Oral and Maxillofacial Surgery Cases最新文献

Calcium pyrophosphate deposition (CPPD) is a condition where calcium pyrophosphate crystals cause arthritis. Its occurrence in the temporomandibular joint (TMJ) is sparingly reported in the literature. Non-surgical treatment modalities consist of non-steroidal anti-inflammatory drugs, colchicine, and intra-articular cortisone injection. In the TMJ, previous reports have described resection of affected joint with reconstruction. We present a case of an extensive CPPD lesion affecting the left TMJ requiring surgical resection and reconstruction with a custom made TMJ prosthesis alongside with a review of the existing literature.

Simple bone cysts (SBCs) are nonneoplastic intraosseous cavities without an epithelial lining, surrounded by bony walls and either empty or containing liquid and/or connective tissue: they were first described in 1929 as a distinct entity of disease. The characteristic that distinguishes SBCs from true cysts is the absence of epithelial lining, that allow us to regard SBCs as pseudocysts.

In the literature, SBCs have been referred to as solitary bone cysts, idiopathic bone cysts, unicameral cysts, traumatic bone cysts, hemorrhagic bone cysts, primary bone cysts, and extravasation cysts.

The pathogenesis of SBC remains uncertains. Radiographically, SBCs usually present as isolated unilocular radiolucencies with well-defined borders. When SBC extends to the interdental bone, the characteristic radiographic “scalloping effect” can be observed. The differential diagnosis includes apical periodontitis, odontogenic keratocyst, central giant cell granuloma, ameloblastoma, odontogenic myxoma, and central and neurogenic neoplasms.

Surgery (curettage) is the gold standard treatment as it allows both diagnosis and treatment by generation of a blood clot in the vacant cavity of SBCs: bone usually regenerates progressively within 6–12 months. Recurrence rate is almost negligible.

The aim of the present article is to present and discuss the diagnosis and management of a case of SBC.

Kaposi's sarcoma (KS) is an uncommon angioproliferative tumour. In its classic form, it rarely affects the head and neck. The etiologic agent in KS is Human Herpesvirus type-8 (HHV-8) infection. Populations in which KS occurs in the setting of immunocompetence tend to have high rates of seropositivity for HHV-8, including Mediterranean and Jewish people. Descriptions of KS in immunocompetent Polynesian individuals are almost non-existent. A reason for this may be the relative inaccessibility, both geographically and culturally, of indigenous peoples living in the Oceanic area. High rates of HHV-8 seropositivity have recently been reported in indigenous Melanesian populations of Vanuatu, New Caledonia and Papua New Guinea, a region neighbouring Polynesia. This paper is the first to describe classic KS isolated to the oral cavity in an immunocompetent patient of Polynesian ancestry and highlights the need for further research to clarify the risk of KS emerging in this region.

Background

The indications for using zygomatic implantsinvolve cases with severe resorption of the maxillary arch resulting in inadequate bone volume. The case report aims to review the HIV virus and current protocols, perioperative management and the surgical approach of zygomatic implant placement in combination with traditional implants in an HIV-positive patient.

Case report

A 59-year-old HIV positive male patient presents with atrophic maxillary and mandibular arches. Surgical placement of two zygomatic implants, two endosseous implants in the maxillary arch, and six endosseous implants in the mandibular arch. A reduction of a large palatal tori was also performed. The patient exhibited no complications after the surgical procedure. The hybrid prostheses were inserted post surgically without any issues.

Conclusion

Zygomatic implants can be an optimal treatment option for prosthetic rehabilitation in patients with atrophic maxilla for better functionality and aesthetics. This case demonstrates the perioperative work up and placement of zygomatic implants in a medically stable HIV-positive patient with no adverse effects five months post-operation. Various surgical approaches may be utilized with excellent patient acceptance and predictable outcomes.

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse during sleep. Since FDA approval in 2014, INSPIRE hypoglossal nerve stimulators have been used for the treatment of moderate to severe OSA in patients who are unable to use CPAP. In this case report we discuss malfunction of a hypoglossal nerve stimulator due to rotational manipulation of the implanted device that is patient generated. This phenomenon is called Twiddler's Syndrome and has been demonstrated with other implantable medical devices. We review risk factors associated with Twiddler's syndrome, and strategies for mitigating risk of occurrence.

The epithelial-myoepithelial carcinoma (EMC) is a rare neoplasm of the salivary glands with an incidence <1% of all cancers affecting them. It commonly affects the parotid gland and less frequently the submandibular gland and minor salivary glands. EMC is a rare low-grade tumor characterized biphasic tubular structure composed by an internal layer of luminal ductal cells surrounded by clear cells of myoepithelial origin. The patient had good prognostic factors determined in previous studies, and achieved complete treatment-response. Further accumulation of cases and long-term follow-up data are needed to elucidate the pathophysiology and prognosis of epithelial-myoepithelial carcinoma.

Familial dysautonomia is a rare disease that impairs the development of sensory nerves, afferent autonomic nerves, and afferent baroreflex pathways. This ultimately results in decreased pain receptors, decreased thermal sensation, blood pressure instability, dysphagia, optic neuropathy, and gait ataxia. The authors are documenting a case of a familial dysautonomia patient who suffered a pathological fracture of the left mandible approximately 4 months after undergoing routine third molar surgery. Due to the patient's inability to perceive pain and lack proprioception, this fracture went undiagnosed until facial swelling was visible. Familial dysautonomia patients require special consideration regarding anesthesia, surgery, and postoperative follow up.

This technical note describes an innovation that addresses a clinical problem in iatrogenic inferior alveolar nerve (IAN) repair. The options for IAN exposure (Miloro, 1995) are less than ideal since they offer limited access and visibility and/or the exposure itself has a risk of inducing iatrogenic IAN injury. This technical note offers the option to perform IAN exposure via a unilateral sagittal split osteotomy (SSO). There are inherent risks of mild transient IAN paresthesia, malocclusion, bad splits, and the additional cost of rigid fixation hardware (Peleg et al., 2021). The significance of this technique is that it permits wide access for IAN reconstruction in cases where the IAN injury is in the posterior mandible (eg. due to mandibular third molar removal) where another option for access is limited. This technique will improve patient care by facilitating IAN exposure and repair. There should be no challenges or delays to implementing this innovation for surgeons who perform orthognathic surgery and nerve repair.

This case report presents a rare but significant complication of abducens nerve palsy following Maxillary Le Fort I osteotomy. The patient, who underwent the procedure for trans palatal distraction indication, experienced left-sided abducens nerve palsy, characterized by the inability to abduct the ipsilateral eye. Undesired fracture patterns can extend to neighbouring structures. The report discusses the management strategies employed and the outcome of this specific complication. By sharing this case, it aims to increase awareness of the potential risks associated with Maxillary Le Fort I osteotomy and provide insights for optimizing surgical outcomes and improving patient safety.