Multi-bracket appliance in management of mandibular reconstruction with vascularized bone graft.
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BACKGROUND: The most commonly used tool for maxillo-mandibular fixation to the patient who underwent reconstruction using a vascularized bone graft after mandibular resection is a dental arch-bar. However, the occlusal relationship achieved by this method is not ideal. Different from the dental arch-bar, the multi-bracket appliance which is frequently used in orthodontic treatment can control the position of each individual tooth three dimensionally. Thus, this appliance was applied for maxillo-mandibular fixation to patients who underwent mandibular reconstruction using a vascularized bone graft. METHODS: A multi-bracket appliance was applied to three patients. Prior to the surgery, standard edgewise brackets were bonded to the teeth in the maxilla and in the remaining mandible. After mandibular resection, wires for maxillo-mandibular fixation were applied. The harvested bone was then carefully fixed with miniplates to maintain the occlusion. The multi-bracket appliance was worn for 3 months when the wound contraction became mild. RESULTS: All three cases demonstrated stable and good occlusion. They also demonstrated satisfactory post-surgical facial appearance. CONCLUSIONS: Compared to conventional dental arch-bars, a multi-bracket appliance offers improved management of mandibular reconstruction. Firstly, its properties are helpful in maintaining occlusion of the remaining dentition accurately in bone grafting procedure as well as protecting against postsurgical wound contraction. Secondly, the multi-bracket appliance keeps the oral cavity clean without periodontal injury. As a result, stable occlusion of the residual teeth and good facial appearance were obtained. (+info)
Cemento-ossifying fibroma presenting as a mass of the parapharyngeal and masticator space.
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We report a case of cemento-ossifying fibroma that presented as a large extraosseous mass in the masticator and parapharyngeal space. CT scanning and MR imaging showed a large extraosseous mass with central conglomerated, well-matured ossified nodules and fatty marrow. The central matured ossified nodules were of low density on CT scans and high signal intensity on T1- and T2-weighted MR images. Multiplanar reformatted CT scans revealed the origin of the mass to be at the extraction site of the right lower second molar tooth. (+info)
Skull metastasis of Ewing's sarcoma--three case reports.
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Three cases of skull metastasis of Ewing's sarcoma were treated. The metastatic lesion was located at the midline of the skull above the superior sagittal sinus in all cases. Surgery was performed in two patients with solitary skull lesions involving short segments of the superior sagittal sinus without remarkable systemic metastasis, resulting in good outcome. The third patient had extensive, multiple tumors involving the superior sagittal sinus which could not be excised, and died due to intracranial hypertension. The surgical indication for skull metastasis of Ewing's sarcoma depends on the location and length of the involved superior sagittal sinus, and general condition. (+info)
The relationship between accessory foramina and tumour spread on the medial mandibular surface.
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The medial cortical surface of the mandible can be involved by tumour infiltration from the floor of the mouth. A detailed study of spread via accessory foramina through the edentulous alveolar crest has been previously undertaken, but no similar study has been carried out for the medial surface. In order to gain further appreciation of the mode of tumour spread, a study of the number and distribution of accessory foramina on the medial mandibular surface was performed on 89 mandibles. The number of foramina varied greatly from specimen to specimen. In the ascending ramus above the inferior dental foramen, 3 mandibles showed no foramina; the condylar section possessed the greatest proportion followed by the sigmoid and the coronoid. On the rest of the medial surface below the inferior dental foramen, all specimens showed at least 1 accessory foramen; the greatest concentration was in the middle third along the path of the inferior dental canal, followed by the upper third and the lower third section. Accessory foramina were repeatedly present at certain dedicated sites. The medial facing wall of the inferior dental foramen was found to be the commonest dedicated site (98.3%) followed by foramina on either side of the genial tubercles (71.9%), the digastric fossa (71.9%) and the median foramen above the genial tubercles (64%). The findings of this study are in keeping with the current observation that the lower border is least commonly involved in tumour spread. In view of the presence of accessory foramina along the inferior dental canal and especially on the medial facing wall of the inferior dental foramen, it is imperative to preclude tumour spread in this region prior to undertaking the conservative rim resection procedure. Medial to the symphysis the alveolar mucosa dips down almost to the level of the dedicated foramina in the vicinity of the genial tubercles. As a general rule the attached muscle forms a barrier to tumour spread except in the later stages, however, in irradiated mandibles resistance to spread has been previously reported to be diminished. Under these circumstances, it is possible that the numerous accessory foramina reported in this study could facilitate a direct pathway into the cancellous bone. (+info)
Amyloid-producing odontogenic tumor in a Shih-Tzu dog.
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A 9-month-old male Shih-Tzu dog had a right mandibular tumor composed of strands, or nest-like proliferation of epithelial cells with abundant fibrous stroma characterized by spheroid to large nodular deposition of amyloid with Congo-red stain. Globule calcification was also seen throughout the tumor tissue and the spheroid depositions often had a concentrically laminated structure (Liesegang rings). The case was diagnosed as amyloid-producing odontogenic tumor in a dog. (+info)
Intraosseous neurilemmoma of the mandible.
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We report a rare case of intraosseous neurilemmoma of the mandible, with an emphasis on radiographic findings. The tumor, located mainly in the premolar region, presented as an expansive, unilocular, well-defined, radiolucent lesion on plain radiography. No dilatation of the mandibular canal was identified. MR imaging helped to identify the solid nature of the tumor. A biopsy was necessary to make the final diagnosis because of the relatively nonspecific nature of the lesion. (+info)
Ewing's sarcoma of the head and neck.
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CONTEXT: Ewing's sarcoma is a rare neoplasm, which usually arises in long bones of the limbs and in flat bones of the pelvis, with the involvement of head and neck bones being very unusual. CASE REPORT: a case of Ewing's sarcoma occurring in the mandible of a 35-year-old female. Pain and swelling of the tumor were the main complaints. The early hypothesis was an undifferentiated malignant neoplasm, possibly a sarcoma. The CT scan depicted an expansive lesion, encapsulated, with septa and characteristics of soft tissue, involving the left side of the mandible and extending to the surrounding tissues. The patient underwent surgical excision of the lesion, the definitive diagnosis of Ewing's sarcoma was established, and the patient commenced on radiotherapy. (+info)
Aggressive epithelial odontogenic ghost cell tumor in the mandible: CT and MR imaging findings.
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We report a case of aggressive epithelial odontogenic ghost cell tumor arising from the mandible in a 32-year-old man. On CT and MR studies, the tumor was seen as a large, heterogeneous soft-tissue mass that caused marked destruction of the mandible and invaded the mouth floor and tongue base. The tumor displayed a variety of densities and signal intensities on CT and MR images, which correlated well with the degree of cellularity of epithelial islands, abundance of ghost cells and eosinophilic materials, calcification, and cystic areas on histologic sections. Owing to the unpredictable biological behavior of this type of tumor, careful, long-term follow-up is highly recommended. (+info)