Walid A. Abdullah

Surgical treatment of keratocystic odontogenic tumour: A review article.

KCOT is one of the most aggressive odontogenic cysts with a high recurrence rate, this was explained histopathologically as it typically shows a thin, friable wall, which is often difficult to enucleate from the bone in one piece, and have small satellite cysts within the fibrous wall. Multiple surgical approaches were introduced including decompression, marsupilization, enucleation with or without adjunct (Carnoys solution, enucleation) and resection. Depending on other studies KCOT can be conservatively treated with enucleation and application of Carnoys solution or cryotherapy. This can be used specially in the large lesions that when treated with resection, the continuity of the jaw will be interrupted. This technique shows comparable results to other more aggressive techniques.

Effect of remifentanil on the hemodynamic responses and recovery profile of patients undergoing single jaw orthognathic surgery

The aim of this study was to compare fentanyl-based versus remifentanil-based anesthesia with regards to the intraoperative hemodynamic stress response and recovery profiles in patients undergoing Le Fort I osteotomy. Seventeen patients were randomly divided into two groups: patients in the F-group received 2 μg/kg fentanyl intravenously followed by an infusion of 0.03-0.06 μg/kg/min, while patients in the R-group received a 0.5 μg/kg bolus of remifentanil followed by an infusion of 0.0625-0.250 μg/kg/min. Mean arterial pressure and heart rate were recorded at the following points: before anesthetic induction, at endotracheal intubation, 5 min after intubation, at incision, just before the osteotomy, during the osteotomy, during the maxillary fracturing, at suturing, at extubation, 5 min after extubation, and then 15 and 30 min postoperatively. Heart rate and mean arterial pressure were significantly lower in the R-group in comparison to the F-group from t1 to t9 (P<0.05). All measured recovery times were significantly shorter in the R-group (P<0.05). The incidence of postoperative side effects was comparable between groups. Remifentanil-based anesthesia is an appropriate alternative to fentanyl during Le Fort I orthognathic surgery; it promotes hemodynamic stability, blunts the stress response to noxious stimuli, and provides a better recovery profile.

The effects of surgicel and bone wax hemostatic agents on bone healing: An experimental study.

Background: The biological effects of hemostatic agends on the physiological healing process need to be tested. The aim of this study was to assess the effects of oxidized cellulose (surgicel) and bone wax on bone healing in goats’ feet. Materials and Methods: Three congruent circular bone defects were created on the lateral aspects of the right and left metacarpal bones of ten goats. One defect was left unfilled and acted as a control; the remaining two defects were filled with bone wax and surgicel respectively. The 10 animals were divided into two groups of 5 animals each, to be sacrificed at the 3rd and 5th week postoperatively. Histological analysis assessing quality of bone formed and micro-computed tomography (MCT) measuring the quantities of bone volume (BV) and bone density (BD) were performed. The results of MCT analysis pertaining to BV and BD were statistically analyzed using two-way analysis of variance (ANOVA) and posthoc least significant difference tests. Results: Histological analysis at 3 weeks showed granulation tissue with new bone formation in the control defects, active bone formation only at the borders for surgicel filled defects and fibrous encapsulation with foreign body reaction in the bone wax filled defects. At 5 weeks, the control and surgicel filled defects showed greater bone formation; however the control defects had the greatest amount of new bone. Bone wax filled defects showed very little bone formation. The two-way ANOVA for MCT results showed significant differences for BV and BD between the different hemostatic agents during the two examination periods. Conclusion: Surgicel has superiority over bone wax in terms of osseous healing. Bone wax significantly hinders osteogenesis and induces inflammation.

Changes in quality of life after orthognathic surgery in Saudi patients.

Aim This study was conducted to measure the impact of orthognathic surgery on quality of life in Saudi patients. Materials and methods Patients with a discrepancy of 5 mm or more who underwent orthognathic surgery either single jaw or bimaxillary at the Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, between September 2007 and June 2013 were included in the study. They were asked to complete the Arabic version of the 22-item Orthognathic Quality of Life Questionnaire (OQLQ) preoperatively and postoperatively. Responses at these two timepoints were compared using paired t-tests, with the significance level set to P < 0.05. Results Seventeen patients participated in the study. Total OQLQ scores and those in the instrument’s four domains (oral function, facial aesthetics, awareness of dentofacial aesthetics, and social aspects) indicated that quality of life was significantly improved by orthognathic surgery (all P < 0.001). The social aspect domain was shown to be more important for patients than were facial aesthetics and oral function. Conclusion The present study revealed highly significant improvement in Saudi patients’ quality of life following orthognathic surgery. This improvement was evident in all four OQLQ domains.

Articaine (4%) Buccal Infiltration versus Lidocaine (2%) Inferior AlveolarNerve Block for Mandibular Teeth Extraction in Patients on WarfarinTreatment

Background: Although lidocaine inferior alveolar nerve block is a common dental injection in case of managing mandibular teeth, it may not be the first choice in specific situations. Patients on warfarin therapy are at high risk of bleeding during dental procedures. In this study we aimed to investigate and compare the efficacy of articaine buccal infiltration in mandibular teeth extraction with lidocaine inferior alveolar nerve block for extraction of mandibular teeth in patients on warfarin treatment. Methods: Patients included in the present study were on warfarin treatment and referred for simple dental extraction. Patients were divided randomly in two groups, one group received standard inferior alveolar nerve block (1.8 ml of 2% lidocaine with 1:80,000 adrenaline) and the second group received buccal infiltration supported with lingual infiltration using 4% articaine and 1:100,000 adrenaline. Data was analyzed by descriptive analysis using SPSS program V.17. A Mann-Whitney U test to compare the results and p value of less than 0.05 was considered significant. Results: A total of 23 adult patients (10 women and 13 men) aged 40 to 57 years (mean=48.9) were recruited into the study with 6 excluded as they needed a second local anesthetic cartridge to obtain profound anesthesia. The success rate of inferior alveolar nerve block using lidocaine was 81.8% while the success rate for articaine buccal infiltration in obtaining good profound pulpal anesthesia was 66.6%. Both surgeons and patients were satisfied with anesthesia using both drugs. Conclusion: Buccal infiltration of 4% Articaine for mandibular teeth can have a high success rate using one local anesthetic cartridge, and is considered a good alternative option for nerve block in patients on warfarin treatment to avoid complication related to the nerve block.

Evaluation of bone regenerative capacity in rats claverial bone defect using platelet rich fibrin with and without beta tri calcium phosphate bone graft material

Aim To compare bone regeneration in noncritical rat calvarial bone defects filled with platelet-rich fibrin (PRF), alone or combined with beta-tricalcium phosphate (β-TCP), using micro-computed tomographic (MCT) evaluation. Animals and methods Two calvarial bone defects were created in each of 45 male Sprague–Dawley rats (age: 20–22 weeks, weight: 350–450 g), using a dental trephine with an external diameter of 3 mm. The 90 defects were randomly allocated among three groups, each containing 30 unilateral defects in a total of 30 rats. Defects in the control group were allowed to heal spontaneously. Defects in the PRF group received PRF alone. Defects in the PRF/β-TCP group received PRF mixed with β-TCP in a 50⧹50 percentage. Nine animals (three per group) were killed after 1, 2, 3, 4, and 6 postoperative weeks, and 18 calvarial defects from each period were analyzed for new bone formation and bone mineral density using MCT. Results were compared by a one-way Analysis of Variance with the POST HOC Least Significant Difference test. Results The volume and mineral density of bone formed in the control group were significantly different from those of the other two groups. Greater bone regeneration was observed in defects receiving PRF with β-TCP compared to defects receiving PRF alone in the first 2 weeks (P < 0.001). However, differences in the volume and density of newly formed bone between the PRF and PRF/β-TCP groups were not significant at 3, 4, and 6 postoperative weeks (P > 0.005). Conclusion The addition of β-TCP to PRF significantly improved bone regeneration in the first 2 weeks after surgery. Although the differences between results with and without the addition of β-TCP to PRF were statistically insignificant from weeks 3 to 6, it was nevertheless apparent that the group receiving the combination showed better results. We suggest a synergistic mechanism for this effect.

Evaluation of bone regenerative capacity following distraction osteogenesis of goat mandibles using two different bone cutting techniques

PURPOSE To compare the regenerative capacity of goat mandibles following sagittal split osteotomy and distraction osteogenesis with a vertical body osteotomy. ANIMALS AND METHODS Bilateral vertical and sagittal body osteotomy was performed on the left and right sides of the mandibles in 18 goats. The distraction period lasted for 10 days at 1 mm/day. Animals were sacrificed at 0, 10, and 35 days post-distraction. Bone mineral density (BMD) and bone volume (BV) were analysed by microcomputed tomography (MCT). Types of bone and cells present in the regenerated defect sites were analysed histologically. RESULTS At 0, 10, and 35 days, BMD was 0.358 ± 0.012, 0.410 ± 0.012, and 1.070 ± 0.019, respectively, for vertical osteotomy and 0.420 ± 0.013, 0.421 ± 0.009 and 1.182 ± 0.030, respectively, for sagittal osteotomy. BV was 973.310 ± 5.048, 1234.589 ± 4.159, and 2121.867 ± 6.519, respectively, for vertical osteotomy and 995.967 ± 2.781, 1755.938 ± 4.379, and 2618.441 ± 21.429, respectively, for sagittal osteotomy at these three time points. BMD and BV differed significantly at all three times. Histological analysis shows that sagittal splitting was characterized by more robust lamellar bone formation bridging the distraction gap than vertical body osteotomy. CONCLUSION Both MCT and histological analyses showed that distraction using the sagittal osteotomy technique resulted in significantly higher BV and BMD than using vertical body osteotomy.

Anesthetic management of a patient with Bartter's syndrome undergoing bilateral sagittal split osteotomy

Bartters syndrome is an unusual (estimated incidence is 1.2 per million people) but important congenital form of secondary hyperaldosteronism; due to abnormalities in renal handling of electrolytes. It is associated with hypertrophy and hyperplasia of the juxtaglomerular cells, normal blood pressure, and hypokalemic alkalosis withoutedema.We present a 22-year-old woman with Bartters syndrome underwent bilateral sagittal split osteotomy to correct mandibular prognathic. The anesthetic management of Bartters syndrome should be relevant to the pathophysiology of the syndrome. Therefore, it should be directed toward maintaining cardiovascular stability, control of associated fluid, electrolyte and acid–base derangements, and the prevention of renal damage.