Bone scan diagnosis of masked mastoiditis.
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Biomedical subjects
Publications and source records attributed to A Gatot.
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Osteoblastic osteitis is a rare kind of bone infection typified by a proliferative reaction of the periosteum and by exuberant bone formation. In the maxillary sinus, it occurs as a consequence of chronic or recurrent sinusitis. It usually manifests with a vague facial discomfort, followed by complications in the deep facial spaces or fossae. The diagnosis is a radiological one. Eradication of this bone infection necessitates removal of the precipitating condition as well as the long-term administration of appropriate anti-biotics. In the case of a deep facial fossae abscess, drainage is mandatory.
Fifteen pediatric patients with orbital floor fractures were successfully treated early, following injury by a transantrally introduced catheter-balloon technique. The latter stabilizes and supports the torn, but still vascularized periosteum at the edges of the fracture and also serves as a guide for its further proliferation and new bone formation. Apart from a transient anesthesia in the dermatome of the infraorbital nerve in certain patients no complication or sequela was noted in this series. Accordingly early repair with the use of catheter-balloon appears to be a viable alternative in the repair of orbital floor fracture in children.
The effects of an inadvertent injection of sodium hypochlorite into the cheek during irrigation of the right maxillary central incisor root canal are reported. The patient suffered from severe pain, edema, and necrosis of subcutaneous tissues and mucosa. Surgical intervention was necessary to contain the destructive process which extended from the upper lip to the right eye. The histopathological examination demonstrated the high cytotoxicity of sodium hypochlorite on vital tissue.
A cystic dilatation of a paranasal sinus by an entrapped air mass has been termed pneumosinus dilatans or a pneumocoele. The occurrence of this condition in the maxillary sinus is quite rare. In the present case, a mid-face mass mimicking an osteoma was the presenting sign of the disease. The pathogenesis, clinical features and radiological aspects of this entity are reviewed. In order to avoid confusion with other conditions of different aetiopathogenesis, we propose to label the lesion as 'air cyst' of the paranasal sinus, a term that best describes the nature of the lesion.
Orbital abscess of rhinosinogenic origin may develop, either by contiguous spread of the infection or by a thrombophlebitic process. While destruction of the bony walls of the paranasal sinus occurs in propagation of the infection by tissue continuity, haematogenous spread may take place through intact bone. Computed tomography demonstrates the status of the bony partitions shared by the orbit and paranasal sinuses, and the source of the orbital sepsis, thereby influencing the therapeutic approach.
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Obturation of the root canal space with an inert filling material and creation of a hermetic apical seal has been shown to improve the success rate of endodontic therapy. A new technique of canal obturation with injection-molded thermoplasticized gutta-percha has been shown to create a good apical seal. However, failure to determine accurately the canal working length and create an apical stop in sound dentin can lead to overextension of the gutta-percha into the periradicular bone. A case of significant overextension of gutta-percha using this new technique is presented along with its ramifications and management.
We present a case of oral papillomatosis occurring in a 52-year-old woman. This condition is well known and is characterized by an exuberant proliferation of multiple, flat, verruca-like elevations on the oral and pharyngeal mucosa. This is apparently the first documented case of oral papillomatosis due to trauma to the oral tissue from a dental prosthesis, with subsequent inflammation. Correction of the prosthesis resulted in marked improvement. This presentation emphasizes the causes, diagnosis, pathologic basis, and treatment of this condition.
An extensive lateral sinus thrombosis secondary to silent otitis media, in a patient with a nephrotic syndrome, is presented. The thrombotic process progressed asymptomatically until the occlusion of the superior vena cava. Removal of the intractable pathology within the mastoid and administration of appropriate antibiotic therapy, prevented the further propagation of the life-threatening condition.
An injury of the inferior alveolar nerve is not an uncommon occurrence. We envisage the physiopathologic process of this involvement. One case of injury of the nerve by endodontic overfilling is presented and analyzed. Prednisone therapy appears to shorten the course of the disease, prevent the secondary fibrosis, and lessen the severity of sequelae.
Two cases of initially undiagnosed silent fractures of the medial wall of the maxillary sinus complicated by a delayed osteomyelitis are presented. The presenting feature was periorbital cellulitis. The etiopathogenesis of this process is based on an interference with the sinus ostium function by ingrowth of hypertrophic scar tissue.
Hypoglossal nerve palsy occurred in 2 patients with infected second branchial arch cleft cyst. This very unusual complication of the congenital anomaly has been related to the mechanical compression of the mass. Histologic features of the perineural coat were also suggestive for this etio-pathogenesis.
Laryngotracheal stenosis is a recognized complication of local injuries, such as prolonged intubation. Surgical reconstruction with the use of a tracheal T-tube is widely recommended. We report a serious complication consisting of the sudden obstruction of the T-tube by viscous secretions. In order to prevent this undesirable consequence, a simple modification of the T-tube technique is proposed.
Temporomandibular joint arthritis is a rare manifestation of familial Mediterranean fever and should be considered in patients of Mediterranean origin. Recently we treated four patients suffering from this condition, and intra-articular corticosteroid injection resulted in rapid resolution of the pain and disability in two. Computed tomography confirmed the usefulness of this therapeutic modality.
Nasal histamine challenge (NHC) was performed on patients suffering from chronic rhinitis. The histamine was administered to the nose in the form of a spray. One hundred sixty-eight patients and 20 healthy subjects were examined. The histamine was sprayed into the nose in seven metered doses, from 0.03 mg to 3 mg. The nose was examined before and 4 minutes after each challenge. A positive reaction to challenge was indicated when the conchae swelled to the point that they impinged against the septum. We found that some patients reacted to a low dose of histamine (0.03 mg to 0.15 mg) while our control group and some other patients reacted positively only to higher doses of histamine (3 mg or more). After the first tests, NHC patients were randomly divided into two groups. One group was treated with placebo and the other group with antihistamines. Three weeks later another NHC was performed (now under treatment) and revealed that patients reacting to low doses of histamine improved significantly with antihistamine treatment, while those reacting to a high dose did not respond to antihistamines. We found the NHC to be a simple test with no complications, and one that is easily tolerated by patients, including children. Nasal histamine challenge helps to identify which patients will improve with antihistamine treatment and aids the evaluation of its efficacy.