Cystic lesions of the jaws: a retrospective clinicopathologic study of 2030 cases.

OBJECTIVE: The aim of this study was to perform an epidemiologic analysis of cases of jaw cysts treated from 1973 to 2012 at the Dentistry and Maxillofacial Surgery Unit of the Verona Hospital, Italy, and to compare the data obtained with those published in the literature. STUDY DESIGN: A retrospective survey of 2030 patients treated for jaw cysts from 1973 to 2012 was performed. The lesions were classified according to the 2005 World Health Organization histologic classification, and the following variables were analyzed: age, gender, histopathologic diagnosis, and site of onset. RESULTS: Of 2030 total lesions, there were 1970 odontogenic cysts (97.04%), 50 nonodontogenic cysts (2.46%), and 10 pseudocysts (0.49%). Of the patients, 314 were children (15.47%), and 1716 were adults (84.53%). Mean age was 37.24 years, with a male/female ratio of 1.71:1. CONCLUSIONS: There is a wide variety of cysts, some of which are subject to variations according to gender, localization, and age.

Bilateral pneumothorax after orthognatic surgery.

Among complications in orthognathic surgery, the insurgence of pneumothorax is very rare. Pneumothorax is the presence of air or gas in the pleural cavity and it is rare complications in the postoperative oral and maxillofacial surgery patient. The clinical results are dependent on the degree of collapse of the lung on the affected side. Pneumothorax can impair oxygenation and/or ventilation. If the pneumothorax is significant, it can cause a shift of the mediastinum and compromise haemodynamic stability. While 10% of pneumothoraces are asymptomatic, patients often complain of acute chest pain and difficulty breathing. There is a reduction in vital capacity, tachycardia, tachypnoea and a decrease in partial pressure of oxygen with an inability to maintain oxygen saturations. We observed this unusual surgical consequence in a 28-year-old female with negative clinical history and instrumental evaluation after Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). No further consequences, no neurological sequelae, no infections and no other osteotomies sequelae were seen. Sudden post-surgical dispnea associated to sub-cutaneous emphysema of the neck and of the thorax must be adequately observed with the aim of monitoring further severe sequelae. The anaesthetic management of the emergency difficult airway in any post-surgical orthognatic treatment can be extremely difficult requiring a multi-disciplinary approach.

One-stage surgical approach to rehabilitate severely injured anterior teeth in a young woman.

Trauma of the maxillofacial district may cause severe injuries to patients, such as tooth loss or tooth fractures, which can irreversibly compromise aesthetics and function.The aim of this clinical report was to illustrate the possibility of achieving positive aesthetic and functional outcomes in a young patient through a 1-stage surgical approach. In a single stage, the patient underwent extraction of a compromised tooth, insertion of 5 implants, bone and connective grafts, and management of a fresh scar. A satisfied and appeased result from the patient's and clinician's points of view was obtained by means of some clinical tricks, avoiding the patient's stress because of a multiple-stage surgery.

Complications of orthognathic surgery: the inferior alveolar nerve.

This study analyzes permanent paresthetic disorders regarding the inferior alveolar nerve (IAN) after mandibular ramus sagittal osteotomy procedures. Fifty patients (ie, 100 nerves) who underwent mandibular bilateral sagittal split osteotomy between 2003 and 2007 were evaluated to detect sensorial disorders of the IAN. The evaluation was performed for each patient at least 1 year after surgical intervention. The sagittal osteotomy of the mandible ramus was performed according to Epker-Hunsuk technique. The method of fixing through titanium plates and monocortical screws and the displacement width of the osteotomized stumps were also considered. The evaluation of the IAN functionality was performed both subjectively, by means of a questionnaire, and clinically, by using 4 types of tests: light-touch sensation, pinprick sensation, Weber test, and Dellon test.The clinical test analysis revealed that no nervous lesion was detected in 52% of the tested sites, whereas 24% reported significant nervous lesions. In the subjective evaluations, 74% of the patients described the discomfort related to the neurologic alteration as "absent to mild" or "mild to moderate," 10% as "moderate to serious," and 4% as "serious."We observe that the percentage of significant nervous lesions is relatively low and that it matches the mean described in literature. The central nervous system capacity to hide or compensate for functional deficits due to peripheral nervous lesions was confirmed by the comparison between the results of the clinical tests and the patients' subjective evaluations.

A case of rapidly progressive peri-implantitis around a short sintered porous-surfaced implant.

The aim of this case report is to show a rapidly progressive form of peri-implantitis around a 7 mm-long sintered porous-surfaced (SPS) implant. It was actually characterized by extremely rapid progression of bone loss, which led to the failure of one implant in about 60 days. Although surgical treatments were attempted to arrest bone resorption, peri-implantitis did not resolve. Short implants are a very useful solution for the management of highly-resorbed posterior areas. That is why patients who rehabilitated with these kinds of implants should adhere to a well-established oral hygiene protocol to prevent bone resorption, which could compromise long-term survival of short implants.