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OBJECTIVE: Temporomandibular disorders (TMDs) are the most common non-dental orofacial pain disorders. Research suggests that patients with TMDs experience eating and swallowing problems, although information is sparse, impacting effectiveness of management. Research aims were to investigate the epidemiology and impact of TMD-related eating and swallowing problems. METHODS: A cross-sectional study was completed in two national Irish specialist centers, with 126 participants with TMDs assessed using a specifically-devised protocol. Descriptive and statistical analyses were completed. RESULTS: Masticatory issues (95%), swallowing difficulties (53%), and weight loss (50%) were prevalent. Participants reported moderately severe eating and swallowing problems impacting participation and well-being across daily and social activities. DISCUSSION: A variety of eating and swallowing problems are reported by adults with TMDs, which impact functioning and psychosocial well-being. The need to improve clinical practice and research is argued. Future research should refine the original assessment protocol developed in this study.

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Introduction Osteosarcoma is the most common primary malignant bone tumour, usually arising in the long bones, with occurrence in the head and neck accounting for 8% of all osteosarcomas. Clinical features include swelling, pain, facial dysesthesia and abnormal mobility of teeth. Treatment consists of a combination of surgery, radiotherapy and chemotherapy.Case series Here, we present four cases of osteosarcoma of the jaws - two maxillary and two mandibular. All cases were initially assessed in the dental primary care setting before being referred for specialist opinion.Discussion The purpose of this paper is to present an overview of an uncommon but serious disease which can mimic common life-threatening dento-facial conditions. We discuss the diagnostic features, with an overview of clinical, histopathological and radiographic features.Conclusion These cases are important reminders of the potential clinical and radiographic appearance of a rare cause of facial swelling, and highlight the role of the general dental practitioner in early diagnosis and referral.

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OBJECTIVE: To evaluate the accuracy of magnetic resonance diffusion weighted imaging (DWI) featuring constrained spherical deconvolution-based tractography in tracking the extracranial course of the facial nerve to provide a reliable facial nerve map to facilitate well-tolerated and effective tumor resection. STUDY DESIGN: Magnetic resonance DWI was conducted on 2 parotid-healthy cadaveric patients with various protocols to identify the best representation of the extracranial facial nerve tract. This was subsequently correlated to dissection of the facial nerves to ascertain anatomic validation. These protocols were applied to 2 live, parotid-healthy patients to assess feasibility of in vivo facial nerve tract identification. RESULTS: Correlations between imaged tracts and the anatomic course of the extracranial facial nerve were identified to an accuracy of 1 mm. The main trunk and bifurcation tracts were identified on imaging. Fractional anisometry values in cadaveric and live patients were within the range expected for the facial nerve within the parotid gland. CONCLUSIONS: Our results indicated the potential for accurate 3-dimensional visualization of the extracranial course of the facial nerve, which could have diagnostic implications in differentiating benign from malignant tumors and, crucially, neural involvement. Preoperative planning applications of DWI could help in planning surgical approaches and providing focused counseling.

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PURPOSE: This study assesses the effectiveness of eminectomy in the management of chronic closed lock, refractory to conservative medical management in the largest multi-centred study of its kind in the UK, with a cohort of 167 patients. Temporomandibular mandibular joint disorder affects 30% of adults in the UK. Chronic closed lock is a well-documented sub-type. METHOD: A retrospective study of patients with refractory closed lock was carried out, where conservative management had been implemented for a minimum of 6 months. Refractory patients were offered eminectomy at three separate centres over a period from 1995 to 2011. The primary variable was the inter-incisal distance (IID). Other variables included pain, clicking and nerve damage pre- and post-operatively. RESULTS: There were 167 patients across all three centres, 81% of which were female. The mean IID was 23 mm pre-operatively and 37 mm post-operatively. There was a statistically significant association with the primary predictor variable, yielding a p value of < 0.05. Clicking resolved completely post-operatively in 84 patients (58%). Pain subjectively improved in 56% cases. CONCLUSION: Eminectomy is a safe and effective surgical procedure and has a role to play as a second-line surgical option in the management of closed lock after more conservative medical options have failed.

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PURPOSE: The wound closure technique for lower third molar surgery (LTMS) is an operative factor that influences wound healing and the occurrence of early postoperative complications. The present study investigated 2 closure techniques (partial closure using 1 suture and the suture-less technique) after use of a modified buccal envelope flap for LTMS. MATERIALS AND METHODS: We performed a prospective, randomized, double-blind, split-mouth, controlled trial. Partial closure using 1 suture was compared with closure using the sutureless technique. The surgical sites were divided into 2 groups, group A (1 suture) and group B (sutureless). Each patient received both treatments at the same surgery. During the first postoperative week, all patients were asked to daily assess pain, facial swelling, and bleeding using self-assessment scales. All patients attended the follow-up appointment at 1 week to objectively assess facial swelling and wound healing and at 1 month to assess wound healing. An analysis of data was performed using the statistical package SPSS Statistics, version 24 (IBM Corp, Armonk, NY). A P value ≤ .05 was accepted as statistically significant. RESULTS: A total of 37 patients with bilateral impacted third molars of similar surgical difficulty were recruited. Of the 37 patients, 34 successfully completed the study. The results showed a statistically significant difference between the 2 techniques in postoperative pain at days 5 (P = .046) and 6 (P = .034); socket healing at 1 week (P = .002) and 1 month (P = .014), and soft tissue healing at 1 week (P = .016). CONCLUSION: We found the 1-suture technique for LTMS to be superior to the sutureless technique in the reduction of postoperative pain and improving wound healing during the early postoperative period. We found no difference between the 2 techniques in the reduction of postoperative swelling.

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PURPOSE: Temporomandibular disorders (TMDs) are caused by changes in the structure and/or function of the temporomandibular joint, masticatory muscles, and/or osseous components. TMDs can result in oral stage dysphagia (OD) with potential effects on function and patient well-being. Little is known about the prevalence, nature, and management of TMD-related OD. The aims of the present study were to estimate the prevalence and nature of OD in adult TMD patients and to identify the common management techniques used to manage the signs and symptoms of TMD-related OD. PATIENTS AND METHODS: An 18-item subjective questionnaire was adapted from existing tools and used to investigate TMD etiology, the symptoms and signs of TMD-related OD, and the intervention techniques used to manage these symptoms. This was disseminated to 178 TMD patients consecutively recruited over 6 months in 2016. Descriptive and statistical methods were used to analyze the data. RESULTS: Of the 178 TMD participants, 99% reported at least one symptom or sign of OD. Individuals presenting with subluxation of the jaw (80%), degenerative joint disorder (67%), and myofascial pain disorder (40%) reported OD most frequently. Common symptoms included painful mastication (90%), masticatory fatigue (78%), difficulties swallowing (33%), and difficulties drinking liquids (28%). The use of a broad range of management techniques was reported, with these including both OD-specific techniques (eg, diet modifications [81%]), and non-OD specific techniques (eg, analgesia [79%] and oral splints [75%]). CONCLUSIONS: OD is prevalent, and difficulties with mastication are common in those with TMDs. The interventions used were diverse, with varying objectives and disparate levels of evidence supporting their efficacy within this cohort. Further research should address the epidemiology of TMD-related OD, evidence-based interventions, and the promotion of collaboration across the disciplines responsible for managing TMD-related OD (eg, speech and language therapy, oral and maxillofacial surgery, dentistry, restorative dentistry, orthodontics, oral medicine).

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This study used an axial transmission quantitative ultrasound (QUS) device to assess mandibular bone strength. The aim of the study was first to establish the precision and repeatability of the axial transmission QUS measurement for a range of mandibular anatomic sites, and second to investigate the ability of the modality to differentiate between osteoporotic subjects and a control group. Three groups of adult Caucasian women were recruited: (1) healthy premenopausal women (n = 26), (2) healthy postmenopausal women (n = 48), and (3) women with osteoporosis (n = 53). Subjects were excluded from groups 1 and 2 if they had any pre-existing bone conditions. Speed of sound (SOS) measurements were taken from the mandible using an OmniSense multisite QUS device. Group 3 had dual-energy X-ray absorptiometry scans of the lumbar spine and femur. The most suitable site on the mandible was determined by repeat SOS measurements in 10 healthy premenopausal subjects, at 5 different sites. The parasymphysis site had the lowest root mean squared coefficient of variation at 0.74%, and was chosen as the most suitable site for mandibular SOS measurements. Group 1 and group 2 had significantly higher mean SOS measurements than the osteoporotic subjects (group 3), with means of 3683 m/s (210), 3514 m/s (221), and 3312 m/s (264), respectively. A 1-way analysis of variance confirmed a statistically significant difference between mean SOS measurements from the 3 groups (p < 0.0001). Axial transmission QUS of the mandible can differentiate between subjects with osteoporosis and a healthy control group, and shows potential for use as a screening tool for osteoporosis.

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PROBLEM: During palatal fenestration procedure the vascularised, respiratory nasal lining is often sacrificed inadvertently. It normally functions to keep the inhaled air warm, humid and dust free. CONCLUSION: This vascularised nasal lining when uninvolved oncologically can easily be preserved. Preservation of the vascularised nasal lining shall decrease the leakage of nasal secretions and aid in the healing of reconstruction of the defect when local or regional flaps are used.

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STATEMENT OF THE PROBLEM: Concerns were expressed that postoperative written instructions following endodontic treatment are not available in the Dublin Dental University Hospital. MATERIALS AND METHODS: Data was collected in three phases: retrospective analysis of clinical notes for evidence of the delivery of postoperative instructions; a randomly distributed questionnaire to patients undergoing root canal treatment prior to the introduction of a written postoperative advice sheet; and, another survey following introduction of the advice sheet. RESULTS: Some 56% of patients' charts documented that postoperative advice was given. Analysis of phase two revealed that patients were not consistently informed of any key postoperative messages. In phase 3 analysis, the proposed benchmarks were met in four out of six categories. CONCLUSIONS: Postoperative advice after root canal treatment in the DDUH is both poorly recorded and inconsistently delivered. A combination of oral postoperative instructions and written postoperative advice provided the most effective delivery of patient information.

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STATEMENT OF THE PROBLEM: Delayed healing, or failure of the alveolus to heal post exodontia, is not an uncommon finding in both primary care and hospital practice. Local factors dominate and the majority of cases are the result of clot dissolution, secondary infection, foreign bodies, etc. However, potentially life-threatening, malignant lesions complicating healing can be overlooked and underestimated due to their rare occurrence. PURPOSE OF THE REVIEW: This article presents a contemporary review of the normal physiological process that directs healing within the extraction socket and a differential diagnosis for delayed healing or failure of healing following extraction, with guidance on appropriate management. METHOD: A case report of a squamous cell carcinoma presenting in the clinical setting of a non-healing extraction socket, and a discussion of local and systemic factors that may interfere with healing, are presented. CONCLUSION: The aetiologies of delayed healing and failure of the extraction site to heal are diverse, and the process can be affected by local and systemic factors alike.'Given that neoplastic lesions are relatively rare, it is therefore all the more important for GDPs to remain cognisant of the diagnostic red flags that may raise suspicions of a mitotic lesion to ensure that appropriate referral pathways are instituted.

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