Massive osteolysis is a rare, insidious, chronic disease characterized by progressive resorption of contiguous osseous structures. The etiology of this disease process is poorly understood and the management is a big dilemma. This is a rare presentation with less than 50 cases of involvement of maxillofacial region that have been reported in the literature. This presentation aims at presenting the differential diagnosis and an outline of possible management.
We report a case of mediastinal emphysema caused by the use of a dental laser device.
Case: A 64-year-old female who had pus retention on the right upper first premolar gum due to periodontitis was treated with an incision and drainage using a dental laser device (YAG laser) at a general dental clinic. Soon after the treatment, swelling on her cheek and neck on the right side was observed. A CT scan revealed massive emphysema extending to the face and neck, retropharynx and mediastinum. Antibiotics were administered prophylactically for several days. After 6 days from the onset, the patient's emphysema had resolved without any complications.
Congenital fusion of the mandible to maxilla can involve soft tissue (synechiae) or bone (syngnathia). Congenital synechiae has been widely reported, whereas congenital syngnathia is rare. Syngnathia severely limits mouth opening. To improve airway control and prevent feeding handicaps, surgical division of the bony fusion or breakdown of the adhesions is recommended within the first few days of life. We described an 8-year-old girl who had unilateral syngnathia with micromandible, reactive coronoid process hyperplasia, cleft palate and congenital corneal opacity. She first underwent surgical treatment to improve jaw function at the age of 8 years. Delayed surgery slightly improved restricted mouth opening.
We described a suspension techniques to correct zygomatic fractures using the external device. Our technique caused no scar formation, and both traction and fixation were possible. The device is easy to construct and cost-effective. Fractured segments can be readjusted, if necessary. Although our technique has a narrow indication range, it has definite advantages in the case of fractures such as type A fracture with maxillary buttress fractures.
We present a rare case of a malignant fibrous histiocytoma (MFH) arising in the mandible of a 74-year-old Japanese woman. Intraoral examination revealed a single ulcer in the right mandibular alveolar ridge at the molar region. Panoramic radiographs revealed ill-defined radiopaque, radiolucent area in the right molar region. Computed tomography demonstrated a mass with cortical bone destruction. The histological examination revealed numerous fibroblast-like spindle-shaped cells arranged in a fascicular pattern and scattered multinucleated and mononuclear cells with bizarre nuclei throughout the lesion. Moderate nuclear pleomorphism was evident with few mitotic cells. The immunohistochemical techniques proved positive for vimentin of all tumor cells and Ki-67 of about half of the tumor cells and negative for c-kit, CD34, smooth muscle actin, CD68, S100 protein, and Factor VIII of all tumor cells. The lesion was diagnosed as a MFH of storiform-pleomorphic type. After surgical removal of the lesion and the adjacent tissues, the patient was referred to a radiotherapist for continuation of treatment and remains well almost a year later.
In order to improve the scientific outcome for bone surgery including fracture healing and bone remodeling processes after correcting facial bone or surgical bone loss, this review focuses on the biophysiology of transforming growth factors (TGF) and bone morphogratic protein (BMP) in the bone remodeling system. Surgical techniques involving the oral maxillofacial skeleton have advanced mainly from experience and experimental models as in traumatology or oncological surgery.
Bone regeneration and calcification are performed at function balances for osteoblastic growth and osteoclastic resorption. Bone synthesis is mediated with differentiation of osteoprogenitor cells. This mechanism is concerned with various growth factors: i.e. TGF and BMP, and those associated factors, as growth differentiation factor 5 (GDF5), cartilage-derived morphologenetic protein (CDMP), noggin, chordin and connective tissue growth factor (CTGF). Except for TGF and BMP, the biological properties of other novel growth factors participating in bone forming activity have not been routinely introduced. The bone remodeling system is a complex phenomenon as well as varying growth factor system for osteoprogenitor target cells. The knowledge obtained from this review will benefit the healing processes and/or bone remodeling system following surgical procedures in the oral-maxillofacial area.
Osseous choristoma is a rare, benign lesion which usually develops in the tongue adjacent to the foramen caecum. This report presents a case occurring in the palatal region, as well as a review of the literature. A differential diagnosis of this condition from other bone-forming lesions of the soft tissue is also discussed.
Accidents at work can cause serious physical injuries and can occur as a result of poor attention, equipment failure or inappropriate use of machinery. This study presents data on work-related facial fractures and its associated injuries over an 11-year period.
A retrospective database of patients presenting to the Oral and Maxillofacial Surgery service at Christchurch Hospital during an 11-year period was reviewed. Variables examined included demographics, types of fractures, mode of injury, other associated injuries and treatment outcome.
A total of 55 patients were identified to have work-related facial fractures. Male accounted for 96% of all patients, with the 31–45 years old group accounting for 33% of patients. Construction workers accounted for 31% of all patients. Sixty seven percent of all fractures involved the mid-face and 28% involved the mandible. Most common mechanism of injuries was due to blow by falling objects. Sixty two percent of all patients required hospitalisation and 49% were treated surgically, with open reduction and internal fixation required in most of the cases.
Accidents at work place can result in serious facial injuries. Men with professions that involve high physical strain and use of machinery and tools are at higher risk. These injuries frequently require hospitalization and surgical treatment.
Burkitt's lymphoma is a malignant lymphoma of high malignancy grade and accounts for less than 1% of all cases of malignant lymphoma. Patients with malignant lymphoma in the oral and maxillofacial region including Burkitt's lymphoma, frequently present with gingival swelling, or a tumor mass/ulcers as the initial symptoms. We present an extremely rare case with bilateral mental nerve paralysis as the initial symptom without not only regional tumor but also brain and nose-pharyngeal area. This report indicates that the unexplained oral abnormalities such as inferior alveolar nerve hypoesthesia must be considered, potentially prodromal symptoms of Burkitt's lymphoma.
This study aimed to explore the risk factors of poor clinical outcome of visually guided irrigation (VGIR) in patients with chronic closed lock (CCL) of the temporomandibular joint (TMJ).
Sixty-one patients with unilateral CCL who underwent a VGIR were enrolled in this study. At the 3-month follow-up after VGIR, the 61 patients were divided into either the good outcome (g-) group (n = 37) or poor outcome (p-) group (n = 24), according to the clinical success criteria. Age, gender, duration of symptoms, preoperative painless range of mandibular motion (P-ROM), preoperative TMJ pain, muscle symptoms, MRI findings (the severity of bony change, disc deformity and joint effusion), and arthroscopic findings (the severity of osteoarthritic change, synovial lesion and fibrous adhesion) were selected as the candidates of prognostic factors for VGIR. Each factor was compared between the two groups. Moreover, multiple logistic regression analysis was performed.
The preoperative P-ROM of the p-group was significantly lower than that of the g-group. The severity of osteoarthritic change in the p-group was significantly greater than that of the g-group. Regarding the MRI findings, there were no significant differences between the two groups. The multivariate adjusted odds ratio showed that only a decreased preoperative P-ROM was significantly predictive for a poor clinical outcome of VGIR.
A pronounced decrease of preoperative P-ROM would be a significant risk factor for a poor clinical outcome of TMJ irrigation in patients with CCL.
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