Life-threatening bleeding after tooth extraction due to vascular malformation: a case report and literature review.

Severe hemorrhages of the oral cavity may be caused by arteriovenous malformations. This case report concerns a 52-year-old healthy female who presented with a painful lower third molar and an extensive arteriovenous high-flow malformation of the floor of the right side of the mouth. During the extraction of the right lower wisdom tooth, an episode of massive life-threatening bleeding occurred. Since the therapy for intraoral arteriovenous malformations of the soft tissue is complex and often difficult to perform, the modus operandi of the present case is presented, and a review of the literature is included.

Osteonecrosis of the mandible due to anti-angiogenic agent, bevacizumab.

BACKGROUND: Osteonecrosis of the jaw (ONJ) is defined by areas of tissue breakdown and exposure of bone in the maxillofacial region that fail to heal within 8 weeks after identification by a health provider in a patient who has not received radiation of the jaws. The disease affects the quality of life and produces significant morbidity in afflicted patients. ONJ is correlated with such risk factors as treatment with bisphosphonates, dental extraction-related trauma, chemotherapy, corticosteroids, renal osteodystrophy and infections. Although the use of bisphosphonates is associated with osteonecrosis of the jaw, the pathophysiology of bisphosphonate-associated ONJ is still unknown. It has been assumed that bisphosphonates lead to the inhibition of capillary angiogenesis and disturbances in the activities of both osteoblasts and osteoclasts, thereby impairing bone remodelling. Currently, inhibitors of angiogenesis used in the treatment of cancer patients are implicated in isolated cases of ONJ. CASE REPORT: This manuscript reports a case of ONJ in a female patient who received bevacizumab (Avastin®, Roche), a humanised monoclonal antibody that recognises and blocks vascular endothelial growth factor (VEGF)-A. CONCLUSION: The anti-angiogenic agent, bevacizumab, may increase the risk of osteonecrosis of the jaw. This agent inhibits VEGF and, therefore, also presumably represses the vascularisation of the jaw, which leads to healing complications. Due to increasing use of bevacizumab, patients receiving this agent should be closely monitored for possible side effects.

Periorbital non-Hodgkin's lymphoma after blunt trauma.

The head and neck region is the second most common site for the development of extranodal lymphomas. Richter's syndrome (RS) involves the transformation of B-cell chronic lymphocytic leukemia (B-CLL) to an aggressive lymphoma, most commonly, diffuse large B-cell lymphoma (DLBCL). We report the case of a 62-year-old man who developed DLBCL in the periorbital region 2 months after blunt trauma to the site. The patient lacked other physical symptoms at the time of presentation. Bone marrow biopsy and immunophenotypic analysis revealed a Richter transformation of unknown B-CLL. RS frequently arises in lymph nodes or bone marrow and rarely presents with extranodal involvement. Chemotherapy resulted in total remission of the lymphoma and no relapse was observed in the 6-month follow-up period. This case demonstrates that the clinician must recognize that unresolved soft tissue swelling after a trauma may be caused by NHL.

Orthognathic surgery in a case of infantile facioscapulohumeral muscular dystrophy with macroglossia.

INTRODUCTION: Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant disorder with a shortened fragment of a D4Z4 repeat on chromosome 4q35. The infantile form of FSHD is relatively rare. CASE REPORT: Within this case report, we describe the orthognatic surgery in a patient with infantile FSHD to diminish the functional and esthetic disturbances in the orofacial region. We saw a 20-year-old female patient suffering from infantile FSHD with remarkable macroglossia and frontal open bite. Diagnosis was based on molecular genetic investigations. To improve the functions of the stomatognathic system, we performed a tongue reduction and a segment osteotomy in the frontal aspect of the mandible. The patient was satisfied with the functional and esthetic results. Lip competence and occlusion were significantly improved. Thus, orthognatic surgery can enhance oral function, facial esthetics, and general quality of life.

Risk factors for a bad split during sagittal split osteotomy.

One of the operative complications during sagittal split osteotomy (SSO) in orthognatic surgery is a bad split, meaning an undesired fracture of the mandible during osteotomy. The aim of this study was to find out if there is a relation between the occurrence of bad splits during SSO and the presence of third molars, the patient's age, or the surgeon's experience. Clinical notes of 110 consecutive patients who had had a total of 220 SSOs using the Obwegeser/Dal Pont technique were evaluated and divided into three groups: 1 missing third molar (n=168); 2 retained or impacted third molar that was removed during the SSO (n=23); and 3 third molar left in place during SSO (n=29). There were a total of 12 (6%) bad splits. 9 (5%) in group 1, two (9%) in group 2, and one (3%) in group 3. There were no significant differences between groups 1-3, in particular the surgeon's qualification had no influence on the incidence. Older patients seemed more at risk of a bad split than younger ones.