Management of the atrophic mandibular fractures: a ten-year prospective study of 48 injuries.

PURPOSE: The purpose of this study was to (a) record and evaluate the epidemiological data relevant to the fractures of the atrophic mandible in the Greek population (b) present our experience in the management of these difficult injuries and (c) compare our results to the outcomes of other similar studies and discuss the postoperative complications. METHODS: A prospective analysis of all the edentulous patients with fractures of the atrophic mandible treated at the Oral and Maxillofacial Surgery Department of K.A.T General Hospital of Athens in Greece was performed from November 2012 to December 2022. Age, gender and medical history of the patient, etiology and site of the fracture, classification of atrophy, type of surgical approach, type of osteosynthesis and postoperative complication. RESULTS: 34 patients were included in the present study and 48 fractures of the atrophic edentulous mandible were managed surgically. 22 fractures were classified as class II of atrophy, 21 fractures as class III and 5 injuries as class I. In 32 patients we used an extraoral approach and only 2 patients were treated with an intraoral access. 44 fractures were treated with a 2.0 mm locking reconstruction plate and only 4 injuries of class I atrophy were treated with mini plates. CONCLUSIONS: Clinical practice has confirmed that for these cases an extraoral approach followed by stable fixation with a 2.0 mm reconstruction locking plate can deliver excellent results. Our findings show that the routine use of primary bone grafts is not necessary and can be reserved for more complex cases.

Management and treatment of four cases of oral carcinoma cuniculatum.

Objectives: Oral carcinoma cuniculatum (OCC) is a rare variant of squamous cell carcinoma (SCC). It has similar clinicopathological characteristics to SCC and verrucous carcinoma (VC). We present a case series of OCC and analyse its unique features, diagnosis, and management. Patients and. Methods: We retrospectively reviewed the medical records of oral cancer patients treated by Oral and Maxillofacial Surgery department from 2009 to 2020 with OCC biopsy findings. The clinicopathological characteristics and management of the OCC cases were analysed. Results: Four patients were identified with histologic findings of OCC, including three on the alveolar ridge mucosa and one on the tongue. Imaging revealed that two of the lesions located in the maxilla had osseous lysis. All four patients were all treated with radical excision, and the histopathology showed findings of SCC cuniculatum. It was decided that no further treatment was necessary. None of the patients has experienced recurrence during follow-up. Conclusion: OCC is a distinct entity that is more locally aggressive than VC but is associated with good prognosis. Radical surgical removal is considered appropriate for OCC. Emphasis should be given on an early diagnosis, as it remains challenging.

Fine-Needle Aspiration Cytology in the Diagnosis of Salivary Gland Tumors Before the Milan System: A Ten-Year Experience From a Tertiary Care Center in Greece.

Objective The objective of this study was to determine the diagnostic value of fine-needle aspiration cytology (FNAC) for salivary gland tumors. Methodology A retrospective file analysis of patients with salivary gland pathology, attending the Department of Oral and Maxillofacial Surgery of a tertiary care center in Athens, Greece, over a 10-year-long period, was conducted. Sensitivity, specificity, accuracy, positive prognostic value (PPV), and negative prognostic value (NPV) of FNAC for benign and malignant tumors separately were assessed and compared with histology. Results A total of 82 patients (46 male and 36 female) with salivary gland tumors, submitted to both FNAC and histology, were included. The mean age was 55 years. A total of 73 tumors were histologically diagnosed as benign and nine as malignant. FNAC identified 62 benign and seven malignant tumors but was inconclusive in 13 cases. The most common diagnosis of both histology and FNAC was pleomorphic adenoma. FNAC sensitivity, specificity, accuracy, PPV, and NPV were 98.3% and 100%, 87.5% and 100%, 97.1% and 100%, 98.3% and 100%, and 87.5% and 100% for benign and malignant tumors, respectively. Conclusions FNAC is highly sensitive but moderately specific for the preoperative identification of benign salivary gland tumors. Its use as an initial diagnostic modality is warranted, thanks to its safeness, rapidity, and lack of pain.

A sizeable aneurysmal bone cyst of the mandibular ramus on 15-year-old patient. Intraoral approach.

Aneurysmal bone cysts (ABCs) are benign, non-neoplastic bone lesions, which contain blood and demonstrate a destructive pattern. They rarely occur in the head and neck region, with the mandible being the most common site of craniofacial origin. They develop in the second decade of life and their etiology is obscure. ABCs can sometimes demonstrate distinct radiological features and imaging is also necessary for preoperative planning. Surgery is the mainstay of treatment. The ABC should be excised in toto and usually osteotomies and primary reconstruction are necessary. We present a case of sizeable ABC of the mandibular ramus that was excised intraorally, without the need of combined approaches or reconstruction.

Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine.

To present five patients with DNM, who were treated during the first quarantine for Coronavirus disease 2019 (Covid-19). Five patients with DNM were treated in our department during the first lockdown. The mean age of the patients was 42,2 years and four were male. Two patients were immunocompromised. Repeated surgical drainage was performed in all patients, whereas four were also subjected to elective tracheostomy during their first operation. The mean hospitalization duration was 55,4 days and mortality was 40%. During the first lockdown for the Covid-19, a rise in the ratio of DNM cases to the overall incidence of cervicofacial infections was observed in our department. All patients with DNM were operated on an emergency basis and were subsequently admitted to the ICU. We consider the effect of the quarantine as a decisive factor for this escalation, because according to the department archives, there had not been any cases of DNM originating from a dental infection, for the past 5 years. Additionally, past studies from the same department reported no more than 6 cases over a 10 year period.

Effect of Causative Tooth Extraction on Clinical and Biological Parameters of Odontogenic Infection: A Prospective Clinical Trial.

PURPOSE: To prospectively compare changes of body temperature, white blood cell count, fibrinogen, and C-reactive protein between odontogenic infections in which the responsible tooth was removed and odontogenic infections in which the treatment included no extraction. MATERIALS AND METHODS: The sample was composed of patients admitted to the authors' maxillofacial unit for odontogenic infection from 2010 through 2013. One hundred seventy-nine patients were categorized into an extraction or a non-extraction group based on whether the causative tooth was non-restorable or restorable, respectively. Non-restorable teeth were extracted at admission of the patient. Otherwise, the treatment protocol, including incision of the involved space in conjunction with intravenous antibiotics, was the same for the 2 groups. The parameters were measured and recorded at admission and 2 days later. Data records were statistically analyzed by comparing the change of the parameters studied between the extraction and non-extraction groups. P values less than .05 were regarded as statistically significant. RESULTS: One hundred seventy-nine patients fulfilled the inclusion criteria and were enrolled in the study. The mean age of the patients was 39.1 years (minimum, 14 yr; maximum, 81 yr; standard deviation, 15.4 yr). One hundred nine patients (60.9%) were male, and 70 (39.1%) were female. Differences in the mean decrease of axillary temperature, white blood cell count, fibrinogven, and C-reactive protein between the 2 groups were 0.178, 2,300, 1.01, and 0.64, respectively. All these differences were statistically significant (P =.02, .001, .001, and .001, respectively). Also, the mean hospital stay in the extraction group was 1.05 days shorter than in the non-extraction group, with the difference being statistically significant (P = .006). CONCLUSIONS: In odontogenic maxillofacial infections, extraction of the causative tooth is associated with a faster clinical and biological resolution of the infection.

Treating maxillofacial trauma for over half a century: how can we interpret the changing patterns in etiology and management?

OBJECTIVE: The aim of this study was to reveal the changes in the etiology and treatment of maxillofacial fractures in Greece over the period of the last 53 years. STUDY DESIGN: A patient-oriented retrospective review of clinical and epidemiologic data was performed to include all patients with maxillofacial fractures treated in the Oral and Maxillofacial Surgery Department of KAT General Hospital of Athens. We reviewed the causes of these injuries, their sites, and treatments (outcome variables) over the last 28 years and compared the results with those of a similar study from the same Department from 1960 to 1984 (predictor variable). RESULTS: The zygomatic complex was the most frequent fracture site in the recent years, whereas the condyle and symphysis were the most common ones in the early period. We observed a remarkable increase of injuries from interpersonal violence (P < .0001) and a divergence from conservative treatment (P < .001) with time. CONCLUSIONS: Universal agreement exists on the rapidly rising prevalence of facial fractures in the developed countries as a result of physical violence, and the present study confirmed this conclusion. Throughout the last 50 years, there has been a constant tendency of surgeons to adopt the concept of open reduction and internal fixation.

Acute osteomyelitis of the mandible caused by Rhodococcus equi in an immunocompromised patient: a case report and literature review.

We present the first case of acute osteomyelitis of the mandible caused by Rhodococcus equi in an immunocompromised patient. A 53-year-old Caucasian man was referred to the outpatient clinic, because of a swelling of the left submental and submandibular spaces. The patient was immunocompromised owing to medication against myasthenia gravis and type II diabetes mellitus. The patient underwent surgical debridement under local anesthesia. Histologic examination showed acute osteomyelitis and both blood and pus cultures isolated Rhodococcus equi. The patient was discharged on linezolid 600 mg orally twice a day for 6 months and remains free of the disease 2 years postoperatively. Most patients with Rhodococcus infection are immunocompromised. Infection with this organism is rare and usually causes a distinct clinical syndrome resembling pulmonary tuberculosis. Diagnosis is frequently missed or delayed. Not only clinicians but also laboratory specialists should be aware of this organism, so as to contribute to prompt diagnosis and treatment of such infections.

Effect of titanium maxillofacial implants and osteosynthesis materials on platelet function.

The use of titanium implants and osteosynthesis materials in orthopaedics, neurosurgery, and maxillofacial surgery has increased considerably, and they may be retained in patients for a long time. We could find no papers in English that provided data about the effect of titanium osteosynthesis materials on platelet function, and the purpose of this study was to evaluate those effects. Platelet function was tested in 33 patients with titanium maxillofacial implants using the PFA-100 (platelet function analyser) system and these results were compared with those of a control group of 34 healthy volunteer blood donors. Platelet function was measured in each group using collagen/adrenaline and collagen/adenosine diphosphate (ADP) as agonists for assessment of platelet function. There were no significant differences between the groups (collagen/adrenaline p=0.1, collagen/ADP p=0.09). Titanium maxillofacial osteosynthesis materials have no significant effect on platelet function as assessed by the PFA-100 system.

Squamous cell carcinoma of the maxillary gingiva, alveolus, and hard palate: is there a need for elective neck dissection?

We retrospectively studied 17 patients with squamous cell carcinoma (SCC) of the maxillary gingiva, alveolus, and hard palate who were treated over a 7-year period (2000-2007) to investigate whether selective neck dissection is justified at an early stage. Four patients presented with metastases in the neck, and all developed early recurrence in the neck, with poor prognosis. Of the 13 patients who initially had no sign of metastases, two developed regional metastases within the first 18 months of initial treatment. Squamous cancers of the maxillary gingiva, alveolus, and hard palate should be treated aggressively, and elective neck dissection should be considered because of the high risk of occult metastases. Prospective studies are difficult because of the rarity of the tumour.

Cutaneous head and neck SCCs and risk of nodal metastasis - UK experience.

AIM: To identify the risk of developing metastases to regional nodes in patients with cutaneous squamous cell carcinomas (CSCCs) of the head and neck. METHODS: A retrospective study of patients with CSCC treated with surgical excision alone between 2000 and 2002 was performed. Demographic details of the patients, the site, size, differentiation, depth of invasion, clearance of surgical margins, and the presence of perineural or lymphovascular invasion of the lesion were documented. During the follow up period, patients with regional metastases were identified. The site of the metastasis and the time after the primary resection were documented and statistical analysis was performed using Chi-square and logistic regression analysis. RESULTS: One hundered and ninety-four patients were included and 218 CSCCs were excised in total during the period of 3 years. The scalp was the most common site of skin lesion, followed by the ear. The incidence of regional metastatic disease was found to be 5.15%. The parotid gland was the most common area of regional metastasis. No metastases occurred after the first 2 years of follow up. The pinna, the poor differentiation and incomplete excision margins were found to be associated with regional metastasis independently, with odds ratio of 16, 21, and 2 respectively. CONCLUSIONS: The rate of regional metastasis from CSCC remains low. The parotid gland was the most favoured metastatic site. Patients with poorly differentiated squamous cell carcinoma (SCC) located on the ear and incomplete excision margins were at the greatest risk for developing regional lymph node metastasis and require close follow up.

Metastases following biopsy of oral carcinoma in hamsters and the role of local prebiopsy bleomycin.

BACKGROUND: This animal study researches the effect of biopsy on metastasis of oral carcinoma. MATERIALS AND METHODS: Sixty hamsters developed oral tumors after treatment with 9,10-dimethyl-1,2-benzanthracene and were then divided into six groups. Animals of groups 1 and 2 did not receive any treatment, while groups 3-6 were biopsied at the end of the 14th week and groups 5 and 6 also received a prebiopsy intratumoral injection of bleomycin. Animals of groups 1, 3, 5 and 2, 4, 6 were sacrificed at the 17th and 19th week respectively. Specimens of tumors, ipsilateral cervical lymph nodes, lungs and livers were obtained from all animals and histologically examined. RESULTS: All animals developed oral squamous cell carcinomas. In group 4, four out of ten animals showed metastases to the cervical lymph nodes, and one out of four showed a distant metastasis to the lung. CONCLUSION: Delay of treatment following biopsy can increase the risk of cervical lymph node metastases which can be reduced by an intratumoral administration of bleomycin.

Maxillofacial injuries sustained during soccer: incidence, severity and risk factors.

A very popular sport worldwide, soccer generates a great number of maxillofacial injuries, mainly fractures, resulting in esthetic or functional problems. The aim of this retrospective study was to contribute to the knowledge of soccer-related maxillofacial injuries, and call attention to the risk factors that favor these injuries. A total of 108 patients, who attended hospital because of maxillofacial injuries during soccer within a period of 8 years, were included in this study. The relationship of the patients with soccer, the type, the site, the severity, the mechanism of the injuries and the applied treatment were analyzed. The injured were all males, and were principally amateurs. Around 89.8% of the patients suffered maxillofacial fractures while 10.2% presented only soft tissue injuries; 13.9% had multiple fractures; 50% of the maxillofacial fractures concerned the zygomatic complex and 38.2% the mandible where the majority occurred at the angle. The prevailing mechanism was the direct impact of players. Head to head impact outnumbered. Elbow to head impact caused contusions of the temporomandibular joint. Kick to head impact was the main cause of multiple fractures. The treatment of fractures was mainly surgical (68.2%). These findings support the fact that maxillofacial injuries sustained during soccer tend to be severe, demanding surgical treatment. The mandibular angle is in danger due to the usual existence of impacted and semi-impacted third molars. There should be a preventive intervention on the above contributors, and mainly coaches and sports physicians should be properly informed about the specificity of the maxillofacial injuries.

Solvent-dehydrated fascia lata allograft for covering intraoral defects: our experience.

Mucosal defects in the oral cavity as a result of tumors, preprosthetic surgical procedure, or trauma are always a concern for surgeons. The aim of this study is to present our experience and discuss the advantages and problems arising with the use of solvent-dried human fascia lata allografts in oral mucosal defects, thus evaluating its clinical efficacy. Sixteen intraoral lesions were removed from 15 patients. The rehabilitation of the mucosal defects was achieved using solvent-dehydrated human fascia lata allografts. No graft rejection or infections were detected. The material was effective for enhancing the hemostasis, relieving the pain, and inducing rapid epithelization. The final result was excellent, even though in 2 cases complications were experienced. Hence, the use of the material proved to be reliable, practical, and safe.

An unreported variation of the course of peroneal artery during fibula flap harvest.

We describe a previously unreported anatomical variant of the peroneal artery that was found both on preoperative angiography and at operation to be related to the fibula only in its distal third. In contrast to previously reported variations, the artery began descending on the medial aspect of the fibula about 26cm from the fibular head.

Metastasising chordoma to the mandible from a rare vertebral site: the first reported case.

Chordoma is a rare tumor, arising from notochord remnants, which usually occurs in the axial skeleton and rarely metastasizes. Although there have been 3 previous reports of metastatic disease to the facial bones from sacrococcygeal chordoma, this is the first to describe spread to the mandible from a vertebral primary chordoma.

Effects of acute and chronic cadmium administration on the vascular reactivity of rat aorta.

The effect of acute and chronic cadmium (Cd) administration on the vascular function of the rat aorta was studied. The rats were randomly divided into four main groups (A: saline controls under chronic administration, B: Cd-treated rats under chronic administration, C: saline controls under acute administration, D: Cd-treated rats under acute administration). After their sacrifice, the aortic rings were divided into rings with endothelium (E+) and without (E-), and suspended in an isolated organ bath with Krebs - Henseleit buffer. Maximal tension (T max, in g) was measured in response to potassium chloride (KCl) and phenylephrine (PE) in all aortic rings. Relaxation response to acetylcholine (ACh) administration was expressed as percent of maximal tension induced by PE. Chronic administration: A statistically significant increase of the contraction was observed between groups B (i.m. Cd 0.5 mg/kg for 120 days) and A (i.m. 0.9% NaCl for 120 days) in response to KCl (20-60 mM) and the T max as well (in both the E+ and the E- subgroups). No statistically significant difference was observed in response to PE and ACh exposure. Acute administration: A statistically significant increase was observed between group D(E+) (i.m. Cd 2 mg/kg, 8 h before sacrifice) and group C(E+) (i.m. 0.9% NaCl, 8 h before sacrifice) in response to 10-30 mM of KCl, and a significant decrease between D(E-) and C(E-) in response to 10(-7)-10(-6) M of PE, though T (max) was increased between D(E-) and C(E-) with PE exposure. The contractile response levels of the E+ aortic rings to PE and ACh showed no statistically significant difference.