Journal of Oral and Maxillofacial Surgery Medicine and Pathology最新文献

Objective

Methods

Results

Conclusions

Objective

Methods

Results

Conclusion

Temporomandibular joint (TMJ) disc displacement without reduction, often referred to as closed lock, is a debilitating condition characterized by a sudden decrease in mouth opening capacity, accompanied by TMJ pain. Over time, this closed lock can lead to the development of TMJ osteoarthritis (OA). While conservative treatments effectively alleviate TMJ pain and improve jaw function in most patients, they seldom restore normal TMJ structures. In this case report, we present a rare case of a 39-year-old woman who experienced the restoration of a normal disc-condyle-mandibular fossa relationship and the repair of OA changes following self-care for chronic TMJ closed lock with OA. She initially presented with a 7-month history of left TMJ pain and limited mouth opening persisting. Magnetic resonance imaging (MRI) of the left TMJ showed anterior disc displacement without reduction and OA changes including erosion, subchondral cyst, and sclerosis of the subchondral bone in the left condyle. Self-care, including parafunction control and stretching exercises, relieved the TMJ pain and increased the range of mouth opening. A follow-up MRI obtained 13 months following the initial MRI revealed a normal disc-condyle-mandibular fossa relationship and repair of the surface erosion with the subchondral cyst. Our clinical findings indicate that although rare, restoration of the normal disc-condyle-mandibular fossa relationship and condylar repair are possible through self-care for chronic closed lock with OA.

Objective

The treatment of condylar fractures can have significant morbidity. The purpose of this study is to suggest the safest approach by comparing endoscope-assisted and open surgery.

Methods

A case-series study was conducted in the Maxillo-Facial Surgery Unit of the Federico II University of Naples from January 2016 to January 2022 on 34 patients who underwent surgery for condylar fracture. Thirty patients met the inclusion criteria. They were divided into two groups according to the surgical technique used: Group A, made up of 15 patients treated by endoscope-assisted surgery; Group B made up of 15 patients treated by traditional non-endoscope-assisted surgery.

Results

The most common complication was transient facial nerve palsy, observed in group B in 4 patients (26%) and in only 2 patients in Group A (13%). Permanent facial nerve palsy occurred in 2 patients (13%) in Group B. No permanent facial nerve palsy was observed in Group A. No plates infection occurred in Group A, 1 case (7%) was recorded in Group B.

Conclusions

From our experience we can consider endoscope-assisted surgery a favorable option for treating condyle fractures. Patients’ selection for transoral endoscope-assisted surgery is extremely important to ensure the best surgical results with the less complications score.

Trabecular juvenile ossifying fibroma (TJOF) is a rare benign fibro-osseous tumor that may develop in the craniofacial bones at an early age. To the best of our knowledge, there is no published case of bilateral monostotic TJOF in the literature. The aim of this study was to report the surgical treatment of a rare case of bilateral mandibular TJOF in an adolescent. A 13-year-old male patient presented with no symptoms other than a slight increase in volume in the lower right facial region. Tomographic examination revealed well-defined hypodense areas, hyperdense islands, and expansion of the involved bone cortices in the posterior mandible bilaterally. After histological and immunohistochemical analysis, the diagnosis was TJOF. Using a rapid prototyping biomodel, enucleation combined with curettage and peripheral osteotomy of the tumors was performed, followed by the placement of a reconstruction plate and screws. After one year, there was a recurrence on the left side, which was treated again with curettage and peripheral osteotomy. The patient is currently under follow-up for 24 months with a favorable prognosis. Despite its aggressive potential and risk of recurrence, an individualized surgical plan should be developed. A conservative approach should be the preferred treatment, aiming to minimize deformation and functional impairment.

Idiopathic Osteosclerosis/dense bone island/enostosis is defined as an asymptomatic, non-expansible, radiopaque lesion in the jawbone. It is classified on the basis of location and is diagnosed incidentally in most cases. Orthodontic treatment is usually delayed when the lesion is present in proximity to the tooth roots. Since its introduction in 2009, Surgery First Orthognathic Approach (SFOA) has been popular for facilitating faster overall treatment time through Frost’s biological theory as well as improving patient comfort. We report a case wherein osteosclerosis of mandible was observed in the premolar region bilaterally. Considering potential complications during pre-orthodontics, we opted for surgery driven SFOA which was then followed by orthodontic treatment. Post-operative orthodontic treatment was completed 11 months after surgery. Surgery driven SFOA allowed for reduction of total treatment duration by enabling faster anterior teeth retraction, space closure and achievement of the preferred facial feature with desired occlusion.

A true aneurysm is a dilation of the arterial wall that preserves vessel continuity, retains three layers (intima, media, and adventitia), and commonly occurs in the aorta, including the thoracic and abdominal aorta. In contrast, true aneurysms of the external carotid artery and its branches are rare. Among several therapeutic options for true aneurysms, catheter-based embolization is the traditional treatment method. However, parent artery occlusion may not always result in permanent exclusion of the aneurysm from the systemic circulation. Dilation of the vasa vasorum is one of the mechanisms of occlusion recanalization. Herein, we present a rare case of a true aneurysm of the facial artery aneurysm. The patient underwent coil embolization as the initial treatment. Subsequently, surgical resection was performed due to aneurysm regrowth caused by vasa vasorum dilation. Although embolization is a useful and safe treatment option for facial aneurysms, careful follow-up radiological examinations are required because of the possibility of regrowth.

Objective

Dental implants are widely accepted in the dental community. Although several studies have reported high dental implant survival rates, complications can still occur. Implant failure is associated with different risk factors, including implant length and diameter. However, no clear consensus has yet been reached. This study aimed to evaluate the influence of different risk factors associated with implant failure.

Methods

This study included patients who received dental implants at Kyoto University Hospital. The inclusion criteria were dental implants placed between January 1, 2005 and December 31, 2022. Data on patient- and implant-related variables were collected. We used a marginal Cox proportional hazards models to investigate the association between the potential factors and implant failure.

Results

This study included 147 patients who received 479 dental implants. Eleven of the 147 patients experienced implant failure, whereas 17 of the 479 implants failed. The cumulative survival rate of dental implants at the final time point was 95.3%. Multivariable marginal Cox analysis showed suggestive evidence that implant length (<10 mm) greatly increased the risk of implant failure compared with implant length (≥10 mm) (reference: <10 mm, hazard ratio, 0.07; 95% confidence interval, 0.01–0.34; p = 0.001).

Conclusions

A cumulative survival rate comparable to that reported in other studies was achieved over prolonged periods of time. Although implant failure is multifactorial and implant length is only one of many factors contributing to implant loss, clinicians must be aware of the potential influence of implant length and make treatment decisions.

Objective

To outline the effect of a Le Fort 1-type advancement osteotomy or Le Fort 1 level distraction osteogenesis (DO) procedure with anterior repositioning on speech, respiration and dimensions of the pharyngeal airway in patients with cleft lip and/or palate.

Methods

This systematic review was conducted by following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). For studies published until October 2023, an electronic search was conducted, and those were included in which the impact of Le Fort 1 maxillary advancement (I) on the speech, breathing, and pharyngeal airway dimensions (O) compared to pre-operative situation (C) in the patients with non -syndromic cleft lip/palate (P) were assessed. A meta-analysis was done to assess the difference in the amount of pharyngeal depth.

Results

From 892 studies, 19 studies were included in the analysis. All studies reported an increase of airway dimensions that were evaluated with 3D-imaging, velar length and improvement in breathing after the intervention. Meta-analysis of the six studies revealed the significant increase of the following variables: nasopharyngeal depth (NPD) immediately after the Le Fort 1 osteotomy, NPD and middle pharyngeal depth immediately and 12 months after Le Fort 1 DO.

Conclusion

In patients with cleft lip and/or palate, maxillary advancement using Le Fort 1 osteotomy and Le Fort 1 DO can significantly increase the dimensions of the airway in the nasopharynx. However, the changes in speech and breathing parameters were not significant in the scrutinized literature. Impact of Le Fort maxillary advancement on patients’ speech remains controversial.

The mandibular canal rarely penetrates the apically fused tooth roots. In this report, we describe three cases of patients in whom the mandibular canal ran between the roots of embedded mandibular teeth with apical fusion. Case 1: A 43-year-old man presented with a completely embedded left mandibular first molar and a swollen gingiva. Cone beam computed tomography revealed apical root fusion and a mandibular canal penetrating the root. Case 2: Cone-beam computed tomography of a 39-year-old female revealed root apical fusion and a mandibular canal between the roots. Case 3: Cone-beam computed tomography of a 30-year-old female with a fully erupted left mandibular third molar revealed a ring of diverging roots fused to the root apex. The mandibular canal runs between the mandibular roots. All three patients were treated under general anesthesia and developed postoperative inferior alveolar nerve palsy; however, their sensory function recovered over time. The prognosis was good in all patients, none of whom experienced any other complications.