Ectopic Molar Removal from the Ramus/Condyle Unit: A Minimally Invasive Approach.

Ectopic molars within the mandibular ramus/condyle unit, although rare, present a unique challenge to the surgeon. Multiple approaches have been described in the literature for their removal. A review of the English literature on the subject of mandibular ectopic molars and their epidemiology, etiology, indications for removal, and surgical techniques was completed. In addition, a case report is presented of an ectopic mandibular molar in the mid-ramus region which was removed via a minimally invasive, intraoral, technique combining the use of endoscopy and piezoelectric surgery. The authors advocate this technique as it offers the following advantages: avoidance of injury to branches of the facial nerve, unaesthetic scars, and sialocele formation; maximization of surgical field visualization with limited dissection; ability for safe sectioning of the tooth with minimal risks to adjacent structures; and precise bone removal, reducing the risk of iatrogenic or postoperative mandible fracture.

Mandibular blastomycosis: A case report and review of the literature.

INTRODUCTION: Blastomycosis is an endemic mycosis in the United States known to primarily cause pneumonia. However, dissemination to different organs including the musculoskeletal system has been described. CASE REPORT: We report a case of mandibular blastomycosis in a healthy patient with no evidence of lung involvement. A 28 year-old female presented with recurrent right mandibular osteomyelitis despite courses of antibiotics and surgical debridement. She eventually underwent right hemimandibulectomy. Budding yeasts visualized on Gomori Methenamine-Silver (GMS) and Periodic acid-Schiff (PAS) were morphologically consistent with Blastomyces dermatitidis, and intra-operative cultures showed growth of mold identified as B. dermatitidis by DNA probe. She was placed on a prolonged course of itraconazole with clinical improvement. We also reviewed the literature and found 5 cases of similar presentation which we briefly summarized in this present case report. CONCLUSION: Blastomycosis should be considered in patients with recurrent or persistent mandibular osteomyelitis even in immunocompetent individuals.

Update on the management of dentoalveolar trauma.

PURPOSE OF REVIEW: Dentoalveolar injuries are the most common type of facial injury and are often associated with concomitant facial fractures. These injuries may initially be seen by surgeons who do not have formal dental training. This article reviews the assessment and management of dentoalveolar fractures. RECENT FINDINGS: Semi-flexible splinting of traumatized teeth for shorter periods of time than previously suggested is associated with better long-term outcomes. The use of dental implants to replace teeth lost to trauma is a predictable restorative option. SUMMARY: Surgeons need to be aware that dentoalveolar injuries may be a marker for other injuries. Prompt relocation and splinting of displaced teeth is associated with better outcomes.

Analysis of results in early versus late midface fracture repair.

OBJECTIVE: To evaluate the complication rate in relation to the timing of surgical repair of midface fractures. STUDY DESIGN AND SUBJECTS: Retrospective chart review at a level 1 trauma center. RESULTS: Thirty-four patients were evaluated. Overall complication rate was 23.5% with no significant difference between the early repair (21.1%) and late repair (26.7%) groups. The scope of facial fracture repair was similar between the two groups as measured by the number of screws used and through an injury quantifying system. The only variable that tended toward significance was intraoperative blood loss, which was greater in the early repair group (P = 0.06). CONCLUSIONS: There is no clear consensus with respect to timing of midface trauma repair. Early repair may result in greater blood loss. Further study is needed to help establish a more precise recommendation for the timing of midface trauma repair.

Strategies for avoiding complications with vascularized bone flaps in head and neck microvascular reconstruction.

Effective osseous reconstruction of the head and neck after congenital, traumatic, and particularly ablative oncologic procedures is a relatively recent innovation. Whereas pioneers led with individual donor sites, it is only in the past 20 years that most centers have developed teams comfortable with use of the four common donor sites for free flaps: iliac crest, fibula, radius, and scapula. Calvarium, though much less frequently used, is a useful donor site for specific reconstructive challenges. Less commonly used sites such as femur, humerus, and rib have not proved universally reliable. This article aims to illustrate some refinements and pitfalls in vascularized osseous reconstruction of the head and neck using the well-recognized flaps, including calvarium, in a variety of pathologic conditions, recipient-site defects, and comorbidities. Strategies for error avoidance will be emphasized. The authors hope that this will support the concept of a reconstructive "toolbox" for this complex area.