Annals of Maxillofacial Surgery最新文献

Rationale: Central giant cell granuloma (CGCG) is a non-neoplastic proliferative lesion that clinically and radiologically mimics various lesions without any unique pathognomic features.

Patient concerns: A 14-year-old male patient reported with a chief complaint of swelling in the right upper back tooth region for four months.

Diagnosis: Incisional biopsy of the lesion shows numerous dilated and thin-walled blood vessels and focal areas of chronic inflammatory cell infiltrate beneath the epithelium suggestive of angiofibroma.

Treatment: Surgical excision of the lesion along with curettage was done under general anaesthesia. On histopathologic examination, the lesion revealed loose connective tissue stroma with mesenchymal cells and multinucleated giant cells suggestive of CGCG.

Outcomes: The patient was followed up for one year without any evidence of recurrences.

Take-away lessons: Presentation of CGCG of the oral cavity is rare and mimics a wide variety of lesions clinically and radiologically. Histopathology remains the only diagnostic modality.

Rationale and patient concerns: A 19-year-old male patient presented with a dentoalveolar Class III malocclusion on a Class III skeletal base with facial asymmetry, increased facial proportions, complicated by anterior open bite of 6.2 mm, unilateral posterior crossbite with Index of Orthognathic Functional Treatment Need score of 5.4.

Diagnosis and treatment: The patient's maxillary arch was bonded initially and 4 months post alignment, pre-surgical intraoral scanning and full skull computed tomography were obtained and subjected to virtual surgical planning (NemoFAB Version 22, Nemotec, Madrid, Spain). Counterclockwise rotational bilateral sagittal split osteotomy setback and genioplasty was performed to close the open bite and correct the Class III skeletal discrepancy with the aid of intermaxillary fixation screws placed in the midline of upper and lower maxillary and mandibular arches for heavy elastic engagement post-surgery.

Outcome: Facial balance was restored, profile was improved, ideal overjet and overbite established.

Take-away lessons: This approach combines the benefits of conventional three-phase surgery and surgery first orthognathic approach by meticulous planning of the intended transitional malocclusion to achieve a stable occlusion. Longer follow-ups in future studies can be investigated.

Introduction: The study was carried out to compare platysma myocutaneous flap and extended nasolabial flap in terms of post-operative mouth opening, duration of surgery and complications associated with it in the surgical management of oral submucous fibrosis (OSMF).

Materials and methods: Patients diagnosed with OSMF (Grade III and IV OSMF according to Khanna and Andrade classification) were included in the study. Thirty patients were selected for the study, out of which 15 patients underwent reconstruction of surgical defects with platysma myocutaneous flap (Group I), and other 15 patients underwent reconstruction with extended nasolabial flap (Group II) post fibrotomy. Pre-operative and post-operative mouth opening, duration of surgery and other complications associated with both procedures were recorded. Postoperatively, patients were evaluated at the end of 1^st week, 3 months and 6 months.

Results: The results were analysed using an Unpaired t-test and Chi-square test. The mean pre-operative interincisal mouth opening in both the groups i.e., Group I was 11.8 mm and Group II was 9.82 mm. It was significantly improved to a mean of 31.9 mm in Group I and 33.87 mm in Group II postoperatively at 6 months of follow-up. However, no significant difference in mouth opening was observed between the groups preoperatively and postoperatively. The mean duration of surgery in Group I was 119.66 ± 12.60 min and was found to be significantly higher than in Group II, which was 102.33 ± 8.83 min. Extraoral scarring was present in both groups. Intraoral hair growth was observed in almost all the male patients in Group II. Transient marginal mandibular nerve injury was reported in four patients (26.6%) in Group II.

Discussion: Both the platysma myocutaneous flap and the extended nasolabial flap serve as a versatile flap in the surgical management of OSMF. However, in young patients, platysma myocutaneous flap can be preferred as scar is present on the collar region as compared to facial scar in the nasolabial flap.

Rationale: Multiple odontogenic keratocysts (OKC) occurs as a component of nevoid basal cell carcinoma syndrome (NBCCS) with concomitant cutaneous, skeletal, ophthalmic and neurological abnormalities.

Patient concerns: A 15-year-old male patient reported with chief complaint of swelling in his upper and lower jaws.

Diagnosis: Orthopantomogram was taken and it showed multiple radiolucent areas present in the maxilla and mandible. Aspiration of the cystic lesion was done under local anaesthesia and it yielded a cheesy exudate which is characteristic of OKC.

Treatment: Complete enucleation of the cyst with chemical cauterisation with Carnoy's solution and peripheral ostectomy was done under general anaesthesia.

Outcome: He was under follow-up for the past 5 years, and there was no recurrence.

Take-away lesson: Multiple OKCs have been known to occur most commonly in syndromic cases. These multiple lesions may be the first manifestation of the NBCCS, or otherwise, they may be because of the multifocal nature of OKCs.

Rationale and patient concerns: A 50-year-old female admitted with right neck swelling and fever was initially diagnosed with infective cervical lymphadenopathy accompanied by internal jugular vein thrombosis for which broad-spectrum antibiotics and anticoagulants were started.

Diagnosis and treatment: A few days later, she developed right common carotid pseudoaneurysm with sentinel bleed which was further managed by common carotid artery repair with the help of pericardial allograft by cardiothoracic vascular surgery and ear, nose and throat team.

Outcome and take-away lessons: This report emphasises the need of having a high index of suspicion for Lemierre's syndrome and its unusual presentation, as well as a multidisciplinary approach to addressing both venous and arterial complications associated with this entity and achieving outstanding results.

The rationale: Oscillating saw breakage during intraoral vertical ramus osteotomy (IVRO) is a rare complication but with potential risk for patients' safety.

Patient concerns: This is a case of oscillating saw breakage during an IVRO in a 25-year-old female patient. Attempts were made with different manoeuvres to retrieve the broken blade without success.

Diagnosis: Postoperative Computed Tomography (CT) images showed the broken blade embedded in the upper part of the right vertical ramus osteotomy.

Treatment: Six weeks following the initial surgery, the patient underwent a new surgical procedure to extract the saw.

Outcome: The broken saw was pushed laterally from the medial aspect of the ramus using a periosteal elevator and retrieved from the lateral aspect of the mandible with curved haemostatic forceps without complications.

Take-away lessons: To prevent this undesirable event, it is crucial to avoid improper manoeuvres that could overstrain the saw during the osteotomy, as well as oscillating saws with multiple prior uses.

Rationale: The importance of a comprehensive and interdisciplinary approach in early diagnosis and managing patients with rare genetic disorders must be highlighted appropriately. This case report delves into the complex clinical presentation of a patient with Gorlin-Goltz Syndrome, emphasizing the multifaceted challenges encountered during diagnosis, treatment, and long-term management and involves a detailed exploration of the patient's clinical history, encompassing cutaneous manifestations, skeletal anomalies, and neurological findings radiological imaging also plays a pivotal role in guiding towards the diagnostic process and forming the basis for a multidisciplinary approach for management of the patient.

Patient concerns: A previously treated case for pain in lower left tooth region, patient concerns for pain and pus discharge from same region.

Diagnosis: After thorough clinical and radiographic findings patient was diagnosed with Gorlin goltz syndrome having multiple cysts.

Treatment: Cyst enucleation of all cysts done under General Anaesthesia along with application of carnoy's solution.

Outcomes: Postoperatively regular follow-up revealed satisfactory bone healing with no signs of recurrence and patient was educated concerning the syndrome.

Take-away lessons: Gorlin-Goltz Syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is a rare autosomal dominant disorder characterized by a constellation of developmental abnormalities and an elevated predisposition to specific malignancies, particularly basal cell carcinoma. This case report describes the way of navigating the complexities of this syndrome and helps inform future diagnostic strategies, treatment modalities, and genetic counseling practices for individuals affected by it.

Introduction: This study was conducted to evaluate the pattern of maxillofacial fractures in Tumkur city over a decade and to compare the results with similar studies from India and the rest of the world.

Materials and methods: Conducted over a decade, this study included patients requiring treatment of maxillofacial fractures in Tumkur city from October 2013 to November 2023.

Results: Peak incidence was noted in the third to fifth decades of life with a mean age of 29.4 ± 2.3 years. Male: female ratio was 4.7:1. The aetiological factors for maxillofacial injuries were: falls (48.5%), road traffic accidents (RTA) (40.3%) and assaults (11.2%). Midface fractures accounted for 54.7% of cases, mandibular fractures for 34.5% and fractures of cranial tables in 10.8%. Open reduction with internal fixation was the most pre-dominant choice of treatment with a conservative mode of treatment in <6% of cases. The mean duration of hospitalisation was 5.3 days.

Discussion: he territorial region of Tumkur and its associated culture have shown a unique result of falls (self, coconut) being the major reason for maxillofacial fractures in the Tumkur district. RTAs still remain one of the main causes of maxillofacial fractures in developing countries such as India. Open reduction internal fixation remains the first choice of treatment in facial fractures due to early return of function with minimal morbidity and better nutritional status in patients compared to closed reduction.

Introduction: Lower third molar surgeries are most commonly associated with morbidities such as swelling, trismus, post-operative infection, dry socket and pain. Various modalities have been tried to reduce these unwanted adverse effects. In this study, we have evaluated the efficacy of low-level laser therapy (LLLT) in minimising morbidity associated with removal of impacted mandibular third molar.

Materials and methods: This in-vivo study was conducted on 60 subjects with similar surgical protocol for both study and control group, with the additional intervention of LLLT in the former.

Results: The results showed a statistically significant (P = 0.05) decrease in the level of pain, facial swelling and trismus in the study group.

Discussion: LLLT, in continuous mode, has a significant effect in reducing post-extraction morbidities and formation of a stable blood clot within the tooth socket.

Introduction: Androgenetic alopecia (AA) is the most common reason for hair loss in men. Minoxidil therapy has been the gold standard. Platelet-rich plasma (PRP) therapy has shown promising results. This study aimed to analyze the hospital data for the clinical efficiency of PRP therapy in comparison to topical minoxidil among AA.

Materials and methods: This retrospective single-centre cohort study analysed the patients treated in the Department of Oral and Maxillofacial Surgery. Sixty-two case records with AA were retrieved, and their treatment options were analysed. Retrieved data were analysed using SPSS v26.0.

Results: Forty complete case records were included for detailed comparison with 20 records in each group of PRP and minoxidil. Twelve had discontinued therapy and analysis included 28 records. Both groups had 6 months of follow-up data checked for a standardised hair growth questionnaire, global photography, hair pull test and patient satisfaction ratings.

Discussion: We observed in our study that PRP therapy was efficient for AA. Minoxidil therapy topically may be advantageously replaced with the PRP injection.