Bone obstacles to successful lower dentures and their surgical elimination.
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Nine patients, five women and four men, demonstrated bone growth in an edentulous region of the posterior mandible covered with a pontic. The reasons for this bone growth could include genetic predetermination, functional stresses, and chronic irritation. This bone growth has important clinical and basic science implications. The condition was seen only in adults, only in the mandibular posterior region, and with a variety of pontic designs. Subpontic osseous proliferation was documented in nine patients, but no conclusion about the etiology was made.
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A case of unilateral mandibular coronoid enlargement associated with facial asymmetry and severe limitation of mandibular movement in a 19-year-old male patient is described. The indications for treatment and the types of surgical approach for removal of the enlarged process are discussed. The dual surgical approach required for resection of the coronoid in this case is described.
A rare case of midline cervical webbing with microgenia and a submental bony spur in a 6-year-old boy is presented. An area of ulceration was associated with the web, and a sinus was identified histologically in the region closely related to a cyst lined with pseudostratified ciliated columnar epithelium. The developmental origins of these lesions are discussed. Primary management comprises excision and Z-plasty, but mandibular surgery may be necessary at a later stage.
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A modified technique for fabricating a maxillary acrylic surgical stent has been described. This simplified technique is not only highly efficient but also simplifies the laboratory procedure. This modified technique may also be used effectively with patients who have mandibular tori.
Florid osseous dysplasia (FOD) is confused in the literature with chronic diffuse sclerosing osteomyelitis. Two cases of each condition are presented to demonstrate the differences between them. In FOD, there are multiple lobulated sclerotic masses in several quadrants of the jaws, usually in black females. In some cases, the sclerotic masses are exposed to the oral cavity, resulting in a secondary osteomyelitis. Periapical cemental dysplasia is often found in association with FOD. Chronic diffuse sclerosing osteomyelitis is a primary inflammatory condition of the mandible. Patients have cyclic episodes of unilateral pain and swelling. The affected region of the mandible exhibits a diffuse opacity with poorly defined borders. Although women are affected more often than men, black persons are not particularly susceptible.
Two cases of exostosis developing after mandibular vestibuloplasty and floor-to-mouth lowering with split thickness skin graft are presented, one with multiple recurrences. The lesion is clinically and microscopically described. Hypotheses with respect to the development of this phenomenon are proposed.
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Specific techniques to treat temboromandibular joint (TMJ) hypomobility caused by capsular restriction are explained. Initially inflammation must be controlled. TMJ manipulation by condylar distraction during opening, protrusion, and lateral movements, and a simple stretching exercise to maintain increased mandibular range of motion, are described. Resistive opening and closing exercises at full opening to relax the lateral pterygoid muscles are prescribed. For all exercises five repetitions, repeated five times per day, are prescribed. These techniques are demonstrated in the successful treatment of a child with a presurgically and postsurgically hypomobile right TMJ.
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A patient presented with signs and symptoms of cervical spinal cord compression. Computed tomography (CT) scan showed diffuse idiopathic hyperostosis of the posterior vertebral border of C4, C5, C6, and C7 cervical vertebrae, with severe spinal stenosis at C5 and C6 level. Computed tomography scan is the single most useful instrument for demonstrating the extent of bony proliferation and severity of spinal stenosis.