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PubMed2005

Bilateral facial pain from cardiac origin. A case report.

A case of a 65-year-old female patient is reported. Her chief complaint was facial pain, so she sought care from her general dental practitioner for evaluation of a suspected temporomandibular disorder, after repeated visits to the emergency department due to excruciating facial pain associated with exertion. The dental examination revealed an edentulous upper and lower jaw. Radiographs of the facial bones revealed no abnormalities. Eventually, she was referred for cardiological evaluation, as her pain radiated to the chest and there was a medical history of myocardial infarction. Cardiac pain may radiate to the face and lead patients to seek dental care. In these settings, dentists may contribute to the diagnosis of ischemic heart disease and refer patients for cardiological evaluation.

Aged↗
PubMed2000

Dismantling and reassembling of the facial skeleton in tumor surgery of the craniomaxillofacial area. History, surgical anatomy, and notes of surgical technique: Part 1.

In recent years, access osteotomies have been suggested to reach areas of the craniofacial skeleton that hitherto would not have been easily resectable. Some techniques of disassembling of the facial skeleton have been described in the past. In some cases, however, when the bony fragments were not pedicled to the soft tissue, reabsorption was noted. For this reason, new dismantling techniques with adequate blood supply to the bony fragments have been developed. Apart from the maxillo cheek flap, other composite flaps have been described. These flaps may be combined if necessary in selected cases. An overview of the surgical anatomy and surgical strategies will be presented. These reported techniques may be considered a major step forward in the treatment of deeply localized tumors in the craniomaxillofacial area.

Cheek↗
PubMed1986

Wound infection after mandibular reconstruction with autogenous graft.

An investigation on the fate of bone grafts in 38 patients, who had been subjected to a partial resection of the mandible for benign and malignant tumours, is presented. Apart from thorough drainage, meticulous suturing and gastric tube feeding, high and prolonged administration of antibiotics was practised to prevent infection. The basic antibiotic coverage in most patients consisted of 4 X 3 grams of flucloxacilline intravenously during ten days. After this period revascularization of a bone graft may be assumed to have progressed to such a degree, that thereafter the graft can "defend itself" against invading micro-organisms, if necessary supported by further lower dosage antibiotic treatment. In 28 patients no complications were encountered. Ten patients showed signs of infection, leading to complete loss of the graft in 3 patients. Incision, drainage, removal of sequestra and further antibiotic treatment resulted in preservation of the major part of the grafts in the other 7 patients. No correlation of infection with type of fixation, extent of soft tissue resection or time at which the reconstruction was done (primary or secondary) was found. The basic difference of maxillo-facial bone grafting as compared to bone grafting in other areas of the body is stressed, massive primary contamination combined with dead space and maybe dehiscence of the oral wound margins being mainly responsible for the relatively unfavourable conditions for grafting in this region.

Ameloblastoma↗
PubMed2006

Facial pain of cardiac origin: a case report.

CONTEXT: Cardiac pain may radiate to the face and lead patients to seek dental care. Dentists may contribute towards the diagnosing of ischemic heart disease and thus refer patients for cardiological evaluation. CASE REPORT: A 50-year-old female patient was referred to a dentist for evaluation of a suspected temporomandibular disorder after repeated visits to medical emergency departments due to excruciating facial and left temporal pain associated with exertion. The pain would start in the chest and radiate to the neck, face and left temporal region. The patient's chief complaint was the facial pain; hence, she sought dental care. The dental examination revealed an edentulous upper jaw and partially edentulous lower jaw with full upper prosthetic set of teeth and decreased vertical dimension. X-ray of facial bones did not reveal any bone abnormalities. A diagnosis of temporomandibular disorder was made. However, she was referred for cardiological evaluation, since her pain was starting in the chest and because she had a past medical history of surgical treatment for coronary artery disease. A diagnosis of angina pectoris was made, the therapeutic regimen was optimized and her angina was brought under control.

Angina Pectoris↗
PubMed1994

Regional Proteus syndrome and somatic mosaicism.

We report on a patient with regional manifestations of Proteus syndrome. Major findings included multiple hyperostoses of the calvaria, facial bones, and mandible. Additionally, the patient had a scleral tumor. This lends further support to the hypothesis of somatic mosaicism as a cause of Proteus syndrome. Because mosaic distribution of lesions is variable in extent, criteria for the diagnosis of Proteus syndrome should be loose rather than overly rigid even though patients with limited regional involvement may be particularly difficult to diagnose.

Child↗
PubMed1997

Craniotubular dysplasia with severe postnatal growth retardation, mental retardation, ectodermal dysplasia, and loose skin: Lenz-Majewski-like syndrome.

The heterogeneous group of craniotubular dysplasias is characterized by modeling errors of the craniofacial and tubular bones. Some conditions in this category cause not only skeletal abnormalities but also a variety of mesoectodermal dysplasias, as exemplified in Lenz-Majewski syndrome (MIM 151050), which comprises craniodiaphyseal dysplasia, failure to thrive, mental retardation, proximal symphalangism, enamel hypoplasia, and loose skin. We report on a boy with a hitherto unknown multisystem disorder, including skeletal changes that were regarded as a form of craniotubular dysplasia. The patient had a large head, exophthalmos, a broad nasal root, anteverted nostrils, large auricles, thick lips, micrognathia, severe postnatal growth retardation with emaciation, severe mental retardation, sparse hair growth, enamel hypoplasia, and thin, loose skin with hyperlaxity. Skeletal changes consisted of thickened calvaria, sclerosis of the skull base and facial bones, thick ribs, and metaphyseal undermodeling of the tubular bones. In addition, generalized osteopenia was evident. The present disorder overlaps phenotypically with Lenz-Majewski syndrome; nevertheless, the absence of diaphyseal hyperostosis and proximal symphalangism in the present patient was not consistent with Lenz-Majewski syndrome.

Adult↗
PubMed1980

Canine retraction with J hook headgear.

Several methods have been described for accomplishing distal movement of canines without losing posterior anchorage. An accepted method in canine retraction is the use of headgear with J hooks. Since it incorporates extraoral anchorage, it is most effective in maximum-anchorage cases. It was the purpose of this study to analyze the distribution of force transmitted to the alveolus and surrounding structures by means of photoelastic visualization, utilizing J hook headgear for maxillary canine retraction. A three-dimensional model representing a human skull was used. This model was constructed with different birefringent materials to simulate bone, teeth, and periodontal membranes. Three different vectors of force were applied representing high-, medium-, and low-pull headgear, which were placed at angles of 40, 20, and 0 degrees to the occlusal plane. The photoelastic analysis was made by means of a circular-transmission polariscope arrangement, and the photoelastic data were recorded photographically. The stress areas created by the three different vectors of force were associated with various degrees of canine tipping. This effect was greater with the low-pull force component than with the medium-pull traction. The high-pull headgear produced the least tipping tendency, being closer to a bodily movemment effect. Further, stresses were transmitted to deeper structures of the simulated facial bones; these regions were the frontozygomatic, zygomaticomaxillary, and zygomaticotemporal sutures.

Alveolar Process↗
PubMed2004

Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations.

The placement of dental implants in the anterior maxilla is a challenge for clinicians because of patients' exacting esthetic demands and difficult pre-existing anatomy. This article presents anatomic and surgical considerations for these demanding indications for implant therapy. First, potential causes of esthetic implant failures are reviewed, discussing anatomic factors such as horizontal or vertical bone deficiencies and iatrogenic factors such as improper implant selection or the malpositioning of dental implants for an esthetic implant restoration. Furthermore, aspects of preoperative analysis are described in various clinical situations, followed by recommendations for the surgical procedures in single-tooth gaps and in extended edentulous spaces with multiple missing teeth. An ideal implant position in all 3 dimensions is required. These mesiodistal, apicocoronal, and orofacial dimensions are well described, defining "comfort" and "danger" zones for proper implant position in the anterior maxilla. During surgery, the emphasis is on proper implant selection to avoid oversized implants, careful and low-trauma soft tissue handling, and implant placement in a proper position using either a periodontal probe or a prefabricated surgical guide. If missing, the facial bone wall is augmented using a proper surgical technique, such as guided bone regeneration with barrier membranes and appropriate bone grafts and/or bone substitutes. Finally, precise wound closure using a submerged or a semi-submerged healing modality is recommended. Following a healing period of between 6 and 12 weeks, a reopening procedure is recommended with a punch technique to initiate the restorative phase of therapy.

Alveolar Bone Loss↗
PubMed1990

The role of the plastic surgeon in the treatment of Gardner's syndrome: a report of two cases.

Gardner's syndrome is a hereditary disease manifested by multiple colonic polyps that progress to malignancy at an early patient age and also manifested by multiple lesions of the different germ layers including sebaceous cysts, lipomas, fibromas, and osteomas of the facial bones. The plastic surgeon often is asked to treat these patients for the more mundane manifestations of the disease such as inclusion cysts or lipomas. At times, however, the plastic surgeon may be faced with an unusual presentation. Two such unusual cases are presented here, the first being a hemangioma of the hand, which has never been described in a patient with Gardner's syndrome, and the second being a fibroma of the left cheek requiring excision by an intraoral approach.

Adult↗
PubMed2002

Clinical application of spiral tomography in anterior implant placement: case report.

BACKGROUND: Placement of endosseous dental implants in edentulous areas of the anterior maxilla poses a unique challenge due to variations in the amount of residual alveolar bone. Implant position becomes crucial in cases demanding high esthetic results but possessing minimal ridge width or in cases requiring augmentation. Recent advances in spiral tomography have allowed for more precise planning and placement of endosseous implants in these challenging areas. METHODS: The purpose of this report is to describe a series of clinical cases in which spiral tomography was utilized in the planning and placement of endosseous dental implants. Two cases will be described utilizing initial spiral tomographic radiographs for implant planning and surgical guide fabrication, followed by post-insertion tomography to evaluate the results of implant position and inclination. RESULTS: Preimplant spiral tomograms revealed that the initial prosthetic trajectory through the proposed incisal edge of each tooth replacement would result in a final osteotomy site that would compromise the overall thickness of the facial cortical plate. After adjusting for magnification and distortion factors, new prosthetic/surgical trajectories were fabricated into the surgical guide, and this information was utilized to prepare the final implant osteotomy site. This adjustment resulted in 2 mm of residual crestal facial bone postimplant insertion, which became wider at more apical measurements. These findings were verified in the postimplant serial tomograms. CONCLUSIONS: Spiral tomography was a valuable adjunct in the treatment planning phases of endosseous dental implant placement especially in cases with minimal crestal width, high esthetic demands, or where exact implant placement is critical for successful treatment outcomes.

Adult↗
PubMed1979

Bioblock therapy.

An orthopedic treatment philosophy has been presented. Attention is drawn to the fact that the facial bones of both experimental animals and human beings respond extensively to physiologic and pathologic forces, and it is suggested that these could be mimicked to advantage. A system of appliances designed to achieve this is described. Some case reports which appear to show induced skeletal change are presented, but it will be some time before the real contribution of bioblock therapy can be assessed scientifically. Meanwhile, we should perhaps look more closely at our patients' faces and consider treating them at an earlier age.

Adolescent↗
PubMed2000

[Orthognathic surgery: corrective bone operations].

The article reviews the history of orthognathic surgery from the middle of the last century up to the present. Initially, mandibular osteotomies were only performed in cases of severe malformations. But during the last century a precise and standardized procedure for correction of the mandible was established. Multiple modifications allowed control of small fragments, functionally stable osteosynthesis, and finally a precise positioning of the condyle. In 1955 Obwegeser and Trauner introduced the sagittal split osteotomy by an intraoral approach. It was the final breakthrough for orthognathic surgery as a standard treatment for corrections of the mandible. Surgery of the maxilla dates back to the nineteenth century. B. von Langenbeck from Berlin is said to have performed the first Le Fort I osteotomy in 1859. After minor changes, Wassmund corrected a posttraumatic malocclusion by a Le Fort I osteotomy in 1927. But it was Axhausen who risked the total mobilization of the maxilla in 1934. By additional modifications and further refinements, Obwegeser paved the way for this approach to become a standard procedure in maxillofacial surgery. Tessier mobilized the whole midface by a Le Fort III osteotomy and showed new perspectives in the correction of severe malformations of the facial bones, creating the basis of modern craniofacial surgery. While the last 150 years were distinguished by the creation and standardization of surgical methods, the present focus lies on precise treatment planning and the consideration of functional aspects of the whole stomatognathic system. To date, 3D visualization by CT scans, stereolithographic models, and computer-aided treatment planning and simulation allow surgery of complex cases and accurate predictions of soft tissue changes.

Europe↗
PubMed1988

[Clinical analysis of trigeminal neuropathy as initial manifestations--an etiological study].

The differential diagnosis of trigeminal neuropathy is quite challenging because there is a significant variety of causes for the disorder. We reviewed our cases of trigeminal neuropathy by studying first the initial manifestations in order to evaluate their underlying disorders. Sixty-four patients with trigeminal neuropathy came to our Out-Patients clinic. We have excluded from our analysis any patients with atypical pain, facial migraine, nasal sinusitis, pain from inflammation of dental pulp or facial bones, and pretrigeminal neuralgia. In 53 cases (83%) we identified the causes; 35 of them were cases of symptomatic trigeminal neuritis and 18 were trigeminal neuralgia while, in the remaining 11 cases, no definitive causative disorder was identified. Among the 35 patients with symptomatic neuritis, 10 cases were found to have malignant neoplasms including 5 cases of squamous cell carcinoma, 6 had a virus infection, 5 had traumatic origin, 4 had multiple sclerosis, 2 exhibited Tolosa-Hunt syndrome, 2 had MCTD, and there were single cases of sarcoidosis, serpentine aneurysm, cavernous sinus thrombosis, maxillary cyst and trigeminal neurinoma. The remaining 11 cases of neuritis whose causes were undetermined showed clinical features similar to trigeminal sensory neuropathy, an analogue of Bell's palsy, a benign self-limiting condition. Since the cases shared symptoms of impairment of taste, and, occasionally, of facial palsy, vestibular insufficiency, hearing disturbance, hypoglossal palsy or signs of cerebellar lesion, we strongly suspected a virus origin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

[Maxillo-facial prostheses: an issue in public health].

BACKGROUND: Acquired or congenital loss of structure can cause facial deformity. This can destroy identity and lead to certain forms of exclusion. Surgical and sometimes prosthetic reconstruction is required. The Maxillofacial Prosthesis (P.M.F) can be defined as the art and science of artificial reconstruction of facial bones. There is a continual increase in patient demand for this type of prosthesis with the development of new materials, methodologies and techniques. METHODS: In Toulouse, the Rangueil University Hospital houses a maxillofacial prosthesis consultation facility linked to the Odontology Service. An exhaustive descriptive study carried out retrospectively on the basis of the files of all patients examined between July 1996 and July 2002 will provide us with an understanding of patient characteristics and also enable us to quantify the level of satisfaction of requirements for rehabilitation of these losses of maxillofacial structure. RESULTS: 215 patient files were processed between July 1996 and July 2002. Separating the patients by sex shows a male prevalence of 66%. An analysis of variations between male and female patients for different aetiologies shows that tumour pathologies are more common in men and that this distinction is all the more marked as regards traumatic facial injuries and in particular suicide attempts. In total, 401 maxillofacial prostheses were carried out, including 116 facial epitheses (new prostheses or renewal of prosthesis). CONCLUSION: Loss of facial structure, whatever its aetiology constitutes a real public health issue. The maxillofacial prosthesis will allow cancer monitoring of the site while at the same time offering out patient treatment. Above and beyond its crafted or empirical aspect, it should find its place in medicine thanks to the overall scope of the rehabilitation that it can offer from both an aesthetic point of view but also a the psychological one, but above all from a functional perspective.

Face↗
PubMed1994

[Esthetic incisions in traumatology involving the mid-face region].

For exposure of the facial bones and orbital floor, various types of incisions can be employed. For exposing the orbital rim, a subciliary incision may have the disadvantage of producing chronic edema and shortening of the lower lid. The transconjunctival approach combined with lateral canthotomy avoids an external scar and allows sufficient exposure of orbital floor and zygomatico-frontal suture line. The placements of implants and osteosynthesis are then possible. In severe midfacial trauma the authors prefer temporo-temporal incision combined with a conjunctival approach, lateral canthotomy and intraoral access to the zygomatico-maxillary area.

Esthetics↗
PubMed1998

Initial evaluation and management of gunshot wounds to the face.

BACKGROUND: The literature on early management of gunshot wounds (GSWs) to the face is scant, with only six series reported in the English-language literature in the last 12 years. In the current study, we present a large series from a busy trauma center in an effort to identify early diagnostic and therapeutic problems and recommend management guidelines. METHODS: Retrospective analysis was done for all GSWs of the face during a 4-year period. Data were obtained from the Trauma Registry and Trauma Patient Summary hard copies. RESULTS: During the study period, there were 4,139 admissions for GSWs, with 247 (6%) involving the face. An associated brain trauma was found in 42 patients (17.0%), and cervical spine fracture was found in 20 patients (8.1%) with GSWs to the face. In 43 patients (17.4%), there was a need for emergency airway control because of local hematoma or edema. Angiography was performed in 70 patients (28.3%) for evaluation of a large hematoma or continuous bleeding, and in 10 of these patients successful embolization of bleeders was achieved. No patient required operative control of bleeding from facial structures. Overall, only 96 patients (38.9%) underwent operation for soft-tissue repair or reduction of facial bone fractures. There were 36 deaths (14.5%) from severe brain injury or severe bleeding from associated chest or abdominal injuries. No death occurred in isolated GSWs to the face. CONCLUSION: Most civilian GSWs can safely be managed nonoperatively. Airway control is required in a significant number of patients and should be established very early. Bleeding from the face is best controlled angiographically. The brain and cervical spine should be aggressively assessed radiologically because of the high incidence of associated trauma.

Adolescent↗
PubMed1980

[Osteodysplasty (Melnick-Needles syndrome) (author's transl)].

Authors report a new case of osteodisplasty (Melnick-Needles syndrome) and describe radiological findings that are typical of this entity: bony sclerosis of base structures, abnormal dental alignment, sclerosis and irregularity of clavicles and ribs, described as "band-like" deformity, cortical irregularity of tubular bones with metaphyseal flaring and diaphyseal bowing. Flat bones are broadened, particularly iliac crest and vertebral bones. Facial features described by the majority of authors in this entity are present in our patient in an incomplete form: craniofacial disproportion, micrognatia, depressed temples, exophthalmus (not in our patient) and broadened forehead. The paper is intended to gather clinical data of already reported cases in order to facilitate clinical research in the future from the immunological, genetical and biochemical points of view. Our patient has the same clinical history as the patient studied in the original paper. Dr. Melnick was kind enough to send us clinical data and autopsy findings.

Bone and Bones↗
PubMed2004

Facial computed tomography use in trauma patients who require a head computed tomogram.

PURPOSE: Head-injured patients admitted to a trauma center may or may not have associated facial fractures. Most head-injured patients undergo head computed tomography (CT) scan early in their evaluation. The question of adding a facial CT at the time of the head CT can be unclear. The aims of our study are 1) to analyze how the facial CT is used in conjunction with the head CT in facial fracture trauma patients, 2) to recognize unique identifiers that would aid the surgeon's decision-making process to order a facial CT in continuity with a head CT, and 3) to examine what is characteristic of head trauma patients who receive a facial CT separately, at some point after the head CT. Materials and methods Data were retrospectively reviewed for a 5-year period at a level I trauma center in which all patients who present with craniomaxillofacial trauma are managed by the oral and maxillofacial surgery (OMFS) service. Included patients must have obtained a head CT during initial resuscitation and be diagnosed with a facial fracture during the same hospital stay. These patients were divided into 3 groups: those who had a 1) head CT only, 2) head CT and facial CT at the same time, and 3) head CT with the facial CT performed at a later time. RESULTS: A total of 9,871 patients were admitted to the trauma service during a 5-year period and 4,926 patients (49.9%) had head CT performed. Of this group, 12% had facial fractures, and the most common associated injury in this group was facial lacerations and concussions. The nasal fracture followed by the orbital fracture was the most common fracture type. Eighty-four percent of the time, the facial CT was used to help diagnose facial fractures in this patient population. The 3 different groups showed unique trends. CONCLUSION: Six points were identified in our study that can augment the physical examination in patients who require head CT. The following points can help prompt the clinician to order a combination head and facial CT: 1) 12% of trauma patients who require a head CT will have a facial fracture, whereas half of these patients will have multiple facial fractures. 2) Orbital fractures are commonly missed in this group and often require a secondary scan such as coronal views for accurate diagnosis. 3) Facial lacerations correlate with ordering a combination head and facial CT. 4) The most common facial fracture identified among patients receiving a trauma head CT is the nasal fracture. 5) The use of the facial CT in more severely injured patients tended to be delayed and was related to increased hospital and intensive care unit days. 6) Only 16% of facial fracture patients who had received an initial trauma head CT did not require further facial CT scanning.

Adult↗