Intraoral Removal Research Articles

Factors Influencing Recurrence after Surgical Treatment of Odontogenic Maxillary Sinusitis: An Analysis from the Oral and Maxillofacial Surgery Point of View.

The aim of the study was to determine the factors influencing the development of recurrence after the surgical treatment of odontogenic maxillary sinusitis in an oral and maxillofacial surgery clinic over a 7-year period. Demographic and anamnesis data, clinical and radiological findings, treatment and outcome were analyzed. A multivariable analysis was performed to find associations between patient age, causative focus, surgical access for sinus revision, multilayer closure with a buccal fat pad, inferior meatal antrostomy (IMA) for temporary sinus drainage and sinusitis recurrence. A total of 164 patients with a mean age of 51.7 years were included. Sinusitis recurrence was observed in nine patients (5.48%) within 6 months after primary surgery. No significant correlation was detected between patient age, causative focus, surgical access for sinus revision, multilayer closure with a buccal fat pad, IMA for sinus drainage and the development of recurrence (p > 0.05). Patients with a history of antiresorptive-related osteonecrosis of the jaw showed a significant tendency toward disease recurrence (p = 0.0375). In conclusion, except for antiresorptive administration, none of the investigated variables were related to a higher risk of sinusitis recurrence. We encourage a combined approach of intraoral removal of the infective focus and sinus drainage via FESS, as well as an individual treatment decision in a multidisciplinary setting with collaboration between dentistry, maxillofacial surgery and otorhinolaryngology to avoid sinusitis recurrence.

Anatomical Relationship Between the Lingual Nerve and Submandibular Duct.

The purpose of this study was to investigate the anatomical relationship between the lingual nerve and submandibular duct. This study included 1403 patients with submandibular or sublingual gland diseases who underwent intraoral removal of submandibular gland sialoliths, submandibular glands, or sublingual glands. Of all patients, 33 patients underwent bilateral surgeries. All surgeries were performed a single surgeon, and the anatomical relationship between the lingual nerve and submandibular duct was always identified intraoperatively and recorded in the operation recorded. The anatomical relationship was investigated based on the intraoperative findings. The lingual nerve which crosses above the submandibular duct was detected in 8 of 1436 sides (0.6%). There were 4 in the right sides and 4 in the left sides. The lingual nerve below the submandibular gland was seen in 99.4%. Although the lingual nerve crosses above the submandibular duct with a rarer incidence, surgeons should beware of injuring the lingual nerve during intraoral salivary gland surgery.

Endoscopically Assisted Intraoral Removal of Infrageniohyoid Dermoid Cyst

Endoscopically Assisted Intraoral Removal of Infrageniohyoid Dermoid Cyst

The intraoral approach for removal of hilar submandibular stones: a case series and review of the literature

Background: Salivary calculi are the most common cause of salivary duct obstruction, often occurring in the submandibular gland. In Australia, transcervical sialadenectomy is routinely performed for hilar submandibular gland stones. However, increasing overseas literature has demonstrated good recovery of glandular salivary function after removal of the obstructive calculus. This study aims to influence local practice and encourage the intraoral removal of hilar stones, by describing our intraoral technique and case series, as well as a review of the current literature.

Clinical Comparison of Transoral Removal with Sublingual Gland Preservation versus without Sublingual Gland Preservation versus Submandibular Gland Resection for Proximal Duct Stone of Submandibular Gland: Prospective Study

Background and Objectives Proximal submandibular stone is not a rare disease. The aim of this study is to evaluate the surgical outcomes of 3 different ways to treat proximal submandibular stone: intraoral removal of stone (IORS) with sublingual gland (SLG) resection, IORS without SLG resection and submandibular gland (SMG) resection.Subjects and Method We prospectively reviewed the surgical outcomes of IORS with SLG resection group (22 patients), IORS without SLG resection group (35 patients) and SMG resection group (22 patients). To evaluate the surgical outcomes, we analyzed the location and size of stones, mean operation time, mean hospital stay, mean postoperative degree of pain based on a visual analog scale (0–10), and incidence of complications.Results There were no significant differences between the mean diameter of stones and length from the hilum to stones. The mean operation time was shorter in the IORS without SLG resection group than that in IORS without SLG resection group, and was significantly shorter than that of the SMG resection group. The mean hospital stay of the IORS without SLG resection group was also shorter than that of IORS with SLG resection group, and was significantly shorter than the SMG resection group. IORS without SLG resection group felt less pain than IORS with SLG resection group and SMG resection group. Four patients who underwent IORS without SLG resection experienced transient and mild SMG swelling, and mild paresthesia was noted on the same side. All patients recovered within 3 months. Intraoral removal of proximal SMG stones exhibited several advantages over SMG resection in terms of hospital stay, mean operation, time and postoperative pain.Conclusion Based on our results, we suggest that IORS without SLG resection be selected as the primary procedure for the removal of proximal submandibular stones rather than SMG resection.

EPIDERMOID CYST OF THE BUCCAL REGION OF THE FACE

Epidermoid cyst is a common cutaneous cyst that occasionally affects the oral cavity. A 52-year-old black woman presented a subcutaneous well-defined swelling in the right cheek, which caused considerable facial asymmetry with duration of 15 years. The lesion was asymptomatic, was firm in consistency, and measured 5 cm. Intraoral examination showed a submucosal nodule in the buccal mucosa. Intraoral conservative surgical removal was performed and grossly, a brownish fragment of irregular cut surface was observed. Microscopic evaluation showed a cystic cavity filled by keratin and lined by orthokeratinized stratified squamous epithelium with highly pigmented basal cells, suggesting origin from the entrapment of the superficial pigmented epithelium of the skin face. The final diagnosis was epidermal cyst of the face with extension to the buccal mucosa. Exuberant epidermal cyst may cause facial asymmetry, and intraoral surgical approach may be required to avoid postsurgical esthetic concerns.

Retrieval of displaced implants inside the maxillary sinus: two case reports and a short review

ObjectiveThe aims of this paper are to demonstrate two cases of implant migration into the maxillary sinus and to give a short review of the literature on this subject.Clinical procedureTwo patients were diagnosed with implant migration into the maxillary sinus. After thorough radiographic examination which revealed the exact position of the implants inside the maxillary sinus, removal was performed through a bony window in the anterior-lateral aspect of the maxillary sinus for both cases.DiscussionImplant displacement into the maxillary sinus can occur intraoperatively or postoperatively either prior to implant loading or after functional loading. Several actors can lead to this complication differing according to the stage of the displacement.Management of this complication is achieved using four surgical techniques: a. Functional endoscopic sinus surgery, b. intraoral removal by the Caldwell-Luc technique, c. removal through the alveolar bone, d. combination of the last two techniques. If implant displacement into the maxillary sinus remains untreated, it can lead to several complications with various effects.ConclusionMigration of dental implants into the maxillary sinus is a rare but severe complication which must be treated as soon as possible.

A case report on meal time syndrome

<p class="abstract">Sialolithiasis is the formation of calculi within the parenchyma of salivary gland or its duct. These cases present with pain and swelling of salivary gland. The exact aetiology of salivary stones is not completely understood and various hypotheses have been put forward. They include agglomeration of sialomicroliths, anatomical variations of salivary ducts and altered biochemical composition of saliva. Here we are reporting a case of 45 year old gentleman with a giant sialolithiasis in submandibular region. He came with pain and pus discharge from left side of floor of mouth for one week. On inspection a bludge was seen in left side of floor of mouth. On bimanual palpation, a stony hard mass was felt which was tender and not mobile. Under local anaesthesia surgical removal of stone done. Sialoliths are equally distributed between left and right side of the oral cavity. Mean size of sialolith is reported as six to nine mm and they infrequently measure more than 1.5 cm. The majority of salivary calculi is formed from phosphate and oxalate salts. Sialography allows whole duct system to be visualised, demonstrating calculi of all sizes and also the glandular percentage. Sialodochotomy is a well-reported technique for the intra-oral removal of ductal stones, including giant calculi. Giant sialolith is a rare entity worth reporting. Though conventional methods are still useful for diagnosis and therapy many innovative techniques are evolving around it.</p><p> </p>

An accessory technique for the intraoral removal of a fractured implant abutment screw

As the use of dental implants becomes more prevalent, mechanical complications become more common. When an implant abutment screw fractures, it can be difficult to retrieve the retained fragment. The purpose of this article is to describe a technique to remove the abutment screw fragments without damaging the implant body or its screw threads.

Caso clínico: Sialolito gigante en el conducto de Wharton.

La sialolitiasis es una afección frecuente de las glándulas salivales mayores, con una frecuencia de aparición del 1.2% en la población mundial, ocurre con mayor frecuencia en la glándula submandibular. Esta se produce debido a la obstrucción de la glándula salival o del conducto de la misma debido a un sialolito. Este cálculo se desarrolla como resultado de un estancamiento de saliva, este proporciona un ambiente idóneo para la deposición de sales y otras sustancias orgánicas formando un cálculo. El tamaño de los sialolitos frecuentemente es de 1 a 10mm y en raras ocasiones se puede apreciar sialolitos gigantes, estos pueden llegan a medir más de 15mm y usualmente se localizan en el conducto de Wharton. En este artículo se reporta un caso de un sialolito de 25mm de diámetro que se localizaba en el conducto de Wharton, el cual no presentaba sintomatología y fue descubierto por un examen de rutina, y el tratamiento que se eligió fue la remoción por vía intraoral.

Risk Factors for Complications of Intraoral Removal of Submandibular Sialoliths

Intraoral removal of submandibular sialoliths is a surgical technique for the treatment of sialolithiasis and is reported to have excellent outcomes. The aim of this study was to determine the risk factors leading to complications of this procedure. The medical records of 200 patients who had undergone intraoral removal of sialoliths from January 2006 through June 2015 were retrospectively reviewed. A telephone survey was used to check postoperative symptoms. Dry mouth, wound infection, lingual nerve dysfunction, and recurrence were considered complications. Computed tomograms of the neck were reviewed for location, shape, number, and size of the stone. Forty-four patients reported a complication. The incidence of complications was significantly higher in patients with stones in the proximal region of the salivary duct (proximal group) than in those with middle or distally located stones (middle/distal group; P<.05). The average stone size was larger in the proximal group; the operation time and length of admission also were longer in the proximal group, with a statistically significant difference (P<.05). Complaints of lingual nerve dysfunction were significantly higher in the proximal group than in the middle/distal group (P<.05). Patients with proximally located stones had more complications, especially lingual nerve dysfunction, than those with middle or distally located stones. The former group also required a longer operation time and hospital stay.

Accidental displacement of mandibular third molar root into the sublingual space and delayed removal

AbstractOral surgeons rarely experience accidental displacement of a mandibular impacted third molar into adjacent anatomical spaces as a complication. As any displaced third molar or its root is commonly removed at the time of displacement or within several weeks of the extraction, delayed removal several years after initial extraction is extremely rare. We report here accidental displacement of a mandibular third molar root into the sublingual space and a 5‐year delay in its removal. A 42‐year‐old woman presented to our department with pain and swelling in the lingual aspect of the left mandible. Computed tomography revealed a 15 × 11 × 9 mm lesion, with a similar density to that of the surrounding bone and involving the lingual cortex of the left mandible. A yellowish‐white hard tissue lesion was protruding from the lingual mucosa of the left mandibular ramus. The patient had undergone removal of a left impacted mandibular third molar at a private dental clinic 5 years earlier and we diagnosed the lesion as a remnant third molar root. The patient had not been informed by her dentist of accidental displacement of the tooth into the sublingual space after crown removal. After complete alleviation of inflammation, the patient underwent intraoral removal of the root under general anaesthesia. After elevating the lingual mucoperiosteal flap from the mandibular ramus to the premolar region, the root was easily removed using an elevator and forceps. Her postoperative course was uneventful and there were no complications such as lingual nerve injury.

Use of a novel tongue retractor for intraoral removal of proximal/hilar submandibular gland stone

ObjectiveIntraoral removal of proximal/hilar or intraglandular stones is technically difficult, because the surgical field is limited. However, intraoral removal of deep submandibular gland stones has several advantages over submandibular sialoadenectomy, including shorter operation time and better gland function. To overcome the technical difficulties associated with intraoral removal of deep submandibular gland stones, we designed a novel tongue retractor and here describe its use. MethodsThe tongue retractor for the intraoral removal of proximal/hilar submandibular gland stones has a wing on each side for the retraction of soft tissues. After careful dissection along Wharton’s duct to the hilum of the submandibular gland, we used the new tongue retractor. ResultsThe new tongue retractor enables the lingual soft tissues to be retracted easily and it maintains a better surgical field, compared with standard tongue retractors. For hilar/intraglandular stones in the medial portion of the submandibular gland, after dissection of the medial side of the gland, the newly designed tongue retractor provided a good surgical field for easy and reliable stone removal. ConclusionThis novel tongue retractor offers a better surgical field and shorter operation time for intraoral stone removal than standard tongue retractors.

Evaluation of the prevalence of residual sialolith fragments after transoral approach of Wharton's duct.

Transoral submandibular duct sialolith removal is a simple technique with very few complications. Nevertheless, following this procedure, we have observed long-term calculus recurrence in a number of patients. We therefore elected to evaluate these cases. This was a monocentric prospective study performed between November 2013 and June 2014. All patients received surgery for submandibular gland lithiasis by intraoral removal of submandibular duct calculi. Between the day following the procedure and 3 months postsurgery, these patients systematically underwent an ultrasound examination of the submandibular gland. The study comprised 15 males and 15 females aged between 19 and 87 years, of which one male presented with bilateral calculi (n=31). Asymptomatic sialolith fragments were found in 16% of patients. A statistically significant risk (p<0.05) of residual sialolith was demonstrated in cases in which the calculus or multiple calculi fragmented perioperatively. Our aim was to remove the sialolith as non-traumatically as possible and to perform sialendoscopy at the end of the procedure to check the patency of the anterior ductal segment and to ensure that no residual calculus fragments were present despite the loss of fluid tightness subsequent to the opening of the hilum.

内視鏡補助下に経口的に摘出した異所性甲状腺腫症例

舌根部異所性甲状腺腫はまれな発生学的異常で，舌盲孔から正常の気管前面への下降障害に起因する。患者は34歳女性で甲状腺機能低下状態であり，呼吸苦や咽頭違和感を呈していた。画像所見では舌正中に境界明瞭な35mm大の腫瘍が認められた。甲状腺ホルモン補充療法を行うも腫瘤のサイズは不変であったため手術療法が選択された。創部の早期治癒や外切開による手術痕を避けるために経口的に内視鏡補助下に舌根部異所性甲状腺腫切除術を施行した。術後経過としては特に合併症は認められなかった。内視鏡補助下での経口的舌根部異所性甲状腺腫切除術は技術的に適しており，かつ安全であることと思われ，有症状の舌根部異所性甲状腺腫の患者には第一選択の治療法として考慮されるべきである。

Use of 2.0 mm drill bit for intraoral removal of ectopically positioned teeth

ObjectiveThe objective of this paper was to use the 2.0mm drill bit instead of a conventional bur for intraoral removal of ectopic teeth. MethodsThe authors have used this method to remove four such ectopic positioned teeth by intraoral approach. ResultsThe use of 2.0mm drill bit proved as a useful tool to remove the ectopic third molars due to its long cutting edge and increased visibility during bone drilling with no complications like breakage. ConclusionThe use of a 2mm long drill bit makes the intraoral removal of ectopic teeth possible with greater ease as compared to conventional burs. It also reduces the amount of bone removal due to its small size as compared to long ENT burs which have a larger diameter.

A Case of Giant Epidermoid Cyst in the Floor of the Mouth That Caused Severe Obstructive Sleep Apnea Syndrome

We describe here, a case with a giant epidermoid cyst in the floor of the mouth that caused severe obstructive sleep apnea syndrome (OSAS). A 37-year-old man was referred to our clinic because of a swelling in the floor of his mouth and sleep apnea syndrome. The occurrence of breathing disorders and daytime drowsiness was monitored to evaluate his OSAS 1 day before and 7 days after surgery. Before surgery, the apnea-hyponea index (AHI) and Epworth Sleepiness Scale (ESS) were 45.7 and 22, respectively. The clinical diagnosis was a dermoid or an epidermoid cyst that caused severe OSAS. Under general anesthesia, the patient underwent intraoral surgical removal of the cyst, along with aspiration to reduce the mass. After surgery, his sleep apnea syndrome was significantly improved. The postoperative AHI and ESS were 5.5 and 7, respectively. As of 2 years after the operation, there was no evidence of recurrence.

Endoscope-Assisted Intraoral Removal of the Thyroid Isthmus Mass Using a Frenotomy Incision

A thyroid isthmus nodule is a relatively rare condition. A small number of patients will present with thyroid mass isolated at the thyroid isthmus, which can cause discomfort in swallowing and cosmetic problems. Thus, some patients choose to have these nodules excised. The surgical removal of the thyroid isthmus mass is usually accomplished through an external incision of the neck. However, this procedure inevitably results in a neck scar. We report a case of an 18-year-old woman with a thyroid isthmus mass. We implemented a modified approach for the removal of the thyroid isthmus mass by using a frenotomy incision of the mouth, accompanied by an endoscope system. A modified approach for the removal of the thyroid isthmus mass was used on the patient. The total operating time was 70 minutes. The patient continues to be free of any diseases 12 months after the excision. Resection of the thyroid isthmus mass can be performed by an intraoral endoscope-assisted approach through a frenotomy incision of the mouth. We described the detailed procedures for an endoscope-assisted transoral thyroid isthmus mass excision using a frenotomy incision.

PP165: Advantages of intraoral removal over submandibular gland (SMG) resection for proximal submandibular stones

Purpose The purpose of our study is to compare surgical outcomes of proximal submandibular stones between intraoral removal and traditional SMG resection. Materials and methods Forty-four patients were diagnosed with proximal submandibular stones by Neck CT. They are randomly assigned to either the intraoral removal of stone (IORS) group or the conventional SMG resection (SMGR) group. A single surgeon performed all of the operations. Results Means stone size was significantly smaller in IORS group than SMGR group by 5.2–9.0 mm.Means distance from hilum of both groups showed no significant difference. Means distance from hilum of both groups showed no significant difference. Mean operation time was significantly shorter in IORS group than that of SMGR group by 51.1 versus 83.2 min. Mean hospital stay was also significantly shorter in IORS group by 2.6–5.3 days. Mean postoperative pain estimated by VAS was significantly lower in IORS group by 3.0 versus 4.3. Conclusions Intraoral removal of proximal submandibular stones has several advantages over SMG resection in terms of hospital stay, mean operation time, and postoperative pain. Also there were no reported complications after the operations. We therefore recommend that our intraoral removal method replace SMG resection as the primary procedure for the removal of proximal submandibular stones.

Endoscope-Assisted Intraoral Removal of Ectopic Thyroid Tissue Using a Frenotomy Incision

Ectopic thyroid tissue is a relatively rare condition and a developmental anomaly characterized by the aggregation of thyroid tissue. Usually, it occurs along the path of descent of the developing thyroid primordium from the foramen caecum, the most common being in the anterior midline of the neck at or below the level of the hyoid bone. Surgical removal of ectopic thyroid tissue is usually accomplished through an external incision in the neck. However, this procedure inevitably results in a neck scar. We report the case of a 30-year-old woman with ectopic thyroid tissue. We implemented a modified approach to ectopic thyroid tissue removal through a frenotomy incision of the mouth using an endoscope system. A modified approach to ectopic thyroid tissue removal was used in this patient. The total operative time was 50 minutes, and the patient remains free of disease 15 months after excision. Resection of ectopic thyroid tissue can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth.