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The progress in diagnosis and treatment of focal infection
ABSTRACTS
OF CURRENT
555
LfTERATURE
lL When, for some reason, interdental wiring would not be suficient, as in patients lack of available teeth, patients with fractures of the symphysis, or with angle fracwith posterior fragments displaced into the upper buccal fornix and compounding the mouth with infection and sloughing, the fractured lower jaw may be immobilized Kirschner wire, .05 to .08 inch, driven across the fracture site. “In an edentulous mouth, internal wires can be u.sed in conjunction with ciroumferential wires around the patient ?s dentures. “The technique of introduction of the internal wire is to drive the wire across the fracture site below the nerve canal with a power drill while another person holds the fragments in reduction. “Asepsis should be as good as possible, the skin and periosteum nicked, the wire cut to minimal length to prevent ‘whipping,’ and a power drill used with a speed fast enough for penetration, but not fast enough to produce necrosis. waste is a further support to the jaw and helps “A fixation dressing of mechanics’ prevent hematomas and soft tissue swelling, decreases the chance of infection, and increases the patient’s comfort. ” with tures into by a
ODONTOGENIC
ABSCESSES
Diagnose und Therapie tular%mischer Abszesse. (Diagnosis and Therapy Abscesses.) II. J. Kutzleb. Deutsche zahnarztl. Ztschr. 4: 997, 1949.
in Tularemic
The beginning of the so-called primary complex of the infection caused by the Pastewrella tularensis may be of acute or chronic nature. At the place of entry of the infection which may be the eyes, tonsils, tongue, fingers, or toes, a painless, firm, partly ulcerated nodule form.s in chronic cases. This is associated with a painless, hard enlargement of the lymph nodes. In the majority of the cases, however, this primary development of the nodes. runs an exceedingly stormy course, with severe pain add acute swelling In patients with low resistance this febrile disease lasts several weeks, and in the absence intra-abdominal) can be diagnosed only by of a visible primary focus (intrathoracic, means of a serologic examination. The lymph nodes enlarge rarely without producing symptoms, are in general very painful, and may produce, after a few weeks, indolent buboes. They may occur only in the region of the primary focus or may be distributed over the whole body. They are particularly found in the floor of the mouth, in the submaxillary and parotid region, and the neck, and may fuse and form masses the size of a child’s fist. More rarely are involved the axillary and the inguinal regions or t,he popliteal space. The tonsils react in a similar manner as the lymph nodes, producing either hypertrophy or ulceration with membranes angina, and can be distinguished resembling diphtheria, Vincent’s angina, and follicular only by their localization and color (more specific details are not given). In some of the eases there is liquefaction of the nodes, which may be mistaken for a ‘(cold abscess.” On to open the abscesse.s puncture a viscous thread-forming pus escapes. It is recommended The differential diagnosis from wide and remove the abscess wall by means of a curette. tuberculo.sis, syphilis, and lymphogranulomatosis is made by histologic examination. H. R. M.
The Progress in Diagnosis and Treatment Lrztl.
Ztschr.
of Focal Infection.
F. Proell.
Deutsche zahn-
4: 228, 1949.
The author recognizes focal Eleven methods of diagnosing 1. Urine test: albumin, 2. Temperature: many similar conditions. 3. Slauck phenomenon:
infection as an important factor in modern the presence of focal infection are discussed:
medicine.
R.B.C., sedimentation rate, vitamin C deficiency. readings must be taken over a long period of time and under fibrillary
tremor
of the muscles of the tibia.
556
QUARTERLY
REVIEW
OF LITERATURE
4. Electrocardiogram: for the detection of heart failure. 5. Histamine reaction. 6. Intracutaneous test of Grumbach, Prader, and Memmesheimer. 7. Focal reaction test with Antisepton Ganslmayer No. 600. 8. Focal reaction with homeopathic Spenglersan D. (Paul Meckel); which is applied by rubbing it into the forearm. 9. Reaction with Bottyan-Granuloextract: 0.1 to 0.3 C.C. subcutaneously. 10. Provocation by Gu,tzeit-Kuchlin: exposure to short waves of the tooth which is suspected of being a focus of infection, The exposure is done together with control of the sedimentation rate. 11. Marschtes by Bottner: in patients with focal infection, the rectal temperatures exceed the axillary temperature. By a massage foci are often detected in the tonsils, the prostate, and in the adnexa. The Antisepton Ganslmayer and Spenglersan D tests indicate the infected tooth in 60 per cent of all cases. The Bottyan test shows reactions which are more generalized. The only treatment of dentogenous focal infection is apicoectomy or the replantation techniques, together with either autovaccination or heterovaccination.
Complications Ztschr.
in the Course of Actinomycosis.
U.
Rheinwald.
Deutsche
zahnarztl.
4: 1078, 1949.
The author points out the diversity of actinomycosis, its atypical course, its possibility of being harmless in some cases and fatal in others. He describes two cases. In one case the actinomycosis invaded the pterygopalatine fossa and the base of the skull and showed the symptoms of trigeminal neuralgia. The second case affected the pterygopalatine fossa, caused temporal and parotid abscesses, and pierced the acoustic meatus provoking a pleuritis purulenta. Subfebrility in the presence of the multiple abscesses and the accelerated sedimentation rate (So-100 mm./hr.) may suggest the diagnosis of actinomycosis. Sulfa drug and penicillin treatment have not yet given satisfactory results. The possibilities of ultra high frequency sound treatment are not fully understood. The author is of the opinion that actinomycosis may be produced through changes in virulence of oral epiphytic anaerobic actinomycetes, but that an exogenous infection with aerobic grass actinomycetes, which may acquire anaerobic properties, is not precluded. H. R. M.
BENIGNORALTUMORS Osteoma
of the Tongue.
Ira S. Witchell.
Arch. Otolaryng.
50: 453, 1949.
“True osteomas occur rather frequently in the bones of the skull and involve the Osteoma of the tongue is a rare condition. Seven cases have previously sinus cavities. been reported. The eighth case is now presented.”
Report of Case ( ‘ Mrs. M. W., a white housewife, age 30, was admitted to the migraine clinic of Montefiore Hospital, on Dec. 23, 1946. Her chief complaints were headache, postnasal These had been present for several months. discharge and a tendency to gag and vomit. There was no history of pain or difficulty in swallowing. On Jan. 23, 1947, she was reAt that time the patient stated ferred to the ear, nose and throat clinic for consultation. that six days previously she had felt with her finger a mass at the back of her throat. At the middle of “Examination revealed no abnormalities except of the tongue. the right limb of the V formed by the circumvallate papillae, a rounded mass about 1 cm. in diameter was attached to the tongue by a short, broad pedicle. The mass was removed with the area under local anesthesia; slight bleeding was easily controlled with nressure. The laryngopharynx was normal,
OF CURRENT
555
LfTERATURE
lL When, for some reason, interdental wiring would not be suficient, as in patients lack of available teeth, patients with fractures of the symphysis, or with angle fracwith posterior fragments displaced into the upper buccal fornix and compounding the mouth with infection and sloughing, the fractured lower jaw may be immobilized Kirschner wire, .05 to .08 inch, driven across the fracture site. “In an edentulous mouth, internal wires can be u.sed in conjunction with ciroumferential wires around the patient ?s dentures. “The technique of introduction of the internal wire is to drive the wire across the fracture site below the nerve canal with a power drill while another person holds the fragments in reduction. “Asepsis should be as good as possible, the skin and periosteum nicked, the wire cut to minimal length to prevent ‘whipping,’ and a power drill used with a speed fast enough for penetration, but not fast enough to produce necrosis. waste is a further support to the jaw and helps “A fixation dressing of mechanics’ prevent hematomas and soft tissue swelling, decreases the chance of infection, and increases the patient’s comfort. ” with tures into by a
ODONTOGENIC
ABSCESSES
Diagnose und Therapie tular%mischer Abszesse. (Diagnosis and Therapy Abscesses.) II. J. Kutzleb. Deutsche zahnarztl. Ztschr. 4: 997, 1949.
in Tularemic
The beginning of the so-called primary complex of the infection caused by the Pastewrella tularensis may be of acute or chronic nature. At the place of entry of the infection which may be the eyes, tonsils, tongue, fingers, or toes, a painless, firm, partly ulcerated nodule form.s in chronic cases. This is associated with a painless, hard enlargement of the lymph nodes. In the majority of the cases, however, this primary development of the nodes. runs an exceedingly stormy course, with severe pain add acute swelling In patients with low resistance this febrile disease lasts several weeks, and in the absence intra-abdominal) can be diagnosed only by of a visible primary focus (intrathoracic, means of a serologic examination. The lymph nodes enlarge rarely without producing symptoms, are in general very painful, and may produce, after a few weeks, indolent buboes. They may occur only in the region of the primary focus or may be distributed over the whole body. They are particularly found in the floor of the mouth, in the submaxillary and parotid region, and the neck, and may fuse and form masses the size of a child’s fist. More rarely are involved the axillary and the inguinal regions or t,he popliteal space. The tonsils react in a similar manner as the lymph nodes, producing either hypertrophy or ulceration with membranes angina, and can be distinguished resembling diphtheria, Vincent’s angina, and follicular only by their localization and color (more specific details are not given). In some of the eases there is liquefaction of the nodes, which may be mistaken for a ‘(cold abscess.” On to open the abscesse.s puncture a viscous thread-forming pus escapes. It is recommended The differential diagnosis from wide and remove the abscess wall by means of a curette. tuberculo.sis, syphilis, and lymphogranulomatosis is made by histologic examination. H. R. M.
The Progress in Diagnosis and Treatment Lrztl.
Ztschr.
of Focal Infection.
F. Proell.
Deutsche zahn-
4: 228, 1949.
The author recognizes focal Eleven methods of diagnosing 1. Urine test: albumin, 2. Temperature: many similar conditions. 3. Slauck phenomenon:
infection as an important factor in modern the presence of focal infection are discussed:
medicine.
R.B.C., sedimentation rate, vitamin C deficiency. readings must be taken over a long period of time and under fibrillary
tremor
of the muscles of the tibia.
556
QUARTERLY
REVIEW
OF LITERATURE
4. Electrocardiogram: for the detection of heart failure. 5. Histamine reaction. 6. Intracutaneous test of Grumbach, Prader, and Memmesheimer. 7. Focal reaction test with Antisepton Ganslmayer No. 600. 8. Focal reaction with homeopathic Spenglersan D. (Paul Meckel); which is applied by rubbing it into the forearm. 9. Reaction with Bottyan-Granuloextract: 0.1 to 0.3 C.C. subcutaneously. 10. Provocation by Gu,tzeit-Kuchlin: exposure to short waves of the tooth which is suspected of being a focus of infection, The exposure is done together with control of the sedimentation rate. 11. Marschtes by Bottner: in patients with focal infection, the rectal temperatures exceed the axillary temperature. By a massage foci are often detected in the tonsils, the prostate, and in the adnexa. The Antisepton Ganslmayer and Spenglersan D tests indicate the infected tooth in 60 per cent of all cases. The Bottyan test shows reactions which are more generalized. The only treatment of dentogenous focal infection is apicoectomy or the replantation techniques, together with either autovaccination or heterovaccination.
Complications Ztschr.
in the Course of Actinomycosis.
U.
Rheinwald.
Deutsche
zahnarztl.
4: 1078, 1949.
The author points out the diversity of actinomycosis, its atypical course, its possibility of being harmless in some cases and fatal in others. He describes two cases. In one case the actinomycosis invaded the pterygopalatine fossa and the base of the skull and showed the symptoms of trigeminal neuralgia. The second case affected the pterygopalatine fossa, caused temporal and parotid abscesses, and pierced the acoustic meatus provoking a pleuritis purulenta. Subfebrility in the presence of the multiple abscesses and the accelerated sedimentation rate (So-100 mm./hr.) may suggest the diagnosis of actinomycosis. Sulfa drug and penicillin treatment have not yet given satisfactory results. The possibilities of ultra high frequency sound treatment are not fully understood. The author is of the opinion that actinomycosis may be produced through changes in virulence of oral epiphytic anaerobic actinomycetes, but that an exogenous infection with aerobic grass actinomycetes, which may acquire anaerobic properties, is not precluded. H. R. M.
BENIGNORALTUMORS Osteoma
of the Tongue.
Ira S. Witchell.
Arch. Otolaryng.
50: 453, 1949.
“True osteomas occur rather frequently in the bones of the skull and involve the Osteoma of the tongue is a rare condition. Seven cases have previously sinus cavities. been reported. The eighth case is now presented.”
Report of Case ( ‘ Mrs. M. W., a white housewife, age 30, was admitted to the migraine clinic of Montefiore Hospital, on Dec. 23, 1946. Her chief complaints were headache, postnasal These had been present for several months. discharge and a tendency to gag and vomit. There was no history of pain or difficulty in swallowing. On Jan. 23, 1947, she was reAt that time the patient stated ferred to the ear, nose and throat clinic for consultation. that six days previously she had felt with her finger a mass at the back of her throat. At the middle of “Examination revealed no abnormalities except of the tongue. the right limb of the V formed by the circumvallate papillae, a rounded mass about 1 cm. in diameter was attached to the tongue by a short, broad pedicle. The mass was removed with the area under local anesthesia; slight bleeding was easily controlled with nressure. The laryngopharynx was normal,