Sid Berrone

Human beta-defensins suppress human immunodeficiency virus infection: potential role in mucosal protection.

ABSTRACT β-Defensins are small (3 to 5 kDa in size) secreted antimicrobial and antiviral proteins that are components of innate immunity. β-Defensins are secreted by epithelial cells, and they are expressed at high levels in several mucosae, including the mouth, where the concentration of these proteins can reach 100 μg/ml. Because of these properties, we wondered whether they could be part of the defenses that lower oral transmission of human immunodeficiency virus (HIV) compared to other mucosal sites. Our data show that select β-defensins, especially human β-defensin 2 (hBD2) and hBD3, inhibit R5 and X4 HIV infection in a dose-dependent manner at doses that are compatible with or below those measured in the oral cavity. We observed that β-defensin treatment inhibited accumulation of early products of reverse transcription, as detected by PCR. We could not, however, detect any reproducible inhibition of env-mediated fusion, and we did not observe any modulation of HIV coreceptors following treatment with hBD1 and hBD2, in both resting and phytohemagglutinin-activated cells. Our data instead suggest that, besides a direct inactivation of HIV virions, hBD2 inhibits HIV replication in the intracellular environment. Therefore, we speculate that β-defensins mediate a novel antiretroviral mechanism that contributes to prevention of oral HIV transmission in the oral cavity. Immunohistochemical data on hBD2 expression in oral mucosal tissue shows that hBD2 is constitutively expressed, forming a barrier layer across the epithelium in healthy subjects, while in HIV-positive subjects levels of hBD2 expression are dramatically diminished. This may predispose HIV-positive subjects to increased incidence of oral complications associated with HIV infection.

Maxillofacial trauma in the elderly

PURPOSE This article gives a general description of the incidence, causes, and complexity of maxillofacial fractures in the elderly and discusses whether modification is required in assessment, surgical indications, and techniques in such cases. PATIENTS AND METHODS A retrospective clinical and radiologic study evaluated 222 patients older than 60 years of age (mean age, 70.3) hospitalized with maxillofacial trauma over the period 1987 to 1996 in the Division of Maxillofacial Surgery, University of Turin. The patients were classified according to the following parameters: age, cause of injury, site of trauma, presence of associated fractures, pertinent medical history, type of treatment, length of hospitalization, and complications. The data were compared with those from a control group consisting of 178 adult patients younger than 60 years of age. RESULTS The presence of a preexisting systemic pathologic condition was the most important factor in determining hospitalization time, which was greater than in the control group. In 89 patients (40.1%), no treatment was considered necessary, whereas 133 patients (59.9%) were treated by surgery. In 115 patients (86.5%), the fractures were treated by open reduction and internal fixation, whereas closed reduction was used in 18 patients (13.5%). There were complications with six patients (2.7%), and one died in the hospital. CONCLUSIONS The findings of this study suggest that surgical intervention is less frequently indicated in facial trauma of the elderly because of physiologic, psychologic, and social changes brought on by the aging process. The principles of treatment, the results, and the complications do not differ greatly in this group when compared with the normal adult population.

Hyperplasia of the mandibular coronoid process: long-term follow-up after coronoidotomy

The aim of this study was to evaluate long-term results of treatment by intraoral coronoidotomy and prolonged physiotherapy in five patients with mandibular coronoid process hyperplasia. Five consecutive cases of coronoid process hyperplasia were studied (two unilateral and three bilateral) at the Department of Maxillo-facial Surgery of the University of Turin during the period 1985-1990. All patients were treated by intraoral coronoidotomy and given physiotherapy from the third postoperative day. This continued for an entire year. A clinical and radiological follow-up (average 39.4 months), in three cases over a 5-year period, was completed. Three months after the operation, all patients had achieved satisfactory improvement in mandibular interincisal opening. The mean value for mouth opening at the end of follow-up was 42 mm. Radiographic follow-up showed the presence of a coronoid process almost the size of the original, apparently united with the mandibular ascending ramus, with moderate dislocation and inclination posterior to the body of the zygomatic bone. The results of this study indicate that treatment of coronoid process hyperplasia by intraoral coronoidotomy, when combined with prolonged postoperative physiotherapy, gives satisfactory and stable long-term results in the correction of coronoid-malar interference.

Surgical treatment and reconstruction for central giant cell granuloma of the jaws: A review of 18 cases

Central giant cell granuloma (CGCG) is an uncommon benign bony lesion that occurs in the mandible and maxilla. The clinical behaviour of CGCG ranges from a slow-growing asymptomatic swelling to an aggressive lesion that presents pain, local bone destruction, root resorption and tooth displacement. Therapeutic options have varied greatly over the years. Non-surgical treatments with alpha interferon (alpha-IFN), calcitonin and corticosteroids have been described and their benefits may be worthy of consideration. Surgery is considered the traditional treatment and it is still the most accepted one, however in the literature not all authors agree on the type of surgery which should be performed. Although en bloc resection provides the lowest recurrence rate, only a few single case reports describe the use of this technique followed by reconstruction with autogenous bone grafts. The authors report their experience with en bloc resection of 18 wide CGCGs which had not been previously treated medically. Immediate reconstruction was carried out for all cases and in one, a fibula free flap was used to reconstruct the mandible. No recurrence was observed. After complete healing of the graft, prosthetic rehabilitation via implants was performed. This allowed the best functional and aesthetic results.

Management of sport-related maxillofacial injuries.

By analyzing sports-related maxillofacial fractures, we sought to describe preventive measures and recovery times until sporting activities could be resumed. Between January 2001 and December 2006, 1241 patients were hospitalized as a result of maxillofacial fractures. The patients with sports-related maxillofacial fractures were analyzed based on age, sex, type of sport, injury mechanism, trauma site, presence of associated fractures, hospitalization, treatment method, and recovery time until the resumption of sporting activities. One hundred thirty-eight patients (11.4%) sustained sports-related maxillofacial fractures: 121 males and 17 females (ratio 8:1), aged between 11 and 72 years. The sport producing the greatest number of injuries was soccer (62.3%), followed by skiing (14.5%), and horseback riding (6.5%). The injuries involved mainly the middle third of the face (71.6%), and the mandible was the most affected site (27.2%), followed by the maxillary-zygomatic-orbital complex (25.9%). Treatment was surgery in 93.5% of the patients, with an average hospitalization period of 3.5 days. The protocol created to manage the follow-up of maxillofacial injury patients advised resuming sports activities at least 40 days after the trauma, except in the case of combat sports, when a period of 3 months was required. Although the results of this study indicate a reduction in the total incidence of sports-related maxillofacial injuries, they also show an alarming secondary increase in trauma resulting from the most popular sport in Italy-soccer. Therefore, stricter regulations are needed to discourage violent play, rather than relying on the use of protective equipment. Moreover, patients should be advised when they can resume sports activities, particularly in the case of professionals and semiprofessionals.

Long-term clinical and radiological outcomes for the surgical treatment of mandibular condylar fractures.

PURPOSE This retrospective study evaluated the long-term results and complications of open reduction and internal fixation of displaced and dislocated fractures of the condylar process. PATIENTS AND METHODS Two hundred four patients were treated via various surgical approaches between 1991 and 2005. Fifty patients with a total of 57 treated condylar fractures who underwent complete clinical and radiological documentation were included in this study. Follow-up clinical and radiological evaluations were carried out after an average period of 88 months. RESULTS We found that 12% of our patients reported temporary weakness of the facial nerve and 4% had mild permanent facial nerve palsy. Clinical and radiological assessment showed satisfactory recovery of facial symmetry. Excellent recovery of function was observed, and very few patients complained of temporomandibular joint-related symptoms. Severe condylar remodeling was observed in 8% of the patients, 47% showed slight or moderate remodeling, and 45% showed no remodeling. A statistically significant association was observed between the presence of condylar remodeling and poor mouth opening at the follow-up examination. CONCLUSIONS Surgical treatment of condylar fractures, in association with postoperative functional therapy, promotes the recovery of function, occlusion, and facial symmetry with few complications. However, some difficulties remain related to the surgeon, the patient, and the objective complexity of this pathology.

Use of Patient and Observer Scar Assessment Scale for evaluation of facial scars treated with self-drying silicone gel.

In this prospective study, we used the Patient and Observer Scar Assessment Scale (POSAS) to evaluate the outcome of the healing process of posttraumatic and surgical facial scars that were treated with self-drying silicone gel, by both the patient and the observer. In our division, the application of base cream and massage represents the standard management of facial scars after suture removal. In the current study, 15 patients (7 men and 8 women) with facial scars were treated with self-drying silicone gel that was applied without massage, and 15 patients (8 men and 7 women) were treated with base cream and massage. Both groups underwent a clinical evaluation of facial scars by POSAS at the time of suture removal (T0) and after 2 months of treatment (T1). The patient rated scar pain, itch, color, stiffness, thickness, and surface (Patient Scale), and the observer rated scar vascularity, pigmentation, thickness, relief, pliability, and surface area (Observer Scale [OS]). The Patient Scale reported the greatest improvement in the items color, stiffness, and thickness. Itch was the only item that worsened in the group self-drying silicone gel. The OS primarily reported an improvement in the items vascularization, pigmentation, and pliability. The only item in the OS that underwent no change from T0 to T1 was surface area. The POSAS revealed satisfactory healing of posttraumatic and surgical facial scars that were treated with self-drying silicone gel.

Pathological mandibular fractures: a review of the literature of the last two decades

Pathological mandibular fractures are rare, accounting for fewer than 2% of all fractures of the mandible. They could be defined as fractures that occur in regions where bone has been weakened by an underlying pathological process. Pathological fractures usually may follow surgical interventions such as third molar removal or implant placement, result from regions of osteomyelitis, osteoradionecrosis, and bisphosphonate-related osteonecrosis of the jaw, occur because of idiopathic reasons or be facilitated by cystic lesions, benign, malignant, or metastatic tumors. Pathological mandibular fractures may be challenging to treat because of their different etiology and peculiar local and general conditions, often requiring a more rigid fixation. In patients with poor medical conditions, simpler and more limited options may be preferred.

Primary and secondary reconstruction of complex craniofacial defects using polyetheretherketone custom-made implants

PURPOSE The aim of this study was to evaluate the surgical outcomes using polyetheretherketone (PEEK) patient-specific prostheses produced by computer-aided design and manufacturing for primary and secondary reconstruction in patients with craniofacial defects. MATERIAL AND METHODS The study included 13 patients who underwent reconstruction for craniofacial defects using PEEK patient-specific implants (PSI). Eight patients underwent single-step primary reconstruction using individual custom-made surgical guides and custom-made prostheses during the same surgery; five patients underwent delayed reconstruction. The material used to manufacture the implants was PEEK in 13 cases. All patients underwent esthetic examination, ophthalmological examination, and radiological evaluation during the preoperative and follow-up periods. The operation duration and short- and long-term complications were recorded. RESULTS The shape and global position of the implants were satisfactory in each case. Fitting of the implant during surgery required extensive adaptation in 1 case and minor in 11 cases. Of 13 implants, 11 adequately restored a morphological complex area with satisfactory cosmetic results. No complications related to the implants were reported. CONCLUSION Reconstruction for cranio-facial defects using PEEK computer-aided designed and manufactured implants is a promising new technique that allows for accurate restoration of the complex 3D anatomy of the craniofacial region.

Management of Needle Breakage Using Intraoperative Navigation Following Inferior Alveolar Nerve Block

This report describes a peculiar case of needle breakage during inferior alveolar nerve block to perform third molar extraction that was removed with the aid of a BrainLAB VectorVision neuronavigation system. This report adds to the currently limited scientific literature on the image-guided removal of foreign bodies from the oral cavity.