Russell-Silver Syndrome

- Definition:

Russell-Silver syndrome is a disorder present at birth involving poor growth. One side of the body also will appear to be larger than the other.

- Causes:
Up to 10% of patients with this syndrome have a defect involving chromosome 7. In other patients, there the syndrome may affect chromosome 11, 15, 17, or 18.
Researchers suspect that at least one third of all cases of Russell-Silver syndrome result from changes in a process called methylation.
Methylation is a chemical reaction that attaches small molecules called methyl groups to certain segments of DNA.
In most patients, the cause is unknown. Most cases occur in people with no family history of the disease.

- Incidence:
The estimated number of people who develop this condition varies greatly. Some say it affects about 1 in 3,000 people. Other reports say it affects 1 in 100,000 people. Males and females are equally affected.

- Symptoms:
Body asymmetry
Coffee-with-milk (cafe-au-lait) birth marks
Curving of the pinky toward the ring finger
Delayed bone age
Failure to thrive
Gastroesophageal reflux disease
Kidney problems, such as:
Horseshoe kidney
Hydronephrosis
Posterior urethral valves
Renal tubular acidosis
Low birth weight
Large head for body size
Poor growth
Short arms
Short height (stature)
Short, stubby fingers and toes
Delayed stomach emptying, and constipation
Wide forehead with a small triangle-shaped face and small, narrow chin

- Signs:
Triangular shaped face in Russell-Silver syndrome patient
Pointed chin that is not fully developed
Thin, wide mouth
Triangle-shaped face with broad forehead

- Tests:
There are no specific laboratory tests to diagnose Russell-Silver syndrome.
Diagnosis is usually based on the judgment of your child’s pediatrician.
However, the following tests may be done:
- Blood Sugar (some children may have low blood glucose)
- Bone Age Testing (bone age is often younger than the child’s actual age)
- Chromosome Testing (may detect a chromosomal problem)
- Growth Hormone (some children may have a deficiency)
- Skeletal Survey (to rule out other conditions that may mimic Russell-Silver syndrome)

- Treatment:
- Growth hormone replacement may help if this hormone is lacking.
- Making sure the person gets enough calories, to prevent low blood sugar and promote growth
- Physical therapy, to improve muscle tone
- Special education, to address learning disabilities and attention deficit problems the child may have

- Prognosis:
Older children and adults do not show typical features as clearly as infants or younger children.
Intelligence may be normal, although the patient may have a learning disability.

- Complications:
- Chewing or speaking difficulty if jaw is very small
- Learning disabilities

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Petersons Principles of Oral and Maxillofacial Surgery - 2004 - 2nd Edition

Overview

Peterson's Principles of Oral and Maxillofacial Surgery 3rd Edition Download PDF Ebook. Michael Miloro encompasses a variety of diverse matters making it a novel text amongst the medical and dental specialties. It also presents color photographs of medical procedures, clear color diagrams and e-studying references. 

The aim of this concise, easy-to-learn two-quantity text is to supply an authoritative and at the moment referenced survey of the specialty of Oral and Maxillofacial Surgery. It contains the mandatory information for clinicians and is a perfect reference text for preparation for board certification within the specialty. It's also very effectively illustrated with over 2,000 shade pictures, figures, and drawings.

The anesthesia sections encompass comprehensive patient assessment and management in the peri-anesthetic period osseointegrated implant section to include chapters on comfortable and laborious tissue adjunctive procedures, zygomaticus and novum methods, in addition to a bit on implant prosthodontics for the surgeon. There are additionally new chapters on cleft orthodontics and distraction osteogenesis.

This book is of undoubted value for college students and recently certified practitioners of dentistry, for whom it acts as an entire and ready reference through which to achieve a firm foothold in oral and maxillofacial surgery.

Product Details

ISBN-13: 9781550092349

ISBN-10: 1550092340

Author: Michael Miloro

Edition: 2nd

Binding: Hardcover

Publisher: Pmph Usa

Published: June 2004

== Download The Torrent ==

Alveolar Osteitis "Dry Socket"

Definition:
- Inflammation of the alveolar bone (i.e. the alveolar process of the maxilla or mandible). Classically this occurs as a postoperative complication of tooth extraction.
- Occurs more commonly occur in the mandible than the maxilla, due to the relatively poor blood supply of the mandible and also because food debris tends to gather in lower sockets more readily than upper ones.
- It more commonly occurs in posterior sockets (molar teeth) than anterior sockets (premolars and incisors), where the created surgical defect is relatively larger, and because the blood supply is relatively poorer posteriorly.

Etiology:
This usually occurs where the blood clot fails to form or is lost from the socket, this leaves empty socket with bare bone with inflammation limited to the lamina dura "the bone which lines the socket".

Signs and symptoms:
- An empty socket, which is partially or totally devoid of blood clot.
- Bone may be visible or the clot may be filled with food debris which reveals the exposed bone once it is removed.
- Surrounding inflamed soft tissues may overgrow to cover the socket.
- Dull, aching, throbbing pain, which is moderate to severe.
- The pain may radiate to other parts of the head such as the ear, temple and neck.
- Pain starts from 2-4 days after extraction.
- Pain may persist for 10-40 days, but most commonly is 10-14 days with adequate treatment.
- The pain might be strong enough so that no medication can relief.
- Intraoral halitosis.
- Bad Taste.

Causes:
- Extraction site: Wisdom Teeth, specially the mandibular.
- Infection: Pre-existing infection in the mouth, such as necrotizing ulcerative gingivitis, chronic periodontitis or pericoronitis.
- Smoking: Smoking and tobacco use of any kind causes vasoconstriction of small blood vessels due to nicotine action.
- Surgical trauma: Excessive force or excessive tooth movements impair the repairing process causing the Alveolar osteitis.
- Vasoconstrictors: The use of Vasoconstrictors may increase the risk for alveolar osteitis, although it is used in local anesthetic solution to make a profound analgesia to the area, specially the areas of acute pain and inflammation.
- Oral contraceptives
- Radiotherapy: That decreases the blood supply to the area.

Diagnosis:
- Pain occurs 2-4 days after extraction.
- Usually part of a broken root or bone fragment is left in the socket.
- A dental radiograph (x-ray) may be indicated to demonstrate such a suspected fragment.

Prevention:
- Avoid excessive forces.
- Press on the alveolar plates to decrease the size of the socket opening.
- Instruct the patient to avoid cold food, beverages, toothpicks into socket, cleaning socket using the tongue or fingers and vigorous mouth rinsing.
- Rinsing with chlorhexidine (0.12% or 0.2%) or placing chlorhexidine gel (0.2%) in the sockets.
- Prophylactic antibiotics prior and after extraction for 3 days, although it's not recommended.
- Antifibrinolytic agents applied to the socket after the extraction.
- Debride the bony walls of the socket to encourage hemorrhage (bleeding) in the belief that this reduces the incidence of dry socket "there is no evidence to support this practice".
- Schedule extraction appointment for females taking oral contraceptives on days without estrogen supplementation (typically days 23-28 of the menstrual cycle).
- Scaling the teeth to be extracted prior to extraction.

Treatment:
1. Pain medication " Non-Steroidal Anti-Inflammatory Drugs".
2. Rinsing / cleaning the socket "removing any debris from the hole".
3. Applying medicated dressings. "antibacterials, topical anesthetics and obtundants, or combinations of all three"
4- Schedule a recall visiting every 3 days to rinsing and cleaning socket and changing the dressing.
5- Prescribe antibiotic to avoid infection of the socket.
6- Oral Hygiene Instructions.
7- Ask the patient to wash the mouth by water and salt or by prescribing Oral Mouthwash.

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Vitamin Deficiency and effects in Oral Cavity

- Certain vitamin deficiencies can have serious effects on your mouth and teeth.
- If your mouth is sore or your gums are bleeding, you might not be able to eat well. This can make any vitamin deficiencies worse.

- Seniors are more likely to have vitamin deficiencies because they may have problems absorbing nutrients from food.
- Younger people can also have conditions that cause difficulties absorbing nutrients.
- The physician can determine whether patient have a vitamin deficiency and how it should be treated.
- While dentist can identify oral abnormalities and determine whether a vitamin deficiency is the cause.

Here are some vitamin deficiencies that might affect your mouth and teeth.

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Vitamin B
Vitamin B deficiencies are one of the most common deficiencies that can affect mouth and teeth.

Signs and Symptoms:
- Burning sensation in the mouth, especially on the tongue (Most common oral effects).
- Difficulty in swallowing. The tongue may feel swollen.
- The tissue of the inner cheeks can be pale and may break apart easily and slough off.
- B-vitamin deficiencies also can lead to anemia (too few red blood cells).
- Severe B12 deficiency can cause neurological problems such as numb or tingling limbs.
- Folic Acid deficiency also can make your mouth feel like it's burning.and numb or tingling limbs.
- Folic acid is crucial to fetal development as well. Not having enough of this vitamin during early pregnancy can increase the risk of having a baby with neural tube defects. These are defects of the brain, spinal cord or both.

Risks:
- Angular Cheilitis:
A painful inflammation and cracking in the corners of the mouth. It usually is related to a fungal infection.
- Recurrent Aphthous Stomatitis:
Also known as recurring canker sores. Anemia, which can occur because of vitamin B deficiency, can increase your risk of these sores.
- Chronic Oral Mucosal Candidiasis:
A fungal infection in the mouth, caused by the Candida albicans fungus that is found naturally in the mouth. It does not normally cause problems. However, poor nutrition or poor absorption of vitamins drop down host immunity and tend to change the oral flora.
- Atrophic Glossitis:
A condition that causes the taste buds to break down, making the tongue look "bald." This condition affects the sense of taste. It can occur with a severe vitamin deficiency.

Sources of Vitamins B:
- Thiamin (B1): Pork, whole and enriched grains, legumes, nuts, dried beans
- Riboflavin (B2): Milk and milk products, eggs, liver, almonds, shellfish
- Niacin (B3): Protein-rich foods, meat, liver, poultry, fish, whole grains, peanuts
- Pyroxidine (Vitamin B6): Meat, poultry, fish, leafy green vegetables, bananas, whole grains, legumes, nuts, fruits
- Cobalamin (B12): Fish, meat, poultry, milk and milk products, eggs, fortified cereals
- Folic acid (also called folate): Leafy green vegetables, orange juice, legumes, broccoli, asparagus, fortified cereals, nuts

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Iron:

Signs and Symptoms:
- Burning sensation in the mouth and tongue
- Fungal infections in the mouth
- Tongue redness and swelling
- Sores and pale tissue in the mouth
- Iron deficiency can be caused by a poor diet or by intestinal problems that reduce iron absorption. It also can result from regular blood loss, such as from heavy menstrual periods or internal bleeding.
- Iron deficiency can cause anemia.

Sources of Iron:
- Lean meat
- Leafy green vegetables
- Beans
- Shellfish
- Whole-grain bread

N.B: People with significant iron deficiency may have to take iron supplements.

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Vitamin C
- Vitamin C is also called ascorbic acid.
- This vitamin is needed to make collagen, the main building block for many tissues.

Signs and Symptoms:
- Gingivitis.
- Fatigue and easy Bruising.

Sources of Vitamin C:
- Citrus fruits
- Dark green vegetables
- Tomatoes
- Strawberries
- Peppers
- Cantaloupe

N.B: Smoking depletes vitamin C in the body, so smokers need extra amounts of this vitamin.

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Vitamin A:
Vitamin A helps skin cells grow and maintain themselves.

Signs and Symptoms:
- Delayed healing in the mouth.

Sources of Vitamin A:
- Fortified milk
- Liver (chicken, beef)
- Leafy green vegetables
- Orange and yellow fruits and vegetables (such as apricots, cantaloupe, pumpkin, sweet potatoes and carrots)

N.B: Vitamin A can be stored in body fat, so high-dose supplements are not recommended.
They can cause side effects such as joint pain, headache, diarrhea, fatigue, vomiting and liver damage.

--------------------------------

Vitamin D
Vitamin D works with calcium to maintain bone quality and strength.

Signs and Symptoms:
- Brittle Bones.
- Increase the risks of jaw fracture.
- Increase the risks of periodontal disease.
- A deficiency early in life could affect the formation of teeth.

N.B:
- Sometimes people with kidney disease also have vitamin D deficiency.
- The body will make its own vitamin D if it is exposed to sunlight for several minutes two or three times a week.

Sources of Vitamin D:
- Fish liver oils and fish
- Fortified milk and milk products
- Egg yolk
- Some cereals

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Vitamin K
- Normally, vitamin K is made by bacteria in your intestines.
- Vitamin K helps to make proteins that allow the blood to clot.

Signs and Symptoms:
- Easy bruising.
- Slow healing
- Excessive bleeding after extracted
- Excessive bleeding after scaling.

Sources of Vitamin K:
- Brussels sprouts
- Green leafy vegetables
- Broccoli
- Eggs
- Beef

N.B: A vitamin K deficiency may be caused by liver disease, long-term antibiotic use or other disease(s).

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Nasopharyngeal carcinoma

- Description:

- Malignant neoplasm, arising from the mucosal epithelium of the nasopharynx, most often within the lateral nasopharyngeal recess or fossa of Rosenmüller (a recess behind the entrance of the eustachian tube opening).

- It is a squamous cell carcinoma or an undifferentiated type.

- Squamous cells are a flat type of cell found in the skin and the membranes that line some body cavities.

- Classification: (By World Health Organization):

The World Health Organization classifies nasopharyngeal carcinoma in three types:

- Type 1: is squamous cell carcinoma.

- Type 2: is keratinizing undifferentiated carcinoma.

- Type 2: is nonkeratinizing undifferentiated carcinoma.

- Stages:
Staging of nasophayngeal carcinoma is based on clinical and radiologic examination.

Most patients present with Stage III or IV disease.
- Stage I is a small tumor confined to nasopharynx.
- Stage II is a tumor extending in the local area, or that with any evidence of limited neck (nodal) disease.
- Stage III is a large tumor with or without neck disease, or a tumor with bilateral neck disease.
- Stage IV is a large tumor involving intracranial or infratemporal regions, an extensive neck disease, and/or any distant metastasis.

- Signs and Symptoms:
- Cervical lymphadenopathy is the initial presentation in many patients.
- A lump in your neck caused by a swollen lymph node
- Blood in your saliva
- Bloody discharge from your nose
- Nasal congestion
- Hearing loss
- Frequent ear infections
- Headaches
- Trismus, pain, otitis media
- Nasal regurgitation due to paresis of the soft palate and cranial nerve palsies (paralysis).
N.B: Larger growths may produce nasal obstruction or bleeding and a "nasal twang".

- Causes:
- Infection with Epstein-Barr virus (EBV) for Type II and III
- Particularly, human papillomavirus HPV for Type I

- Complications:
- Cancer that grows to invade nearby structures, Invading throat, bones and brain.
- Cancer that spreads to other areas of the body, regional metastases invading the lymph nodes in the neck, or distant metastases invading bones, lungs and liver.

- Treatment:
Nasopharyngeal carcinoma can be treated by surgery, by chemotherapy, or by radiotherapy.

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