Effectiveness of facial exercise therapy for facial nerve dysfunction after superficial parotidectomy: a randomized controlled trial.

OBJECTIVES: To compare the effectiveness of a daily home-based facial exercise therapy with a supervised rehabilitation technique for the treatment of postoperative facial dysfunction in patients undergoing conventional superficial parotidectomy. DESIGN: Prospective, randomized trial, controlled. SETTING: Surgery and Rehabilitation Units, university hospital. SUBJECTS: Consecutive patients ( n=79, mean age 48 years) who underwent superficial parotidectomy with facial nerve dissection were randomly divided into two groups. INTERVENTION: Control group (CG) were given a daily homework manual to perform ordinary postoperative facial mimic exercises autonomously in front of the mirror at home. Experimental group (EG) patients with moderate-severe paresis received supervised rehabilitation therapy that consisted in weekly sessions with facial exercises and massages and performed daily facial exercises at home. EG patients with slight paresis were instructed to undertake self-massage and mirror exercises. MAIN OUTCOME MEASURES: Postoperative dysfunction of facial nerve and branches was quantified measuring the prevalence, magnitude and duration of paresis by the House-Brackmann Facial Nerve Grading System up to 12th months. RESULTS: Facial paresis incidence at 1st week was 77.2%, being the marginal-mandibular nerve the most affected (64.5%). No statistically significant differences were found at any time of the study when comparing the frequency, magnitude and duration of paresis between EG and CG and among patients who had presented moderate-severe paresis. In the absence of intraoperative nerve injury, complete recovery of facial mobility was observed within 12 months, regardless of treatment group. CONCLUSION: Rehabilitation therapy and mirror facial exercises performed autonomously at home were equally effective for postoperative functional recovery.

Ectopic third molar in the mandibular condyle: a review of the literature.

OBJECTIVES: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. STUDY DESIGN: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. RESULTS: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. CONCLUSIONS: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery.

Treatment of recurrent mandibular ameloblastoma.

Ameloblastoma is a locally invasive benign odontogenic tumor with a high rate of recurrence in the long term. The authors conducted a retrospective study of patients with mandibular ameloblastoma in order to evaluate recurrent ameloblastoma management. The study included data from 31 patients over a period of 10 years. Data collected included age, gender, tumor location, histological findings, initial treatment, number of recurrences and year of onset, type of treatment of recurrence, reconstruction and follow-up. Recurrences were detected in nine patients (29%). Tumor recurrences appeared at 32 months on average following the initial surgical procedure. Recurrences were associated mainly to inadequate initial therapeutic approach and were treated by bone resection with a safety margin of at least 1 cm beyond the radiographically visible margins. Immediate reconstruction of bone defects was performed with grafts or free flaps.