The restoration of severely carious primary anterior teeth is a challenge to the pediatric dentist. The introduction of new materials and technologies makes re-evaluation of existing treatment philosophies necessary.A technique involving the placement of an omega shaped stainless steel wire extension into the entrance of the root canal prior to restoring the crown with a compomer material is described. 96 restorations were placed in 25 children. After 18 months 81.2% of the 96 restorations, which were available for evaluation, 60 (79.9%) were intact.The technique for restoring primary anterior teeth was simple, quick and effective.
The three following cases of tuberculoma, one of the orbit and two of the lacrimal gland, are described because of their rarity (Offret, I939; Duke-Elder, I952). Case reportsThe three patients reported below were in good general condition, with no enlargement of the lymph glands, liver, or spleen. Apart from increased lymphocytes the blood count was normal. The urine was free from albumin and sugar. The blood pressure, pulse rate, and body temperature were normal. The faeces showed no parasitic ova. There was no abnormnality of the chest, air passages, abdomen, skin, or bones. The blood Wassermann reaction was negative. There were no septic foci in the body. Skull x rays showed no abnormality of the orbital bones. There was no history of trauma, and no signs of syphilis, sarcoidosis, or Nlikulicz's disease. The tuberculin test was positive.Case I, an obese woman aged 35 years, complained of gradual painless proptosis of the left eye of 6 months' duration.The right eye and fundus were normal, and the visual acuity was 6/6.The left eye showed a forward proptosis of 20 mm. (Hertel) with downwards limitation of ocular movements. The fundus was normal and the visual acuity was 6/9. A hard orbital mass was felt in the lower eyelid extending backwards below the eye into the orbit. When the mass was pressed backwards the globe was made to protrude forwards.The tumour, which was removed through a lower fornix conjunctival incision, measured 2-5 X I-5 x I cm. and was pink, firm, and encapsulated. Histopathological examination showed a granulomatous structure with giant cells (Fig. i) which is characteristic of tuberculoma, but tubercular organisms were not seen.
DuKE-ELDER (1949) stated that "a considerable number, probably some 15 to 20 per cent. of cases of ophthalmoplegias always remain undiagnosed and must be classified as of uncertain aetiology despite the most careful investigations".Roger and Alliez (1935) collected fifty cases of superior orbital fissure syndrome from the literature and added fifteen of their own; in 27 the cause was orbital apex neoplasm, seventeen were syphilitic, and many were of uncertain presumably inflammatory origin. Rucker (1958) gave statistics of 1,000 cases of ocular nerve paralysis, and showed that 3rd and 6th nerve affections were common. Paralysis of the 4th or combined 3rd, 6th, 4th nerves were infrequent. The causes were trauma to the head 17 per cent.; cerebral neoplasms 17 per cent.; vascular diseases and diabetes 15 per cent.; aneurysms of the circle of Willis 11 per cent.; infections, poliomyelitis, syphilis, and disseminated sclerosis 12 per cent., and undetermined in 28 per cent.Unilateral ophthalmoplegias of uncertain origin may present in various ways:(1) The superior orbital fissure syndrome, first described by Rochon-Duvigneaud (1896), is characterized by local pain, proptosis, paralysis of the 6th, 4th, 3rd, and first division of the 5th nerves, with neuralgic pains, and anaesthesia of the upper lid, side of the nose, forehead, temple, conjunctiva, and cornea.(2) The partial superior orbital fissure syndrome may present as complete or partial 3rd or 6th nerve paralysis, usually accompanied by affection of the nasociliary nerve giving neuralgic pain and anaesthesia of the cornea and of the skin and conjunctiva of the medial canthus. Paralysis of the 4th nerve alone is rare.(3) The orbital apex syndrome is a superior orbital fissure syndrome with involvement of the optic nerve in retrobulbar neuritis or papilloedema which may be followed by atrophy. Collier (1921) described a sphenoidal fissure syndrome in patients at any age from puberty onwards which was due to transient periostitis of the sphenoid fissure. In many cases he attributed the condition to exposure to cold or to septic nasal sinuses; but in many others the cause was not obvious. He compared these cases to cases of common Bell's palsy. Almost all his *
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