The transcervical incision for use in oral and maxillofacial surgical procedures.

PURPOSE: The aim of this study was to evaluate the long-term outcome of the transcervical approach to treat various mandibular problems. MATERIALS AND METHODS: Sixty-two patients (37 males and 25 females; age range, 15 to 80 years; mean age, 45.1 years) were treated via the transcervical approach. Twenty-eight patients (45.1%) had multiple mandibular fractures, 23 (31.7%) had tumor resections and selective neck dissections with microsurgical reconstruction, 7 (11.3%) had severe micrognathia and temporomandibular joint ankylosis, and 4 (6.4%) had mandibular atrophy requiring grafting. The patients were followed up to 15 years. The rates of complications due to surgery were evaluated. RESULTS: The most common complication was dysesthesia at the C2-4 distribution in 54 patients (87.1%), which was usually transient. Nine patients (12.9%) had permanent damage to the inferior alveolar nerve (V3) unilaterally due to segmental mandibulectomy. Other less common complications were transient dysesthesia at the V3 distribution and transient weakness of the lip commissure unilaterally. Hypertrophic scars, seroma formation, soft tissue infection, and orocervical fistula formation were rare. Most of the patients (96.8%) were satisfied with the amount of scarring. CONCLUSION: The transcervical approach provides broad exposure of the mandible and neck structures with excellent access to the operative field and a minimal rate of complications.

Evaluation of long-term stability in second metatarsal reconstruction of the temporomandibular joint.

PURPOSE: Our goal was to evaluate long-term stability and function of 5 condyles reconstructed with vascularized second metatarsal joint grafts. MATERIALS AND METHODS: Four patients were reconstructed with 5 vascularized metatarsal grafts. These reconstructed joints were then followed for an average of 12.5 years. These patients represent the entire series and were all successfully contacted and reevaluated for this article. Measures of opening, deviation, excursion, symmetry, and clinical symptoms relating to the reconstructed joints are evaluated. RESULTS: Mean preoperative interincisal aperture was 12 mm, and postoperative aperture 48.5 mm. Three unilaterally treated patients had lateral excursion with opening. The mean deflection was 4.3 mm toward the operated side. Lateral and protrusive movements were limited in reconstructed joints, but up to 3 mm of protrusion was shown at 12.5 years. Subjectively, all patients rated their function as acceptable and were able to occlude and masticate without difficulty. Symmetry at rest was improved by surgery. CONCLUSIONS: Vascularized metatarsal joints represent a potentially suitable long-term substitute for condylar reconstruction. This limited series shows the technical viability of the procedure. A larger series may be warranted to compare this promising technique with conventional methods of temporomandibular joint reconstruction.

Tuberculous granuloma and adenoid cystic carcinoma presenting as a single buccal space mass.

We report an unusual case of a 58-year-old man with a "collision lesion" of the buccal space. Initially diagnosed as tuberculoma, the patient showed only partial response to an extensive course of antibiotics, prompting more vigorous investigation. This revealed the presence of a concomitant malignancy, specifically adenoid cystic carcinoma. Definitive treatment was then achieved by surgical resection and flap reconstruction with postoperative radiation therapy.