Postsurgical Edema Research Articles

Comparison of different dual-wavelength photobiomodulation protocols application in third molar extractions. A split-mouth randomized controlled trial

ObjectiveTo compare the use of PBMT in the soft tissue and bone healing after third molar extraction using the dual-wavelength laser directly into the post-extraction alveoli (PBMT-I), or PBMT with a red laser directly into the alveoli and with an infrared laser externally on the patient's face (PBMT-IE). MethodsTwenty patients underwent extraction of four third molars were involved in this split-mouth double-blind randomized controlled trial. The Post-extraction alveoli were treated with the following protocols: PBMT-IE: Application of a red laser directly into the alveolus, and infrared laser irradiation transcutaneously and PBMT-I: Application of dual-wavelength laser intraorally. Patients were clinically evaluated 3, 7, 14, 30, and 90 days after the surgical procedure. The analyses in this study were divided into qualitative (centered on the patient's report and on the evaluators' analysis), and quantitative analyses (measurement of the vertical and horizontal dimensions of the face with the objective of measuring post-surgical edema and radiographic analyses for evaluation of the density and structure of the newly formed bone). ResultsA progressive improvement was observed in all parameters evaluated in this study, however, this improvement was time dependent, with no distinct effect observed between the PBMT treatments applied. ConclusionThe different dual-wavelength PBMT protocols induced a similar postoperative clinical course in third molar extraction surgeries, with a reduced occurrence of complications and a good healing pattern of hard and soft tissues.

Abdominal Liposuction Post-Surgical Management Controlled with Kinesiotherapy

Introduction: Body contouring is commonly used to enhance abdominal aesthetics; however, managing post-surgical edema remains a challenge. Kinesiotherapy, involving continuous abdominal bandaging, may offer a solution. Objectives: This study aims to demonstrate the effectiveness of Kinesiotherapy in managing edema, ecchymosis, seroma, and post-surgical pain in abdominal liposuction. Material and Methods: In a clinical trial, 50 patients undergoing abdominal liposuction were evaluated over one year, with 25 in a control group and 25 in an experimental group. The study monitored the effects of Kinesiotherapy during the first 7 and 21 days post-surgery, using Nuclear Magnetic Resonance (NMR) to assess reductions in seroma, ecchymosis, edema, and pain. Results: The study showed a decrease in edema measured by cm2 in MRI, with an average reduction of 373 cm2 in the control group compared to 635 cm2 in the experimental group, leading to decreased edema, ecchymosis, pain, and seroma. Discussion: Liposuction is a widely used surgical technique for removing fat to improve body contour. However, some patients may experience an excessively flat abdomen. Kinesiotherapy, a daily-use intervention, has shown proactive benefits in managing post-surgical complications related to body contouring. Conclusions: Abdominal belts, used for controlled management of post-surgical edema, facilitate lymphatic and nervous recirculation, ultimately reducing seromas, fibrosis, ecchymosis, and paresthesias. This study highlights the importance of incorporating Kinesiotherapy for optimal patient outcomes.

A Cross-sectional Survey on Dentist’s Knowledge and Attitude towards the Application of Arnica Montana in Dental Practice

Introduction: Postsurgical oedema (PSE) is a common complication encountered in the dental field following different surgical procedures including wisdom teeth extraction and other periodontal and implant surgeries. Arnica Montana (AM) is a homeopathic agent which may represent as a safe, effective and an alternative agent for Non Steroidal Anti-Inflammatory (NSAID) medications to prevent or decrease the risk of PSE. Aim: The aim of this study was to evaluate the knowledge of practicing dentists and their experiences using AM supplements in their daily practice for management of PSE. Materials and Methods: This was an observational, crosssectional self reported electronic based study to survey practicing dentists on the application of AM in daily dental practice conducted from January to September 2021. The electronic survey included 13 questions on: 1) dentist’s demographics and educational backgrounds; 2) knowledge related to AM supplement; and 3) previous experience, if any, with AM use for management of PSE. The survey was distributed to potential subjects and descriptive statistics was used to summarise the data, and presented as percentages and frequencies using Microsoft Excel for mac (Version 16.40). Results: A total of 84 subjects participated in the survey, out of which 23 (27.3%) were familiar with AM use in dentistry. Overall, 15 participants (65.2%) indicated preventions or reduction of PSE risk and pain and seven participants reported prevention and reduction of postsurgical discolouration and bleeding (30.4%) as potential indications for AM use. In total, eight participants (34.7%) have prescribed AM to patients before, mainly for external and internal sinus grafting (4/8; 50% for both) and surgical extraction of impacted teeth (2/8; 25%). Out of all, five participants (5/8; 62.5%) reported significant benefit with using AM following a surgical procedure and four participants (50%) reported numbness of the lips, altered taste sensation and increased bleeding as associated toxicities. Conclusion: From the present study the uses and user based experienced of the material AM in the field of dentistry can be well understood and analysed. This was the first survey to discuss the knowledge and application of AM among dentists from various specialties.

Sub-mucosal Dexamethasone for Post-operative Pain and Oedema Control in Lower Third Molar Surgery.

Background:Surgical excision of the problematic mandibular third molars causes substantial tissue damage and an inflammatory response. Discomfort and edema are common postoperative signs and symptoms caused by the latter. To find out whether dexamethasone may help with the edema and pain that come along with the surgical removal of impacted mandibular third molars, researchers have performed clinical studies.Methods:Twenty individuals with bilaterally affected mandibular third molars who were scheduled for extraction participated in a prospective trial. At two separate sessions, teeth were raised and cut after buccal ostectomy. Since the surgical operation on the left foot, both patients were administered a mixture of 4 mg dexamethasone submucosal injection and antibiotics for 3 days. On the 1st, 3rd, and 7th postoperative days, edema and pain were assessed.Results:At the 1st, 3rd, and 7th postoperative days, there was a clinically meaningful decrease in the level of edema and discomfort in both arms.Conclusions:The current report offers empirical proof that administering a 4 mg dexamethasone submucosal injection during surgery greatly reduced post-surgical edema and discomfort.

Development of Surgical and Visualization Procedures to Analyze Vasculatures by Mouse Tail Edema Model

BackgroundBecause of the high frequency of chronic edema formation in the current “aged” society, analyses and detailed observation of post-surgical edema are getting more required. Post-surgical examination of the dynamic vasculature including L.V. (Lymphatic Vasculature) to monitor edema formation has not been efficiently performed. Hence, procedures for investigating such vasculature are essential. By inserting transparent sheet into the cutaneous layer of mouse tails as a novel surgery model (theTailEdema bySilicone sheet mediatedTransparency protocol; TEST), the novel procedures are introduced and analyzed by series of histological analyses including video-based L.V. observation and 3D histological reconstruction of vasculatures in mouse tails.ResultsThe dynamic generation of post-surgical main and fine (neo) L.V. connective structure during the edematous recovery process was visualized by series of studies with a novel surgery model. Snapshot images taken from live binocular image recording for TEST samples suggested the presence of main and elongating fine (neo) L.V. structure. After the ligation of L.V., the enlargement of main L.V. was confirmed. In the case of light sheet fluorescence microscopy (LSFM) observation, such L.V. connections were also suggested by using transparent 3D samples. Finally, the generation of neo blood vessels particularly in the region adjacent to the silicone sheet and the operated boundary region was suggested in 3D reconstruction images. However, direct detection of elongating fine (neo) L.V. was not suitable for analysis by such LSFM and 3D reconstruction procedures. Thus, such methods utilizing fixed tissues are appropriate for general observation for the operated region including of L.V.ConclusionsThe current surgical procedures and analysis on the post-surgical status are the first case to observe vasculatures in vivo with a transparent sheet. Systematic analyses including the FITC-dextran mediated snap shot images observation suggest the elongation of fine (neo) lymphatic vasculature. Post-surgical analyses including LSFM and 3D histological structural reconstruction, are suitable to reveal the fixed structures of blood and lymphatic vessels formation.

Influence of Anatomical Parameters on the Dimensions of the Subantral Space and Sinus Mucosa Thickening after Sinus Floor Elevation. A Retrospective Cone Beam Computed Tomography Study.

Background: Various anatomical parameters might influence the surgical approach for maxillary sinus floor elevation. The objective of the present study was to retrospectively evaluate the influence of anatomical parameters on the dimensions of the subantral space and of the sinus mucosa thickening after sinus floor elevation. Material and Methods: Seventy-eight maxillary sinuses in sixty-five patients were evaluated on cone beam computed tomographies taken before surgery and after one week (t1w) and nine months (t9m). Several parameters such as the distance XF between an axis parallel to the base of the nose (X-axes) and the sinus floor (F) were correlated with the height gain (IF) at t1w and t9m and the post-surgical edema. Results: A weak significant positive correlation was observed between height gain vs. sinus height of interest (XF), the balcony, and the sinus floor angle. The post-surgical edema was influenced by the initial mucosa thickness and the xenograft used. Conclusions: Various parameters might affect height gain and sinus mucosa thickening after sinus floor elevation. The height of interest, the balcony, and the sinus floor angle showed significant correlations with height gain. The initial thickness of the mucosa and the biomaterial used influenced the post-surgical edema.

Variations of Intraocular Pressure Measured by Goldmann Applanation Tonometer, Tono-Pen, iCare Rebound Tonometer, and Pascal Dynamic Contour Tonometer in Patients With Corneal Edema After Phacoemulsification.

Edematous corneas had lower Goldmann applanation tonometer (GAT) intraocular pressure (IOP) compared with other tonometers. A significant, mild negative correlation between central corneal thickness (CCT) and GAT IOP was found in a group of significant edematous corneas with CCT increases of >100 µm. To compare the IOP that was randomly obtained with the GAT, Tono-Pen, iCare, and Pascal dynamic contour tonometer in patients with corneal edema after phacoemulsification. Corneal edema was quantified by CCT measurement. The agreement between IOP measurements assessed by different instruments was evaluated using Bland-Altman plots. The relationship between CCT and IOP was investigated using the coefficient of correlation. The CCT and IOP were compared between the periods of postsurgical edema and after its resolution. The mean age of 60 patients was 75.9±7.8 years. CCT increased significantly after surgery, by an average of 96.1±39.9 µm (P<0.001). Relative to the IOPs measured with the GAT in edematous eyes: the mean difference in Tono-Pen IOPs was 4.7 mm Hg; 95% limits of agreement (LOA), -0.3 to 9.6 mm Hg. For iCare, was 2.3 mm Hg; 95% LOA, -2.2 to 6.8 mm Hg. For Pascal dynamic contour tonometer, was 3.0 mm Hg; 95% LOA, -0.4 to 6.5 mm Hg. Edematous corneas had significantly lower GAT IOP than Tono-Pen IOP; 12.3±3.2 versus 16.9±3.1 (P=0.02). Pearson correlation coefficients (r) showed a high correlation between the 4 tonometers in eyes without edema. There was a significant, mild negative correlation between CCT and GAT IOP (r=-0.25, P=0.02) in a group of significant edematous corneas with CCT increases of >100 µm: GAT IOP decreased by 3.1 mm Hg for every 10-µm increase in CCT. IOP readings with GAT tended to be lower than those obtained with the other tonometers, especially the Tono-Pen. GAT IOP readings in cases of severe corneal edema should be interpreted with caution.

Laser Vestibuloplasty for Peri-implant Gingiva Implementation in the Atrophic Mandible of a Medically Compromised Patient

Despite the good clinical outcomes of the conventional technique of vestibulopasty performed with a scalpel, patients frequently perceive pain and discomfort after surgery. Diode laser use in oral surgery is, instead, well tolerated as it is mini-invasive and with a very low occurrence of post-surgical complications. In addition, the lack of bleeding during surgery and the reduced/absent post-surgical edema makes diode laser surgery the most suitable for medically compromised patients. We report a case of vestibuloplasty performed by diode laser in a patient on therapy with warfarin and without drug discontinuation.

Aminogam® Gel Allows Faster Wound Healing after Oral Surgery by Formation of Mature Connective Tissue with Low Vascular Density and Reducing Inflammatory Infiltration. A Retrospective Study on 580 Cases with Histological and Confocal Laser Investigation

Reduction of the wound healing time after surgical procedures along with good hemostasis, and the reduction of post-surgical edema, pain and infective complications are generally desirable to both clinicians and patients. Recently, a gel compound containing sodium hyaluronate and four synthetic aminoacids (glycine, leucine, proline, lysine) and marketed as Aminogam® (Errekappa Euroterapici, Italy), has been proposed as a medical device promoting faster wound healing after oral surgery procedures. To assess its achievable clinical benefits, we studied retrospectively 580 cases (290 study cases and 290 control cases) undergoing oral surgery and receiving Aminogam ® gel application. More precisely, cases were divided into 7 groups on the bases of the kind of surgery (teeth extraction, oral surgery in patients taking bisphosphonates, surgical treatment of jaw osteonecrosis related to bisphosphonates therapy, placement of endosseous implants, diode laser surgery of oral mucosa lesions with second intention healing without stitches, diode laser photocoagulation of slow flow vascular malformations and bone surgery). In all instances, Aminogam® gel was applied at least five times a day until the wound healed completely. We compared the elapsed time between surgery and complete healing with Aminogam® application compared to control cases receiving no other drug treatment. Our results confirmed that the overall time of healing is certainly reduced in cases receiving Aminogam® gel regardless of the kind of oral surgery.

Photobiomodulation as oedema adjuvant in post-orthognathic surgery patients: A randomized clinical trial

Photobiomodulation therapy (PBMT) has been used in multiple applications in general medicine as powerful anti-inflammatory, analgesic and reducing oedema in different parts of the body. The aim of this study is to compare the effect on post-surgical oedema after mandibular orthognathic surgery, between two different laser power densities and oral medication with non-steroidal anti-inflammatory. In a randomized clinical trial, on 60 patients who were subject to mandibular orthognathic surgery were divided into three groups. All groups received sodium naproxen 250mg every 8hours for 6days. Two groups were irradiated with two different laser application protocols and the other was a control group. In G1 group the irradiation parameters three times per week for two weeks were: 940nm, in continuous mode, 2.5W, 120s, 85.71J/cm2, 0.89W/cm2, over the right and left side with a distance from the skin surface of 1mm with the whitening handpiece (spot size of 2.8cm2). In G2, the irradiation parameters three times a week for two weeks were: 940nm, in continuous mode, 4.1W, 120s, 68.33J/cm2, 0.58W/cm2 over the right and left side with a distance from the skin surface of 15mm, with the deep tissue handpiece (spot size of 7.1cm2). In all the groups, millimetric facial measurements were taken from tragus to lateral commissure, and from lateral commissure to gonion in both sides. All differences between T1 and T6 were significant for the three groups, (paired T, P<0.05). The differences between the groups were generally not significant (P>0.05) except for commissure-right and left gonion when compared G1 vs CG (P<0.05) and G2 vs CG (P<0.05). Initial changes (T1-T2) between groups were significantly different except for the measurement from commissure to right tragus G1 vs CG (P=0.411) and from commissure to left tragus G2 vs CG (P=0.94). The faster resolution of the oedema occurred in G2 group. PTBM with an energy density of 68.33J/cm2 was the most effective adjuvant to oral medication with non-steroidal anti-inflammatory, to decrease post-surgical oedema after mandibular orthognathic surgery.

Prospective Evaluation of Perioperative Steroid Dosing on Postsurgical Edema in Orthognathic Surgery

Prospective Evaluation of Perioperative Steroid Dosing on Postsurgical Edema in Orthognathic Surgery

Argon Laser Peripheral Iridoplasty and Argon Laser Pupilloplasty: Alternative Management for Medically Unresponsive Acute Primary Angle Closure.

Objective To introduce the combined laser technique, argon laser peripheral iridoplasty (ALPI) and argon laser pupilloplasty (ALPP), in the management of medically unresponsive acute primary angle closure (APAC). Design Retrospective study. Methods We retrospectively reviewed the records of 23 patients (27 eyes) with APAC, who were applied ALPI and ALPP when traditional treatment failed. The visual acuity and intraocular pressure (IOP) were monitored before surgery and at 1, 2, 12, 24, and 48 h after surgery. Additionally, the angle-opening status was monitored before surgery and 48 h after the treatment by using an ultrasonic biological microscope (UBM), and the presurgical and postsurgical cornea edema statuses were observed by using a slit lamp. We also documented the complications of laser treatment. Results For the ALPI + ALPP laser-effective group, the presurgical IOP was 52.1 ± 9.3 mmHg and the postsurgical IOP was 37.6 ± 10.9 mmHg (1 h), 28.4 ± 12.4 mmHg (2 h), 19.9 ± 9.0 mmHg (6 h), 16.8 ± 7.3 mmHg (12 h), 15.9 ± 5.9 mmHg (24 h), and 14.9 ± 5.0 mmHg (48 h), with statistically significant differences (p < 0.05) in each time point. It was observed in all the patients that the corneal edema alleviated, the angles opened, and visual acuity recovered with varying degrees at 48 h after applying combined laser treatment. For the ALPI + ALPP laser-ineffective group, further interventions were taken. Definite treatment was given in both groups to maintain the long-term IOP control. Conclusions Although the combination of ALPI and ALPP is a temporizing therapeutic strategy for APAC, it is effective in relieving pupillary block which is unresponsive to miotic agents, opening the closed angle to a certain extent, restoring the transparency of cornea, and reducing IOP to a safe level for further definitive treatment.

Abnormal Anatomical Etiology and the Resultant Bilateral Thoracic Outlet Syndrome: An Exploration Case Report

HISTORY: 32-year-old healthy female presented to the vascular surgeon for right arm pain (pn) and a hand tremor. She was a mesomorph with forward head posture and was a volleyball athlete and triathlete. PHYSICAL EXAMINATION: Patient reported years of pn and disfunction with no mechanism of injury. Symptoms began as stabbing pn 8/10 along right ulnar and radial nerves. Pn increased when the arms were unsupported. Right hand tremor increased with ADLs, and arm above 100 degrees. Feeling of heaviness and tingling in the arms impaired sleep and decreased effective grasping of objects causing patient to often drop things. Left arm pn 6/10 in trapezius, radiated to the forearm. Trapezius felt as if it needed to be stretched, but stretching increased pn 7/10. Pn was felt in the jaw and teeth 5/10 and the ear had a “cloudy” sensation. Patient had three root canals yet the facial pn persisted. DIFFERENTIAL DIAGNOSIS: Paget-Schroetter syndrome Rotator Cuff injury Multiple Sclerosis TEST AND RESULTS: MRA right shoulder: -Labrum tear, infraspinatus atrophy, rotator cuff tear. Suprascapular nerve laceration with maximal involvement of infraspinatus MRI c-spine: -Minor arthrosis, slightly desiccated discs with no bulging at C5-C6 X-ray c-spine: -No cervical ribs or narrow facets MRI brain: -No multiple sclerosis Electromyography: -Infraspinatus atrophy Special Tests - Adson, Allen, Military Brace: -Absent bilateral pulse DASH score: -Significant ADL impairment Lidocaine muscle block, scalenes and right pec minor: -Patient reported 50% decrease in pn MRI bilateral brachial plexus: -Post-surgical edema, asymmetrically large right jugular vein, pec minor and subclavian muscle atrophy with scarring at SC joint. Brachial plexus matted in scalene compartment; left side normal FINAL/WORKING DIAGNOSIS: Bilateral TOS with right pec minor impingement TREATMENT AND OUTCOMES: 1. Sx 1: Subtotal resection of subclavius, scalenes, resection of scalene minimus, division of pec minor, brachial plexus neurolysis, and subclavian artery lysis 2. Sx 2: Subtotal resection of subclavius, scalenes, brachial plexus neurolysis, and subclavian artery lysis 3. Sx 3: Scalenectomy of right scalenes and scar tissue removal 4. Paralyzed right diaphragm from surgery complication 5. Patient reports 75% improvement on right, 90% improvement on left.

Upper Eyelid Gold Weight Implantation for Facial Nerve Palsy—Short-Term and Long-Term Results

Lid loading with upper eyelid gold weight implants is one of the more accepted ways of treating facial paralysis-related lagophthalmos. This study evaluates the short- and long-term outcomes of the technique in terms of objective and subjective functional and aesthetic outcomes. Two groups of 10 patients in each group were included in the study for prospective and retrospective evaluation of outcome of upper eyelid gold weight implant in Indian ethnicity. Assessment of the weight and dimension of gold implant was done in both sexes along with an evaluation of patient satisfaction, medical observations and ophthalmological assessment for corneal integrity, symmetry and exposure. Chi-square test, Friedman’s test and Wilcoxon rank-sum (Mann–Whitney) test. The mean weight–length of the implant for appropriate correction was noted as 1.12 g (range 0.9–1.3 g) and 17.8 mm (range 16–20 mm). Initial postsurgical congestion and eyelid oedema was near universal. Comparing the short-term and long-term assessments, palpebral fissure height reduction and eye closure was noted as stable and all subjective parameters were relatively consistent. Nineteen of 20 patients reported satisfaction with the cosmetic and functional results. Upper eyelid loading by gold weight implantation results in consistent and sustained improvement for eye closure in patients with facial paralysis.

Three Cases of Postsurgical Granulation and Edema in the Trachea Treated with Steroid Injections of Triamcinolone Acetonide

Three Cases of Postsurgical Granulation and Edema in the Trachea Treated with Steroid Injections of Triamcinolone Acetonide

Assessment of bone augmentation using silica calcium phosphate nanocomposite (SCPC)versus hydroxyapatite in open sinus lift Surgeries(A Scanning Electron Microscope, Cone Beam Computerized Tomography and histological study)

ObjectivesMaxillary sinus pneumatization and extraction of posterior maxillary teeth are among the most common factors attributing to the diminished alveolar process. Implants placed in posterior region of maxilla showed the highest failure rates due to poor bone density in addition to insufficient remaining bone volume needed for implant primary stability. Materials and methodsTen patients were selected from out patient clinic with partially or fully edentulous maxilla missing premolars or molars with residual alveolar bone height less than 6 mm, both groups received open sinus lift surgery with different grafting material group1 (control group) received hydroxyapatite (HA)in a disc form, group 2(Study group) received silica calcium phosphate nanocomposite (SCPC) in a disc form. Clinical evaluation, Cone Beam Computerized Tomography (CBCT) (Pre-operative, 0 & 4 months postoperatively), Scanning Electron Microscopy (SEM) (4 months postoperatively) and histological study (4 months postoperatively)were performed for both groups as follow-up following either stages of surgery. Resultsall patients had uneventful wound healing, and none experienced excessive postsurgical edema. Following surgical stage II (implant placement) all patients exhibited proper dental implant osseointegration, and all were properly restored by fixed prosthodontics. For radio graphical results the bone height and bone width showed statistically significant increase in both groups; The histopathological results of both groups revealed new bone formation in the histological sections attained from the core bone biopsies over 4 months postoperatively. While the analysis of the SEM images revealed that in the control group (HA), the new bone exhibited an irregular and porous appearance In the study group (SCPC), the bone appeared as a continuous plate with nearly homogenous surface. Conclusionwithin the limitations of the present study, the present data support the fact that both HA and SCPC can be used, successfully, in sinus augmentation procedures. Moreover, the suggested technique in combination with grafts in the form of discs, and using piezoelectric surgical units are simpler and safer approaches to lateral sinus lift augmentation procedures.

The 3 R’s for Platelet-Rich Fibrin: A “Super” Tri-Dimensional Biomaterial for Contemporary Naturally-Guided Oro-Maxillo-Facial Soft and Hard Tissue Repair, Reconstruction and Regeneration

Platelet-Rich fibrin (PRF) is a three-dimensional (3-D) autogenous biomaterial obtained via simple and rapid centrifugation from the patient’s whole blood samples, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents. At the moment, it is safe to say that in oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-families) are receiving the most attention, essentially because of their simplicity, cost-effectiveness, and user-friendliness/malleability; they are a fairly new “revolutionary” step in second-generation therapies based on platelet concentration, indeed. Yet, the clinical effectiveness of such surgical adjuvants or regenerative platelet concentrate-based preparations continues to be highly debatable, primarily as a result of preparation protocol variability, limited evidence-based clinical literature, and/or poor understanding of bio-components and clinico-mechanical properties. To provide a practical update on the application of PRFs during oral surgery procedures, this critical review focuses on evidence obtained from human randomized and controlled clinical trials only. The aim is to serve the reader with current information on the clinical potential, limitations, challenges, and prospects of PRFs. Accordingly, reports often associate autologous PRFs with early bone formation and maturation; accelerated soft-tissue healing; and reduced post-surgical edema, pain, and discomfort. An advanced and original tool in regenerative dentistry, PRFs present a strong alternative and presumably cost-effective biomaterial for oro-maxillo-facial tissue (soft and hard) repair and regeneration. Yet, preparation protocols continue to be a source of confusion, thereby requiring revision and standardization. Moreover, to increase the validity, comprehension, and therapeutic potential of the reported findings or observations, a decent analysis of the mechanico-rheological properties, bio-components, and their bioactive function is eagerly needed and awaited; afterwards, the field can progress toward a brand-new era of “super” oro-dental biomaterials and bioscaffolds for use in oral and maxillofacial tissue repair and regeneration, and beyond.

Prevention of Postsurgical Lymphedema by 9-cis Retinoic Acid

To determine the effect of 9-cis retinoic acid (9-cis RA) on postsurgical lymphedema. 9-cis RA promotes lymphangiogenesis in vitro and in vivo and has promise as a therapeutic agent to limit the development of postsurgical lymphedema. Lymphedema was induced in the right hind limb after a single fraction of 20 Gy radiation, popliteal lymphadenectomy, and lymphatic vessel ablation. Postoperatively, mice were randomly divided in to 2 groups that received daily intraperitoneal injections of either (1) an oil-based vehicle solution (control) or (2) 0.08 mg/kg of 9-cis RA dissolved in a vehicle solution. Outcome measures included paw thickness, lymphatic drainage, and lymphatic vessel density as measured by podoplanin immunohistochemistry and whole mount skin analysis. Using our combined injury protocol, postsurgical lymphedema was observed 89% of the time. 9-cis RA-treated animals had less early postsurgical edema and significantly less paw lymphedema compared with vehicle-treated animals at all time-points (P < 0.001). 9-cis RA-treated animals had significantly faster lymphatic drainage as measured by indocyanine green clearance and increased lymphatic vessel density as measured by podoplanin immunohistochemistry (P < 0.001) and whole mount skin analysis (P < 0.05). We have developed a highly reproducible model of secondary lymphedema and have demonstrated that 9-cis RA significantly prevents postsurgical lymphedema. Treatment with 9-cis RA is associated with increased lymphatic clearance and lymphangiogenesis. Because 9-cis RA (alitretinoin) is already approved for clinical use by the US Food and Drug Administration for other conditions, it has the potential to be repurposed as a preventative agent for postsurgical lymphedema in humans.

Evaluation of the 3-dimensional threadlock plate in the management of mandibular angle fractures: A clinical and radiographic study

PurposeMandibular angle fractures remain among the most difficult and unpredictable fractures to treat compared with those of other areas of the mandible. This study was done to clinically and radiographically evaluate the use of three-dimensional (3D) Threadlock plate for the treatment of mandibular angle fractures. Materials and methodsTen patients were selected from those admitted to the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, suffering from isolated mandibular angle fracture. Management was accomplished after careful case history, clinical examination and radiographic examination. Reduction of the fracture was accomplished through an extraoral approach followed by fixation with 3D Threadlock plates. The patients were then followed up for 6 months postoperatively and the collected clinical and radiographic data was statistically analyzed. ResultsThe following clinical parameters were used: pain intensity, postsurgical edema, maximal mouth opening, sensory function, surgical wound, and occlusion. All the results showed that the clinical findings were within reasonable limits and returned to normal values during the follow up period. Radiographically, the increase in mean bone density was statistically significant from preoperative to 6 weeks postoperative, from 6 weeks to 3 months and from 3 months to 6 months postoperatively, consistent with the progress of fracture bone healing. ConclusionConsidering the results of the current study, it is concluded that the 3-D plate has all the advantages of 2 miniplate fixation i.e. 1) High fracture fragment stability, 2) Harmonius occlusion, 3) Early return of the patient to his/her normal social life and function. 4) At the same time, it overcomes all the shortcomings of single miniplate, and satisfies the biomechanical requirements for occlusal loading. According to this study, the 3D Threadlock plating system through an extraoral/transbuccal approach is a suitable method for fixation of mandibular angle fractures, providing adequate stability especially in severely displaced mandibular angle fractures.

Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia

Microcannular liposuction in tumescent anesthesia is the most effective treatment for painful lipedema. Tumescent anesthesia is an established and safe procedure in local analgesia when performed according to guidelines. Major adverse effects are rare. In patients with advanced lipedema, however, the commonly presented comorbidities bear additional risks.We report on post-surgical acute pulmonary edema after tumescent liposuction according to guidelines in a 52-year-old female patient with lipedema of the legs. We discuss in detail possible scenarios that might be involved in such emergency. In the present case the most likely was a retarded community acquired atypical pneumonia with aggravation of pre-existent comorbidities.A combined treatment with intravenous b-lactam antibiosis, positive pressure ventilation, and continuous venovenous hemodialysis and filtration resulted in complete remission in a couple of days. In conclusion, tumescent liposuction of advanced lipedema patients should only be performed in well-trained centers with sufficient infrastructure.