ABSTRACT
Representing unusual fracture patterns is extremely important to understand. A 27-year-old male patient with a known history of a road traffic accident with sustained injury reported to the Department of Oral and Maxillofacial Surgery in Saveetha Dental College with pain in the left and right lower jaw region of three days duration. The patient provided a history of frontal impact in the symphysis region after a fall from a two-wheel vehicle. Clinical examination revealed a laceration of 2 cm in the chin region with bilateral pre-auricular swelling and trismus with an anterior open bite. The computed tomography scan revealed a bilateral dicapitular condyle fracture with an oblique impacted fracture of the symphysis with a displaced inferior border and left lingual cortical displacement. Apart from this, an incomplete fracture was evidenced, extending along the inferior border to the right body of the mandible. The fracture site was exposed through the laceration. The impacted mandibular fracture segments were mobilized and fixation was done using a 2 mm five-hole plate at the lower border across the sagittally split segment after placement of maxillomandibular fixation with an arch bar at the alveolar border as a part of tension banding. The oblique lingual fracture was reduced and fixed with a 2 x 14 mm bicortical screw. The primary objective of the current case report is to elucidate an unusual fracture of the mandible and discuss the management of such impacted mandibular fractures.
ABSTRACT
Eagle's syndrome, a condition associated with the elongation of the styloid process or calcification of the stylohyoid ligament, is clinically characterized by throat and neck pain radiating into the mastoid region. The diagnosis can be made through a thorough history, correct clinical and pathological correlation and radiographic examination. The elongated styloid process can be treated conservatively or surgically. Conservative treatment options include transpharyngeal injections of steroids and lignocaine, nonsteroidal anti-inflammatory drugs, diazepam, and the application of heat. The surgical management of Eagle's syndrome consists of two major approaches: the transoral and the transcervical approaches. In this paper, we present a comparative study of two cases of classic bilateral elongated styloid process syndrome, treated with transcervical styloidectomy and transoral styloidectomy, their surgical time, intraoperative difficulties and complications, and recovery time. In conclusion, the management of Eagle's syndrome requires a comprehensive approach that includes a thorough preoperative evaluation of the length of the styloid process via imaging and digital palpation. The choice of surgical approach, whether extraoral or transpharyngeal, should be based on factors such as the surgeon's experience and the patient's comorbidities, as well as the length and palpability of the styloid process. Our comparative study of two cases treated with transcervical and transoral styloidectomy demonstrated that the extraoral method offers a direct and well-controlled approach for excessive styloid processes, while the transpharyngeal approach is preferred for cases where the process can be easily identified by palpation. Therefore, proper patient selection and preoperative planning are essential to achieving successful outcomes with minimal complications.
ABSTRACT
Benign fibro-osseous lesions are a group of pathological conditions characterized by the replacement of normal bone with cellular fibrous connective tissue that undergoes mineralization. The most common types of benign fibro-osseous lesions include fibrous dysplasia, ossifying fibroma, and osseous dysplasia. However, diagnosing these lesions can be challenging due to their overlapping clinical, radiological, and histological features, which can cause a diagnostic dilemma for surgeons, radiologists, and pathologists. One rare type of benign fibro-osseous lesion is the cemento-ossifying fibroma (COF), which is a definitive form of a benign fibro-osseous tumor that affects the craniofacial region, particularly the jaws (70%). Here, we present a case of COF in a 61-year-old female patient in the maxillary anterior region. Due to a clear distinction between the lesion and healthy bone, the lesion was treated with conservative surgical excision followed by curettage and primary closure. However, differential diagnosis of COF can be highly challenging for clinicians due to its overlapping features with other fibro-osseous lesions like Paget's disease and fibrous dysplasia. Ossifying fibroma and fibrous dysplasia often present a histopathological, clinical, and radiological overlap. The post-operative follow-up after eight months was unpredictable, with a radiological picture showing the increased thickness of the frontal bone, parietal bone, and maxilla with obliteration of marrow spaces, alteration of the trabecular pattern with a cotton wool/ground glass appearance, and reduced maxillary sinus space. Proper evaluation and diagnosis of fibro-osseous lesions are necessary before arriving at a final conclusion. Cemento-ossifying fibroma in the maxillofacial skeleton is uncommon, and after eight months, the recurrence rate is rare. This case highlights the importance of considering COF as a differential diagnosis for fibro-osseous lesions in the maxillofacial region and the necessity for proper evaluation and diagnosis to determine the appropriate treatment plan and prognosis. In summary, the diagnosis of benign fibro-osseous lesions can be challenging due to their overlapping features, but early diagnosis and proper evaluation are essential for successful treatment outcomes. COF is a rare type of benign fibro-osseous lesion where other fibro-osseous lesions in the maxillofacial region should be considered as a differential diagnosis, and the necessary steps should be taken to confirm the diagnosis before arriving at a final conclusion.
