Asian Journal of Oral and Maxillofacial Surgery最新文献

Odontogenic keratocyst is one of the most aggressive odontogenic cyst due to its relatively high recurrence rate, fast growth, and its tendency to invade adjacent tissue. The aim of the present study is to analyze retrospectively the clinico-pathological characteristics of the 220 KCOTs cases in 181 and find the relationship among the various factors. And the following data were obtained: patient age ranged from 8 to 77 years with an average of 33.06 years. There were 111 male and 70 female patients. The mandibular angle and ascending ramus was the most frequent site of KCOTs. Swelling, the most presenting sign, was noted in 97 cases, followed by the pain, 85 cases, and 78 cases showed no presenting signs and symptoms. On radiologic findings, the primary KCOTs appeared as a unilocular in 59 cases or multilocular in 39 cases. The KCOTs can achieve the size of which may vary from 1.0 cm to 13.0 cm, and the mean size was 4.07 cm. The KCOTs were associated with the displacement of impacted teeth, the mandibular third molar; 47 cases, was the most frequent impacted teeth. Four patients (2.21%) were confirmed to be associated with nevoid basal cell carcinoma syndrome. Enucleation or curettage was the most common employed treatment modality (164 cases), followed by marsupialization or decompression (17 cases), and lateral decortication (13 cases). The recurrence rate was 10.78%. Most of the recurrences (21 cases) were found during the first 5 years after the first treatment for the KCOTs.

Meningiomas are usually benign tumors that originate from the meningothelial arachnoidal cells that are normally found in arachnoid villi of the meninges surrounding the brain and spinal cord. Rarely, these tumors are found extracranially, primarily in the head and neck region. A 14-year-old boy presented with a lesion in the left premolar area of his maxilla that appeared to be a buccal swelling. Computed tomography on bone window setting demonstrated an expansile mass with high density area in the left maxillary sinus. The anterior wall of the maxillary sinus was thinned by the expanding mass. Magnetic resonance imaging revealed the well-circumscribed lesion to be homogeneously and relatively hypointense on T2-weighted imaging. The lesion was weakly enhanced by gadolinium. Imaging study of the lesion revealed a mass with no intracranial extension and no metastasis nests. The mass was removed surgically, and pathological studies showed a fibrous meningioma. Five years have elapsed since this surgical excision, with no evidence of recurrence. Primary meningiomas of the paranasal sinuses may arise from heterotopic meningeal tissues displaced during closure of midline structures during fetal development. Symptoms include progressive exophthalmos, nasal obstruction, and epistaxis. No cases in the maxillary sinus presenting as buccal swelling have been described.

This report presents a case of maxillary osteosarcoma that was initially considered to be granulomatous epulis. A pedunculated mass was found on the buccal gingiva in the right maxillary molar region in a 45-year-old male patient at the initial examination. The clinical and pathological findings indicated that the mass was an epulis. However, a partial maxillectomy was performed under general anesthesia because the rapidly enlarged mass was clinically diagnosed as a maxillary tumor. A pathological examination of the resected specimen revealed that the maxillary tumor was osteosarcoma with a partially positive surgical stump. A total resection of the maxilla was performed under general anesthesia because recurrence was observed at 3 years postoperatively. Recurrence of a tumor that invaded into the cranial base was found at 2.5 years after reoperation despite three courses of adjuvant chemotherapy. Heavy particle radiotherapy was administered. Unfortunately, the patient died at 6 years and 2 months after the first operation due to tumor growth and a gradual worsening of his general condition. The experience from the present case suggested that an early diagnosis and an appropriate surgical therapy is very important for a satisfactory treatment outcomes of the jawbone osteosarcoma.

Le Fort III osteotomy is commonly indicated for the treatment of midface hypoplasia in Crouzon syndrome. However, if there is significant maxillary dentoalveolar protrusion associated with midface hypoplasia, the use of Le Fort III osteotomy alone for midface advancement will result in a poor facial aesthetic outcome. We have recently published a new treatment strategy of correcting this form of deformity by a combination of simultaneous Le Fort III and Le Fort I osteotomies for non-syndromic cases. We would like to report a case of 16-year-old girl presenting with Crouzon syndrome with orbital proptosis, which is caused by a combination of zygomatico-naso-maxillary hypoplasia, as well as maxillary and mandibular dento-alveolar hyperplasia. A combined orthognathic surgical procedure of simultaneous Le Fort III and Le Fort I osteotomies were performed to correct the midface hypoplasia and maxillary dentoalveolar protrusion, while the mandibular dentoalveolar hyperplasia was corrected by a mandibular sub-apical osteotomy. The operation went uneventfully with 10 mm advancement of the midface achieving eye protection, occlusal correction and significant facial aesthetic improvement. At 12 months post-operatively, the aesthetic and occlusal results were stable and the patient was very pleased with the clinical outcome. This case was performed in collaboration between the Oral Health Division, Ministry of Health Malaysia and the Faculty of Dentistry, The University of Hong Kong. The report illustrates the clinical outcomes of the simultaneous Le Fort III and Le Fort I osteotomies for the correction of midface hypoplasia and maxillary dentoalveolar protrusion presenting in a Crouzon syndrome patient.

Geniohyoid (GH) plays a vital role in maintaining upper airway patency and anomalies pertaining to this muscle should not be overlooked. In fact, a careful recognition of these variations is mandatory while planning any interventional procedure in the suprahyoid region. We report a rare muscular anomaly in the suprahyoid region of the neck. The significance of the stratification of the GH muscle could be related to the physiological role of the muscle of elevating the larynx during deglutition. Additionally, GH is an important muscle which is preferably preserved in procedures such as mandibulotomy. The presence of this unusual constitution of GH muscle could possibly alter the steps of this operational procedure. While performing routine educational dissection, the suprahyoid region displayed a rare bilaminar constitution of the Geniohyoid (GH) muscle bilaterally. The configuration of Geniohyoid muscle revealed stratification into two layers or lamina, superficial and deep. The attachments of the muscle were as usual and the deep lamina of GH was found to be in the same plane as Genioglossus muscle. The accessory muscles received innervation from the hypoglossal nerve.

This is the first reported case of an osteolipoma affecting the left lower lip of a 68-year-old Japanese man. It is important to be aware of lipomas, such in the present rare case, to avoid their misdiagnosis.

Objective

Various modalities of treatment for temporomandibular ankylosis have been undertaken from time to time. The aim of this study was to analyse the most successful treatment modality for the management of temporomandibular ankylosis and review their complications.

Study design

This clinical study of 791 patients of temporomandibular joint ankylosis, included 623 interposition arthroplasty with temporal fascia, 48 dermal fat, 29 auricular cartilage, 12 acrylic joint replacement, 11 silicon, 24 costochondral graft, 23 sternoclavicular graft, and 21 chondro-osseous iliac graft. These patients were evaluated with regard to type of ankylosis, pre and postoperative mouth opening, and associated complications.

Results

Complications like recurrence (4.80%), involvement of facial nerve (3.67%), anterior open bite (19.09%) and overgrowth of graft (0.5%) were observed in a follow up period ranging from 2 to 17 years.

Conclusion

Sternoclavicular graft reconstruction in children and dermal fat interposition arthroplasty in adults should be the treatment of choice for management of temporomandibular ankylosis.

A patient with Bernard–Soulier syndrome (BSS), characterized by extremely large platelets, thrombocytopenia and prolonged bleeding time underwent general anesthesia for platelet adhesion aberration. This patient has developed a refractoriness to platelet transfusion due to a frequent transfusion of platelets; however the operation was completed without abnormal bleeding by transfusing HLA-matched platelets during the procedure. BSS is a very rare syndrome so there are no well-defined protocols for the management of perioperative bleeding associated with this syndrome. In this report, we present the detail of the perioperative management for these patients with BSS who has a refractoriness to platelet transfusion.

The purpose of this article is to describe a case of ameloblastic fibroma (AF) with difficult treatment planning. In the present case, a 12-year-old girl with chief complaint of painless swelling on the right mandibular body was referred to our hospital. The biopsy of the lesion confirmed AF. Although it was a solid tumor, the tumor debulking surgery was applied with corresponding open decompression therapy. However, one month after the debulking surgery, the residual lesion had grown rapidly. Then she was treated by enucleation and repeated dredging with a rapid and sufficient bone formation. A conservative approach, including the dredging method appeared to be successful for the avoidance of a radical surgery in the present case.

In clinical practice, some patients complain of persistent discomfort or pain during or after root canal treatment. In cases wherein non-surgical retreatment is infeasible, the last available option that can be considered to save the tooth would be periradicular surgery or intentional replantation (IR). Since maxillary molars are anatomically close to the maxillary sinus, the apical surgery may perforate the floor of the maxillary sinus. On the other hand, with IR, tooth fracture may occur while extracting the tooth if the root is curved or if the buccal cortical bone is particularly thick. To help minimize such risk, we chose IR with partial osteotomy performed on the buccal side of the left maxillary first molar and extraction of both the alveolar bone and the tooth. Osteotomy enabled the tooth extraction without causing damages such as fracture to the roots and offered partial protection of the periodontal ligament. Here, we present a case wherein the root apex of a maxillary molar was physically close to the bottom of the maxillary sinus and the buccal cortical bone was thick. IR with partial osteotomy was successful in alleviating symptoms of persistent discomfort and pain.