Midline versus paramidline mandibulotomy: a radiological study.

Mandibulotomy allows for wide exposure of deep oral cavity and oropharyngeal tumors and may be performed medial or lateral to the mental foramen. Medial mandibulotomy is divided into midline and paramidline. Midline mandibulotomy requires detachment of muscles which may lead to masticatory and swallowing problems and could potentially jeopardize the central incisors. Our study provides a basis for placement of bone cuts in mandibulotomy. The angles between the long axis of the two central incisors, the lateral incisor and canine bilaterally were measured in panoramic radiographs of 100 healthy patients. The distances between the roots were measured. The angle between the lateral incisor and the canine ranged from 1 degrees to 8 degrees compared to 1 degrees -4 degrees (P<0.001) between the central incisors. The distances between the lateral incisor and the canine were 1-6.2mm while the distances between the two central incisors ranged from 0.5 to 4.7mm (P<0.05). Although the measurements were taken from a younger group of patients compared to the usual age of presentation of oropharyngeal cancer, it shows that the paramidline mandibulotomy in which bony cuts are performed through a wider gap is the preferred approach.

Mandibular buccal bifurcation cyst: enucleation without extraction.

The mandibular buccal bifurcation cyst (MBBC) is a cystic lesion, which occurs on the buccal surface of the permanent mandibular first molar in children around 6-8 years old. Treatment of the cyst has been controversial: extraction of the involved tooth and enucleation of the cyst, or only enucleation, without extraction. The aim of this article is to familiarize oral and maxillofacial surgeons with this entity and the appropriate treatment approach. The diagnostic features of MBBC are described and the treatment approach in five patients with a total of seven cysts is presented. Two cases were identified in identical twins. Enucleation of the cyst without extraction of the involved tooth is the treatment of choice when the available data and experience in treating MBBC are considered.

[Medical treatment of central giant cell granuloma of the jaws].

Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the jaws that is found predominantly in children and young adults. The lesion appears mostly in the mandible and presents as a unilocular or multilocular radiolucent defect. Although it is benign, it may be locally aggressive, causing extensive bone destruction, tooth displacement and root resorption. Two variants of the lesion, non-aggressive and aggressive, have been described. Traditionally, CGCG was treated surgically with aggressive curettage and peripheral ostectomy. The more aggressive type or recurrent lesions require wide resection, that lead to major defects in the jaws. This form of surgical treatment could be particularly disfiguring for a child or young adult. An alternative, non-surgical approach, was developed during the past several years. The present review describes several medical treatments available for CGCG that have been reported in the literature, such as corticosteroids, calcitonin and Interferon Alfa-2a. These alternatives are advantageous for large aggressive lesions in order to cure, or reduce the size of the lesion and thus minimize the need for extensive surgical resection that could result in functional and esthetic deficits.

Ampicillin-resistant Hemophilus influenzae type B infections in hospitalized pediatric patients.

Thirty-two pediatric patients with invasive Hemophilus influenzae type B (HITB) infections were evaluated according to the frequency of resistant strains and the clinical profile. The incidence of resistant strains was 28% (9/32), all of them due to beta-lactamase-producing bacteria. The rate of ampicillin resistance was significantly higher among patients who had received beta-lactam antibiotics. The initial treatment of HITB infections in our region should therefore include chloramphenicol; the indiscriminate day-to-day use of beta-lactam antibiotics should be reconsidered.