Clinical Study of Reconstruction Plates Used in the Surgery for Mandibular Discontinuity Defect.

BACKGROUND/AIM: Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as plate fracture and/or plate exposure can occur. The purpose of this study was to analyze complications and survival of reconstructive plates used to correct mandibular defects caused by oral cancer. PATIENTS AND METHODS: Clinical and radiological data from 34 patients were analyzed. Only discontinuous mandibular defect cases were included in this study. All cases were classified using the Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and clinical treatment methods were significantly related to complications. RESULTS: Complications after mandibular reconstruction occurred in 10 of 34 patients, specifically, two plate fractures, one screw fracture, and seven plate exposures occurred. The plate fractures occurred 5 and 6 months after operation, and the screw fracture occurred 39 months after operation. Using the Hashikawa's CAT classification, the two cases of plate fracture were one of AT type and the other of T type, and the screw fracture was AT type. Using Eichner's classification, all three cases of plate and screw fractures were B2 type. CONCLUSION: We suggest that plate and screw fractures were caused by the type of mandibular defect and bite force.

Mandibular metastasis as the first clinical indication of occult lung adenocarcinoma with multiple metastases: A case report.

RATIONALE: Although metastases to the oral and maxillofacial region (OMR) are rare, the lung is the most common primary site metastasizing to the OMR. PATIENT CONCERNS: An 83-year-old woman presented with reports of trismus, occlusal discomfort, swelling, and spontaneous pain in the right buccal region. Despite the absence of abnormal chest imaging findings, immunohistochemical analysis of biopsy specimens of the mandible and the thyroid indicated that the patient had multiple metastases from a lung poorly differentiated adenocarcinoma. DIAGNOSES: Metastases to the OMR and the thyroid from an undiscovered lung adenocarcinoma. INTERVENTIONS: Gefitinib was started as first-line chemotherapy, and zoledronic acid was administered for bone metastases. OUTCOMES: Follow-up imaging examinations showed ossification and deformation of the right mandibular ramus and the condylar process. Although 2 years have passed since the first visit to our hospital, lung lesions have not been confirmed by imaging examinations. LESSONS: Clinicians should consider the possibility that symptoms in the OMR may be the first clinical sign of an undiscovered distant primary tumor, and the primary tumors may not be detected by imaging examinations even when metastases to the OMR are revealed.

Axial four-dimensional computed tomographic images to analyze crosswise differences in protrusive condylar movement in patients who underwent mandibulectomy and free flap reconstruction.

OBJECTIVE: Few studies evaluate condylar movement following mandibular reconstruction. The main objective of this study was to show that axial four-dimensional computed tomography (4DCT) could visualize bilateral protrusive condylar movement directly. We used axial 4DCT images to assess condylar protrusion in patients who underwent mandibular reconstruction. METHODS: We enrolled seven healthy volunteers (median age 30 years, range 27-38 years) and seven patients (median age 65 years, range 52-80 years), who underwent mandibulectomy (segmental in five, hemi in one, marginal in one) and free flap reconstruction (using the fibula in six and the radial forearm in one). Six study subjects were instructed to masticate a cookie during the 4DCT scan (the seventh made chewing motions). The distance between the most anterior and posterior positions of the bilateral condyles on 4DCT (axial view) images was then measured and compared between controls and patients using the Mann-Whitney U-test. RESULTS: The crosswise difference in the distances of condylar protrusion was significantly greater in patients than in the controls. CONCLUSION: Axial 4DCT images can visualize a bilateral condylar protrusive path. Axial 4DCT images for patients who have undergone mandibulectomy and reconstruction may be useful for evaluation of functional movement of condyles.

Diagnóstico de mieloma múltiple a raíz de una lesión osteolítica mandibular / Diagnosis of multiple myeloma following an osteolytic mandibular lesion

Objetivo. El mieloma múltiple es una neoplasia de células plasmáticas con repercusión sistémica y lesiones osteolíticas. Su diagnóstico a raíz de una lesión mandibular es bastante infrecuente. Por ello presentamos un caso de mieloma múltiple diagnosticado a partir de sintomatología dolorosa e inflamatoria por una lesión osteolítica en la rama mandibular y revisamos la literatura para establecer el perfil clínico e imagen radiológica típica que nos faciliten sospechar el diagnóstico con más certeza. Material y métodos. Mujer de 46 años acude al servicio de Urgencias por inflamación y dolor preauricular. La ortopantomografía muestra una imagen radiolúcida multilobulada a lo largo de la rama y cóndilo mandibulares. El estudio anatomopatológico y de extensión desenmascaran un mieloma múltiple. Se hace además una revisión de la base de datos Pubmed para casos de diagnóstico de mieloma múltiple a partir de una lesión mandibular en los últimos 5 años. Resultados. Se encontraron 13 casos incluyendo el presente. La edad media era de 61 años con ligero predominio del sexo masculino; la clínica más frecuenta era inflamación indurada de la región mandibular afectada con o sin ulceración mucosa, y la imagen radiológica característica osteólisis uni o multilocular, en un caso con reacción perióstica. Conclusiones. La presentación inicial del mieloma múltiple mediante una lesión mandibular es poco frecuente. Sin embargo, el cirujano maxilofacial debe sospechar una neoplasia de células plasmáticas ante imágenes radiolúcidas mandibulares y no demorar un estudio más exhaustivo (AU)

Purpose. Multiple myeloma is a neoplasic proliferation of plasma cells with systemic repercussion and osteolytic lesions. The initial diagnosis by a mandibular lesion is extremely rare. Therefore we present a clinical case of multiple myeloma diagnosed following pain and swelling from an ostelytic mandibular lesion, and we review the literature in order establish a clinical profile and a typical radiological image that would allow us to suspect the diagnosis with more certainty. Material and methods. A 46 year-old woman comes to the Emergency Department complaining about preauricular pain and swelling. The orthopantomography shows a radiolucid multilolocular image along the mandibulary ramus and condyle. The histology and extension follow up concludes with a multiple myeloma diagnosis. A systematic review of Pubmed database was made searching for mandibular lesion at initial diagnosis of multiple myeloma within the last 5 years. Results. We found 13 cases including ours The mean age was 61 years with a slight male predominance; the most common clinical presentation was a firm to hard mandibular swelling with or without mucosal ulceration; and the most characteristic radiological image was a uni or multilocular osteolysis, with periostic reaction in one case. Conclusions. A mandibular lesion as a first sign of multiple myeloma is infrequent. Nevertheless, a maxilofacial surgeon should suspect a plasma cell neoplasia in cases of mandibular osteolytic images and start further studying without delay (AU)

[The cross-plastic correction of the soft tissue defect on the neck with the use of a pectoral flap harvested from the opposite side]. / Perekrestnaya plastika defekta myagkikh tkanei shei pektoral'nym loskutom s protivopolozhnoi storony.

The authors describe a patient presenting with initially multiple metachronous cancer spreading over the right-handed side of the mouth floor and the right-handed part of the lower jaw. The patient who underwent cross-plastic surgery for the correction of the extensive soft tissue defect on the neck with the use of the musculocutaneous pectoral flap with the axial blood supply is described. The observation during the 14 year follow-up period confirmed the good functional outcome of the treatment.

The Role of Sonic Hedgehog Signaling in Osteoclastogenesis and Jaw Bone Destruction.

Sonic hedgehog (SHH) and its signaling have been identified in several human cancers, and increased levels of its expression appear to correlate with disease progression and metastasis. However, the role of SHH in bone destruction associated with oral squamous cell carcinomas is still unclear. In this study we analyzed SHH expression and the role played by SHH signaling in gingival carcinoma-induced jawbone destruction. From an analysis of surgically resected lower gingival squamous cell carcinoma mandible samples, we found that SHH was highly expressed in tumor cells that had invaded the bone matrix. On the other hand, the hedgehog receptor Patched and the signaling molecule Gli-2 were highly expressed in the osteoclasts and the progenitor cells. SHH stimulated osteoclast formation and pit formation in the presence of the receptor activator for nuclear factor-κB ligand (RANKL) in CD11b+ mouse bone marrow cells. SHH upregulated phosphorylation of ERK1/2 and p38 MAPK, NFATc1, tartrate-resistant acid phosphatase (TRAP), and Cathepsin K expression in RAW264.7 cells. Our results suggest that tumor-derived SHH stimulated the osteoclast formation and bone resorption in the tumor jawbone microenvironment.

Recurrent giant mandibular ameloblastoma in young adults.

BACKGROUND: The purpose of the study was to define the most appropriate management of the giant mandibular ameloblastoma (GMA) in young adults. METHODS: A retrospective study was performed on patients with GMA <30 years old. The data collected included initial treatment, tumor margins, reconstruction, and follow-up. Patients evaluated speech, chewing, swallowing, and facial appearance after definitive treatment. RESULTS: Thirteen patients were identified with recurrent solid/multicystic disease requiring further treatment. Definitive treatment involved segmental mandibulectomy and reconstruction with free fibular flap in all patients. Seven patients had immediate reconstruction (group A) and 6 had secondary (group B). Mandibular resection was planned at least 2 cm beyond the radiological limit, free margins were achieved in all patients, and all flaps were transplanted successfully. In group A, functional score was 13.7 ± 0.45 and facial appearance score was 4.5 ± 0.49, whereas in group B were 11.16 ± 0.37 and 3.3 ± 0.5, respectively (both p < .05). CONCLUSION: Aggressive resection of the GMA and immediate reconstruction is strongly advised. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1947-E1954, 2016.

Failure location prediction by finite element analysis for an additive manufactured mandible implant.

In order to reconstruct a patient with a bone defect in the mandible, a porous scaffold attached to a plate, both in a titanium alloy, was designed and manufactured using additive manufacturing. Regrettably, the implant fractured in vivo several months after surgery. The aim of this study was to investigate the failure of the implant and show a way of predicting the mechanical properties of the implant before surgery. All computed tomography data of the patient were preprocessed to remove metallic artefacts with metal deletion technique before mandible geometry reconstruction. The three-dimensional geometry of the patient's mandible was also reconstructed, and the implant was fixed to the bone model with screws in Mimics medical imaging software. A finite element model was established from the assembly of the mandible and the implant to study stresses developed during mastication. The stress distribution in the load-bearing plate was computed, and the location of main stress concentration in the plate was determined. Comparison between the fracture region and the location of the stress concentration shows that finite element analysis could serve as a tool for optimizing the design of mandible implants.

Evaluation of Masticatory Efficiency and QoL Improvements After Prosthetic Rehabilitation of Mandibular Cancer Patients Reconstructed with a Fibula Free Flap.

PURPOSE: The purpose of this noninferiority study was to determine whether removable or implant-supported fixed dental prostheses restored patients' abilities to preoperative levels after cancer removal in the mandible. MATERIALS AND METHODS: Ten patients who had undergone mandibular resection to remove cancer and subsequent reconstruction with microvascularized free fibula flaps were examined in this study. Five patients were rehabilitated with removable prostheses and five received implant-supported fixed prostheses. Health-related quality of life was evaluated using the Head and Neck (H&N30) questionnaire. Kruskal-Wallis nonparametric analysis of variance and Tamhane's T2 test were used to analyze results in comparison with a control group composed of 10 subjects with Class I natural dentition. RESULTS: Masticatory efficiency among the three groups of patients differed significantly (P=.003); in particular, that of the patients who received removable prostheses was not inferior to that of the control subjects (P=.019). Analysis of responses to the Head and Neck module of the Quality of Life Questionnaire showed no significant difference between patients with fixed dentures and patients with removable dentures. CONCLUSIONS: There is no apparent difference in quality of life between patients using implant-supported fixed prostheses and those using removable prostheses. Regarding masticatory efficiency, when feasible, the use of implant-supported fixed prostheses is recommended in patients who have undergone free fibula flap surgery, although the removable prostheses also were not inferior in patients who underwent no surgery.

Fibro-odontoma ameloblástico de la mandíbula / Ameloblastic fibro-odontoma of the jaw

El fibro-odontoma ameloblástico (FOA) es un tumor odontogénico poco frecuente que afecta a personas jóvenes, sin predilección por género y usualmente se localiza en la zona posterior de la mandíbula. Clínicamente el paciente puede presentar retraso en la erupción dentaria acompañado de aumento de volumen indoloro. Radiográficamente es una lesión radiolúcida uni o multilocular de tamaño variable con áreas radiopacas. El tratamiento varía de acuerdo a su tamaño y se debe tener especial cuidado en la decisión de conservar o no los dientes adyacentes, ya que existe la posibilidad de recurrencia de la lesión. Presentamos un caso de FOA de gran tamaño en un paciente de 4 años. Se describen las características específicas, histológicas y clínicas. Se discute en la conducta terapéutica conservadora y la necesidad de control postoperatorio prolongado en el tiempo(AU)

Ameloblastic fibro-odontoma (AFO) is an infrequent odontogenic tumor that affects young people of either sex and is usually located in the posterior mandibular zone. Clinically, the patient might present a delay in dental eruption with a painless increase in volume. Radiographically, it is a uni- or multilocular radiolucent lesion of variable size with radiopaque areas. Treatment varies with tumor size and the decision to conserve the adjacent teeth must be weighed carefully due to the possibility of recurrence. The case of a large AFO in a 4-year-old patient is reported. The specific histological and clinical characteristics are described and the conservative therapy and need for long-term postoperative follow-up are discussed(AU)

Spontaneous regeneration of bone after resection of central giant cell lesion: a case report.

There are several treatment modalities to date for central giant cell granuloma including conservative treatment and surgical treatment with often planned reconstruction of the bony defect. Spontaneous bone regeneration of mandibular defects following complete resection of mandible has rarely been reported in the literature. We report a case of spontaneous bone formation after resection of a central giant cell granuloma in the anterior mandible of a pediatric patient and the importance of maintaining the periosteum during surgical resection as a rare case report.

Tumor hemorrágico en encía mandibular de paciente nefrópata / Bleeding tumour in the mandibular gum of a nephropathy patient

No disponible

Diverse growth patterns in an intraosseous ameloblastoma: a case report.

Desmoplastic ameloblastoma (DA) is a benign but locally invasive variant of the solid/multicystic ameloblastoma (SMA). In the recent World Health Organization classification of odontogenic tumours, DA has been characterised as a variant, with specific clinical, radiographic and histopathological features. A possible 'transitional' form of DA, showing microscopic features of the desmoplastic variant together with areas typical of classic follicular or plexiform ameloblastoma, has been described as a 'hybrid' lesion of ameloblastoma (HLA). A unique case with synchronous emergence of desmoplastic and unicystic ameloblastoma (different growth patterns) in the mandible of a 50-year-old male is reported.

An estimate of the rate of growth of a juvenile aggressive ossifying fibroma in a 15 year old child.

Juvenile ossifying fibroma (JOF) is an uncommon fibro-osseous lesion occurring in the facial bones. It has been recognised as a separate histopathological entity among the fibro-osseous group of lesions. Fibro-osseous lesions of the craniofacial bones are difficult to classify and treat however a common factor to all is the conversion of the bone to benign fibrous tissue with a varying degree of mineralised tissue. This case describes a 15 year old patient with a juvenile aggressive ossifying fibroma (JAOF) and an estimate of the rate of growth of such a rare lesion.

Comparison of food mixing ability among mandibulectomy patients.

Many papers have been published on surgical mandibulectomy and reconstruction. However, only a few reports refer to masticatory function after prosthodontic treatment in mandibulectomy patients. The aim of this study was to investigate the masticatory function of mandibulectomy patients. Twenty-three subjects (10 males and 13 females, with an average age of 63 years) participated in this study: 11 subjects who had undergone unilateral marginal mandibulectomy, six subjects with unilateral segmental mandibulectomy with reconstruction and six subjects with hemimandibulectomy without reconstruction. Mixing Ability Index (MAI) was used to measure masticatory function on the non-defect side and on the defect side with a prosthesis installed. Comparisons were carried out among the marginal, segmental and hemimandibular groups and between the non-defect side and the defect side. Consequently, our study indicates these results. On the non-defect side, a significant difference was found between the marginal and the segmental groups, and between the marginal and the hemimandibular groups. In the marginal and the segmental groups, a significant difference was found between the non-defect and the defect sides. In conclusion, our study suggests that MAI is an adequate tool to study the masticatory function in mandibulectomy patients, the masticatory function of the mandibulectomy patients is more impaired than that of the ordinary removable partial denture patients, and that surgical intervention affects the masticatory function on not only the defect side but also the non-defect side in mandibulectomy patients.

Carcinoma mucoepidermoide central de la mandíbula, en un paciente con displasia fibrosa quística mandibular / Central mucoepidermoid carcinoma of the mandible, in a patient with dysplasia fibrosis cystic to mandible

El carcinoma mucoepidermoide de glándula salival es un tumor frecuente; constituye el 15 por ciento de los tumores de dicha estructura. Sin embargo, en la madíbula son mucho menos frecuentes (menos de 200 casos reportados) y se le conoce como carcinoma mucoepidermoide central. La patogenia de este tumor intraóseo sigue siendo controversial. Al igual que otros carcinomas intaóseos primarios, puede tener varios orígenes: 1) atropamiento de glándulas mucosas retromolares en la mandíbula, 2) epitelio del seno maxila, 3) atropamiento iatrogéncio de glándula salivar menor (ej. en una osteomielitis o sinusitis crónica), 4) remanentes de lámina dental, 5) remanentes de tejido de glándula salival en la mandíbula, 6) transformación neoplásica de células mucosecretoras en el epitelio de revestimiento de quistes odontogénicos. Se presenta el caso de un hombre con un carcinoma mucoepidermoide central de la mandíbula y se hace una revisión del tema.

Adamantinoma of the spine: case report.

OBJECTIVE: We report a patient with a cervicothoracic spinal and a mandibular adamantinoma. Adamantinoma is a rare malignant neoplasm of bone and, to our knowledge, there have been only five cases of spinal adamantinoma reported. The pathogenesis of the adamantinoma, as well as the management of this extremely rare spinal tumor, is reviewed. CLINICAL PRESENTATION: A 55-year-old man was admitted to our service with cervical pain and signs of C8 and T1 radiculopathy. On physical examination, cervical spine deformity, swelling in the left mandible region, and signs of C8 and T1 radiculopathy were observed. Neuroradiology examinations showed an osteolytic mass of the C6, C7, and T1 vertebral bodies, extending into the lateral masses and transverse processes. After surgical procedures, the patient had clinical improvement. INTERVENTION: Corpectomy of C6, C7, and T1 was performed through a cervicothoracic anterior approach. Anterior stabilization of the spine was obtained using an autologous iliac crest graft and osteosynthesis with an anterior plate. On a second procedure, posterior tumor resection and spinal stabilization were performed. After the 1-year follow-up examination, a new anterior procedure was performed because of tumor recidivity and spine instability. CONCLUSION: Adamantinoma, an extremely rare lesion, is a locally aggressive tumor with slow growth and the potential to metastasize. Although it is an extremely rare occurrence in the spine, adamantinoma should be considered on the diagnosis of tumors of the vertebrae. Neuroradiological examinations are not specific in the differentiation of this tumor from other conditions. This fact, coupled with the limited experience that most physicians in general have in dealing with this tumor, makes the diagnosis and treatment of adamantinoma challenging.

[Functional recovery with prosthetic management for segmental resection of the mandible without reconstruction].

PATIENT: The patient, a 54-year-old male, consulted the Oral Surgery Department of Iwate Medical University Hospital with a complaint of a mass in the left oral base in June 1992. In September 1992, the patient was diagnosed as having cancer in the left mandibular base, and the tumor was excised by resection of the entire cervical region on the left side. Since radiation osteonecrosis in the left mandible and mandibular fracture were detected, segmental excision of the left mandible was performed in March 1993. Although the postoperative course was good without reconstruction, the patient consulted the Second Prosthetic Department to achieve functional recovery in February 1996. This patient had no occlusal contact between the maxilla and mandible because the mandible shifted to the affected side. After fixation of a mandibular prosthetic appliance for the defective mandible, a palatal plate for the maxilla in occlusal contact with the mandibular dentition and mandibular prosthetic appliance were fixed in November 1997. After fixation of a new mandibular prosthetic appliance and dentures for the maxilla with palatal ramp in April 2001, masticatory function was observed to have improved with control of the mandible. DISCUSSION: To prevent the mandibular shift and improvement of the masticatory function, a palatal plate with a palatal ramp in the occlusal contact region was fixed, and a balance of the masticatory muscles could be maintained. An evaluation of the level of improvement in the masticatory function and the pronunciation function indicated that the mandibular prosthetic appliance and palatal plate with a palatal ramp in the occlusal contact region increased the kind of food that the patient could take. Moreover, by enlarging the narrow Donders space, the pronunciation was improved. CONCLUSIONS: Fixation of a palatal plate with a palatal ramp in the occlusal contact region without reconstruction of the mandibular bone was useful for the control of mandibular deviation to the affected side and improvement of the masticatory function.

Evaluation of quality of life among patients after extirpation of mandibular ameloblastoma.

OBJECTIVE: To evaluate the quality of life (QOL) based on the functional, aesthetic and personal satisfaction among patients with ameloblastoma who underwent either partial or total mandibulectomy without reconstruction. DESIGN: Cross-sectional study. SETTING: The Department of Oral Surgery and Oral Pathology, School of Dentistry; Muhimbili University College of Health Sciences, Tanzania. SUBJECTS: Patients surgically treated for ameloblastoma without reconstruction. RESULTS. The postoperative problems were mostly associated with eating of solid foods, appearance and speech. All patients treated by total mandibulectomy had moderately severe problems with eating of solid foods and were dissatisfied with their appearance. CONCLUSION: The relatively small tumours resulted in a much better QOL. Public awareness programmes to avoid late referral and treatment is the most effective way to reduce the number of patients who after treatment suffer a poor QOL.