Primary melanoma of submandibular gland: case report and literature review of a very rare entity.

BACKGROUND: Cutaneous melanomas account for more than 95% of all cases of primary melanoma, making non-cutaneous primary melanomas truly rare. Cases of primary mucosal melanomas of the oral cavity have been widely described; however, instances of primary melanomas arising from salivary glands have been rarely described. To date, this is only the second case of primary melanoma of the submandibular gland. CASE PRESENTATION: This is a report of a case of a 36-year-old healthy male patient, who was referred to us with the chief complaint of a growing swelling on the left side of his lower jaw. Evaluations revealed an evident facial asymmetry in the frontal view with a firm, non-tender swelling. Initial orthopantomogram did not reveal any alterations in the trabeculation or morphology of the jaws and the surrounding structures. A soft tissue ultrasonography of the left submandibular gland and anterior region of mandible revealed a hypoechoic cystic mass with numerous micro-echoes. Further para-clinical examinations yielded the definitive diagnosis of primary melanoma of the submandibular gland. Moreover, no evidence of distant osteometastasis was observed in whole-body scans. Subsequent surgical management with the approach of excising the submandibular salivary gland and concurrent selective neck dissection was implemented. CONCLUSIONS: This report emphasizes the importance of thorough examination and prompt referral to designated specialists in cases with suspicious behaviors which are unresponsive to treatments. It can be further concluded that melanoma can mimic a range of benign pathologies; therefore, putting it in the list differential diagnosis of similar lesions seems plausible.

Comparison of therapeutic results of closed and open repair of mandibular condylar fractures.

BACKGROUND: Mandibular condylar fractures mostly result from traumatic accidents or strife. There is still dispute on the effectiveness of various therapeutic methods. Here we aimed to evaluate and compare the open or closed repair methods for mandibular condylar fractures. METHODS: This is a clinical trial that was performed in 2015-2021 in Iran on all patients that referred to our medical centers with mandibular fractures due to traumatic events. Those cases with severe lateral dislocation of the mandibular condyles or severe dislocations of the fractured parts were assigned to the open surgical treatment group. The other patients were treated using Arch bar + intermaxillary fixation (IMF). The patient's abilities of mouth opening were assessed in centimeters within 1 month, 3 months, 6 months, 1 year and 2 years after the operations. RESULTS: 726 mandibular fractures were evaluated. Our data showed that 302 fractures (41.6%) were in the mandibular condyles. Of the 302 condylar fractures, 172 fractures (57.1%) occurred due to automobile accidents and 82 fractures (27.5%) occurred due to direct trauma. 203 patients (67.2%) underwent the close surgical procedures using maxillary and mandibular fixation using arch bar + IMF. 99 patients (32.8%) underwent open mandibular fixation operation and internal fixation (ORIF). Assessments of mouth opening showed significant improvements in this ability within the follow-up period in both groups (P<0.001 for both). Furthermore, we observed that patients treated by the open mandibular fixation procedure had significantly better results within the 6 months and 1 year after the procedures but after 2 years, no significant differences could be observed between groups. CONCLUSION: Both open and closed surgical approaches for condylar fractures are associated with significant improvements, however, patients that were treated with ORIF had better clinical results in the first year after the surgical procedures.

Intraoral transnasal approach for surgical extraction of bilateral deeply impacted mesiodens: A case report.

We describe a novel modified intranasal approach to minimize the complications of the impacted mesiodens surgical extraction. Also, it can be performed under local anesthesia with proper preoperative workup.