Oral and Maxillofacial Surgery Cases最新文献

Ameloblastoma is a rare epithelial odontogenic tumor of the oral cavity, representing only 1% of all oral tumors. Despite being a benign neoplasm, ameloblastomas are slow-growing, locally aggressive tumors that may infiltrate adjacent tissues, causing extensive tissue destruction. It usually presents as an asymptomatic swelling in the posterior region of the mandible. Ameloblastoma in non-tooth-bearing areas is very rare.

We present a case of peripheral ameloblastoma (PA) appearing as a solid mass in the temporal fossa. The lesion was initially diagnosed as a cystic lesion and hematoma, but further treatment with complete removal and histopathological analysis led to the diagnosis of PA.

Tumoral calcinosis (TC) refers to calcium salt deposition around large joints. It rarely affects the temporomandibular joint (TMJ), and only eight cases have been reported to date. We describe a case of TC in the left TMJ with resorption of the condyle and mandibular fossa. A 37-year-old woman complaining of malocclusion and a painless swelling around the left TMJ was referred to our hospital. The patient's medical history included Sjogren's syndrome and systemic sclerosis. Computed tomography and magnetic resonance imaging revealed calcification with a maximum diameter of 25 mm and resorption of the condyle and mandibular fossa. A clinical diagnosis of tophaceous pseudogout was made on the basis of these findings. The calcification was removed, and the TMJ was reconstructed under general anesthesia using a total TMJ replacement system. Pathological examination revealed TC. The patient was considered to have secondary TC based on the patient's medical history and results of additional blood tests. At six months post-operation, the patient had stable occlusion without TC recurrence.

A 64-year old male presented to our institution with painful ophthalmoplegia. The initial differential diagnosis included orbital apex disorders, such as orbital apex syndrome (OAS), cavernous sinus thrombosis (CST), and superior orbital fissure syndrome (SOFS). Ultimately, the diagnosis was acute invasive fungal rhinosinusitis (AIFRS) secondary to an odontogenic infection from carious teeth in the maxilla. Significant overlap exists between AIFRS and orbital apex disorders, making it prudent to include AIFRS in the differential diagnosis for painful ophthalmoplegia. The purpose of this review is to detail this specific patient's presentation and hospital course along with a brief review of AIFRS and orbital apex disorders with their distinguishing features.

Pleomorphic adenoma (PA) is a salivary gland tumour characterised microscopically by architectural rather than cellular pleomorphism. The neoplasm also has finger-like projections into the pseudocapsule, which clinically has attributed to the high recurrence rate associated with the neoplasm. Vascular and neural invasion have been reported and are regarded as atypical features of the neoplasm. Review of the literature suggests that invasion of bone without malignant transformation by the neoplasm is very rare.

A 28-year-old female was diagnosed with an invasive recurrent PA of the palate, which required en-bloc resection of the left maxilla. The computed tomography scan showed a homogeneous, well-defined, multilocular lesion which extended from the anterior to the posterior of the maxilla. The histological analysis did not report any malignant transformation of the lesion. Although bone erosion is a known feature of this lesion, bone invasion is atypical. This case represents a rare occurrence of an invasive recurrent pleomorphic adenoma.

Numb chin syndrome (NCS) has been described in the context of known malignancy or as a signal of disease recurrence; however, it is unusual to be the initial presenting symptom of malignancy. We offer a case report of an otherwise healthy 14-year old female who presented with NCS of seven months duration. Radiographic imaging showed a ill-defined “moth eaten” appearance of the mandible and incisional biopsy showed diffuse lymphocyte infiltrates. Immunohistologic staining performed was consistent with T-cell acute lymphoblastic leukemia/lymphoma (T-ALL), which was later confirmed with bone marrow aspirate. While traditionally the diagnosis of lymphoma was reserved only for bulky lesions with minimal disease of the peripheral blood and bone marrow, current trends have shifted to group lymphoblastic leukemia and lymphoma as a single disease process spectrum. After a review of the literature, no reports were identified of NCS as the only presenting symptom of T-ALL in a previously healthy child. We therefore propose an algorithm to guide clinicians in an accurate and timely diagnosis of this common pediatric malignancy.

Giant cell lesions of the maxillofacial region constitute a diverse group of lesions, which frequently affect the lower jaw, and are commonly detected at younger ages, in the second and third decades of life. They can be categorized as aggressive or non-aggressive lesions, mainly based on clinical behavior. Management is most commonly through surgical intervention. However, many patients consider surgery to be unfavorable due to the sacrifice of surrounding anatomic structures, potentially necessitating reconstruction procedures. Therefore, alternative modalities of conservative therapy have emerged. One method of alternative management is intralesional corticosteroid injections, which have been described with promising results. Here we report our experience with the treatment of a 56-year-old female patient, in whom a non-aggressive giant cell lesion was managed using intralesional steroid injections. This treatment resulted in total regression according to radiographic examinations.

In the head and neck, osteomas are the most common benign neoplasms of the nose and paranasal sinuses. They often form from the normal bone of the sinus cavities. The source of development of osteomas are unknown, though they are thought to arise from traumatic or infectious causes. Osteomas are often asymptomatic and detected incidentally, though larger osteomas may impart symptoms based on their mass effect. Whereas common within the nasal cavity and sinuses, osteomas arising from the external facial skeleton are exceedingly rare and not well described in the literature. Here we present a rare case of the diagnosis and surgical management of an osteoma of the zygoma.

With the increasing desire to beautify the skin and rejuvenate the face, today the use of hyaluronic acid as a filler in cosmetic procedures is a common and widely used among physicians because Hyaluronic acid (HA) is a relatively suitable substance for this purpose, but in some cases, it has adverse effects. Vascular involvement, followed by necrosis at the injection site, is a serious but rare complication. Of course, with careful injection and, most importantly, the speed of the operation at the beginning of the treatment process, if adverse effects are observed, these complications can be minimized.

Background

The challenge in surgical treatment for retro-pharyngeal lymph node (RPLN) metastasis is to safely and reliably reach the parapharyngeal space and ensure removal of lesions while preserving the surrounding vitally important structure. The transoral approach has the shortest reach to the lesion, but has a narrow field of view and a small working space. Although there have been some recent reports of transoral robotic surgery (TORS), we have performed transoral RPLN dissection using an endoscope that is extremely cost-effective and often used in otolaryngology. In this study, we report a technique and the usefulness of endoscopic video-assisted transoral dissection of RPLNs in head and neck cancer patients.

Methods

A case series of patients undergoing endoscopic video-assisted transoral RPLN dissection was conducted from April 2012 to March 2020. The surgical technique, local control and complications were examined.

Results

Six patients underwent transoral endoscopic video-assisted transoral dissection of RPLN. The pathology was squamous cell carcinoma (SCC) in 4 patients and papillary thyroid cancer (PTC) in two patients. No postoperative complication was observed. No local recurrence was seen.

Conclusion

Using an endoscope that otolaryngologists are accustomed to handling, endoscopic video-assisted transoral dissection of RPLN was performed safely and with a good field of view. The identification of the tumor localization by indocyanine green (ICG) fluorescence method was also effective. Compared to TORS, it costs less and is considered to be an effective technique that can be performed without the need for special equipment.