Oral and Maxillofacial Surgery Cases最新文献

This case report documents a patient with a Class II skeletal malocclusion and suspected obstructive sleep apnea who underwent a combined mandibular inverted L osteotomy and total subapical osteotomy. The surgery involved a single-piece Lefort 1 osteotomy of the maxilla, bilateral inverted L osteotomies of the mandible, and a total mandibular subapical osteotomy. After the patient's pre-surgical orthodontic phase was completed, a traditional bilateral sagittal split osteotomy (BSSO) was initially planned to achieve mandibular advancement. However, the large horizontal and yaw correction required for the patient's mandibular teeth made a BSSO alone unrealistic. The virtual surgical plan (VSP) indicated that a subapical osteotomy was necessary, and due to the extension of the total subapical segment, an inverted L osteotomy was added to benefit the subapical osteotomy. The patient's surgery was successful, and the results were satisfactory.

Ankylosis of temporomandibular joint (TMJ) is a complicated condition which impairs jaw function and nutrition. Post-traumatic joint ankylosis could be treated with various surgical techniques. However, no standard surgery guarantees symptom-free success. Treating post-traumatic TMJ thus remains a challenging task to oral and maxillofacial surgeons. This paper is a case of a bilateral post-traumatic TMJ ankylosis. The 27-year-old young man sustained mid-face and mandible fractures including bilateral condyles due to a road accident and was treated 7 years ago. The injured condyles are managed conservatively. He presented with limited mouth opening (13mm) along with bite changes. Conservative treatments failed to restore normal jaw movement. Preoperative cone beam CT revealed ankyloses joint of both sides. An arthroplasty with the interpositional umbilical fat grafting was performed. Follow-up course was uneventful with up to 40mm mouth opening. Arthroplasty with interpositional fat grafting is an effective technique to restore jaw function and to prevent relapse.

Amyloidosis of the submandibular gland is a rare manifestation of extranodal marginal zone lymphoma (eMZL). Here, we present a case-report of a 62-year-old female patient with a history of eMZL, limited stage IIEA. The patient was initially treated with radiotherapy; however large glands remained with lack of clinical response to the radiotherapy. Consequently, a surgical excision of the submandibular glands was performed, and histology revealed massive amyloid deposits in the gland tissue next to eMZL. This case report highlights the importance of considering amyloidosis as a possible cause of submandibular gland enlargement in patients with a history of lymphoma and emphasizes the need for a histological diagnosis to direct appropriate treatment.

Background

The Le Fort I osteotomy is a commonly employed and predictable surgical technique used to treat maxillofacial deformities. While considered technically safe, orthognathic surgery can cause significant vascular complications. Presentation: This case report describes a 20-year old male who had undergone a routine Le Fort I osteotomy to treat maxillo-mandibular discrepancy, and subsequently developed an internal maxillary artery pseudoaneurysm that caused uncontrolled hemorrhage and hemodynamic instability. The patient ultimately required interventional radiology coil embolization for source control.

Discussion

Although rare, internal maxillary artery pseudoaneurysms continue to be reported as postoperative complications in Le Fort I osteotomies, wherein coil-embolization technique remains a viable option for treatment. Additionally, the presentation of temporal swelling and retrobulbar pain may be useful in diagnosing the existence of a maxillary artery pseudoaneurysm. Conclusion: Pseudoaneurysm of the internal maxillary artery is a possible sequela of orthognathic surgery, and proper monitoring and management can avoid morbid outcomes.

Richieri-Costa-Pereira syndrome (RCPS) is a rare genetic disease with an autosomal recessive inheritance pattern characterized by craniofacial alterations such as microsomia, Pierre-Robin sequence, mandibular cleft, absence of lower central incisors, short stature, and changes in the upper and lower limbs. Mandibular clefts are rare and can vary from a slight notch in the lower lip or mandibular alveolus to a complete mandibular cleavage. Only three cases of total mandibular rehabilitation with a customized prosthesis have been published, and none have described a patient born with a mandibular cleft. With the aid of computer-aided design/computer-aided manufacturing technology, virtual surgical planning, and customized manufacturing of surgical materials, the rehabilitation of this case became attainable. In this study, we describe the case of a patient with RCPS and median mandibular cleft treated with a customized total mandibular prosthesis.

Objectives

We aimed to report the surgical outcomes of phosphaturic mesenchymal tumors causing tumor-induced osteomalacia in the head and neck.

Methods

This study analyzed nine patients who underwent surgical excision of phosphaturic mesenchymal tumors in the head and neck region. The primary sites were two in the maxilla and ethmoid sinus, and one in the intracranial, skull, parotid gland, maxillary sinus, and nasal cavity in each patient. Outcomes were compared with those in the extremities and trunk (n = 32).

Results

Five of nine patients (56%) developed residual disease/local recurrence associated with low serum phosphate level after initial surgical excision. At the last follow-up, the biochemical parameters were normalized in four of the five patients after re-excision without any medication. The local recurrence/residual disease risk was significantly higher for the head and neck compared with the extremities and trunk (56% vs. 25%, p = 0.048). The rate of remission (normalized serum phosphate without medication) at final follow-up was similar in both groups after re-excision (head and neck vs. extremities and trunk, 86% vs. 73%, p = 0.827).

Conclusions

Phosphaturic mesenchymal tumor resection in the head and neck region was challenging because of its complex anatomy and proximity to the brain or other crucial organs, which was associated with high local recurrence/residual disease rate. However, biological remission was achieved in the majority of the patients after re-excision.

We present a quite rare case of MALT lymphoma originating from the palatal minor salivary gland in a 37-year-old woman with Sjögren's syndrome (SS). She underwent an excision biopsy and definite diagnosis of MALT lymphoma was obtained on the basis of microscopic finding with lymphoepithelial lesion, immunohistochemistry positive for CD20 and negative for CD3, CD5, cycclinD1, and detection of immunoglobulin light chain restriction with kappa light-chain restricted monoclonality. MALT lymphoma is considered in the differential diagnosis of a painless, non-ulcerative palatal swelling. In this case, SS remained undiagnosed until after MALT lymphoma diagnosis. Patients with MALT lymphoma in the minor salivary glands need to be investigated for SS even if there is no clinical symptom of SS. Surgical excision can be recommended in case of limited stages resulting in good prognosis.