Ramus Of Mandible Research Articles

Does mandible ramus height asymmetry affect postoperative skeletal stability in orthognathic surgery patients?

BackgroundRelapses following orthognathic surgery have been reported to exceed 2% to 50%, depending on multiple factors. This study aimed to analyze the stability after orthognathic surgery in patients with mandibular ramus height asymmetry through 3D reconstruction using Cone-beam CT.MethodsThis retrospective cohort study investigated patients who underwent mandibular setback surgery using bilateral sagittal split ramus osteotomy. Three-dimensional CT scans were taken at three different time points. Evaluation of the postoperative stability involved measuring changes in the x, y, and z axes as well as roll and yaw rotations of the mandible at specific landmarks (B point, mental foramen) on 3D CT scans obtained immediately after surgery and 6–12 months postoperatively. They were categorized into four groups based on bilateral mandibular height asymmetry through Asymmetry index (AI). The one-way ANOVA was implemented to compare the intergroup differences and Tukey's post hoc test was employed. Additionally, the Pearson correlation coefficient was also calculated.ResultsA total of 24 patients were included in this study. The corresponding AI, representing the degree of asymmetry in both mandibles, were calculated as Group 1 was 1.25 ± 0.64%, Group 2 was 2.89 ± 0.47%, Group 3 was 5.03 ± 0.51%, and Group 4 was 9.40 ± 1.99%. The x-axis change in Group 4 was significantly larger at 1.71 mm compared to Group 1 at 0.64 mm. The mandibular roll, Group 4 showed a statistically significant increase at 1.33° compared to Group 1 at 0.35°. And there was a significant positive correlation observed between x-axis change and AI (p = 0.019), as well as between mandibular roll and AI (p = 0.025).ConclusionAfter orthognathic surgery, stability was influenced by numerous factors, with the findings of this study suggesting that the degree of ramus height asymmetry in the mandible can be considered one contributing factor.

Changes of masseter muscle after mandible distraction osteogenesis in patients with Hemifacial microsomia: a retrospective study.

Mandible distraction osteogenesis (MDO) is widely used to reconstruct the mandible in patients with mild Hemifacial microsomia (HFM). However, the masseter's response to mandible distraction remains unclear. In this study, we analyze the effect of the surgical intervention on masseter muscle by a retrospective analysis. The procedure consisted of a five-day latent period, a three-week distraction period, and a six-month consolidation period. CT data were manually segmented and measured with Mimics software before surgery, within 3 months, and more than 1 year postoperatively. Masseter volume, masseter length, masseter width, and mandible ramus height were measured and analyzed using paired t-test, Pearson, and Spearman correlation analysis. We included 21 patients with HFM who underwent mandible distraction osteogenesis from 2015 to 2020. The masseter volume on the affected side increased immediately after surgery from (6,505.33 ± 3,671.95) mm3 to (10,194.60 ± 5638.79) mm3, but decreased to (8,148.38 ± 3,472.57) mm3 at the second follow-up correlated to mandible ramus height (r = 0.395, P = 0.038). A similar trend was observed in changes in masseter length. Symmetry and width of masseter muscle had no longitudinal statistical significance. Masseter muscle involvement benefits from MDO in the short term. To achieve long-term efficacy, more attention should be paid to muscle reconstruction.

A Preclinical Trial Protocol Using an Ovine Model to Assess Scaffold Implant Biomaterials for Repair of Critical-Sized Mandibular Defects.

The present work describes a preclinical trial (in silico, in vivo and in vitro) protocol to assess the biomechanical performance and osteogenic capability of 3D-printed polymeric scaffolds implants used to repair partial defects in a sheep mandible. The protocol spans multiple steps of the medical device development pipeline, including initial concept design of the scaffold implant, digital twin in silico finite element modeling, manufacturing of the device prototype, in vivo device implantation, and in vitro laboratory mechanical testing. First, a patient-specific one-body scaffold implant used for reconstructing a critical-sized defect along the lower border of the sheep mandible ramus was designed using on computed-tomographic (CT) imagery and computer-aided design software. Next, the biomechanical performance of the implant was predicted numerically by simulating physiological load conditions in a digital twin in silico finite element model of the sheep mandible. This allowed for possible redesigning of the implant prior to commencing in vivo experimentation. Then, two types of polymeric biomaterials were used to manufacture the mandibular scaffold implants: poly ether ether ketone (PEEK) and poly ether ketone (PEK) printed with fused deposition modeling (FDM) and selective laser sintering (SLS), respectively. Then, after being implanted for 13 weeks in vivo, the implant and surrounding bone tissue was harvested and microCT scanned to visualize and quantify neo-tissue formation in the porous space of the scaffold. Finally, the implant and local bone tissue was assessed by in vitro laboratory mechanical testing to quantify the osteointegration. The protocol consists of six component procedures: (i) scaffold design and finite element analysis to predict its biomechanical response, (ii) scaffold fabrication with FDM and SLS 3D printing, (iii) surface treatment of the scaffold with plasma immersion ion implantation (PIII) techniques, (iv) ovine mandibular implantation, (v) postoperative sheep recovery, euthanasia, and harvesting of the scaffold and surrounding host bone, microCT scanning, and (vi) in vitro laboratory mechanical tests of the harvested scaffolds. The results of microCT imagery and 3-point mechanical bend testing demonstrate that PIII-SLS-PEK is a promising biomaterial for the manufacturing of scaffold implants to enhance the bone-scaffold contact and bone ingrowth in porous scaffold implants. MicroCT images of the harvested implant and surrounding bone tissue showed encouraging new bone growth at the scaffold-bone interface and inside the porous network of the lattice structure of the SLS-PEK scaffolds.

Mandibular hypoplasia in hemifacial microsomia: A cross-sectional study

BackgroundHemifacial microsomia (HFM) results from the malformation of facial structures derived from the first and second pharyngeal arches. The ramus of the mandible is the most deformed part of the mandible in HFM, which subsequently affects the linear measurements of the different parts of the mandible. This study evaluated the anatomical differences between the affected and contralateral mandibular ramus and body (MRB) in a select cohort of HFM patients in South Africa. MethodsThis is a serial retrospective study of 20 HFM patients. They were categorised into mild or severe groups by the Pruzansky-Kaban grading and into three age-dependent groups (1–5, 6–12 and 13–19 years old). Linear and angular measurements of the MRB components were recorded from preoperative computed tomography scans to compare severity, age groups, ramus and body index (RBI), and the affected to contralateral (A/C) sides ratio. ResultSignificant differences existed in the linear and angular measurements of the mandible and RBI between affected and contralateral sides, except for the MBL. The mean differences between the mild and severe RBI deformities were insignificant. The A/C ratio was insignificantly smaller in the severe group than in the mild group. Age grouping did not significantly affect the A/C ratio in the mandible ramus and body. ConclusionMandibular asymmetry is more noticeable in HFM patients between 13 and 19 years old. The A/C ratio of the MRB did not worsen with different age groups and severity grading in this study. Hence, clinicians should postpone surgery until HFM patients attain skeletal maturity.

The Maxillary Artery Loops Dangerously Approaching the Mandible's Lingula and Inferior Orbital Fissure.

The maxillary artery (MA) leaves from the external carotid artery and further courses through the infratemporal fossa to reach the pterygopalatine fossa. It typically has an ascending course either on the lateral or on the medial side of the inferior bundle of the lateral pterygoid muscle. While studying retrospectively, the computed tomography angiogram of an adult male case with peculiar tortuosities of the MA was documented. The left MA described a large inferior sagittal loop applied on the mandible's ramus's inner cortical in the pterygomandibular space's upper part. That loop reached 1.66 cm inferior to the mandible's notch and 0.5 cm superior to the mandibular foramen and was applied on the mandible's lingula (spine of Spix). That MA continued to the pterygomaxillary suture, and a second superior coronal loop was found applied on the posterior wall of the maxillary sinus, reaching the inferior orbital fissure. It is therefore mandatory to take good care in the decortication of the mandibular ramus or during osteotomies of the ramus. When an inferior loop of the MA approaches the spine of Spix, bleeding when an inferior alveolar nerve block is performed seems hardly avoidable.

Evaluation of Mandibular Lingual and Foramen Location in Class I, Class II, and Class III Patients and its Significance in Sagittal Split Ramus Osteotomy

The precise location of the mandibular lingual (ML) and foramen (MF) is clinically significant because they are crucial anatomic markers for the inferior alveolar nerve protection in sagittal split ramus osteotomy. To determine the position of the ML and MF among subjects with class I, class II, and class III skeletal patterns to obtain information that could be useful for interventions in mandibular ramus. A retrospective study of 324 mandibular ramus from 162 patients was performed to evaluate the distance from the MF to the occlusal plane (OP) and the distance of the ML to the MF, OP, and the margin of the mandible ramus. The MF was more often located below the OP in class III (55.1%), compared with class I (29.0%) and class II (45.3%) patients (P<0.05). The distance from the ML to the MF in skeletal Class III patients (10.15 ± 1.56 mm) was found to be greater than class I (9.25 ± 1.52 mm) and class II (8.34 ± 1.79 mm) patients (P<0.001). And the distance from the ML to the OP was shown to be longer in class III (9.40 ± 2.53 mm) than in class I (6.85 ± 2.55 mm) and class II (6.99 ± 2.53 mm) patients (P<0.001). Therefore, we believe that a low medial horizontal cut at the height of OP is dangerous for Class III patients. And the safe zone for the high medial horizontal cut over the ML should be determined according to the patient’s skeletal patterns.

Research on cone-beam CT of mandibular foramen location in children aged 7-10 years

Objective: Cone-beam CT (CBCT) images were used to investigate the relative position changes of mandibular foramen in the mandible of children and the relative position relationship with the occlusal plane, so as to provide clinical guidance for inferior alveolar nerve block (IANB) anesthesia of children. Methods: The CBCT data of 202 children aged 7-10 years in the image database of the First Affiliated Hospital of Zhengzhou University from March 2021 to February 2023 were included. Patients were divided into 4 groups according to age diffrences as 7-year-old, 8-year-old, 9-year-old and 10-year-old. There were 20 males and 22 females in the 7-year-old group, 31 males and 28 females in the 8-year-old group, 30 males and 26 females in the 9-year-old group, and 22 males and 23 females in the 10-year-old group, respectively. Forty-six adults aged 25-30 years were selected as control group, 24 males and 22 females included. The distance between the center point of mandibular foramen with the anterior edge of ascending ramus of mandible (MF-A), the posterior edge of the ascending ramus of mandible (MF-P) and the shortest distance between the center point of mandibular foramen with occlusal plane (MF-OP) were measured. The angle between the center point of the mandibular foramen with the sagittal plane of the mandibular first deciduous molar (or mandibular first premolar) and mandibular second deciduous molar (or mandibular second premolar) (∠A) was measured. The data of mandibular foramen were compared between the left and right sides and among different genders and different age groups. Results: The position of mandibular foramen in children aged 7-10 years maintained bilateral symmetry, and mandibular growth and development were relatively consistent between different genders (P>0.05). MF-A increased with age, from (15.83±1.28) mm in 7-year-old group to (17.10±1.60) mm in 10-year-old group gradually. There were significant differences in MF-A between the 10-year-old group with the 7-year-old group, the 8-year-old group [(15.98±1.53) mm] and the 9-year-old group [(16.43±1.49) mm] respectively (P<0.05). MF-P increased with age, from (9.12±1.17) mm in 7-year-old group to (11.25±1.60) mm in 10-year-old group. There were statistically significant differences in MF-P among all age groups (P<0.05). MF-OP increased with age, from below the plane (-0.24±2.31) mm in the 7-year-old group to above the plane (1.08±1.95) mm in the 10-year-old group. There were significant differences between the 10-year-old group with the 7-year-old group, the 8-year-old group [(-0.01±1.93) mm], and the 9-year-old group [(0.31±1.95) mm] (P<0.05). The ratio of MF-A to MF-P decreased as the age increased, from 1.77±0.30 in the 7-year-old group to 1.55±0.29 in the 10-year-old group. There were statistically significant differences in MF-A/MF-P among all age groups (P<0.05), except for between the 8-year-old group (1.66±0.19) and the 9-year-old group (1.65±0.28) (P>0.05). The ∠A of children in all age groups was significantly greater than the reference value (45°) (P<0.05), and there was no statistical significance among all groups (P>0.05). The differences of MF-A, MF-P, MF-OP, MF-A/MF-P and ∠A between children of all age groups and the control group were statistically significant (P<0.05). Conclusions: In children aged 7-10 years, the mandibular foramen is located behind the midpoint of the anteroposterior diameter of the mandibular ramus. With the increase of age, the mandibular foramen gradually moves from below the occlusal plane to above, and is flush with the occlusal plane at the age of 8 years. Compared with adults, the mandibular foramen in children is more backward and lower on the medial side of the mandibular ramus. When IANB is operated to children, the syringe can be moved distally from the contact area of the contralateral deciduous molars or premolars, so that the injection angle can be greater than the reference value 45° to improve the accuracy of IANB.

AMELOBLASTOMA IN A 2-YEAR-OLD BOY: A CASE REPORT

A 2-year-old boy presented a normochromic swelling on the left cheek for an unknown period. Panoramic radiography revealed a well-circumscribed, unilocular, radiolucent area extending from body to angle and ramus of mandible, measuring around 4 cm. The exploratory puncture was negative, and an incisional biopsy was performed. In the histopathology, the sections revealed neoplastic proliferation of sheets and strings of odontogenic cells, in a solid arrangement. Epithelial cells had a hyperstained nucleus with a basaloid pattern. Peripheral cells occasionally showed reverse polarization and nuclei arranged in a palisade, and central cells were loosely arranged like the stellate reticulum of the enamel organ. The neoplasm is externally lined by a thin fibrous connective tissue capsule, and the presence of tumor cell nests was observed within the capsule. There were significant hypercellularity and multiple mitotic figures throughout the lesion. The patient was sent to treatment. A 2-year-old boy presented a normochromic swelling on the left cheek for an unknown period. Panoramic radiography revealed a well-circumscribed, unilocular, radiolucent area extending from body to angle and ramus of mandible, measuring around 4 cm. The exploratory puncture was negative, and an incisional biopsy was performed. In the histopathology, the sections revealed neoplastic proliferation of sheets and strings of odontogenic cells, in a solid arrangement. Epithelial cells had a hyperstained nucleus with a basaloid pattern. Peripheral cells occasionally showed reverse polarization and nuclei arranged in a palisade, and central cells were loosely arranged like the stellate reticulum of the enamel organ. The neoplasm is externally lined by a thin fibrous connective tissue capsule, and the presence of tumor cell nests was observed within the capsule. There were significant hypercellularity and multiple mitotic figures throughout the lesion. The patient was sent to treatment.

SECONDARILY INFECTED CYSTIC LESION: MICROSCOPIC MISCHARACTERIZATION MIMICKING SPINDLE CELL LESION

A 27-year-old man sought health care, complaining of discomfort and drainage of purulent secretion in the retromolar region of the mandible. Clinical examination revealed a slight volume increase of the left buccal bone plate, effacement of vestibule fundus, drainage of white/yellow content from gingival sulcus of tooth 37, and moderate painful symptoms on palpation. Radiographic examination revealed a well-delimited, multiloculated, radiolucent image, extending from the periapical region of tooth 37 to the middle portion of the mandible ramus. Diagnostic hypotheses were keratocyst and ameloblastoma. Aspiration puncture revealed reddish content. An incisional biopsy was performed, and the lesion was decompressed with a drain. Histopathological evaluation reported a lesion compatible with fusocellular injury of uncertain nature. Immunohistochemical evaluation showed positive CD34 (QBEnd10), Vimetine (VIM3B4), and low Ki67 antigen (KiS5) expression. A 3-month follow-up showed bone neoformation in the entire extension of the lesion. The final diagnosis was a secondarily infected cystic lesion. A 27-year-old man sought health care, complaining of discomfort and drainage of purulent secretion in the retromolar region of the mandible. Clinical examination revealed a slight volume increase of the left buccal bone plate, effacement of vestibule fundus, drainage of white/yellow content from gingival sulcus of tooth 37, and moderate painful symptoms on palpation. Radiographic examination revealed a well-delimited, multiloculated, radiolucent image, extending from the periapical region of tooth 37 to the middle portion of the mandible ramus. Diagnostic hypotheses were keratocyst and ameloblastoma. Aspiration puncture revealed reddish content. An incisional biopsy was performed, and the lesion was decompressed with a drain. Histopathological evaluation reported a lesion compatible with fusocellular injury of uncertain nature. Immunohistochemical evaluation showed positive CD34 (QBEnd10), Vimetine (VIM3B4), and low Ki67 antigen (KiS5) expression. A 3-month follow-up showed bone neoformation in the entire extension of the lesion. The final diagnosis was a secondarily infected cystic lesion.

Farklı Frez Türlerinin Kullanımında Açığa Çıkan Sıcaklık Değerlerinin Değerlendirilmesi

Aim: In our study, we aimed to measure the amount of released head by recording it with a thermal camera during the osteotomies made utilizing round, fissure and lindemann burs to the synthetic bone blocks to simulate the mandible ramus region which is often preferred when obtaining autogenous bone from the mouth. Material and Methods: The burs in our study were used at rotational speeds of 10000 rpm and 15000 rpm and feed rates of 60 mm/min and 90 mm/min, and each osteotomy was made with a CNC milling machine in order to standardize the applied force. Results: According to the results of our study, the highest temperatures were observed in the fissure bur groups, and the round bur and lindemann bur groups gave similar results. In addition, when the feed rate is increased from 60 mm/min to 90 mm/min in all groups at constant rotational speed, the heat released increases significantly. When the groups are evaluated within themselves; the temperature values observed at 15000 rpm and 60 mm/min feed rate in the groups using round bur were found to be significantly lower than the group observed at 10000 rpm and 60 mm/min feed rates (p=0.028), in fissure bur groups, the temperature values observed at 10000 rpm and 60 mm/min feed rate were significantly lower than the values observed at 15000 rpm and 60 mm/min feed rates (p=0.028). No statistically significant difference was observed between the heat exchange averages of the 10000 rpm and 15000 rpm groups at a Lindemann bur 60 mm/min feed rate (p=0.182). Conclusion: This study has shown that while the generated heat in the bone is thought to increase when the bur speeds are increased, the head generated according to bur designs can decrease and it is necessary to operate according to the characteristic features of the preferred bur.

Trigeminal Schwannoma - Case Report of a Rare Tumour.

Schwannomas are benign nerve tumours arising from the Schwann cells. Approximately 25-45% of schwannomas occurs in the head and neck region. Majority of schwannomas in the head and neck region arise from the vagus nerve. Trigeminal schwannomas account for about 0.2% of all intracranial tumours. Trigeminal schwannomas can originate from any section of the fifth cranial nerve, from the root to the distal extracranial branches, but majority develops from the Gasserian ganglion, usually growing in the middle cranium. Most common presenting symptom is facial pain. MRI is the imaging modality of choice and CT scan usually serves as a supplementary imaging especially for skull base tumours. 47 year old male patient presented to the outpatient department with complains of swelling over the left side of palate. Contrast enhanced CT scan demonstrated a large bilobed heterogeneously enhancing soft tissue lesion in the left infratemporal fossa with widened foramen ovale and extension of lesion into the Meckel's cave, larger contiguous component extending into ramus of mandible. MRI scan showed a large lobulated mass in the left masticator space with intracranial extension. Biopsy of the lesion was suggestive of schwannoma. The patient underwent left composite resection with dural repair and free flap reconstruction. Post operatively, on day 5 he developed features of meningitis for which he was treated conservatively and later discharged in stable condition. Trigeminal schwannomas are rare tumours with very low chance of malignant transformation which commonly presents with facial pain. MRI is the imaging modality of choice. Complete surgical excision is the treatment of choice.

A Comparative Analysis of Mandibular Ramus and Maxillary Sinus in Sex Determination among the Population of West Godavari, India: A Tool in Forensic Identification

Introduction: The application of dental principles to legal issues is known as forensic dentistry. Among the skull’s various bones, mandible is the strongest and most diverse bone and is crucial in determining sex. It is been reported in many studies that maxillary sinus seems to be intact, although other bones may be severely deformed and can be applied to determine sex. Aim: To assess, analyse and compare the morphometric analysis of maxillary sinus and ramus of mandible for gender determination using digital Orthopantamograph (OPG). Materials and Methods: A cross-sectional study comprising of 64 individual radiographs (32 men and 32 women) were measured for mandibular ramus (maximum ramus width, condylar and coronoid height) and maxillary sinus length, width and compared bilaterally. The results were tabulated and statistically analysed using discriminant functional analysis after the mean values were calculated. Results: In this study, the overall measurements of mandibular ramus were more in males than females whereas maxillary sinus measurements were more in females when compared with males. Condylar length (right and left), width of ramus (right) and width of maxillary sinus (left) were found to have statistical significance in determining the gender (p-value&lt;0.001,0.024,0.024). Length of the condyle showed highest accuracy of 73.8% in gender determination. Conclusion: This study suggests that the mandibular ramus and maxillary sinus measurements using OPG are helpful in dealing forensics, with condylar height being the most accurate indicator for gender determination.

Morphometric features of the condylar process of the mandible

The aim of the study is to determine the X-ray morphometric parameters of the neck of the mandible for the rational choice of fixing elements during osteosynthesis. Based on 145 computed tomography scans of the mandible, the parameters of the upper and lower borders, the area and thickness of the neck of the mandible were studied. The anatomical boundaries of the neck were determined using the classification of A. Neff (2014). The parameters of the neck of the mandible were studied depending on the shape of the mandible ramus, gender, age and preservation of dentition. The sizes of morphometric parameters of the neck of the mandible prevail in men. Statistically significant differences were found between the sizes of the neck of the mandible in men and women in the width of the lower border, area, and thickness of bone tissue. It was revealed that there are statically significant differences between hypsiramimandibular, orthoramimandibular and platyramimandibular forms in the following parameters: the width of the lower and upper borders, the middle of the neck, the area of bone tissue. When comparing the morphometric parameters of the neck of the articular process, there were no statistically significant differences between the age groups (p>0.05), and no differences were found between the groups identified by the degree of preservation of the dentition (p>0.05). Morphometric parameters of the neck of the mandible have individual variability, statically significant differences depending on the sex and shape of the mandibular ramus. The obtained results on the width, thickness, and area of the bone tissue of the neck of the mandible will help in clinical practice to rationally choose the length of screws; the size, number, and shape of titanium mini-plates to achieve the requirements of stable functional osteosynthesis.

Comparison of mandibular ramus and mental foramen among men and women: a study of panoramic radiographs in dental hospital of universitas gadjah mada

Background: The identification of victims is becoming an integral part of forensic investigations. The initial step in forensic identification is sex determination. Using panoramic radiographs, it is possible to determine the height of the mandibular ramus and the distance to the mental foramen for the purpose of sex determination. This study aimed to compare the mandible ramus height and mental foramen distance on panoramic radiographs between men and women. Method: This study utilized 70 panoramic radiographs of complete mandibular dentition from 35 men and 35 women aged 20 to 40 years. The samples were obtained from Dental Hospital of Universitas Gadjah Mada. Result: The average height of mandible ramus in male and female groups were 58.39±2.25 mm and 53.14±2.66 mm, respectively. The distance of the mental foramen was 12.68±1.63 mm in the male group and 10.83±1.23 mm in the female group. The Independent Sample t-test revealed that the p value for the difference between men and women in ramus height and mental foramen distance was 0.000 (p&lt;0.05). Conclusion: Based on the result of this study, both the height of the mandible ramus and the distance of mental foramen on a panoramic radiograph differ significantly between males and females.

Treatment of mandibular ameloblastoma with surgical resection in combination with radiation therapy in a 15‐year‐old Hanoverian gelding

SummaryA 15‐year‐old Hanoverian gelding was admitted for evaluation of a firm, expansive mass about 5 cm in diameter, in the horizontal ramus of the right mandible, between teeth 406 and 408. Histological examination revealed a highly invasive ameloblastoma with severe secondary fibrosis. Resection of the tumour was performed under general anaesthesia, a 4.5 locking compression plate with 14 holes was placed over the defect with eight locking screws, and the defect was filled with Cerasorb M. The horse received radiation therapy with a dose of 4.2 Gy every day for 10 consecutive days. Twenty months after surgery, the horse is in a good general condition and a repeat biopsy showed no signs of tumour recurrence.

Synovial Sarcoma Arising in the Retromolar Trigone: A Rare Presentation

Synovial sarcoma is a rare malignant neoplasm of young adults with poor survival. These usually arise from large joints and articular tendons. We describe an unusual case of synovial sarcoma arising from the left retromolar trigone upon initial presentation. To the best of our knowledge, this case is the only patient with left retromolar trigone involvement recorded in the literature. A 33-year-old female presented to us with complaints of a lesion in the left retromolar trigone. An ulcerated lesion with irregular margins and a smooth base was noted at the left retromolar trigone. CT scan demonstrated a soft tissue mass predominantly involving the left buccal space measuring 5.0 × 4.2 × 2.8 cm superiorly extending into the left infratemporal region, closely abutting posterior lateral of the left maxillary sinus with gross bone thinning. Biopsy was taken from the temporal and infratemporal region, which was positive for synovial Sarcoma. She received 2 cycles of neoadjuvant chemotherapy AIM protocol followed by wide local excision, however, the margin status could not be ascertained. Subsequently, treatment with a total of 60 Gy adjuvant radiotherapy was given. Patient tolerated the treatment well and remained disease-free for 4.5 years. She then developed biopsy-proven recurrence at the primary site; her metastatic workup was negative. Unfortunately, the patient was lost to follow-up for 2 years and then presented with a very large lobulated mass in the left infratemporal fossa, now measuring 6.2 × 7.6 × 6.3 cm, encasing ramus of mandible, temporomandibular joint and muscle of mastication with intra-orbital extension. She received 2 cycles of chemotherapy with gemcitabine and docetaxel. However, she did not tolerate the chemotherapy well. Subsequently, she developed tumor bleeding and received palliative radiation for bleeding and pain control. Patient is now on the best supportive care, her general condition deteriorating rapidly with the passage of time. Synovial sarcoma of the retromolar trigone is a rare malignant tumor with a poor prognosis. As there is no standard treatment protocol for synovial sarcomas of the head and neck, optimal antineoplastic treatment remains unclear. Mainstay of treatment is surgical resection with high relapse rates. Radiation therapy, with or without chemotherapy, appears to improve survival.

A Five-Year Retrospective Study on Fractured Orbital Walls: A Spearman Correlation Analysis

Objective: The purpose of this study is to find propotion of fractured orbital walls in the maxillofacial trauma cases and its associated maxillofacial fracture treated in the Oral Maxillofacial Clinic Oral Maxillofacial ward and operation theatre of Hospital USM in Kelantan, Malaysia. Materials and methods: From July 2013 to June 2018, records of patients who sustained maxillofacial fractures and presented them to the Accident and Emergency Department, Oral Maxillofacial Clinic, Hospital USM were reviewed, recorded, and analyzed. There are 294 patients whose data has been collected because they met the inclusion criteria. Each patient with a complete medical record was reviewed. Data were collected under the variables: Zygomatic Complex, Zygomatic Arch, Nasal, Maxillary Sinus, Le Fort I, Le Fort II, Le Fort III, Orbital Wall, Alveolar Process, Symphysis of Mandible, Condyle of Mandible, Ramus of Mandible, Maxillary Bone and Mandibular Bone of maxillofacial fracture. The fractured orbital walls in these cases was reviewed. At the first stage, all the selected variables will be screened for their important clinical point of view. The SPSS software version 26.0 was used to determine all possible factors contributing to orbital wall fracture. Results: This was a retrospective cross-sectional analysis of the medical records of 294 patients with maxillofacial fracture treated in the Oral Maxillofacial Clinic and Oral Maxillofacial ward, Hospital USM. There were 228 (77.3%) men and 66 (22.4%) women included in this study. The most common age range is 11-20 years (39.8%), 21-30 years (26.2%). Maxillary Bone Fracture (0.371; p &lt;0.05), Maxillary Sinus Fracture (0.180; p &lt;0.05), Zygomatic Arch Fracture (0.127; p &lt;0.05) were found to be the most affected site, which had a positive correlation with an orbital fracture of the maxillofacial trauma cases. A path analysis based on the Spearman correlation was developed by taking into account significant correlations at the level of 0.05. Conclusion: Using the matrix spearman correlation, multiple response analysis (MRA), path analysis, we discovered a clear connection between orbital wall fracture and several other factors. This discovery will aid in the understanding of the most common fracture and the causes of orbital wall fracture in maxillofacial trauma. The Zygomatic Arch Fracture, Maxillary Sinus Fracture, and Maxillary Bone Fracture were found to have a significant relationship with the orbital wall when the significance level was set at 0.05. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 744-750

Distraction Osteogenesis for Mandibular Ramus lengthening in Temporomandibular Joint Ankylosis Patients simultaneously with Interposition Gap Arthoplasty

Temporomandibular joint ankylosis is the most common cause of facial deformity.1-4The main etiology of TMJ ankylosis include trauma and infection3,5.TraditionallyTemporomandibular joint Ankylosis patients had been managed with different treatment options including Gap arthoplasty6,Interpositiongap arthroplasty ,distraction osteogenesis and total joint replacement.To prevent reankylosis interposition of fascia or muscle had been documented and if reconstruction of the joint was needed Alloplastic(sialistic)or Autogenous graft ( Costochondral bone graft) had been used.6, 7,8,9 Costochondral graft is preferred for reconstruction because morphological it is similar to the condyle of mandibleandhas agrowth capacity.9But thisgraft is unpredictable in nature and different results are reported and documented including facial asymmetry, over growth, graft resorption, graft failure and even reankylosis.9 Distraction osteogenesis is a recent treatment method for the correction of hypo plastic mandible in Temporomandibular joint ankylosis patients. By using distraction osteogenesislarge skeletal movements are possible with little or no relapse commonly seen in other orthognathic corrections. In this study of 30 patients all patients were treated with TMJ Interposition gap arthoplasty (interposition of temporalis fascia) followed by the application of distractors at ramus of mandible. Mean age was14.96±4.17 years. Patient’s minimum and maximum age was 8 and 24 years respectively. Gender distribution shows that 15(50%) of the patients were male and 15(50%) were females. Male to female ratio was 1:1.Mean ramus length before distraction was 38.70±7.28 mm with 28-52 mm range. Mean ramus length after distraction osteogenesis was 49.00±8.01 mm. Mean increase in vertical ramus length was 10.26±2.86 mm. Minimum increase was 5mm and maximum increase in vertical ramus length was 15 mm respectively. In this study we were able to achieve increase in ramus length in all patient and only patient require reoperation due to failure of distractor appliance which was replaced successfully.

ENUCLEATION OF MANDIBULAR ODONTOGENIC KERATOCYST: CONDUCT REPORT

The odontogenic keratocyst (OKC) is a developmental cyst originated from the cell debris of the dental lamina. This lesion affects the mandible in 60% to 80% of cases, and the posterior body and mandible ramus are the most frequently affected regions. The following clinical case report is about a 24-year-old male patient without comorbidities who complained of facial swelling. On the panoramic radiographic exam, the presence of unilocular circumscribed radiolucent image was observed in the body and in the right mandible ramus, suggesting the hypothesis of OKC. The patient underwent surgical enucleation under general anesthesia for total removal of the lesion. The collected soft tissue fragments were sent for anatomopathologic analysis, in which microscopy revealed a cystic fibrous wall coated with parakeratinized stratified squamous epithelium showing atrophy without atypia that confirmed the diagnosis of OKC. After 8 months of postoperative follow-up, satisfactory healing and considerable bone repair at the lesion site could be observed.

Mandibula processus coronoideus morfometrik parametrelerinin taraflar arası incelenmesi

Aim: In our study, the relationship between mandible coronoid process and other mandible morphometric parameters in dry bones and it is aimed to compare these data between the sides. Materials and Methods: In the anatomy laboratory, 22 mandible from the bone collection were photographed in three different ways, from right-left lateral and posterior, using a digital camera. Measurements were performed on digital images using Image J software. Morphometric parameters of coronoid process and morphometric parameters of mandible ramus and body were determined. Coronoid process types were hooked, triangular, round and square. The parameters were compared between the two sides and correlation analysis was performed. Results: There was no significant difference between the right and left sides in all parameters. There was no difference between the parties in the percent distribution of processus coronoideus types. There was a high correlation between processus coronoideus area and processus coronoideus height on both sides (p &amp;lt;0.001). Correlation values of the processus coronoideus parameters on the right side were higher than the left side. Conclusion: For the differences in the morphometric parameter values between the coronoid process between the sides, further studies should be conducted in the developmental process up to childhood, adolescence and adulthood. Furthermore, further studies are needed to evaluate the effects of chewing side preference on processus coronoideus and to assess the differences in side/gender.