Surgical resection of a huge cemento-ossifying fibroma in skull base by intraoral approach.

Cemento-ossifying fibroma, also known as ossifying fibroma, usually occurs in the mandible and less commonly in the maxilla. The huge example in the skull base is even rare. We present a case of a huge cemento-ossifying fibroma arising below the skull base of a 30-year-old woman patient. Radiologic investigations showed a giant, lobulated, heterogeneous calcified hard tissue mass, which is well circumscribed and is a mixture of radiolucent and radiopaque, situated at the rear of the right maxilla to the middle skull base. The tumor expands into the right maxillary sinus and the orbital cavity, fusing with the right maxilla at the maxillary tuberosity and blocking the bilateral choanas, which caused marked proptosis and blurred vision. The tumor was resected successfully by intraoral approach, and pathologic examination confirmed the lesion to be a cemento-ossifying fibroma. This case demonstrates that cemento-ossifying fibroma in the maxilla, not like in the mandible, may appear more aggressive because the extensive growth is unimpeded by anatomic obstacles and that the intraoral approach can be used to excise the tumor in the skull base.

Effects of nerve growth factor delivery via a gel to inferior alveolar nerve in mandibular distraction osteogenesis.

Inferior alveolar nerve (IAN) injury is a concern in mandible distraction osteogenesis (DO). We have previously demonstrated that repeated local injections of human nerve growth factor beta (NGF-beta) have significantly enhanced the histologic recovery of the IAN in a rabbit model of DO. This study was to further test the effect of a single injection of human NGF-beta delivered via a collagen/nanohydroxyapatite/kappa-carrageenan gel to the recovery of the IAN in DO. Rabbits underwent mandibular DO at a rate of 0.75 mm/12 h for 6 days. At the end of the distraction period, injections were performed near the IAN percutaneously as follows: group 1, human NGF-beta in the gel; group 2, human NGF-beta in saline; group 3, the gel alone; and group 4, saline alone. At 14 days after the end of distraction, IAN histologic findings and histomorphometric parameters were evaluated. Histologically, there were less myelin debris and more abundant regenerating nerve fibers in group 1 than the other groups. Both the myelinated fiber density and the myelinated axon area in group 1 were significantly higher than groups 3 and 4 (P < 0.01); the myelinated axon area in the group 1 was significantly higher than group 2 (P < 0.01). In conclusion, the delivery of human NGF-beta in the gel leads to a better acceleration of the IAN injury recovery over the saline delivery. It provides a possible way to enhance the recovery of nerve injuries in craniofacial DO clinically.

Preventing Early-Stage Graft Bone Resorption by Simultaneous Innervation: Innervated Iliac Bone Flap for Mandibular Reconstruction.

BACKGROUND: Postoperative resorption of vascularized bone grafts jeopardizes the success of dental implant(s) and functional rehabilitation of the jaw. Recent evidence supports the crucial role of innervation in bone regeneration and turnover. METHODS: This study reports a new technique for simultaneous innervation of vascularized iliac flaps in mandibular reconstruction, through neurorrhaphy between ilioinguinal nerves, which innervate iliac bone, and inferior alveolar nerves or great auricular nerves. Twenty-two patients (aged 50 to 69 years) with postoncologic continuity defects of the mandible underwent mandibular reconstruction (10 innervated flaps and 12 control flaps). Graft bone resorption was analyzed by computed tomographic scans at 6 and 12 months postoperatively, and bone quality was evaluated for dental implantation, with histologic and histomorphometric analyses for graft samples. RESULTS: At 12-month follow-up, graft bone density loss in the control group was significantly higher than in the innervated group (p < 0.05). Bone quality evaluation indicated a suitable condition for dental implantation in all patients in the innervated group but in 41.7 percent of patients in the control group. Histologic and histomorphometric analyses showed successful innervation in the innervated group but not in the control group. Osteoclast activity was significantly higher in the control group than in the innervated group (p < 0.05). CONCLUSIONS: Innervated iliac flaps may effectively prevent bone resorption of grafts in mandible reconstruction that otherwise jeopardize the success of dental implants. This new strategy of innervation of bone flaps appears clinically valuable and provides insights into the homeostasis of grafts for functional reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.