Clinics and Practice

Background: Ledderhose Disease, or plantar fibromatosis, is a fibroproliferative disorder affecting the plantar fascia with limited effective treatment options. Although hyaluronidase has a long history of clinical use, it has not been previously used for Ledderhose Disease. This study explores the use of combined hyaluronidase and triamcinolone acetonide enzymatic injections as a novel and promising technique for managing Ledderhose Disease. Methods: This paper investigates the use of combination therapy with hyaluronidase, triamcinolone acetonide, and lidocaine injections in three patients with Ledderhose Disease. Injection protocols, dosage, frequency, and patient outcomes are all discussed. Additionally, this study explores the underlying mechanisms of hyaluronidase action in Ledderhose Disease, shedding light on its potential to modulate fibrotic tissue and alleviate symptoms. Results: All three patients treated with a series of hyaluronidase, triamcinolone acetonide, and lidocaine anesthetic injections experienced either a significant reduction in or elimination of nodules and associated pain within 6 weeks after initial injection. Patients were asymptomatic at two years follow-up after injections. Conclusions: The combination of hyaluronidase and triamcinolone acetonide injections significantly decreased pain and softened fibromas faster than triamcinolone acetonide injection alone, as explored in previous studies. Large prospective studies are needed to further compare enzymatic injection therapies in the management of Ledderhose Disease.

In the original publication [...]

Background: Rotary instrument fracture during third molar extraction is rare but clinically relevant, presenting diagnostic and therapeutic challenges. Aim: This scoping review summarizes available evidence on bur breakage and displacement during third molar surgery, focusing on causes, clinical manifestations, and management strategies. Materials and Methods: A systematic search of PubMed, Virtual Health Library, and Google Scholar was conducted for studies published from January 2008 to March 2025 reporting rotary instrument fracture during third molar extraction. Extracted data were qualitatively analyzed. Results: Eight studies reporting eleven clinical cases were included. All fractures occurred during mandibular third molar extractions. Pain was the most frequent symptom (45%), followed by swelling (27%) and trismus (18%). Management varied from immediate surgical retrieval to conservative observation. Conclusions: Although uncommon, rotary bur fracture during third molar extraction requires preventive attention and accurate reporting. Adherence to manufacturer recommendations, single-use bur policies, and adequate irrigation should be considered. Prospective multicenter and mechanical studies are needed to establish standardized management protocols.