Central giant cell granuloma of the mandibular condyle: A rare case and a literature review.

INTRODUCTION: Central giant cell granuloma is a benign intraosseous lesion; tumours in the condylar region are rarely reported. CASE PRESENTATION: We present the case of a 60-year-old woman with preauricular swelling, limitation of joint motion and pain on only the right side. DISCUSSION: The patient was evaluated based on her preoperative clinical manifestations, by orthopantomography and computed tomography (CT). CT revealed a lesion on the right condylar head. Surgery was scheduled based on this imaging finding, histological findings from an incisional biopsy specimen, and the patient's indications and symptoms. CONCLUSION: Of all reported cases of central giantcell granuloma, only five (including this case) were located in the mandibular condyle.

Facial Trauma: A Retrospective Study of 1262 Patients.

INTRODUCTION: Traumatic injuries are the leading cause of death among <40 year olds, a good part of the working age population. Traumatic injuries are also the leading cause of lost productivity, causing more lost working days than cancer or vascular cardiomyopathy. MATERIALS AND METHODS: We retrospectively and statistically analyzed the characteristics of facial fractures treated between June 2010 and December 2016 at the Maxillofacial Adult Surgery Unit, Spedali Civili Brescia, Italy. DISCUSSION: Facial fractures are common in polytrauma patients, due to exposure of the cephalic end. The incidence of concomitant facial injuries with major trauma is 15%-24% in England (between Liverpool and London) and up to 34% in Washington, based on a large database of 87,174 patients. High-energy trauma frequently involving multiple traumatic injuries often leads to complex facial fractures, affecting different portions of the splanchnocranium. CONCLUSIONS: Treatment of facial fractures often focuses on functional or esthetic outcomes, and the outcomes are often substantially worse than those of other trauma treatments. Given the esthetic value of the face, facial trauma often leads to heightened emotional distress.

The first case of osteoma of the mandibular notch located both medially and laterally and treated with a transoral endoscopy assisted approach. A case report.

INTRODUCTION: Osteomas are slow-growing benign tumours composed of mature compact or cancellous bone and are seen in facial bones but uncommonly in the mandible; cases that arise in the notch region are rarely reported in the literature. PRESENTATION OF CASE: This article presents a 37-year-old woman with no preauricular swelling, no limitation of joint motion and pain only on the left side. DISCUSSION: The patient was evaluated based on preoperative clinical manifestations, orthopantomography and a computed tomography (CT) scan. The CT scan showed bone density irregularity between the coronoid process and the left mandibular condyle in the notch region arising both medially and laterally. Surgery was performed based on these images and the patient's indications and symptoms. CONCLUSION: Among the cases of osteoma in the literature, only six originated in the mandibular notch, but this is the only that was both medially and laterally located.

Soft-Tissue Chondroma in the Preauricular Region: An Unusual Presentation.

Chondroma is a benign cartilaginous tumor composed of mature hyaline cartilage and represents only 2.38% of all osteocartilaginous tumors; cases that arise in the preauricular region are rarely found in the literature. This article presents an 80-year-old man with preauricular swelling on the right side and pain with no limitation of joint motion. This patient was evaluated by preoperative clinical manifestation, fine needle aspiration, ultrasound, and magnetic resonance imaging (MRI) scans. The MRI shows a solid lobulated lesion between the masseter muscle and the parotid gland whereas fine-needle aspiration did not provide a diagnosis. Based on these images and the patient's indications and symptoms, a surgical intervention was performed. It is possible to identify three different types of chondromas in the parotid region based on their location. Among the cases of chondroma in the literature, only six originating in the soft tissue of the parotid region have been reported, including this one.

New Management in Bilateral Masseter Muscle Hypertrophy.

Bilateral masseter muscle hypertrophy is an alteration in shape and thickness of the masseter muscles that can modify the width of the lower face causing aesthetic and functional problems. A 21-year-old man was referred to the Department of Maxillofacial Surgery at the Civil Hospital in Brescia by his dentist for an evaluation of his facial appearance with a square-face type. To reduce the undesirable facial appearance, a surgical intraoral approach was performed; the procedure includes the bilateral dissection of the masseter muscle, partial lipectomy, and the ostectomy of the mandibular angle assisted by a surgical guide built on a stereolithographic model. The patient was satisfied with the functional and aesthetic outcomes of both the profile and the frontal views. There was no evidence of complication at a 1-year follow-up. This new method yields optimal aesthetic results with an enhanced outline of the lower face.

A Hemangioma of the Zygomatic Bone: Management Ensuring Good Reconstructive and Aesthetic Results.

Hemangiomas are benign tumors representing only 0.7 to 1% of all bone tumors; those that arise in the zygomatic region are rarely described in the literature. Here, we describe the case of a 55-year-old woman with a mass in the right orbitozygomatic region. She was diagnosed on the basis of preoperative clinical manifestations, data from an earlier histopathological examination, and computed tomography (CT). The CT scan revealed a lesion in the right zygomatic region at the level of the cancellous component. This caused thinning and remodeling of the deformed cortex both medially and laterally. Surgery was performed. We describe the clinical characteristics of our case with an emphasis on surgical management of the lesion using a titanium grid prepared by reference to a stereolithographic model.

Chronic nonbacterial osteomyelitis involving the mandible: A case report.

INTRODUCTION: Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO), is a very rare condition of unknown aetiology. It is characterised by focal sterile inflammatory disease with prolonged, self-limiting and recurrent episodes. CASE PRESENTATION: We report the discovery of this very rare disease following a mandibular abscess in a 10-year-old female. We initially focus on the difference between the preoperative orthopantomography and the maxillofacial computed tomography and magnetic resonance images obtained, and then on the improvement of strategies for correct diagnosis and treatment of this disease. DISCUSSION: Bone pain and localised swelling can occur in a single bone or can spread to soft tissue and adjacent bone; areas commonly affected by CMRO include the metaphyseal plates of the long bones, as well as the spine, clavicle and, rarely, the maxillofacial area. The clinical presentation of CMRO includes pain, functional impairment, and swelling, similar to our case. CONCLUSIONS: We report a very rare case of this unifocal mandibular disease in a child who presented for an abscess and was then diagnosed and treated for CNO.

Massive Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum Developing during a Dental Hygiene Procedure.

Subcutaneous emphysema is rare during or after dental procedures (usually extractions). Here, we describe the case of a 65-year-old woman who developed massive cervicothoracic subcutaneous emphysema and pneumomediastinum during a dental hygiene procedure employing an artificial airflow. She was diagnosed based on clinical manifestations and computed tomography (CT). CT revealed massive subcutaneous emphysema extending from the superior left eyelid to the diaphragm. We describe the clinical and radiological characteristics of this rare case.

From tooth extraction to Gorham-Stout disease: A case report.

INTRODUCTION: Gorham-Stout disease (GSD), or vanishing bone disease, is a very rare condition of unknown aetiology. It is characterised by progressive osteolysis and angiomatosis. CASE PRESENTATION: We report the discovery of this very rare disease following a trivial deciduous tooth extraction in a 14-year-old female. We focus initially on the difference between the preoperative orthopantomography and the whole-body computed tomography and magnetic resonance images obtained post-haemorrhage, and then on the improvement of strategies for the correct diagnosis and treatment of this disease. DISCUSSION: Bone loss and the proliferation of vascular structures can occur in a single bone or spread to soft tissue and adjacent bone; areas commonly affected by GSD include the ribs, spine, pelvis, skull, clavicle, and the maxillofacial area. The clinical presentation of GSD includes pain, functional impairment, and swelling, although a few asymptomatic cases have been reported, similar to our case. CONCLUSION: We report a very rare case of this multicentric disease in an asymptomatic child who presented for dental extraction, almost died, and was then diagnosed with and treated for GSD.

A massive haemorrhage developing during deciduous tooth extraction in a young child: A case report.

INTRODUCTION: Major haemorrhage developing during oral or maxillofacial surgery is uncommon, but potentially life-threatening. Dental extractions in childhood are common, but blood loss is unusual. CASE PRESENTATION: Here, we report a rare case of a complication developing during a trivial deciduous tooth extraction. We focus on the great difference between the preoperative orthopantomography and the maxillo-facial computed tomography obtained post-haemorrhage. DISCUSSION: The surgical procedures most commonly associated with acute haemorrhage are orthognathic, oncological, and temporomandibular joint procedures. When acute haemorrhage develops, the surgeon must remain calm, temporarily arrest the bleeding, and ultimately definitively control it. Although ligation of the offending artery, vein, or vascular malformation is clearly the treatment of choice, identifying the offending vessel and gaining adequate access thereto are often difficult. CONCLUSION: We emphasise that what we encountered could happen in routine daily practice.

Unusually rapid development of a lateral neck mass: Diagnosis and treatment of a branchial cleft cyst. A case report.

INTRODUCTION: Branchial cleft cysts are benign lesions caused by anomalous development of the branchial cleft. Cases that arise in the lateral neck region are often misdiagnosed, resulting initially in inappropriate management. CASE PRESENTATION: We describe a 32-year-old woman with a swelling on the right side of her neck and no pain during palpation or neck motion. DISCUSSION: The patient was evaluated using fine-needle aspiration cytology (FNAC), ultrasound, and magnetic resonance imaging (MRI) scans. The MRI showed a right-sided cervical mass with hyperintense content, well-defined margins, and no evidence of infiltration into surrounding structures, while FNAC found a yellow, pus-like fluid, keratinised anuclear cells, squamous epithelium, and a matrix of amorphous debris. CONCLUSION: Based on the images and the patient's symptoms, a surgical intervention was performed.

A rare case of intraosseous fibrolipoma of the mandible: diagnosis and treatment.

Lipomas are common soft tissue tumors. Intraosseous lipoma is a rare lesion that constitutes not more than 0.1% of bone tumors. It can occur anywhere in the body and there have only been a few cases found in the mandible. Intraosseous fibrolipoma of the jaw is an uncommon histological variant of the classic lipoma and to the best of our knowledge only one case has previously been reported in the literature. The cause of this lesion is uncertain. Clinically the lesion is generally asymptomatic and its radiographic feature is a well-defined radiolucency. Surgery is the treatment of choice. We present a case of an intraosseous fibrolipoma in the right mandibular ramus in a 25-year-old female.

A rare case of synovial chondromatosis of the inferior TMJ compartment. Diagnosis and treatment aspect.

AIM: Synovial Chondromatosis (SC) is a rare, benign non neoplastic arthopathy characterized by the metaplastic development of cartilaginous nodules within the synovial membrane. In only 3% of all cases does it affect the temporomandibular joint (TMJ) and cases that arise from the lower compartment are rarely found in literature. The aim of this paper is to report a new case of SC of the inferior TMJ compartment with the description of the clinical, therapeutic and histopathological findings. CASE REPORT: This article presents a 68-year-old woman with preauricular swelling on the right side, pain, crepitus and limited joint motion. This patient was evaluated by preoperative clinical manifestation, CT scan and MR images. Both showed multiple, calcified loose bodies in the inferior compartment. Based on these images as well as the patient's signs and symptoms, a surgical intervention was performed. A good functional recovery with no signs of recurrence at 36 months of follow up was obtained. CONCLUSION: Among cases of synovial chondromatosis in literature, only twelve originating in the lower compartment have been reported, this one included. In all the cases treated for SC in the lower compartment, both in literature and in our case report, surgical treatment led to healing.