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Caudal nasal deviation.

Caudal nasal deviation, manifested by a "crooked tip," asymmetric nostrils, and a deviated columella, is one of the most challenging deformities encountered in rhinoplasty. This entity is often ignored by rhinoplasty surgeons, on the basis of the assumption that correction of other segments of the deviated nose will improve the caudal nose. Failure to correct this imperfection (or, occasionally, deformity) invariably produces suboptimal results. The nasal structures involved in caudal nasal deviation, namely, the septum, the lower lateral cartilages, and the anterior nasal spine, must be evaluated for identification of the anatomical blocks that have a causative role in caudal nasal deviation. The specific structures with abnormalities related to this deformity are discussed, as are techniques for the correction of the deformities. These techniques significantly augment the surgeon's repertoire of methods for addressing the subtleties of caudal nasal deviation correction and achieving predictable results.

Adult↗

Dermoid sinus and cyst of the lip.

Midline dermoid cysts, although rare, typically present as nasal or glabellar masses with potential sinus tract extension to the skin or to the central nervous system. Craniofacial dermoid cysts present in varied ways, including asymptomatic puncti, infection, or seizure secondary to intracranial invasion. This article describes the previously unreported occurrence of a midline dermoid within the labial frenulum diagnosed on surgical excision of the cyst and its orocutaneous sinus tract, which extended to the skin at the base of the columella.

Cutaneous Fistula↗

Unknown posttraumatic foreign body in facial region.

This study emphasizes the importance of scrupulous diagnostic first aid procedures to avoid the consequences of trauma due to a foreign body. Two patients were examined, both with facial trauma showing nonspecific symptoms. Through objective internal and external oral examination complete with clinical and radiographic examinations Three dimensional computed tomography (TC3D), foreign bodies unknown at the time of the trauma were identified. When the foreign bodies had been removed, the ache symptoms disappeared, restoring functionality and the patient's facial appearance. This study shows the need for detailed early diagnosis to achieve correct monitoring and therefore proper treatment for these patients.

Adolescent↗

Labial food challenge in children with food allergy.

The current increase in the prevalence of food allergies appears to have several causes including better screening, improved diagnosis and changes in both the techniques used by food manufacturers and eating habits. Labial food challenge (LFC)is simple, rapid to perform and is associated with only low risks of systemic reaction. It is thus an appealing alternative to the oral food challenge (OFC) for pediatric use. We report a series of 202 LFC performed over two years in 142 children with food allergy suspected from the case history, positive skin prick tests and specific serum IgE assays: 156 LFC were positive; and 46 negative, followed by positive single-blind, placebo-controlled food challenges (SBPCFC). The foods provoking reactions were egg white (75 cases), peanut (60 cases), mustard (23 cases), cow's milk (13 cases), cod (8 cases), kiwi fruit, shrimp (4 cases each), chicken, peanut oil (3 cases each), hazel nuts (2 cases), and snails, apple, fennel, garlic, chilli peppers, pepper, and duck (1 case each). LFC positivity was mostly (89.7% of cases) manifested as a labial edema with contiguous urticaria. There were systemic reactions in 4.5% of cases: generalized urticaria, hoarseness and rapid-onset and generalized eczema. The 46 infants with negative LFC results had positive SBPCFC. The reactions were in 34 cases generalized urticaria, 10 cases asthma attacks, 2 cases early and generalized eczema, and in one case general anaphylactic shock. The sensitivity of the LFC was 77%. The LFC was easy to perform with children. Positive results indicate the presence of food allergy, but negative results require further investigations preferably double-blind, placebo-controlled food challenge (DBPCFC).

Administration, Oral↗

A longitudinal study of isolated gingival recession in the mandibular central incisor region of children aged 6-8 years.

A 2-year longitudinal investigation of isolated gingival recession was undertaken in 42 children aged 6-8 years at the commencement of the study. Gingival inflammation was controlled by supervised tooth brushing or professional plaque control. Mandibular anterior crowding considered to have contributed to the degree of recession was untreated in 11 subjects, while in 13 subjects serial extractions had been undertaken. No attempt was made to correct frenal involvement in those subjects (9) where it might have been considered a contributing etiologic factor. After 2 years, improvement in gingival contour was most apparent in those subjects whose gingival inflammation had been controlled. This was achieved more readily with professional plaque control than with supervised tooth brushing. Improvement in arch alignment and gingival contour was greater in untreated subjects than in those receiving serial extractions. WHen gingival inflammation was controlled evidence of frenal involvement declined. Control of gingival inflammation appears to be the most important factor in the treatment of isolated gingival recession in the mandibular central incisor region.

Child↗

Buccal attachment loss in Swedish adolescents.

A case referent study was performed to identify factors connected with loss of buccal attachment in adolescents. The study group was identified among 18-year-olds who had participated 2 years earlier in a study of periodontal conditions in adolescents. The criterion for inclusion in the case group was buccal attachment loss (greater than or equal to 1 mm) in one or more sites. Information on 28 variables, identified earlier as being related to recessions, was collected in a clinical examination, interview and observation. The referent group consisted of 66 subjects and the case group of 71 subjects. The case group comprised 2 subgroups, one identified as having buccal attachment loss in 1987 and the other with attachment loss occurring in the years 1987-89. Statistical analyses, using the chi 2 test, logistic regression and a variance component model, were performed to detect factors related to buccal attachment loss. These factors were thin alveolar tissue, narrow width of the attached gingiva and presence of teeth with buccal displacement. The results indicate that the anatomy of the buccal alveolar process is related to the presence of buccal attachment loss in populations with a high level of oral hygiene. To evaluate the importance of possible risk factors or etiological factors for development of buccal loss of tooth support, prospective epidemiological or experimental studies are needed.

Adolescent↗

Prevalence of narrow zone of attached gingiva and improper attachment of labial frena in youths.

An epidemiologic study comprising 1542 girls and boys aged 15--17 revealed that the occurrence of the narrowest attached gingiva zone (greater than 0, less than or equal to 1 mm) was more frequent in the mandible (23.0%) than in the maxilla (2.0%). At the same time, the first type of labial frena attachment (mucosal type) was observed most often, again dominating in the mandible (71.0%).

Adolescent↗

Sexual cyclicity in captive lowland gorillas.

Oppositely sexed pairs of gorillas exhibit some behavior indicative of higher cognitive functioning, such as individual partner preferences and varied copulatory positions, but also mate in a cyclic manner closely related to the degree of female genital swelling. The latter finding is contrary to predictions based on their advanced position in phylogeny.

Animals↗

Best evidence topic report. Torn frenulum and non-accidental injury in children.

A short cut review was carried out to establish whether a torn frenulum in a child is indicative of non-accidental injury. Altogether 104 papers were found using the reported search, of which none presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.

Accidental Falls↗

Congenital oral mucosal abnormalities in true umbilical cord knots.

OBJECTIVE: The pathogenesis and clinical significance of true umbilical cord knots remain controversial. Here, we tested the hypothesis of the presence of congenital oral mucosal changes in newborns with true umbilical cord knots. STUDY DESIGN: Seven consecutive infants with true umbilical cord knots and 50 gestational age- and sex-matched controls were enrolled. The proportion of oral frenulum abnormalities and the two-dimensional vascular network geometry [fractal dimension, D, at two scales: D(1-46), and D(1-15), with the relative Lempel-Ziv complexity, (L-Z)], were analyzed. RESULTS: Infants with true umbilical cord knots showed significantly higher proportions of mandibular frenulum agenesis compared to controls (p = 0.000006). The oral vascular networks of these infants exhibited a significantly higher D(1-46) and D(1-15) (p < 0.0001, respectively), and higher L-Z values (p < 0.0001) than control networks. CONCLUSION: These findings indicate the presence of significant congenital oral mucosal changes in newborn infants with true umbilical cord knots, thus suggesting a previously unrecognized association between true umbilical cord knots and a subclinical extracellular matrix disorder.

Female↗