Locoregional anesthesia for removal osteosynthesis hardware from healed corpus mandibularis fractures: A descriptive study of a series of 40 cases.

INTRODUCTION: Locoregional anesthesia represents a very interesting modality for the removal of osteosynthesis hardware of the corpus mandibularis. Several procedures have been described, but each is dedicated to a single mandibular segment. MATERIAL AND METHODS: The surgical records of 40 patients treated with rigid internal fixation after maxillofacial traumas were reviewed. Study variables included age, sex, site and number of plates, time of plate removal, reasons for plate removal, and postoperative. RESULTS: Our study enrolled 40 patients, 45% of whom had single-focal plate placement and 55% of whom had bifocal plate placement. 66% of the patients with bifocal plate placement had the plates removed during the same operation. The average operative time was 45 min for bifocal and 28 min for single-focal approaches. Postoperative complications were observed only for the truncal analgesia procedure of the inferior alveolar nerve at the mandibular foramen. Anesthesia failure was reported in 2 patients. DISCUSSION: Various locoregional anesthetic procedures are used to remove mandibular body plates but each has its indication depending on the mandibular segment being treated. Factors that can lead to failure of locoregional anesthesia are dominated by the state of inflammation at the site and patient anxiety which can be minimized by premedication with anxiolytics. CONCLUSION: Locoregional anesthesia for removal of osteosynthesis hardware of the corpus mandibularis remains a good anesthetic method that is performed in good conditions when it is done in compliance with standards. Its use avoids the usual risks and complications that can occur under general anesthesia.

Parotid swelling revealing an unusual pathological state: HIV and ewing sarcoma.

Swelling of the parotid region is a frequent reason for consultation and the first clinical sign of both benign and malignant parotid tumors. These parotid tumors represent 80 % of tumors of the main salivary glands. They present a highly variable clinical and radiological picture and are known to have a wide histological diversity. Some histological types are rare entities found in the parotid gland, such as Ewing's sarcoma and lymphoepithelial cyst, the latter of which is often associated with HIV co-morbidity, and therefore requires careful and adequate therapeutic attitudes and strategies. We report two cases of parotid swelling revealing unusual pathologies: HIV and Ewing's sarcoma.

Repair of the orbital floor fractures: The endoscopic trans-maxillary approach as minimally invasive approach: A case-report.

INTRODUCTION: The endoscopy in orbital surgery provides, similar to other surgical fields, the option of combining an extended view of the surgical field with minimally invasive approaches; also allows an excellent functional and esthetic results. Trans-maxillary endoscopy of the orbital floor offers excellent visualization of the posterior bony shelf and confirms that the implant rests securely in place. PRESENTATION OF CASE: The authors report a ten years-old male child, reported to the oral and maxillofacial surgery department, Ibn Rochd university hospital, Casablanca, Morocco. The child was diagnosed for left orbital floor fracture, complaining of orbital trauma due to road accident. The injury occurred at the left orbit level. There was no general story of any disease. DISCUSSION: In more than 40% of all the facial fractures parts of the orbital rim or/and the internal orbit are injured with a variety of fracture patterns. Accurate assessment is required in order to correct any bone defects or displacements. The surgical approaches have become more reduced offering better control of orbital pathological processes. Orbital lesions are precisely localized through imaging. Also, the approach decision depends on location, size and vascularization. No consensus exists regarding the timing of the repair, the repair technique and the optimal implant. In this case presentation, the defect on the orbital floor was extended by mobilization of the fragments. A combination of incisions was necessary due to the change in the dimensions of the defects intraoperatively and entrapment of orbital tissue by the placement of an implant. CONCLUSION: The endoscopic approaches provide excellent visualization and safe from eyelid complications with no visible scar when secondary open fracture reduction is avoided. Also; the rate of postoperative complications are reduced: optic nerve injury, orbital apex injury.

Squamous cell carcinoma during long term hydroxyurea treatment: A case report.

BACKGROUND: Hydroxyurea (HU) is a ribonucleotide diphosphate reductase inhibitor that interferes with the S phase of cell replication and inhibits DNA synthesis, with limited or no effect on RNA or protein synthesis. The cutaneous side effects of hydroxyurea treatment are diverse and frequent. Squamous cell carcinoma is one of the most challenging side-effect. CASE PRESENTATION: The authors report the case of a healthy 59-year-old woman on long-term therapy with Hydroxyurea 500 mg daily for essential thrombocytosis, presented with a painless slow-growing lesion of the jaw that had persisted and increased in size for six months, the appearance of the lesion is correlated to the administration of the hydroxyurea treatment. Clinical examination revealed a large nodular lesion 4 × 4 cm with irregular borders of the right cheek, infiltrated into underlying tissue, the lesion extending to the free border of the right lower eyelid without sensory disturbances or diplopia. The surgery was indicated. The surgical procedure had the aim of the restoration of the anatomic landmarks after a large excision of the tumor and reconstruction of full-thickness eyelid defect with a local flap under general anesthesia. CONCLUSION: Maxillofacial surgeons must be aware of the side effects of hydroxyurea including facial cancer, ulceration, etc. Rigorous follow-up of patients on hydroxyurea is required.

The high subangulomandibular approach for condylar fractures of the mandible.

INTRODUCTION: The approaches to mandibular condyle fractures are described in the literature in an abbreviated manner. Their complications, especially facial nerve damage, have limited the surgical indication. PRESENTATION OF CASE: Through this clinical case, we reported the way and the interest of using a twisted steel wire to increase the visibility of the fracture site and facilitate the reduction of even the highest localized fractures. DISCUSSION: The high subangulomandibular approach remains a safe approach, with less risk of facial nerve injury if the planes are respected and the facial nerve is avoided if encountered. Nevertheless, this approach is indicated in low condylar and some neck fractures. CONCLUSION: Given the benefits of this approach compared to other techniques, we recommend its use.

Mucoepidermoid carcinoma of the retromolar trigone in an elderly female: A case report.

Tumors of the retromolar trigone area represent 12% of neoplasms of the oral cavity, and of which squamous cell carcinoma represents the main histological type. Mucoepidermoid carcinoma (MEC) of the accessory salivary glands is a rare entity, representing less than 5% of head and neck cancers, and 10% of all salivary gland tumors; its biological characteristics are very diverse, correlated to the histological grade of the tumor. This tumor has an excellent outcome after surgical management, with a prognosis related to the histological grade of the tumor. The authors reported a case of low-grade mucoepidermoid carcinoma, arising in the left retromolar trigon, in an 83-year-old woman who was treated by surgical removal of the tumor with a 1.5 cm border.

The solitary plasmacytoma of mandible: A case report.

BACKGROUND: the solitary plasmacytomas entities characterized by the neoplastic proliferation of a single clone of plasma cells, typically producing a monoclonal immunoglobulin. It represents less than 5% of plasma cell dyscrasias. The most common sites of solitary plasmacytomas are long bones. The jaws location remains extremely rare, only 4.4% of solitary plasmacytomas of bone occur in the mandible, the diagnosis is based on the biopsy evidence of plasma cell proliferation and absence of evidence of involvement of other bones. CASE PRESENTATION: The authors report the case of a healthy 49-year-old man with no general history, presented with a painless slow-growing lesion of the left jaw that had persisted and increased in size for one month. Clinical examination revealed a large lesion 4 × 4 cm with irregular borders of the retro-molar area on the left jaw, infiltrated into underlying tissue, with sensory disturbances and facial asymmetry. CONCLUSION: Treatment methods of plasmacytomas of the jaw include local surgery (curettage of the lesion), local irradiation, systemic chemotherapy, or a combining therapy. Early diagnosis and treatment are crucial for better resolution of the disease.

Mandibular unicystic ameloblastoma revealed by florid epulis of the gum: Case report.

Ameloblastomas are quite frequent odontogenic tumors, they can be intraosseous or peripheral to the gum, it's rare to find an intraosseous ameloblastoma with gingival extension. Here, we report the case of a 40 years old woman who presented with an exophytic gingival lesion at the gum level of the 46 tooth that was extracted at a quack 01 years before her consultation due to pain in this area. Clinical and radiological examination revealed the presence of two tumors in the same area. The patient benefited from an excision of her gingival tumor and an enucleation of her intraosseous tumor. Histopathological and immunohistochemical examinations revealed that the respective tumors were a spindle cell epulis and an intraluminal unicystic ameloblastoma of different origins, leaving the question and search for the relationship between these two tumors. The postoperative course was uneventful during the 12-month follow-up period after surgical treatment.

Bone choristoma of the gingiva: A case report.

INTRODUCTION: Bone choristoma is a benign tumor with normal histology and ectopic location. This paper aims to report a rare case of bone choristoma in the maxillary gingival location. OBSERVATION: The authors report a case of a 39-year-old woman, with a history of maxillary full edentulousness, who consulted for a slight pain evolved for about six months, triggered by movements on the lesion. Clinical examination found growth at the level of the right maxillary gingival alveolar ridge. Surgical biopsy was indicated and performed under local anesthesia. The histological examination of the excisional specimen concluded at a bone choristoma. The patient had a good evolution after the surgical removal. CONCLUSION: Choristoma is a rare and benign condition. The management is surgical.

Well-differentiated liposarcoma of the cheek misdiagnosed for lipoma: A case report.

INTRODUCTION: Liposarcoma is the most common sarcoma entity and accounts for 17% to 30% of soft tissue sarcomas. There are several histological types including well-differentiated liposarcoma. This paper aims to underline the interest of immunohistochemical and cytogenetic studies to diagnose well-differentiated liposarcoma and to show the delicacy of performing a surgical procedure in the cheek area. CASE PRESENTATION: The authors report the case of a 48-year-old female patient who presented with the recurrence of a right jugal mass initially diagnosed as a lipoma on the resection specimen. The patient was reoperated 5 years later and further immunohistochemical and cytogenetic studies confirmed the diagnosis of well-differentiated jugal liposarcoma. DISCUSSION: Sarcomas are rare malignant tumors of mesenchymal origin, arising from connective and supporting tissues. It should be noted that certain MRI features can distinguish liposarcoma from lipoma. Conventional histology and immunohistochemistry are the basic means for the diagnosis and classification of liposarcomas. However, molecular biology can add to the pathologist's analysis and rule out differential diagnoses Liposarcoma of the maxillofacial region has a better prognosis compared to other parts of the human body. CONCLUSION: This paper underlines the interest of complementary immunohistochemical and cytogenetic studies to differentiate well-differentiated liposarcoma from lipoma as well as the potential for local recurrence of liposarcomas.

Parotid Ewing's sarcoma: Extra-skeletal uncommon condition.

INTRODUCTION: The parotid gland is a very rare location of Ewing's sarcoma. Its clinical and radiological manifestations are atypical. Its management is based on a multidisciplinary approach to improve prognosis and survival. DISCUSSION: The diagnosis of parotid Ewing's sarcoma is determined by a combination of genetic and histological criteria. Its local aggressiveness and high metastatic potential require prompt and appropriate management. Many prognostic features affect its management, the most important is the TNM staging. CONCLUSION: Limited cases of parotid Ewing's sarcoma have been published in the literature. This small number of reported cases is the only way to study its characteristics.

Scorfuloderma of cheek (a cutaneous tuberculosis colliquativa cutis): Case report.

INTRODUCTION: Scrofuloderma is the most common form of cutaneous tuberculosis. The facial location is unusual and requires special care. DISCUSSION: The diagnosis of cutaneous tuberculosis is difficult due to the polymorphism of the anatomo-clinical pictures as well as the difficulty of isolating the causal agent. The combination of a range of clinical and paraclinical arguments justifies starting antibacillary treatment. CONCLUSION: Tuberculosis is endemic disease in our country; this endemicity is attested by the multiple cases of cutaneous tuberculosis reported in the literature.

Arteriovenous malformation in cheek and tongue aggravated by cellulitis: A case report and literature review.

Arterio-venous malformation (AVM) is a congenital disorder of blood vessels, causing abnormal passage of blood between the artery and vein, which most often results in abnormal development of the vascular system in embryonic life. Arteriovenous malformations of the head and neck pose a challenging therapeutic and reconstructive problem. We present a rare case of a 22-year-old white woman, who complained of facial asymmetry on the right side, evolving after an episode of jugular cellulite of dental origin treated 6 months ago. Clinical examination revealed a palpable nodule measuring approximately 25 mm, soft, painless, of sub-mucosal location and a swollen, bluish right hemi tongue. Ultrasonography was requested, which indicated the hypothesis of a vascular lesion. The microscopic diagnosis was of arterio-venous malformation with thrombus formation. The patient has been followed for 3 months and is without signs of relapse. We treated the cellulite and closely followed the patient.

Cavernous Sinus Thrombosis related to Orbital Cellulitis Serious Complication to Prevent: a case report and literature review.

INTRODUCTION: The authors report a case which aims to underline the importance of multidisciplinary management and rapid diagnosis of orbital cellulitis, for an adequate treatment of ocular damages and related complications, to prevent serious and permanent sequelae and avoid a fatal prognosis. PRESENTATION OF CASE: A 61-year-old female reported to the oral and maxillofacial surgery department after she was dragged around for two months. She presented with a right facial swelling and orbital apex syndrome including proptosis, ophthalmoplegia and ptosis. DISCUSSION: Complications of orbital cellulitis may be limited to the orbit, such as subperiosteal or orbital abscess, optic neuritis, blindness, or intracranial such as meningitis, sinus cavernous thrombosis, cerebral abscess and even death. CONCLUSION: Maxillofacial surgeons must be aware of this complication in a multidisciplinary context to adopt adequate treatment as soon as possible.

Melanoma of the oral cavity: A silent killer.

Melanoma of the mouth is a rare entity of cancer. It has a bad prognosis. We report two cases of mouth melanoma. In the first case, 68 years old man developed a mandibular gingival tumor. Head and neck MRI scans showed an aggressive tumor process in the mouth with bone extension and in the deep spaces. The patient was free of cervical lymph nodes. The second case is a 75-years-old male with heavy tobacco smoke. The man felt a burgeoning mass on the right palate. The neck palpation found a firm mobile non-tender mass at the left upper jugular region. The anatomopathological study of the biopsies assigned both cases to malignant melanoma. Because of the rarity and delays in diagnosis, case reports are an invaluable source of information.

Restorative management of human bite injuries to the face: Case series.

Facial skin wounds are common problems seen and treated by emergency centers around the world. Among all wounds, cat and dog bites are frequently seen. Human bite injuries are both deceptive and difficult in their presentation and management. The injuries have a disfiguration effect with possible psychological impact on the patient. The aim of this paper is to compare experience with human bites of the face in our surgical unit, with other similar trials in term of reasons for the circumstances of injuries, age, and sex of the patients, site of injury, pan-time between consultation and treatment, incidence of infection and surgical management. Data in terms of age, gender distribution, circumstances of injury, location of injuries, evolution of surgical management and complications were recorded. We report here a series of 10 cases of human bite wounds to the face, admitted to our department, and treated with different reconstruction procedures.

The deltopectoral flap in full-thickness cheek defect: A case report.

INTRODUCTION: Defects caused after tumor resection should be closed with flaps that match the neighboring cheek's skin. PRESENTATION OF CASE: the authors report a patient diagnosed with squamous cell carcinoma and its management. A 50-year-old man patient presented with a painless slow swelling in the left cheek, which had increased in size in the last four months, tobacco smoking, and alcohol intake for 15 years. Clinical examination revealed left cheek swelling without any lymph nodes at the palpation. DISCUSSION: Reconstruction of the full-thickness is a real challenge. The deltopectoral flap offers several advantages despite the increasing use of microvascular reconstruction; technically is a simple and reliable flap that is preferred for the reconstruction of large through-and-through defects after resection of oral carcinoma. Preoperative planning of flap and early recognition of issues can avoid postoperative complications. CONCLUSION: This reconstruction technique was demonstrated in large, full-thickness defects involving the cheek.

Management of mandibular angle fractures through single and two mini-plate fixation systems: Retrospective study of 112 cases.

INTRODUCTION: The aim of this paper is to compare the clinical results between the different methods of fixation of standard mini-plates for the management of mandibular angle fractures. STUDY DESIGN: This was a retrospective analysis study of 196 patients with mandibular angle fractures divided into 3 groups at our hospital 20 august 1953 specialist hospital, which is a referral center between January 2015 and January 2020. The patients were assessed for malocclusion, infection, wound dehiscence, neuro-sensory deficit, mouth opening, stability, operating time, blood loss, and hardware failure. Group (I) comprised 72 men and 40 women with a mean age of 43 years. Group (II) comprised 36 men and 12 women with a mean age of 47 years. Group (II) comprised 29 men and 7 women with a mean age of 33 years. The assessment of surgical outcomes after the last follow-up visit clearly showed a lack of stability in patients group II compared to the other groups. The operating time was reduced in group I compared to Group II/ III. (P = 0.03) The wound dehiscence occurred mostly in Group III unless it was statistically no significant. The infection events occurred in 36 patients of the sample, which was not statistically significant (Table 4). DISCUSSION: Fractures of the mandibular angle represent 23-42% of all mandibular fractures, in our context road accidents followed by aggression are the most frequent mechanisms found. A various types of treatment approaches for the treatment of angular fractures have been described. Our analysis revealed that surgical time and complication rate has been reduced when using the Group I technique compared to the other groups. CONCLUSION: The use of the monocortical external oblique miniplate provides the best results. Successful treatment of mandibular fractures depends on stability in the ideal anatomical position since abnormal mobility at the fracture site will lead to non-union, malocclusion, and infection.

Central Giant cell tumor of jaw bone in child: A case report.

INTRODUCTION: Central giant cell tumors (CGCTs) bones are uncommon benign bone tumors in the jaw. PRESENTATION OF CASE: The authors report a pediatric patient who was diagnosed with an aggressive central giant cell cyst of the mandible and its management. The CGCT usually occurs in adolescents patients from 5 to 10 years of age. An 8-year-old female patient presented with progressive non-pulsatile swelling of the mandible. Intraoral examination revealed mobility of teeth, associated with gingival swelling. DISCUSSION: Common sites of giant cell tumors are the epiphysis of the long bones. Giant cell tumors accounted for 4-7% of all primary bone tumors. The mandible localization is exceptional, the main treatment for giant cell tumors is surgical excision and different surgical approaches had been reported in the literature thus depending on the size of the cyst, localization, and experience of the surgeon. CONCLUSION: Giant cyst tumor of the jaw is rare and less common in childhood. The clinical behavior is very diverse. The main treatment is surgical removal and follow-up to reveal recurrence.

Lipofilling as an aesthetic restorative technique for the facial hemiatrophy of Parry-Romberg syndrome: An analysis of 27 cases.

INTRODUCTION: The aim of this paper is to present our experience using autologous fat transplantation for facial augmentation and to evaluate the effectiveness of lipofilling in different regions of the face for the reconstruction and aesthetic improvement of the facial contouring. CASE PRESENTATION: Data in term to the age, gender distribution, harvest and injection sites, degree of satisfaction with post-surgical facial, and complications were recorded. DISCUSSION: Progressive haemifacial atrophy, also Known as Parry Romberg's disease, is a common craniofacial disease that conventionally affects the subcutaneous tissue on one side of the face. We report here a series of 27cases of hemifacial atrophy (Parry-Romberg syndrome), admitted to our department, and treated with lipofilling in conformity with Coleman's guidelines. The volume of fat grafting was assessed by an attempt to reach symmetry with the controlateral side within a single procedure. CONCLUSION: All patients claimed that they were satisfied or very satisfied with the aesthetic results and affirmed that it had a positive psychological impact on their daily life.