Extended Total Temporomandibular Joint Replacement - A Feasible Option for Functional and Aesthetic Reconstruction of Mandibular Defects Involving the Temporomandibular Joint.

Study design: Retrospective case series. Objective: Alloplastic temporomandibular joint replacement has been established as a standard technique for end- stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique. Methods: Included were all patients undergoing extended TMJ-replacements (TMJe), all operatrions were carried out by the senior author. Surgical technique was either single stage or two stage protocol. Surgical details and pitfalls and outcome of more than 2 years follow-up with reference to thirteen including twelve patients were recorded. Results: The most common diagnosis was ameloblastoma of the mandibular ramus. Single stage or two stagge regime were carried out depending on resection requirements and involvement of teeth. Improved mouth opening of more than 30mm was achieved in 10 of 12 patients. One patient with previous TMJ replacement reported temporary weakness of the facial nerve, which resolved after 10 months. Conclusions: The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured.

A case of facial lymphoma mimicking dental infection.

UNLABELLED: Infective and neoplastic swellings of the face are common. Often, the differential diagnosis is obvious, but sometimes it can be difficult to ascertain. We report the case of a cheek swelling thought to be infective in origin, but this unusual lesion turned out to be a diffuse large B-cell lymphoma. This was found to be a solitary cutaneous lesion, with associated submandibular lymphadenopathy. The initial plan was for treatment with chemo-radiotherapy, however, the lesion has, surprisingly, begun to resolve spontaneously following biopsy. CLINICAL RELEVANCE: The most frequent cause of facial swellings presenting to dentists is infective, usually from dental sources, but other causes of facial swelling do need to be considered.

Silent sinus syndrome.

Silent sinus syndrome is defined as a spontaneous and progressive enophthalmos and hypoglobus with hypoplasia of the maxillary sinus and resorption of the orbital floor. It is caused by atelectasis of the maxillary sinus in the presence of ipsilateral chronic hypoventilation of the sinus. The problem may be idiopathic, but the term is now also used to describe cases that follow operation or trauma. We describe three cases, each with a different aetiology, and discuss the clinical and radiographic evaluation of the condition, theories regarding its pathophysiology, and surgical correction.

Mandibular fractures that have healed are not weakened permanently: series of nine patients who sustained mandibular fractures at different sites on two separate occasions.

Some patients are concerned that after satisfactory healing of a mandibular fracture the jaw will be weaker than it was before the injury, and will break readily at the same site after relatively minor injury. We aimed to find out if these concerns have any basis, and report the pattern of fracture in a series of nine patients who had sustained fractures of the jaw on two separate occasions. All fractures were at different sites from the original ones, and in only one case was the fracture adjacent to plates that had been placed previously. Once a mandibular fracture has healed, the bone at the fracture site is not obviously weaker from a clinical perspective than it was before the injury.