Modified Retromandibular Approach for the Management of Condylar Fractures of the Mandible.

Condylar fractures of the mandible have been of particular interest to surgeons for decades, as there is a big debate regarding the management option: conservative versus surgical modality. Conservative treatment is the preferred treatment modality for condylar head (diacapitular) fractures. Currently, surgical modality is favored and surgeons are opting for open reduction and internal fixation for diacapitular fractures as it reestablishes the anatomical position of the fragments and disc, and permits immediate functional mobility of the jaw, thereby reducing the chances of occurrence of temporomandibular joint ankylosis. This case series enumerates the pros and cons of open reduction and internal fixation of condylar fractures of the mandible occurring at various levels using a modified retromandibular approach and highlights that this can be considered as one of the treatment options for condylar fractures.

A Rare Case of Benign Osteoblastoma of the Mandible.

Benign osteoblastoma is an uncommon, solitary, osteoid, bone-producing tumor containing a rich vascularized delicate fibrous stroma and active osteoblasts. Benign osteoblastoma is a unique benign bone neoplasm that mostly affects the vertebrae and long tubular bones and rarely affects the maxillofacial skeleton. Many bone-producing lesions have clinical, radiological, and histological features that are similar to osteoblastoma. Benign osteoblastoma manifests clinically as localized swelling of the jaw, presenting as an asymptomatic or a symptomatic lesion, and proper investigations are necessary for accurate diagnosis. It usually manifests in the second and third decades of life predominantly in males. In this report, we present a case of benign osteoblastoma of the mandible in a 39-year-old male patient. The lesion was treated by complete surgical excision, and uneventful wound healing was observed during the one-year postoperative follow-up period.

An Uncommon Presentation of Ossifying Fibroma in the Maxilla.

Ossifying fibromas are rare, benign, nonaggressive fibro-osseous lesions that manifest in the craniofacial region. Ossifying fibromas are benign tumors of bone, commonly involving the posterior dentate mandible in middle-aged individuals with a female predilection. Clinical manifestations are an asymptomatic expansion of the dentate mandible, with infrequent maxillary lesions. Benign fibro-osseous lesions of the maxilla exhibit similar histopathological findings. Cone-beam computed tomography scan plays an important role in diagnosing and understanding the invasiveness of this lesion. This case report describes an uncommon presentation of ossifying fibroma in the posterior maxilla in an adult male patient. Treatment consisted of surgical excision, and wound healing was uneventful during the one-year postoperative follow-up period.

Atypical Presentation of Peripheral Ossifying Fibroma in the Mandible.

Peripheral ossifying fibroma (POF) is a localized reactive enlargement of the gingiva often associated with the papilla and originate from underneath the periodontium. POF occurs predominantly in females, especially in the anterior maxillary region of young adults. The histopathological examination provides a confirmatory diagnosis of such lesions due to their heterogeneous clinical and radiographic characteristics. This case report describes an atypical presentation of POF in the anterior mandible in an adult male patient. Treatment consisted of complete surgical excision and gingival curettage resulting in uneventful healing during the postoperative follow-up period.

Evaluation of patterns in mandibular fractures among South Indian patients.

The objective of this study is to evaluate the predicted mandibular fracture pattern among a sample of patients visiting a dental hospital in Chennai, India based on patient demographics. This retrospective analysis involved 46 patients out of which 39 were male and 7 were female who were referred to the Oral Surgery Clinic, Chennai. The medical records and orthopantograms for these 46 patients who received treatment for fractures of the mandible from June 2019- March 2020 were reviewed. Parameters such as age, gender, pattern of distribution, type of mandibular fracture, combination of the fracture and treatment done, were evaluated and assessed by one examiner and reviewed by 2 independent investigators. Data shows that the angle region to be the most common area to be affected (31.67%), accompanied by parasymphyseal region (28.33%), condylar region (13.33%), dento-alveolar region ( 10%), body (8.33%), symphyseal region ( 6.67%) and finally the coronoid region ( 1.67%). Data analysis also revealed that 84.78% of all patients with fractures of the mandible were male and 34.78% of all patients were in the age group of 21-30 years. Most fractures presented with a single fracture site (60.87%), and among combinations of fractures, fractures of parasymphyseal region along with angle region (41.67%) were seen more commonly. Pearson's Chi Square Test was used to determine the association linking the type of mandibular fracture and treatment modality used and p value was < 0.05, which was considered statistically significant. Thus, the patterns of mandibular fractures delineate a significant occurrence of angle fractures among mandibular fractures, commonly seen along with fractures of parasymphyseal region and occurring with a significant male predilection.

Bifid Mandibular Condyle as the Hidden Cause for Temporomandibular Joint Disorder.

Bifid mandibular condyle is a rare occurrence, more frequently unilateral. The etiology of this condition is controversial. Bifid mandibular condyles of developmental origin are mostly asymptomatic and discovered incidentally through imaging. Here, we report a 38-year-old male patient, previously in good health, presented with progressive pain in his right temporomandibular joint and restricted joint movements. MRI of the bilateral temporomandibular joints revealed mild degenerative disc on the right side and bifid mandibular condyle on the left side. Conservative treatment comprising a series of soft, medium, and hard splint therapy in combination with analgesics showed symptomatic improvement initially but did not improve the condition in the long term. He subsequently underwent arthrocentesis of the right temporomandibular joint and perceived a good clinical improvement until he developed progressive pain in the left temporomandibular joint and radiating to the left side of the face. He underwent partial condylectomy and discopexy following which all of his symptoms improved; which drives us to question if bifid mandibular condyle is the hidden cause for bilateral temporomandibular joint pain.

Glandular Odontogenic Cyst: A Diagnostic and Management Dilemma.

The glandular odontogenic cyst (GOC) is a rare odontogenic cyst that can develop in the maxillofacial region with aggressive behavior. It tends to develop into enormous proportions with high recurrence rates. The mandibular anterior area is the common site of occurrence of GOC, and it appears as an asymptomatic slow-growing swelling. GOC mimics other odontogenic cysts and tumors both clinically and radiographically, thus posing difficulty in diagnosis. Due to the aggressive potential of GOC, precise diagnosis and prompt treatment are crucial. Both conservative and aggressive surgical therapies have been advocated for GOC with a preference for aggressive therapy due to its high potential for recurrence. In this report, we present a case of GOC of the mandible in an adult female patient, which was successfully treated by segmental resection and primary reconstruction with stainless steel recon plate with uneventful healing during the one-year postoperative follow-up period.

Pleomorphic Adenoma of the Cheek: A Case Report.

Pleomorphic adenoma (PA) is the most common benign tumor affecting both major and minor salivary glands. Parotid gland is the most commonly affected major salivary gland. Among minor salivary glands, palate is the most commonly affected site followed by lips, cheeks, gingiva, floor of the mouth, and tongue. PA of buccal minor salivary glands is a very rare occurrence both in adults and children. In this report, we present a case of PA of buccal minor salivary gland in an adult patient who was successfully treated by wide local surgical excision, and after a follow-up period of one year there was no recurrence. A review of literature of PA of cheek is also presented.

Surgical Access to a Complex Composite Odontoma via Sagittal Split Osteotomy of the Mandible.

This case report presents the removal of complex composite odontoma in a young patient in the right body of mandible via the unilateral sagittal splitting of the mandible. This article shows that sagittal split osteotomy of the mandible can be very useful to access various pathologies in the body, angle, and ramus of the mandible and to navigate lesions that are in proximity to the inferior alveolar nerve. This technique also helps in avoiding postoperative morbidity when compared to other conventional surgical approaches. It can be used to remove large cysts, benign non-infiltrative tumours of the mandible, odontogenic myxoma, large odontoma, and deeply impacted lower third molars.