Maxillofacial Surgery Service Research Articles

Экспертные подходы к оценке организации оказания медицинской помощи по профилю «челюстно-лицевая хирургия» на региональном уровне.

Evaluating the effectiveness of healthcare services is an urgent task because it allows us to identify and analyze the existence of health potential risks and organizational difficulties, and it also assesses in developing preventive measures to eliminate them. Currently, there is no regional unified system to evaluate the existing organizational issues of the regional oral and maxillofacial surgery service. Purpose: accordingly, this study aims to determine an evaluation criterion for the organization of regional oral and maxillofacial surgery service and use an expert assessments method. Materials and methods. We conducted a study in 2019–2022 on the base medical organizations of the Volga Federal District using an expert evaluation method. In the first phase, we selected 60 participants in the organization of oral and maxillofacial surgery service, both at the level of the medical organization and at the regional and federal levels. The experts proposed 64 criteria for evaluating the organization of regional oral and maxillofacial services, which were included in the map of expert evaluation. In the second phase, we selected 21 experts by the inclusion criteria and scored the proposed criteria. To evaluate the questionnaire results, 95 percent of the confidence interval (MDI) was calculated using Fisher’s method. Kendall’s coefficient of concordance (W) was used to determine the consistency of experts’ views on the importance of the criteria chosen. The estimation of the concordance coefficient was considered relevant if the probability of the first type of error was less than 0.05. Results and discussion. Analysis of the results and their ranking by experts made it possible to identify the 20 most significant indicators and observe more than 8 points and a concordance correlation coefficient of 0.7 or more. According to experts, for organizing the provision of oral and maxillofacial surgery service, the most important issue is the availability of regulatory documents, regulations for routing patients, rules for the provision and infrastructure of oral and maxillofacial surgery service, the recommended standard of medical equipment and recommended staffing standards, staffing, the availability of emergency round-the-clock dental service, equipping a panel of devices, sets of surgical instruments for surgical interventions in the maxillofacial region, organizing the provision of care in oral and maxillofacial surgery for children and the disabled in the departments, regular monitoring of patient satisfaction by surveys. Conclusions. Significant criteria for assessing the organization of regional maxillofacial surgical service were identified, which made it possible to identify existing shortcomings in the organization of activities and outline ways to eliminate them.

Alternatives to β-Lactams as Agents for the Management of Dentoalveolar Abscess.

Dentoalveolar abscesses are localized infections within the tooth or the surrounding alveolar bone, often resulting from untreated dental caries or dental trauma causing alveolar bone resorption or even loss. Serious consequences arising from the spread of a dental abscess can often lead to significant morbidity and mortality. The acute dentoalveolar abscess is a polymicro-bial infection comprising strict anaerobes, such as anaerobic cocci i.e., Prevotella fusobacterium species, and facultative anaerobes i.e., Streptococci viridians and Streptococcus anginosus. Moreover, inappropriately managed dental infections can progress to severe submandibular space infections with associated serious complications, such as sepsis and airway obstruction. An audit of the Hull Royal Infirmary between 1999 and 2004 showed an increase in the number of patients presenting to oral and maxillofacial surgery services with dental sepsis. Thus, the scientific com-munity is forced to focus on treatment strategies for the management of dentoalveolar abscess (DAA) and other related dental problems. The current treatment includes antibiotic therapy, including β-lactams and non-β- lactams drugs, but it leads to the development of resistant micro-organisms due to improper and wide usage. Furthermore, the currently used β-lactam therapeutics is non-specific and easily hydrolyzed by the β-lactamase enzymes. Thus, the research focused on the non-β-lactams that can be the potential pharmacophore and helpful in the management of DAA, as the appropriate use and choice of antibiotics in dentistry plays an important role in antibiotic stewardship. The newer target for the choice is NLRP inflammasome, which is the major chemical mediator involved in dental problems. This review focused on pathogenesis and current therapeutics for the treatment of dentoalveolar abscesses.

The role of telehealth in the delivery of oral and maxillofacial surgery services at a level 6 hospital in New South Wales Australia during COVID-19 - the John Hunter Hospital experience: a commentary, review and cautionary tale for the future.

The objective of this article is to understand the uptake in use of Telehealth services during the COVID-19 pandemic as a way to provide compelling impetus for further research and promotion of Telehealth in general. A data review of Outpatient Department data from 2020 to 2023, as compiled by the Surgical Outcomes improvement Unit. Telehealth was widely adopted during the COVID-19 pandemic for clinicians to provide healthcare to patients whilst adhering to strict lockdown guidelines aimed at limiting exposure and spread of the respiratory virus. There has been minimal analysis, however, of the ethical and legal implications of telemedicine. Whilst it seems that access to care is improved via telehealth, there are subtle, inherent barriers intrinsic to it. There was a significant increase in the use of audio and audiovisual aids in the delivery of Oral and Maxillofacial Outpatient care during the COVID-19 period. Further analysis and improvements need to be made to the system before it can be considered as sufficient and adequate. Where there is rapid adoption of Telehealth in the delivery of Oral and Maxillofacial Surgery Services, there must be concurrent rigorous review and update of systems in order to address the key areas of patient safety and accuracy of treatment.

Primary cutaneous anaplastic large-cell lymphoma resembling infratemporal space infection: a case report

BackgroundPrimary cutaneous anaplastic large-cell lymphoma (PC-ALCL) is a rare T-cell lymphoma belonging to the CD30 + T-cell lymphoproliferative disorders. The case of PC-ALCL in the temporal region is exceedingly rare. Herein, we report a case of PC-ALCL involving the temporal region mimicking infratemporal space infection.Case presentationA 78-year-old woman presented to maxillofacial surgery service with a 6-month history of swelling and pain in the left side of her face. Laboratory investigations found an elevated C-reactive protein (CRP). Imaging findings showed enlarged lymph nodes and extensive thickening of subcutaneous tissue of the left temples. Based on these findings, the infratemporal space infection was suspected initially. The patient underwent incision and drainage, and we unexpectedly found no pus in the lesion area. Incisional biopsy showed necrosis and extensive involvement of the left temples by a diffuse infiltrate containing large, atypical cells. The tumor cells were positive for CD30, CD3, Ki67. They were negative for ALK (SP8), CD5, CD8, CD20 and PAX5. After considering these findings, a diagnosis of PC-ALCL was rendered. The patient was admitted to the lymphoma department for systemic chemotherapy and no relapse occurred during a follow-up period of six months.ConclusionsThis report suggests that if there are suspicious intraoperative manifestations, carrying out a biopsy simultaneously, using Hematoxylin and eosin (HE) staining, and a comprehensive Immunohistochemistry (IHC) panel are essential to diagnosing PC-ALCL to prevent misdiagnosis.

Surgical demands of patients attending an Oral and Maxillofacial Surgery clinic in a Nigerian Hospital

Objectives: Reports on most performed oral and maxillofacial surgical procedures (OMSPs) are scarce globally. This study aimed to determine the pattern of surgical demands of patients attending oral and maxillofacial surgery services at the University of Benin Teaching Hospital, Edo State, Nigeria. Materials and Methods: A retrospective study was conducted on patients managed in the Department of Oral and Maxillofacial Surgery from March 2011 to April 2021. Data were collected from theatre logbooks and case notes of patients who had surgery. The data collected were the age of patients, gender, employment status, educational status, residential distance to the hospital, and type of surgery performed. Descriptive statistics were done using the IBM Statistical Package for the Social Sciences statistics for Windows version 20 (Armonk, NY: IBM Corp) software. Results: A total number of 550 patients were seen in the ten-year study period. The age of the patients ranges between 2 and 97 years. The mean age was 23.5 ± 2.08 years. More than half (55.6%) of the patients were male. The highest (47.1%) number of patients that had OMSP had only primary education, followed by tertiary education (25.1%), secondary (17.8%), and no formal education (10.0%). Cleft lip and palate repairs were the most common surgical demands (34.5%), followed by mandibulectomy, open reduction, and fixation. The least surgical demands were neck dissections (0.36%), and none (0.0%) of the patients had cosmetic surgery. Conclusion: The most common surgical demand by patients was cleft lip and palate repairs, while neck dissection was the least common demand, respectively.

Reconstruction of atrophic maxilla with calvarial bone graft and concomitant implant placement: case report

The aim of this study was to report a case of atrophic maxillary reconstruction with calvarial bone graft and immediate installation of implants, and to present the benefits of reconstruction for rehabilitation with dental implants. A 66-year-old female patient came to the Oral and Maxillofacial Surgery service of the Hospital dos Fornecedores de Cana de Piracicaba complaining of non-retention of the total prosthesis. On clinical examination, there was no intraoral or extraoral pathological condition. After initial clinical and radiographic evaluation, we considered the need for maxillary reconstruction with calvarial bone graft, bilateral maxillary sinus lifting, and installation of implants in the maxilla concomitantly with the adaptation of the blocks. Moreover, the installation of implants in the mandibular region was performed. According to the results of this case report and according to the literature, the use of calvarial bone grafting has some advantages: effective in the correction of extensive maxillary bone deficiencies, restoring aesthetics and functionality to the patient, and high rates of success with implants. Thus, bone grafts from the calvaria are viable options for the rehabilitation of atrophic maxilla.

The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region.

The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma. This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated. Eight patients (mean age 55.8y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9cm 2 (range 17-85cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90d). Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.

Preliminary Findings of the Efficacy of Botulinum Toxin in Temporomandibular Disorders: Uncontrolled Pilot Study

Temporomandibular disorders are a common pathology affecting up to 70% of the population, with a maximum incidence in young patients. We used a sample of twenty patients recruited in the Maxillofacial Surgery Service of the University Hospital of Salamanca (Spain), who met the inclusion criteria, with unilateral painful symptomatology of more than three months' duration. All patients were randomly treated by intramuscular and intra-articular injections of botulinum toxin (100 U) in eight predetermined points. Pain symptomatology was assessed by the visual analog scale (VAS) at the different locations, together with joint symptomatology, at baseline and six weeks after treatment. Adverse effects were also evaluated. In 85% of the patients, pain upon oral opening improved and 90% showed improvement in pain upon mastication. A total of 75% of the patients reported improvement in joint clicking/noise. Headaches improved or disappeared in 70% of the patients treated. Despite the limitations of the study and the preliminary results, intramuscular and intra-articular infiltrations with botulinum toxin were effective in the treatment of symptoms associated with temporomandibular disorders (TMDs), with minimal adverse effects.

Osteoma in the temporomandibular joint (Case report)

Osteomas are benign slow growing osteogenic tumors mostly arising in the craniofacial region and characterized by the deposition of differentiated and mature either or both cancellous and compact bone. Osteoma accounts for 2-3% of all bone primary tumors with an incidence of 10-12% among all benign skeletal neoplasms. Objective: The objective of this work is to describe a clinical case of an osteoma in the temporomandibular joint diagnosed in the maxillofacial surgery service of the General Hospital of Pachuca in the State of Hidalgo, Mexico. Clinical Case: A 39-year-old female patient who comes to the General Hospital Pachuca, Mexico due to pain and noises in the right preauricular region of 6 years of evolution, with facial asymmetry, mandibular deviation to the left and limited mouth opening. Clinically, facial asymmetry, mandibular deviation to the left, right posterior crossbite, anterior open bite mainly on the affected side, preauricular pain, joint sounds, and limitation of mandibular movements were observed. Radiographic examination revealed a trapezoidal mass measuring 2.5 by 2.0 cm, with alteration of the condyle-mandible anatomy on the right side. An insertional biopsy is performed, reporting an osteoma, and surgical intervention is continued. Conclusion: The osteoma in the temporomandibular joint is a rare lesion, its timely value is essential for its treatment. Surgical resection is the gold standard treatment, which is based on a radical excision that extends to the altered normal bone, with the contextual objective of achieving an optimal aesthetic result by choosing the least invasive surgical treatment possible.

Detection of NOTCH1 mutations in paraffin samples in patients with potentially malignant lesions.

On certain occasions, oral cancer is preceded by potentially malignant lesions. The degree of dysplasia in Guinea pigs attempts to determine the risk of developing a malignant lesion. The search for genetic mutations, biomarkers, as a more truthful and reproducible diagnostic tool, tries to fill the gaps in the anatomopathological study. In this line, the present retrospective case-control study is based on the detection of known mutations of the NOTCH1 gene in biopsied samples of potentially malignant lesions from 22 patients who attend the Oral and Maxillofacial Surgery service of the Virgen del Rocío University Hospital. DNA extraction after dewaxing of the samples using the Minikit QIAamp DNA FFPE tissue extraction kit with extraction kit (reference 56404) of QIAGEN. Subsequently, with the DNA obtained, 4 amplification reactions were carried out using enzyme polymerase. Before sequencing the samples, they were purified with the ExoSAP-IT for PCR product cleaning kit of the INVITROGEN brand. Finally, to detect somatic mutations in NOTCH1, TaqMan Mutation Detection Assays was used and for the analysis of mutations we worked with the Mutation Detector software. The mutation for NOTCH1 is not detected, the studied sample does not present the mutation, or it is below the limits of detection of the software. In the clinical setting of the sample, the NOTCH1 mutation seems to be not very frequent, although NOTCH1 has been described as a gene related to oral cancer in other geographical settings. Key words:Oral cancer, NOTCH1, mutations.

Retrospective Cohort Study on the Management of Diffuse Deep Neck Space Infections Using a Modified Submental Approach and Placement of Wound Vacuum

Diffuse deep neck space infection (DDNSI) is an emergent condition that requires efficient surgical and airway management. A novel surgical approach has been developed to enhance access and improve visualization of the involved deep neck spaces, which allows for better evaluation of the extent of tissue necrosis. This study will compare the treatment of DDNSI with traditional incision and drainage with drain placement (Conventional) versus the new incision and drainage design with the use of a wound vacuum (VAC). This retrospective cohort study was performed on DDNSI cases treated with the VAC versus Conventional techniques from July 2014 to September 2020 at Memorial Hermann Hospital by the oral and maxillofacial surgery service. To be categorized as a DDNSI, the patient had to demonstrate radiographic evidence of an infection bilaterally in a minimum of four spaces, such as bilateral submandibular, sublingual, and submental spaces. Primary predictor variable was treatment method for DDNSI, Conventional versus VAC. Primary outcome variables were hospital length of stay (LOS), number of washouts, and days of intubation. Covariates were age, sex, number of spaces involved, presence of necrotic tissues, comorbidities, and mortality. Appropriate uni- and bi-variate statistics were calculated. Statistical significance was set a P < .05. Fifty-one patients (17 female and 34 male) aged 18 to 65years were treated for DDNSI. Twenty-eight patients were treated using the VAC approach and 23 patients were treated with the conventional approach. The average LOS 8.3± 0.8days (P-value=.0001), number of days intubated 3± 0.3 (P-value=.0001), and number of required washouts 2± 0.2 (P-value=.004) were statistically lower in the VAC group compared to the Conventional group. There were significant improvements encountered with overall length of hospital stay, number of days intubated, and the number of required wash outs. There were significant differences in outcomes between patients with comorbidities when compared to those who had none.

Effectiveness of piezoelectric versus straight hand piece at low speed within the surgical extraction of retained lower third molars

Determine the effectiveness of the piezoelectric handpiece vs. the straight handpiece at low speed in surgeries of impacted lower third molars, in relation to post-surgical effects (edema, pain and trismus) and the operative time of the osteotomy, in patients attending the Maxillofacial Surgery Service of the "Hospital de Especialidades Fuerzas Armadas N°1". It is an observational, analytical, longitudinal prospective cohort clinical study. A sample of 40 patients of both sexes aged between 18 and 25 years was taken, divided into two groups of 20 patients each, in group A extractions were performed with piezoelectric and in group B with straight rotary handpiece at low velocity. The results were analyzed on the third, fifth and eighth day, the edema was measured with the method of Amin and Laskin, for the pain the Visual Analogous Scale (VAS) was used, and for the presence of trismus with the instrument foot of king. In group A, edema (11.72 mm), pain (4.67) and mouth opening (39.49 mm) were lower than in group B edema (12.29 mm), pain (4.8) and mouth opening (35.83 mm) and osteotomy time was significantly longer with piezoelectric (6.54 ± 3.05 min) compared to the straight handpiece (1.55 ± 0.57 mm). min) and there was a difference in edema, pain and trismus under normal conditions in contrast to what was obtained at 3, 5, 8 days between the two instruments. the post-surgical effects of edema, pain and trismus of the extraction of retained lower third molars are less intense with the piezoelectric compared to the straight handpiece, the use of the piezoelectric being recommended.

Management of MACROGLOSSIA: Case Series and Suggested Algorithm

Idiopathic macroglossia is a rare entity of true tongue enlargement without an underlying etiology. There are only a few case reports on the diagnosis and management of idiopathic macroglossia. This study's purpose was to present a series of patients with idiopathic macroglossia and suggest a treatment algorithm. This was a retrospective case series of a cohort of patients with macroglossia who were treated by the Oral and Maxillofacial Surgery service at the University of Texas Health Science Center at Houston (UTHealth)and Emory University. The patient's medical comorbidities, history of present illness, clinical presentation, radiographic findings, and disease management were studied. The outcome variables include normalization of the tongue size, dependence on parenteral nutrition, and tolerating tracheostomy decannulation. Five patients with a mean age of 45years were included in the study. All of the patients (n=5, 100%) in our cohort developed macroglossia following prolonged oral intubation, with 3.5weeks being the average length of intubation. All patients presented with difficulty feeding orally and breathing. The average tongue dimension was 12.20 x 6.25cm. All tongue enlargements were located in the anterior 2/3 of the tongue, and all patients had displaced anterior dentition. In addition, 60% of the patients (n=3) experienced altered tongue sensation (pain and/or decreased taste). These patients were surgically managed with tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement followed by partial glossectomy (n=5, 100%). We defined successful outcomes as 1) modifying the tongue to a functional, nonprotruding form, 2) tracheostomy decannulation and 3) PEG tube removal. Tracheostomy decannulation and PEG tube removal were achieved in 80% of the patients (n=4). In this patient cohort, we were unable to identify the cause of the pathology based on existing clinical data. When the etiology is unclear or irreversible, management should involve tracheostomy and surgical feeding access for the initial stabilization, followed by modified glossectomy to improve form, function, and cosmesis thereby improving the overall quality of life.

SURGICAL TREATMENT OF CALCIFYING ODONTOGENIC CYST—CASE REPORT

An 18-year-old male patient reporting swelling in the mouth was referred to the oral and maxillofacial surgery service. On intraoral examination, the presence of a bulge along the bottom of the posterior right mandibular vestibule was noted, with normal color and a smooth surface. Panoramic radiographic examination revealed a multilocular radiolucent intraosseous lesion, with well-defined limits and radiopaque structure inside. Cone beam computed tomography showed root apices resorption of teeth 45, 46, and 47; expansion of the buccal and lingual cortical bone; and close contact of the lesion with the inferior alveolar vasculature-nervous bundle. Incisional biopsy revealed a calcifying odontogenic cyst. Surgical treatment was performed through enucleation, followed by curettage of the intraosseous lesion, under general anesthesia. The 1-year postoperative follow-up showed complete bone regeneration and there were no signs of recurrence. An 18-year-old male patient reporting swelling in the mouth was referred to the oral and maxillofacial surgery service. On intraoral examination, the presence of a bulge along the bottom of the posterior right mandibular vestibule was noted, with normal color and a smooth surface. Panoramic radiographic examination revealed a multilocular radiolucent intraosseous lesion, with well-defined limits and radiopaque structure inside. Cone beam computed tomography showed root apices resorption of teeth 45, 46, and 47; expansion of the buccal and lingual cortical bone; and close contact of the lesion with the inferior alveolar vasculature-nervous bundle. Incisional biopsy revealed a calcifying odontogenic cyst. Surgical treatment was performed through enucleation, followed by curettage of the intraosseous lesion, under general anesthesia. The 1-year postoperative follow-up showed complete bone regeneration and there were no signs of recurrence.

ODONTOGENIC MYXOMA WITH AN UNUSUAL PRESENTATION IN THE ANTERIOR MANDIBLE: A CASE REPORT

A 36-year-old dark-skinned female patient attended the oral and maxillofacial surgery service with a complaint of a “lump on the gums.” The patient reported smoking and drinking and no comorbidities. Intraoral examination revealed a nodular, sessile, normochromic, and asymptomatic lesion located in the gingiva around teeth 42 and 43. The panoramic radiograph revealed a well-defined radiolucent image, without root resorption and with discrete thin, bony trabeculae inside. Odontogenic tumors and central giant cell lesion were suggested as diagnostic hypotheses. Incisional biopsy was performed, and the material was sent for histopathologic analysis. The conclusive diagnosis was odontogenic myxoma. The proposed treatment was marginal resection. A 36-year-old dark-skinned female patient attended the oral and maxillofacial surgery service with a complaint of a “lump on the gums.” The patient reported smoking and drinking and no comorbidities. Intraoral examination revealed a nodular, sessile, normochromic, and asymptomatic lesion located in the gingiva around teeth 42 and 43. The panoramic radiograph revealed a well-defined radiolucent image, without root resorption and with discrete thin, bony trabeculae inside. Odontogenic tumors and central giant cell lesion were suggested as diagnostic hypotheses. Incisional biopsy was performed, and the material was sent for histopathologic analysis. The conclusive diagnosis was odontogenic myxoma. The proposed treatment was marginal resection.

PLEOMORPHIC ADENOMA OF THE PALATE—A CASE REPORT

A 74-year-old male patient was referred to the oral and maxillofacial surgery service with a diagnosis of pleomorphic adenoma after a previous incisional biopsy under local anesthesia. The patient had complained of a painless nodular lesion on the hard palate, with slow and progressive growth for 1 year. Upon clinical examination, we observed a nodular lesion, sessile, with a firm consistency, 5.0 cm in its largest diameter and localized on the right side of posterolateral region on the hard palate, extending to the soft palate. Cone beam computed tomography showed no evidence of bone involvement or even communication with the maxillary sinus. After routine preoperative examinations, the patient underwent total excision of the lesion under general anesthesia. Histopathologic analysis of the specimen confirmed the preoperative diagnosis. After 8 months of postoperative follow-up, the surgical site was completely repaired with no signs of recurrence.

ODONTOGENIC KERATOCYST IN THE MAXILLA: CASE REPORT

A 32-year-old female patient was referred to the oral and maxillofacial surgery service with pain in the jaw for approximately 1 year. On extraoral and intraoral examination, there were no apparent changes or asymmetry. Cone beam computed tomography evidenced an extensive cystic lesion in the left maxillary bone, hypodense, with well-defined limits, extending to the maxillary sinus and involving the impacted tooth 28. Surgical treatment was performed under general anesthesia through enucleation followed by curettage of the entire lesion and removal of the involved impacted tooth. Histopathologic analysis of the specimen resulted in the diagnosis of odontogenic keratocyst. At 10-day follow-up, the surgical site showed adequate tissue repair process. In the postoperative clinical and radiographic follow-up at 1 year and 2 months, a complete bone regeneration was observed and there was no signs of lesion recurrence.

MANAGEMENT OF A MAXILLO-ZYGOMATIC FIBROUS DYSPLASIA IN A GROWING-UP CHILD: EIGHT YEARS’ FOLLOW-UP CASE REPORT

Fibrous dysplasia (FD) is a benign dysplastic disorder of bone development in which the normal bone matrix is replaced by fibroblastic proliferation. The aim of this case report is to report a case of a 12-year-old White male patient who was referred to an oral and maxillofacial surgery service with the main complaint of facial asymmetry and tumefaction in the right maxillo-zygomatic region. Physical examination, computed tomography, and incisional biopsy were performed, which confirmed the diagnosis of FD. A stereolithographic model was generated to manufacture a surgical guide. Osteoplasty was conducted under general anesthesia and the patient was follows up every 6 months after surgery. After 8 years of follow-up, a positive control of facial asymmetry, contour, and volume of bone affected were achieved. Final computed tomography showed that the maxilla and zygomatic bones increased in size and volume, with no compression of important structures and no functional damage.

What is Idiopathic Macroglossia? A case series and review of literature

<h3>Purpose</h3> Macroglossia is pathological condition which resulted in hypertrophy of tongue muscles. It is classified into congenital and acquired macroglossia. Idiopathic macroglossia (IM) is tongue hypertrophy without systemic or genetic causes. This condition has a significant impact on the quality of life, and often require tracheostomy and percutaneous endoscopic gastrostomy (PEG) to sustain living. Guidelines regarding treatment for this subtype are scant. The purpose of this project to present diagnosis and management of a series of patients with idiopathic macroglossia. <h3>Methods</h3> This was a retrospective case series of a cohort of patients with IM who were treated by Oral and Maxillofacial Surgery (OMS) service at University of Texas Health Science Center in Houston (UTHealth) and Emory University from 2019 to 2021. Inclusion criteria are (1) 18 years or older, (2) diagnosed with macroglossia, (3) managed with surgery, (4) with normal tongue tissue on histopathology results, and (5) with a negative COVID test. Patients were excluded if they are younger than 18 years old and diagnosed with macroglossia due to an underlying etiology such as congenital anomaly, systemic conditions, and intraoral inflammatory changes. Study variables were patient demographics, social history, medical comorbidities, clinical presentation, clinical dimensions, presence of tongue protrusion, difficulty feeding, difficulty in breathing, imaging characteristics/dimensions, pathological findings, management (tracheostomy, PEG, glossectomy), and length of inpatient stay. The outcome variables were normalization of tongue size, return of parenteral nutrition, and able to tolerate tracheostomy decannulation. Data were collected using a standardized collection form. Descriptive statistics were computed. <h3>Results</h3> Five patients (mean age, 45 years) with IM met inclusion criteria. All patients had history of hypertension, cerebral vascular disease, and prolong intubation. All patients presented with anterior tongue enlargement, with mean dimension of 13 × 6 cm, full or partial dentition, altered tongue sensation. They were all managed with tracheostomy to secure the airway, PEG and partial glossectomy. Average length of inpatients stay was 10 days. All IM achieved clinical resolution, 80% of the patients had their tracheostomy decannulated and PEG tube removed. <h3>Conclusion</h3> Management of macroglossia requires multidisciplinary approach. While etiology can often be identified and medical treatment can be initiated for reversible causes, most of the macroglossia cases previously reported required surgical management. Surgical reduction offers the best functional and cosmetic results and minimizes morbidity. In the case idiopathic macroglossia, management should involve tracheostomy and feeding access for the initial stabilization followed by reduction glossectomy for improvement of functional outcomes.

ADENOMATOID ODONTOGENIC TUMOR OF THE JAW: CASE REPORT

A 35-year-old woman was referred to the oral and maxillofacial surgery service for excision of a benign intra-osseous lesion with histopathologic report of adenomatoid odontogenic tumor. On intraoral examination, the presence of a bulge along the bottom of the left mandibular body vestibule, with normal color and a smooth surface, was noted. Cone beam computed tomography showed an extensive hypodense image, with defined limits, comprising the region between teeth 31 and 35, expanding the buccal and lingual cortical bones with displacement of adjacent teeth and resorption of the 33-tooth apex root. Complete surgical excision of the lesion was performed under general anesthesia. At 1 year postoperative follow-up, the surgical site region showed a completely healed mucosa with no signs of recurrence and complete bone repair on the control radiograph.