Radiological examination of the relationship between the pterygomaxillary junction and fracture pattern.

BACKGROUND: Le Fort 1 (LF1) osteotomies are widely used to correct midface deformities. To move the maxilla freely, the ptery-gomaxillary junction (PMJ) must be separated. When performing this osteotomy, the pterygoid plate must remain intact. The objective of this study was to evaluate relationship between the anatomical features of the PMJ and fracture patterns in LF1 osteotomy. METHODS: Pre-operative and post-operative cone-beam computed tomography images of 41 patients (82 samples) who have undergone LF1 osteotomy surgery were radiologically evaluated. Morphologic measurements of the pterygomaxillary fissure area and pterygoid plate were carried out. Moreover, pterygomaxillary separation was divided into the clean-cut, maxillary sinus, and pterygoid plate fracture types. RESULTS: Statistically significant difference was observed between clean-type fracture and pterygoid plate fracture groups' thickness of the pterygoid process and thickness of the pterygomaxillary region. CONCLUSION: Anatomical variations make it difficult to separate the PMJ properly. Low thickness of PMJ increases the risk of unwanted fractures; however, according to our experience, the use of an osteotome with an incorrect angle, excessive force, and inexperienced surgeons can also cause undesirable pterygoid plate fractures.

Effects of sagittal split osteotomy on brainstem reflexes.

OBJECTIVES: This prospective study was designed to assess whether patients with skeletal deformities show characteristic masseter inhibitory reflex (MIR) and blink reflex (BR) patterns. A secondary aim was to investigate whether these reflexes change following bilateral sagittal split osteotomy (BSSO). MATERIALS AND METHODS: Fourteen consecutive patients who underwent single-jaw BSSO and 14 class I subjects who constituted the control group were enrolled into the study. MIR and BR, obtained by the stimulation of supraorbital (SBR) and mental nerves (MBR), were electrophysiologically recorded. Sensory impairment in the mental nerve distribution was clinically tested. Three evaluation periods were specified as immediately before (T0), 1 month (T1) and 6 months (T2) after surgery. RESULTS: MIR early silent period duration was significantly shorter in the patients at T0 (p < 0.001). Sensory deficits developed on 23 sides after BSSO, of which, 17 recovered after 6 months. At T1, MBR was inelicitable bilaterally in 3 patients and unilaterally in 2 patients. These responses were still unrecordable bilaterally in 1 patient, and unilaterally in 4 patients at T2. MIR were unrecordable on 18 sides at T1 and recovered on 11 sides at T2. There were no parallels between the clinical sensory deficits and the abnormal results of the reflexes. CONCLUSIONS: Shorter MIR in patients with dentofacial abnormalities may be a reflection of an adapted trigeminal reflex mechanism. Although MBR and MIR abnormalities do not develop parallel to the clinical sensory deficits, their course might provide insights into the disturbed trigeminal reflex pathways.

Osteolipoma: a review of the literature and a rare case report.

OBJECTIVES: Lipomas are the most common benign mesenchymal tumors of soft tissue. According to previous studies, 1-4% of the cases has been observed in the oral cavity. A histological variant of lipoma featuring bone formation is called osteolipoma and has been very rarely observed (less than 1% of the total). In order to make a meaningful addition to this rare knowledge base, our study aims to provide a literature review and to report an additional case of osteolipoma. METHODS: An electronic search in the PubMed database with the keyword "osteolipoma" was conducted. Among 69 search results, only the cases of osteolipoma located in the "oral cavity" were included in this study. The findings of the previously reported 20 cases (in English) of osteolipoma of the oral cavity were organized in a table along with a new case of osteolipoma located in the mandibular buccal vestibule with radiological and histopathological findings provided by the authors. RESULTS: Osteolipoma affects both sexes and usually emerges in middle-aged or elderly patients with a long history of slow progression. Different imaging techniques may be utilized in the radiographic evaluation. CONCLUSION: Differential diagnosis includes a wide range of lesions; therefore, the clinical and radiographic evaluation should be confirmed by histopathological examination. The suggested treatment is complete surgical excision and follow-up, and the prognosis is generally good.

Orthognathic Surgery after Mandibular Large-Volume Osteoma Treatment.

Osteoma is a benign asymptomatic osseous tumor. Characterization of osteoma is the proliferation of cancellous or compact bone that increases in size by continuous formation of bone. It can be seen in any craniofacial structures, usually in paranasal sinuses and jaws. In this study, we present a 17-year-old male patient with a giant osteoma in the mandibular condyle. Posttreatment post-op follow-up, post-ortho, and orthognathic surgery after dental implantation are described.

Prospective Analysis of the Swallowing Reflex After Sagittal Split Osteotomy: Comparison with Normal Volunteers.

The aim of this study was electromyographic description of changes in swallowing before and after bilateral sagittal split ramus osteotomy. In this prospective study, twenty-eight patients were divided into 3 groups according to the occlusion pattern: Group I (Angle Class III), Group II (Angle Class II), and Control (Class I). Serial cone-beam computed tomography analyses and electromyographic data were collected preoperatively, 1st and 6th months after setback surgery in Group I, and advancement surgery in Group II. Swallowing reflex with 3-20 ml water bolus were studied. Patients were further divided into two subgroups according to the magnitude of relapse. The mean setback of the mandible was 4.62 ± 1.92 mm in Group I, and the mean advancement was 4.19 ± 2.00 mm in Group II. Mandibular relapse rate was 17.40%. Oral preparation phase shortened after surgery in both study groups. Two subjects in Group II and one in Group I had piecemeal deglutition, and two of them became normal postoperatively. Most of the swallowing durations of the relapsed cases were longer than those of stabilized patients. Important clinical considerations are as follows: the oral preparation period becomes shorter after surgery; piecemeal deglutition may disappear after treatment; and individuals with a longer oral period and piecemeal deglutition may have increased tendency to skeletal relapse. This multidisciplinary study enhances our understanding of the adaptive response to the swallowing reflex after orthognathic surgery and provides novel insight into the association between the submental muscle activity and relapse in orthognathic patients.

A comparative study of surgical drain placement and the use of kinesiologic tape to reduce postoperative morbidity after third molar surgery.

OBJECTIVES: Our aim was to compare the effects of the surgical drain and kinesiotape applications on postoperative morbidity after mandibular third molar surgery in a split-mouth study design. MATERIALS AND METHODS: A single-centre, split-mouth study was performed in 23 patients who needed surgical removal of bilateral mandibular third molars. Each patient was treated with a drain tube on one side of the mandible and Kinesio tape (KT) on the contralateral side. RESULTS: Swelling was significantly greater in the KT group than in the drain group throughout the study period. The groups did not differ significantly in the amount of trismus at any time point. The Visual Analogue Scale (VAS)-measured pain intensity was significantly lower in the drainage group. Patients with KT had greater postoperative discomfort than those with a drain tube. All patients were generally satisfied with their treatments. CLINICAL RELEVANCE: Although both treatments were useful, a surgical drain was significantly more effective at reducing swelling and pain intensity than Kinesio tape. The effects of both on trismus were similar.

Management of the Bilateral Chronic Temporomandibular Joint Dislocation.

Temporomandibular jaw dislocation is an uncontrolled anterior movement of the condyle beyond the articular eminence. It can occur mostly in young adults, and the symptoms are mouth opening disturbance, preauricular skin depression, tense masticatory muscles, and pain. The main purpose of the eminectomy procedure is removal of a part of the articular eminence to maintain free movement of the condyle. The surgical procedure may be performed by conventional surgery or piezosurgery. The present case report describes the management of a recurrent mandibular dislocation in a 28-year-old patient who had also treated conservatively with autologous blood injection. In this report, bilateral eminectomy was performed by piezosurgery to provide soft-tissue protection, precise cut, and optimal view of the surgical area. The management technique is discussed within the current literature.

Autogenous Dermis-fat Graft in Temporomandibular Joint Ankylosis Surgery.

Temporomandibular joint (TMJ) ankylosis is fusion or a bony union of the head of the condyle and the glenoid fossa by bony or fibrotic tissues. Due to the immobility of the TMJ, all mandibular movements get affected. Treatment goals are to allow nearly normal TMJ movements, restore symmetry of the face and occlusion, and promote growth and correction of deformity in children. The surgical techniques used to treat TMJ ankylosis are a gap or interpositional arthroplasty, joint reconstruction, and distraction osteogenesis. Appropriate interposition materials include autogenous tissues, allogeneic tissues, and alloplastic and xenograft tissues. This report presents the treatment of a patient with a diagnosis of TMJ ankylosis, who had failed surgery. Interpositional autogenous dermis-fat graft was used to manage TMJ ankylosis of the right side. The technique is discussed within the current literature.

Cavernous lymphangioma of the tongue in an adult: a case report.

Lymphangioma is a benign hamartomatous lesion caused by congenital malformation of the lymphatic system. This benign tumor is detected most commonly at birth or in early childhood but rarely in adults. On clinical examination, most lymphangiomas contain clear lymph fluid, but some may present as transparent vesicles containing red blood cells due to hemorrhage. In addition, lymphangioma may occur in association with hemangioma. This tumor occurs most commonly in the head and neck area, but rarely in the oral cavity. The dorsum of the tongue is the most common location in the mouth, followed by the lips, buccal mucosa, soft palate, and floor of the mouth. There are various treatment approaches for lymphangioma, but surgical excision is the preferred method. We present a case of a 26-year-old man with lymphangioma on the anterior dorsal part of the tongue, not associated with any dysfunction in mastication or speech disorders.

Aspergillosis associated with surgically assisted rapid maxillary expansion.

Surgically assisted rapid palatal expansion (SARPE) is one of the most common orthognathic surgery operations for the treatment of maxillary transverse deficiencies. Although this operation is considered technically simple and has low complication rate, predisposing factors can complicate the postoperative period. In this case report, fistula formation and aspergillosis after SARPE operation were presented.

Oral and maxillofacial considerations in Gardner's Syndrome.

Gardner's Syndrome is a variant of familial adenomatosis polyposis (FAP) with a triad consisting of polyps of the colon, multiple osteomas and surface tumors of soft and hard tissue. The intestinal polyps have a %100 risk of undergoing malignant transformation, therefore early identification of this disease is very important. There are several symptoms of Gardner's syndrome in the oral and maxillofacial surgery, which can be discovered during routine dental examination. We report a case of a 25-year old male patient with Gardner's syndrome who has not any intestinal polyps but osteomas in the mandible and jaw deformalities.

Decompression, enucleation, and implant placement in the management of a large dentigerous cyst.

The dentigerous cyst is a developmental odontogenic cyst, accounting for 10% of all cysts of the jaws. The treatment options are decompression, marsupialization, or enucleation regarding the features of the lesions. In this article, a case of a 17-year-old adolescent girl having a large mandibular dentigerous cyst associated with an unerupted third molar is presented. The treatment is composed of decompression for 6 months and enucleation. Decompression and enucleation are a predictable choice in the treatment of large cysts. Radiologic evaluation is mandatory to decide for the appropriate time for the removal of the decompression stents, the enucleation time, and also for the evaluation of the adequate new bone formation for implant placement. The present case emphasizes the success of a conservative approach in the management of a large dentigerous cyst in a young patient and also the maintenance of the new bone formation without using any graft materials for the placement of dental implants.

Radiologic evaluation of an unusually sized complex odontoma involving the maxillary sinus by cone beam computed tomography.

As a group, odontomas are the most common odontogenic neoplasms. This case report illustrates the benefits of cone beam computed tomography, in terms of treatment planning and surgical technique, to localize a large maxillary odontoma and accurately establish its relationship with the maxillary sinus and molar.