Infraorbital Region Research Articles

Tunneled superior naso-labial island flap in post mucor infraorbital defect

<p class="abstract">Reconstruction of facial infraorbital defects, an untoward sequel of mucormycosis, is an issue confronting the rhinologist.<strong> </strong>Tunneled island flap was used in a patient with a wide defect involving the infraorbital region. Inspite of intricate pedicle dissection and likelihood of a trapdoor deformity these flaps facilitate repair in a single-staged procedure. The flap is so sited that its vascularity is not compromised neither by stretch tension or overlying tissue compression; while in the tunnel. The occasional, slight bulging is observed which is due to the pedicle; just over the undermined tunnel.<strong> </strong>This effect settles down with time and doesn’t need corrective intervention<strong>.</strong> Moreover<strong>,</strong> the donor site scars are merged in the margins of the aesthetic units thereby retaining central facial symmetry.</p>

A retrospective clinical, multi-center cross-sectional study to assess the severity and sequela of Noma/Cancrum oris in Ethiopia.

Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal. A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,-the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score. A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25-50%), Grade-3 (50-75%), Grade-1 (0-25%), and Grade-4 (75-100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma. The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one's family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity.

Epidemiological survey of the quantity and anatomical position of facial pigmented spots in relation to age in 454 Japanese women.

Facial pigmented spots are one of the phenotypes of skin aging, but no quantitative analysis of spot features such as color intensity, size, anatomical position, and number on the cheek has yet been performed. In the current study, we conducted an epidemiological survey of 454 Japanese women in their 20s to 70s and analyzed age-related changes and site differences of facial pigmented spots. Using image analysis of high-resolution digital facial photographs, 4912 individual pigmented spots were quantified according to color, size, anatomical position, and total number on the cheek. As a result of color analysis, the color intensity of individual pigmented spots increased with aging, significantly so between ages 30s and 50s. The age-related increase in melanin index of facial spots was confirmed in all sites but did not significantly differ between facial subregions. Regarding the size of pigmented spots, the frequency of large spots increased with age, and large spots were detected in all facial sites. The total number of pigmented spots on the entire cheek increased with aging, significantly so between the 20s and 40s. The number of pigmented spots tended to increase from the region near the canthi to the lower cheeks. The number of spots was markedly increased in the buccal regions compared with the infraorbital and zygomatic regions. The data and methodology presented in the current study can link the state of facial pigmentation with the various factors involved in the histological development of pigmented spots, opening new possibilities in the fields of skin pharmacology and dermatology.

Neurosensory Assessment of Infraorbital Nerve Injury Following Unilateral Zygomaticomaxillary Complex Fracture – A Prospective Study

Background: This study aimed to assess the difference in the recovery pattern of branches of infraorbital nerve paraesthesia after zygomaticomaxillary complex (ZMC) fracture in both surgically and non-surgically managed patients. Materials & Methods: A prospective, observational study involving 31 patients with unilateral ZMC fracture - 15 in the surgical group (Group A) and 16 in the non-surgical group (Group B) was evaluated. These patients were assessed at the time of injury, 3-months follow-up, and 6-months follow-up for the sensory function of the infraorbital nerve. The assessment of paraesthesia by cotton wisp test, light touch monofilament test, and the cold thermal test was subjected to intra-group and inter-group correlation by McNemar test and Fischer's exact test. Repeated Measures ANOVA with post-hoc Bonferroni test for intra-group correlation and independent sample t-test for inter-group correlation were used for two-point discrimination. Results: A statistically significant improvement was noted on both 3 and 6 months follow-up in the malar region in group A. Other statistically significant improvements were noted only on 6 months follow-up in the infraorbital region in group A. On the 2-point discrimination test, all the facial regions showed significant improvement in both the groups over 3 months and 6 months of follow-up. Conclusion: There was a significant improvement in the infraorbital nerve sensory function following ZMC fracture over 6 months; however, the surgical intervention showed no statistical significance. Further, it can also be concluded that the inferior palpebral branch of the infraorbital nerve shows maximum functional disruption resulting in a higher incidence of paraesthesia in the infraorbital and malar region.

Perception and Propagation Characteristics of Bone-Conducted Stimuli Presented to the Human Facial Cranium.

Since bone conduction (BC) has the advantage that it does not cover the ear canal and can be easily heard even when earplugs are worn, it has been applied to various communication devices. Conventional BC is mainly applied to the mastoid process of the temporal bone (the osseous bulge behind the ear), however, some of recent BC devices, such as smart glasses, present stimuli to faces. The face has very complex structures in the human body; therefore, it is highly likely that the hearing and propagation characteristics of sound will change depending on the part to which sound is presented. However, the characteristics of BC presented to the face has not yet been studied in detail. In this study, we measured hearing threshold and ear canal sound pressure (ECSP) when BC stimuli were presented to various parts of the facial cranium (nasal, infraorbital region, zygomatic, jaw angle, and chin), and compared them with conventional placements of BC stimulus (the mastoid process, condyle process, and forehead). The facial parts such as the infraorbital region, zygomatic, and jaw angle had similar hearing thresholds and ECSPs to those of the mastoid process. The results suggested that these facial parts can be used as stimulus placements of BC devices.

Infraorbital fat tissue volume and density changes in different age groups: Evaluation with computed tomography

ObjectivesWe investigated senile volume and density changes in infraorbital fat to evaluate by computed tomography (CT). MethodsCT examinations of a total of 120 patients (60 males and 60 females) were included in 3 age groups: 18–29 (group 1), 30–49 (group 2), and 50 years and older (group 3). Body weight and height and BMI were recorded, and infraorbital fat tissue volume and density were measured on CT. ResultsBody weight and BMI of ≥50 years of age were significantly higher than the younger ones. In overweight and obesity groups, infraorbital fat volume increased and density decreased compared to the underweight and normal weight groups. In ≥50 years of age group, infraorbital fat volume was higher; density was lower than 18–29 years of age. Female's infraorbital fat volume was higher; density was lower than males. In each age group, the infraorbital fatty tissue density of the females was significantly lower than those in the males. There was a negative correlation between infraorbital fat volume and density. In older patients and as age groups, body weight and BMI increased, infraorbital fat volume increased, and infraorbital fat density decreased. ConclusionBy aging, BMI and body weight and infraorbital fat volume increased, and infraorbital fat density decreased, especially at ≥50 years of age that is thought to be one of the factors that play a role in the downward bulging of infraorbital fat tissue. Females’ higher infraorbital fat volume and infraorbital fat density may be a reason for the females’ bulging in the infraorbital fat region.

Pronounced mediastinal emphysema after restorative treatment of the lower left molar—a case report and a systematic review of the literature

This case report presents an iatrogenic induced mediastinal emphysema after restorative treatment of the lower left second molar, aimed to highlight the potential life-threatening consequences, and providing diagnostics and treatment concepts of complicated dental induced emphysema based on literature review. A 74-year-old female patient was admitted to the emergency department due to a fall on her shoulder. Additional finding was a significant swelling of the face and neck. In the computer tomography of the head, neck, and thorax, a humerus fracture and pronounced soft tissue emphysema from the infraorbital region to the mediastinum was detected. The patient reported that she had been treated by her dentist 4 days earlier. The treatment had to be discontinued after beginning of a pronounced swelling. Other reasons for the emphysema could be excluded out on an interdisciplinary teamwork. The patient was monitored as an inpatient for 5 days and received intravenous antibiotic therapy. This case report shows the rare complication of pronounced mediastinal emphysema after root canal treatment. Emphysema should always be a differential diagnosis of soft tissue swelling and, in case of doubt, a general medical presentation should be made.

Expert Recommendations on the Use of Hyaluronic Acid Filler for Tear Trough Rejuvenation.

Restylane® Lidocaine is one of the most widely used hyaluronic acid (HA) fillers to replace lost or displaced volume during tear trough correction. Patient goals for tear trough correction include looking less tired or removing dark circles and this may be achieved by administering HA filler into the infraorbital region to correct the lower eyelid relative to the volume deficit, thereby smoothing the transition from the lower eyelid to the cheek. To achieve patient satisfaction and consistent results with Restylane, optimal application is essential; however, clinical guidance based on experience is limited. This paper reflects the recommendations of an interdisciplinary expert panel for the use of Restylane in correcting tear trough deformity, including patient selection, dosing, injection technique, and post-treatment care. Recommendations were discussed and agreed as a consensus, according to cross-sectional expertise and clinical experience. J Drugs Dermatol. 2022;21(4):387-392. doi:10.36849/JDD.6597.

Management of basal cell carcinoma: our experience at tertiary care institute

Background: Basal cell carcinoma (BCC) is a slow growing, locally invasive and most common skin cancer. Its etiology is mostly linked to exposure to U.V. rays in sunlight. Diagnosis is mostly clinical and wide local excision is main treatment modality.Methods: The study was conducted on 50 cases of BCC diagnosed at Sri Guru Ramdas University of Health Sciences during a study period extending from January 2013 to January 2021. In the present study various variables associated with BCC i.e. age, gender, size, site, and histopathology were studies.Results: The present study was conducted on 50 patients of BCC. Total number of males was 32 (64%) and there were 18 (36%) females. Mean age of patients presented with BCC was 65 years and SD=14.054. It was observed that most common site of lesion was infra orbital region 12 (24%). Size of lesion varied from 1 to 3 cm and wide local excision with flap was most commonly performed procedure at our Institute. Nodular sclerosing was observed to be the most common histopathological type accounted for 35 (70%) of total cases.Conclusions: BCC is a common surface malignancy amenable to early detection and potential cure. Infra orbital region is most common site and nodular sclerosing is most common histopathological type. Wide local excision remains the heart of treatment.

Facilitatory Effect of Intermittent Repetitive Transcranial Magnetic Stimulation on Perceptual Distortion of the Face

Orofacial pain patients often report that the painful facial area is “swollen” without clinical signs - known as perceptual distortion (PD). The neuromodulatory effect of facilitatory repetitive transcranial magnetic stimulation (rTMS) on PD in healthy individuals was investigated, to provide further support that the primary somatosensory cortex (SI) is involved in facial PD. Participants were allocated to active (n = 26) or sham (n = 26) rTMS group in this case-control study. PD was induced experimentally by injecting local anesthesia (LA) in the right infraorbital region. PD was measured at baseline, 6 min after LA, immediately, 20 and 40 min after rTMS. Intermittent theta-burst stimulation (iTBS) as active rTMS and sham rTMS was applied to the face representation area of SI at 10 min after LA. The magnitude of PD was compared between the groups. The magnitude of PD significantly increased immediately after iTBS compared with sham rTMS (P = .009). The PD was significantly higher immediately after iTBS compared to 6 min after LA (P = .004) in the active rTMS group, but not in the sham rTMS group (P = .054). iTBS applied to a somatotopic-relevant cortical region appears to facilitate facial PD further supporting the involvement of SI in the processing of one´s own face and PD. PerspectiveThis study provides information on neural substrate responsible for processing of perceptual distortion of the face which is speculated to contribute to the chronification of orofacial pain. The findings of this study may aid in mechanism-based management of the condition in orofacial pain disorders and possibly other chronic pain states.

Eyelid Reconstruction and Infraorbital Repair Using a Mustardé Flap Technique in a Dog

This case report describes a 5-year-old dog with a defect in the right eyelid, absence of orbicularis musculature, and absence of cutaneous tissue in the infraorbital region, submitted to the Mustardé flap technique. A large rotational flap was performed, including a cartilage graft from the outer ear, to correct the defect in the lower eyelid and infraorbital region. Also, euryblepharon correction of the upper eyelid was performed with wedge excision. The techniques were performed in a single surgical step and with appropriated functional and aesthetic results. The described approach may be employed as a surgical option in large eyelid defects.

Soft tissue filler augmentation of the orbicularis retaining ligament to improve the lid-cheek junction.

The orientation of facial ligaments changes with increasing age due to the loss of bony support. Soft tissue filler injections placed in close proximity to facial ligaments can alter their orientation to help achieve an improved and younger aesthetic appearance. To assess the anatomic and aesthetic effects of a standardized injection with soft tissue filler placed directly inferior to the orbicularis retaining ligament in the infraorbital region. A total of 163 patients with signs of infraorbital aging were treated with a standardized soft tissue filler injection into and in close proximity to the orbicularis retaining ligament (ORL). 2D frontal images of the infraorbital region were rated by eleven blinded and independent raters with regards to the aesthetic appearance of the infraorbital region before and after the standardized injection treatment. The aesthetic appearance of the entire infraorbital region (lid-cheek junction) was rated before and after the treatment. The severity of the tear trough (medial aspect of the infraorbital region) as well as the hollowing of the lateral aspect of the infraorbital region also was rated before and after the treatment. Aesthetic improvement was statistically significant when evaluated by the blinded raters, the treating physician, and the patients. All the results were "very much improved" compared to baseline. The effectiveness of this injection technique is thought to be due to the strategic placement of soft tissue filler that helps to reposition facial ligaments that have changed their orientation during the aging process.

Population affinity and variation of sexual dimorphism in three-dimensional facial forms: comparisons between Turkish and Japanese populations

Examining the extent to which sex differences in three-dimensional (3D) facial soft tissue configurations are similar across diverse populations could suggest the source of the indirect evolutionary benefits of facial sexual dimorphism traits. To explore this idea, we selected two geographically distinct populations. Three-dimensional model faces were derived from 272 Turkish and Japanese men and women; their facial morphologies were evaluated using landmark and surface-based analyses. We found four common facial features related to sexual dimorphism. Both Turkish and Japanese females had a shorter lower face height, a flatter forehead, greater sagittal cheek protrusion in the infraorbital region but less prominence of the cheek in the parotid-masseteric region, and an antero-posteriorly smaller nose when compared with their male counterparts. The results indicated the possible phylogenetic contribution of the masticatory organ function and morphogenesis on sexual dimorphism of the human face in addition to previously reported biological and psychological characteristics, including sexual maturity, reproductive potential, mating success, general health, immune response, age, and personality.

Quantitative assessment of Bell's palsy-related facial thermal asymmetry using infrared thermography: A preliminary study.

The temperature distribution of normal human skin is symmetrical. Facial paralysis generally changes this thermal symmetry. The aim of this study is to analyze facial thermal asymmetry during the early onset of Bell's palsy, and to assess the feasibility of the diagnosis of early-onset Bell's palsy using infrared thermography (IRT). Fifteen subjects with Bell's palsy and 15 healthy volunteers were considered in this study. The infrared thermal images of the front, left, and right sides of all the subjects were collected and analyzed. Each group of facial thermograms was divided into 16 symmetrical regions of interest (ROIs) with respect to the left and right sides. Three different temperature difference calculation methods were used to express the degree of thermal symmetry between the left- and right-side ROIs, namely, the mean temperature difference (ΔTroi), maximum temperature difference (ΔTmax), and minimum temperature difference (ΔTmin). Among the facial ROIs, there were significant differences in the thermal symmetries of the frontal region, medial canthus region, and infraorbital region between subjects with and without Bell's palsy (p<0.05). Based on the results, ΔTroi was more effective than the other two methods for the diagnosis of early-onset Bell's palsy. The area under the ROC curve (AUC) of ΔTroi in the infraorbital region was 0.818; and the sensitivity and specificity were 0.867 and 0.800, respectively. Subjects with early-onset Bell's palsy exhibited thermal asymmetry on the left and right sides of their faces. The diagnosis of early-onset Bell's palsy using IRT is therefore necessary. Nevertheless, more effective thermal symmetry analysis methods will be investigated further in future research.

A case of Nevus of Ota treated with laser picosecond Alexandrite 755 nm: A case-report

Background: Nevus of Ota is a well-defined dermal melanocytosis characterized by bilateral multiple small, bluish-brown macules in the area innervated by the first and second branches of the trigeminal nerve. Currently, the therapeutic modalities for this condition are still limited and complete resolution is difficult to achieve.Case Description: A 23-year-old woman complained a brown spot on the right cheek since the patient was born. It looked like the skin but slightly darker than its surroundings. Four years ago the patient had received 6 sessions of QS: Nd-YAG laser therapy, but the spot is still clearly visible. Dermatological status of the orbital, infraorbital, zygomatic, and right buccal regions showed multiple hyperpigmented patches, gray-brown, well-defined, geographically in shape with size 0.2 x 0.3cm – 5 x 7cm. The lesion was unilateral and distributed within the innervation area of the second and third trigeminal nerve. Miravex® skin analysis showed that the average level of melanin was 0.464 with a melanin variation of 45%. Therefore, patient was diagnosed with Nevus of Ota. The proposed treatment was picosecond alexandrite 755nm laser, with a frequency of 2.5 Hz, pulse duration 550-750 ps, spot size 4 mm, and fluence 1.59 J/cm2. A marked improvement was observed after the treatment and after 21 days, a good grade of improvement was reported.Conclusion: Nevus of Ota can effectively treated with 755nm picosecond alexandrite laser therapy and results in a good grade of improvement.

After the Temporal Lifting Technique-What comes next?

The temporal lifting technique can provide lateral facial lifting when administering hyaluronic acid (HA)-based soft tissue fillers into the subdermal plane of the temple. However, the central facial oval is not influenced by this technique. To identify the safety and esthetic effectiveness of additional midfacial injection points (in addition to the temporal lifting technique) that can volumize the medial midface, lift the lateral face, and increase jawline contouring when included into a full-face injection algorithm. The patient records of nine consecutive patients (all females) with a mean age of 35.0 (8.4) years and a mean body mass index of 21.7 (2.4)kg/m2 were retrospectively analyzed after a full-face injection algorithm was performed using HA-based fillers. The additional injection points target the supraperiosteal plane of the medial zygomatic arch, the lateral infraorbital region, and the pyriform fossa using both needles and cannula. No adverse events were observed during the 6-month retrospective observational period. The volume of the medial midface increased, the volume of the lateral midface decreased, and the contour of the jawline improved; all effects reached a highly statistically significant level with p<0.001. Despite each individual injection is currently performed on a daily clinical basis the evaluated injection algorithm following the temporal lifting technique shows some evidence that it is safe and esthetically effective. Future studies will need to confirm the results presented herein in a larger sample and with objective outcome measures to guide safe and effective esthetic outcomes.

Dermal Fillers for Tear Trough Rejuvenation: A Systematic Review.

There is significant variation in treatment parameters when treating the infraorbital region. Thorough knowledge of these pertinent factors, choice of the optimal filling material, and proper understanding of the anatomy of this unforgiving region will contribute to a safe, effective, and natural result. We aim to conduct a systematic review of published literature related to soft tissue fillers of the tear trough and infraorbital region. A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included PubMed, Embase, and Science Direct databases. The Medical Subject Headings (MeSH) terms used were "tear trough" OR "infraorbital" AND "dermal filler" OR "hyaluronic acid" OR "poly-L-lactic acid" OR "calcium hydroxyapatite" OR "Restylane" OR "Radiesse" OR "Perlane" OR "Juvéderm" OR "Belotero." Different combinations of these key terms were used. The initial search identified 526 articles. Six additional articles were identified through references. Two-hundred twenty-five duplicates were removed. A total of 307 studies were screened by title and abstract and 258 studies were eliminated based on inclusion and exclusion criteria. Forty-nine articles underwent full-text review. The final analysis included 23 articles. Patient satisfaction was high, and duration of effect ranged from 8 to 12 months. Restylane was most commonly used. Injection technique varied, but generally involved placing filler pre-periosteally, deep to orbicularis oculi muscle, anterior to the inferior orbital rim via serial puncture or retrograde linear threading with a 30-gauge needle. Topical anesthetic was most commonly used. Side effects were generally mild and included bruising, edema, blue-gray dyschromia, and contour irregularities. Nonsurgical correction of the tear trough deformity with soft tissue filler is a minimally invasive procedure with excellent patient satisfaction with long-lasting effects. It is essential to have a fundamental understanding of the relevant anatomy and ideal injection technique to provide excellent patient outcomes and prevent serious complications.

A comparative study between two point and three point fixation for zygomatic complex fractures

The fractured fragments of a zygomatic complex fracture near the suture lines needs to be restabilized by open reduction by fixation. Depending on the displacement of fracture segments and anticipating the stability of the reduced fracture, one, two or three point fixation is applied. The choice of points of fixation is inclusive and best left to surgeon and depending on the fracture type.The aim of this study was to compare and evaluate functional and aesthetic outcome of two point fixation at frontozygomatic suture and buttress with three point fixation at FZ, buttress and infraorbital region in patients with zygomatic complex fractures.This study included 30 patients who underwent treatment of zygomatic complex fractures between 2011 to 2013. Fifteen patients were treated with ORIF using two point fixation and remaining 15 with three point fixation and patients were evaluated and compared preoperatively, first post op day, 7 day, first month and third month post op for anatomic form, function, aesthetics and complications. There was no statistically significant difference in stability, function and aesthetics achieved with fixation and aesthetics. Two point fixation modality for displaced zygomatic complex fractures is as effective as three point fixation. The surgical treatment varies from surgeon to surgeon and also depends on the type of fracture.

Abordagem estética da região palpebral inferior – Uma revisão das principais opções terapêuticas

Introdução: As alterações do tear through e da região infraorbital são um dos primeiros sinais reconhecíveis de envelhecimento. Estas são queixas comuns comum na medicina estética e há muitas opções de tratamento disponíveis. Tendo isso em vista, o objetivo do presente estudo é realizar uma revisão de literatura para descrever a anatomia e as alterações da região infraorbital decorrentes do envelhecimento e apresentar as principais opções terapêuticas para cada caso. Materiais e métodos: Uma revisão simples de literatura foi realizada nas bases de dados: Pubmed, Scielo, Web of Sciences, usando os descritores: Tear trough , Infra-orbital, Dark-circles, Lower-Eyelid, Hyperpigmentation e Midface, treatment, therapeutics com seus termos correspondentes em inglês e português. Resultados: Preenchimentos, bioestimuladores de colágeno, lasers, dispositivos de radiofrequência, microagulhamento, peelings químicos, cosmecêuticos e toxina botulínica são opções de tratamento não cirúrgico disponíveis discutidas na literatura, constatou-se que melhora e rejuvenesce significativamente a região infraorbital. Conclusão: A compreensão completa da anatomia e das alterações que ocorrem com o envelhecimento são de extrema importância na avaliação da região infraorbital para determinar as opções de tratamento adequadas como uma forma de alcançar um rejuvenescimento ideal.

PERIODONTAL DISEASES IN DOGS (ETIOLOGY, CLINICAL SIGNS, DIAGNOSIS)

. Recently, t he number of non-communicable pathologies in dogs is increasing and a large part of them are caused by diseases of the oral cavity area. A significant number of them are dental problems. One of them is periodontitis. More often periodontitis occurs as a result of tooth fractures and the development of caries, which are complicated by necrotic pulpitis. The main forms of periodontitis in dogs: fibro us , granulomatous, granulating , and suppurative. The work describes clinical manifestations of periodontal pathology and interprets the radiological image s taken for fin al diagnosis of oral cavity pathology. Fibrous periodontitis was found to be asymptomatic and characterized by insignificant equitable expansion of the periodontal slit in the apex area. Granul ating periodontitis is characterized by hyperemia and swelling of the mucous membrane of the gums in the area of tooth root projection and uneven jaw bone destruction with deformation of the periodontal slit. Granulomatous periodontitis is asymptomatic and is characterized by the development of a rounded defect of the jaw bone, which is associated with periodontitis and is radiologically detected . A f istula in the infraorbital region (fourth upper premolar) is observed q uite often. In cases of suppurative periodontitis in dogs, t oot h ache , hyperemia and swelling of the gums, fistula, destruction and melting of the periodontal ligament were noted. Odontogenic abscesses can be considered not only as an independent nosologic unit but also as a kind of suppurative periodontitis. Granulomas of periodontal tissue are a part of chronic periodontitis including its similar etiology, pathogenesis, symptoms , and localization. Keywords : fistulas, caries, tooth fractures, deformation, periodontal slit