Mandibular Tumor Research Articles

Establishing a Novel Treatment Algorithm for Pediatric Mandibular Tumor Reconstruction.

Guidelines for pediatric mandibular reconstruction (PMR) are not well-established. One must consider the growing craniofacial skeleton, mixed dentition, long-term dental occlusion, need for secondary reconstruction, and speech development. The traditional guideline (bone defect > 5 cm) for use of vascularized bone grafts (VBG) is not applicable given the variation of pediatric mandibular size and growth. We seek to propose a novel algorithm for PMR. An Institutional Review Board approved retrospective review of patients who underwent PMR for tumor resections between 2005 and 2019 evaluated patients' demographics, complications, resection index (RI) (resection length to mandibular length), and surgical outcomes. Outcomes based on RI were analyzed to establish guidelines for VBG utilization. Twenty-four patients underwent PMR at a mean age of 9.1 years (range: 1 - 18). The mandibular defect (mean± standard deviation) fornon-VBG (n = 18) and VBG (n = 6) was 6.6 ± 3.0 cm and 12.8 ± 4.3 cm, respectively. The VBG group had fewer return trips to the operating room (P = 0.028) and fewer major complications (P = 0.028). When non-VBG with RI > 32% were compared to <32%, there was statistically less returns to the operating room for complications and a lower rate of early (< 30 days) major complications. Our algorithm proposes an RI cutoff of 32% for VBG use for PMR. Patients with a sizable soft tissue defect, previous chemotherapy and/or radiation, planned adjuvant chemotherapy and/or radiation therapy, or a history of failed non-VBG should undergo reconstruction using VBG.

Diagnosis of mandibular metastatic tumour leading to findings of advanced lung carcinoma: A case report

AbstractBackgroundDue to their low prevalence and variable clinical presentation, oral metastatic tumours present a diagnostic challenge to the clinician. This case describes the presentation of a mandibular metastatic tumour in an apparently healthy patient, initially managed as dento‐alveolar infection by her general dental practitioner (GDP).Case descriptionA 56‐year‐old female attended her GDP with a small intraoral swelling buccal and lingual to the lower left incisors, canine and first premolar. Radiographic examination revealed gross caries in the lower left anterior dentition and periapical bone loss in the region. A week's course of antibiotics had no effect. The swelling increased rapidly and the involved teeth were extracted by the GDP before referral to Oral Surgery. The patient offered no history of weight loss, febrility or breathlessness. Her medical history was unremarkable. She smoked and did not consume alcohol. Histological examination revealed a poorly differentiated metastatic carcinoma. A computerized tomography scan of the neck showed a 4 cm mass in the left anterior mandible with adjacent bony destruction. There was bilateral cervical lymphadenopathy and a large right‐sided upper lobe lung mass with metastasis to the contralateral upper lobe of the lung, the right adrenal gland and brain. A diagnosis of poorly differentiated non‐small cell carcinoma of the lung was made, staged T4 N3 M1c. Nine weeks after her initial presentation to the GDP, the patient suffered a seizure and passed away.ConclusionThis case demonstrates an uncommon presentation of mandibular metastatic tumour as the first indicator of advanced malignant disease. The presentation of such tumours can often mimic more common, benign processes, making diagnosis challenging. At a time of increased remote assessment of patients due to the COVID‐19 pandemic, it is particularly important for clinicians to consider the possibility of malignancy when faced with any unusual case of swelling.

Pediatric Aggressive Benign Mandibular Tumors: Clinical Features and Management.

Aggressive benign mandibular tumors are uncommon in the pediatric population, and there is few publishing in the literature specifically dealing with them. Aggressive tumors can be defined based on known biologic behavior and/or histologic type and/or clinical characteristics. To review the clinical features and management of lower jaw pediatric aggressive benign tumor. Medical records review of pediatric patients presented with aggressive benign mandibular tumors to the Maxillofacial and Plastic Surgery Department, University of Alexandria, Egypt between 2011 and 2019. Fifty-eight patients were included in this study, aged between 2 and 16 years (average = 11.8). Ameloblastoma was the commonest pathological diagnosis (n = 18) followed by central giant cell granuloma (n = 11) and juvenile ossifying fibroma (n = 10). Patients with central giant cell granuloma were treated by en-block resection (n = 4) or curettage after interferon alfa injection (n = 7). All other benign tumors were treated by en-block resection. The length of follow-up ranged from 1 to 8 years. Successful reconstruction was accomplished in 45 patients (88.2%). Aggressive lesion should be treated in an aggressive manner and immediate reconstruction is advocated. However, pharmacotherapy combined with enucleation is a more conservative approach for management of aggressive central giant cell tumors.

Primary Reconstruction of Mandibular Defects after Resection of Aggressive Pediatric Mandibular Tumors by Split Rib Bundle Bone Graft. A Retrospective Study

Background: A retrospective study was done to evaluate the success rate of immediate reconstruction by split rib bundle bone grafting after segmental resection of Aggressive Pediatric mandibular tumors. Materials and Patients: The present study enrolled sixty-one pediatric patients with aggressive mandibular tumors that had been treated during the period from January 2008 to December 2018. All patients were examined clinically and radiographically by Orthopantomograms, CTs and CBCTs. Radical segmental resection with resultant mandibular continuity defects were thus created followed by immediate reconstruction with non-vascularized Split Rib Bundle Bone Graft (SRBBG). Patients were then rehabilitated by osseointegrated implants with fixed or removable partial dentures. Success of reconstruction was assessed by the percentage of complications, interincisal opening and patient satisfaction. Assessment was performed at 1,3,6 and 12 months postoperatively. All patients were followed up for 4-7 years. Results: Successful reconstruction was accomplished in 55 patients (90.16 %). Successful dental rehabilitation was accomplished in 49 patients (89%). Three patients had complete failure due to severe postoperative infection. Another three cases had partial resorption of the graft due to moderate infection to whom re-augmentation by another rib graft had been performed. Conclusion: Pediatric aggressive mandibular tumors should be treated in an aggressive manner relative to its biologic behavior and immediate reconstruction is advocated. The Split Rib Bundle Bone Graft is an adequate alternative for mandibular reconstruction in the absence of microvascular surgery as it shows early revascularization thus permitting rehabilitation with successfully osseointegrated dental implants.

Mandibular rehabilitation: From the Andy Gump deformity to jaw-in-a-day.

The mandible is a critical structure of the lower facial skeleton which plays an important role in several vital functions. Segmental resection of the mandible is at times required in patients with advanced oral cavity malignancies, primary mandibular tumors, and radiation or medication induced osteonecrosis. Mandibulectomy can significantly decrease quality of life, and thus mandibular reconstruction is an important aspect of the operative plan. Mandibular reconstruction is challenging due to the complex three‐dimensional anatomy of the mandible, and the precision required to restore dental occlusion in dentate patients. Significant advances have been made over the past decade in the ability to reconstruct and rehabilitate patients after a segmental mandibulectomy. This review will highlight these advances and discuss the timing of dental implantation.

Endoscopically Assisted Marginal Mandibulectomy Using an Intraoral Approach Alone for Squamous Cell Carcinoma of the Posterior Mandibular Gingiva: A Technical Note.

Technical note. Marginal mandibulectomy is a surgical procedure for treatment of mandibular gingival tumors. The intraoral approach to the posterior region of the mandible for marginal mandibulectomy is difficult due to limited access and operating field visibility; the conventional surgical procedure may require some skin incisions. This report discusses the effectiveness of endoscopic assistance in marginal mandibulectomy. This article describes endoscopically assisted marginal mandibulectomy using an intraoral approach alone for squamous cell carcinoma of the posterior mandibular gingiva. The advantages of this surgical method are twofold: (1) superior visibility to the lower edge of the mandible without any skin incision; and (2) safe surgical confirmation of important anatomy on the buccolingual side (e.g., mental foramen, lingual nerve, mandibular foramen, and neurovascular bundle). This minimally invasive approach without any skin incision, as well as the superior visibility of the operating field, are important advantages of endoscopically assisted marginal mandibulectomy that cannot be obtained by other surgical methods. Endoscopically assisted marginal mandibulectomy using an intraoral approach alone may be useful because it avoids damage to facial skin and improves safety by employing an enlarged bright field.

Unique Techniques Utilizing Rib Grafts for Mandibular Reconstruction in the Pediatric Population.

Pediatric mandibular reconstruction requires a grafted segment of sufficient height and stability to support dental implant placement. Double barreling and mandibular distraction osteogenesis (MDO) after reconstruction are two techniques to achieve this, but they have only been reported with fibular grafts. Rib grafts not only have a lower donor site morbidity than fibular grafts, but they also provide adequate defect coverage in children. As such, we propose their use with either a double barrel technique or with MDO. Three pediatric patients underwent mandibular resection and reconstruction using rib grafting. One patient underwent single rib graft placement with subsequent vertical rib distraction. In the remaining two patients, a double-barreled rib technique was used, stacked horizontally in one patient and vertically in the other. From March 2018 to May 2019, three patients with an average age of 11 underwent resection of mandibular tumors or tumor-like lesions followed by immediate reconstruction with rib graft. Due to postoperative wound complications, the graft was completely removed in one patient. The remaining two patients had an uneventful recovery with dental implants planned for one and fully osseointegrated in the other. None of the patients experienced donor-site complications. This case series supports the utility and versatility of autogenous rib grafts as a reconstructive option in children. Not only is rib an excellent bone source with low donor site morbidity, but its height can be augmented through MDO or double barreling, facilitating the successful placement of implants and oral rehabilitation in pediatric patients.

Clinical application and accuracy analysis of 3D printing guide plate based on polylactic acid in mandible reconstruction with fibula flap

BackgroundDue to the special anatomy morphology and physiological function of the mandible, it has always become a challenge to accurately reconstruct the mandibular defect in maxillofacial surgery. Digital three dimensions (3D) printing surgical guide, as the effective method for individual and accurate surgery, is a hotspot of clinical research at present. In this study, 3D printing PLA surgical guide plate was applied to reconstruct the mandibular defect with fibula flap, its clinical effect and accuracy were evaluated, which aimed to improve the accurate reconstruction of mandibular defects.MethodsAfter sterilization, the dimension deformation of the PLA standard specimen were measured. Eighteen patients diagnose with mandibular tumor were collected as observation objects. Then partial mandible resection and simultaneous mandible reconstruction with fibula graft were implemented according to the computer-aided design plan. The clinical effects of 3D printing PLA guide plates application were evaluated by facial contours, occlusal stability and chewing function. Through registering the postoperative computed images reconstruction with preoperative designed shape, the reconstruction accuracy was evaluated by detecting the maximum difference including the distance between lateral convex point of the condyles, the distance between medial convex point of the condyles and the horizontal contained angle between long axis of the condyles.ResultsAfter high temperature steam sterilization, the curvature of the PLA specimen with 100% filling rate and 4.8 mm thickness were the smallest and their dimension deformation had no statistical significance (P>0.05). The minimally deformed 3D printing PLA guide plate were smoothly placed in the right place during the operation. After surgery, the face was symmetrical, the occlusal relationship was restored well and no deviation of the mandibular movement were found. The spiral computed tomography (SCT) scanning showed that the distance between lateral/medial convex points of the condyle and the horizontal contained angle were 128.34±8.68 mm, 88.69±6.75 mm and 145.87°±12.01°. Compared with preoperative design, the maximum deviation of the actual postoperative registration was 1.67±0.63, and the difference was not statistically significant (P>0.05).ConclusionsThe application of 3D printing PLA guide plate in the segmental section and reconstruction of the mandible can effectively simplify the operation, and better reconstruct the continuity of the mandible. The surgical accuracy can fully meet clinical needs with relatively low prices.

Porosity and compressive strength of PLA-based scaffold coated with hydroxyapatite-gelatin to reconstruct mandibula: a literature review

Ameloblastoma is one of odontogenic tumours that is classified as benign, aggressive, and destructive. Mandibular tumours potentially cause bone disruption or damage, so it is necessary to do a resection to remove the infected part. Treatment done by resection may cause defects starting from the gap in the alveolar bone to the discontinuity of the mandible. Thus, it is necessary to reconstruct the mandible using a scaffold. Scaffold is made by using the PLA 3D-printing with the Fused Deposition Modelling (FDM) method. PLA is non-bioactive and hydrophobic, so the surface needs to be modified by coating PLA with hydroxyapatite (HA) and gelatine. This article aims to examine the effect of PLA surface modification using HA-Gelatine through a review article. The searching strategy for articles is by using databases of internationally reputable journals with certain keywords. From the search, journals were obtained (with status Q3, Q2 and Q1) as reference journals in this review. Literature review shows that the addition of hydroxyapatite can improve the bioactive properties of PLA, while the addition of gelatine can increase its hydrophilicity properties. Therefore, HA-Gelatin coating on 3D PLA has the potential to be used as a scaffold for mandibular reconstruction.

Evaluation of urinary hydroxyproline and creatinine level in patients with benign mandibular odontogenic tumor.

BackgroundOdontogenic tumors are relatively common oro‐facial tumors seen in our environment with challenges encountered with management in terms of inadequate infrastructure and high cost of treatment. They are often associated with bone resorption with concomitant collagen degradation and excretion of their by‐products in serum or urine. The aim of this present study was to evaluate urinary hydroxyproline level in patients with benign mandibular odontogenic tumors.Materials and methodsTwenty‐two consecutive patients with histologically diagnosed mandibular odontogenic tumors were recruited. Twenty‐two controls who matched the study group for sex and age were also recruited. The study group had CT‐Scan of their lesions done. All participants were required to fast 12 hours overnight and their early morning second void urine collected between 7 a.m and 8 a.m. The collected urine samples were stored frozen at −20°C until analysis. Colorimetric method of analysis of urinary hydroxyproline and creatinine were done using Biovision hydroxyproline kit and Randox creatinine kit, respectively. The results were recorded as urinary hydroxyproline alone (μg/μl) and as urinary hydroxyproline/creatinine ratio.ResultsThe mean age of the participants was 28.45 ± 6.8 years. The mean duration of the tumors in the study group was 5.9 ± 4.4 years. A mean urinary hydroxyproline/ creatinine ratio of 0.081 ± 0.129 was noted in the study group as compared to 0.016 ± 0.006 that was noted among healthy Nigerian who served as controls in the study.ConclusionThere was a significant increase in urinary hydroxyproline level in patients with odontogenic tumors when compared with healthy Nigerians.

Melanoma of the oral cavity: A silent killer

Melanoma of the mouth is a rare entity of cancer. It has a bad prognosis. We report two cases of mouth melanoma. In the first case, 68 years old man developed a mandibular gingival tumor. Head and neck MRI scans showed an aggressive tumor process in the mouth with bone extension and in the deep spaces. The patient was free of cervical lymph nodes. The second case is a 75-years-old male with heavy tobacco smoke. The man felt a burgeoning mass on the right palate. The neck palpation found a firm mobile non-tender mass at the left upper jugular region. The anatomopathological study of the biopsies assigned both cases to malignant melanoma. Because of the rarity and delays in diagnosis, case reports are an invaluable source of information.

Congenital mandibular granular cell tumor in a male neonate: A rare case report

Congenital epulis or granular cell tumors are rare neonatal oral tumors. We report the case scenario of a male neonate presenting with congenital epulis on day 2 of life on the mandibular alveolar ridge. It was successfully treated with surgical resection under general anesthesia. During our wide review of the literature, we could not find a single case reporting a mandibular granular cell tumor in a male neonate.

An Unusual Metastatic Signet-ring Cell Carcinoma of the Rectosigmoid Colon Presenting as Mandibular Tumor in a Female patient: A Case Report and Review of the Literature

Background: Metastatic adenocarcinomas of the colon to the oral cavity are very uncommon, especially signet-ring cell carcinoma (SRCC) is relatively extremely rare, and constitutes about 1% of all oral malignancies.

Mandibular Postirradiation Osteosarcoma: Clinical Case Report

Osteosarcoma is a malignant tumor of Mesenchymal cells capable of producing osteoid tissue. Its age distribution is wide, being more common between the third and fourth decades of life. Mandibular tumors affect more the posterior region. Radiographic findings range from dense sclerosis to radiolucent lesions. More than 10% of Osteosarcoma cases have etiology associated with previous radiotherapy. Female patient, 56-years-old, brown, complained of tingling and shock in the chin and fast growing swelling of the left mandible. Patient reported treatment with radiation and chemotherapy for Hodgkin's disease in the left parotid thirteen years ago. On clinical examination, facial asymmetry was observed, with vestibular rubbery normochromic swelling in the mandible and bottom of the left vestibule, symptomatic on palpation and extending from the canine to the molars, with dental marks on its surface.

Acanthomatous ameloblastoma – A case report

Ameloblastomas are locally aggressive jaw tumors with a high propensity for recurrence that are believed to arise from remnants of odontogenic epithelium, lining of odontogenic cysts and basal layer of overlying oral mucosa. They can occur in either the maxilla or mandible at nearly any age but most frequently are discovered as a painless expansion in the mandible of patients in their 20s-40s. Histopathologically, the follicular and plexiform patterns are the most common. When extensive squamous metaplasia, often associated with keratin formation occurs in central portions of the epithelial islands of follicular ameloblastoma, the term acanthomatous is sometimes applied. Here we present a case of acanthomatous ameloblastoma in a 20 year old patient. Key words:Ameloblastoma, Aacanthomatous, Mandibular Tumors. How to cite this article: Geeta Singh, Rashmi Agarwal, Vimlesh Kumar, Deepak Passi. Acanthomatous Ameloblastoma- A Case Report. J Int Oral Health 2013; 5(2):60-64..

Primary Intraosseous Carcinoma Arising in a Mandibular Keratocystic Odontogenic Tumor: A Case Report

Primary Intraosseous Carcinoma Arising in a Mandibular Keratocystic Odontogenic Tumor: A Case Report

BRAF V600E mutation-specific immunohistochemical analysis in ameloblastomas: a 44-patient cohort study from a single institution.

The aim of this study is to investigate the presence and prevalence of BRAF V600E mutation in ameloblastomas using anti-BRAF V600E monoclonal antibody (VE1 clone) and to identify any clinicopathologic correlation with BRAF V600E mutation in ameloblastoma. The pathology files of the Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria, were searched for the diagnosis of ameloblastoma from 2016 to 2020. Archived non-decalcified formalin-fixed paraffin-embedded tissue underwent immunohistochemistry using anti-BRAF V600E antibody at the University of Pittsburgh, Pennsylvania. Clinicopathologic data such as age at diagnosis, gender, jaw bone involved (mandible or maxilla), tumor location (anterior or posterior) and histologic subtype were collected. The clinicopathologic parameters were analyzed using Chi-square test and Fisher's exact test according to the BRAF status. Forty-four cases of ameloblastoma were retrieved. The male to female ratio was 1.32:1. The average age of patients at diagnosis was 33.3years. Thirty-nine cases were located in the mandible and 5 cases in the maxilla. Only cases in the mandible were positive for anti-BRAF V600E antibody (n = 15/39; 38.5%). There was a significant correlation between BRAF V600E expression in mandibular tumors and histologic subtype (p = 0.02); however, no significance was observed for gender, age and tumor location. BRAF V600E mutation preferentially occurs in mandibular ameloblastomas, especially in non-plexiform ameloblastomas. These patients may benefit therapeutically from the use of BRAF inhibitors.

Reconstruction of Oromandibular Defect After Tumor Resection by Sternomastoid-clavicular Flap.

The study aims to evaluate sternocleidomastoid-clavicular osteo-myocutaneous flap (SCM-OMCF) for reconstruction of mandibular defects after tumor resection. In the period between 2010 and 2018, thirteen patients with primary mandibular tumors underwent mandibular resection and reconstruction with SCM-OMCF. Patients were followed up for 10 to 66 months. Hospital was 13 ± 4 days. All patients started fluid in the 2nd day. The mean time to start oral fluid was 7.5 ± 0.8 day. Four (30.8%) patients suffered from complications (infection and salivary leak in 1 case due to partial flap loss, donor wound dehiscence in 1 case, deep venous thrombosis in 1 case and chest infection in 1 case). None of our cases experienced motor disability. Two cases (15.9%) underwent reoperations. The overall aesthetic outcome was found excellent in 5 cases, satisfactory in 5 cases and fair in 3 cases. The functional outcomes were satisfactory. Tumor recurrences were detected in 2 (15.9%) patients. Two patients died during follow up within 2 years after 1st surgery due to local and distant recurrences. SCM-OMCF is a versatile, safe and simple technique for reconstructing mandibular defects less than 11 cm.

Complex Mandibular Reconstruction for Head and Neck Squamous Cell Carcinoma-The Ongoing Challenge in Reconstruction and Rehabilitation.

Simple SummaryCancer therapy includes a broad range of microvascular free flaps that may restore defects and improve patients’ quality of life. This is particularly important for head and neck squamous cell carcinoma (HNSCC) and composite mandibular reconstructions, containing tissues of bone, muscle, and skin, which may be problematic due to their magnitude and sensitive location. The subscapular system offers a highly valuable donor site with the most versatility and the potential for rapid rehabilitation. Interestingly, other donor sites are more commonly used internationally. Therefore, we evaluated the use of the subscapular system free flap (SFF), which is the most commonly used free flap at our department. To our knowledge, this retrospective study represents the largest number of SFF cases reported to date in the literature. Furthermore, we examined the quality of life in a subgroup of patients, combining prospective occurrences to provide insight into overall rehabilitation from the patients’ viewpoints.Large head and neck squamous cell carcinoma (HNSCC) tumors affecting the mandible require a versatile reconstruction to maintain form, function, and quality of life. Large defect reconstruction of soft and hard tissue in the head and neck necessitates, at best, one vascular system including various tissues by large dimensions. The subscapular flap system seems to meet these standards. A retrospective study was conducted focusing on clinical data, including an analysis of the quality of life with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires, (QLQ-C30 and QLQ-H&N43). A total of 154 patients (122 males, 32 females; age range: 31–71 years, mean: 54.5 years) treated at our department from 1983 through to 2019 were included. Of the subscapular system free flaps (SFFs), 147 were based on the angular artery branch of the thoracodorsal pedicle (95.45%), and the remaining seven cases (4.55%) were lateral scapular border flaps. Mean mandible defect length was 7.3 cm. The mean skin paddle dimension was 86.8 cm2. The most common recipient artery was the thyroid superior artery (79.22%). Major postoperative complications occurred in 13 patients (8.44%). This study confirms that SFFs offer excellent soft and hard tissue quality, component independence, a large arc of rotation length, and a large gauge of pedicle, making them the gold standard for the reconstruction of large composite defects of mandibular HNSCC tumors.

Surgical approach associated with cryotherapy of unicystic mandibular ameloblastoma with 19-year follow-up – a case report

Ameloblastoma is a benign odontogenic tumor of epithelial origin with slow, asymptomatic, rare growth and is associated with a high rate of recurrence, being responsible for 1% of mandibular tumors. There are several variations of these tumors, with solid / multicystic and unicystic types being the most recurrent. The signs are discrete and rarely noticed by the patient in the early stages. In the imaging examination, it presents itself as a well-delimited radiolucent image, which may be associated with the crown of an unerupted tooth, resorption of adjacent roots and vestibular-lingual medullary expansion. In the literature, the most appropriate treatment for the management of such pathology is still controversial, since there are conservative philosophies such as curettage, marsupialization (decompression) and defending currents of the radical surgical approach through resection with a safety margin. This study aims to report a case of curettage of follicular unicystic ameloblastoma with a single incidence of recurrence and treated again by means of a conservative surgical approach and continuing with a 19-year clinical preservation, without any clinical or imaging signs of recurrence.