Advances in Oral and Maxillofacial Surgery最新文献

Introduction

Pierre Robin syndrome is a malformative sequence associating retrognathism, glossoptosis and a median cleft palate which is usually large. This poses the problem of its therapeutic management.

Purpose

To show the approach of the Stomatology and Maxillofacial Surgery Department of the Mohammed VI University Hospital in the management of cleft palate in Pierre Robin syndrome.

This was a retrospective study, covering 5 years, which allowed us to include 7 cases of cleft palate in Pierre Robin syndrome. Our study parameters were epidemiological, clinical, therapeutic and evolutionary.

Results

The average age of our patients, at the time of the 1st consultation, was 4 months. There was a slight male predominance with a sex ratio = 1.3. The patients presented a U-shaped cleft in 57.1% of cases, and a V-shaped cleft in 42.9% of cases. Three patients underwent a one-stage closure by velopalatoplasty using the Von Langenbeck technique. Four patients underwent a 2-stage closure, i.e., intravascular veloplasty in the first stage, followed by closure of the residual cleft palate in the second stage. The results were satisfactory. A palatal fistula was noted in 42.8% of cases, which was managed secondarily.

Conclusion

The management of cleft palate in Pierre Robin syndrome is a real challenge for the maxillofacial surgeon.

The diagnosis of Cleidocranial dysplasia is approached via clinical features, genetic testing, and imaging. CCD includes delayed or non-closure of cranial sutures the presence of bulging anterior fontanelle and multiple supernumerary teeth. We report two twin sisters presenting all CCD characteristics but surprisingly post-extraction of supernumerary teeth they both developed newly formed dental buds.

Inflammatory dentigerous cysts are rare and can present with diagnostic and management challenges. The management of an inflammatory dentigerous cyst should aim to preserve the permanent dentition whenever possible. This case report highlights conservative management which has resulted in a positive outcome for the patient. This alternative management arose due to parental preference and disruption to services caused by the coronavirus pandemic.

Objective

To describe the epidemiological, diagnostic and therapeutic aspects of odontogenic cervicofacial cellulitis in rural Togo, and more specifically in the town of Dapaong.

Method

This was a monocentric, retrospective, descriptive study conducted at the Dapaong regional hospital over 03 years from January 2019 to December 2021.

Results

A total of 103 cases were collected, representing an annual frequency of 34.33 cases per year. The mean age of the patients was 45.69 ± 17.49 years. We reported a male predominance, with a male/female sex ratio of 2.03. We had high exposure to risk factors for cervicofacial cellulitis (92.23%), with HIV infection predominating. Anti-inflammatory drugs and traditional therapy concerned 43.68% and 48.54% of our sample respectively. The average consultation time was 16.17 ± 7.42 days. Pain (100%) and swelling (84.46%) were the clinical signs most frequently encountered. Involvement was predominantly hemifacial, with diffuse cellulitis predominating (56.31%). The maxillary molars (38.83%) were the main site of infection. Resuscitation and triple antibiotic therapy concerned 23.30% of patients, and surgery 59.22%. The in-hospital mortality rate for odontogenic cervicofacial cellulitis in our study was 11.65%.

Conclusion

Although odontogenic cervicofacial cellulitis is uncommon in the town of Dapaong, it is associated with a delay in treatment and a high mortality rate.

The bilateral sagittal split osteotomy (BSSO) is the established workhorse in mandibular orthognathic surgery. Despite the frequency at which this procedure is performed, alterations in condylar position from the surgery remain a concern to the operating surgeon. Such changes in condylar positioning have long been associated with relapse. A systematic literature review was carried out to address the question: ‘condylar re-positioning devices in orthognathic surgery – is there a benefit to their use?'. As of yet there is no robust scientific evidence to suggest that these devices confer any clinical benefit over traditional manual re-positioning in orthognathic surgery cases. It would seem appropriate that future research focus on cost effective methods for intra-operative identification of a mal-positioned condyle with the aim of preventing later relapse.

Mandibular condyle and glenoid fossa fusion results in temporomandibular joint (TMJ) ankylosis.

Paediatric TMJ ankylosis has a negative impact on facial growth, resulting in micrognathia, dental malocclusions, and sometimes facial asymmetry, which leads to significant morbidity.

We present a case of a bilateral TMJ ankylosis with an infectious odontogenic origin.

Purpose

This review aimed to evaluate the current evidence on the effectiveness of bromelain in controlling postoperative pain, swelling, and trismus associated with third the molar surgery.

Results

The search strategy produced 26 articles. After reading the abstracts, 8 articles were excluded and the full-text articles in English of the remaining 18 studies were separately examined for eligibility by 2 authors, with 12 studies being excluded because they did not fit the inclusion criteria. Finally, 6 systematic reviews satisfied the criteria for inclusion and were processed for critical evaluation, with all the included studies reporting high quality evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation system.

Conclusions

Oral Bromelain has been shown to reduce postoperative pain, improve a patient's quality of life and reduce the need for postoperative analgesics after third molar surgery. However, oral bromelain have no effect in reducing postoperative trismus and oedema.

A mesiodens is a supernumerary tooth located in the premaxilla between the two central incisors. Although various complications attributed to mesiodens have been reported, oronasal fistula are rare. We encountered a 62-year-old male patient with a complaint of leakage of water into the nose over the past 1 year. A small fistula was observed in the middle of the hard palate. Computed tomography revealed two inverted impacted mesiodens with osteolytic changes extending from the oral cavity to the nasopalatine canal; thus, we diagnosed the patient with an oronasal fistula attributed to infection of the mesiodens. The two mesiodens were extracted under general anaesthesia and closure of the fistula was performed. No recurrence was observed at the 1 year follow up.

Purpose

Endoscopes are increasing the surgical spectrum for Oral and Maxillofacial Surgery. Naaj et al. quote that for third molars below the inferior dentoalveolar nerve (IDN), extra-oral removal is the best technique. The authors demonstrate that with endoscopic assistance, deeply impacted third molars can be removed intra-orally instead, without any complications. Endoscopes have demonstrated their usefulness in Oral and Maxillofacial surgery by aiding intra-oral repair of condylar fractures and submandibular gland removal; surgeries that are traditionally carried out with extra-oral access. The authors demonstrate how endoscopes have a place in minor oral surgery, particularly reducing the amount of bone removal needed to gain access to the surgical site.

Methods

The article reports on two case studies of lingually placed third molars lying below the IDN. They were removed with endoscope assisted lingual access. Surgical planning was done using CT/CBCT scanning. The authors also detail how neurosensory disturbance was avoided when raising a lingual flap.

Results

Wisdom teeth were successfully removed in all instances, whole, via lingual access. Patients had uneventful recovery and there were no cases of reported neurosensory disturbance.

Conclusion

The authors demonstrate that the use of an endoscope, CT/CBCT guided surgical planning and careful lingual retraction provides a safe alternative to extra-oral removal of deeply impacted third molars. The advantages are avoidance of post-operative scarring and the potential to operate in ambulatory care.