Intraoral Approach Research Articles

Endoscopic-Assisted Intraoral Approach for Osteosynthesis of Mandibular Subcondylar Fractures.

Introduction:The aim of this study is to follow-up and evaluate the treatment result of mandibular subcondylar (MSC) fractures by osteosynthesis via endoscopy-assisted intraoral approach.Materials and Methods:This is a prospective study, in which 47 patients with 51 sites of MSC fractures treated osteosynthesis via endoscopic-assisted intraoral approach at the Department of Maxillofacial Surgery, National Hospital of Odonto-Stomatology HoChiMinh City—Vietnam were followed-up and evaluated clinically and radiographically up to 6 months postoperative.Results:Before surgery, all of the patients were malocclusion, 15% of patients were isolated MSC fractures, the rate of concomitant midface fractures were 30%, 92.2% of fracture sites with moderate displacement, 7.8% of fracture sites with severe displacement, 5.9% of fracture sites with dislocation. After surgery, all of the patients had preinjured centric occlusion; no patient had facial paralysis; 6% of patients had surgical site infection within 1 week; pain frequency were 56.9% at 1 month, 35.3% at 2 months, 7.8% at 3 months, and 2.0% at 6 months with Visual Analog Scale (VAS) means of pain were 1.74±1.85 at 1 month, 0.55±1.12 at 2 months, 0.08±0.27 at 3 months and 0.02±0.14 at 6 months; 90% of fracture sites had precise anatomy at 1 week and 96% at 6 months; 96% fracture sites had no displacement the of correlation between condyle and articular fossa at 1 week and 98% at 6 months; 1 fracture site had screw loosening at 2 months; 88% fracture sites had stage-4 radiographic bone healing at 6 months.Conclusion:Endoscopic-assisted intraoral approach for osteosynthesis of MSC fractures have provided the esthetic and functional success and good bone healing.

SCHWANNOMA TONGUE: TWO CASE REPORTS

Schwannoma of the tongue is a relatively rare tumor of the head and neck. Intraoral schwannoma accounts for 1% of head and neck region and are commonly seen at the base of tongue. In this article we report two cases of schwannoma in young adult presented with painless swelling of the tongue. Lesion was completely excised via an intraoral approach and confirmed as schwannoma tongue in histopathology.

Comparison of intra-oral and extra-oral approaches in mandibular angle fractures

Aims and Objective: The aim of this study was to compare the outcomes of intra-oral and extra-oral approaches to mandibular angle fractures.Material and Methods: A Retrospective study was conducted in the Department of Maxillofacial surgery, Government Dental College and Hospital, Ahmedabad, India, for 1 year. Total 80 Patients with angle fracture that required open reduction and internal fixation were include in this study. All the Patients were reviewed for age, gender, presence of other fractures, type of surgical approach, OT time, which was calculated from the beginning of the incision till the closure. Length of admission and complications such as malocclusion, non- union, re-operation, post-op infection, neurosensory deficit, facial nerve injury, implant retrieval, scarring and wound dehiscence were also studied.Result: There were a total of 80 patients with mandibular angle fracture who underwent open reduction and internal fixation, 40 (50%) of them were treated intra-orally and the remaining 40 (50%) of them extra orally. The main etiology of injury was RTA in both the groups 30 (75%) in extra-oral group and 25 (62.5%) in intra-oral approaches. The mean operating room time for intra-oral approach was 81.89 minutes when compared to 99.8 minutes for extra-oral approach (p< 0.05). Intra-oral approach had a mean length of stay of 2.1 days and 2.69 days for extra-oral approach (p=>0.05). Malocclusion was seen in 5(12.5%) subjects of extra-oral group and 8 (20%) subjects of intra-oral approach patients (p=>0.05).Conclusion: We conclude the use of intraoral approach while clinically favorable with single miniplate along the superior border.

Intraoral route for excising a large dermoid cyst of the floor of mouth: A discussion

Surgical excision is an effective treatment for a dermoid cyst (DC) of the floor of the mouth (FOM). A dichotomy of opinions exist regarding the appropriate approach to surgical excision. In this study, we discuss our experience with excising a large DC via an intraoral route. An 18-year-old female presented with swelling of the submental region for one year. Under general anesthesia, an incision was conducted in the mucosa of FOM. By removing some contents, the cyst was delivered in toto. While some studies have stressed that the location of origin and size of the DC influence the route of excision, other authors have pointed out that by the time both median genioglossal and geniohyoid cysts become large enough to produce symptoms, both the muscles are splayed out and thus, the cysts are more amenable to excision by intraoral approach. This case highlights a dichotomy of opinion regarding the existing literature and to educate the clinicians about the benefits of the intraoral route of excision.

Lateral Pterygoid Muscle Ossification After Intraoral Condylectomy.

Lateral pterygoid muscle ossification has not been reported in condylectomy patients. This study aimed to explore the incidence, risk factors, and imaging characteristics of 38 cases with lateral pterygoid muscle ossification among 54 patients after condylectomy via intraoral approach. This retrospective study included 54 patients following simultaneous orthognathic surgery and condylectomy with coronoid process resection via intraoral approach. The authors evaluated the preoperative, 1 week, 6 months, and 1 year or more postoperative computed tomographic (CT) scans for the presence of lateral pterygoid muscle ossification and its characteristics. Sex, age at the time of surgery, disease course, affected side, preoperative alkaline phosphatase, pathology diagnosis, the height of the removed condyle, condylar shape, operator, preoperative temporomandibular joint movement, and clinical symptoms were assessed as risk factors for ossification. No incidence of lateral pterygoid muscle ossification was found on preoperative CT images. Various small-size osseous masses were observed in the lateral pterygoid muscles on postoperative 6 months CT images in 38/54 patients (70.37%) after condylectomy. But no apparent enlargement of the osseous masses was found. No patients complained of clinical discomfort or functional disorder during the follow-up period (23.11 ± 13.16 months). No significant risk factors for ossification were found. Lateral pterygoid muscle ossification is relatively common in patients after condylectomy via intraoral approach. However, its enlargement is self-limited and remains stable 6 months after surgery. it has no adverse effects on the temporomandibular joint functional movement.

Resection of Giant Cemento-Ossifying Fibroma of Jaws by Intraoral Approach—A Case Report and Review

Introduction: The World Health Organization in 1971 first classified fibro-osseous lesions (FOLs) as cementum forming tumors of jaws as ossifying fibroma (OF), cement-osseous dysplasia, and fibrous dysplasia. Various theories have been put forward regarding the origin of cemento-ossifying fibroma (COF) but current interests are oriented toward traumatic and developmental etiologies. The COFs are a slow-growing osteoexpansile tumor which grows to a considerable size. The tumor usually arises from tooth bearing and periodontal ligament region basically of odontogenic origin. Background: An inordinate, bony hard swelling, present united in both the jaws showing radiopaque-radiolucent mass, corticated margins, with expansion of buccal as well as lingual cortex gives a delusional image for the provisional diagnosis for surgeon, particularly to decide the surgical approach. These traits showing similarity with FOLs, more particularly cemento-OF, owing to its odontogenic or periodontal origin. Case Report: In this case, a 42-year-old female presented with abovementioned features was first taken for biopsy and then planned for simultaneous surgical resection of pathology for both jaws, from an intraoral approach giving a scar-free result. Preclusion of immediate complications was dealt with reconstruction of mandible with 2.5-mm titanium reconstruction plate. Conclusion: The diagnosis of cement-OF is based on clinical-radiographic-histopathologic evaluation. If remain untreated, these tumor can grow up to an average size of 80 mm, therefore, demanding an early surgical intervention. In our case, intraoral approach leads to almost no residual fibrosed tissue. The patient is further being planned for rehabilitation with either free fibula graft or 3-dimensional mandibular prosthesis.

Long-standing temporomandibular joint dislocation treated by intraoral condylectomy: a case report and review of the literature

BackgroundNoninvasive management by closed reduction is a desirable treatment for temporomandibular joint dislocation. However, reduction of long-standing temporomandibular joint dislocation is often difficult. Various conservative treatments have been attempted, but these often render poor outcomes. This article reports the case of long-standing temporomandibular joint dislocation that was successfully closed using intraoral condylectomy.Case presentationA 69-year-old Japanese man who sustained an injury in a car collision was unable to close his mouth. Owing to the diagnosis of long-standing temporomandibular joint dislocation, intraoral condylectomy was performed. In the case of temporomandibular joint dislocation, it is convenient to reach the condyle from the oral cavity because sufficient opening is maintained. The condyle can be clearly visualized using an approach similar to sagittal split ramus osteotomy, and the operation using surgical instruments can be facilitated by resecting the coronoid process. By separating the surrounding soft tissue and pulling the cut condyle with sufficient visual field, the condyle can be resected while addressing the hemostasis. During the 12-month postoperative follow-up period, no temporomandibular joint dislocation recurred and the occlusion remained stable.ConclusionsThe limited intraoral incision of this surgical technique provides sufficient access for condylectomy. The results of this case report suggest that condylectomy by intraoral approach could become the treatment of choice for long-standing temporomandibular joint dislocation.

Computer-assisted intraoral approach in the management of infected comminuted mandibular fractures: Technical notes

In the extraoral approach for mandibular fractures, facial scars and facial nerve injury are common complications. Herein, we introduce an improved surgical technique to reduce fragments of infected comminuted mandibular fractures with the assistance of computer software. Firstly, the model was reset by 3-dimensional (3D) printing, and then the titanium plate was reconstructed on the model. Finally, open reduction and internal fixation through intraoral approach. This method can effectively control infection, reduce facial scars and avoid the risk of facial nerve injury.

Hyaluronic acid filler injection for deep nasolabial folds: A novel intraoral approach.

Hyaluronic acid filler injection is a minimally invasive procedure for facial rejuvenation that involves injecting filling materials to correct the volume or augment specific areas in the face. Deep nasolabial folds are a common concern in aging people. The simplest way to correct a deep nasolabial fold to rejuvenate the face is to inject Ristow's space with hyaluronic acid fillers. However, conventional injection methods, such as percutaneous injections using a needle, can cause severe complications, such as skin necrosis or blindness due to intravascular injections. Therefore, the aim of the present study was to introduce a safe technique for intraoral filler injections in deep nasolabial folds and review related anatomic features to evaluate the safety of this technique.

Contribution of anatomical criteria to surgical approach for treatment of bilateral coronoid hyperplasia

IntroductionBilateral coronoid hyperplasia is a rare condition characterized by a progressive and painless limitation of mouth opening. The treatment consists of coronoidectomy by intraoral or coronal approach. There is no recommendation in the literature on the choice of the surgical approach according to the importance of the hypertrophy. The objective of our study is to search for predictive anatomical criteria of each approach. Material and methodsThese anatomical criteria were evaluated from 3D CT facial reconstructions of 4 male patients aged 4 to 30 years retrospectively after their surgery. A single intraoral approach was used for cases 1 and 2 (group A), a double approach for cases 3 and 4 (group B). Same measurements were performed on 10 male case controls (group C). We performed a descriptive analysis of our results due to an insufficient number of patients. ResultsThe average width of the coronal processes was much greater in group B, when a double approach was necessary, than in groups A and C. In groups A and B, the average height of the coronoid notch is low compared to group C when there is a need for a coronal approach. The width/TZS ratio is increased in group B compared to group C. DiscussionIn our study, 3 criteria could be informative for the choice of the surgical approach: the width at the superior end of the coronoid process, the width/TZS ratio and the height of the coronoid notch but additional data are needed to confirm our therapeutic options.

A large submandibular salivary stone: A case report

Sialolithiasis accounts for the most cases of salivary gland obstruction which leads to recurrent painful swelling of the involved gland which often exacerbates while eating. Stones may be encountered in any of the salivary glands but most frequently in the submandibular gland and its duct. This is a case report of a 40-year-old male patient who had a submandibular sialolith. The sialolith was removed with intraoral approach and no post-operative complications were noted. The article also reviews the various available diagnostic modalities and treatment options.

Botulinum toxin injections in jaw-opening dystonia. The lateral pterygoid – maxillary artery problem

It has been suggested that the variations in the trajectory of the maxillary artery (MA) near the lateral pterygoid muscle (LPM) play a critical role in Botulinum neurotoxin (BoNT) injections in patients with jaw-opening/deviation dystonia (JOD). In the case of a lateral course to the LPM, an extraoral injection entails risks of MA injury, pain, and hematoma. Previous reports suggest geographical differences in variations of the MA-LPM relationship. We aimed to determine these variations in Turkish individuals and highlight the need to establish a consensus on approach to LPM injections. In 284 individuals, contrast-enhanced magnetic resonance angiography (MRA) images were evaluated by two radiologists on both sides for the variations in the course of the MA in the infratemporal fossa. Images of 44 were excluded due to trauma, arteriovenous malformation, mass, surgery, and imaging artifacts. Of the included, 62.1% were female. In 480 evaluations of 240 individuals, the MA passed lateral to the LPM in 65.6% (n = 315). No sex difference was noted. In 51 individuals (21.3%), the MA course differed on the right and left sides (medial–lateral asymmetry). These results confirm that the lateral course of the MA is more frequent. In patients with JOD, the trajectory of the MA should be determined with imaging prior to extraoral BoNT injections. In the case of a lateral course, an intraoral approach seems to be safer to avoid a potential MA injury.

A Combined Transoral and Contralateral Submandibular Approach in the Surgical Management of Osteoradionecrosis of the Mandible With Free Flap Reconstruction

We describe a method for performing mandibular resection and vascularized tissue transfer via an intraoral and contralateral submandibular approach to minimize the risk of wound complications in a radiated field. Surgery on radiated tissue associated with osteoradionecrosis of the mandible can present with oral cutaneous fistulas, dense fibrotic skin, and altered tissue planes to make dissection through this tissue tedious and can place the marginal mandibular nerve at increased risk of injury. The use of custom plates allows surgeons to minimize incisions and depend less on anatomic/visual cues during surgery to obtain an accurate result. Our experience in 8 patients has shown a predictable method for resection and reconstruction of the mandible, while minimizing the potential complications associated with previously radiated and operated patients.

Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature.

Background: The purpose of the present case report was to investigate a very rare ectopic third molar removal by a trans-sinusal approach and report the study findings through a systematic review of the literature on this topic. Case presentation: A 38-year-old female patient was visited for pain at the level of the right maxillary region. No relevant medical history was reported. The CBCT tomography assessment revealed an impacted third tooth at the level of the postero-lateral maxilla. Review Methods: An electronic search was performed through Boolean indicators query on Pubmed/Medline, EMBASE, Cochrane Library databases. The clinical reports were identified and selected in order to perform a descriptive analysis. The surgical approach concerned a trans-sinusal access to the site for the ectopic tooth removal with a lateral antrostomy. No evident inflammatory alteration was associated to the ectopic tooth and a non-relevant post-operative sequelae was reported at the follow up. Results: A total of 34 scientific papers were retrieved from the database search. Only two cases reported a wait-and-see radiographical follow-up approach, while the most common treatment was surgical removal, also for asymptomatic cases. Conclusion: The third-molar ectopic tooth into the maxillary sinus is an uncommon occurrence that is beast treated by an in-chair intraoral tran-sinusal approach, with a consistent reduction of the invasivity, a mild morbidity and a successful functional outcome.

Role of general anesthetic agents in postoperative nausea and vomiting: A review of literature.

Postoperative nausea and vomiting (PONV) is considered to be the most unpleasant experience associated with surgery and is believed to be one of the most common reasons for poor patient satisfaction in the postoperative period. It also results in prolonged hospitalization and increased use of resources such as intravenous fluids and drug supplements along with prolonged medical attention, all of which have psychological and financial implications. In addition to this, PONV can result in aspiration, laryngospasm, dehydration, electrolyte disturbances, gastric bleeding, increased intracranial pressure, increased intraocular pressure, and wound dehiscence particularly when the surgical intervention is performed through an intraoral approach. It is a well-known fact that there are many etiological factors as well as predisposing factors for PONV. Hence, this review is intended to evaluate as an individual factor what the role was played by the anesthetic agents used for GA in the incidence of PONV.

EAGLE SYNDROME: ETIOLOGY, DIAGNOSIS AND TREATMENT. A LITERATURE REVIEW AND PRESENTATION OF CASES

Objectives: The aim of this poster presentation is to review the etiology, diagnostic process and management of Eagle syndrome. In addition, some cases diagnosed with Eagle syndrome are discussed. Materials and Methods: Searches were conducted in Google Scholar, PubMed and Science Direct databases. Only English language results were reviewed. The following key words were used: “Eagle Syndrome” and “stylohyoid syndrome”. Typical cases will be presented. Results: Eagle Syndrome is a rare clinical condition (4–8 per 10,000 people) that presents with a variety of symptoms. It was first described by Eagle in 1937. It is more common in females than males (2:1 ratio) and in ages mainly greater than 50 years. Eagle syndrome is characterised by elongation of the styloid processes and/or stylohyoid ligament calcification, unilaterally or bilaterally. Due to its atypical symptoms, it is easy to be misdiagnosed. Common symptoms are: facial and neck pain, otalgia or temporomandibular joint pain, dysphagia/odynophagia, foreign body sensation. Other conditions related with Eagle syndrome are: ischemic attacks, carotid artery dissection and Horner’s syndrome. The patient’s history, physical examination and imaging are essential for management of this condition. Three-dimensional reconstructive computed tomographic (CT) scan remains the gold standard for diagnosis, as is shown in our case . Eagle syndrome is commonly treated either with conservative methods (e.g. analgesics, anticonvulsants, local injections) or surgically (intraoral or extraoral approach). Conclusion: Eagle syndrome is rare and difficult to diagnose. Various specialists are involved in its management. Proper diagnosis and treatment are significant due to its potentially serious complications. Surgical treatment is more definitive and provides long lasting relief.

Intraoral and transcutaneous point-of-care-ultrasound: an adjunct bedside tool for oral and maxillofacial clinicians.

Point-of-care-ultrasound (PoCUS) is performed by the clinician at the patient's bedside and is an essential diagnostic tool in many medical subspecialties, in hospital-based care, emergencies, trauma, and in general practice. A simple, novel approach for implementation of PoCUS of the oral cavity and maxillofacial complex is introduced. Relevant indications include differentiating abscess from cellulitis, detecting jaw and facial fractures, assessment of surgical complications, removing foreign bodies, and evaluating soft tissue masses. Intraoral and transcutaneous approaches may be used alone or in combination. This pilot series shows the capability of PoCUS to improve diagnostic accuracy, speed diagnosis, guide procedures, and improve management. Prospective studies are underway to determine the strengths and weaknesses of the method and its impact on patient outcomes.

ORAL PRESENTATION: Eagle Syndrome: The Forgotten Entity

Elongated styloid process or Eagle syndrome is a rare condition presenting with a wide range of symptoms including throat pain, foreign body sensation, neck pain and ear pain. Establishing a diagnosis requires a high index of suspicion and understanding of this entity by the physician. Computed tomography (CT) is the gold standard to diagnose Eagle syndrome. Conservative medical treatment with analgesics, oral steroids and anticonvulsants are offered in patients who refused surgery. The mainstay of treatment is surgical resection via intraoral or cervical approaches. We describe a rare case of bilateral Eagle syndrome in a 46-year-old female who was presented with chronic foreign body sensation in the throat but aggravated following fish bone ingestion. Flexible nasopharyngolaryngoscopy (FNPLS) and cervical x-ray did not reveal any foreign body and the patient was treated conservatively. Incidentally, a cervical x-ray also revealed an elongated styloid process bilaterally. Upon follow-up, the patient was still symptomatic. Thus, a CT scan with contrast of the neck was requested, which reported no foreign body, but the presence of bilateral elongated styloid process suggesting Eagle Syndrome. The patient was subjected to transoral endoscopic assisted bilateral styloidectomy following tonsillectomy. There was a complete resolution of the symptoms postoperatively. This approach is recommended to avoid external scarring and minimize postoperative pain. Eagle syndrome is diagnosed based on a combination of physical examination and radiological findings. The treatment options may vary based on the severity of symptoms.International Journal of Human and Health Sciences Supplementary Issue: 2022 Page: S14

Precise Intraoral Condylectomy With the Guide of Three-Dimensional Printed Template in a Mandibular Condylar Hyperplasia Patient.

This study aimed to introduce an innovative method for mandibular condylectomy. A customized three-dimensional (3D) printed template is used to perform precise condylectomy in an intraoral approach. Condylectomy combined with orthognathic surgery was used for the treatment of facial asymmetry secondary to unilateral condylar hyperplasia. The customized 3D printed osteotomy guide was placed with an intraoral approach under endoscopy, in order to perform a precise condylectomy. With the customized 3D printed template, the condylectomy was performed more precisely, and the conventional extraoral incision was avoided. The osteotomy line was accurately transferred from the virtual surgical plan to the real surgery, which assured the precise resection. The intraoral approach combined with a 3D printed template provides a novel solution to perform the condylectomy precisely.

Management for the rehabilitation of atrophic mandible fracture: case using a conservative approach and short implants

The treatment of atrophic jaw fracture is a challenge in maxillofacial surgery, due to both local and systemic factors of the affected patients. This article aims to report a case of bilateral atrophic fracture of the mandible treated with an intraoral approach through a thinner and locked 2.0 mm system mandibular plate and subsequent rehabilitation with an implant- supported prosthesis. This technique provided the patient with excellent masticatory, aesthetic, and functional recovery with less morbidity and faster recuperation.