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1.
Int J Oral Maxillofac Implants ; 37(4): 793-803, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35904837

RESUMO

PURPOSE: The aim of this study was to introduce and evaluate a modified one-and-a-half-barrel fibular technique guided by occlusion for functionally reconstructing mandibular defects. MATERIALS AND METHODS: Fifteen patients underwent mandibular reconstruction with the modified one-and-a-half-barrel technique and simultaneous insertion of dental implants. A vascularized fibular segment was used to reconstruct the alveolar ridge of the neomandible with dental implants loaded simultaneously. The inferior border was reconstructed with a nonvascularized segment. Panoramic radiographs were taken 1 week, 6 months, and 12 months after the surgery to measure the vertical height of the fibular segment, calculate the bone resorption rate at different time points, and observe the implant marginal bone loss and crown-to-implant ratio. The OHIP-14 questionnaire was employed to evaluate the perceived outcomes of oral rehabilitation. RESULTS: The vertical height of the vascularized and nonvascularized fibular segments 1 week, 6 months, and 12 months after the surgery was 14.51 ± 1.93, 14.19 ± 1.88, and 13.81 ± 1.78 mm; and 8.65 ± 0.98, 7.72 ± 0.94, and 7.25 ± 0.93 mm, respectively. The bone resorption rate of vascularized and nonvascularized fibular segments was 2.20% ± 1.04% and 10.69% ± 5.73%, respectively, in the first 6 months, and 2.67% ± 1.44% and 6.16% ± 2.75%, respectively, in the latter 6 months, showing a significantly higher resorption rate in the nonvascularized segment (P < .05). The implant marginal bone loss after functional loading was significantly greater than that before dental rehabilitation (P = .001). The OHIP-14 total scores were 20.07 ± 10.24, 19.00 ± 7.82, and 3.93 ± 1.87 before surgery, at 6 months, and at 12 months after surgery, respectively (P = .000). CONCLUSION: The proposed technique not only guarantees the esthetic appearance of patients but also achieves a suitable vertical height to facilitate the placement of the implant at the same time.


Assuntos
Reabsorção Óssea , Implantes Dentários , Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reabsorção Óssea/cirurgia , Transplante Ósseo/métodos , Implantação Dentária Endóssea/métodos , Humanos , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(6): 691-697, 2022 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-35712925

RESUMO

Objective: To explore the application of personalized guide plate combined with intraoperative real-time navigation in repairing of mandibular defect using fibula muscle flap, providing the basis for the precise repair and reconstruction of mandible. Methods: The clinical data of 12 patients (9 males and 3 females) aged from 23 to 71 years (mean, 55.5 years) between July 2019 and December 2021 were recorded. These patients were diagnosed as benign or malignant mandibular tumors, including 2 cases of ameloblastoma, 6 cases of squamous cell carcinoma, 2 cases of osteosarcoma, 1 case of adenoid cystic carcinoma, and 1 case of squamous carcinoma. All patients were treated with mandibular amputation, and then repaired by double-stacked three-segment fibula muscle flap. Preoperative virtual design scheme and guide plate were performed. During the operation, personalized guide plate combined with real-time navigation was used for fibular osteotomy and shaping. Thin-slice CT examination was performed at 2-3 weeks after operation, and was fitted with the preoperative virtual design scheme. The difference between the distance of bilateral mandibular angles relative to the reference plane in three-dimensional directions (left-right, vertical, and anterior-posterior) and the difference of the medial angle of the lower edge of the mandible reconstructed by fibula were measured, and the mean error of chromatographic fitting degree was calculated. Results: The guide plate and navigation were applied well, and the fibula shaping and positioning were accurate. The fibula muscle flap survived, the incision healed well, and the occlusal relationship was good. All 12 patients were followed up 1-29 months, with an average of 17 months. There was no significant difference on the distance of bilateral mandibular angles relative to the reference plane in the left-right [(-0.24±1.35) mm; t=-0.618, P=0.549], vertical [-0.85 (-1.35, 1.40) mm; Z=-0.079, P=0.937], and anterior-posterior [(-0.46±0.78) mm; t=-2.036, P=0.067] directions. The difference of the medial angle of the lower edge of the mandible reconstructed by fibula was also not significant [(-1.35±4.34)°; t=-1.081, P=0.303)]. Postoperative CT and preoperative virtual design fitting verified that there was no significant difference in the change of the mandibular angle on both sides, and the average error was (0.47±1.39) mm. Conclusion: The personalized guide combined with intraoperative real-time navigation improves the accuracy of peroneal muscle flap reconstruction of the mandible, reduces the complications, and provides a preliminary basis for the application of visual intraoperative navigation in fibula muscle flap reconstruction of the mandible.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Procedimentos Cirúrgicos Reconstrutivos , Feminino , Fíbula/cirurgia , Humanos , Masculino , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Reconstrução Mandibular/métodos , Músculos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos
3.
Shanghai Kou Qiang Yi Xue ; 31(1): 71-74, 2022 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-35587673

RESUMO

PURPOSE: To explore the appropriate surgical approach for each type of maxillary ameloblastoma. METHODS: The clinical data of 92 patients with maxillary ameloblastoma were retrospectively analyzed. All patients were pathologically diagnosed, followed up for 3-8 years after surgery, maxillofacial CT and panoramic images were taken regularly to observe the surgical outcomes. SPSS 22.0 software package was used for data analysis. RESULTS: The proportion of maxillary ameloblastoma in male and female patients was 3 to 1,with more male patients and the mean age was 45.77 years old. The total recurrence rate of 92 patients was 21.74%, among which unicystic ameloblastoma had no recurrence after different surgical procedures. Among 38 patients with typical maxillary ameloblastoma, 14 underwent curettage, 3 underwent decompression,16 underwent extended resection, 3 underwent subtotal maxillary resection, 1 underwent iliac bone transplantation after subtotal maxillary resection, and 1 underwent reconstruction with anterolateral thigh flap after subtotal maxillary resection. Among them, 18 had recurrence and 5 had canceration. Three patients with extrasseous/peripheral type underwent expanded resection and two underwent curettage,none of them had recurrence. One patient with metastasizing ameloblastoma recurred after extended resection. CONCLUSIONS: Maxillary ameloblastoma with unicystic type should be completely removed with minimal trauma. The recurrence rate of maxillary ameloblastoma via simple curettage or extended resection is still relatively high, which may be due to the large tumor involvement scope of these patients and the failure of complete tumor removal by curettage. For external/peripheral ameloblastoma and metastatic ameloblastoma, the involved jaw bone should be removed as much as possible to prevent recurrence. For malignant transformation of ameloblastoma, the tumor and jaw bone should be dissected during the operation to reduce recurrence rate. The primary site, cervical lymph nodes and lungs should be closely followed after operation to detect early metastasis.


Assuntos
Ameloblastoma , Neoplasias Mandibulares , Ameloblastoma/diagnóstico por imagem , Ameloblastoma/patologia , Ameloblastoma/cirurgia , Transplante Ósseo , Feminino , Humanos , Masculino , Neoplasias Mandibulares/patologia , Neoplasias Mandibulares/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos
4.
Curr Oncol ; 29(5): 3375-3392, 2022 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-35621664

RESUMO

The aim of this monocentric, retrospective clinical study was to evaluate the status of osseous union in uni- and poly-segmental mandible reconstructions regarding conventional angle-stable manually bent osteosynthesis plates (Unilock 2.0 mm) versus titan laser-melted PSI patient-specific implant's (PSI). The clinical impact of PSI's high stiffness fixation methods on bone healing and regeneration is still not well addressed. The special interest was in evaluating the ossification of junctions between mandible and fibula and between osteotomized fibula free flap (FFF) segments. Panoramic radiograph (OPT), computed tomography (CT) scans, or cone-beam CTs (CBCT) of patients who underwent successful FFF for mandible reconstruction from January 2005 to December 2020 were analyzed. A total number of 89 cases (28 females (31.5%), 61 males (68.5%), mean age 58.2 ± 11.3 years, range: 22.8-82.7 years) fulfilled the chosen inclusion criteria for analysis (conventional: n = 44 vs. PSI: n = 45). The present study found an overall incomplete ossification (IOU) rate of 24.7% (conventional: 13.6% vs. PSI: 35.6%; p = 0.017) for mandible to fibula and intersegmental junctions. Between osteotomized FFF segments, an IOU rate of 16% was found in the PSI-group, while no IOU was recorded in the conventional group (p = 0.015). Significant differences were registered for IOU rates in poly-segmental (p = 0.041), and lateral (p = 0.016) mandibular reconstructions when PSI was used. Multivariate logistic regression analysis identified plate exposure and type of plate used as independent risk factors for IOU. Previous or adjuvant radiotherapy did not impact incomplete osseous union in the evaluated study sample. PSI is more rigid than bent mini-plates and shields functional mechanical stimuli, and is the main reason for increasing the rate of incomplete ossification. To enhance the functional stimulus for ossification it has to be discussed if patient-specific implants can be designed to be thinner, and should be divided into segmental plates. This directs chewing forces through the bone and improves physiological bone remodeling.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Idoso , Transplante Ósseo/métodos , Feminino , Fíbula/cirurgia , Humanos , Masculino , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Reconstrução Mandibular/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
J Med Case Rep ; 16(1): 176, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35484609

RESUMO

BACKGROUND: Mandible can be the site of benign or malignant lesions of different origins, including odontogenic and non-odontogenic lesions. Cartilage-forming tumors have been rarely reported at this site. Chondrosarcoma is a rare malignant cartilage-producing neoplasm that is extremely rare in the mandible. The rarity of cartilage-forming tumor occurrence in the mandible can make diagnosis difficult for pathologists, as they do not expect this type of tumor at this anatomical site. Here we report a case of chondrosarcoma of mandibular angle. CASE PRESENTATION: A 70-year-old Moroccan male patient consulted a dentist for wisdom tooth pain. Wisdom tooth extraction was conducted. After 6 months, the patient reported the recurrence of pain associated with swelling in the mandibular area and paresthesia along the path of the mandibular nerve. A panoramic radiograph demonstrated a mixed radiolucent-opaque lesion involving the mandibular angle. Computed tomography showed a large osteolytic spontaneously hypointense and multilobulated lesion. A biopsy was done. Histopathological examination revealed sheets and irregular lobules of atypical cells presenting cartilaginous differentiation. Tumor cells showed severe nuclear atypia and were located within a hyaline cartilage matrix. Some foci of necrosis were noted. Osteoid deposits were not found. The patient was diagnosed with grade III chondrosarcoma and underwent a right segmental mandibulectomy with submandibular lymph node dissection. Macroscopically, the tumor was localized in the mandibular angle with extension in the mandibular body. Histopathology confirmed the previous diagnosis of grade III chondrosarcoma and did not show any lymph node metastasis. CONCLUSIONS: Owing to many histological similarities, grade III chondrosarcoma must be distinguished from chondroblastic osteosarcoma and metastatic lesions. In addition, chondroblastic osteosarcoma of the jawbones has a worse prognosis than chondrosarcoma, making the distinction between these two malignant tumors the most important concern of the pathologist when dealing with a cartilage-forming tumor at this site. Surgery with wide excision margins remains the best therapeutic approach, while the role of radiotherapy is controversial. The management of mandibular chondrosarcoma requires a multidisciplinary approach involving maxillofacial surgeons, radiologists, pathologists, and oncologists.


Assuntos
Condrossarcoma , Neoplasias Mandibulares , Neoplasias de Tecido Conjuntivo , Osteossarcoma , Idoso , Cartilagem/patologia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/cirurgia , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/patologia , Mandíbula/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/patologia , Neoplasias Mandibulares/cirurgia , Dor , Doenças Raras
6.
Plast Reconstr Surg ; 149(6): 1419-1428, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35426886

RESUMO

BACKGROUND: Precise planning and evaluation of the fibula bone are necessary if immediate endosseous implant placement is considered. Limited information is available on the anatomical dimensions or density of fibula used in mandibular reconstructions. This study aimed to describe the morphology and dimensions of the fibula used to reconstruct segmental mandibular defects and contrast the findings with the native mandible. METHODS: A retrospective analysis was performed of patients who underwent segmental mandibulectomy reconstructed with osteocutaneous fibula flaps and had at least one postoperative computed tomography scan. Fibula cross sectional dimensions and densities were evaluated with three-dimensional software. Radiographic measurements were obtained from the contralateral mandible medial to the first molar for comparison. RESULTS: Four hundred seventy-seven fibula cross sections from 159 segments were evaluated. Cross-sectional oval, quadrilateral, triangular, and pentagonal shapes differed significantly in proportion (p < 0.001). Thirty-eight percent of segments (95 percent CI, 30 to 46 percent) had differences in cross-section height greater than 1 mm (p < 0.001). Between segments within the same patient, the median height difference was 1.58 mm (range, 0.14 to 6 mm). The superior cortex density was significantly higher for the fibula than the native mandible; however, the medullary space density was significantly lower (p < 0.001). CONCLUSIONS: The current study comprises the most comprehensive description of fibula morphology in mandibular reconstructions and highlights the significant variability that exists. The findings provide justification for the added time and cost of computer-aided design and computer-aided manufacturing in centers interested in performing immediate dental implant placement, as the technology provides the necessary precision and accuracy.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Transplante Ósseo , Estudos Transversais , Fíbula , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Reconstrução Mandibular/métodos , Estudos Retrospectivos
7.
Oral Oncol ; 127: 105800, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35255279

RESUMO

INTRODUCTION: Post- resection defects in the area of the head and neck frequently result in functional impairment of the masticatory system and unaesthetic outcome in the facial appearance. In pediatric population they exert a devastating effect on speech development, breathing and facial growth leading to secondary deformations which are extremely challenging in reconstruction by means of conventional surgery protocols. MATERIAL AND METHODS: 21 patients (14 males/ 7 females) aged 4-17 years old, treated between 2015 and 2019 due to malignant/benign tumors or congenital deformities requiring mandible resection were enrolled in the study. All patients underwent Virtual Surgical Planning (VSP), mandible tumor resection with use surgery guides and defect reconstruction with microvascular bone graft supported with custom implants. Postoperatively, 3D models used for the planning and postoperative 3D model of the reconstructed mandible were compared using authors method based on easily measurable morphometric measurements (3 angles, 3 linear dimensions), allowing a three-dimensional quantitative assessment of postoperative outcomes of the surgery. Linear regression analysis and one-way analysis of variance were used to evaluate the clinical material. The difference was considered significant if p < 0.05. RESULTS: Free fibula flap (FFF) was most commonly used type of the reconstruction of the pediatric mandible. The average maximum deviation for the analyzed cases was 7.7 mm, and the average minimum deviation was -6.09 mm, however without significant differences and the postoperative position of the mandible condyle was comparable to the position designed in the 3DVSP preoperatively. Position of the whole reconstructed mandible by means of individually planned grafts and plates provided comparable position of the ramus and mandible body and no chin deviation as the differences between the pre-operative axial and sagittal angles and their post-operative equivalents were insignificant (p > 0,05). CONCLUSIONS: This study confirms applicability of the 3DVSP in pediatric craniomaxillofacial surgery. Preoperative planning of the osteotomies, grafting technique and production of the individualized guides and implants provides precise tumor resection and immediate reconstruction adjusted to the specific anatomy of the pediatric patients.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Adolescente , Criança , Pré-Escolar , Feminino , Fíbula/cirurgia , Retalhos de Tecido Biológico/cirurgia , Humanos , Masculino , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Reconstrução Mandibular/métodos
9.
Ned Tijdschr Tandheelkd ; 129(2): 67-71, 2022 Feb.
Artigo em Holandês | MEDLINE | ID: mdl-35133736

RESUMO

In an 18-year-old boy, the middle segment of the mandible was removed because of a locally aggressive tumour. The reconstruction became infected and was lost, resulting in 2 separately-moving mandible parts and oral disability. For the second reconstruction, skeletal fixation with osteosynthesis plates, dental fixation with a stabilization frame and intermaxillary fixation were used. Preparation for returning the jaws to their original position was facilitated by three-dimensional simulation software. After a successful second reconstruction, an implant-supported removable bridge was eventually placed.


Assuntos
Neoplasias Mandibulares , Mixoma , Tumores Odontogênicos , Adolescente , Humanos , Masculino , Mandíbula , Neoplasias Mandibulares/cirurgia , Mixoma/cirurgia , Tumores Odontogênicos/cirurgia
10.
J Oral Maxillofac Surg ; 80(6): 1115-1126, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35189087

RESUMO

PURPOSE: We present our experience with transoral segmental mandibulectomy, in conjunction with vascularized osseous mandibular reconstruction, utilizing an intraoral anastomosis and free of extraoral incisions. Virtual surgical planning and intraoperative navigation were used to help achieve this minimally invasive and scar-free approach. METHODS: A retrospective study was performed on 9 patients who underwent transoral segmental mandibulectomy followed by vascularized osseous reconstruction using an intraoral anastomosis between January 2018 and October 2018. The anastomotic recipient vessels were the facial artery and vein. The outcome variable was defined as the flap survival. Postoperative panoramic radiographs and computed tomography images were obtained for assessment of the neo-mandible. In addition, we performed a cadaver dissection to highlight relevant anatomic details of the facial artery and vein. RESULTS: Successful transoral segmental mandibulectomy was achieved in 9 patients, with an intraoral anastomosis successfully achieved in 8 patients. In one patient, an extraoral anastomosis was required because of challenging facial vein anatomy. Both recipient and donor sites healed uneventfully with a 100% successful rate of flap survival. In all cases, a well-positioned neo-mandible with good occlusion was demonstrated on postoperative imaging and examination. A symmetric facial appearance with no restrictions in mouth opening was also achieved in each case. In our cadaver dissection, we describe the anatomical course of the facial artery and vein. An average angle of 30° between these vessels is identified. CONCLUSIONS: Transoral segmental mandibulectomy combined with intraoral microvascular mandibular reconstruction is a surgically achievable technique with the benefit of being scar free.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Procedimentos Cirúrgicos Reconstrutivos , Transplante Ósseo/métodos , Cadáver , Cicatriz , Retalhos de Tecido Biológico/cirurgia , Humanos , Neoplasias Mandibulares/cirurgia , Osteotomia Mandibular/métodos , Reconstrução Mandibular/métodos , Estudos Retrospectivos
11.
J Med Case Rep ; 16(1): 8, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34996519

RESUMO

BACKGROUND: Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandible. The etiology is still unknown, and the hypothesis of its development is debated. CASE PRESENTATION: A 35-year-old Caucasian man presenting a tumor lesion in the right jawbone that had been growing for 8 years sought medical service complaining of speaking impairment. According to the patient, the tumor appeared shortly after a minor trauma caused by tooth extraction. The diagnosis of the lesion was made through clinical, radiographic, and histological methods, and the surgical treatment was successful and satisfactory for the patient as well as the surgical team, despite a short follow-up. CONCLUSION: Etiopathogenesis of osteoma is not determined in the majority of cases. In the present report, it was possible to hypothesize the association between a minor trauma and the development of the tumor, reinforcing the reactive theory of tumor development. The uncommon location of the osteoma, as well the possibility of identifying the possible cause of the lesion, makes this case particularly interesting.


Assuntos
Neoplasias Mandibulares , Osteoma , Adulto , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/cirurgia , Anamnese , Osteoma/diagnóstico por imagem , Osteoma/cirurgia , Extração Dentária
14.
Int J Oral Maxillofac Surg ; 51(2): 191-199, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34384647

RESUMO

Unsuccessful mandibular reconstruction occasionally occurs, leaving the patient with undesirable function and contours. In such cases, second- or third-time corrective operations are challenging. However, published studies on the complicated retreatment of such patients are scarce. A retrospective analysis covering the years 2015-2019 was conducted in three centers. All 17 patients included had undergone prior failed mandibular reconstructions in other institutions. Salvage secondary or tertiary reconstructive surgeries were attempted and the results are presented. Major factors for these failed reconstructions included exposed non-vascularized bone grafts (n = 7, 41.2%), flap loss (n = 4, 23.5%), exposed artificial joint (n = 3, 17.6%), skewed occlusion with deformity (n = 1, 5.9%), non-union (n = 1, 5.9%), and recurrence (n = 1, 5.9%). Fibula flaps were transferred in 15 patients, while iliac flaps were used in two patients for mandibular re-do reconstructions. Virtual surgical designs were conducted in nine (52.9%) patients, with navigation-guided approaches performed in three cases. Postoperative functions were relatively favorable in these complicated mandibular re-do reconstruction cases. Mandibular symmetry (mandibular length and height; P = 0.002) and condylar position (P < 0.001) were regained after these re-do attempts. Secondary or tertiary mandibular re-do reconstruction can still achieve good functional outcomes with appropriate preoperative selection and well-conceived designs, especially with the aid of virtual surgery and navigation.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Procedimentos Cirúrgicos Reconstrutivos , Transplante Ósseo , Fíbula , Humanos , Mandíbula/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos
16.
Medicine (Baltimore) ; 100(50): e28001, 2021 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-34918649

RESUMO

RATIONALE: Melanocytic neuroectodermal tumor of infancy (MNTI) is a rare benign pigmented neoplasm that arises from the neural crest and has an aggressive growth pattern. It is predominantly seen in infants under 1 year of age, and the most common site of involvement is the maxilla. The currently accepted treatment is removal by surgical resection. Herein, we report a case of MNTI that involved the anterior alveolar ridge of the mandible in a 6-month-old infant. PATIENT CONCERNS: A case of a 6-month-old male child with a huge mass in the anterior alveolar ridge of the mandible. DIAGNOSIS: The tumor was diagnosed using histopathological and immunohistochemical techniques on the biopsy specimen obtained following incisional biopsy. Based on the findings, a final diagnosis of MNTI was established. INTERVENTIONS: Radical resection of the tumor was performed, after determining the extent of resection by referring to the mandibular 3D model created using the pre-operative CT data. OUTCOMES: The postoperative course was uneventful, and no recurrence has been observed to date for more than 4 years after surgery. LESSONS: This case emphasizes that early diagnosis and radical surgery are critical to the effective treatment, as MNTI exhibits rapid and destructive growth. It also requires careful and close follow-up because of high recurrence rates.


Assuntos
Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Osteotomia Mandibular , Tumor Neuroectodérmico Melanótico/cirurgia , Biópsia , Criança , Humanos , Lactente , Masculino , Mandíbula/diagnóstico por imagem , Neoplasias Mandibulares/diagnóstico , Neoplasias Mandibulares/patologia , Tumor Neuroectodérmico Melanótico/diagnóstico , Tumor Neuroectodérmico Melanótico/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Medicina (Kaunas) ; 57(12)2021 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-34946328

RESUMO

Cemento-ossifying fibroma (also known as ossifying fibroma or cementifying fibroma) is a benign osteogenic neoplasm. Pain and paresthesia are rarely associated with cemento-ossifying fibroma; thus, nerves must be preserved during excision. With the advent of computer-aided techniques, the use of virtual surgical planning and a customized template can improve the precision of resection and reconstruction, reduce operating time, and improve postoperative outcomes. In this report, we describe a case of cemento-ossifying fibroma in a female patient who underwent segmental mandibulectomy and reconstruction with an iliac bone graft. Additionally, we describe a simple and effective way to preserve the inferior alveolar nerve.


Assuntos
Cementoma , Fibroma Ossificante , Neoplasias Mandibulares , Feminino , Fibroma Ossificante/diagnóstico por imagem , Fibroma Ossificante/cirurgia , Humanos , Remoção , Neoplasias Mandibulares/cirurgia , Nervo Mandibular/cirurgia
18.
Indian J Dent Res ; 32(2): 256-260, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34810399

RESUMO

Squamous cell carcinoma (SCC) is commonly seen malignant epithelial neoplasm of the oral cavity, which is characterized by variable clinical manifestations. It arises from dysplastic squamous epithelium. Majority of the spread of oral SCC (OSCC) to mandibular bone occurs by direct infiltration of the tumour through alveolar ridge or lingual cortical plate. Only 6% of the OSCC present with primary tumour; hence, a comprehensive whole body imaging needs to be done for ruling out primary tumour anywhere else in the body along with a proper clinical examination. Here, we present an unusual case of long-standing aggressive primary malignancy with unusual clinical presentation in mandibular anterior region associated with chronic tobacco chewing in a 65-year-old male patient.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Mandibulares , Neoplasias Bucais , Idoso , Processo Alveolar , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/cirurgia
19.
Artigo em Chinês | MEDLINE | ID: mdl-34666440

RESUMO

Objective: To analyse the quality of life of patients receiving repair of bone defect with folded fibula flap after removal of mandibular ameloblastoma. Methods: The case data of 39 patients with ameloblastoma admitted to the First Affiliated Hospital of Zhengzhou University from August 2013 to April 2016 were retrospectively analysed, including 21 males and 18 females, from 18 to 58 years old. 3D printing and digital technology were used in flap preparation before surgery in all patients. The folded fibular flaps were used to repair mandibular defects and the implants were placed between 6-9 months after surgery. The short form-36 health survey questionnaire (SF-36) and the university of Washington quality of life questionnaire (UW-QOL) were applied to evaluate the quality of life of patients before surgery and at 6 months and 24 months after surgery. The higher the score, the better the condition. SPSS 20.0 was adopted for statistical analysis. Results: The SF-36 survey showed that the mean score of body role before surgery (72.4±11.7) was significantly higher than that at 6 months after surgery (39.6±11.1, t=23.580, P<0.05) or that at 24 months after surgery (59.8±6.4, t=8.358, P<0.001). Compared with the preoperative mean scores of Physical Pain (73.0±11.0), General Health (73.4±10.4) and Health Changes (79.2±3.9) before surgery, the mean scores Physical Pain (53.1±7.7), General Health (53.5±7.5) and Health Changes (63.9±11.7) at 6 months after surgery were decreased significantly respectively (t=13.068, 13.756 and 10.880, respectively, all P<0.05), but the mean scores Physical Pain (78.8±14.0), General Health (80.9±12.6) and Health Changes (84.4±4.6) at 24 months after surgery were increased significantly respectively (t=-2.904, -4.027 and -7.586, respectively, all P<0.05), with significant differences in the mean scores of Physical Pain, General Health and Health Changes between 6 and 24 months after surgery (t=-14.241, -16.490, -14.294, respectively, all P<0.001). The UW-QOL survey showed that the mean scores of chewing, language and taste functions decreased at 6 months after surgery (53.1±6.7, 53.0±7.7 and 62.2±9.9, respectively), but improved at 24 months after surgery (67.9±3.9, 63.9±2.9 and 68.4±11.1, respectively), with statistically significant difference (t=-16.765, -11.675 and 2.498, respectively, all P<0.001). Conclusion: The application of folded fibula flaps to repair bone defects after sugery of mandibular ameloblastoma can better meet the needs of language and chewing functions and improve the quality of life of patients.


Assuntos
Ameloblastoma , Retalhos de Tecido Biológico , Neoplasias Mandibulares , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Ameloblastoma/cirurgia , Transplante Ósseo , Feminino , Fíbula/cirurgia , Humanos , Masculino , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Adulto Jovem
20.
Diagn Pathol ; 16(1): 91, 2021 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-34657606

RESUMO

BACKGROUND: The rarity of juvenile psammomatoid ossifying fibroma (JPOF) and lack of cytogenetic studies prompted us to report a novel SETD2 gene mutation in a benign odontogenic tumour. CASE PRESENTATION: A 21-year-old man presented with a hard, expanded mandibular cortex. Computed tomography revealed multilocular radiopacity in the mandible; this was reconstructed via segmental mandibulectomy using a vascularised iliac crest flap. Based on the clinical and histological findings, we diagnosed JPOF associated with an aneurysmal bone cyst. Microscopically, the solid area was characterised by many rounded or angular ossicles in a cellular fibrous stroma. The stromal cells were spindle-like or stellate. Next-generation sequencing detected a frame shift mutation of the SETD2 gene, while the copy number was normal. CONCLUSIONS: Our findings suggest further genetic studies should be performed to assess whether this mutation is related to tumour genesis. .


Assuntos
Biomarcadores Tumorais/genética , Cistos Ósseos Aneurismáticos/genética , Fibroma Ossificante/genética , Mutação da Fase de Leitura , Histona-Lisina N-Metiltransferase/genética , Neoplasias Mandibulares/genética , Tumores Odontogênicos/genética , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/patologia , Cistos Ósseos Aneurismáticos/cirurgia , Análise Mutacional de DNA , Fibroma Ossificante/diagnóstico por imagem , Fibroma Ossificante/patologia , Fibroma Ossificante/cirurgia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/patologia , Neoplasias Mandibulares/cirurgia , Tumores Odontogênicos/diagnóstico por imagem , Tumores Odontogênicos/patologia , Tumores Odontogênicos/cirurgia , Adulto Jovem
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