Advances in Oral and Maxillofacial Surgery最新文献

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.

We report a case of a 47year old male who presented with a history of pain while chewing in the right masseter muscle, was diagnosed with Cysticercosis involving the right masseter muscle. The patient was prescribed Tab albendazole 400 mg (BD) for 4 weeks and Tab Prednisolone – 10 mg (TDS) for 2 weeks which lead to the complete resolution of the lesion.

The omohyoid muscle is a useful anatomical landmark during neck surgery. The superior belly delineates the inferior limit of a supra-omohyoid neck dissection. We report a rare variant seen during a level I-IV neck dissection surgery with a duplicate superior belly, that initially was confusing in establishing the inferior aspect of level III. We discuss the implications of this finding. A cadaveric and clinical study is in progress.

Introduction

Inflammatory odontogenic cysts are lesions that develop from the cellular remains of odontogenesis. They are lesions that may recur after incomplete surgical enucleation with a variable clinical appearance depending on the clinical form. These clinical variations could be explained by the biological behaviour of the lesion cells which can be explored by the study of the cell proliferation index (Ki67). This justifies the initiation of this work whose objective was to study the level of expression of Ki67 and to measure the index of proliferation in odontogenic inflammatory cysts.

Material and method

This was a cross-sectional study with an analytical aim on surgical parts of odontogenic inflammatory cysts over a period of 31 months in the odontostomatology department of the Hôpital Général Idrissa Pouye. The Ki67 immunohistochemistry study was performed on 3μ thick histological sections of paraffin-fixed tissue. The inclusion criteria were any surgical specimen of odontogenic inflammatory cyst that we could collect. The variables studied were sociodemographic, clinical and histopathological.

Results

Radiculo-dental cysts represented 80.5% of the surgical specimens collected and residual cysts 12.2%. The percentage of Ki67-labelled cells was greater than 15% in 80.5% of the odontogenic inflammatory cysts and less than 7% in 19.5% of the cases. In addition, intense labelling was noted in radiculo-dental cysts and weak labelling in the other clinical forms of inflammatory odontogenic cysts obtained. An association was noted between the percentage of Ki67 labelled cells and histological types (p-value <0.001); but also between the intensity of Ki67 labelling and histological types (p-value <0.001).

Conclusion

The cell proliferation index (Ki67) could be used as a prognostic biomarker in odontogenic inflammatory cysts.

Objective

The purpose of this study was to ascertain the correlation between COVID-19 infection and jaw osteonecrosis, along with the identification of risk factors that could be associated with the development of the condition. Another aim of our study is to establish whether maxillofacial osteonecrosis is an early or late complication seen in COVID-19 patients.

Material and method

This was a retrospective study conducted over a period of two years. Case records of patients with a history of severe COVID and steroid treatment who later developed jaw osteonecrosis were evaluated.

Result

13 patients with an age range from 8 years to 70 years were identified. Osteonecrosis was seen as late as 21 months after COVID-19. The majority of the cases involved maxilla, one case was of bi-jaw involvement, and one case presented with isolated mandibular involvement. 6 patients were diabetic and 11 patients gave a history of provocative dental treatment like extraction.

Conclusion

A triad of post-COVID coagulopathy, steroid administration, and a provocative dental treatment may contribute to jaw osteonecrosis which may be seen in patients without pre-existing systemic illness and may present as late as 21 months after COVID-19.

Introduction

Severe cervicofacial cellulitis are emergencies, mostly of odontogenic origin, and frequently observed in developing countries. Their management is still a challenge despite the improvement of the antibiotic therapy these last decades. We highlight our experience in the management of this life-threatening condition.

Material and methods

This was a descriptive and prospective study of all patients presenting with severe cervicofacial cellulitis between December 2020 and February 2021 in the odontostomatology department of the Garoua Regional Hospital (Cameroon). The data concerning demography (age, sex), clinical manifestations, treatment, and prognosis were analysed using SPSS version 20.0.

Results

45 cases of severe cervicofacial cellulitis were diagnosed, representing 13.76% of the total consultations. The female represented 55.55%. The mean age was 32.6 years. The main aetiology was odontogenic (93.33%). Clinical manifestations included swelling (100%), pain (100%), trismus (88.89%), dysphagia (53.33%), asthenia (35.56%), sepsis (4.44%). The main location involved was submandibular (75.56%). The overall severity score revealed the extremely high (24.44%), high (33.33%), and moderate (42.22%) grades. The antibiotic therapy was systematically administered. Short-course corticosteroids (46.67%), surgical debridement (88.89%), and etiological treatment (68.89%) were associated. Complications occurred in 13.33% of cases. The evolution was favourable in 95.56% of cases.

Conclusion

The severity of cervicofacial cellulitis can be assess with a proper recognition and evaluation of the clinical signs. This will allow the practician to better manage these conditions and to improves their prognosis.

The mandible is the second most fractured bone of the facial skeleton. The most common imaging modality for diagnosis are the Orthopantomogram (OPG) and posterior-anterior mandible (PAM) x-rays. This study was designed to develop a machine learning (ML) model for use to detect mandibular fractures on both OPG and PAM. 2000 consecutive incidences of orders for mandibular imaging were retrospectively collected, with 409 incidences of orders performed for the indication of trauma, and 117 incidences with fractures. These were used to train and validate the developed model. The best ML model achieved a precision of 81.9, recall of 71.9, mean Average Precision (mAP) @ 0.5 of 72.6 and F1-score of 76.5. Current research within the ML field on mandibular fractures is not standardised which makes it difficult to compare results across different datasets. ML in this research area requires standardisation and models require further development with heterogeneous and clinically relevant datasets to prove useful within the clinical environment.

Craniofacial osteosarcoma accounts for 10% of osteosarcoma malignancies, typically affecting the 4-5th decade of life, with the maxilla being the second-most common site.

We report a 58-year-old male, non-smoker, with a lump of his upper jaw which occasionally bled during mastication. Clinical examination revealed an exophytic mass in the upper left tuberosity of the maxilla and no lymphadenopathy, where initial differential diagnosis was squamous cell carcinoma.

Radiological investigations revealed a metabolically active left maxillary lesion with maxillary sinus destruction, representing primary malignancy. Histological analyses initially suggested a fibro-osseous lesion; further immunohistochemistry showed cytokeratin AE1/AE3/CK(MNF.116) positivity with 60% ki67 proliferation index; diagnostic of grade 2–3 osteosarcoma. Management included neoadjuvant chemotherapy prior to total maxillectomy and dental prosthetic rehabilitation.

We report a novel case of primary osteosarcoma of the maxilla in an adult. Osteosarcoma is challenging to diagnose and an important differential to consider where the mainstay of treatment is early invention.

This paper reports a case of Castleman disease. Rare parotid hyaline vascular Castleman disease with multiple hepatic cysts and kidney cancer. The patient underwent surgery and no recurrence was found during the 34-month follow-up period.