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PubMedDate not supplied

Invading basal cell carcinoma of the jaw: an under-evaluated complex entity.

Basal cell carcinoma (BCC) is a locally invasive neoplasm, rarely metastatic, yet capable of significant local destruction and disfigurement. Invasion into the bone is uncommon and only a few cases of invasion into facial bones, but never to the mandible or maxilla, have been described. We report three patients with BCC lesions invading their jaws, as a consequence of which either their mandible or maxilla had to be partially resected. This resulted in facial mutilation which required comprehensive multi-disciplinary therapy to restore function and esthetics. Such therapy requires a combination of modalities offered by both plastic and maxillofacial surgeons, as well as oral and dental rehabilitators.

Adult↗
PubMed1995

Parosteal osteoma of bones other than of the skull and face.

BACKGROUND: Osteoma of the skull and facial bones is not uncommon, is usually asymptomatic, and may be associated with Gardner's syndrome. Osteomas involving other bones are unusual. METHODS: The authors describe 14 cases (eight men and six women from age 21-66 years) of parosteal osteoma of bones other than of the skull and face. RESULTS: Thirteen lesions involved long bones, and one involved the clavicle. A long-standing (18 months to 31 years) mass was reported in seven patients. Symptoms of pain, a mass, or both were present in all except three patients who were asymptomatic. Lesions ranged from 2.5 to 20 cm in greatest dimension. Histologically, they blended with the cortex, did not infiltrate the medullary cavity, and consisted of dense sclerotic lamellar bone with haversian systems, similar to the architecture of normal cortical bone. There was no spindle cell proliferation. Nine patients underwent resection, four had biopsy, and one had debulking. With a follow-up of 1-23 years, no recurrence or metastasis was reported. CONCLUSIONS: Parosteal osteoma must be distinguished from parosteal osteosarcoma, a low grade malignant neoplasm. If radiographs do not identify areas of radiolucency and sections do not contain spindle cells, the diagnosis of parosteal osteoma is justified.

Adult↗
PubMed1994

Facial trauma in motor vehicle accidents: etiological factors.

The effects of seat belts and the use of alcohol and drugs have been studied as etiological factors in facial trauma to occupants of motor vehicle accidents (MVAs). During a 15-month period, 461 patients were admitted to a regional trauma center as a result of injuries sustained in MVAs. Two hundred thirty-seven (51%) of these patients had facial trauma. Facial trauma was the single most common injury in these patients. One hundred eighty-five patients (78%) had major soft tissue injury, and 52 patients (22%) had facial bone fractures. Forty-two of 237 patients (18%) with facial trauma were wearing seat belts compared with 74 of 224 patients (33%) without facial trauma who were wearing seat belts at the time of the accident. Large numbers of patients who were wearing seat belts at the time of the accident had minor injuries and were never admitted to the hospital. Sixty-five of 224 patients (24%) without facial trauma and 121 of 237 patients (51%) with facial trauma tested positive for alcohol or drugs. The majority of the patients who tested positive for alcohol had blood alcohol levels of more than 100 mg/dL. Head injuries and blunt chest trauma were most commonly associated injuries in these patients. This study suggests that use of alcohol and drugs in occupants of the motor vehicle had a major effect on the etiology of facial trauma. Also it supports the data that suggests that the use of seat belts prevents a wide range of injuries including facial trauma in MVAs.

Accidents, Traffic↗
PubMed2002

Dysplastic cortical hyperostosis (Kozlowski-Tsuruta syndrome): report of a second case.

We report a fetus from a pregnancy that was terminated at 26 weeks gestation for hydrops and short limb skeletal dysplasia. The parents were first cousins. Post mortem examination showed pulmonary hypoplasia and hepatomegaly. The radiographs showed shortening and cortical thickening of all long bones. The cortical thickening was most marked in the long bones, ribs, clavicles and scapulae but spared the skull vault, facial bones and pelvis. There were coronal clefts in the lower lumbar vertebrae. The clinical and radiological features of this fetus conform to those reported in a stillborn male by Kozlowski and Tsuruta in 1989 (Br J Radiol 62:376-378). This is the second reported case of this condition and confirms that it is a distinct and recognisable, lethal skeletal dysplasia. The parental consanguinity in our patient suggests that this condition may be inherited in an autosomal recessive manner.

Aborted Fetus↗
PubMed1992

[Assembly of free osseous fragments in the treatment of injuries of the external orbital area].

The good long term results obtained following the remodeling of the frontal bandeau in craniosynostosis have demonstrated the viability of large bony segments following total periosteal stripping. In this present study, this concept has been applied in the management of acute midfacial fractures and their sequelae. To try to answer the fundamental questions of how wide of an exposure is needed for the treatment of these fractures, how denuded can bone segments be and expect to survive, and above all, how frequently is primary bone grafting needed, the author resorts to the complete detachment and removal of the fractured segments and their reassembly on a side table. This, theoretically, accomplishes the following: the best exposure of fragments, the best anatomical reduction, an accurate assessment of segmental loss and the need for immediate bone grafting, a normal topographical reconstruction. Bone scans have indicated long term perfusion in every case in which they were obtained. Except in cases of post traumatic deformity correction, bone grafts were not needed. The free segment reassembly fractured facial bones is but one additional technique gained from craniofacial surgery. Much, however, remains to be learned about large free segment revascularization and healing.

Adult↗
PubMed1995

[Should osteosynthesis plates in the area of the facial skull be removed again? Results of experimental and clinical studies].

We discuss the arguments dealing with removal of fixation devices and plates after osteosynthesis of facial bone fractures. As an experimental model for examining the soft tissue reaction to implants under standard conditions, an inguinal flap was prepared in 24 Wistar rats. Titanium mesh implants (10 x 8 x 0.3 mm) were then inserted into the flaps. Twelve implants were additionally bent to investigate histologically the influence of mechanical preparation on tissue reactions. Examination of all specimens was carried out with the technique of Donath and showed a thin capsule around the titanium implants but without any signs of infection. Around the bent areas of the implants there were minimal signs of local chronic inflammation without a capsule. Use of titanium microplates instead of miniplates in 89 patients with midfacial fractures diminished the rate of local complications. Based on our experimental and clinical results, indications for the different types of plates and the necessity for their later removal are discussed. Our present plates are only removed from the maxillary sinus wall and the alveolar ridge, after osteosynthesis in children, and in patients with local complications. If removal of the material is planned (because of the location), less expensive steel implants are used.

Adult↗
PubMed2000

Bioceramics as an option in correction of facial skeleton deformities.

The removal of certain deformities of facial bones is a prerequisite to a restoration of function, stability, and appearance. Synthetic bone substitutes are beneficial in cases where other operative technique would represent an inadequate burden for a patient. A result is achieved in one surgical intervention with low costs and low demands on technical equipment. Biocompatible nonresorbable glass-ceramics based on oxyfluoroapatite and wollastonite presenting osteoconductivity permits osteointegration, i.e., direct physicochemical bonds between live bone tissue and the implant without formation of a fibrous capsule. It presents better durability to stress in simulated body fluid than the usually used hydroxyapatite. It was used for restoration of facial skeletal framework contour in 14 cases under conditions where prior solutions were doubtful. Good results were reached in all patients. The mean time of observation was 18 months. During that period, the rate of complications was 14.3%. This approach may be found to be a suitable technique, especially for patients exhausted by prior unsuccessful treatment but still not acquiesced in a result.

Adult↗
PubMed1990

Facial asymmetry.

A case of monostotic, mandibular fibrous dysplasia has been described in a 22-year-old Amerasian male, who had facial asymmetry of approximately 5 years' duration. Foci of ill-defined sclerotic, pagetoid calcifications were seen on routine film. The CT scans demonstrated bone facial and slight lingual expansion of bone with thinning of the cortex. A three-dimensional, enhanced CT film showed that this lesion was greater than 4 cm. The clinical, radiologic, and microscopic features of fibrous dysplasia have been described.

Adult↗
PubMed1996

Cerebellomedullary compression in recessive craniometaphyseal dysplasia.

Craniometaphyseal dysplasia (CMD) is a very rare disorder of bone remodelling characterised by sclerosis of the skull base, vault and facial bones and metaphyseal splaying of tubular bones. The recessive form appears to be more severe than the dominant. Cranial nerve deficits have been reported in infancy and early childhood in a few patients, but the long-term history of recessive CMD is not well documented. We report cerebellomedullary compression in a girl with recessive CMD recognised at 14 years because of progressive truncal ataxia. MRI revealed backward angulation of the thickened clivus, narrowing of the foramen magnum and upward deviation of the cerebellum by a markedly thickened occipital squama, tonsillar herniation and obliteration of the infratentorial cerebrospinal fluid spaces. Posterior cranial fossa decompression resulted in marked improvement of the ataxia. Compression of posterior cranial fossa structures has to be considered in the natural history and management of CMD.

Brain Diseases↗
PubMed1986

Low velocity hand-gun injuries of the maxillofacial region.

In contrast to the number of reports in the literature describing high velocity injuries of the maxillo-facial region, there are relatively few which deal with civilian type gunshot injuries. The purpose of this study was to undertake a retrospective analysis of 40 cases of low-velocity hand-gun injuries of the maxillo-facial region. The majority of cases were due to assault followed by accidental shootings and failed suicide attempts. Injuries ranged from mild soft tissue damage without fractures to severe, comminuted fractures of the facial bones. In some cases, soft tissue damage was severe. Rarely were injuries life threatening. Entrance wounds were characteristically small and well circumscribed. In 60 per cent of cases the bullet did not exist and was retained within the tissues. The floor of the mouth and tongue were the soft tissues most commonly injured. Other structures injured were major blood vessels, nerves and the eye. Mandibular fractures occurred in 58 per cent of cases, followed in frequency by maxillary complex fractures. Twenty per cent of fractures simultaneously involved bones of the upper, middle and lower-thirds of the facial skeleton. The above injuries are discussed and a classification of low-velocity hand-gun injuries of the maxillo-facial region is proposed.

Adolescent↗
PubMed1995

Fibrous dysplasia of the temporal bone: imaging findings.

Lichtenstein [1] in 1938 coined the term fibrous dysplasia to describe a disorder characterized by the progressive replacement of normal bone elements by fibrous tissue. Histopathologically, these lesions consist of an abnormal proliferation of fibrous elements intermixed with haphazardly arranged trabeculae of woven bone. The disease can involve any bone in the body. In the head and neck, the skull and facial bones are involved in 10-25% of cases of monostotic fibrous dysplasia and in 50% of the polyostotic variety. Involvement of the temporal bone, however, is relatively rare, and only 53 cases have been reported. The three major radiographic classifications of fibrous dysplasia are pagetoid, sclerotic, and cystic. Any of these types may involve the temporal bone and related structures, including the external canal, middle ear, jugular foramen, or, rarely, the otic capsule. In this essay, we illustrate the radiographic features of the disease based on our experience with seven cases, seen at our institution since 1977, of fibrous dysplasia involving the temporal bone.

Adult↗
PubMed1999

Temporomandibular joint ankylosis: the Egyptian experience.

This is a review of 204 patients with temporomandibular joint (TMJ) ankylosis treated according to a definitive protocol in the Cranio-Maxillo-Facial Department of the Alexandria University Hospital during the period 1990-1996 with a follow-up varying from 1.5 to 7 years. A history of trauma was confirmed in 98% of cases. Patients were grouped into: (1) Those with ankylosis not associated with facial deformities. The management involves release of the ankylosed joint(s) and reconstruction of the condyle ramus unit(s) (CRUs) using costochondral graft(s) (CCGs). (2) Those with mandibular ankylosis complicated by facial bone deformities, either asymmetric or bird face. The treatment consists of release of the ankylosis, reconstruction of the CRUs, and correction of jaw deformities--all performed simultaneously. Respiratory embarrassment was an important presenting symptom in the second group, all of whom complained of night snoring, eight of whom had obstructive sleep apnoea (OSA). In this latter group, respiratory obstruction improved dramatically after surgical intervention. The degree of mouth opening, monitored as the interincisal distance (IID) improved from a range of 0-12 mm to over 30 mm in 62% of patients and to 20-30 mm in 29% of patients. However, reankylosis was still around 8% and was attributed to lack of patient compliance in 75% and to iatrogenic factors in 25% of patients. CCGs resorption, whether partial or complete, occurred in 27% of patients, resulting in retarded growth, relapse of deformities and night snoring.

Adolescent↗
PubMed2005

[An individual facial shield for a sportsman with an orofacial injury].

Facial shields are used when practising contact sports, high speed sports, sports using hard balls, sticks or bats, sports using protective shields or covers, and sports using hard boardings around the sports ground. Examples of facial shields are commercially available, per branch of sport standardised helmets. Fabricating individual protective shields is primarily restricted to mouth guards. In individual cases a more extensive facial shield is demanded, for instance in case of a surgically stabilised facial bone fracture. In order to be able to fabricate an extensive individual facial shield, an accurate to the nearest model of the anterior part of the head is required. An accurate model can be provided by making an impression of the face, which is poured in dental stone. Another method is producing a stereolithographic model using computertomography or magnetic resonance imaging. On the accurate model the facial shield can be designed and fabricated from a strictly safe material, such as polyvinylchloride or polycarbonate.

Athletic Injuries↗
PubMed1975

Radiographic findings in previously untreated children with non-Hodgkin's lymphoma.

The initial radiographs of 51 consecutive, previously untreated children with non-Hodgkin's lymphoma were reviewed. The chest radiograph was abnormal in 37%, with pleural effusions seen in 14% of patients. Lymphography, readily performed in children, was positive in 30% of the successful studies. There was a high incidence of bone lesions (18% of patients), due in large part to involvement of the facial bones; all were symptomatic and/or seen on the routine chest and abdominal radiographs. Intrinsic disease of the small bowel (10%) and colon (8%) was also associated with symptoms, so that the value of routine barium studies in asymptomatic children is questioned.

Adolescent↗
PubMed1985

Changes in bone remodeling after palatal surgery.

It is generally well known that an infant with a cleft palate will have facial underdevelopment after corrective surgery. In such a case, we can suppose that the internal remodeling of the facial bone becomes abnormal postoperatively. The purpose of this study was to observe the changes in palatal bone remodeling after palatal surgery and the external bone growth inhibition using the microradiography and hard tissue labeling method. In this investigation we had 4 experimental groups and used large undecalcified ground sections to observe the whole palatal bone. Our experiments showed that the changes resulting from surgery include not only external bone growth inhibition, but also considerable abnormal remodeling in the interior of the bone. When the mucoperiosteum was removed, the changes continued to occur for an especially long period.

Animals↗