O nline C ase R eports Surgical Dental Treatment for Military Personnel: Where and When?—A Case Report Marcus Stoetzer, Roland Schmidt, Nils-Claudius Gellrich, Constantin von See ABSTRACT Introduction: Oral health is essential for combat readiness. The classification for combat readiness includes the Dental Fitness Categories, which are used to estimate a soldier’s need for emergency dental care while deployed overseas. When the issue at hand is in regard to unerupted or additional teeth, the treating dentist faces a difficult decision since there is no evidence-based practice guidelines. Case Report: An otherwise healthy 20 year-old soldier initially presented to his general physician (Role I) with toothache in the lower jaw. The initial referral to a general dentist (Role II) led to a diagnosis of an additional tooth 45; therefore, he was transferred to the oral surgeon (Role III). A computed tomography scan revealed fully retained besides the additional 45, wisdom teeth, and additional wisdom teeth, as well as retained tooth 23. After careful consideration, osteotomies of all retained teeth were performed under general anesthesia. A titanium miniplate was placed for stabilization. Discussion: Despite variability among dentists in assigning a particular Dental Fitness Class, the clinical and radiologic examination must take into account treatment options that may become necessary for unerupted and retained teeth, doi: 10.7205/MILMED-D-13-00579
How to Reconstruct an Upper Full-Thickness Abdomen Wall Defect in Austere Environment? Interests of the Pedicled Myofascial Latissimis Dorsi Flap Emmanuel Hornez, Nicolas Pellet, Faye Roswadosky, Radek Ponhan, Didier Ollat, Patrice Ramiara, Frederic Rongieras ABSTRACT Upper abdominal wall defects secondary to trauma are not amenable to immediate closure in most cases. After a primary coverage, the definitive reconstruction can be done at a later date, using prosthetic mesh or flap. The majority of these complex procedures is, however, not available in the austere environment. The authors report a clinical case of upper full-thickness defects of the abdominal wall secondary to an explosion in Afghanistan. The patient was managed by a French Forward Surgical Team. The defect was immediately reconstructed in a one-stage surgery using a pedicled myofascial latissimus dorsi flap with good functional results. The pedicled latissimus dorsi flap is commonly used for coverage of both extrathoracic and intrathoracic defects. It is, therefore, possible to extend the harvesting of the muscle to the thoracolumbar fascia and the posterior third of the iliac crest. It provides a very large flap to cover an upper fullthickness abdomen wall defect. The harvest technique is simple, short, and largely accessible to a general surgeon. It provides immediate and definitive closure with a short hospital stay, what is clearly adapted in austere environment, doi: 10.7205/MILMED-D-13-00232
Painful Ophthalmoplegia: A Case of Tolosa-Hunt Syndrome Mohenish K. Singh, Brittany Marshall, John Hawley ABSTRACT Unilateral painful opthalmoplegia involving the third, fourth, or sixth cranial nerve in association with a retro-orbital mass should be evaluated for rheumatologic conditions and malignancy. The assessment may require a biopsy of the mass. Once cancer and autoimmune conditions such as sarcoidosis have been ruled out, Tolosa-Hunt should be consid ered. Tolosa-Hunt is a rare condition that presents as an acute unilateral eye pain with motor dysfunction and responds to prolonged treatment with corticosteroids. Presented is a case of Tolosa-Hunt syndrome, doi: 10.7205/MILMED-D-14-00265
Full article available online
1400
M ILITARY MEDICINE, Vol. 179, November 2014
Copyright of Military Medicine is the property of AMSUS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
How to Reconstruct an Upper Full-Thickness Abdomen Wall Defect in Austere Environment? Interests of the Pedicled Myofascial Latissimis Dorsi Flap Emmanuel Hornez, Nicolas Pellet, Faye Roswadosky, Radek Ponhan, Didier Ollat, Patrice Ramiara, Frederic Rongieras ABSTRACT Upper abdominal wall defects secondary to trauma are not amenable to immediate closure in most cases. After a primary coverage, the definitive reconstruction can be done at a later date, using prosthetic mesh or flap. The majority of these complex procedures is, however, not available in the austere environment. The authors report a clinical case of upper full-thickness defects of the abdominal wall secondary to an explosion in Afghanistan. The patient was managed by a French Forward Surgical Team. The defect was immediately reconstructed in a one-stage surgery using a pedicled myofascial latissimus dorsi flap with good functional results. The pedicled latissimus dorsi flap is commonly used for coverage of both extrathoracic and intrathoracic defects. It is, therefore, possible to extend the harvesting of the muscle to the thoracolumbar fascia and the posterior third of the iliac crest. It provides a very large flap to cover an upper fullthickness abdomen wall defect. The harvest technique is simple, short, and largely accessible to a general surgeon. It provides immediate and definitive closure with a short hospital stay, what is clearly adapted in austere environment, doi: 10.7205/MILMED-D-13-00232
Painful Ophthalmoplegia: A Case of Tolosa-Hunt Syndrome Mohenish K. Singh, Brittany Marshall, John Hawley ABSTRACT Unilateral painful opthalmoplegia involving the third, fourth, or sixth cranial nerve in association with a retro-orbital mass should be evaluated for rheumatologic conditions and malignancy. The assessment may require a biopsy of the mass. Once cancer and autoimmune conditions such as sarcoidosis have been ruled out, Tolosa-Hunt should be consid ered. Tolosa-Hunt is a rare condition that presents as an acute unilateral eye pain with motor dysfunction and responds to prolonged treatment with corticosteroids. Presented is a case of Tolosa-Hunt syndrome, doi: 10.7205/MILMED-D-14-00265
Full article available online
1400
M ILITARY MEDICINE, Vol. 179, November 2014
Copyright of Military Medicine is the property of AMSUS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
