ABSTRACT
The term fibro-osseous lesion is a generic designation of a group of jaw disorders (ranging from inflammatory to neoplastic) that microscopically exhibit, a connective-tissue matrix and islands/trabeculae of bone. Although the histologic appearance, and frequently the clinical and radiographic features, may be similar for many of these lesions, they demonstrate a wide range of biologic behavior. Treatment therefore is varied, and there are few well-established guidelines to help the surgeon. Five fibro-osseous lesions with atypical features are presented to demonstrate the diagnostic difficulties associated with these lesions and to show the need for accurate classification in order to help direct treatment and predict outcome. Final diagnoses for "atypical" fibro-osseous lesions included: multiple ossifying fibromas, unclassifiable fibro-osseous lesion, osteosarcoma with concomitant multiple ossifying fibromas, juvenile or psammomatoid ossifying fibroma, and central low-grade osteosarcoma. "Fibro-osseous lesion" should be viewed as a working diagnosis, and a definitive diagnosis should be actively sought; the addition of "atypical" to this designation suggests the likelihood of an aggressive lesion. Treatment of lesions having atypical and nonclassical microscopic features must be based on the biologic behavior of the tumor.
Subject(s)
Fibroma, Ossifying/pathology , Jaw Diseases/pathology , Jaw Neoplasms/pathology , Osteosarcoma/pathology , Adolescent , Adult , Aged , Child , Diagnosis, Differential , Female , Humans , MaleABSTRACT
PURPOSE: Reports on treatment of "infected" mandibular fractures with open reduction and rigid internal fixation (RIF) consist of either isolated cases or mixed series of patients with soft tissue infections or inadequately documented osteomyelitis. The definition of "infected fracture" is often vague and may include both soft tissue or bone sepsis. MATERIALS AND METHODS: In this retrospective study, seven patients with mandibular fractures and documented osteomyelitis were treated by a protocol that included open reduction and RIF. Technetium-99m methylene diphosphonate (99mTc) and Indium 111 (111In) radionuclide scans, bone cultures, and microscopic examination were used to document the diagnosis of osteomyelitis. The infections were treated with antibiotics, incision and drainage, and surgical debridement. Reconstruction plates that were large enough to provide four holes in each bone segment were used for RIF of the fractures and simultaneous reconstruction of the osseous defects. RESULTS: After an average follow-up of 26 months, all patients remained infection free, and the fracture sites were stable. Five of the seven patients had inferior alveolar nerve dysfunction after treatment; no other significant complications were noted. CONCLUSION: The results of this study indicate that the protocol of simultaneous debridement, reduction, and RIF is a satisfactory method for treatment of mandibular fractures complicated by osteomyelitis. Prospective studies and longitudinal follow-up of larger numbers of patients would be desirable to confirm these findings.
Subject(s)
Fracture Fixation, Internal/methods , Mandibular Fractures/complications , Mandibular Fractures/surgery , Osteomyelitis/etiology , Adult , Bone Plates , Bone Wires , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Trigeminal Nerve InjuriesABSTRACT
Cherubism is a well-known disease entity that was first described by Jones in 1933. A case is presented in which the usual course of the lesion changed dramatically during treatment. The lesion demonstrated unilateral growth with a vascular proliferation after surgical recontouring. Vascular transformation and surgical activation of cherubism, as well as treatment considerations, are discussed.
Subject(s)
Cherubism/complications , Cherubism/surgery , Postoperative Complications , Child , Embolization, Therapeutic , Humans , Male , Mandible/blood supply , Neovascularization, Pathologic/etiology , Neovascularization, Pathologic/therapyABSTRACT
Many artists, orthodontists, and surgeons have proposed guidelines for esthetic facial evaluation, but few have shown a scientific basis for their criteria. Farkas, however, made a substantial contribution to anthropometric facial measurements of adult whites. His raw data were used to develop a comprehensive set of ratios to define the esthetic face. A systematic maxillofacial evaluation derived from Farkas's data is presented, along with a brief description of its clinical application.
Subject(s)
Anthropometry , Esthetics , Face/anatomy & histology , Adult , Female , Humans , Male , Physiognomy , Reference Values , White PeopleABSTRACT
Traditionally, cosmetic maxillofacial surgery designed to rejuvenate "the aged face" has been reserved for the elderly. However, any patient with facial manifestations that reflect, but are not limited to, an increased chronologic age is a candidate for esthetic maxillofacial surgery. In this text, the aged face refers to any facial manifestations that are perceived as indices of advanced age beyond an individual's chronologic or desired age. This paper presents a brief outline of the specific facial features that account for the aged face and describes surgical correction.
