Mohammed El-Maaytah

Experience versus complication rate in third molar surgery

ObjectivesThe records of 1087 patients who underwent surgical removal of third molar teeth were prospectively examined to analyse the possible relationship between postoperative complications and the surgeons experience parameter.Method and materialsSeven surgeons (three specialists in surgical dentistry [specialists SD] and four oral and maxillofacial Senior House Officers [OMFS residents]) carried out the surgical procedures. For each patient, several variables were recorded including age, gender, radiographic position of extracted teeth, treating surgeon, duration of surgery and postoperative complications.ResultsAnalysis of the data revealed some differences in the incidence of complications produced by the specialists SD and OMFS residents. The main statistically relevant differences were increase the incidences of trismus, nerve paraesthesia, alveolar osteitis and infection in the resident-treated group, while the specialist-treated group showed higher rates of post-operative bleeding.ConclusionThe higher rate of postoperative complications in the resident-treated group suggests that at least some of the complications might be related to surgical experience.Further work needs to compare specialists of training programmes with different years of experience, using large cross – sectional studies.

Impact of educational posters on the lay knowledge of school teachers regarding emergency management of dental injuries

The purpose of this study was to investigate the knowledge of school teachers about the emergency management of dental trauma, after an educational poster campaign. A total of 1000 questionnaires were sent to 100 schools in the area where the poster had been distributed. This was compared to another 100 schools (1000 questionnaires) in an area, Where the poster had not been distributed. The questionnaire surveyed demographic data, basic knowledge of emergency management of tooth fracture, luxation and avulsion injuries. A total of 511 questionnaires were returned (25.5%) and analyzed. Results showed differences between the two assessed areas. Teachers, who worked in the area with poster distribution, had better knowledge in handling tooth injuries. For the management of tooth fractures the portion of teachers, who knew the correct handling procedure, was 78.9% (area with poster campaign) vs 72.1% (area with no poster campaign), for the management of tooth luxation it was 87% vs 84% and for the management of tooth avulsion it was 71% vs 54%. In the area with the poster campaign 49% (n = 90 out of 185) of the teachers stated to have gained some knowledge about this topic beforehand. Out of these, 75 teachers (75/90 = 83%), had gained their information from the educational poster. Out of the 75 teachers, who had seen a poster on this topic, 68 (68/75 = 91%) would have managed such an emergency correctly. The present study shows the positive effect of educational poster campaigns. It therefore should encourage professionals in this field to embark on similar projects.

The effect of the new "24 hour alcohol licensing law" on the incidence of facial trauma in London

On 24 November 2005 the new 2003 Licensing Act was implemented. It permits licensed premises to close at different times under English and Welsh law, rather than at 2300h as under the previous law. The aim of this study was to assess whether head and neck trauma secondary to alcohol-associated assaults had increased, decreased, or stayed the same since the introduction of the act. Data were collected from the Accident and Emergency Department, University College Hospital, attendance databases for two six-month periods: 24 November 2004 to 30 April 2005, and 24 November 2005 to 30 April 2006. There were 1102 attendances for head and neck trauma secondary to alcohol-associated assaults during the six months before the introduction of the 2003 Licensing Act and 730 such attendances during the similar period after the introduction of the law, with fewer cases in each corresponding month during the later period. There were more cases at weekends than on weekdays during both periods. There were fewer cases but more at weekends in 2005-6 than in 2004-5 (423, 58% compared with 584, 53%, respectively). Neither rainfall nor temperature had any influence on the results. The 2003 licensing Act seems to have reduced the number of attendances at the A&E department for head and neck trauma secondary to alcohol associated assaults.

Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature

BackgroundChronic granulomatous disease is an extremely rare primary immunodeficiency syndrome that can be associated with various oral complications. This can affect high number of patients. However, data on oral complications is sparse. Here we will review the literature and describe the orofacial findings in 12 patients.FindingsThe age range was 5-31 years. Oral findings were variable, and reflected a low level of oral hygiene. They included periodontitis, rampant caries, gingivitis, aphthous-like ulcers, and geographic tongue. One patient had white patches on the buccal mucosa similar to lichen planus. Another patient had a nodular dorsum of the tongue associated with fissured and geographic tongue. Biopsies from the latter two lesions revealed chronic non-specific mucositis. Panoramic radiographs showed extensive periodontitis in one patient and periapical lesions in another patient.ConclusionPatients with chronic granulomatous disease may develop oral lesions reflecting susceptibility to infections and inflammation. It is also possible that social and genetic factors may influence the development of this complication. Therefore, oral hygiene must be kept at an optimum level to prevent infections that can be difficult to manage.

Gingival hyperplasia associated with juvenile hyaline fibromatosis: a case report and review of the literature.

R Molluscum fibrosum,” a variant of the neurofibromaosis disorders, was first described by Murray in 873. However, in 1973 it was Kitano et al who enamed the disease “juvenile hyaline fibromatosis” JHF). There have been approximately 70 cases of JHF eported in the literature to date. JHF is a rare autosomal dominant systemic disease f the connective tissue, typically presenting in childood. In 2002, Rahman et al performed a genetic nalysis of 2 families with JHF and linked JHF to a utation on chromosome 4q21. The exact underlying athogenesis of JHF is yet to be identified, but some nvestigators have proposed it results from an abnor-

Interleukin 12 Receptor β1 Chain Deficiency in a Child With Disseminated Tuberculosis: A Case Report

F a nterleukin (IL) 12 receptor 1 chain (IL-12R 1) deciency is 1 of 5 rare genetic defects of Mendelian usceptibility to mycobacterial disease. The known utations in the IL-12R 1 genes are autosomal recesive and associated with the abolition of the response o IL-12 and IL-23. Affected individuals have an inreased susceptibility to Mycobacterium tuberculosis nd non-typhoid salmonellosis. Etiologic agents inlude bacille Calmette-Guérin (BCG) vaccine, envionmental nontuberculous mycobacteria (NTM), and on-typhoid Salmonella species. The typical onset is in early childhood. The patient ay present with disseminated lymphadenopathy, reuiring medical and sometimes surgical intervention. owever, the prognosis is poor and may cause death n the first decade of life. Less frequently, when the nset of the disease is delayed until adulthood, there s a better prognosis. Antimycobacterial therapy is he treatment of choice. Because there is a high incience of relapse, this therapy may even have to be ontinued after complete healing has been achieved.

Cervical Lymphadenitis Due to Mycobacterium Malmoense

Nontuberculous mycobacteria are isolated from soil, dust, water, milk, eggs, vegetables, and domestic animals. They may be transmitted to humans through inhalation of particles from the air. 1-4 Nontuberculous mycobacteria were first described as pathogens of the head and neck in 1956. 5,6 Mycobacterium malmoense (MM) is a rare infection 7 and was first described in 1977 by Schroder and Juhlin. 8 This atypical mycobacterium has been isolated in increasing numbers from clinical samples next to Mycobacterium tuberculosis and the Mycobacterium avium complex. 9 Cervical lymphadenitis and lymphadenopathy are common in children and may be caused by local or systemic infection (Table 1). The most common presentation of nontuberculous mycobacterial (NTM) infection in children is cervicofacial adenitis. 10 In 2006 Thavagnanam et al 11 conducted a review of pediatric data over the last 14 years from mycobacterial laboratories in Northern Ireland. They found an upward trend in the number of cases of cervical lymphadenitis attributable to NTM infections. MM is primarily a pulmonary pathogen. 12 The main extrapulmonary disease type of MM infection is pediatric cervical lymphadenitis. 13 Most of the literature supports the view that the treatment of choice for cervical lymphadenitis due to NTM infection is surgical excision. 14 However, the complications of surgery are also well documented, and some authors advocate medical therapy, with antimicrobials, as an alternative or as an adjunct. 1 We report 2 cases of 2.5-year-old immunocompetent female patients with unilateral cervical lymphadenitis due to infection with MM. The clinical features and management are described.

New Titanium Arch Bar for the Management of Maxillomandibular Injuries: an Update

Abstract Arch bars still play an important role in the treatment of severely dislocated and comminuted fractures as well as in injuries where functional treatment is required. In an effort to optimise stability and reduce operation time, we developed a new titanium arch bar for use in maxillomandibular fixation. This report is an update on old and current methods of maxillomandibular fixation and the application of this new arch bar.