Ameloblastic fibrosarcoma of the maxilla arising in an old woman, a rare case report and literature review.

BACKGROUND: Ameloblastic fibrosarcoma (AFS) is a rare malignant odontogenic tumor, commonly occurring in young adults and typically affecting the mandibular region. We report an exceptionally rare and highly atypical case of AFS in an elderly female patient originating from the maxillary bone. CASE PRESENTATION: A 66-year-old woman was admitted with a two-week history of a lump in her left upper molar. CT scans suggested a cyst in the maxillary bone. An incisional biopsy revealed a spindle cell neoplasm. MRI showed abnormalities in the left maxilla, indicating a possible tumorous lesion. The patient underwent a subtotal maxillectomy, wide tumor excision, intraoral epithelial flap transplantation, and dental extraction. Histology identified atypical tumor cells with visible mitotic figures. Immunohistochemistry showed negative for PCK and CD34 expression, but positive for Vimentin and SMA expression. The Ki-67 proliferation index ranged from 30 to 50%. These findings suggested a potentially malignant soft tissue tumor in the left maxilla, leaning towards a diagnosis of AFS. The patient received postoperative radiotherapy. There was no recurrence during the six-month follow-up. CONCLUSION: Based on repeated pathological evidence, we report a rare case of an elderly female with AFS originating from the maxillary bone. Surgery and postoperative radiotherapy resulted in a favorable outcome.

Heterochrony and the evolution of the longjaw mudsucker (Gobiidae, Teleostei).

Although longjaw mudsucker (Gillichthys mirabilis, Gobiidae) has been studied extensively for its ability to occupy low-oxygen environments, few studies have addressed the evolution of its exceptionally elongated jaws that extend posteriorly beyond the gill opening in large adults. In this study, the ontogeny of the maxillae of G. mirabilis, Gillichthys seta, and the out-group species Eucyclogobius newberryi was studied within the heterochrony framework using digitized landmarks and caliper measurements. The results show that the maxilla of both species of Gillichthys evolved via acceleration (increased growth rate) and that of G. mirabilis via hypermorphosis (continued growth to a larger body size); two forms of peramorphosis. This is in contrast to earlier studies that concluded that G. seta is paedomorphic. We were unable to confirm an earlier hypothesis of sexual dimorphism in the jaw length of G. mirabilis. The evolution of the elongated jaws and associated large buccopharyngeal membrane in G. mirabilis is hypothesized to increase the surface area for gas exchange during aerial respiration and may also serve to amplify the aggressive gaping display as observed in other fishes.

Anatomical Patterns of the Nasopalatine Canal and Incisive Foramen in an African Setting: A Cross-Sectional Study.

Study Design: Descriptive cross-sectional. Objective: To determine the morphology and morphometry of the nasopalatine canal (NPC) and incisive foramen (IF) in an African population. Methods: Measurements of the NPC and the IF were carried out on 150 Cone-Beam computed tomography (CBCT) scans. The maxillary bone thickness anterior to the NPC was measured at 3 levels. Independent t-test and Chi-square test were performed to determine the presence of sexual dimorphism. Results: The presence of one Stenson's foramen was most prevalent. The mean length of NPC was 13.21 ± 3.25 mm with significantly longer canals in males. The most prevalent shape of NPC was cylindrical in sagittal view and a single canal in coronal view. The mean angulation of NPC was 118.42° to the horizontal plane. The average dimensions of the IF were 3.53 mm and 3.07 mm in the anteroposterior and mediolateral diameter, respectively, while the most common shape was round. The anterior maxillary bone was thicker in males and generally reduced in thickness from the anterior nasal spine superiorly towards the alveolar crest inferiorly. Conclusion: This study highlights the anatomical characteristics of the NPC and IF, with significant sexual dimorphism observed regarding the number of Stenson's foramina, length of NPC, shapes of the NPC and IF, as well as alveolar bone thickness anterior to NPC.

Chitosan Nanoparticle/Simvastatin for Experimental Maxillary Bony Defect Healing: A Histological and Histomorphometrical Study.

Biomaterials such as chitosan and simvastatin (Sim) have been introduced to accelerate the extensive and multicellular biological process of bone healing. The aim of this study was to evaluate the bone healing potential of chitosan and Sim, alone or combined. Forty-two male New Zealand rabbits were divided into three groups: chitosan nanoparticles (ChN), Sim and chitosan simvastatin nanoparticles (ChSimN). Two bony defects were created in the maxillary bone. The hole on the right side received one of the experimental materials, while the other side was assigned as the control and left to heal without any intervention. Bone specimens were collected at 2 and 4 weeks and then taken for histological and histomorphometrical analyses. The histological findings revealed that ChN possessed the highest number of osteoblasts and osteoclasts at weeks 2 and osteocytes after 4 weeks. There was a significant difference between the two healing periods regarding all bone parameters across all groups. ChN stood out as the only group that had a significant difference in the count of all bone cells between the two periods, thus having the best potential in promoting bone healing.

Influence of buccal and palatal bone thickness on post-surgical marginal bone changes around implants placed in posterior maxilla: a multi-centre prospective study.

BACKGROUND: Numerous clinical variables may influence early marginal bone loss (EMBL), including surgical, prosthetic and host-related factors. Among them, bone crest width plays a crucial role: an adequate peri-implant bone envelope has a protective effect against the influence of the aforementioned factors on marginal bone stability. The aim of the present study was to investigate the influence of buccal and palatal bone thickness at the time of implant placement on EMBL during the submerged healing period. METHODS: Patients presenting a single edentulism in the upper premolar area and requiring implant-supported rehabilitation were enrolled following inclusion and exclusion criteria. Internal connection implants (Twinfit, Dentaurum, Ispringen, Germany) were inserted after piezoelectric implant site preparation. Mid-facial and mid-palatal thickness and height of the peri-implant bone were measured immediately after implant placement (T0) with a periodontal probe and recorded to the nearest 0.5 mm. After 3 months of submerged healing (T1), implants were uncovered and measurements were repeated with the same protocol. Kruskal-Wallis test for independent samples was used to compare bone changes from T0 to T1. Multivariate linear regression models were built to assess the influence of different variables on buccal and palatal EMBL. RESULTS: Ninety patients (50 females, 40 males, mean age 42.9 ± 15.1 years), treated with the insertion of 90 implants in maxillary premolar area, were included in the final analysis. Mean buccal and palatal bone thickness at T0 were 2.42 ± 0.64 mm and 1.31 ± 0.38 mm, respectively. Mean buccal and palatal bone thickness at T1 were 1.92 ± 0.71 mm and 0.87 ± 0.49 mm, respectively. Changes in both buccal and palatal thickness from T0 to T1 resulted statistically significant (p = 0.000). Changes in vertical bone levels from T0 to T1 resulted not significant both on buccal (mean vertical resorption 0.04 ± 0.14 mm; p = 0.479) and palatal side (mean vertical resorption 0.03 ± 0.11 mm; p = 0.737). Multivariate linear regression analysis showed a significant negative correlation between vertical bone resorption and bone thickness at T0 on both buccal and palatal side. CONCLUSION: The present findings suggest that a bone envelope > 2 mm on the buccal side and > 1 mm on the palatal side may effectively prevent peri-implant vertical bone resorption following surgical trauma. TRIAL REGISTRATION: The present study was retrospectively recorded in a public register of clinical trials ( www. CLINICALTRIALS: gov - NCT05632172) on 30/11/2022.

Buccal and palatal alveolar bone dimensions in the anterior maxilla: A micro-CT study.

OBJECTIVE: Anterior maxillary immediate implant placement has become a popular procedure. It has aesthetic and functional risks. A prerequisite for success is sufficient alveolar bone for primary stability. Many cone-beam computed tomography (CBCT) studies have assessed alveolar bone dimensions in the anterior maxilla, with varying results. More accurate information on the alveolar bone dimensions in the anterior maxilla is required. The objective of the present study was to evaluate bone dimensions in the anterior maxilla using micro-CT, a high-resolution imaging tool. MATERIALS AND METHODS: Seventy-two human skulls were scanned using micro-CT at the South African Nuclear Energy Corporation. Specialized software was used for 3-D rendering, segmentation, and visualization of the reconstructed volume data. Axial planes were created over each alveolus/tooth from canine to canine. Buccal and palatal bone dimensions were measured at crestal, 3 mm, 6 mm, and 9 mm levels. RESULTS: Buccal bone rarely exceeded 0.5 mm, consisting of bundle bone only for all investigated teeth at all levels. Up to a third of teeth showed buccal fenestrations. Alveolar bone on the palatal side was thicker than buccal and increased from <1 mm at crestal level up to 3.77 mm, 4.56 mm, and 5.43 mm for centrals, laterals, and canines at the 9 mm level, respectively. CONCLUSIONS: Immediate implants in the anterior maxillae has anatomical risks. Alveolar bone on the buccal aspect is very thin, with fenestrations in certain positions. Therefore, a thorough planning and individual approach are needed to avoid possible complications and achieve stable aesthetic and functional results in the long-term.

Bone vitality and vascularization of mandibular and maxillary bone grafts in maxillary sinus floor elevation: A retrospective cohort study.

OBJECTIVES: Mandibular retromolar (predominantly cortical) and maxillary tuberosity (predominantly cancellous) bone grafts are used in patients undergoing maxillary sinus floor elevation (MSFE) for dental implant placement. The aim of this retrospective cohort study was to investigate whether differences exist in bone formation and vascularization after grafting with either bone source in patients undergoing MSFE. METHODS: Fifteen patients undergoing MSFE were treated with retromolar (n = 9) or tuberosity (n = 6) bone grafts. Biopsies were taken 4 months postoperatively prior to dental implant placement, and histomorphometrically analyzed to quantify bone and osteoid area, number of total, apoptotic, and receptor activator of nuclear factor-κB ligand (RANKL)-positive osteocytes, small and large-sized blood vessels, and osteoclasts. The grafted area was divided in three regions (caudal-cranial): RI, RII, and RIII. RESULTS: Bone volume was 40% (RII, RIII) higher and osteoid volume 10% (RII) lower in retromolar compared to tuberosity-grafted areas. Total osteocyte number and number of RANKL-positive osteocytes were 23% (RII) and 90% (RI, RII) lower, but osteoclast number was higher (retromolar: 12, tuberosity: 0) in retromolar-grafted areas. The total number of blood vessels was 80% (RI) to 60% (RIII) lower, while the percentage of large-sized blood vessels was 86% (RI) to 25% (RIII) higher in retromolar-grafted areas. Number of osteocyte lacunae and apoptotic osteocytes were similar in both bone grafts used. CONCLUSIONS: Compared to the retromolar bone, tuberosity bone showed increased bone vitality and vascularization in patients undergoing MSFE, likely due to faster bone remodeling or earlier start of new bone formation. Therefore, tuberosity bone grafts might perform better in enhancing bone regeneration.

Highly Aggressive Osteosarcoma of the Ethmoids and Maxillary Sinus-A Case of Successful Surgery and Proton Beam Radiotherapy in a 65-Year-Old Man.

Sarcomas in the head and neck area are rare diseases with an incidence of under 1% of all head and neck malignant tumours. Osteosarcomas or osteogenic sarcomas consist of neoplastic cells that produce osteoid bone or immature bone. Sarcomas develop more in the mandible than the maxilla. The exact diagnosis of different types of sarcomas is based on the immunohistochemical investigation. These rare tumours are of mesenchymal origin; osteosarcomas and chondrosarcomas are the most common types-Ewing's sarcomas. The use of proton beam radiotherapy in the treatment of osteosarcoma of the maxilla is rarely reported in the literature. We present a case of successfully treated (surgery and proton beam radiotherapy) poorly differentiated highly aggressive osteosarcoma in the ethmoids and maxillary sinus and morbidity after the treatment. We were presented with a case of a 65-year-old man with anaesthesia and palsy of the right face. The stomatology department performed the extraction of a tooth. One month later, the wound was still open. The histology showed an osteogenic sarcoma in the area of the wound. The oncologist and maxillofacial surgeons in a catchment hospital recommended a nonsurgical approach. Hence, we performed a radical maxillectomy and ethmoidectomy, after which we continued with proton bean radiotherapy. The patient is now five years after therapy without signs of sarcoma; however, he has blindness in the right eye and reduced vision in the left eye, as well as gliosis of the brain, vertigo, tinnitus, trismus, and ancylostomiases. Head and neck osteosarcomas treatment is considered a complex multidisciplinary task. It is currently argued that there is no clear therapeutic protocol for successful treatment. Innovations in treatment modalities such as proton beam radiotherapy appear to have potential, although their effects on long-term morbidity and survival outcomes are still undetermined. We present a rare case report of an osteosarcoma of the maxilla involving an innovative, successful treatment procedure combining surgical excision followed by proton beam radiotherapy. This treatment approach may enable maximum tumour control. This protocol has not been adequately described in the world literature for this diagnosis.

Computed tomographic assessment of the lacrimal sac fossa in southwest population of Iran.

To determine the morphology of the lacrimal sac fossa and bony nasolacrimal duct using computed tomography for obtaining detailed anatomical understanding of the drainage system and utilizing these measurements in planning for dacryocystorhinostomy (DCR) and nasolacrimal duct (NLD) obstruction in normal southwest (SW) population of Iran. One-hundred-sixty-five cases referred for the diagnosis of neuro-ophthalmic conditions were retrospectively studied. Measurements of lacrimal sac fossa were taken on three anatomical sections (upper, middle, and lower planes) utilizing a digital caliper/protractor instrument. Lacrimal thickness and two measurements of maxillary bone thickness were taken at each plane-namely, the "midpoint thickness" and the "maximum thickness." The anterior extent of the nasal mucosa and NLD width was also evaluated. The mean maximum thickness of the maxillary bone at the three anatomical planes of the lacrimal sac fossa was 4.07 mm, 4.78 mm, and 5.60 mm, respectively. The midpoint thickness of the maxillary bone at each plane was 2.38 mm, 1.99 mm, and 1.68 mm, respectively, in both sexs. The lacrimal bone thickness at each level was 0.76 mm, 0.69 mm, and 0.67 mm, respectively. The proportion of the lacrimal sac fossa comprising the lacrimal bone at lower plane was 43.57% and showed a positive correlation with age (P=0.01). The mean anteroposterior bony nasolacrimal diameter was 5.94 mm with no significant difference between patient sex and age. According to the results, its indicate that performing an osteotomy during DCR could be easier in the Iranian SW population compared to other ethnics.

Clinical and imaging features of melanotic neuro-ectodermal tumor of infancy of the maxillary bone: report of four cases and review of the literature.

Melanotic neuro-ectodermal tumor of infancy (MNTI) is an extremely rare tumor. The purpose of this study was to describe the imaging features of maxillary bone MNTIs and introduce the key points for clinical diagnosis of MNTI. We retrospectively reviewed four patients with histology-proven MNTIs arising from the maxillary bone. All patients underwent ultrasonic inspections, CT and/or MR scanning. Combined with previously literature, the imaging features were comprehensively evaluated and analyzed. All MNTIs showed a firm, non-ulcerated rapidly-growing soft-tissue swelling with pigmented (blue-colored or black-colored or gray-colored) mucosa. The onset ages were younger than 6 month-old. CT images showed osteolytic or expansive bone destruction of the involved maxillae, fragmentary cortical bone, "free-floating" tooth germs, with or without spiculated/sunburst periosteal reaction. The tumor appeared lightly hyper-intense on T2-weighted sequences, while isointense or lightly hypo-intense or lightly hyper-intense signal on T1-weighted sequences. Enhanced images all displayed heterogeneous enhancement. No metastasis features of lymph nodes or abdominal organs were demonstrated by cervical and abdominal ultrasonic inspections. As a conclusion, accurate recognition of the imaging features of MNTI combined with history and clinical manifestations (early infancy, painless, firm, pigmented mucosa, non-ulcerating lesion) can provide clues for diagnosis of this rare entity.

Management of coronavirus disease (Covid-19) associated mucormycosis with palatal ulcer, dental pain and anterior maxillary teeth mobility- A clinical dilemma of Covid 19 pandemic in India.

Mucormycosis represents a group of life-threatening infections caused by fungi of the order mucorales of subphylum mucormycotina. Due to high vascularity, the maxilla rarely undergoes necrosis. Mucormycosis is an opportunistic fulminant fungal infection, which mainly infects immune-compromised patients. Due to the inhalation of fungal spores, the infection may begin in the nose and paranasal sinuses. Necrosis of hard and soft tissues is due to thrombosis of arteries, which is caused by the inhalation of fungal spores. We report a case of maxillary necrosis by mucormycosis in a COVID-19-recovered patient to emphasize the early diagnosis of this potentially fatal fungal infection. We reviewed the current concepts in the management of mucormycosis and different diseases that can lead to maxillary necrosis. The mortality and morbidity of this lethal fungal infection can be successfully reduced by early diagnosis and quick treatment by the general primary care provider, family physicians, and dentists.

[Histiocytosis of Rosai-Dorfman-Destombes extranodal of the jawbone: Report of a case and review of the literature]. / Histiocytose de Rosai-Dorfman-Destombes extra-ganglionnaire du maxillaire : à propos d'un cas et revue de la littérature.

Rosai-Dorfman-Destombes histiocytosis is a rare histiocytosis characterized by an accumulation of histiocytes within the tissues. It is a heterogeneous entity with various clinical phenotypes: isolated lymph nodes, in association with extranodal involvement, autoimmune disease or neoplasm. These extra nodal lesions mainly affect the skin, the nasal cavity, orofacial sinuses, or are lytic bone lesions or even damage to the central nervous system. The diagnosis is histopathological. We present here the case of a histiocytosis of Rosai-Dorfman-Destombes in a 46-year-old patient with a lesion of the left palate. Our observation discuss the diagnostic hypotheses in front of a lytic lesion of the ENT sphere predominantly histiocytic.

Clinical manifestations of diffuse large B-cell lymphoma that exhibits initial symptoms in the maxilla and mandible: a single-center retrospective study.

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphatic tumor; however, extranodal DLBCLs that exhibit initial symptoms in the maxilla and mandible are rare. Moreover, DLBCL is clinically classified as a moderate to highly malignant lymphatic tumor that can progress rapidly; therefore, early diagnosis is crucial. However, diagnosis is difficult as the disease causes a diverse range of clinical symptoms with no characteristic imaging findings. We conducted a clinical investigation to clarify the clinical characteristics of DLBCL that exhibits initial manifestation in the maxilla and mandible. METHODS: Of the 2748 patients with malignant tumors of the oral and maxillofacial region examined at our hospital during a period of 11 years between January 2006 and December 2016, 27 primary cases diagnosed with DLBCL based on the chief complaint of symptoms in the gingiva and bone of the maxilla and mandible were enrolled in this study. Evaluations were based on sex, age, whether treatment was provided by a previous physician, symptoms, duration of disease until treatment was sought, clinical diagnosis, laboratory findings, and imaging results. RESULTS: There were 15 cases that involved the maxilla and 12 that involved the mandible. The median duration of disease until treatment was sought was 60 d (3-450 d). All cases exhibited a tumor or a mass, and hypoesthesia of the chin was confirmed in eight cases wherein the mandible was involved. The clinical stages were stage I in eight cases, stage II in ten cases, and stage IV in nine cases. Serum lactate dehydrogenase (LDH) levels were elevated in 13 of 22 patients. The overall survival rate was 63%. CONCLUSIONS: Symptoms associated with nontender swelling and numbness of the lip or chin in the absence of other findings such as dental infections should raise suspicions about DLBCL. Patients should be provided appropriate imaging and accurate biopsy assessments to improve prognosis.

In-bone protein digestion followed by LC-MS/MS peptide analysis as a new way towards the routine proteomic characterization of human maxillary and mandibular bone tissue in oral surgery.

Proteomic characterization of alveolar bones in oral surgery represents an analytical challenge due to their insoluble character. The implementation of a straightforward technique could lead to the routine use of proteomics in this field. This work thus developed a simple technique for the characterization of bone tissue for human maxillary and mandibular bones. It is based on the direct in-bone tryptic digestion of proteins in both healthy and pathological human maxillary and mandibular bone samples. The released peptides were then identified by the LC-MS/MS. Using this approach, a total of 1120 proteins were identified in the maxillary bone and 1151 proteins in the mandibular bone. The subsequent partial least squares-discrimination analysis (PLS-DA) of protein data made it possible to reach 100% discrimination between the samples of healthy alveolar bones and those of the bone tissue surrounding the inflammatory focus. These results indicate that the in-bone protein digestion followed by the LC-MS/MS and subsequent statistical analysis can provide a deeper insight into the field of oral surgery at the molecular level. Furthermore, it could also have a diagnostic potential in the differentiation between the proteomic patterns of healthy and pathological alveolar bone tissue. Data are available via ProteomeXchange with the identifier PXD026775.

Amblyopia due a dentigerous cyst. Case report and literature review.

PURPOSE: The goal of this article is to present an infrequent clinical case and to review the available literatura, with an emphasis on ophthalmological symptoms. METHODS: We present the case of a 4-year-old girl with a large dentigerous cyst on the maxillary bone, who had long-standing unilateral epiphora associated with progressive ocular dystopia, facial asymmetry and ipsilateral amblyopia. A multidisciplinary approach was taken by the maxillofacial surgery, ophthalmology and optometry teams. This included systemic antibiotic administration, surgical cyst drainage and amblyopia treatment. The literature review was carried out in the MEDLINE database through the free electronic access to PubMed in March 2020. RESULTS: At the 6-month follow-up, the patient was asymptomatic. The most common symptoms of dentigerous cysts are epiphora 36.8%, ocular dystopia 31.2%, diplopia 21.1%, proptosis, nasolacrimal duct obstruction and blurred vision at 10.5%. Amblyopia has not been reported. CONCLUSIONS: Dentigerous cysts are benign odontogenic cysts, which can be found in the jaw and less frequently on the maxillary bone. They are usually asymptomatic, and the occurrence of ophthalmic complications is very infrequent. Multidisciplinary management is essential to avoiding long-term morbidity of maxillary dentigerous cysts and should include an ophthalmologist.

Preparation and osteogenic properties of nanocomposite hydrogel beads loaded with nanometric bioactive glass particles.

Bone reconstruction in the oral and maxillofacial region presents particular challenges related to the development of biomaterials with osteoinductive properties and suitable physical characteristics for their surgical use in irregular bony defects. In this work, the preparation and bioactivity of chitosan-gelatin (ChG) hydrogel beads loaded with either bioactive glass nanoparticles (nBG) or mesoporous bioactive glass nanospheres (nMBG) were studied.In vitrotesting of the bionanocomposite beads was carried out in simulated body fluid, and through viability and osteogenic differentiation assays using dental pulp stem cells (DPSCs).In vivobone regenerative properties of the biomaterials were assessed using a rat femoral defect model and compared with a traditional maxillary allograft (Puros®). ChG hydrogel beads containing homogeneously distributed BG nanoparticles promoted rapid bone-like apatite mineralization and induced the osteogenic differentiation of DPSCsin vitro. The bionanocomposite beads loaded with either nBG or nMBG also produced a greater bone tissue formationin vivoas compared to Puros® after 8 weeks of implantation. The osteoinductivity capacity of the bionanocomposite hydrogel beads coupled with their physical properties make them promissory for the reconstruction of irregular and less accessible maxillary bone defects.

Non-surgical treatment of vertical excess of the premaxilla in growing bilateral cleft lip and palate patients.

Patients with bilateral complete cleft lip and palate (BCLP) may present a vertical excess of the premaxilla in childhood. This is a severe functional and aesthetic problem, where bone grafting is more challenging. The aim of this study was to describe a simple and reproducible non-surgical orthopaedic treatment for vertical excess of the premaxilla in the deciduous/early mixed dentition phase in BCLP patients. Six growing patients with complete BCLP with a severe vertical excess of the premaxilla were included. An intrusion device associated with a bonded rapid palatal expander was applied to intrude the premaxilla. Radiographic and photographic records obtained before and at the end of the orthodontic intrusion, at short- and long-term follow-up, were available. A flattening of the occlusal plane was achieved in all patients. Normalization of the position of the maxillary incisors and gingival display in relation to the upper lip was obtained, and an improvement in anterior nasal spine position was also observed in all cases. The novel technique described might be of assistance in treating BCLP children with vertical excess of the premaxilla during the deciduous/early mixed dentition phase. This simplified, easily reproducible method may allow the burden of care of this rare but complex problem affecting BCLP patients to be reduced significantly.

Evaluation of Bite Force After Treatment of Le Fort Fractures by Internal Fixation and Mandibulomaxillary Fixation.

OBJECTIVES: Evaluation of bite force one, two, and four weeks after discharge following treatment of Le Fort I and/or Le Fort II fracture by rigid fixation and mandibulomaxillary fixation. OBJECTIVE: The aim of this study was to evaluate bite force following treatment of Le Fort I and/or Le Fort II fractures by rigid fixation and mandibulomaxillary fixation at one, two, and four weeks after discharge. This provides valuable results to guide the development of a treatment protocol for Le Fort fractures. METHOD: This was a prospective study including 31 patients who underwent followup examination three times after being discharged from hospital. The examination evaluated bite force using a bite force meter in the right molar, left molar, and incisor regions. RESULTS: One week after discharge, bite forces in the right molar, left molar, and incisor regions were 94.29 ± 58.80 N, 95.42 ± 57.34 N, and 39,94 ± 30,29 N, respectively. Two weeks after discharge, bite forces in the right molar, left molar, and incisor regions were 153.84 ± 89.14 N, 153.00 ± 78.55 N, and 65,9 ± 43.89 N, respectively. Four weeks after discharge, bite forces in the right molar, left molar, and incisor regions were 279.77 ± 95.46 N, 285.00 ± 90,47 N, and 123.42 ± 54.04 N, respectively. CONCLUSIONS: Bite forces in the right molar, left molar, and incisor regions were significantly increased one week, two weeks, and four weeks after discharge. Bite force may be a helpful parameter to confirm the stability of the midface bone after treatment of Le Fort fractures.

Maxillary bone metastasis, as an early sign of breast cancer; an unusual & rare site of metastasis from the common cancer.

Oral cavity metastases are considered rare and represent approximately 1% of all oral malignancies. Due to their rarity and atypical clinical and radiographic appearance, metastatic lesions are considered a diagnostic challenge. In this article we present a rare, unusual & exceptional case of left maxillary mass which on further evaluation leading to diagnosis of left breast carcinoma with metastasis to isolated left maxillary bone. Sixty five year old postmenopausal woman of low socioeconomic status with good performance status presented with a 3 months history of progressive pain and swelling in the left maxillary region. Fine Needle Aspiration Cytology (FNAC) from the maxillary mass shows invasive ductal carcinoma. On further clinical, radiographic, and histopathological examination findings from the breast lesion confirmed the diagnosis of hormone receptor positive metastatic breast carcinoma. In view of painful metastatic maxillary lesion with breast disease she was managed with a palliative radiotherapy to the maxillary lesion and palliative chemotherapy with Doxorubicin-Cyclophosphamide and bhisphosphonate-Zolendronic acid. Patient responded very well to palliative radiotherapy and chemotherapy, in view of hormone receptor positive breast cancer, now she is on Tab. Anastrazole 1 mg once a day along with monthly Zolendronic acid injection since last 13 months without any symptoms of disease evolution. A high index of clinical thought of metastatic cancer to maxilla is necessary when evaluating patients who complain of maxillary pain and swelling without a history of pain or swelling in the head and neck & non-head and neck region. To the best of our knowledge, this is the first reported case of a metastatic isolated solitary maxillary bone metastasis presenting as an early sign of breast cancer.

Zygomatic Implants: A Solution for the Atrophic Maxilla: 2021 Update.

Restoring the dentition of an edentulous patient is often challenging. Endosseous dental implants have allowed for far more versatility in this area but still require adequate maxillary and mandibular alveolar bone. Often, unless significant bone grafting techniques are used, true restoration of the dentition can be impossible with traditional endosseous implants. The advent of zygomatic implants, however, may provide a viable, predictable, and stable alternative for the restoration of the dentition in patients with severe maxillary alveolar bone loss.