Management of pseudoaneurysms of the internal maxillary artery derived from orthognathic surgery based on one case.

PURPOSE: The purpose of this article is to highlight the risk of pseudoaneurysms formation after orthognathic surgery, their clinical features and management. METHODS: A case report of a 24-year-old man who suffered a pseudoaneurysm of the internal maxillary artery after sagittal osteotomy during orthognathic is reported. After three bleeding episodes, a pseudoaneurysm was diagnosed with a computed tomography angiogram (CTA) and treated with an embolization of the internal maxillary artery with polyvinyl alcohol (PVA) successfully. RESULTS: Pseudoaneurysms derived from the external carotid artery are an uncommon complication of orthognathic surgery, especially related to sagittal osteotomy instead of LeFort I osteotomy. CONCLUSION: Pseudoaneurysms derived from external carotid artery branches must be suspected when patients show multiple episodes of bleeding (epistaxis or through the surgical approach) within the first two weeks after orthognathic surgery. If so, vascular CT or angiography should be performed to rule out the presence of vascular injuries. In case a pseudoaneurysm is identified, vascular embolization with N-butyl-cyanoacrylate seems to be the best treatment if available. If this treatment is not available or bleeding cannot be controlled, surgical ligature of the injured vessel is a valid treatment.

Accessory submaxillary gland: Two new case reports and a literature review.

BACKGROUND: The accessory submaxillary gland is a very uncommon anatomical variant, and incidence in the general population has not yet been quantified. The presence of pathology in these glands is rarer still, thus often going unnoticed. MATERIAL AND METHODS: We describe two accessory submaxillary gland cases, one asymptomatic and the other with chronic sialadenitis in the main and accessory gland caused by sialolithiasis. Although our diagnosis was by computerized tomography, magnetic resonance sialography is helpful to understand and describe this entity with greater precision. RESULTS: The first case report is an incidental finding and no intervention was required. However, case report number two had clinical symptoms and required a first intervention in which the main submaxillary gland was resected, and a second intervention in which the accessory submaxillary gland was removed. Both patients are asymptomatic to date. CONCLUSIONS: Awareness of the possible presence of accessory submaxillary glands and of potential variations of the excretory ducts is useful in diagnosis, as well as leading to more precise treatment for salivary pathology, and allowing surgeons to avoid complications or injuries during surgery. Key words:Accesory, submaxillary gland, submandibular gland, salivary gland, sialolithiasis, head and neck pathology.

Transoral (transvestibular-paramandibular) endoscopic approach for benign tumours in the infratemporal fossa.

We describe a minimally invasive transoral approach to the infratemporal fossa, by means of endoscopy, which facilitates examination and resection of lesions in this area. Furthermore, we outline the technique employed and a case treated with this approach, which permits a rapid access with very low patient morbidity, due to the use of endoscopy and of transoral access, instead of traditional transfacial approaches.

Caliber-persistent Artery: A Case Report.

The caliber-persistent labial artery (CPLA) is a vascular anomaly in which a main branch of the artery penetrates the submucosal area of the lip without loss of caliber. It commonly presents as an elevated soft tissue mass and is often pulsatile on manual palpation. Clinical suspicion is important, given the risk of bleeding, either from slight trauma or accidentally if lack of awareness leads to excision of the lesion owing to an incorrect diagnosis. CPLA should be considered in the differential diagnosis of any lesion affecting the lip, especially to differentiate from mucocele or squamous cell carcinoma. This particular case of CPLA in the upper lip of a girl presents a both unusual and interesting clinical picture and could provide essential diagnostic and procedural information. HOW TO CITE THIS ARTICLE: Segundo-Jiménez MMG-S, Puche-Torres M, Torres-Gaya J, et al. Caliber-persistent Artery: A Case Report. Int J Clin Pediatr Dent 2019;12(5):475-477.

Temporomandibular chronic dislocation: The long-standing condition

BACKGROUND: The temporomandibular joint (TMJ) dislocation can be categorised into three groups: acute, habitual or recurrent and long-standing. The long-standing or protracted lower jaw dislocation refers to a condition that persists for more than one month without reduction. There are a great variety of methods for its treatment, from the manual or non-surgical, to surgical ones like the indirect approach (conservative surgical approach) and direct approach (open joint). Additional procedures in unsuccessful cases may include extra-articular orthognathic techniques to correct a malocclusion until joint replacement. MATERIAL AND METHODS: We report four new cases with a minimum of 6 weeks dislocation who were seen since 1995 to 2015 in the Maxillofacial Department of the Clínico Hospital (Valencia, Spain), in which the mean age was 57.5 years. Most of them were bilateral and the gender was predominantly female. Additionally, we have reviewed the related literature. RESULTS: All of the cases were successfully treated and half of them required open surgery. CONCLUSIONS: The report confirms the difficulty of the treatment and reaffirms the necessity to bear in mind the wide variety of methods available for the treatment of this pathology. We stress the difficulties associated with managing the treatment and of suggesting new guidelines. The best option still remains not to delay the diagnostic and to select the appropriate initial treatment

Platelet-Rich Plasma: A Study of the Variables that May Influence Its Effect on Bone Regeneration.

BACKGROUND: Currently, the use of platelet-rich plasma in bone regeneration is a real option, although more than one opinion has alerted us to the absence of clinical benefits. PURPOSE: Analysis of the factors able to modify the characteristics of the platelet preparation obtained by Curasan, Plasma Rich in Growth Factors (PRGF), Platelet Concentrate Collection System (PCCS) and SmartPrep systems, relating them to the type of clinical application and the final bone regeneration achieved. MATERIALS AND METHODS: A search was conducted in PubMed using the keywords "platelet-rich plasma," "PRP," "platelet rich growth factors," and "oral bone regeneration." Four widely accepted protocols for the obtention of PRP (above) were analyzed. Any clinical studies with controls, using the four preparation protocols and with a 4 to 6 weeks follow-up period were compared. The protocols were also grouped according to the type of PRP application: PRP-alone, with bone, or with bone substitutes. RESULTS: Bone regeneration was not achieved in any of the cases using PRP obtained by Curasan and PCCS systems, whereas PRP obtained by SmartPrep achieved it only in one in three published cases and PRGF in one in six. CONCLUSION: Based on the poor results observed in current literature, the use of PRP in oral surgery cannot be recommended.

Malformación venosa intraósea primaria en hueso cigomático: actualización en criterios diagnósticos / Primary intraosseous venous malformation of the zygoma: update in diagnostic criteria

Las anomalías vasculares incluyen dos entidades bien diferenciadas aunque frecuentemente confundidas en la literatura científica: los hemangiomas y las malformaciones vasculares. La localización primaria intraósea cigomática es muy infrecuente. Además, la mayoría de los casos publicados han sido categorizados de «hemangioma» de forma poco rigurosa. Los autores describen un caso de malformación venosa intraósea cigomática y discuten las características clínicas, histológicas e inmunohistoquímicas distintivas de las anomalías vasculares que conducen a un adecuado diagnóstico y un tratamiento eficaz (AU)

Vascular anomalies include two well-differentiated conditions that are nevertheless often confused in the scientific literature: haemangiomas and vascular malformations. Primary intraosseous involvement of the zygoma is particularly rare. Moreover, most reported cases of zygomatic involvement have been categorised as “haemangioma” without appropriate diagnostic criteria. The authors describe a case of intraosseous venous malformation of the zygoma and discuss the specific clinical, histological and immunohistochemical criteria of vascular anomalies that lead to a correct diagnosis and subsequent effective treatment (AU)

Autologous fat transfer to the cranio-maxillofacial region: updates and controversies.

BACKGROUND: Autologous fat grafts have gained popularity among Cranio-Maxillofacial surgeons within the past years. Most publications report favourable outcomes but lack quantifiable evidence of graft survival. OBJECTIVES: To assess autologous fat transfer for facial asymmetry, and review the literature focusing on current indications, techniques, complications, fat survival and patient satisfaction. PATIENTS AND METHODS: Nine patients presented facial asymmetry due to onchological resection, congenital anomaly, or craniofacial traumatism. A total of 11 autologous fat transfers were performed. Four procedures followed the Coleman technique; in the other seven procedures, fat centrifugation was obviated. RESULTS: No significant complications derived. Progressive volumetric decrease was evidenced for up to 6 months after surgery. A second procedure was performed in two patients. No clinical differences in cosmetic outcomes or graft survival were observed between centrifuged and non-centrifuged grafts. Patients reported high satisfaction. CONCLUSIONS: Facial recontouring with autologous fat transfer restores volumetric defects with high patient satisfaction. The scientific literature offers inconsistent results. The authors did not find clinical differences between centrifuged and non-centrifuged grafts. Volume gain may result from induced fibrosis, inflammation and native adipocyte growth or differentiation. The heightened interest in these procedures should instigate further investigation to refine surgical procedures and improve predictability.

Bilateral synovial chondromatosis of the temporomandibular joint.

PURPOSE: To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data. PATIENTS AND METHODS: A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ. RESULTS: SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians' lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy. CONCLUSION: SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.

The meridian incision: a technical modification in the conservative surgery of the impacted maxillary canine.

We describe a technical modification of the apical repositioning flap in the conservative surgical treatment of the impacted canine in buccal position. This amendment improves the tooth's eventual visualization, thus permitting a better evolutive follow-up of its eruption process and, most importantly, providing the tooth with buccal attached gingiva that will accompany it in its downward progression, procuring a cervical contour without retraction, a satisfactory esthetic outcome and a physiologically correct periodontal ridge. The traditional apical repositioning flap also bestows the canine with attached gingiva; however, since the flap is sutured apically and its width is significantly smaller than the remaining surgical defect, the wound's closure is compromised at one of its edges and often requires healing by second intention at an undesired location next to the buccal sulcus. We believe the introduction of the meridian incision is a simple, expedient technical modification with efficient results.

The meridian incision: A technical modification in the conservative surgery of the impacted maxillary canine

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We describe a technical modification of the apical repositioning flap in the conservative surgical treatment of the impacted canine in buccal position. This amendment improves the tooth’s eventual visualization, thus permitting a better evolutive follow-up of its eruption process and, most importantly, providing the tooth with buccal attached gingiva that will accompany it in its downward progression, procuring a cervical contour without retraction, a satisfactory esthetic outcome and a physiologically correct periodontal ridge.The traditional apical repositioning flap also bestows the canine with attached gingiva; however, since the flap is sutured apically and its width is significantly smaller than the remaining surgical defect, the wound’s closure is compromised at one of its edges and often requires healing by second intention at an undesired location next to the buccal sulcus. We believe the introduction of the meridian incision is a simple, expedient technical modification with efficientresults

Primary mandibular bone xanthoma. A case report.

We describe a case of a xanthoma located in the mandible of an 11-year-old boy. The lesion, apparently benign, did not produce pain. It did, however, produce mandibular expansion by infiltration. In jaws, xanthoma has been very rare; in order to diagnose primary xanthoma, it was necessary to discount other histological entities or the association of hyperlipoproteinemia. Treatment was the total excision of the lesion.