Mandibular symphyseal fracture simulated by a foreign body in the chin.

INTRODUCTION: Penetrating foreign bodies occurring after maxillofacial injuries are a diagnostic challenge for the trauma surgeon. Different materials and various sites of penetration in the maxillofacial region are described in the literature. We present the peculiar course of a patient with an endoral retained foreign body after a penetrating facial injury. The diagnostic pitfall in this type of trauma is highlighted owing to the hyperdensity of the foreign body that, at the computed tomographic (CT) axial scan, simulated a vestibular cortical fracture of the mandibular body and deceived both the radiologist and the surgeon. CLINICAL REPORT: We introduce the case of a boy who fell from his bicycle. Computed tomography was performed to detect any bone injuries. The radiologic report stated that a left condylar fracture was presented, associated to a vestibular cortical fracture of the mandibular body. Anamnestic questions revealed that the boy fell from his bicycle in a dug-up street. Clinical examination revealed 2 extraoral open wounds in the subnasal and periorbital areas and an endoral linear wound in the inferior fornix at the mandibular symphyseal region. Consequently, the left condylar fracture was surgically treated, and the mandibular body was explored by the endoral wound revealing an intact cortex: the road metal was removed from the soft tissue of the chin. The initial diagnostic pitfall was clarified: the radiodense foreign bodies penetrated the endoral wound in the soft tissue of the chin during the fall. They simulated a vestibular cortical fracture of the mandibular body at the CT scan deceiving both the radiologist and the surgeon. DISCUSSION: According to the literature, soft tissue foreign bodies can be detected by ultrasonography, plain radiography, CT, and magnetic resonance imaging. Superficially retained foreign bodies are easily detected with ultrasonography if they are not covered by overlying bone or gas. If this easily available technique had been applied initially in this case, the correct diagnosis might have been established at the initial admittance. Deeply located foreign bodies are best visualized by CT. The foreign body in the case introduced was made by radiopaque substance it presented the same radiodensity as the bone.

Management of an exposed mandibular plate after fibula free flap with vacuum-assisted closure system.

INTRODUCTION: In 1997, Morykwas et al introduced negative pressure dressings to manage complicated wounds; since its introduction, the vacuum-assisted closure (VAC) system has been successfully used in the fields of general surgery, orthopedic surgery, plastic surgery, and gynecology. Recently, some authors described this technique to manage complex wounds in the craniomaxillofacial region; we introduce the case of exposed peroneal bone and mandibular reconstruction plate after a fibula osteomyocutaneous free flap managed with this method. CLINICAL REPORT: A 41-year-old man presented an advanced mandibular osteoradionecrosis with an extensive composite three-dimensional defect of the lower jaw involving the oral mucosa, the mandibular bone, the external skin, and the soft tissue, with a clear communication between the oral cavity and the exterior. A subtotal mandibulectomy and a fibula osteomyocutaneous free flap to reconstruct the defect was performed; 1 month after surgery, the patient presented an exposition of a segment of the fibula and reconstruction plate. The patient was put on VAC for 20 days before a pedicle pectoralis major musculocutaneous flap was performed as definitive reconstruction. DISCUSSION: The advantages of the VAC device in the management of complicated craniofacial wounds have been discussed by a multitude of experimental and clinical studies. This method removes fluids and infectious materials and helps draw together wound edges, increasing blood flow and promoting wound healing. Of the 2 proposed mechanisms (fluid-based and mechanical), it seems that the latter is of greater importance in the production of new tissue. Up-to-date adequate surgical debridement, wet-to-dry dressing changes, and appropriate antibiotic treatment remain the mainstay in treating complex craniofacial wounds; however, in selected cases, the VAC system can be used to achieve a primary closure or to provide a transitory coverage preparing the wound bed until a definitive reconstruction is planned and/or performed. CONCLUSIONS: This therapy is a safe, innovative, and useful tool and can be of great assistance especially in complex craniofacial wounds, but it poses some problems such as intricate contours and orifices of the head and neck region, painful dressing changes, and remarkable costs.

Simultaneous palatal pleomorphic adenoma and mandibular keratocystic odontogenic tumor in a pediatric patient.

BACKGROUND: Neoplasms of the salivary gland account for 3% of all head and neck tumors; most of these occur in the parotid gland and are benign; 80% of them are pleomorphic adenomas. Benign neoplasms of the salivary gland are rare in children compared with adults. Keratocystic odontogenic tumor (KCOT) is considered the second most frequent neoplasm of all odontogenic tumors after the ameloblastoma. In the present report, we introduce the unusual presentation of a child with a simultaneous pleomorphic adenoma of the right hard palate and a KCOT of the left mandibular angle. DISCUSSION: The case is significant for 2 reasons; according to the literature, there are few reports of pleomorphic adenoma arising from a minor salivary gland of the palate in a patient younger than 18 years. This is to our knowledge the first recorded instance of simultaneous palatal pleomorphic adenoma and mandibular KCOT occurring in a child.

Mandibular bone deficit with a histologic study in man.

The aim of this study was that to determine the clinical and histologic results of a new hydroxyapatite, with innovative properties compared with the other alloplastic materials used in the regenerative treatment of grade 3 bony defects of the mandibular furcations in the human. The hydroxyapatite used in our research is characterized by a scarce density and crystallinity, while from a microstructural point of view, the granules have nanometric dimensions (0.05-0.1 microm). The patient reported here by the authors had a grade 3 infrabony defect into a mandibular furcation. The surgical procedure used consists of the creation of a flap, roots planing, the conditioning of the roots with tetracycline HC, the accurate positioning of the granules of the hydroxyapatite in the furcation area, the crown replacing of the flap, and finally the suture of the same. Six months after the insertion of hydroxyapatite, the clinical effect was studied, comparing the variations found in probing the insertion of depth. At the end of the treatment, a block section of the molar was performed, with part of the surrounding soft tissues, whose histologic analysis underlined the moderate and initial formation of bony tissue, periodontal ligament, and radicular cement in the middle and lower portion of the furcation. In light of these results, the authors conclude that the use of this new hydroxyapatite is promising in the treatment of the mandibular furcations in the human, even if it will be necessary to continue to test its effectiveness through more studies.

Transient facial nerve paralysis after mandibular sagittal osteotomy.

Facial nerve injuries are rare complications after orthognathic surgery. A literature review shows that such damages can develop with various mechanisms and are usually transient. Two cases of delayed facial paralysis after mandibular osteotomy with spontaneous recovery are reported.