HighlightsChronic recurrent multifocal osteomyelitis (CMRO), or chronic nonbacterial osteomyelitis (CNO), is a very rare condition of unknown aetiology. It is characterised by focal sterile inflammatory disease with prolonged, self-limiting and recurrent episodes.Relatively few cases of CMRO have been reported since the first description in 1972 by Giedion, and is poorly characterised in the maxillofacial surgery literature due to the use of inconsistent terminology.CMRO is a very rare disease characterised by recurrent flare-ups of inflammatory bone pain related to aseptic osteomyelitis; lesions can be unifocal (CNO) or multifocal (CMRO).The proper course of treatment for CMRO remains unclear and no standard therapy is available.
HighlightsGorham-Stout disease (GSD) is a very rare idiopathic bone disorder characterised by spontaneous and progressive osteolysis, associated with angiomatous proliferation and soft tissue swelling without new bone formation.The clinical presentation of GSD includes pain, functional impairment, and swelling, although a few asymptomatic cases have been reported, similar to our case.We present this rare case of GSD with several localisations to emphasise that any procedure appearing to be simple can go catastrophically wrong and can result in the discovery of something that is unexpected and extremely rare.We wish to emphasise the extreme rarity of the case, focusing on the large difference between the preoperative panoramic radiograph and whole-body CT and MRI images obtained on the day after the first surgical procedure.
HighlightsVarious evidence-based guidelines for dental clinicians deal with the use of general anaesthesia when treating children.Management of acute haemorrhage can be difficult and the decision of how to manage a severe acute haemorrhage is influenced by many factors.we had identified the patient as a “fragile child’; our protocol dictated that she should be treated in the operating room.This meant that, when the emergency developed, we had everything that we needed to hand.
Condylar fractures (CFs) are about 30% of mandibular fractures. Condylar fractures are treated with several protocols, and unsatisfying outcome is achieved in some cases. A staging system for classifying CFs is of paramount importance to plan therapy, to define prognosis, and to exchange information among trauma centers. The Strasbourg Osteosynthesis Research Group proposed a classification system for CFs, but no report focusing to its effectiveness is still available. Thus, we performed a retrospective study on a series of patients affected by CFs.The Strasbourg Osteosynthesis Research Group classification defines 3 main types of CFs: diacapitular fracture (i.e., through the head of the condyle [DF]), fracture of the condylar neck, and fracture of the condylar base (CBF). A series of 66 patients (and 84 CFs) was evaluated, and age, sex, clinical diagnosis at admission, treatment, and outcome were considered.Fractures of the condylar base and DFs are the most (52.4%) and the least (4.8%) frequent fractures, respectively. Conversely, associated fractures of the facial skeleton are found in most cases of DFs (75%) and in few cases of CBFs (20.5%). Surgery was performed in about 15% of all cases: no DF was operated, whereas fractures of the condylar neck and CBFs have an open reduction and an internal rigid fixation in 57% and 43%, respectively. Postsurgical and late sequelae were 22.3% and 19%. Temporomandibular joint symptoms and malocclusion cover about 80% and 90% of postsurgical and late sequelae.The new classification is a simple method to define CFs and can give some elements about the prognosis.
Purpose
Special needs children presenting with dental problems were penalised during the Covid-19 pandemic due to the reduction of clinical activity and the risks of nosocomial infection. The aim of this study is to evaluate the impact of the pandemic on oral healthcare in paediatric special needs patients.
Methods
We retrospectively assessed and compared the outpatient clinic activity and dental procedures performed under general anaesthesia in children with special needs at Brescia Children’s Hospital (Italy) in 2019, 2020, and 2021. Any delay between expected waiting time based on assigned priority and surgery was recorded. The efficacy of the protocol adopted to reduce the spread of Covid-19 was evaluated by reporting any infections in patients, parents, and health care providers.
Results
In 2020, 270 outpatient visits were performed, and 40 patients were treated under general anaesthesia, with a 26% and 65% reduction, respectively, compared to 2019. In 2021, 362 visits were performed (similar to 2019) and 48 patients were treated under general anaesthesia (58% compared to 2019). The mean delay in the planned treatment was 1.0 month in 2019 (pre-pandemic period), 2.1 months in 2020, and 1.1 month in 2021. No cases of Covid-19 infection were reported in the cohort of patients and parents or among the operators related to nosocomial infection.
Conclusions
The Covid-19 pandemic has profoundly reduced the activity of general anaesthesia in paediatric special need patients during 2020, with a gradual return to normal pre-pandemic activity in 2021. The adopted protocol prevented the spread of COVID-19 during hospitalisation.
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