Periangular transmasseteric infraparotid approach in the treatment of condylar-base and low condylar­neck fractures.

AIM: Mandibular condylar fractures account for 25 to 52 % of all mandibular fractures. Though current literature favors open reduction and internal fixation (ORIF) of condylar­base and low condylar­neck fractures, extraoral approaches are usually considered to be complicated by the risk of facial nerve injury and other possible complications. This study was undertaken to demonstrate that the periangular transmasseteric infraparotid surgical approach (TMIP) to condylar­base and low condylar­neck fractures provides excellent access to the bony fragments with minimal risk of complications such as facial nerve and parotid gland injury. PATIENTS: In the period from January 2010 to December 2018, 81patients (96 fractures) with condylar­base and low condylar­neck fractures underwent ORIF via periangular transmasseteric infraparotid surgical approach. RESULTS: The results of this retrospective study showed minimal postoperative complications. The periangular transmasseteric infraparotid surgical approach allowed precise anatomic repositioning and fixation of the bony fragments in almost all cases except for two juvenile cases with noticeable scars and one case with plate fracture. There were no transient or permanent facial nerve palsies, parotid gland or salivary fistulae complications during a 12­month follow­up period. CONCLUSION: The periangular infraparotid transmasseteric approach to ORIF of condylar­base and low condylar­neck fractures is an effective and safe approach allowing accurate anatomic reposition and fixation of the fragments with minimum surgical complications (Tab. 1, Fig. 12, Ref. 21).

3D navigation in surgery of Eagle syndrome.

NTRODUCTION: Eagle's syndrome is a rare condition caused by the elongation of the styloid process (> 4 cm) or calcification of the stylohyoid ligament. Patients with Eagle's syndrome typically present various clinical symptoms, such as headache, facial pain, neck pain, pulsating pain, sore throat, foreign body sensation, dysphagia, dysphonia, cough, voice changes, otalgia or vertigo. 3D printing refers to processes in which successive layers of material are formed from 3D computer tomography data to synthesize a three-dimensional object. This new diagnostic technique of rapid prototyping technology led to innovative new applications in biomedicine. OBJECTIVE: The primary goal for this case study was to find out, whether the nowadays so popular 3D technology aids in the treatment of the Eagle syndrome or other similar craniofacial abnormalities during the surgical procedure. CASE PRESENTATION: We report a case of a patient who initially presented a combination of symptoms like headache, sore throat, neck pain, which exacerbated with the movement of the head. This case report provides a brief review of the diagnosis and surgical management of the Eagle's syndrome with the help of 3D model navigation. CONCLUSION: Eagle's syndrome is difficult to diagnose due to its wide variability in symptoms. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with great benefit to the maxillofacial surgery. With the assistance of 3D technology, it is much easier for the surgeon to plan the surgical approach and the surgery, and significantly reduce the operation time (Fig. 3, Ref. 22).

Surgical treatment of condylar head fractures, the way to minimize the postraumatic TMJ ankylosis.

Management of condylar head fractures (CHF) of the temporomandibular joint (TMJ) remains a source of controversy. Based on established literature, group of CHFs and conservative treatment connected with period of maxillomandibular fixation (MMF) increases the risk for TMJ ankylosis. This paper presents anatomical and functional results of surgical treatment of condylar head fractures in a group of 24 patients (29 joints). Fractures were diagnosed based on conventional radiographs and computed tomography (CT) scans. Utilising an intraoperative arthroscopy authors evaluated actual intraarticular posttraumatic changes. This study presents acceptable functional and radiological results of surgical treatment of condylar head fractures with more than 3-year follow-up. The authors believe that re-establishing the pretraumatic anatomic position of the TMJ components (fragment and the disc) and early postoperative rehabilitation are inevitable to minimize the risk of postraumatic TMJ ankylosis (Tab. 2, Fig. 8, Ref. 31).

Is the prevalence of the medication-related osteonecrosis of the jaws underestimated, evaluation in oncological and non-oncological disease.

OBJECTIVES: The purpose of this study was to evaluate the prevalence of medication-related osteonecrosis of the jaw in Slovak population and compare the literature findings, whether the prevalence of MRONJ is underestimated. BACKGROUND: Antiresorptive drugs significantly increase quality of life, although during therapy, or in post-treatment period, osteonecrosis of the jaws might occur as a severe adverse effect. Medication-related osteonecrosis of the jaws (MRONJ) is a severe problem that has been observed in the past few years. METHODS: This multi-centric study evaluates the prevalence in Slovak population, assesses the values from 4 largest centres of maxillofacial surgery in Slovakia (1166 patients with MRONJ) and provides the comparison of literature review. RESULTS: Between 2010-2015, there was increasing number of newly diagnosed patients with MRONJ (1166 overall MRONJ patients) annually, except 2012 (mean growth of 123.88 %). This finding was supported by a statistical analysis of the rising tendency of prevalence in literature, where there was a significant difference in prevalence of non-oncologic patients before and after 2010 t(15) = 2.725, p = 0.016. The 6-year prevalence was 1.34 % in population with antiresorptive drugs intake, for osteoporosis 0.47 %, for breast cancer 4.10 %, prostate cancer 3.99 % and multiple myeloma 21.26 %. CONCLUSION: This study considers that there is a significant rising tendency of MRONJ in non-oncological patients, what could be caused by underestimation of the risk for development MRONJ in these patients. There should be a better cooperation and information among dentists and doctors indicating the antiresorptive treatment and strong emphasis on primary prevention before the initial treatment even in non-oncological patients (Tab. 5, Fig. 7, Ref. 69).

Plasmocytoma, multiple myeloma and plasma cell neoplasms in orofacial region.

A neoplastic proliferation of B cell lymphocyte is called plasma cell neoplasms, results from malignant plasma cells transformation in bone marrow. The authors present a clinical study and overview of this pathology in maxillofacial region for six years (Tab. 2, Ref. 14).