Unusual giant plunging sublingual epidermoid cyst: A case report and review of literature.

Key Clinical Message: When treating a painless or asymptomatic mass in the submental or floor of the mouth, sublingual epidermoid cyst should be considered. Despite its irregularity, preventing malignant transformation is essential for a successful outcome. Abstract: Dermoid and epidermoid cysts are rarely found in the head and neck region. They account for less than 0.01% of all oral cavity cysts. This is a rare case of a sublingual epidermoid cyst of the oral cavity in a 25-year-old male. The patient presented with a painless sublingual swelling for a duration of 1 month. The clinical examination revealed a non-tender swelling in the sublingual region extending to the submental triangle. Magnetic resonance imaging confirmed a 6.2 × 7.7 × 3.2 cm cystic lesion in the sublingual space. Fine needle aspiration cytology confirmed dermoid cyst contents. Intra-oral surgical excision under general anesthesia was performed successfully. Histopathological analysis revealed that the cyst wall was lined by stratified squamous epithelium. The presence of a prominent granular layer and keratin flakes confirmed the diagnosis of an epidermoid cyst. Postoperative recovery was good, and no recurrence was observed during follow-up. This case emphasizes the infrequent and unusual presentation of a case of a giant plunging sublingual epidermoid cyst and promotes awareness and potential studies in the enhancement of patient care in this area.

Physical, oral, and swallowing functions of three patients with type a xeroderma pigmentosum: a report of three cases.

BACKGROUND: Xeroderma pigmentosum (XP) is an extremely rare and severe form of photosensitivity. It is classified into types A-G or V according to the gene responsible for the disease. The progression and severity of symptoms vary depending on the type. Although dysphagia caused by decreased swallowing function and dental malposition due to stenosis of the dentition in the facial and oral regions is common, it has not been reported in detail. We report three cases of type A XP, in which central and peripheral neurological symptoms appeared early on and progressed rapidly. We describe the oral function of these patients, focusing on the swallowing function and dentition malposition. CASE PRESENTATION: Two males (27 and 25 years old) and one female (28 years old) presented with diverse neurological symptoms. We focused on the relationship between the changes in swallowing and oral functions and conditions due to decline in physical function. Some effects were observed by addressing the decline in swallowing and oral functions. In particular, a dental approach to manage the narrowing of the dentition, which was observed in all three patients, improved the swallowing and oral functions and maintained the current status of these functions. CONCLUSIONS: In type A XP, early decline in oral and swallowing functions is caused by the early decline in physical function, and it is necessary to monitor the condition at an early stage.

The Surgical Odyssey: Romania's Contributions to Pituitary Gland Procedures.

The pituitary gland, a puzzling medical subject up until the 20th century, had its early pathologies first documented in the 19th century by Pierre Marie and Hutchinson, where the gland's meaningful study was hindered by its hard-to-reach location. This paper revisits the pioneering work of Romanian doctors such as Gheorghe Marinescu, Nicolae Paulescu, and Grigore T. Popa in surgical techniques targeting the pituitary gland. Marinescu's 1892 experiment, albeit unsuccessful, laid the groundwork for future research in this area. Before Paulescu, surgical attempts could be classified into three types: oral, cranial, and sphenopalatine fossa approaches-all of which were notably dangerous and often resulted in fatal bleeding. Paulescu was the first to successfully and safely perform a complete in vivo hypophysectomy, opting for an innovative subtemporal method. He also conducted extensive research over four years to identify the gland's essential functions. Later, a 1938 study by Popa and Harris demonstrated a temporal approach to the hypothalamo-hypophysial region in a rabbit. These groundbreaking contributions significantly influenced the trajectory of pituitary gland surgery.

Extraoral Versus Intraoral Approach for Removal of Styloid Process in Treatment of Eagle's Syndrome: A Report of Two Cases.

Eagle's syndrome, a condition associated with the elongation of the styloid process or calcification of the stylohyoid ligament, is clinically characterized by throat and neck pain radiating into the mastoid region. The diagnosis can be made through a thorough history, correct clinical and pathological correlation and radiographic examination. The elongated styloid process can be treated conservatively or surgically. Conservative treatment options include transpharyngeal injections of steroids and lignocaine, nonsteroidal anti-inflammatory drugs, diazepam, and the application of heat. The surgical management of Eagle's syndrome consists of two major approaches: the transoral and the transcervical approaches. In this paper, we present a comparative study of two cases of classic bilateral elongated styloid process syndrome, treated with transcervical styloidectomy and transoral styloidectomy, their surgical time, intraoperative difficulties and complications, and recovery time. In conclusion, the management of Eagle's syndrome requires a comprehensive approach that includes a thorough preoperative evaluation of the length of the styloid process via imaging and digital palpation. The choice of surgical approach, whether extraoral or transpharyngeal, should be based on factors such as the surgeon's experience and the patient's comorbidities, as well as the length and palpability of the styloid process. Our comparative study of two cases treated with transcervical and transoral styloidectomy demonstrated that the extraoral method offers a direct and well-controlled approach for excessive styloid processes, while the transpharyngeal approach is preferred for cases where the process can be easily identified by palpation. Therefore, proper patient selection and preoperative planning are essential to achieving successful outcomes with minimal complications.

Hyaluronic acid filler injection for deep nasolabial folds: A novel intraoral approach.

Hyaluronic acid filler injection is a minimally invasive procedure for facial rejuvenation that involves injecting filling materials to correct the volume or augment specific areas in the face. Deep nasolabial folds are a common concern in aging people. The simplest way to correct a deep nasolabial fold to rejuvenate the face is to inject Ristow's space with hyaluronic acid fillers. However, conventional injection methods, such as percutaneous injections using a needle, can cause severe complications, such as skin necrosis or blindness due to intravascular injections. Therefore, the aim of the present study was to introduce a safe technique for intraoral filler injections in deep nasolabial folds and review related anatomic features to evaluate the safety of this technique.

Rare and unusual benign tumors of the sinonasal tract and pharynx: Case series and literature review.

There are a number of benign tumors of the nose and pharynx that are seldomly reported in literature but that can sometimes prove difficult to treat and extremely important for differential diagnosis. The present study presents cases of rare benign tumors localized in the pharynx, nasal and sinus cavities, as well as reviews of literature and historical references for each type of tumor. Unilateral nasal hemangioma in a 72-year-old male which, although not a rare pathology, raised problems due to auto-resection of the tumor. The surgeon was able to pull it out with ease without bleeding; it is possible that the mass would have eventually fallen out. Pilomatrixoma is a relatively uncommon ectodermal benign tumor of the skin derived from hair matrix cells. Surgical resection is curative but recurrence is possible (≤5% risk). The presented case is of a 26-year-old female with a pilomatrixoma of the left cheek who, for aesthetic reasons, refused a classical external surgical approach. Trans-oral resection was performed, which proved feasible but laborious and prone to recurrence. Inverted Schneiderian papilloma is a rare benign tumor of the nasal and sinus cavities with increased potential for invasion, recurrence and malignant transformation compared with other types of papilloma and other benign tumors of the area. The tumor represents 0.5-4.0% of all nasal tumors and has been described under different names, such as villiform cancer and cylindrical/transitional papilloma. The present study reports a rare case of bilateral papilloma in a 68-year-old male. He presented with bilateral evolving nasal obstruction and hyposmia. Following surgery, the patient was treated by a multidisciplinary team and followed by a respiratory rehabilitation program.

Giant Cell Tumour of Hard Palate and its Surgical Management: Case Report.

The giant cell tumour is a benign but locally aggressive tumour accounting for 5% of all bone tumours typically seen at the metaphyseo-epiphyseal ends of long bones with 1% incidence in skull bones. We are presenting a case report of 40 year old female with GCT of hard palate. An initial pre-operative plan was hard palate removal with complete tumour clearance trans-orally with iatrogenic oro-nasal fistula with rehabilitation to be done with obturator for closure of fistula and dentures to aid chewing. However, intra-operatively the surgical plan was revised and the tumour was removed with preservation of party wall mucosa. Thus, we present this case due to its clinical rarity and academic interest.

Management of Sub-Condylar and Angle of Mandible Fracture by a Trans-Buccal Trocar Along With an Intra-Oral Approach.

To evaluate the management of sub-condylar and angle of mandible fracture by a trans-buccal trocar along with an intra-oral approach. Study parameters included were assessment of adequacy of anatomical repositioning, fixation and stability of fracture site by radiographs, pre and post - operative occlusion by photographs. Evaluation of anatomical repositioning was done with fracture gap measurement on orthopantomogram after 6 months by applying paired student's T test. In mandibular angle fracture, pre- operatively, the mean of anatomical repositioning fracture gap measurement on orthopantomogram was 4.06 mm with a standard deviation of 1.42 mm and 6 months post-operatively, the mean was 0.5 mm with a standard deviation of 0.32 mm. The P value was < 0.00001, which shows a very high significant. In sub-condylar fractures, pre- operatively, the mean of anatomical repositioning fracture gap measurement on orthopantomogram was 6.77 mm with a standard deviation of 3.54 mm and 6 months post-operatively, the mean was 1.57 mm with a standard deviation of 2.37 mm. As the sample size was small, P value could not be calculated. The use of the trans-buccal trocar provides adequate anatomical repositioning, fixation, stability, occlusion and good accessibility during placement of plate and screws.

Intra-oral reduction of zygomatic fractures.

Zygomatico-maxillary complex fractures present a challenging diagnostic and reconstructive task to the surgeon. Gillie's temporal approach has been a commonly used technique for zygomatic arch reduction, but surgeons have been commonly using a buccal sulcus approach for the reduction of zygomatic arch fractures as well as for combined zygomatico-maxillary complex fractures. This article outlines the use of Rowe's elevator (modification of Bristow's elevator) intra-orally to reduce zygomatic arch fractures and, if required, simultaneously plate the zygoma through the same approach. A retrospective analysis of 379 patients treated with this technique in the last 10 years has been presented along with a comprehensive treatment protocol including a description of its advantages over the Gillie's approach. Based on the inclusion criteria, the study group consisted of 327 patients. In 281 patients, the zygomatic complex was fractured, whereas 46 patients presented with a solitary zygomatic arch fracture. Two hundred and three cases were successfully treated with the buccal sulcus approach, whereas 124 cases required both the buccal sulcus and the extra-oral lateral orbital approaches. The described approach has advantages over Gillie's temporal approach by being simple, faster and cost-effective, can be performed under local anesthesia, and is more esthetic as it does not leave any scars.

Mucoepidermoid carcinoma of the base of tongue.

Mucoepidermoid carcinoma (MEC) is the most common malignant, locally-invasive tumour of the salivary glands, and accounts for approximately 35% of all malignancies of the major and minor salivary gland. Minor salivary glands are scattered in different areas of the oral cavity such as palate, retromolar area, floor of the mouth, buccal mucosa, lips and tongue. MECs of tongue base are not common. We present a rare case of MEC localised at the tongue base in a 42-year-old Caucasian woman and discuss the histopathological types, management and review the literature. Adequate intra-oral excision was the treatment of choice in this case and in low-grade MEC. Prognosis of MEC is a function of the histological grade, adequacy of excision and clinical staging.

Thyroidectomy using pure natural orifice transluminal endoscopic surgery in a porcine model.

Surgical procedures for thyroid disease that provide cosmetically acceptable results are in demand. Natural orifice transluminal endoscopic surgery (NOTES) is performed through natural orifices and thus avoids incision of the body wall. This study aimed to develop an incision-free surgical procedure for thyroid lobectomy using pure NOTES with an oral approach. In six pig carcasses, an incision was made between the mandible and subcutaneous tissue under direct vision. After subcutaneous dissection and identification of the hyoid bone, the operative field was developed under endoscopic view. After the thyrohyoid membrane was identified, dissection was continued along the thyroid cartilage until the cricoid cartilage was identified and the thyroid isthmus was reached. An original retractor was inserted between dissected tissues to lift and fix the carcass. The thyroid gland was successfully removed through the incision. Similar macroscopic and histological findings were observed on the normal and treated sides, with no damage to the recurrent laryngeal nerves. The times required for securing the operative field and thyroidectomy improved with each operation. This study suggests the feasibility and safety of using pure NOTES for thyroidectomy through a subcutaneous route with an original retractor.

Extra-oral approach for removal of ectopic impacted lower third molar: a case report.

Extra oral approach for removal of the lower third molar is uncommon. This case report illustrates an example of removal of lower third molar by extra-oral approach preserving the inferior dental nerve.

Management of Subcondylar Fracture through Intraoral Approach with Rigid Internal Fixation.

BACKGROUND: In Oral and Maxillofacial Surgery, the majority of the condylar fractures are treated by closed reduction with generally satisfactory long term results. But in such cases of closed reduction, patient will be uncomfortable owing to long term application of inter maxillary fixation (IMF). Where as, Disadvantages of extra oral open reduction and fixation of condylar fracture includes facial nerve damage, facial scars etc. which are surely eliminated by the intraoral reduction and rigid fixation. AIMS AND OBJECTIVES: The present study was conducted to determine the efficacy of reduction and fixation of low sub-condylar fractures through intra-oral approach. METHODOLOGY: In this study, ten patients with low sub-condylar fracture, reported to department of Oral and Maxillofacial Surgery. P.M.N.M. Dental College and Hospital Bagalkot were included. These patients were treated by open reduction and internal fixation through intra-oral approach. All the patients were evaluated postoperatively for mouth opening, occlusion and mandibular deviation with regular radiographic examination for 6 weeks. RESULTS: All operated patients followed for 6 weeks, maximum mouth opening was more than 40 mm in seven patients (range from 40 to 50 mm) and less than 40 mm in three patients. Occlusion was satisfactory in all and none of the patients showed deviation of mandible on mouth opening. Statistical analysis showed that postoperative mouth opening was significant ('t' value = 7.88, 'P' = (0.000) < 0.05) and the test result was significant (S) at 5% level of significance. Statistical analysis of deviation of mouth opening was nonsignificant ['t' value = 1.96, 'P' value (0.081), 0.05]. For occlusion standard photographs were obtained at sixth week and found minor occlusal corrections in two patients are treated by elastic traction for few days. DISCUSSION AND CONCLUSION: Open reduction with internal fixation through intraoral approach has proved to be safe for early function and also effective by avoiding the patient discomfort due to long term intermaxillary fixation, psychological effect, facial nerve damage, facial scar and weight loss.

The prospective preliminary clinical study of open reduction and internal fixation of mandibular angle fractures using 2 miniplates

INTRODUCTION: The placement of a single miniplate is not sufficient to achieve rigid fixation in mandibular angle fractures. It often causes difficulties in reducing the intermaxillary fixation (IMF) period. Consequently, the placement of 2 miniplates is preferable. The intraoral approach in an open reduction and internal fixation (ORIF) of a mandibular angle fracture with 2 miniplates is often challenging. Accordingly, an alternative of transbuccal approach is performed. However, this method leaves a scar on the face and can result in facial nerve injury. This clinical study suggests a protocol that can maintain rigid fixation without a transbuccal approach in mandibular angle fractures. MATERIALS AND METHODS: The subjects were 7 patients who sustained fractures of the mandibular angle and treated at Department of Oral and maxillofacial surgery, Sacred Heart Hospital, Hallym University. ORIF under general anesthesia was done using the intraoral approach. One miniplate was inserted on external oblique ridge of the mandible, and the other was placed on lateral surface of the mandibular body with contra-angle drill and driver. A radiographic assessment and occlusal contact point examination was carried out before surgery, and 2, 4 and 6 weeks after surgery. RESULTS: The mean operation time was 80 minutes. Regarding the occlusion state, the number of contact points increased after surgery. Paresthesia and infection were reported to be complications before surgery. CONCLUSION: The placement of 2 miniplates using contra-angle drill for ORIF of mandibular angle fractures allows early movement of the mandible without IMF. We propose this approach to reduce the patients' discomfort and simplify the surgical procedure.

A Case of Bleeding from Proximal Jejunal GIST Diagnosed by Colonoscopy through the Oral Approach / 대한소화기내시경학회지

Gastrointestinal bleeding from small bowel lesions is uncommon but it is the most common cause of obscure gastrointestinal bleeding that can go undiagnosed using traditional upper endoscopy and colonoscopy. Recently, various new methods, including wireless capsule endoscopy and double-balloon enteroscopy have been used to detect and manage small bowel lesions. A 51-year-old man was admitted with hematochezia. The source of bleeding could not be identified using conventional upper endoscopy and colonoscopy. Wireless capsule endoscopy revealed a mass-like lesion with active blood spurting in the proximal jejunum. Finally, a tumor with central ulceration was detected at the proximal jejunum using a clean colonoscope through the oral approach. This lesion was surgically resected, and the histology findings were consistent with a gastrointestinal stromal tumor. We report a case of gastrointestinal bleeding from a proximal jejunal GIST diagnosed by clean colonoscopy through the oral approach with a review of the relevant literature.

Open reduction and internal fixation for fractured condylar neck and mandible ramus via intraoral approach / 中华创伤杂志

Objective To discuss the way of open reduction and internal fixation for fractured condylar neck and mandible ramus via intraoral approach aiming to avoid the facial incision. Methods Fifteen cases (17 sides) with mandibular condyle fractures underwent open reduction and osteosynthesis with plates and screws. After the mandibular ramus was under vertical osteotomy with an oscillating saw, the posterior border bone block of mandibular ramus as well as the free condyle neck were taken out. The fractured condyle neck and the posterior border bone block of mandibular ramus were fixated with a titanium miniplate in vitro. The reunion bone was implanted and reposited in the mouth incision. Of all, two cases suffered fracture of the condyle neck in the other hospital when they received esthetic surgery and resection of prominent mandible angle (PMA). Results Anatomic reduction was achieved in all cases, without damage to facial nerve and major auricular nerve or salivary fistula. There were slight bony resorption and good temporomandibular joint function one year after surgery, with range of mouth opening for 25-40 mm (mean 35.8 mm). Two cases regained their occlusion before their PMA operation. One case had premature contact of the buccal teeth,with 1 mm diverging to medline of the incisor teeth. Intraoral approach not only could avoid large facial scars and facial nerve injury, but also allow visualization of the occlusion during the procedure. Conclusions As more and more consideration is taken to cosmetology, the transoral approach is a reliable surgical alternative for fractures of the condyle neck, without leaving extensive visible scars or damaging facial nerve. The disadvantage is vertical osteotomy of the posterior border of the mandibular ramus.