Asunto(s)
Neoplasias Mandibulares/diagnóstico , Diente Molar , Tumores Odontogénicos/diagnóstico , Femenino , Humanos , Mandíbula , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/patología , Persona de Mediana Edad , Diente Molar/diagnóstico por imagen , Diente Molar/patología , Tumores Odontogénicos/diagnóstico por imagen , Tumores Odontogénicos/patología , Radiografía PanorámicaRESUMEN
The central granular cell odontogenic tumor (CGCOT) is a rare odontogenic neoplasm, usually occurring in the mandible of middle-aged women. Previous studies have reported only 34 cases, all of whom were white or black individuals. The present study reports an additional case of CGCOT, occurring in the posterior mandible of a 69-year-old Taiwanese man. To the authors' knowledge, this is the first reported case in Oriental people. The odontogenic epithelium exhibited strong positive immunoreactivity for pan-cytokeratin, and focal weak staining for bcl-2. The granular cells showed strong positivity for vimentin and α1-antichymotrypsin, and focal weak staining for carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and CD68. These features indicated a mesenchymal origin and possible histiocytic lineage for the granular cells. This study also presents a literature review and describes immunohistochemical features of the tumor.
Asunto(s)
Tumor de Células Granulares/patología , Neoplasias Mandibulares/patología , Tumores Odontogénicos/patología , Anciano , Diagnóstico Diferencial , Tumor de Células Granulares/diagnóstico , Humanos , Inmunohistoquímica , Masculino , Tumores Odontogénicos/diagnósticoRESUMEN
The reconstruction of a through-and-through cheek defect with oral commissure involvement can be challenging. When attempting to reconstruct its seam-like structure or to replace its supple lip tissue, postoperative morbidities such as drooling, microstomia, and poor aesthetic appearance can often occur and be difficult to correct. After inspecting the oral commissure, one can observe that the morphology of the upper lip acts as a "drape" hanging over the upper teeth, whereas the lower lip functions similarly to a "dam" holding the constant pour of saliva within the oral cavity. We noted that if we tailored a single fasciocutaneous flap to satisfy these morphologies during reconstruction, not only were the mentioned morbidities of reconstruction greatly diminished, but the reconstructed oral commissure could also spontaneously mimic the contralateral side in form. We presented 10 consecutive patients with cheek defects with concomitant oral commissure involvement, which underwent reconstruction by using a single-folded fasciocutaneous flap. We described how the flaps are tailored to suit the mentioned upper and lower lip morphology. For certain defects, such as a cheek defect with oral commissure involvement, the loss of functional morphology greatly outweighs its anatomical or tissue losses. Our method provides a simple and straightforward surgical option in this area, which was previously perceived as a challenging reconstruction site.
Asunto(s)
Mejilla/cirugía , Labio/cirugía , Neoplasias de la Boca/cirugía , Colgajo Perforante , Procedimientos de Cirugía Plástica/métodos , Adulto , Humanos , Masculino , Persona de Mediana EdadRESUMEN
To optimize the outcome of the free fibula flap in mandibular reconstruction, the central portion of the mandible can be divided into upper and lower arches during preoperative evaluation and planning. We present 2 cases requiring mandibular reconstruction with free fibula flap after ameloblastoma excision, to illustrate the "two arches" concept and its applicability in mandibular reconstruction. The postoperative course was uneventful. Follow-up at 24 months postoperative revealed a considerable restoration in facial appearance and provided functional teeth. Recent advances in mandibular reconstruction could be further refined through the application of the "two arches" concept. This approach simplifies surgical planning in selective cases and directs the attention of surgeons to the specific needs of the 2 distinct regions of the mandible during reconstruction.