Oral and Maxillofacial Surgery Cases最新文献

Two cases of peripheral odontogenic keratocyst (POKC) of the gingiva presenting as asymptomatic nodules are described. The exceptional finding of cystic radiolucency in POKCs was observed on dental radiography in one case, which had a diameter of 10 mm. Conservative surgical excision was performed on both cases, and histopathological examination showed features consistent with keratocysts. POKC may recur and should thus be followed up like intraosseous keracysts. No recurrences were observed after 10-years in our two cases. POKC is managed by conservative treatment. Recurrences should be excised more radically. Adjunct treatment with modified Carnoy's solution or topical 5Fluorouracil should be considered. POKC should be included in the differential diagnosis of asymptomatic gingival nodules.

Introduction

Understanding the pathophysiology, clinical characteristics, and postoperative complications of parotid tumors is crucial in light of the growing emphasis on the occurrence and development of parotid tumor disease.

Materials and methods

The study population consisted of 387 cases of primary parotid tumors treated surgically at our institution between July 2015 and November 2020. We statistically analyzed the gender, age, and pathological findings of patients, 307 of whom underwent postoperative return visits and were included in the study of postoperative complications.

Results

The ratio of male to female parotid tumor patients was 1.39:1, and the best possible age range was between 51 and 60 years. The percentage of benign to malignant tumors (342/45) was 7.6:1. Pleomorphic adenoma constituted the majority of benign tumors. Adenoid cystic carcinoma constituted the majority of malignant tumors.The sensory deficit of the auricle, salivary fistula, facial nerve paralysis, and Frey's syndrome were the most prevalent postoperative complications of parotid tumors.

Conclusions

Our efforts should focus on active prevention and treating parotid tumor postoperative complications.

Several techniques have been reported for the reconstruction of total defects of the lower lip. However, the most effective method for total or subtotal resection of the lower lip remains controversial. The Karapandzic flap is commonly used for middle to large defects of the lower lip, although it does not introduce new tissue into the oral cavity and may result in postoperative microstomia. We present the case of a 73-year-old Japanese female with a lower lip tumor occupying 80% of the lower lip, confirmed by biopsy as well-differentiated squamous cell carcinoma. Imaging showed a 50mm tumor in diameter in the lower lip and multiple right-sided cervical lymphadenopathy. The tumor was excised and reconstruction was performed with bilateral extended Karapandzic flaps, along with simultaneous cervical lymph node neck dissection, with preservation of the feeding facial artery. The patient made an uneventful postoperative recovery, and two years after surgery both appearance and function of the lower lip were satisfactory. Our findings suggest that the use of bilateral extended Karapandzic flaps may be a viable option for total defects of the lower lip and simultaneous neck dissection is possible when the feeding facial artery is preserved.

The present report describes the rehabilitation of partial edentulism (Kennedy's class II) in an elderly woman presenting with severe atrophy of the posterior maxilla, preventing standard implant placement. The woman had a positive history for osteoporosis and ongoing oral bisphosphonates therapy, thus, bone regeneration procedures, such as sinus lifting, were ruled out from the available options for her. Plus, the woman desired immediate fixed rehabilitation, thus, a 3D-printed custom subperiosteal implant was planned. The entire process, from impression acquisition to implant production was implemented in a digital setting and completed in three weeks. The surgeon was in charge of designing general implant features and the number, size, and position of future abutments. At surgery, the implant showed excellent fit and stability. One year after loading, the implant showed perfect integration and no complication could be recorded. Custom subperiosteal implants might represent a valid alternative for the rehabilitation of severely resorbed maxilla in elderly patients who cannot or do not want to undergo bone regeneration procedures. Further studies with large sample size and longer follow-up are recommended.

We describe here a rare case of giant intramuscular lipoma of the tongue. A 67-year-old male patient presented to our department with a large tumefaction on the tip of the tongue that he refers has started to grow about 20 years before. Clinical examination revealed a yellowish lesion, measuring no more than 5 cm in diameter, protruding from the lingual surface. Histological examination showed a non-encapsulated lipomatous tumor composed of mature adipocytes, uniform in size and shape, diffusely infiltrating striated muscle fibers of the tongue. The patient is fine with no local recurrence after 15 months follow-up period.

Medication-related osteonecrosis is a well-documented yet rare complication of antiresorptive treatment. The risk of MRONJ is well established in the adult population but has yet to be established in the pediatric population. Additionally, the risk to this population in adulthood following many years of antiresorptive use is unknown. This case report describes a patient who received long-term antiresorptive medication as an adolescent and spontaneously developed MRONJ at age 23. To the authors’ knowledge, this is the youngest patient with MRONJ reported in the literature.

A myoepithelioma is a type of salivary gland tumor composed entirely of myoepithelial cells. Previously, this was considered a subtype of pleomorphic adenoma. Here, we report an extremely rare case of myoepithelioma of the upper lip. A 33-year-old female patient presented with a painless mass on her upper lip. Magnetic resonance imaging revealed a 23 mm × 18 mm well-defined tumor. We clinically suspected a benign minor salivary gland tumor and the patient underwent complete resection of the tumor under general anesthesia. Since the tumor was diagnosed as a myoepithelioma by rapid pathological examination, it was resected with a safety margin of approximately 5 mm. Pathologically, this tumor showed mild to moderate cell atypia, and focal invasion into the capsule. Immunohistochemical findings showed that the tumor was positive for the S-100 protein and vimentin. The Ki-67 labeling index was less than 1%, and there were no malignant findings. The postoperative clinical course has been good for approximately 5 years, and satisfactory results were obtained both functionally and esthetically. Herein, we also discussed the clinical and immunohistochemical features of myoepitheliomas.

Chondroid Syringoma is a rare benign mixed tumor characterized by gland elements in a cartilaginous stroma. These tumors most commonly occur in the skin of the head and neck district, affecting only rarely the periorbital area.

Below we present two cases of Chondroid Syringoma, the first on the upper lip, and the second in the orbital cavity. Both are characterized by an epithelial component in a cartilaginous stroma.

Lipoma is a common soft tissue benign neoplasm originating from the mesenchymal cells of connective tissue. It is a painless neoplasm characterized by slow growth. The incidence in the oral cavity is relatively rare (1–4%). A predisposing cause of the onset in the oral cavity is the continuous trauma due to the action of the teeth. Patients can live with an oral lipoma for several years before experiencing symptoms that usually coincide with speech and chewing disorders. We report a case of unusual, intraoral lip lipoma that caused discomfort to the patient. Case Report: A 72 years old man presented a soft mass in the mucous membrane of the lower lip. The patient reported that he noted the lesion for about 5 years but he decided to treat this condition after a long period since he developed discomfort during speaking and chewing. The patient underwent surgical excision of the lesion, which was then sent for histological examination. Results confirmed the initial hypothesis of lipoma. Conclusions: Lipomas of the oral cavity are slow-growing neoformations that patients usually underestimate or tolerate until they feel disturbances, especially in speaking and chewing, or if they create aesthetic problems. Although lipoma represents a benign condition surgical excision should be recommended and histopathological examination is necessary to confirm the diagnosis.