1/8. Management of complex multi-space odontogenic infections.The successful management of multi-space orofacial odontogenic infections involves identification of the source of the infection, the anatomical spaces encountered, the predominant microorganisms that are found during the various stages of odontogenic fascial space infection, the impact of the infectious process on defense systems, the ability to use and interpret laboratory data and imaging studies, and a thorough understanding of contemporary antibiotic and supportive care. The therapeutic goals, when managing multi-space odontogenic infections, are to restore form and/or function while limiting patient disability and preventing recurrence. Odontogenic infections are commonly the result of pericoronitis, carious teeth with pulpal exposure, periodontitis, or complications of dental procedures. The second and third molars are frequently the etiology of these multi-space odontogenic infections. Of the two teeth, the third molar is the more frequent source of infection. diagnostic imaging modalities are selected based on the patient's history, clinical presentation, physical findings and laboratory results. Periapical and panoramic x-rays are reliable initial screening instruments used in determining etiology. magnetic resonance imaging and computed tomography are ideal imaging studies that permit assessment of the soft tissue involvement to include determining fluid collections, distinguishing abscess from cellulitis, and offering insight as to airway patency. Antibiotics are administered to assist the host immune system's effort to control and eliminate invading microorganisms. Early infections, first three (3) days of symptoms, are primarily caused by aerobic streptococci which are sensitive to penicillin. amoxicillin is classified as an extended spectrum penicillin. The addition of clavulanic acid to amoxicillin (Augmentin) increases the spectrum to staphylococcus and other anaerobes by conferring beta-lactamase resistance. In late infections, more than three (3) days of symptoms, the predominant microorganisms are anaerobes, predominantly peptostreptococcus, fusobacterium, or bacteroides, that are resistant to penicillin. clindamycin is an attractive alternative drug for first line therapy in the treatment of these infections. The addition of metronidazole to penicillin is also an excellent treatment choice. Alternatively, Unasyn (ampicillin/Sublactam), should be considered. The mainstay of management of these infections remains appropriate culture for bacterial identification, timely and aggressive incision and drainage, and removal of the etiology. It is usually preferable to drain multi-space infections involving the submandibular, submental, masseteric, pterygomandibular, temporal, and/or lateral pharyngeal masticator spaces, as early as possible from an extraoral approach. trismus and airway management are important considerations and may preclude the selection of other surgical approaches. The patients with multi-space infections should be hospitalized and patient care provided by experienced clinicians capable of management of airway problems, in administration of parenteral antibiotics and fluids, utilization of interpretation of laboratory and diagnostic imaging studies, and control of possible surgical complications.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Crohn's disease with oral presenting signs masquerading as chronic osteomyelitis.BACKGROUND: A case of Crohn's disease (CD) was diagnosed following recognition of oral and systemic signs and symptoms in a 19-year-old male patient. methods: Clinical investigation utilized included blood tests (full blood count, electrolytes, urea, creatinine, liver function tests), computed tomogrphy scans, magnetic resonance imaging scans, oral biopsies, colonoscopy and biopsies of the terminal ileum and colon. RESULTS: A diagnosis of CD was made which then allowed appropriate medical treatment to be initiated. CONCLUSION: The importance of a thorough medical history and full physical examination with appropriate investigations as dictated by clinical findings is demonstrated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Familial malignant osteopetrosis in children: a case report.The clinical, radiological, pathological and laboratory findings of two brothers with autosomal recessive malignant osteopetrosis are presented. Our findings are similar to characteristics previously reported in the literature about patients with osteopetrosis. The 6-year-old male patient was pale and had petechiae on his arms and legs. He also had macrocephalia, splenomegaly, severe pancytopenia, genu valgus, hypocalcemia, amaurosis, cessation of physical development, generalized bone sclerosis and recurrent infections with a history of multiple incidences of acute otitis media. Generalized bone sclerosis and irregular sclerosis of the maxilla and mandible were seen on radiographs. The oral mucosa was apparently normal but permanent tooth eruption was delayed although there was early loss of deciduous teeth. The recommended treatment was blood transfusion and therapy with antibiotics when necessary; a bone marrow transplant was not possible due to lack of a compatible donor.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Linezolid-induced optic neuropathy: a mitochondrial disorder?We report a case of bilateral mitochondrial optic neuropathies secondary to long-term linezolid treatment, show the nature of recovery, review the findings in the literature and propose a potential mitochondrial mechanism for linezolid-induced mitochondrial optic neuropathy. This is an observational case report and literature review with presentation of the clinical course of linezolid mitochondrial optic neuropathies through clinical and psychophysical documentation. Main outcome measures included: visual acuity, funduscopical examinations and peripapillary retinal nerve fibre layer (PRNFL) optical coherence tomography (OCT). A 6-year-old boy presented with bilateral optic neuropathies secondary to 1 year of linezolid treatment for osteomyelitis of the mandible. On presentation, visual acuities were 20/400 in both eyes, with considerable optic disc oedema, hyperaemia and PRNFL swelling confirmed by OCT. 2 weeks after the discontinuation of linezolid, visual acuities returned to 20/25 in both eyes, with reduction in the optic disc oedema, hyperaemia and PRNFL swelling. 3 months after the discontinuation of linezolid treatment, visual acuities were stable at 20/20 in both eyes, with a marked decrease in PRNFL swelling confirmed by OCT, and the development of mild temporal optic disc pallor in both eyes. Doctors should be aware of impairments of vision among patients on long-term linezolid treatment and promptly discontinue treatment to prevent irreversible vision loss. The development and resolution of bilateral optic neuropathies with considerable PRNFL swelling in this patient provide insight into the more general rubric of mitochondrial optic neuropathies.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Congenital monostotic fibrous dysplasia--a new possibly autosomal recessive disorder.Two siblings, a 3-month-old white male infant and a 12-day-old female infant, had an anterior mandibular bony lesion that, in both cases, had been present at birth. After evaluation of clinical, physical, radiographic, laboratory, and histologic findings, a diagnosis of congenital monostotic fibrous dysplasia was made. Thorough review of the literature on fibrous dysplasia yielded no similar cases. The two cases presented appear to be the first reported examples of congenital monostotic fibrous dysplasia in siblings. The parents said there was no consanguinity. The possibility of a new autosomal-recessive disorder is likely.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. Early surgical correction of unilateral TMJ ankylosis and improvement in mandibular symmetry with use of an orthodontic functional appliance--a case report.Early ankylosis of the temporomandibular joint (TMJ) can be a deterrent to normal mandibular growth. The frequency of occurrence is rare in the population of young patients who undergo orthodontic treatment. early diagnosis of TMJ ankylosis is important and early surgical intervention is now an accepted mode of treatment. ankylosis infers minimal, if any joint function. Caldwell argues that restoration of joint function at an early age is necessary to activate as much growth potential as possible. Laboratory and clinical studies have supported the theory that the mandibular condyle is adaptable under function and perhaps even the most deformed condylar head may exhibit growth when released and placed in function. The purpose of this article is to present a case report of surgical release of TMJ ankylosis followed by radiographic and clinical evidence of unilateral condylar growth. The surgical procedure involved maintenance of the condyle, the disk and majority of fibrocartilage covering the mandibular condyle. Aggressive postoperative physical therapy and the employment of a functional orthodontic appliance appeared to have assisted in a more symmetric growth pattern and maintenance of appropriate function.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Right mandible swelling of unknown origin.Infantile cortical hyperostosis (ICH), or Caffey's disease, has a low prevalence, is not easily recognized clinically, and is seldom reported in the primary care literature. A case of infantile cortical hyperostosis of the right mandible of a newborn is reported. Multiple radiographic tests, as well as bone biopsy, were necessary to establish a definitive diagnosis. The most striking features of this disease are presented, including the clinical and physical presentation, radiographic characteristics, and pathology.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Odontogenic keratocyst of the mandible: an unusual cause of a parotid mass.Odontogenic keratocyst (OKC) of the mandible refers to an uncommon benign lesion of the jaw that originates from dental primordia. Clinically an OKC is characterized by aggressive, local growth. The likelihood of local recurrence following initial treatment is high. The diagnosis of a mandibular OKC may be suspected based on physical examination and plain film radiographic findings. However, histopathological confirmation is required to make the diagnosis with certainty. Complete surgical removal is the preferred treatment. In the current report, we describe the management of a patient with a large mandibular OKC that produced an apparent mass in the parotid gland. In addition, the diagnosis, management, and long-term results of treatment of mandibular OKCs are reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |