Extracorporealization of the Mandibular Condyle: Effects on Viability and Function.

Study Design: For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we conducted a retrospective analysis of surgical outcomes. Objective: For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we investigated the viability of this technique through a retrospective analysis of outcomes. Methods: Twenty-six patients were treated using EVRO with extracorporealization of the condyle for both condylar fractures (18 patients) and osteochondroma (8 patients). Of the 18 trauma patients, 4 were excluded due to limited follow-up. Clinical outcomes were measured, including occlusion, maximum interincisal opening (MIO), facial asymmetry, incidence of infection, and temporomandibular joint (TMJ) pain. Radiographic signs of condylar resorption were investigated, quantified, and categorized using panoramic imaging. Results: Average follow-up was 15.9 months. Average maximum interincisal opening was 36.8 mm. Four patients demonstrated mild resorption and one patient demonstrated moderate resorption. Two cases of malocclusion were attributed to failed repairs of other concurrent facial fractures. Three patients reported TMJ pain. Conclusions: Extracorporealization of the condylar segment with EVRO to facilitate open treatment of condylar fractures is a viable treatment option when more conventional approaches prove unsuccessful.

Central compact osteoma of the mandible: case report featuring unusual radiographic and computed tomographic presentations and brief literature review.

Central osteomas of the jaws have been infrequently reported, mostly presenting as a well-defined opacity on conventional radiography projections and as a hyperdensity on computed tomography scans. To increase the knowledge of the phenotypic expression of gnathic central osteomas, an unusual case has been described, including the clinical, radiographic, cone beam computed tomography (CBCT) and histopathologic findings. The lesion was initially discovered 4 years prior as an asymptomatic ovoid radiolucency in the posterior mandible. A 25-year-old female presented with a hyperdense expansile mass with a hypodense rim on a CBCT scan. The enucleated mass was diagnosed as a compact central osteoma. A literature search has identified 4 other cases with similar hypodense borders on CT scans. We propose that a subset of central osteomas should be considered in the differential diagnosis of osteopathologies of the jaws with hyperdense internal architecture and hypodense borders, as seen on CT images.

Melanotic Neuroectodermal Tumor of Infancy: Case Report and Review of Management.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare pigmented tumor of the head and neck, which most commonly presents during the first year of life. Most cases present in the bones of the craniofacial region, including the maxilla (60.3%), skull (18.1%), and mandible (10.3%). The alveolar crest of the anterior maxilla is the most common site. MNTIs are locally aggressive, but benign, lesions derived from neural crest cells. However, they have a high rate of recurrence, and ≤6.5% of cases will demonstrate metastasis to lymph nodes or distant organs. They present clinically as an expansile pigmented mass. Radiographically, these lesions are often intraosseous expansile lytic lesions that can envelope or displace teeth. Extraosseous components might be better visualized on magnetic resonance imaging, demonstrating an enhancing iso- or hypointense mass on T1- and/or T2-weighted imaging. MNTIs have a distinctive biphasic cell population composed of large pigmented epithelial cells and small blue neuroblastic cells. Many immunohistochemical markers have also been identified. The large cell population often expresses cytokeratins, HMB-45, and vimentin; S100 is much less common. The small cell population typically expresses synaptophysin but will be negative for another neuroendocrine marker, chromogranin A. Rarely, patients will have elevated levels of urine vanillylmandelic acid, similar to findings from other tumors of neuroectodermal origin, such as neuroblastomas. First-line treatment of these lesions should be surgery with the goal of complete local excision. Radiotherapy and chemotherapy have been described but have been largely used as adjuvant or neoadjuvant therapy and for metastatic disease. We present a case of MNTI in an 8-week-old male, who had presented with a nonpigmented mass of the mandible associated with a pathologic fracture. In addition to a review of the data, our case serves to highlight potential prognostic factors, current clinical management, and local complications of this rare tumor.