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PubMed1996

The mandible fracture: a treatment protocol.

Treatment of the mandible fracture is basic to the treatment of maxillofacial trauma. Although there is universal agreement as to treatment goals and therapeutic principles, a plethora of currently accepted treatment modalities indicates a lack of consensus. This article reviews 435 mandible fractures in 268 patients treated by the Oral and Maxillofacial Surgery Service of Kings County Hospital/State University of New York Health Science Center at Brooklyn during a 3-year period from July 1, 1992 to June 30, 1995. Fifteen cases required reoperation or readmission for a complication rate of 3.4%. There was satisfactory bone healing in 99% of the cases. Based on these results, a mandible fracture protocol is proposed.

Adult↗
PubMed2002

[Diffuse sclerosing osteomyelitis of the mandible and SAPHO syndrome].

BACKGROUND: Diffuse sclerosing osteomyelitis of the mandible (DSOM) and SAPHO (synovitis, acne, palmo-plantar pustulosis and psoriasis, hyperosteosis, osteitis) syndrome are not commonly associated. SAPHO has not been described to date in the stomatology and maxillo-facial surgery literature in French. Were report here a homogeneous series of 12 patients with DSOM. MATERIAL AND METHODS: All patients had mandibular osteitis. RESULTS: Five patients with multifocal osteitis wre considered to present SAPHO syndrome because of the associated skin lesions. One patient with a unique focus of mandibular osteitis and palmo-plantar pustulosis probably had early-stage SAPHO syndrome. The diagnosis in the other cases was diffuse sclerosis osteitis of the mandible. DISCUSSION: We compared our series with those reported in the literature, emphasizing diagnostic and therapeutic difficulties. Diffuse sclerosing osteomyelitis of the mandible should be distinguished from microbial osteitis. Early diagnosis is required to avoid successive and unnecessary dental avulsions. There is a possible link between DSOM and SAPHO and all patients should have a complete work-up including whole-body scintigraphy to search for other foci. A biopsy is indicated to rule out malignancy. Nonsteroidal antiinflammatory drugs can improve patient comfort in this particularly long syndrome. Although the efficacy is demonstrated, surgery and antibiotics can only delay relapse for a few months.

Acquired Hyperostosis Syndrome↗
PubMed2003

A large glandular odontogenic cyst of the mandible: report of case.

Glandular odontogenic cyst (GOC) is generally considered uncommon, but several investigators claim there is a more frequent occurrence than previously thought. However these case reports lacked confirming data to validate their claim. On the other hand, it is possible that cases of central mucepidermoid carcinoma or later periodontal cyst might be viewed as glandular odontogenic cyst. This is a report of a case of a 70-year old male who presented with a firm swelling in the right side of his edentulous mandible. Radiographic examination revealed a multilocular radiolucent lesion in the mandible extending from the right first premolar to the left second premolar and reaching the inferior mandible. Clinical findings, the health history, and microscopic examination of excised tissue confirmed the diagnosis of GOC. The lesion was excised and post-operative healing was uneventful.

Aged↗
PubMed2003

MR imaging of traumatic lesions of the inferior alveolar nerve in patients with fractures of the mandible.

BACKGROUND AND PURPOSE: The objective of this study was to assess whether MR imaging can image the neurovascular bundle in patients with fractures of the mandible. In addition, an attempt was made to evaluate whether MR images provide information regarding the continuity of the inferior alveolar nerve before surgery and regarding signal intensity changes after trauma. METHODS: We analyzed preoperative MR images of 23 patients with mandibular fractures. Object-oriented sagittal view proton density- and T1-weighted sequences (before and after the administration of contrast agent) were used not only in an attempt to obtain purely qualitative information regarding nerve continuity in the neurovascular bundle (inferior alveolar nerve, artery, vein) but also to perform quantitative region-of-interest measurements of signal intensities at four defined measurement sites. The measurements were compared with those obtained for a patient population with healthy mandibles. RESULTS: It was possible to interpret MR images in 21 cases. MR imaging findings showed that the neurovascular bundle had been cut in two patients and was intact in the remaining 19 patients. These MR imaging findings were confirmed intraoperatively in all cases. Although we found no significant signal intensity differences between patients with intact nerves and patients with cut nerves, we found significant differences between patients with mandibular fractures and patients with unremarkable mandibles. CONCLUSION: It is possible to diagnose the interruption of nerve continuity by using MR imaging. Signal intensity measurements in the neurovascular bundle provide no information regarding nerve continuity.

Adolescent↗
PubMed2000

[3D solid model of mandible with dental arch via LOM method].

OBJECTIVE: Based on 3D reconstruction data from CT scanning, a solid model of mandible with dental arch is obtained via a rapid prototype machine using LOM method. METHODS: 3D reconstruction data is transferred to STL file using software of Delcam(UK),which will be fed to Magics RP software for detection and rebuilding. Reproduction of the papery model of mandible with dental arch is then performed with highly geometric similarity. RESULTS: The RP model of mandible with dental arch is obtained. CONCLUSION: Accuracy of the reproduction model meets the demands of students in prosthetic dentistry,which gives the possibility of computer aided design of prosthetic dentistry based on 3D solid model.

English Abstract↗
PubMed2004

[Repair of mandibular defects by dosed distraction. Part I. Distraction of the callus for osteoplasty of the mandible by local tissues].

During the war in Afghanistan the author repaired gunshot defects in the mandible using a compression-distraction device (CDD) which he designed in cooperation with A. Kh. Shamsudinov. Osteoplasty of the mandible is based on the distraction osteogenesis phenomenon. Proceeding from this phenomenon, the author developed several variants of mandibular osteoplasty in 1982-1983, one of these variants being osteoplasty with local tissues, permitting bloodless repair of mandibular defects of up to 5 cm long. Osteoplasty with local tissues can be used not only for repair of mandibular defects of any origin, but for enlarging the mandible in congenital or acquired abnormalities as well.

Bony Callus↗
PubMedDate not supplied

A 3-arm study of early loading of rough-surfaced implants in the completely edentulous maxilla and in the edentulous posterior maxilla and mandible: results after 1 year of loading.

PURPOSE: The aim of the present prospective study was to evaluate the concept of early loading of rough-surfaced implants in the completely edentulous maxilla and in the edentulous posterior mandible and maxilla. MATERIALS AND METHODS: Fifty-four consecutive patients were treated. Twenty patients were completely edentulous in the maxilla (group A), 19 patients were edentulous in the posterior left and/or right maxilla (group B), and 15 patients were edentulous in the posterior left and/or right mandible (group C). One patient in group B and 5 in group C were bilaterally treated. Two hundred thirty-four solid screw-type, sandblasted, large-grit, acid-etched (SLA) ITI implants were placed, 58 (25%) immediately after tooth extraction. Mean placement torque and standard deviations were measured at all sites. Sixty fixed prostheses were delivered after a mean delay of 9 days (range, 4 to 22 days). Mean marginal bone reduction was measured after 1 year of loading. RESULTS: Two implants were lost (0.9%), 1 before functional loading and 1 after 1 year. All other implants were clinically stable, with a mean marginal bone loss of 0.75 mm (+/-1.3 mm). Marginal bone loss ranged from 0 to 3.5 mm. Mean placement torque on implants placed in healed bone or immediately after tooth extraction ranged from 29.1+/-9.3 Ncm to 35.5+/-5.8 Ncm. No statistical difference was found (P > .05) between implants placed in healed bone and those placed immediately after tooth extraction. DISCUSSION: There is little documentation for immediate or early loading in the areas studied. However, in this study, favorable results were obtained in 54 consecutive patients in these regions. CONCLUSION: In this study population, early loading protocols can be applied with predictable results using rough-surfaced implants for rehabilitation of the completely edentulous maxilla, posterior maxilla, and posterior mandible.

Adult↗
PubMed2005

Treatment of completely edentulous patients with fixed implant-supported restorations: three consecutive cases of simultaneous immediate loading in both maxilla and mandible.

This article aims to: (1) describe the treatment of three consecutive completely edentulous patients with fixed implant-supported restorations, including simultaneous same-day immediate loading with fixed provisional restorations in both jaws; and (2) illustrate a step-by-step definitive restoration approach. All patients followed the same diagnostic protocol. One surgical intervention was performed for simultaneous implant placement in both maxilla and mandible. Following implant placement, all patients received a simultaneous, same-day, complete-arch, screw-retained provisional restoration in both jaws according to the "pickup" technique. After healing, final impressions were taken, and occlusion recorder devices were prepared on working casts. For the first occlusal record, the "half-provisionals" method was used. Definitive solid abutments were used for both laboratory and clinical procedures. After casting and finishing, the frameworks were tried in, and a new occlusal record was made. The definitive segmented restorations consisted of four fixed partial dentures in the maxilla and three in the mandible and were cemented with provisional cement. All patients received a nightguard. The pickup technique facilitated simultaneous immediate loading in both maxilla and mandible. A complete, fixed, segmented rehabilitation supported by six to eight anteroposterior implants is a reproducible treatment for completely edentulous patients when optimal anatomic conditions are present.

Dental Implantation, Endosseous↗
PubMed1992

[Malignant lymphoma of the mandible].

A 73 year-old man consulted for a swelling of the endentulous horizontal branch of the mandible. X-ray examination showed a lytic defect. Two successive, but superficial biopsies, directed the diagnosis towards osteomyelitis. In spite of antibiotic therapy, the destruction continued to progress and was finally complicated by a pathological fracture. A radial resection of the horizontal branch of the mandible was performed; on this surgical specimen the diagnosis of primitive lymphoma of the mandible (diffuse centroblastic type) was made. The authors discuss the diagnostic difficulties of mandibular lymphomas, which according to Ostrowski represent 4.7 per cent of the primitive bone lymphoma.

Aged↗
PubMed2005

Three cases of diffuse large B-cell lymphoma of the mandible treated with radiotherapy and chemotherapy.

CASE REPORT: We report three cases of diffuse large B-cell lymphoma of the mandible and a review of the literature. All 3 of our patients had stage I AE disease and had complete remission for more than 2 years after 42-46 Gy of irradiation to the primary tumor with regional lymph nodes and 3 courses of chemotherapy consisting of cyclophosphamide, adriamycin, vincristine, and predonisolone (CHOP). Literature analysis, although biased toward published data, indicated that the 3-year disease-specific survival rates for non-Hodgkin's lymphoma (NHL) of the mandible were 90.5% and 47.6% for stages I and II, respectively. The treatment results for NHL of the mandible may be similar to general primary bone NHL and to other extranodal NHL's. CONCLUSION: Radiotherapy alone is not sufficient for tumor control for stage I+II, disease, and combination chemotherapy may be needed.

Combined Modality Therapy↗
PubMed1992

Management and treatment of a mandible fracture in an athlete.

The purpose of this paper is to demonstrate a treatment program that may permit a student-athlete who has a mandible fracture to continue participation in a sport without further jeopardizing his or her health. This article is based on an actual case in which a student-athlete sustained a mandible fracture during an intercollegiate basketball game. Within 24 hours, the injured athlete resumed basketball practice. Three days following the injury, he was permitted to compete in a game. In addition to recommendations regarding acute care, we discuss protective equipment, follow-up guidelines, and nutritional considerations. These guidelines may assist the sports medicine team in determining when an athlete with a mandible fracture can return to competitive and contact sports.

Journal Article↗
PubMed2006

Use of short implants for functional restoration of the mandible after giant cell tumor removal. Case report.

The giant cell tumor of the jaws is a rare benign lesion, it has a slow and progressive evolution and it is locally aggressive. Its etiopathogenesis is unknown, it is most common in the mandible and it is often asymptomatic but pain arises from palpation of the area. Diagnosis is made by radiological and histological examination and surgical treatment is necessary. The clinical case of a 28-year-old man affected by a giant cell tumor of the mandible with an aggressive clinical and radiographical behaviour is reported. The patient showed a jaw swelling covered by hyperemic fibro-mucous tissue from tooth 4.6 to 3.4, absence of cortical bone and mobility of teeth. He also reported lip anesthesia. The giant cell tumor diagnosis was made with orthopantomography (OPT), computed tomography (CT) and needle biopsy. The lesion was surgically removed and histological examination confirmed the diagnosis. In spite of the wide loss of bony substance after surgery, the patient was provided with an implant supported fixed prosthesis without previous bone graft. In this case short implants allowed the prosthetic rehabilitation of a mandible with severe ''resorption'' due to surgical removal of a tumor. Implants were placed in the residual bone volume and successfully used to support a fixed prosthesis. The final result is optimal as is the quality of life of the young patient.

Adult↗
PubMed1990

[Atrophy of the mandible and maxilla as complication of treatment and healing of jaw fractures].

The authors discuss in the light of literature data the causes of bone atrophy and report two own cases of extensive atrophy of the mandible and atrophy of the maxilla developed during treatment of their fractures. Parallel mandibular atrophy in a patient aged 67 years was observed 3 years after surgical union of fractured fragments of the edentulous mandible with metal plates. The cause of atrophy is related by the authors to prolonged malnutrition of the patient who had partial gaestrectomy 24 years earlier, and his failure to observe the suggested mandible immobilization during the required length of time. Considerable degree of maxilla atrophy in a 34-year-old man developed during treatment of a Le Fort III maxilla fracture. The atrophy affected mainly the apical base of the alveolar process, and it was observed 4 months after fracture. The cause was not systematic, prolonged without informing the stomatologist, and excessive traction was exerted by the rubber band in the chin-sling used for the treatment of the fracture. The treatment used in this case permitted to restore in the maxilla the proportions of bone structures approaching the normal ones.

Adult↗
PubMed1990

ITI implants with overdentures: a prevention of bone loss in edentulous mandibles?

Changes in the bone mineral content (BMC) of edentulous mandibles with osseointegrated ITI implants supporting overdentures were measured in vivo by dual-photon absorptiometry. The BMC measurements were performed 3 weeks postoperatively and at the 2-year follow-up visit. Measurements were made in the ITI site (anteriorly), the premolar region just behind the fixtures, and the standard site of the mandible for obtaining reference values of the age-related MBC loss. The increased function of the mandible after this treatment seems to cause a load-related bone formation that minimizes, or in some cases may counteract, the physiologic age-related BMC loss leading to osteoporosis.

Absorptiometry, Photon↗
PubMed1990

Mucoepidermoid carcinoma of the mandible.

Mucoepidermoid carcinomas originating within the body of the mandible are uncommon tumors with histogenesis and treatment reviewed. The second youngest patient in the literature is reported with a tumor originating within the angle of the mandible. Treatment consisted of wide local excision, including composite resection of the mandible without evidence of recurrence at two years.

Carcinoma↗
PubMed1990

Malignant lymphoma involving the mandible. Clinical, morphologic, and immunohistochemical study of 17 cases.

We present 17 cases of non-Hodgkin's lymphoma of the mandible, collected over a span of 10 years. Clinically, the patients showed a male:female ratio of 1:2.4 and a mean age of 60.6 years. Swelling was the most common symptom. In 11 of 17 patients, the disease presented in stage I. Radiotherapy alone was employed in 11 patients, in conjunction with chemotherapy in 5 patients, and was preceded by surgery in the remaining case. At this writing ten of the subjects are still alive, five died following progression of the disease, and two were lost during follow-up while in complete remission. Histopathology revealed 15 B-cell lymphomas (1 centroblastic/centrocytic, nine centroblastic, one Burkitt's, two immunoblastic, and two lymphoblastic) and two peripheral T-cell lymphomas (pleomorphic). The above diagnoses were confirmed by immunohistochemical analysis with a wide panel of reagents against fixative-resistant molecules. Our data suggest that (a) lymphomas of the mandible are principally represented by high-grade B-cell varieties (88%); (b) primitive T-cell lymphomas (here documented for the first time) have the same incidence in the mandible as they have in lymph nodes; and (c) immunohistochemistry, besides confirming histogenetic interpretations based on morphologic findings, provides the key to the differential diagnosis from malignant large-cell nonlymphoid tumors.

Adult↗
PubMed1989

[Two cases of intra-arterial infusion of antibiotics in intractable chronic osteomyelitis of the mandible].

Two cases of intractable chronic osteomyelitis of the mandible were encountered recently. The first of these was a 51-year-old man who complained of swelling in the right cheek and the mandibular region. The other was a 27-year-old man who chiefly complained of swelling, pain and trisms in the right mandible. Both patients were treated with antibiotics and the osteosclerotic tissue was removed. The antibiotics were injected into the superficial temporal artery using a one-shot technique. Radiographs of the patients taken one to two years after the treatment revealed normal conditions with no signs of recurrence. It appears that this form of treatment is effective in the case of intractable chronic osteomyelitis of the mandible.

Adult↗
PubMed1989

[Fractures of the mandible--an analysis of the etiology and localization].

A retrospective analysis of fractures of the mandible in 993 patients treated in the Department of Oral Surgery, Odense University Hospital, during the period 1978-1987 is presented. The investigation is compared with a previous analysis from the period 1964-1973. There is a marked increase in the total number of fractures as well as an increase in the number of cases of violence involving fractures of the mandible. Jaw fractures caused by sport accidents are rare, but it is surprising that horse riding is the sport that is causing most mandibular fractures. The present investigation demonstrates that fractures of the condyles are the prevailing type of fractures, followed by fractures of the mandible body. Presence or lack of teeth seems to have no or little importance with reference to localization of the fractures.

Adolescent↗