Computed tomographic analysis of the position of the mandibular canal in unilateral temporomandibular joint ankylosis patients.

The aim of this study was to investigate the position of the mandibular canal through the region of the mandibular angle and body using computed tomographic (CT) imaging, and to relate the findings to those in the molar region on the ankylosed temporomandibular joint (TMJ) and the normal side. The mandibles of 25 patients with unilateral ankylosis of the TMJ (14 women and 11 men) were recorded on coronal CT slices 2mm thick. All patients included in the study had had ankylosis diagnosed before they were 16 years old. The position of the mandibular canal was studied from the region of the third molar to that of the first molar on ankylosed and normal mandibles. The following variables were measured: the distance between the external surface of the buccal cortical plate and the outer surface of the mandibular canal (B); the distance between the external surface of the lingual cortical plate and the outer surface of the mandibular canal (L), and the distance between the external surface of the inferior border of the mandible and the outer surface of the mandibular canal (I). Our results suggest that changes are more pronounced in the regions of the second and third molars. The mandibular canal is closest to the inferior border of the mandible in the region of the second molar and farthest in that of the third molar. The greatest distance between the outer surface of the mandibular canal to the external surface of the buccal cortex on the ankylosed and normal sides was found in the first and second molars, and it was greater on the normal side. To minimise the risk of injury to the inferior alveolar nerve, the measurements of B, L, and I should be considered separately on the ankylosed and normal sides when planning mandibular osteotomies for distraction osteogenesis and orthognathic surgery, and when using monocortical screws.

Calcifying epithelial odontogenic cyst associated with complex odontome of maxilla.

The term calcifying odontogenic cyst was first introduced by Gorlin in 1962 (Eshghyar et al., Acta Med Iran 44(1):59-62, 2006). The lesion is unusual in that it has some features of a cyst but also has many characteristics of a solid neoplasm (Cysts and tumors of odontogenic origin: textbook of oral pathology, 2006). It is classified into two types-Type I-the cystic variant, Type II-solid tumor variant. This case report present Type I B-odontome producing intraosseous calcifying odontogenic cyst and Type I C-with ameloblastomatous proliferation in a 19 years old male patient in the right maxillary quadrant. The lesion involved an unerupted permanent maxillary central incisor, which was displaced to the infraorbital ridge of right side and the radiograph revealed a calcified mass in the periapical region of right incisor that was later recognized histopathologically as complex composite odontoma. The lesion was removed surgically. This case report emphasizes on the presence of this Type I B and C lesion and the need to keep them in follow up.

Deep venous thrombosis: report of 2 cases.

Postsurgical deep venous thrombosis (DVT) is an established complication with rare incidence in maxillofacial surgery. We report 2 cases of postsurgical proximal DVT after hemimandibulectomy from 2000 to 2009 along with pathogenesis, clinical findings, and management of DVT.

Hereditary gingival fibromatosis.

Hereditary gingival fibromatosis is a rare benign oral condition characterised by slow and progressive enlargement of both maxillary and mandibular attached gingiva. It may develop as an isolated disorder but can feature along with a syndrome. A case of 12 year old female child who presented with generalised severe gingival overgrowth, involving both the arches and covering almost the entire dentition, and had all the teeth remaining invisible within the confinement of gingival tissues. The excess gingival tissue, in this non-syndromic case was removed by conventional gingivectomy using local as well as general anaesthesia. The post-operative result was uneventful and the patient appearance improved considerably. Good aesthetic result was achieved to allow patient to practice oral hygiene measures. After treatment regular recall visits are necessary in order to evaluate oral hygiene and stability of periodontal treatment.

Ameloblastoma: an evidence based study.

OBJECTIVE: The purpose of this study is to present a series of 46 cases of ameloblastoma-38 in mandible and 8 in maxilla treated in the Oral and Maxillofacial Surgery Department of Government Dental College and Hospital, Nagpur during 1997-2006 with emphasis on various treatment modalities used in treating different types of ameloblastoma and how to define the safe margin for different clinical and histopathological types of ameloblastoma with their follow-up. METHOD: Confirmation of lesion done by incisional biopsy upon which treatment plan was decided and if resection is done then section was studied for amount of infiltration in adjoining bone histopathologically. RESULT: In a follow-up period of 1-9 years recurrence was observed in six cases, two in patients treated with enucleation and curettage, three in patients treated with segmental resection and one in patient with peripheral ameloblastoma treated with soft tissue resection. CONCLUSION: From this study we conclude that depending upon the histopathological type different amount of adjoining bone is resected to get the safe margin and based upon the result it is recommended to remain a bit aggressive in maxillary lesions.

Comparative efficacy of spiral computed tomography and orthopantomography in preoperative detection of relation of inferior alveolar neurovascular bundle to the impacted mandibular third molar.

PURPOSE: To assess the relationship of the inferior alveolar neurovascular canal (IANC) and the impacted mandibular third molar on spiral computed tomography (SCT), determine the validity of this assessment, and compare it with that for an orthopantomogram (OPG). MATERIALS AND METHODS: Patients visiting the Oral and Maxillofacial outpatient department at the Government Dental College and Hospital, Nagpur, India, were chosen as the subjects for our study. Patients were operated on and the actual clinical findings were compared with the SCT findings. Sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve were determined as a part of ROC analysis. The values for both the diagnostic modalities were then compared using a chi(2) test. RESULTS: Objective evaluation of the SCT showed that the number of positive clinical findings (marking on tooth surface, visualization of the neurovascular bundle, intraoperative excessive hemorrhage, and IAN paresthesia) were significantly more in patients with no measurable distance between the tooth and the canal. Also, the positive clinical findings were observed significantly more in patients who had the following features observed on spiral CT: lack of cortication of the canal and lingual or intraradicular course of the inferior alveolar neurovascular bundle (IANB). ROC analyses of both these diagnostic modalities have shown that the SCT performed better than OPG, although the difference is not statistically significant (P = .9871; chi(2) test). CONCLUSIONS: The spiral CT images definitely enhanced the visualization of the relation of the tooth to the IANB, which might provide a higher level of intrasurgical safety and safeguard the interests of both the surgeon and the patient.