Kostas Antoniades

Non-AIDS Kaposi's sarcoma in the head and neck area

Kaposis sarcoma is classified into 4 types: classic (sporadic), African (endemic), iatrogenic (transplant recipients), and epidemic (acquired immunodeficiency syndrome [AIDS]‐associated). This article aims to feature a comprehensive review of non‐AIDS Kaposis sarcoma, including literature review and report of 3 cases. Case material was from our hospitals archive. Literature review was conducted via electronic and manual medical database searches. Biological aspects, diagnostic difficulties, investigation protocols, and management modalities are discussed.

Mandibular lesions of vasoocclusive origin in sickle cell hemoglobinopathy

Sickle cell hemoglobinopathy is an inherited disorder characterized by vasoocclusive crises. Involvement of the maxillofacial skeleton leading to radiopaque lesions that correspond to bone infarcts has rarely been reported in the literature. Forty-two adult patients suffering from sickle cell anemia were examined radiographically for radiopaque lesions situated in the course of a known vessel or in the apical region of the teeth. In 6 cases, such lesions were combined with facial pain during sickle cell crisis and absence of dental pathology and were considered to be of possible vasoocclusive origin. In conclusion, vasoocclusive involvement should be taken into consideration when assessing painful episodes or neurological symptoms in the maxillofacial region in this patient population.

Abducent nerve palsy following transverse fracture of the middle cranial fossa

Transverse sphenoidal fractures may be associated with a variety of skull base injuries and neural deficits. Among those nerve injuries, oculomotor palsies and particularly sixth cranial nerve palsy, are quite common. Blows on the side of the head in the squamous temporal region may run across the floor of the middle cranial fossa through the greater wing of the sphenoid in the transverse cranial axis. We report three cases of patients who had sustained craniofacial injury which included a transverse fracture of the middle cranial fossa through the sphenoid sinus, extending to the petrous apex and producing abducent, facial, and eighth nerve dysfunction. Spontaneous recovery from diplopia occurred in all cases within 4 months. The management of the patients and the patterns of transverse cranial base fractures and their associated clinical features are discussed.

Chronic idiopathic hyperphosphatasemia : case report

Chronic idiopathic hyperphosphatasemia, or juvenile Paget disease is a very rare syndrome that is characterized by fragile bones, bowing deformities, shortness of stature, large head, premature loss of teeth, radiographic evidence of expanded osteoporotic long bones with coarse trabeculations, and widened bones of the skull. Increased levels of serum alkaline phosphatase and increased levels of urinary total hydroxyproline are notable. We present a case of juvenile Paget disease that was associated with a history of precocious puberty. The patient had odontogenic osteomyelitis of the mandible that was treated by drainage, surgical debridement and antibiotic therapy.

Sagittal fracture of the maxilla

Although sagittal fractures of the maxilla are not common, they can be observed in some cases following severe trauma to the facial skeleton. 18 of the 23 cases reported had combined mandibular and midfacial fractures. Sometimes in severe cases they may demonstrate instability with conventional methods of treatment; thus for adequate stabilization they may need a palatal splint, direct wiring (internal fixation in the buttresses), intermaxillary fixation and cranial suspension.

Salivary Gland Trauma: A Review of Diagnosis and Treatment

Salivary gland trauma is uncommon. Parotid gland and duct injuries are far more common than injuries to submandibular and sublingual glands due to anatomic position. Several methods of treating salivary duct injuries and their complications have been advocated. Optimal treatment outcomes can be achieved with early diagnosis, adequate evaluation, and proper management. This article presents current diagnostic and treatment protocols of salivary gland trauma. The anatomy of the salivary glands is briefly described and clinical cases are also presented to illustrate the treatment options described.

Familial nemaline myopathy: Case reports

Two siblings of two generations in the same family with nemaline myopathy are described. The disease affects all skeletal muscles, especially the facial muscles, producing a typical facial appearance. The diagnosis was made by light microscopy of histologically stained sections of muscle biopsy. The disease in our patients seems to be transmitted in an autosomal dominant manner. The purpose of this article is to emphasize the importance of recognition of the facial appearance by maxillofacial surgeons and the appropriate referral of patients for further neurologic examination.

Mycotic aneurysm of the internal carotid artery.

Mycotic aneurysms of the extracranial carotid artery are rare. We describe a case of a patient with an aneurysm of extracranial internal carotid artery, presented as a swelling at the right submandibular triangle. Carotid angiography revealed a saccular aneurysm. During the operation, an abscess, due to Salmonella, was found around the aneurysm. Ten days later, after the drainage of the pus, new carotid angiography revealed thrombosis of the right internal carotid artery. Two months later, the physical condition of our patient improved.Atherosclerosis, trauma, and many microbial agents are common causes of the aneurysm. The symptoms of the aneurysm may vary according to its size and location. Pain over the aneurysm is a common symptom. Rupture of the aneurysm is the most dramatic complication. Clinical examination, color Doppler ultrasonography, angiography, and computed tomography are the most common diagnostic modalities. Differential diagnosis must be done from other expansive pathologies. Resection of the aneurysmatic sac with restoration of flow is the preferred method of treatment.

McCune-Albright syndrome: Report of a case☆

The McCune Albright syndrome is seldom encountered and rarely reported in dental literature. It represents a special category of polyostic fibrous displasia associated with skin pigmentation and endocrine disturbances. We describe the case of a 9-year-old boy with the McCune Albright syndrome, who was treated for a mandibular osteolytic lesion.

Saliva and Blood Concentration of Cefuroxime in Patients Undergoing Maxillofacial Surgery

PURPOSE To investigate the penetration of cefuroxime into the parotid saliva after short-term intravenous administration in patients undergoing various maxillofacial surgical procedures. PATIENTS AND METHODS A total of 12 patients, 10 males and 2 females, with a mean age of 41 ± 21.2 years, participated in the present study. Each patient received 1.5 g of intravenous cefuroxime every 8 hours. Blood and parotid saliva samples were collected concomitantly, on the third day of therapy, just before the infusion of the first morning dose, and 0.5 hour after its end. All samples were analyzed using high-performance liquid chromatography. RESULTS The cefuroxime concentration in plasma and saliva before infusion was 2.08 ± 1.05 mg/L and 0.46 ± 0.33 mg/L, respectively. At 30 minutes after the end of infusion, the corresponding concentrations were 55.54 ± 20.24 mg/L and 14.50 ± 7.85 mg/L. The saliva/plasma ratio was 0.25 ± 0.18 before and 0.26 ± 0.12 after the infusion. CONCLUSIONS Cefuroxime is excreted in saliva in high levels shortly after infusion but is detected in far lower levels 8 hours after infusion. Taking into consideration the minimum inhibitory concentration values of common pathogens, we have concluded that the saliva concentrations of the drug are sufficient against some, but not all, pathogens involved in the oral-maxillofacial area.