Vascular Floor of Mouth Mass with Unanticipated Intracranial, Orbital, and Vertebral Associated Involvements.

We report on a case in which a blanching, unobtrusive oral growth proved to be a systemic threat. A blind, epileptic child presented with a bleeding oral floor mass of 4 weeks. Biopsy showed small, dilated vascular spaces with reactive fibroblasts. MRI indicated distribution of expansile lesions in the mandible, cranial base, and right orbit that had possibly contributed to the patient's years-long neurologic deficits. A subsequent bone scan indicated lesions in multiple axial bones. Histologic markers confirmed the presentation of a rare cystic vascular pathology. Cystic Angiomatosis is a disease of intraosseous vascular malformations with occasional visceral involvements. Oral and craniomaxillofacial cases are especially rare and presentations can involve neuropsychiatric deficits, sensory issues, and mucosal bleeding. While clinicians are often dismissive of intraoral bleeding because of the prevalence of periodontal disease, careful evaluation is nonetheless critical to rule out underlying diseases with a possibly significant systemic involvement.

Anesthetic Management of a Cardiac Transplant Patient After Extensive Facial Trauma Caused by a Pit Bull Attack.

A 72-year-old male cardiac transplant patient presented after sustaining facial and extremity trauma caused by a pit bull dog attack. The case was further complicated by the duration of the surgery, bleeding, infection risk, intraoperative hypothermia, immunosuppression, and the risk of sepsis. His anesthetic management required careful coordination with his transplant team. We also sought the expertise of the in-house pharmacist to obtain the appropriate administration strategies for the patient's immunosuppressant agents. As the number of transplant patients increases, oral and maxillofacial surgeons must remain cognizant of the challenges and strategies associated with treating those undergoing graft-preserving immunosuppression. We have presented a more complex case of a cardiac transplant patient requiring extensive facial soft tissue reconstruction. The experience achieved in the management of a complex cardiac patient will no doubt provide guidance in the management of elective surgical procedures in other patients with simpler transplant histories.

Stryker SMARTLock Hybrid Maxillomandibular Fixation System: Clinical Application, Complications, and Radiographic Findings.

BACKGROUND: The SMARTLock Hybrid MMF System from Stryker is a newer approach for maxillomandibular fixation. This study was performed to determine the clinical application, complications, radiographic findings, and cost effectiveness of the SMARTLock system. METHODS: A retrospective cohort study was performed with the SMARTLock system over 6 months. Demographics, history, fracture location, placement/removal time, and complications were obtained, along with cost analysis. RESULTS: The authors identified 35 patients with the SMARTLock system. Twenty-four patients remained after exclusion criteria. There were 19 male patients (79 percent) and five female patients (21 percent), with a mean age of 30.7 years. The mean application time of the SMARTLock system was 14.4 minutes, and the mean removal time was 10.5 minutes. Three hundred nineteen total screws were placed. The number and percentage of patients with complications associated with the SMARTLock system were as follows: mucosal overgrowth [n = 9 (38 percent)], screw loosening [n = 4 (17 percent)], lip irritation [n = 4 (17 percent)], malocclusion [n = 3 (13 percent)], nonunion [n = 1 (4 percent)], wound dehiscence [n = 1 (4 percent)], screw loss [n = 1 (4 percent)], tooth devitalization [n = 1 (4 percent)], loose plate [n = 1 (4 percent)], and plate fracture [n = 1 (4 percent)]. There were no instances of sharps exposure, tooth loss, or infection. One tooth required endodontic therapy. The number of screws that damaged teeth on cone-beam computed tomographic imaging was 24 (7.5 percent). The cost analysis showed similar cost between Erich arch bars and the SMARTLock system. CONCLUSIONS: This study suggests that the SMARTLock Hybrid MMF System is safe and easy to use, and with a cost similar to that of Erich arch bars. Appropriate treatment planning and previous surgical experience should be used to determine appropriate case selection, as this system is not ideal in all situations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Osteoplasty flap technique for repair of latent (30-year) post-traumatic frontal sinus mucocele: case report and review of the literature.

Mucoceles are benign, slow-growing lesions defined as mucus-filled pseudocystic formations. Paranasal mucoceles predominantly affect the frontal sinus (60% to 65%), followed in frequency by the ethmoidal (20% to 30%), maxillary (10%), and sphenoid (2% to 3%) sinuses. Mucoceles usually arise because of sinus ostium obstruction, preceded by infection, fibrosis, inflammation, trauma, surgery or tumors such as osteomas. Mucoceles arising from the frontal sinus present with a variety of clinical signs, including decreased visual acuity, visual field abnormalities, proptosis, ptosis, periorbital swelling, displacement of the globe, restricted ocular movements, and choroidal folds. We describe a case of orbital involvement from a mucocele of the frontal sinus 30 years after the initial trauma, with a review of the published data concerning the etiology, diagnosis, and treatment planning.