Defecto oncológico maxilar reconstruido mediante colgajo de músculo temporal / Maxillary oncologic defect reconstructed with temporal muscle flap / Defeito oncológico maxilar reconstruído por aba muscular temporal

El macizo facial es una región anatómica compleja que alberga órganos sensoriales. El desarrollo de una enfermedad oncológica, así como su tratamiento, causan defectos funcionales y estéticos con un alto costo físico y psíquico para el paciente y su entorno. Es por ello que la reconstrucción representa un reto. Las diferentes posibilidades incluyen prótesis obturatríces, colgajos libres, pediculados o microvascularizados. En este artículo se describirá el colgajo de músculo temporal y se desarrolla un caso clínico de cirugía oncológica maxilar reconstruido mediante éste en un paciente que presenta una lesión exofítica en cuadrante superior derecho, que se extiende sobre el flanco vestibular, reborde alveolar y zona palatina, desde zona de premolares hasta la zona del segundo molar inclusive, impidiéndole usar la prótesis dental. Esta cirugía es una técnica económica, que requiere menor tiempo quirúrgico que otras técnicas, asociándose a poco porcentaje de fracaso y pocas complicaciones post operatorias.

The facial mass is a complex anatomical region that houses sensory organs. The development of an oncologic disease, as well as its treatment, causes functional and esthetic defects with a high physical and psychological cost for the patient and his environment. This is why reconstruction represents a challenge. The different possibilities include obturator-root prostheses, free, pedicled or microvascularized flaps. In this article the temporal muscle flap will be described and a clinical case of maxillary oncologic surgery reconstructed by means of it is developed in a patient who presents an exophytic lesion in the right upper quadrant, which extends over the vestibular flank, alveolar ridge and palatal area, from the premolar area up to and including the second molar area, preventing him from using the dental prosthesis. This surgery is an economical technique that requires less surgical time than other techniques, and is ass

A massa facial é uma região anatômica complexa que abriga órgãos sensoriais. O desenvolvimento de uma doença oncológica, assim como seu tratamento, causa defeitos funcionais e estéticos com alto custo físico e psicológico para o paciente e seu ambiente. A reconstrução é, portanto, um desafio. As diferentes possibilidades incluem as próteses de raiz obturadora, abas livres, pediculadas ou microvascularizadas. Este artigo descreve o retalho muscular temporal e descreve um caso clínico de cirurgia oncológica maxilar reconstruída utilizando-o em um paciente com lesão exofítica no quadrante superior direito, estendendo-se pelo flanco vestibular, rebordo alveolar e área palatina, desde a área do pré-molar até a área do segundo molar inclusive, impedindo-o de utilizar a prótese dentária. Esta cirurgia é uma técnica econômica, que requer menos tempo cirúrgico que outras.

[Surgical Treatment of Maxillary Gingival Carcinoma with Mental Retardation-A Case Report].

Many patients with mental retardation have a limited awareness of abnormalities in the oral cavity, making early detection of oral cancer difficult. Moreover, during examination and treatment, these patients may not understand well-intentioned verbal explanations and may express their anxiety through nonverbal communication. Herein we discuss a case in which favorable results were obtained when surgical treatment was performed on a maxillary gingival carcinoma patient with mental retardation. The patient was a 61-year-old man who was admitted to our hospital with maxillary gingival pain. A biopsy revealed well-differentiated oral squamous cell carcinoma(cT4aN0M0, Stage ⅣA). Hemi-maxillectomy was performed and postoperative recovery was uneventful. A maxillary prosthesis was provided for oral rehabilitation. At the 5-year follow-up, there were no signs of recurrence or metastasis. This case illustrates the importance of collaboration between oral maxillofacial surgeons and specialists from related departments for the comprehensive management of patients with mental retardation.

Evaluation of dentofacial asymmetry caused by odontomas using panoramic radiographs.

AIMS: To evaluate the presence of dentofacial asymmetry in patients with odontoma by panoramic radiography. METHODS: Panoramic images with odontoma were selected among all panoramic radiographs (3058 patients). Maxillary odontoma was detected in 27 patients while mandibular odontoma was detected in 25 patients. In addition, 30 patients with similar age and gender characteristics were selected as the control group. Skeletal angular, skeletal linear and dental measurements were performed on panoramic radiographs. The odontoma region and the opposite side of the odontoma of the individuals were examined. The dentofacial asymmetry of the odontoma groups was compared with the control group. Paired t-test was used to determine dentofacial asymmetry on the right and left side of the patients with odontoma. The ANOVA test was used for testing the differences among groups. RESULTS: As a result of study, no significant difference was found between the region of the odontoma and the symmetrical region in the maxilla and mandibula (P > 0.05). In the control group, a statistically significant difference was found in the angle between the mandibular canal and the mental foramen, lower incisor size, PFH/CutCat(°), and Co-Mc-Me(°) measurements (P < 0.05). In the maxillary and mandibular odontoma groups, a statistically significant difference was found in the angle between the mandibular canal and the menton, CH (mm), RH (mm), and CrH (mm) in the comparison of the odontoma and the control group (P < 0.05). CONCLUSIONS: No difference was found between the right and left sides of the jaws related with the asymmetry of the maxilla and mandible.

Ameloblastic fibro-odontoma in an unusual area of the maxilla: two case reports / Fibro-odontoma ameloblástico en una región inusual de los maxilares: reporte de dos casos

Ameloblastic fibro-odontoma (AFO) is a mixed odontogenic tumor, which has an epithelial and mesenchymal component. It can be observed in imaging tests as a radiomixed lesion, with some authors claiming it represents only the predecessor of an odontoma. Epidemiologically, it appears between the second and third decade of life, predominantly in males and with a predilection for the posterior area of the mandible. This lesion presents a good prognosis and it responds well to enucleation by curettage with a low rate of recurrence. In the present article, two cases of ameloblastic fibro-odontoma in an unusual region of the maxilla are presented.

El Fibro-odontoma ameloblástico (FOA), es una lesión tumoral mixta de origen odontogénico, el cual tiene un componente epitelial y mesenquimático. En su imagenología se observa como una lesión radiomixta, debido a que algunos autores afirman que este no es más que el predecesor de un odontoma. Epidemiológicamente, se presenta entre la segunda y tercera década de la vida, preferencia por sexo masculino y predilección por el área posterior de la mandíbula. Es una lesión de buen pronóstico que responde bien a la enucleación por curetaje con baja tasa de recidiva. En el presente artículo, se presentan dos casos de fibro-odontoma ameloblástico en una región inusual de los maxilares.

Odontoma composto associado a incisivo central superior impactado: relato de caso / Compound odontoma associated with impacted upper central incisor: case report

Introdução: o odontoma é um tipo de tumor do epitélio odontogênico com ectomesênquima, podendo estar relacionado à presença de dentes não irrompidos. O tratamento consiste em excisão cirúrgica da lesão. Nor-malmente, dentes impactados são assintomáticos, sendo descobertos em radiografias de rotina. A impactação é causada por fatores sistêmicos ou etiológicos locais. Objetivo: reportar um caso clínico de uma criança com impactação dentária de um incisivo central superior esquerdo associado a um odontoma, enfatizando e discutindo a técnica cirúrgica e o planejamento realizado. Relato de caso: paciente de 13 anos de idade, do gênero feminino, com a não erupção do incisivo central superior esquerdo, ao exame clínico, apresentou ausência clínica do dente 21, persistência do dente 61 e um discreto aumento de volume entre os elementos 61 e 22. Foi solicitada uma tomografia computadorizada de feixe cônico (cone beam) da região, na qual se diagnosticou a presença de uma massa radiopaca envolta por um halo radiolúcido sugestivo de odontoma composto, alterando a posição e impedindo a erupção do dente 21, que se encontrava em posição transal-veolar. O plano de tratamento proposto foi remoção cirúrgica do odontoma e tracionamento do dente não irrompido. Conclusão: a remoção cirúrgica de patologias associadas e as manobras referentes aos dentes envolvidos devem ser realizadas no momento mais oportuno e com adequado planejamento, evitando lesões a estruturas nobres e permitindo, assim, um processo de reparo adequado e uma completa restauração da saúde bucal do paciente. (AU)

Introduction: Odontoma is a type of tumor of the odontogenic epithelium with ectomesenchyme and it may be related to the presence of unerupted teeth. The treatment consists of surgical excision of the lesion. Usually, unerupted teeth are asymptomatic and discovered in routine radiographs. Impaction is caused by local systemic or etiological factors. Objective: The present study aims to report a clinical case of a child with an impacted upper central incisor associated with an odontoma, highlighting and discussing the surgical technique and treatment planning. Case report: A 13-year-old female patient without eruption of the left upper central incisor. After clinical examination, the absence of tooth 21, persistence of tooth 61, and a discrete volume increase between elements 61 and 22 were observed. A cone beam computed tomography of the region was requested, which diagnosed the presence of a radiopaque mass involved by a radiolucent halo suggestive of compound odontoma. This condition changed the position and prevented the eruption of tooth 21, which was found in a transalveolar position. The treatment plan proposed was the surgical removal of the odontoma and orthodontic traction of the unerupted tooth. Conclusion: The surgical removal of associated pathologies and maneuvers related to the teeth involved should be performed in a timely manner, with adequate planning, preventing lesions in noble structures, thus allowing an adequate repair process and a complete restoration of the oral health of the patient. (AU)

Central Osteoma of Maxilla Associated with an Impacted Tooth: Report of a Rare Case with Literature Review.

Osteomas are benign osteogenic neoplasms caused by proliferation of mature compact or cancellous bone. Clinically they may be classified as peripheral, central or extraskeletal. Osteomas usually involve the craniofacial region with mandible being the most common site. Central osteoma of the jaws is a very rare entity with only 13 cases reported in the literature till date of which only five cases occurred in the maxilla. Here we present a case of a large central osteoma of anterior maxilla associated with an impacted tooth, the first of its kind and a review of literature.

Jaw bones regeneration using mesenchymal stem cells. A single-center experience.

PURPOSE: Mesenchymal stem cells (MSC), which are multipotent stromal cells, are considered to be a promising resource in tissue engineering and tissue regeneration. MSCs have been used to generate new maxillary bone with clinically successful results. The aim of this study was to determine the role of MSC in bone regeneration procedures in patients with benign maxillary lesions. METHODS: A study was conducted on five patients treated for maxillary bone defects resulting from biopsy of benign lesions at the University Hospital of Magna Græcia, Catanzaro, Italy from January 2015 to October 2016. MSC from autologous bone marrow were used for bone regeneration. The bone mineral density was compared, using the Hounsfield scale, before and after treatment. Follow-up was monthly for six months, and the patients underwent a computed tomography scan of the maxilla at 6 months. RESULTS: Five patients, who underwent biopsy of osteolytic odontogenic benign tumors, were included in the study. There were no intraoperative or postoperative complications. The mean volume of the newly formed bone was 2.44cm3 (range 2,0-3,1) and the mean bone density was 1137 Hounsfield Units (range 898-1355). CONCLUSIONS: Bone regeneration with MSC from autologous bone marrow appears to be a valid treatment option for maxillary bone defects. KEY WORDS: Bone regeneration, Mesenchymal stem cells, BM-MSC, Upper jaw, Mandible.

A Bag of Marbles: A Fascinating Compound Odontoma of the Maxilla.

Odontomas are the most common odontogenic tumors, typically diagnosed during the first two decades of life. 1 The purpose of this paper was to report an interesting case of an eight-year-old Caucasian boy who presented with an asymptomatic, progressive, firm swelling of the right maxilla with no eruption of the permanent maxillary right lateral incisor. Radiographic investigation revealed a mixed radiolucent and radiopaque lesion measuring 28 by 24 by 17 mm with a corticated border causing expansion and thinning of the buccal cortical plate. This large bag-of-marbles-like appearance representing odontoids was impeding his adult teeth from erupting; hence, complete surgical removal under general anesthesia was the treatment of choice. Removal of the lesion resulted in an unexpected loss of the embedded permanent maxillary right lateral incisor. Histopathological investigations gave a diagnosis of compound odontoma; due to their low growth potential, recurrence after removal is not expected.

Ameloblastic Fibro-Odontoma of the Maxilla in a Pierre-Robin Sequence Patient.

INTRODUCTION: Pierre Robin sequence (PRS) is a rare disorder classically observed as a triad of features including micrognathia, glossoptosis, and upper airway obstruction. It is associated with a syndrome in about 60% of cases. While odontogenic tumors are common findings in patients with familial adenomatous polyposis and nevoid basal cell carcinoma syndromes, PRS has not been found to be consistently associated with any tumors of the jaw. CASE REPORT: The current report aims to describe a patient with PRS who presented with an extensive ameloblastic fibro-odontoma (AFO) of the maxilla. CONCLUSION: Continued observation for odontogenic tumors in PRS is necessary.

Autotransplantation of Odontoma-Associated Impacted Teeth-A Treatment Strategy for Satisfying Immediate Esthetic Demands: A Case Report.

Compound odontomas are common odontogenic tumors associated with permanent tooth impaction in the premaxilla. This report describes the case of a 14-year-old girl with an odontoma-associated impaction over the premaxilla that was treated using autotransplantation to satisfy an immediate esthetic demand. At postoperative follow-up conducted in the 14th month, a satisfactory cosmetic appearance with a healthy periodontal status was observed. In addition, the authors discuss the possible complications of autotransplantation and different treatment strategies for odontoma-associated impaction and for correcting bone defects in this case report. Autotransplantation for treating odontoma-associated impaction can be an alternative solution for satisfying an immediate cosmetic demand and providing a favorable outcome.

Sequence of Surgical Reconstruction in a Child With Cleft Lip and Palate Associated With Congenital Facial Teratomas.

We describe a case of left homolateral complete cleft lip/palate associated with a congenital left maxillary teratoma and left orbital teratoma. The patient required step-by-step reconstruction that first included resection of the 2 teratomas in consideration of cleft lip repair, cleft palate repair, and correction of the left periorbital anomalies, which were performed later. After performing all the necessary procedures, complete resection of the tumors and correction of the anomalies associated with the lip, palate, and left orbit were achieved. The rare occurrence of this type of association and its devastating effect on a patient's growth, aesthetics, and function of craniofacial elements require careful surgical planning to enable restoration of the anatomy and proper functional development. At follow-up, the patient showed significant improvement in the functional and aesthetic aspects.

Using Bar and Ball Attachments in Maxillary and Mandibular Implant-Supported Overdentures in a Patient with Adenoid Cystic Carcinoma Associated with Microstomia: A Clinical Report.

Many clinical studies and literature reviews have suggested that bar and ball attachments in maxillary and mandibular implant-supported overdentures (ISOs) should be indicated only when there is sufficient interocclusal space (IOS; minimum = 30 mm). The aim of this clinical report was to present the prosthetic rehabilitation of a patient with adenoid cystic carcinoma associated with microstomia due to radiotherapy (IOS = 23 mm). ISOs offer superior retention and greater stability than conventional obturators, so that base extensions were kept to the minimum. Placing the balls parallel to the prosthesis path of insertion is much easier with this treatment modality.

Tumor-induced Osteomalacia in a 3-Year-Old With Unresectable Central Giant Cell Lesions.

Tumor-induced osteomalacia (TIO) is a rare cause of hypophosphatemia involving overproduction of fibroblast growth factor 23. TIO has been described largely in adults with small mesenchymal tumors. We report a case of TIO in a child who presented with knee pain and radiographic findings concerning for rickets, and was found to have maxillomandibular giant cell lesions. The patient was treated with oral phosphorus and calcitriol, surgical debulking, and intralesional corticosteroids, which resulted in tumor regression and normalization of serum fibroblast growth factor 23 and phosphorus. This case illustrates the occurrence of this rare paraneoplastic syndrome in children and adds to our knowledge about clinical manifestations and pathologic findings associated with pediatric TIO.

Reduction surgery using a combination of a stereolithographic model and navigation system for ossifying fibroma with secondary central giant cell granuloma.

Both central giant cell granuloma (CGCG) and ossifying fibroma (OF) are relatively common diseases. The synchronous presentation of CGCG and OF is, however, an extremely rare occurrence. We present an unusual case with the synchronous presentation of these two diseases in the maxilla and introduce a surgical strategy based on a combination of the stereolithographic model and navigation system for the treatment of gigantic OF with secondary CGCG.

Impacted permanent incisors associated with compound odontoma.

Odontomas are the most common odontogenic tumours of the maxillary bones, characterised by a slow growth and benign behaviour. They are usually small, asymptomatic and diagnosed after routine radiographic examination. The aim of this study was to report a case of a compound odontoma in the anterior maxilla of a 7-year-old girl, which was causing the impaction of the maxillary right central and lateral incisors, as well as the prolonged retention of the corresponding primary teeth. We also aimed to review the literature about these tumours, since they are not part of the dentist's day-to-day clinical practice. The clinical and radiographic features, the diagnosis and treatment of the case were discussed in this work.

[Maxillary tumor revealing primary hyperparathyroidism]. / Tumeur maxillaire révélant une hyperparathyroïdie primaire.

INTRODUCTION: Primary hyperparathyroidism can infrequently present as a giant cell tumor of the jaw. We report the case of a patient presenting with a giant cell tumor leading to the discovery of a parathyroid adenoma. OBSERVATION: A 70-year-old male patient consulted for a stiffly swollen right jaw. The radiological assessment revealed osteolytic lesions of the right maxilla. The calcium and phosphate levels were disrupted and the parathyroid hormone level was high. A neck ultrasonography revealed a parathyroid adenoma. The patient underwent excision of the maxillary mass and of the parathyroid adenoma; the outcome was marked by normalization of calcium and phosphate levels. DISCUSSION: Giant cell tumors unusually reveal primary hyperparathyroidism and their maxillary location is exceptionally rare. The diagnosis is made on parathyroid hormone level and imaging. The treatment is surgical.