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A short history and introduction to radioisotopes used in bone scanning is presented. Five cases of malignancy with bone involvement of the head and neck region are described to demonstrate this technique.
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Midface osteotomy was performed on 5 young adult sheep aged 10-12 months. In 4 animals midface advancement by gradual distraction was performed using an external device; one animal served as a control. The midface was advanced by 2 mm per day for 21 days. The amount of advancement was 36 mm in the nasofrontal area and 43 mm on the lateral aspect of the maxilla. After the period of active distraction the midface was maintained with external fixation for an additional 6 weeks to allow for ossification. Radiographs were obtained immediately postoperatively, after 21 days of distraction, and at the end of the 6 week fixation period. New bone formation in the distracted area was obvious radiographically, clinically and histologically. In conclusion, midface advancement by osteotomy and gradual distraction is possible in the sheep model and may offer controlled correction of deformity, obviating the need for the bone grafting.
Facial contact with the steering wheel was the most common source of maxillofacial injuries sustained by vehicle occupants. Maxillofacial injuries to non-restrained occupants, especially children, most commonly resulted from contact with the vehicle's seats. In contrast to previous studies, contact with the windscreen by non-restrained occupants produced only a small number of minor facial injuries. Serious fractures of the facial skeleton were rare and no maxillofacial injury was fatal. A relationship between impact speed and the severity of facial injury sustained was demonstrable. Total compliance with seat belt legislation could be expected to save the National Health Service in excess of 5 pounds million/year from the reduction in maxillofacial injuries alone.
The first case of prenatal real-time ultrasonographic diagnosis of micrognathia is presented. Diagnosis was made at 17 weeks' gestation in the fetus of a patient with previous infant affected with the syndrome of thrombocytopenia with absent radii (TAR). Recognition of micrognathia as a part of TAR syndrome and the easy visualization of fetal facial bones in the second trimester made diagnosis possible.
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Aggressive juvenile fibromatosis involving the facial bones is rare, difficult to diagnose clinically, histologically confusing, and requires aggressive surgical treatment. Only four cases involving the mandible have been previously reported. A review of the literature is presented here in conjunction with a case report of this rare tumor.
Radiographic examination of the facial bones frequently reveals osteolytic and osteoblastic changes. A case of undifferentiated large-cell carcinoma of the lung with metastasis to the anterior maxilla is reported. Intraoral dental radiographs revealed an ill-defined lytic area in the left anterior maxilla. The periphery of the lesion revealed saberlike extensions of bone extending into the lytic defect. Cytologic and biopsy studies of the oral mucosa led to identification of the tumor as an undifferentiated large-cell carcinoma of the lung.
Invasive and metastatic oral carcinomas can and often do result in pathologic fractures of the facial bones. Three cases of invasive oral carcinomas resulting in fractures of the mandible have been reported. It was only after multiple-view radiographs that pathologic fractures could be identified. It is mandatory that dental practitioners avail themselves of the radiographic views which assist in establishing a diagnosis. In addition, the role of the dental profession in diagnosing primary and secondary oral carcinomas cannot be overemphasized.
Angiographic findings in seventy cases of maxillofacial hemangioma are reported. The tumors have been divided into four types: (1) plexiform hemangioma, (2) cavernous hemangioma with venous drainage, (3) cavernous hemangioma without venous drainage, and (4) the so-called "diffuse type" of cavernous hemangioma. The angiographic features of the four types are described, and clinical application is evaluated. The angiograms demonstrate the location, extent, blood supply, and drainage of the tumors and show whether they communicate intracranially, thus providing valuable criteria for planning and determining the mode of treatment.
A significant proportion (31%) of southern (Hong Kong) Chinese patients who received therapeutic transcutaneous electrical stimulation with the Myo-Monitor experienced uncomfortable twitching of the muscles of facial expression of the upper and middle portions of the face. This can be attributed, at least in part, to anatomic variation in the position and branching pattern of the upper (temporofacial) division of the facial nerve in the sample population. Our observations of living patients support the contention that muscular contraction resulting from Myo-Monitor stimulation is neurally mediated.
A clinicopathologic study of five patients with Paget's disease of the jaws is reported. All patients had well-documented cases of osteitis deformans with polyostotic involvement. Histologic studies of facial bones could be performed because surgery was necessary for either cosmetic or functional reasons. Three specimens consisted of maxillary bone, and two were mandibular. Microscopically, all cases showed multiple and irregular fibroproliferative lesions containing mineralized structures intermingled with bone characteristic of Paget's disease. The purpose of this article is to present these fibro-osseous lesions in relation to Paget's disease of the jaws and to emphasize their close resemblance to other benign fibro-osseous lesions of the jaws, especially cementifying and ossifying fibroma, and florid osseous dysplasia.
Fifty patients with maxillary fractures treated by closed reduction over an 85 month period at a Level I trauma center were reviewed. Thirty patients (60%) experienced forty-one midfacial complications. The most frequent problems were infraorbital nerve paresthesia (12), enophthalmus (5), septal deviation (3), and altered vision (3). No relationship could be established between complications and age, sex, cause of injury, or the method of suspension used. Most complications were related to concomitant injury or the concurrent management of fractures of other facial bones. Only eight problems (16%) were directly attributed to the closed reduction of maxillary fractures. Patients treated by closed reduction and maxillomandibular fixation without suspension experienced no surgical complications.
BACKGROUND: Up to 60% of the patients with known adenomatous polyposis coli may present hyperostosis of the skull and facial bones, and/or a susceptibility to fibromas. This is known as the Gardner's syndrome, and is considered as an allelic variant of familial adenomatous polyposis (FAP). Also, although very rare, an adenomatous polyposis coli may occur with malignant tumors of the central nervous system, known as Turcot syndrome. If both syndromes are different phenotypic presentation of FAP, this would explain a simultaneous occurrence. METHOD: We report the history of a patient who showed clinical signs of the simultaneous occurrence of both Gardner's and Turcot syndromes. The syndromes are compared, and in view of the literature, a genetic explanation for the concomitant occurrence is discussed. RESULTS: Evidence obtained from the literature to consider Turcot syndrome as a phenotype of FAB is as follows: (1) The occurrence of Gardner's and Turcot syndromes in one family, but in different members; (2) The presence of congenital hypertrophic retinal pigmented epithelium (CHRPE), which correlates with the expression of polyps in FAP patients, in both syndromes; (3) Linkage of the Turcot phenotype to the adenomatous polyposis coli locus by genetic markers. Evidence obtained from this case report indicates that there is a manifestation of both syndromes in one patient together with a positive family history for FAP. CONCLUSION: This concomitant occurrence of both Gardner's and Turcot syndromes in one patient clinically supports genetic and ophthalmic investigation to consider Turcot syndrome (like Gardner's syndrome) as a phenotypic variant of FAP. Patients with FAP should be examined for the presence of Gardner's syndrome. In case a Gardner's syndrome is suspected, a computed tomography scan of the brain is recommended because of the possible existence of a simultaneous Turcot syndrome.
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A study of 34 patients who were investigated for maxillofacial trauma using high resolution computed tomography (CT) scanning is presented. The areas where this increasingly available technique offers more accurate information than conventional plain radiographs are discussed.
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