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Objective: Endoscopically assisted extracapsular dissection through a single incision along the cephaloauricular furrow has been adapted as a method of access for operating on benign parotid gland tumors. However, no study has compared the immune and stress responses after surgery between the endoscopic procedure and conventional open surgery., Methods: Through a randomized method, 50 patients with benign parotid gland tumors were assigned to undergo either endoscopically assisted extracapsular dissection or open parotidectomy. The postoperative inflammatory changes and hormonal response in the patients were analyzed at serum level during the preoperative period and at 12, 24, and 72 hr after either surgery., Results: Twenty-three patients received an endoscopic procedure, while 27 underwent open surgery. The size of the incision, amount of intraoperative bleeding, volume of drainage, postoperative pain score, and satisfaction with appearance were all improved in the endoscopic procedure group. Additionally, the serum levels of C-reactive protein, interleukin (IL)-6, IL-10, and cortisol were significantly lower in the endoscopy group in comparison with those in the open surgery group., Conclusion: Endoscopically assisted extracapsular dissection on patients with benign parotid gland tumors is associated with lower inflammatory changes and hormone responses than open surgery, thereby reducing perioperative pathophysiological disturbance and enhancing recovery after surgery., (© 2020 Wiley Periodicals LLC.)

Introduction: The aim of this study was to examine the histological effect of papain and sodium fluoride in delayed replantation of rat incisor teeth on the repair process., Methods and Materials: Forty upper incisors of Wistar rats were randomly assigned to four groups ( n =10). In group I, the dental papilla and the pulp tissue of extracted teeth were removed before immediate replantation in their sockets. In the other groups, the extracted teeth were maintained in dry storage for 60 min and subjected to different root surface treatments. In group II, the teeth were immersed in 10% papain for 20 min, scrubbed with gauze soaked in saline for 1 min, and immersed in a 2% acidulated-phosphate sodium fluoride solution for 20 min. In group III, the teeth were immersed in saline for 20 min, scrubbed with gauze soaked in saline for 1 min, and immersed in a 2% acidulated-phosphate sodium fluoride solution for 20 min. In group IV, root surface treatment was not applied. The root canals were treated and filled with a calcium hydroxide paste and the teeth were replanted. The animals were euthanized after 60 days and anatomic specimens containing the teeth were subjected to routine histochemical processing and staining with hematoxylin and eosin. The Kruskal-Wallis test was used, followed by the Dunn's test for multiple comparisons., Results: Groups I and II had less inflammatory root resorption and total area of root resorption ( P <0.05) than groups III and IV respectively., Conclusions: Based on this animal study, root surface treatment with papain and sodium fluoride in delayed tooth replantation showed greater efficacy in controlling inflammatory root resorption and may be a viable option for clinical application., Competing Interests: ‘None declared’.

Purpose: The maxillary advancement using Le Fort I osteotomy directly affects in the positioning of the upper lip (UL) and the nasolabial angle (NLA), which plays an important role in facial expression and aesthetics, because of this, the aim of this study was to evaluate the ability of Dolphin Imaging 11.8 software in predicting changes to the UL position and NLA in patients undergoing maxillary advancement., Materials and Methods: It was a retrospective cohort study. Predictive and final tracings using pre- and postoperative Cone beam computed tomography (CBCT) of 24 patients undergoing maxillary advancement, regardless of mandibular movement, were compared. Whether the amount of advancement changes this predictability was also analyzed. The predictive and the 12-month postoperative data were evaluated using Dolphin Imaging 11.8 software and compared. Student t test was used to get the results., Results: The vertical analysis of the incisal tip and cementoenamel junction of the upper central incisor (UCI) and of the UL were statistically significant ( P = .001 for all). The horizontal measurements of the same variables ( P = .238, P = .516, P = .930, respectively) and the NLA ( P = .060) showed no statistical significance. The amount of advancement did not interfere with the variables analyzed, except for the exposure ( P = .009) and inclination of the UCI ( P = .010)., Conclusion: It was concluded that the amount of maxillary advancement does not interfere with the UL prediction; the prediction capacity of the software was good for the horizontal measurements, but had a significant error index for vertical measurements., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

The objectives of this study were to assess the relationship between mandibular third molars and the mandibular canal, establishing which radiographic signs are most prevalent in predicting contact between these structures, and to associate these signs and the proximity with the position of the third molar according to the classifications of Pell & Gregory and Winter. A retrospective, cross-sectional observational study was carried out on panoramic radiographs. From a dataset of 3289 images, a convenience sample of 1548 panoramic radiographs with a total of 2639 third molars was selected for evaluation. The inclusion criteria were patients of both sexes who had at least 1 totally formed mandibular third molar that was adjacent to a second molar. Radiographs were excluded if they were of poor quality or revealed evidence of cystic or tumoral processes or extensive caries. Seven radiographic signs were used to determine if there was contact between the third molar and mandibular canal. A proximity to the mandibular canal was verified for 1677 (63.5%) of 2639 third molars. The most frequent radiographic signs of proximity were darkened roots (767 teeth [29.1%]) and discontinuity of the mandibular canal (757 teeth [28.7%]). Third molar/mandibular canal proximity was found significantly more frequently in female patients and in patients aged 24 years and younger (P < 0.001). The tooth positions most frequently associated with proximity between the third molar and the mandibular canal were position C (highest point of the third molar located at or below the cervical margin of the second molar) and the mesioangular position (long axis of the third molar angled mesially toward the second molar)., Competing Interests: The authors report no conflicts of interests pertaining to any of the products or companies discussed in this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

While nasopharyngeal carcinoma (NPC) commonly presents lymphoid metastases, the enormous cervical metastasis causing dysphagia and limitation of neck motion is not a familiar symptom for most of NPC cases. We report a 23-year-old male with undifferentiated carcinoma of the nasopharynx, stage III (T3N2M0), who had undergone aggressive surgical resection of bilateral huge cervical mass first followed by concurrent chemo-radiotherapy with cisplatin-based regimens. The postoperative clinical course was uneventful and follow-up, 2 years later, revealed no recurrence of primary lesion and neck metastases. We recommend that aggressive surgical resection may be considered when NPC patients significantly suffer clinical symptoms from a huge cervical metastasis., Competing Interests: Conflict of interest: The authors report no conflict of interest.

Background: Endoscopically assisted selective neck dissection (SND) has recently been applied in clinical N0 cases of oral squamous cell carcinoma (OSCC). However, nothing is known of the immune response after surgery., Methods: A total of 60 patients with cT1-2N0 OSCC randomly underwent endoscopically assisted SND and open operations. The serum levels of IL-6, IL-8, IL-10, IL-1b, TNF-a, CRP, cortisol, ACTH, and growth hormone were analyzed before the start of the surgery (T0) and at 2 (T1), 6 (T2), 24 (T3), and 72 h (T4) after surgery., Results: A total of 31 patients were randomized for endoscopic SND, whereas 29 underwent open procedures. The release of IL-6, IL-10 and CRP was significantly lower in the endoscopic group than in the open surgery group (p < 0.05), and cortisol levels were also lower in the endoscopic group (p < 0.05)., Conclusions: Endoscopic SND could effectively provide lower inflammatory responses and surgical stress, reducing peri-operative trauma and accelerating recovery., (Copyright © 2016. Published by Elsevier Ltd.)

Background: The reconstruction of bilateral osteoradionecrosis (ORN) of mandibular defects using a single free bone flap is rarely performed because extensively radiated neck tissue with severe fibrosis is usually unsuitable for vascularized reconstruction., Methods: Thirty-one patients with nasopharyngeal carcinoma (NPC) underwent bilateral reconstruction of advanced ORN in the mandible using a single fibular osteocutaneous flap. Clinical factors associated with the operation were assessed, including classification of mandible defects, types of recipient vessels, perioperative complications, and postoperative outcomes., Results: All of the fibular osteocutaneous flaps survived completely, with the exception of 1 inner skin paddle that presented partial necrosis in a reconstruction of through-and-through defects. All patients experienced an improvement in cosmetic results 6 months after the reconstruction, whereas 23 patients experienced improved mouth opening compared to the preoperative condition., Conclusion: Advanced bilateral ORN in patients with NPC could be synchronously reconstructed with a single fibular osteocutaneous flap. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016., (© 2015 Wiley Periodicals, Inc.)

Condylar resorption is understood as changes in shape and volume of the condylar bone, due to local, systemic, and iatrogenic factors. The occurrence of condylar resorption after orthognathic surgery can occur when the condylar repositioning in mandibular fossa is performed improperly. In addition, systemic diseases such as osteoarthritis and rheumatoid arthritis seem to influence this process. The aim of this study was to report 3 cases of patients with severe condylar alterations, submitted to orthognathic surgery for treatment of dentofacial deformities. Considerations regarding the diagnosis, surgical planning (counterclockwise rotation), surgical techniques (bilateral sagittal split osteotomy, bimaxillary osteotomies, rigid fixation, maxillomandibular fixation period), and results (short terms) are discussed.

The aim of this study was to report the orthodontic-surgical approach of a 21-year-old female patient diagnosed with cleidocranial dysplasia. An orthognathic surgery was performed in the maxilla and mandible during the same procedure to correct an existing dentofacial deformity (class III malocclusion). In addition, malar prostheses were used to correct midface deficiency. After surgical intervention, orthodontic treatment continued in order to promote stability, function, and aesthetics. Cases of cleidocranial dysplasia treated with the defined criteria can bring aesthetic and functional benefits to the patient.

Background: Selective neck dissection (SND) in clinical N0 (cN0) cases of oral squamous cell carcinoma (SCC) has been performed by surgeons using a retroauricular or modified facelift approach with robotic or endoscopic assistance. However, these procedures provide cosmetic satisfaction at the cost of possible maximal invasiveness. In this prospective study, we introduced and evaluated the feasibility as well as surgical invasiveness and cosmetic outcome of endoscopically-assisted SND via a small submandibular approach., Methods: Forty-four patients with cT1-2N0 oral SCC (OSCC) were randomly divided into two groups of endoscopically-assisted SND and conventional SND. Perioperative and postoperative outcomes of patients were evaluated, including the length of the incision, operating time for neck dissection, estimated blood loss during the operation, amount and duration of drainage, total hospitalization period, total number of lymph nodes retrieved, satisfaction scores based on the cosmetic results, perioperative local complications, shoulder syndrome, and follow-up information., Results: The mean operation time in the endoscopically-assisted group (126.04 ± 12.67 min) was longer than that in the conventional group (75.67 ± 16.67 min). However, the mean length of the incision was 4.33 ± 0.76 cm in the endoscopically-assisted SND group, and the amount and duration of drainage, total hospital stay, postoperative shoulder pain score, and cosmetic outcomes were superior in the endoscopically-assisted SND group. Additionally, the retrieved lymph nodes and complications were comparable., Conclusions: Endoscopically-assisted SND via a small submandibular approach had a longer operation time than the conventional approach. However, endoscopically-assisted SND was feasible and reliable while providing minimal invasiveness and satisfactory appearance.

We compared the buccal infiltration of 4% articaine with 1 : 100,000 or 1 : 200,000 epinephrine without a palatal injection for the extraction of impacted maxillary third molars with chronic pericoronitis. This prospective, double-blind, controlled clinical trial involved 30 patients between the ages of 15 and 46 years who desired extraction of a partially impacted upper third molar with pericoronitis. Group 1 (15 patients) received 4% articaine with 1 : 100,000 epinephrine and group 2 (15 patients) received 4% articaine with 1 : 200,000 epinephrine by buccal infiltration. None of the patients in group 1 reported pain, but 3 patients in group 2 reported pain, which indicated a need for a supplementary palatal injection. The palatal injections were all successful in eliminating the pain. Two additional patients in group 2 experienced pain when the suture needle penetrated their palatal mucosa. Based on these results, 4% articaine with 1 : 100,000 epinephrine was found to be more effective for the removal of upper third molars in the presence of pericoronitis than 4% articaine hydrochloride with 1 : 200,000 epinephrine when only a buccal infiltration was used.

Oral squamous cell carcinoma (OSCC) has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases (CLNM) in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy (aRT) and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.

Calcifying epithelial odontogenic tumor (CEOT) is a rare, locally invasive neoplasm characterized by the presence of amyloid material that can become calcified. It often is found in the posterior region of the mandible. Such tumors in the maxilla and those that invade the maxillary sinus are extremely rare. This article presents the sixth reported clinical case of a CEOT that invaded the maxillary sinus and extended to the interior of the nasal cavity. The tumor had grown toward the sinus roof, but there was no association with an impacted tooth. Histopathologically, the tumor was composed of plates of polyhedral epithelial cells with highly eosinoplilic cytoplasm, nuclear polymorphism, clear-cell contours, and intercellular bridges in fibrous conjunctive tissue. Amorphous eosinophilic material and diverse calcifications permeated the epithelial cells.

This paper reported a case of fusion between an impacted third molar and a supernumerary tooth, in which a surgical intervention was carried out, with the objective of removing the dental elements. The panoramic radiography was complemented by the Donovan's radiographic technique; but because of the proximity of the dental element to the mandibular ramus, it was not possible to have a final fusion diagnosis. Hence, the Cone-Beam Computed Tomography-which provides precise three-dimensional information-was used to determinate the fusion diagnosis and also to help in the surgical planning. In this case report we observed that the periapical, occlusal and panoramic were not able to show details which could only be examined through the cone-beam computed tomography.

Objective: We compared the anesthetic efficacy of inferior alveolar nerve block (IANB) plus buccal infiltration (BI) and IANB plus periodontal ligament (PDL) articaine injections in patients with irreversible pulpitis in the mandibular first molar., Study Design: Fifty-seven volunteers, patients with irreversible pulpitis in the mandibular first molar admitted to the Department of Stomatology, Second Affiliated Hospital, Sun Yat-Sen University, randomly received conventional IANB, containing 1.7 mL 4% articaine/HCl with 1:100,000 epinephrine, plus either BI or PDL injections containing 0.4 mL articaine/HCl with 1:100,000 epinephrine. The patients recorded the pain of the injections and endodontic access on a Heft-Parker visual analog scale (VAS)., Results: According to the VAS scores, all patients experienced no or mild pain with BI and PDL injections after the application of IANB. Anesthetic success occurred in 81.48% for IANB plus BI (IANB/BI) compared with 83.33% for IANB plus PDL injection (IANB/PDL injection). None of the observed differences between the 2 groups was significant (P > .05)., Conclusion: Both injection combinations resulted in high anesthetic success in patients with irreversible pulpitis in the mandibular first molar.

Aims: The aim of this study was to evaluate the vestibular-palatal diffusion of 4% Articaine with epinephrine 1:100,000 and 1:200,000, in impacted maxillary third molar extractions, without palatal injection., Materials and Method: Two hundred teeth were selected from patients age 15 to 46. Patients were divided into 4 groups: 1A, were anesthetized with 4% articaine 1:100,000 and the surgery was initiated 5 minutes following anesthesia. 1B, used 4% articaine 1:100,000 but the surgery was started 10 minutes after anesthesia. 2A, used 4% articaine 1:200,000 the surgery was started 5 minutes after. 2B, used 4% articaine 1:200,000 but 10 minutes was allowed for anesthetic diffusion before the initiation of in groups (50 extractions each) only buccal vestibule anesthesia was initially administered (i.e. no palatal injections were used)., Results: The rate of sufficient vestibule-palatal diffusion, as determined by the lack of necessity of supplemental palatal anesthesia, was: 1A(84%), 1B(98%), 2A(78%), 2B(82%). Chi-square (Chi2) and residual analyses showed that a higher vestibule-palatal diffusion was obtained using 4% articaine 1:100,000 with a period of 10 minutes (p<0.05)., Conclusions: Most of the extractions could be performed only with vestibule anesthesia. However, vasoconstrictor concentration and the time interval between administration of the anesthetic and initiation of surgery did influence buccal vestibule-palatal diffusion of 4% articaine in the extraction models used.

The Odontogenic Keratocyst is a developmental odontogenic cyst and deserves special attention because of its peculiar histopathologic features and biologic behavior. It is believed that the Odontogenic Keratocyst arises from the proliferation of remnants of dental lamina. It is usually asymptomatic, and solitary lesion, however, it may be associated with Nevoid Basal Cell Carcinoma Syndrome. This work aimed to present a case of a very extensive Odontogenic Keratocyst in a 28-year-old woman.