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Editorial Board/Reviewing Committee
doi : 10.1016/S0901-5027(21)00376-3
Volume 50, Issue 12, December 2021, Page i
Volume and location of the defect as predictors of speech outcome after glossectomy: correlation with a classification
S.Bhattacharya1K.Thankappan1S.V.Sukumaran2M.Mayadevi3D.Balasubramanian1S.Iyer1
doi : 10.1016/j.ijom.2021.02.026
Volume 50, Issue 12, December 2021, Pages 1533-1539
The evaluation of speech outcomes after resection and reconstruction of the oral tongue remains largely unsystematic. A cross-sectional study was performed to analyse the speech outcomes of patients who underwent curative treatment with appropriate reconstruction. Sixty-nine patients were assessed for speech intelligibility and phonetics using a validated speech intelligibility assessment tool in the local language. Volume defects were classified as class I (less than one third), II (one third to half), III (half to two-thirds), or IV (two-thirds to total glossectomy). Defect location was defined as lateral, tip, or sulcus. The ?2 test and Kruskal–Wallis test were used to test volume and location as predictors. Twenty-six patients had class I defects, 29 had class II defects, seven had class III defects, and seven had class IV defects. Twenty-two patients (31.9%) received adjuvant radiotherapy. Mean vowel, consonant, word, and paragraph intelligibility were 99.27%, 86.86%, 85.52%, and 88.72%, respectively. The incremental volume of the glossectomy defect was significantly correlated with speech intelligibility scores and phonatory alterations. In classes II and III, tip resection significantly affected interdental sounds. All patients in class III had affected alveolar and alveo-palatal sounds. The results positively corroborated the volume and location of the glossectomy defect to a classification system.
Malignant transformation of calcifying epithelial odontogenic tumour with solitary pulmonary metastasis
A.S.Tabaksert1G.Jenkins1P.Sloan2J.Adams1
doi : 10.1016/j.ijom.2021.02.031
Volume 50, Issue 12, December 2021, Pages 1540-1545
This report describes the management of a case of calcifying epithelial odontogenic tumour (CEOT) that underwent malignant transformation and metastasized to the lung. The solitary pulmonary metastasis was discovered incidentally on computed tomography (CT) imaging of the neck. It appears that only one previous case with proven pulmonary metastasis has been reported in the literature, which involved multiple pulmonary deposits managed with platinum chemotherapy. The long-term prognosis of metastatic CEOT is therefore unknown. In the case presented here, the patient was managed successfully with surgery alone. There is often diagnostic uncertainty because histological features of benign, recurrent, and malignant CEOT are not dissimilar. Ki-67 immunohistochemistry is helpful, as higher levels are more indicative of malignancy. We consider that in cases of suspected recurrent and malignant CEOT, CT imaging of the thorax and abdomen as part of follow-up may identify metastases early, resulting in earlier treatment, an improved prognosis, and reduced morbidity and mortality.
Squamous cell carcinoma of the tongue in 5-year-old girl with dyskeratosis congenita
KimJHKimCS
doi : 10.1016/j.ijom.2021.02.027
Volume 50, Issue 12, December 2021, Pages 1546-1549
Dyskeratosis congenita is a rare inherited bone marrow failure syndrome with three distinct clinical features: nail dystrophy, reticular skin pigmentation, and oral leukoplakia. The case of a 5-year-old female patient diagnosed with squamous cell carcinoma of the tongue is reported here. An autosomal dominant type 3 TINF2 mutation subsequently confirmed the diagnosis of dyskeratosis congenita. The traditional tongue cancer treatment was adapted for this young patient. While the tongue cancer lesions and leukoplakia were removed, the deep margins were minimized to preserve the tongue muscles and flap surgery was avoided. Additional conservative measures were applied to suppress new leukoplakia lesions.
Parapharyngeal metastasis in hepatocellular carcinoma—a rare entity
J.Chee1G.H.Lee23L.Y.Ooi4J.E.Seet4T.Loh15L.S.Ng15
doi : 10.1016/j.ijom.2021.05.012
Volume 50, Issue 12, December 2021, Pages 1550-1553
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. It most commonly metastasizes haematogenously to the lungs and bones, less commonly via lymphatics to lymph nodes. However, metastasis to the parapharyngeal space has yet to be reported. This is the first clinical report of the treatment of parapharyngeal metastasis from HCC. The case of a 46-year-old man who was found to have a parapharyngeal soft tissue mass during routine follow-up 12 years post deceased-donor liver transplantation for hepatitis B-related HCC is reported here. This was investigated and diagnosed to be metastatic HCC. He underwent excision of the parapharyngeal metastasis, followed by adjuvant radiotherapy. Parapharyngeal metastasis is a rare occurrence in HCC. It is important to be cognizant of the possibility of disease spread to this location in order to ensure early detection and treatment. Surgical excision with adjuvant radiotherapy should be considered to achieve disease control.
Cubik system: maximizing possibilities of in-house computer-guided surgery for complex craniofacial reconstruction
A.Tel1F.Tuniz2S.Sembronio1F.Costa1V.Bresadola3M.Robiony1
doi : 10.1016/j.ijom.2021.07.008
Volume 50, Issue 12, December 2021, Pages 1554-1562
Craniofacial reconstruction represents a major challenge due to the complex anatomical morphology. Although implant production has often been outsourced to external companies, in-house planning and manufacturing has developed in many centres. This note introduces a conceptualized modular mould system to perform any desired craniofacial reconstruction, named ‘Cubik’, inspired by the famous Rubik’s cube. A sophisticated virtual process is described that simulates realistic cranio-orbital resections, and the workflow to create multi-component moulds in order to achieve intraoperatively moulded implants is presented. The description focuses on the appropriate definition of interfaces between the subdivision surfaces of the planned implant, which is the key element to successful design and function of the moulds during surgery and is the peculiarity of the Cubik system. The use of Cubik does not prolong the overall duration of surgery, and it appears to be a very versatile tool, allowing personalized implants with different morphology to be created, which are suitable to cover every potential defect of the skull and the orbital region. This study extends the potential of in-house production, allowing highly accurate implantable craniofacial implants to be fabricated, and in the future this might represent a solution to achieve in-house replacement of other segments of the facial skeleton.
In-office 3D printed guide for rhinoplasty
C.GuevaraM.Matouk
doi : 10.1016/j.ijom.2021.05.005
Volume 50, Issue 12, December 2021, Pages 1563-1565
Rhinoplasty is one of the most technically challenging aspects of facial cosmetic surgery. Various versions of predictive computer software have been developed to aid the surgeon in obtaining predictable results. In the rapidly progressing era of three-dimensional (3D) printing, we present an intraoperative technique that has enabled us to reliably monitor planned surgical changes to the nasal form.
Protuberant fibro-osseous lesion of the temporal bone: report of four cases and review of the literature
J.Bouaoud12F.Larousserie3L.Galmiche-Rolland4C.Bouvier5A.Picard1R.H.Khonsari1
doi : 10.1016/j.ijom.2021.03.002
Volume 50, Issue 12, December 2021, Pages 1566-1570
‘Bullough lesions’, also referred to as protuberant fibro-osseous lesions (PFOL), are rare temporal bone lesions initially described in 1999. Since only 12 cases have been reported, several key issues, such as their origin and recommended management strategies, remain unresolved. This article reports the largest cohort included in the literature to date, comprising four patients with PFOL. PFOL appears to be characterized by female and right-side predominance. These lesions were consistently located regarding the mastoid, generally diagnosed in early adulthood, without functional symptoms, and were always fibro-osseous. Invasive/malignant features were not found on imaging or histology. The main differential diagnosis was malignant low-grade parosteal osteosarcoma. Clinical examination and computed tomography images provided strong elements supporting the diagnosis of PFOL. Biopsy allowed molecular biology investigations (MDM2 and CDK4 amplification), in order to rule out low-grade parosteal osteosarcoma.
Endoscope-assisted greater neurovascular palatal bundle release in cleft palatoplasty
T.Yamanishi1K.Otsuki1T.Harada12T.Kurimoto13
doi : 10.1016/j.ijom.2021.03.009
Volume 50, Issue 12, December 2021, Pages 1571-1575
Performing surgery in the oral cavity is difficult because of the limited view of the surgical field. Intraoral surgery for infantile oral disorders, such as cleft palate, is even more challenging. Endoscopy provides a minimally invasive approach and clear surgical view in surgeries with a constrained field of view. To date, very few reports have described endoscope-assisted palate surgery for children with cleft palate. At the authors’ institution, endoscopes have been used in primary palatoplasty using the double-opposing Z-plasty technique. A novel endoscope-assisted procedure is described herein, in which a dissection around the greater palatine neurovascular bundle is used to obtain tension-free closure of the palatal cleft. With this technique, it was possible to minimize the application of additional von Langenbeck-type relaxation incisions, which were previously introduced in most of our cases; the relaxation incision was successfully circumvented in 42.3% of cases. This led to lesser surgical interference, which possibly resulted in favourable palatal development. It was also found that the endoscopic procedure did not increase the operation time or blood loss when compared to those patients who underwent the non-endoscopic procedure. It is concluded that endoscopic guidance is quite useful in primary palatoplasty procedures with a constricted surgical view.
Non-surgical treatment of vertical excess of the premaxilla in growing bilateral cleft lip and palate patients
M.C.Meazzini1N.Cohen1L.Autelitano2J.Radojicic3
doi : 10.1016/j.ijom.2021.04.012
Volume 50, Issue 12, December 2021, Pages 1576-1582
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.
Use of a ‘low and short’ medial cut limits sagittal ramus osteotomy interferences
J.C.Posnick1234B.E.Kinard5
doi : 10.1016/j.ijom.2021.02.021
Volume 50, Issue 12, December 2021, Pages 1583-1587
The traditional ‘high and short’ medial cut of the sagittal ramus osteotomy (Hunsuck modification) is a frequent cause of lingual plate interferences in patients undergoing mandibular yaw or cant corrections. We describe how the modified ‘low and short’ medial cut of the sagittal ramus osteotomy reduces lingual plate interferences with improved passive alignment of the osteotomy segments.
Technique to manage intraoperative cuff leak from damaged endotracheal tube pilot balloon
D.Hao1J.J.Johnson1S.S.Patel2C.A.Liu1
doi : 10.1016/j.ijom.2021.02.007
Volume 50, Issue 12, December 2021, Pages 1588-1590
We report a technique that was utilized to manage an intraoperative airway complication occurring during orthognathic surgery wherein the endotracheal tube pilot balloon was inadvertently damaged during the procedure. Readily available operating room materials were used to safely and rapidly repair the damaged endotracheal tube pilot balloon. This allowed the perioperative team to avoid emergent endotracheal tube exchange and potential airway complications.
Maxillomandibular osteotomy healing in a patient with hypophosphatemic rickets
J.Ponto1D.Farkas1J.D.Segal2Y.Yusupov1
doi : 10.1016/j.ijom.2021.05.001
Volume 50, Issue 12, December 2021, Pages 1591-1595
Hypophosphatemic rickets is a hereditary disease of childhood that affects bone metabolism. Patients with this disease can have poor bony healing at growth centers due to impaired mineralization of the cartilaginous bone plates. The orthopedic literature has shown appropriate long bone healing in patients with rickets who are undergoing concurrent medical management. However, there has never been a report of successful osteotomy or fracture of the maxillomandibular skeleton in a patient with rickets with documented radiographic and clinical resolution. This report describes a case of successful Le Fort I osteotomy with bilateral mandibular sagittal split osteotomies with concurrent medical management in an 18-year-old female with hypophosphatemic rickets. Before surgery the patient was consented and understood that because there has never been a documented case such as this, she might especially risk complications including non-union, malunion, or unfavorable osteotomy splits. The intraoperative quality of the patient’s bone was of normal caliber and allowed routine osteotomy creation and internal fixation with no complications. She was followed for over 3 years and showed uneventful healing. While this disease is especially rare, practitioners should be aware that acceptable healing alongside appropriate medical management has been documented.
Recurrent mandibular fractures: a retrospective study over 17 years on aetiology, demographics, fracture patterns, and management
J.Sadhu ReddipoguE.LightfootC.ScottM.Thomas
doi : 10.1016/j.ijom.2021.05.002
Volume 50, Issue 12, December 2021, Pages 1596-1602
Recurrent fractures of the mandible are rare, however in Darwin, Australia, their occurrence is relatively frequent. This retrospective study identified 127 patients with 148 recurrent mandibular fractures treated at Royal Darwin Hospital between 2000 and 2017. Age, sex, ethnicity, marital status, aetiology, risk factors, anatomical location of the fractures, fracture patterns, and management of the fractures were analysed. The majority of patients were male (85.8%) (P < 0.001); 62.8% were unmarried (P < 0.001) and 72.4% were indigenous (P < 0.001). Alcohol was involved in 79.1% of cases (P < 0.001) and assault was the most common mechanism of injury (84.5%) (P < 0.001). The angle of the mandible was the most common site (P < 0.001), and recurrent fractures were more likely to occur at sites different to a previous fracture fixation site (P < 0.001). Smoking, alcohol abuse, and diabetes were strongly associated with recurrent fractures (all P < 0.001). Most patients were managed with open reduction internal fixation. In conclusion, recurrent fractures of the mandible frequently involved the angle of the mandible and occurred at different sites. Their incidence was more common among the unmarried, male, and indigenous population, and smoking, alcohol abuse, and diabetes were found to be significant risk factors.
Posterior occipital gunshot wound causing orbital roof blow-in fracture with encephalocele
N.CallahanL.Moles
doi : 10.1016/j.ijom.2021.04.005
Volume 50, Issue 12, December 2021, Pages 1603-1605
Isolated orbital roof fractures are rare fractures that usually occur in conjunction with other facial bone fractures during high velocity trauma. This report concerns a patient with an isolated orbital roof fracture with encephalocele, including its diagnosis, surgical management, and clinical follow-up. This case required a multidisciplinary approach to safely repair the fracture, reduce the encephalocele, restore the orbital volume, and restore the patient’s form and function.
Healing of a large avulsed mandibular bony segment: report of a unique case
S.YounasN.RiazM.Ehsan-Ul-HaqS.Mubeen
doi : 10.1016/j.ijom.2021.05.017
Volume 50, Issue 12, December 2021, Pages 1606-1608
This case report puts an emphasis on retaining and re-fixing any avulsed bony segments in the maxillofacial region and maintaining the periosteal layer whenever possible, especially in young patients. Adequate bony fixation and watertight soft tissue closure are vital components for bone healing. The healing potential of facial bones is much higher as compared to the long bones, due to the superior blood supply.
Texture analysis of cone beam computed tomography images reveals dental implant stability
A.L.F.Costa1B.de Souza Carreira2K.A.C.Fardim2A.D.Nussi1V.C.da Silva Lima2M.M.V.Miguel2M.A.N.Jardini2M.P.Santamaria2S.L.P.de Castro Lopes2
doi : 10.1016/j.ijom.2021.04.009
Volume 50, Issue 12, December 2021, Pages 1609-1616
The aim of this study was to characterize the alveolar bone of edentulous maxillary sites using texture analysis (TA) of cone beam computed tomography (CBCT) images and to correlate the results to the insertion torque, thus verifying whether TA is a predictive tool of final implant treatment. This study was conducted on patients who had received single implants in the maxilla (46 implants) 1 year earlier and whose torque values were properly recorded. Three cross-sections of the sites were selected on CBCT scans. Two regions of interest (ROIs) corresponding to the implant bone site and peri-implant bone were also outlined, according to virtual planning. The CBCT scans were exported to MaZda software, where the two ROIs were delimited following the previously demarcated contours. Values for the co-occurrence matrix were calculated for TA. With regard to the insertion torque value, there was a direct correlation with the contrast of the peri-implant bone (P < 0.001) and an inverse correlation with the entropy of the implant bone site (P = 0.006). A greater contrast indicates a greater torque value for insertion of the implants, and there is a possible association with a lower entropy value of the implant–bone interface.
Outcomes of alveolar segmental ‘sandwich’ osteotomy with interpositional particulate allograft for severe vertical defects in the anterior maxilla and mandible
C.ChanA.MirzaiansB.T.Le
doi : 10.1016/j.ijom.2021.06.004
Volume 50, Issue 12, December 2021, Pages 1617-1627
The purpose of this study was to report the outcomes of interpositional osteotomy with mineralized allograft in the treatment of alveolar vertical defects in preparation for implant placement. Thirteen defects (11 maxillary and two mandibular) were treated with osteotomy segments ranging in length from two to five missing teeth. The segments were positioned 5–7 mm coronally, with the gap space filled with allograft and then fixated with titanium hardware. Vertical bone augmentation was analyzed by superimposing pre- and post-surgical cone beam computed tomography images and stratified based on the length and number of missing teeth in each edentulous segment. The mean vertical bone gain was 3.7 ± 1.6 mm in the area of greatest vertical defect and the mean length of the transport segment was 20.5 ± 8.1 mm. These segments represented two-, three-, four-, or five-tooth edentulous sites; the mean vertical bone gain for these segments was 1.7 ± 0.5 mm, 3.8 ± 1.0 mm, 4.6 ± 0.9 mm, and 6.7 ± 0.0 mm, respectively. Stability of vertical height gain was found to be directly proportional to the span length of the osteotomy segment, with the largest five-tooth segment achieving the greatest gain. Vertical bone gain in two-tooth segments was minimal, indicating a moderate amount of resorption.
Synovial entrapment in alloplastic temporomandibular joint replacement
D.F.Ângelo12H.J.Cardoso1D.Sanz1
doi : 10.1016/j.ijom.2021.05.022
Volume 50, Issue 12, December 2021, Pages 1628-1631
Complications of alloplastic temporomandibular joint (TMJ) prostheses can lead to stress and anxiety for the patient and the surgical team, and prosthesis substitution is sometimes required. The aim of this case report is to describe the surgical finding of synovial entrapment with interposed fibrosis in a postoperative alloplastic TMJ revision, managed effectively with adequate surgical debridement. The authors believe that synovial entrapment needs to be considered as a possible postoperative complication of total joint replacement when no clear symptoms of infection, metal hypersensitivity, osteolysis, or heterotopic bone formation are present. The implications of synovial entrapment in TMJ alloplastic replacement remains relatively unpredictable and poorly understood.
Pre-autotransplantation alveolar process augmentation and premolar autotransplantation as a treatment method for single tooth replacement in adolescents
J.P.Verweij12J.T.Wes3R.A.van Teeseling4A.G.Becking15
doi : 10.1016/j.ijom.2021.04.010
Volume 50, Issue 12, December 2021, Pages 1632-1637
The treatment of young patients with missing teeth and an atrophied alveolar process after trauma or agenesis of a tooth can be challenging. The aim of this study was to evaluate autotransplantation of a premolar after pre-autotransplantation alveolar process augmentation (PAPA) as a treatment option for these patients. A retrospective cohort study was implemented to analyse the PAPA procedure and subsequent autotransplantation procedure. Alveolar process augmentation was performed using different types of autologous bone grafts. Subsequent autotransplantation of one or more premolars was performed approximately 4 months later. Nine patients with a mean age of 12 years were included. Twelve premolars were transplanted after a PAPA procedure: seven in the maxillary incisor region, four in the mandibular premolar region, and one in the mandibular incisor region. Initially all transplanted teeth functioned well. However, one mandibular premolar that was transplanted in the maxillary incisor region was lost because of resorption after 6 years of follow-up. The other 11 transplanted teeth functioned well. The mean follow-up was 6 years (range 3–13 years). The results showed that autotransplantation can be facilitated by PAPA with a high chance of success. It can therefore be a valuable addition to other existing treatment options.
Use of the temporal extension of the buccal fat pad for closure of oro-antral communications
N.RathodB.KhobaragadeK.Ganesan
doi : 10.1016/j.ijom.2021.02.030
Volume 50, Issue 12, December 2021, Pages 1638-1642
Oro-antral communications/fistulae (OAC/OAF) can cause significant patient morbidity, with treatment for defects greater than 5 mm in size requiring surgical reconstruction. This technical note evaluates the effectiveness, and proposes the use of, the temporal extension of the buccal fat pad (TEBFP) for the closure of large OAC. The TEBFP can be an effective means of large OAC closure due to its ease of harvesting, with minimal damage to surrounding structures or aesthetic changes. The use of the TEBFP provides stability, versatility, and tension-free closure, with minimal postoperative complications.
Decreased recurrence of symptoms in oral lichen planus with intralesional injection of hyaluronic acid and triamcinolone
F.Agha-Hosseini1F.Atyabi2K.Akbari3M.-S.Moosavi1
doi : 10.1016/j.ijom.2021.02.028
Volume 50, Issue 12, December 2021, Pages 1643-1648
Oral lichen planus (OLP) is a chronic non-infectious, inflammatory, immunological disease. In contrast to skin lesions, which are often self-limiting, oral lesions rarely heal on their own and can be resistant to local and systemic treatments. In this clinical trial, hyaluronic acid (HA) was mixed with triamcinolone for intralesional injection to reduce side effects in the treatment of OLP. This randomized clinical trial with a split-mouth design was performed on 28 patients with OLP. The mouth was divided randomly into two sides: a test side, which received HA combined with triamcinolone, and a control side, which received triamcinolone alone. The rate of symptom recurrence was 74.1% on the control side and 11.1% on the test side (significant difference, P < 0.01). Pain scores did not differ between the two groups when assessed after 2 weeks. The group treated with a combination of HA and triamcinolone experienced a significantly better resolution of lesions and symptoms. Considering the role of HA in tissue healing and in regulating inflammatory responses, as well as its antioxidant and hydration properties, it appears that HA could be effective in improving of OLP and decreasing the rate of symptom recurrence.
The impact of complex facial surgery provided on a short-term surgical mission
A.O.Jenkinson1M.Fell2M.Eshete34V.Patel5Y.Demissie4F.Abate4M.McGurk6
doi : 10.1016/j.ijom.2021.05.009
Volume 50, Issue 12, December 2021, Pages 1649-1652
The long-term consequences of performing facial surgery on patients living in rural Ethiopia are largely unknown. A review of 36 patients who had been treated on a short-term surgical mission (STSM) in the previous 2 years was conducted to evaluate the outcomes of the surgical interventions performed. There was a significant reduction in social isolation following a surgical intervention. Improvements in postoperative self-reported changes were found for facial appearance, facial function, and quality of life. Positive outcomes can be achieved when surgical treatment is performed on a STSM.
Corrigendum to “An ectomesenchymal chondromyxoid tumour on the lateral border of the tongue” [Int J Oral Maxillofac Surg 49 (2020) 1290–1203]
K.SakuraiaK.NakamoribM.YamazakicJ.-I.Tanumac
doi : 10.1016/j.ijom.2021.05.021
Volume 50, Issue 12, December 2021, Page 1653
Thanks to Reviewers, 2021
doi : 10.1016/S0901-5027(21)00384-2
Volume 50, Issue 12, December 2021, Pages I-III
