High Submandibular Anteroparotid Approach for Open Reduction and Internal Fixation of Condylar Fracture.

AIM: There are several techniques for the treatment of mandibular condylar fractures. This is the first report of the high submandibular anteroparotid approach for open reduction and internal fixation of condylar fracture. MATERIALS AND METHODS: A 41-year-old woman fell indoors and injured her face. She was referred to our department for detailed examination and treatment of a suspected mandibular fracture. X-ray and computed tomography showed a right mandibular condylar base fracture and lateral dislocation of the fracture fragment. Open reduction and internal fixation procedures were performed for a right mandibular condylar fracture under general anesthesia. The mandibular ramus was reached by approaching from the inferior margin of the mandible, delaminating the masseter fascia posteriorly, and bypassing the anterior margin of the parotid gland. Once the fractured bone was reached, reduction and fixation were performed. RESULTS: We have achieved good results by the high submandibular anteroparotid approach, which is minimally invasive and simple, to reduce and fix condylar fractures. With this approach, no facial artery or retromandibular vein was encountered, and the mental stress for the surgeon was minimal. Postoperative wound infection, parotid gland complications such as parotitis and salivary fistula, facial nerve dysfunction such as facial paralysis, and esthetic disorders such as scarring were not observed. CONCLUSIONS: Although it is necessary to examine more cases in the future, the high submandibular anteroparotid approach may be useful as a new approach for open reduction and internal fixation of condylar fractures.

Reconstruction of maxillary palatal defects after partial maxillectomy using a pedicled buccal fat pad and a nasolabial flap.

The novelty of this procedure is the reconstruction of a maxillary palatal defect with two pedicled flaps: a pedicled buccal fat pad and a nasolabial flap. This use of combination flaps makes the surgery simple, short, and useful for a wide defect.The novelty of this procedure is the reconstruction of a maxillary palatal defect with two pedicled flaps: a pedicled buccal fat pad and a nasolabial flap. This use of combination flaps makes the surgery simple, short, and useful for a wide defect.

A Case of a Stafne Bone Defect Associated with Sublingual Glands in the Lingual Side of the Mandible.

A Stafne bone defect from the mandibular anterior to the premolar region is an extremely rare case. A case of a Stafne bone defect extending from the mandibular anterior to the premolar region was presented. Computed tomography (CT) and magnetic resonance imaging (MRI) suggested that salivary gland tissue connected to the sublingual glands was involved in the formation of the cavity. The patient was a 68-year-old man who was examined at our hospital's emergency outpatient department after a traffic accident. He was referred to our department for the treatment of contusions of the lips and oral cavity. A bone defect in the lingual side of the mandible from the right anterior to the right premolar region was incidentally detected on CT. CT showed a rounded cavity in the lingual side of the mandible that had a lingual opening, was monocystic, and had a cortical margin. The margin of the cavity was relatively dull and regular. MRI showed that the tissue filling the cavity in the lingual side of the mandible had similar signal intensity as the sublingual glands and was contiguous with the normal sublingual glands. Based on these findings, the bone defect was diagnosed as a Stafne bone defect filled with salivary gland tissue connected to the sublingual gland tissue.

Case of cervical carcinoma of unknown primary treated through multidisciplinary approach.

Carcinoma of unknown primary (CUP) is where the primary site remains unidentified even though metastases are present, and accounts for 3-5% of all human malignancies. Here, we report a multidisciplinary approach to the treatment of a squamous cell CUP occurring in the left cervical region. Following radical surgery for carcinoma of the colon, swelling occurred in the left cervical region in a 59-year-old man. The results of an incisional biopsy indicated a diagnosis of squamous cell carcinoma (SCC), and he was referred to our department for examination. The primary carcinoma was not identifiable despite an extensive diagnostic workup including a physical examination, fiberoptic endoscopy, computed tomography, magnetic resonance imaging, and fluorodeoxyglucose F18 positron emission tomography, resulting in a diagnosis of an SCC of unknown in the cervical region. The patient was initially treated with three cycles of docetaxel 75 mg/m(2)/day, cisplatin 100 mg/m(2)/day, and 5-fluorouracil 1,000 mg/m(2)/day as induction chemotherapy. This was followed by concurrent chemoradiotherapy (cisplatin 30 mg/m(2)/day, 70 Gy) and neck dissection. Subsequent pathological examination revealed no vestiges of the tumor. The patient has remained free from recurrence and metastasis for 6 years.

Nasolabial flap reconstruction of floor of mouth.

We treated two patients requiring nasolabial flap reconstruction. The first patient was a 75-year-old man with mucoepidermoid carcinoma in the left-side floor of the mouth; requiring resection of the floor of the mouth, partial mandibulectomy, and left supraomohyoid neck dissection. The second patient was a 74-year-old man with recurrent acinic cell carcinoma in the anterior oral floor infiltrating as far as the mandible. This patient required wide excision of the anterior part of the oral cavity, including amputation of the mandible. After tumor resection, both cases had a nasolabial flap reconstruction. The postoperative course of both cases was good; neither postoperative flap necrosis nor infection developed.

Fluid extravasation of the articular capsule as a complication of temporomandibular joint pumping and perfusion.

This report is a retrospective study of fluid extravasation as a complication of temporomandibular joint pumping and perfusion. Contrast-enhanced 3D-CT of the upper joint compartment was performed for presurgical diagnosis before temporomandibular joint arthroscopic surgery in our hospital from 1996 to 2000. From these cases, 43 joints and 38 patients were selected because they had not improved under conservative treatment during the previous six months. Fluid extravasation of the articular capsule was recognized in 9 joints (20.9%) in 9 patients, 3 males and 6 females. Two of the nine patients had undergone arthroscopic observation before surgery. This test had revealed only thin articular capsule, not a perforation, in any of these cases. The data indicate only extremely tiny perforations or infiltration leakage due to the fluid pressure in the upper joint compartment during pumping or perfusion. Oral and maxillofacial surgeons should be aware of this complication.