Mihai Săndulescu

Infraorbital canal bilaterally replaced by a lateroantral canal

The infraorbital canal (IOC) normally courses above the maxillary sinus in the orbit floor. During a retrospective study of cone beam computed tomography (CBCT) scans, we found a previously unknown variant of the IOC. The IOCs were absent, being replaced by lateroantral canals coursing around and not above the maxillary sinus to open at infraorbital foramina which were located above the second upper premolar teeth. On coronal multiplanar reconstructions, the lateroantral canals were located anatomically at the outer limit of the zygomatic recess of each maxillary sinus, while the upper wall of the sinus was devoid of any canal. Such rare variant should be kept in mind by dental practitioners and surgeons, as it can determine modifications of common procedures. In this regard, the anatomy of maxilla, as well as mandible, should be evaluated in CBCT on a case-by-case basis.

The pterygopalatine recess of the superior nasal meatus

The pneumatizations surrounding the pterygopalatine fossa (PPF) and closely related to the sphenopalatine foramen are anatomically variable. During the assessment of a cone beam computed tomography of a 64-year-old male patient, we found bilaterally a previously unreported anatomic variant. This was represented by a lateral or pterygopalatine recess (PPR) of the superior nasal meatus which extended in the anterior wall of the PPF and protruded within the maxillary sinus to determine a maxillary bulla. The PPR was antero-superior to the sphenopalatine foramen. Additionally were found a right nasal septal deviation, seemingly compensated by a left middle concha bullosa and a left prominent ethmoidal bulla. The superior turbinates were also pneumatized. Such anatomic variants related to the pterygopalatine angle of the maxillary sinus should be explored prior to surgical or endoscopic procedures which target the maxillary sinus, the pterygopalatine fossa, or the skull base.

Nasopharyngeal bacterial colonization in children – study hypothesis

Background With monthly reports of decreased bacterial susceptibility to antibiotics and the soaring incidence of invasive infections, it becomes increasingly important to assess bacterial colonization, as this can easily constitute a reservoir for infection. Entering the community for kindergarten and school training is an important step for children, particularly since this may be associated with a change in the microbiota.

The extramandibular inferior alveolar nerve in cases with severely atrophic lower jaws

There are very few evidences on the extramandibular course (EMC) of the inferior alveolar nerve (IAN). We report here two such cases. The first one was encountered at dissection, in a human adult female cadaver where the right IAN terminal division was identified in the premolar region, above a severely atrophied mandibular body. The second case was a patient evaluated by cone-beam CT, who presented with an extremely atrophic mandible with bilateral extramandibular courses of the IANs. Such severe atrophy of the mandible may be considered as residual ridge class 7 along with the existing Atwood classes. EMCs of the IAN may not only occur in extreme mandibular atrophy, but also in dentate mandibles. In edentulous mandibles, an extramandibular IAN may complicate local surgical procedures or hamper denture wearing.

A rare case of impacted maxillary first premolar.

Among the dental and maxillary anomalies, impacted teeth are frequently encountered. However, the incidence of impaction of maxillary first premolars is very low. Herewith, we report a rare case of impacted maxillary left first premolar, in a vertical position, with the apical two-thirds of the root situated in the angle between the medial and antero-lateral walls of the maxillary sinus. The persistence of the maxillary left primary canine was also observed. The cone beam computed tomography evaluation of the case identified the close proximity of the impacted tooth with the root of the permanent canine and the nasal fossa. The finding may be helpful to dental practitioners, not only to anticipate the difficulties which may occur during surgical interventions, but also to prevent possible complications, such as maxillary infections or root resorptions.

Rare anatomic variation: true bifid inferior turbinate

Nasal anatomic variations are relevant during nasal surgical and endoscopic procedures. The extent of imaging methods, such as the cone beam computed tomography (CBCT), allows a better characterization of such peculiar anatomic traits. The bifid inferior turbinate (BIT) is a rare finding, being previously reported less than ten times. It was found and described on CT scans of patients, being usually associated with the absence of the uncinate process (UP). We hereby report for the first time a bilateral true BIT which differs from the previously reported BITs by the fact that the UPs were present and the bifidity was oriented laterally. In the light of this new find, we consider that the variant resulted from UP displacement should be regarded as a false bifid, or double, inferior turbinate. Bifidity of the inferior turbinate was not previously evaluated in CBCT, as well as in three-dimensional volume renderizations. So, CBCT proves as an efficient tool to investigate prevalence of rare anatomical variants. Noteworthy, CT studies of patients on a case-by-case basis allows a better performance of surgical and endoscopic procedures.

Vertical and sagittal combinations of concha bullosa media and paradoxical middle turbinate

Common anatomic variants of the middle nasal turbinate include its pneumatization (i.e. concha bullosa media) and its paradoxical curvature. We report here two cases of differently combined variations of the middle turbinate which were documented in cone beam computed tomography (CBCT). The first report presents the vertical combination of a double or septated lamellar concha bullosa with the paradoxical curvature of middle turbinate. This combined variant associated (coincidental findings): ipsilateral paradoxical superior turbinate and contralateral paradoxical middle turbinate, concha bullosa superior and concha bullosa suprema. In the second case was found the sagittal combination of successive anterior concha bullosa media and posterior paradoxical curvature of the middle turbinate. An ethmoidal sinolith was found embedded in lamella basalis. The contralateral superior turbinate was pneumatized. These rare findings demonstrate that sound knowledge of possible anatomical variations, supported by a complete use of the tools available for the CBCT documentation of cases, is able to enrich the picture of human anatomic variations, with a direct impact on clinical and surgical practice. The septa-containing lamellar concha bullosa and paradoxical middle concha combination is a variation that affects surgical practice.

Anti-biofilm Agents

Biofilms are microbial communities with enhanced interbacterial communication and cooperation. A good knowledge of anti-biofilm options is essential to ensuring correct management and treatment of biofilm-driven infections, with two main interest areas, namely prevention of biofilm formation and eradication of mature biofilm. Wounds can become infected with a wide array of germs, and among frequently encountered pathogens are Staphylococcus aureus and Pseudomonas aeruginosa, either separately or in microbial consortia. Depending on the type of wound, different techniques can be used to prevent, reduce, or eradicate biofilms, including mechanical options, surgical wound care, use of specific absorbent dressings, antiseptic soaks, or administering antibiotics either systemically or locally. Antimicrobial associations may be useful alternatives to single-agent therapy for biofilms, but they should be thoughtfully chosen, to ensure synergy. When dealing with S. aureus biofilms, fifth-generation cephalosporins, lipoglycopeptides, lipopeptides, oxazolidinones, or glycylcyclines may display important anti-biofilm effect, and the same is true for the association of rifampin or gentamicin to other active anti-S. aureus agents. For P. aeruginosa biofilm-driven infections, options include fluoroquinolones such as levofloxacin and ciprofloxacin, potentially associated with colistin. Bacteriophages are gradually gaining more important roles in the armamentarium of anti-biofilm agents, and so are engineered peptides or natural products extracted from plants or bacteria.

Bifid and secondary superior nasal turbinates

The lateral nasal wall contains the nasal turbinates (conchae) which are used as landmarks during functional endoscopic surgery. Various morphological pos- sibilities of turbinates were reported, such as bifidity of the inferior turbinate and extra middle turbinates, such as the secondary middle turbinate. During a retrospective cone beam computed tomography study of nasal turbinates in a patient we found previously unreported variants of the superior nasal turbina- tes. These had, bilaterally, ethmoidal and sphenoidal insertions. On the right side we found a bifid superior turbinate and on the left side we found a secondary superior turbinate located beneath the normal/principal one, in the superior nasal meatus. These demonstrate that if a variant morphology is possible for a certain turbinate, it could occur in any nasal turbinate but it has not been yet observed or reported.

Nasopharyngeal microbiota evaluation in three cohorts of children in the Romanian pediatric population

Methods We performed a screening study for nasopharyngeal carriage of Staphylococcus spp. in immunocompetent children aged 7-10 years old, attending a community school in central Bucharest (group 1), and in two groups of immunosuppressed children: children with hemato-oncologic diseases (lymphoma/leukemia) admitted to the Fundeni Clinical Institute, Bucharest (ages 2-10 years, group 2), and institutionalized children with vertically transmitted HIV infection, from the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest (ages 1-10 years, group 3).