Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Ameloblastoma is benign slow-growing but locally invasive neoplasm of odontogenic origin. In 2005, the WHO has classified ameloblastomas into multi cystic, unicystic and peripheral subtypes. The clinical picture, radiographic findings and differential diagnosis are presented. Treatment of ameloblastomas is primarily surgical. There has been some debate regarding the most appropriate method for removing. These range from conservative to radical modes. Some authors advocate conservative approach and thought that ameloblastoma are essentially benign in nature and should be treated as such. However, this conservative approach result in recurrence rates of 55% to 90%of the cases. Currently, the standard of care for ameloblastoma includes en bloc resection with 1-2 combine margin and immediate bone reconstruction. Despite the medical nature of a surgical resection, it may actually involve less morbidity than extensive hard and soft tissue resection with associated extensive morbidity that may be warranted in case of recurrence following inadequate primary treatment.
Benign, locally aggressive tumor of odontogenic epithelium, Previously called adamantinoma, Second most common odontogenic tumor after odontoma, Mandible is most common site, Usually asymptomatic and can be found incidentally on routine dental examinations
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Benign, locally aggressive tumor of odontogenic epithelium, Previously called adamantinoma, Second most common odontogenic tumor after odontoma, Mandible is most common site, Usually asymptomatic and can be found incidentally on routine dental examinations
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
ODONTOGENIC MYXOMA :
Benign mesenchymal lesion that mimics microscopically the dental pulp or follicular connective tissue
Derived from odontogenic ectomesenchymeClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effected
Radiographic feature :
Radiolucent and it appear as a well circumscribed or diffuse lesion
Often multilocular with honey comb pattern
Cortical plate expansion, root displacement or resorption may be seen Histopathology :
Tumor consist of acellular myxomatous connective tissue.
Benign fibroblast and myofibroblast with some amount of collagen are found in matrix
Bony island representing residual tubeculae
Capillaries are scattered through out the lesion
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
ODONTOGENIC MYXOMA :
Benign mesenchymal lesion that mimics microscopically the dental pulp or follicular connective tissue
Derived from odontogenic ectomesenchymeClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effected
Radiographic feature :
Radiolucent and it appear as a well circumscribed or diffuse lesion
Often multilocular with honey comb pattern
Cortical plate expansion, root displacement or resorption may be seen Histopathology :
Tumor consist of acellular myxomatous connective tissue.
Benign fibroblast and myofibroblast with some amount of collagen are found in matrix
Bony island representing residual tubeculae
Capillaries are scattered through out the lesion
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Description of Ameloblastoma with clinical features, radiographic features, and management in detail. Examples of a few clinical cases in the end to reinforce management techniques graphically.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Austin Head & Neck Oncology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Head & Neck Oncology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of head & neck oncology. Austin Head & Neck Oncology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Head & Neck Oncology.
Austin Head & Neck Oncology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Austin Head & Neck Oncology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Head & Neck Oncology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of head & neck oncology. Austin Head & Neck Oncology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Head & Neck Oncology.
Austin Head & Neck Oncology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
The primary goal of the present book is to produce a comprehensive text that fully integrates the latest concepts and techniques in management of odontogenic infections. The main aim is to provide the readers with an update information regarding pathophysiology, clinical and radiographic presentation, microbiology, diagnosis, management, and complications of odontogenic infections. Accordingly, the text has been divided into six chapters. Chapter one is concerned with oral microbiology and immunology. Chapter two is dealing with the pathophysiology of odontogenic infections. In chapter three, management of odontogenic infections is presented. In chapter four, antibiotic therapy of odontogenic infections is given. Chapter five deals with life-threatening complications. In chapter six osteomyelitis of the jaws is discussed.
Facial trauma is without doubt a most challenging area within the specialty of oral and maxillofacial surgery. Trauma with all its aspects has great importance, being the main cause of morbidity and mortality with rising frequency worldwide, especially in recent decades. Traumatic facial injuries are often associated with high mortality and varying degrees of physical, functional, psychological damage, cosmetic disfigurement, and concomitant injuries to other organs that may be added complicating factors. Road traffic accidents represent the main cause of facial trauma. According to WHO, Egypt leads the Middle East when it comes to road accidents, with an average of 12,000 people killed annually. Interpersonal violence is the second most prevalent etiologic factor. Our society is progressively becoming more and more violent and impatient, perhaps due to overcrowding, so the frequency of patients reporting in emergency with facial bones fracture is increasing.
During the last three decades, significant advances have occurred in the methods of fixation used for facial bone fractures, resulting in improved functional and aesthetic outcomes. Surgical techniques have been moving away from delayed closed reduction with internal wires suspension to early open reduction and internal plate fixation. The transition from wire osteosynthesis to rigid internal fixation in facial bone fractures using different micro or mini-plates and screw systems is regarded as one of the greatest advances in the field of maxillofacial surgery. I hope this book reflects the latest trends, concepts and innovations in the care of patients with facial trauma.
For convenience, the text is divided into 3 sections. Section 1 deals with primary care of the patients. Section 2 is concerned with midface fractures. In section 3 management of trauma to the lower face is discussed. Upper face injuries are not included and the reader could find the subject elsewhere under the topic of craniofacial traumatology. From the basic to the most complex, readers will find that each chapter is sequentially organized to provide a concise, and practical description of the operative details. The goal was to provide the reader with a fully comprehensive, yet highly illustrated text on the subject of facial trauma.
Nasal and nasoethmoidal fractures.
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
Nasal bone fractures comprise up to 50% of all facial fractures. Nasal fractures can be classified in two broad categories based on impact force: lateral-type versus frontal-type injuries. Lateral-type injuries tend to be more common, have fewer residual anatomic and functional defects compared with frontal injuries, and are more amenable to closed reduction. Frontal injuries classically produce a posteriorly displaced fracture where the nasal septum is always involved. They have a higher risk of residual post-surgical deformity, and as the impact force increases, nasal, orbital, and ethmoidal fractures occur in combination. The extent of the septal injury determines the appropriate technique for septal correction. Closed reduction of fractured nasal bone can be performed by elevation of depressed bones or depression of elevated bones to restore the symmetry of the nasal aperture. Septal injuries that cannot be realigned with a closed reduction should be addressed with open techniques. Symmetrical fixation of the bones, restoration of orbital volume, globe position, frontonasal angle, and nasal projection are essential for a satisfactory cosmetic outcome.
Management of soft tissue injuries in facial traumaAhmed Adawy
Management of soft tissue injuries in facial trauma
Dr. Ahmed M. Adawy.
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine, Al-Azhar University.
Soft-tissue injuries are the most common presentation following maxillofacial trauma. In general, injuries can initially be classified as open or closed wounds. A closed wound is one that damages underlying tissue and/or structures without breaking the skin. Examples of closed wounds include hematomas, contusions, and crush injuries. In contrast, open wounds involve a break in the skin, which exposes the underlying structures to the external environment. Open wounds include simple and complex lacerations, avulsions, punctures, abrasions, accidental tattooing, and retained foreign body. Detailed description of management is presented. The principles of repair is discussed.
Emergency management of patients with facial traumaAhmed Adawy
Emergency management of patients with facial trauma
Dr. Ahmed M. Adawy Professor Emeritus, Dept. Oral & Maxillofacial Surg. Former Dean, Faculty of Dental Medicine
Al-Azhar University.
Maxillofacial trauma is without doubt a most challenging area within the specialty of oral and maxillofacial surgery. As with all traumas, basic Advanced Trauma Life Support principles (ATLS) should be applied to the initial assessment of the casualty. The primary survey is given by the letters ABCDE.
• Airway maintenance with cervical spine protection.
• Breathing and ventilation.
• Circulation with hemorrhage control.
• Disability: neurological status.
• Exposure/environmental control - undress the patient but prevent hypothermia.
Each was explored and discussed.
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
The term “blow out” refers to partial herniation of the orbital contents through one of its walls. This usually occurs via blunt force trauma to the eye. Most often, the orbital floor is fractured in conjunction with the inferior orbital rim “impure” blowout fracture, but “pure” orbital floor fractures, with intact orbital rim can be seen. An extensive and careful history, physical examination, together with CT scans is vital for the diagnosis of orbital floor fractures. The timing of treatment, surgical approaches, and reconstruction of the orbital floor are presented.
Zygomatic Complex Fractures
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
The term “zygomatic complex” refers to zygomatic bone and parts of maxilla, frontal, temporal and sphenoid bone. Fracture of the zygomatic complex, also known as a quadripod fracture, and formerly referred to as a tripod fracture, varies in severity from a simple crack to major disruption. The etiology, clinical presentations, and radiographic findings are presented. Classification systems are mentioned. The management of zygomatic complex fracture depends on the degree of displacement and the resultant esthetical and functional deficit. As a general rule, non- displaced or minimal displaced fracture can usually be treated conservatively. On the other hand, open reduction and internal fixation is applied in all dislocated, instable, and comminuted fractures of the zygomatic bone. Different surgical approaches and fixation methods are discussed.
Mandibular fractures
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
Fractures of the mandible are a common form of facial injury in adults and occur most frequently in males during the third decade of life. The main causes of mandibular fractures are road traffic accidents, interpersonal violence, falls and sport injuries. Mandibular fractures are classified according to various criteria. The three main factors to consider are the cause of the fracture, the type of fracture and the site of the fracture. Clinical diagnosis as well as radiographic examinations are presented. Treatment modalities are discussed. Moreover, treatment-related complications are given.
Facial bone fractures: an overview
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
The bone and soft tissues of the face are able to absorb the energy from impact forces. Force to the bone in the elastic range causing the deformation and after force removal, bone returns to its previous state, but if the force be greater than the elasticity of bone, a permanent displacement occurs and be irreversible. Furthermore, when these forces exceed the strength of these tissues, a variety of fractures can occur. The buttress theory proposes that the midfacial region is like a framework that is stabilized by horizontal and vertical buttresses. The most common causes of maxillofacial trauma are traffic accidents, injuries from fights, sport accidents or falls. The Le Fort’s classification is based on low-velocity trauma, and does not completely reflect the breadth of high-velocity fractures encountered in modern practice. Currently, facial fractures are classified into central midface fractures, lateral midface fractures and mandibular fractures. Nasal, nasoethmoidal, Zygomatic bone, and orbital fractures are presented. Today, surgical techniques have been moving away from delayed closed reduction with internal wires suspension to early open reduction and internal plate fixation. Different treatment approaches exist to restore the facial skeleton using the different facial buttresses as landmarks.
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
Salivary glands are exocrine glands that produce saliva through a series of ducts. The glands may be affected by a wide range of disorders. They can be involved with acute and chronic inflammatory processes, give rise to benign and malignant tumors, manifest congenital abnormalities or represent involvement of a systemic disorder. Further, partial or complete obstruction of the ductal element can occurs. Physical examination and diagnostic aids are presented. Current surgical managements of these disorders are discussed.
Oral surgery during pregnancy
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
Pregnancy, also known as gestation, is the time during which a fetus develops inside a woman's uterus. Pregnancy is typically divided into three trimesters. The common belief has been that, if an oral surgery procedure is recommended, but it’s not an emergency, the second trimester is the ideal time. Pregnancy however, is not a disease and pregnant woman should not be treated differently than the general population. In short, it could be concluded that:
• Dental care is safe and essential during pregnancy
• Pregnancy is not a reason to defer routine dental care or treatment
• Diagnostic measures, including needed dental x-rays, can be undertaken safely
• Emergency care should be provided at any time during pregnancy
Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose level caused by either absolute or relative deficiency of insulin. Classifications,sings and symptoms,complications,and prevalence of the disease particularly in Egypt are presented. Management of diabetic patients undergoing oral surgical procedures is discussed.
Differential diagnosis of oral and maxillofacial lesionsAhmed Adawy
A wide variety of lesions from the soft and hard tissues may arise in the orofacial region. Clinical diagnosis is a cognitive process of applying logic and knowledge in a series of step-by-step decisions, to create a list of possible diagnosis.
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
The condition of being prognathic indicates abnormal forward projection of one or of both jaws beyond the established normal relationship with the cranial base. The skeletal manifestation can be due to mandibular anterior positioning (prognathism) or growth excess (macrognathia), maxillary posterior positioning (retrognathism) or growth deficiency (micrognathia), or a combination of both. The prevalence of mandibular prognathism, the etiologic factors, evaluation of patients, and treatment modalities are presented.
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar UniversityOrthognathic surgery is the art and science of combining orthodontics and maxillofacial surgery to correct dento-facial deformities.The etiology, prevalence,diagnosis and preoperative planning,and Surgical procedures are presented.
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University. Numerous etiologies lie behind mandibular defects including pathologic lesions, trauma related, infectious diseases and congenital defects. At present, the methods to restore mandibular defects can be classified into four basic categories:
1.Autogenous bone grafts in the form of nonvascularized free bone transfer, or vascularized tissue transfer, either pedicled or based on microvascular anastomosis
2. Distraction osteogenesis
3. Alloplastic materials (with or without bone)
4. Tissue engineered grafts
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University. By definition, a cyst is a “pouch” or sac without an opening, provided with a distinct membrane, and containing fluid or semifluid material, abnormally developed in one of the natural cavities or in the substance of an organ. Cysts of the oral region may be epithelial or non-epithelial, odontogenic or non-odontogenic, developmental, or inflammatory in origin. The distribution of jaw cysts according to diagnosis in a general population is given. The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the cystic wall, its proximity to vital structures and patient age.Treatment modalities are discussed.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Teeth in The Line of Mandibular FracturesAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Approximately 60% of fractures of the mandible occur in the teeth bearing area. Incisors and third molars are the most commonly involved teeth on the fracture lines. The damaged to the tooth involved at the fracture site may include exposure of the root surface subluxation, avulsion or root fracture. This may lead to the vitalization, consequent infection and complicated healing of the fraction. Wether to remove or preserve the tooth in line of fraction is discussed. Certain guidelines have been suggested.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Ameloblastoma
1.
2. Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
3. Ameloblastoma is benign, slow-growing but locally
invasive neoplasm of odontogenic origin. Theoretically,
it may arise from the cell rests of the enamel organ,
remnants of dental lamina, epithelial lining of an
odontogenic cyst, or basal epithelial cells of the oral
mucosa (1). The name “Ameloblastoma” is derived from
the old English word ‘‘amel’’ which means enamel, and
the Greek word ‘‘blastos’’ meaning germ. It is the second
most common odontogenic tumor after Odontomes in
prevalence and accounts for approximately 1% of all oral
tumors and 18% of all odontogenic tumors
4. Approximately 80% arise in the mandible, most commonly in
the molar-ramus region, occasionally associated with impacted
third molars and the remainder occur in the maxilla (2). The
peak incidence is in the 3rd-4th decades of life and the male to
female ratio is 1:1
5. Based on clinicoradiographic findings,
ameloblastoma is classified into multicystic
(solid), unicystic and peripheral subtypes.
Multicystic ameloblastoma is the most common
type and represent 86% of cases. Peripheral
tumors occur solely in the soft tissues covering
the tooth-bearing parts of the jaws and have the
histological characteristics of intraosseous
ameloblastoma (3)
6. Unicystic ameloblastoma has been identified as a separate
entity in 1977 (4). Two histologic variants of unicystic
ameloblastoma are described, mural ameloblastomas
and luminal ameloblastomas. In mural ameloblastoma,
the fibrous wall of the cyst is infiltrated with tumor
nodules. In luminal ameloblastoma, the tumor is
confined to the luminal surface of the cyst. The tumor
often occurs as a painless swelling involving the posterior
region of the mandible in younger patients.
Radiographically, the tumor presents primarily as a
unilocular radiolucency. This variant of ameloblastoma
was reported to have less aggressive behavior than the
conventional multicystic ameloblastoma
8. Histopathologically, ameloblastoma has six types
namely; acanthomatous, granular cell,
desmoplastic, basal cell, follicular and plexiform
whereas, the last two types are more common.
Though the treatment options and recurrence rate
are irrespective to its histological variants (5)
10. Two rare forms of malignancy are associated with
ameloblastoma: malignant ameloblastoma and
ameloblastic carcinoma. The cardinal feature of malignant
ameloblastoma is metastatic spread. The histologic
appearance of the primary and metastatic lesions is
indistinguishable from benign ameloblastoma. In contrast,
the primary and metastatic lesions of an ameloblastic
carcinoma show histologically malignant epithelial
features similar to an epidermoid carcinoma (6)
11. The diagnosis of ameloblastoma is suggested by
nonspecific radiographic findings and a thorough
physical examination. Nevertheless, a definitive
diagnosis is only obtained through a
histopathological examinations
Diagnosis
12. Typically ameloblastoma present as painless slow growing
swelling that can progress to great size and cause facial
asymmetry, though it may be discovered during routine
radiographic examinations. Pain with rapid growth may
represent the rare malignant ameloblastoma. Tooth
displacement and root resorption are infrequent and
usually is an indication of the aggressive nature of the
lesion. Paresthesias are uncommon, and can result from
perineural invasion
13.
14.
15. Radiographically, ameloblastoma shows radiolucent lesion that
may have either a unilocular or multilocular appearance.
Unicystic ameloblastoma may expand the cortical plate and
gives rise to a paper-thin appearance osteolytic lesion usually
with scalloped margins, resorption of tooth roots, and impacted
molars. The classic ‘‘soap bubble or honeycomb’’ appearance is
seen with the most common ameloblastoma, the multilocular
type (7). plain X-rays are however, of limited value and lack
sensitivity and specificity for the extent of bone and soft tissue
invasion
16.
17. Computed tomography (CT) is the most useful
diagnostic imaging modality, typically demonstrating
well defined radiolucent uni/multilocular expansible
lesions. CT is also useful for the evaluation of cortical
destruction and soft tissue extension, identifying the
full extent of the tumor to support surgical planning
20. Differential Diagnosis
However, even when an ameloblastoma shows the
typical expansive multilocular appearance, the
differential diagnosis can include a variety of
odontogenic and nonodontogenic lesions with similar
radiographic characteristics namely; aneurysmal bone
cyst, odontogenic keratocysistc tumor, ameloblastic
fibroma, odontogenic myxoma, giant cell lesions and
brown tumor of hyperparathyroidism
21. When the lesion presents with a cystic, unilocular and
well-defined aspect, the differential diagnosis is
typically of odontogenic keratocysistc, dentigerous
cyst, residual and radicular cysts or even a traumatic
bone cyst. Additionally, peripheral ameloblastomas
may resemble lesions such as fistulas, pyogenic
granulomas, peripheral giant cell lesions and
peripheral odontogenic fibromas (8)
22.
23. Treatment of ameloblastomas is primarily surgical. There
has been some debate regarding the most appropriate
method for surgical removal of ameloblastomas. These
range from conservative to radical modes of treatment.
The conservative modalities include enucleation and
curettage; while the radical modalities are marginal,
segmental and composite resections. Those advocate
conservative approach believe that ameloblastomas
though, locally invasive, are essentially benign in nature,
therefore, they should be treated as such (9)
24. Conservative approach in the form of enucleation and
curettage is still commonly practiced, despite reported
recurrence rates of 55% to 90% for solid multicystic
treated conservatively(10). To limit recurrence rates of
unicystic ameloblastomas, oral surgeons have extended
this procedure to include intra-operative adjuvant
treatment of the bony margins with cryotherapy(11), tissue
fixatives such as Carnoy’s solution(12), drilling and
cautery. The outcomes of the these procedures
demonstrate decreased recurrence rates, but still higher
recurrences compared with the more extensive radical
procedures
25. The ‘‘radical’’ surgical option is the current standard of
care for ameloblastoma and includes en bloc resection
with 1–2 cm bone margins (13) and immediate bone
reconstruction. The bony margin is defined as the distance
away from the radiographic margin predicted to be disease
free and safe to perform osteotomies. It has been
documented that ameloblastoma specimens showed
microscopic tumor extension 2–8 mm beyond the
radiographic boundaries of the tumor (14). Hence, the
recommended bone margins are 1–1.5 cm for unicystic
and 1.5–2 cm for multicystic histological types. The
healthy mucosa overlying cortical perforation is often
removed as a margin
26. Segmental resection of the mandible results in
discontinuity of the jaw, which is stabilized to its
previous position by titanium reconstruction plates to
ensure proper occlusion. A fibular free flap is used to
restore bone continuity and allow for dental restoration.
Reconstructive outcomes show a high rate of success
for both esthetic and functional outcomes (15)
29. Despite the ‘radical’ nature of a surgical resection, it
may actually involve less morbidity than extensive
hard and soft tissue resection with associated
extensive morbidity that may be warranted in case
of recurrence following inadequate primary
treatment
30. Follow-up of patients with ameloblastoma should
be carried out regularly. As most recurrences
present within the first 5 years, yearly follow-up
during this period is advisable. Thereafter, follow-
up every 2 years seems appropriate but should
extend for at least 25 years, as recurrences may
appear after a long time (16)
31.
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J Oral Surg. 36:771, 1978.
3. Gardner D G, Heikinheimo K, Shear M, et al. Ameloblastomas. In World Health
Organization Classification of Tumours. p.296-300. Edited by Barnes L, Eveson
JW, Reichart P, Sidransky D. IARC Press, Lyon, France, 2005.
4. Robinson L, Martinez MG. Unicystic ameloblastoma: a prognostically
distinct entity. Cancer. 40:2278, 1977.
5. Mendenhall WM, Werning JW, Fernandes R, et al. Ameloblastoma.
Am J Clin Oncol 30: 645, 2007.
6. Witterick IJ, Parikh S, Mancer K, et al. Malignant ameloblastoma.
Am J Otolaryngol. 17: 122, 1996.
7. Underhill TE, Katz JO, Pope TL Jr, et al. Radiologic findings of diseases
involving the maxilla and mandible. Am J Roentgenol 159:345, 1992.
8. Martins, R, Sobrinho J, Rapoport A, et al. Histopathologic features and
management of ameloblastoma: study of 20 cases. Rev. Paul. Med. 117:171,1999.
33. 9. Sammartino G, Zarrelli C, Urciuolo V, et al. Effectiveness of a new
decisional algorithm in managing mandibular ameloblastomas: A 10-years
experience. Br J Oral Maxillofac Surg. 45:306, 2007.
10. Hong J, Yun PY, Chung IH, et al. Long term follow up on recurrence of
305 ameloblastoma cases. Int J Oral Maxillofac Surg. 36:283, 2007.
11.Rosenstein T, Pogrel MA, Smith RA, Regezi JA (2001) Cystic
ameloblastoma—behavior and treatment of 21 cases. J Oral Maxillofac
Surg. 59:1311, 2001.
12. Lau SL, Samman N. Recurrence related to treatment modalities of
unicystic ameloblastoma: a systematic review. Int J Oral Maxillofac Surg.
35:681, 2006.
13. Becelli R, Morello R, Renzi G, et al. Treatment of recurrent mandibular
ameloblastoma with segmental resection and revascularized fibula free flap.
J Craniofac Surg 22:1163, 2011.
14. Carlson ER. Ameloblastoma. In: Symposium on odontogenic
tumors, AAOMS 82nd annual meeting and scientific sessions, San
Francisco, CA, September 23, 2000
34. 15. Chana JS, Chang YM, Wei FC, et al. Segmental mandibulectomy and
immediate free fibula osteoseptocutaneous flap reconstruction with
endosteal implants: an ideal treatment method for mandibular
ameloblastoma. Plast Reconstr Surg. 113:80, 2004.
16. Demeulemeester LJ, Mommaerts MY, Fossion E, et al. Late loco-
regional recurrence after radical resection for mandibular ameloblastomas.
Int J Oral Maxillofac Surg. 17:310, 1988.