Search

The oral pulse granuloma represents a rare form of oral foreign body granulomas and results from encapsulation of particles of vegetable nutrition. Histologically, the oral pulse granuloma consists of multinucleated foreign body type giant cells, hyaline rings and chronic inflammation tissue. Intraosseous granulomas can be distinguished from extraosseous granulo- mas. Intraosseous granulomas are often asymptomatic, whereas the extraosseous type may be clinically apparent as an indolent swelling of the mucosa. Therapy consists of curettage or surgical excision. We report on the clinical, radiological and histopathological characteristics of an oral pulse granuloma in the mandible associated with an erupting tooth 46 of a seven-year-old boy, and the surgical management and follow-up.

Background: Langerhans cell histiocytosis is characterized by a clonal proliferation of Langerhans cells. The clinical manifestation varies from a localized lesion (eosinophilic granuloma) to a systemic disease. The diagnosis can only be confirmed histopathologically. A comprehensive staging is necessary to determine the extent of the disease and to establish an adequate therapy., Case Report: We report on a 27 years old patient who was referred to our clinic with the diagnosis of an osteomyelitis of the mandibular angle and a pathological fracture after extraction of tooth 38 one month before. Curettage and primary bone grafting were performed. In the histological examination of the specimen infiltrates of a Langerhans cell histiocytosis were found. The clinical and radiological staging demonstrated a solitary mandibular lesion (eosinophilic granuloma). After wound healing a low-dose radiotherapy with 6 Gray was performed. Two years after completion of the therapy the patient is asymptomatic and does not show any evidence of recurrence., Conclusion: Langerhans cell histiocytosis has to be included in the differential diagnosis of osteolytic lesions of the mandible. A low-dose radiotherapy is a reasonable and well-tolerated treatment option.

The two-phase reconstruction of the mandible with a 2.7-mm-Martin-reconstruction-plate creates a tumor free period that is followed by bone grafting to the embedded plate. We have treated 61 patients following this pattern from 2000 to 2005, follow-up was done in 56. 14 patients had received radiotherapy of 70 Gy. 43 plates healed in without any complications. Until 2005 bone grafting had been performed in 18 patients, in ten patients the plate had been removed.

This article reports on the treatment of jaw cysts using a new bone substitute material. Ostim is a nanocrystalline, phase-pure hydroxylapatite which is manufactured in an aqueous suspension and then concentrated to form a white paste with a 35% content. The material is applied directly into the bone cavity using a syringe and, due to its paste consistency, produces uniform surface contact with the walls of the bone cavity. The material is fully resorbed and ensures rapid bony regeneration of jaw defects with no complications during the healing process. The results of 44 applications were described.

Unilateral or bilateral dislocation of the TMJ is frequent. Usually it can be treated by the method described by Hippocrates. If conservative treatment (splint therapy, biofeedback, etc.) does not succeed related to recurrent fixed TMJ-dislocation, surgical therapy strategies become necessary. Above all mentally retarded or patients with neuromuscular disorders may necessitate surgical treatment. The two surgical main procedures are: 1. Removal of mechanical obstacles by reduction of the eminentia. 2. Creation of a mechanical obstacle towards the anterior condylar translation. The here presented case shows the treatment of a reccurent, fixed anterior TMJ-dislocation using a miniplate which enables a absolut heightening of the articular tubercle in a 76 years old lady with Morbus Alzheimer and Parkinson. Due to the high incidence of plate fractures, this well discribed therapy, known as miniplate eminoplasty, can not be considered as the treatment of choice for mandibular dislocation. It can be indicated in non-compliant patients or in patients with neuromuscular disorders or in the combination of both as in our case.

Case Report: We report on a rare case of secondary chronic osteomyelitis of the left condyle. Haemophilus aphrophilus could be isolated from the abscess material. The condyle was resected and reconstructed with an endoprosthesis in the same operation., Discussion: Possible causes of the rare location of secondary chronic osteomyelitis are assembled in a review of the literature and compared with the actual case., Conclusion: We suggest the inoculation of microorganisms through the needle of a local anesthetic injection, bacterial contamination during the tooth extraction, or bacteremia following the dental extraction to be possible causes for the infection.

Background: Glandular odontogenic cyst (GOC) is a rare lesion of both, the maxilla and mandible, leading to extensive osteolysis. Histologically, it shows thin layers of squamous and cylindrical cells, lined with mucinous metaplasia. This makes it difficult to differentiate from a mucoepidermoid carcinoma. The recurrence rate is high., Case Report: During a routine X-ray examination we saw massive osteolysis of the whole mandible in a 30-year-old female. All teeth were vital. The biopsy taken showed a benign cyst although the clinical aspect was similar to an ameloblastoma. The cyst was removed after intravital fixation with Carnoy's solution. The bony cavity was left without filling material. Uneventful bony healing occurred., Discussion: Due to rare occurrence and similarity to botryoid odontogenic cyst and low-grade mucoepidermoid carcinoma GOC is difficult to identify. It remains without clinical signs for years and is identified in routine X-rays in most cases. We recommend cystectomy after use of Carnoy's solution for intravital fixation. No filling material is required for complete bony healing.

Recurrence following the surgical treatment of keratocysts of the jaws may present a major problem to the oral surgeon. The surgical treatment of patients with odontogenic keratocysts is concerning the high recurrence rate demanding and difficult. It has been suggested that recurrence is a consequence of technical of microcysts in the mucosa overlying the recurrent lesions. Attemps have been made to reduce this high recurrence rate by improved surgical techniques, such as removal of superadjacent mucosa, smoothing of the osseous wall of the cystic cavity, resection of neighboring parts of the mandible, tanning of the epithelial lining of the cyst with Carnoy's solution and marsupialisation. On the basis of a case report it was the aim of the authors to present the surgical treatment of odontogenic, recurrent keratocysts at the Clinic for Maxillo-Facial Surgery, University Hospital Zurich, from the primary operation following the Brosch-procedure in 1971 up to the latest cystectomy in 2004.

In extended cysts of the jaw bone particular demands are made in terms of wound closure, especially if an intraoral surgical approach is chosen. A tight closure is even more important if the bony defect has been filled with an alloplastic material or autologous cancellous bone. In our case a keratocyst of the left mandibular angle and ascending ramus was treated. After enucleation of the cyst and grafting with autologous cancellous bone the graft was lost following a wound breakdown. Subsequently a system was developed to apply intraoral V.A.C.-therapy. This led to a safe separation of the cystic defect and the oral cavity and a conditioning of the wound ground. A grafting with an alloplastic material was carried out successfully. With this method the length of treatment could be reduced by several months compared to a conventional therapy with an obturator.

Introduction: Nodular fasciitis (nF) was first described in 1955 by Konwaler et al. as a benign fibroblastic proliferation. The onset of the disease occurs suddenly as a solitary tumor reaching a size of 10 to 50 mm in a few weeks. Relapse is rare and spontaneous remission frequent. The literature points out histologic similarities to a sarcoma., Case: The 57 year old female patient presented a spheroid, coarse, nonadherent, slightly painful tumor of the left paramandibular region. The history was inconspicuous. The B-scan sonography revealed a spheroid, anechoic, defined mass of 10-11 mm. The palpatory dimension increased noticeably during the following 2 weeks. Under local anesthesia the suspected lymph node was exposed via intraoral approach. Intraoperatively a non-capsulated, coarse, adherent, spheroid node of 25 mm was resected subtotally to preserve the marginal branch of the facial nerve. Histologically a fibroblastic cell-rich proliferation with mucoid milieu and few mitosis was found. No atypical cells or nuclei were observed and the proliferation reached fascial parts., Discussion: Based on clinical findings the diagnosis nF cannot be proven. Ultrasound and clinical findings suppose a lymphadenopathia, whereas the dynamics points out a malignant tumor. Therefore, histologic assurance after diagnosis is mandatory. In case of vulnerable anatomic structures in vicinity, the absence of a capsule should lead to partial resection despite of a total excision. The histology plays a primary role to avoid surgical overtherapy.

Besides several conventional therapeutic regimens to treat severe forms of alveolar ridge atrophy the distraction osteogenesis is an alternative method. We introduced a new technique for the treatment of alveolar ridge atrophy encouraged by the advantages of distraction osteogenesis in the last decade. A new technique called "vertical distraction osteogenesis (VDO)" has been developed by our study group to move dentolous and edentolous segments of the alveolar process vertically with a device in microplate-design. Vertical distraction osteogenesis was completed successfully in nine patients with segments length ranging from 6.5 mm to 43 mm with an average of 23.7 mm. The vertical distraction rate was 9.9 mm on average in seven mandibular and two maxillar segments. In all cases we found good stability and the predicted movement of the segments. In contrast to bone transplantation an earlier mineralization in the vertically distracted area could be seen by radiological examination and biopsy. Five patients were treated with dental implants 12 weeks after distraction procedure. Main advantages of vertical distraction osteogenesis are: 1. No bone harvesting, 2. decreased resorption tendency, 3. lower morbidity compared with conventional techniques, 4. lower infection rate and 5. feasibility to insert dental implants 12 weeks after distraction procedure, 6. gain of soft tissue.

Rehabilitation in patients with severe alveolar ridge atrophy of the maxilla or mandible is problematic and can often only be achieved by long-term treatment. In most cases, autologous bone grafting with iliac crest bone has been used to augment severely atrophied upper jaws. In our experience, iliac bone grafts are less useful, since iliac bone appears to be of inferior quality; in elderly osteoporotic women, the bone is soft, indentable, and of poor osteogenic potency. In our department, we have been using only autologous calvarial bone grafts for augmentation of alveolar ridge atrophy since 1993. The bone is removed from the outer table of the skull only, trimmed to the alveolar ridge, und fixed with titanium lag scews. The skull defect created is covered with crushed bone or a titanium mesh to avoid aesthetic problems. Insertion of dental implants follows after a healing period of the bone grafts of 5-6 months. A total of 63 patients underwent calvarial split-graft augmentation; augmentation of the maxilla and mandible was carried out in 15 of these patients, of the maxilla only in eight, and of the mandible only in 40. The investigations 1 year later showed a resorption rate of approximately 10%. This is lower than when using iliac bone grafting. The resorption results were stable between 6 and 12 months after augmentation. Using dental implants (12 patients with 32 implants), the resorption rate was low and constant. We have never seen total loss of bone grafts or intracranial complications. All patients were pleased with the treatment. In our opinion, severe alveolar atrophy of the maxilla or mandible should be compensated for by augmentation with autologous calvarial bone grafts to obtain good long-term results.

Magnetic resonance imaging (MRI) is used as a diagnostic tool for special indications in oral and maxillofacial surgery. We describe a new MRI technique that presents images in a panoramic view analogous to orthopantomography. This technique is based on three-dimensional T1- and T2-weighted sequences. The familiar panoramic view in MRI provides better orientation and makes diagnosis faster and easier. However, the acquisition time is long (6-12 min per sequence), with a correspondingly high risk of motion artifacts. Moreover, the final workup is also time-consuming. These restrictions could be overcome by progress in hardware and software. There are promising indications for dental MRI.

Ceratocysts prefer attaint the jaws solitarily or multiply. Familiar heapings are described in connection with the naevoid basal cell carcinoma syndrome (Gorlin-Goltz-Syndrome). In most of the patients they are removable simply by enucleation. The histological typing as a cyst suggests a harmlessness of the disease. There is a significant higher amount of recurrent cysts compared to other odontogenous cysts, whereas clinical symptoms are absent for a long time. That give reasons for findings of breakthrough to the skull base. There are no real alternatives for the impairing operation procedures. It is reported about 69 patients with ceratocysts. In 6.9% a breakthrough to the skull base was found. Therefore a radical operation procedure and a close meshed postoperative checking management with regular MRI and conventional x-ray will be demanded.

Four clinical cases are presented to demonstrate the self-correcting potential of aberrant tooth germs after the elimination of eruption obstacles (in 2 cases cysts, in 2 other cases severely infraoccluded primary teeth). In the case of the submerging deciduous teeth, the tilted adjacent teeth were orthodontically uprighted after the surgical procedure. Possible causative mechanisms are discussed.

Background: Aneurysmal bone cysts are benign lesions of bone consisting of a septated, cystic cavity filled with non-endothelium-lined, blood-filled spaces. Aneurysmal bone cysts mainly occur in children and adolescents. Only a few occur in the jaws., Patient: This is the report of a 9-year-old girl with an aneurysmal bone cyst in the condyle of the mandible who was admitted to the hospital with swelling in front of her right ear. Because of the location and to eliminate recurrence, complete surgical excision of the condyle was performed., Discussion: Fifty-seven cases of aneurysmal bone cyst of the mandible have been reported to date. Aneurysmal bone cyst is treated by surgical excision, which ranges from enucleation and curettage to conservative resection., Conclusion: Simple curettage for aneurysmal bone cyst is reported to be associated with a high recurrence rate, a result of the difficulty of completely excising such a vascular lesion. We recommend complete surgical excision as the best treatment.

Report on a purulent fistulation of the mandibula in a rabbit, caused by displaced molar teeth. Diagnosis, surgery and recovery are being described.

Because treatment of fractures of the atrophic mandible still today presents significant difficulties and treatment modalities remain controversial, 87 of these consecutive fractures which were treated by an uniform method as compression osteosynthesis were evaluated. A new classification of the degree of atrophy which considers the special interest of fracture treatment is introduced. It is based on a metrical measurement of the height of the mandible in the fracture area. Mandibles of 16 to 20 mm height are classified as class I atrophy, those of 11 to 15 mm as class II atrophy, and those with a height of 10 mm or less as extremely atrophic mandibles or class III atrophy. This simple and reliable classification could also be used in future investigations on the results of different treatment modalities in atrophic mandibles. In our series of 87 fractures of the atrophic mandible which were treated by compression osteosynthesis 97% resulted in a solid osseous union without the need of a second surgical intervention. Three major complications occurred: 1 osteomyelitis and 2 non-unions (the latter in one patient with a double fracture of a class III atrophy mandible). To the best of our knowledge this series is the largest of fractures of truly atrophic mandibles treated by one uniform method. Compared to other treatment modalities compression osteosynthesis produced acceptable results and is recommended as the treatment of choice in fractures of the atrophic mandible.

Background: The localized form of the Langerhans cell histiocytosis was referred to earlier as eosinophilic granuloma, which has the best prognosis of all histiocytosis syndromes concerning survival. The non-malignant proliferative disorder of the histiocytic system is still of unknown etiology. Characteristic radiographic signs are osteolytic lesions., Patient: We report on an otologic manifestation of a 20-year-old man's temporal bone, which developed three years after a successful treatment of an eosinophilic granuloma of the mandible., Results: Surgery and low-dose irradiation led to a complete remission of the disease. Other manifestations of the disease were not detected until now., Conclusions: In the presence of chronic aural discharge, Langerhans cell histiocytosis must bei considered in differential diagnosis and a histopathological examination should be performed.

Hemimandibular elongation is characterized by unilateral continuous growth of the mandibular ramus and condyle. Skeletal scintigraphy is indicated for the assessment of prospective growth. When growth has ceased a correcting osteotomy may be performed. In the case of severe active growth and fast progressive facial asymmetry the growth centre should be removed surgically by condylectomy. 21 patients with facial asymmetry and/or laterognathia underwent skeletal scintigraphy. 19 patients showed symmetrical or nearly symmetrical nuclear uptake. In 11 cases a correcting osteotomy was performed without any relapse. 2 patients showed markedly unilateral increased nuclear uptake. One of them underwent condylectomy and showed a stable result 3 years postoperatively. The other patient underwent a correcting osteotomy with subsequent recurrence of laterognathia. By visualization of the pathophysiological process skeletal scintigraphy yields information for treatment planning in hemimandibular elongation.

Eleven patients with reconstruction of a massive mandibular defect with a vascularized full-thickness calvarian bone flap or a free full-thickness calvarian bone flap together with a temporalis muscle flap are reported. In six cases the resection was done because of squamous cell carcinoma, in four cases because of radioosteomyelitis and in one case because of gun shot trauma. In one case we lost the whole calvarian bone because of necrosis and in another case a permanent palsy of the frontal branch of the facial nerve remains. An advantage of using full-thickness calvarian bone flaps is that the donor area is in the same operation field and that the thickness of bone allows insertion of titanium osseointegration posts, which was done in five patients. The transplantation of full-thickness calvarian bone and temporalis muscle is a real alternative to an osseomyocutaneous microvascularized free flap for reconstruction of the mandible in cases where the neck was operated and radiated before, and anastomosis may be critical. Further advantages are virtual absence of postoperative pain in the donor area and an invisible scar. With this method we can reach satisfying functional and esthetic results.

Over the past twenty years the titanium mesh combined with autologous iliac crest spongiosa and hydroxylapatite has performed well in the restoration of mandibular discontinuity defects in 79 patients. In 14 irradiated patients with a transplant bed of inferior quality, however, complications and failures occurred more often than in the 65 not irradiated patients. The results of our investigation clearly show, that the success of mandibular reconstruction mainly depends on a well vascularized transplant bed.

Nowadays the exclusive intraoral approach is standard in the operative treatment of mandibular fractures. However there is still scepticism in the selection of the intraoral approach for mandibular reconstruction. Between 1980 and 1992 we performed in 21 patients mandibular reconstructions by rib or iliac bone grafts after resections of benign tumors in the mandible. One transplant was lost, the remaining transplants were incorporated without problems. According to our results the exclusive intraoral approach of primary mandibular reconstructions by free bone-grafts after removal is a reliable procedure.

119 avascular osseous transplants from the iliac crest were used for mandibular reconstruction. In case of irradiation we prepared the region of transplantation by using myocutaneous flaps. We lost 2.5% of our transplants. Analysing the orthopantomogram after a special method regarding reproducibility, we found a loss of height of the transplant of about 30% in the middle term. During rigid fixation of the transplant in the first 3 month, there was the biggest loss of height. Transplants ending free in the region of the TMJ showed less consistency than transplants interposed between original mandibular bone.

Sialo-odontogenic (glandular-odontogenic) cyst is a new entity in the classification of developmental epithelial odontogenic cysts. Differentiation of this type of odontogenic cysts from dentigerous cysts and keratocysts and also from cystic mucoepidermoid carcinoma is essential. A sialo-odontogenic (glandular-odontogenic) cyst is likely to show aggressive growth, so that complete resection is essential. We demonstrate sialo-odontogenic (glandular-odontogenic) cyst by presenting four new cases and differentiate it from a special type of odontogenic keratocyst and a typical cystic mucoepidermoid carcinoma.

The advantage of electrosurgery in minor dental surgery is demonstrated with regard to contraindications and especial precautions. In reports of case some indications are presented in combination with the treatment procedure.

Results after simultaneous resection and reconstruction of the mandible in odontogenic osteomyelitis and in radio-osteomyelitis are reported from the Department of Maxillofacial Surgery, University Hospital Zurich. In addition a comparative study is presented in cases of radioosteomyelitis of simultaneous resection and reconstruction and of resection and secondary reconstruction after an interval free of infection. The results after simultaneous reconstruction in cases of odontogenic osteomyelitis are identical to those achieved in non-infected cases. The results after simultaneous reconstruction in cases of radioosteomyelitis seem to be superior to those of secondary reconstruction after an infection free interval. In both groups a high rate of complications is found; their management need extensive experience in reconstructive maxillofacial surgery. Whenever possible we perform nowadays the replacement of hard and soft tissues in severe cases of radioosteomyelitis, f.i. using the pedicled temporalis muscle flap plus a free bone graft or the osteomyocutaneous pectoralis major flap. The use of free microvascular tissue transfer in high dose irradiated patients with uni- or bilateral neck dissection seems less suitable than expected.

This Report deals with surgical treatment of the extended osteolysis processes for the mandibular posterior tooth area. It will show the advantages of an osteoplastical method of operation. According to a case report the therapy of an extended solitary bone cyst will be carried out with an apisectomy of the molar 46 at the same time.

A case of aneurysmatic bone cyst of the mandible is described. Following curettage the condition recurred twice and was then successfully treated with cross-section and primary reconstruction of the mandible. The pathogenesis of aneurysmatic bone cysts and the indications for radical surgical treatment are discussed.

A plan of treatment was worked out based on the current classification of osteomyelitis of the mandible. On the basis of clinical follow-up examinations between 1973 and 1977 and the use of improved diagnostic tools, it was shown that active surgical procedures have become more and more accepted in our hospital.

Operations to improve the profile in abnormal positions of the mandible serve as preventive measures on the one hand for improving and harmonizing the external shape of the face and for improving the function of chewing on the other, with consequent prevention of premature loss of teeth, periodontosis and complaints of the temporomandibular joint, and preventing the appearance of digestive diseases. The different bite and mandibular abnormalities are discussed in groups classified according to their operability.

In this paper we describe the various surgical techniques in the treatment of cysts of the mandible and maxilla. The importance of primary reconstruction of extensive defects is pointed out. We developed a special press for autologous cancellous bone to achieve better osteoplastic results. We describe the advantages of this technique in comparison to the conventional methods.