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Anticancer Res ; 41(8): 3983-3988, 2021 Aug.
Article En | MEDLINE | ID: mdl-34281862

BACKGROUND: When assessing sharply delineated bone lesions of the mandibular angle on X-rays, numerous diagnoses must be considered. The static bone cavity (Stafne's bone cavity, SBC) is a harmless lingual bone depression of the mandibular angle that usually does not require any treatment. It is essential to differentiate this bone deformity from other lesions that may require treatment. CASE REPORT: The 22-year-old patient was referred for further diagnosis and therapy after osteolysis of the mandible was noticed on a panoramic view (PV). The location and size of the lesion was typical of SBC. Only the three-dimensional representation of the lesion on cone beam computed tomographs revealed an intraosseous lesion. Histological examination of the lesion provided evidence of a fibrous neoplasm. CONCLUSION: The typical image of SBC is ambiguous on plain radiographs such as PV. The radiological diagnosis of the lesion should be based on the representation of the region of interest in different planes.

Mandibular Neoplasms/diagnostic imaging , Neoplasms, Connective Tissue/diagnostic imaging , Adult , Cone-Beam Computed Tomography , Humans , Male , Mandible/abnormalities , Mandible/diagnostic imaging , Mandible/pathology , Mandibular Neoplasms/pathology , Neoplasms, Connective Tissue/pathology , Young Adult
PLoS One ; 16(7): e0254997, 2021.
Article En | MEDLINE | ID: mdl-34283883

This study aimed to develop a high-performance deep learning algorithm to differentiate Stafne's bone cavity (SBC) from cysts and tumors of the jaw based on images acquired from various panoramic radiographic systems. Data sets included 176 Stafne's bone cavities and 282 odontogenic cysts and tumors of the mandible (98 dentigerous cysts, 91 odontogenic keratocysts, and 93 ameloblastomas) that required surgical removal. Panoramic radiographs were obtained using three different imaging systems. The trained model showed 99.25% accuracy, 98.08% sensitivity, and 100% specificity for SBC classification and resulted in one misclassified SBC case. The algorithm was approved to recognize the typical imaging features of SBC in panoramic radiography regardless of the imaging system when traced back with Grad-Cam and Guided Grad-Cam methods. The deep learning model for SBC differentiating from odontogenic cysts and tumors showed high performance with images obtained from multiple panoramic systems. The present algorithm is expected to be a useful tool for clinicians, as it diagnoses SBCs in panoramic radiography to prevent unnecessary examinations for patients. Additionally, it would provide support for clinicians to determine further examinations or referrals to surgeons for cases where even experts are unsure of diagnosis using panoramic radiography alone.

Image Processing, Computer-Assisted/methods , Mandible/diagnostic imaging , Odontogenic Cysts/diagnostic imaging , Algorithms , Ameloblastoma/diagnostic imaging , Ameloblastoma/pathology , Databases, Factual , Deep Learning , Humans , Jaw/diagnostic imaging , Jaw/pathology , Mandible/abnormalities , Mandible/pathology , Mandibular Diseases/diagnostic imaging , Neural Networks, Computer , Odontogenic Cysts/pathology , Radiography, Panoramic/methods , Tomography, X-Ray Computed/methods
Pan Afr Med J ; 38: 257, 2021.
Article Fr | MEDLINE | ID: mdl-34104305

Orofacial clefts are common congenital malformations. Tessier's classification system is the most widely used; it consists of 30 variants including median mandibular clefts (Tessier's cleft No. 30). They can be isolated or associated with cleft of the lower lip, tongue or more rarely, of the sternum. They are very rare, less than 70 cases (all types taken together) have been reported in the literature. We here report an exceptional case of mandibular and sternal cleft with literature review.

Mandible/abnormalities , Musculoskeletal Abnormalities/diagnostic imaging , Sternum/abnormalities , Abnormalities, Multiple/diagnostic imaging , Female , Humans , Mandible/diagnostic imaging , Mandible/surgery , Sternum/diagnostic imaging , Young Adult
Sci Rep ; 11(1): 9881, 2021 05 10.
Article En | MEDLINE | ID: mdl-33972643

In children with mandibular hypoplasia, airway management is challenging. However, detailed cephalometric assessment data for this population are sparse. The aim of this study was to find risk factors for predicting difficult airways in children with mandibular hypoplasia, and compare upper airway anatomical differences using three-dimensional computed tomography (3D CT) between children with mandibular hypoplasia and demographically matched healthy controls. There were significant discrepancies in relative tongue position (P < 0.01) and anterior distance of the hyoid bone (P < 0.01) between patients with mandibular hypoplasia and healthy controls. All mandibular measures were significantly different between the two groups, except for the height of the ramus of the mandible. After adjusting for age and sex, the anterior distance of hyoid bone and inferior pogonial angle were significantly associated with a difficult airway (P = 0.01 and P = 0.02). Quantitative analysis of upper airway structures revealed significant discrepancies, including relative tongue position, hyoid distance, and mandible measures between patients with mandibular hypoplasia and healthy controls. The anterior distance of the hyoid bone and inferior pogonial angle may be risk factors for a difficult airway in patients with mandibular hypoplasia.

Airway Management/adverse effects , Critical Illness/therapy , Mandible/diagnostic imaging , Micrognathism/complications , Airway Management/statistics & numerical data , Case-Control Studies , Cephalometry/statistics & numerical data , Child , Child, Preschool , Female , Healthy Volunteers , Humans , Imaging, Three-Dimensional , Infant , Male , Mandible/abnormalities , Micrognathism/diagnosis , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , Tomography, X-Ray Computed , Treatment Failure
J Plast Reconstr Aesthet Surg ; 74(10): 2622-2628, 2021 Oct.
Article En | MEDLINE | ID: mdl-33952433

BACKGROUND: Digital technology has been widely used in mandibular curved osteotomy to improve accuracy. However, the planning process still highly dependent on the experience and judgement of the surgeon. This study describes an automatic method to design the new gonion and osteotomy line based on the aesthetic standards in attractive women, and assesses its clinical outcomes. METHODS: An automatic surgical planning method for mandibular curved osteotomy was developed based on our previous research of mandibular angle aesthetics. A prospective clinical study was conducted from April 2016 to April 2018. Twenty-five female patients with prominent mandibular angle were enrolled. Pre- and postoperative skull computed tomography (CT) was performed. Three-dimensional (3D) CT data were obtained and processed by Mimics 18.0. Surgical templates were designed according to the automatic surgical planning method and 3D printed for the surgery. Preoperative measurements, surgical simulation and postoperative measurements were taken to evaluate the surgical outcomes. RESULTS: There were significant differences between the preoperative and the postoperative groups' results (p < 0.01). There was no difference between the surgical simulation and the postoperative results. All postoperative measurements were consistent with aesthetic features of mandibles. Patients were satisfied with their outcomes in terms of outline, symmetry and lower facial width. CONCLUSIONS: Our study developed an automatic method to position the new aesthetic gonion and osteotomy line for prominent mandibular angle patients. We proved that this method is safe, effective and reliable.

Cosmetic Techniques , Mandible/surgery , Mandibular Osteotomy/methods , Surgery, Computer-Assisted , Adolescent , Adult , Automation , Computer Simulation , Esthetics , Female , Humans , Imaging, Three-Dimensional , Mandible/abnormalities , Mandible/diagnostic imaging , Patient Satisfaction , Postoperative Period , Preoperative Period , Printing, Three-Dimensional , Skull/diagnostic imaging , Tomography, X-Ray Computed , Young Adult
Aging (Albany NY) ; 13(4): 4926-4945, 2021 02 22.
Article En | MEDLINE | ID: mdl-33618333

Mandibular hypoplasia, Deafness and Progeroid features with concomitant Lipodystrophy define a rare systemic disorder, named MDPL Syndrome, due to almost always a de novo variant in POLD1 gene, encoding the DNA polymerase δ. We report a MDPL female heterozygote for the recurrent p.Ser605del variant. In order to deepen the functional role of the in frame deletion affecting the polymerase catalytic site of the protein, cellular phenotype has been characterised. MDPL fibroblasts exhibit in vitro nuclear envelope anomalies, accumulation of prelamin A and presence of micronuclei. A decline of cell growth, cellular senescence and a blockage of proliferation in G0/G1 phase complete the aged cellular picture. The evaluation of the genomic instability reveals a delayed recovery from DNA induced-damage. Moreover, the rate of telomere shortening was greater in pathological cells, suggesting the telomere dysfunction as an emerging key feature in MDPL. Our results suggest an alteration in DNA replication/repair function of POLD1 as a primary pathogenetic cause of MDPL. The understanding of the mechanisms linking these cellular characteristics to the accelerated aging and to the wide spectrum of affected tissues and clinical symptoms in the MDPL patients may provide opportunities to develop therapeutic treatments for progeroid syndromes.

Acro-Osteolysis , Cellular Senescence , DNA Polymerase III/genetics , DNA Repair/genetics , Lipodystrophy , Mandible/abnormalities , Phenotype , Syndrome , Acro-Osteolysis/genetics , Acro-Osteolysis/physiopathology , Adult , Deafness , Female , Humans , Lipodystrophy/genetics , Lipodystrophy/physiopathology , Mandible/physiopathology , Young Adult
Eur J Med Genet ; 64(2): 104138, 2021 Feb.
Article En | MEDLINE | ID: mdl-33422685

Mandibuloacral dysplasia with type A lipodystrophy is a rare autosomal recessive disorder characterized by craniofacial dysmorphism, type A lipodystrophy, clavicular dysplasia, and acroostelolysis. It is caused by homozygous or compound heterozygous missense mutations in LMNA gene. We report five Tunisian patients harboring the same homozygous c.1580G > A; p. (Arg527His) mutation in LMNA gene. The patients presented with typical features of mandibuloacral dysplasia including, prominent eyes, thin or beaked nose, dental overcrowding, mandibular hypoplasia, short and broad finger's distal phalanges with round tips and lipodystrophy type A. Newly recognized signs are growth hormone deficiency and dilated cardiomyopathy. Genotype-phenotype correlation found that at least one of the disease's LMNA mutant alleles involve one of the highly conserved aminoacids, residing in a key site domain for protein function within the C-terminal globular domain of A-type lamins. Also, the severity of the disease depends on the position in the protein's domain and on the type of substitution of the concerned aminoacid.

Acro-Osteolysis/genetics , Lamin Type A/genetics , Lipodystrophy/genetics , Mandible/abnormalities , Acro-Osteolysis/pathology , Adolescent , Child , Female , Humans , Lamin Type A/chemistry , Lipodystrophy/pathology , Male , Mandible/pathology , Mutation, Missense , Pedigree , Phenotype , Protein Domains
Am J Hum Biol ; 33(2): e23446, 2021 03.
Article En | MEDLINE | ID: mdl-32537788

OBJECTIVE: This study evaluates the correlations amongst mandibular torus, palatine torus, oral exostoses to dental wear/loss and temporomandibular damage. METHODS: The sample consists of 504 skulls from the Hamann-Todd Osteological Collection; 223 African American and 281 European Americans aged between 30 and 80 years. The sample was analyzed using Pearson's Chi-square for significance of sex, age, ancestry, and wear as well as the interactions between the demographic variables and the presence of mandibular torus, palatine torus and oral exostoses. RESULTS: Wear was statistically significant by age and sex but not ancestry. The maxillary exostoses varied significantly by age, ancestry and wear but not sex. Mandibular torus frequencies varied significantly by wear, sex and ancestry. The palatine torus varied significantly across wear groups, sex and ancestry. DISCUSSION: The etiology of nonmetric oral cavity characteristics, mandibular torus, palatine torus and oral exostosis, is complex. The degree to which traits' presence and expression is the result of genetic and environmental interactions is not fully understood. More than age, sex or ancestry, the degree of dental wear and tooth loss influences the presence and expression of the oral cavity traits. The sample can be characterized as the presence of exostoses in higher frequencies in young African American males with little tooth loss. Males of both ancestral groups with heavy wear have higher frequencies of mandibular tori than females. The palatine torus is more common in edentulous European American females.

Exostoses/pathology , Mandible/abnormalities , Mandible/pathology , Mouth/pathology , Palate, Hard/abnormalities , Palate/pathology , Tooth Wear/pathology , Adult , African Americans , Aged , European Continental Ancestry Group , Exostoses/etiology , Female , Humans , Male , Middle Aged , Ohio , Palate, Hard/pathology , Tooth Wear/etiology , United States
Laryngoscope ; 131(7): 1647-1651, 2021 07.
Article En | MEDLINE | ID: mdl-33300625

OBJECTIVES/HYPOTHESIS: The anatomy of children with severe Pierre Robin sequence can present a challenge for direct laryngoscopy and intubation. Advanced techniques including flexible fiberoptic laryngoscopic intubation have been described but require highly specialized skill and equipment. Rigid video laryngoscopy is more accessible but has not been described in this population. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective review was completed at a tertiary care center of all children between January 2016 and March 2020 with Pierre Robin sequence who underwent a mandibular distraction osteogenesis procedure. Intubation events were collected, and a descriptive analysis was performed. A univariate logistic regression model was applied to direct laryngoscopy and flexible fiberoptic laryngoscopy with rigid video laryngoscopy as a reference. RESULTS: Twenty-five patients were identified with a total of 56 endotracheal events. All patients were successfully intubated. Direct laryngoscopy was successful at first intubation attempt in 47.3% (9/19) of events. Six direct laryngoscopy events required switching to another device. Rigid video laryngoscopy was successful at first intubation attempt in 80.5% (29/36) of events. Two cases required switching to another device. Flexible fiberoptic laryngoscopy was found successful at first intubation attempt in 88.9% (8/9) of events. Direct laryngoscopy was 4 times more likely to fail first intubation attempt when compared to rigid video laryngoscopy (P < .05). There was no significant difference between rigid video laryngoscopy and flexible fiberoptic laryngoscopy for intubation. CONCLUSIONS: For children with Pierre Robin sequence rigid video laryngoscopy should be considered as a first attempt intubation device both in the operating room and for emergent situations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1647-1651, 2021.

Airway Obstruction/surgery , Intubation, Intratracheal/methods , Laryngoscopy/methods , Pierre Robin Syndrome/complications , Adolescent , Airway Obstruction/etiology , Child , Child, Preschool , Equipment Failure , Female , Humans , Infant , Infant, Newborn , Intubation, Intratracheal/instrumentation , Laryngoscopes , Laryngoscopy/instrumentation , Male , Mandible/abnormalities , Mandible/surgery , Osteogenesis, Distraction , Pierre Robin Syndrome/diagnosis , Retrospective Studies , Severity of Illness Index , Treatment Outcome
Neuroradiol J ; 34(3): 249-252, 2021 Jun.
Article En | MEDLINE | ID: mdl-33307982

Torus mandibularis is a benign osseous overgrowth arising from the lingual surface of the mandible. It is a common, incidental finding on imaging due to its relatively high prevalence. In the majority of cases, mandibular tori are asymptomatic. We report a novel presentation of a giant torus mandibularis causing bilateral obstruction of the submandibular ducts and consequent sialadenitis. Our patient presented with progressive pain centered in the floor of his mouth and had bilateral submandibular glandular enlargement on exam. Computed tomography showed a giant right torus mandibularis, which was causing obstruction and dilation of the bilateral submandibular ducts. Although conservative management was attempted, he ultimately underwent surgical resection of his torus with symptomatic improvement. This patient highlights a novel complication of torus mandibularis and illustrates successful treatment. Though not previously described, this complication may be underreported and should be considered in the appropriate clinical setting.

Exostoses/complications , Exostoses/diagnostic imaging , Mandible/abnormalities , Palate, Hard/abnormalities , Sialadenitis/etiology , Submandibular Gland Diseases/etiology , Tomography, X-Ray Computed , Contrast Media , Exostoses/surgery , Humans , Male , Mandible/diagnostic imaging , Mandible/surgery , Middle Aged , Palate, Hard/diagnostic imaging , Palate, Hard/surgery , Sialadenitis/surgery , Submandibular Gland Diseases/surgery
Poult Sci ; 99(11): 5197-5205, 2020 Nov.
Article En | MEDLINE | ID: mdl-33142435

The prevalence of crossed beaks ranging from 0.2 to 7.4% was documented in at least 12 chicken strains. Previous studies focused largely on candidate molecules, whereas the morphological observation was missing. This study reported a detailed phenotype and prevalence of crossed beaks based on morphological observation in nine thousand nine hundred 1-day-old female Beijing-You chicks. Affected chicks were classified into 2 categories based on the direction of the mandibular deformation: left and right. Each category was selected to sacrifice for the measurement of length, width, and thickness of the bilateral mandibular ramus (MR). The normal chicks were used as controls. Paraffin section was made for the bilateral MR of a crossed beak and a normal control for histology analysis. A total of 97 out of 9,900 chickens showed beak deformity including 71 crossed beaks (0.72%) and 26 side beaks (0.26%) for which the upper and lower beak were both bent in the same direction. There was no difference in the direction of the bend of the lower beak in crossed beaks (P > 0.05). The incidence of crossed beaks increased quickly from 0 to 56 d and no new incidence after 56 d. The angle of the crossed beaks was below 5° in the first week and had grown more severe with age until 56 d. The mandible structure showed that condyle served as a growth center for the MR extension. The short-side MR of crossed beaks was thicker than normal ones (P < 0.05) and caused the mandible deviated to the same direction. Meanwhile, the short-side MR prevented the occlusion, leading the jugal arch deformity, which in turn resulted in a bent maxillary horizontally. Similarly, chicks with side beaks also had asymmetry in MR length and the deformities of the jugal arch after dissection. In summary, asymmetric growth of bilateral MR induced crossed beaks and side beaks; the mandibular condyle could be an ideal sample for the related molecular mechanism studies underlying this trait.

Beak , Chickens , Congenital Abnormalities , Animals , Beak/abnormalities , Beak/anatomy & histology , Beijing/epidemiology , Chickens/anatomy & histology , Congenital Abnormalities/epidemiology , Congenital Abnormalities/pathology , Congenital Abnormalities/veterinary , Female , Incidence , Mandible/abnormalities , Phenotype
J Craniofac Surg ; 31(8): 2204-2207, 2020.
Article En | MEDLINE | ID: mdl-33136855

In hemifacial microsomia (HFM), the correlations between mandibular dysplasia and maxillary deformities in HFM patients have not yet been assessed. The objective of the present study was to examine the association of maxillary volumetric and linear measurements with mandibular ramus height or corpus length on the affected side in children with unilateral HFM.In this retrospective research, a total of 70 children with unilateral HFM were enrolled at our department from 2010 to 2019. Demographic information was recorded, and computed tomographic scan were reconstructed and analyzed by segmentation, volumetric, and cephalometric measurements. Analyses involved independent sample t-test, univariable, and multivariable linear regression.In the overall population, mandibular ramus height (MRH) was positively associated with the maxillary bone volume (MBV) (r = 0.484, P < 0.001) and maxillary total volume (MTV) (r = 0.520, P < 0.001). Similarly, mandibular corpus length (MCL) was significantly associated with the MBV (r = 0.467, P < 0.001) and MTV (r = 0.520, P < 0.001). Multivariate regression analysis revealed that the MRH or MCL were significantly and independently associated with MBV or MTV (MRH/MBV ß = 0.420, P < 0.001; MRH/MTV ß = 0.391, P < 0.001; MCL/MBV ß = 0.403, P < 0.001; MCL/MTV ß = 0.307, P < 0.01).These results demonstrated that the MBV and MTV are independently associated with MRH or MCL on the affected side in children with unilateral HFM, suggesting a potential interaction between mandibular dysplasia and maxillary deformities.

Goldenhar Syndrome/surgery , Mandible/surgery , Maxilla/surgery , Adolescent , Cephalometry/methods , Child , Facial Asymmetry , Goldenhar Syndrome/diagnostic imaging , Humans , Mandible/abnormalities , Mandible/diagnostic imaging , Maxilla/abnormalities , Maxilla/diagnostic imaging , Orthognathic Surgical Procedures , Retrospective Studies , Tooth
Eur J Med Res ; 25(1): 50, 2020 Oct 22.
Article En | MEDLINE | ID: mdl-33092645

BACKGROUND: Mandibular deviations are common clinical complaints. The orthodontic or orthognathic treatment of mandibular deviations is tricky because a comprehensive diagnosis, especially a functional one, is difficult to make. A inaccurate diagnosis may lead to a compromised and unstable treatment outcome. CASE PRESENTATION: This article describes the diagnosis and treatment of a woman with a mandibular deviation and facial skeletal asymmetry. By eliminating the disharmony of the arch form with elastics and bite turbos, her esthetic and functional outcomes improved. Cone-beam CT (CBCT) and Joint Space Index (JSI) analyses served as the diagnostic approaches and outcome evaluation methods before and after treatment. CONCLUSIONS: A condyle position displacement could be an indication of functional deviation. JSI analysis is a quantitative and convenient choice to compare condyle relative positions.

Facial Asymmetry/therapy , Malocclusion/therapy , Mandible/abnormalities , Orthodontic Brackets , Cone-Beam Computed Tomography/methods , Facial Asymmetry/diagnostic imaging , Female , Humans , Malocclusion/diagnostic imaging , Mandible/diagnostic imaging , Temporomandibular Joint/diagnostic imaging , Treatment Outcome , Young Adult
Nat Commun ; 11(1): 4589, 2020 09 11.
Article En | MEDLINE | ID: mdl-32917887

Mandibuloacral dysplasia syndromes are mainly due to recessive LMNA or ZMPSTE24 mutations, with cardinal nuclear morphological abnormalities and dysfunction. We report five homozygous null mutations in MTX2, encoding Metaxin-2 (MTX2), an outer mitochondrial membrane protein, in patients presenting with a severe laminopathy-like mandibuloacral dysplasia characterized by growth retardation, bone resorption, arterial calcification, renal glomerulosclerosis and severe hypertension. Loss of MTX2 in patients' primary fibroblasts leads to loss of Metaxin-1 (MTX1) and mitochondrial dysfunction, including network fragmentation and oxidative phosphorylation impairment. Furthermore, patients' fibroblasts are resistant to induced apoptosis, leading to increased cell senescence and mitophagy and reduced proliferation. Interestingly, secondary nuclear morphological defects are observed in both MTX2-mutant fibroblasts and mtx-2-depleted C. elegans. We thus report the identification of a severe premature aging syndrome revealing an unsuspected link between mitochondrial composition and function and nuclear morphology, establishing a pathophysiological link with premature aging laminopathies and likely explaining common clinical features.

Acro-Osteolysis/metabolism , Genetic Predisposition to Disease/genetics , Lipodystrophy/metabolism , Mandible/abnormalities , Membrane Proteins/metabolism , Mitochondria/metabolism , Mitochondrial Proteins/metabolism , Acro-Osteolysis/diagnostic imaging , Acro-Osteolysis/genetics , Acro-Osteolysis/pathology , Aging, Premature/genetics , Aging, Premature/metabolism , Animals , Apoptosis , Caenorhabditis elegans , Cell Proliferation , Child , Down-Regulation , Female , Fibroblasts/metabolism , Fibroblasts/pathology , Gene Expression Regulation , Genotype , Homozygote , Humans , Lipodystrophy/diagnostic imaging , Lipodystrophy/genetics , Lipodystrophy/pathology , Male , Mandible/diagnostic imaging , Membrane Proteins/genetics , Metalloendopeptidases , Mitochondrial Membrane Transport Proteins/genetics , Mitochondrial Proteins/genetics , Mutation , Phenotype , Skin , Whole Genome Sequencing
BMJ Case Rep ; 13(9)2020 Sep 14.
Article En | MEDLINE | ID: mdl-32928838

Central giant cell granuloma (CGCG) is an expansile osteolytic lesion of the jawbone. Conventional treatment of CGCG is surgical and vary from simple curettage to more aggressive resection of the jaw. However, surgical management is associated with drawbacks including requirement of hospitalisation and general anaesthesia, damage to vital anatomic structures and continuity defect of the mandible requiring reconstruction surgery. Use of intralesional injections of corticosteroid for the management of CGCG have been inconsistently used as an alternative non-surgical method of management of CGCG with varying success. While the use of such conservative modality over ablative surgery can significantly reduce postoperative morbidity, follow-up of such cases for a long period is important to study the possible recurrence. This paper reports successful treatment of a recurrent CGCG of posterior mandible by intralesional administration of triamcinolone acetonide in a 27-year old female patient, with long-term follow-up of 10 years.

Adrenal Cortex Hormones/administration & dosage , Granuloma, Giant Cell/surgery , Mandible/abnormalities , Adrenal Cortex Hormones/therapeutic use , Adult , Aftercare/methods , Disease Management , Female , Humans , Injections, Intralesional/methods , Reconstructive Surgical Procedures/methods
Medicina (Kaunas) ; 56(7)2020 Jun 30.
Article En | MEDLINE | ID: mdl-32630080

BACKGROUND: Plexiform ameloblastoma is a locally aggressive odontogenic tumor, rare in the anterior mandible. The treatment of choice is resection with 1-3 cm free margins. In most of reported cases, the affected mandible is reconstructed by autogenic bone graft or osseocutaneous microvascular free flap in order to return function and esthetics. CASE DESCRIPTION: A 2 cm diameter exophytic ameloblastoma, located in the anterior mandible of a 50-year-old male was resected and reconstructed in a unique manner-allogenic bone block, recombinant human bone morphogenetic protein (rhBMP) and xenograft particles via transcutaneous submental approach. After bone maturation, dental implants were placed and restored by fixed prosthetics. PRACTICAL IMPLICATIONS: Mandible reconstruction modalities have a crucial influence on patient quality of life, function and esthetics. Allogenic bone block combined with rhBMP and xenograft particles can replace the traditional autogenous bone in certain circumstances. A submental transcutaneous "tent pole" approach can improve the success rate of the reconstruction procedure.

Mandibular Osteotomy/standards , Neurofibroma, Plexiform/surgery , Bone Transplantation/methods , Humans , Male , Mandible/abnormalities , Mandible/pathology , Mandibular Osteotomy/adverse effects , Mandibular Osteotomy/methods , Middle Aged , Neurofibroma, Plexiform/complications , Neurofibroma, Plexiform/physiopathology , Reconstructive Surgical Procedures/adverse effects , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/standards
Med Sci Monit ; 26: e921401, 2020 Jun 26.
Article En | MEDLINE | ID: mdl-32588836

BACKGROUND The purpose of this prospective study was to compare adolescent and post-adolescent growth periods regarding the effectiveness of conventional activator appliance in patients with Class II mandibular retrognathia by using lateral cephalometric radiographs and three-dimensional photogrammetry (3dMDface). MATERIAL AND METHODS We enrolled 2 groups: 15 patients in the adolescent growth period and 17 patients in the post-adolescent growth period. All patients had Class II anomaly with mandibular retrognathia and were treated with conventional activator appliances. Lateral cephalometric radiographs and three-dimensional photogrammetric views were obtained at the beginning and end of the activator treatment of Class II patients. Maxillomandibular discrepancy, mandibular protrusion and lengths, convexity angles, facial heights, and dental measurements were evaluated cephalometrically. Projections of the lips and the chin and volumetric measurements of the lip and the mandibular area were assessed using three-dimensional photogrammetry. RESULTS Conventional activator therapy resulted in similar effects in both growth periods regarding improvements in the mandibular sagittal growth and maxillomandibular relationship (ANB° and the SNB° angles). Mandibular effective length was increased (Co-Gn length) and the maxillary horizontal growth was restricted (decreased SNA° angle) in both groups following the treatment. Treatment duration was significantly longer in the post-adolescent group. Increases in the projections of menton, pogonion, and sublabial points were observed in the three-dimensional photogrammetric views. Total lip volume was reduced while the mandibular volume was significantly increased in both groups. Lower gonial angle showed a greater increase in the post-adolescent group. CONCLUSIONS Correction of Class II anomaly with mandibular retrognathia was achieved with a combination of dental and skeletal changes in both growth periods. Conventional activator therapy may be an alternative treatment approach in the late growth period as it led to significant skeletal and dental changes.

Activator Appliances , Malocclusion, Angle Class II/therapy , Mandible/diagnostic imaging , Retrognathia/therapy , Adolescent , Age Factors , Bone Development , Carpal Bones/diagnostic imaging , Carpal Bones/growth & development , Cephalometry , Child , Female , Hand Bones/diagnostic imaging , Hand Bones/growth & development , Humans , Imaging, Three-Dimensional , Male , Malocclusion, Angle Class II/diagnostic imaging , Mandible/abnormalities , Maxilla/diagnostic imaging , Maxillofacial Development , Photogrammetry , Prospective Studies , Retrognathia/diagnostic imaging , Treatment Outcome
Medicina (Kaunas) ; 56(6)2020 May 27.
Article En | MEDLINE | ID: mdl-32471305

Background and Objectives: Implant stability in vivo is contingent on multiple factors, such as bone structure, instrument positioning and implant surface modifications, implant diameter, and implant length. Resonance-frequency analysis is considered a non-invasive, reliable, predictable, and objective method by which to evaluate implant stability, due to its correlation with bone-to-implant contact. The purpose of this study was to evaluate the effect of implant length on the primary and secondary stability of single-implant crown rehabilitations, as measured by resonance-frequency analysis at different times. Materials and Methods: Implants of 10 and 11.5 mm were placed, and the resonance frequency was measured at the time of surgery (T0), as well as at 3 (T1), 6 (T2), and 12 (T3) months post-surgery. Results: A total of 559 implants were placed in 195 patients. Significant differences were observed when comparing the implant stability quotient (ISQ) values at T1, with values for 10-mm implants being greater than those for 11.5-mm implants (p = 0.035). These differences were also observed when comparing ISQ values for buccal and lingual areas. At T0, T2, and T3, no significant differences in ISQ values were observed. The use of 10-mm implants in the anterior maxilla yielded significantly greater values at T0 (p = 0.018) and T1 (p = 0.031) when compared with 11.5-mm implants. Significant differences in measurements were observed only for buccal areas (p = 0.005; p = 0.018). When comparing the sample lengths and sex, women with 11.5-mm implants showed significantly lower results than those with 10-mm implants (p < 0.001). Conclusions: There is a direct relationship between implants of a smaller length and greater ISQ values, with this relationship being most evident in the maxilla and in women.

Dental Implantation, Endosseous/classification , Mandible/surgery , Maxilla/surgery , Prostheses and Implants/standards , Quality of Health Care/standards , Adult , Dental Implantation, Endosseous/methods , Dental Implantation, Endosseous/standards , Female , Follow-Up Studies , Humans , Male , Mandible/abnormalities , Maxilla/abnormalities , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Prostheses and Implants/statistics & numerical data , Quality of Health Care/statistics & numerical data , Resonance Frequency Analysis
Surg Radiol Anat ; 42(9): 1073-1079, 2020 Sep.
Article En | MEDLINE | ID: mdl-32399625

PURPOSE: The bifid mandibular canal is an anatomical variation, which causes anesthetic failure and surgical accidents occasionally. The purpose of this study is to observe the prevalence and anatomical location of bifid mandibular canals, providing clinical value in reducing the occurrence of surgical accidents and postoperative complications. METHODS: A total of 321 outpatients were selected in this study. Their CBCT images were observed, and the prevalence of bifid mandibular canals as well as the composition ratios of each branch type was evaluated according to the classification of Naitoh. The bifid mandibular canals and their branches' diameter, length, horizontal distance to the buccal/lingual wall of the mandible, and vertical distance to the mandibular alveolar ridge were measured. Furthermore, 194 dry adult mandibles from the Department of Oral Anatomy and Physiology of Tianjin Medical University were observed to evaluate the prevalence and the average diameter of retromolar foramina. RESULTS: Of all the 321 patients, 84 (26.17%) cases of bifid mandibular canals and 105 (16.36%) sides of unilateral bifurcation were observed. Based on Naitoh's classification, the retromolar canals were the most common types (46.67%), followed by the forward canals (40.00%), the dental canals (10.48%) and the buccolingual canals (2.86%). In 194 dry adult mandibles, 23 cases (11.86%) and 29 sides (7.47%) of retromolar foramina were found and the average diameter of retromolar foramina was 0.94 ± 0.30 mm. CONCLUSION: More than a quarter of the population has the bifid mandibular canal, which is a potential factor of the onset of surgery accidents. CBCT is an effective method to identify the branches of mandibular canals. Preoperative CBCT examination can help reduce various postoperative complications.

Anatomic Variation , Cone-Beam Computed Tomography , Mandible/abnormalities , Maxillofacial Abnormalities/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Cadaver , Child , Feasibility Studies , Female , Humans , Male , Mandible/diagnostic imaging , Maxillofacial Abnormalities/diagnosis , Middle Aged , Prevalence , Young Adult