Journal of Maxillofacial & Oral Surgery最新文献

Background: Dental implants require an adequate amount of bone volume for successful and good prosthetic support. However, in severe alveolar bone width deficiency, onlay grafts from intraoral donor sites like zygomatic buttress, ramus and symphysis may be taken.

Method: A prospective comparative study was conducted on 30 patients with upper and lower anterior edentulous arches of width less than 4 mm. They were evaluated for the efficacy of three types of onlay grafts for ridge augmentation prior to implant placement. Patients were randomly divided into Group 1 (Ramal), Group 2 (Symphysis) and Group 3 (Zygomatic buttress) grafts of n = 10 each. The grafts were evaluated in terms of bone width, pain, mouth opening, teeth vitality, neurosensory loss and patient satisfaction score till 6 months follow-up.

Findings: Graft uptakes were good in all three groups with maximum width gained in the symphysis group. More postoperative complications (reduced mouth opening, swelling, paresthesia, mobility) occurred in the ramal graft group.

Conclusion: The use of autogenous onlay bone grafts from intra-oral donor sites provides promising results with reduced operative time for augmenting atrophic ridge prior to implant placement, but the symphysis graft provides the maximum bone width to accommodate the dental implant, with minimal complications.

Background: Ignoring this anatomic structure would have implications for iatrogenic perforation with the trocar toward the FH during the initial blind drilling or due to the diffusion of the infusion liquid toward the middle ear.

Purpose: To analyze the prevalence of the FH in an institutional population with a high incidence of TMD to provide further guidelines in diagnosing this anomaly and the planification of TMJ arthroscopy.

Materials and methods: A retrospective tomographic study was conducted at the ENT-Oral and Maxillofacial and Radiology Department of the Hospital Universitario la Samaritana in Bogotá, Colombia. Inclusion criteria were patients over 18 years of age who had complementary exams such as ear, face, paranasal sinus, and/or TMJ tomography. Exclusion criteria were history of direct trauma to the external auditory canal in the medical history, patients with craniofacial syndromes, congenital anomalies, and/or history of cranial, mandibular, or temporal fractures. Two radiologists were part of the evaluators of the CT images who conducted the measures in the axial tomographic section and established the presence of the tympanic defect.

Results: A sample size of 139 medical records of patients, where females represent n: 101 (72.6%) and males represent n: 38 (27.4%). The average age was 43 years ± 18 years. Among the studied population, a total of five FH were detected, corresponding to a prevalence of 3.6% (95% CI 1.5-8.1%). The average size of the defect was 3.52 mm ± 1.1 mm. All the patients had TMJ-related symptoms, but none of them reported otalgia.

Conclusion: The initial evaluation of each patient must be addressed to assess the integrity of the tympanic bone. In this study, the defects size was smaller than others previously reported. However, diffusion through the tympanic defect could spread the lavage substance into the middle ear during TMJ arthroscopic surgery.

Introduction: Adenoid ameloblastoma (AdAM) is a rare epithelial odontogenic tumour recently included in the 5th World Health Organization classification of head and neck tumours as a separate tumour from conventional ameloblastoma. It presents diagnostic and management challenges due to its morphological overlapping features with adenomatoid odontogenic tumour (AOT) and conventional ameloblastoma.

Case report: A 32-year-old female with neurofibromatosis type I presented with a 4-month history of right-sided facial swelling. Clinical examination revealed a firm, expansive mass in the right anterior mandibular region with associated tooth mobility. Radiographic evaluation demonstrated a well-demarcated unilocular radiolucency mimicking a cystic lesion. Histological examination revealed an epithelial odontogenic neoplasm composted of nests of ovoid to spindle-shaped cells demonstrating pseudo-duct-like spaces, cribriform areas and a whirling pattern with deposition of dentinoid material. These features confirmed the diagnosis of AdAM. The tumour was resected and immediately reconstructed with a fibula free flap. The patient remains diseases-free 2 years post-surgery.

Conclusion: There are some overlapping clinico-pathological features of this tumour with AOT, which has led to inadequate surgical management previously with high recurrence rates. Emphasis should be placed on identifying all histopathological features described to arrive at an accurate diagnosis. Surgical treatment of AdAM should be radical resection despite its clinical and radiographic presentation mimicking the less aggressive AOT.

Background: The treatment of mandibular sub-condyle fractures is controversial. Guiding elastics play an important role in managing sub-condylar fractures, as their rationale revolves around the vector and traction alteration of the fractured ends.

Purpose: This study aims to compare the outcomes of conventional closed treatment and dynamic elastic therapy for the treatment of unilateral mandibular sub-condylar fractures.

Study design: The study design was a double-blinded prospective randomized controlled trial. Patients ≥ 18 years of age, with unilateral sub-condylar fractures with or without associated mandibular fractures, were randomized into experimental and control groups.

Predictor: The predictor variable was the type of method used for fracture management, either conventional way or dynamic elastic therapy.

Main outcome variables: Primary outcome variables were post-treatment occlusion, mouth opening, deviation, and patient satisfaction level scores and secondary outcome variables were protrusion, laterotrusive and mediotrusive movements, Ramal height, degree of displacement, and complications.

Covariates: Age, etiology, and site of the associated mandibular fracture were the covariates.

Analyses: Data were analyzed using the Student's t test, ANOVA followed by post hoc test, and frequencies were compared using the chi-square test. For all the statistical tests, p < 0.05 was considered to be statistically significant.

Results: The study incorporated 34 patients, out of which 22 had sub-condylar fractures along with associated mandibular fractures, and the rest 12 were isolated. There were no significant differences between the two groups in terms of occlusion, mouth opening, Ramal height, mediotrusion, and laterotrusion, and degree of the displaced condyle. (p > 0.05). Among the GOHAI scale questions, used for patient satisfaction score assessment, question 10 produced a highly statistically significant p value < 0.001 (p value- 0.006). There is a statistically non-significant difference seen (p > 0.05) for the values of all variables between the groups, except for the protrusion baseline with higher values in the conventional group (p = 0.044) and deviation baseline with higher values in the dynamic elastic therapy group. (p = 0.018).

Conclusions: Both treatment options provide satisfactory results for the management of sub-condylar fractures but novel guiding elastic therapy has few advantages over conventional elastic therapy such as improved treatment satisfaction.

Clear cell odontogenic carcinoma is a very rare malignant tumor of the jaw. Diagnosis and treatment may be challenging as the tumor grows locally aggressive and infiltrative with possible metastatic spread, while the clinical presentation varies, and the definitive diagnosis can only be confirmed by immunohistopathology. The case of a 25-year-old male patient with clear cell odontogenic carcinoma of the mandible is presented. Therapeutic treatment included primary surgical resection with bilateral removal of cervical lymph nodes followed by a two-stage reconstruction approach. Continuous follow-up over 7.5 years showed no signs of tumor recurrence.

Purpose: Trifocal (bilateral condyle and anterior mandible) fractures of mandible lead to increased lower facial width. The methods currently described in literature are associated with limitations and offer less predictable intra-operative guidance. This study was designed to evaluate the effectiveness of pre-fabricated inter-occlusal splints in restoring the lower facial width.

Materials and methods: A retrospective cohort study was designed involving patients who were treated for trifocal fractures. Pre-fabricated inter-occlusal splint had been used during reduction and stabilization/fixation of symphysis/condyle fracture to establish the lower facial width. Data were collected from clinical records (photographs and case sheets) and computed tomographic (CT) images. Study variables included clinical parameters such as inter-gonial width, lower facial height, mouth opening, and occlusion. Radiological (CT) parameters were inter-gonial width and inter-molar width. Data analysis was done by SPSS (V 26) using Shapiro-Wilk test and paired t test.

Results: A total of nine patients (eight males and one female) with mean age of 27.2 (SD ± 8.47) years were included in the study. The study showed statistically significant decrease (p value-0.001) in inter-gonial width (clinical and radiological), lower facial height, and inter-molar width after treatment. All patients demonstrated improved mouth opening (p value-0.001) and corrected dental occlusion.

Conclusion: The intra-operative use of splints is effective in restituting lower facial width in the management of trifocal fractures. The technique is simple and predictable.

Introduction: The 'progression model' of oral carcinogenesis emphasizes that initial irreversible genotypic damage produces tissue disorganization and dysmaturation which, if allowed to progress, leads invariably towards invasive oral squamous cell carcinoma. Recognition of these genotypic changes is fundamental for a successful management strategy. Genetic studies have confirmed the role of pro-carcinogens present in tobacco and alcohol contributing to DNA damage and genotoxicity. Many molecular epidemiological studies have evaluated the association of head and neck cancer with polymorphisms in DNA repair genes. Our study aimed to investigate the association between single nucleotide polymorphisms (SNPs) of DNA repair genes OGG1 Ser326Cys, APE1-Asp148Glu, XRCC1- Arg194Trp, XRCC1-Arg280His, XRCC1-Arg399Gln, ADPRT-V762A, APEX1-D148E, LIG3-R780H, MUTYH-Tyr165Cys and the risk of oral squamous cell carcinoma and oral precancerous lesions.

Materials and method: Our study included two patient groups. Group I (n = 58) included patients with leukoplakia, oral submucous fibrosis and biopsy-proven oral squamous cell carcinoma. Group II (n = 58) included patients who had no clinically detectable lesions. Patients in both groups had tobacco chewing and smoking history. Blood samples were collected, and gene polymorphisms were identified using PCR-RFLP technique.

Results and discussion: Our study results revealed a statistically significant association between gene polymorphisms OGG1-Ser326Cys (p = 0.008), XRCC1-Arg194Trp (p = 0.009), XRCC1-Arg399Gln (p < 0.001), APEX1-Asp148Glu (p < 0.001) and the occurrence of leukoplakia, OSMF and OSCC.

Purpose: To propose a novel and viable modality for guarding an isolated zygomatic arch fracture following reduction in the initial postoperative phase.

Method: A silicone non-invasive ventilation mask is used efficiently as a guard during the initial postoperative period following reduction of an isolated zygomatic arch fracture.

Results: The use of a non-invasive ventilation mask as a guard is safe and versatile. However, it can be employed only in clinical situations where there are no other associated injuries or fractures of the facial skeleton.

Conclusion: The non-invasive ventilation mask is easy to use, less traumatic to the patient in addition to the fact that it aids in guarding an isolated zygomatic arch fracture following reduction during the initial postoperative phase.