Odontogenic Cutaneous Fistula: A Case in Aged Patient With Delayed Diagnosis.

ABSTRACT: Odontogenic cutaneous fistula is a pathologic communication between the cutaneous surface of the face and the oral cavity and it is a rare entity frequently misdiagnosed.Therefore, the lesion may persist for a long period before the correct diagnosis is made and odontogenic source is treated appropriately. Delay in diagnosis adds to the chronicity of the lesion and if not diagnosed in times fistula can even leave deforming scars.Considering the scarceness and diagnostic predicament of odontogenic cutaneous fistulas, the authors report a significant case of 80 years old female.

Eosinophilic Granuloma of the Mandible: Is a Conservative Treatment Sufficient for Local Disease Control?

Eosinophilic granuloma is the most benign and common form of the Langerhans cell histiocytosis, a rare proliferative disease that can affect single or multiple organs. In the quite common head and neck manifestation these lesions can be confused in the beginning, with other bone diseases such as odontogenic cysts, periodontal disease, or malignancies. Treatment varies depending on the size, number, localization of the lesions, and patient's general conditions. The authors describe here a patient of a single lesion of eosinophilic granuloma localized in the posterior mandible region treated with a very conservative surgical approach in a patient with poor socio-economic conditions. The authors performed teeth extractions, an excisional biopsy and open curettage and after a follow-up of 24 months without partial mandible resection and reconstruction time the lesion had healed. The clinical situation confirmed that, in carefully selective patients, a conservative approach could be a useful therapeutic opportunity.

Radiographic superimposition and mandibular peripheral osteoma: the importance of clinical and CT findings.

Peripheral osteomas are benign, slow-growing osteogenic tumors that are caused by centrifugal growth of the periosteum and develop as masses attached to the cortical plates.The pathogenesis of osteomas is unclear, and embryologic, traumatic, inflammatory, metaplastic, and genetic causes have been proposed. A solitary peripheral osteoma of the jaws is uncommon.The purpose of this paper is to present a peculiar case of mandibular peripheral osteoma with a particular radiographic superimposition that stress the importance of clinical and CT findings.

Late surgical treatment of posttraumatic mandibular deformity.

Delays in treatment may complicate the treatment of mandibular trauma, leading to a bone healing in an abnormal position and to a posttraumatic mandibular deformity such as malunion, malocclusion, and asymmetry. All these features may make delayed treatment a challenging issue. Therefore, early reduction and fixation of displaced mandibular fractures is mandatory to allow precocious healing and return to the normal function. In this article, we describe a patient treated in our unit for a diagnosed posttraumatic malocclusion after lack of primary trauma treatment.

Clinical outcomes of surgical management of anterior bilateral mandibular fractures.

PURPOSE: The aims of this study were to assess the clinical outcomes of patients with anterior bifocal mandibular fractures and to discuss the management of this peculiar type of trauma. METHODS: From the systematic computer-assisted database that has continuously recorded patients hospitalized with maxillofacial fractures, only patients admitted with anterior bifocal bilateral mandibular fractures between 2001 and 2011 were considered. Patients were contacted, and they were invited to volunteer for a clinical follow-up examination. Statistical analysis was performed using the Fisher exact test, and P < 0.05 was considered statistically significant. RESULTS: Forty dentate patients with anterior bifocal bilateral mandibular fractures (without the presence of further mandibular fractures) were included in the study. Nineteen patients with dislocated anterior segment underwent surgical intervention within 12 hours from hospital admission in the emergency department, whereas 21 patients with nondisplaced mandibular fractures were surgically treated in the elective operating room within 72 hours. Only 3 patients underwent tracheostomy. All patients underwent open reduction and internal fixation with 2.0- and 2.4-mm plates via intraoral approach, except for patients with submental or submandibular facial lacerations. CONCLUSIONS: Anterior bifocal bilateral mandibular fractures may involve a challenging management because they can compromise the upper airway. Accurate reduction and internal fixation of these fractures have been critical to restoring form and function of the mandible. The upper airway management and securing always take first, but a prompt surgical intervention of dislocated fractures avoids upper airways impairment.

Pathological mandibular fractures: a review of the literature of the last two decades.

Pathological mandibular fractures are rare, accounting for fewer than 2% of all fractures of the mandible. They could be defined as fractures that occur in regions where bone has been weakened by an underlying pathological process. Pathological fractures usually may follow surgical interventions such as third molar removal or implant placement, result from regions of osteomyelitis, osteoradionecrosis, and bisphosphonate-related osteonecrosis of the jaw, occur because of idiopathic reasons or be facilitated by cystic lesions, benign, malignant, or metastatic tumors. Pathological mandibular fractures may be challenging to treat because of their different etiology and peculiar local and general conditions, often requiring a more rigid fixation. In patients with poor medical conditions, simpler and more limited options may be preferred.

An unusual trilobate Stafne bone cavity.

This report describes an unusual case of trilobate Stafne bone cavity in a 72-year-old male asymptomatic patient, presenting as a radiolucency in the left mandibular body with an irregular peripheral border and a central area of reduced density on panoramic radiograph.

Bilateral buccal bifurcation cyst.

This report describes an unusual case of bilateral buccal bifurcation cyst in a 9-year-old patient, presenting as a slight expansion in the mandibular body region in correspondence with the first permanent mandibular molar bilaterally.

Complex and compound odontomas.

PURPOSE: This study aimed to analyze and discuss the demographic, clinical, and surgical aspects of 53 surgically treated odontomas and to review the literature. PATIENTS AND METHODS: A retrospective review was performed on all cases of treated odontomas in our center. A review of the recent literature about demographic aspects of odontomas was performed. RESULTS: A total of 53 odontomas with a mean age of 35 years were surgically treated during the study period: 32 complex odontomas, 20 compound odontomas, and 1 immature odontoma. Compound odontomas occurred more often at the mandible with a predilection for the anterior region, whereas complex odontomas showed up more often in the posterior regions of the mandible. Odontomas most commonly occurred in patients in the second decade of life. The main presenting sign was the eruption failure of permanent teeth (44 cases), whereas 1 patient referred pain as the presenting symptom. CONCLUSIONS: Odontomas are hamartomas not rarely encountered by oral and maxillofacial surgeons. Odontomas usually determine delayed eruption; thus, in case of any dentition anomaly or jaw deformation in children and adolescents, it is very important to investigate the presence of possible odontomas with radiographs.

Surgical management of pathologic mandibular fractures.

BACKGROUND: The aim of this article was to present our experience in the management of pathologic mandibular fractures. METHODS: We conducted a retrospective analysis of 14 patients with pathologic mandibular fractures associated with osteoradionecrosis, bisphosphonate-related osteonecrosis of the jaw, benign/malignant lesions, osteomyelitis, idiopathic, or iatrogenic etiology. Data collected included age, sex, etiology, site, treatment, and outcome. RESULTS: Five patients had iatrogenic fractures, 3 patients had osteomyelitis, 2 had benign cystic lesion, and the remaining 4 had primary squamous cell carcinoma, histiocytosis, multiple myeloma, and bisphosphonate-related osteonecrosis of the jaw, respectively. Eleven fractures of 14 were treated using a 2.4-mm mandibular plate. CONCLUSIONS: Pathologic mandibular fractures may be challenging to treat because of their different etiology and peculiar local and general conditions, often requiring a more rigid fixation. In patients with poor medical conditions, simpler and more limited options may be preferred.

Conservative treatment of unilateral displaced condylar fractures in children with mixed dentition.

PURPOSE: The aim of the study was to present the outcomes of the conservative treatment of unilateral displaced condylar fractures in a series of children with mixed dentition. METHODS: The treatment protocol of our study population included the placement of fixed orthodontic appliances, the preparation of a maxillary acrylic splint, and functional exercises. Six and 12 months after trauma, patients underwent clinical temporomandibular joint dysfunction and mandibular motion assessments and a panoramic radiography. RESULTS: Fourteen children with a mean age of 7.2 years were included in the study. At 1 year follow-up, complete clinical and functional recovery was observed in all patients. A complete healing process leading to a normal condylar process was observed in almost all patients. CONCLUSIONS: Conservative treatment of displaced condylar fractures in children, using a progressively remodeled splint, showed satisfactory functional outcomes at 12 months of follow-up.

Rugby athletes' awareness and compliance in the use of mouthguards in the North West of Italy.

BACKGROUND: The prevention of dental injuries during full-contact sports such as rugby is extremely important. Wearing a mouthguard can significantly reduce the frequency and severity of orofacial injuries, but it is not always used as athletes find it difficult to tolerate. The purpose of the present study was to determine the awareness and the extent of mouthguard use in a sample of young rugby athletes in the North West of Italy. MATERIAL AND METHODS: The athletes of four amateurs rugby teams based in the Province of Turin, Italy completed a questionnaire about playing history, current use and type of mouthguards, disturbs associated with mouthguard use, and general attitudes towards mouthguards. RESULTS: Only 53.85% of the subjects reported wearing their mouthguard all the time both during training and games. The most commonly reported problem associated with using a mouthguard was the discomfort on speech, followed by difficulty in closing lips, adversely affected breathing, adversely affected swallowing and slipping sensation. A statistically significant association between patients <22 years and non-use of mouthguards was observed. CONCLUSION: Limited knowledge about oral injury prevention and limited use of mouthguards were observed. The present study suggests that educational courses for rugby players and coaches to promote the use of mouthguards would be extremely important to reduce common complaints about these devices and increase their usage.

Clinical and histologic outcomes of calcium sulfate in the treatment of postextraction sockets.

OBJECTIVES: The aim of this prospective study was to assess the clinical and histologic outcomes obtained with calcium sulfate (CS) used as a filler material in fresh premolar and molar postextraction sockets. MATERIALS AND METHODS: Sixty premolar or molar postextraction sockets were filled with CS. Among the 60 grafted sockets, after 3 months, 50 underwent implant placement and clinical assessment. The removal of a sample core of newly generated intrasocket tissue was performed in 19 sockets. Collected samples were sent for histologic examination. The percentage of vital bone, nonvital bone, residual CS, amorphous material, and connective areas in every sample was calculated and recorded. RESULTS: Fifty postextraction regenerated sockets that underwent implant placement 3 months after tooth removal were included in this study.A partial postoperative exposition of the graft was observed in 12 of 50 sockets. At the surgical reentry, the augmented extraction sockets were completely filled by a hard material with an adequate alveolar crest in 41 cases. Histologic examination of the cores revealed that 63.16% of the intrasocket tissue was new vital bone, 2.1% was nonvital bone, 4.74% was fibrous tissue, and 30% was amorphous material. No residual CS was identified in bone cores. CONCLUSIONS: This study confirmed that CS is an ideal grafting material. The clinical adequacy aspect of filled sockets at surgical reentry seemed to be indicative of a qualitatively better bone regeneration. Postoperative exposition of graft material after a first intervention seemed to constitute an important risk factor for a worse bone regeneration.

Diagnosis and surgical treatment of a nasolabial cyst.

Nasolabial cysts are uncommonly diagnosed nonodontogenic soft tissue lesions located close to the nasal alar region of the face, presenting as extraosseous swelling in the region of the nasolabial fold. Nasolabial cysts are likely to remain undetected unless and until they become infected or are associated with facial deformity. Histologically, it is lined with nonkeratinized squamous epithelium or, more frequently, with respiratory-type cylindrical epithelium with goblet cells. The aim of this article was to present and discuss the surgical management of a case of nasolabial cyst and to briefly review the literature.

Platelet-rich fibrin and piezoelectric surgery: a safe technique for the prevention of periodontal complications in third molar surgery.

PURPOSE: The surgical removal of impacted mesioangular mandibular third molars (3Ms) may produce trauma to the soft tissues and bony structures. In particular, healing of postextractive socket may cause periodontal defects at the distal root of the second molar. The aim of the present prospective study was to assess the outcomes of a surgical protocol to remove 3Ms including the use of ultrasound bone surgery devices and platelet-rich fibrin (PRF) as a grafting material. PATIENTS AND METHODS: Twenty-eight impacted mandibular 3Ms were removed. Fourteen 3Ms were removed by piezoelectric osteotomy and PRF application. Instead, the 14 3Ms of the control group were removed by piezoelectric osteotomy but without PRF application. Probing depth in the distal position for all the mandibular second molars was registered before and 6 months after surgery. RESULTS: No complications were encountered. In the study group, alveolar socket fulfillment was rated as sufficient in 4 cases and adequate in the remaining 10 cases, whereas in the control group, it was rated as insufficient in 3 cases, sufficient in 4 cases, and adequate in 7 cases. Mean preoperative periodontal probing in the control group was 3.78 mm, whereas in the study group, it was 3.93 mm.Six months after surgery, mean periodontal probing was 3.28 mm in the control group and 3.07 mm in the study group. CONCLUSIONS: Combined action of PRF and piezoelectric surgery can be considered a safe and fine technique for third molar surgery and alveolar socket healing.

Surgical treatment of odontogenic myxoma.

BACKGROUND: There is no consensus about the surgical treatment of odontogenic myxoma. The aim of the current study was to present our experience and discuss the surgical management and outcome in 10 patients diagnosed with odontogenic myxoma. METHODS: A retrospective review of charts of patients who were surgically treated for odontogenic myxoma was performed. Patients were recalled, and eventual recurrences were investigated. RESULTS: Eight lesions were mandibular, whereas 2 were maxillary. In 3 patients, enucleation and curettage was performed. Instead, in the remaining 7 patients, segmental resection and immediate reconstruction were decided. At follow-up, no patient showed recurrence of the lesion. CONCLUSIONS: Our protocol is to perform conservative surgery by enucleation and curettage when lesions were smaller than 3 cm, whereas a segmental resection with immediate reconstruction is preferred in patients affected by bigger tumors. Long-term follow-up is required, in particular when conservative surgery is preferred.

Keratocystic odontogenic tumor (odontogenic keratocyst): preliminary retrospective review of epidemiologic, clinical, and radiologic features of 261 lesions from University of Turin.

PURPOSE: To analyze and discuss the demographic, clinical, and surgical aspects of 261 surgically treated keratocystic odontogenic tumors. PATIENTS AND METHODS: A retrospective review was performed of all cases of treated keratocystic odontogenic tumors. Statistical analysis was used to search for associations among age, presenting symptoms, location, dimension, and locularity. RESULTS: Keratocystic odontogenic tumors most commonly occurred in patients in the third and fourth decades of life. The ratio of males to females was 2:1. The mandibular angle region was the most frequently involved site. Significant associations were found between multilocular lesions and lesions larger than 31 mm (P < .00000005), a mandibular site and larger lesions (P < .05), patients younger than 41 years old and multilocular lesions (P < .05), and younger patients and larger lesions (P < .00005). CONCLUSION: It is likely that most multilocular, larger (and probably aggressive) lesions are found in patients younger than 41 years of age.

Exposed inferior alveolar neurovascular bundle during surgical removal of a residual cyst.

Iatrogenic neurodeficiency is one of the most distressing complications to any surgical procedure. The prediction of close proximity of the oral lesions to the inferior alveolar neurovascular bundle is extremely important. Furthermore, iatrogenic neurosensory dysfunctions of the facial region involve important medicolegal issues. In this report, we describe the case of a patient who did not show either paresthesia or anesthesia after the surgical removal of a mandibular residual cyst that exhibited adherence to the inferior alveolar nerve bundle.

Surgical treatment of a giant sialolith of the Wharton duct.

Sialoliths are responsible for the obstruction of the secretion of saliva. They are rarely larger than 15 mm. A 48-year-old man was referred for the assessment of swelling and pain in the submandibular right region during meals. A hard mass was palpable along the right Wharton duct. A panoramic radiograph showed a single, elongated, radiopaque, 22-mm-long mass in the right submandibular region. A diagnosis of giant sialolith in the right Wharton duct was made. Removal of the giant sialolith and sialodochoplasty were performed via an intraoral approach. Six months after the intervention, salivary flow was normal. Diagnosis and management of sialoliths of a remarkable size are challenging for the clinician. Conservative methods of treatment should be considered as an alternative for surgical excision, in particular for little calculi, but for giant sialoliths, transoral sialolithotomy with sialadenectomy or sialodochoplasty still remains the mainstay of management.

Surgical extraction of impacted inferior third molars at risk for inferior alveolar nerve injury.

The objective of the study was to prospectively assess the intraoperative findings and the radiographic signs of a study population of patients with impacted third molars at risk of inferior alveolar nerve injury. One hundred thirty-four patients with impacted mandibular third molars at risk for nerve injury were included in the study. Radiographic signs of possible close relationship between the 2 structures and intraoperative exposition or damage of the inferior alveolar nerve were recorded. The follow-up controls comprised clinical examinations and assessment for the sensation of the lower lip and chin. In 24 patients, a real contiguity was encountered between the third molars and nerve. Among these, intraoperative neural exposition was observed in 19 patients. Four patients complained of postoperative temporary hypoesthesia. No deficit of sensibility was found in cases with no exposition of the nerve. The accidental exposition of the inferior alveolar nerve is associated with an increased risk for neural injuries. At panoramic radiograph, the presence of signs of bifid and radiolucent apex, superimposition, and radiolucent root band should be considered at high risk for neural damage.