Left Mandibular Area Research Articles

Beyond dermatomes disseminated Herpes zoster in the immunocompetent: two rare cases

Herpes zoster is typically a localized reactivation of the varicella-zoster virus (VZV) that occurs in individuals following a primary varicella infection (chickenpox). Disseminated herpes zoster, characterized by widespread vesicular lesions beyond the primary dermatome, is uncommon and usually associated with immunocompromised states. Till date only 25 immunocompetent patients with disseminated HZ have been reported in literature. We report two such cases of disseminated HZ in immunocompetent individuals. The 1st patient is a 53-year-old woman with painful, itchy multiple grouped erythematous papules, vesicles, and bullae over right T8-T9 dermatome and multiple papules, crusted papules, and vesicles over face associated with fever and fatigue. The 2nd patient is an 8-year-old boy with multiple grouped clear vesicles and bullae with erythematous base involving the left S1-S5 dermatome. Multiple discrete erythematous papules and vesicles (active and crusted) were noted over trunk, right forearm, left arm, bilateral thigh and left mandibular area. Routine laboratory investigations were within normal limits. Tzanck smears were done, and multinucleated giant cells were seen in both cases. They were treated with antivirals and showed improvement. We have reported these two cases of disseminated HZ due to their occurrence in immunocompetent patients, which is a very rare phenomenon.

Guided Bone Regeneration to Support Lack of Mandibular Buccal Plate

Background: Insufficient bone condition can pose a significant challenge in dental implant procedures. The success of implant therapy relies on having sufficient bone thickness at the implant site. Factors such as bone atrophy, periodontal disease, trauma, and intermaxillary relationships (vertical, horizontal, and sagittal) can lead to insufficient bone volume for placing implants. To address this issue, bone augmentation techniques are commonly used to restore function and improve aesthetics in areas with inadequate bone. Various techniques and materials are available for bone augmentation, including Guided Bone Regeneration (GBR), which is one of the known methods with varying success rates. Objective: provide information about the management of bone augmentation in dental implants using the GBR technique. Case report: involves a 21-year-old male patient who sought treatment at a clinic to resolve functional issues and prevent dental shifting following a tooth extraction. The patient desired permanent dentures for the left mandibular area. After undergoing several examinations, it was determined that dental implants on tooth 46, with a diameter of 4.1 mm and length of 10 mm, accompanied by a cemented-screw type porcelain-fused-to-metal (PFM) crown, would be appropriate. In this particular case, the GBR technique with allograft bone grafts was employed for bone augmentation. After approximately one year of observation, evidence of new bone formation was observed, indicating the success of the dental implant treatment. Conclusion: there are several effective techniques for correcting inadequate bone conditions before placing dental implants.

Survey on change temperature of skin surface when using auricular acupuncture at the Jaw point in each side of the ear in healthy people: A cross-over study

Auricular acupuncture (AA) is a method for diagnosing and treating physical and psychosomatic dysfunctions by stimulating a specific point in the ear. Some studies prove that the acupoints on the pinna have a corresponding relationship to areas of the body. According to several studies, acupoints on the body may influence the temperature of the corresponding region. In our study, we surveyed the change in temperature of the skin surface at the mandibular area when using AA at the Jaw point on each side of the ear in healthy people. A cross-over study with 35 healthy volunteers was conducted in the Acupuncture Experimental Research Lab, Faculty of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City from November 2021 to May 2022. Temperatures of the mandibular area before and after using auricular acupuncture were recorded. After using AA at the Jaw point on the left, the temperature of the left mandibular area was increased statistically from that before (from 34.34 ± 0.69 to 34.76 ± 0.72). After using AA at the Jaw point on the right, the temperature of the right mandibular area was increased statistically from that before (from 34.50 ± 0.86 to 34.31 ± 0.68). No side effects were observed during the study. When using AA at the Jaw point on the ear, the temperature of the mandibular area on the side of using auricular acupuncture increased statistically, showing the relationship of the Jaw point on the ear with the mandibular area.

Prosthetic and surgical management of a sizeable epulis fissuratum: a case report

This case report describes the management of a large-sized Epulis Fissuratum (EF) in a 70-year-old female patient using an original prosthetic technique. It consists of a combination of a tissue conditioning and a resection surgery. The patient´s main concern was a mucogingival tissue growth located on the left mandibular area. The interesting clinical findings deriving from this technique are: tissue conditioning is an important phase prior to the surgical resection of a large EF and occlusal functions can be maintained during the procedures with patient´s corrected dentures. After clinical, radiological and pathological examinations, the diagnosis was of an EF induced by an ill fitted mandibular denture. The intervention carried out was a combination of a 2 weeks tissue conditioning period followed by a cold blade surgical resection. After a 3 months follow-up period, a completely healed vestibular sulcus was observed with no scar tissue. The present technique facilitates the resection surgery by removing the inflammatory component of the EF. It also guides the post-surgical tissue healing, allowing the obtention of a deep vestibular sulcus, thus creating a better bearing surface for subsequent renewed dentures. Not depriving the patient of her dentures during the healing process helped to improve her quality of life and her cooperation.

Incomplete Implant Insertion Due to the Use of A Non-dynamometric Torque Wrench: A Case Report

A case is reported in which the use of a non- dynamometric torque wrench could be the cause of incomplete implant insertion. A woman, 73-year-old, visited the dentist in March 2021 for oral rehabilitation due to the absence of teeth in the left mandibular area. A Galimplant IPX 4.5 x 8 implant (internal hex connection) (Sarria, Spain) was placed in position 36. Bone drilling was performed correctly in width and depth, however, insertion of the implant was difficult due to the hardness of the cortical bone. New drillings were made in the bone with insertion and removal of the implant on three occasions. On the third occasion, the implant was threaded to a depth of 7 mm. At that time, the thread that the implant had carved in the bone had been lost and the implant did not advance until 8 mm in depth, nor could it go back to remove it and continue drilling the bone. We estimate that a dynamometric torque wrench should have been used during implant insertion, to provide adequate torque and not cause the loss of the thread that the implant had carved into the bone. The use of a non-dynamometric torque wrench does not allow a precise insertion torque. If excessive torque is applied, the thread carved by the implant in the bone can be lost and this finally causes an incomplete insertion of the same.

Case of multiple myeloma with cutaneous involvement and aberrant CD3 expression

A six-year-old golden retriever presented for a fast-growing mass at the level of the left mandibular area. Cytological evaluation was consistent with an anaplastic round cell neoplasm. CT scan and...

ODONTOGENIC MYXOMA

A 19-year-old female patient was referred to the oral medicine clinic to evaluate an asymptomatic and unilateral swelling in the left mandibular area. The periapical radiography showed an apparently unilocular radiolucency located in the radicular area of the left second premolar. Previous radiographic examinations and a cone beam CT study were requested for lesion study. An incisional biopsy was performed for histopathologic analysis. Macroscopic examination showed a sample with a white and gelatinous appearance. Microscopically, the lesion was composed of haphazardly arranged stellate, spindle-shaped, and round cells in an abundant, loose myxoid stroma. Histopathologicfindings were compatible with odontogenic myxoma. Immunohistochemical study was performed to rule out other pathologic entities. The complete elimination of the lesion was performed by block resection followed by reconstruction and subsequent clinical controls. The case is reported under the informed consent of the patient. A 19-year-old female patient was referred to the oral medicine clinic to evaluate an asymptomatic and unilateral swelling in the left mandibular area. The periapical radiography showed an apparently unilocular radiolucency located in the radicular area of the left second premolar. Previous radiographic examinations and a cone beam CT study were requested for lesion study. An incisional biopsy was performed for histopathologic analysis. Macroscopic examination showed a sample with a white and gelatinous appearance. Microscopically, the lesion was composed of haphazardly arranged stellate, spindle-shaped, and round cells in an abundant, loose myxoid stroma. Histopathologicfindings were compatible with odontogenic myxoma. Immunohistochemical study was performed to rule out other pathologic entities. The complete elimination of the lesion was performed by block resection followed by reconstruction and subsequent clinical controls. The case is reported under the informed consent of the patient.

Case Series: Successful Resuscitation of Severe Facial Injuries Caused by a Chainsaw

The treatment outcome remains poor of severe facial injuries because of the high risk of compromised airway or massive bleeding. We experienced two successful treatment cases of severe facial injury by the chainsaw. A 52-year-male had his face injured by the chainsaw during his work. He was transferred to the Level I trauma center using the Doctor-Helicopter. During his flight, bleeding control was tried and the information was given to the trauma surgeons before his arrival. His consciousness was alert and the vital signs were stable. The crushing wound, mandible open fracture, deep laceration of tongue, lip, neck and arterial bleeding were noted around his mandible. Nasotracheal intubation was performed under the bronchoscope-guided. Emergency operation (open reduction & internal fixation, primary repair with neurorrhaphy) was performed. At 30 hospital days, he was discharged with facial palsy on left mandibular area. A 30-yearmale had his face injured by the chainsaw. He was transferred to our Level I trauma center from the local hospital. The deep-mutiple lacerations on right upper eyelid and forehead with the bony exposure were noted. The vital signs were stable and emergency operation was performed. He was discharged at 20 hospital days. Bone loss or tissue loss were not devastating than we expected even though the injury was occurred by the chainsaw. Aggressive treatment including airway manipulation or bleeding control and maximal opportunity of therapy are absolutely needed.

Intramuscular Hemangioma Misdiagnosed as Unilateral Masseter Hypertrophy: A Case Report

Intramuscular hemangioma is a rare type of hemangiomas and sometimes overlooked by orofacial pain specialist who encountered various types of masticatory muscle problems. A 42-year-old male, presented with feeling of unilateral hypertrophy on left mandibular area, is finally diagnosed as hemangioma with thrombus by excisional biopsy. However, he was initially treated by injection of botulinum toxin A due to misdiagnosis as unilateral masseter hypertrophy. In the present report, we remind the importance of careful examination and diagnostic images to orofacial pain clinicians in early detection of intramuscular hemangioma of masticatory muscles.

Pseudoaneurysm of the Facial Artery After the Injection of Local Anesthetics

Generally, a true aneurysm is a dilatation of the vessel wall, whereas a pseudoaneurysm (PA) is a weakening or rent in a vessel wall, with contained rupture into the surrounding tissues. In the face, PAs of the facial artery are an extremely rare development after penetrating or blunt trauma. A 31-year-old woman presented with nontender, palpable, and firm lump that had been steadily increasing in size over a 4-week period. Examination confirmed a firm and spherical swelling in the left mandibular area, which was nonpulsatile. The patient presented with a mass on the upper part of her left chin 6 months after the injection of local anesthetics for dental treatment. After the procedure, a hematoma developed over the injection site, and it was treated with local ice. This case is unique in that the lesion seen using computed tomography and ultrasonography scanning had an unusual presentation. Ultrasonography revealed thrombi within the tumor, and color Doppler examination showed blood moving in the perivascular mass. During the operation via intraoral incision, a lesion was found as a dilation of the muscular branch of the facial artery. The facial artery was exposed, isolated, and tied off with a 2-0 white silk ligature. Histopathologic analysis determined that the content of the fragile cystic lesion was an organized thrombus and hematoma. As with any penetrating facial injury, local anesthetics can damage vessels and produce a PA. Therefore, we present a rare case of false facial artery aneurysm with no associated risk factors, which was nonpulsatile on presentation.

Nodular Colloid Degeneration

This report presents a case of nodular colloid degeneration in a 76-year-old man with a solitary facial lesion. The skin lesion was a yellowish indurated plaque on the left mandibular area. Histopathologic examination revealed the amorphous colloid material in the upper dermis. The Congo red stain was negative, no birefringence was observed under polarized light, and elastic stain showed positivity in both the colloid and the surrounding fibers. To the best of our knowledge, nodular colloid degeneration is a rare entity and has only been reported in published literature a few times in the last 8 decades.

Giant Cell Tumor of the Mandible

A 53-year-old woman presented with left mandibular area pain, trismus, and facial numbness that had persisted for 4 years. Physical examination revealed a 3×5 cm, hard, non-tender, and round mass on the left mandibular area. Computed tomography and magnetic resonance imaging revealed an expansile tumor involving the left mandibular ramus and temporomandibular joint area with bone destruction, extending to the base of middle cranial fossa and left zygomatic bone. The mass at the segment of left mandible and zygomatic bone, and base of middle cranial fossa was removed. Pathological examination of the mass revealed a giant cell tumor. The defect was reconstructed with iliac bone for the mandible and temporal bone and fascia for the cranial bone and dura. The case is described along with a review of the literature.

Oral leiomyoma extending in retromolar region

Leiomyoma is a benign smooth muscle tumor that rarely affects children and occurs most frequently in the uterine myometrium and gastrointestinal tract. Its occurrence in the oral cavity is considered rare probably because of the scarcity of smooth muscle tissue in the oral cavity. The most common intraoral sites for leiomyoma are lips, palate and tongue. The purpose of this case report is to present the clinical features, diagnosis and treatment of a rare case of oral leiomyoma in a 13-year-old girl with a 4-month history of a swelling in her left mandibular area extending from first molar to retromolar region.

A computer-based assessment of structural and displacement asymmetries of the mandible

The purpose of this article was to assess and quantify the different components that can lead to mandibular asymmetry in a person during or at the end of growth and to investigate the extent to which improvement can be obtained in the different situations. Three boys and 17 girls, 8 to 21 years of age, with facial asymmetry and chin deviation were selected. Posteroanterior cephalometric radiographs were taken in intercuspal position. On each radiograph, three mandibular points (menton, gonion or antegonion, and articular point) were selected to define a mandibular area. A vertical axis of reference was also determined. Computer-aided design was employed to develop two systems (A and B) to assess a symmetry degree of the mandible. With system A, the left mandibular area was rotated around the vertical axis of reference, and the degree of the superimposition between the left and right areas was plotted. With system B, the left area was rotated around an axis that ran through menton and was perpendicular to a line connecting the two articular points of the mandible. Also, in this case, the degree of superimposition between the two areas was plotted. With system A, the degree of superimposition was a function of mandibular position and mandibular symmetry. With system B, it was a function of mandibular symmetry only. Thus through comparative examination of the data, assessment of displacement asymmetry and structural asymmetry was possible. In two patients, only displacement asymmetry was present, whereas 14 patients showed various features of structural asymmetry. The patients were treated with orthopedic splints to keep the mandible in a position of symmetry. Orthodontic treatment followed so that the intercuspal position would finally coincide with the position of symmetry. Computer-aided design analysis was performed again after a mean observation period of 41.1 months. In 11 patients an improvement in symmetry was observed with both systems. The patients in whom no improvement of structural asymmetry was observed showed a relatively high degree of symmetry at the beginning or had a considerably higher age than the mean age of the whole group. The clinical implications of the data are discussed. (A M J O RTHOD D ENTOFAC O RTHOP 1991;100:19-34.)