Central giant-cell granuloma in a patient with neurofibromatosis type 1: 7 years of follow-up.

Neurofibromatosis type 1 (NF1) is an autosomally dominant tumor suppressor syndrome and multisystem disease. Central giant-cell granulomas (CGCGs) can be seen in patients with NF1. A 21-year-old female was diagnosed with two CGCGs, one in the mandible and then one in the maxilla, in a 7-year period. Increased incidence of CGCGs in NF1 patients was thought to be caused by an underlying susceptibility to developing CGCG-like lesions in qualitatively abnormal bone, such as fibrous dysplasia. However, germline and somatic truncating second-hit mutations in the NF1 gene have been detected in NF1 patients with CGCGs, validating that they are NF1-associated lesions. Oral manifestations in patients with NF1 are very common. Knowledge of these manifestations and the genetic link between NF1 and CGCGs will enhance early detection and enable optimal patient care.

Osteoradionecrosis in osseous free flap reconstruction: Risk factors and treatment.

OBJECTIVE: To determine the rate and risk factors for osteoradionecrosis (ORN) in osseous free flaps after postoperative radiation therapy (PORT). To describe the treatment of free flap ORN. METHODS: Seventy-four patients undergoing osseous free flap reconstruction were analyzed. Thirty-eight completed PORT. Patients were followed for ≥6 months. RESULTS: The rate of ORN was 34% overall; 0% with 50 to 59.9 Gy; 8% with 60 Gy; 40% with 66 Gy; 56% with 70 to 74.4 Gy. Mean time to ORN was 13.1 months. 0/28 patients without PORT developed free flap osteonecrosis. Multivariate analysis found the only factor predicting ORN: PORT >60 Gy, which increased the risk 21-fold. Treatment included PENTACLO, hyperbaric oxygen, and surgical debridement with 75% within 2 years. CONCLUSION: PORT >60 Gy is significantly associated with free flap ORN. As the dose of adjuvant RT increases beyond 60 Gy, the risk of ORN in free flaps rises. Consideration should be given to lower PORT doses or delaying free flap reconstruction when feasible.

Gorham-Stout disease of the mandible: case report and review of literature of a rare type of osteolysis.

Gorham-Stout disease (GSD) is a rare form of osteolysis, the aetiology and pathogenesis of which remains controversial to this date. Although more than 200 cases of GSD have been reported so far, this disease continues to go undiagnosed in the initial stages owing to its varied clinical presentations and rarity. Through this case report of GSD in a 3-year-old boy, we discuss the slow progression of the disease over a period of 13 years. The literature review is also done with an emphasis on the role of an oral and maxillofacial radiologist in understanding the disease at its incipient stage.

Evaluation of Early Postoperative Complications Following Tracheotomy.

PURPOSE: The purpose of this study was to evaluate the early postoperative complications related to tracheotomy performed by surgeons and residents in the Department of Oral and Maxillofacial Surgery (OMS) at the University of Florida College of Dentistry (UFCD; Gainesville, FL). The authors hypothesized that complications with this surgical technique would be substantially different among the different medical diagnoses of these patients and the number of complications would positively correlate with the American Society of Anesthesiologists (ASA) physical status classification. PATIENTS AND METHODS: The authors implemented a retrospective study of all patients who underwent a tracheotomy procedure by the UFCD OMS department from July 2011 through March 2015. Patients were evaluated for medical comorbidities (predictor variables) and tracheotomy complications (outcome variable) within 1 week of the procedure and were compared across ASA classes. RESULTS: A total of 319 patients were evaluated in this retrospective study. There were 14 patients identified with recorded complications, including 11 patients with a bleeding complication (3.4%), and 3 patients with other complications (0.9%). The other complications included dislodgement of the tube, subcutaneous emphysema, and cellulitis. The distribution of patients across ASA groups was not statistically different for patients with no bleeding versus bleeding complications (P > .05 by χ2 test). However, the distribution of patient gender was found to differ across ASA groups (P < .001 by χ2 test). The proportion of men to women in the bleeding complications group was not statistically different (P > .1 by binomial test). However, mean age was found to be statistically different for bleeding complications between men and women (63.4 yr for men; 42.7 yr for women; P < .05 by t test). CONCLUSIONS: The result of this study supports a low rate of complications after a tracheotomy procedure performed by faculty and residents at the UFCD OMS department and is lower than published tracheotomy complication rates reported by other surgical specialties.