Anterior Protrusion Research Articles

Analysis of mitochondrial sequences in patients with keratoconus

AbstractPurpose Keratoconus (KTCN) is thinning and anterior protrusion of the cornea. The etiology of KTCN remains unknown. Both genetic and environmental factors are associated with the disorder. The purpose of this study was to identify novel genetic factors by analyzing mitochondrial sequences in cases and controls from Polish population. There are available only a few analyses of some mitochondrial sequences in KTCN studies.Methods A total of 96 individuals from Polish population were included into this study. Chosen mtDNA fragments of all individuals were sequenced.Results Sequencing analysis of chosen mitochondrial genome fragments have revealed numerous alterations including several novel polymorphisms. No sequence variants segregated significantly more frequent with KTCN have been identified.Conclusion Analysis of chosen fragments of mitochondrial genome in Polish patients have revealed numerous sequence variants, however our results do not support involvement of mtDNA changes in KTCN in Polish patients. The KTCN development does not depend on a single change in the gene, but on the accumulation of numerous sequence variants. The complexity of the genetic basis of KTCN causes the need to find another approach to further investigate the etiology of KTCN. Support: National Science Centre (Poland), Grant 2011/03/N/NZ5/01470

Do Jumbo Cups Cause Hip Center Elevation in Revision THA? A Computer Simulation

Acetabular revision THA with use of a large (jumbo) cup is an effective treatment for many cavitary and segmental peripheral bone defects. However, the jumbo cup may result in elevation of the hip center and protrusion through the anterior acetabular wall as a result of the oversized geometry of the jumbo cup compared with the physiologic acetabulum. The purpose of this computer simulation was to determine how much elevation of the hip center and anterior wall protrusion occurs in revision THA with use of a jumbo cup technique in which the inferior edge of the jumbo cup is placed at the inferior acetabular rim and the superior edge of the jumbo cup is placed against host bone at the superior margin of a posterosuperior bone defect. Two hundred sixty-five pelvic CT scans were analyzed by custom CT analytical software. The computer simulated oversized reaming. The vertical and anterior reamer center shifts were measured, and anterior column bone removal was determined. The computer simulation demonstrated that the hip center shifted 0.27 mm superiorly and 0.02 mm anteriorly, and anterior column bone removal increased 0.86 mm for every 1-mm increase in reamer diameter. Our results indicate that the jumbo cup technique results in hip center elevation despite placement of the cup adjacent to the inferior acetabulum. For a hypothetical increase from a 54-mm socket to a 72-mm socket, as one might see in the context of the revision of a failed THA, our model would predict an elevation of the hip center of approximately 5 mm and loss of approximately 15 mm of anterior column bone. This suggests that an increase in femoral head length may be needed to compensate for the hip center elevation caused by the use of a large jumbo cup in revision THA. A jumbo cup may also result in protrusion through the anterior wall.

Substitution atIL1RNand Deletion atSLC4A11Segregating with Phenotype in Familial Keratoconus

Keratoconus (KTCN) is a thinning and anterior protrusion of the cornea that results in altered refractive powers and loss of visual acuity. Despite numerous studies, the reasons for development and progression of KTCN remain unknown. Genetic studies have led to identification of several loci linked with KTCN, including a locus in one multigenerational Ecuadorian family. The purpose of this study was to identify sequence variants in candidate genes segregating with the KTCN phenotype in another Ecuadorian family. Nonparametric linkage analysis was performed in Ecuadorian family KTCN-019. Candidate genes IL1A, IL1B, IL1RN, and SLC4A11 were selected and examined in this family by direct sequencing of all exons, promoters, and intron-exon junctions. Two novel suggestive loci were identified in 2q13-q14.3 and 20p13-p12.2. Screening of the candidate genes revealed 66 sequence variants, including five novel variants, in both coding and noncoding regions. The substitution c.214+242C > T in the IL1RN gene was observed in all affected individuals and three apparently unaffected family members. The novel deletion of 54 nucleotides in position c.2558+149_2558+203 in SLC4A11 was observed in all patients but one, as well as two healthy individuals and one person with an unknown phenotype. The analyses of selected genes have led to identification of numerous sequence variants in the examined Ecuadorian family. Both substitution c.214+242C > T in IL1RN and novel deletion c.2558+149_2558+203del54 in SLC4A11 were observed significantly more frequently in family members with KTCN (P = 0.004525 and P = 0.00761, respectively), suggesting involvement of these two genes in KTCN etiology in the studied family.

Miniscrew-assisted mandibular molar distalization in a patient with skeletal class-III malocclusion: A clinical case report

In nongrowing patients with mild skeletal Class-III malocclusion, premolar extraction or molar distalization in the lower arch can be done as a part of camouflage treatment. Temporary anchorage devices are widely used for this purpose because they do not produce undesirable reciprocal effects and do not depend on the patient's cooperation. However, most reported cases in this regard have used interradicular miniscrews in the mandibular arch and these have a risk of failure as they can loosen due to collision with adjacent roots. This article showcases mandibular molar distalization utilizing miniscrews, inserted at the retromolar area to correct a Class-III problem. A 24-year-old girl with a mild skeletal Class-III malocclusion and dental Class-III molar and canine relationship bilaterally was referred for orthodontic treatment. The treatment plan included distalization of the lower molars bilaterally followed by full fixed appliance therapy, after third molar extractions. For the lower molar distalization, the miniscrews were inserted at the retromolar pad. At the end of 21 months, a Class-I molar and canine relationship, normal overjet and overbite were obtained. The average amount of distalization of mandibular first molar was 3.2 mm at the crown level. In conclusion, placing miniscrews at the retromolar pad area for lower molar distalization was found to be a simple and effective method for correcting anterior cross bite and mandibular anterior crowding or protrusion, without the need for patient compliance.

Co-existence of the Onodi cell with the variation of perisphenoidal structures

The presence of the Onodi cell (OC) may be accompanied by morphological variations of the neighboring anatomic structures. Such variations carry significant surgical implications and challenges. Pneumatization of the sphenoid sinus induces anterior clinoid pneumatization (ACP), affects the type of the Vidian nerve (VN) canal or alters the courses of the internal carotid artery (ICA), and the optic nerves (ONs) are strongly depending on it. Onodi cell pneumatization may reach and surround the optic nerve in various extension. Our aim in the study was to investigate the effect of Onodi cell's potential co-existence on these structures. This study was planned as a retrospective and cross-sectional study. This study performed in a tertiary referral center. Coronal computerized tomography images of 999 patients were examined. Using an 64 slices tomography machine, images taken at 3-mm sections were reconstructed using a bone algorithm and evaluated. OCs were present at 212 of the total 320 sides in 160 patients. Type-2 was found to be the most prevalent type of VN canal configuration (Type-2: VN canal partially protrudes into the sphenoid sinus or into the floor of the sphenoid) among all patients (66.5 %) and among those with OCs (71.2 %). The presence or absence of the OC did not cause a statistically significant alteration of the intrasphenoidal course of the VN. The presence of OCs was found to be significant (p < 0.01) in accompanying pneumatization of the anterior clinoid process (34.4 %, 73/212), protrusion (80.1 %, 170/212) and dehiscence (36.3 %, 77/212) of the optic nerve, and protrusion (59 %, 125/212) and dehiscence (20.8 %, 44/212) of the ICA. In 108/320 sides where OCs were absent, no significant correlations existed. This study shows that in the co-existence of an OC, ACP, protrusion and dehiscence of the optic nerve and ICA are encountered at significantly higher rates, while the course of the VN is not necessarily altered.

Residents' journal review

Residents' journal review

Reasearch progress in posterior corneal surface anterior protrusion after the excimer laser corneal refractive surgery

With the mature of techniques and development of equipments in excimer laser corneal refractive surgery,the postoperative complications are decreasing gradually.As the center of cornea become thin after laser in situ keratomileusis (LASIK) and laser subepithelial keratomileusis ( LASEK ),the strength of cornea and the intraocular pressure relatively step down,which can cause cornea anterior protrusion more or less.Because the posterior surface which is not directly affected by surgical process and healing process,so it is usually used to evaluate the protrusion of cornea.As the application of.ophthalmic anterior segment imaging and analysis system,we can get more message of cornea posterior surface.The manifestation,principle and precautionary measures of corneal posterior surface anterior protrusion after the excimer laser corneal refractive surgery were reviewed. Key words: Excimer laser; Myopia; Posterior corneal surface; Anterior protrusion

Analysis of locus 2q13 in Ecuadorian family with keratoconus

AbstractPurpose Keratoconus (KTCN) is described as a non‐inflammatory thinning and anterior protrusion of the central cornea which results in altered refractive powers, and loss of visual acuity. The etiology of KTCN remains unknown. Both genetic and environmental factors are associated with the disorder. The purpose of this study was to identify novel genetic factors involved in familial form of KTCN by extensive analysis of multigenerational Ecuadorian family.Methods A total of 22 individuals from KTCN‐019 family were included into this study. Genomic DNA samples of all members of KTCN‐019 family were genotyped with highly polymorphic microsatellite markers. After linkage was established, two positional and functional candidate genes, IL1A and IL1B, were examined with polymerase chain reaction amplification, and direct sequencing of all exons, and intron‐exon boundaries was performed.Results The disease susceptibility locus was mapped on 2q13 chromosome in KTCN‐019 family. Sequencing analysis of the candidate genes, IL1A and IL1B have revealed numerous alterations in coding and non‐coding sequences of both genes including several novel single nucleotide polymorphisms. No mutations segregated with KTCN phenotype have been identified.Conclusion Analysis of IL1A and IL1B genes revealed no mutations segregating with affected phenotype in large Ecuadorian family, indicating that other genes are involved in KTCN causation in this family.

A clinical study of the male anterior hairline

To measure the male anterior hairline (AH) and provide data for hair transplantation. 205 males were randomly involved and divided into different age groups, as the young group( age 18-29), the middle-aged group (age 30-49) and the old group (age 50+). Their AH shape and height were measured. The data was then analyzed. According to the morphological classification of AH, the linear type was most common in the young and middle-aged groups (48.40% and 37.33%), the anterior protrusion type was most common in the old group (34.80%). The mean height of AH was 6.42 cm (5.00-8.50 cm)for the median line, and there was no statistical difference between groups (P > 0.05); the mean ratio of median line AH height to facial length was 0.30 (0.22-0.37), there were significant differences between the old group against the young, or the middle-aged group (P < 0.05), and no difference between the young group and the middle-aged group (P > 0.05); the mean height of AH was 5.83 cm (3.5-8.0 cm) for the paramedian line, and there was no statistical difference between groups (P > 0.05); the mean height of AH was 8.34 cm (5.5-10.5 cm) for the lateral line, there were significant differences between the young group against the middle-aged, or the old group (P < 0.05), and no difference between the middle-aged group and the old group (P > 0.05). The shape and height of AH were age-associated. The linear type is most common in the young and middle-aged groups, the anterior protrusion type is most common in the old group. The change first occurs on the lateral lines since the age of 30, and the central portion is involved since the age of 50. The older the age gets, the higher the hairline is.

Atypical orthodontic extraction pattern managed by differential en-masse retraction against a temporary skeletal anchorage device in the treatment of bimaxillary protrusion

This report introduces an innovative treatment approach of selecting atypical and unconventional teeth for orthodontic extraction without compromising the quality of treatment outcomes by using temporary skeletal anchorage devices in patients with bimaxillary protrusion. Both patients introduced in this report had solid Class I molar relationships with bimaxillary anterior protrusion without facial or dental midline asymmetry. Their chief concerns were significant facial convexity, which conventionally requires the extraction of all 4 first premolars. However, 3 second premolars and 1 first premolar were removed in the first patient, and 2 second premolars and 2 first premolars were removed in the second patient. All second premolars extracted had previously had root canal treatment and large prosthodontic restorations, which resulted in a compromised short lifespan of the teeth relative to the natural dentition. To manage these cases of asymmetric extraction space in a symmetric dental and skeletal environment, 2 mini-implants were placed in the posterior maxillary interradicular spaces, 1 on each side. Despite the unusual asymmetric extraction of teeth, superimposition of the pretreatment and posttreatment cephalometric tracings shows excellent treatment outcomes of facial convexity reduction by asymetric maximum retraction of the anterior teeth with no change in the molar relationships.

Changes in vaulting of myopic and toric implantable collamer lenses in different lighting conditions

To evaluate the changes in vaulting of myopic and toric Implantable Collamer Lenses (ICLs) in different lighting conditions. Thirty-seven eyes of 37 patients implanted with a myopic ICL and 26 eyes of 26 patients implanted with a toric ICL were examined using Visante optical coherence tomography (OCT) in photopic (257 lux) and mesopic (2 lux) conditions. Pupil diameter and distance changes between the ICL and adjacent intraocular structures were measured. The mean horizontal pupillary diameters in mesopic conditions were 5.3 ± 0.9 (SD) mm. In photopic conditions, a mean decrease of -1.8 ± 0.6 mm [95% confidence interval (95% CI) -2.0 to -1.7; p < 0.0001] was observed. The mean distances between the ICL and the crystalline lens in mesopic conditions were 0.33 ± 0.17 mm. In photopic conditions, a mean decrease of -0.04 ± 0.06 mm (95% CI -0.05 to -0.02; p < 0.0001) in the ICL-crystalline lens distance was found. There was a -0.02 ± 0.04 mm (95% CI -0.03 to -0.01; p = 0.0022) decrease in the anterior chamber depth and a 0.02 ± 0.06 mm (95% CI 0.002 to 0.032; p = 0.0275) increase in the distance between the cornea and the ICL. We found no difference in the change in vaulting between the two ICLs in different lighting conditions. There is a decrease in the central vaulting of myopic and toric ICLs in photopic conditions. This is due to both posterior movement of the ICL and anterior protrusion of the crystalline lens.

Impingement Between the Acetabular Cup and the Femoral Neck After Hip Resurfacing Arthroplasty

Loosening, femoral neck fracture, and metal ion release have been well documented after hip resurfacing arthroplasty, but impingement between the acetabular cup and the femoral neck has not. The goal of this study was to analyze radiographic findings that were presumed to represent impingement of the neck after hip resurfacing arthroplasty, and to describe the mechanism of impingement. Of the 635 hips (579 patients) that underwent hip resurfacing arthroplasty between September 1998 and May 2008, forty hips (6.3%) with positive radiographic findings were available for this study. The mean age of the patients was 34.9 years and there were thirty-five men and five women. The average follow-up was sixty-eight months (twenty-four to 132 months). Radiographic evaluation included an analysis of neck-shaft angle, inclination of the acetabular cup, head-neck ratio, lateral protrusion of the cup, anterior protrusion of the cup, and stem angle to the axis of the femoral neck. Impingement between the acetabular cup and the femoral neck occurred in 6.3% of hips and appeared at an average of seven months after surgery. There was no further change two years postoperatively. The impingement findings did not correlate with the clinical outcome, but all instances of impingement were located in the lateral or anterolateral part of the femoral neck along the arc from the center of the femoral head to the lateral edge of the socket. No significant factors were found to be related to the occurrence of impingement. Femoral-neck impingement should be differentiated from notching, narrowing, stress-shielding, or osteolysis of the femoral neck. Although we found no significant factors to explain the impingement found in the hips in our study, it appears that repetitive extreme motion of the involved hip and malposition of the implants can cause impingement after hip resurfacing arthroplasty.

Acoustic communication in the electric yellow cichlid, Labiochromis caeruleus.

The cichlidae represent an attractive model for acoustic communication as their well‐characterized adaptive radiation can serve as a backdrop for testing evolutionary hypotheses. Despite interest in sound communication in cichlids, little is known of their hearing ability and less is known about hearing and sound production in the same species. The current study examined sound production, hearing, and auditory morphology in a Lake Malawi cichlid Labidochromis caeruleus. Males and females were paired in the laboratory and all behavioral and acoustic displays recorded. Hearing was tested to tone bursts and samples of recorded calls using auditory evoked potentials and morphology was assayed using MicroCT scans of intact fish. Males produced calls with dominant frequency of approximately 300 Hz but only when simultaneously performing a quiver display. Fish detected tones from 100–1000 Hz and were more sensitive to tones than to playbacks of call segments. Finally, MicroCT showed a heart‐shaped swim bladder with anterior protrusions directed at the large saccular otoliths, possibly reducing self‐generated noise by focusing the call away from the ears. With this combination of behavioral, morphological, and physiological approaches, we were able to fully characterize acoustic communication in this species for the first time.

Clinical observation of posterior polymorphous corneal dystrophy

To research the clinical features and in vivo confocal microscopic findings of posterior polymorphous corneal dystrophy (PPCD). It was a retrospective consecutive case study. Ten patients with PPCD, attended at Optometry Department of Henan Eye Institute from March 2007 to August 2009, were analyzed. All the subjects were examined by slit-lamp, OrbscanII, specular microscopy, HRT3/RCM confocal microscopy. Mann-Whitney U test was used to analysis the data. The age of the patients ranged from 8 to 35 years. Seven eyes of the 4 patients have the vesicular lesions, five eyes of the 5 patients were band lesions and 1 patient had bilateral diffused opacities, this patient also had iridocorneal adhesions with associated papillary ectropion but without glaucoma. In total, 14 eyes of the 10 patients had PPCD. Two eyes had abnormal OrbscanII topography, it showed both anterior and posterior surface protrusion. Specular microscopy exam indicated large cells in size and reduced endothelium density. The mean size of the affected eye was 584 µm(2), the normal eye was 316 µm(2). The difference was statistically significant (U = 0.000, P = 0.002). The density of the endothelium was 1746 cells/mm(2) in affected eye and 3201 cells/mm(2) in normal eye. The difference was also statistically significant (U = 0.000, P = 0.002). In vivo confocal microscopy showed endothelial polymorphism. Occasional bright endothelial nuclei were seen. A variety of curvilinear and vesicular abnormalities were imaged including orange or finger like lesion, round or oval dark area with hyper reflectivity border. Some large lesions may lose endothelium with rough surface have a dike appearance. Careful exam by slit-lamp may help to diagnose PPCD and further specular microscopy and(or) in vivo confocal microscopy exam will confirm it. Some cases may have abnormal topography, or associated with high intraocular pressure.

The genetics of keratoconus

Keratoconus (KTCN) is non-inflammatory thinning and anterior protrusion of the cornea that results in steepening and distortion of the cornea, altered refractive error, and decreased vision. Keratoconus is a complex condition of multifactorial etiology. Both genetic and environmental factors are associated with KTCN. Evidence of genetic etiology includes familial inheritance, discordance between dizygotic twins, and association with other known genetic disorders. Several loci responsible for a familial form of KTCN have been mapped; however, no mutations in any genes have been identified for any of these loci. This article focuses on the genetic aspects. In addition, bioinformatics methods applied in KTCN gene identification process are discussed.

Preliminary proposal for surgical classification of sacral tumors

The authors propose a new surgical classification method for sacral tumors that improves the guidance for specific surgical decisions and approaches. The authors retrospectively studied the clinical courses of 92 patients with sacral tumors treated at the Changhai Hospital; all patients underwent tumor resection between January 2000 and August 2005. The clinical characteristics, imaging features, and pathological classifications were carefully assessed in each case. The tumors were classified according to the imaging features and intraoperative findings. The surgical approach and the resection area were determined according to the tumor classification. The proposed surgical classification system divided the sacral tumors into 2 major types according to the lesion's anatomical position in the sagittal plane. The tumors were further divided into 4 subtypes according to the length of the tumor's anterior protrusion into the pelvic cavity. Finally, each tumor subtype was classified into 16 areas according to the anatomical position in the cross-sectional plane. This classification method was used to categorize the sacral tumors, all of which were totally resected under the naked eye. Postoperatively symptoms were improved to varying degrees. The appropriate classification of sacral tumors and the selection of a corresponding surgical approach can improve the rate of total resection and the surgical safety, as well as decrease the recurrence rate.

SOBP Is Mutated in Syndromic and Nonsyndromic Intellectual Disability and Is Highly Expressed in the Brain Limbic System

Intellectual disability (ID) affects 1%-3% of the general population. We recently reported on a family with autosomal-recessive mental retardation with anterior maxillary protrusion and strabismus (MRAMS) syndrome. One of the reported patients with ID did not have dysmorphic features but did have temporal lobe epilepsy and psychosis. We report on the identification of a truncating mutation in the SOBP that is responsible for causing both syndromic and nonsyndromic ID in the same family. The protein encoded by the SOBP, sine oculis binding protein ortholog, is a nuclear zinc finger protein. In mice, Sobp (also known as Jxc1) is critical for patterning of the organ of Corti; one of our patients has a subclinical cochlear hearing loss but no gross cochlear abnormalities. In situ RNA expression studies in postnatal mouse brain showed strong expression in the limbic system at the time interval of active synaptogenesis. The limbic system regulates learning, memory, and affective behavior, but limbic circuitry expression of other genes mutated in ID is unusual. By comparing the protein content of the +/jc to jc/jc mice brains with the use of proteomics, we detected 24 proteins with greater than 1.5-fold differences in expression, including two interacting proteins, dynamin and pacsin1. This study shows mutated SOBP involvement in syndromic and nonsyndromic ID with psychosis in humans.

Bilateral loss in the quality of vision associated with anterior corneal protrusion after hyperopic LASIK followed by intrastromal femtolaser-assisted incisions

A patient was treated bilaterally for hyperopia (twice in the right eye and 3 times in the left eye) using laser in situ keratomileusis (LASIK) and achieved stable vision. Preoperatively, there was no known risk factor for ectasia. Three years after the last LASIK enhancement treatment, intrastromal femtolaser-assisted incisions (Intracor procedure using the Technolas femtosecond laser) were made bilaterally. After the procedure, a severe loss in the corrected distance visual acuity and in the quality of vision occurred, associated with a topography pattern suggestive of isolated anterior central protrusion. This case suggests that intrastromal femtosecond incisions in eyes that have had hyperopic LASIK should be done with caution, as there is no certainty about how the treated corneas will respond.

Cervical spinal cord injuries without radiographic abnormality: classification and surgical treatment

Objective To investigate the traumatic characters, the causative factors and the outcomes of surgical treatments of cervical spinal cord injuries without radiographic abnormality(SCIWORA).Methods From March 2000 to July 2004, 81 patients of cervical SCIWORA undergone surgery were evaluated retrospectively. There were 55 males and 26 females, with a mean age of 57.3 years. According to the mechanisms of injuries and pathological changes of the cervical spine, the causative factors were divided into 3 groups: hyper-flexion type of injury (1 or 2 segments) with protrusion or prolapse of the cervical intervertebral discs (19 cases), hyper-extension type injury with multiple (≥3 segments) cervical spinal stenosis (41cases), and whiplash injury with multiple cervical spinal stenosis and segmental intervertebral instability or anterior protrusion of the cervical intervertebral discs (21 cases). A variety of surgeries as anterior discectomy with interbody fusion, multiple posterior decompressions with cervical laminoplasty, and multiple posterior decompressions with internal fixation at the facet joints were performed based the classification. Results The average follow-up period was 78.5 month (54-118 months). During the follow-up of 1 month, 3 months,1 year and last visit post-operatively, the rate of JOA improvement were 25.1%, 41.3%, 63.6% and 60.9%respectively. In the long-term follow-up, the good ratio of neurological function was obtained with 80.2%.Conclusion SCIWORA is considered as a course of acute, dynamic and limited injury. In spite of common clinical manifestation, its traumatic characters and causative factors are different indeed. The distinct improvement of neurological function can also be achieved with proper classification and surgery. Key words: Cervical vertebrae; Spinal cord injuries; Surgical procedures, operative

Evaluation of Orofacial Manifestations in 50 Thalassemic Patients: A Clinical Study

Background and Objectives: Thalassemia has been reported as a high prevalence genetic disorder with some oromaxillofacial complications. The aim of this study was to evaluate the prevalence of oromaxillofacial disorders in thalassemia patients and to detect the presence of any correlation between the orofacial manifestations and the hematological picture/systemic findings.Materials and Methods: A total of 50 thalassemic, 36 with thalassemia major and 14 with thalassemia minor were selected from the hematology Department of Lokmanya Tilak Medical College and Government (LTMG) Hospital, Sion, Mumbai.Results: The most prominent features included, skull bossing seen in 74% of the patients, hypertelorism, depressed bridge of the nose, prominent malar bones, pallor of oral mucosa, gingival pigmentation and proclination of teeth. Splenomegaly, hepatomegaly and cardiovascular changes were also commonly seen. The blood picture showed for a low mean Hb value of 6.63 gm/dl. Microcytosis, anisocytosis, hypochromasia and poikilocytosis was seen in the blood smear. Hemoglobin electrophoresis patterns revealed raise HbF and HbA2 levels.Conclusions: This study showed that about 84% (42 cases) of all patients under consideration showed changes in oral and maxillofacial complications including upper and lower jaw protrusion, saddle nose, space between anterior teeth, anterior teeth protrusion, and frontal bossing. It was noted that the severity of orofacial manifestations increased with a decline in the systemic health and a deterioration in the blood picture. Also, it was revealed that the rate of prevalence for oral and maxillofacial complications decreases when patients receive blood at younger ages.