Journal of Maxillofacial & Oral Surgery最新文献

Background: Ameloblastic carcinoma (AC) represents a rare and aggressive malignant odontogenic tumor that derives from the epithelial tissue of the jawbone, predominantly affecting the mandible. This report describes a case of ameloblastic carcinoma that occurred after removal of a right-sided maxillary ameloblastoma.

Case presentation: A 17-year-old male teenager visited author's affiliation with a complaint of a two-week history of spontaneous pain around upper right premolar area after a primary ameloblastoma resection. Intraoral examination revealed that an ulceroproliferative growth with everted margins was noted over the retromolar region adjacent to #17. An occupying lesion was observed in the right side of maxilla by maxillofacial imaging. The patient underwent partial maxillectomy, elective level I-II neck dissection, and immediate reconstruction with submental island flap. Histopathological assessment post-right maxillectomy identified a high-grade AC with malignant spindle cell transformation. Post-treatment follow-up for 6 months showed no recurrence of the malignancy.

Conclusion: Primary ameloblastoma or AC is increasingly being reported, but secondary AC of the maxilla is rarely described in detail. Although the underlying causes of this condition are still not well understood, intensive treatment and careful follow-up are key steps in preventing the disease from recurrence and malignant changes.

Aim and objective: To evaluate the correlation between the position of inferior alveolar nerve canal and the angulation of impacted mandibular third molars. Also, the bone width and shape of the mandible at impacted third molar region determined precisely from CBCT cross-sectional images.

Material and methods: CBCT data of the impacted mandibular third molar of 89 patients were included in the study where an initial radiographic assessment demonstrated overlap/close proximity of the impacted mandibular third molar and inferior alveolar nerve canal. Using cross-sectional views and adjusting the position in panoramic view, the outline of the inferior alveolar canal was done and its buccolingual position was assessed. All the scans were taken using Carestream 9300 with 5/5 segment FOV size and operated at 75 kV and 8 mA. Scans were evaluated by two Oral and Maxillofacial Radiologist on same computer (Intex^®Core^TMi7-8700 CPU @3.20 GHz, 64-bit operating system with 32.0 GB memory, with use of software CS 3D imaging v 3.8.7), and following parameters were noted: type of impaction, relative position of the mandibular canal, bone contact, shape of mandible, space, width of cortical bone, apex canal distance, width and height of the canal. All the data were analyzed statistically.

Result: Class I position A impactions were found in majority of the cases, where the position of inferior alveolar canal was inferior and lingual to the impacted third molar (61.4%) and the result was statistically significant. 81% of inferior alveolar canal showed bone contact. Of these, 72.8% of the canal exhibit lingual bone contact, inferior to impacted third molar, and the results were statistically significant. Mesioangular impactions were most common in mandible having lingual and inferior position of the IAN canal (67.5%). The morphology of mandible at third molar region was observed as round (63%), lingual concave (25%) and lingual extended (12%) and was significantly associated with the type of impacted third molar. The space and the width of the lingual cortex were significantly associated with type of impactions (p = 0.016 and p = 0.036, respectively).

Conclusion: The type of impacted tooth, morphology of the mandible and location of the IAN canal can be precisely determined on CBCT which can help the surgeon to predict any damage to the canal and to prevent sequelae of numbness.

Introduction: The perception of facial attractiveness (PFA) varies between cultures.

Objectives: This study aimed to assess the PFA in Saudi culture and compare it with the golden proportions (GP).

Materials and methods: A total of 500 survey papers were formulated using the frontal views of different photographs with high beauty scores selected from the universal benchmark dataset. The selected photographs were modified. The different perception questions were formulated, followed by subjective and objective soft tissue analyses of the selected frontal photographs.

Results: A total of 488 participants reported differing opinions on the most important element that determines facial beauty. Male participants scored the eyes, whereas female participants scored the lips; this difference was statistically significant (p value < 0.009). The photograph with the highest score (86%) had an asymmetrical face of more than 4 mm, which was statistically significant between the Saudi participants who lived abroad and those who were not expatriates (p = 0.037).

Conclusion: The participants had higher scores for short facial morphology. The facial analysis proportions reported percentage differences from the GP (1.618). These findings could provide guidelines for clinicians for improving facial aesthetics. Thus, further studies using a local database of the local population should be conducted.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-025-02477-5.

Introduction: p63 is essential for normal proliferation and differentiation of odontogenic epithelium. Since odontogenic keratocyst (OKC), dentigerous cyst (DC) and radicular cyst (RC) are odontogenic epithelial lesions, p63 may play a role in their pathogenesis and biological behaviour. p63 can preserve keratinocytes with stem cell potential by preventing premature apoptosis and terminal differentiation during wound healing.

Aim: The aim is to explore the role of p63 in pathogenesis, regenerative potential and biological behaviour of various odontogenic cysts.

Materials and method: The study involved 40 samples, which are OKC (n = 10), DC (n = 10), RC (n = 10) and regenerating tissue samples (n = 10), are taken as a comparative measure. p63 protein expression was evaluated by immunohistochemistry. (qualitative, quantitative and topography).

Result: p63 was expressed in basal and parabasal layer in lining epithelium of OKC. In addition, p63 was expressed throughout the lining epithelium in RC and DC.

Conclusion: The present study suggests that p63 overexpression is associated with increased proliferation. Thereby, p63 can be a prognostic biomarker in odontogenic lesions with aggressive phenotype. Henceforth, discerning the pathogenesis of developmental and inflammatory cysts is critical for determining the surgical approach and predicting the prognosis of odontogenic cysts.

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.