RESUMEN
BACKGROUND: Chondroblastomas, which account for approximately 1% of all bone tumors, typically occur in long bones, such as the femur, humerus, and tibia. However, in extremely rare cases, they may also occur in the craniofacial region where the tumor is often found in the squamous portion of the temporomandibular joint (TMJ) and in the temporal bone. CASE PRESENTATION: This case report describes a large chondroblastoma (diameter, approximately 37 mm) that occurred in the TMJ. The tumor was sufficiently aggressive to destroy the TMJ, mandibular condyle neck, external auditory canal (EAC), mandibular fossa of the temporal bone, and facial nerve. The tumor was completely excised using a pre-auricular approach. The EAC and surgical defect were successfully reconstructed using a temporoparietal fascia flap (TPFF) and an inguinal free fat graft. There was no local tumor recurrence at the 18-month follow-up visits. However, the patient developed sensory neural hearing loss, and his eyebrow paralysis worsened, eventually requiring plastic surgery. CONCLUSION: Large, invasive chondroblastomas of the TMJ can be completely removed through a pre-auricular approach, and the resulting surgical defect can be reconstructed using TPFF and free fat grafts. However, preoperative evaluation of the facial nerve and auditory function is necessary. Therefore, a multidisciplinary approach is essential.
RESUMEN
BACKGROUND: Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction. CASE PRESENTATION: This case report describes a monostotic fibrous dysplasia in which the patient's right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort. CONCLUSIONS: In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.
RESUMEN
BACKGROUND: Oroantral communicating defects, characterized by a connection between the maxillary sinus and the oral cavity, are often induced by tooth extraction, removal of cysts and benign tumors, and resection of malignant tumors. The surgical defect may develop into an oroantral fistula, with resultant patient discomfort and chronic maxillary sinusitis. Small defects may close spontaneously; however, large oroantral defects generally require reconstruction. These large defects can be reconstructed with skin grafts and vascularized free flaps with or without bone graft. However, such surgical techniques are complex and technically difficult. A buccal fat pad is an effective, reliable, and straightforward material for reconstruction. CASE PRESENTATION: This report describes three cases of reconstruction of large oroantral defects, all of which were covered by a pedicled buccal fat pad. Follow-up photography and radiologic imaging showed successful closure of the oroantral defects. Furthermore, there were no operative site complications, and no patient reported postsurgical discomfort. CONCLUSION: In conclusion, the use of the pedicled buccal fat pad is a reliable, safe, and successful method for the reconstruction of large oroantral defects.
RESUMEN
The purpose of this study was to evaluate if the arch coordination manifested by preorthodontics had an effect on the short-term stability after orthognathic surgery by evaluating the B point, menton, overjet, and overbite. The subjects were 10 healthy adult female and male Koreans (mean age, 24.9 years) with insufficient arch coordination and 10 healthy adult female and male Koreans (mean age, 22 years) with sufficient arch coordination. All subjects had sagittal split ramus osteotomy with 1-piece maxillary Le Fort I surgery with/without genioplasty done from the same practitioner at Kyung Hee University Hospital at Gangdong from 2009 to 2011. All arch widths of the maxilla and mandible were measured. Cephalometric tracings of the subjects were made of the presurgical and postsurgical period with a follow-up at 3 months. Relapse was measured according to cephalometric tracing changes using the V-ceph Cephalometric Analysis Software version 5.5(Osstem, Seoul, South Korea). Insufficient arch coordination did not definitively affect the overall treatment outcome. There was significant difference in the horizontal dimensions of the mandible (vertical plane to point B, overjet) in the study group. The study group showed instability in orthodontic factors, whereas skeletal factors were stable. Vertical dimensions (horizontal plane to point B, horizontal plane to menton, overbite) were not statistically significant.
Asunto(s)
Arco Dental/anatomía & histología , Maloclusión de Angle Clase III/cirugía , Mandíbula/anatomía & histología , Maxilar/anatomía & histología , Procedimientos Quirúrgicos Ortognáticos/métodos , Cefalometría/métodos , Mentón/anatomía & histología , Arco Dental/cirugía , Femenino , Estudios de Seguimiento , Mentoplastia/métodos , Humanos , Masculino , Mandíbula/cirugía , Maxilar/cirugía , Osteotomía Le Fort/métodos , Osteotomía Sagital de Rama Mandibular/métodos , Sobremordida/patología , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Dimensión Vertical , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the tooth image measurements according to the tooth location and to calculate the magnification rate for comparison and analysis in digitalized panoramic and cone beam computed tomographic (CBCT) images. METHODS: A diagnostic template was fabricated and delivered on the preimplant sites. A 5-mm gutta-percha cone or a metal ball was inserted in the coronal part of each tooth. Panoramic images were obtained with Ortho stage (AUTO III N CM; Asahi, Japan) or Promax (Planmeca, Helsinki, Finland) and CBCT images were obtained with PANORAMIC CT (PSR9000N; Asahi) for each patient and the same region. The vertical length of the gutta-percha cone or the metal ball was measured and compared with the panoramic and CBCT images according to the tooth location. Magnification rate was compared between the 2 types of panoramic machines. RESULTS: About 1.09 to 1.28 magnification occurred in panoramic images, depending on the tooth location. The magnification rate was significantly different between the panoramic machines (Ortho stage, 1.27; Promax. 1.17). Almost no magnification of images occurred in CBCT images with no difference to the tooth location. CONCLUSIONS: In panoramic radiography, it is inappropriate to apply a general magnification ratio covering the whole image. For a more accurate implant surgery, the use of a metal ball or a premeasured gutta-percha cone on the preimplant site as standard measurement is recommended. However, in recently introduced CBCT, magnification of images did not occur, allowing it being used for accurate clinical procedures.