Intraoral multistage mandibular angle ostectomy: 10 years' experience in mandibular contouring in Asians

In Asia, a round face rather is more acceptable than a square face. Intraoral mandibular angle ostectomy is a common aesthetic procedure for correcting a prominent mandibular angle. However, an operation of sheer straight-lined prominent mandibular angle resection would sometimes create extramandibular angles or palpable bone steps in the margin of mandibular body and produce unnatural lower one-third facial appearance, especially for a square and disproportional mandibular angle even extending to the middle mandibular body. This article describes the method of multistage mandibular angle ostectomy to produce a natural lower one-third facial contour. This method mainly focused on the posterior area of mandibular ostectomy by intraoral approach, although it has modifications. Mandibular contouring is realized first through bone cutting from antegonial notch posteriorly upperward, reaching to the middle ramus of the mandible near the earlobe; second ostectomy followed along mandible lower part is to get rid of extramandibular angle according to the preoperative design; sometimes necessarily, third ostectomy creates a smooth mandibular contour. From January 2000 to January 2010, 379 patients were operated on, and satisfactory results were achieved. Thus, this procedure could avoid excessive bone cutting, extramandibular angles, unnatural appearance, and palpable bone steps.     

Perineural infiltration of the inferior alveolar nerve in mandibular ameloblastomas

Our aim was to evaluate the histological association of mandibular solid and multicystic ameloblastoma with the inferior alveolar nerve, both in situ and in segments of the nerve that had been removed separately, to assess the feasibility of preserving the nerve during resection of mandibular ameloblastomas. In this prospective histological examination of 13 resected hemimandibulectomy specimens, we studied the proximity of tumour cells to the inferior alveolar nerve. In group 1 (n = 8) this association was examined with the nerve still within the mandibular segment after resection, while in group 2 (n = 5) the nerve was removed from the resected tumour and examined separately. Perineural and intraneural involvement of the ameloblastoma with the nerve was confirmed in 5 cases in group 1 and 2 cases in group 2. Tumour cells abutted the nerve directly in group 1. In group 2 tumour was removed with, and found within, the nerve. On this evidence we cannot recommend preservation of the inferior alveolar nerve during operation for large, advanced, mandibular ameloblastomas.     

Primary post-traumatic mandibular reconstruction in infancy: a 10-year follow-up

Ballistic trauma to the craniofacial skeleton combines the challenges of complex bone injury and loss with severe soft tissue injury and violation of the naso-orbital or oropharyngeal cavities. The authors report a patient who experienced a unique ballistic injury at 28 months of age that resulted in loss of the mandibular ramus and condyle. A segmental injury to the facial nerve was also identified. Primary costochondral grafting and delayed interpositional nerve grafting was undertaken. After 10 years, the patient has nearly 40 mm of opening, with only slight deviation to the injured side. Her facial nerve regeneration provides complete orbicularis oculi function, oral competence, and only slight facial asymmetry. This traumatic reconstruction differs from that of patients with hemifacial microsomia or post-traumatic/arthritic ankylosis in that the joint space itself was spared. Thus, the costochondral graft benefits from the remaining articular disk and upper disk space and is able to rotate and translate. Function and growth are adequately re-established, even in this young pediatric patient.     

Growth characteristics of large mandibular ameloblastomas: report of 5 cases with implications for the approach to surgery

The aim of this study was to establish surgical guidelines based on the growth pattern of ameloblastomas in relation to the possible infiltration of the cortical bone, the inferior alveolar nerve, the periosteal layer and the surrounding soft tissues. Five male patients with voluminous mandibular ameloblastomas were treated by means of radical surgery. Ameloblastomas showed an invasive growth pattern in the cancellous bone with small tumour nests at a maximum distance of 5mm away from the bulk of the tumour. Expansive and invasive growth in the Haversian canals was observed. There was no invasion of the inferior alveolar nerve. The mucoperiosteal layer was invaded but not perforated. No invasion was observed in the surrounding soft tissues of the periosteum and in the skin tissue. A local resection with a surgical margin of spongious bone of 1cm is suggested. When the tumour is radiologically closer than 1cm to the inferior border of the mandible, a continuity resection is mandatory. A conservative approach concerning the inferior alveolar nerve is suggested. Removal of an excess of perimandibular soft tissue is not indicated. The overlying attached mucosal surface should however be excised together with the underlying bone.     

Outcomes in pharyngoplasty: a 10-year experience.

OBJECTIVE: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation. DESIGN: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes. PARTICIPANTS: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency. RESULTS: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p > .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low. CONCLUSIONS: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.     

Establishing and managing a periodontal biobank for research: the sharing of experience

Periodontal bio‐repositories, which allow banking of clinically validated human data and biological samples, provide an opportunity to derive biomarkers for periodontal diagnosis, prognosis and therapeutic activities which are expected to improve patient management. This article presents the establishing of the Malaysian Periodontal Database and Biobank System (MPDBS) which was initiated in 2011 with the aim to facilitate periodontal research. Partnerships were established with collaborating centres. Policies on specimen access, authorship and acknowledgement policies were agreed upon by all participating centres before the initiation of the periodontal biobank. Ethical approval for the collection of samples and data were obtained from institutional ethics review boards. A broad‐based approach for informed consent was used, which covered areas related to quality of life impacts, genetics and molecular aspects of periodontal disease. Sample collection and processing was performed using a standardized protocol. Biobanking resources such as equipment and freezers were shared with the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS). In the development of the MPDBS, challenges that were previously faced by the MOCDTBS were considered. Future challenges in terms of ethical and legal issues will be faced when international collaborations necessitate the transportation of specimens across borders.     

Bilateral mandibular infected buccal cyst: a new image

BACKGROUND: The mandibular infected buccal cyst is an uncommon lesion associated with the permanent mandibular first or second molar in children just prior to tooth eruption. The World Health Organization includes this lesion under the category of paradental cyst and suggests the term "mandibular infected buccal cyst" (MIBC) for lesions that occur on the buccal surface of the permanent mandibular first molar in children approximately 6 to 8 years of age. We present the case of a patient with bilateral mandibular cyst affecting the second molars of an 8-year-old boy. To the best of our knowledge, this is the first case of bilateral MIBC published with a three-dimensional model made using an interactive three-dimensional (3D) implant planning system. METHODS: An 8-year-old boy presented with swelling over the buccal gingiva of his lower left first molar. He complained of pain on chewing. Clinical examination revealed a 10-mm, firm, round swelling buccal to the lower left first molar. Computed tomography with multiplanar reconstruction of the jaws showed well-defined bilateral ovoid radiolucencies at the apices of the lower left first molar and the lower right first molar. A three-dimensional study was made using the interactive 3D implant planning system showing the presence of the cyst and its relation with the molar and the dental nerve. The treatment was to enucleate the left cyst and maintain the involved tooth. RESULTS: The histopathologic diagnosis of the lesion was an MIBC. CONCLUSION: The objective of the present study is to 1) familiarize dentists and oral surgeons with the entity of the MIBC; 2) show new image techniques for the diagnosis; and 3) emphasize the appropriate treatment approach.     

Indications for removal of impacted mandibular third molars: a single institutional experience in Libya

Aims  

To investigate the various indications for the removal of impacted lower third molars in a dental school in Libya.     

Treatment of mandibular retrusion by distraction osteogenesis: a new technique

We treated the mandibular retrusion of a 20-year-old man by distraction osteogenesis. Our aim was to avoid any visible discontinuities in the soft tissue profile that may result from conventional "one-step" genioplasty. The result was excellent. In addition to a good aesthetic outcome, there was increased bone formation not only between the two surfaces of the osteotomy but also adjacent to the distraction zone, resulting in improved coverage of the roots of the lower incisors. Only a few patients have been treated so far, but the method seems to hold promise for the treatment of extreme retrognathism, as these patients often have insufficient buccal bone coverage.     

Metachronous ameloblastomas in the maxilla and mandible: report of a case.

Ameloblastoma is a locally aggressive tumour of odontogenic origin, with an unknown aetiology. Metachronous ameloblastoma in the maxilla and the mandible is rare. In this report, a case of a 63 year-old man is described with a solid ameloblastoma in the posterior part of the upper jaw. After surgical treatment, the patient returned 8 years later with a similar lesion in the anterior lower jaw. Both ameloblastomas were of the solid type but differed in their histological patterns. No evidence of recurrence was found in either of the surgical sites for the last 4 years.     

Soft tissue recurrent ameloblastomas also show some malignant features: A clinicopathological study of a 15-year database

Background

To investigate the clinicopathological features of six cases of soft tissue recurrent ameloblastoma and explore the role of increased aggressive biological behavior in the recurrences and treatment of this type of ameloblastomas.

Material and Methods

In this study, we retrospectively reviewed recurrent ameloblastomas during a 15-year period; six cases were diagnosed as soft tissue recurrent ameloblastoma. The clinical, radiographic, cytological and immunohistochemical records of these six cases were investigated and analyzed.

Results

All the six soft tissue recurrent ameloblastomas occurred after radical bone resection, and were located in the adjacent soft tissues around the osteotomy regions. In Case 4, the patient developed pulmonary metastasis, extensive skull-base infiltration and cytological malignancy after multiple recurrences and malignant transformation was diagnosed. In the other five cases, although there were no cytological signs are sufficient to justify an ameloblastoma as malignant, some malignant features were observed. In Case 1, the tumor showed moderate atypical hyperplasia and the Ki-67 staining percentage was 40% positive, which are strongly suggestive of potential malignance. In Case 5, the patient developed a second soft tissue recurrence in the parapharyngeal region and later died of tumor-related complications. All the remaining three patients showed cytology atypia of varying degrees and high expression of PCNA or Ki-67, which confirmed active cell proliferation.

Conclusions

Increased aggressiveness is an important factor of soft tissue recurrence. An intraoperative rapid pathological examination and more radical treatment are suggested for these cases. Key words: Ameloblastoma, soft tissue recurrence, aggressive biological behaviour.     

Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial

To evaluate the effect of postoperative irrigation with chlorhexidine on inflammatory complications after the extraction of lower third molars under local anaesthesia, we recruited 100 patients to participate in a controlled, single-blind, randomised clinical trial. They were assigned to one of two groups: the intervention group (postoperative irrigation of the surgical site with chlorhexidine for seven days) or the control group (postoperative chlorhexidine mouth rinse for seven days). The primary outcome variables were pain, swelling, trismus, infection, and alveolar osteitis. The secondary outcome variables were wound dehiscence and food impaction. A total of 95 participants completed the study (47 in the irrigation group and 48 in the rinse group). In the irrigation group, alveolar osteitis and facial swelling had reduced significantly at seven days postoperatively (both p < 0.01). Pain scores had also reduced significantly at seven days (p < 0.01), but not at 48 hours, and patients had lower levels of food impaction (p < 0.01) and less severe symptoms (p = 0.02). Routine irrigation with chlorhexidine after the extraction of third molars helps to reduce pain and lowers the incidence of alveolar osteitis.     

Etiology and patterns of pediatric mandibular fractures in Portugal: a retrospective study of 10 years

OBJECTIVE: To determine the pattern of occurrence of mandibular fractures in the pediatric population in Portugal. MATERIALS AND METHODS: This retrospective study reviews the records of patients 18 years of age or younger from the 10-year period 1993 to 2002. Age, gender, anatomic site, cause of the accident, weekly and monthly variation, location and type of fractures, presence and location of associated injuries, treatment methods, and complications were reviewed. RESULTS: During this 10-year period, 521 patients with 681 mandibular fractures were treated. Motor-vehicle accident (MVA) was the most common (53.9% patients) cause of fracture. Almost half of the patients (48.8%) were in the oldest age group (16 to 18 years old). The condyle of the mandible was involved in 31.0% of the fractures. Maxillomandibular (MMF) fixation was used in 534 (78.4%) fractures. Overall mortality in this series was 0.6% (3 patients); mortality was caused by multiple traumas, mainly head trauma. CONCLUSION: There is a need to reinforce legislation aimed to prevent MVA and the total enforcement of existing laws to reduce maxillofacial injuries among children and adolescents.