Mandibular Body Research Articles

PINDBORG TUMOR PRESENTING IN EARLY ADOLESCENT- A RARE CASE REPORT

As infrequent as it may be, a calcifying odontogenic tumor As infrequent as it may be, a calcifying odontogenic tumor is more commonly seen in the late decades of life. It is a locally aggressive lesion that might interfere function by virtue of its expansile growth through the cortices of the involved jaw. This is a case report of Pindborg tumor in 11 year old male in the right mandibular body region and a rundown on the various investigations done and the final treatment plan adopted. A review of literature on the lesion and justification for the chosen treatment modality is included.

Enlarged occipital spur and craniofacial morphology: a cephalometric analysis.

This cross-sectional study aimed to investigate the association between the occipital spur length and craniofacial morphology in individuals with occipital spur (OS). The study included cephalometric images from 451 individuals (196 females, 255 males, age range was 9-84years). The spur length and craniofacial characteristics were evaluated using cephalograms. Based on spur length, subjects were divided into two groups: the OS group (N = 209) and the enlarged occipital spur (EOS) group (N = 242). Descriptive statistics, Independent T-test, Mann-Whitney U test, chi-square test, Kruskal-Wallis test, and age- and sex-based stratified analyses were performed. The level of significance was set at p < 0.05. Males had significantly larger spur length than females. Spur length was shorter in individuals under 18 than the groups over 18. After adjusting for gender and age, ramus height, mandibular body length, effective length of maxilla, effective length of mandible, anterior cranial base length, posterior cranial base length, anterior facial height, posterior facial height, facial height index, and lower anterior facial height had statistically significant differences between OS group and EOS group. Males exhibit greater spur length than females. Patients under 18 had a shorter spur length than adults. Linear craniofacial measurements were found to be greater in subjects with EOS than the individuals with OS. The craniofacial growth and development of an individual might be associated with EOS. The causal relationship between EOS and craniofacial development requires further longitudinal studies.

Comparative Evaluation of Cranial Base Length and Flexure on Facial Parameters in Hypodivergent, Normodivergent and Hyperdivergent Patients: A Retrospective Cephalometric Study.

The aim of the study was to assess the influence of cranial base length (CBL) and Flexure on facial parameters in Hypodivergent, Normodivergent, and Hyperdivergent patients. Around 60 standardized cephalograms were divided into Hypodivergent, Normodivergent, and Hyperdivergent groups (20 each) based on the FMA angle. The CBL, cranial flexure (CF), and various facial parameters were measured for each case. The results were analyzed for the correlation between Cranial and facial parameters in each of the three study groups. Comparison and Pairwise Comparison of variables between study groups were done using ANOVA and Tukey's post hoc Test. Cranial base length, mandibular body length, LAFH, N-Me-Go angle (p-value <0.001), and Jarabak's ratio were found to be significantly different between the groups. Pearson's Correlation showed that most of the facial parameters had a significant correlation with CBL in Hypodivergent groups. The CBL is more closely related to facial parameters in vertical dysplasia individuals than CF. The CBL is positively correlated to facial variables, especially in Hypodivergent individuals. The N-Me-Go Angle introduced in the study was significantly different in all three vertical facial types studied; hence, it cannot be used as a valuable diagnostic tool. Changes in the length and flexure of the cranial base influence the anteroposterior position of jaw bases. The influence of the cranial base on the development of vertical dysplasias is not studied much, hence the present study aims at resolving this lacuna in literature.

MAXILLOFACIAL DIPROSOPUS: AN EXTREMELY RARE CONGENITAL ANOMALY AND ITS SURGICAL MANAGEMENT

Diprosopus characterizes congenital craniofacial duplication, an exclusive maxillofacial involvement that has only been documented twice. A seven-month-old girl attended the surgical outpatient clinic due to a congenital mandibular alteration and cervical tumor mass. Extraoral physical examination revealed a 3cm right sessile appendiceal nodule with a central ostium, which secreted a hyaline fluid in the mandibular cutaneous region and was mobile during breastfeeding. Moreover, an ipsilateral level II asymptomatic cervical enlargement was observed. A computed tomography showed the duplication of the condyle, ramus, and mandibular body on the right side, which had a mandibular canal and teeth germs emerging toward the skin nodule, as well as a 4.1cm submandibular/cervical well-defined cystic hypodense image. Clinicoradiographic aspects were conclusive for mandibular and mouth duplication. Surgical excision of the accessory mandible, cutaneous nodule/accessory mouth, and cervical cyst were performed and sent for pathological examination. The patient is undergoing strict follow-up, without post-surgical complications. Diprosopus characterizes congenital craniofacial duplication, an exclusive maxillofacial involvement that has only been documented twice. A seven-month-old girl attended the surgical outpatient clinic due to a congenital mandibular alteration and cervical tumor mass. Extraoral physical examination revealed a 3cm right sessile appendiceal nodule with a central ostium, which secreted a hyaline fluid in the mandibular cutaneous region and was mobile during breastfeeding. Moreover, an ipsilateral level II asymptomatic cervical enlargement was observed. A computed tomography showed the duplication of the condyle, ramus, and mandibular body on the right side, which had a mandibular canal and teeth germs emerging toward the skin nodule, as well as a 4.1cm submandibular/cervical well-defined cystic hypodense image. Clinicoradiographic aspects were conclusive for mandibular and mouth duplication. Surgical excision of the accessory mandible, cutaneous nodule/accessory mouth, and cervical cyst were performed and sent for pathological examination. The patient is undergoing strict follow-up, without post-surgical complications.

MULTIPLE SIMPLE BONE CYSTS: A RARE MANIFESTATION

A 45-year-old female sought out care due to a radiolucent area in the right mandibular body, observed during routine dental treatment. Computed tomography showed a hypodense area extending to the midline, with displacement of the right mandibular canal. During the anamnesis, she reported previous treatment of a lesion in the body of the left mandible with surgical exploration and intralesional injection of dexamethasone. In intraoral physical examination, expansion of the cortical bone and vital teeth were observed in the mandible on the right side. Under diagnostic hypothesis of Simple Bone Cyst (SBC), puncture and exploratory surgery were performed, which revealed an empty cavity. Microscopically, vital mature mineralized tissue confirmed the diagnosis of SBC. Currently, the patient is undergoing follow-up. A 45-year-old female sought out care due to a radiolucent area in the right mandibular body, observed during routine dental treatment. Computed tomography showed a hypodense area extending to the midline, with displacement of the right mandibular canal. During the anamnesis, she reported previous treatment of a lesion in the body of the left mandible with surgical exploration and intralesional injection of dexamethasone. In intraoral physical examination, expansion of the cortical bone and vital teeth were observed in the mandible on the right side. Under diagnostic hypothesis of Simple Bone Cyst (SBC), puncture and exploratory surgery were performed, which revealed an empty cavity. Microscopically, vital mature mineralized tissue confirmed the diagnosis of SBC. Currently, the patient is undergoing follow-up.

PERSISTENT SOLITARY FIBROUS TUMOR APPEARING AS AN AGGRESSIVE MANDIBULAR RADIOLUCENCY

We report an unusual case of solitary fibrous tumor (SFT) with persistent behavior. A 41-year-old female was referred for evaluation due to tender swelling on the right chin of unknown duration. Intraoral examination revealed a firm well-circumscribed mass in the right lower buccal vestibule and imaging exams showed slight buccal cortical resorption. An incisional biopsy was performed, and microscopic analysis revealed cellular proliferation of bland spindle cells, admixed with dense collagen, prominent staghorn blood vessels, and positivity for CD34, CD99, Bcl-2, and positive nuclear staining for STAT6, rendering a diagnosis of SFT. Five years after complete surgical excision of the tumor, the patient presented a 3 cm, ill-defined expansive radiolucency in the right mandibular body, which was microscopically diagnosed as persistent SFT. No signs of malignancy were observed. SFT closely related to the mandible may persist after long-term follow-up, appearing as aggressive and extensive radiolucency. We report an unusual case of solitary fibrous tumor (SFT) with persistent behavior. A 41-year-old female was referred for evaluation due to tender swelling on the right chin of unknown duration. Intraoral examination revealed a firm well-circumscribed mass in the right lower buccal vestibule and imaging exams showed slight buccal cortical resorption. An incisional biopsy was performed, and microscopic analysis revealed cellular proliferation of bland spindle cells, admixed with dense collagen, prominent staghorn blood vessels, and positivity for CD34, CD99, Bcl-2, and positive nuclear staining for STAT6, rendering a diagnosis of SFT. Five years after complete surgical excision of the tumor, the patient presented a 3 cm, ill-defined expansive radiolucency in the right mandibular body, which was microscopically diagnosed as persistent SFT. No signs of malignancy were observed. SFT closely related to the mandible may persist after long-term follow-up, appearing as aggressive and extensive radiolucency.

SYNCHRONOUS ODONTOGENIC MYXOMA AND ODONTOGENIC KERATOCYSTS IN NEVOID BASAL CELL CARCINOMA SYNDROME: A CASE REPORT

Nevoid basal cell carcinoma syndrome (NBCCS) is a hereditary condition characterized by a wide range of developmental abnormalities and a predisposition to neoplasms. An 11-year-old girl was referred for evaluation due to a lack of eruption of teeth 14 and 15. Her past medical history and physical examination were unremarkable. Imaging exams showed well-defined pericoronal radiolucencies associated with teeth 14 and 37, as well as an additional radiolucent lesion affecting the right mandibular body. Microscopic analyses of both pericoronal lesions proved to be odontogenic keratocysts (OKC). The additional mandibular lesion showed a proliferation of spindle and stellate cells in a predominantly myxoid stroma and numerous concentric basophilic calcifications, consistent with odontogenic myxoma (OM). The patient was referred for genetic counseling and the diagnosis of NBCCS was made. To the best of our knowledge, this represents the second case of synchronous OKC and OM in a patient with NBCCS. Nevoid basal cell carcinoma syndrome (NBCCS) is a hereditary condition characterized by a wide range of developmental abnormalities and a predisposition to neoplasms. An 11-year-old girl was referred for evaluation due to a lack of eruption of teeth 14 and 15. Her past medical history and physical examination were unremarkable. Imaging exams showed well-defined pericoronal radiolucencies associated with teeth 14 and 37, as well as an additional radiolucent lesion affecting the right mandibular body. Microscopic analyses of both pericoronal lesions proved to be odontogenic keratocysts (OKC). The additional mandibular lesion showed a proliferation of spindle and stellate cells in a predominantly myxoid stroma and numerous concentric basophilic calcifications, consistent with odontogenic myxoma (OM). The patient was referred for genetic counseling and the diagnosis of NBCCS was made. To the best of our knowledge, this represents the second case of synchronous OKC and OM in a patient with NBCCS.

USE OF CYTOLOGICAL SMEAR AND CELL BLOCK TECHNIQUE FOR THE DIAGNOSIS OF PLASMA CELL MYELOMA INFILTRATION IN THE MANDIBLE

Fine-needle aspiration cytology (FNAC) is a diagnostic tool using a needle to collect samples for cytopathological examination. We report a case of a 49-year-old male patient with previous medical history of plasma cell myeloma (PCM), who had osteolytic lesions in the mandible, diagnosed by FNAC. Imaging exams exhibited multiple osteolytic lesions with ill-defined margins in the bilateral mandibular body. FNAC of the intraosseous lesion of the mandible was performed. Cytological smear and cell block technique revealed plasma cells in different degrees of maturation, predominantly eccentric pleomorphic nuclei and abundant, eosinophilic cytoplasm without a paranuclear halo. Immunohistochemistry exhibited positivity for CD138, lambda light chain and Ki-67 (proliferation index was ∼50%). Based on clinicoradiographic, microscopic, and biochemical findings, the diagnosis was PCM infiltration in the mandible. The patient underwent chemotherapy and autologous hematopoietic stem cell transplantation, and had partial remission after 10 months of follow-up. Fine-needle aspiration cytology (FNAC) is a diagnostic tool using a needle to collect samples for cytopathological examination. We report a case of a 49-year-old male patient with previous medical history of plasma cell myeloma (PCM), who had osteolytic lesions in the mandible, diagnosed by FNAC. Imaging exams exhibited multiple osteolytic lesions with ill-defined margins in the bilateral mandibular body. FNAC of the intraosseous lesion of the mandible was performed. Cytological smear and cell block technique revealed plasma cells in different degrees of maturation, predominantly eccentric pleomorphic nuclei and abundant, eosinophilic cytoplasm without a paranuclear halo. Immunohistochemistry exhibited positivity for CD138, lambda light chain and Ki-67 (proliferation index was ∼50%). Based on clinicoradiographic, microscopic, and biochemical findings, the diagnosis was PCM infiltration in the mandible. The patient underwent chemotherapy and autologous hematopoietic stem cell transplantation, and had partial remission after 10 months of follow-up.

METASTATIC ADENOCARCINOMA OF THE JAW

A 59-year-old female patient presented a painful expansive tumor in the mandible, with 3 months of evolution. Computed tomography revealed a hypodense, unilocular lesion, with ill-defined limits and a moth-eaten appearance, with expansion and disruption of the cortical bone, measuring 30 mm, located on the right side of the mandibular body, extending close to the base of the mandible. Medical history was not contributory. An incisional biopsy was performed. Microscopic examination revealed proliferation of neoplastic cells arranged in nests, trabeculae, and duct-like structures. The cells had a cuboidal and polyhedral shape, eosinophilic cytoplasm, hyperchromatic and pleomorphic nuclei, and loss of cell cohesion. Neoplastic nests surrounding irregular bone trabeculae were observed. Neoplastic cells were immunopositive for AE1/AE3, CK7, and Ki67 (40%). Negativity was observed for CD31, CD34, factor VIII, CD99, S100, and CK20. The final diagnosis was metastatic adenocarcinoma, and the patient was referred for further treatment. Funding: CAPES. A 59-year-old female patient presented a painful expansive tumor in the mandible, with 3 months of evolution. Computed tomography revealed a hypodense, unilocular lesion, with ill-defined limits and a moth-eaten appearance, with expansion and disruption of the cortical bone, measuring 30 mm, located on the right side of the mandibular body, extending close to the base of the mandible. Medical history was not contributory. An incisional biopsy was performed. Microscopic examination revealed proliferation of neoplastic cells arranged in nests, trabeculae, and duct-like structures. The cells had a cuboidal and polyhedral shape, eosinophilic cytoplasm, hyperchromatic and pleomorphic nuclei, and loss of cell cohesion. Neoplastic nests surrounding irregular bone trabeculae were observed. Neoplastic cells were immunopositive for AE1/AE3, CK7, and Ki67 (40%). Negativity was observed for CD31, CD34, factor VIII, CD99, S100, and CK20. The final diagnosis was metastatic adenocarcinoma, and the patient was referred for further treatment. Funding: CAPES.

Trends in mandibular fractures in the USA: A 20-year retrospective analysis.

The mandible is one of the most fractured bones in the maxillofacial region. This study analyzes trends in mandibular fracture patterns, demographics, and mechanisms since the early 2000s. Mandibular fractures were reviewed from the 2007, 2011, and 2017 National Trauma Data Bank including 13,142, 17,057, and 20,391 patients by year, respectively. This database contains hundreds of thousands of patients annually and represents the largest trauma registry in the United States. Variables included number of fractures, sex, age, injury mechanism, and fracture location. Mechanism of injury included assault, motor vehicle crash, fall, motorcycle, bicycle, pedestrian, and firearm. Anatomic locations based on ICD-9/10 codes included symphysis, ramus, condyle, condylar process, body, angle, and coronoid process. Frequencies were compared using Chi-square tests of homogeneity with effect sizes estimated using Cramer's V. Mandibular fractures represent 2%-2.5% of all traumas reported in the database from 2001 to 2017. The proportion of patients sustaining a single reported mandibular fracture decreased from 82% in 2007 to 63% in 2017. Males consistently experienced 78%-80% of fractures. Eighteen to 54-year-olds experienced the largest percentages of fractures throughout the 21st century, while median age of fracture shifted from 28 to 32 between 2007 and 2017. The most common fracture mechanisms were assault (42% [2001-2005]-37% [2017]), motor vehicle crash (31%-22%) followed by falls (15%-20%). From 2001-2005 to 2017, a decrease was observed in assaults (-5%) and motor vehicle crash (-9%) and an increase in falls (+5%), particularly among elderly females. The mandibular body, condyle, angle, and symphysis represent approximately two-thirds of all fractures without a consistent temporal trend among them. The temporal trends observed can be linked to shifting age demographics nationally that may aid clinicians in diagnosis and inform public safety policies aimed at reducing these injuries, particularly among the growing elderly population.

Secondary Treatment of Mandibular Bone Fracture Using Sagittal Split Osteotomy and Segmentation of the Mandible: A Case Report

The secondary treatment of mandibular bone fractures poses a great challenge due to the complexity of several factors, such as incorrect primary fracture repositioning, inadequate internal fixation, nonunion, necrosis, local inflammation and infection, tooth loss, and malocclusion, serving as obstacles encountered by surgical teams. The aim of this case report is to detail the planning process, surgical technique, and outcome of the secondary treatment of the post-traumatic deformation, bone exposure, and partial necrosis of the mandible. The new approach described herein incorporated 3D planning and printing procedures, employing surgical techniques such as the segmentation of the mandible with unilateral sagittal split osteotomy and the vertical osteotomy of the mandibular body. New, stable occlusion; appropriate spatial relations; and proper osteosynthesis of the mandible were achieved. The encouraging results obtained demonstrate that the described method can be incorporated in similar cases of the secondary treatment of mandibular fractures and possibly lead to shorter hospitalization and convalescence and lower the associated costs.

Application of Surgery-First Approach in Treating Skeletal Dentofacial Asymmetry with Orthognathic Surgery.

Skeletal dentofacial asymmetry decreases patient's attractiveness by deteriorating symmetry of facial appearance which is of great significance to individuals. Surgery-first orthognathic approach manifests its advantages of shortening treatment time and improving patient's quality of life. However, current literature on surgery-first approach mainly focuses on treating prognathism, overlooking its efficacy in improving facial symmetry of skeletal dentofacial asymmetry patients. This study aimed to assess SFA's efficacy in improving facial appearance by analyzing morphological features of asymmetric bone and facial soft tissue in a three-dimensional manner. Thirty-four patients who received orthognathic surgery in a surgery-first fashion were included. Based on three-dimensional CT reconstruction, bilateral preoperative morphological features and postoperative symmetry of hard tissue were compared respectively. Efficacy of facial soft tissue symmetry restoration was evaluated using root mean square deviation (RMSD). Asymmetric features mainly located in menton, mandibular body length, angulation between ramus and midsagittal plane (MSP), distance between gonion and MSP and so on, which were significantly restored after the whole treatment. RMSD of facial soft tissue surface were significantly declined after the treatment and prognathism was corrected simultaneously if existed. Surgery-first orthognathic approach is proved to be capable of treating skeletal dentofacial asymmetry effectively and efficiently.

A retrospective three-dimensional study of the mandibular growth during preoperative orthodontics in late adolescent patients with skeletal Class III malocclusion

IntroductionThe mandible's ongoing development presents a contraindication for combined orthodontic–orthognathic treatment. The aim of this study was to evaluate the mandibular stability before and after preoperative orthodontic treatment in late adolescent patients with skeletal Class III malocclusion and to investigate the most appropriate time to start preoperative orthodontic treatment. Material and methodsThe study population consisted of 58 adolescents, aged between 15 and 21 years, with skeletal Class III malocclusion; the adolescents underwent CT scans at the beginning (T1) and the end (T2) of preoperative orthodontic treatment. The CT data were analyzed using ITK-SNAP and 3D Slicer software, and the effects of age and gender on mandibular development were investigated. ResultsIn these 58 patients, there were no significant local bone alterations in the condyle and anterior chin point between T1 and T2 and no significant changes in the mandibular branch height, mandibular body length, condylar distance, and mandibular angle distance (p>0.05). The mandibular growth at the angel of mandible was statistically significant (p<0.05), but it was not clinically significant because the mean value of the growth was small (right: 0.416±0.986 mm, left: 0.328±0.886 mm). No effect of age and gender on mandibular development was observed. ConclusionThe mandibular morphology was stable during preoperative orthodontic treatment in patients at the late adolescent stage. This study provides evidence for the possibility of early implementation of preoperative orthodontics.

Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis.

The aim of this study was to compare the anterior and posterior occlusal plane characteristics of patients with different temporomandibular joint osseous statuses. A total of 306 patients with initial cone beam CT (CBCT) and cephalograms were included. They were divided into three groups on the basis of their temporomandibular joint osseous status: bilateral normal (BN) group, indeterminate for osteoarthrosis (I) group, and osteoarthrosis (OA) group. The anterior and posterior occlusal planes (AOP and POP) of the different groups were compared. Then, the regression equation was established after adjusting for confounding factors, and a correlation analysis between the occlusion planes and other parameters was performed. SNA, SNB, FMA, SN-MP, Ar-Go, and S-Go were correlated with the occlusal planes. Relative to the BN and I groups, the FH-OP of the OA group increased by 1.67° on the average, FH-POP increased by 1.42° on the average, and FH-AOP increased by 2.05° on the average. The occlusal planes were steeper in the patients with temporomandibular osteoarthrosis than in the patients without it, and the mandible rotated downward and backward. The height of the mandibular ramus, the mandibular body length, and the posterior face height were small. In clinical practice, attention should be given to the potential risk of temporomandibular joint osteoarthrosis in such patients. In addition, SNB, FMA, SN-MP, Ar-Go, S-Go, and occlusal planes had moderate correlations.

Lateral Bone Augmentation Using a Three-Dimensional-Printed Polymeric Chamber to Compare Biomaterials.

The aim of this study was to test the suitability of calcium phosphate cement mixed with poly(lactic-co-glycolic acid) (CPC-PLGA) microparticles into a ring-shaped polymeric space-maintaining device as bone graft material for lateral bone augmentation. Therefore, the bone chambers were installed on the lateral portion of the anterior region of the mandibular body of mini-pigs. Chambers were filled with either CPC-PLGA or BioOss® particles for comparison and left for 4 and 12 weeks. Histology and histomorphometry were used to obtain temporal insight in material degradation and bone formation. Results indicated that between 4 and 12 weeks of implantation, a significant degradation of the CPC-PLGA (from 75.1% to 23.1%), as well as BioOss material, occurred (from 40.6% to 14.4%). Degradation of both materials was associated with the presence of macrophage-like and osteoclast-like cells. Furthermore, a significant increase in bone formation occurred between 4 and 12 weeks for the CPC-PLGA (from 0.1% to 7.2%), as well as BioOss material (from 8.3% to 23.3%). Statistical analysis showed that bone formation had progressed significantly better using BioOss compared to CPC-PLGA (p < 0.05). In conclusion, this mini-pig study showed that CPC-PLGA does not stimulate lateral bone augmentation using a bone chamber device. Both treatments failed to achieve "clinically" meaningful alveolar ridge augmentation.

Epidemiology of maxillofacial fractures in northwest China: an 11-year retrospective study of 2240 patients

BackgroundThe aim of this study was to determine the epidemiological pattern of maxillofacial fractures in northwestern China by retrospectively analysing the demographics, aetiologies, concomitant injuries, fracture sites, and management.MethodsA 10-year retrospective analysis of 2240 patients with maxillofacial fractures admitted to the General Hospital of Ningxia Medical University was conducted. The extracted data included sex, age, aetiology, fracture site, concomitant injuries, time of treatment, therapeutic approaches and complications. Statistical analyses were performed, including descriptive analysis and the chi-square test. Logistic regression was used to determine the impact factors of maxillofacial fractures and concomitant injuries. P values < 0.05 were considered statistically significant.ResultsThe age of the included patients ranged from 1 to 85 years, and the mean age was 35.88 ± 15.69 years. The male-to-female ratio was 3.9:1. The most frequent aetiology of maxillofacial fractures was road traffic accidents (RTAs) (56.3%), and the most common fracture sites were the anterior wall of the maxillary sinus, arcus zygomaticus and mandibular body. A total of 1147 patients (51.2%) were affected by concomitant injuries, with craniocerebral injury being the most common. Logistic regression analyses revealed increased risks of mid-facial fractures in elderly individuals (odds ratio (OR) = 1.029, P < 0.001) and females (OR = 0.719, P = 0.005). Younger patients had a higher risk of mandibular fractures (OR = 0.973, P < 0.001). RTAs increased the risk for mid-facial fractures and high falls increased the risk for mandibular fractures.ConclusionsThe maxillofacial fracture pattern is correlated with sex, age and aetiology. Patients were mainly young and middle-aged males, and the main cause of injury was RTAs, mostly causing compound fractures. Medical staff must be systematically educated to comprehensively examine patients with injuries resulting from RTAs. The management of patients with fractures requires thorough consideration of the patient’s age, aetiology, fracture site, and concomitant injuries.

Three-dimensional Analysis of Facial Asymmetry in Unilateral Lambdoid Craniosynostosis.

Unilateral lambdoid synostosis (ULS) is characterized by occipital flattening, mastoid bulging, and contralateral parietal bossing. Anterior craniofacial features are less well-defined. This study utilizes volumetric, craniometric, and composite heat maps of three-dimensional (3D) rendered CT scans to analyze anterior craniofacial asymmetry in ULS and compared to controls. A retrospective review of three-dimensional CT scans. Tertiary care pediatric institution. 30 ULS and 30 control patients. Volumetric and craniometric analysis of the anterior fossa, orbits, zygomas, maxilla, and mandible was performed. The anterior fossa volume was greater bilaterally (0.047, 0.038), and the fossa angle was more anterior contralaterally (<0.001) and more anterior bilaterally than controls (0.038, 0.033). The orbits had greater height and lesser depth bilaterally compared to controls (0.006, 0.009; < 0.001, < 0.001). Zygoma length was significantly greater on the contralateral side than controls (0.048; < 0.001). Nasal contralateral deviation of 3.57 ± 1.97°. The maxillary length was longer on the contralateral side (0.045). The mandibular angle was more anterior on the ipsilateral side and posterior on the contralateral side (<0.001) compared to controls (0.042, < 0.001). Chin had a contralateral deviation of 1.04 ± 3.74°. ULS has significant asymmetry in the anterior craniofacial skeleton. There is a bilateral expansion of the anterior cranial fossa with greater frontal bossing on the contralateral side. Increased orbital height and decreased depth. Contralateral zygomatic and mandibular body lengthening with posterior mandibular deviation. These features may provide more effective diagnosis and potential clinical management strategies.

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.

Imaging Features of Intraosseous Schwannoma: A Case Series and Review of the Literature.

To characterize the imaging features of patients with pathologically confirmed intraosseous schwannoma (IOS), institutional pathology and imaging databases were searched for IOS cases over a period of 17 years. A musculoskeletal radiologist evaluated all imaging studies. Additionally, a literature search was performed to identify IOS cases that had imaging findings of at least two modalities. Six patients (one female, five males, mean age of 50 ± 14 years) with IOS were identified, with all lesions localized to the lumbosacral region. Radiographic imaging was available in four patients, while all patients underwent CT and MR imaging. Radiographs depicted lytic lesions, and CT depicted heterogeneous expansile lesions with centrally hypodense areas and peripheral sclerosis. All cases involved extra-osseous extension, producing a mass effect on adjacent soft tissues and nerve roots. On MRI, the neoplasms displayed iso- to- slightly- low signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images with heterogeneous enhancement. The literature review resulted in 102 IOS cases, which to the best of our knowledge, is the largest review on IOS, and the imaging findings of the previously published cases were the same as our cases. IOSs are rare benign neoplasms that should be considered in the differential diagnosis of well-defined expansile lytic lesions with sclerotic borders. This is particularly important in middle-aged adults with mandibular, sacral, or vertebral body mass.

A retrospective comparative fractal and radiomorphometric analysis of the effect of 3 generations of anti-epileptic drugs on the mandible

The present study investigated the possible impacts of anti-epileptic drugs (AEDs) on trabecular and cortical bone in the mandible. Fractal dimension (FD) and the radiomorphometric parameters of mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI) were assessed on 497 dental panoramic radiographs (DPRs) of patients in the case group and controls. AEDs were compared according to 3 generations, duration of use, and patient age and sex. FD of the angle and body of the mandible and MCW were significantly lower in the case group than in the control group (P < .001). FD values in the ramus and angle were lower in first-generation and third-generation AEDs than in second-generation drugs (P ≤ .011). FD in the mandibular body was lower in first-generation and second-generation AED users than in third-generation drugs (P=.017). Drug use for at least 1 year resulted in significantly lower values for all FDs and MCW values and more class 3 MCI assessments than short-duration use, but PMI was higher with more than 1 year of AED use (P ≤ .020). Age and sex had no significant effects. AEDs caused significant changes in bone compared with controls in some FD values, MCW, and MCI. The effect of drug generation is pronounced in trabecular bone. Anti-epileptic drug use for more than 1 year had a greater effect than short-term use.