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The HIV-AIDS infected child: a walking atlas of pathology
P21-20rthognathic surgery & Temporomandibular joint 12. The HIV-AIDS Infected Child: a Walking Atlas of Pathology
Creanga, A., Niculae, L, Vlad, D.
157
combination of clindamycin and b-lactam antibiotics, was useful for these infections. We conclude that recognition of underlying diseases, proper drainage of the involved spaces, and administration of the appropriate antibiotics are necessary to resolve maxillofacial infections.
Ovidius University of Constanta-Romania, Oral and Maxillofacial Department, Constanta, Romania The HIV-AIDS infection has a great impact in all surgical and medical specialties. HIV infection causes a large range of diseases, the onset being asymptomatic and going progressively to an AIDS complex condition. In Romania, and particularly in Constanta, the majority of AIDS patients are children. Almost all from over the 1200 HIV-AIDS positive children were infected in their first year of life, and they survive 7-10 years or even more. In this period of time they develop several diseases affecting practically all organs and systems. We like to present some children with lesions in the oral and maxillofacial region and in the same time emphasize the correlation with lesions in the rest of the body.
13. Clinical Evaluation of Maxillofacial Infections
Kaneko, S., Nakamura, S., Oya, R., lkemura, K. Department of OMS, Univ. of Occupational and Environmental Health, Japan We evaluated our methods of treatment of maxillofacial infections, focusing in particular on the causative teeth, the use of imaging in identifying the spread of infections, host defense mechanisms, the microbiology of the infection and the antibiotics used. One hundred and five patients who were microbiologically examined were included in this study. These patients visited our department during the three-year period from 1994 to 1996. There were 63 males and 42 females, with a mean age of 48.7 years and a range of 5 to 80 years. The most frequent cause of infection was non-cystic odontogenic infection (73 patients). The other cause was secondary cystic infection (32 patients). There was an increased involvement of the molars, especially the lower third molar (40%) in more severe infections. Five of fifteen patients with these infections had some weakness in their host defense mechanisms due to rheumatoid arthritis with long-term corticosteroid therapy (three patients), chronic heart failure (one patient), or hypoalbuminemia (one patient). Computed tomography was indicated for patients with deep cervical infections, as it could help guide the surgical incision and subsequent drainage. These deep cervical infections included two cases of necrotizing fasciitis, one arising from a primary odontogenic infection and the other from a post-extraction infection. All of the severe maxillofacial infections were shown to be polymicrobial mixed aerobic-anaerobic infections. The commonly isolated aerobic and anaerobic bacteria were Streptococcus and Prevotella, respectively. Empirical antibiotic therapy, such as a
14. Costoehondral Grafts to Reconstruct Mandibular Condyle
Martin-Granizo, R. 1, Monje, ~. , Fernandez-Sanroman, j.3, Goizueta, C 1, Sastre, j.1, Diaz, E j.1 1Department of Oral & Maxillofacial Surgery. University "Hospital de la Princesa'; Madrid, 2Infanta Cristina Hospital, Badajoz, 3povisa Medical Center, Vigo, Spain Results obtained in 14 patients (15 joints) treated with costochondral grafts for mandibular condyle replacement, are presented. There were 6 males and 8 females included. Eight of them were in the growing age, and 6 adults. A new method of graft fixation to the mandibular ramus, the "green-stick" fracture technique is presented. It provides an excellent means to contour the shape of the ramus. No abnormal growth of the graft was seen, although 2 mm resorption of the chondral edge of the graft was measured. This was observed in the first 6 months postoperatively. Complications included 1 case of wound infection, 1 graft fracture under the costochondral junction and 1 pneumothorax. Functional and aesthetic results were satisfactory, with good oral opening and acceptable occlusions. The use of constochondral grafts appears as a valid option to reconstruct the condyle, particularly in growing patients, as it supports a chondroblastic activity similar to the original condyle. Its main disadvantages are donor site morbidity, facial scars and, according to some authors, impredictible growth.
15. Prognostic Factors in Temporomandibular Joint Surgery
Martin-Granizo, R. 1, Rodriguez, F..2, Gil-Diez, J. L. z, Munoz, M. a, Monje, F.3 tOral & Maxillofacial Unit, Ntra Sra de Regla Hospital, Leon, 2University "Hospital de la Princesa'" Madrid, 3Infanta Cristina Hospital, Badajoz, Spain The aim of the present study was to analyze the influence of different factors (age, sex, Wilke's stage, splint therapy and intra-articular injection of sodium hyaluronate) on the results of TMJ arthroscopic surgery. 73 patients with temporomandibular dysfunction (reciprocal clicking, reducing disk displacement with reduction, disc displacement without reduction) were included in this study. All of them underwent arthroscopic treatment with lysis and lavage. Patients were evaluated for preoperative and post-
Creanga, A., Niculae, L, Vlad, D.
157
combination of clindamycin and b-lactam antibiotics, was useful for these infections. We conclude that recognition of underlying diseases, proper drainage of the involved spaces, and administration of the appropriate antibiotics are necessary to resolve maxillofacial infections.
Ovidius University of Constanta-Romania, Oral and Maxillofacial Department, Constanta, Romania The HIV-AIDS infection has a great impact in all surgical and medical specialties. HIV infection causes a large range of diseases, the onset being asymptomatic and going progressively to an AIDS complex condition. In Romania, and particularly in Constanta, the majority of AIDS patients are children. Almost all from over the 1200 HIV-AIDS positive children were infected in their first year of life, and they survive 7-10 years or even more. In this period of time they develop several diseases affecting practically all organs and systems. We like to present some children with lesions in the oral and maxillofacial region and in the same time emphasize the correlation with lesions in the rest of the body.
13. Clinical Evaluation of Maxillofacial Infections
Kaneko, S., Nakamura, S., Oya, R., lkemura, K. Department of OMS, Univ. of Occupational and Environmental Health, Japan We evaluated our methods of treatment of maxillofacial infections, focusing in particular on the causative teeth, the use of imaging in identifying the spread of infections, host defense mechanisms, the microbiology of the infection and the antibiotics used. One hundred and five patients who were microbiologically examined were included in this study. These patients visited our department during the three-year period from 1994 to 1996. There were 63 males and 42 females, with a mean age of 48.7 years and a range of 5 to 80 years. The most frequent cause of infection was non-cystic odontogenic infection (73 patients). The other cause was secondary cystic infection (32 patients). There was an increased involvement of the molars, especially the lower third molar (40%) in more severe infections. Five of fifteen patients with these infections had some weakness in their host defense mechanisms due to rheumatoid arthritis with long-term corticosteroid therapy (three patients), chronic heart failure (one patient), or hypoalbuminemia (one patient). Computed tomography was indicated for patients with deep cervical infections, as it could help guide the surgical incision and subsequent drainage. These deep cervical infections included two cases of necrotizing fasciitis, one arising from a primary odontogenic infection and the other from a post-extraction infection. All of the severe maxillofacial infections were shown to be polymicrobial mixed aerobic-anaerobic infections. The commonly isolated aerobic and anaerobic bacteria were Streptococcus and Prevotella, respectively. Empirical antibiotic therapy, such as a
14. Costoehondral Grafts to Reconstruct Mandibular Condyle
Martin-Granizo, R. 1, Monje, ~. , Fernandez-Sanroman, j.3, Goizueta, C 1, Sastre, j.1, Diaz, E j.1 1Department of Oral & Maxillofacial Surgery. University "Hospital de la Princesa'; Madrid, 2Infanta Cristina Hospital, Badajoz, 3povisa Medical Center, Vigo, Spain Results obtained in 14 patients (15 joints) treated with costochondral grafts for mandibular condyle replacement, are presented. There were 6 males and 8 females included. Eight of them were in the growing age, and 6 adults. A new method of graft fixation to the mandibular ramus, the "green-stick" fracture technique is presented. It provides an excellent means to contour the shape of the ramus. No abnormal growth of the graft was seen, although 2 mm resorption of the chondral edge of the graft was measured. This was observed in the first 6 months postoperatively. Complications included 1 case of wound infection, 1 graft fracture under the costochondral junction and 1 pneumothorax. Functional and aesthetic results were satisfactory, with good oral opening and acceptable occlusions. The use of constochondral grafts appears as a valid option to reconstruct the condyle, particularly in growing patients, as it supports a chondroblastic activity similar to the original condyle. Its main disadvantages are donor site morbidity, facial scars and, according to some authors, impredictible growth.
15. Prognostic Factors in Temporomandibular Joint Surgery
Martin-Granizo, R. 1, Rodriguez, F..2, Gil-Diez, J. L. z, Munoz, M. a, Monje, F.3 tOral & Maxillofacial Unit, Ntra Sra de Regla Hospital, Leon, 2University "Hospital de la Princesa'" Madrid, 3Infanta Cristina Hospital, Badajoz, Spain The aim of the present study was to analyze the influence of different factors (age, sex, Wilke's stage, splint therapy and intra-articular injection of sodium hyaluronate) on the results of TMJ arthroscopic surgery. 73 patients with temporomandibular dysfunction (reciprocal clicking, reducing disk displacement with reduction, disc displacement without reduction) were included in this study. All of them underwent arthroscopic treatment with lysis and lavage. Patients were evaluated for preoperative and post-