Oral and Maxillofacial Surgery Cases最新文献

英文中文

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

Occult papillary thyroid carcinoma presenting as parapharyngeal space mass: A case report and literature review 隐匿性甲状腺乳头状癌表现为咽旁间隙肿块：1例报告并文献复习

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-05-24 DOI: 10.1016/j.omsc.2025.100402

Fawaz Alotaibi , Harish Tummala , Mitchell Naito , Yousef Alshamrani

Papillary thyroid carcinoma presenting as a parapharyngeal mass is uncommon clinical presentation^1,2. Papillary thyroid cancer is the most common primary thyroid cancer (80–90 % of cases)¹⁷. 20–50 % of cases have lymph node metastasis⁴. Superior thyroid lesions usually metastasize through superior pretracheal and cervical nodes while inferior thyroid and isthmus drainage travel via the paratracheal and deep cervical nodes¹⁷. Parapharyngeal space (PPS) tumors are rare and represent about 0.5 % of all head and neck tumors^1,2. We report a case of 59 years-old man who presented initially with left parapharyngeal mass for about four months and a chief complaint of dysphagia. Exam revealed a submucosal 4 cm mass in the oropharyngeal wall, no tumor was palpable in the neck and his physical examination was otherwise unremarkable. Preoperative work up was completed, and Fine Needle Aspiration (FNA) was inconclusive. The mass was excised via transcervical-mandibular swing approach and a diagnosis of papillary thyroid carcinoma was rendered. Subsequently, the patient underwent a total thyroidectomy and neck dissection. This case report highlights the unusual metastasis to parapharyngeal space from occult papillary thyroid carcinoma, reviews the lymphatic drainage system of the head and neck responsible for this route of metastasis, recommendations for preoperative imaging, surgical treatment, and adjuvant treatment of this uncommon presentation.

甲状腺乳头状癌表现为咽旁肿块是罕见的临床表现1,2。甲状腺乳头状癌是最常见的原发性甲状腺癌（占病例的80 - 90%）17。20 - 50%的病例有淋巴结转移4。上甲状腺病变通常通过上气管前淋巴结和颈淋巴结转移，而下甲状腺和峡部引流则通过气管旁淋巴结和颈深部淋巴结转移17。咽旁间隙（PPS）肿瘤很少见，约占头颈部肿瘤的0.5% 1,2。我们报告一个59岁的男性病例，他最初表现为左侧咽旁肿块约4个月，主诉为吞咽困难。检查发现口咽壁黏膜下4厘米肿块，颈部未见肿瘤，其他体格检查无明显异常。术前工作完成，细针抽吸（FNA）不确定。肿块经经颈-下颌摆动入路切除，诊断为甲状腺乳头状癌。随后，患者接受了甲状腺全切除术和颈部清扫术。本病例报告强调隐匿性甲状腺乳头状癌向咽旁间隙的不寻常转移，回顾头颈部淋巴引流系统对这种转移途径的影响，建议术前影像学、手术治疗和辅助治疗这种不寻常的表现。

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引用次数: 0

Unusual displacement of maxillary lateral incisor into the orbital floor after panfacial trauma: A case report 全面外伤后上颌侧切牙异常移位至眶底1例

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-05-16 DOI: 10.1016/j.omsc.2025.100406

Mojtaba Salehi Karizmeh, Farnaz Keyhanlou

Panfacial trauma often involves extensive fractures across the facial skeleton and is frequently associated with dentoalveolar injuries. In cases with missing teeth, extra caution is needed, as avulsed teeth or fragments may be displaced into adjacent structures such as the maxillary sinus, nasal cavity, airway, or even the gastrointestinal tract. This report presents a rare case of a maxillary lateral incisor displaced into the orbital floor following panfacial trauma. The case highlights the critical importance of thorough clinical and radiographic assessment, particularly with CT imaging, to ensure accurate diagnosis, prevent complications, and achieve optimal management in panfacial trauma.

全面外伤通常包括广泛的面部骨骼骨折，并常伴有牙槽损伤。在牙齿缺失的情况下，需要格外小心，因为脱落的牙齿或碎片可能会移位到邻近的结构中，如上颌窦、鼻腔、气道甚至胃肠道。本文报告一例罕见的上颌侧切牙在全面外伤后移位到眶底。该病例强调了全面的临床和放射学评估，特别是CT成像的重要性，以确保准确诊断，预防并发症，并实现全面创伤的最佳治疗。

引用次数: 0

Large intraosseous xanthoma of the mandible – A case report 下颌骨骨内大黄瘤1例

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-05-12 DOI: 10.1016/j.omsc.2025.100404

Brett A. Wilson, Jeffrey H. Brooks, Sloan B. Ashabranner, Franklin B. Ivers

Xanthoma is derived from the Greek word xanthos, meaning yellow, and is related to the altered metabolism of lipids resulting in their accumulation in skin, tendon sheaths, and internal organs. Xanthomas manifest as yellowish papules, plaques, or nodules and are characterized by lipid-laden macrophages (foam cells). Xanthoma of bone is extremely rare and, when present, is often secondary to dyslipidemias or endocrine disorders. The former would be considered a secondary intraosseous xanthoma of bone. A xanthoma that is identified within bone in the absence of dyslipidemia or endocrine disease is considered a primary intraosseous xanthoma. When a xanthoma presents in the maxilla or mandible, it is considered an intraosseous xanthoma of the jaw. The first intraosseous xanthoma of the jaw was reported in 1964 and was referred to as a xanthogranuloma of the mandible. Since that initial report, less than 60 total cases have been reported in the English literature. The cases reported are typically small in size and amenable to enucleation and curettage. Our report contributes to the existing literature by providing a unique case example, highlighting the potential for these lesions to progress to a considerable size, impact adjacent anatomical structures, and necessitate more aggressive treatment.

黄瘤源于希腊语xanthos，意思是黄色，它与脂质代谢的改变有关，导致脂质在皮肤、肌腱鞘和内脏中积聚。黄斑瘤表现为淡黄色丘疹、斑块或结节，以脂质巨噬细胞（泡沫细胞）为特征。骨黄色瘤极为罕见，当出现时，通常继发于血脂异常或内分泌紊乱。前者被认为是继发性骨内黄斑瘤。在没有血脂异常或内分泌疾病的情况下，在骨内发现的黄瘤被认为是原发性骨内黄瘤。当黄色瘤出现在上颌骨或下颌骨时，它被认为是颌骨骨内黄色瘤。第一例颌骨骨内黄色瘤于1964年报道，当时被称为下颌骨黄色肉芽肿。自那份初步报告以来，英国文献中报告的病例总数不到60例。报告的病例通常体积小，适合去核和刮除。我们的报告通过提供一个独特的案例，对现有文献做出了贡献，强调了这些病变发展到相当大的可能性，影响邻近的解剖结构，需要更积极的治疗。

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引用次数: 0

Osteocutaneous radial forearm free flap with islanded bony segments for maxilla reconstruction: A case report 前臂桡骨皮游离皮瓣重建上颌骨1例

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-04-25 DOI: 10.1016/j.omsc.2025.100401

Emily DuBuc , Russell Arellanes , Greta Guillette , Changxing Liu

Maxillofacial LeFort 1 surgery is a widely used procedure for correcting midface deformities, but it can occasionally result in rare and destructive complications such as non-union of osteotomy gaps and maxillary necrosis. Addressing these complications requires careful consideration of their severity, the surgeon's expertise, and the patient's desired outcomes. Comprehensive imaging, a detailed surgical history, and thorough preoperative planning are essential. We present the case of a 61-year-old Caucasian male referred to the otolaryngology – head and neck surgery clinic for bilateral oroantral fistulas, with multiple failed repair attempts following LeFort I osteotomy for midfacial deformity correction. Reconstruction was performed using an osteocutaneous radial forearm free flap with two separate osteotomy segments to fill the bony defect and seal the fistulas, resulting in full resolution of symptoms.

颌面LeFort 1手术是一种广泛使用的矫正中脸畸形的手术，但偶尔会导致罕见的破坏性并发症，如截骨间隙不愈合和上颌坏死。处理这些并发症需要仔细考虑其严重程度、外科医生的专业知识和患者期望的结果。全面的影像、详细的手术史和周密的术前计划是必不可少的。我们报告一名61岁的白人男性，在耳鼻喉头颈外科诊所就诊，治疗双侧口鼻瘘，在LeFort I截骨术进行面中畸形矫正后，多次修复失败。采用前臂桡骨皮游离皮瓣进行重建，该皮瓣带有两个独立的截骨节段，以填补骨缺损并封闭瘘管，从而完全解决了症状。

引用次数: 0

Maxillary angiosarcoma: a case report and literature review 上颌血管肉瘤1例报告并文献复习

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-04-24 DOI: 10.1016/j.omsc.2025.100403

Kamdem Benedikta , Sala Nathalie , Broome Martin , May Laurence

Angiosarcoma is a rare and aggressive malignant mesenchymal neoplasia developing from endothelial cells, comprising only 2 % of soft tissues sarcomas. While primarily affecting soft tissues and skin, its occurrence in the oral cavity is exceptionally rare (1.6 %). We present the case of a 78-year-old woman with a nodular gingival lesion initially suspected as squamous cell carcinoma. Despite an uneventful postoperative course following maxillectomy, the histological examination revealed angiosarcoma. Discussion highlights the diagnostic challenges due to its varied clinical and histological presentation, often mimicking other lesions. Treatment involves complete surgical excision, followed by adjuvant chemotherapy and radiotherapy. However, the prognosis remains poor, with a high recurrence rate and metastatic potential. Our case underscores the importance of accurate diagnosis through comprehensive clinical, radiological, and histological evaluation, emphasizing the need for early detection and multidisciplinary management to improve outcomes in angiosarcoma patients.

血管肉瘤是一种罕见的侵袭性恶性间充质瘤，起源于内皮细胞，仅占软组织肉瘤的2%。虽然主要影响软组织和皮肤，但在口腔发生的情况非常罕见（1.6%）。我们提出的情况下，一个78岁的妇女与结节性牙龈病变最初怀疑为鳞状细胞癌。尽管上颌切除术后的手术过程顺利，但组织学检查显示血管肉瘤。讨论强调了诊断的挑战，由于其不同的临床和组织学表现，往往模仿其他病变。治疗包括完全手术切除，然后辅助化疗和放疗。然而，预后仍然很差，具有高复发率和转移潜力。我们的病例强调了通过全面的临床、放射学和组织学评估准确诊断的重要性，强调了早期发现和多学科管理的必要性，以改善血管肉瘤患者的预后。

引用次数: 0

Application of low-profile patient-specific surgical cutting guides in the management of craniofacial fibrous dysplasia: A case report and review of current surgical approaches 在颅面纤维发育不良治疗中应用低轮廓患者特异性手术切割指南：一个病例报告和当前手术入路的回顾

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-04-11 DOI: 10.1016/j.omsc.2025.100399

Mahdi Zakeri , Brian Kinard

Managing craniofacial fibrous dysplasia (FD) poses significant challenges, particularly in balancing functional and aesthetic outcomes. Traditional approaches often require broad exposure through coronal flaps or midfacial degloving, leading to increased morbidity and extended recovery. This case report highlights a minimally invasive approach for a 20-year-old female with disfiguring zygomaticomaxillary FD. Through computer-aided surgical simulation (CASS), low-profile patient-specific recontouring guides were employed to perform precise bone recontouring through transconjunctival and intraoral incisions. Postoperative imaging confirmed accurate bone removal when superimposed with the preoperative plan. The patient achieved satisfactory facial symmetry with reduced morbidity. This approach demonstrates that combining CASS with low-profile patient specific recontouring guides can optimize outcomes for complex craniofacial FD cases. Further research and comparative studies are necessary to fully assess the long-term benefits of this technique in surgical managing FD and other benign craniofacial lesions.

处理颅面纤维发育不良（FD）提出了重大挑战，特别是在平衡功能和美学结果方面。传统的方法通常需要通过冠状皮瓣或面中脱手套广泛暴露，导致发病率增加和恢复时间延长。本病例报告强调了一种微创入路治疗20岁女性颧颌畸形FD。通过计算机辅助手术模拟（CASS），采用低轮廓的患者特异性重建指南，通过经结膜和口内切口进行精确的骨重建。术后影像学检查与术前计划相结合，证实了取骨的准确性。患者获得了令人满意的面部对称，发病率降低。该方法表明，将CASS与低轮廓患者特异性重轮廓指南相结合可以优化复杂颅面FD病例的预后。进一步的研究和比较研究是必要的，以充分评估该技术在外科治疗FD和其他良性颅面病变中的长期效益。

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引用次数: 0

Oral mycetoma of the upper lip nasolabial region in a healthy host: A case report and minireview of diagnostic and therapeutic considerations 健康宿主上唇鼻唇区口腔真菌瘤：病例报告及诊断和治疗注意事项综述

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-04-11 DOI: 10.1016/j.omsc.2025.100400

Kenichi Ogata , Michiaki Akashi , Shintaro Kawano

Oral mycetoma, or fungal ball, is a rare entity typically affecting immunocompromised individuals; its presentation in the oral cavity, particularly the upper lip of healthy hosts, is exceedingly rare. We report a unique instance of upper lip nasolabial mycetoma in a 60-year-old immunocompetent male presenting with painless swelling. Initial imaging (magnetic resonance imaging/ultrasonography) revealed a well-defined, fluid-filled nodule, mimicking a benign neoplasm or mucocele. Excisional biopsy and subsequent histopathological examination with Grocott methenamine silver staining definitively diagnosed mycetoma, revealing encapsulated abscesses with filamentous fungal hyphae, suggestive of Aspergillus etiology. This case highlights the diagnostic ambiguity of atypical fungal infections in immunocompetent patients and underscores the necessity to consider fungal etiologies in the differential diagnosis of oral lesions, irrespective of patient immune status. Histopathology remains crucial for definitive diagnosis and appropriate management. Surgical excision with 1-year follow-up proved to be an effective therapeutic modality for localized oral fungal mycetoma in this healthy individual.

口腔真菌瘤或真菌球是一种罕见的实体瘤，通常会影响免疫力低下的人，而出现在口腔，尤其是健康宿主的上唇则极为罕见。我们报告了一例独特的上唇鼻唇真菌瘤病例，患者是一名 60 岁的免疫功能正常男性，表现为无痛性肿胀。初步影像学检查（磁共振成像/超声波检查）发现一个界限清晰、充满液体的结节，类似良性肿瘤或粘液瘤。切除活检和随后的组织病理学检查（Grocott methenamine silver staining）明确诊断为真菌瘤，发现包裹性脓肿中长有丝状真菌菌丝，提示病因为曲霉菌。该病例凸显了免疫功能正常患者非典型真菌感染的诊断模糊性，并强调了在口腔病变的鉴别诊断中考虑真菌病因的必要性，无论患者的免疫状态如何。组织病理学仍是明确诊断和适当治疗的关键。事实证明，手术切除并随访1年是治疗该健康人局部口腔真菌真菌瘤的有效方法。

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引用次数: 0

Managing wound complications in hypoglossal nerve stimulation: Prevention strategies and criteria for avoiding device explantation 舌下神经刺激术中伤口并发症的处理：避免器械外植的预防策略和标准

Q3 Dentistry

Oral and Maxillofacial Surgery Cases

Pub Date : 2025-03-31 DOI: 10.1016/j.omsc.2025.100398

Kai-Yuan Hsiao , Martha Lucía Gutiérrez Pérez , Patrícia S. Cé , Thomaz Fleury Curado

Hypoglossal nerve stimulation is a proven treatment for obstructive sleep apnea, yet its invasive nature raises concerns about wound complications. This case series examines three distinct postoperative scenarios: (1) early infection in a patient with poor glycemic control and inadequate self-care, (2) late-stage infection in a patient with prolonged device non-use, and (3) early wound dehiscence caused by nonadherence to postoperative restrictions, successfully managed with a novel wound management protocol that preserved the device. These cases highlight the importance of comprehensive risk assessment, adherence to postoperative guidelines, the control of metabolic diseases and individualized management strategies to preserve device functionality while reducing healthcare costs. Notably, this is the first report demonstrating successful device retention in hypoglossal nerve stimulation despite wound dehiscence. Further studies are essential to refine risk stratification and establish evidence-based treatment protocols for this innovative and increasingly utilized therapy.

舌下神经刺激术是治疗阻塞性睡眠呼吸暂停的一种行之有效的方法，但其侵入性引起了人们对伤口并发症的担忧。本系列病例研究了三种不同的术后情况：(1)血糖控制不佳和自我护理不足的患者早期感染，(2)长期不使用装置的患者晚期感染，以及(3)因不遵守术后限制而导致的早期伤口开裂，该患者通过新颖的伤口管理方案成功保住了装置。这些病例凸显了全面风险评估、遵守术后指导原则、控制代谢性疾病和个体化管理策略对于在降低医疗成本的同时保持设备功能的重要性。值得注意的是，这是第一份在伤口开裂的情况下仍能成功保留舌下神经刺激装置的报告。进一步的研究对于完善风险分层和建立循证治疗方案至关重要，这种创新疗法的使用率越来越高。

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引用次数: 0

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