Post-operative acute circulatory collapse following craniofacial surgery: Rare event and rarer cause.

We are presenting a case of a 13-year-old female patient diagnosed and operated for maxillary odontogenic myxoma extending to the anterior cranial base. The postoperative complication occurred in the form of acute circulatory collapse. The patient was bailed out with cardiopulmonary resuscitation and return of spontaneous circulation occurred. Investigations into the cause of the event led to the finding of an uncommon syndrome. Meigs syndrome is a triad of ovarian tumor mass, pleural effusion and ascites. It has been the topic of interest for the gynecologic fraternity since 1934, when the first case was reported by J. V. Meigs. According to the best of our knowledge, this is the first case report of an acute circulatory collapse due to Meigs syndrome in a maxillofacial patient.

"Vanishing Bone Disease" in Maxillofacial Region: A Review and Our Experience.

Vanishing bone disease (VBD) is a rare disease of unknown etiology which is characterised by progressive replacement of bony framework by proliferation of endothelial lined lymphatic vessels. It has been given numerous names like massive osteolysis, Gorham's disease, phantom bone disease, and progressive osteolysis. It has no age, sex or race predilection. It may involve single or multiple bones and spread of the disease does not respect the relevant joint as boundary. The first report of the disease was published around two decades back but the mysterious nature of its etiology and ideal management strategy has still not been completely unfolded. The disease may functionally or aesthetically effect the patient and also has the potential to be life threatening. The first case of VBD in maxillofacial region was reported by Romer in 1924, Handbuch der speziellen pathologischen Anatomie and histology, Springer, Berlin. Since then, there have been few case reports of the same in maxillofacial region. We present a review of cases of VBD in maxillofacial region reported in literature along with our experience of a case.

Potentially fatal supramylohyoid sublingual epidermoid cyst.

A case of chronic and slow growing massive lateral neck swelling is presented which gradually resulted in dysphagia to an extent that patient reported in emergency room. Clinical findings were indicative of a cystic swelling or a massive lipoma. Temporary decompression of the lesion was achieved by partially aspirating the contents of the cyst. Nature of aspirate and its microscopic and biochemical analysis excluded lipoma, vascular malformation and salivary phenomenon. The diagnosis tapered to developmental lateral neck cysts. Magnetic Resonance Imaging (MRI) revealed a massive cystic lesion in the left floor of mouth extending to the right lingual aspect of mandible and posteriorly to impinge on the medial wall of pharynx. A combined intraoral and extraoral approach was used to expose and excise the lesion in toto. Final histological diagnosis of the pathology was epidermoid cyst.

Retrospective Analysis of Ossifying Fibroma of Jaw Bones Over a Period of 10 Years with Literature Review.

OBJECTIVE: The purpose of this retrospective analysis is to document and discuss the features, treatment rendered and result of 25 histologically proven cases of ossifying fibromas of jaw bones operated by a single surgeon over a period of 10 years. MATERIALS AND METHODS: The records of ossifying fibroma were obtained from the archives of Oral and Maxillofacial Surgery at Maulana Azad Institute of Dental Sciences (MAIDS) from 2001 to 2011. Only those cases were included in the study where definitive surgery was performed based on clinical, radiological & histopathological features. RESULTS: Twenty-five patients were analyzed with a final diagnosis of ossifying fibroma comprising of 14 males (56 %) and 11 females (44 %). The age range was 11-45 years with a mean of 24.12 years. Mandible was involved in 72 % and maxilla in 28 % cases with a predominance of mandibular posterior [19 (76 %)] cases. The study showed similar findings in regard to clinical, radiographic & histological features of ossifying fibroma as compared to other studies. It also showed that the treatment rendered in the form of eneucleation, curettage or resection of the lesion depending on its stage and extent were adequate, as no recurrence has been reported till date. CONCLUSION: Enucleation is preferred in small and well demarcated lesions. Curettage should be done in relatively large lesions with ill defined borders, not involving basal bone of mandible or cortical perforation. Resection should be reserved for aggressive and extensive cases with involvement of basal bone or perforation of cortices.

A rare cause of lateral facial swelling.

A case of chronic, recurrent and asymptomatic facial swelling in a young male is presented. Swelling extended from lower midface to upper lateral neck and right commissure to anterior massetric border. History, clinical signs and symptoms and examination pointed towards the benign nature of the swelling. Fine-needle aspiration cytology tapered the diagnostic possibilities to a salivary cyst or pseudocyst. Ultrasonography identified the lesion to contain echogenic fluid with irregular borders. "Tail sign" was absent on contrast magnetic resonance imaging, excluding the involvement of the sublingual gland. Surgical excision of the lesion was done along with submandibular gland as both were in continuity via a bottle-neck tract. Final histopathological diagnosis was that of the submandibular gland extravasation phenomenon. As per the best of our knowledge, it is the first case report of a submandibular gland extravasation causing swelling in a retrograde direction onto the face.

Unilocular radiolucencies of anterior mandible in young patients: A 10 year retrospective study.

INTRODUCTION: Mandibular anterior region is an uncommon site for occurrence of intrabony pathologies. Unilocular presentation of a lesion is again less common than multilocular appearance. Demographically, most lesions occur in middle to elderly age group. The study is designed to review the pathologies manifesting a combination of these rare demographic and radiological criteria. MATERIALS AND METHODS: A retrospective analysis of patients with anterior unilocular radiolucencies of mandible in young patients was done. Records of past 10 years were searched. There were a total of 17 patients. Their clinical history and radiographs were reviewed from the case files and correlated with histopathological examination of the lesion. RESULTS: Nine different pathologies constituted the sample size of 17. A wide array of lesions was found to manifest similar signs and symptoms and radiographic findings namely ameloblastoma (three), adenomatoid odontogenic tumor (AOT, four), odontogenic keratocyst (OKC, three), ossifying fibroma (OF, two), idiopathic bone cavity (IBC, one), dentigerous cyst (DC, one), radicular cyst (RC, one), central giant cell granuloma (CGCG, one), and calcifying odontogenic cyst (COC, one). CONCLUSION: Anterior mandible is a rare site for occurrence of intrabony pathologies. Majority of patients are females. Lesions acquire large size before they are detected. Growth occurs more in length than in width. Root resorption is not uncommon and root displacement is almost a consistent feature.

Pseudoaneurysm of the internal maxillary artery: a rare complication of condylar fracture.

Pseudoaneurysms are among very rare complications of maxillofacial trauma. When encountered, they have the potential to cause life-threatening hemorrhage. A wise surgeon should consider the possibility of underlying aneurysm even if the classic sign of pulsatile mass is not present. The role of interventional radiology is immaculate in the management of these aneurysms.

Mandibular angle and coronoid process fracture secondary to orofacial dystonia: report of a case.

As the angle is a weak region in the continuity of mandible, so it is more prone to fracture. It has been proven time and again that coronoid fracture results from a strong sudden contraction of temporalis. Muscular forces influence the remodeling of bones. Orofacial dystonia is a centrally mediated disease in which there is an uncontrolled spasmodic contraction of facial and masticatory muscles. This continuous force applied over a long period of time has the potential to unfavorably remodel or weaken bone. A case is presented in which the dystonic action of facial musculature gradually resorbed the bone to such an extent that there was spontaneous fracture at the right angle of mandible as well as the contra lateral coronoid. Management of this fracture posed a challenge at every step eventually leading to resection of the ramus-condyle unit. No case has been reported so far in the literature where dystonic movements have resulted in fracture of the mandible.