ABSTRACT
Clear cell odontogenic carcinoma (CCOC), a rare tumor in the head and neck region, displays comparable properties with other tumors clinically and pathologically. In consequence, an incorrect diagnosis may be established. A 51-year-old male patient who was admitted to the Department of Oral and Maxillofacial Surgery at Pusan National University Dental Hospital was initially diagnosed with ameloblastoma via incisional biopsy. However, the excised mass of the patient was observed to manifest histopathological characteristics of ameloblastic carcinoma. The lesion was ultimately diagnosed as clear cell odontogenic carcinoma by the Department of Oral Pathology of Pusan National Dental University. Therefore, segmental mandibulectomy and bilateral neck dissection were performed, followed by reconstruction with fibula free flap and reconstruction plate. Concomitant chemotherapy radiotherapy was not necessary. The patient has been followed up, and no recurrence has occurred 6 months after surgery.
ABSTRACT
Clear cell odontogenic carcinoma (CCOC), a rare tumor in the head and neck region, displays comparable properties with other tumors clinically and pathologically. In consequence, an incorrect diagnosis may be established. A 51-year-old male patient who was admitted to the Department of Oral and Maxillofacial Surgery at Pusan National University Dental Hospital was initially diagnosed with ameloblastoma via incisional biopsy. However, the excised mass of the patient was observed to manifest histopathological characteristics of ameloblastic carcinoma. The lesion was ultimately diagnosed as clear cell odontogenic carcinoma by the Department of Oral Pathology of Pusan National Dental University. Therefore, segmental mandibulectomy and bilateral neck dissection were performed, followed by reconstruction with fibula free flap and reconstruction plate. Concomitant chemotherapy radiotherapy was not necessary. The patient has been followed up, and no recurrence has occurred 6 months after surgery.
Subject(s)
Humans , Male , Middle Aged , Ameloblastoma , Ameloblasts , Biopsy , Diagnosis , Diagnostic Errors , Drug Therapy , Fibula , Free Tissue Flaps , Head , Mandibular Osteotomy , Neck , Neck Dissection , Pathology, Oral , Radiotherapy , Recurrence , Surgery, OralABSTRACT
BACKGROUND: After the resection at the mandibular site involving oral cancer, free vascularized fibular graft, a type of vascularized autograft, is often used for the mandibular reconstruction. Titanium mesh (T-mesh) and particulate cancellous bone and marrow (PCBM), however, a type of non-vascularized autograft, can also be used for the reconstruction. With the T-mesh applied even in the chin and angle areas, an aesthetic contour with adequate strength and stable fixation can be achieved, and the pores of the mesh will allow the rapid revascularization of the bone graft site. Especially, this technique does not require microvascular training; as such, the surgery time can be shortened. This advantage allows older patients to undergo the reconstructive surgery. CASE PRESENTATION: Reported in this article are two cases of mandibular reconstruction using the ready-made type and custom-made type T-mesh, respectively, after mandibular resection. We had operated double blind peer-review process. A 79-year-old female patient visited the authors’ clinic with gingival swelling and pain on the left mandibular region. After wide excision and segmental mandibulectomy, a pectoralis major myocutaneous flap was used to cover the intraoral defect. Fourteen months postoperatively, reconstruction using a ready-made type T-mesh (Striker-Leibinger, Freibrug, Germany) and iliac PCBM was done to repair the mandible left body defect. Another 62-year-old female patient visited the authors’ clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular squamous cell carcinoma (SCC), reconstruction was done with a reconstruction plate and a right fibula free flap. Sixteen months postoperatively, reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair the mandibular defect after the failure of the fibula free flap. The CAD-CAM T-mesh was made prior to the operation. CONCLUSIONS: In both cases, sufficient new-bone formation was observed in terms of volume and strength. In the CAD-CAM custom-made type T-mesh case, especially, it was much easier to fix screws onto the adjacent mandible, and after the removal of the mesh, the appearance of both patients improved, and the neo-mandibular body showed adequate bony volume for implant or prosthetic restoration.
Subject(s)
Aged , Female , Humans , Middle Aged , Autografts , Bone Marrow , Carcinoma, Squamous Cell , Chin , Computer-Aided Design , Fibula , Free Tissue Flaps , Mandible , Mandibular Osteotomy , Mandibular Reconstruction , Mouth Neoplasms , Myocutaneous Flap , Titanium , TransplantsABSTRACT
Non-Hodgkin's lymphoma on the parotid gland is a relatively rare occurrence among head and neck tumors. The mass of parotid gland lymphoma cannot be distinguished from other benign masses of the parotid gland; therefore, it is important to consider lymphoma in the differential diagnosis when examining parotid swellings and masses. Parotid gland lymphoma is most likely to be B-cell, non-Hodgkin's lymphoma of one of three types, which include follicular, marginal zone, and diffuse large B-cell, although other histologic patterns have been described. We present a review of a patient with diffuse large B-cell lymphoma (DLBCL) who presented to the Department of Oral and Maxillofacial Surgery of Pusan National University Hospital (Yangsan, Korea).
Subject(s)
Humans , B-Lymphocytes , Diagnosis, Differential , Head , Lymphoma , Lymphoma, B-Cell , Lymphoma, Non-Hodgkin , Neck , Parotid Gland , Surgery, OralABSTRACT
OBJECTIVES: The purpose of this study was to estimate the volumetric change of augmented autobone harvested from mandibular body cortical bone, using cone-beam computed tomography (CBCT) and three-dimensional reconstruction. In addition, the clinical success of dental implants placed 4 to 6 months after bone grafting was also evaluated. MATERIALS AND METHODS: Ninety-five patients (48 men and 47 women) aged 19 to 72 years were included in this study. A total of 128 graft sites were evaluated. The graft sites were divided into three parts: anterior and both posterior regions of one jaw. All patients included in the study were scheduled for an onlay graft and implantation using a two-stage procedure. The dental implants were inserted 4 to 6 months after the bone graft. Volumetric stability was evaluated by serial CBCT images. RESULTS: No major complications were observed for the donor sites. A total of 128 block bones were used to augment severely resorbed alveolar bone. Only 1 of the 128 bone grafts was resorbed by more than half, and that was due to infection. In total, the average amount of residual grafted bone after resorption at the recipient sites was 74.6%+/-8.4%. CONCLUSION: Volumetric stability of mandibular body autogenous block grafts is predictable. The procedure is satisfactory for patients who want dental implants regardless of atrophic alveolar bone.
Subject(s)
Humans , Male , Alveolar Bone Grafting , Bone Transplantation , Cone-Beam Computed Tomography , Dental Implants , Inlays , Jaw , Tissue Donors , TransplantsABSTRACT
Keratocystic odontogenic tumor (KCOT) is a common benign tumor of osseous lesions in dental and maxillofacial practice. We describe three cases of large KCOT located in the posterior part of the mandible extending to the angle and ramus region, which were enucleated via sagittal split osteotomy (SSO) of the mandible. There are cases in which a conventional enucleation procedure does not ensure complete excision of the entire lesion without damage to vital structures like the inferior alveolar nerve. In such cases, a SSO approach could be a better choice than conventional methods. The purpose of this article is to describe our experience using unilateral mandibular SSO for removal of a KCOT from the mandible.
Subject(s)
Mandible , Mandibular Nerve , Odontogenic Cysts , Odontogenic Tumors , Osteotomy , Osteotomy, Sagittal Split RamusABSTRACT
PURPOSE: The purpose of this study was to analyze the clinical courses of patients with gastric cancer and positive resection margins after a gastrectomy for gastric cancer who did not undergo subsequent surgery. MATERIALS AND METHODS: Among 4,452 patients who underwent surgery for gastric cancer from January 2001 to December 2007, 20 patients with positive resection margins after gastrectomy for gastric cancer who did not undergo subsequent surgery were included. The recurrence patterns were confirmed by postoperative computed tomography and gastroscopy, which were performed on a planned schedule. All recurrence patterns after gastrectomy were classified as loco-regional, peritoneal, or distant metastases. RESULTS: The patients with confirmed recurrence all had advanced stage cancer (III-IV), and the recurrence sites were variable. However, peritoneal and distant recurrences were more common than loco-regional recurrences. The patients with loco-regional recurrence also had peritoneal and/or distant recurrence. CONCLUSIONS: Patients with gastric cancer and a positive resection margin showed more frequent peritoneal and distant metastases than loco-regional recurrence. In addition, patients with loco-regional recurrence also had peritoneal and distant recurrence. A positive resection margin of gastric cancer was related with poor histological differentiation, diffuse type, and advanced stage (III-IV).