Εvaluation of a treatment protocol for unerupted maxillary central incisors: retrospective clinical study of 46 children.

AIM: To evaluate the clinical outcome of a treatment protocol performed in children with unerupted permanent maxillary central incisors, including surgical removal of any related obstruction and traction initiation in one stage, under fully repositioned flap, combined with pre- and post-operative orthodontics for space creation and final alignment. METHODS: Forty-six patients aged 7.3-12.7 years (mean = 9.44 ± 1.36) having 54 impacted maxillary central incisors were reviewed. The study group included 37 patients fully treated by us and nine referrals with eruption failure of impacted incisors following previous surgical removal of various obstructions. Detailed patient's clinical and radiographic data were recorded. RESULTS: Aetiology of unerupted incisors included 9 patients with odontomas, 24 with supernumerary teeth, 1 with skeletal lack of space, 1 with a dentigerous cyst, 4 with dilaceration, 1 with severe incisor MIH, 5 with luxation injuries to primary predecessors and 1 with coexisting dilaceration and odontoma. The total treatment time following the standardised protocol ranged from 5 to 21 months (mean 9.88 ± 3.10), while the time needed using different approaches (no pre-operative orthodontics or obstruction removal and then to wait over an assessment period) ranged from 12 to 18 months (mean 15 ± 2.12) and 17 to 30 months (mean 23.73 ± 5.14), respectively (p < 0.05). The time needed for full alignment depended on the inclination, the height of the impacted tooth (p = 0.001) and the patient's age (p = 0.002). Additionally, the absence of pre-operative orthodontics for space creation dramatically increased treatment time (p = 0.018). In contrast, the maturity of the impacted tooth and the developmental stage of the anterior teeth did not affect treatment time. Finally, when the location of the impacted tooth and the space availability allowed waiting for spontaneous eruption, treatment time was not statistically different from that of the main treatment protocol (p = 0.545). CONCLUSIONS: The studied treatment protocol appears ideal for successful results and minimum treatment time. Space creation followed by surgical removal of any obstruction together with orthodontic traction initiation produces excellent results, while waiting for spontaneous eruption is indicated only in cases of favourable patient's age and tooth location. Treatment initiation with operation in the absence of the required eruption space is not recommended, whereas in unfavourable cases obstruction removal without simultaneous orthodontic traction increases dramatically the total treatment time and requires an unnecessary second operation for traction.

Oro-facial tumours and tumour-like lesions in Greek children and adolescents: an 11-year retrospective study.

OBJECTIVE: To determine the epidemiology, histological diagnosis and treatment outcome of oro-facial tumours and tumour-like lesions in Greek children and adolescents. MATERIAL AND METHODS: The medical records of patients with oro-facial lesions who presented at the Department of Oral and Maxillofacial Surgery at "A. & P. Kyriakou" Children's Hospital from 2000 to 2010 were reviewed. Data was analyzed in relation to age, gender, location, histology, treatment choice and outcome. RESULTS: Two hundred and eleven oro-facial lesions were identified. Age ranged from 14 days to 15 years (mean 8 years); the male-to-female ratio was 1.09: 1; 90.05% of the lesions were benign and 9.95% malignant. Vascular anomalies were the most common benign lesion (22.1%) and rhabdomyosarcoma was the most prevalent malignancy (28.57%). One hundred and ten lesions (52.1%) involved soft tissue, most commonly the tongue and 96 cases (45.5%), involved hard tissue, most frequently the mandible; 5 lesions (2.4%) involved both hard and soft tissue. Surgery was performed under general anaesthesia in 198 cases (93.84%). Some malignant lesions were treated with chemotherapy and/or radiotherapy. CONCLUSIONS: Oro-facial tumours and tumour-like lesions are not uncommon in the Greek paediatric population; although most frequently benign, these may cause considerable morbidity. As such early diagnosis and treatment are imperative.

Iliac crest morbidity following maxillofacial bone grafting in children: a clinical and radiographic prospective study.

UNLABELLED: Bone harvesting from the anterior iliac crest is commonly performed for grafting of maxillofacial defects. PURPOSE: To evaluate the morbidity of the procedure in children and adolescents with clefts or maxillofacial defects after tumour removal. PATIENTS AND METHODS: Between 2001 and 2008 36 consecutive patients who underwent iliac crest bone grafting using the trap-door technique were evaluated 6 months to 7 years postoperatively. Objective and subjective findings regarding the donor site mostly but also the recipient site were assessed by a standardized physical and radiological examination and a questionnaire. The donor site scar, neurosensory and motility function were evaluated clinically and osseous healing was investigated through radiographic examination of the ilium. RESULTS: All respondent patients (29 out of the 36) tolerated the procedure well without major complications. Minor complications (mild pain and limp) were of short duration. No growth disturbances or contour deficits at the donor site were noted. No neurosensory or functional irregularities were detected. The donor site scar was considered aesthetically acceptable and most of the patients were satisfied with the functional outcome at the recipient site. CONCLUSIONS: Bone harvesting from the anterior iliac crest was found to be a safe and reliable procedure for maxillofacial bone grafting in paediatric patients. No complications were encountered, the morbidity was minimal and the aesthetic outcome was good.

Case report: desmoplastic fibroma of the mandible in a child presenting with TMJ dysfunction.

BACKGROUND: Desmoplastic fibroma of bone is a rare intraosseous benign but locally aggressive tumor of connective tissue origin. The lesion may affect the metaphyses of the long bones but it may also involve the skull bones and more specifically the mandible, with most lesions appearing in the ramus-angle area. Treatment is surgical although additional chemotherapy or radiation has been applied. CASE REPORT: A 10-year-old boy initially presented with restriction and deviation of mouth opening. Clinical and radiological examination revealed a tumor-like lesion of the mandible extending into the soft tissues, which on biopsy proved to be a desmoplastic fibroma. TREATMENT: The surgical treatment included peripheral ostectomy of the mandible, via an intraoral approach, for the removal of the lesion and restoration of the bone defect with an iliac bone autograft. FOLLOW-UP: The high recurrence rate of this type of lesion, demands a strict follow-up schedule. In the case presented, 5 years post-operatively, there are no signs of local recurrence. CONCLUSION: Changes in mouth opening when not attributed to obvious reasons, such as trauma, should make a dentist suspicious and lead to further investigation. In the case presented, a central lesion was revealed in the radiograph and the patient was referred and treated early. Extended surgical removal of the tumor, with wide margins, proved to be the appropriate treatment.

Use of membrane and bone grafts in the reconstruction of orbital fractures.

OBJECTIVE: To present and analyze the clinical results derived from the use of different grafts for the reconstruction of orbital defects during a 10-year period. STUDY DESIGN: Fifty-five fracture cases with orbital bony defect, requiring a graft, are presented. The surgical treatment includes the reconstruction of the fracture (osteosynthesis) and the repair of the remaining bone defect by graft, with the type of graft dependent on the size of the defect. For minor defects membranes were used (lyophilized dura or alloplastic dura mater), whereas major defects were repaired with bone grafts (autografts, heterografts, or bone substitute material). All patients have been regularly evaluated for at least one year postoperatively. RESULTS: All grafts were well tolerated by the patients. Diplopia subsided in all but 5 cases, motility disturbance was fully repaired in all but 3 cases. Esthetics were improved in cases with severe bone defect. CONCLUSION: The wide variety of grafts available allows successful reconstruction of all types of orbital bony defects. The clinician should be able to use different types of grafts depending on the type and size of the defect.

Miniplate osteosynthesis for fractures of the edentulous mandible: a clinical study 1989-96.

Our 8 years experience of treating fractures of the edentulous mandible by miniplate osteosynthesis, is discussed. Forty patients (31 men and 9 women) aged 37 to 86 years (mean: 64.6 years, SD: +/- 14.07) with 67 fracture sites were treated. The surgical approach was mainly intraoral (37 out of 40 patients) without the use of intermaxillary fixation. The postoperative clinical and radiological findings are reported and discussed. The advantages of the method are of great importance since immediate postoperative opening of the mouth is permitted, as the fractured bones are anatomically stabilized by means of titanium miniplates and screws. Our results were felt to be satisfactory, with a reoperation rate of only 3.9% (two out of 51 operated fracture sites, 16 condylar fractures were treated conservatively). This allows us to propose intraoral miniplate osteosynthesis as a routine method of treatment in cases of edentulous mandibular fractures which are mainly seen in elderly people.