Oral and Maxillofacial Surgery Cases最新文献

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.

Background

Anterolateral thigh flap (ALT) is used as a workhorse flap for head and neck reconstruction. The most used method to map the perforators nowadays is hand-held Doppler although several more sophisticated techniques have been described. This paper is to investigate whether harvesting the ALT flap without preoperative mapping is safe.

Materials and methods

Twenty consecutive patients were randomly assigned to one of two groups: A or B. Patients of A group (n = 10) were marked before the operation with the use of a Doppler probe whilst patients of group B (n = 10) were not marked preoperatively using Doppler to detect the perforators. Complications and time of ALT dissection were documented.

Results

There was no statistical difference of complications between the two groups. Mean time of flap harvesting (skin incision up to main pedicle) was approximately 140 min in group A and 165 min in group B (statistically significantly less in group A p = 0.008).

Conclusions

This paper is an indication that harvesting the ALT flap without preoperative mapping, even with hand-held Doppler, does not compromise safety of the procedure although operative time is prolonged.

The necessity of an ‘adequate’ keratinized mucosa at the emergence profile of dental implants is a controversial and debated topic. But, in recent years, research suggests that a minimum of at least 2mm of keratinized mucosa is recommended for the maintenance of peri-implant health. The latest systematic reviews on this topic are largely in favor of keratinized mucosa, as are the recommendations of some expert panels. The present paper presents a novel technique for peri-implant flap suturing that can be used in combination with soft tissue augmentation procedures, such as laterally positioned flaps, roll-flaps, and decellularized dermal matrix xenografts. The technique stabilizes the flap on the buccal surface of the healing screw or the emergence profile of the tissue-level implant with a circumferential continuous mattress design that is anchored on the buccal margins and/or periosteum with a final knot. The technique is carried out with a sterile 6/0 synthetic absorbable glyconate monofilament surgical suture (Monosyn, Bbraun, B. Braun Milano S. p.A., Via Vincenzo da Seregno, 14, 20,161 Milan, Italy). This type of suture is ideal, as it slides smoothly through the tissues and allows for the ideal adjustment of the tension and the position of the flap margins until the final knot is positioned. Furthermore, these augmentative procedures make use of second-intention healing and mattress sutures are always ideal to stabilize flap margins without excess tension in such cases. This case series involves patients with a reduced band of keratinized mucosa and, as such, in need of augmentative flap procedures.

We describe here a rare case of pilomatrix carcinoma in the right parotid region, arising in a young patient.

Pilomatrix carcinoma is a rare, locally aggressive tumor with a tendency to recur. Pilomatrixoma is a superficial benign skin tumor arising from the matrix cells of the hair follicle generally located in the scalp, face, and upper limbs. Clinically, it usually presents as a solitary subcutaneous blue-black nodule which grows slowly.

An 18-year-old male, non-smoker, in good health, was referred to our Unit after the onset of a swelling in the right parotid region. The lesion had been present for 1 year but the patient did not seek medical attention in that time. Clinical examination showed an exophytic mass in the right parotid region measuring 20 × 20 mm. An ultrasound of the major salivary glands showed an oval lesion of the right parotid gland; contrast-enhanced MRI appeared to show an oval lesion in the right intraparotid region, approximately 20 × 25 mm, which was hypointense in T1 images, and hyperintense in T2 images, with inhomogeneous contrast-enhancement; Fine Needle Aspiration Cytology (FNAC) was indicative of a lesion with high suspicion of malignancy.

We elected to carry out a facial nerve sparing total parotidectomy, under general anesthesia, and facial reconstruction of the remaining gap with a sternocleidomastoid muscle flap. Histopathological analysis demonstrated basaloid cell proliferation beneath granulation tissue, hemorrhage, and large number of “ghost cells” with high mitotic activity. This confirmed the diagnosis of pilomatrix carcinoma. Postoperative outcome was uneventful.