Traumatic dental disease and soft tissue injuries of the oral cavity

Trauma to the oral cavity can result in an array of injuries affecting teeth, bone, and soft tissue. A thorough examination of the oral cavity is often facilitated by employing a full-mouth speculum after the horse has been tranquilized. Identification of broken, loose, or split teeth; fractures of the premaxilla or mandible; and avulsion or laceration of soft tissue structures such as the lips or tongue is usually straightforward. Treatment options vary depending on the structure involved; however, appropriate treatment generally results in a functional and cosmetically acceptable end result.     

Involvement of GABAB receptors in the antinociception induced by baclofen in the formalin test

Pathological calcifications of skin manifest as small or large deposits of calcium in the dermis and subcutaneous tissues. One form of these conditions is described as subepidermal calcified nodule seen on the facial skin of young children without any underlying connective tissue disease or any abnormality in calcium or phosphorus metabolism. The oral cavity is rarely affected. Recently, two cases were reported in the oral mucosa and the term "mucosal calcified nodule" was coined for such an entity. We report another case of such a process involving the oral mucosa of a 5-month-old infant who presented with an enlarging lesion at the junction of the hard and soft palate.     

A cervical manikin procedure for chiropractic skills development

Spinal injuries resulting from falls out of tree stands are often associated with concomitant neurologic deficit, prolonged hospitalization, and long-term disability. The purpose of this study was to review the types of spinal injuries that resulted from falls from hunting tree stands. We retrospectively reviewed 27 patients who came to our institution for treatment of spine injuries related to tree-stand accidents between 1981 and 1997. Eleven percent of the falls were alcohol related. Mean height of the fall was 19.6 feet (range, 10 to 35 feet). There were 17 burst fractures, 8 wedge compression fractures, 4 fractures involving the posterior elements, and 1 coronal fracture of the sacral body. Significant neurologic injury occurred in 12 patients (44%). Sixteen patients (59%) had associated injuries. Nine patients (33%) had open reduction, internal fixation, and fusion of their spine fractures. One patient was treated with a halo jacket. The remaining patients were treated in rigid, molded, polypropylene thoracolumbar orthoses or lumbosacral corsets. Accidental falls from tree stands may result in significant spinal fractures often associated with concomitant neurologic injury, extended hospitalization, and permanent disability. Many of these injuries may be prevented through aggressive hunter safety education.     

Oro-dental injuries during intubation anesthesia

Injuries to the oro-dental tissue are still one of the most frequent mishaps during endotracheal intubation and general anaesthesia. However, damage to the soft and hard tissues in most cases involves oral structures already showing advanced pathogenic alterations. Injuries to the teeth are therefore rather more often due to the disease of the teeth than to mistakes during anaesthesia. The risk of injuries to the teeth can be ascertained by means of a presurgical inspection of the oral cavity and evaluation of the individual anatomical conditions in the head and neck region, which may well interfere with the endotracheal intubation. In contrast to anaesthetic pitfalls causing severe disturbance of general health, dental trauma can be treated with quite satisfying functional and aesthetic results. However, in order to maintain conditions for the complete restitution of injured teeth immediate dental therapy is recommended. In preterm infants which need mechanical ventilation during the postnatal period direct laryngoscopy as well as mechanical alterations caused by an oral tube can cause injuries to the tooth germs of the first and second dentition and deformation of the maxillary skeleton. In consequence the patient will need intensive therapy of the resulting disturbances for several years. This review gives information about the causes and types of injuries to the oral and maxillofacial region during general anaesthesia. In addition, the anatomical conditions and pathological changes associated with an increased risk for oro-dental injuries and the facilities for prevention are discussed. Finally, the main aspects of emergency treatment of injuries to the dental hard tissues are presented.     

Management of the thumb-index web space contracture

This paper focuses on the management of the thumb-index web space contracture, a contracture that can interfere significantly with hand function. The anatomy of the thumb-index web space and the contracture mechanism are reviewed. Contractures frequently result from traumatic hand injuries involving the web space or peripheral nerves. Exercises and splinting techniques for preventing or correcting these contractures are directed at achieving and maintaining maximum range of motion and strength of the thumb. Case reviews are reported that show improvements in range of motion measurements of 31 patients treated with the described techniques.     

Intraarticular fractures of the foot. Talus and lesser tarsals

In the absence of historical comparative data for the treatment of tarsal fractures, commonly abided maxims of trauma care are noteworthy. A displaced fracture involving an articular surface or a fracture interrupting a mechanical axis is treated by open reduction and internal fixation. Rigid fixation is followed as early as possible with active and passive mobilization. Unlike long bones, whose motion and fracture patterns (i.e., segmental, transverse, and oblique) are understood, the tarsal bones are small bones with complex shapes and restricted motion. As a result, tarsal injuries most often occur with multiple ligamentous and bony injuries. Articular step-off is difficult to establish roentgenographically, the blood supply is tenuous, and fixation is largely dependent on screws and Kirschner wires. Good outcome can be obtained by following principles of internal fixation established in treatment of major joint injuries.     

Surgical tactics in severe combined injuries of the face and other body regions

The results of treatment in 67 patients with associated injuries of the face and other regions of the body are analysed. Sixteen of them died. Their poor state was conditioned not by facial injuries but by traumas of other organs and system of the organism. It is concluded that such patients should be treated not in stomatological but in special traumatological departments for polytraumas. Surgery is first to be performed in the region where the damage is most hazardous. But the first step is to prevent aspiration of blood from the oral cavity into the respiratory tract followed by the fixation of jaw fragments.     

A new incision for intra-oral access without lip split

A non-lip-splitting approach to the oral cavity is described, using a curved incision through the angle of the mouth along the inferior buccolabial sulcus. The incision provides good access to the entire oral cavity and heals efficiently with good cosmetic results. It is suited to patients who require excision of the oral commissure.     

Use of the laser in the oral cavity

Literature on head and neck oncology continues to support the use of lasers in surgery of malignant and premalignant lesions of the oral cavity. This article explores the indications, techniques, results, and complications of laser use for surgery involving these lesions. Highlighted is the carbon dioxide laser, which is well suited for transoral resections of premalignant lesions and early carcinomas in the oral cavity. In this study the local control, the 5-year survival rates, and the postoperative function with the carbon dioxide laser are at least comparable with those obtained using other surgical methods. The neodymium:yttrium-aluminum-garnet laser, which has specific advantages in the treatment of large vascular malformations of the oral cavity because of its unique characteristics, is also discussed.     

Actinomycosis in otorhinolaryngology. Apropos of a case with localization in the nasal cavity

The authors report an atypical case of actionomycosis implanted in the nasal cavity and occurring twenty years after septum surgery. Treatment by penicillin and surgical excision gave a good result. Cervicofacial actinomycosis is caused by actinomyctes which usually lives as a saprophyte in the oral cavity. A trauma is often found in the previous history. Diagnosis with tumors and abscess may be difficult. The histopathological examination shows typical aspects of the granuloma (gram+ and Grocott+) and the bacteriological isolation of the germ is difficult to obtain. Penicillin associated with surgical excision is the best therapy, but high doses must be used for a long time. The literature is reviewed without finding such a case.     

Current advances in sports-related cartilage research. Meniscus and ligament injuries are associated with increased risk of knee joint arthrosis

The majority (up to 87%) of patients with meniscus and ligament injuries of the knee develop degenerative radiological changes in a 10-20-year perspective, patients with knee injuries involving several structures being at the greatest risk. A high level of activity has been shown to be a correlate both of repeat injury and the development of osteoarthrosis. However, it has not been determined when or in what proportion of cases such changes result in joint destruction and permanent disability. The incidence of isolated cartilage injuries is low, and it is unclear whether such injuries predispose to osteoarthrosis. No validated method is yet available for the effective treatment of circumscribed or more extensive cartilage injuries, which would be preferable to conservative treatment.     

A survey of health care and child protective services provider knowledge regarding the toe tourniquet syndrome

Recent efforts to increase public awareness of child abuse may result in an increased number of inappropriate reports of suspected child abuse. The authors believe that digital hair strangulation should be included among the conditions that may be confused with child abuse. Digital hair strangulation (toe tourniquet syndrome) occurs primarily in infants and is characterized by a constricting band of foreign material that becomes tightly wrapped around a digit or digits (most often the toes). The consensus in the medical literature is that this condition is not the result of intentional injury. As no reference to the toe tourniquet syndrome exists in the child abuse literature, it was hypothesized that child welfare workers would be more likely than physicians and public health nurses to misinterpret this condition as resulting from intentional injury. A survey was conducted to test this hypothesis. Professionals from the fields of medicine, nursing, and child welfare were provided with a history and photographic findings of a child with a typical case of the toe tourniquet syndrome. Participants were surveyed regarding their interpretation of the described injuries. More than 50% of all respondents indicated that they would report this case as suspected abuse. Child welfare workers responded that the injuries were suggestive of abuse (83%), significantly more often than public health nurses did (45%), (chi 2 = 4.55, p = .03).(ABSTRACT TRUNCATED AT 250 WORDS)     

Ocular sequelae of BB injuries to the eye and surrounding adnexa

BACKGROUND: BB injuries continue to be one of the most common causes of severe ocular injury among adolescent males. Extraocular and nonperforating anterior globe injuries most commonly result in favorable visual outcomes. The appropriate medical management of both perforating and nonperforating anterior globe injuries resulting from BB trauma and their potential ocular sequelae are reviewed. CASE REPORTS: Three cases illustrating typical as well as atypical anterior globe injuries caused by BBs are presented. Two cases involve nonperforating anterior globe injuries--one with intracranial and one with intraorbital involvement. The third involves a retained intraocular foreign body. The biomicroscopic and ophthalmoscopic features of these injuries are discussed, as are potential complications and management strategies associated with these types of trauma. CONCLUSIONS: Injuries associated with intraocular BBs often result in enucleation if functional vision is not salvageable. Sequelae to such injuries include endophthalmitis, traumatic hyphema, ocular siderosis, and sympathetic ophthalmia. Plain-film radiography and axial computed tomography are critical first steps in determination of the position of any intracranial or intraorbital metallic foreign body. Routine observation for the development of ocular sequelae resulting from retained intraocular, intracranial, and intraorbital BB injuries is recommended.     

Ingestion of caustic hair relaxer: is endoscopy necessary?

Hair relaxer, a commercially available alkaline product, is commonly the offending agent in caustic ingestion. These patients often experience oral cavity and facial burns; however, no clinically significant esophageal injuries have been reported. Therefore, we questioned the therapeutic and economic efficacy of the "standard treatment protocol" that includes hospitalization and endoscopic evaluation. Twenty-six patients over a 7-year period presented to our institution having ingested hair relaxer. Presenting signs and symptoms, esophageal findings, and cost of the standard treatment protocol were reviewed. Also, we analyzed the caustic potential and current packaging of hair relaxer. Our findings support modifications in the standard treatment protocol for hair relaxer ingestion including elimination of hospitalization and endoscopy in most patients. We also question compliance with childproof packaging laws and suggest avenues for prevention of hair relaxer ingestion.     

Oral and periodontal tissue. Maintenance, augmentation, rejuvenation, and regeneration

This article discusses the controversies, usefulness, and limitations of oral and periodontal tissue maintenance, augmentation, rejuvenation, and regeneration in the dog and cat. It details many of the specialized materials and techniques used in these procedures in attempts to re-establish healthy conditions within the periodontium. Bone loss following tooth extraction is discussed with consideration as to which teeth should have alveolar ridge maintenance procedures and the important reasons as to why. Radiographs show the degree of improvement demonstrated in treatment of various cases involving bone loss from periodontal disease, treatment of bone injuries with oral fractures and their prevention.     

Central and peripheral nervous complications of dental treatment

This review outlines the complications involving the central or peripheral nervous system arising from dental procedures reported in the last decade. By far the commonest complications were related to intraoperative mechanical peripheral nerve injury. Trauma to branches of the mandibular nerve occurring during oral operations may potentially result in varying degrees of hypoesthesia, paresthesia, dysesthesia or in chronic pain syndromes. An increase in malpractice suits related to such a complication has been recognized in the late years. A warning of the possibility of occurrence of this complication should to be given to all patients undergoing risky procedures as part of the process of obtaining informed consent to operation. Mandibular third molar extraction seems to be alone the most hazardous procedure related to mechanical nerve injuries and also with anesthesiological accidents. Severe but rather infrequent infectious (meningitis, brain abscess and cavernous sinus thrombophlebitis) and anesthesiological complications (occular and facial palsies, optic nerve injury and complications related to general anesthesia) were also reported in this period.     

Melanoma arising from the mucosal surfaces of the head and neck

Oral mucosal malignant melanoma is a rare disease. We reviewed 30 years of data from a tumor registry and identified 65 patients who had head and neck melanomas. Two thirds (43) of the 65 patients were identified as male, with the mean age in the sixth decade. Of the 65 patients, only 6 had melanoma that arose from the oropharyngeal mucosa. Of the lesions involving the oral mucosa, each lesion manifested itself as a mass or was associated with symptoms of discomfort; only one third (2) of the lesions were pigmented. The clinician must carefully examine the head, neck, and oral cavity, and any pigmented lesion that is not recognized as a specific entity, such as amalgam tattoo, should be biopsied. The more common presentation of amelanotic malignant melanoma requires a high index of suspicion for masses identified in the mouth and requires biopsy for definitive diagnosis. The prognosis for oral mucosal malignant melanoma is poor.     

Analysis of Construction Worker Injuries That Do Not Result in Lost Time

Attempts to examine the root causes of injuries in the construction industry have been largely focused on fatalities and other serious injuries. These efforts were undertaken with the assumption that the root causes of serious injuries could lead to identifying approaches that could prevent the recurrence of similar injuries in the future and that these approaches would also be successful in eliminating many minor injuries. While some injuries may be either minor or serious depending on small differences in worker position, etc., that assumption does not appear to be valid for most injuries. The trends of causes leading to minor injuries are often quite different from those resulting in serious injuries. With this assumption, an examination was conducted to profile nearly 136,000 construction worker injuries, most of which did not result in lost time. Results indicate that these injuries, not resulting in lost time, generally do not fit the profile of injuries that result in fatalities or that are serious. Over half of the injuries in the present study were associated with lacerations (usually of the fingers and hand) and injuries sustained by the lumbar spine, upper extremities, or eyes. The percentage of injuries that involved lacerations was considerably higher for construction than for all other industries. The costs of injuries were found to be quite varied, depending on the part of the body that was injured.     

Case-control study of agricultural injuries to women in central Wisconsin

A small number of women are the owner/operators of farms and women often participate in the work of production agriculture. Estimates of the percentage of females involved in agricultural injuries range from 11-45% and it is not clear if the risk factors associated with injuries to women are different from those for men. In a two year case-control study of injuries to farm residents, there were 40 injuries involving adult women. Multivariable analysis revealed that the two major risk factors for agricultural injury to females were number of hours worked and the presence of bulls on the farm. Most (55%) of the women were injured while in a barn. A cow was the primary agent of injury in 17 (42.5%) of the cases. Efforts to reduce the rate of injuries to women in agriculture should be targeted to the particular risks they experience.     

Surgical treatment of patients with open tibial fractures

Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitis, which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm accidents, falls from heights, or gunshot wounds. Initial management of patients with multiple trauma injuries focuses on their life-threatening injuries before or during orthopedic surgical intervention for open tibial fractures. Orthopedic surgeons often work in collaboration with general, vascular, and plastic surgeons and perform multiple surgical procedures (eg, fasciotomy procedures for compartment syndromes, irrigation and debridement of wounds, application of external fixation devices, placement of intramedullary nails, possible limb amputations). The type and extent of open tibial fractures and soft tissue injuries determine the best treatment options for patients. Perioperative nurses should help patients focus on treatment choices for their open tibial fractures that ensure optimal surgical outcomes and maintain their quality of life.