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Context:Since Demirjian system of estimating dental maturity was first described, many researchers from different countries have tested its accuracy among diverse populations. Some of these studies have pointed out a need to determine population-specific standards.Aim:The aim of this study is to evaluate the suitability of the Demirjian's method for dental age assessment in Tunisian children.Materials and Methods:This is a prospective study previously approved by the Research Ethics Local Committee of the University Hospital Fattouma Bourguiba of Monastir (Tunisia). Panoramic radiographs of 280 healthy Tunisian children of age 2.8–16.5 years were examined with Demirjian method and scored by three trained observers.Statistical Analysis Used:Dental age was compared to chronological age by using the analysis of variance (ANOVA) test. Cohen's Kappa test was performed to calculate the intra- and inter-examiner agreements.Results:Underestimation was seen in children aged between 9 and 16 years and the range of accuracy varied from −0.02 to 3 years. The advancement in dental age as determined by Demirjian system when compared to chronological age ranged from 0.3 to 1.32 year for young males and from 0.26 to 1.37 year for young females (age ranged from 3 to 8 years).Conclusions:The standards provided by Demirjian for French-Canadian children may not be suitable for Tunisian children. Each population of children may need their own specific standard for an accurate estimation of chronological age.

Postobstructive pulmonary edema is a life-threatening complication that occurs after the removal of severe upper airway obstruction. Development of postobstructive pulmonary edema has been described after several cases of upper airway obstruction. However, postobstructive pulmonary edema developing after non-lethal hanging has not been reported widely in the literature. Herein, we describe a fatal case of postobstructive pulmonary edema in a 10-year-old girl, which was brought to the hospital with history of attempted suicide by hanging. At presentation, the girl was breathing laboriously. The oxygen saturation was of 82% and pulmonary auscultation revealed bilateral and diffuse crepitations. The chest computed tomographic scan showed bilateral diffuse infiltrates consistent with pulmonary edema. After 3 days of hospitalization, the respiratory state of the girl worsened leading to death despite intensive care. An autopsy was conducted and confirmed the diffuse pulmonary edema. Hence, this case confirms that delayed death in near hanging may occur. Pulmonary edema which develops subsequently in such patients is an uncommon mechanism of death that physicians should consider in emergency room.

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Most asphyxia deaths caused by foreign body aspiration occur in children and the elderly. It can also occur in specific high-risk groups of adults, such as those with underlying esophageal diseases, prisoners, those with mental retardation, and those with psychiatric illnesses. We report the case of a 49-year-old man, without previous medical history, who died rapidly after aspirating a sole fish while he was unraveling the fishing net using his teeth. At autopsy, the foreign body was found in the trachea, wedged in the carina and obstructing the right bronchus origin. The finding from the usual toxicological screening was negative.

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