Pediatric Aggressive Benign Mandibular Tumors: Clinical Features and Management.

INTRODUCTION: Aggressive benign mandibular tumors are uncommon in the pediatric population, and there is few publishing in the literature specifically dealing with them. Aggressive tumors can be defined based on known biologic behavior and/or histologic type and/or clinical characteristics. AIM OF THE STUDY: To review the clinical features and management of lower jaw pediatric aggressive benign tumor. PATIENTS AND METHODS: Medical records review of pediatric patients presented with aggressive benign mandibular tumors to the Maxillofacial and Plastic Surgery Department, University of Alexandria, Egypt between 2011 and 2019. RESULTS: Fifty-eight patients were included in this study, aged between 2 and 16 years (average = 11.8). Ameloblastoma was the commonest pathological diagnosis (n = 18) followed by central giant cell granuloma (n = 11) and juvenile ossifying fibroma (n = 10). Patients with central giant cell granuloma were treated by en-block resection (n = 4) or curettage after interferon alfa injection (n = 7). All other benign tumors were treated by en-block resection. The length of follow-up ranged from 1 to 8 years. Successful reconstruction was accomplished in 45 patients (88.2%). CONCLUSIONS: Aggressive lesion should be treated in an aggressive manner and immediate reconstruction is advocated. However, pharmacotherapy combined with enucleation is a more conservative approach for management of aggressive central giant cell tumors.

Efficacy of stem cell allograft in maxillary sinus bone regeneration: a randomized controlled clinical and blinded histomorphometric study.

PURPOSE: This study aimed to evaluate the quality and quantity of newly generated bone in the maxillary sinus grafted with stem cell-based allograft material. METHODS: This study was a single site, prospective, blinded, randomized, and controlled clinical trial. Eleven subjects with 18 edentulous posterior maxillary sites requiring sinus augmentation for delayed implant placement using a lateral window approach were enrolled. At the time of sinus augmentation, test sinus was grafted with stem cell-based allograft (Osteocel Plus; NuVasive Therapeutics), while the control sinus was grafted with conventional cortico-cancellous allograft (alloOss; ACE Surgical). Cone beam computer tomography (CBCT) scan was taken before and 14 weeks post-sinus augmentation procedure, i.e., 2 weeks before implant placement. Thirty-six trephined core bone biopsies were harvested from the anterior and posterior grafted lateral-window osteotomy sites at the time of implant placement. RESULTS: The results showed a statistically significant difference in the vital bone percentage between the test and the control groups at the posterior grafted sites (p = 0.03). There was no significant difference in the percentage of vital bone between the anterior and posterior grafted sites within the test and control groups (p > .05). The CBCT analysis showed that the maxillary sinuses at the posterior grafted sites were statistically wider than those at the anterior grafted sites in both groups (p < .05). CONCLUSIONS: Different allograft bone materials can be used in the maxillary sinus augmentation procedures. Stem cell allograft has more osteogenic potential with a better outcome in the wide posterior sinus.

Resorbable Versus Nonresorbable Membranes: When and Why?

Guided bone-regeneration techniques use either resorbable or nonresorbable membrane. Ideal membrane material should be biocompatible with tissue integration, be able to create and maintain space, be occlusive with selective permeability, and have good handling properties. Commercially available nonresorbable membranes are Gor-tex (e-PTFE), Cytoplast (d-PTFE), and titanium mesh. Resorbable membranes are available as natural and synthetic. Clinical trials, a systematic review and meta-analysis have shown no statistically significant difference in most clinical indications between both types of membrane. The choice of membrane varies according to the choice of grafting materials and nature of defect.

Zygoma Implants or Sinus Lift for the Atrophic Maxilla with a Dentate Mandible: Which is the Better Option?

Rehabilitation of maxillary atrophy with dental implants is challenging to the clinician despite the wide variety of surgical techniques available. Finding the right indication for a procedure is highly important for the long-term stability of dental implants. With the introduction of the concept of "teeth-in-a-day," clinicians have explored innovative techniques to attain the goal of immediate implant-supported provisional prosthesis. However, costs and comorbidities are limitations to advancing these techniques. This article focuses on algorithms to rehabilitate the atrophic maxilla with the purpose of providing immediate provisional prosthetic teeth regardless of the mandibular dentition.

Simultaneous and differential fronto-orbital and midface distraction osteogenesis for syndromic craniosynostosis using rigid external distractor II.

In syndromic craniosynostosis, the relation between the supraorbital area and the frontal bone is not good, and it is not possible to reform this area with 1-block advancement. To avoid this problem, the frontal bone is separated from the fronto-orbital bandeau, each is reshaped and remodeled separately, and then both are reattached. The retrusion of the midface, especially in syndromic craniosynostosis, is usually greater than that of cranial bones, so the technique usually separating the midface from the cranium is Le Fort III osteotomy, which allows differential distraction of each part. In this procedure, the cranial and midfacial bones are advanced simultaneously and differentially, both to the planned extent, in a single-stage operation, using rigid external distractor II, correcting exorbitism, respiratory embarrassment, and cranial structures and avoiding eye complications in the future. This procedure was used, with a follow-up, in 10 patients with syndromic craniosynostosis from 2 to 5 years.

A foreign body in the floor of the mouth.

A case of unusual presentation of foreign body in the floor of mouth is reported. The patient presented with a history and clinical findings of sublingual ranula. Marsupialisation and sublingual sialadenectomy was planned. After marsupialisation, a foreign body (spray cover) was found between the lumen of the submandibular duct and the ranula.

Modified bimaxillary distraction osteogenesis: a technique to correct facial asymmetry.

AIM: To study the efficacy of modified simultaneous maxillary-mandibular distraction to correct facial asymmetry in patients with compensated occlusion and a canted occlusal plane. PATIENTS AND METHODS: During the period January 1998-December 2003, 15 patients with facial asymmetry (8 male and 7 female, mean age 18 years) were treated using a modified technique of simultaneous maxillary-mandibular distraction. Their facial deformities were caused by hemicraniofacial microsomia (n=6) or ankylosis of the temporomandibular joint (TMJ) (n=9). RESULTS: The mean (range) gain in mandibular height was 16 (13-22) mm, and increase in elongation 14 (11-18) mm achieved over 11-22 days. Predicted movement on cephalometric analysis correlated closely with the actual distraction (mean accuracy 0.4mm). CONCLUSION: Simultaneous bimaxillary distraction osteogenesis is a robust technique that provides the surgeon with the ability to correct facial asymmetry in patients with hemicraniofacial microsomia and those with facial deformity after ankylosis of the TMJ. A cephalometric prediction tracing made before distraction is a reliable guide to the actual distraction needed to correct the facial deformities in these patients.