Cases reported "Mandibular Diseases"

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1/34. Endoscopically assisted removal of unilateral coronoid process hyperplasia.

    Coronoid process hyperplasia (CPH) is an uncommon disorder characterized by an enlarged coronoid process impinging against the posterior aspect of the zygomatic arch. Young male adults are usually affected, presenting with limited mouth opening, which is typically painless and progressive in nature. The diagnosis of true CPH is established by the findings of (1) uniform coronoid enlargement on radiographic examination and (2) normal bone structure on histopathological examination (i.e., the specimen should be free of any neoplastic growth, such as the previously reported cases of coronoid osteomas, osteochondromas, or exostoses). The treatment is mainly surgical, by means of a coronoidectomy. An intraoral approach is mostly preferred for this procedure to avoid an external scar. However, to avoid the drawbacks of this approach, such as limited exposure and the risk of hematoma and subsequent fibrosis, an extraoral approach may be indicated. This report describes a case of true unilateral CPH in a 17-year-old boy who presented with progressive limited mouth opening in the absence of any pain. Computed tomography (CT) demonstrated a uniformly enlarged right coronoid process. A coronoidectomy was performed with the aid of endoscopic systems, approaching via two short incisions in the temporal scalp. Histopathological examination of the specimen demonstrated essentially a normal bony structure with no evidence of a neoplasm. The authors present the endoscopically assisted technique of coronoid process excision as an alternative method of surgical treatment of CPH and any mass of the coronoid process in general. With this method, the incision is much shorter than a conventional coronal incision and thus morbidity is diminished considerably.
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2/34. So-called simple bone cyst of the jaw: a family of pseudocysts of diverse nature and etiology.

    The nature and etiology of so-called simple bone cyst (SBC) are still a subject of debate. Our comprehensive review of the literature suggests that SBC, which appears histologically to be a single entity, has different natures and etiologies, resulting in divergent clinical features. In addition, an interesting case of mandibular SBC in an 11-year-old girl is presented with details of radiographic changes over a 7-year period. Fully documented patient records revealed that this lesion originated in the apical area of the first molar and took about 4 years to develop into a clinically evident bony expansion.
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3/34. paresthesia and the traumatic bone cyst. Abbreviated case report.

    A case of a traumatic bone cyst is reported because of the unusual nature of the chief complaint. The initial symptom of the disease was mandibular nerve neuropathy with numbness of the left side of the lower lip and chin.
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4/34. Mandibular histiocytosis X and acute lymphoblastic leukemia.

    The occurrence together of two major distinct diseases in the oral area is relatively rare. In this report, a case is presented in which histiocytosis X was found to develop in a child with acute lymphoblastic leukemia. The nature of the differentiated histiocytoses is explored, and the possibility of the relationship between a lymphoproliferative and a histiocytic disease entity is investigated.
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5/34. Intralesional corticosteroid injection for treatment of central giant-cell granuloma.

    BACKGROUND: The central giant cell granuloma, or CGCG, is a benign intraosseous lesion of the jaw. It is found predominantly in children and young adults. It is an asymptomatic lesion, which often becomes evident on routine radiographic examination. Giant cell lesions have been described as both nonaggressive and aggressive in nature, with recurrence noted in cases of aggressive lesions. Central giant cell lesions present as unilocular or multilocular radiolucent defects on radiographs. Multinucleated giant cells within a collagenous stroma are the characteristic histopathologic feature of CGCG. CASE DESCRIPTION: The authors describe a 10-year-old girl with an expansile lesion of the mandible. The panoramic radiograph showed a well-circumscribed mixed radiolucent-radiopaque lesion of the left mandibular body. An incisional biopsy of the lesion was performed to establish a histologic diagnosis. The specimen was submitted for frozen-section examination, and a diagnosis of CGCG was made. serum calcium, parathyroid hormone and phosphorous levels were normal. The patient was treated successfully with intralesional corticosteroid injections. CLINICAL IMPLICATIONS: Central giant cell lesions have been treated surgically with aggressive curettage. More aggressive and recurrent lesions require resection, which leads to major defects of the jaws. This form of surgical treatment can be particularly disfiguring for a child or young adult. An alternative nonsurgical approach is the intralesional administration of corticosteroids, which have been effective in the treatment of CGCG. If a dentist suspects a patient may have CGCG, he or she should refer the patient to an oral surgeon for follow-up.
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6/34. myxoma of the jaws. Report of three cases.

    Odontogenic myxoma is a locally aggressive, uncommon benign tumour which arises from mesenchymal tissues normally present in developing teeth. The most frequent locations of odontogenic myxoma are the posterior regions of the mandible, as well as the condylar region. Since odontogenic myxomas are not associated with any specific clinical or radiological sign, a histopathological examination of the specimen is required for confirmation of the primary diagnosis. We report three cases of myxoma diagnosed during the last 18 years. Two of them were located in atypical regions of the mandible and one was located in the maxilla. Presence of a slow-growing swelling associated with expansion of the bone plates raised suspicion of a tumour in two cases, while in the third patient the myxoma was an incidental finding during radiological examination. Due to the unspecific nature of these lesions, in every case a histopathological examination of the surgical specimen was required for diagnostic confirmation. In one of the three reported cases, we shall underline the need to follow a correct diagnostic work-up of all radiolucent lesions of the jaws, in order to avoid contraindicated therapeutic procedures.
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7/34. Proliferative periostitis of Garre: Report of a case.

    Proliferative periostitis of Garre is described as a productive and proliferative inflammatory response of periosteum to infection or other irritation. This can be odontogenic or non-odontogenic in nature. This is a case report of an odontogenic periostitis resulting from periapical inflammation of endodontic origin. It was successfully treated by nonsurgical endodontics. Antibiotic therapy was not used during the treatment of this patient.
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8/34. Chronic recurrent multifocal osteomyelitis of the spine and mandible: case report and review of the literature.

    At initial presentation, chronic recurrent multifocal osteomyelitis may mimic acute hematogenous osteomyelitis; however, cultures of affected bone are sterile. Nuclear scintigraphy identifies additional foci of involvement that present concurrently or sequentially. Unlike acute bacterial osteomyelitis, chronic recurrent multifocal osteomyelitis seems unaffected by antibiotic therapy and typically responds to treatment with antiinflammatory drugs. Surgical decortication has been reported for refractory cases. The case presented here illustrates the rare involvement of the mandible after initial presentation in the spine of a 4-year-old girl and the refractory nature of the disease over 6 years despite treatment with various medical and surgical therapies.
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9/34. Idiopathic bone cavity (traumatic bone cyst) with the radiographic appearance of a fibro-osseous lesion.

    This article presents an unusual case of idiopathic bone cavity that originally was either not observed or diagnosed as a fibro-osseous condition. When a differential diagnosis was established, it included fibro-osseous conditions, odontogenic cysts and neoplasms, and central giant cell granuloma but not the definitive diagnosis. The patient's demographic data, history, symptoms, and clinical and radiographic appearance all conspired to obscure the true nature of the condition, which was not revealed until a biopsy was attempted. A more thorough initial radiographic examination might have led to an earlier diagnosis.
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10/34. eosinophilic granuloma: resolution of maxillofacial bony lesions following minimal intervention. Report of three cases and a review of the literature.

    INTRODUCTION: Langerhans' cell histiocytosis is a collective term used to describe a group of enigmatic proliferative disorders. The natural history of the disease varies from a slow, benign, localized symptomatic bony or soft tissue lesion, to a rapidly progressive widespread multiple organ disorder which is often fatal. eosinophilic granuloma accounts for 60-70% of all cases of Langerhans' cell histiocytosis and can present as solitary (50-75%) or multifocal defects in bone. It occasionally presents as a localized soft tissue lesion. There are multiple treatment options but the response is unpredictable. AIMS: We present three separate cases, of the maxillofacial skeleton where the lesions of eosinophilic granuloma resolved following incisional biopsy only. patients AND RESULTS: Three patients presented with solitary lesions of the maxillofacial skeleton. All were diagnosed as Langerhans' cell histiocytosis following open curettage, which also resulted in resolution of the lesions. Follow-up has thus far been disease free. CONCLUSION: For some solitary Langerhans' cell histiocytosis lesions, simple curettage is the only treatment required. The paper discusses the need to confirm the solitary nature of the disease and the need for follow-up. Reviewing the literature on the disease, the authors suggest that perhaps cellular immaturity holds the cells of the lesion in a disease state until pushed to maturity by the trauma of open curettage surgery, resulting in a complete resolution of the disease.
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