Spontaneous resolution of an intraosseous mandibular lesion: a case report and review of the literature.

The objective of this case report and review of the literature is to address spontaneously regressing radiolucent lesions affecting the mandible. In 2010, a 16-year-old girl presented with an impacted mandibular third molar associated with a radiolucent lesion. At that time, the treating clinician considered the lesion to be at high risk of causing life-threatening bleeding. Therefore, it was suggested that she not have her tooth extracted. The patient was lost to follow-up for 8 years. Recent radiographs obtained by an oral and maxillofacial surgeon revealed that the lesion had resolved spontaneously. This article also reviews and summarizes cases in the literature in which radiolucent mandibular lesions regressed without treatment or with minimal intervention such as aspiration or incisional biopsy. The current case report and previously reported findings of spontaneous regression underscore the importance of establishing an accurate differential diagnosis and highlight the benefits of a multidisciplinary approach involving general dentists, oral and maxillofacial radiologists, pathologists, and surgical colleagues for management of mandibular radiolucencies.

Does Simultaneous Third Molar Extraction Increase Intraoperative and Perioperative Complications in Orthognathic Surgery?

BACKGROUND: Prior to orthognathic surgery, most surgeons recommend third molar extraction. Espoused reasons include potential risk for infection, untoward osteotomies, and worsened postoperative discomfort. However, in addition to being another procedure for the patient, this may necessitate a longer preorthognathic surgery phase. The purpose of this study is to compare the outcomes of orthognathic surgery with staged versus simultaneous third molar extractions. METHODS: This was a retrospective analysis of patients who underwent orthognathic surgery from 2013 to 2014, with at least a 1-year follow-up period. Patients were stratified into 2 groups: Extraction of third molars at the time of surgery and prior extraction of third molars. Primary outcomes included the occurrence of unfavorable splits, infection, bleeding, malocclusion, and hardware failure. Secondary outcomes were procedure time, postoperative pain, and length of stay. Pearson χ tests and 2-tailed unpaired t tests were performed to determine if there was an association between the simultaneous removal of third molars and the primary and secondary outcome measures, respectively. RESULTS: One hundred patients were included in the study. Forty-nine patients had third molars extracted at the time of surgery and fifty-one did not. Complications included unfavorable split, postoperative infection, mild postoperative bleeding, postoperative malocclusion, and hardware failure. There was no significant difference in the incidence of complications in both groups. Procedure time was not considerably increased with extractions. There was no significant difference in postoperative pain or length of stay between both groups. CONCLUSIONS: Removing third molars concurrently with orthognathic surgery does not increase the risk of adverse outcomes, nor does it significantly influence hospital course.

Access to the Mandibular Angle Using a Sagittal Split to Address Pathologic Displacement of a Mandibular Third Molar.

Access to the mandibular angle for removal of pathology poses a unique challenge to surgeons. Intraoral approaches result in considerable bone removal and potential damage to the inferior alveolar nerve (IAN). Extraoral approaches are associated with a cutaneous scar and the potential for facial nerve damage. This report describes the case of a 53-year-old man with a deeply impacted third molar associated with a cystic lesion that was treated by enucleation using an intraoral sagittal split osteotomy. This approach allowed for complete access and visualization of the cyst and displaced third molar and protection of the IAN with minimal surgical morbidity.