Cervical Perforation Research Articles

Management of obliterated canal, periapical injury and cervical perforation

Management of obliterated canal, periapical injury and cervical perforation

Perforation of the Cervix by the Strings of an Intrauterine Device (IUD): a Novel Case and Systematic Review of the Literature.

Introduction:Geriatric population is most vulnerable to various emerging communicable and noncommunicable diseases due to various socio-economic, physiological, psychological and nutritional risk factors. Adequate nutritional status is utmost important in older age as it helps in maintaining the immune response and preventing the morbidities and mortalities in this age. Thus, the opportunistic screening of malnutrition among geriatric population gives an extra edge for achievement of healthy ageing in the elderly. The objective of the present study was to assess the nutritional status among the elderly population and provide cut-off values of various anthropometric measurements for detecting the risk of malnutrition among old age people. Materials and methods:A 43-year-old female patient attended the gynecology clinic in order to remove her copper IUD. Speculum examination revealed that both strings of the IUD had perforated the anterior lip of the cervix. Management options were offered and the patient opted for a hysteroscopic removal. We searched several electronic databases, including MEDLINE, Cochrane Library, Google Scholar, and EBSCO, in order to find similar cases. Results:The electronic search yielded 1 821 articles, of which eight were selected for inclusion. The mean age of women was 35.37±7.781 (range 26-47) years. One woman (12.5%) was nulligravida, and three women were multigravida (37.5%). Seven women (87.5%) were asymptomatic. Of all IUDs, three (37.5%) were LNG-IUS and five (62.5%) contained copper. Conclusion:Cervical perforation by the strings of the IUD is an extremely rare clinical entity. It is generally asymptomatic and, in most cases, the strings of the IUD may be returned back to the endocervical canal after surgical maneuvers.

Emergency management of jujube pit esophageal impactions using rigid esophagoscopy in the aged.

ObjectiveTo study the emergency management of esophageal jujube pit ingestion.Study DesignRetrospective case series.MethodsA retrospective study of 114 consecutive cases of jujube pits esophageal impaction during 3 months was performed.ResultsOne hundred and fourteen cases were confirmed as jujube pit esophageal impaction using contrast‐enhanced radiography. All jujube pits were retrieved using rigid esophagoscopy under general anesthesia as outpatients, except one case where a direct laryngoscope was used. In four cases, esophageal perforation was found, the patients were treated with conservative measures, and none died.ConclusionJujube pit esophageal impaction is characterized by a high incidence of perforation. The conservative management of cervical perforation is effective in this study. Rigid esophagoscopy under general anesthesia is safe for jujube pit esophageal impaction.Level of Evidence4.

Clinical analysis of the MyoSure hysteroscopic tissue removal system of endometrial polyps in women with an intact hymen

BackgroundTo investigate the clinical efficacy of the MyoSure hysteroscopic tissue removal system in the treatment of endometrial and cervical polyps in women with an intact hymen.MethodsRetrospective analysis was performed on the clinical data of 32 patients treated with the MyoSure hysteroscopic tissue removal system for endometrial and cervical polyps.ResultsAll the patients successfully completed the procedure. No intraoperative complications, such as cervical trauma, uterine perforation or TURP syndrome, were reported. The surgical time ranged from 5 to 35 min, with an average time of 19.3 min, and the intraoperative blood loss ranged from 2 to 50 ml with an average blood loss of 10.8 ml. After surgery, all patients were shown to have intact hymens. No residual polyp tissues were observed under the microscope, and abnormal uterine bleeding was relieved.ConclusionsThe MyoSure hysteroscopic tissue removal system can be a safe and effective treatment for endometrial and cervical polyps in women with an intact hymen.

Tertiary dentin deposition in the proximity of the cervical perforation aperture – A case study

Dead tracts are dentin areas characterized by degenerated odontoblastic processes; may result from injury caused by caries, attrition, erosion, or cavity preparation. Odontoblasts can also form tertiary dentin, as a response to injury, in association with caries, trauma, or restorative procedures. Generally, this dentin is less organized than primary and secondary dentin and mostly localized to the site of injury. The reactive dentin formation that lays under caries, the pulp displays chronic inflammation and tertiary dentinogenesis takes place on the inner walls of the pulp space, in the region of the dentinal tubules associated with the base of the carious lesion. Higher-power photomicrograph of tertiary dentin shown in a primary dentin, first period of tertiary dentin formation, second period of tertiary dentin formation. We initiated a case study regarding depositition of tertiary dentin in the close proximity of the cervical perforation hole on mesial root of the second maxillary molar. The repair material used (Biodentine, Septodont) was found placed under the tertiary dentin layer, rather than at the perforation place, mentioning the fact that the group of residents was not experienced with the management of the endodontic microscope and did not use a proper field. We consider that we have identified dead tracts due to the fact that they were formed consequently carious lesions pathology, thereafter the tertiary dentin at the appearance of the coronal aspect was identified at the end of the dead tracts. The portion of the canal entrances were investigated both with analyzed filters (Crossed Polars) and with compensatory devices (retardation plates). The present study identified tertiary dentine deposits in the coronary portion of the adjacent root canal entered in the perforation. At a thorough analysis of the coronal portions of the mesial root canal with compensating devices and analyzers filters, it was noticed a soft dentin blanket in which the dentinary tubules do not exist or are of very rare deposition.

Surgical management and prognostic factors in esophageal perforation caused by foreign body.

Esophageal perforation is associated with multiple serious complications and high mortality. Herein, we identify some predictors for postoperative outcomes, compare the outcomes of various surgical approaches, and summarize our experience with esophageal perforation over the past 13years. We retrospectively analyzed 38 patients diagnosed with esophageal perforation caused by foreign body between November 2004 and May 2018. Univariate analysis and multivariate logistic regression analysis were performed to identify potential risk factors related to prognosis. Effects of different surgery were compared based on postoperative outcomes. Of the 38 patients, the number of females was equal to males with a mean age of 55.6 ± 14.9(range 23-93)years; 22 had thoracic perforations and 16 had cervical perforations. The overall mortality rate was 5.3%. Univariate analysis revealed that sex (p = 0.049), type of foreign body (p = 0.042), abscess (p = 0.049), and site of perforation (p = 0.031) were associated with prognosis. The interval between perforation and surgery did not significantly influence prognosis (p = 0.929). No significant difference was found in postoperative outcomes among various surgeries. The interval between perforation and treatment was not as important as previously reported. Surgical management should be performed early when feasible, even if the interval between perforation and surgery is 24h or longer.

Surgical management of esophageal perforation: role of primary closure.

Esophageal perforation is a life-threatening condition associated with high mortality and morbidity. Ambiguous clinical presentation is one of the most common causes of delayed and difficult diagnosis of esophageal perforation. In this retrospective single-center study, we reviewed the outcome of primary closure in patients with esophageal perforation between 2009 and 2017. The data of 65 patients attending our department of thoracic surgery (from 2009 to 2017) for esophageal perforation were reviewed. Primary repair was attempted in 63 patients irrespective of the site of perforation and time interval between injury and hospital admission. In intrathoracic lesions, continuous mediastinal and pleural irrigation was undertaken, whereas in cervical perforations, gauze packing and local irrigation were performed. Jejunotomy was carried out in patients with inadequate healing. Of the 65 patients, 63 underwent primary closure and 2 were left to heal spontaneously. The majority of patients ( n = 44) had an esophageal perforation at the thoracic level, and only one was admitted early (<24 h after injury). Among the 63 patients managed with primary closure, 55 had satisfactory healing with one surgery. Healing was delayed in the other 10 patients. No mortality was reported. Esophageal perforation can be well managed by primary closure, irrespective of the time interval between injury and hospital admission and the site of perforation. Conservative management might lead to an increased rate of complications such as empyema or necrotizing mediastinitis, and increased morbidity and mortality.

Evaluation of tooth discoloration after treatment with mineral trioxide aggregate, calcium-enriched mixture, and Biodentine® in the presence and absence of blood

Calcium silicate cements in treatments such as revascularization and apexogenesis are adjacent to blood and pulp tissues. This study evaluated tooth discoloration after treatment with mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement, and Biodentine® in the presence and absence of blood using spectrophotometric analysis. In this experimental study, A total of 68 extracted permanent anterior teeth were prepared and randomly divided into two groups as follows: the sponge embedded in access cavities was saturated with fresh blood or normal saline using insulin syringe, and then each group was subdivided into the following three cement subgroups: MTA-Angelus®, CEM cement, and Biodentine; these materials with a thickness of 3 mm were placed in the access cavity on the sponge. In the control group, the sponges were saturated in saline and blood in the absence of cements. Discoloration rate was measured by spectrophotometer within the following four intervals: after preparing the cavity and 1 day, 1 month, and 6 months after material placement. ANOVA and Tukey's test were used to assess the effect of blood and materials and time on discoloration. (P < 0.05). In general, discoloration rate is significantly higher in blood group than saline group (P < 0.05) and an increase in Δ E is observed over time for the materials in all groups. In this study, discoloration rate in the presence and absence of blood in Biodentine group was lower, and this difference was statistically significant compared to that of MTA group (P < 0.05) but not significant compared to that of the CEM group. This study indicated that Biodentine induces the lowest tooth discoloration in the presence and absence of blood, and its discoloration rate is significantly lower than that of MTA. Therefore, it can be suggested that Biodentine can be used more confidently for endodontic treatments with coronal blood contamination such as regeneration and cervical perforation repair in esthetic zone of teeth.

Selamento de perfuração radicular cervical com reabilitação imediata - relato de caso

Objective: To present a treatment option for sealing of cervical root perforation, through a clinical case report performed in the upper lateral incisor in a patient assisted at UNIPAR Dental Clinic, in Francisco Beltrao. Materials and methods: Patient presented root perforation of iatrogenic origin, at cervical third level, in dental element (12), where a therapy protocol was proposed and performed. Initially, it was performed an increase of clinical crown to expose the area of interest, and later the sealing was performed with glass ionomer cement, endodontic treatment and rehabilitation with glass fiber pin and composite resin. The clinical and radiographic follow-up was done from month to month until it reached 12 months. Conclusion: Root perforations are considered real challenges for the clinician, from diagnosis to appropriate therapy, as well as from dubious prognosis. However, through this case report it can be seen that when well conducted, the therapy presents good results, allowing the maintenance of the element in the oral cavity, preserving function and aesthetics

Osteogenic Response of Osteoblastic Cells to Root-End Filling Materials

Perforations can occur during endodontic treatment, post placement and removal, and operative procedures. These defects have been treated with a variety of different materials such as resin ionomer, glass ionomer cement and intermediate restorative material. However, the osteogenic response to these substances using osteoblasts have been rarely studied. Thus, the aim of the present study is to evaluate the osteogenic response to resin ionomer (Geristore) and mineral trioxide aggregate (MTA). The surface roughness was significantly higher in the MTA than in the resin ionomer (p&lt;0.05). After 72 hours of incubation mouse osteoblasts attached and spread well over the surfaces of resin ionomer and MTA. As a result from MTT assay, the number of cells gradually increased as the cell incubation time increased. In particular, control group showed higher cell proliferation than the other two groups on days 3 and 5. Resin ionomer showed more active early cell proliferation than MTA (p&lt;0.05). The alkaline phosphatase (ALP) activity was significantly higher in the MTA surface than in the resin ionomer and glass coverslip (p&lt;0.05). Resin ionomer was active in early cell proliferation and adhesion. Resin ionomer may be more suitable for cervical perforation or for perforation of adjacent to the gingiva requiring rapid wound closure. Also, MTA has a rough surface and low initial cell adhesion but because of its superior osteogenic response, it may be appropriate for the area close to the apical region, where the perforation site is wide and the bone tissue regeneration is necessary.

241 - Laparoscopic Repair of Posterior Cervical Perforation

241 - Laparoscopic Repair of Posterior Cervical Perforation

Delayed Cervical Perforation With a Levonorgestrel-Releasing Intrauterine System

Delayed Cervical Perforation With a Levonorgestrel-Releasing Intrauterine System

Influence of operating microscope in the sealing of cervical perforations.

Context:Accidental root canal perforations are among the main complications of endodontic treatment.Aim:This study evaluated the influence of operating microscope (OM) in the marginal adaptation of mineral trioxide aggregate (MTA) (Angelus®) and glass ionomer (Vitremer) inserted into cervical perforations.Materials and Methods:Perforations were made in the cervical third of the buccal wall of the root canal in mandibular incisors. Next, the teeth were divided into four groups (N = 10): MG — MTA without OM; VG — Vitremer without OM; MOMG — MTA with OM; VOMG — Vitremer with OM. The perforations were sealed according to the group and the teeth were prepared for analysis by confocal laser scanning microscope. Images of perforation region (1,024×) were made and the gap presented by the materials was measured using the Image J program. LEXT OLS4100 three dimensional (3D) measuring laser microscope measured the volumetric misfit. Data of gap were analyzed by Kruskal-Wallis and Dunn's tests. Analysis of variance (ANOVA) and Tukey's tests compared the volumetric misfits.Results:The results showed lower volume and gap in the interface dentin/material in VOMG compared to the other groups (P < 0.05).Conclusion:The use of OM improved the quality of cervical perforations sealed with Vitremer, being indicated in clinical situations of iatrogenic cervical perforations.

Oesophageal injury

Oesophageal injury

Nondestructive methods for recovery of biological material from human teeth for DNA extraction.

The extraction of DNA from human skeletal remains applied to forensic, and evolutionary studies do not exclude risks, which are to be evaluated when working with unique specimens that could be damaged or even destroyed. In the present study were evaluated several nondestructive methods for recovering DNA instead of the most currently used pulverization method. Three different procedures to access inside the dental pieces (occlusal perforation, cervical perforation, and cervical cut) have been compared with the aim of recovering as many cell remains as possible to carry out a DNA extraction. Given the DNA quantitation results, a method was proposed that consists of a cervical cut to facilitate the access to the pulp cavity and a subsequent filing of the root canals down to the apex of the dental root. This methodology allows the recovery of both mitochondrial and nuclear DNA, with the minimum deterioration for the dental pieces.

A Two Year Review of Hysteroscopic Practice at Queen Alia Military Hospital

Results: The most common indications for diagnostic hysteroscopy were abnormal uterine bleeding (45%), abnormal ultrasound findings (27%), infertility (15%), recurrent abortions (12%), and missed intrauterine contraceptive device (1%). The most common diagnostic findings were submucous fibroid (19%), h yperplastic endometrium (17.8%), uterine polyps (16.7%), uterine septum (4.8 %), endometrial carcinoma and atrophy (1.7%). The most common pathologies to operative hysteroscopy were endometrial polyps (39.5%), missed intrauterine contraceptive device (16.3%), uterine septum (14.6%) subm ucous myomas (12.45%), and Asherman's syndrome (9%). The complication rate was 1.2 % of the total hysteroscopies. Cervical laceration and uterine perforation were the most common acute complications. Conclusion: Hysteroscopy is an easy, inexpensive and effective procedure for the diagnosis and treatment of intrauterine pathology. It is minimally invasive and can be used with a high degree of safety. Hysteroscopy must take its place as one of the basic diagnostic methods in gynaecology.

Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta‐Analysis of 75 Studies

The current prognosis of esophageal perforation and the efficacy of available treatment methods are not well defined. We performed a systematic review of esophageal perforations published from January 2000 to April 2012 and subjected a proportion of the retrieved data to a meta-analysis. Meta-regression was performed to determine predictors of mortality immediately after esophageal perforation. Analysis of 75 studies resulted in a pooled mortality of 11.9 % [95 % confidence interval (CI) 9.7-14.3: 75 studies with 2,971 patients] with a mean hospital stay of 32.9 days (95 % CI 16.9-48.9: 28 studies with 1,233 patients). Cervical perforations had a pooled mortality of 5.9 %, thoracic perforations 10.9 %, and intraabdominal perforations 13.2 %. Mortality after esophageal perforation secondary to foreign bodies was 2.1 %, iatrogenic perforation 13.2 %, and spontaneous perforation 14.8 %. Treatment started within 24 h after the event resulted in a mortality rate of 7.4 % compared with 20.3 % in patients treated later (risk ratio 2.279, 95 % CI 1.632-3.182). Primary repair was associated with a pooled mortality of 9.5 %, esophagectomy 13.8 %, T-tube or any other tube repair 20.0 %, and stent-grafting 7.3 %. Results of recent studies indicate that mortality after esophageal perforation is high despite any definitive surgical or conservative strategy. Stent-grafting is associated with somewhat lower mortality rates, but studies may be biased by patient selection and limited experience.

Esophageal perforation in South of Sweden: Results of surgical treatment in 125 consecutive patients

BackgroundFor many years there has been a debate as to which is the method of choice in treating patients with esophageal perforation. The literature consists mainly of small case series. Strategies for aiding patients struck with this disease is changing as new and less traumatic treatment options are developing. We studied a relatively large consecutive material of esophageal perforations in an effort to evaluate prognostic factors, diagnostic efforts and treatment strategy in these patients.Methods125 consecutive patients treated at the University Hospital of Lund from 1970 to 2006 were studied retrospectively. Prognostic factors were evaluated using the Cox proportional hazards model.ResultsPre-operative ASA score was the only factor that significantly influenced outcome. Neck incision for cervical perforation (n = 8) and treatment with a covered stent with or without open drainage for a thoracic perforation (n = 6) had the lowest mortality. Esophageal resection (n = 8) had the highest mortality. A CAT scan or an oesophageal X-ray with oral contrast were the most efficient diagnostic tools. The preferred treatment strategy changed over the course of the study period, from a more aggressive surgical approach towards using covered stents to seal the perforation.ConclusionPre-operative ASA score was the only factor that significantly influenced outcome in this study. Treatment strategies are changing as less traumatic options have become available. Sealing an esophageal perforation with a covered stent, in combination with open or closed drainage when necessary, is a promising treatment strategy.

Chronic Cervical Perforation by an Intrauterine Device

The intrauterine device (IUD) is a widely used, highly effective method of birth control. Uterine perforation is a rare yet serious complication and is usually seen during insertion of the IUD. A regular examination is necessary for follow-up. We present a patient with an IUD that had perforated the cervix. The diagnosis was made during routine gynecological examination, and the patient was treated in a timely manner before any complications such as ectopic pregnancy, intrauterine pregnancy, infection or irreversible harm to the cervix arose. This case stresses the importance of regular visits to maintain health and diagnose possible adverse effects of intrauterine contraceptive methods.

Cervical dilation in second-trimester abortion.

Dilation and evacuation, the most common method performed for second-trimester abortion in the United States, requires sufficient cervical dilation to reduce the risk of complications such as cervical laceration or uterine perforation. The cervix may be prepared with osmotic dilators such as laminaria, Lamicel, or Dilapan-S, or with pharmacologic agents such as misoprostol. Dilapan-S and Lamicel achieve their maximum dilation faster than laminaria, making same-day procedures possible. Misoprostol has limited data supporting its use in this setting. Decisions regarding which method is best are clinician-dependent, and factors such as gestational age and time allowed for preparation should be considered.