Hemifacial microsomia: a scoping review on progressive facial asymmetry due to mandibular deformity.

PURPOSE: This scoping review explores various parameters of the mandible in progressive facial asymmetry (FA) in hemifacial microsomia (HFM) patients, highlighting its relationship with sex, population, and age group. METHODS: The review was based on a comprehensive search of PubMed, EBSCOhost, and Web of Science. Eligible studies that met the inclusion criteria form part of the selection study. The included studies were appraised using screening and quantitative criteria of mixed-method appraisal tools. The authors utilised a pre-set data extraction form to obtain information from the included studies. RESULTS: Eleven studies met the inclusion criteria. The mandible parameters used were angular measurements, chin point, ramal height, body length, and total length. There was no relationship between FA and sex in HFM patients in the included studies. Most of the studies were comprised of European participants (55%), followed by Americans (36%) and Chinese (9%). The age groups included in the selected studies were categorised as dentition age (18%), early-to-middle childhood (18%), and varied ages (64%). The data presented in this review only pertains to the anomalous characteristics recorded on the affected side in HFM patients. No concomitant control data was recorded in this review. CONCLUSION: An assessment of the included studies revealed that FA does not increase with age in HFM. Hence, FA is non-progressive in HFM patients. This information is relevant to diagnosing and managing HFM patients. More reports are needed on the progression of FA in HFM patients.

Deep learning in sex estimation from photographed human mandible using the Human Osteological Research Collection.

Sex estimation is a necessary part of forensic and osteological analyses of skeletal human remains in the construction of a biological profile. Several skeletal traits are sexually dimorphic and used for skeletal sex estimation. The human mandible and morphological traits therein have been long used for sex estimation, but the validity of using the mandible in this purpose has become a concern. In this study, we examined the potential of artificial intelligence (AI) and especially deep learning (DL) to provide accurate sex estimations from the mandible. We used 193 modern South African mandibles from the Human Osteological Research Collection (HORC) in the Sefako Makgatho Health Sciences university with known sex to conduct our study. All mandibles were photographed from the same angle and the photographs were analyzed with an open-source DL software. The best-performing DL algorithm estimated the sex of males with 100% accuracy and females with 76.9% accuracy. However, further studies with a higher number of specimens could provide more reliable validity for using AI when building the biological profile from skeletal remains.

Telangiectatic osteosarcoma of the mandible-A rare case report and an insight into differential diagnosis.

Telangiectatic osteosarcoma (TOS) is a rare variant of osteosarcoma that typically affects young individuals and long bones. The case under discussion was seen in the mandible of a 57-year-old female and had rapidly grown in size within a week. Microscopically, the tumour was characterised by large vascular cavities surrounded by anaplastic cells. Thin lacy tumour osteoid was observed at various foci. Abundant multinucleated osteoclastic giant cells along with areas of necrosis were also noted. The tumour cells were positive for SATB2, while negative for Cytokeratin AE1/3, CD 34. Ki-67 positivity was observed in more than 50% of tumour cells. A diagnosis of high grade telangiectatic osteosarcoma was thus made.

A finite element study on the risk of bone loss around posterior short implants in an atrophic mandible.

PURPOSE: This study aimed to evaluate the risk of bone loss around single short molar crown-supporting implants in an atrophic mandible. METHODS: Implants of different lengths (L = 4 or 6 mm) and diameters (Ø = 4.1 or 4.8 mm) were placed in the molar area of an atrophic mandible. Additional control mandible models were simulated for 4.1 mm diameter implants (L = 4, 6, 8, and 10 mm). A vertical masticatory load of 200 N was applied to three or six occlusal contact areas (3ca or 6ca) of the prosthetic crown. The bone strain energy density (SED) of 109.6 µJ/mm3 was assumed to be the pathological threshold for cortical bone. The peri-implant bone resorption risk index (PIBRri) was calculated by dividing the maximum SED of the crestal cortical bone by the SED pathological threshold. RESULTS: Increasing the implant length from 4 to 6 mm, implant diameter from 4.1 to 4.8 mm, and number of contact areas from 3 to 6 reduced the SED and PIBRri values by approximately 20%, 35%, and 40%, respectively, when comparing pairs of models that isolated a specific variable. All models with 6ca had a low bone resorption risk (PIBRri<0.8), while the Ø4.1 short implant with 3ca had a medium (0.8≤PIBRri≤1.0) or high (PIBRri>1.0) resorption risk. CONCLUSIONS: Increasing the diameter or occlusal contact area of a 4 mm short implant in an atrophic mandible resulted in reduced bone resorption risks, similar to or lower than those observed in a regular mandible with standard-length implants.

The Crucial Role of Physiotherapy in the Postoperative Case of Temporomandibular Joint Ankylosis for Restoration and Normalization of Functions in a 23-Year-Old Patient.

Ankylosis of the temporomandibular joint (TMJ) is a pathological condition of the joint. The disease manifests as a limitation to total failure of movement of the TMJ, usually following trauma or surgery or due to local infection. The condition may result in difficulty masticating, speaking, structure of the mouth, face, or jaw, and maintaining oral hygiene to a significant degree. A computed tomography (CT) scan is the best method of evaluating the bony anatomy of the TMJ. The present report shows the surgical correction of the TMJ ankylosis. A 23-year-old female attended the hospital, showing severe mouth opening limitation (9 mm). On investigations, left TMJ ankylosis was diagnosed. The surgical approach consisted of distraction osteogenesis of the left side, followed by vigorous physiotherapy. In patients with TMJ ankylosis, restoration of normal function and jaw movement is difficult. This case report highlights the importance of physiotherapy as an emerging adjuvant therapy in the treatment of TMJ ankylosis. There have also been several treatment methods used to improve the patient's self-esteem and confidence, including speech therapy and psychological counseling.

Unraveling Cherubism: Examining the Classical "Eye to Heaven" Phenomenon.

Cherubism, an infrequent disorder with paramount autosomal importance, predominantly targets the mandible, with occasional involvement of the maxilla. Manifesting in childhood, it typically improves over time but never fully resolves in adulthood. Clinically, it presents as a uniform enlargement of the bones, and when the upper jaw is involved, it can create a cherub-like appearance with exposure to the sclera. As the volume grows, it can cause symptoms such as dental misalignment, delayed tooth eruption, speech difficulties, and tooth loss, in addition to psychological and cosmetic effects that require medical attention. The disorder progresses naturally in youngsters, exhibiting phases of expansion, stabilization, and regression. Cherubism initially is encountered in early childhood, reaches its peak during early years, balances out around puberty, and then steadily recedes after that. We describe the example of a male patient, age 20, who sought correction due to worries about his appearance. He had a bilateral mandibular angle and malar edema. The patient's aesthetic discontent was satisfactorily resolved with surgical intervention, and further pharmaceutical therapy was implemented during follow-up visits.

Long-Term Follow-Up of Computer-Assisted Microvascular Mandibular Reconstruction: A Retrospective Study.

Background: Virtual surgical planning has become a well-established practice in head and neck surgery. In oncological surgery, it permits the achievement of safe margins resections and ensures functional reconstructions and optimal esthetic outcomes. This study aimed to evaluate the long-term outcomes after virtually planned mandibular microvascular reconstruction, focusing on functional and esthetic results, as well as health-related quality of life. Methods: A long-term retrospective evaluation of 17 patients with oral cavity malignancy who underwent computer-assisted mandibular resection and reconstruction was performed. Functional and esthetic outcomes were analyzed using the EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires. Results: Time since reconstruction ranged from 7 to 14 years. Patients reported high functional levels on the QLQ-C30 functional scales but lower scores on H&N35. On FACE-Q, patients demonstrated higher appraisal and satisfaction with their smiles compared to their overall facial appearance. Conclusions: In this retrospective case series, patients undergoing computer-assisted mandibular reconstruction for oral malignancies achieved good long-term functional and esthetic outcomes. Although limited by the small sample size, these results support the enduring benefits of virtual planning for mandibular reconstruction. To minimize declines in function and appearance, considerations should include immediate dental implants, enhanced reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia, and oral exercises to prevent trismus.

[Bilateral hyperplasia of the coronoid process in an adolescent patient. case report]. / Hiperplasia bilateral de la apófisis coronoides en paciente adolescente. reporte de caso.

Hyperplasia of the coronoid process is a rare alteration that is characterized by the exaggerated and progressive development of said process over periods of months or years, both in height and volume, which finally causes mandibular hypomobility. It is important to highlight the importance of imaging for the correct diagnosis and treatment of said entity, taking into consideration the great variety of differential diagnoses that can occur. In this sense, conventional radiographs constitute a basic and indispensable tool for approaching the diagnosis. However, it is actually the CT scan that offers the greatest precision. The case of a 14-year-old male patient is presented, with no contributing medical history, who was referred for presenting progressive opening limitation since childhood, for which, after clinical and imaging evaluation, he was treated with total bilateral coronoidectomy, postoperative follow-up was performed. for a year in which recurrence of said entity could be observed. This case demonstrates the importance of correct diagnosis, as well as postoperative control and the rehabilitation scheme carried out by the patient.

Examination of coronoid foramen and coronoid canal with CBCT.

Objective: This study aimed to examine the coronoid foramen using CBCT not only according to its localization, distribution to gender and age but also to determine whether there are canals associated with the coronoid foramen and to identify them and their clinical significance. Methods: 488 images obtained between 2022 and 2023 were retrospectively evaluated in sagittal, horizontal, and coronal sections. During the evaluation of the images, the number and localization of the coronoid foramen and the coronoid canals originating from this foramen were recorded and examined. In addition, the patient images were divided into different age groups and the presence of coronoid foramen was analyzed. Results: Coronoid foramen was detected in 5.1 % and coronoid canal in 1.6 % of the images. Unilateral coronoid foramen was found in 1.4 % and bilateral coronoid foramen was found in 3.7 % of the patients. Unilateral coronoid canal was found in 1.0 % and bilateral coronoid canal in 0.6 % of the patients. When the presence of coronoid foramen was analyzed according to age groups, no significant difference was found between age groups. Conclusion: Recognition of the coronoid foramen and coronoid canal will not only reduce the likelihood of complications in surgical procedures but also influence the treatment plan. Further research is needed to recognize the content of this variations.

A challenging diagnosis of Langerhans' cell histiocytosis with hypothalamic-pituitary and mandibular involvement: case report and literature review.

Background: Langerhans cell histiocytosis (LCH) is a rare bone marrow derived neoplasm that mainly affects children. It is a multiorgan disorder and hypothalamic-pituitary involvement is uncommon. LCH reveals a wide spectrum of indications; thus, the diagnosis and treatment are usually challenging. Case Report: A 22-year-old male presented with polydipsia, polyuria with nonspecific radiological findings, later on, developed a mandibular lesion and a biopsy was conducted which led to LCH diagnosis. After many improper treatments due to unclear diagnosis, the patient was finally placed on chemotherapy and is now under surveillance. Discussion: LCH is a rare disease with diverse clinical manifestations affecting various organs. Associated mutations, such as BRAF V600E, contribute to its complexity. In adults, initial symptoms include pain, weight loss, and fever, with potential pituitary involvement leading to Arginine vasopressin (AVP) deficiency. Commonly affected organs include bone, skin, and the pituitary gland. The disease can be categorized into single-system and multisystem. Pathological diagnosis involves electron microscopy or immunohistochemical staining. Treatment options vary; the presented case utilized Desmopressin acetate and prednisolone before transitioning to cyclophosphamide for multisystemic LCH. Conclusion: AVP deficiency can suggest hypothalamic-pituitary LCH, and a biopsy, if possible, is recommended to confirm the diagnosis.

Follicular Thyroid Carcinoma with Unusual Mandible Metastasis.

Follicular thyroid cancer is the second-most common type of thyroid cancer after papillary thyroid cancer. Metastases to the mandible and maxillofacial region are rare. Our study presents a 55-year-old patient who underwent total thyroidectomy for follicular thyroid cancer and subsequent radioactive iodine therapy. Sixteen years after diagnosis, elevated thyroglobulin levels suggested disease recurrence. Using advanced imaging techniques - Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography scan, bone scintigraphy, and posttreatment I-131 scan-an unexpected metastatic site was identified: the left mandibular condyle. A biopsy confirmed the presence of metastatic follicular thyroid cancer.

Surgical management of mandibular ameloblastoma and immediate reconstruction with iliac crest and costochondrial bone grafts: A case report.

INTRODUCTION AND IMPORTANCE: Ameloblastoma is a benign but locally aggressive odontogenic tumor mostly occurring in the jaws. Ameloblastoma can be difficult to diagnose because it mimics other benign lesions. Its diagnosis requires a combination of imaging data, histopathological analysis, and molecular tests. Its treatment modality diverges from simple enucleation with bone curettage up to wide surgical resections. CASE PRESENTATION: A 25-year-old female presented with a right-sided mandibular mass for five years. Histopathology and radiology tests confirmed it to be an ameloblastoma. A hemimandibulectomy was done, followed by immediate reconstruction using an autogenously inserted iliac crest bone and a costochondral graft as an interposition graft for the lost part. The patient had a satisfactory clinical outcome, and no sign of recurrence after a follow-up of six months. CLINICAL DISCUSSION: The ideal management of ameloblastoma should minimize recurrence, restore function and appearance, and present minimal donor site morbidity. While the removal of a wide part of the bone and soft tissue leads to defects that may cause functional and aesthetic concerns, conservative management is associated with minimal downtime but high recurrence rates. Reconstructive surgery is of paramount importance for the recovery of the lost parts in these patients. CONCLUSION: Radical surgery is the treatment of choice for large tumors to minimize recurrence, and immediate reconstruction utilizing grafting techniques is essential to restoring function and appearance. The autologous bone graft technique is satisfactory for immediate mandibular reconstruction as it represents a simple, easy, less costly, and reliable method for restoring mandibular continuity defects.

Occurrence of neurosensory disturbance after the use of articaine and lidocaine in the inferior alveolar nerve block: a double-blind randomised clinical trial.

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study's predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18-44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.

Comparative osteology of the skull of cowbirds (Icteridae: Molothrus).

Detailed osteological descriptions of the craniomandibular complex of passerine birds are lacking for most species, limiting our understanding of their diversity and evolution. Cowbirds (genus Molothrus) are a small but widespread group of New World nine-primaried songbirds, well-known for their unique brooding parasitic behavior. However, detailed osteological data for cowbirds and other Icteridae are currently scarce and several features of their skulls remain undescribed or poorly known. To address this issue, a detailed comparative osteology of cowbird skulls is presented here for the first time based on data from x-ray microcomputed tomography, dry skeletal data, and multivariate analyses of linear morphometric data. Cowbird skulls offer some functional insights, with many finch-like features probably related to a seed-rich diet that distinguishes them from most other icterids. In addition, features previously overlooked in earlier studies might provide valuable phylogenetic information at different levels of passerine phylogeny (Passerida, Emberizoidea, Icteridae, and Agelaiinae), including some of the otic region and nasal septum. Comparisons among cowbirds show that there is substantial cranial variation within the genus, with M. oryzivorus being the most divergent cowbird species. Within the genus, distantly related species share similar overall skull morphology and proportions, but detailed osteological data allow species identification even in cases of strong convergence. Further efforts are warranted to furnish baseline data for future studies of this iconic group of Neotropical birds and to fully integrate it into phylogenetic comparative frameworks.

A novel method for determining dose distribution on panoramic reconstruction computed tomography images from radiotherapy computed tomography.

Purpose: Patients with head and neck cancer (HNC) who undergo dental procedures during radiotherapy (RT) face an increased risk of developing osteoradionecrosis (ORN). Accordingly, new tools must be developed to extract critical information regarding the dose delivered to the teeth and mandible. This article proposes a novel approach for visualizing 3-dimensional planned dose distributions on panoramic reconstruction computed tomography (pCT) images. Materials and Methods: Four patients with HNC who underwent volumetric modulated arc therapy were included. One patient experienced ORN and required the extraction of teeth after RT. In the study approach, the dental arch curve (DAC) was defined using an open-source platform. Subsequently, pCT images and dose distributions were generated based on the new coordinate system. All teeth and mandibles were delineated on both the original CT and pCT images. To evaluate the consistency of dose metrics, the Mann-Whitney U test and Student t-test were employed. Results: A total of 61 teeth and 4 mandibles were evaluated. The correlation coefficient between the 2 methods was 0.999, and no statistically significant difference was observed (P>0.05). This method facilitated a straightforward and intuitive understanding of the delivered dose. In 1 patient, ORN corresponded to the region of the root and the gum receiving a high dosage (approximately 70 Gy). Conclusion: The proposed method particularly benefits dentists involved in the management of patients with HNC. It enables the visualization of a 3-dimensional dose distribution in the teeth and mandible on pCT, enhancing the understanding of the dose delivered during RT.

Repeated unilateral injections of botulinum toxin in masticatory muscles in adult rats do not amplify condylar and alveolar bone loss nor modify the volume of the hypertrophic bone proliferation at enthesis.

OBJECTIVES: Botulinum toxin is used in human in repeatedly masticatory muscles injections. A single BTX injection in animal induces mandibular bone loss with a muscle enthesis hypertrophic metaplasia. Our aim was to evaluate mandibular bone changes after unilateral repeated injections of BTX in adult rats. STUDY DESIGN: Mature male rats were randomized into 3 groups: one, two or three injections. Each rat received injections in right masseter and temporalis muscles. The left side was the control side. Microcomputed tomography was used to perform 2D and 3D analyses. RESULTS: Bone loss was evidenced on the right sides of alveolar and condylar bone. Alveolar bone volume increased in both control left side and injected right side whereas condylar bone volume remained constant in all groups, for both sides. Enthesis bone hypertrophic metaplasias were evidenced on the BTX injected sides without any modification with the number of injections. CONCLUSION: BTX repeated injections in masticatory muscles lead to major mandibular condylar and alveolar bone loss that does not worsen. They lead to the occurrence of an enthesis bone proliferation that is not dependent on the number of injections. These results are an argument for the safety of BTX injections in masticatory muscles in human.

A Case Report of Mandibular Gingival Metastasis From Sigmoid Colon Adenocarcinoma With Phenotypical Transformation Into Neuroendocrine Carcinoma.

This case report presents a 59-year-old female patient with mandibular gingival metastasis from adenocarcinoma of the sigmoid part of the colon, who underwent radical colectomy with simultaneous hysterectomy involving and left oophorectomy (due to tumor involvement) eight years ago. Because of metastatic spread to the liver, a partial left lateral lobectomy was performed, and because of a metastatic lesion in the left adrenal gland, the latter was excised and a partial resection of the left kidney was performed. The patient was given a number of courses of chemotherapy, target therapy, and immunotherapy. In 2024, because of a tumor mass in the oral cavity that was growing and interfering with normal nutrition and speech, she was hospitalized and a radical resection of the lesion was performed along with the involved underlying bone of the lower jaw on the right. The morphological analysis revealed metastasis from large cell neuroendocrine carcinoma and the immunohistochemical stains verified the gastrointestinal origin of the lesion. The lesion was accepted as being a result of the phenotypical transformation of the primary adenocarcinoma of the sigmoid colon. The patient had a normal postoperative period and a smoothly healing wound and continued to be under the management of clinical oncologists supporting chemo-, targeted, and immunotherapy. However, five months after the appearance of the lesion and three months after its surgical removal, after a serious deterioration of her general condition, she passed away at home.

Management of Osteomyelitis in Autosomal Dominant Osteopetrosis: A Rare Case Report.

Albers-Schönberg disease, also known as osteopetrosis or marble bone disease, is a rare genetic disorder characterised by increased cortical bone mass due to dysfunctional osteoclast cells. This case report presents a 34-year-old male with autosomal dominant osteopetrosis (ADO), who was referred for evaluation and treatment of a chronic mandibular abscess with associated osteomyelitis and fistula. The patient's medical history included multiple fractures necessitating open reduction and internal fixation. Radiological examinations revealed the presence of chronic osteomyelitis in the mandible, marked by an increase in bone density and obliteration of medullary spaces. The treatment approach included surgical debridement, extraction of adjacent teeth, sequestrectomy, and antibiotic therapy. Notably, Enterobacter cloacae bacteria were identified through culture, leading to a tailored antibiotic regimen. Follow-up assessments, including clinical photographs and postoperative CT scans, were conducted to monitor the patient's progress. Histopathological examination confirmed osteomyelitis showing both viable and non-viable bone, surrounded by significant inflammatory infiltrate. This case underscores the complexity of managing osteomyelitis in patients with osteopetrosis and highlights the importance of early diagnosis, particularly before dental extractions, to prevent disease exacerbation. The rarity of this condition emphasises the need for further research and awareness among healthcare providers for optimal patient care.