Najla Dar-Odeh

Dear Editor, In April 2024, a 24-year-old non-smoker female patient with controlled asthma presented with a sore throat, left-sided cervical lymphadenopathy, and a painful, red maculopapular rash on the hands and feet.

Reconstruction of facial defects requires highly accurate techniques that utilize modern effective technologies. 3D printing has revolutionized the field of reconstructive surgery. The introduction of new materials, devices, and technologies that utilize advanced computer modeling and artificial intelligence has increased the safety and efficiency of these techniques. Bioactive materials induce a positive reaction after implantation in terms of bone tissue formation, strengthening, and interlocking, which in turn promotes bone regeneration and function. The advantages of biomaterials are largely due to their biocompatibility, accelerating osteogenesis and regenerative processes. In the present study, we evaluated the efficacy of a 3D-printed, custom-made poly- L -lactic acid/beta-tricalcium phosphate (PLA/β-TCP) scaffold in managing a complex zygomaticomaxillary defect caused by trauma in a female patient.

Introduction: HSPG2 ‐related dyssegmental dysplasia (heparan sulfate proteoglycan 2) is an extremely rare and severe autosomal recessive skeletal dysplasia. The low incidence and the overlapping features with other types of lethal skeletal dysplasia represent the main challenges in diagnosis. Early diagnosis is essential and can be achieved by ultrasound examination and genetic analysis. This report describes a case of HSPG2 ‐related dyssegmental dysplasia, Silverman–Handmaker type (DDSH) diagnosed prenatally through a combination of detailed ultrasound imaging and subsequent genetic analysis. Case Presentation: A 21‐year‐old pregnant lady (G2P1) was referred to our center at 17‐week gestation upon the detection of severe shortening of fetal limbs. Detailed ultrasound examination revealed small for gestational age, and specific craniofacial features such as severe micrognathia, short neck, microcephaly, prominent eyes, and occipital encephalocele. Other abnormalities were detected in extremities in the form of bowing of lower limbs, severe tetramicromelia, and upper limbs in a fixed flexion. Amniocentesis for whole exome sequencing was performed. It showed a homozygous pathogenic variant in the HSPG2 gene (c.11565+1G>A), a result consistent with the genetic diagnosis of autosomal recessive HSPG2 ‐related DDSH. Medical termination was performed based on the decision of parents. Parents signed a written consent for the publication of this case report. Discussion: Findings of this report support the growing evidence of the phenotypic spectrum and genetic underpinnings of the lethal disorder of HSPG2 ‐related DDSH, emphasizing the importance of early and accurate diagnosis for optimal patient care. DDSH can be diagnosed prenatally using fetal ultrasound as early as 13 weeks. Radiographic assessment and molecular analysis of the HSPG2 gene are essential for confirming the prenatal diagnosis. Accurate diagnosis enables appropriate healthcare delivery and facilitates informed reproductive decision‐making, including prenatal diagnosis and preimplantation genetic testing in future pregnancies.

Objective: This study aims to review case reports/series on West Nile virus (WNV) infection-associated cranial nerve (CN) neuropathy to explore the associated patterns and characteristics. Design: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data sources: We reviewed the literature in PubMed/Medline, Google Scholar and ScienceDirect databases to retrieve relevant case reports. Eligibility criteria: Case reports published in the past 25 years on CN neuropathy in WNV-infected patients, with no language or geographic restrictions. Data extraction and synthesis: Retrieved data included patient demographics, disease presentation and treatment outcomes. Descriptive statistical analyses were performed to describe frequency and characteristics of CN neuropathies. Cross tabulation was performed to calculate statistical significance of association between patient characteristics, disease factors and treatment outcomes. Risk of bias was assessed using the JBI Critical Appraisal Tool for case reports. Results: A total of 30 case reports satisfied inclusion criteria. These studies described 42 cases that developed CN neuropathies as an outcome of WNV infection. Patients were in the main males (54.8%) and had a mean age of 52.5±15.5 years. The most frequently affected CNs were, in descending order, optic (n=21, 50.0%), facial (n=14, 33.3%) and abducent nerves (n=8, 19.0%). Age was significantly associated with optic nerve neuropathy (≥51 years) and facial palsy (<51 years) (p=0.005 and p=0.008, respectively). Regression analysis of patient and disease variables did not reveal any significant predictor for delay of CN neuropathy following the onset of illness. As for treatment outcomes, complete recovery was significantly associated with absence of comorbidities and administration of systemic antivirals (p=0.029 and p=0.041, respectively). Conclusions: CN neuropathy represents an important subset of neuroinvasive disease caused by WNV. There is a slight male preponderance among the patient population who are mostly middle aged. Optic and facial nerves are mostly affected. Most patients show complete recovery, particularly in the absence of chronic diseases. The role of systemic antivirals in improving disease outcomes should be further investigated. Early detection of CN neuropathies is recommended by routine CN screening and use of specific tools such as MRI and neurophysiological tests.

Objectives: The aim of this study was to examine etiology, patterns, and associated demographic factors of facial fractures in Northern Saudi Arabia. Method: This was a retrospective study of patients admitted to a tertiary care trauma center in Northern Saudi Arabia with a diagnosis of facial fracture. Medical patient records were retrieved for the period 19/1/2000 to 24/11/2015. Retrieved data were demographics (age, gender, nationality), types and etiology of fractures. Results: A total of 2066 patient records were included. Patients had a mean age of 24.7 ± 11.7 years, (range = 1-90 years). Most patients were males (n = 1755, 84.9%), and young (19-30 years old; 52%). Fractures of the zygomatic maxillary complex and mandibular parasymphysial fractures were the most commonly encountered fractures (n = 609, n = 603 respectively). Road traffic accidents (RTAs; 66.1%), falls (15.2%), and assault (13.0%) were the main causes of fractures. RTAs were significantly identified among age group (19-30; P < .001). Assault was significantly associated with males, age group (19-30) and Saudi nationality ( P < .001, P < .001and P = .032 respectively). Lastly, falls had a significant association with male, children and older adults who were >30 years old ( P = .001, P < .001 respectively). Conclusions: RTAs, assaults, and falls are the most frequently reported causes of facial fractures among trauma patients in Northern Saudi Arabia. RTAs are the leading cause of facial fractures in the young adult population, while assaults are significantly seen in young Saudi males. Maxillary and mandibular fractures are the most commonly observed types of facial fractures. Targeted public health interventions are recommended to address road safety education and enforcement of traffic regulations. Community-based prevention programs could mitigate assault-related trauma, particularly among the young male population.

Aim: This review aims to identify demographic and clinical characteristics of oral cancer (OC) identified among female patients in the past 25 years, and to explore associated potential risk factors. Materials and Methods: We systematically reviewed the literature in PubMed/Medline, Google Scholar, and Scopus data bases to retrieve case reports published during the period 2000–2024 that described OC in women. Retrieved data included patient (age, country, history) and disease (location, presentation) factors. Results: A total of 63 cases for females affected by OC were included. A proportion of 32.8% was reported from East Asia. Mean age was 48.7 ± 19.9 years (range = 17–88 years). The main locations of cancer were the tongue (44.4%), followed by the gingiva (36.5%). Age was a significant factor for cancer location; tongue in patients P < .001); and gingiva in patients ≥50 years ( P = .001). Most cases of OC were squamous cell carcinoma (SCC; 92.1%), and identified in East Asian countries. Tumors presenting as a mass were significantly located on the gingiva ( P = .011). Most tongue cancers were ulcers; however, there was no significant association ( P = .058). Twelve (19.0%) cases were pregnant with OC significantly presenting on tongue ( P = .025). A proportion of 89.6% constituted SCC in the tongue presenting mainly as a lump (49.2%), and ulcer (39.7%). Conclusions: Traditional risk factors were not identified in most cases. Females of all age groups regardless of medical/habitual background should be properly screened for OC. Improvements are warranted in healthcare systems particularly in low-resource settings to spread awareness among patients, their families, and their healthcare providers.

Oral and maxillofacial surgeons (OMFSs) face peculiar challenges that may hinder surgical careers and jeopardize job satisfaction. More data are necessary on these challenges, particularly among females in conservative societies and politically unstable areas. This study aimed to perform a gender-based analysis of social and professional challenges faced by OMFSs in Egypt, Jordan, Libya, and Saudi Arabia. An online questionnaire was distributed among OMFSs to explore career-hindering factors, factors influencing OMFS career choice by female surgeons, and surgeons’ preferences for online educational platforms. The results showed that male professionals performed more surgical procedures under general anesthesia and identified “financial revenues” as a significant career obstacle (p≤0.05). Regarding the most important factors that impact female surgeons’ choice of OMFS career, significantly more females cited “lack of mentors” (p=0.012), while significantly more males cited “marriage” and “having children” (p=0.001). Further, significantly more males stated that “males are better suited for leadership positions” (p<0.001). Female OMFSs in conservative societies encounter challenging social and professional barriers, which may adversely affect job stability and career aspirations. Adopting policies that promote a work-family balance for female surgeons and providing institutions with a sufficient number of mentors may be crucial in mitigating the obstacles and challenges they face. Further leadership opportunities should be made accessible to women, supported by establishing an inclusive and unbiased environment that engages all stakeholders, regardless of their gender.

A dental anomaly is any deviation from normal tooth development, affecting the number, size, form, position, or structure of one or more teeth. Examining affected family members can enhance our understanding of the genetic factors involved in both normal and abnormal dental development. Hypodontia is a common dental anomaly characterized by the congenital absence of one or more teeth. It may exhibit a familial pattern associated with certain dental anomalies in siblings. The two main treatment modalities for hypodontia are space opening for prosthetic replacement of the missing tooth or space closure, which underscores the need for an interdisciplinary approach of management. This case series aims to present the clinical dental features and treatment modalities of 10 siblings from 5 families who exhibited hypodontia and other nonsyndromic dental anomalies with malocclusion. A thorough literature review on familial and genetic basis of hypodontia and associated dental anomalies in siblings is also presented.

Introduction: Surgical training is an importantly developing aspect in the advancement of healthcare and improving clinical outcomes. We conducted this study in four Arabic countries aiming to evaluate the factors that influence training in the specialty of oral and maxillofacial surgery (OMFS). Materials and Methods: An online questionnaire was distributed among OMFSs in Egypt, Jordan, Libya and Saudi Arabia. There were 30 closed-ended questions on socioprofessional characteristics; sources of support during surgical training; relations with peers, mentors and patients; and training satisfaction in the main areas of OMFS. Results: A total of 137 surgeons participated. Their age range was 27–70 years (Mean = 39.7 ± 8.6). Males were 54.0% and married surgeons were 75.1%. The greatest and least sources of support during training were family (89.9%) and institution (53.3%), respectively. Significantly more males perceived sufficient support from family and peers during training (P ≤ 0.05) and significantly more married practitioners and surgeons working in Jordan, Libya, and Saudi Arabia perceived support from family (P ≤ 0.05). Participants were least satisfied in oncology training (55.5%). Males and surgeons working in Jordan, Libya and Saudi Arabia were more significantly satisfied in oncology training, whereas surgeons working in Egypt were more significantly satisfied in TMJ surgery training (P ≤ 0.05). A proportion of (83.2%) perceived career satisfaction particularly those who have received adequate training in advanced surgical topics, and those who received sufficient support from family, mentors, and organization during their training (P ≤ 0.05). Conclusion: Family remains the most important source of support during OMFS training, however, more family support is essential for female, single trainees particularly those working in Egypt. Country-specific focus is warranted for oncology and TMJ surgery training. Further, sufficient training in the advanced areas of OMFS has a great impact on future career satisfaction. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Medical knowledge, and Interpersonal and communication skills.

Objectives: To evaluate the indications and dosing regimens for oral metronidazole monotherapy (OMM) for the management of oral anaerobic infections (OAIs) other than periodontitis. Materials and methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in literature of PubMed/Medline, Scopus, and Cochrane databases. Data were retrieved from reports published in English in the period January 1, 1980 - August 30, 2023. Joanna Briggs Institute Critical Appraisal Tools were used to assess study risk of bias. Results: A total of 228 articles were retrieved from the databases of which 16 met the inclusion criteria necessary for achieving the aims of the study. OAIs in which OMM was used or recommended included pericoronitis; necrotizing ulcerative gingivitis/periodontitis/stomatitis, osteomyelitis, acute periapical infection, and cellulitis. OMM was prescribed in dosages ranging from 200 to 500 mg t.i.d. for periods ranging from 2 to 7 days. Osteomyelitis of the jaw was the only infection for which the dosage regimen of metronidazole was not clearly described. Conclusion: Evidence from the databases searched support the view that OMM has clinical efficacy in the treatment of specific OAIs namely pericoronitis and necrotizing oral infections in immune-competent and immune-compromised patients. The evidence does not support the use of OMM in "deep tissue" infections such as osteomyelitis, and odontogenic infections such as acute apical infection and cellulitis. Clinical trials are warranted to determine the efficacy of OMM in comparison with other antibiotic regimens.