Traumatic Events and Eagle Syndrome: Is There Any Correlation? A Systematic Review

The interaction between gut microbiome and bone health

PURPOSE OF REVIEW

This review critically examines interconnected health domains like gut microbiome, bone health, interleukins, chronic periodontitis, and coronavirus disease 2019 (COVID-19), offering insights into fundamental mechanisms and clinical implications, contributing significantly to healthcare and biomedical research.

RECENT FINDINGS

This review explores the relationship between gut microbiome and bone health, a growing area of study. It provides insights into skeletal integrity and potential therapeutic avenues. The review also examines interleukins, chronic periodontitis, and COVID-19, highlighting the complexity of viral susceptibility and immune responses. It highlights the importance of understanding genetic predispositions and immune dynamics in the context of disease outcomes. The review emphasizes experimental evidence and therapeutic strategies, aligning with evidence-based medicine and personalized interventions. This approach offers actionable insights for healthcare practitioners and researchers, paving the way for targeted therapeutic approaches and improved patient outcomes.

SUMMARY

The implications of these findings for clinical practice and research underscore the importance of a multidisciplinary approach to healthcare that considers the complex interactions between genetics, immune responses, oral health, and systemic diseases. By leveraging advances in biomedical research, clinicians can optimize patient care and improve health outcomes across diverse patient populations.

Advancing Postoperative Pain Management in Oral Cancer Patients: A Systematic Review

The goal of this review is to shed light on the management of orofacial discomfort after a cancer diagnosis in the head and neck region. A search was conducted on PubMed, Scopus, and Web of Science to identify studies on postoperative pain control in oral cancer. The review included open-access research, investigations into pain management, randomized clinical trials, retrospective studies, case-control studies, prospective studies, English-written studies, and full-text publications. Exclusion criteria included animal studies; in vitro studies; off-topic studies; reviews, case reports, letters, or comments; and non-English language. Three reviewers independently accessed databases and assigned a quality rating to the chosen articles. The review explores postoperative pain management in oral cancer patients; highlighting persistent opioid use; the efficacy of adjuvant drugs, such as gabapentin; and a multimodal approach. It emphasizes the need for personalized pain management, recognizing individual pain perception and tailoring interventions. Integrating pharmacological and non-pharmacological strategies is crucial for comprehensive pain management. The review also serves as a guide for future research, emphasizing the need for standardized methodologies and diverse participant populations.

Soft Tissue Calcifications in the Head and Neck Region

This article provides an overview of the soft tissue calcifications in the head and neck region as noted on dental imaging, with particular focus on the radiographic appearance of these entities..

Traumatic Eagle's Syndrome: A Rare Cause of Neck Pain and Headache in Trauma Patients

BACKGROUND Eagle syndrome can be a rare cause of neck pain and headache. The elongated styloid process typically irritates and compresses adjacent neurovascular structures in the neck, leading to insidious signs and symptoms classic of Eagle syndrome. However, neck pain after traumatic events can be the only sign of elongated styloid processes. Therefore, knowledge of this syndrome is necessary to prevent misdiagnosis and futile attempts at treatment, especially in the setting of trauma. CASE REPORT In this article, we report the case of a 20-year-old man who presented with throbbing neck pain and headache immediately after a motor vehicle accident. The patient's symptoms did not improve with analgesics and muscle relaxants. He was then admitted for overnight monitoring while awaiting computed tomography imaging of the head and neck, which revealed elongated styloid processes on both sides. CONCLUSIONS One of the most challenging aspects of diagnosing Eagle syndrome is the need for high clinical suspicion combined with adequate understanding of the neck anatomy and its structures. Owing to the proximity of the elongated styloid process to important neurovascular structures, such as the carotid arteries and vagus nerve, early diagnosis of Eagle syndrome is necessary to guide the clinical decision-making and provide optimal care for patients.

Evaluation of Styloid Process Elongation in Madinah, Saudi Arabia: A Retrospective Radiographic Investigation

OBJECTIVES

This study aimed to identify the prevalence of an elongated styloid process and analyze the presence of its calcification in the Saudi population using panoramic radiographs.

METHODS

The Taibah Outpatient Dental Clinic's OPG radiographs for 962 patients who attended screening clinics between December 2022 and October 2023 were all included in the study. Patients' demographics, such as age, gender, and nationality, as well as radiological data, were included in the following study variables: the presence of an elongated styloid on both sides of a panoramic radiograph, right side styloid length, left side styloid length, right side distal end thickness, and left side distal end thickness.

RESULTS

The study evaluated 438 (45.5%) processes found in individuals aged 16-80 years old. The elongated process length ranged from 30.0 to 40.1 mm, and the diameter ranged from 0.81 to 7.79 mm at the origin to 0.56-3.79 mm at the end. There was no statistically significant difference in process length across genders or age groups. The diameters of the styloid bones on the left side vary significantly across genders at the start and completion of the process.

CONCLUSION

The prevalence of elongated styloids in the studied population was 4.26%. The radiological evaluation of the styloid process is a crucial stage in dental surgery planning.

Long term remineralizing effect of casein phosphopeptide amorphous calcium phosphate in white spot lesions: A systematic review and meta-analysis

BACKGROUND

White spot lesions (WSLs) appear as white, opaque areas on the teeth and are caused by a demineralization of the enamel.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to determine whether casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has beneficial effects on WSLs and provides remineralizing benefits that are superior to those of placebo or no treatment.

METHODS

Following a thorough analysis of the literature across major online sources, 103 papers - 54 of which underwent in-depth evaluation - were found. We used inclusion and exclusion criteria to choose research articles that were appropriate for our review.

RESULTS

10 papers met this review's requirements and were subsequently included. As compared to the controls, CPP-ACP demonstrated increased efficacy in treatment of WSLs in terms of remineralisation and other parameters which included microhardness tests and enamel surface roughness. The forest plots present the results of meta-analyses comparing the effect of CPP-ACP versus control/other agents on white spot lesions (WSLs). In terms of odds ratios (OR), CPP-ACP showed a small increase in the odds of WSLs compared to control/other agents. In-vitro studies showed no significant difference in relative risk (RR) between CPP-ACP and control/other agents. Randomized control trials indicated a small increase in the risk of WSLs with CPP-ACP treatment, but the overall effect was not statistically significant.

CONCLUSION

There was evidence to support the use of CPP-ACP over other agents for WSL prevention or treatment, but further research is needed to confirm these findings.

Prevalence and Characteristics of Eagle's Syndrome in a Syrian Population: A Cross-Sectional Descriptive Study

Objectives Elongation of the styloid process causes different symptoms with varying degrees of severity in some people. This elongation can be detected haply during routine reading of panoramic X-ray. The aim of this study is to determine the prevalence rate of Eagle's syndrome among a population from Damascus, Syria, and to evaluate the accompanying clinical symptoms. Methods This is a descriptive epidemiological study including 3,962 patients who attended one of the many dental clinics of educational and/or healthcare institutions in Damascus. All digital panoramic radiographs were reviewed, and the styloid processes were measured and assessed for elongation. Patients with styloid process of more than 3 cm in length were contacted and their consents were obtained to participate in the study to assess the presence of clinical symptoms. Results Radiographic elongation of the styloid process was found in 179 out of the 3,962 assessed dental records (prevalence rate was 4.5%). Length ranged from 30 to 90 mm, with an average of 55.9 mm. Of the patients with elongated styloid process, 10.2% had undergone tonsillectomy. All patients who underwent tonsil surgeries were symptomatic with at least three of the studied symptoms. Symptoms included peri-orbital pain (40.9%), orbital pain (35.2%), neck and shoulders pain (52.3%), ipsilateral headache (58%), earache (30.7%), tinnitus (37.5%), articular clicking (29.5%), throat pain (31.8%), globus sensation (22.7%), and dysphagia (21.6%). Conclusions The prevalence of Eagle's syndrome according to this study was 4.5%. Patients who had undergone tonsillectomy were more likely to be more symptomatic. The most common symptom was severe headache (migraine) on the same side of styloid elongation. Panoramic radiography is a low-cost means that can be helpful in the diagnosis of vague pain and symptoms caused by Eagle's syndrome in the head and neck regions.

The Use of a CAD/CAM Thermoformed Splints System in Closed Reduction of Condylar Fractures

(1) Background: Mandibular fractures are very common. Common indications of closed treatment for mandibular fractures are non-displaced or minimally displaced simple fractures in adult compliant patients with good dentition, the absence of occlusal disruption, and fractures in growing children. In closed treatment, the mandible is maintained in centric occlusion with a maxillomandibular fixation (MMF) with orthodontic elastics. Many methods of MMF have been described, often using orthodontic appliances. In recent years, CAD-CAM technology has improved many procedures used in maxillofacial surgery and orthodontics. The device we present is manufactured following a digital workflow, and was designed specifically for MMF. (2) Materials: Two patients with mandibular fractures were treated with an MMF method whose procedure comprised scanning of the dental arches, followed by construction of thermoformed splints on which buttons for the elastics and retention holes are made. The splints were fixed on the dental arches with composite resin at the level of the holes, and were kept in place for the period of healing of the fracture, with the intermaxillary elastics hooked to the buttons. (3) Results: The application time of the splints was very quick. The splints remained stable for the necessary time, without causing particular discomfort to the patients. (4) Conclusions: From our experience, this technique has proved to be reliable and reproducible and could represent a valid tool in the closed treatment of mandibular fractures.

A Case of Eagle Syndrome in a Chiropractic Patient

Eagle syndrome is a rare condition that is characterized by, among other things, pain in the face and neck, with the majority of cases being unilateral and isolated to the lower jaw. It is not uncommon for the pain to radiate to the ear. Symptoms can be constant or intermittent and may increase with yawning or rotation of the head, causing Eagle syndrome to be frequently misdiagnosed. The objective of this report is to summarize the symptoms, diagnostic workup, necessary imaging, and management of Eagle syndrome.

Correlation between Temporomandibular Disorders (TMD) and Posture Evaluated trough the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): A Systematic Review with Meta-Analysis

Background: Temporomandibular disorders (TMDs) are a series of disorders that affect the muscles and joint. Symptoms include joint pain, muscle pain, and limitation of mouth opening. One of several multifactorial diseases, temporomandibular dysfunction has mostly been linked to five etiological factors: occlusion, trauma, severe pain stimuli, parafunctional activities, and psychological elements, including stress, anxiety, and depression. The position of the human body as it is displayed in space is referred to as posture. Several nerve pathways regulate posture, and through ligaments, TMD and posture affect each other. The purpose of this study is to evaluate the possible correlation between posture and TMD through a meta-analysis of the literature; Methods: A literature search was performed on PubMed, Lilacs, and Web of science, and articles published from 2000 to 31 December 2022 were considered, according to the keywords entered. The term “temporomandibular disorders” has been combined with “posture”, using the Boolean connector AND; Results: At the end of the research, 896 studies were identified from the search conducted on the 3 engines. Only three were chosen to draw up the present systematic study summarizing the article’s main findings. The meta-analysis showed through forest plot analysis a correlation between posture and TMD Conclusions: This literature meta-analysis showed a correlation between posture and TMD. Nerve pathways probably regulate both body posture and mandibular posture. Further clinical studies will be needed to confirm this hypothesis and to indicate the main conclusions or interpretations.

Gaucher: A Systematic Review on Oral and Radiological Aspects

Background and Objectives: Gaucher disease (GD) is a lysosomal storage disorder with the genetic autosomal recessive transmission. Bone involvement is a prevalent finding in Gaucher disease. It causes deformity and limits daily activities and the quality of life. In 75% of patients, there is bone involvement. This review aims to evaluate the principal findings in the jaw by a Cone-beam computed tomography (CBTC) and X-ray orthopantomography; Materials and Methods: PubMed, Web of Science, Lilacs and Scopus were systematically searched until 31 December 2022. In addition, a manual search was performed using the bibliography of selected articles and a Google Scholar search. Clinical studies were selected that considered principal radiographic findings in radiography in a group of patients affected by GD. Results: Out of 5079 papers, four studies were included. The main findings are generalized rarefaction and enlarged narrow space, anodontia. Conclusions: The exact mechanism of bone manifestation is probably due to the infiltration of Gaucher cells in the bone marrow and, consequently, the destruction of bone architecture. All long bones are a potential means of skeletal manifestation. The jaw is more affected than the maxilla, and the principal features are cortical thinning, osteosclerosis, pseudocystic lesions, mental demineralization, flattening in the head of the condyle, effacement of anatomical structures, thickening of maxillary sinus mucosa. The dentist plays a crucial role in diagnosing and treating these patients. Sometimes the diagnosis can be made by a simple panoramic radiograph. All long bones are affected, and the mandible is particularly involved.

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review

Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

Differences in the Osseous Ultrastructure in 2 Differing Etiologies of Eagle Syndrome. A Micro-CT Study

OBJECTIVES

Eagle syndrome is a rare disease caused by an elongated styloid process (type I) or ossified stylohyoid ligament (type II) and causes a heterogeneous symptom complex, ranging from pain in the throat and neck to neurological symptoms and neurovascular entrapment. The 2 different types present differing shapes and ultrastructures and cause different symptoms. This study aimed to distinguish the 2 types by investigating the structures by micro-computed tomography.

METHODS

Micro-computed tomography was performed and evaluated in n=10 resected styloid processes from patients diagnosed with Eagle syndrome. The tissues were measured for their shape, ratio of soft tissue and bone amounts, bone volume, and ultrastructure, and compared within the groups.

RESULTS

The shapes of the different types were different and the ultrastructure differed between the 2 groups, with an absence of trabecular architecture in type II. The area of bone to nonbone tissues in type I samples was significantly higher compared with type II (P=0.007). Alike these results, the bone volume and bone-to-soft tissue ratio were significantly higher in type I compared with type II (P=0.009).

CONCLUSIONS

The findings suggest that both the popular theories (hyperplasia and metaplasia) may be probable but each solely valid for 1 type of Eagle. Type I may derive from bone hyperplasia with cancellous bone formation and rather high bone density in the elongated styloid process. Type II most likely originates from ligament metaplasia into bone without a compact structure.

Styloid Jugular Nutcracker: The Possible Role of the Styloid Process Spatial Orientation-A Preliminary Morphometric Computed Study

Styloid Jugular Nutcracker (SJN, also known as Eagle Jugular Syndrome EJS) derives from a jugular stenosis caused by an abnormal styloid process, compressing the vessel in its superior portion (J3) against the C1 anterior arch. It could be considered a venous vascular variant of Eagle Syndrome (ES). Main clinical features of this ES variant are headache, pulsatile tinnitus and dizziness, possibly related to venous hypertension and impaired cerebral parenchyma drainage. In our opinion, conceptually, it is not the absolute length of the styloid bone that defines its abnormality, but its spatial direction. An elongated bone pointing outward far away from the midline could not compress the vein; vice versa, a short styloid process tightly adherent to the cervical spine could be pathological. To prove this hypothesis, we developed a semi-automatic software that processes CT-Angio images, giving quantitative information about distance and direction of the styloid process in three-dimensional space. We compared eight patients with SJN to a sample of healthy subjects homogeneous for sex and age. Our results suggest that SJN patients have a more vertically directed styloid, and this feature is more important than the absolute distance between the two bony structures. More studies are needed to expand our sample, including patients with the classic and carotid variants of Eagle Syndrome.

Stylohyoid Ligament Calcification and Its Association With Dental Diseases

OBJECTIVES

This research aimed at investigating the relationship between calcification of the stylohyoid ligaments (SHLs) and odontogenic inflammatory events.

METHODS

Cone-beam computed tomography scans of 175 patients were retrospectively assessed for presence of SHL calcifications. Frequencies of 4 types of odontogenic inflammatory events were assessed using the same scans, namely dental extractions, root canal treatments, furcation lesions, and periapical lesions. Patients were telephone-interviewed and asked about histories of tonsillectomy and head and neck trauma. Mann-Whitney U and binary logistic regression tests were used to assess associations between SHL calcification and mean ranks of odontogenic inflammatory events.

RESULTS

Calcification of SHLs was detected in 71 (41%) and 58 (33%) patients on the right and left sides, respectively. Tonsillectomy and trauma were reported in 14% and 10% of the sample, respectively. Amongst all inflammatory events, root canal treatments were significantly associated with SHL calcification (U = 2755; Z = -2.1; P = .035). This association was independent from patient age, tonsillectomy, trauma, and other inflammatory events (odds ratio, 1.2; 95% confidence interval, 1.0-1.4; P = .036).

CONCLUSIONS

This study presents new evidence that intra-oral inflammatory events, particularly related to root canal treatments, have a stronger association with SHL dystrophic calcification than that associated with traditional predisposing factors (ie, old age, tonsillectomy, and trauma).