Oral and Maxillofacial Surgery Cases最新文献

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.

Background

A recent increase in the prevalence of mucormycosis of the head and neck in patients who have recovered from COVID-19 following hospitalization has been reported. A Majority of the cases have been reported from India. Conditions such as diabetes mellitus, use of corticosteroids for other autoimmune conditions, organ transplant, immunosuppression, immunodeficiency, and malignancies especially hematologic ones, are all known risk factors for mucormycosis. Recently, hospitalization for COVID-19 has been added to the list of risk factors for opportunistic mucormycosis infection. This is likely attributable to the high doses and prolonged use of corticosteroids in the treatment of hospitalized COVID-19 patients. Case Description: Two patients with post-COVID-19 associated rhinocerebral mucormycosis presented with profound unexplained dental disease including tooth mobility and dental abscess mimicking periodontal disease. The patients were previously hospitalized for COVID-19 and received prolonged treatment with high doses of corticosteroids. The patients responded well to the surgical debridement with or without antifungal therapy. Conclusion: Oral healthcare providers including oral and maxillofacial surgeons, dentists, dental hygienists, and other dental practitioners can play a vital role in the recognition and early diagnosis of rhinocerebral mucormycosis given the large number of patients with severe COVID-19 infection who have recovered following hospitalization and/or received long-term high doses of immunosuppressive treatment.

Multifocal nodular oncocytic hyperplasia (MNOH) is an extremely rare pathological entity occurring in the parotid gland, even more rarely described in the submandibular gland. We report a case of bilateral parotid MNOH in a 71-year-old woman and perform a search of the existing literature that is compiled in a table. Fifty-nine cases are described in 34 publications. Half of the published cases presented as bilateral lesions, either synchronous or metachronous. Other lesions of the oncocyte-spectrum such as oncocytomas are frequently described on the ground of oncocytic hyperplasia. MNOH rarely occurs before the age of 40 years and mean age of the described cases is 62 years. The condition is considered as benign by all authors, but surgery was performed in nearly all cases, most often due to a lack of diagnostic certainty. Nevertheless, the radiologic presentation of MNOH is often highly suggestive. Based on the existing literature, recommendations for the management of MNOH are formulated.

In this case report, we present a pleomorphic adenoma that presented as a hard nodule on the upper lip in a man in his 30s. Differential diagnosis is necessary, as there are multiple causes of a nodule in the lip. The nodule was excised extracapsularly and a histopathological examination was performed. Although the tumor was found to be benign, there is a risk of late malignant conversion, which underscores the importance of prompt treatment.

Trauma to the craniofacial structures can result in both functional and aesthetic defects. Mucosa lines the frontal sinus outflow tract (FSOT) from the frontal sinus to the nasal cavity and any obstruction to the flow of mucus can lead to complications such as mucocele formation or chronic frontal sinusitis. If the FSOT or posterior cranial vault is not damaged, reestablishment of the aesthetic contour of the frontal bandeau becomes the primary concern. There are several materials that have been proposed for treatment of frontal bone defects. Technological advances such as computed tomography (CT) scan, computer assisted design (CAD), and computer assisted manufacturing (CAM), have led to the development of three-dimensionally printed patient-specific implants. Poly-Ether-Ketone-Ketone (PEKK) is a biocompatible material from the same polyaromatic semicrystalline polymer family as Poly-Ether-Ether-Ketone (PEEK). Patient specific implants have given way to smaller surgical incisions that enable the implant to be slipped into the bony defect to reestablish contour of the frontal bandeau and secured with lag screws. The aim of this study is to describe a case of frontal bone defect reconstruction with PEKK implant via a lateral nasal/Lynch incision.

This is the first reported case of medication-related osteonecrosis of the jaw (MRONJ) resulting from the use of romosozumab, a new anti-resorptive medication that functions through inhibition of sclerostin. It was approved by the FDA in 2019, and mentioned in the 2022 AAOMS Position Paper on MRONJ. Although initial evidence from animal studies and clinical trials showed a low risk of MRONJ from romosozumab, recent publications on adverse event monitoring demonstrate the need for continued observation and research. Little is known regarding the risk of MRONJ from romosozumab, however, oral surgeons will inevitably be first line clinicians to manage patients on this medication. The purpose of this extremely unusual case report is to improve knowledge and heighten awareness about the association between romosozumab and MRONJ.

The treatment of condylar fractures has been the subject of debate and controversy. Open reduction and internal fixation, along with closed reduction, are the 2 main treatment modalities when well indicated and performed. In specific situations, however, the success of both treatment modalities can be challenged by local or systemic conditions. Alloplastic total temporomandibular joint replacement (TMJR) with the current systems, Biomet and Stryker, has proven to be successful in the long-term. The authors present 2 cases and propose the consideration of TMJR as a first-line treatment for condylar fractures in the following situations: fractures older than 4 weeks; 2) elderly patients with severely dislocated or displaced condyles; 3) condylar dislocation into the cranial fossa; 4) maxillomandibular fixation is not a viable option.

Intraorbital foreign bodies are not uncommon, and the outcome is not always satisfying after management. A 41-year-old male presented to the ER with a history of occupational trauma 30 minutes before presentation. On non-contrast CT, a 4 cm curved nail was visualized near the lateral orbital wall penetrating the zygomatic buttress with no evidence of retrobulbar haemorrhage or bulbus oculi perforation. Under coverage of proper antibiotics, the nail was removed using lateral eyebrow approach keeping the globe intact, and the wound was closed in layers. The injured eye demonstrated free range of movement postoperatively. The patient was then referred for retinal repair surgery. Early management and meticulous extraction can lead to satisfying outcomes even with large foreign bodies.