Khalij-Libya Journal of Dental and Medical Research

Early versus Interval Laparoscopic Appendectomy for Appendicular Abscess: A Prospective Randomized Comparative Study

Fathi Asnini, Faraj Aljali — Wed, 08 Apr 2026 00:00:00 +0000

The optimal timing for laparoscopic surgery in patients presenting with an appendicular abscess remains controversial. Management strategies include immediate laparoscopic drainage and appendectomy versus initial conservative treatment with antibiotics, with or without percutaneous drainage (PCD), followed by delayed interval appendectomy. This study aimed to compare early versus delayed laparoscopic intervention in terms of technical difficulty, safety, and postoperative outcomes. This prospective randomized trial included 50 patients diagnosed with appendicular abscess, equally allocated into two groups: the Early Laparoscopic Group (ELG, n=25), who underwent immediate laparoscopic drainage and appendectomy, and the Delayed Laparoscopic Group (DLG, n=25), who received initial conservative management followed by interval laparoscopic appendectomy after 6–8 weeks. The primary outcome was postoperative complications, including fecal fistula and intra-abdominal collections. Secondary outcomes included operative time (min), hospital stay, conversion rate, and overall treatment success. Baseline demographic, clinical, and radiological characteristics were comparable between the groups. The mean operative time was significantly longer in the ELG (105.4 ± 18.7 min) compared to the DLG (68.2 ± 15.3 min; P<0.001). Conversion to open surgery occurred more frequently in the ELG (16%) compared to the DLG (4%), although this difference was not statistically significant (P=0.35). The total hospital stays over the entire treatment period showed a trend toward being shorter in the ELG (6.1 ± 2.1 days) compared to the DLG (8.5 ± 3.4 days), although this did not reach statistical significance (P=0.06). Postoperative fecal fistula occurred in 2 patients (8%) in the ELG and in none of the patients in the DLG (P=0.49). During the waiting period, 2 patients (8%) in the DLG developed recurrent collections, both managed conservatively, while no postoperative collections were observed in the ELG. Additionally, 4 patients (16%) in the DLG required readmission or unplanned intervention prior to scheduled surgery. Both early and delayed laparoscopic approaches are viable options for managing appendicular abscess. Early intervention offers a single-stage treatment and eliminates the risk of recurrence during the waiting period, but is associated with longer operative time and a tendency toward higher postoperative morbidity. Delayed laparoscopic appendectomy is technically less demanding but requires an initial conservative phase, with a risk of treatment failure and the need for multiple hospital admissions. Careful patient selection and shared decision-making remain essential.

Obstetric and Perinatal Outcomes in Pregnancies Complicated by Placenta Previa and Placental Abruption

Khiria benibrahim, Noura Elawam — Wed, 15 Apr 2026 00:00:00 +0000

Antepartum hemorrhage is a grave and potentially life-threatening condition and a major cause of both maternal and fetal mortality. The study aims to compare the fetal and maternal outcomes of patients with placental abruption and placental praevia. This was a comparative retrospective case series study conducted in the University Hospital, Tripoli/Libya, during the year 2025. Seventy patients (35 with placenta previa and 35 with placental abruption) who were diagnosed by ultrasound were randomly selected for the study. The following data were obtained from the files: the age, gravidity, parity, history of previous abortion, history of bleeding, maternal outcome, mode of delivery, and fetal outcome. The mean age of the previa group was 28.4 years, and the mean of the abruption group was 26.7 years. Regarding the past obstetric history, the present study showed no significant differences between the two groups in terms of gravidity, parity, and previous abortion. Regarding the bleeding in previous pregnancies, about 5.7% of both groups had APH. PPH were as following 5.7% of the previa group and 11.4% of the abruption group. Only 1 case of the previa group had intrapartum bleeding. about 5.7% of the previa group had hypertension, and about 42.8% of the abruption group had hypertension. Only the abruption group had diabetes, with a percentage of 22.9%. PROM was higher in the abruption group (25.7%) than in the previa group (5.7%), while anemia was higher in the previa group (48.6%) than in the abruption group (28.6%). Regarding fetal outcome, the result showed the following: 2 cases (5.7%) of the previa group died compared to 13 cases (37.1%) of the abruption group. About 54.3% of the previa group neonates needed resuscitation, and about 85.7% of the abruption group needed resuscitation. Nursery admission was almost the same between the two groups (42.9% in the previa group and 40% in the abruption group). About 20% of both groups had respiratory problems. Prematurity was seen in 42.9% of the previa group versus 54.3% of the abruption group. Despite similarities, some patient characteristics and outcomes in APH due to placenta praevia compared to abruptio placenta differ. Abruptio placentae was associated with younger age, hypertension, diabetes, PROM, prematurity, fetal death, and neonatal resuscitation. Placenta previa was associated with older age, anemia, and nursery admission.

Mouth Breathing Revisited: A Functional Disorder Linking Airway Physiology, Craniofacial Development, and Clinical Management

Ahmed Abulwefa, Khalid Benelhaj — Wed, 15 Apr 2026 00:00:00 +0000

Mouth breathing (MB) is a prevalent breathing pattern observed in both pediatric and adult populations. Although often regarded as a benign habit, growing evidence indicates that chronic MB represents a maladaptive functional disturbance with significant systemic and oral health implications. This narrative review synthesizes current evidence on the pathophysiology of MB, its effects on craniofacial development and orofacial function, and contemporary approaches to diagnosis and management, while highlighting important regional gaps in the literature. A comprehensive literature search was conducted across major electronic databases, including PubMed, Scopus, and Web of Science. To enhance retrieval sensitivity and ensure broader coverage, supplementary searches were performed using Google Scholar, alongside manual screening of reference lists of relevant articles. Available evidence consistently associates chronic MB with impaired nasal breathing, altered orofacial muscle function, characteristic craniofacial changes, and functional disturbances. It is also associated with sleep-disordered breathing and reduced oral health-related quality of life. Emerging evidence further links it to temporomandibular joint dysfunction and cervical muscle impairment, likely mediated by postural adaptation and altered neuromuscular coordination. Epidemiological and functional data from regions such as Libya remain limited, with existing research predominantly focused on structural dental outcomes rather than airway- related determinants. MB should be recognized as a modifiable functional disorder with multisystem effects. Standardized diagnostic criteria, longitudinal studies, and region-specific epidemiological investigations, particularly in underrepresented settings, are essential to advance evidence-based and contextually relevant clinical practice.

Impact of the Articular Angle on Skeletal Class II Division 1 Malocclusion in Libyan Patients: A Retrospective Cephalometric Analysis

Ahmed Benomran — Wed, 22 Apr 2026 00:00:00 +0000

The articular angle (S-Ar-Go) is one of the important cephalometric parameters influencing mandibular growth direction, rotation, and overall skeletal morphology. This study aims to assess the relationship between the articular angle and Class II Division 1 malocclusion in Libyan patients, evaluating its role in mandibular retrusion and skeletal disharmony. A total of 116 lateral cephalometric radiographs of Libyan white population patients diagnosed with Class II Division 1 malocclusion (SNA≥ 4) and proclined upper incisors, i.e., overjet > 3 mm) were analyzed using Dr. Ceph software. Measurements included the articular angle (S-Ar-Go), ANB angle, SNB angle, and mandibular plane angle (SN-MP). Statistical analysis was performed using SPSS 12.0 software, employing Pearson correlation analysis and independent t-tests to determine the significance of articular angle variations. A significantly larger articular angle was observed in Class II Division 1 Libyan patients compared to normal Libyan cephalometric values (p < 0.01). The articular angle exhibited a strong positive correlation with ANB (r = 0.312, p = 0.001) and a negative correlation with SNB (r = -0.285, p = 0.002). Additionally, increased articular angles were associated with clockwise mandibular rotation and a steeper mandibular plane. This study confirms that an increased articular angle contributes to skeletal Class II malocclusion by influencing mandibular growth and posterior positioning of the mandible. The findings emphasize the necessity of considering the articular angle in cephalometric diagnosis and treatment planning, particularly in cases requiring orthopedic interventions in growing patients or camouflaging or orthognathic surgery of non-growing patients.