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PubMed2003

Radiotherapy for symptomatic metastases to the mandible in adults.

Since 1996, seven patients from six radiotherapy facilities that treat more than 2,000 patients per year were treated with radiotherapy for symptomatic metastases to the mandible from primary carcinoma of the prostate (3 patients), carcinoma of the breast (2 patients), adenocarcinoma of the ethmoid sinuses (1 patient), and multiple myeloma (1 patient). All patients presented with pain of several weeks' duration and had radiographic confirmation of a destructive lesion in the mandible. Administered radiotherapy doses ranged from 400 cGy/1 fraction to 4,000 cGy/20 fractions. All patients experienced excellent palliation with complete or almost complete resolution of all symptoms within 1 month. The authors suggest short courses of radiotherapy for symptomatic metastases to the mandible.

Adult↗
PubMed2005

Complications and the time to repair of mandible fractures.

OBJECTIVE: Treatment delays in the operative management of mandible fractures are often unavoidable. We were interested in determining whether delays increased the incidence of complications in these patients. STUDY DESIGN AND SETTING: A retrospective chart review was performed on all patients who presented to the San Francisco General Hospital with an operative mandible fracture in 2002. On the basis of the number of days from initial injury to surgery, the patients were divided into two groups: those repaired in 3 days or less and those repaired after 3 days. The incidence of infectious and technical complications was then compared between these groups. Substance abuse was also evaluated for its role in complication risk. RESULTS: Of the 84 patients in the study, 11 had infectious complications, and 10 had technical complications. Although treatment delay did not increase the risk of developing an infectious complication, substance abuse considerably increased this risk. The incidence of technical complications was remarkably higher in patients repaired after 3 days. CONCLUSION: Although patients with mandible fractures treated after 3 days do not have a higher risk of developing an infectious complication, this risk is elevated in patients who abuse substances regularly. The risk of technical complications increases with treatment delay, and therefore the surgical team must be even more vigilant when reducing these fractures.

Adult↗
PubMed2005

The pediatric mandible: II. Management of traumatic injury or fracture.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the changing epidemiology of mandibular fractures in children and adolescents. 2. Discuss the appropriate use of internal fixation in the treatment of pediatric mandibular fractures. 3. Describe the difficulties posed by the deciduous dentition in the use of interdental wiring. 4. Understand reasons why techniques specific to adult fractures may not be applicable to the growing mandible. 5. Understand the etiology and epidemiology of pediatric mandibular fractures. 6. Understand the reasons for conservative (closed) versus aggressive (open) treatment of mandibular injury. BACKGROUND: Fractures of the pediatric mandible are complicated by the anatomic complexity of the developing mandible, particularly by the presence of tooth buds and the eruption of deciduous and permanent teeth. Traditional methods of fracture reduction and fixation employed in adults have little applicability in the pediatric population. METHODS: The authors describe the surgical techniques that have been used at their institution and those that can be used safely in the pediatric setting. RESULTS: In most cases, "conservative" management is the preferred option, especially in the treatment of condylar fractures. In cases requiring surgical intervention, interdental wiring, drop wires in combination with circummandibular wires, and acrylic splints are suited well to specific phases of dental maturation. CONCLUSION: Open reduction and internal fixation using monocortical screws and microplates or resorbable plates and screws are acceptable techniques in the pediatric patient, but they require special safeguards. Algorithms are presented to simplify management of these complicated injuries.

Adolescent↗
PubMed2004

Central adenoid cystic carcinoma of the mandible manifesting as an endodontic lesion.

AIM: To present a case of adenoid cystic carcinoma (ACC) in the mandible, and manifesting as a periapical lesion. SUMMARY: A 56-year-old male suffered from pain around the right mandibular first molar for approximately 1 week. Oral examination revealed that the involved tooth was restored by a full coverage crown with no obvious abnormalities. A periapical radiograph revealed two ill-defined radiolucencies associated with the tooth, one over the mesial and another over the distal roots of the tooth; incomplete root filling and furcation involvement also being noted. The affected tooth was extracted based on the clinical impression of apical periodontitis. The surrounding tissue of the root apex was curetted and sent for histopathological examination, which revealed ACC. KEY LEARNING POINTS: Adenoid cystic carcinoma affecting the mandible may mimic a periapical lesion. Proper diagnosis of such a lesion is dependent on thorough clinical, radiographic and microscopic examinations. Such a case highlights the benefits of biopsy and histological examination of collected tissues. Diagnosis of lesions in the mandible should include salivary gland tumours.

Carcinoma, Adenoid Cystic↗
PubMed1993

Cortical bone mineral density in the mandible and osteoporosis status in postmenopausal women.

Mineral density of the cortical bone of the mandible was determined by single-energy QCT (quantitative computed tomography) for 77 menopausal women. Bone mineral densities (BMD) were measured in the buccal and lingual layers of the cortex, distally from the foramen mentale, on both sides of the mandible. All the women were edentulous in that region, and the alveolar processes were far resorbed. These results were compared with the BMD values of the femoral neck, lumbar spine, and trabecular portion of the mandible between the detected layers of cortex. The BMD of the buccal cortex correlated remarkably well with all values, except those of the trabecular portion. Of the women tested, the correlations were lowest in the least osteoporotic group. The values for the lingual cortex did not correlate with other variables as well as did those for the buccal cortex, but in the most osteoporotic part of the sample the lingual cortex values correlated significantly with the BMD of the trabecular portion. The BMD values for the buccal cortex were significantly higher than those for the lingual cortex.

Absorptiometry, Photon↗
PubMed2005

Bilateral intraosseous adenoid cystic carcinoma of the mandible: report of a case with lung metastases at first clinical presentation.

OBJECTIVE: Malignant epithelial tumours arising in the jaws are very rare. Adenoid cystic carcinoma (ACC) represents approximately 7.5% of all carcinomas and only a few cases of intraosseous (central) ACC have been reported in the literature. MATERIALS: The salient clinico-pathological features of a case of ACC, bilaterally occurring in the mandible of a young caucasian woman who also had lung metastases are reported to appropriately characterize such unusual lesions and discriminate them from other tumours that more commonly affect the mandible. RESULTS: The patient presented with a painful swelling of the right retro-molar area and paraesthesia of the ipsilateral lower lip and radiological investigations disclosed bilateral radiolucent lesions of the mandible with unequivocal signs of malignancy but without intra-lesional calcifications or association with teeth roots or cystic component. Conventional histological examination disclosed typical ACC with solid and cribriform growth patterns and extensive infiltration of the adjacent tissues. CONCLUSIONS: The diagnosis of intraosseous malignant salivary gland type neoplasms is very difficult in view of their rarity and lack of specific signs and mainly achieved after histological examination and complete clinico-radiological work up. As surgical treatment of the patient was not indicated, due to extensive neoplastic disease, the patient is being controlled with multimodal treatment, including chemo- and radiotherapy and is alive with persistent disease 3 years after the original diagnosis.

Adult↗
PubMedDate not supplied

Fractures of the mandible in the aging population.

Maxillofacial trauma in elderly patients represents a significant social concern, as it uses one-third of all medical resources allocated to trauma care. Studies have shown the incidence of maxillofacial trauma in the elderly population has been increasing over the past 30 years. A common injury in patients who present with maxillofacial trauma is fracture of the mandible. The etiology, demographics, and management of elderly patients with mandibular fractures differ from younger cohorts. Falls are the primary reason for mandibular fracture in the elderly with 30% of individuals over 65 years of age falling each year. This increases to more than 40% in persons 80 years and older. Elderly persons with atrophic mandible have less osteogenic capability and reduced blood flow, and may have a complex medical history, so that management of a fracture of the mandible may require special considerations. The purpose of this review paper was to examine demographic patterns and the etiology of mandibular fractures in the elderly; and to evaluate treatment strategies.

Accidental Falls↗
PubMed2005

Chronic suppurative osteomyelitis of the mandible: case report.

BACKGROUND: Osteomyelitis of the maxillofacial skeleton is rare in developed countries such as Australia. This case report describes the successful surgical treatment of chronic suppurative osteomyelitis (CSO) of the mandible in a 75 year old man. The precipitant factor was thought to be a retained tooth root in the (right) posterior body of the mandible. METHODS: Treatment included a pre-surgical course of antibiotics (clindamycin 300mg, p.o. q.i.d. for two weeks) followed by removal of the retained root, surgical débridement of the affected bone, the intra-oral draining sinus, and resection of the cutaneous sinus tract. Specimens were taken for bacterial cultures and antibiotic sensitivity testing, and the resected tissue sent for histopathological review. RESULTS: On clinical and radiographic review at three months, the patient was well, completely symptom free and the osteomyelitis had fully resolved. CONCLUSION: This case report demonstrates the typical features of CSO. The combination of antibiotic therapy and surgical débridement was effective in the treatment of chronic suppurative osteomyelitis of the mandible utilizing intravenous sedation, and so averting the need for a general anaesthetic.

Aged↗
PubMed1994

Mandible fracture repair: specific indications for newer techniques.

Mandible fracture repair is commonly undertaken by otolaryngologists. Although the essential principles of reduction and immobilization are undisputed, the approach used to obtain these goals varies considerably. We performed a critical evaluation of all mandible fractures treated at the Santa Clara Valley Medical Center by the otolaryngology service between January 1988 and February 1992, with the purpose of better defining the indications for plate fixation and for the use of more traditional techniques. One hundred eighty-three fractures in 112 patients were evaluable. Thirty-six (32.1%) of these patients had at least one plate placed (group A); 39 (34.8%) underwent an open procedure, with interosseous wire fixation (group B); and 37 (33.0%) were treated with closed techniques (group C). The severity of fracture (indexed by comminution, presence of infection, teeth in the fracture line, interval to repair, and whether the fracture was open or closed) was similar in plated and nonplated mandibles. Mean (+/- standard deviation) operative times for the three groups were 3.2 +/- 1.6 hours for group A, 3.0 +/- 0.9 hours for group B, and 1.4 +/- 0.5 hours for group C. The number of follow-up visits required was not statistically different (group A, 5.6 +/- 3.8 visits; group B, 5.2 +/- 2.5 visits; and group C, 5.3 +/- 2.0 visits). The overall incidence of major complications was 14.3% (16 of 112), including 11 of 36 (30.6%) in group A, 4 of 39 (10.3%) in group B, and 1 of 37 (2.7%) in group C.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Regenerative repair of the mandible using a collagen sponge containing TGF-beta1.

INTRODUCTION: Alveolar bone resorption and atrophy of the mandible are a major challenge for regeneration medicine. In the present investigation, a collagen sponge that contained TGF-beta1 was placed at a mandibular defect and the osteogenic effects of collagen-TGF-beta1, complex were evaluated. MATERIAL AND METHODS: The Pm2, Pm3, and Pm4 teeth on both sides of the mandibles of 12 adult beagle dogs (9.0-12.0 kg) were extracted. After the extraction-site wounds healed, a bone defect (10.0 x 15.0 mm-wide, 10.0 mm-deep or 10.0 x 10.0 mm-wide, 10.0 mm-deep) was created on the mandible. A collagen sponge (10.0 x 10.0 x 10.0 mm) that contained TGF-beta1 (1.0 microg, 5.0 microg, or 10.0 microg, in physiological saline) was placed at the bottom of the defect and the overlying mucous membrane was sutured with 4-0 prolene. As a control, a collagen sponge that contained physiological saline only was placed in a defect on the opposite side. Two weeks after the surgery the wounds above the bone defects on both the control and TGF-beta1-treated sides had healed completely. RESULTS: At four, six, or eight weeks post-operatively animals were killed. Soft X-ray and bone-salt measurement analyses confirmed clearly that there was greater calcified bone formation in the defects into which TGF-beta1 had been incorporated than with the control defects. The implanted collagen sponges were fully resorbed and the bone tissue had regenerated from the bottom of the defects on the TGF-beta1, side by four weeks. On the control side, no such regeneration was observed. CONCLUSIONS: These results indicate that TGF-beta1, released slowly from a collagen sponge was effective in promoting bone remodeling when applied to mandibular defects in adult dogs.

Alveolar Bone Loss↗
PubMed2006

Schwannoma with secondary erosion of mandible: case report with a review of the literature.

Schwannoma (neurilemmoma) is a common, histologically distinctive, benign, usually encapsulated, peripheral nerve tumour of Schwann cell origin. We report a case of schwannoma arising from soft tissue near the mandible. A 53-year-old female presented at our department with painless swelling of lingual mucosa of the mandible. The first molar was extracted 20 months before. Panoramic radiograph showed a suspected residual cyst. It was impossible to determine prior to surgery whether this was a peripheral nerve sheath tumour. The lesion was completely removed; the tumour appears to have originated in soft tissue and caused secondary erosion of the mandible.

Bone Resorption↗
PubMed2002

Seventeen-year follow-up of a patient with median cleft of the lower lip, mandible, and tongue with flexion contracture: a case report.

PURPOSE: We present a 17-year follow-up of an unusual patient with median cleft of the lower lip, mandible, and tongue with a flexion contracture. CONCLUSION: Timing of the mandibular reconstruction needs to take into account growth of the mandible and masticatory function. In this case, fixation of the mandible performed at the age of 6 years 6 months and reconstruction carried out at 7 years 8 months of age resulted in satisfactory occlusion and masticatory function.

Bone Plates↗
PubMed1978

Recording of the retruded position of the mandible in patients with mandibular dysfunction.

The precision (reproducibility) of active and passive recordings of the retruded position of the mandible was studied by two examiners on 10 patients with mandibular dysfunction symptoms. The position of the mandible was recorded with an intra-oral graphic method, before and after treatment of the symptoms. The precision of the recording was highest when the retruded position was recorded by passive hinge movement and lowest when it was recorded by active hinge movement and when recording habitual closure. Both systematical and accidental errors tended to be somewhat larger among these patients than that previously found among individuals without signs or symptoms of mandibular dysfunction. The accidental errors in antero-posterior and medio-lateral directions were the same fo both examiners and of the same magnitude before and after treatment of the symptoms. Both examiners recorded the retruded position on the average 0.20 mm more posterior after treatment than before. The results showed that because of its good reproducibility the retruded position of the mandible can be recommended as a reference position in functional analysis of occlusion and for jaw recordings also in patients with TMJ muscle-pain dysfunction symptoms. During the recording the conventional technique with passive hinge movement and a posterior pressure should be used.

Adult↗
PubMed1982

Aberrations of the tooth arcade and mandible in Dall's sheep from southwestern Yukon.

Nine Dall's sheep (Ovis dalli dalli) collected in the Ruby Mountains of southwestern Yukon were examined for aberrations of the tooth arcade and mandible. Missing and displaced teeth were common in older sheep (greater than or equal to 6 yr). Necrosis of the mandible was observed in five of eight rams and in one ewe. Corynebacterium pyogenes was cultured from exudates from two rams with enlarged fistulated mandibles. The sequence of events leading to lesions of the tooth arcade and to "lumpy jaw" is postulated to be associated with abnormal wearing of teeth and a disrupted alignment of the tooth arcade, impaction of vegetable matter between teeth and between the gingiva and the root of the tooth, and penetration of the traumatized gingiva membrane and alveolus by oral bacteria which induce a necrotizing infection.

Animal Feed↗
PubMed1996

Unilateral comminuted and complicated fracture of the mandible due to dog attack.

Fractures of the mandible and their management are discussed in detail in textbooks and articles dealing with facial trauma. This paper presents the management and treatment of a case of a unilateral comminuted and complicated fracture of the mandible due to dog attack on a geriatric patient. The attack also severed the patient's right arm. Due to the severity of the trauma, an emergency surgery was performed on the mandible and arm.

Aged↗
PubMed1998

[Malignant tumors of mandible in children].

Primary bone tumors represent about 7% of paediatric malignancies. Osteosarcoma and Ewing's tumor are the most frequent ones, however they are rare in facial bones. Mandibular localization is slightly more frequent and of better prognosis than maxillary one. Until 1995 there were only about 70 cases reported in the medical literature, mainly in the oncological or dental periodics. Our material consists of two children with Ewing's tumor of the mandible and one patient with osteosarcoma. The diagnosis was based on histopathological or cytological studies. The combined treatment--chemotherapy and radiotherapy--was performed in two patients with Ewing's tumor. The recommended resection of the mandible including the tumor mass has not been performed. No facial asymmetry is seen after termination of the radiotherapy. The boy with osteosarcoma underwent primary mandibular partial resection; a two-year chemotherapy was introduced only when metastases in the regional lymph nodes occurred (BLM, CTX, ACT-D, ADM, CDDP). The mandible was reconstructed surgically in 5 years after termination of radiotherapy and the anatomical relationship in the masticatory organ was restored. All children are now in good condition under our long-term observation. We present these cases of mandibular tumors regarding their rare occurrence and positive results of the introduced treatment.

Child↗
PubMed1999

Peripheral osteoma of mandible arising from anterior lingual alveolar plate--a case report.

Peripheral osteomas of the mandible are uncommon bony tumours. Of those that have been described, the location is normally posterior to the premolars on the lingual surface of the mandible or in the condylar area. This article presents a case of an atypical presentation of an osteoma arising from the anterior lingual alveolar cortical plate of the mandible.

Alveolar Process↗
PubMed1998

[Vascular structure of malignant tumours of the mandible shown by specimen arteriography].

OBJECTIVE: To investigate the vascular structure of different kinds of malignant tumours of the mandible. METHODS: Specimen arteriography was performed on 11 cases of malignant tumours of the mandible. RESULTS: Malignant tumours could be divided into two groups: 1. the hypervascular tumours, the arteries are dilated, distributed evenly and arranged in a bush-like pattern. 2. hypovascular tumours, the scanty arteries are distributed unevenly without dilation, in some areas, the shape of arteries are irregular and arranged in a network pattern. CONCLUSION: Variation in vascular structure of malignant tumours in the mandible may be related to the outcome of regional chemotherapy.

Adolescent↗