Modified surgical approach for removal of an ivory osteoma in the paranasal sinus. A case report.

Osteomas are benign tumors that consist mainly of mature compact or cancellous bone. The most common site in maxillofacial complex is the mandible, particularly the angle, followed by sinuses. The authors report a case of an ivory osteoma of the paranasal sinus in a 16 year-old male patient. The lesion was located in the left paranasal sinus (frontal, ethmoidal and maxillary), obstructing the nasolacrimal duct, resulting in dacryocystitis and frontal mucocele. The ethmoid and orbital portions were approached and excised through a Weber-Ferguson incision and maxillary osteotomy was carried out to remove the ivory osteoma, considering its location in the central and deep region of the face. After tumor removal and drainage of frontal and ethmoidal sinuses, the bone flap was repositioned using titanium microplates and screws. Soft tissue was then sutured. The patient was seen again at 3 weeks, 3 months and 2 years after surgery. Overall, he showed a good recovery and wound healing. A multispeciality team approach is advisable in such cases if radical excision is necessary. A craniofacial approach made radical single stage excision of this multicompartmental ivory osteoma possible with an uneventful postoperative period.

Effects of surgical removal of mandibular third molar on the periodontium of the second molar.

OBJECTIVE: The effects on periodontal tissues of adjacent second molars after semi-impacted mandibular third molar surgery were evaluated. The influence of flap design was studied. METHODS: Twenty volunteers randomly underwent the three-cornered flap technique (group A) or the distal wedge flap technique (group B). The periodontal probing depth was measured by using a 'Williams'-type probe just prior to surgery and three months post-operatively. Six sites, mesio-buccal, buccal, disto-buccal, disto-lingual, lingual and mesio-lingual, around the second molar were selected for measurement. Kruskal-Wallis test and Dunn test (post hoc) were used. Significance level was set at 5%. RESULTS: There were no complications (oedema, alveolitis, etc.) in any of the patients of the study. The results showed that both methods caused shallow pocket depth (P > 0.05) and there were no statistically significant differences between the flap techniques (P > 0.05). Flap design was not an important factor affecting the periodontal status of the second molar. CONCLUSION: The decision to use any of the various flap designs for access to mandibular third molars should be based on operator preference rather than on the assumption that periodontal health of the adjacent second molar will be improved.