Total Alloplastic Joint Reconstruction in a Patient With Temporomandibular Joint Ankylosis Following Condylar Dislocation Into the Middle Cranial Fossa.

PURPOSE: Traumatic dislocation of the mandibular condyle into the middle cranial fossa is an extremely rare complication of maxillofacial injury. Management case of the of dislocation of the mandibular condyle complicated by bilateral temporomandibular joint ankylosis is presented. MATERIALS AND METHODS: A 17year old male patient presented to the outpatient clinic complaining of inability to open his mouth following a motor vehicle accident 6 months prior. Examination revealed bilateral TMJ ankylosis following left condylar head fracture and dislocation of the right condylar head into the middle cranial fossa. Bilateral total alloplastic TMJ reconstruction was performed. RESULTS: MIO at a three-year follow-up was 35mm, occlusion was intact and the patient was functioning optimally.

Reconstruction of 56 mandibular defects with autologous compressed particulate corticocancellous bone grafts.

We retrospectively evaluated the results of particulate corticocancellous bone grafting of mandibular defects. Patients with deficits of mandibular continuity as a result of injuries or resection of disease had the affected segment debrided or resected, followed by placement of a patient-specific reconstruction plate. Eight weeks after resection, it was reconstructed with an autotransplant from the posterior iliac crest. Grafts were deemed successful if the regenerated ossicle (after 6 months' maturation) was adequate to take an osseointegrated fixture at least 10mm long. Fifty-six patients were treated, of whom 5 were lost to follow-up. The remaining 51 patients were followed up for a mean (SD) of 29 (18) months. The mean (SD) length of the defect was 12.4 (8.4) cm. Of the 51 reconstructions, 43 healed uneventfully and the grafts were deemed successful. Two healed grafts developed recurrent tumour, which required resection of the entire reconstructed area in one, and partial resection in the other. Three patients lost the complete graft from sepsis, and five developed sepsis that required debridement with partial loss of the graft. Two patients in the latter group required a second graft. One patient required an augmentation graft, as the ossicle was not sufficient to take an implant. The technique of staged grafting with particulate corticocancellous bone after moulding of the recipient site with a spacer produces unmatched restitution of mandibular anatomy with low morbidity.

Ossifying Fibroma in a Patient With Oculocerebrocutaneous (Delleman) Syndrome.

Delleman syndrome is a rare neurocutaneous disorder characterized by congenital anomalies affecting the eye, skin, and central nervous system. This disorder was first raised as a distinct syndromic entity by Delleman and Oorthuys in 1981 under the term "oculocerebrocutaneous syndrome" (OCCS). Since then, fewer than 40 cases have been reported. All cases have been sporadic, and no patient with an abnormal karyotype has been reported. Although the etiology is still unknown, several theories have been advanced. Most of the tissues affected by OCCS are neural crest derivatives, with a striking homogeneity of the tissues and regions involved. It is this recurring craniofacial pattern of OCCS that lends support to the hypothesis that the most probable pathogenesis is a neurocristopathy that interferes with craniofacial morphogenesis. Ossifying fibroma is a destructive, potentially deforming, benign tumor that can occur almost anywhere in the facial skeletion. Some cases of ossifying fibroma have occurred in patientswith underlying neurocutaneous syndromes such as neurofibromatosis, Sturge-Weber syndrome, and encephalocraniocutaneous lipomatosis (ECCL). We report a patient with OCCS who presented with an ossifying fibroma. This has not been reported previously and is noteworthy in that it might be part of a wider phenotypic spectrum of the less common manifestations associated with OCCS.

Interim reconstruction and space maintenance of mandibular continuity defects preceding definitive osseous reconstruction.

The use of space maintenance in mandibular defects as an interim measure before definitive osseous reconstruction may prevent problems associated with delayed reconstruction including increased technical difficulty, contracture of soft tissues that limits the volume of the final reconstruction, and the potential for iatrogenic injury to adjacent anatomical structures. The use of a condyle/ramus spacer made of medical grade, ultrahigh-molecular-weight polyethylene, and a flexible body spacer made of high quality, inert, non-toxic medical and food grade silicone rubber, was tested in 38 patients with mandibular defects after the resection of benign but locally aggressive disease, advanced osteomyelitis, and injuries. The spacer was retained for a maximum of 8 weeks, and was then removed through an extraoral approach before definitive reconstruction with a particulate corticocancellous bone graft. One of the 38 patients failed to attend for follow up and returned 7 months later with severe, generalised sepsis that required removal of the spacer and exclusion from the study. Of the remaining 37 patients, 32 healed uneventfully, 1 required removal of the spacer 2 weeks after implantation for intraoral wound dehiscence, and 4 had mild to moderate disturbances of wound healing that required either minor revision or local wound care until removal at the time of reconstruction. The use of a spacer promotes wound healing and simplifies and expedites secondary reconstruction of mandibular defects.

Central adenoid cystic carcinoma of the mandible with odontogenic features: Report of a case.

BACKGROUND: Primary intraosseous salivary-type adenocarcinomas are rare neoplasms of uncertain histogenesis. The prevailing theories suggest origin from heterotopic salivary glands, odontogenic rests, or cystic epithelium. METHODS: A case of central adenoid cystic carcinoma is reported in a 53-year-old woman who presented with a painless swelling in the anterior segment of her lower jaw. Radiographic examination confirmed the presence of an expansile, radiolucent lesion within the mandible with a multilocular appearance. On light microscopy analysis, areas showing cribriform and tubular growth patterns; admixed cysts, some of which were characterized by the presence of localized plaque-like thickenings of their epithelial linings; and the formation of aberrant dental hard tissue were observed. RESULTS: The radiographic and histomorphologic findings highlight the potential misdiagnosis of this rare tumor. The findings also draw attention to an embryologic histogenetic concept for some central salivary neoplasms. CONCLUSION: The divergent salivary and odontogenic differentiation evident in this tumor signifies the pluripotential nature of derivatives of oral ectoderm.

A prospective audit over a six month period of condylar fractures at Chris Hani Baragwanath Hospital.

OBJECTIVE: To determine the frequency of occurrence, patterns, aetiology and outcome of treatment of mandibular condylar fractures at Chris Hani Baragwanath Hospital. MATERIALS AND METHODS: All patients with condylar fractures seen at Chris Hani Baragwanath Hospital over a six-month period from January to June 2003 were included in the study. Data was recorded on sex, age, date of injury, cause of trauma, status of the occlusion and presence of associated facial injuries. The type of condylar fracture was recorded and classified following the radiographic examination according to Spiessl and Schroll. The type of treatment rendered and its outcome were also documented. Patients were followed up from 1 week to 6 months post-treatment. RESULTS: The sample comprised 84 patients with 95 condylar fractures; 69 (82%) males and 15(18%) females. 73.8% of the fractures were caused by interpersonal violence followed by road traffic accidents (16,67%) and falls (7.14%). 73 (87%) patients had unilateral fractures and 11 (13%) had bilateral condylar fractures. Of the 95 condylar fractures, there were 16 medially dislocated condylar fractures in 13 patients. Type I, Type II and Type III fractures accounted for 31%, 26% and 25% of the total fractures respectively. CONCLUSION: A relationship exists between the type of condylar fracture and the cause of the fracture: road traffic accidents and falls produce more bilateral and dislocated fractures than interpersonal violence. Prolonged intermaxillary fixation, failure to use training elastics, absence of active physiotherapy and poor patient compliance results in increased risk of hypomobility.