Intraoral Approach Research Articles

Collaborative supernumerary nasal tooth extraction by nasal and intraoral approaches

AbstractBackgroundThe purpose of this report was to describe an effective technique by which a fractured intranasal supernumerary tooth was pushed from the oral cavity side toward the nasal cavity.Case presentationA 6‐year‐old female with two maxillary supernumerary median impacted teeth, including an intranasal tooth, performed teeth extraction. The surgical procedure was a collaboration operation of oral and maxillofacial surgery and otorhinolaryngology. By pushing the fractured tooth in the nasal cavity from the oral cavity toward the nasal cavity, the remaining root in her maxilla could be easily removed from the nasal cavity with an endoscope.ConclusionCollaboration surgery of the intraoral and nasal approaches could achieve minimally invasive surgery for the removal of the remaining fractured root of intranasal teeth.

Postoperative wound dehiscence in mandibular fractures

Objective To clarify the occurrence and causes of non-infection-related surgical wound dehiscence (SWD) in intraorally treated mandibular fractures. Material and Methods Patients with one or two fractures of the dentate part of the mandible treated surgically via an intraoral approach were included in this retrospective study. The primary outcome variable was SWD. Associations between patient-, fracture- and surgery-related variables and SWD were evaluated. Results Altogether 232 patients with 270 mandibular angle, body, symphysis and/or parasymphysis fractures were included in the analysis. In all, 22 SWDs were detected. These occurred in 9.5% of patients and in 8.1% of fractures. Surgery performed at night-time showed a significantly higher SWD rate than daytime surgeries (p = .012). Additionally, a significantly greater SWD rate was found among smokers (p = .041). Other studied variables remained statistically non-significant for SWD. In a multivariate analysis, night-time was the only significant independent variable with an odds ratio of 3.297 (95% CI 1.238 − 8.780, p = .017) for SWD. Conclusion The approach or closure technique used and the fracture type had only a minor effect on non-infection-related SWD in patients with mandibular fractures. To avoid SWDs, mandibular fracture surgeries should be conducted during the daytime with adequate support from an experienced surgeon.

Mandible Angle Resection with the Retroauricular Approach

Square-shaped and large moon-shaped faces are commonly observed in Asians, and the contour of the mandible is associated with the shape of the lower part of the face. Mandible contouring surgery is performed to create a softer impression for East Asians. Currently, most surgeries are performed using an intraoral approach. External approaches have not been cosmetically attempted because of possible damage to the facial nerve and visible scarring and have been limited to mandible bone fracture reduction. This study included 42 patients who underwent mandibular angle reduction via classical intraoral incision and retroauricular incision between April 2019 and October 2021. Clinical outcomes were assessed using the Global Aesthetic Improvement Scale and Visual Analog Scale. Surgery was successful in all cases, with no significant complications. An appropriate mandibular contour was achieved postoperatively. All patients were satisfied with the outcome. Some patients experienced short-term complications, such as hematoma and wound disruption of the skin above the incision line. However, these improved within 3 weeks, and no serious long-term complications were observed. Mandible angle resection with the retroauricular approach is a promising alternative for patients, allowing speedy recovery and the resumption of routine daily life.

Surgical approaches of condylar fracture management - A Mini Review

Mandibular condylar neck and subcondylar fractures are common in maxillofacial surgery. The justification for surgical treatment of these fractures has varied over time, to avoid the most concerning side event, namely facial nerve injury. We offer a new approach that combines intraoral and cutaneous pre-auricular access, allowing for quick and safe access to the surgical site while avoiding facial nerve injury and surgical scars in high-impact aesthetic areas of the neck. Five patients with condylar neck or subcondylar fractures were treated at the same hospital using a combined intraoral and pre-auricular approach. Three months following surgery, the results were assessed in terms of mandibular mobility, complications, and patient satisfaction All five patients had a positive outcome, with complete fracture healing and no sequelae, including no facial nerve palsy. The safe reduction of the two mandibular pieces achieved by a combined intraoral and cutaneous pre-auricular surgical access is a major element of the approach. The periosteal plan of the ramus can be broadly and safely elevated using the intraoral approach and connected to the condylar bone plane with the pre-auricular cutaneous approach, avoiding facial nerve damage. The wide ramus periosteum elevation generates an "optical space" that allows fragment reduction and fixation in direct oblique view without the requirement for endoscopic intervention. Our findings strongly imply that with our technique, it is possible to treat sub-condyle and condylar neck fractures safely while avoiding facial nerve injury, which is an undesirable consequence due to its severe impact on quality of life.

Intraoral Endoscopic Approach to Excision of an Infratemporal Fossa Tumour

Introduction: The infratemporal fossa is an inverted pyramid shaped structure that lies at the skull base, posterior to the maxillary sinus. It has a complex anatomy due to its relationship to various important vascular and neural channels. Surgical approaches to this region, via the lateral skull base and access mandibulotomies, have high morbidity. By our minimally invasive intra-oral endoscopic technique, an external incision, bony osteotomies and cranial nerve palsies were avoided with an expedited road to recovery and shorter hospital stay. Case Report: A middle aged lady who presented with left sided facial swelling and numbness was evaluated for the same with a Diagnostic nasal endoscopy and imaging. MRI of the maxilla with contrast revealed a well-defined left infra-temporal fossa soft tissue signal intensity mass, which was subsequently planned for intra-oral endoscopic removal. The surgery was performed via a transvestibular-paramandibular incision through which the endoscope was passed, structures delineated and tumour removed piece meal. Immunohistochemical analysis confirmed that it was a Spindle cell Rhabdomyosarcoma. Hence, she was given post operative chemoradiotherapy and is currently one year post surgery, with good outcomes. Discussion The infratemporal fossa has a varied and complex anatomy, due to its interior location and multiple important neurovascular structures within it. This intra-oral endoscopic approach, although challenging for the novice surgeon, avoided an external scar, providing better cosmesis and also had lesser patient morbidity related to wound gaping and dehiscence. It also allowed a direct and magnified visualization of the neuro-vascular structures in that region, aiding in tumour removal.

Palatal Mucoperiosteum-A Redeemable Barrier in Surgical Management of Rhinocerebral Mucormycosis.

Ever since the commencement of the COVID-19 pandemic, post-recovery complications have been in the highlights, out of which rhinocerebral mucormycosis tops the chart. The surgical management of this disease was always aggressive debridement, resection, and antifungal treatment. Oronasal communication after aggressive surgical management always leads to breathing, feeding, and cosmetic impairments. In this study, cases were managed by leaving the palatal mucosa intact after the removal of all the affected hard and soft tissues including the periosteum attached to the mucosa, to preserve the palatal mucoperiosteum and to improve the postoperative complications in patients by maintaining the oronasal separation. Prospective review of the operated case of rhinocerebral mucormycosis in 20 patients was presented. An intraoral approach for hard and soft tissue resection was employed. The palatal mucoperiosteum was salvaged in all patients. Postoperative complications like oronasal communication, ill-fitting prosthesis, and healing were evaluated. A total of 20 patients underwent maxillectomy for mucormycosis involving the maxilla and palate along with other facial bones. The palatal mucosa was preserved and used for oronasal separation. The expected complications of nasal regurgitation, crustation of the maxillary cavity, ill-fitting prosthesis, etc. were evaded due to this. The administration of Inj. liposomal amphotericin B (LiAB) postsurgically has been the backbone of this procedure.

The Surgical Management of Oroantral Communications: Recommendations for Routine Practice Combined Endoscopic and Intraoral Approach

The Surgical Management of Oroantral Communications: Recommendations for Routine Practice Combined Endoscopic and Intraoral Approach

Application of N-Butyl-2-Cyanoacrylate for the Treatment of Comminuted Fractures in the Anterior Wall of the Maxillary Sinus: A Prospective Clinical Study.

Objective The purpose of the study was to assess the clinical outcome of patients by using n-butyl-2-cyanoacrylate in the management of comminuted fracture segments of the anterior wall of the maxillary sinus in the zygomatico-maxillo-facial complex region. Material and methods A prospective study was done at a tertiary care teaching institute in India with a study population of ten patients in a single group. The method of recruitment was a convenient sampling method. Out of all the study subjects, three patients had isolated maxillary sinus wall fractures, whereas the remaining seven had other associated facial fractures that required stable fixation with mini plates. The comminuted fractures of the anterior wall of the maxillary sinus were carefully reduced through an intra-oral approach, and n-butyl-2-cyanoacrylate was applied over the edges of fractured segments. The segments were left undisturbed for one minute and closed with a 3-0 vicryl. The outcome variables, namely bone alignment visualised through computed tomography (CT) scan postoperatively, paresthesia or hypoesthesia of the infraorbital nerve, postoperative infection, and wound dehiscence, were noted at one-week, one-month, three-month, and six-month intervals. Data were analysed using the Chi-square test. Results Among all patients, seven had satisfactory bone alignment. A total of seven patients recovered from hypoesthesia of the infraorbital nerve. The association of bone alignment with hypoesthesia or paresthesia revealed a highly significant p-value (0.002) using the Chi-square test. Also, an association between postoperative infection and wound dehiscence showed substantial results with a p-value less than 0.05. Conclusion Good bone alignment was seen postoperatively in 70% of patients. The cyanoacrylate used had no adverse reactions, and its application was restricted to non-load-bearing areas in this study. Further studies with a higher level of evidence and a larger sample size are needed to validate the use of adhesives for bone fixation in other regions of the face.

Safety and Efficacy of Midface Augmentation Using Bio-Oss Bone Powder and Bio-Gide Collagen Membrane in Asians.

(1) Background: Asians tend to have a regressive midface. Midface augmentation is an effective treatment, and various materials have been used as fillers for this purpose. Bio-Oss bone powder has a strong positive effect on promoting new bone regeneration, and has been used in the dental field for over 30 years. However, it has not been used and reported as a filler in midface augmentation. (2) Objective: To evaluate the safety and efficacy of midface augmentation using Bio-Oss bone powder in treating midface retrusion and resulting nasolabial folds, and to develop a predictive model for patient satisfaction. (3) Methods: 85 patients underwent midface augmentation through an intraoral approach with Bio-Oss. Treatment efficacy was assessed by blinded investigators. The data on safety were collected from patient interviews at each follow-up visit. A questionnaire was used for investigating patient satisfaction. The influencing factors of satisfaction were analyzed by univariate and multivariate analysis. A nomogram to predict the risk of dissatisfaction was built based on significant factors with R software. Results: Compared to baseline, there was a significant improvement (p < 0.001) in Wrinkle Severity (4) Rating Scale scores at week 24, with a mean decrease of 0.52 ± 0.57. The aesthetic improvement rate evaluated by the Global Aesthetic Improvement Scale was 92.9%. Four mild treatment-related adverse events were noted. The majority of patients were satisfied overall. A nomogram with good prediction performance was plotted. (5) Conclusions: This new procedure yielded safe and satisfactory aesthetic results. A nomogram with good test performance and discriminative ability was established for predicting patient satisfaction.

Minimally Invasive Mandibular Microsurgery: A Systematic Review and Meta-analysis.

All known cases of MIMMR were identified following the Preferred Reporting Items for Systematic Reviews, Meta-Analyses guidelines, and our own surgical experience. Patient demographics, MIMMR type [submandibular (SM), modified facelift/retroauricular (MFL/RA), or intraoral (IO)], methodology, and clinical outcomes were analyzed with the Fisher exact and Kruskal-Wallis tests. Forty-seven patients underwent MIMMR. Ameloblastoma was the most common pathology treated using all approaches, and MFL/RA was the only approach used to treat squamous cell carcinoma (P = 0.0103). Reconstruction was reported for large, bilateral defects only via the SM or IO approach (P = 0.0216). The iliac crest or fibula was used as a donor site. The facial artery was the most common recipient vessel using the IO and SM approaches, whereas the superior thyroid and external carotid vessels were the most common in the MFL/RA approach (P < 0.0001). Virtual planning was used in all cases performed via an IO approach, 80.0% of cases using an SM approach, and no MFL/RA cases (P < 0.0001). Good aesthetic and functional outcomes were reported for every patient, and there was no difference in complication rates (P = 0.2880). Minimally invasive approaches are safe and effective treatment options for patients requiring mandibular microsurgery, usually in the setting of benign pathology. The IO and SM approaches usually rely on the facial vessels, whereas the MFL/RA approach permits access to the superior thyroid and external carotid vessels and cervical lymphadenectomy.

Pediatric mandibular fractures: Surgical management and outcomes in the deciduous, mixed and permanent dentitions.

Mandibular fractures are the most frequent type of pediatric facial traumatic injury, but their treatment remains controversial. The aim of this retrospective study was to analyze the surgical treatment and long-term outcomes of dentate mandibular fractures in children and adolescents. Patients with mandibular fractures in the dentate area who were surgically treated in the period from January 1, 2001, to December 31, 2020, were included. The following data were collected: age, gender, cause and mechanism of injury, fracture site and type, associated maxillofacial fractures, the timing of surgical treatment, Facial Injury Severity Scale (FISS) score, surgical approach, number and thickness of plates, hospitalization stay and outcome. Patients were divided into three groups: deciduous (≤6 years, group A), mixed (7-12 years, group B), and permanent (13-18 years, group C) dentitions. Statistical analyses were performed using SPSS software. During the study 91 patients (male: female ratio, 3.8:1), 4 in group A, 12 in group B, and 75 in group C, with 65 single and 52 double fractures were included. An intraoral approach was used in 87% of patients. In group C, 90% of patients were treated with fixation schemes consistent with those suggested in the literature for adults, versus 75% in groups A and B. Median follow-up time was 20 months. No tooth germ injury or facial asymmetry was observed and only six group C patients had post-operative malocclusions. Hardware removal occurred in 22% of the patients. This 20-year retrospective study shows that open reduction and internal fixation of pediatric dentate mandibular fractures caused no tooth germ damage or disturbances of mandibular growth in any dentition stage. Internal fixation schemes were similar to those used for adults, although it was necessary to adapt hardware size and position according to tooth and patient age.

Management of superficial ranula via intraoral approach: A case report

Management of superficial ranula via intraoral approach: A case report

Management of third molars projected into the temporal fossa and infratemporal fossa: systematic literature review

Introduction: Projection of the maxillary third molar into the temporal or infra temporal fossa is a rare complication. There is no recommendation for the management of such complication. The aim of this work is to try establishing a removal protocol. Materials and methods: A systematic review of the literature was conducted using all cases reports of iatrogenic projection of the tooth into the temporal fossa or infratemporal fossa and how they were treated. The last search was conducted in July 2021. Results: 27 cases involving 28 teeth, published between 1986 and 2020 were included. Discussion: The intraoral approach seems to be preferred in the first instance for teeth in the infra temporal fossa and a cutaneous approach for teeth in the temporal fossa. This should be done within 3–6 weeks after projection to attempt removal. This allows the formation of a fibrous capsule and the downward migration of the tooth to facilitate removal. The use of complementary technological means can improve the chances of success. Conclusion: Resulting a flow chart, who is an aid to management of this type of situation, providing a clear idea of the approach to be taken.

Giant Cell Fibroma of the Tongue: A Rare Entity

Giant cell fibroma is a rare entity classified as a benign tumour of the oral cavity, accounting for 2% to 5% of all oral benign fibrous growths. It can occur at various sites in the oral cavity, such as the tongue, palate, lip, and buccal mucosa, with the gingiva being the most common site. As the growth is self-limiting, it has been concluded that its recurrence is negligible. The aetiology of the growth has not been clearly known, but the fibrous proliferation suggests that chronic irritation or trauma to the tissue can give rise to such lesions. The growth is generally described as a dome-shaped nodule, either sessile or pedunculated, with an average diameter of 1cm. Usually, the lesion is asymptomatic unless it becomes secondarily infected. The present article presents the diagnosis and surgical management of a giant cell fibroma localised to the lateral border of the left-side of the tongue, corresponding to the occlusal surface of the molar teeth. Hereby, the author presents a case of a 58-year-old-male patient reported to the Department of Oral and Maxillofacial Surgery (OMFS) with a chief complaint of a growth on the left lateral border of the anterior region of the tongue for 2 to 3 years. On intraoral clinical examination, a dome-shaped, pedunculated mass measuring 1cm in diameter was observed. The lesion was asymptomatic and self-limiting. A provisional diagnosis of irritational fibroma was made. After a thorough history taking and clinical examination, surgical excision through an intraoral approach under local anaesthesia was performed to remove the lesion. The histopathological reports confirmed the diagnosis as giant cell fibroma. Rigorous clinical and histopathological examination has proven to be significant in making a precise diagnosis and planning accurate treatment for the uneventful elimination of lesions like giant cell fibroma. It is also essential to differentiate it from other pathologies to prevent complications.

Surgıcal Extraction Of Impacted Maxillary Third Molar Tooth Dısplaced In Infratemporal Space With Intraoral Approach: Case Report

Surgıcal Extraction Of Impacted Maxillary Third Molar Tooth Dısplaced In Infratemporal Space With Intraoral Approach: Case Report

Managing nasolabial cyst: Experience at a tertiary care teaching hospital in Eastern India

Abstract Background: Nasolabial cysts are non-odontogenic cysts that arise from the nasal alar area. Sublabial resection of the nasolabial cyst is considered an effective surgical modality of treatment. Objective: This study aimed to evaluate the clinical presentation, diagnosis and treatment of nasolabial cyst at a tertiary care teaching hospital in eastern India. Methods: This was a retrospective study of 38 cases of nasolabial cysts managed between May 2018 and June 2022. The detailed clinical presentations, investigations and treatment of nasolabial cysts of the patients were studied. Results: Out of 38 cases of the nasolabial cyst, 22 (57.9%) were seen on the left side, 13 (34.2%) were seen on the right side and 3 were seen bilaterally. The most common presenting complaint was facial swelling (84.2%). Computed tomography of the nose and paranasal sinuses was done in 24/38 (70.5%) patients studied. Surgical excision of the nasolabial cysts was done by intraoral sublabial approach in 32 (84.2%) cases and 6 underwent endoscopic transnasal marsupialisation. The most common post-operative complication was post-operative facial/perinasal swelling. One case of recurrence was reported who underwent endoscopic transnasal marsupialisation. Conclusions: Nasolabial cysts are an uncommon clinical entity but manifest cosmetic deformity and nasal obstruction. Intraoral sublabial excision and endoscopic transnasal marsupialisation are important surgical techniques for the nasolabial cyst. The post-operative complications and chance of recurrence are rare.

Endoscopic and Intraoral Approach for Removal of an Ectopic Third Molar associated with a Dentigerous Cyst in the Maxillary Sinus: A Case Report

Dental ectopia is the presence of deciduous, permanent, or supernumerary teeth in non dentate areas. It is very rare, especially in the maxillary sinus. Treatment is surgical removal because left untreated, there is a tendency to form a cyst, tumour, or lesion that can cause the perforation of the orbital floor and the obstruction of the nasal cavity. Although, panoramic radiography is the common form of radiological examination for this type of eruption, Cone Beam Computed Tomography (CBCT) is the gold standard for pinpointing the exact location of the ectopic tooth and evaluating the characteristics of any associated lesion prior to a surgical procedure. A 17-year-old woman was referred with swelling, asymmetry, and local pain in her right maxillary region. On radiological examination, an ectopic third molar surrounded by a dentigerous cyst obstructing both the right maxillary and ethmoid sinuses was observed. The tooth was attached to the zygomatic bone, right under the orbital floor. Ectopic maxillary third molars are extracted mainly by the Caldwell-Luc technique but also by nasal endoscopy. The treatment of this eruption and its management is heterogeneous and multidisciplinary. In the present case, under general anaesthesia, the ectopic tooth and all cystic tissue occupying the entire right maxillary and ethmoid sinuses were successfully enucleated with an intranasal endoscopic approach by an otolaryngologist and with lateral sinus antrostomy, utilising a standard Caldwell-Luc approach, by an oral and maxillofacial surgeon. After the 6th and 12th months, the patient had no signs of sinus infection and had an uneventful recovery

Comparison of Single Plate Transbuccal Fixation with Intraoral External Oblique Ridge Fixation in Mandibular Angle Fractures

Background: Mandibular angle fractures are treated by many open reduction and fixation techniques. Each technique has several advantages and disadvantages. The external oblique ridge fixation via introral approach versus transbuccal fixation and intraoral approach together were compared in this study. Objective: To compare the clinical outcomes of intraoral external oblique ridge fixation vs an intraoral transbuccal technique. A single miniplate fixation for the therapy of mandibular angle fractures.Material and Methods: A total of 180 angle fracture patients were randomly assigned to one of two experimental groups in this randomized control trial. Each group had 80 patients: group A and group B. On the first week, first month, and third month, all of the patients were followed up on to assess infection and malocclusion.Results: With an age range of 16 to 60 years, the average age of the 160 patients was 24.79 years (SD 6.855). At the end of three months, 12 (15%) of patients in group A and 7 (8.75%) of patients in group B had infection. At the last follow-up appointment, 2 (2.5%) patients in group A and 1 (1.25%) patients in group B both had malocclusion (03 months post-op). At the third month after using the Chi square test, the P-value for infection and malocclusion was negligible.Conclusion: The present study concluded that combination method (introral with transbuccal) can effectively treat mandibular angle fractures because it allows for easier plate adaption and placement of the plate in the mid neutral area, which reduces the risk of infection and malocclusion.

Epidermoid cyst of floor of mouth

&lt;p&gt;Epidermoid cysts are developmental malformations which are soft, mobile and slow-growing masses and they are unattached to the overlying skin. The most common cervical location of these cysts is the floor of the mouth without any gender predilection. The following report presents a case on epidermoid cyst and its management and a discussion on various differential diagnoses. This report presents a case with a painless swelling over the floor of mouth with dysphagia, dysarthria and orthopnea. Thorough history and examination of the swelling was done. Preoperative assessment was made with CT imaging. Complete surgical excision of the mass was done via intraoral approach under general anaesthesia with an uneventful recovery period. Swellings over the floor of mouth can be congenital, infectious, inflammatory or tumours. Preoperative evaluation can be done by taking thorough history, examination and radiological imaging. Surgical excision is the treatment of choice for epidermoid cysts with approach based on its relation with the mylohyoid muscle.&lt;/p&gt;

Surgical Treatment of Sublingual Gland Ranulas.

Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period. Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review. Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed. Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average. Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.