OBJECTIVES
To assess systemic immune-compromised comorbidities in patients presenting with odontogenic infections that extend to fascial spaces. This study was designed to investigate the incidence of immune-compromising systemic comorbidities among patient presenting with odontogenic infections.METHODOLOGY
This cross-sectional study was performed at the Department of Maxillofacial Surgery, Hayatabad Medical Complex (HMC) Peshawar from October 2018 through April 2019. However, patients older than 10 years of age, presenting with fascial space infections other than odontogenic cause, secondary fascial space infections and patients with multiple organ failure were excluded. The odontogenic infections were categorized according to their anatomical location. The prevalence of comorbidities was also assessed.RESULTSA total of 145 patients were included, where the male to female ratio was 3.8:1, mean age ~ 56 ± 14.74 years (range: 12-80 years) and mean duration of the odontogenic infections was 5± 1.2 days. The submandibular space was the most frequent site involved in odontogenic infections with a frequency of 60 (41.4%), followed by buccal space with 44 (30.3%) patients & canine space with 31 (21.4%) patients. Of the 79 patients with comorbidities out of total 145 patients, diabetes mellitus was recorded in 60 patients. Other comorbidities included hypertension, renal and hepatic impairment.
CONCLUSION
Diabetes mellitus was the most common immune compromising comorbidity presented in patients with odontogenic infections extending in fascial spaces. Assessment of diabetes in routine dental practice is emphasized to avoid exacerbation of the odontogenic infections.
Hypoplastic asymmetry due to hemifacial microsomia (HFM) often represents the most difficult reconstruction in the craniomaxillofacial clinic. Although autogenous grafts are generally used for temporomandibular joint reconstruction (TMJR), the use of TMJR prostheses is not well established. The aim of this review was to identify, collect and analyse the use of extended TMJR (eTMJR) prostheses in patients with HFM, describing clinical features, surgical procedures and postoperative complications. Online searches of all major databases were performed according to PRISMA guidelines. All studies with HFM patients treated with the eTMJR prostheses were included. Descriptive statistics were used for data analysis. A total of 19 studies, including 08 case studies, 06 case series and 05 retrospective cohort studies, met the inclusion criteria, where a total of 42 HFM patients were reported from 18 countries, mostly from the United States (05; 26%). Fifteen of the 42 cases (~36%) were male. The mean ± SD (range) age of patients in all studies was 19.79 ± 5.81 (9‐36) years. The mean ± SD (range) of patient follow‐up was 41.30 ± 35.50 (6‐136) months. A total of 5 (10.6%) patients were implanted with bilateral eTMJR prostheses. The Pruzansky classification was used in 18 (~89.5%) studies, OMENS classification in 01 (~5%) study, whereas no classification was reported in one study. Only 01 (7.1%) study had documented the eTMJR classification for the prosthesis used. In growing patients with or without a history of failed autogenous tissues, TMJR prostheses may provide a viable alternative. Randomized studies with large cohorts are warranted to validate these preliminary results.
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