Postoperative manifestations like pain, edema, affected oral functions provoke transitory morbidity in patients to a late recovery. Various classes of medicines are prescribed to prevent placing patients in such unpleasant situations. Both dexamethasone and methylprednisole can be used to reduce the manifestations of the postoperative disease. Although the state of local inflammation is precursory to healing, its exacerbation can lead to extremely painful severe local edema through tissue distention. In the initial phase of the inflammatory process, glucocorticoids act as producers of vein-active substances like prostaglandins and leukins, as dexamethasone has a recognised capacity of reducing COX-2, which is responsible for generating PGs which are produced within the inflammatory response. The efficiency of glucocorticoids is admitted in reducing the inflammatory state, lying at the top of oral maxillofacial surgeons�s choice in the therapy of postoperative manifestations. Our research was addressed to a lot of 68 patients to whom we performed interventions of oral and maxillofacial surgery at the Outpatient Clinic of Oral-Maxillofacial Surgery of Ia�i. Dexamethasone is a strong glucocorticoid with the following chemical formula: 90-fluoral-160 methylprednisole. The antiinflamatory effect of a 0.75 mg dosis of dexamethasone is equivalent to that produced by 5 mg of Prednison. Dexamethasone is more efficient than Medrol in the treatment of postoperative edema with complete remission of symptomatology.
The progress of fundamental medical sciences, of other medical and surgical specialties enabled a fast development pace of modern maxilla-facial surgery. Oro-maxilla-facial surgery bring together science and art in order to prevent, diagnose and cure disease, to reconstitute shapes and restore functions of the oro-maxilla-facial area often by surgery. Apical surgery is a standard surgical procedure including incision of the apex and resection of the apical and periapical diseased site, preceded or not by the correct endodontic treatment and the adequate root canal obturation. Periapical pathology is maintained in an endodontic treatment considered correct, being resolved by endodontic surgery with apicoectomy and avoiding extracting the causal tooth. In this way the area is kept as favorable as possible for future prosthetic works. It is achieved mostly in monoradicular teeth and this intervention is suitable for molars, yet the topography and the morphology of the molars make the surgery more difficult. Oral surgery and endodontics have accumulated a rich experience in maintaining the teeth on the arch for as long as possible. The study material for endodontic case selection, examination and resolving is gathered from the Clinic of Oral and Maxillo-Facial Surgery of the Spiridon Teaching Hospital over a period of two years, from 2014 to 2016; the study group for endodontic therapy and surgery comprises 59 patients. To receive apicoectomy, the tooth and its periodontium should meet certain conditions after apicoectomy, the operated root needs to keep an osseous implantation length equal to two thirds or at least half its initial length. Complex oral rehabilitation of various clinical cases met in dental surgery is a challenge for the dental surgeon due to the various degrees of impairment of all system elements. The emerging malfunction is difficult to diagnose and to treat, asking for dental surgeon�s special experience and clinician skills.
Post-operative alveolitis is a topical issue in dental practice, which is also reflected by the etiopathogenic aspects. The conservative principle requires the maintenance of dento-periodontal units in the arch for as long as possible, but there are situations where dental extraction is required. The healing process of the post-surgical wound is complex and involves processes of gingival mucosal regeneration and bone reshaping, involving several local factors: wound size, presence of infection, alveolar vascularization, intraalveolar foreign bodies, and general factors, especially general condition, age and body reactivity. The quality, structure, maintenance, and retraction of the clot are key factors in the formation of connective tissue during the healing of the post-extraction would. At the Oral and Maxillofacial Surgery Clinic of Gala�i, during a 2-year period between January 2015 and December 30, 2016, 2780 patients that required surgery - dental extraction were consulted and diagnosed. We found that among those 2780 patients with dental extractions 105 (3.77%) had post-treatment alveolitis. No post-surgical alveolitis from the case study was complicated by osteomyelitis of the jaws or by suppurations of the superficial or deep compartments of the face. The prophylactic measures in each dental extraction, together with the correct and timely curative treatment, combined with the dentist�s competence and responsibility, can shorten the time of suffering, actively combating the risk factor and accelerating the social reintegration of the patient with post-treatment alveolitis.
Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration.
Introduction: Human immunodeficiency virus (HIV) infection is often preceded or accompanied by neuropsychiatric symptoms, including depression. This fact has been evaluated in most of the clinical studies to date as associated with HIV infection already diagnosed. Case report: We report a case of a 46-year-old woman patient with no prior diagnosed pathology, suffering from depressive disorder for roughly 6 months, with a progressive evolution under treatment. Blood tests showed a moderate normochromic normocytic anemic syndrome of unspecified origin. Given the fact that depressive syndrome has not improved under treatment, a cerebral computed tomography (CT) scan and a cerebral magnetic resonance imaging (MRI) are decided, revealing an expansive cerebral process which in turn recommends performing stereotactic biopsy, but the family of the patient refuses the procedure. The patient is neurologically evaluated and after considering the cerebral MRI pattern and the presence of anemia, an HIV and syphilis detection test is decided, revealing a positive result for HIV infection. An antiretroviral therapy has been initiated, resulting in favorable clinical and imaging outcomes. Conclusions: Each patient and each case are individual and is to be approached as such. Depression in a progressive evolution under treatment requires imaging evaluation (cerebral CT scan, ideally cerebral MRI).
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