Maxillofacial Unit Research Articles

Three-dimensional correlation between condylar size and mandibular asymmetry with type 1B condylar hyperplasia: A quasi-experimental study from PERU

Aim: Condylar hyperplasia (CH) is an alteration of condylar development, which causes mandibular asymmetry and dentofacial deformity in different magnitudes. The aim of this investigation was to determine the relationship of the condylar size and mandibular asymmetry in patients with type 1B CH through analysis of cone beam computer tomographies (CBCT). Materials and Methods: The research was a quasi-experimental study. Thirty subjects were studied using a CBCT. Patients were recruited from the Dental Service of the Oral and Maxillofacial Surgery Unit of the Hospital Guillermo Almenara Irigoyen, Lima, Peru, between 2016 and 2018. Anteroposterior, upper–lower, and middle–lateral distance measurements of the condyle head were obtained and correlated with the difference of the measurements obtained. Spearman correlation coefficient was used and established a level of significance of P < 0.05. Results: The results showed a correlation between condylar size and mandibular asymmetry. In addition, it was found that the greater the difference in the upper–lower part of the hyperplastic (CH) and nonhyperplastic (NCH) condyles, the greater the magnitude of the mandibular asymmetry, finding a positive correlation r = 0.331 with significant value (P = 0.037). Conclusion: There was a positive correlation between upper–lower difference and mandibular asymmetry. Similarly, in the middle–lateral measurement, a negative correlation was found between the condylar difference and the mandibular symmetry in the anteroposterior measurement.

Study the association among human papilloma virus subtypes 16 and 18, codon 72 P53 gene polymorphism, and oral squamous cell carcinoma in Upper Egypt: a case–control study

Objectives To investigate the possible association among oral squamous cell carcinoma (OSCC), human papilloma virus (HPV) subtypes 16 and 18, and P53 codon 72 genotypes in Upper Egypt population. Patients and methods The present case–control study included patients presented to Maxillofacial Unit, General Surgery Department, Faculty of Medicine at Assiut University Hospital, Egypt. The biopsies were collected from patients with OSCC, patients with leukoplakia, and healthy oral mucosa as a control group. The P53c72 genotypes and gene expression for HPV subtypes 16 and 18 were determined using the real-time PCR method. Results The study was done on 69 patients: 45 cases (28 OSCC cases and 17 leukoplakia cases) and 24 patients as a control group. There was no statistically significant association between both OSCC and leukoplakia and P53 codon 72 gene polymorphism. The distribution of P53 genotypes in patients with OSCC was 21.4% were wild, 39.3% were mutant, and 39.3% were heterogeneous, whereas in leukoplakia, 23.6% were wild, 17.6% were mutant, and 58.8% were heterogeneous when compared with controls, where 45.8% were wild,12.5% were mutant, and 41.7% were heterogeneous. Conclusion No statistically significant correlation between HPV 16 and 18 genotypes and OSCC in the present study could be noted. Moreover, there is no association between codon 72 of P53 gene polymorphism and OSCC, so other environmental factors should be studied to detect the causal factors of oral carcinoma in our society.

PATTERN OF CONDYALR FRACTURES AND ITS TREATMENT IN TERTIARY CARE HOSPITAL-A STUDY

Objective: To evaluate the occurrence of mandibular condylar fractures in our area regarding age, gender, etiological factors, type and level, any associated facial fractures and treatment modality adopted in our centre.&#x0D; Materials and Methods: Data of 120 patients presented with the features of mandibular condylar fracture at Oral and Maxillofacial Surgery Unit, Bacha Khan Medical College Mardan from September 2016 to October 2019 was recorded. Non probability, convenience sampling technique was used. History, clinical and radiographic examination was performed for diagnosis. Treatment modalities included conservative, closed reduction and open reduction and internal fixation. Data regarding the age, gender, etiology, pattern and level of fracture, associated facial fractures and treatment modalities were evaluated and analyzed.&#x0D; Results: Mean age was 21 ± 11.97 years, with an age range of 5-75 years. Age group 11-20 years were most commonly affected (38.4%).The ratio of male and female was 3.80:1. Road Traffic Accidents (38.3%) was the common cause of injury. Unilateral fractures (65%) dominated the bilateral pattern (35%).Condylar head was most common fracture (58.60%). Parasymphysis was most common associated fractures (26.3%) followed by body and zygomatic bone (18.4%). Most of the patients were treated by closed reduction (54.2%).&#x0D; Conclusion: Public awareness is required regarding the significance of the condylar injuries. Randomized Controlled Trials are required to compare the outcome of different treatment modalities.&#x0D;

Predisposing Factors and Clinico-Pathological Presentation of Malignant Lesions Of the Oro-Facial region in Dar es Salaam, Tanzania

Background: The oro-facial region is made up of a complex anatomical relationship of structures which may be a source of development of malignant lesions. Majority patients who present at the oral and maxillofacial unit of MNH with a variety of malignant lesions are referred cases from upcountry district/regional hospitals and present with advanced stages of disease often with a wide range of complications. Of recent, there has been a dramatic change in the characteristics and demography of some of the common malignant lesions of the oro-facial region. Such changes mightbe attributed to predisposition or systemic changes following exposure to certain external factors.&#x0D; Objective: To determine the predisposing factors and clinico-pathological presentation of malignant lesions of the oro-facial region among patients attending the Muhimbili National Hospital.&#x0D; Methodology: This was a cross-sectional descriptive hospital-based study carried out in the Department of Oral and Maxillofacial Surgery at the Muhimbili National Hospital. A sample of 186 patients with malignant tumours in the oro-facail region attended at MNH during the study period.For every patient, demographic details were recorded and history, clinical examination and laboratory investigations, including biopsy were done.&#x0D; Results: A total of 186 patients, 104 (56.0%) males and 82 (44.0%) females with a ratio of 1.3:1 were included in the study. The age ranged from 3 to 83 years with a mean age of 48.4 ± 19.2 SD years. Thirty-three percent of the patients were aged below 40 years. The commonest reported oral and maxillofacial malignant tumour was SCC with 96 (51.6%) patients followed by KS which had 17 (9.1%) patients and non-specific carcinoma 10 (5.4%) patients. Tobacco use was reported by 89 (47.8%) among whom 62 (69.6%) had used tobacco for more than 20 years. Ninety-six (51.6%) patients reported alcohol use among whom 49 (51.0%) reported to have used alcohol for more than 20 years. Thirty-three (17.7%) patients were HIV positive. All patients with KS were also HIV positive. MEP and PLGA were among very rare tumours occurring in the maxillofacial region that were encountered in this study.&#x0D; Conclusion: There was an increased frequency of malignant tumours in the oral and maxillofacial region among young patients. Tobacco use and HIV infection seemed to have influence on the occurrence of SCC and KS respectively. Majority of patients reported late with advanced disease and over 95% of patients with SCC presented with stages III or IV tumours.

Surgical management of unilateral body fractures of the edentulous atrophic mandible.

Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery. This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications. A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases. Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.

The priorities and emergency treatments of multisystem injuries associated with maxillofacial traumas

Background: The purpose of this study is to evaluate the care of multiple trauma victims with maxillofacial injuries in terms of epidemiological distributions, types of injuries, the related different modalities of surgical treatments delivered, and their complications. Materials and Methods: This prospective study was performed on 50 patients with multiple traumas including maxillofacial injuries, caused by different etiological factors, who were brought first to the surgical emergencies department of the Medical City then referred to the Maxillofacial unit in the Specialized Surgeries Hospital, Baghdad, Iraq, during the period from April 2007 to April 2008. Information was documented prospectively from the time of the emergency call to discharge (or death). Results: the age range was from 6 to 63 years, with the most frequent age group for injury being ranged between 21-30 years. The male to female ratio was 6:1. The missile injuries accounted for 90% of multiple traumas with maxillofacial injuries, while civilian injuries accounted for 10% of the cases. The mechanisms of injury, concerning war injuries, were gunshot injuries 46% and blast injuries 44%, while concerning civilian injuries: road traffic accidents 8% and stabbing injuries 2%. Among 50 people injured, 3 (6%) died. Conclusion: The priority during initial treatment is the achievement of patent airway, hemostasis, and the maintenance of vital tissues oxygenation.

Optimising the management of concurrent symphyseal/parasymphyseal and bilateral extracapsular condylar fractures using three-dimensional printing.

Three-dimensional (3D) printing plays an important role in the diagnosis and treatment planning of many elective procedures in oral and maxillofacial surgery (OMFS). 3D printers and the associated print materials are now within the price range of most maxillofacial units, requiring less work to be sent out to commercial printers. Whilst their use in the planning of elective procedures is commonplace, acute trauma is an area where 3D printing remains underutilised. The successful management of complex fracture patterns such as concomitant symphyseal/parasymphyseal and bilateral condylar fractures often warrants this approach. Freeware digital processing and manipulation software packages were used to view and segment structures from computed tomography (CT) data. Thereafter, fractures were digitally reduced. 3D printed models were produced from the digitally reduced models, allowing preoperative custom adaptation of osteosynthesis plates, facilitating accurate fracture fixation intraoperatively. For less than one hundred pounds sterling (STG), a 3D printer (with print material) capable of producing a model of sufficient quality can be purchased. The use of freeware digital processing software allows digital manipulation of CT data. Production of 3D models and plate adaptation can be carried out within hours after CT examination. The construction of digitally reduced 3D models and custom adapted plates enables the surgeon to achieve accurate fixation of complex fracture patterns in theatre which is clearly of benefit to patients. The potential for reduced theatre time also renders this approach more desirable, making this a worthwhile investment despite the additional non-clinical time associated with training and initial expenditure.

An audit of the quality of referrals to a North London Hospital Oral and Maxillofacial Unit: are referrals putting patients at risk?

Introduction/Aims High quality referrals are essential in an Oral and Maxillofacial Unit (OMFSU) in order to triage and deliver treatment efficiently and appropriately. Referrals to our service should contain correct patient demographics, medical history, reason for referral, relevant imaging, urgency of referral and be legible. Failure to provide these aspects may result in inappropriate delays, further radiation exposure and misdiagnosis. The aim of this audit is to evaluate the quality of referrals received and improve any shortcomings to prevent delayed or inappropriate patient care.

Using the false negative rate and number of nodes harvested as proxy markers of quality when setting up a new sentinel lymph node biopsy service in a maxillofacial unit.

Using the false negative rate and number of nodes harvested as proxy markers of quality when setting up a new sentinel lymph node biopsy service in a maxillofacial unit.

How frequently is pus sent and how often does it change practice? A Maxillofacial Trainee Research Collaborative (MTReC) Project

The Maxillofacial Trainee Research Collaborative performed a national snapshot audit of inpatient management of cervicofacial infection in UK maxillofacial units between May and September 2017.Our previous research identified widespread variation in practice, necessitating a national project to define current practice. The usefulness of microbiology sampling is one such area of variability and uncertainty.

The epidemiology of edentulous atrophic mandibular fractures in Europe

IntroductionThe objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented. MethodsThe data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay. ResultsA total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study population was 75 years. Statistically significant associations were found between Luhr classes I – II and condylar fractures on one hand (p < .0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p < .05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries. ConclusionsThe management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites.

Management of mandibular condylar fractures in patients with atrophic edentulous mandibles

IntroductionTreatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. MethodsThe data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. ResultsA total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. ConclusionsThe golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.

Rhino-maxillary aspergillosis in an immunocompetent patient. Case report.

Introduction: Aspergillosis is the second most frequent opportunistic fungal infection of the paranasal sinuses. It primarily affects the maxillary sinus and occurs mainly in immunocompromised individuals. Infection is caused by inhalation of spores or by an oro-sinusal communication. Aspergillosis is classified into an invasive and non-invasive form or Aspergilloma, which usually affects immunocompetent patients. Violaceous lesions, ulcers, necrosis and tissue destruction can be manifested clinically. Patients may experience pain, paresthesias, increases in the volume of purulent or bloody nasal discharge and congestion. Case report: A 62-year-old female patient, immunocompetent, with a condition evolving for about six years. Condition began after a dental extraction, and consisted of absence of scarring and recurrent episodes of symptomatology suggestive of maxillary sinusitis with poor response to antibiotics. The patient was referred to the maxillofacial care unit, presenting an increase of volume in the right genial region, pain and paraesthesia of infraorbital region. The CT scan showed the presence of a radiopaque foreign body in the right maxillary sinus. A surgical procedure was carried out using the Caldwell-Luc technique and biopsy; the case was diagnosed with Aspergillosis. The patient was treated without antifungal therapy because she had a good immune status. Conclusion: Aspergilloma is the most common form of Aspergillosis in immunocompetent individuals. It is usually diagnosed late, as its clinical picture is similar to bacterial sinusitis. In most cases, patients respond well to surgical treatment, and systemic antifungal therapy is not necessary.

Treatment of Deformational Plagiocephaly With Physiotherapy.

Non-synostotic plagiocephaly consists in an asymmetry of the skull due to mechanical forces applied in utero or postnatally: main differential diagnosis is with true synostotic asymmetry, which is caused by the premature closure of a suture. The correction of positional forms is mostly conservative, with 3 main strategies: counterpositioning, physiotherapy and helmet therapy. There is no synthesized evidence on which is the most effective. The Authors evaluate the modification of antropometric measurments before and after a pediatric physical therapy program in a sample of patients with non-synostotic skull asymmetry, in order to evaluate the improvements in the skull shape. The hypothesis being tested was that physical therapy alone could improve the antropometric measurments. The authors enrolled in this study 24 patients diagnosed of non-synostotic asymmetry, clinically and with ultrasound, referred to the Maxillo-facial Unit of Policlinico Umberto I, Rome, within 2013 and 2016. A standardized pediatric physical therapy intervention program was designed: it consisted in a combination of excercises and manipulative procedures to reduce positional preference, musculoskeletal disorders and cranial deformity. Infants received 16 sessions of physical therapy, of 40 minutes each, once a week, for four months. The Authors evaluate the variation of four anthropometric measurments, performed before and after the physical therapy program: Argenta scale, Oblique Diameter Difference Index (ODDI), Cranial Proportional Index (CPI) or Cephalic Ratio (CR), Cranial Vault Asymmetry Index (CVAI). Craniometric evaluations were extrapolated by standardized 2D digital photographs of frontal, sagittal and transverse planes, by the same physician to minimize bias. The management of positional cranial deformities is still controversially discussed and especially the effects of physiotherapy and osteopathy have been only marginally researched. Statistical analysis revealed the effectiveness of the protocol: all anthropometric measurements improved with a high rate, major in youngest children (P < 0.5) and in more severe first presentations (P < 0.05 or P < 0.01). The results suggest manipulative approach may improve the outcome in the long term follow up of cranial asymmetries.

Antimicrobial regimens used in the treatment of mandibular fractures in UK maxillofacial units: changes over 12 years.

In the case of most mandibular fractures, the prescription of antimicrobials for more than 24 hours postoperatively confers no clinical benefit. To establish the prescribing patterns for mandibular fractures in UK OMFS units, and to compare them with those used 12 years ago, we did a telephone and email survey of OMFS units in the UK. Antimicrobials were prescribed for more than 24 hours postoperatively by 76 units (65%) (considerably fewer than the 82 (87%) in 2005). The most commonly prescribed first-line antimicrobial was co-amoxiclav (75%). Although there has been some improvement since 2005, most units still prescribe antimicrobials for periods longer than 24 hours. National collaboration may improve their appropriate prescription.

Study of Agreement between two Wereable Inertial Systems for Gait Analysis based on a different sensor placement: G-Walk System and Opal System

In March 2020 a new viral pandemic was declared. As etiological factor a virus belonging to the coronavirus family was isolated. This virus was named SARS-CoV-2 or COVID-19. This virus can cause different clinical frames, variating from mild symptomatology to cases of ARDS or death. Although the pandemic outbroke in China, COVID-19 had one of first hotspots in Italy, where the Public Health System needed a re-arrangement to face the disease. The incidence of oncological disease doesn't suffer any variation in relation to pandemics or emergency period, but need to be managed as soon as possible in every situation. In our maxillo-facial surgery Unit we continued our regular activities to treat all oncological patient that needed surgery during the pandemic. Because of the absence of knowledge about the COVID-19, first periods were very difficult to manage, due to the risk of infection of patients and health professionals. We decided to share our experience.Between March and June 2020, 34 patients affected by head and neck cancer were admitted at our Unit. All patients underwent surgical treatment and were hospitalized until their situation guaranteed a safe discharge.All patients treated for head and neck cancer underwent surgery. All the medical and nurse post-operative management was performed by health operators by using all the personal protective equipment (PPE) to prevent any possible infection. All contacts between patients and their family were suspended.During phase 1, all patients were submitted to a short verbal triage, measurements of physiological parameters and qualitative COVID-19 test. They were also screened by imaging to guarantee there were not any bronchopulmonary diseases referable to viral infections. During phase 2, patients were also screened by serological tests. During phase 3, all patients practiced oropharyngeal swap before being hospitalized.During lockdown a re-arrangement of the management of oncological patients was mandatory. The difficulties were caused by the restriction of several activities that guarantee a normal health care system function. To date there is not a standardized therapeutic protocol to face the infection. Main therapies are symptomatic and a lot of patients need to be treated in ICUs. To prevent any possible infections, surgical activities were reserved only for urgent disease that cannot be delayed. In our Unit we continued to manage oncological patients. Social distancing and confinement measures were necessary and mandatory, in order to manage our patients. During first phases we had not any valid instrument to totally exclude COVID-19 infection. During phase 3, when oropharyngeal swaps were introduced in the screening of our patients, we could start to work in a safer way.There are still a lot of difficulties in the management of patients during COVID 19 pandemic. Because of the important consequences deriving from the delay of oncological patients their management must to be clearly defined.

A review of the electronic two-week rule referrals for head and neck cancer to Western Sussex Hospitals NHS Foundation Trust

Introduction The two-week rule (2WR) for referring suspected malignancies aims to improve access and outcomes for cancer patients. However, there has been criticism of the rule in the literature. GDPs have an important role in spotting head and neck cancer (HNC) and using the 2WR appropriately to ensure their patients get fast and effective treatment.Aims 1) To evaluate adherence to guidelines of electronic 2WR referrals for HNC sent to Western Sussex Hospitals Trust from GDPs in Sussex; 2) to determine the detection rate of oral malignancies from these referrals; 3) to determine the success of the maxillofacial unit in seeing referred patients within two weeks.Materials and methods Two hundred and nineteen randomised electronic 2WR referrals were analysed for adherence to the guidelines for referral of suspected oral cancer. Patient waiting times, subsequent correspondence and pathology results were analysed.Results One hundred and thirty-five referrals (62%) were deemed to be compliant with the NICE NG12 guidelines, while 186 referred patients (85%) were seen within the two-week time frame. Six referrals (2%) resulted in a positive detection of malignancy (a lower rate compared to similar previous studies).Discussion There are several possible reasons for the poor rate of guideline adherence from GDPs, such as pressure to refer defensively and a lack of knowledge of referral guidelines or oral pathology. This may contribute to a poor detection rate, although there may be other contributing factors.Conclusions Thirty-eight percent of electronic 2WR referrals from GDPs were deemed inappropriate; ongoing education is required to minimise these inappropriate referrals. Patients must be made aware of the reason for their referral to promote attendance. Further studies are required to identify the reasons for such a low detection rate.

Mandibular advancement splints for obstructive sleep apnoea – a cautionary tale

Obstructive sleep apnoea is a serious medical condition of increasing prevalence that has a multitude of treatment modalities. The aim of this study was to review the results of patients treated with mandibular advancement splints in the Oral and Maxillofacial Surgery Unit of South Australia to inform ongoing practice in this area. The casenotes of patients who received a splint for obstructive sleep apnoea between January 2008 and June 2014 were audited. Data collection included referral and demographic details, sleep study results, splint type and follow-up details. Three hundred and four patients were identified as having been provided a mandibular advancement splint for obstructive sleep apnoea, of which 82 had diagnostic and splint-in-situ sleep studies available for comparison. It was observed that 27 had clinically significant objective improvement, 40 had no clinically significant change and 15 had clinically worse OSA following MAS therapy. Mean reductions in Apnoea-Hypopnoea Index and Respiratory Disturbance Index were eight events (27%) and 13 events (33%) per hour respectively with treatment. Based on this study, mandibular advancement splint therapy is a viable treatment for a subset of patients with obstructive sleep apnoea. Protocol driven, multi-disciplinary care with auditing of results is recommended.

Does Middle Meatal Antrostomy Prevent the Onset of Maxillary Sinusitis After Zygomatic Implant Placement?

To evaluate the role of middle meatal antrostomy in preventing the onset of maxillary sinusitis after placement of zygomatic implants. We hypothesized that middle meatal antrostomy might reduce the incidence of this complication. A prospective longitudinal study was performed of patients who had undergone placement of 4 zygomatic implants and concurrent middle meatal antrostomy with an endoscopic approach at the maxillofacial surgery unit of Verona University. The radiological results of the maxillary sinuses were evaluated on computed tomography scans performed 12months after surgery using the Lund-Mackay staging system. Clinical symptoms were evaluated both preoperatively and 12months after surgery using the Sino-Nasal Outcome Test-20 (SNOT-20). Intraoperative violation of the Schneiderian membrane was also assessed. The outcomes from the present study were compared with historical controls. The sample included 13 patients, 26 maxillary sinuses with negative radiologic findings of sinonasal pathologic features, and 52 zygomatic implants. A moderate increase was found in radiologic findings of sinonasal pathologic features postoperatively compared with preoperatively, with mucosal hypertrophy in 3 maxillary sinuses (11.5%). The incidence and severity of mucosal hypertrophy was significantly lower than the outcomes of the historical controls. The average preoperative SNOT-20 score was 13.45, and thepostoperative SNOT-20 score was 1.18. The Schneiderian membrane was pierced in 13 sinuses in9patients. Shrinkage of the ostiomeatal complex seems to play a fundamental role in the onset of sinonasal pathologic features after zygomatic implant placement compared with implant-related causes. Although functional endoscopic sinus surgery is a supplementary surgical method in implant placement, it seems to provide statistically significant improvement in the health of the sinonasal system. Perforation of the Schneiderian membrane does not appear to correlate with the onset of sinus opacification and sinonasal symptoms.

ODONTOGENIC TUMORS: A 50-YEAR EXPERIENCE

Objectives Odontogenic tumors are a heterogeneous group of lesions of diverse clinical behavior and histopathologic types, ranging from hamartomatous lesions to malignancy. They are derived from epithelial and mesenchymal elements of the tooth-forming apparatus so they are unique to the jaws. The last update of these tumors was published in 2017 January. According to this classification, benign odontogenic tumors are classified as follows: Epithelial, mesenchymal (ectomesenchymal), or mixed depending on which component of the tooth germ gives rise to the neoplasm. Malignant odontogenic tumors are quite rare and named similarly according to whether the epithelial or mesenchymal or both components are malignant. Epidemiological data on odontogenic tumors within in Turkey is scarce. Our aim is to determine the incidence of odontogenic tumors according to the new classification within a Turkish population. These tumors were identified using the pathology files, Istanbul, about a 50-year period. Findings Over a thousand cases of odontogenic tumors were diagnosed in the Oral and Maxillofacial Pathology Unit between 1971-2018. The cases were reviewed and reclassified histopathologically in accordance with the 2017 WHO classification of head and neck tumors. The most common three tumors were ameloblastoma (n:366, including unicystic and peripheral ameloblastomas), odontoma (n:335, both complex and compound), and odontogenic myxoma/fibromyxoma (n:190), respectively. Malignant and peripheral odontogenic tumors are a small proportion of this series. The mean age is about 32 and there is a slight female predilection. The most common site is molar region of the mandible, followed by the anterior mandible and the anterior maxilla. Conclusions This is one of the largest series of odontogenic tumors to be described from the Europe. The location, site, gender and age of the patients are similar to that in other populations, however there are some differences about the frequency of the tumors types.