Morton H. Goldberg

Late onset of mandibular and lingual dysesthesia secondary to postextraction infection

A ltered or impaired sensation of the distribution of the inferior alveolar and lingual branches of the trigeminal nerve is most commonly associated with complications of mandibular third molar surgery. Numerous reports and reviews of this problem reveal, however, that the late onset of impaired sensation is uncommon and that nerve dysfunction related to postsurgical infection is unusual. Three cases will be reported in this article, with a discussion of the possible pathophysiologic mechanism of injury, Therapy and prognosis for recovery will also be discussed.

Diagnosis and treatment of cervicofacial actinomycosis

Actinomycosis is an uncommon and frequently misdiagnosed infection of the cervicofacial region that may be acute or indolent. The term ‘‘actinomycosis’’ derives from the Greek aktino (ray) and mykos (fungus). Historically, Langenback may have been the first to describe the disease in humans (1848), although it had been considered to be a sarcoma in cattle 20 years earlier by Leblanc. Bollinger (1870) coined the term ‘‘lumpy jaw’’ in its bovine form, whereas Harz (1877) described the appearance of a ray-like microorganism, which he named Actinomycoses bovis. In 1878, Israel and Ponfick observed and described ‘‘sulfur granules’’ in human disease, and in 1891, Israel and Wolf isolated the anaerobic filamentous organism from humans. In 1898, the organism found in humans was named Actinomycoses israelii, and by the 1940s further research had confirmed that whereas A. bovis was responsible for ‘‘lumpy jaw’’ in cattle, A. israelii was the etiologic agent of human disease [1–3]. Originally considered to be a fungus (mykos) because of its slow growth and filamentous appearance, it is currently generally accepted that Actinomyces are bacteria and are taxonomically classified accordingly as members of the order Actinomycetales and the family Actinomycetacae. Other orders classified as Actinomycetales include Mycobacteriaceae and Nocardiaceae. Evidence that Actinomyces are bacteria include their filaments, which are narrower than the hyphae of fungi, their morphology, including bacillary forms, and their reproduction by typical bacterial fission rather than by budding or by spores. Actinomyces are anaerobic (whereas fungi are aerobic) and lack the nuclear membrane of fungi and yeasts. Actinomyces are destroyed by antibacterial agents such as penicillin and erythromycin but are not affected by antifungal medications, such as amphotericin B (see box 1) [2,3].

Lymphangioma and cystic hygroma. Correction of facial growth disharmony and obstructive sleep apnea

Soft tissue tumors and masses of the mouth and face can adversely affect the growth of facial bones. Cystic hygroma and lymphangioma, when massive, can create serious deformities of the maxilla and mandible. These deformities are correctible, surgically, and may be preventable if surgery and orthodontics are coordinated early in life. During and after surgery, airway management is paramount, but paradoxical effects such as obstructive sleep apnea may be observed.

Acute suppurative parotitis

Abstract The etiology and therapy of modern staphylococcal parotitis have been presented. When antibiotic therapy, hydration, and local hygiene fail to produce adequate relief, carly surgical decompression of the gland is recommended.

Gross displacement of the mandibular canal: A radiographic sign of benign fibro-osseous bone disease

Gross displacement of the mandibular neurovascular canal is an uncommon phenomenon. It is suggested that displacement of the canal should be included as one of the possible diagnostic criteria of benignity of disease of the mandible. Superior displacement of the canal should be considered an unusual but observable characteristic of benign fibro-osseous disease. The anatomic position of the displaced canal should be considered when one is planning a surgical approach to the mandible.

Split-thickness skin graft for treatment of oral benign mucous membrane pemphigoid: Report of a case

The painful oral lesions of benign mucous membrane pemphigoid often make the wearing of complete dentures difficult or impossible. A mandibular split-thickness skin graft vestibuloplasty was performed on a patient with benign mucous membrane pemphigoid. This procedure may be indicated in those cases which do not respond to meticulous denture construction and steroid therapy.

Halothane and hepatic toxicity

Abstract Ilalothane anesthesia, long respected for its potency and potential for cardiovascular depression, has recently been described as a hepatic toxin. Nineteen case reports are analyzed, the significance of the findings are discussed, and the suggestion is offered that a careful hepatic history be considered prior to administration of halothane.