1/9. Painful trigeminal neuropathy caused by severe mandibular resorption and nerve compression in a patient with systemic sclerosis: case report and literature review.Systemic sclerosis is a multi-system disorder characterized by abundant fibrosis of the skin, blood vessels, and visceral organs. Although resorption of the mandible has been commonly observed and reported, we found no report of resorption leading to a painful neuropathy of the inferior alveolar nerve. We report a case of a patient with systemic sclerosis, severe resorption of the angles, and inferior alveolar border of the mandible, resulting in a compression neuropathy of the inferior alveolar nerve. Diagnostic tests, medical treatment, and surgical treatment are discussed, and the relevant literature is reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. osteoradionecrosis of the mandible after oromandibular cancer surgery.Although postoperative radiotherapy has proved effective in improving local control and survival in patients with head and neck cancers, its complications, especially mandibular osteoradionecrosis, reduce the quality of life. Mandibular surgery before the radiotherapy adds an additional risk factor for osteoradionecrosis. This study reviews patients in Chang Gung Memorial Hospital, Taipei, taiwan, over a 10-year period, who underwent intraoral cancer resection followed by postoperative radiotherapy and thereafter developed osteoradionecrosis of the mandible. A total of 24 men and three women with a mean age of 49.9 years were identified and included in the study. In 10 cases, tumor resection was performed with a marginal mandibulectomy; in eight cases, tumor resection was performed after mandibular osteotomy; and in three cases, a segmental mandibulectomy was performed, and the defect was reconstructed with a fibula osteoseptocutaneous flap. In six cases, tumor excisions were performed without interfering with the mandibular continuity. patients received postoperative external beam radiotherapy into the primary site and the neck, with a mean dose ( /-SD) of 5900 /- 1300 cGy in an average of 35 fractions during an average of 6.5 weeks. The average elapsed time between the end of radiation therapy and clinical diagnosis of osteoradionecrosis of the mandible was 11.2 months (range, 2 to 36 months). The time elapse between the end of the radiation therapy and the diagnosis of osteoradionecrosis was influenced by initial treatment (Kruskal-Wallis test: n = 27, chi-square = 12.884, p < 0.005), and this period was shorter if the mandibular osteotomy or marginal mandibulectomy was performed (the two lowest mean ranks in the test). However, if the initial surgery resulted in a segmental mandibulectomy reconstructed with a fibula osteoseptocutaneous flap, onset of the osteoradionecrosis was relatively late (Kruskal-Wallis test: n = 21, chi-square = 7.731, p = 0.052). After resection of osteoradionecrotic bone and surrounding soft tissue, 22 patients underwent reconstructive procedures with a fibula osteoseptocutaneous flap, and five patients underwent reconstructive procedures with an inferior genicular artery osteoperiosteal cutaneous flap. One fibula osteoseptocutaneous flap showed total failure and another showed a 25 percent skin loss; both were revised with pedicled flaps. The skin paddle of an inferior genicular artery flap was replaced with an anterolateral thigh flap because of anatomic variation of the skin vessel. Once the diagnosis of osteoradionecrosis is established, replacement of the dead bone and surrounding tissue with a vascularized free bone flap is inevitable, and a composite osteocutaneous free flap is a good option.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/9. Total mandibular reconstruction for massive osteolysis of the mandible (Gorham-Stout syndrome).Massive osteolysis (Gorham-Stout syndrome) is a rare condition of unknown aetiology that is thought to result from a localised endothelial proliferation of lymphatic vessels resulting in destruction and absorption of bone. The diagnosis of Gorham-Stout syndrome can be made only after first excluding osteolysis from infection, inflammation, endocrine disease, and cancer. The syndrome is rarely seen in the facial skeleton and has a variable prognosis. Many treatments have been advocated but only surgery and radiotherapy have had some success. We present a case of massive osteolysis of the entire mandible, which was reconstructed with a free vascularised fibular graft and bilateral prosthetic replacements of the temporomandibular (TMJ) joints. Four years later the fibular graft had been absorbed requiring further reconstruction with another fibula graft.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/9. Mandibular condylosis and apertognathia as presenting symptoms in progressive systemic sclerosis (scleroderma). Pattern of mandibular bony lesions and atrophy of masticatory muscles in PSS, presumably caused by affected muscular arteries.Apertognathia (open bite) is usually a developmental deformity of the jaws and the dentoalveolar segments in childhood and adolescence. The sudden insidious appearance of an open anterior bite in adult life is extremely rare and may be due to pathologic condylar fractures (with displacement) or to bilateral condylosis. To the best of our knowledge, only five cases of bilateral mandibular condylosis in progressive systemic sclerosis (PSS) have been reported in the literature, and the present article deals with the sixth known case. In the 22-year-old woman presented in this article the mandibular manifestations were the very early symptoms of PSS, which had a very rapid fatal course. A review of the literature is presented, and attention is called to the serious significance of sudden apertognathia. PSS is a chronic generalized disease of the small arterial vessels and the mesenchyme tissues of unknown origin. The musculoskeletal system is often involved, and the disease may affect the mandible, causing bony erosions, osteolysis, and atrophy of the masticatory muscles. It is believed that these bony lesions are of ischemic origin. The lesions, which are usually bilateral, occur only in the condyles, the coronoid processes, and the gonial angles. The main arterial blood supply to the mandible and to the major part of the ascending ramus originates from the inferior alveolar artery. The blood supply of the condyles, the coronoid processes, and the gonial angles originates in small muscular arteries.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/9. Massive osteolysis of the mandible.This report deals with a massive osteolysis, which is a rare disease characterized by the progressive dissolution of contiguous osseous structure, occurring in the mandible of a 46-year-old Japanese female. Histopathologic examination of the amputation material revealed that the mandibular body, ramus, condylar and coronoid processes were completely replaced by fibrous tissue, but inferior alveolar nerve and artery in the lesion were intact. A few small islands of osteoid tissue or immature fibrous bone were seen in the lesion. In the transitional area between the lesion and normal bone, active absorption of bone trabeculae was in progress and intertrabecular spaces were occupied by densely packed fibroblastic cells, however, angiomatous proliferation of vessels was not observed. A few bone trabeculae were surrounded by osteoclasts, but osteoclasts might not play a primary etiological role in massive osteolysis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/9. Major mandibular reconstruction with vascularized bone grafts: indications and selection of donor tissue.Free vascularized bones have been shown by many specialists to exhibit specific capabilities of reconstructing a major mandibular defect and can solve problems that may be insoluble by other methods. Nevertheless, absolute indications for using vascularized bone for major mandibular reconstructions have not been sufficiently well delineated to convince people of always considering vascularized bone for major mandibular reconstructions as a first option. Based on our experience with 55 major mandibular reconstructions, we might delineate the absolute indications for using free vascularized bone for major mandibular reconstructions explicitly: 1) osteoradionecrosis of mandible or on irradiated tissue bed; 2) hemimandibular reconstruction with a free end facing the glenoid fossa; 3) long segment mandibular defect, especially across the symphysis; 4) inadequate skin or mucosal lining; 5) defects demanding sandwich reconstruction; 6) inability to obtain secure immobilization on the reconstructed unit; 7) failure of reconstruction by other methods; 8) near total mandibular reconstruction. Selection of donor tissue should be according to 1) the amount of tissue deficiencies, 2) composition of the defect, 3) design and placement of the flap, 4) irradiation on the recipient site or not, 5) which vessels to be used, 6) which flap has the appropriate vessel length 7) skin color and texture of the donor tissue, 8) how many osteotomies required to stimulate the curvature of the resected mandible 9) speed of bony union, 10) feasibility of future osseointegration. We have used three kinds of vascularized bones (iliac bone, fibula, scapula). Iliac bone was most frequently used, and has always been our first choice, since it can carry good quality bone, a large skin flap, and ample soft tissue. The fibula has the merit of being less bulky and good for simultaneous intraoral lining, but the contour is more rigid and the bony height is insufficient. The scapula bone is rarely used at present because of its relative inconvenience.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/9. ehlers-danlos syndrome (type VIII).ehlers-danlos syndrome (EDS), a group of rare, autosomal dominantly inherited connective tissue dysplasias, characterized mainly by abnormal collagen synthesis, has been shown to exhibit extensive heterogeneity with at least 11 clinical entities differentiated by their clinical, biochemical, and genetic features. Of these, Type VIII EDS is of special interest from a dental viewpoint, due mainly to the resulting fragility of the oral mucosa and blood vessels, and an aggressive type of periodontitis causing severe loss of alveolar bone; all of these clinical manifestations of the entity make it necessary to exercise care during the dental treatment procedures. Here we present a case of EDS Type VIII with typical clinical findings, together with details of the dental treatment modalities, placing emphasis on surgical methods.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/9. Arteriovenous malformation of the mandible: report of a case with a note on the differential diagnosis.arteriovenous malformations are extremely rare conditions that can result from congenital or acquired abnormalities in the structure of blood vessels; they are potentially fatal. arteriovenous malformations may be asymptomatic or may show various signs and symptoms including soft tissue swelling, pain, changes in skin and mucosal color, erythematous and bleeding gingiva, bruit, and paresthesia. Radiographically, there are no pathognomonic features. The present case illustrates an arteriovenous malformation in a 16-year-old Hispanic female. The case report is unique because the malformation was previously interpreted as a pathosis of pulpal origin and was initially treated as such, although the tooth showed no gross or radiographic dental caries. A broad view of the diagnostic imaging, radiographic differential diagnosis, treatment, and histopathologic description is also presented.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/9. Cyst-like lesion of a developing tooth induced by mandibular fracture.A dentigerous cyst-like formation in the lower canine region caused by mandibular fracture in a 10-year-old boy is reported. His medical history revealed that he had been unconscious for about 2 weeks after traumatic head injuries sustained in a traffic accident, and a complicated mandibular fracture had been left untreated until his dentist diagnosed the lesion. Eleven months after trauma, a dentigerous cyst measuring 20 mm in diameter was found in the fracture area. The lesion was enucleated and the boy's postoperative recovery was uneventful. The mass completely enveloped the developing canine, and epithelial cells proliferated into the connective tissue. However, there was no distinct epithelial lining. Small round cell infiltrations and several vessels with thrombosis were noted in the cyst wall. The cause of cyst formation was considered to be infection of the canine tooth bud and the surrounding soft tissue.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |