Cysticercosis of the masseter: MRI and sonographic correlation.

Cysticercal involvement of the masseter is an uncommon manifestation of a relatively common parasitic infestation. Sonographic evaluation of many isolated cases of cysticercosis has been extensively described. However, there are scanty reports on MRI appearance of cysticercal involvement of the masseter. This report presents classical imaging appearance of cysticercal involvement of the masseter on sonography and MRI. The pattern of the disease and MRI appearance of lesions in the masseter, highlighting the role of diffusion-weighted images, are described.

Malformación vascular intraósea en el maxilar que se presenta en forma de sangrado gingival / Intra-osseous vascular malformation in the maxilla

Las malformaciones arterio-venosas intraóseas (MAVs) en la región maxilofacial son entidades clínicas poco frecuentes. Ofrecen una amplia gama de presentación clínica y no siempre se diagnostican sin sorpresa. El tratamiento de estas lesiones siempre ha representado un reto para el cirujano debido a su intensa vascularización y a la elevada incidencia de recurrencia. Se presenta el caso de una malformación arterio-venosa intraósea en el maxilar superior que se manifiesta como sangrado gingival, cuyos exámenes radiológicos de rutina no fueron concluyentes. Se llevó a cabo la excisión quirúrgica y el empaquetado del hueso con cera, y se realizó el seguimiento del paciente durante 1 año sin que se produjera recurrencia. Las malformaciones vasculares deben tenerse en consideración en el diagnóstico diferencial del sangrado gingival con radiografías dentales no concluyentes(AU)

Intraosseous arterio-venous malformations (AVM) in the maxillofacial region are rare clinical entities. They have a wide range of clinical presentation and are not always diagnosed without a surprise. Treatment of these lesions has always been a challenge to the surgeon due to extreme vascularity and the high recurrence rate. The case presented is that of an intraosseous arterio-venous malformation in the maxilla that started as gingival bleeding and routine radiographic examinations were inconclusive. Surgical excision and bone wax packing was performed there were no recurrences during 1-year of follow-up. Vascular malformations may be considered in differential diagnosis of gingival bleeding with inconclusive dental radiographs(AU)

New perspectives in the management of cranio-mandibular ankylosis.

Cranio-mandibular ankylosis is characterized by the formation of a bony mass, which replaces the normal articulation. Although the bony mass represents the pathology responsible for the ankylosis, it is not a neoplastic process capable of continued growth. For this reason excision of this mass is not necessary for the release of ankylosis. An osteotomy performed inferior to the base of the ankylotic mass converts this into a situation akin to that of a subcondylar fracture. The technical details of this conceptually new approach to the management of TMJ ankylosis is described and the advantage of this technique over the conventional ones, particularly in cases of recurrent ankylosis, is discussed.

Soft and hard tissue correction of facial deformity associated with bilateral temporomandibular joint ankylosis.

Bilateral temporomandibular joint ankylosis in childhood can result in severe facial deformity characterized by both hard and soft tissue changes. The soft tissue deformity manifests as a submental hump of redundant soft tissue which has been displaced inferiorly due to deficiency of skeletal attachments. Improved results can be produced in these cases if the orthognathic correction is complemented by correction of the soft tissues. The presence of microgenia makes it possible to reach the subplatysmal plane through an intraoral incision allowing for the plication of platysma and relocation of the displaced soft tissues from the cervical to the mental region.

The trans naso-orbito-maxillary approach to the anterior and middle skull base.

The nose, along with the anterior wall of the maxillary antrum in continuity with the inferior orbital rim, can be transposed on a skin pedicle. This procedure can be combined with a Le Fort I osteotomy and mandibulotomy to gain access to, and to create a space for the delivery of anterior, middle and retromaxillary skull base lesions. The technique is illustrated by a case report and the merits and versatility of this technique are discussed.

Immediate reconstruction of the mandible after resection by sliding osteotomy: a new technique.

A technique of sliding osteotomy is described illustrated by a case for bridging mandibular defects of up to 7 cm. The defect is bridged by mobilizing full thickness inferior part of the mandibular corpus, and the defect thus produced is covered by the advanced outercortex from the ramus. The technique has particular advantage in the reconstruction of defects of the para symphysial region.

Management of large vascular lesions of the lip: case reports.

Vascular lesions of the head and neck region have been classified as either hemangiomas or vascular malformations. In adults, the lesions usually seen are malformations which may be large. Total resection of these lesions necessitates extensive reconstructive procedures and involves the risk of massive hemorrhage. It is for localized vascular malformations which arise in accessible areas of the face, e.g., the lip, that we developed a technique of circumferential ligation and partial resection. In our experience, this technique successfully circumvents the above problems. We present three cases which illustrate our contention.

Anteriorly based palatal flap for closure of large oroantral fistula.

A technique for closure of large oroantral fistula as a lateral transposition flap with an anteriorly based palatal flap is described. Mucoperiosteum of the posterior third of the hard palate, which is more yielding, is raised to bridge large defects without leaving any considerable exposed raw area. The technique is particularly useful in the correction of defects at the tuberosity region.

Reconstruction of mandible and surrounding soft tissues in patient with necrotizing fasciitis.

Necrotizing fasciitis is rare in the orofacial region, with fewer than 20 cases reported in the literature. Extension of the disease process to involve the underlying bone has not been previously reported. A patient is presented in whom destruction of superficial skin and fascia, necrosis of a portion of the mandible, and involvement of the parotid gland complicated reconstruction.

Hypoglycemia as a possible factor in the induction of vasovagal syncope.

Glucose level was estimated in capillary blood of 16 patients, who had vasovagal syncope during exodontia with local anaesthesia. One consistent finding was the low blood sugar level in all patients during syncope, as compared with the level 1 hour after recovery. Hypoglycemia can be induced by parasympathetic activation; this may be the product of reflex conditioning. Modest lowering of blood sugar levels can also act in synergy with hypotension and hypocapnea to induce loss of consciousness. Psychogenic syncope may be mediated through a mechanism involving hypoglycemia. Reflex conditioning perhaps accounts for the small but consistent fraction of the adult population who have repeated fainting episodes.

Vital root retention: a clinical procedure.

Retention of vital roots retards the resorption of residual alveolar ridges under complete dentures. It also eliminates the patient's responsibility of maintaining the periodontal health of overdenture abutments. The procedure involves (1) preparing the teeth to be retained from a periodontal standpoint to reduce the possibility of contamination of the surgical site, (2) removing hopeless teeth, (3) sectioning and contouring the teeth so that the retained roots are contiguous with the crestal bone, (4) preparing and suturing labial and lingual flaps to cover the prepared roots and maintain proper vestibular depth, and (5) placing an immediate denture relined with tissue-conditioning material.

Bursitis: a factor in the differential diagnosis of orofacial neuralgias and myofascial pain dysfunction syndrome.

A woman had pain on swallowing and talking when initially seen. Previous diagnoses of glossopharyngeal, neuralgia and myofascial pain dysfunction syndrome had been made. Appropriate treatment for these conditions failed to produce any improvement. Palpation revealed two tender areas bilaterally, overlying the hamulus. Treatment with an injection of 1 ml of dexamethasone (Decadron) 4 mg/ml into each area of tenderness resulted in a dramatic improvement. An anatomic review disclosed the presence of a bursa on the hamulus to protect the tendon of tensor veli palatini. A diagnosis of bursitis was made because of the dramatic improvement in the patient's condition as the result of corticosteroid therapy. Bursitis should therefore be considered in the differential diagnoses of orofacial neuralgias, temporomandibular joint dysfunction, and myofascial pain dysfunction syndrome.