Osteomyelitis of the mandible following third molar surgery: a regrettable consequence in a healthy patient.

This clinical case describes mandibular osteomyelitis in a healthy 31-year-old man as a severe complication following third molar removal. Recurrent abscess formations were treated with intensive therapy involving antibiotics, surgical debridement of the affected region, and hyperbaric oxygen. In the follow-up, despite microbiologic study to determine the indicated treatment approach, a severe osteomyelitis was present, clinically and radiographically. Finally, a partial resection of the mandible, including exarticulation, was indicated to manage this severe complication.

Speech and swallowing impairment after treatment for oral and oropharyngeal cancer.

OBJECTIVES: To assess the prevalence of speech and swallowing impairment after radical surgery for oral and oropharyngeal cancer from the patient's viewpoint and to examine the association of these functional alterations with selected clinical characteristics regarding patients, tumors, and oncologic treatment. DESIGN: Cross-sectional, multicenter study using a self-administered questionnaire. SETTING: Forty-three hospitals in Germany, Switzerland, and Austria. PATIENTS: A total of 3894 questionnaires about rehabilitation problems after treatment for oral and oropharyngeal squamous cell carcinoma were sent to patients. Of these, 1652 were filled out and returned, and 1334 (80.8%) met the inclusion criteria. MAIN OUTCOME MEASURES: Morbidity associated with treatment of oral and oropharyngeal cancer. RESULTS: Speech problems were reported by 851 patients (63.8%), and swallowing problems were reported by 1006 patients (75.4%). The variables that presented a significant association with speech and swallowing impairment were sex, tumor location, pTNM stages, stage of tumor, treatment modality, and reconstruction type. CONCLUSIONS: This survey, based on patient perception, suggests that those who undergo radiotherapy associated with the surgical removal of a tumor, have late-stage tumors (III-IV), or have tumors located in the floor of the mouth should be informed of the greater risk of persistent severe speech and swallowing problems.

Diplopia and acute rectus muscle palsy as symptoms of an infected follicular cyst of a maxillary right third molar: a case report.

Severely impacted third molars have a high risk of developing a dentigerous cyst. Dental cysts in the maxilla can cause acute infection of the maxillary sinus that can involve the orbital cavity. Possible complications of infections of the orbital cavity are eyesight reduction, including blindness, and disseminated infections, including brain abscesses. This article reports on a 53-year-old male patient with diplopia caused by acute rectus inferior muscle palsy as symptoms of an empyema of the maxillary right sinus. An infected follicular cyst due to the impacted and displaced maxillary right third molar caused the empyema. An emergency trepanation with drainage of the right maxillary sinus was performed. Additionally, intravenous antibiotic therapy with penicillin G and metronidazole resulted in improvement. In a secondary surgical process 2 weeks later, the cyst and the third molar were removed. Complete recovery was noted. It is important to be familiar with clinical diagnostics in cases of undefined pain of the teeth and jaws. Radiographic imaging is indicated in such cases. Disseminated odontogenic infections must be considered as the primary origin of pain and diplopia.

Zygoma implant-supported prosthetic rehabilitation after partial maxillectomy using surgical navigation: a clinical report.

The rehabilitation of patients with acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. In most patients these goals are met by means of prosthetic rehabilitation with an obturator prosthesis. If the remaining dentition does not offer sufficient retention and support, the placement of zygoma implants can enhance the stability of the prosthesis. Due to the anatomic intricacies of the zygomatic bone and the implant length, computer-supported navigated implant placement can be advantageous. In the following clinical report, a diabetic patient with a status of posthemimaxillectomy secondary to aspergillusis infection is presented, in whom a zygoma implant was placed using a CT scan-based navigation system. A special retentive anchoring abutment was used to integrate the zygoma implant into a telescopic crown-retained denture on the residual dentition. This tooth-implant-supported obturator prosthesis restored function and phonetics, as well as esthetics, for this young patient.

Complicated late mandibular fracture following third molar removal.

Mandibular fractures are a rare complication after third molar removal. Symptoms show a wide variance. Treatment options range from prescription of a soft diet to surgical treatment by open reduction and internal fixation. This article describes a patient who presented a late mandibular fracture following third molar removal. The fracture was not detectable in radiographs at the time of fracture. Six weeks after the reported cracking noise, the patient presented a mandibular fracture with associated osteomyelitis. Treatment by open reduction and internal fixation and autologous iliac crest graft was performed via a submandibular approach. The delayed diagnosis of this pathologic fracture demonstrates the necessity of repeated radiologic controls to prevent osteomyelitis when a fracture is suspected.

Bone formation after sinus augmentation with engineered bone.

OBJECTIVES: The aim of the following investigation was to quantify the resorption rate of tissue-engineered bone grafts in the maxillary sinus using volume measurements. MATERIAL AND METHODS: Sinus floor augmentation using autologous bone grafts from the iliac crest (n=17, group 1) was compared with commercially produced transplants of human cells seeded on polyglycolid-polylactid (PLGA) scaffolds (Oral Bone) (n=14, group 2). RESULTS: The total resorption rate for autologous transplants 3 months post operation was 29%, while the tissue-engineered bone showed a resorption rate of 90%. The autologous bone had a bone density of up to 266-551 Hounsfield units (HU), while sufficient mineralization of tissue-engineered bone was found in only one case (152 HU). CONCLUSION: In this clinical study, the use of autologous cancellous bone grafts in sinus augmentation was more reliable than scaffolds containing cultured osteoblasts. Further tissue-engineered bone transplants should be examined to draw general conclusions about the use of tissue-engineered grafts compared with autologous bone grafts for maxillary sinus augmentation.

Alveolar zygomatic buttress: A new donor site for limited preimplant augmentation procedures.

PURPOSE: Augmentation of anterior maxillary alveolar bone defects before placement of endosseous implants still poses a clinical challenge. Previous traumatic loss of upper anterior teeth is often concomitant with significant bone loss. The aim of augmentation is to reconstitute as far as possible the original hard tissue contour. This is a prerequisite for later optimal positioning of the dental implants in accordance with prosthodontic and functional principles. MATERIALS AND METHODS: This article describes a new method for the reconstruction of small anterior maxillary alveolar bone defects using donor bone from the zygomatic buttress region. RESULTS: This region provides harvested bone with a natural convex shape, which is ideally suited for the anterior alveolar process region. Later fibrous tissue transplantation to provide more anterior projection to the anterior dental area is also avoided. CONCLUSION: Bone harvesting was done with the piezoelectric device, which avoids trauma to the mucosal membrane of the maxillary sinus.

Orbital abscess after extraction of a maxillary wisdom tooth.

A 21-year-old patient with orbital abscess and vision loss left after wisdom-tooth extraction is presented.

Computer-assisted reconstruction of orbital floor based on cone beam tomography.

We used a navigation system for computer-assisted preoperative planning based on cone beam tomography with virtual reconstruction to obtain symmetry of the orbit and intraoperative control of virtual contours. In operations for reconstruction of the orbital floor this technique offers a reliable intraoperative control in an area of limited exposure and visibility. There was no significant difference in visualisation of anatomical structures between the cone beam tomographic digital imaging and communication (DICOM) data and computed tomographic data. Cone beam tomography seems to be suitable for computer-assisted planning in the management of orbital trauma with reduced costs and less radiation.

Obturator after marsupialization of a recurrence of a radicular cyst of the mandible.

The radicular cyst is the most common odontogenic cyst. We present the case of a 51-year-old man with an extended recurrence of a radicular cyst of the mandible that was treated with marsupialization. Subsequently, an obturator was fitted, and in 10 months a resolution (clinically and radiographically) of the cystic cavity was noticed without any signs of recurrence. The marsupialization is a well-established, nonaggressive treatment of large odontogenic cysts and shows advantages in preserving vital structures, with reduced risk of pathological mandibular fractures. The patient, however, must be compliant and accept the prolonged treatment of marsupialization.

Minimally invasive open reduction of a displaced condylar fracture in a child.

We treated successfully a severely displaced condylar fracture in a child 9 years of age by endoscopically assisted open operation.

Navigation-aided reconstruction of medial orbital wall and floor contour in cranio-maxillofacial reconstruction.

The reconstruction of the anterio-posterior inclination of the medial aspect of the orbital floor, despite a wide 360 degrees exposure, including coronal and conjunctival incisions, is a challenging task in severe injuries of the orbit with massive comminution and complete displacement of the medial orbital wall and orbital floor. Out of a total of 20 patients with orbital fractures, five underwent a surgical intervention of repositioning the medial aspect of the orbital floor and especially the transition area between the orbital floor and medial orbital wall, using navigation-aided procedures. Using the mirroring tool of the Stryker-Leibinger STN-system, post-operative CTs indicated an average difference of the globe position of -4.9% between the operated side and the unaffected side, depending on the position of the medial aspect of the orbital floor. Navigation-aided procedures proved to be an essential precondition for achieving precise and predictable results in orbital reconstruction. In such cases, unlike those with an intact medial orbital wall remnant as a surgical target, bone grafts for reconstruction of the orbital floor cannot be implanted as onlay grafts.