Oral and Maxillofacial Surgery Cases最新文献

Osteonecrosis of the jaw (ONJ) is a rare phenomenon that usually occurs in individuals exposed to certain medications, radiation, or physical or chemical insults that ultimately result in compromised vascularity of the jaws. However, in some cases, it is difficult to pinpoint a specific risk factor that might have caused the patient to suffer this pathologic condition. Here, we are reporting a case of idiopathic maxillary necrosis for which a specific risk factor could not be established despite thorough investigations.

Purpose

Present case reports that have generated new treatment protocols improving treatment of patient outcomes with jaw deformities and airway compromises requiring counterclockwise rotation (CCWR) of the maxillo-mandibular complex (MMC) with or without a requirement for temporomandibular joint (TMJ) total joint prostheses (TJP). Presented are studies that verify the efficacy of these procedures.

Methods

Initial case presentations were identified in reference to CCWR of the MMC without and with TMJ total joint prostheses in cases of co-existing end-stage TMJ pathology. A non-systematic literature search was conducted to identify studies pertinent to subject matter.

Results

Two case reports are presented that have significantly affected our specialty: 1) CCWR of the MMC and effect on airway, and 2) TMJ TJP with concomitant maxillary osteotomies for CCWR of the MMC.  Forty papers were identified meeting the filtered criteria. Twenty-nine papers were excluded as case reports, philosophy, technique, or small case series. Eleven studies met the inclusion criteria and are summarized according to the data included. These studies validate the efficacy and stability of CCWR of the MMC in the presence of healthy joints as well as patients with end-stage TMJ pathology using custom TMJ TJP in conjunction with orthognathic surgery.

Conclusions

Patients with healthy TMJs can be treated with CCWR of the MMC with predictable outcomes and stability. Patients with end-stage TMJ pathology can benefit from TMJ TJP and orthognathic surgery for CCWR of the MMC with good stability, improved function, decreased pain, improved airway, and quality of life.

Treatment of advanced-stage head and neck cutaneous squamous cell carcinoma is a challenge for maxillofacial surgeons, oncologists, and radiotherapists. These carcinomas respond with difficulty to systemic therapy and most of them relapse. Electrochemotherapy combines the use of cytotoxic drugs and electroporation, preserving organ function in combination with effective local control of the tumour. It can be used alone or in combination with other therapies, such as immunotherapy.

This study aims to verify whether electrochemotherapy performed with immunotherapy on head and neck squamous cell carcinoma can lead to an increase in the objective response rate. We report the case of a patient with head and neck skin squamous cell carcinoma treated with a combination of electrochemotherapy (by using both linear and finger probes) and immunotherapy (by using Cemiplimab, antibody blocking the programmed death receptor-1 – PD-1). This association has been shown to be effective both in controlling the progression of the disease, and in reducing the symptomatology of the patient (reduction of pain and bleeding), leading to an improvement in the quality of life.

Background

The ameloblastoma is a benign but locally aggressive epithelial odontogenic neoplasm. Although rare, the ameloblastoma is the most common odontogenic tumor associated with the maxillofacial complex which possesses a significant propensity for local recurrence in the setting of conservative treatment. Concordantly, definitive therapy is predicated on wide surgical excision with reconstruction of ablative defects dictated by the resultant tissue defects. The purpose of this report is to highlight specific treatment and reconstructive challenges, emphasizing the essential need for collaborative patient care within a large multidisciplinary team.

Case description

A 31-year-old Vietnamese-speaking male was referred for management of an extensive ameloblastoma associated with the left mandible. Management consisted of a bilateral composite mandibular resection and reconstruction via free tissue transfer utilizing an osteocutaneous fibular free flap. Histopathologic analysis confirmed the diagnosis of a conventional ameloblastoma. Delayed oral rehabilitation employing virtual surgical planning to facilitate the placement of endosseous implants with immediate loading of a fixed acrylic prosthesis was accomplished in the post-operative period without any evidence of recurrence.

Practical implications

Multidisciplinary collaboration in the setting of advanced odontogenic tumors is paramount in enhancing treatment outcomes. This case strengthens the need for accurate and rapid diagnosis in the primary care setting with collaborative interprofessional management utilizing advances in digital technologies to optimize both functional and aesthetic outcomes which have significant influence over long-term quality-of-life.

Hypoglossal nerve injury is a known complication of oral intubation, otolaryngology procedures, and trauma. More rarely, hypoglossal nerve injury has been described as a complication of dental procedures. While iatrogenic damage to the inferior alveolar nerve has been extensively described in the oral and maxillofacial surgery literature, a paucity of literature can be found related to 12th cranial nerve complications. This case report aims to describe a case presenting to our office and the available treatment for patients suffering from this pathology.

Background

Only 8 cases of Rosai-Dorfman disease (RDD) involving the submandibular gland (SMG) have been reported. We report one more such case, involving a 51-year-old man, thus, adding to the available body of knowledge for this specific pathology.

Methods

The patient presented with a growing mass in the right SMG. Along with physical examination, hematologic and imaging-based diagnostic techniques were used. A diagnosis of the right SMG tumor was made and, thus, resection of the right SMG along with the lesion was carried out.

Results

Post-operative pathology was found to correspond to that of RDD. After 24 months of observation, the patient remained healthy.

Conclusion

RDD involving the SMG is rare, but not improbable, and hence, should be considered during diagnosis, especially when accompanied by neck lymph node enlargement. This is imperative because RDD is generally benign and self-limiting, and thus, a correct diagnosis may prevent SMG resection.

Oral and maxillofacial pathology is replete with rare diseases that by their very nature, are difficult to study. Adequately powered, randomized controlled trials cannot be performed when cases are rare and spread across a large geographic area among numerous institutions. For example, there are approximately 500 ameloblastoma tumors diagnosed in the United States each year and these necessarily represent a heterogenous group with maxillary, mandibular, anterior/posterior, old and young all part of this group. To detect a treatment outcome difference of 5% at 80% power would require a sample size of over 3000 Ameloblastoma tumors. The specific aim of this manuscript is to highlight several of these rare diseases and the case reports that have contributed to our evolving knowledge to emphasize the significance of case reporting in oral and maxillofacial pathology.

Ameloblastoma is the most common odontogenic tumor found at the posterior region of mandible. Granular cell ameloblastoma is one of the histological subtypes of ameloblastoma, mainly characterized by nests of large eosinophilic granular cell. Here, we reported a rare case of 75-year-old female patient presented with granular cell ameloblastoma in maxilla region. The conventional surgery was performed by upper lip-splitting technique and partial maxillectomy. The prosthetic obturators were delivered to rehabilitate a maxillofacial integrity, improving facial appearance and functional abilities. Long-term follow up revealed a favorable outcome without an evidence of tumor recurrence.