Recurrent dislocation of the temporomandibular joint: a literature review and two case reports treated with eminectomy.

AIMS: Dislocation of the temporomandibular joint (TMJ) is a troublesome condition that occurs in a chronic or acute form. It is a distressing and highly embarrassing situation that may occur as a result of daily activities such as yawning, laughing, or during events that require keeping the mouth open for a long time. This review aims to present and discuss different conservative and surgical techniques to treat patients with a dislocated mandible, and to present two cases of surgical treatment. METHODOLOGY: A search of the literature was completed (Medline, PubMed) using the keywords TMJ dislocation, TMJ luxation, mandibular dislocation and surgical and non-surgical methods of treatment for this condition. RESULTS: Eminectomy (Myrhaug's surgery) has been used with satisfactory results. Most of reports present large series of patients with more than one year of follow-up and no recurrence of complications. Is less invasive and take a short operation time; need no bone transplantation or placing any kind of foreign body into the joint. CONCLUSION: Eminectomy results in long-term resolution of recurrent TMJ dislocations, when compared with others surgical techniques.

Eagle's syndrome: treatment by intraoral bilateral resection of the ossified stylohyoid ligament. A review and report of two cases.

The complexities of Eagle's syndrome are examined according to anatomical, historical, clinical, and treatment aspects. There appears to be little correlation between the extent, form, and size of the anomalies of the styloid process and the stylohyoid ligament and the predictability of patients with related symptoms. Surgical treatment and the advantages and disadvantages of each surgical approach (intra- and extraoral) are discussed. The probable causes of enlargement of the styloid process and ossification of the stylohyoid ligament are addressed. Two cases of Eagle's syndrome are presented: one unilateral and the other bilateral. An intraoral modified surgical technique is presented.

Oral and maxillofacial manifestations of familial adenomatous polyposis (Gardner's syndrome): a report of two cases.

AIM: The aim of this case report is to emphasize the importance of an early diagnosis of Gardner's syndrome through the detection of lesions appearing in the oral and maxillofacial area as well as to present two cases of the disease. BACKGROUND: Gardner's syndrome is an autosomal dominant disease characterized by gastrointestinal polyps that develop in the colon as well as in the stomach and upper intestine, along with multiple osteomas, skin, and soft tissue tumors. Cutaneous findings may include desmoid tumors, epidermoid cysts, and other benign tumors. Early diagnosis and therapy of the disease are critical because polyps have a 100% risk of undergoing malignant transformation. Craniomaxillofacial manifestations (osteoma formation, tooth impaction, diffuse opacities in the skull, mandible and maxilla, scalp tumors) usually precede polyposis. REPORT: Case 1: Gardner's syndrome was diagnosed in a 25-year-old Caucasian man who was referred by his endodontist for evaluation of an uncommon radiographic image in the mandibular molar area. Further investigation revealed a familial adenomatous polyposis (FAP) complicated by adenocarcinoma of the colon. A colectomy and an ileorectal anastomosis were performed. Case 2: A 12-year-old Caucasian girl, who is a niece of the patient described in Case 1, presented with progressive difficulty with mouth opening but no complaints of digestive problems. Radiographic examination revealed multiple radiopacities in the maxilla, mandible left temporomandibular joint, and in the left mandibular angle. Multiple impacted teeth were present. A colonoscopy was suggested, but the patient's parents decided to continue the investigation and treatment with their own physician in their home town. SUMMARY: Since an early diagnosis is essential and general dental practitioners may be the first healthcare professionals to suspect the diagnosis, it is important for them to be familiar with the features of Gardner's syndrome.

Osteochondroma of the mandibular condyle: literature review and report of a case.

AIM: The intent of this report is to present a brief review of the literature on osteochondroma and to present a case involving the surgical removal and replacement of a major portion of the condyle and angle of the mandible using free autogenous mandibular bone. BACKGROUND: While osteochondroma is the most common tumor of skeletal bones, it is relatively uncommon in the jaws occurring at the condyle or the tip of the coronoid process. This benign cartilage-capped growth is usually discovered incidentally on radiographic examination or on palpation of a protruding mass in the affected area. Malocclusion and progressive facial asymmetry are common findings in most cases of condylar osteochondroma. REPORT: A case of a 29-year-old woman with an osteochondroma of the mandibular condyle is presented. Surgical treatment was tumor resection, grafting, and reshaping of the mandibular angle and ramus. As this lesion is usually asymptomatic and discovered incidentally on radiographic examination, the general practitioner usually is the first professional to make the diagnosis. SUMMARY: Condylectomy cannot be recommended as routine in all cases.37 Common surgical treatments include condylectomy and reconstruction.24 If the tumor involves only a limited area of the condylar surface, then preservation of the remaining portion of the condyle and reshaping should be done. Reasons for not taking such a conservative approach are the possibilities of malignancy and the risk of recurrence. In this case report the extraoral vertical ramus osteotomy, associated with free autogenous mandibular bone, presented several advantages.

Report of ankylosis of the temporomandibular joint: treatment with a temporalis muscle flap and augmentation genioplasty.

A case of true bilateral ankylosis of the temporomandibular joint (TMJ) is presented. A 19-year-old male patient had a life-threatening ear infection at the age of ten resulting in a progressive restriction of his mouth opening. He presented with almost complete lack of mobility of the mandible. Surgical treatment was a resection of the ankylotic mass, interpositional temporalis composite muscle flaps, and early mobilization and aggressive physiotherapy. The functional results of the interpositional arthroplasty were excellent. After a two-year follow up, an augmentation genioplasty was performed in order to improve facial aesthetics.

Dentoalveolar and mandibular body fractures caused by a horse kick: report of a case.

A rare case of multiple mandibular fractures and severe facial laceration is presented. The cause was a horse hoof kick to an unmounted equestrian. The pertinent literature is reviewed and the maxillofacial injuries associated with animal interaction are discussed.

Traumatic pseudolipoma of the oral cavity: report of a case.

An uncommon traumatic pseudolipoma of the oral cavity is presented. In this particular case there was evidence of previous trauma to the buccal fat pad during a difficult extraction of a maxillary premolar. Evidence is presented that iatrogenic trauma resulting in foreign body introduction might produce traumatic pseudolipoma in the oral cavity. The morphology of the buccal fat pad, the possible pathogenisis of the condition, as well as the diagnostic and the management of the case are presented.

Combined endodontic therapy and surgery in the treatment of dens invaginatus Type 3: case report.

An accurate understanding of the morphology of the root canal system is a prerequisite for successful root canal treatment. Invaginated teeth have a complex root canal configuration that cannot be instrumented effectively and should be treated by both endodontic therapy and surgery. A case of dens invaginatus Type 3 in a maxillary lateral incisor with a periapical lesion and its successful treatment by these combined methods is reported.

Fracture of the alveolar process in a 2-year-old child: a report of an unconventional immobilization.

This is a report of fracture of the maxillary anterior segment of the alveolar process of an energetic 2-year-old child. The fracture was reduced under general anesthesia, and the fractured segment was immobilized using only 2-0 chromic gut in order to avoid a second surgical episode to remove traditional fixation after healing. The patient was followed for one year and healed well with no evidence of the lack of vitality of the involved teeth.

Aneurysmal bone cyst of the coronoid process of the mandible: a case report.

A rare case of aneurysmal bone cyst (ABC) located in the ramus of the mandible with involvement of the coronoid process is presented. The pressure of the slow growing tumor apparently caused severe resorption of the zigomatic arch. Treatment consisted of enucleation of the tumor via a pre-auricular access. A two year follow-up showed restoration of facial symmetry and partial regeneration of the coronoid process. To our knowledge this is the second published case of an ABC of the coronoid process of the mandible.

Recurrence of an ameloblastoma in an autogenous iliac bone graft.

A rare case of recurrence of an ameloblastoma in an iliac bone graft many years after the initial operation for a mandibular amelolastoma with evidence of soft tissue invasion is presented. A review of the literature disclosed only 11 cases of recurrence of ameloblastoma in bone grafts. In the case presented the initial operation was a hemimandibulectomy followed by autogenous iliac bone graft. Sixteen years after the surgery there was clinical and radiographic signs of recurrence. It was concluded that extensive resection including bone as well as adjacent soft tissues is critical because the recurrences seem to stem from the soft tissues, especially from the adjacent periosteum.

Congenital maxillary double lip: review of the literature and report of a case.

A double lip is an anomaly that may be either congenital or acquired. It occurs most often in the upper lip, although both upper and lower lips are occasionally involved. Surgical intervention (simple excision) produces good functional and cosmetic results. In this report, we describe a case of congenital double upper lip, present a review of the literature and discuss the differential diagnosis. Double lip is of special interest in dentistry because the general practitioner is often the first professional to detect and establish the diagnosis of this uncommon condition.

Partial spontaneous bone regeneration subsequent to mandibulectomy.

A case of spontaneous bone regeneration after mandibulectomy is presented. The patient was young and had a mandibular resection performed for a large fibroma. Only one of the condyles was preserved. Partial preservation of the periosteum may play an important role in rapid bone regeneration. In this case bone regeneration occurred only in mandibular regions where the periosteum could be preserved.

Microstomia caused by swallowing of caustic soda: report of a case.

A case of microstomia caused by swallowing caustic soda is presented. A 54-year old man developed a progressive stricture of the circumoral region following accidental ingestion of caustic soda when he was 9 years old. He was treated by a general surgeon who performed bilateral commissurotomies when he was 19 years old and lived normally until he needed major dental prosthetic treatment. His dentist was unable to perform the treatment due to the mouth stricture. The surgical option was to perform bilateral buccal mucosal flaps. A review of the literature and the surgical technique are presented.

Multiple dentoalveolar traumatic lesions: report of a case and proposition of dental polytrauma as a new term.

Traumatic injuries to permanent teeth are common, and dramatic episodes can occur during childhood. The aim of this paper is to present a report of severe trauma to the orofacial complex of an 8-year old girl that resulted in multiple injuries. The use of the term "dental polytrauma" (concomitant different dental traumatic injuries) is advocated in this case presentation.

Horizontal and vertical maxillary osteotomy stability, in cleft lip and palate patients, using allogeneic bone graft.

OBJECTIVE: This study was carried out to evaluate maxillary stability after orthodontic-surgical treatment of patients with cleft lip and palate. Cephalometric analysis was applied to two different groups, with and without allogeneic bone graft. METHODS: The sample comprised 48 patients with cleft lip and palate. The test group comprised 25 patients who, after correction of maxillary position, received allogeneic bone graft at the gap created by Le Fort I osteotomy. The control group comprised 23 patients and its surgical procedures were similar to those applied to the test group, except for the use of bone graft. Manual cephalometric analysis and comparison between lateral teleradiographs, obtained at the preoperative phase, immediate postoperative phase and after a minimum period of six months, were carried out. RESULTS: An higher horizontal relapse was observed in the control group (p>0.05). There were no statistically significant differences in vertical relapses between test and control groups (p<0.05). CONCLUSION: The use of allogeneic bone graft in cleft lip and palate patients submitted to Le Fort I osteotomy contributed to increase postoperative stability when compared to surgeries without bone graft.

Horizontal and vertical maxillary osteotomy stability, in cleft lip and palate patients, using allogeneic bone graft

OBJECTIVE: This study was carried out to evaluate maxillary stability after orthodontic-surgical treatment of patients with cleft lip and palate. Cephalometric analysis was applied to two different groups, with and without allogeneic bone graft. METHODS: The sample comprised 48 patients with cleft lip and palate. The test group comprised 25 patients who, after correction of maxillary position, received allogeneic bone graft at the gap created by Le Fort I osteotomy. The control group comprised 23 patients and its surgical procedures were similar to those applied to the test group, except for the use of bone graft. Manual cephalometric analysis and comparison between lateral teleradiographs, obtained at the preoperative phase, immediate postoperative phase and after a minimum period of six months, were carried out. RESULTS: An higher horizontal relapse was observed in the control group (p<0.05). There were no statistically significant differences in vertical relapses between test and control groups (p>0.05). CONCLUSION: The use of allogeneic bone graft in cleft lip and palate patients submitted to Le Fort I osteotomy contributed to increase postoperative stability when compared to surgeries without bone graft.

OBJETIVO: avaliar a estabilidade maxilar após o tratamento ortodôntico-cirúrgico de pacientes portadores de fissura labiopalatal, por meio de análise cefalométrica, em dois diferentes grupos, com e sem utilização de enxerto ósseo alógeno. MÉTODOS: a amostra foi constituída de 48 pacientes portadores de fissura labiopalatal. O grupo teste foi composto de 25 pacientes que, após a correção da posição da maxila, receberam enxertia óssea alógena para preenchimento dos espaços gerados pelas osteotomias maxilares do tipo Le Fort I. O grupo controle foi composto por 23 pacientes, com os procedimentos cirúrgicos similares aos do grupo teste, com a diferença de que não se utilizou enxertia óssea. Realizaram-se traçados cefalométricos manuais e comparação entre as telerradiografias em perfil, obtidas no pré-operatório, no pós-operatório imediato e após o período mínimo de seis meses. RESULTADOS: ocorreu maior recidiva horizontal no grupo controle (p < 0,05). Não houve diferenças estatisticamente significativas nas recidivas verticais entre os grupos teste e controle (p > 0,05). CONCLUSÃO: a utilização de enxertos alógenos em pacientes portadores de fissura labiopalatal submetidos a osteotomias maxilares Le Fort I contribuiu para o aumento da estabilidade horizontal pós-operatória, quando comparada com cirurgias sem enxertia óssea.

Oral focal mucinosis.

Oral focal mucinosis is an uncommon clinicopathologic condition that is considered the oral counterpart of cutaneous focal mucinosis. It is a disease of unknown etiology where the connective tissue undergoes a focal myxoid degeneration. A literature review disclosed 47 published cases of oral focal mucinosis. An additional case is presented; the clinical and histologic differential diagnosis, sex, age, location, treatment, and recurrence are discussed.