Dentigerous Cyst and Ameloblastoma of the Jaws.

AIM: To determine how many ameloblastomas were misdiagnosed as dentigerous cysts (DCs) by correlating the radiological and histopathological features of a series of both entities. METHODS AND RESULTS: Histopathology reports and radiological imaging of 135 DCs and 43 ameloblastomas were reviewed. Any clinical or radiological feature that suggested that the diagnosis of DC was wrong-for example, absence of an unerupted tooth-prompted review of the original histology. A total of 34 cases coded as DC at diagnosis were excluded; in the remaining 101 patients, the clinicoradiological and histopathological features were consistent with DC in 96 (95.0%). Review of the histology revealed that 4 patients had actually had odontogenic keratocysts (OKCs) and one a luminal/simple unicystic ameloblastoma (UA). One other OKC and 3 other ameloblastomas (1 luminal UA, 2 solid/multicystic) had originally been diagnosed as DC; these had been identified prior to the study. Of the 9 misdiagnosed patients, 6 were ≤20 years old. Clinically, DC had been the only, or one of the differential, diagnoses in 7 patients; in the other 2, the clinical diagnosis was radicular cyst. In none of the 4 misdiagnosed ameloblastomas was the radiology compatible with a diagnosis of DC. Incorrect terminology had been used on the histopathology request form in 5 of the 34 excluded cases where the clinical diagnosis was DC, despite the cyst being periapical to an erupted carious or root-filled tooth. CONCLUSIONS: The entire clinical team must ensure that a histopathological diagnosis of DC is consistent with the clinicoradiological scenario, particularly in younger patients.

Biodegradable fixation in oral and maxillofacial surgery.

UNLABELLED: Fixation of the maxillofacial skeleton following trauma or osteotomy surgery has been achieved by the use of titanium plates and screws for the past two decades. Advances in materials science has enabled the development of biodegradable or resorbable plates and screws for internal fixation of the maxillofacial skeleton. This paper presents the biochemistry of resorbable materials and our early experiences in their clinical applications. CLINICAL RELEVANCE: This manuscript illustrates the use of a resorbable material to fix the maxillofacial skeleton following osteotomies and trauma.

Surgical management of the severely contracted socket following reconstruction.

PURPOSE: To present a surgical technique for the early maintenance of the severely contracted socket following reconstruction. METHODS: Two patients with severely contracted sockets following multiple procedures and recurrent failure were identified over a 1 year period. Following fornix and eyelid reconstruction, silicone fixative was injected into the fornix through a standard conformer. The silicone fixed around a pre-placed K-wire passed from the lateral orbital rim to the posterior lacrimal crest. Both silicone and wire were removed at 3 months. RESULTS: Both patients were able to wear and maintain an acceptable prosthesis following the surgical procedure. CONCLUSION: This is a safe and effective method for the early maintenance of a severely contracted socket. This technique minimizes cheesewiring or extrusion and avoids damage to superior and inferior muscles and structures.

A rare case of an extensive plunging ranula: discussion of imaging, diagnosis, and management.

A plunging ranula is a mucous extravasation cyst appearing as a swelling in the submental and submandibular regions. We describe a rare case of massive plunging ranula involving multiple tissue spaces. A magnetic resonance imaging scan revealed the true extent of the lesion and its relationship to the surrounding structures. Other imaging techniques and diagnostic tests are discussed. The unusual course of events following surgical excision of the offending sublingual gland is presented. The relevant literature is reviewed.