 2015. In every study, the intervention characteristics and the outcome were recorded. Results Out of the 756 initial results, only 17 articles fulfilled the predetermined inclusion and exclusion criteria. They consisted of 9 retrospective case reports or series and 8 prospective randomized clinical trials. Overall, the studies included 174 patients. In these patients, 214 SSO augmentation procedures were performed in the posterior mandible and 444 implants were placed. The follow-up period after implant loading ranged between 8 months and 5.5 years. The success rate of SSO ranged between 90% and 100%. The implant survival during the follow-up period ranged between 90.9% and 100%. Conclusions Segmental Sandwich Osteotomy should be considered as a well documented technique for the rehabilitation of the atrophic posterior mandible, with long-term postsurgical follow-up. The success rates are very high, as well as the survival of the dental implants placed in the augmented area. Key words:Segmental osteotomy, dental implant, mandible, inlay graft.

Plazmacitoidni mioepiteliom tvrdog nepca: prikaz slučaja

Background Myoepitheliomas are uncommon salivary gland neoplasms consisting entirely or predominantly of cells with myoepithelial phenotype. They commonly involve the parotid gland and the minor salivary glands of the palate. Aim A case of plasmacytoid myoepithelioma of the hard palate is described. Case description and results A 55-year-old woman presented to her oral surgeon with a tumor on the hard palate. Microscopic examination showed a well-circumscribed but non-encapsulated tumor, consisting mostly of plasmacytoid cells in a loose fibrovascular stroma. Neoplastic myoepithelial cells showed immunoreactivity for S-100 protein, CK AE1/AE3 (Figure 5b), GFAP, calponin, and CD138/Syndecan-1. Total excision of the tumor under local anesthesia was performed and no recurrence was noted 14 months after treatment. Conclusions Since plasmacytoid myoepithelioma is uncommon, minor salivary glands, its immunohistochemical features, management and prognosis should be further investigated.

A painful swelling of the mandible

CLINICAL PRESENTATION A 54-year-old female patient presented to the Department of Oral and Maxillofacial Surgery with a chief complaint of lower jaw pain and a feeling of numbness in the lower lip, both on the right side. The patient reported that her symptoms started 3 months ago as numbness and feeling of swelling of the lower lip accompanied by ear pain on the right side; no treatment was administered. Fifteen days earlier, the patient had presented to a General Hospital complaining of gingival pyorrhea and swelling of the right mandible. Antibiotic treatment (amoxicillin 1 g two times daily and metronidazole 500 mg three times daily) was administered with limited improvement. At this point, the patient was referred to our Department for additional evaluation and management. Her medical history was significant for breast cancer diagnosed 5 years ago. Her initial treatment included chemotherapy with docetaxel, four cycles of cyclophosphamide, epirubicin, and 5-fluorouracil and radiotherapy, which resulted in full remission. For the last 4 years, the patient was receiving the aromataseinhibitor anastrazole for hormone manipulation. No use of bisphosphonates was reported. She was a light smoker (of approximately one to two cigarettes per day for several years) and a nondrinker. Intraoral clinical examination did not reveal significant findings, except for a palpable swelling of the buccal cortical plate in the right posterior mandible toward the angle. Extraoral examination revealed facial asymmetry due to swelling of the body of the right mandible extending to the angle (Figure 1). Review of a

Atypical Presentation of an Upper Lip Pleomorphic Adenoma: Case Report

The pleomorphic adenoma (PA) or mixed tumor is the most common neoplasm of the salivary glands, usually presenting with a non-specific clinical manifestation and a diverse histopathological pattern. The region of the lips is the second most common site for minor gland neoplasms. The aim of this paper is to report the case of a 39 year old caucasian woman presenting with a swelling on the right side of the upper lip combined with a history of trauma in the region of the upper right central incisor, eight years ago. The swelling was attributed to the periapical lesion of the upper right central incisor that was observed on the orthopantomography. Intraoperatively the surgeon came upon a nodule of firm consistency in the mucolabial fold. The histopathologic diagnosis of this lesion was benign mixed tumor of salivary gland. This report discusses the deviation in frequency of mixed salivary gland tumor between upper and lower lip, the clinical differential diagnosis, the histopathological pattern and the appropriate treatment.