Unwarranted intrusion of odontogenic cyst into the maxillary antrum.

During the early growth phase, every individual is involved in a prolonged series of developmental processes in the maxillofacial region. Formation of cysts associated with such three-dimensional growth of the maxillofacial skeleton as well as deciduous and permanent tooth development. The origin of cystic jaw lesions may be odontogenic or non-odontogenic, developmental, or inflammatory and they are epithelial-lined or non-epithelial-lined cysts in nature. These cysts are considered to be aggressive cysts when they tend to grow rapidly and can cause significant damage to the surrounding bone and tissues if left untreated. Aggressive cystic lesion of the jaw needs special attention in order to prevent recurrences or even worsen and widespread disease. The management of the maxillary sinus requires individualisation based on its clinical and histopathological characteristics. Here, we report a case of an aggressive odontogenic cyst in a 30s-aged female patient in the left maxillary sinus with the literature review.

Predictors of length of stay following maxillofacial abscess surgery: A 10-year retrospective cohort.

The aim of this study was to identify predictors of length of stay (LOS) after surgical therapy of maxillofacial abscess. Patients diagnosed with a maxillofacial abscess who underwent extraoral incision and drainage under general anesthesia between January 1st, 2012 and January 1st, 2022 were retrospectively reviewed Univariable and multivariable linear regressions were performed to identify the association between pre- and perioperative variables and the LOS. In total, 228 patients were included. In the forward stepwise multivariable analysis, all factors with a p-value <0.2 in the univariable model were included. Ultimately, six independent predictors of increased LOS were identified: female (coef. 0.14, 95% CI 0.03-0.25), immunosuppression (coef. 0.37, 95%CI 0.13-0.61), penicillin allergy (coef. 0.25, 95% CI 0.04-0.46), C-reactive protein (coef. 0.0008, 95% CI 0.0001-0.0014), multiple spaces involvement (coef. 0.36, 95% CI 0.13-0.59), and time to operation (coef. 0.005, 95% CI 0.002-0.008). In conclusion, our study provides new insights into predicting LOS for patients admitted with maxillofacial abscesses. The identification of these markers not only enhances the ability to forecast LOS, but also lays the groundwork for optimizing resource planning and potentially integrating them into a primary prevention algorithm.

Report of intraosseous intravascular papillary endothelial hyperplasia associated with an odontogenic cyst in the maxilla and literature review.

Intravascular papillary endothelial hyperplasia (IPEH) represents an uncommon reactive endothelial hyperplastic proliferation. A 46-year-old man experienced increased volume in the right maxilla, elevation of the nasal ala, and swelling of the hard palate with a reddish hue for 3 months. Computed tomography revealed an expansive hypodense region and cortical bone destruction associated with an impacted supernumerary tooth and an endodontically treated tooth. Under the differential diagnoses of a radicular cyst, dentigerous cyst, and ameloblastoma, an exploratory aspiration and incisional biopsy were performed. This revealed the formation of blood vessels of various diameters lined by endothelium, forming intravascular papillae positive for CD-34. The definitive diagnosis was IPEH, and the patient was treated by embolization and surgery. Histological analysis confirmed the presence of IPEH associated with an odontogenic cyst. After 12 months of follow-up, no recurrence was observed. Also, we reviewed case reports of IPEH affecting the maxilla and mandible. Fourteen intraosseous cases were reported in the maxilla and mandible, with a preference for males and affecting a wide age range. Complete surgical excision was the treatment of choice, and recurrences were not reported. The pathogenesis of IPEH is controversial and may originate from trauma or inflammatory processes. To the best of our knowledge, this is the first report of an association of IPEH with an odontogenic cyst. The importance of IPEH in the differential diagnosis of intraosseous lesions in the jaws is emphasized, and preoperative semiotic maneuvers are needed to prevent surgical complications.

Volumetric changes in the size of odontogenic keratocysts after decompression followed by enucleation, peripheral ostectomy, and Carnoy's solution: A retrospective study.

The study aimed to retrospectively analyze the reduction pattern of odontogenic keratocysts (OKCs) after decompression, followed by enucleation (EN), peripheral ostectomy (PO), and Carnoy's solution (CS) to establish the appropriate time for inserting implants, along with assessing the long-term success of conservative treatment with adjunctive therapy. The predictable variables were the reduction pattern and the study's treatment option. The outcome variable was the volumetric changes in the size of bony defects. These changes were determined using a percentage difference and a reduction rate. They were recorded after decompression and one, three, six, twelve, and eighteen months after EN. P-values of .05 were considered significant. The study included 66 patients with 71 OKCs. Males, younger ages, and mandibular OKCs significantly predominated. The decompression significantly changed the initial volume from 135.40 ± 1.2 cm3 to 101.55 ± 0.1 cm3 with 28.6 percentage difference and 25% reduction rate. At the end of the first and third months after EN, the reduction pattern is 50.0%-75.5% of the initial volume, with no significant prediction for the direction of the reduction pattern. After 18 months, all bony defects disappeared, with no recurrences for the next 18 years. In conclusion, the reduction pattern is 75.5% of its initial volume at the end of the third month after OKC management. Therefore, within the limitations of the study, its treatment approach seems to be an option amongst other protocols that includes a view to early implant based dental rehabilitation.

The use of zygomatic implants in severe maxillary atrophy: a systematic and meta-analysis review of randomised clinical trials / El uso de implantes zigomáticos para atrofia maxilar severa: una revisión sistemática y meta-análisis de ensayos clínicos aleatorizados

SUMMARY: Conventional implant treatment cannot always be used to rehabilitate edentulous patients with advanced maxillary atrophic. Zygomatic dental implants have been used over the past 20 years as an alternative treatment solution to bone grafting. The purpose of this meta-analysis is to evaluate the implant and prosthetic survival rate in non-oncologic patients with a severely atrophic maxilla. This review also aims to better understand the rate of peri-operative complications in this cohort of patients. A multi-database (PubMed, MEDLINE, EMBASE, and CINAHAL) focused systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Any randomised control trials studies involving human participants treated with zygomatic osseous implants were included. After eliminating duplicates, a total of 4 studies met the inclusion criteria for this meta-analysis review. With all the studies included there was a total of 174 patients treated with zygomatic osseous implants. The overall implant success rate was 98.03 %. The prosthetic success rate was 96.4 %. The most frequent peri-operative complication was sinusitis. Based on the limited data available in literature, zygomatic dental implants represent a valid alternative to bone augmenting procedure. However, they are not without risks and longer follow-ups are required to confirm the validity of the treatment in long term.

Los tratamientos convencionales con implantes no siempre pueden ser usados para rehabilitar pacientes edentulos con atrofia maxilar avanzada. Los implantes dentales zigomáticos son usados por los pasados 20 años como alternativa de tratamiento a las reconstrucciones óseas. El objetivo de este meta-análisis es evaluar la sobrevida de implantes y prótesis en pacientes no oncológicos con maxila severamente atrófica. Esta revisión también pretende entender al promedio de complicaciones peri operatorias en esta cohorte de pacientes. Una búsqueda sistemática en bases de datos múltiples (PubMed, MEDLINE, EMBASE y CINAHAL) fue desarrollada de acuerdo a recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Cualquier estudio clínico aleatorizado de participantes humanos donde se utilizaron los implantes zigomáticos fueron incluidos. Después de eliminar duplicados, un total de 4 estudios cumplieron los criterios de inclusión para esta meta análisis. Con todos los estudios incluidos se obtuvieron 174 pacientes tratados con implantes zigomáticos. El promedio de éxito fue de 98,03 %. El promedio de éxito de la rehabilitación fue de 96,4 %. La complicación mas frecuente fue la sinusitis. Basados en los datos limitados en la literatura, los implantes zigomáticos representan una alternativa valida a los procedimientos de aumento óseo. Sin embargo, estos no están libres de riesgos y seguimientos de mayores periodos son necesarios para confirmar la validez de los tratamientos en el largo plazo.

Tratamento cirúrgico da osteomielite dos maxilares: relato de caso / Surgical treatment of osteomyelitis of the jaws: Case report / Tratamento quirúrgico de la osteomielitis de los maxilares: reporte de um caso

A Osteomielite dos Maxilares (OM) é uma inflamação óssea, de origem na maioria infecciosa, podendo atingir a porção medular e cortical dos ossos maxilares. Apresenta-se em maior extensão na mandíbula, devido ao pobre suprimento sanguíneo que essa possui, sendo mais prevalente em homens entre a faixa etária de 40 a 60 anos. Sua etiologia está relacionada principalmente às infecções odontogênicas, infecções secundárias e corpos estranhos ocasionais, como os implantes dentários. Tem-se por objetivo apresentar um relato de caso clínico sobre OM na região posterior da mandíbula, bem como sua associação a uma insatisfatória implantação dentária onde houve desenvolvimento de lesão peri-implantar. Paciente do gênero feminino, 53 anos, melanoderma, apresentou dor crônica, abaulamento ósseo sem outros sinais significativos na região de molares inferiores no lado direito, radiograficamente visualizava-se imagem mista sendo sugestiva de sequestro ósseo. Na história pregressa relatou ter realizado explantação na referida região após ser diagnosticada com peri implantite. Ao final do estudo concluiu-se que a afecção teve como causa a infecção bacteriana proveniente de contaminação durante a inserção de implante dentário. Optou-se por remoção cirúrgica do osso necrótico e inflamado... (AU)

Osteomyelitis of the Jaws (OM) is a bone inflammation, of mostly infectious origin, which can affect the medullary and cortical portion of the maxillary bones. It presents itself to a greater extent in the mandible, due to the poor blood supply that it has, being more prevalent in men between the age group of 40 to 60 years. Its etiology is mainly related to odontogenic infections, secondary infections and occasional foreign bodies, such as dental implants. The objective is to present a clinical case report on OM in the posterior region of the mandible, as well as its association with an unsatisfactory dental implantation, where there was development of a peri-implant lesion. Female patient, 53 years old, melanoderma, presented chronic pain, bone bulging without other significant signs in the region of lower molars on the right side, radiographically a mixed image was visualized, suggesting bone sequestration. In her previous history, she reported having performed explantation in that region after being diagnosed with peri-implantitis. At the end of the study, it was concluded that the disease was caused by bacterial infection from contamination during dental implant insertion. We opted for surgical removal of the necrotic and inflamed bone... (AU)

La osteomielitis de los maxilares (OM) es una inflamación de los huesos, en su mayoría de origen infeccioso, que puede afectar la porción medular y cortical de los huesos maxilares. Se presenta en mayor medida en la mandíbula, debido a la escasa irrigación sanguínea que tiene, siendo más prevalente en hombres entre el grupo de edad de 40 a 60 años. Su etiología se relaciona principalmente con infecciones odontogénicas, infecciones secundarias y cuerpos extraños ocasionales, como los implantes dentales. El objetivo es presentar un reporte de caso de OM en la región posterior de la mandíbula, así como su asociación con una implantación dentaria insatisfactoria a partir de la cual desarrollamos una lesión periimplantaria. Paciente femenina, 53 años, melanodermia, presenta dolor crónico, tumefacción ósea con otros signos significativos en región molar inferior del lado derecho, radiográficamente se visualiza imagen mixta sugestiva de pérdida ósea. En su historia previa menciona haber realizado una explantación en esa región tras ser diagnosticada de periimplantitis. Al final del estudio, se concluyó que la enfermedad fue causada por una infección bacteriana provocada por la contaminación durante la inserción del implante dental. Se optó por la extirpación quirúrgica de la piel necrótica e inflamada... (AU)

Tratamento cirúrgico do mixoma odontogênico sem ressecção maxilar: relato de caso / Surgical Treatment od Odontogenic Mixoma Without Maxillary Resection: Case Report / Tratamiento Quirúrgico del Mixoma Odontogénico Sin Resección Maxilar: Informe de Caso

Mixoma Odontogênico é um tumor de origem mesenquimal raro, de desenvolvimento lento e agressivo que acomete indivíduos entre os 10 e 40 anos de idade e principalmente, do gênero feminino. Este estudo teve como principal objetivo descrever um caso clinico de tratamento cirúrgico do mixoma odontogênico sem ressecção maxilar em uma paciente do gênero feminino que compareceu ao Ambulatório de Patologia Oral e Maxilo Facial, da Faculdade de Odontologia da UNIRG, na cidade de Gurupi-TO - Brasil. A paciente foi submetida ao tratamento cirúrgico conservador, através da curetagem e enucleação total do tumor. A proservação foi realizada em períodos de 12 meses, 24 meses e 48 meses aonde pode-se observar a sequencial e completam reparação óssea, inclusive a permanência dos dentes envolvidos que foram submetidos a tratamento endodôntico com total remodelação da lâmina dura e do ligamento periodontal... (AU)

Odontogenic Myxoma (OM) is a rare tumor of mesenchymal origin, of slow and aggressive development that affects individuals between 10 and 40 years of age and mainly female. This study aimed to describe a clinical case of surgical treatment of odontogenic myxoma with out maxillary resection in a female patient who attended the Outpa tient Clinic of Oral Pathology and Facial Maxillo, of UNIRG Dental School, in the city of Gurupi-TO - Brazil. The patient underwent con servative surgical treatment through curettage and total enucleation of the tumor. Proservation was carried out in periods of 12 months, 24 months and 48 months where it was possible to observe the sequential and complete bone repair including the permanence of the involved teeth that underwent endodontic treatment with total remodeling of hard blade and of the periodontal ligament... (AU)

El mixoma odontogénico es un tumor de origen mesenquimal poco frecuente, de desarrollo lento y agresivo que afecta a individuos entre 10 y 40 años de edad y principalmente mujeres. El objetivo principal de este estudio fue describir un caso clínico de tratamiento quirúrgico de mixoma odontogénico sin resección maxilar en una paciente femenina que asistió a la Clínica Ambulatoria de Patología Oral y Maxilo Facial, de la Facultad de Odontología de UNIRG, en la ciudad de Gurupi-TO - Brasil. El paciente se sometió a tratamiento quirúrgico conservador mediante legrado y enucleación tumoral total. La conservación se realizó en periodos de 12 meses, 24 meses y 48 meses donde es posible observar reparación ósea secuencial y completa, incluyendo la permanencia de los dientes implicados que fueron sometidos a tratamiento endodóntico con remodelación total de la durancia y ligamento periodontal... (AU)

Rol de la cirugía endoscópica en el tratamiento de quistes odontogénicos del hueso maxilar: revisión de la literatura / Role of endoscopic surgery in the treatment of maxillary odontogenic cysts

Los quistes odontogénicos son lesiones óseas, de carácter benigno, la mayoría asintomáticas, que habitualmente corresponden a un hallazgo radiológico. El tratamiento es quirúrgico y está condicionado por factores como localización, tamaño y la afectación de estructuras vecinas. El objetivo es elegir la modalidad de tratamiento que conlleve el menor riesgo de recurrencia, la mínima morbilidad, y al mismo tiempo la erradicación de la lesión. Siguiendo esta premisa han sido abordados, tradicionalmente, con técnicas abiertas con buenos resultados, pero con el advenimiento y desarrollo de la cirugía endoscópica, se empezó a usar esta técnica en forma exclusiva o en forma mixta para la resección de los quistes odontogénicos, logrando similares tasas de éxito, pero con menores complicaciones y morbilidad posoperatoria. Además, presenta una ventaja respecto del seguimiento para las recurrencias, ya que se pueden controlar endoscópicamente en la consulta ambulatoria. El objetivo de esta revisión es describir el desarrollo del rol de las cirugías endoscópicas para el tratamiento de lesiones odontogénicas maxilares.

Odontogenic cysts are benign bone lesions, most of them asymptomatic, which usually constitute a radiological finding. The treatment is surgical and is conditioned by factors such as location, size and involvement of nearby structures. The objective is to choose the treatment mode that presents the lowest risk of recurrence, the minimum morbidity, and at the same time, the eradication of the lesion. Following this premise, the treatment of these lesions has traditionally been approached with open techniques with good results but, with the advent and development of endoscopic surgery, this technique began to be used exclusively or in a mixed form for the resection of odontogenic cysts, achieving similar rates of surgical success, but with fewer complications and postoperative morbidity. It also has an advantage regarding follow-up for recurrences, since patients can be controlled endoscopically in the outpatient clinic. The objective of this review is to describe the development and role of endoscopic surgery for the treatment of maxillary odontogenic lesions.

Rosai Dorfman's disease of the maxillary bone with soft tissue involvement of the cheek: Case Presentation and Literature Review / Enfermedad de Rosai Dorfman de maxilar con compromiso de partes blandas de mejilla: Presentación de caso y revisión de la literatura

The Rosai-Dorfman disease (RDD) is a bening entity, of unknown etiology, rare, characterized by the overproduction of histiocytes and their subsequent accumulation in the lymph nodes, which may also compromise other organs and systems. It predominantly affects young people. The histological study, which shows emperipolesis, is very indicative but not pathognomonic, but with the immunohistochemistry the diagnosis of the disease is reached, which does not have a well-protocolized treatment. Its evolution is highly variable, with spontaneous remission being a possibility, although in some cases the commitment is extensive, compromising important or vital anatomical structures that requiere vigorous treatment, which can be surgical, radiotherapy and even chemotherapy. We present a case of RDD that affected a 17-year-old girl with upper jaw and right maxillary sinus commitment, which began with loss of teeth, and subsequent appearance of a painless and deforming facial tumour that underwent surgical resection. In this case, the etiological diagnosis was not posible in the preoperative period despite multiple biopsies. An extensive review of the literature is carried out in order to a better understanding of this pathology.

La Enfermedad de Rosai-Dorfman (ERD) es una entidad benigna, de etiología desconocida, poco frecuente, caracterizada por la sobreproducción de histiocitos y su posterior acúmulo en los linfonodos, pudiendo comprometer también a otros órganos y sistemas. Afecta predominantemente a personas jóvenes. El estudio histológico, que muestra emperipolesis, es muy orientativa pero no patognomónica, aunque con la Inmunohistoquímica se llega al diagnóstico de la enfermedad que no tiene un tratamiento bien protocolizado. Su evolución es muy variable, siendo la remisión espontánea una posibilidad, no obstante, en algunos casos, el compromiso es extenso, comprometiendo estructuras anatómicas importantes o vitales que requieren de un tratamiento enérgico, pudiendo ser éste quirúrgico, radioterápico y aún quimioterápico. Se presenta un caso de ERD que afectó a una joven de 17 años, con compromiso de maxilar y seno maxilar derecho, que debutó con pérdida de piezas dentarias y posterior aparición de un tumor facial indoloro y deformante que fue sometido a resección quirúrgica. En este caso no fue posible el diagnóstico etiológico en el preoperatorio pese a múltiples biopsias. Se hace una extensa revisión de la literatura con el objeto de conocer mejor esta patología.

Complications According to the Handling of the Pterygoid Plate During Bimaxillary Surgery.

BACKGROUND: During bimaxillary surgery, manipulation of the pterygoid plate is required to facilitate movement of the maxilla. This study examined the complications that occurred after handling the pterygoid plate during a Le Fort I osteotomy. PATIENTS AND METHODS: This study compared and analyzed complications according to the pterygoid plate handling method in 80 patients who underwent bimaxillary surgery at Pusan National University Dental Hospital from December 2015 to July 2020. The pterygoid plate was fractured or removed intentionally only if it interfered with the maxilla. Otherwise, it was not treated. The complications during surgery and the follow-up period were investigated. RESULTS: Fourteen patients experienced complications, of which excessive bleeding, hearing problems, and nonunion were encountered in 10, 2, and 2 patients, respectively. Of the 10 patients with excessive bleeding patients, the pterygoid plate was manipulated in 8 patients, which was controlled during surgery. Two patients complained of hearing loss with ear congestion immediately after surgery; both patients improved spontaneously within 1 month. Two nonunion patients underwent plate refixation at least 6 months postoperatively, and normal healing was achieved afterward. CONCLUSIONS: Fracture and removal of the pterygoid plate during orthognathic surgery did not significantly affect the occurrence of complications during and after surgery.

Queratoquistes odontogénicos maxilares en paciente con síndrome de Gorlin. Descripción de un caso y revisión de la literatura / Maxillary odontogenic keratocysts in a Gorlin síndrome patient: Case report and literatura review

Los queratoquistes maxilares son frecuentes en pacientes con síndrome de Gorlin. Su tratamiento es debatido por su alta tendencia a la recidiva. En los últimos años la cirugía endoscópica nasosinusal ha adquirido importancia en el manejo de esta patología. Exponemos en caso de un varón de 16 años afecto de este síndrome con queratoquistes maxilares donde se realiza un abordaje combinado, endonasal y transoral.

Maxillary keratocysts are frequent in Gorlin Syndrome patients. Its treatment is discussed due to the high tendency to recurrence. In the last years the sinonasal endoscopic surgery has become an important tool in the management of this pathology. We report a 16 years old boy with Gorlin Syndrome and maxillary keratocysts treated with a trans-nasal endoscopic and intra-oral combined approach.

Mucormicosis Maxilar posterior, secundaria a una exodoncia: Reporte de un caso y revisión de la literatura / Posterior maxillary mucormycosis, secondary to an exodontics: A case report and literature review

RESUMEN: La Mucormicosis se describe como una infección fúngica de tipo oportunista y potencialmente mortal, reportándose en la literatura como la tercera en frecuencia, muy por detrás de la Candidiasis y Aspergilosis. Esta infección es causada por hongos de la familia de los Mucorales. Se presenta el caso de un hombre con Diabetes Mellitus II con un control metabólico deficiente, el cual posterior a una exodoncia, presenta una Mucormicosis Maxilar, presentando una etiología atípica y logrando ser confirmada posterior a biopsias y pruebas de cultivo, demostrando elementos del tipo Mucor. Se realizó una Maxilectomía parcial del lado afectado como tratamiento con una evolución favorable. Esta revisión destaca la importancia de la búsqueda activa basada en la semiología y la importancia de los exámenes complementarios, implicando lograr un correcto diagnóstico y pronóstico de la enfermedad.

ABSTRACT: Mucormycosis is described as an opportunistic and life-threatening fungal infection, being reported in the literature as the third in frequency, far behind candidiasis and aspergillosis. This infection is caused by fungi of the Mucorales family. We present the case of a man with Diabetes Mellitus II with poor metabolic control who, after an extraction, presents a Maxillary Mucormycosis, with an atypical etiology and confirmed after biopsies and culture tests, demonstrating elements of the Mucor type. A partial maxillectomy was performed on the affected side as a treatment with a favorable outcome. This review highlights the importance of active search based on semiology and of complementary examinations, implying a correct diagnosis and prognosis of the disease.

Association of Virtual Surgical Planning With External Incisions in Complex Maxillectomy Reconstruction.

Importance: Maxillectomy can commonly be performed through a transoral approach, but maxillectomy defect reconstruction can be difficult to precisely design, contour, and inset through this approach. Objective: To evaluate whether the use of virtual surgical planning (VSP) and 3-dimensional (3-D) modeling is associated with a decrease in the requirement of lateral rhinotomy (LR) for patients undergoing total and partial maxillectomy reconstruction. Design, Setting, and Participants: This retrospective cohort study was conducted among patients undergoing subtotal or total maxillectomy with microvascular free flap reconstruction with or without VSP and 3-D modeling at a single tertiary care academic medical center between January 1, 2008, and October 3, 2019. Interventions: Maxillectomy and free flap reconstruction with or without VSP. Main Outcomes and Measures: Necessity of LR or other external incision for contouring, placement, and fixation of reconstruction as well as surgical complications. Results: Fifteen patients (12 men [80%]; mean age, 64 years) underwent maxillectomy with free flap reconstruction without VSP. Eight patients (53%) in this group underwent total maxillectomy, and 4 patients in this group (27%) underwent partial maxillectomy. Twenty-three patients (18 men [78%]; mean age, 58 years) underwent maxillectomy with free flap reconstruction and VSP and 3-D modeling. Twelve of these patients (52%) underwent total maxillectomy, and 11 (48%) underwent partial maxillectomy. Lateral rhinotomy was necessary for 1 patient (4%) in the VSP group vs 12 patients (80%; 95% CI, 54%-98%) in the pre-VSP group. There were no LR complications in the VSP group vs 6 in the pre-VSP group. Among both groups, 14 patients underwent fibula free flap, 22 patients underwent subscapular system free flap, and 2 patients underwent cutaneous or osteocutaneous radial forearm free flap. There were no flap failures in the LR group and 1 flap failure in the group without LR. Conclusions and Relevance: This cohort study suggests that the use of VSP and 3-D modeling for maxillectomy reconstruction is associated the a decrease in the need for external incisions without compromising reconstructive flap utility.

Biomechanical Behavior of All-on-4 and M-4 Configurations in an Atrophic Maxilla: A 3D Finite Element Method.

BACKGROUND In edentulous patients, the concept of 4 implants with early loading has been widely used in clinical settings. In the case of bone atrophy in the anterior maxilla, using short implants or an angulated implant may be a good choice for treatment. The occlusal scheme remains a key aspect of All-on-4. The aim of this study was to use the 3-dimensional (3D) finite element method (FEM) to evaluate how different All-on-4 designs for canine-guided and group function occlusion affected the distribution of stress in the atrophic premaxilla. MATERIAL AND METHODS A 3D edentulous maxilla model was created and in 3D FEM, 3 different configurations - M4, All-on-4, and short implant - were modeled by changing the anterior implants and using 2 different occlusal schemes. For each model, the occlusal load was applied to simulate lateral movements. For cortical bone, the maximum and minimum principal stress values were generated, and for ductile materials, von Mises stress values were obtained. RESULTS No significant differences were detected among the models; generally, however, the highest stress values were observed in the M-4 model and the models with short implants. Slightly higher stress values were observed in the group function occlusion group than in the canine-guided occlusion group. CONCLUSIONS To promote better primary stabilization, M-4 or short implant configurations with canine-guided occlusion appear to be preferable for patients who have severe atrophy in the anterior maxilla.

Endoscopic management of a giant dentigerous cyst.

Dentigerous cyst is one of the most common developmental cyst of the jaw which accounts for approximately 20%-30% of bone cyst in the head and neck region. Most common site is the third molar of the mandible. However, maxillary involvement is not uncommon. The clinical presentation of this depends mainly on the size and anatomical compromise that occur due to compression. This case highlights the role of endoscopic approach in the management of large expansible cyst of maxilla involving the palate, thus preserving the anatomy and reducing the morbidity associated with an open procedure.

Marsupialização de cisto dentígero após traumatismo / Marsupialization of dentigerous cyst after traumatism

Objetivo: as causas mais comuns das alterações na dentição permanente são os traumatismos alvéolo-dentários (TAD) na dentição decídua, ultrapassando, inclusive, as incidências de cárie ou doença periodontal. Estes podem levar a hipoplasia de esmalte, alterações na morfologia dentária e desenvolvimento de cistos, como o cisto dentígero, considerando ainda que o tratamento desta ocorrência diverge ao tratar da dentição decídua e não da permanente. O objetivo deste trabalho é ilustrar essas características e como elas podem ser manejadas através de um relato de caso. Relato de caso: no caso em questão, ocorreu o desenvolvimento de um cisto dentígero de grandes dimensões após traumatismo alvéolo-dentário em dentição decídua na região anterior da maxila com retenção de três dentes permanentes. Foram discutidas as formas terapêuticas para tal situação clínica, bem como a possibilidade de uma abordagem multidisciplinar da cirurgia-ortodontia. Considerações finais: os TADs na dentição decídua devem ser bem diagnosticados e tratados, visando a prevenção de sequelas na dentição permanente.(AU)

Objective: the most common causes of changes in permanent dentition are alveolar-dental trauma (TAD) in deciduous dentition, with occurrence rates even higher than decays or periodontal disease, which can lead to enamel hypoplasia, changes in dental morphology and the development of cysts such as the dentigerous cyst, considering treatment differs when dealing with deciduous dentition instead of permanent dentition. The objective of this work is to illustrate these characteristics and propose a possible treatment, through a case report. Case report: in the case at hand occurred a development of a large dentigerous cyst occurred after TAD in primary dentition, in the anterior region of the maxilla with retention of three permanent teeth, discussing the therapeutic forms for such clinical situation, as well as the possibility of a multidisciplinary approach to surgery-orthodontics. Final considerations: TAD in deciduous teeth should be well diagnosed and treated aiming to prevent sequelae in permanent dentition.(AU)

Modified V-Y Myocutaneous Flap With Vascular Pedicle for the Repair of Maxillofacial Skin Defects.

OBJECTIVE: It is challenging to repair postoperative defect caused by skin tumor resection on the maxillofacial, which not only affects appearance but also impairs functions. To better repair skin defect on the maxillofacial, the application value of V-Y vascular myocutaneous flap was introduced in our study. METHODS: Between June 2011 and December 2018, 16 patients with maxillofacial skin tumors who received extensive resection were enrolled in our study. The defect on the maxillofacial was repaired by V-Y vascular myocutaneous flap. The follow-up period lasted for 12 to 24 months. RESULTS: All 16 cases of myocutaneous flaps survived with 1 case of partial venous congestion and 1 case of partial distal necrosis. No recurrence occurred during follow-up. The color and texture of myocutaneous flaps like those of the surrounding skin. CONCLUSION: Featured with better freeness, larger repair range and aesthetic effect of "kite" flaps, V-Y vascular myocutaneous flap can repair the superior border of zygomatic arch pedicled with facial artery and repair 1.5 cm above the superior border of zygomatic arch pedicled with transverse facial artery for elderly patients in Asia.

Advanced osteoradionecrosis of the maxilla: a 15-year, single-institution experience of surgical management.

BACKGROUND: Osteoradionecrosis (ORN) of the maxilla is a rare disease. In contrast with a mandibular predominance, maxillary ORN has not been widely reported. OBJECTIVE: To review clinical features, surgical treatments, and results of maxillary ORN and offer recommendations for surgical decision-making. MATERIAL AND METHODS: We retrospectively reviewed medical records of maxillary ORN at our hospital between 2002 and 2017. Clinical data were collected, including age, sex, primary tumor characteristics, radiotherapy dose, clinical findings of maxillary ORN, and treatment outcomes. Descriptive statistics and multiple factors were analyzed. RESULTS: Twenty-four patients were included for analysis. The primary symptoms of maxillary ORN were pain, trismus, pus, bone exposure, and skin fistula. Twenty (83.3%) patients were completely cured after single-operation. Thirteen patients underwent sequestrectomy, and the cure rate was 76.9% (10/13). Eleven patients received segmental osteotomy and flap reconstruction, with the cure rate of 90.9% (10/11). There was no significant statistical difference in the cure rate between these two groups (p = .596). CONCLUSIONS AND SIGNIFICANCE: Compared with mandibular ORN, the surgical effect of maxillary lesions is better and the choice of operation methods can be relatively conservative. Both sequestrectomy and segmental osteotomy with flap reconstruction can achieve good results in appropriate conditions.

Retrospective 3D analysis of bone regeneration after cystectomy of odontogenic cysts.

BACKGROUND/OBJECTIVE: In this retrospective study, we aimed to investigate a new 3D evaluation method for evaluating bone regeneration after cystectomy of odontogenic cysts. METHODS: The study included 26 patients who underwent cystectomies between 2012 and 2017 and had received either fillings or non-fillings with autologous iliac crest. Bony regeneration was analyzed using 3D imaging software and comparing identical regions of interest (ROIs) that were determined by exact overlays of the postoperative cone beam computer tomography (CBCT) or computer tomography (CT) images. Outcome measures, including volume changes according to the defect size and configuration, patient age, the entity and distribution of the cysts, were collected. RESULTS: Twenty-six patients (5 women and 21 men) had 30 defects, including nine keratocysts, seven radicular cysts and 14 dentigerous cysts. A total of 73% of the defects were in the mandible. The mean 3D follow-up time was 12 months. According to the 3D evaluation of bony regeneration, the defect size and configuration showed no significant differences between the groups (filled or non-filled with 15 defects per group). CONCLUSIONS: By establishing a standardized 3D method for evaluating bone regeneration, healing can be better monitored and evaluated.

Application of Suprafascially Harvested Anterolateral Thigh Perforator Flap for the Reconstruction of Oral and Maxillofacial Defects.

PURPOSE: The aim of this study was to evaluate the feasibility and efficacy of the suprafascially elevated anterolateral thigh (ALT) perforator flap for reconstructing oral and maxillofacial defects. PATIENTS AND METHODS: The authors analyzed a retrospective case series of 15 patients who underwent reconstruction of oral and maxillofacial defects with the suprafascially raised ALT perforator flap from June 2015 through January 2017 at the Second Xiangya Hospital. The flap harvest and the methods for defect reconstruction are described, and the reconstructive efficacy is reported. RESULTS: Of the 15 patients, 12 were men, and 3 were women, with an average age of 49.5 years. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. All patients were followed for approximately 1 to 37 months, and they were satisfied with the esthetic and functional results of the recipient- and donor- sites after the reconstruction. CONCLUSIONS: Because of the reduced donor-site complications, satisfactory esthetic and functional results, and high success rate of flap transplantation, the use of suprafascially harvested ALT perforator flap is a good choice for the reconstruction of oral and maxillofacial defects, in cases in which the fascia lata is not needed.