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A prospective evaluation was made of 71 patients with 102 mandible fractures managed with rigid internal compression plate and screw osteosynthesis and allowed to function immediately following surgery. An analysis of the data reveals that this method of internal fixation is an effective and predictable alternative for the treatment of fractures of the mandible.
Metastases to the mandible are rare. In this article, nine cases of tumors metastatic to the mandible of various origins and locations, including metastasis to the condyle, are reported. The most common primary tumor was breast adenocarcinoma (three cases). The clinical features, diagnosis, and treatment of metastatic lesions, especially emphasizing clinical and radiologic aspects, are described, and a review of the literature is presented.
A case involving primary lymphoma of the mandible is presented. The difficulties in diagnosis of this particular pathology are highlighted. The features of primary lymphoma of the mandible are described based on a review of the literature. Malignant lymphoma must be considered in the differential diagnosis of unexplained dental pain, swelling, ulceration, and radiographic evidence of rarefaction.
Ten new cases of peripheral osteoma of the mandible are described. These lesions are uncommon and only 15 other cases have been reported in the English language literature over the past 30 years. There is evidence to suggest that the peripheral osteoma of the mandible is a traumatically induced reactive lesion and that muscle traction plays a role in its initiation. In view of this possibility, the term "parosteal osseous hyperplasia" may be more appropriate for those lesions in which a positive history of trauma preceded the onset.
AIMS: To report the imaging features of osteomyelitis of the mandible in various two-dimensional multiplanar and three-dimensional reformations using cone beam computed tomography (CBCT). METHODS: The images were 12-bit DICOM files acquired with a 10cm field of view and voxel resolution of 0.4mm. Two-dimensional multiplanar reformatted reconstructions included coronal, "panoramic" (variable thickness), and serial cross-sections. Three-dimensional reconstructions included surface renderings. Images were presented to referring oral and maxillofacial surgeons in "real time" immediately after acquisition. RESULTS: The features of mandibular osteomyelitis seen on CBCT included: a peripheral sclerotic rim, cortical layering (involucrum), central loss of trabecular pattern with internal round radiolucent resorptive tracts, minimal jaw expansion, and reduction of the alveolar cortex. Sequestra were occasionally evident. The history and presentation of each case on CBCT were consistent with osteomyelitis of the mandible; however, the clinical differential diagnosis in each case had included malignancy. The definitive diagnosis was confirmed by histological examination of biopsy specimens. Two of the three cases were patients who had been treated with bisphosphonates. CONCLUSION: CBCT facilitated comprehensive and dynamic imaging of the jaws based on surgical consultation, rather than inflexible imaging protocols. CBCT images guided operative planning.
Langerhans' cell histiocytosis (LCH) can involve virtually any site and organ of the body, either as an isolated lesion or as a widespread systemic disease. Bone can be involved as a part of generalised disease or as a separate entity, formerly known as eosinophilic granuloma. The clinical cause of localised LCH (LLCH) to bone is generally benign. Solitary bone lesions may resolve spontaneously after diagnostic biopsy in a period of months to years. If treatment is indicated, as in larger lesions with pain, swelling and risk for spontaneous fracture, the disease can be controlled by chemotherapy or local measures such as surgical curettage, low-dose radiotherapy and intralesional injection of corticosteroids. There are no controlled studies in the literature comparing outcomes of these treatment modalities because of low incidence of the disease and general tendency to regress. Three patients (female, 28 months; male, 9 years; male, 15 years) with LLCH of the mandible were treated in an one stage procedure with intralesional injection of 80, 40 and 80 mg methylpredisolone succinate, respectively, as the primary form of treatment. Patients were seen for clinical and radiological evolution 1, 3, 6, 9 and 12 months after treatment, and yearly thereafter. The overall outcome was excellent. The lesions showed clinically and radiologically complete remission approximately 6 months after treatment. There were no complications nor morbidity of the treatment. After a follow-up period of 12 months, the patients are well with no evidence of residual disease on radiographs. Local injection of corticosteroids should be the initial choice of treatment of LLCH of the mandible, because of the favourable treatment outcome in this disease and possible complications and lasting effects of surgery, radiotherapy and chemotherapy.
Melorheostosis is a linear bone dysplasia of unknown origin that may be associated with soft-tissue alterations. Although any part of the skeleton can be affected, this condition is rarely observed in the craniofacial region. Only seven cases of melorheostosis with craniofacial involvement have been reported and cranial manifestation only is even rarer. To the authors' knowledge, manifestation in the mandible only has not yet been documented. A patient with isolated melorheostosis of the mandible with characteristic symptomatic bone pain is presented. The clinical, radiological and histological findings are described and possible therapeutic options are discussed.
One of the most significant characteristics of the temporomandibular joint (TMJ) is that it is in fact composed of two joints. Several finite element simulations of the TMJ have been developed but none of them analysed the different responses of its two sides during nonsymmetrical movement. In this paper, a lateral excursion of the mandible was introduced and the biomechanical behaviour of both sides was studied. A three-dimensional finite element model of the joint comprising the bone components, both articular discs, and the temporomandibular ligaments was used. A fibre-reinforced porohyperelastic model was introduced to simulate the behaviour of the articular discs, taking into account the orientation of the fibres in each zone of these cartilage components. The mandible movement during its lateral excursion was introduced as the loading condition in the analysis. As a consequence of the movement asymmetry, the discs were subjected to different load distributions. It was observed that the maximal shear stresses were located in the lateral zone of both discs and that the lateral attachment of the ipsilateral condyle-disc complex suffered a large distortion, due to the compression of this disc against the inferior surface of the temporal bone. These results may be related with possible consequences of a common disorder called bruxism. Although it would be necessary to perform an exhaustive analysis of this disorder, including the contact forces between the teeth during grinding, it could be suggested that a continuous lateral movement of the jaw may lead to perforations of both discs in their lateral part and may damage the lateral attachments of the disc to the condyle.
A 53-year-old patient with a giant osteoma of the right mandible is presented. The clinicopathological features of osteoma of the mandible are discussed and Gardner's syndrome was excluded.
PURPOSE: Benign fibrous histiocytoma (BFH) is a very rare benign tumor occurring in the jaw. The purpose of this article is to describe the clinical, radiographic, and microscopic appearance of BFH occurring in the mandible. STUDY DESIGN: A 42-year-old man had an asymptomatic swelling of the left mandibular posterior area. RESULTS: Conventional radiographs revealed a well-defined multilocular radiolucency involving the left mandibular body, ramus, coronoid process, and condylar head. The lesion showed the thinning and expansion of the cortex. There were many thin, indistinct septa in the lesion. The computed tomography (CT) scans showed bone destruction with marginal sclerosis and a heterogeneous soft-tissue mass expanding the mandible. Microscopic examination revealed a cellular tumor composed of uniform spindle-shaped cells arranged in a storiform pattern. CONCLUSIONS: BFH is a very rare benign tumor occurring in the jaw, so more cases should be reported to understand the characteristics of the lesion.
BACKGROUND: Aggressive fibromatosis (AF) involving the mandible is rare, and surgery is often complicated by a high recurrence rate. CASE REPORT: A 4-year-old boy was referred because of a fast growing painless mass which involved the entire left angle of the mandible. Excisional biopsy revealed AF, and local excision of the tumor was performed. Six months after surgery a recurrence was detected. The tumor was determined to be unresectable and the boy was treated with low-dose chemotherapy including methotrexate and vinblastine for 1 year. With combined chemotherapy and surgical debulking, mutilating surgical resection will be delayed as long as possible or until completion of facial growth. CONCLUSION: According to the literature, surgery is the most common treatment of AF in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations.
Segmental resection of the mandible with disarticulation of the temporomandibular joint is occasionally required in the management of extensive tumors. The reconstruction of these deformities is complex, frequently involves staged procedures, and may result in significant deformity and loss of function for patients. The fibula free flap has become a standard treatment option for primary restoration of segmental mandibular deformities. However, little is published about its role in reconstructing the mandibular condyle. This paper describes a simplified technique for primary reconstruction of mandibular defects, including the mandibular condyle, in disarticulation resections of the mandible utilizing the fibula free flap.
In 1948, Dr Kurt H Thoma, a leading authority of the day, published a paper on new methods for immobilization of the mandible in the first issue of this Journal. He reviewed the state of the art for management of patients with fractures of the mandible. By reviewing the paper now we can see how difficult to treat some of the injuries he saw were. This paper assesses his patient management in light of today's knowledge and experience. It discusses changes in therapy that have occurred during this over fifty-year time span. Although many things have changed since then, what has not changed is our desire to provide the best care for our patients using currently available scientific knowledge and clinical evidence.
Central intraosseous adenoid cystic carcinoma (ACC) of the mandible, formerly known as cylindroma, is a rare neoplasm with only 16 cases reported in the literature. We describe the diagnosis, etiology, and treatment of a central ACC located in the mandibular premolar region. We also review the literature. This case illustrates 2 key facts regarding the diagnosis and etiology of ACC. First, central salivary gland tumors should be considered in the differential diagnosis of cystic lytic lesions in the mandible. Second, even though the origin of this type of tumor is still unknown, the presence of ectopic tissue anterior to the submandibular gland in the submandibular area indicates that this tumor might be made up of ectopic embryogenic inclusions.
Osteopetrosis is a rare hereditary bone disorder presenting with variable clinical features and is characterized by an increase in bone density. The main clinical findings of the benign-type of osteopetrosis (autosomal dominant) are fractures and osteomyelitis of the mandible, leading to the detection of the disease. We report a case of autosomal dominant osteopetrosis with secondary mandibular osteomyelitis. Clinical and radiological patterns and treatment evaluation were assessed. The patient was referred for evaluation and treatment of an acute abscess in the left side of the face and osteomyelitis of the mandible. Several imaging studies were performed to assess the lesion and the adjacent bone and soft tissue structures. Treatment consisted of intravenous antibiotic therapy, debridement of the necrotic bone and sequestrum, and extra-oral drainage of the abscess, with submandibular access. Healing was uneventful.
Osteoblastoma is a benign neoplasm of bone characterized by a proliferation of osteoblasts forming bone trabeculae set in a vascularized fibrous connective tissue stroma. We report 24 examples of this neoplasm arising in the maxilla and mandible and compare the clinical and radiographic characteristics of this neoplasm to 53 previously reported examples of osteoblastoma and osteoid osteoma in the jaws. Our results reveal more females reported in the new examples of osteoblastoma than in the previously reported examples of osteoblastoma and osteoid osteoma. This raises the overall female percentage from 47.2% to 58.4%. In addition, significantly fewer patients reported pain, tenderness, and discomfort associated with their neoplasms than in previously reported cases. When all cases are combined, a predominant trend is observed whereby osteoblastoma occurs predominantly on the left side of the posterior mandible and is associated with pain, tenderness, and discomfort. We also provide a rationale for use of the term "osteoblastoma" for any benign osteoblastic neoplasm arising in the jaws.
OBJECTIVE: Myofibroma frequently manifests as a solitary soft tissue tumor and less as simultaneous multiple tumors in both soft tissues and bones. The present study evaluated clinical, radiological, and histopathologic features of myofibroma of the jaws. STUDY DESIGN: Nineteen cases from the literature and 4 new cases were analyzed. RESULTS: At initial diagnosis, age ranged from birth to 34 years (mean 7.2 years, median 6 years). Male/female ratio was 2.3:1. Myofibromas were radiolucent solitary lesions located solely in the mandible: 70% unilocular, 30% multilocular; 67% with well-defined borders. Conservative treatment was performed on 75% of the patients; 25% underwent partial jaw resection. Where information was provided, no lesion recurred during 6-month to 17-year follow-up. CONCLUSION: Although rare, myofibroma of the mandible should be considered in the differential diagnosis of radiolucent lesions (particularly unilocular), especially in children. Treatment of choice is conservative surgery to minimize potential functional and/or esthetic damage.
Cysticercosis is a parasitic infestation caused by the pork tapeworm larval stage, Cysticercus cellulosae. The majority of the cases present in ocular, cerebral, and subcutaneous locations. We report the presence of cysticercosis inside the submandibular gland in association with squamous cell carcinoma of the inferior alveolar ramus of the mandible. To the best of our knowledge, this is the first case report documenting cysticercosis inside a salivary gland. A 65-year-old male presented with complaints of an ulcerative lesion on the inferior alveolar ramus present for 2 months. Histological examination revealed a keratinizing well-differentiated squamous cell carcinoma involving the alveolar margin and mandible. The histopathological examination of the submandibular gland revealed cysticercosis. This case emphasizes the importance of adequate sampling of all the tissues obtained for associated infectious disorders, more so in immunosuppressed patients, which will help the clinician to manage the case appropriately.