Oral and Maxillofacial Surgery Cases最新文献_第3页

The trinity of chronic kidney failure, hyperparathyroidism, and brown tumors: a case report 慢性肾衰竭、甲状旁腺功能亢进和棕色肿瘤三位一体：1例报告

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-08-22 DOI: 10.1016/j.omsc.2025.100417

Alamira haya Salloum , Nayar Khadro , Iyad Ali , Mounzer Assad , Zuheir Alshehabi

Introduction

Chronic kidney disease (CKD) is an irreversible progressive glomerular disease, and it can cause many complications like osteodystrophy, hyperparathyroidism (HPT), or bone lesions such as Brown Tumors (BT)

BTs are rare slow-growing lesions in skeletal and facial bones and are benign.

This paper describes a patient with tertiary hyperparathyroidism (THPT) and CKD-MBD who developed a large maxillary BT.

Case presentation

A 28-year-old male presented with swelling in the maxillary bone caused by secondary hyperparathyroidism (SHPT) after 14 years of chronic kidney disease (CKD). Radiological examinations confirmed the presence of a bone lesion localized to the maxillary bone, indicating a tumor, followed by histological tests confirmed the tumor was a brown tumor and the role of CKD and SHPT hypothesis involvement. The tumor was treated surgically after controlling the other underlying conditions.

Discussion

The impaired kidney function in Chronic kidney disease (CKD) leads to vitamin D deficiency and abnormal calcium and phosphorus levels, which stimulate the parathyroid glands to overproduce parathyroid hormone (PTH), and alteration in bone resorption and formation leading to bone lesions like BTs.

The diagnosis of brown Tumors is quite challenging and usually requires a combination of clinical and laboratory examination with imaging.

The cornerstone in treating BTs is managing the underlying HPT, which may involve medication, surgery, or both.

Conclusion

Brown Tumors are a late complication of hyperparathyroidism and chronic kidney disease. A thorough medical history is essential for early diagnosis and appropriate treatment of BTs.

慢性肾脏疾病（CKD）是一种不可逆的进行性肾小球疾病，它可以引起许多并发症，如骨营养不良、甲状旁腺功能亢进（HPT）或骨病变，如棕色肿瘤（BT）， BT是骨骼和面部骨骼中罕见的缓慢生长病变，是良性的。本文报告一位患有慢性肾脏疾病（CKD） 14年后继发性甲状旁腺功能亢进症（SHPT）的28岁男性患者，上颌骨肿胀。影像学检查证实上颌骨存在骨病变，提示肿瘤，随后组织学检查证实肿瘤为棕色肿瘤，假设CKD和SHPT的作用涉及。在控制了其他基础条件后，对肿瘤进行了手术治疗。慢性肾脏疾病（CKD）的肾功能受损导致维生素D缺乏和钙磷水平异常，从而刺激甲状旁腺过量产生甲状旁腺激素（PTH），改变骨吸收和形成，导致骨病变，如BTs。棕色肿瘤的诊断相当具有挑战性，通常需要结合临床和实验室检查以及影像学检查。治疗bt的基石是控制潜在的HPT，这可能涉及药物、手术或两者兼而有之。结论褐色肿瘤是甲状旁腺功能亢进和慢性肾脏疾病的晚期并发症。全面的病史对于早期诊断和适当治疗bt至关重要。

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引用次数: 0

The interplay of soft tissue and osseous structures in bifid mandibular condyle: Implications for diagnosis and treatment. Case series and literature review 软组织和骨性结构在下颌髁的相互作用：对诊断和治疗的意义。病例系列和文献回顾

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-08-07 DOI: 10.1016/j.omsc.2025.100415

Gustavo Andres Grimaldi Finol , Alaa Abdulsattar Kadhim Al-Taie , Renan Elsadig Ibrahem Aadam , Ismail Farag , Abdul-Aziz ALaqeeli

Bifid mandibular condyle (BMC) is a rare developmental or acquired anomaly of the temporomandibular joint (TMJ), characterized by the presence of a duplicated condylar head. Although often asymptomatic and discovered incidentally on imaging, BMC can be associated with TMJ dysfunction, facial asymmetry, and a history of trauma or developmental disturbances. The clinical significance of BMC remains poorly understood, with controversies surrounding its etiology, classification, and management. This article presents a comprehensive literature review on the current understanding of BMC, supported by the presentation of a unique clinical case involving a symptomatic patient diagnosed through advanced imaging modalities. The diagnostic process, clinical presentation, and treatment approach are detailed to highlight the role of thorough evaluation and multidisciplinary management. Our findings suggest that while conservative management remains the mainstay in asymptomatic cases, individualized approaches are essential when functional disturbances are present. Further studies are warranted to clarify long-term outcomes and to standardize diagnostic and therapeutic protocols for BMC within maxillofacial practice.

双裂下颌髁（BMC）是一种罕见的发育或获得性颞下颌关节（TMJ）异常，其特征是存在重复的髁头。虽然BMC通常无症状且在影像学上偶然发现，但它可能与颞下颌关节功能障碍、面部不对称、创伤史或发育障碍有关。BMC的临床意义仍然知之甚少，围绕其病因、分类和管理存在争议。本文介绍了一个独特的临床病例，该病例涉及一位通过先进的成像方式诊断出有症状的患者，并对目前对BMC的理解进行了全面的文献回顾。诊断过程，临床表现和治疗方法详细强调全面评估和多学科管理的作用。我们的研究结果表明，虽然保守治疗仍然是无症状病例的主流，但当存在功能障碍时，个性化治疗是必不可少的。进一步的研究是必要的，以澄清长期结果和标准化的诊断和治疗方案BMC在颌面外科实践。

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引用次数: 0

Evaluation of the effectiveness of anterior segmental maxillary osteotomy in management of anterior vertical maxillary excess associated with gummy smile: A clinical study 上颌前节段截骨术治疗上颌前垂直过度伴粘笑的临床研究

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-08-05 DOI: 10.1016/j.omsc.2025.100414

Mohammad Kouja, Abdul Karim Khalil

To evaluate the effectiveness of anterior segmental maxillary osteotomy in improving The amount of gingival exposure (above incisors and above canines) and the measurement of the nasolabial angle and increasing patient satisfaction in cases of excessive vertical growth of the upper jaw associated with a gummy smile.

Materials and methods

10 female patients, aged 20–34 years, were diagnosed with anterior vertical maxillary excess combined with a gummy smile. They underwent anterior segmental maxillary osteotomy using digital three-dimensional planning. Gingival exposure above the incisors and canines and the nasolabial angle were measured. Patient satisfaction was assessed using a numerical scale from 1 to 5 six months post-surgery.

Results

The findings demonstrated a statistically significant reduction in gingival exposure (from 7.00 mm to 1.20 mm above incisors, with an 97.14 % improvement) and (from 6.30 mm to 1.40 mm, with a 93.65 % improvement).And nasolabial angle(from 84.24° to 98.77° with 92.20 %).The average patient satisfaction score was 4.70 out of 5, with a low standard deviation (0.48), indicating a high level of satisfaction consistency among the patients.

Conclusion

Anterior segmental maxillary osteotomy is an effective and safe technique for improving gingival exposure over the maxillary incisors and canines, optimizing the nasolabial angle, and enhancing patient satisfaction in cases of excessive vertical maxillary growth associated with a gummy smile, particularly when performed with digital planning.

评价上颌前节段截骨术对提高上颌垂直生长过度伴粘笑患者牙龈暴露量（门牙上和犬齿上）和鼻唇角测量的效果，提高患者满意度。材料与方法10例女性患者，年龄20 ~ 34岁，诊断为上颌前垂直增生合并粘牙。他们采用数字三维规划进行上颌前段截骨术。测量门齿和犬齿以上牙龈暴露量和鼻唇角。术后1 - 6个月采用数值量表评估患者满意度。结果龈外露（从门牙以上7.00 mm减少到1.20 mm，改善97.14%）和（从6.30 mm减少到1.40 mm，改善93.65%）均有统计学意义。鼻唇角（84.24°~ 98.77°）占92.20%。患者满意度平均得分为4.70分（满分5分），标准差较低（0.48分），表明患者满意度一致性较高。结论上颌前节段截骨术是一种安全有效的方法，可以改善上颌切牙和犬齿的牙龈暴露，优化鼻唇角，提高上颌垂直生长过度伴粘笑患者的满意度，特别是在数字计划下。

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引用次数: 0

Desmoplastic melanoma of the lower lip: A case report in an 82-year-old male 下唇的纤维组织增生黑色素瘤：一名82岁男性病例报告

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-07-16 DOI: 10.1016/j.omsc.2025.100413

Braden S. Bybee , Robert S. Julian , Brian M. Woo , Adnan Mubasher

This case report details the diagnosis and management of desmoplastic melanoma (DM) in an 82-year-old male presenting lower lip mass. DM is a rare, aggressive form of melanoma characterized by spindle-shaped cells within a dense fibrous stroma, often making diagnosis challenging due to its amelanotic and indurated nature. The patient presented with a 2cm × 2cm mass. After biopsy, the lesion was confirmed as DM with a Breslow thickness of 5.1mm, indicating advanced disease.

The patient underwent wide local excision with reconstructive surgery, partial parotidectomy, and selective neck dissection. Postoperatively, the lesion was re-excised to achieve negative margins. Immunotherapy with Pembrolizumab was initiated due to the stage IIB classification. The patient declined adjuvant radiation therapy but has shown no signs of recurrence on a follow-up PET scan nine months later.

This case highlights the diagnostic challenges of DM, especially on the lip, and underscores the importance of early biopsy in atypical lesions. Achieving clear surgical margins is crucial for improving outcomes, as local recurrence is a significant concern. Intraoperatively, frozen sections are not routinely performed on desmoplastic melanoma due to lack of diagnostic value and high rate of false negative. Permanent H&E sections with indicated staining can take 1–3 days to obtain results. The multidisciplinary approach, involving surgery, oncology, and radiation therapy, remains essential for optimal patient management. Although the role of adjuvant therapies is still debated, this case contributes to growing evidence suggesting the benefit of adjuvant treatments in reducing local recurrence and improving prognosis.

本病例报告详细介绍了一名82岁男性出现下唇肿块的结缔组织增生黑色素瘤（DM）的诊断和治疗。糖尿病是一种罕见的侵袭性黑色素瘤，其特征是致密纤维间质内的梭形细胞，由于其无色素变性和硬化的性质，通常使诊断具有挑战性。患者表现为2cm × 2cm的肿块。活检证实病变为DM， Breslow厚度5.1mm，提示病情进展。患者接受了广泛的局部切除和重建手术，部分腮腺切除术和选择性颈部清扫术。术后，病变被再次切除以达到阴性边缘。Pembrolizumab的免疫治疗是由于IIB期的分类。患者拒绝了辅助放射治疗，但在9个月后的随访PET扫描中没有显示复发迹象。本病例强调了糖尿病的诊断挑战，特别是在唇部，并强调了非典型病变早期活检的重要性。由于局部复发是一个重要的问题，因此获得清晰的手术切缘对改善预后至关重要。术中，由于缺乏诊断价值和假阴性率高，冷冻切片不常用于结缔组织增生黑色素瘤。有指示染色的永久性H&；E切片需要1-3天才能得到结果。多学科的方法，包括外科，肿瘤学和放射治疗，仍然是优化患者管理的必要条件。尽管辅助治疗的作用仍有争议，但该病例有助于越来越多的证据表明辅助治疗在减少局部复发和改善预后方面的益处。

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引用次数: 0

Angina bullosa hemorrhagica: A case report and review of the literature 大疱性出血性心绞痛1例报告及文献复习

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-07-12 DOI: 10.1016/j.omsc.2025.100412

Hassan El-Awour , Kinda Allaham , Mohammed Inam Ullah Khan

Here we present a case of Angina Bullosa Hemorrhagica (ABH) and review the literature highlighting its features, differentiation diagnosis from similar lesions, management considerations, and treatment options. Furthermore, we present a treatment algorithm for managing cases of this rare disorder. ABH lesions commonly manifest on the palate, tongue, buccal mucosa, lips, the floor of the mouth, and uvula. ABH range in size, from 4 to 30 mm in diameter. ABH lesions are generally self-limiting and resolve within a few days without scarring. Management recommendations may include supportive therapy for small lesions, incision for large bulla and continued palliative therapy using mouthrinses and analgesics. Though, ABH is a rare disorder, general dental practitioners ought to be aware of it. This report provides guidance on diagnosis, management and investigations in hopes to avoid ill-informed or unnecessary treatments.

在此，我们报告一例大疱性出血性心绞痛（ABH），并回顾文献，强调其特征，与类似病变的鉴别诊断，管理注意事项和治疗方案。此外，我们提出了一种治疗算法来管理这种罕见疾病的病例。ABH病变通常表现在上颚、舌头、颊粘膜、嘴唇、口腔底和小舌。ABH的尺寸范围，从直径4到30毫米。ABH病变通常是自限性的，在几天内消退，不会留下疤痕。治疗建议包括对小病变的支持治疗，对大球囊的切开治疗和使用止疼药和止痛药的持续姑息治疗。虽然，ABH是一种罕见的疾病，普通牙科医生应该意识到这一点。本报告提供了诊断、管理和调查方面的指导，希望能避免不了解情况或不必要的治疗。

引用次数: 0

Tumor Transformation: Case of conversion of Ossifying Fibroma to Osteosarcoma post-excision in a young male 肿瘤转化：一例年轻男性骨化纤维瘤切除术后转化为骨肉瘤

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-07-10 DOI: 10.1016/j.omsc.2025.100409

Sagar Rane, Nitin Bhola, Chetan Gupta

Ossifying fibroma (OF) is a benign fibro-osseous tumor characterized by slow growth and a low recurrence risk, primarily affecting the mandible in young females. Although OF is typically non-invasive, rare cases demonstrate locally aggressive behavior, requiring surgical resection. Post-surgical transformation of into osteosarcoma, a rare malignancy with a prevalence of 0.7 per million in the jaw, is exceptionally uncommon. This report presents a rare case of a 28-year-old male initially diagnosed with ossifying fibroma, managed surgically through excision and reconstruction with an iliac crest graft. Despite achieving negative margins, the lesion underwent malignant transformation into fibroblastic osteosarcoma within a month, presenting diagnostic and therapeutic challenges.

The malignant transformation was confirmed through histopathological and immunohistochemical evaluations, revealing a high Ki-67 labeling index (60 %), indicative of aggressive tumor behavior. Following multidisciplinary tumor board discussions, the patient underwent extensive surgical management, including composite resection, segmental mandibulectomy, neck dissection, and microvascular reconstruction with a free fibula osteocutaneous flap. Despite its rarity, this case highlights the need for vigilant follow-up and comprehensive diagnostic workups for recurrent or progressive lesions post-OF resection.

This report contributes to the limited literature on malignant transformation in fibro-osseous lesions, emphasizing the importance of differentiating benign conditions from low-grade malignancies and discussing the role of surgical intervention in such transformations. Further research is required to elucidate the mechanisms of transformation, optimize management strategies, and improve outcomes for patients with similar rare pathologies.

骨化纤维瘤（OF）是一种生长缓慢、复发风险低的良性纤维骨肿瘤，主要影响年轻女性的下颌骨。虽然OF通常是非侵入性的，但很少有病例表现出局部侵袭性行为，需要手术切除。骨肉瘤是一种罕见的恶性肿瘤，在颌骨中发病率为百万分之0.7，非常罕见。本文报告一例罕见的28岁男性患者，最初诊断为骨化性纤维瘤，通过手术切除和髂骨移植重建。尽管边缘呈阴性，但病变在一个月内恶性转化为纤维母细胞骨肉瘤，给诊断和治疗带来了挑战。通过组织病理学和免疫组化评价证实了恶性转化，显示Ki-67标记指数高（60%），表明肿瘤具有侵袭性行为。在多学科肿瘤委员会讨论后，患者接受了广泛的手术治疗，包括复合切除术、下颌骨节段性切除术、颈部剥离术和腓骨骨皮皮瓣重建微血管。尽管罕见，该病例强调了对肿瘤切除术后复发或进展性病变的警惕随访和全面诊断的必要性。本报告补充了有限的关于纤维骨病变恶性转化的文献，强调了区分良性和低级别恶性肿瘤的重要性，并讨论了手术干预在这种转化中的作用。需要进一步的研究来阐明转化机制，优化管理策略，改善类似罕见病理患者的预后。

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引用次数: 0

Enhanced fixation techniques in orthognathic surgery for improved nasal aesthetics 在正颌手术中增强固定技术以改善鼻美观

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-07-07 DOI: 10.1016/j.omsc.2025.100410

Flávio Fidêncio de Lima , Maria Carolina de Sousa Melo , Thamyryz Rafaela Almeida Simões , David Fischer , Luiz Carlos Magno Filho

引用次数: 0

Primary sclerosing fibroinflammatory pseudotumor of the maxillary sinus misdiagnosed as migraine: A case report 上颌窦原发性硬化性纤维炎性假瘤误诊为偏头痛1例

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-07-05 DOI: 10.1016/j.omsc.2025.100411

Safwan Salih, Sadeq Qanah, Fadi Nahhab

The head and neck region is a complex anatomical area where overlapping structures and nonspecific symptoms often make accurate diagnosis challenging. Facial pain, in particular, is a common yet ambiguous symptom frequently attributed to prevalent conditions like migraine, which can delay recognition of less common but clinically significant diseases. One such condition is Primary Sclerosing Fibroinflammatory Pseudotumor—a rare, benign lesion that can mimic malignancy both clinically and radiologically.We present the case of an 18-year-old female with chronic facial pain and globe displacement, misdiagnosed as migraine for four years. Imaging revealed a mass in the maxillary sinus with bone erosion and orbital involvement. A core needle biopsy was inconclusive, and definitive diagnosis was achieved only after surgical excision. Histopathological and immunohistochemical analysis confirmed Primary Sclerosing Fibroinflammatory Pseudotumor. The patient experienced substantial clinical improvement following combined surgical and corticosteroid therapy. This case highlights the importance of including rare pathologies in the differential diagnosis of maxillofacial masses and demonstrates the value of thorough investigation when symptoms persist despite standard treatment.

头颈部是一个复杂的解剖区域，其中重叠的结构和非特异性症状往往使准确诊断具有挑战性。尤其是面部疼痛，是一种常见但模棱两可的症状，通常归因于偏头痛等常见疾病，这可能会延迟对不太常见但具有临床意义的疾病的识别。其中一种情况是原发性硬化性纤维炎性假瘤，这是一种罕见的良性病变，在临床和放射学上都能模仿恶性肿瘤。我们提出的情况下，18岁的女性慢性面部疼痛和全球位移，误诊为偏头痛四年。影像学显示上颌窦肿块伴骨侵蚀及眼眶受累。核心穿刺活检不确定，只有在手术切除后才得到明确诊断。组织病理学和免疫组化分析证实原发性硬化性纤维炎性假瘤。在手术和皮质类固醇联合治疗后，患者的临床状况得到了显著改善。本病例强调了在颌面部肿块鉴别诊断中包括罕见病理的重要性，并证明了在标准治疗后症状仍然存在时进行彻底检查的价值。

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引用次数: 0

Revolutionizing maxillofacial care: Exploring denosumab's impact on giant cell granuloma – A comprehensive case series and literature review 革新颌面护理：探索地诺单抗对巨细胞肉芽肿的影响-一个全面的病例系列和文献综述

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-06-27 DOI: 10.1016/j.omsc.2025.100408

Gustavo Andres Grimaldi Finol , Ammar Khalafalla , Mohamed Amir , Saba Hawamdeh , Moustafa Al Khalil , Ismail Farag , Ayoub Alaud

Giant cell lesions (GCLs) of the maxillofacial complex present a therapeutic challenge due to their aggressive nature and potential for recurrence. Traditional treatment modalities often includes surgical intervention with varying degrees of success and associated morbidities. In recent years, denosumab, a monoclonal antibody targeting the RANK ligand pathway, has emerged as a promising alternative in the management of GCLs. This article provides a comprehensive overview of denosumab's efficacy, safety profile, and clinical outcomes in treating GCLs through a meticulous analysis of case series and literature review. We describe denosumab's potential as a novel therapeutic option, offering improved outcomes and reduced morbidity for patients with GCLs in the maxillofacial region with the presentation of two cases using a comprenhesive diagnosis and management. On the other hand, this article highlights the need for further prospective studies to stablish optimal dosing regimens, long-term efficacy, and potential adverse effects, for enhanced patient care and management strategies in this challenging clinical scenario.

颌面部巨细胞病变（GCLs）由于其侵袭性和复发的可能性，目前的治疗挑战。传统的治疗方式通常包括手术干预，有不同程度的成功和相关的发病率。近年来，针对RANK配体途径的单克隆抗体denosumab已成为治疗gcl的一种有希望的替代方案。本文通过对病例系列的细致分析和文献综述，全面概述了denosumab治疗gcl的疗效、安全性和临床结果。我们描述了denosumab作为一种新型治疗选择的潜力，为颌面部区域的gcl患者提供了改善的结果和降低的发病率，并介绍了两例使用综合诊断和管理的病例。另一方面，本文强调需要进一步的前瞻性研究来建立最佳的给药方案、长期疗效和潜在的不良反应，以便在这种具有挑战性的临床情况下加强患者护理和管理策略。

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引用次数: 0

Iatrogenic intra-temporomandibular joint emphysema during injection: A case report 注射时医源性颞下颌关节内肺气肿1例

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-05-26 DOI: 10.1016/j.omsc.2025.100405

Asaad Shehada, Mazen Zenati

The temporomandibular joint has a variation in its atmospheric pressure during the mouth movement, although the intra-articular injection is widely used as one of the management strategies for reducing the pain and enhancing the mouth movement range, there are atmospheric fluctuations in the joint space due to make a passage between this closed spaces and the external medium when the needle inserted into the joint capsule. This report presents iatrogenic emphysema in two cases, while this emphysema is absent in a different case.

颞下颌关节在口腔运动过程中存在大气压的变化，尽管关节内注射被广泛用于减轻疼痛和增加口腔运动范围的治疗策略之一，但当针头插入关节囊时，由于关节间隙与外部介质之间存在通道，因此关节间隙存在大气波动。本报告报告了两例医源性肺气肿，而另一例无此肺气肿。

引用次数: 0