Intraoral Approach Research Articles

Dermoid Cysts on the Floor of the Mouth.

The authors analyzed the clinical features and treatment results of surgical patients with a final diagnosis of dermoid cyst on the floor of the mouth over 14 years at our hospital. A total of 5 patients with a final diagnosis of dermoid cyst of the floor of the mouth from January 2010 to December 2023 were enrolled. All patients complained of swelling in the submentum or floor of the mouth. The mean tumor size was 4.2±1.0cm. All patients underwent complete surgical resection. A transcervical approach was performed in 3 patients, and an intraoral approach was implemented in 2 patients. There were no major complications after surgery with either method. The follow-up period was 71.4±75.7 months. There was no disease recurrence during follow-up. Dermoid cysts rarely occur on the floor of the mouth but should be considered in the differential diagnosis of other oral cavity tumors. Dermoid cysts on the floor of the mouth can be safely removed using the current transoral approach without scarring or recurrence.

Infraorbital nerve block for pain management in pediatric cleft lip surgery in resource-limited areas of Indonesia: A case series

Introduction and importanceCleft lip and palate (CLP) are congenital anomalies of the craniofacial region, commonly found in low- and middle-income countries, including Indonesia. Surgical correction of clefts typically begins at around three months of age to support infant growth. An infraorbital nerve block is an option for regional anesthesia in CLP surgery. This case series aims to determine the effectiveness of infraorbital nerve block in pain management for pediatric CLP surgery. Case presentationThis case series includes five patients who fulfilled the Millard criteria for CLP surgery. All patients received general anesthesia followed by an infraorbital nerve block with 0.2 % ropivacaine in the infraorbital foramen area using the intraoral approach. Data were collected preoperatively, intraoperatively, and postoperatively. DiscussionThe combination of general anesthesia and infraorbital nerve block resulted in stable hemodynamics, low delirium scores, low pain intensity, and adequate oral intake postoperatively. ConclusionInfraorbital nerve block with ropivacaine provides intraoperative hemodynamic stability, decreased delirium, and effective postoperative pain management in pediatric patients undergoing CLP surgery.

Surgical retrieval of displaced mandibular third molars: A five-year experience with 16 cases

BACKGROUNDThis study aimed to report the surgical retrieval of iatrogenic displaced mandibular third molars using Computed Tomography CT and Cone Beam Computed Tomography CBCT as pre-surgical diagnostic imaging. MethodsSixteen patients were referred to the Oral and Maxillofacial Department, Faculty of Dentistry, XXXXX University for surgical retrieval of displaced third molars. Patients consented and thorough clinical assessment and radiographic examinations were done using either CT or CBCT scans before the standard surgical procedure to retrieve the displaced teeth. It was intended for all patients to have their displaced teeth or root fragments retrieved using an intra-oral approach while under general anesthesia. Results7 (43.75%) third mandibular left molars/root fragments and 9 (56.25 %) third mandibular right molars/root fragments were retrieved. There was no statistically significant difference regarding swelling between the two CT and CBCT groups (P> 0.05). One patient in the CT group and three patients in the CBCT group experienced lingual nerve paresthesia which was resolved after three months. ConclusionsCT and CBCT scans are crucial diagnostic tools for pre-surgical evaluation and planning for the displaced mandibular third molars. CT provides clearer images and enables easy pre-surgical assessment.

A Combined Ventral Extraoral and Intraoral Approach for Mandibulectomy in 9 Cats: A Case Series.

This retrospective case series describes a combined ventral extraoral and intraoral approach for mandibulectomy in cats and highlights the importance of prompt management of the postoperative iatrogenic malocclusion through dental extraction, crown height reduction with vital pulp therapy or root canal therapy of the contralateral mandibular canine tooth. Nine cats were reviewed for signalment, history and physical examination, diagnostic workup, tumor type, mandibulectomy extension, lymph node removal as well as both intraoperative and postoperative complications. The performed surgical procedure was a combination of an extraoral approach ventrally to the mandible and an intraoral approach to remove the whole or a part of the mandible. Lymphadenectomy was achieved using the same surgical access. None of the cats had intraoperative complications. Postoperative complications were limited to regional swelling and drooling lasting a week. Seven cats were able to eat immediately after the surgery. Of the other 2 cats, 1 regained the ability to eat within a month and 1 only ate from the owner's hands. The surgical approach for mandibulectomy described allowed better access and visualization of the caudal part of the mandible and direct access to regional lymph nodes. Moreover, if the expected postoperative malocclusion is managed during the same surgical procedure, there is a higher rate of postoperative eating ability compared to what is reported in the literature.

A Huge Infected Dentigerous Cyst Occupying the Maxillary Sinus

A dentigerous cyst (DC) ranks as the second most common odontogenic cyst after a radicular cyst arising from the crowns of impacted, embedded, or unerupted teeth. DC frequently causes the corresponding tooth to be displaced into an ectopic location, such as the sinus cavity in the maxilla. Surgical treatment involves extracting the tooth and enucleating the cyst using a conservative intra-oral approach or endoscopic surgery. We report a rare case of a 25-year-old woman with maxillary third molars inside the maxillary sinus attached to a dentigerous cyst and treated with Caldwell Luc surgery through an intraoral approach.

Panfacial fracture osteosynthesis combined with submental orotracheal intubation: A case report

Panfacial fractures can be a surgical challenge due to bone instability and loss of facial landmarks. Accurate diagnosis and planning favor the correct restoration of facial architecture. Good results depend on the acquisition of occlusal relationships, which is difficult in classic orotracheal intubation. Thus, submental bypass is an interesting way of maintaining the airway during surgery and simultaneously allowing occlusal contacts. This study aims to evaluate multiple facial osteosyntheses in a patient with panfacial fracture, for whom submental orotracheal intubation was chosen by means of a case report. A 29-year-old male patient, victim of a car accident, presented trismus, dystopia, enophthalmos, occlusal changes, hyposphagma, bilateral periorbital ecchymosis, loss of the anteroposterior projection of the face and pain. The imaging examination showed multiple fracture patterns, which characterized a panfacial fracture. Orotracheal intubation with submental bypass was performed to improve osteosynthesis results and guarantee air permeability. “Bottom-up” and “outside-in” reconstruction sequences were chosen through coronal access with left preauricular extension and subtarsal and intraoral vestibular approaches. The procedure was uneventful and the signs and symptoms were cured. Proper planning in complex cases, such as panfacial fractures, allows adequate resolution and satisfactory aesthetic-functional results. Furthermore, submental orotracheal intubation is safe and can be an interesting and valuable ventilation alternative.

Feasibility of 2-Point Fixation by Absorbable Plates Using the Transoral Approach in Management of the Zygomatic Complex Fractures.

The purpose of this study was to retrospectively evaluate the feasibility of 2-point fixation using absorbable plates by the transoral approach in the management of the zygomatic complex (ZMC) fractures. Twenty-five patients (15 male and 10 female, age range 16y to 55y) with Knight and North Group Ⅲ zygomatic fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using absorbable plates placed at the zygomaticomaxillary buttress and infraorbital rim. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mouth opening, facial asymmetry, diplopia, and paresthesia. Postoperatively, all patients achieved uneventful healing; facial symmetry and wound healing were achieved, along with sensory recovery involving the infraorbital nerve. Complications such as sensory disturbances, infection, diplopia, malunion, and nonunion were not encountered in these patients. Two-point fixation using absorbable plates by transoral approach can provide sufficient stabilization for Knight and North Group III zygomatic fractures.

Effect of tranexamic acid on blood loss reduction in patients undergoing orthognathic surgery under hypotensive anesthesia: a single-center, retrospective, observational study.

Orthognathic surgery is a surgical procedure performed by intraoral approach with established and safe techniques; however, excessive blood loss has been reported in rare cases. In response, investigative efforts to identify methods to reduce the amount of blood loss have been made. Among such methods, the administration of tranexamic acid was reported to reduce the amount of intraoperative blood loss. However, few studies to date have reported the effect of tranexamic acid in orthognathic surgery under hypotensive anesthesia. The present study aimed to investigate the effect of the administration of tranexamic acid on intraoperative blood loss in patients undergoing bimaxillary (maxillary and mandibular) orthognathic surgery under hypotensive anesthesia. A total of 156 patients (mean age, 27.0±10.8 years) who underwent bimaxillary orthognathic surgery under hypotensive anesthesia performed by the same surgeon between June 2013 and February 2022 were included in this study. The following data were collected from the medical records of each patient: background factors (age, sex, and body mass index), use of tranexamic acid, surgical procedures, previous medical history, duration of surgery, American Society of Anesthesiology physical status findings before surgery, intraoperative blood loss as a primary outcome, in-out balance, and blood test results. Descriptive statistics were calculated for statistical analysis, and a t -test and the chi-squared test were used for between-group comparisons. Group comparisons were performed after 1:1 propensity score matching to adjust for confounding factors. Statistical significance was set at P<0.05. Comparison between the groups based on the use of tranexamic acid revealed a significant difference in operation time. Propensity score matching analysis revealed that intraoperative blood loss was significantly lower in the tranexamic acid group. The administration of tranexamic acid was effective in reducing intraoperative blood loss in patients undergoing bimaxillary orthognathic surgery under hypotensive anesthesia.

Congenital Midline Upper Lip Sinus: Case Report and Review of the Literature.

Congenital midline sinus of the upper lip are rare congenital malformations. We recently identified a case featuring a congenital midline sinus of the upper lip. The punctate opening was positioned at the midline of the philtrum, immediately below the base of the columella. Surgical removal of the sinus tract was conducted through an intraoral approach. Up to now, fewer than 70 cases have been reported. Several postulates, including the fusion theory, merging theory, and invagination theory, have been proposed to explain the formation of the congenital midline sinus of the upper lip. Nevertheless, the etiology of this uncommon abnormality remains unclear. This report details a case of a congenital upper lip sinus presenting as a congenital midline sinus of the upper lip and reviews the current literature on this condition.

A randomized clinical trial comparing the efficacy of lidocaine administered intravenously, intranasally or as infraorbital nerve block in dogs undergoing rostral rhinosocopy

ObjectiveTo compare the efficacy of lidocaine administered intravenously, intranasally or as an infraorbital nerve block in dogs undergoing rostral rhinoscopy. Study designRandomized clinical trial. AnimalsA total of 43 client-owned dogs. MethodsAfter premedication with medetomidine 0.01 mg kg–1 and methadone 0.2 mg kg–1 intramuscularly, anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Dogs were randomly allocated to receive 2 mg kg–1 of 2% lidocaine as a bilateral infraorbital nerve block (INB) via the caudal intraoral approach, via bilateral topical intranasal administration (TIA) or as an intravenous bolus (IVB). At 5 minutes following lidocaine administration, responses to rhinoscopy (RR) and biopsies (RB) were evaluated using a simple scoring system (0: no reaction; 1: reaction). Response to the rhinoscopy in the recovery period (RE) was recorded. Recovery quality was scored using a simple descriptive score. Heart rate, respiratory rate and noninvasive arterial blood pressure were recorded. Intravenous (IV) fentanyl 0.001 mg kg-1 was administered if an increase > 20% in any variable occurred. Gross movement was attenuated using propofol 0.5 mg kg–1 IV. Scores were analysed using the Chi-square test with Monte Carlo method. Cardiorespiratory changes among and overtime between groups were compared using one-way anova and one-way anova for repeated measures, respectively, or the correspondent non-parametric tests; p < 0.05. ResultOf the 43 dogs, 42 completed the study. No statistically significant differences were detected in either physical reactions or changes in cardiorespiratory variables for RR, RB, RE or recovery quality, although RB tended to be higher in group TIA (7/10 versus 1/10 INB and 3/13 IVB).Various cardiorespiratory variables changed overtime within groups. Conclusions and clinical relevanceIn dogs, all three investigated techniques attenuated responses during rostral rhinoscopy in dogs, although INB and IVB were more efficacious when biopsies were taken.

Ultrasound diagnostics: assessment of tumor thickness and depth of invasion in squamous cell carcinoma of the oral cavity

Aim. To evaluate the capabilities of ultrasound using various approaches in determining the depth of invasion of squamous cell carcinoma of the oral cavity and to compare the results obtained with data obtained by the use of other diagnostic methods. Materials and methods. In our reserch, ultrasonography was performed on 193 patients with primary malignant tumors of the mobile part of the tongue, floor of the oral cavity and tumors of rare locations (mucous membranes of the lip, cheek, alveolar processes). The age of the patients ranged from 15 to 85 years. In all patients, tumors were squamous cell carcinoma. ultrasound was performed using submandibular, intraoral and transbuccal approaches. ultrasonic data were compared with the results of pathomorphological examination, as well as of X-ray computed tomography and of magnetic resonance imaging with contrast. Results. A statistically significantly high correlation was obtained for all ultrasound approaches (submandibular, intraoral and transbuccal) with the depth of invasion of the oral tumor determined pathomorphologically (r = 0.78; r = 0.89; r = 0.93; p &lt;0.001). Ultrasound using all approaches shows statistically significantly better results in determining the thickness of tumorsof the tongue and mouth floor in comparison with X-ray computed tomography and magnetic resonance imaging (p &lt;0.001). All diagnostic methods are characterized by an overestimation of the tumor invasion depth (overdiagnosis) as compared with pathomorphological examination. for exophytic tumors and oral cavity tumors of mixed growth with an exophytic component, the depth of invasion was less than the tumor thickness. Conclusion. Ultrasound is an accessible, easily reproducible, radiation-free method, the resolution of which makes it possible to accurately determine not only the depth of invasion of oral tumors, but also the distance from the tumor to the midline of the tongue, that represents an important information when choosing the extent of surgical intervention.

Evidence-based Decision-making on Management of Arteriovenous Malformation of Face

Abstract Arteriovenous malformations (AVMs) are uncommon inborn vascular anomaly, making for about 1.5% of all vascular aberrations. Remarkably, approximately half of AVM cases manifest in the mouth cavity and faciomaxillary region. A female patient, age 18 with an AVM on the right side of her face, is the subject of this case report. She had soft, compressible, nontender swelling on the right side of her face since birth; this swelling had gotten worse with age and she had surgery for it when she was 8 years old. The three-dimensional computed tomography scan of the face with angiography was done with findings of heterogeneous soft-tissue density lesion with increased volume, measuring 7.15 cm × 3.2 cm × 6.23 cm involving the right cheek. The surgery was planned through an intraoral approach over the right buccal mucosa with surgical excision and debulking with primary closure with the remaining buccal mucosa was done. Then, the patient kept on follow-up and the potential results were observed.

A Combined Endoscopic and Intraoral Approach for the Removal of a Dentigerous Cyst Associated with an Ectopic Wisdom Tooth in the Maxillary Sinus: A Case Report

A Combined Endoscopic and Intraoral Approach for the Removal of a Dentigerous Cyst Associated with an Ectopic Wisdom Tooth in the Maxillary Sinus: A Case Report

Combined Use of Endoscopic Techniques and Virtual Surgical Planning for Intraoral Approach for Hemi-mandibular Resection and Reconstruction.

The study aimed to describe our experience in using endoscopic procedures to aid hemi-mandibular reconstruction with bone flaps through transoral approach. Five patients with huge benign mandibular tumors underwent transoral mandibulectomy and hemi-mandibular reconstruction, using endoscopy. Facial symmetry, occlusion, bone healing, and mandibular similarity were all evaluated postoperatively. The paired-samples t test was used to compare quantitative data, and a P value less than 0.05 was considered a significant difference. All five patients who received transoral mandibular surgery recovered in terms of TMJ functionality, facial symmetry, and aesthetic results. Endoscopy monitored and ensured that bone flaps were correctly connected and fixed. The accuracy of endoscopy-guided mandibular reconstruction was confirmed by quantitative examination for four cases, which revealed no statistically significant variations between postoperative CT analysis and preoperative virtual surgical planning data. Endoscopy-assisted virtual surgery may resolve concerns with transoral hemi-mandibular reconstruction and broaden indications for mini-invasive mandibular reconstruction. However, only patients with benign mandibular tumors were included in our study, so surgeons should be very cautious if applying this technique to malignant lesions or bony tumors invading soft tissues.

Infratemporal Fossa Schwannoma Surgery via a Combined Prelacrimal Recess, Caldwell-Luc, and Distal Intraoral Approach.

The deep location of infratemporal fossa (ITF) combined with the abundant vascular plexus in it increased the difficulty of removing the mass in ITF through endoscope surgery approach. However, under appropriate circumstances, the excision of ITF tumors through a combined prelacrimal recess, Caldwell-Luc, and distal intraoral approach can be safely performed with minimal impact on the surrounding tissues. The Department of Neurology received a 69-year-old male patient who had been experiencing headache, dizziness, and numbness from the mastoid region of his left ear to the corner of his mouth for a duration of 22 days. Cranial magnetic resonance imaging revealed the presence of a tumor located in the ITF. Following transfer to our department, surgical intervention was performed using a combined approach involving the prelacrimal recess, the anterior wall of maxillary sinus, and lateral ITF to successfully remove the tumor. Postoperative pathologic examination confirmed schwannoma as its nature. The patient was discharged in excellent condition without any functional impairment. On the basis of this case, the authors believe that this combined approach can offer a distinct endoscopic perspective and adequate surgical workspace, which is crucial for tumor removal while preserving the integrity of surrounding normal tissues. Moreover, the utilization of multiple small incisions has minimal impact on postoperative recovery.

Interpositional bone graft with cortical and cancellous calvarial bone for addressing the bone gap after reduction malarplasty: a case report

Asians typically exhibit prominent zygomas; therefore, several attempts have been made to reduce these structures to achieve a softer appearance. The intraoral approach is preferred because of its shorter surgical duration and lower invasiveness; however, it is associated with serious complications, such as nonunion. In revisional surgery, the intraoral approach poses limitations in accessing the upper part of the zygoma and the lateral orbital rim area due to its restricted operative field. Therefore, we developed an intraoral interpositional bone graft technique that enabled almost complete reconstruction. A 40-year-old woman presented with persistent depression in the left infraorbital and cheek regions after two revision operations after reduction malarplasty. Based on computed tomography (CT) scan findings, reconstruction using bone grafts was planned. Calvarial bone was harvested and divided into cortical and cancellous parts. The cortical bone was sculpted into an L-shape and inserted into the gap between the maxilla and the lower zygoma body. The hard-to-reach lateral orbital rim area was filled with cancellous bone without fixation. Follow-up CT scans showed that the cortical bone grafts were well-maintained and stabilized with titanium plates, while the cancellous bone had undergone significant resorption and was replaced by new bone, indicative of successful natural healing.

Sialolithiasis in children

Introduction: Sialolithiasis is a disease in which calcified substances accumulate in the ducts or parenchyma of the salivary glands. This disease can occur in people of all ages but is mostly seen in middle-aged adults and rarely in children. This case report aimed to describe a case of sialolithiasis in children Case Report: A 3-year-old girl presented with a lump that enlarged progressively on the right side of the neck since 1 year ago. The patient also complained of painful swallowing. Palpation of the right submandibular revealed a solid, mobile mass measuring 0.5x0.5cm without tenderness or hyperemia. A neck ultrasound showed an enlarged submandibular gland and right parotid gland. A midface and neck multi-slice computed tomography scan (MSCT) supported the diagnosis of sialolithiasis. The patient underwent stone removal with an extraoral approach and general anesthesia. The patient then was discharged with cefixime, methylprednisolone, and paracetamol. Discussion: Sialolithiasis that cannot be removed by opening the canal can be removed by trans-oral or extra-oral sialolithotomy, extracorporeal lithotripsy, sialendoscopy, or laser treatment. Submandibular stones can be removed surgically by intraoral or extraoral approaches. Extraoral approaches are indicated for intra-glandular stones and stones embedded in the hilum of the gland. Conclusion: The diagnosis of sialolithiasis in this patient was confirmed through history taking, physical examination, ultrasound, and a CT scan. Management of sialolithiasis focuses on removing the stone and maintaining salivary gland function. In this case, the stone was removed using an extraoral approach under general anesthesia which resulted in a good outcome

Surgical treatment of clinically infected mandibular fractures

PurposeTo clarify reasons for infections, surgical techniques, and occurrence of postoperative surgical site complications in infected mandibular fractures.MethodsPatients with clinically infected mandibular fracture of the dentate part without preceding surgery were studied retrospectively. Clinical infection was defined to occur if pus, abscess, or a fistula in the fracture area was present. Patient-, fracture-, and surgery-related variables were evaluated, and predictors for postoperative complications were analysed.ResultsOf 908 patients with surgically treated fracture in the dentate part of the mandible, 41 had infected fracture at the time of surgery (4.5%). Of these patients, 46.3% were alcohol or drug abusers. Median delay from injury to surgery was 9 days. Patient-related factors were the most common cause for delayed surgery (n = 30, 73.2%), followed by missed diagnosis by a health care professional (n = 8, 19.5%). Twenty-two fractures were treated via extraoral approach (53.7%) and the remaining 19 intraorally (46.3%). Postoperative surgical site complications were found in 13 patients (31.7%), with recurrent surgical site infections predominating. Notable differences between total complication rates between intraoral and extraoral approaches were not detected. Secondary osteosynthesis for non-union was conducted for one patient treated intraorally.ConclusionsPostoperative surgical site complications are common after treatment of infected mandibular fractures, and these occur despite the chosen surgical approach. Infected mandibular fractures heal mainly without bone grafting, and non-union is a rare complication. Due to the high complication rate, careful perioperative and postoperative care is required for these patients.

Management of a recurrent third branchial arch fistula using combined endoscopic and open approach

Branchial cleft anomalies are rare, congenital lesions, that occur due to the maldevelopment of the branchial apparatus, during fetal maturation. Anomalies of the third and fourth arch contribute to a very small proportion of these. Most cases are detected in childhood, either as a cyst, sinus or fistula in the neck. Some of the common treatment approaches to third branchial cleft fistulas include endoscopic cauterization, open cervical fistulectomy and, in cases of recurrence, selective neck dissection. Here, we present a case of recurrent branchial fistula of the third arch, wherein we used a combined cervical and intraoral approach, conserving the thyroid cartilage, to achieve a complete excision of the fistula tract.

Intraoral Approach for Zygomaticomaxillary Complex and Orbital Floor Fracture With a Customized Ballooning Technique.

The zygomaticomaxillary complex and the orbital floor are commonly affected by mid-face fractures; their fractures pose challenges in reconstruction and can result in complications, such as enophthalmos. This study explores an intraoral approach with the help of a customized balloon technique and a contrast agent as an alternative to the conventional methods. A case report of a 67-year-old man with complex midfacial trauma is presented. The surgical process involved open reduction through an intraoral approach along with a transantral approach with the customized balloon technique. The procedure aimed to achieve reduction, fixation, and reconstruction of a complex mid-face fracture.