Oral and Maxillofacial Surgery Cases最新文献

Facial cosmetic surgery has a long and rich history, dating back to ancient times when people attempted to improve their appearance through various methods such as using makeup, wigs, and even undergoing rudimentary surgical procedures. With the advancement of medical knowledge and technology, facial cosmetic surgery has evolved into a sophisticated and specialized field that aims to enhance the aestheticfeatures of the face while also ensuring functional outcomes. This chapter will review the history of facial cosmetic surgery and present some of the most influential case reports that have contributed to the development of facial cosmetic surgery as we know it today.

Osteoblastoma is a benign tumor of bone representing less than 1% of all primary bone tumors [1]. Osteoblastomas are primarily reported in long bones and the spinal column, with craniofacial cases representing about 15% of the literature (Meli et al., 2008; Kroon and Schurmans, 1990) [1,2]. Osteoblastoma with orbital involvement is exceedingly rare, with less than twenty-five documented cases (Akhaddar et al., 2004; Meli et al., 2008; Bilkay et al., 2004; Hafidi and Daoudi, 2013) [3,1,4,5]. The mainstay of treatment for osteoblastoma is surgical excision with consideration for resection depending on the lesion, size, location, involved structures, and clinical presentation. The authors present a case of an orbital osteoblastoma presenting with globe subluxation in a pediatric patient.

Primary hepatic carcinomas are a leading cause of cancer deaths worldwide and more so, an important cause in women. Metastases from hepatic carcinomas to the oral cavity are rare. However, those reported are usually the first manifestation of the tumor.

We report a case of an oral metastasis from a primary hepatic carcinoma to a rare maxillary location including the hard palate presenting as a manifestation of the disease in a 48-year-old woman with elevated urine β-hCG. A biopsy of the oral lesion revealed nests of epithelial cells with hyperchromatic nuclei suggestive of metastatic hepatocellular carcinoma.

A possible route for this metastasis is the Batson's venous plexus. The prognosis after the appearance of oral metastases is usually poor as was observed with the demise of our patient about 12 weeks after the apparition of the oral mass. A multidisciplinary approach towards patients will help in early diagnosis, treatment and reduce morbidities and mortalities associated with this rare pathology.

Limited literature exists regarding massive hemorrhage following maxillofacial trauma. We present a case of facial hemorrhage resulting from a displaced mandibular body fracture.

A 69-year-old male presented 3 days after blunt trauma to the left mandible following a fall sustaining a left mandibular body fracture. The patient was initially hemostatic but later developed hemorrhage from the severed facial vein. He was emergently taken to the operating room for airway establishment and definitive treatment. Surgical exploration and ligation of the facial vein was an appropriate and effective treatment in this case given the superficial location of the vessel as well as allowing for definitive repair of the fracture.

We review alternative options for management of maxillofacial hemorrhage including direct packing, temporary anatomic bony reduction, and transcatheter embolization. A facial trauma provider needs to have a facile understanding of hemostasis methods to provide optimal care for the bleeding patient.

The placement of immediate implants in compromised sockets often requires adjunctive reconstructive measures. In particular, the loss of integrity of the buccal wall may preclude implant placement or, at least, it requires contextual, guided bone regeneration. There is no uniform consensus regarding the best biomaterial or strategy to reconstruct buccal bone defects.

In this clinical case, two immediate transgingival implants were placed in the extractive socket of the upper right first molar and in the second premolar position. The buccal bone defect was managed with sticky bone made out of calcium sulfate blended with patient-derived leukocyte- and platelet-rich fibrin (L-PRF).

After 4 months, the implants were connected to definitive abutments and crowns. The comparison between pre- 1-year—post-treatment computed tomography scans revealed exceptional bone reconstruction at the buccal level, where the initial lesion was present.

The use of a composite graft made out of calcium sulfate blended with L-PRF ensured bone reconstruction of the buccal defect around two immediate implants without the use of heterologous bone particulate and/or overlying collagen membranes. Further clinical studies are needed to explore the potential and limits of this technique.

Thyroglossal duct cysts (TGDCs) are the most common congenital cysts in the anterior neck. The incidence of papillary thyroid carcinoma (PTC) being present within a cyst is less than 1% and in most cases, the diagnosis is made postoperatively. We present a 60-year-old female with PTC arising from a lateral TGDC, identified in pathologic study after intra-oral excision of the cyst. Further thyroid ultrasound and fine-needle aspiration of a highly suspicious lesion at the superior pole of the left thyroid lobe showed PTC. The patient then underwent left hemithyroidectomy, isthmusectomy, ipsilateral and central neck dissection revealing PTC with ipsilateral nodal metastasis. The patient later underwent completion thyroidectomy and right neck dissection which did not reveal any additional malignant disease or nodal metastasis.

Spindle cell hemangioma (SCH) is a rare benign vascular neoplasm. Its occurrence is infrequently in the oral cavity and can be mistaken for other common oral lesions such as mucocysts and fibroma. Microscopically it mimics some malignant vascular tumors and could be misdiagnosed. We report a case of SCH in the upper lip of a 49-year-old woman. The mass was diagnosed as a benign tumor and resected under local anesthesia. Histopathological findings showed dense proliferation of short spindle cells, dilated capillaries, and collagen fibers at the margin. The tumor was positive for the human erythroblast transformation-specific related gene. Thus, considering the clinical and pathological findings, a diagnosis of SCH was made. Three years have passed since the operation, and no recurrence has been observed. Our findings indicate that although SCH in the oral cavity is rare, it must be considered during the differential diagnosis of a benign lip lesion.

Solitary fibrous tumors (SFT) are an uncommon group of neoplasm with an unknown origin reporting to appear in less than 2% of soft tissue tumors. Although SFT most commonly occurs in the pleura, several extra pleural sites of involvement have been reported. SFT most commonly present during the fifth and sixth decades of life, and there is no significant sex predilection. This report describes the case of a 44-year-old male patient who had unusual presentation of SFT in the anterior midline hard palate describing the morphology, histopathology, radiology management plan as well as follow up and literature review.

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.