Central granular cell odontogenic tumor of mandible in a child.

Central granular cell odontogenic tumor (CGCOT) is sporadic benign odontogenic tumor and it especially occurs in women older than 50 years of age. Radiologically it manifests as unilocular to the multilocular radiolucency with sometimes mixed densities. Histopathology displays sheets and islands of large eosinophilic cells with abundant granular cytoplasm, however few cases exhibit inadequate epithelium, thus creating a diagnostic confusion. Though, resection is advocated by some surgeons, however because of the non-aggressive biological behaviour, enucleation or curettage is the treatment of choice for this lesion. Till now only 39 cases have been reported in the past six decades. We are reporting the first case of CGCOT occurring in the youngest age of eleven-year-old patient with massive size of 11 × 7 × 6 cm. This would add CGCOT as a differential diagnosis in the bony lesions of younger individuals. In addition, the importance of immunohistochemistry studies in cases with scarce odontogenic epithelium and the potential role of Carnoy's solution in the management of this rare tumor in this age group was emphasized.

A novel economically viable solution for 3D printing-assisted cranioplast fabrication.

Cranioplasty is a common neurosurgical procedure which makes use of autologous bone or alloplastic material for cranial defect reconstruction. Alloplastic reconstruction is routinely done in cases where viable autologous bone is not available due to various reasons. Hydroxyapatite implants, patient-specific titanium and PEEK are widely employed materials due to their biocompatibility, durability, and high adaptation accuracy. However, their high cost and limited availability make them a less viable option for the common man. Polymethyl methacrylate (PMMA) is one of the commonly used alloplastic material for cranioplasty. This note presents a novel, economic, patient-specific, 3D printing-assisted and heat polymerized PMMA cranioplast fabrication technique with an accuracy comparable to that of patient-specific titanium and PEEK cranioplast.

A screw and wire assisted coronoidectomy procedure: A technical note.

Temporomandibular joint (TMJ) ankylosis and oral submucous fibrosis (OSMF) often exhibit elongated hyperplastic coronoid processes with fibrous attachments to the temporalis muscle. In managing this condition, a vital step involves performing a coronoidotomy or coronoidectomy alongside the primary surgical procedure. While coronoidectomy is preferable due to reattachment issues, its complexity arises from the thickened and elongated coronoid process. Our technical note introduces a screw and wire assisted coronoidectomy method, found to be efficient, replicable, and time-saving.

Evidence-based management of isolated dentoalveolar fractures: a systematic review.

Dentoalveolar (DA) trauma, which can involve tooth, alveolar bone, and surrounding soft tissues, is a significant dentofacial emergency. In emergency settings, physicians might lack comprehensive knowledge of timely procedures, causing delays for specialist referral. This systematic review assesses the literature on isolated DA fractures, emphasizing intervention timing and splinting techniques and duration in both children and adults. This systematic review adhered to PRISMA guidelines and involved a thorough search across PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library from January 1980 to December 2022. Inclusion and exclusion criteria guided study selection, with data extraction and analysis centered on demographics, etiology, injury site, diagnostics, treatment timelines, and outcomes in pediatric (2-12 years) and adult (>12 years) populations. This review analyzed 26 studies, categorized by age into pediatrics (2-12 years) and adults (>12 years). Falls were a common etiology, primarily affecting the anterior maxilla. Immediate management involved replantation, repositioning, and splinting within 24 hours (pediatric) or 48 hours (adult). Composite resin-bonded splints were common. Endodontic treatment was done within a timeframe of 3 days to 12 weeks for children and 2-12 weeks for adults. Tailored management based on patient age, tooth development stage, time elapsed, and resource availability is essential.

A Novel Minimally Invasive and Cost-Effective Internal Fixation of the Le Fort I Fracture by Using Intermaxillary Fixation Screw and Wire: A Technical Note.

Introduction: Le Fort I fractures represent a significant proportion of craniofacial trauma, often occurring alongside other injuries to the craniomaxillofacial region. Management options include open reduction and internal fixation (ORIF) or skeletal suspension, each with its limitations and considerations. Material and Methods: This technical note presents a novel technique for managing isolated Le Fort I fractures using intermaxillary fixation (IMF) screws, offering a minimally invasive alternative to ORIF. The technique involves the strategic placement of IMF screws in the stable zygomatic bone, coupled with arch bar fixation and wire manipulation for maxillary fragment reduction. Results: This approach is cost-effective, can be performed under local anesthesia, and provides stability without the need for prolonged maxillomandibular fixation (MMF). Conclusion: The simplicity and efficacy of this technique make it suitable for emergency settings and cases where traditional approaches may not be feasible. However, this technique is only feasible in isolated Le Fort I fractures and is contraindicated in comminuted Le Fort I fractures and in edentulous patients with upper jaw involvement.

Throat packing via nasopharyngeal airway for severe trismus cases requiring surgical intervention under general anesthesia: A simplified and innovative approach.

Throat packing is essential in oral and maxillofacial surgeries to prevent blood and tissue debris aspiration, reducing postoperative complications. Traditional oral route methods are often inadequate, especially in severe trismus cases like Oral Submucous Fibrosis (OSMF), TMJ Ankylosis, and post-traumatic conditions due to limited mouth opening. This study introduces a novel technique using a nasopharyngeal airway (NPA) for throat packing. The method involves inserting a hemostatic dressing through an NPA, ensuring minimal invasiveness and effective airway management. Proper positioning is confirmed with a laryngoscope or fiberoptic scope, and the dressing is secured to prevent dislodgement. This technique is easy, reproducible, and less injurious compared to traditional methods. At our center, throat packing via NPA was performed on 35 patients undergoing surgery under general anesthesia, resulting in high satisfaction and no reported complications.

In-house dental lab-based cranial prosthesis fabrication: a technical note.

Cranial prostheses are frequently required for patients with cranial defects secondary to trauma, decompressive craniectomy, or other pathologies. When the resected or craniotomized bone cannot be reused, cranioplasty with artificial materials offers both aesthetic and protective benefits. However, high-end custom-made options, like polyether ether ketone or titanium prostheses, are expensive and not widely available. Heat-cured polymethyl methacrylate (PMMA) prostheses are generally preferred over their cold-cured counterparts. In-house dental laboratories can provide a cost-effective and practical solution by employing a lost-wax technique akin to denture fabrication, utilizing a three-dimensional printed custom open mold. Fabricating large heatcured PMMA cranioplasts presents certain challenges, such as the need for large flasks and potential porosity. These can be overcome by using a large stainless steel container (a tiffin box) and M-Seal epoxy to ensure an airtight curing process. This method can be easily adopted by standard dental laboratories. At our center, four patients have successfully fitted with cranioplasty prostheses produced using this technique. Even though the patients are outside of the scope of this technical note all of them indicated high satisfaction, and no complications were reported. This straightforward approach demonstrates that in-house, heat-cured PMMA cranioplasts can represent a viable, cost-effective option for cranial reconstruction.

A rare case of bilateral pseudoaneurysm secondary to mandibular condyle fracture-a case report with review of literature.

This paper aims to present a rare case report of bilateral pseudoaneurysm secondary to condylar fracture and its management with a brief review of literature. A patient of age 19 years with alleged history of road traffic accident presented 6 weeks lately to our department with slow growing swelling in right preauricular area. History revealed bilateral condylar fracture with right parasymphysis fracture of mandible for which patient underwent maxillomandibular fixation for 4 weeks. The diffuse swelling in preauricular region showed positive signs of pulsation and audible bruit. Ultrasonography and contrast-enhanced computed tomography suggested the bilateral presence of vascular anamoly from the terminal branches of external carotid artery. Diagnostic angiography confirmed presence of pseudoaneurysm at the bifurcation of the internal maxillary artery and superficial temporal artery (STA) on right side whereas on the left side it was at proximal STA. Bilateral endovascular coil and gel foam embolization was done and thrombosis was confirmed with high frequency ultrasound on fourth postintervention day. The swelling completely resolved in a period of 1 month with no evidence of recurrence in the following 2-year follow-up period. Routine investigation revealed presence of pseudoaneurysm on left side which was completely without any clinical signs as repoterd by many cases of condylar fracture in the literature review. Pseudoaneurysm may remain silent and are exposed intraoperatively with massive bleeding which causes significant morbidity. Hence, prompt diagnosis and management is essential to avoid unexpected complication perioperatively.

Role of iodoform in jaw lesions: a systematic review.

Iodoform formulations are used as packing material following the surgical removal of jaw lesions. The purpose of this review was to explore the evidence and efficacy of iodoform-based dressings. We have systematically reviewed published articles according to the PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library database for articles mentioning the use of iodoform as dressing material for jaw lesions from January 2000 to March 2022. Finally, 92 studies were included. A total of 386 patients whose ages ranged from five months to 86 years (male n = 180, female n = 117). Different formulations of iodoform used were BIPP (n = 67), Whitehead's varnish (n = 17), iodoform (n = 7) and, iodine (n = 1) for its antiseptic properties. An iodoform impregnated gauze pack was changed once a week, most commonly, for a stipulated duration, until complete healing of the cavity. In the present review, iodoform was used, most commonly, in pathological cavities following surgical treatment of ameloblastoma and odontogenic keratocyst. Toxicity was reported in two studies. Based on the current review, iodoform is relatively safe and can be used in the management of extensive jaw lesions in which secondary healing is expected. Prospective and randomised control trials are recommended to assess the efficacy of various formulations and to delineate the timeframe for patient compliance.

Endoscopic-assisted intraoral approach for mandibular condyle fracture management: A systematic review and meta-analysis.

OBJECTIVE: Surgical innovation led to an endoscopic-assisted intraoral approach for managing condyle fractures. The purpose of this systematic review is to purview the role of the endoscope and determine the range of information, summarizing the evidence for the benefit of surgeons on an endoscopic-assisted intraoral approach. STUDY DESIGN: A literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases for studies mentioning the endoscopic intraoral approach for managing mandibular condylar fractures. Outcomes include the role of the endoscope, challenges, adjunct armamentarium, duration, and complications associated with the transoral and transbuccal approach for screw fixation. The meta-analysis was conducted with prevalence estimates and standardized means using STATA. RESULTS: Thirty-nine studies were included. A 30° angulated, 4-mm-thick endoscope was the most commonly used endoscope. Two mini plates were most commonly used for fixation. Facial nerve weakness was higher in the transbuccal approach (1.24%) than in the transoral approach (0.8%). Pooled analysis (6 studies) showed that the duration of the surgical procedure was less in the transoral approach compared with the transbuccal approach for screw fixation. The bailout was 1.49%. CONCLUSIONS: The endoscopic-assisted intraoral approach is reliable for condylar fracture management. The transoral and transbuccal approaches can be used for screw fixation with comparable outcomes.

Does surgical treatment of mandibular condyle head (diacapitular) fractures provide better outcomes than closed treatment? - a systematic review and meta-analysis.

The choices for managing a condylar head fracture (CHF) of the mandible are either open surgical or closed functional treatments (CFT) and the decision depends on various factors. The purpose of this systematic review was to ascertain from the available literature whether the open method or CFT yields better outcomes in managing CHF. We have systematically reviewed published articles according to the PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library database for comparative studies about both open and closed treatments from inception until April 2023. The outcomes of interest were mouth opening (MO), protrusion, laterotrusion, postoperative pain, and malocclusion. Eight studies met the inclusion criteria. The review comprised of 326 cases, among which 177 were managed by open methods and 149 were treated by CFT. The incidence of postoperative malocclusion and pain were significantly less in the open group. MO was better in the open treatment group although this was not statistically significant. Protrusion and laterotrusion occurred slightly more in CFT, although these were also statistically not significant. Overall, meta-analysis favoured open methods of managing CHF. Although enough evidence exists for the use of open methods for selected condylar head fractures, CFT still demonstrated favourable outcomes in undisplaced fractures. The selection of a particular treatment method should be individualised on the basis of each particular case considering the risk/benefits. Further high quality randomised trials are needed to establish a therapeutic guideline.

Nonendoscopic intraoral approach for condylar fracture management-a systematic review.

OBJECTIVE: The recent trend favors the open reduction and internal fixation of condylar fractures to prevent long-term consequences. Nonendoscopic intraoral approach is an option for management without a visible scar. The purpose of this systematic review was to explore the evidence, armamentarium, methods of reduction and fixation, challenges, and complications. STUDY DESIGN: We have systematically reviewed published articles on the intraoral approach for condylar fracture management following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane library database, to find relevant articles from January 1980 to March 2022. Descriptive statistics were applied to obtain the results. RESULTS: Finally, 23 studies were included. The incision described for the intraoral approach was similar to sagittal split osteotomy in all studies. A wide array of specialized instruments, methods, and challenges has been outlined for visualization, reduction, and fixation. The incidence of complications in the entire review was 23% (72/306). CONCLUSION: The challenges encountered in the nonendoscopic intraoral approach for condylar fracture management can be negated with the use of specialized instruments and with experience. However, further research is warranted for a specialized set of miniature instruments to ease the procedure, make it time-efficient and optimize hardware selection.

A systematic review and meta-analysis of the surgical outcomes in patients with osteochondroma of mandibular condyle.

Many options exist in the diagnosis and management of condylar osteochondroma. The purpose of this study was to provide a congregate information concerning treatment of the osteochondroma involving the mandibular condyle. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane database until February 2022. Twenty-seven studies were included for the final review. The review included 439 patients who underwent surgical management for mandibular condylar osteochondroma. The position of osteochondroma was mentioned in 13 studies. Preauricular, retromandibular, endaural, submandibular, transzygomatic, and intraoral approaches were used for approaching the tumor. Surgical techniques included resection, conservative condylectomy, and total condylectomy. Concomitant orthognathic surgery was performed along with tumor resection in 19 studies. In the entire review, the recurrence rate was 0.22% (1/439). The results of the meta-analysis showed that 2 studies reported significant malocclusion events after surgical therapy. Total joint replacement after tumor resection has a higher improvement in maximal mouth opening (8 mm) compared with vertical ramus osteotomy and no reconstruction groups, which have similar improvements (6 mm). The mainstay of treatment of osteochondroma is surgical excision either as condylectomy or conservative condylectomy. Among the various reconstruction modalities, total joint replacement showed better improvement in mouth opening. Adjunct procedures like orthodontic and orthognathic surgery have an important role in holistic management of severe cases. The treating surgeon must choose the surgical procedures in a pragmatic way.

Straight lift technique as an alternative to surgical extraction of an intact, partially impacted mesioangular mandibular third molar.

Impacted mandibular third molar removal is the most common procedure performed by oral and maxillofacial surgeons. An array of alternative procedures have been suggested, like operculectomy in cases of pericoronitis and coronectomy in certain cases. However, these procedures pose several disadvantages, and we propose a relatively non-invasive 'straight lift technique'. This technique is specifically useful in straightening abnormally positioned mesioangular third molars as a substitute of complete removal. This can improve tooth function, eliminate the need for surgical intervention, and reduce the risk of complications associated with third molar removal.

Does suprahyoid muscle complex pull cause relapse following genial advancement by distraction osteogenesis? An electromyographic study.

Active pull of the suprahyoid muscle complex (SMC) was thought to be the main contributor of relapse in mandibular or chin advancement, but literature evidence lacks human studies that assess the role of the SMC following genial advancement (GeA). This study therefore aimed to analyse the influence of SMC pull on relapse following GeA by distraction osteogenesis based on electromyographic (EMG) changes. EMG was recorded and analysed preoperatively (T0), at four months (T1), and at one-year follow up (T2) at three submental regions during two different activities. The outcome variables were EMG changes of the SMC, and hard and soft tissue relapse. Assessment was carried out by comparison of EMG and lateral cephalograms taken at T0, T1, and T2. Ten patients (7 male and 3 female; median (SD) age 21.2 (3.99) years, range 18-28) were included. The EMG values revealed a statistically significant reduction between T0 and T1. T2 values were not higher than T0 during any activity. The results of Pearson's correlation demonstrated no significant relation between the amount of relapse and change in EMG values. This study concluded that active pull of the SMC is not the actual reason for skeletal relapse in chin or mandibular advancement. Passive biomechanics such as adnexial or muscular connective tissue, and paramandibular periosteum pull with native bone remodelling might be the prime reasons for relapse. However, further large sample studies are warranted to find the actual causes of relapse.

Evaluation of fit feasibility of stock total joint replacement in temporomandibular joint ankylosis patients.

Long standing adult temporomandibular joint ankylosis (TMJA) results in smaller ramal height, and warped and undulated ramus. Despite the efforts made to standardise the sizes available in stock joint (Zimmer Biomet®), the system causes fit challenges in TMJA patients. The aim of the study was to evaluate the virtual feasibility of stock prostheses in TMJA patients. The data included amount of bone contouring for fossa placement, available ramal length, length discrepancy if placed straight, angulation of mandibular component required to adapt to the bone, and mediolateral fit discrepancy. CT data of 50 TMJA patients (71 joints; unilateral, n=29; bilateral, n=21; male, n=33; female, n=17) with mean age of 24.26±8.88 years were included. 53 joints required more than 3mm lateral bone reduction for fossa placement. The ramal length were categorised into ranges 35-40mm (n=15), 41-45mm (n=14), 46-50mm (n=28) and >50mm (n=14). Correlation between the age of occurrence of ankylosis and ramal length using the Pearson correlation coefficient revealed a positive correlation (r=0.38, p=0.001). Length discrepancy, angulation of mandibular component, and mediolateral fit discrepancy decreases as the ramal length increases. Only 14 joints had appropriate fit of stock prostheses while the remaining 57 joints warranted compromised placement. Even the smallest available stock mandibular component (45mm) had a compromised fit in terms of length and adaptability on the lateral aspect of ramus. The study concludes that a short ramus is mostly limiting factor in using stock prosthesis in TMJA patients. There is a need for still smaller size stock prostheses.