Tianeptine is an atypical tricyclic antidepressant that is prescribed mainly for the treatment of depression and anxiety disorder. There have been scattered reported cases of tianeptine dependence and abuse in the literature. We report the case of a 32-year-old gentleman with resistant major depressive disorder that was initially successfully treated with Tianeptine. When his depression relapse due to work-related issue, he step-up his dosages without supervision. He developed tolerance and withdrawal to tianeptine making it difficult for him to stop without help. This case highlights the possibility of tianeptine abuse to its high tolerability and easy access for purchase.
Distraction osteogenesis allows superior skeletal advancement compared to conventional surgical osteotomy. It can be considered as a reliable and predictable surgical procedure and is widely used to correct the craniomaxillofacial bone discrepancy. Nevertheless, the outcome is technically dependent and requires comprehensive peri-operative assessment, preparation, and precision in application. The objective of this study is to highlight some important technical issues in distraction osteogenesis when the technique is indicated in various craniomaxillofacial regions and at the same time to discuss the options of preventing and overcoming these technical complications based on our experience and relevant literature. Important technical issues on the application of distraction osteogenesis in 5 different craniomaxillofacial regions were selectively highlighted based on the completed cases in one centre. Potential complications and its prevention methods were documented and discussed. The 5 highlighted regions of craniomaxillofacial distraction osteogenesis were alveolar, mandibular, cleft maxilla, craniofacial and facial cleft. Technical issues and complications were mostly device related and associated with anatomical limitations and surgical technique. Nevertheless, these complications are preventable and can be appropriately managed. From the literature and our experience, the technical aspects vary according to its application in different craniomaxillofacial regions. Preventing the potential complications contribute to the success of its application. This article also discussed the concept of Ihsan application in the medical field, to achieve the best of treatment in terms of delivery and technical preparation for the patients.
Maxillofacial injuries comprising hard tissue as well as soft tissue injuries can be associated with traumatic brain injuries due to the impact of forces transmitted through the head and neck. To date, the role of maxillofacial injury on brain injury has not been properly documented with some saying it has a protective function on the brain while others opposing this idea.