[A toddler with a mandibular fracture]. / Een peuter met een mandibulafractuur.

BACKGROUND: Mandibular fractures are rare in children. Symptoms of these fractures include preauricular pain and swelling, trismus and pain when opening the mouth, and they are often preceded by a fall on the chin. If the diagnosis is missed they may have serious consequences for the growth and development of the jaw. CASE DESCRIPTION: A 3-year-old boy was referred with a swelling in his left cheek, fever and vomiting. Two days earlier he had fallen on his chin. At physical examination he had severe preauricular pain on palpation and a trismus. The patient was admitted because of suspicion of a viral parotitis and the threat of dehydration. After discharge, he went to the dentist for examination of a molar that was painful to the touch. The dentist performed an orthopantomogram and discovered a fracture of the left mandibular collum. CONCLUSION: Any child with trauma to the chin should be observed for symptoms of a mandibular fracture, and if it seems necessary non-invasive radiographic examination should be performed.

An unexpected finding in the resection specimen of a carcinoma of the oral cavity: A case report.

INTRODUCTION: The occurrence of two synchronous, primary cancers is rare. Thyroid carcinoma is incidentally found in the resection specimen after surgery for head and neck cancer in 0.3-1.9% of the patients. PRESENTATION OF CASE: In this report, we describe the case of a 72-year-old patient in whom a primary (synchronous) papillary thyroid carcinoma was found coincidentally upon pathologic examination of lymph nodes recovered from the cervical neck lymph node dissection specimen after a 'commando' procedure for carcinoma of the oral cavity. DISCUSSION AND CONCLUSION: There is no gold standard concerning treatment of the incidentally discovered thyroid gland carcinoma. The decision to perform surgery depends on the life expectancy of the patient, whether the thyroid gland demonstrates clinical or radiologic lesions, the already completed treatment for the head and neck cancer and should always be adjusted to the specific patient.

The combined use of two endosteal implants and iliac crest onlay grafts in the severely atrophic mandible by a modified surgical approach.

Seventeen patients, who received an iliac crest onlay bone graft augmentation to their severely atrophic mandible with simultaneous placement of two endosteal implants by a modified surgical approach, were studied retrospectively. Follow-up ranged from 0.5 to 7.9 years after implant loading with an average follow-up of 4.3 years. Frequency of wound dehiscences and other postoperative complications, the extend of resorption of the initial graft, and the implant success rate were assessed. Two patients, who had a previous history of preprosthetic and implantological procedures at the surgical site, developed a serious wound dehiscence with loss of two implants in one patient and need for antibiotic treatment and sequestrectomy in the other patient. One implant was lost in two other patients with a negative surgical history, resulting in an implant success rate of 88.2%. The average resorption at the last follow up visit was 15% of the initial graft. Damage of the mental nerve was seen in 14.7% of nerves. Our preliminary data indicate that the procedure presented provides a reliable and predictable method for the construction of an implant-bearing overdenture in patients with a severely atrophic mandible. This one-step procedure can not be recommended for patients with a history of surgery in the anterior mandible.

[Chronic facial pain due to nerve injury. Deafferentation pain]. / Chronische aangezichtspijn na zenuwbeschadiging. Desafferentiepijn.

Patients presenting chronic facial pain are very common. After profound examination a significant cause for this pain often cannot be found. Some patients are suffering from this pain due to injury of a sensible nerve and then it is called deafferentation pain. This somatic disorder can give different complaints. Pain can develop as a result of formation of neuromas 'cross-talking' of nerves and alterations in the central nerve system. It seems to be difficult to make clinical features to diagnose deafferentation pain and differentiate it from pain disorders where the psychic suffering seems to be very important. The treatment is based mainly on the reduction of the conducting of abnormal pulses by the damaged or changed nerves.