[Mandibular neoplasms--hemiresection and immediate resection].
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In a 5-year period, 30 titanium implants (Bowerman and Conroy 1969) were utilised for the reconstruction of mandibular defects following tumour operations. Of these, 20 implants were removed prematurely. Reasons for early removal were: 1. postoperative dehiscence of wound (5), 2. perforation through the skin or mucosa (5), 3. infection of graft bed (7), 4. breakage of the implant (1), 5. tumour recurrence (2). A total of 9 implants were retained for one or more years. The results are compared with those of Bowerman (1974). Reasons for the early loss as well as the clinical implications are discussed.
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When confronted with a case of angioma of the mandible, treatment should be directed towards two main areas:--to stop blood loss. Ligature of the external carotid can be life-saving, but it does not prevent the formation of nearby anastomotic vessels which refill, more or less rapidly, the external carotid axis. Ligature make embolization impossible by femoral way. A by-pass operation to improve permeability is also dangerous if not impossible. Ligature should be reserved only for those cases in which there is an immediate threat to life. On the contrary, embolization is necessary before surgery. --to treat the angioma. As radiotherapy is not effective or is dangerous, surgical treatment is necessary; either by a conservative operation or by radical resection. All these facts are illustrated dramatically by the case reported.
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Mandibular reconstruction is one of the most challenging fields in plastic and reconstructive surgery. Deficiencies of the mandible occur in congenital anomalies, trauma, oral and mandibular neoplasms and osteoradionecrosis. Conventional reconstructive aids like bone grafting or insertion of a metallic implant often fail in such situations due to poor local blood supply, deficient oral lining, inadequate skin coverage, large mandibular defects, irradiated fields or infected wounds. A free vascularized bone graft of a osteocutaneous flap overcomes the incompetence of conventional mandible reconstruction. It offers not only a desirable length of vascularized bone, but also has an adequate skin lining for oral mucosa and external tissue deficiencies, as well as a "sandwich reconstruction" for the mandible. The results are usually satisfactory in terms of function and aesthetics. Experience in 8 cases with iliac and scapular osteocutaneous free flaps are presented and discussed in this report. We conclude that a vascularized bone graft, especially the iliac crest, provides reliable and contented results for major mandibular reconstruction.
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A 7-month-old female mouse was killed after developing lethargy, rough hair coat and enlarged superficial lymph nodes. Postmortem and histologic examination revealed lymphocytic leukemia involving several organs and a bilateral mast cell neoplasm in the mandible.
Reconstruction after mandbulectomy for cancer presents a major problem in head and neck surgery. This study reports the experiences with a planned staged method of reconstruction that aims at both cosmetic and functional rehabilitation and that is based on a close cooperation between surgeon and prosthodontist. Stabilization of the remaining mandibular fragments by means of intermaxillary fixation at the time the tumor is resected, delayed bone grafting, and preprosthetic surgery to allow the use of a functional denture are the high points of the method. The results in 58 patients are discussed.
A case of delayed pulmonary metastases from an ameloblastoma of the mandible, which occurred 20 years after surgical resection of the primary tumor but with no recurrence at the primary site, is reported. Combination chemotherapy using cisplatin, adriamycin, and cyclophosphamide has produced a very good clinical and radiologically documented response in this case.
The ideal natural or prosthetic mandibular replacement should be adjustable at the time of surgery, completely stable, free from tissue reaction or rejection, rapidly incorporated into surrounding tissue, and unlimited in lifespan. A brief review of clinically utilized mandibular replacements is discussed in relation to the ideals. At this time the replacement most adequately satisfying these principles is autogenous cancellous bone and marrow supported by a titanium mesh trough. This article describes the details of external mandibular fixation and the reconstructive procedure including preoperative preparation and common postoperative complications. Modifications of the prosthesis and surgical technique are suggested in order to decrease the chances of postoperative exposure, a complication in any type of mandibular reconstruction.
Forty-nine cases of primary tumors of the mandible have been reviewed. The anatomic location, pathologic features, sites of metastases, survival rates, and treatment methods were evaluated. Lesions studied included ameloblastoma, osteogenic sarcoma, reticulum cell sarcoma, fibrosarcoma, chondrosarcoma, myxosarcoma, epidermoid carcinoma, adenocarcinoma, and giant cell sarcoma. An in-depth discussion of primary osteogenic sarcoma of the mandible is presented. Because of upper cervical lymph node metastases in two cases of osteogenic sarcoma of the mandible, an upper neck dissection should be considered in the primary treatment. Also presented in this study are the first reported cases or primary myxosarcoma of the mandible and giant cell sarcoma of the mandible. Recent methods of treatment of ablative resection of the mandible followed by immediate or delayed repair are discussed. A revised technic for mandibular replacement which has met with success in six of seven cases is presented.
The clinical and pathologic features of congenital granular-cell myoblastoma in five infant girls are reported. One lesion, treated expectantly, progressively decreased in size and after 3 yr and 9 mo could not be detected, while two lesions which were imcompletely excised did not recur. It is suggested that congenital granular-cell myoblastoma is caused by an intrauterine stimulus, and that this stimulus may possible be production of estrogen by the fetus. Congential granular-cell myoblastoma should be treated expectantly or by limited excision, and has an excellent prognosis.
Epithelial islands in association with nerve fibers in the jaw bones have been reported previously. We describe two such cases and present evidence that the epithelial structures as observed in this study are odontogenic rests and not neuroepithelial organs. Regardless of origin, it should be recognized that these epithelial islands do not represent neural invasion by carcinoma.
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This study constitutes a follow-up of a study completed in March 1988, involving 18 patients receiving bone plate stabilization for the repair of surgical defects after mandibular resection. An additional 11 cases are presented with follow-up periods of 3 to 23 months. Of the original study of 18 patients, follow-up was available for 13. Of these 13, five patients died, three as a result of their tumors. One patient was previously reported to have had recurrent disease and loss of the stabilization plate. One patient lost the plate in an area of recurrent tumor just before succumbing to his malignancy. The remaining three died with their stabilization plates in place and functioning. The eight remaining patients with long-term follow-up and 11 additional patients with shorter-term results are now described.
Two cases of metastatic renal clear cell carcinomas of the mandible are presented in which the jaw symptoms preceded the discovery of the primary lesions. Their presentation mimicked vascular abnormalities both clinically and on special investigations and both required biopsy, one of which was a major excision, for diagnosis. The histological differential diagnosis of metastatic renal clear cell carcinoma from other clear cell tumours arising in the orofacial tissues can also be difficult, often requiring specialised knowledge and techniques. These points illustrate that the differential diagnosis of a pulsatile soft tissue jaw tumour developing below intact mucosa and eroding bone, should include metastatic tumour as well as vascular anomaly, vasoformative tumour, extra nodal lymphoma and primary bone tumour.