Oral metastases from pulmonary carcinomas are uncommon and may occur either as the first manifestation of an occult primary tumor or during the course of previously diagnosed disease. We report two cases and present a narrative, case-based review of published oral metastases from pulmonary carcinoma. The first patient was a 42-year-old man with a history of pulmonary adenocarcinoma who developed an asymptomatic hard-palatal lesion ten years after treatment; biopsy showed metastatic adenocarcinoma, and subsequent PET/CT demonstrated pulmonary recurrence. The second patient was a 72-year-old man who presented with a rapidly progressive mandibular lesion associated with pain, swelling, ulceration, paresthesia, and osseous destruction. Histopathologic and immunohistochemical findings supported metastatic pulmonary adenocarcinoma, followed by rapid clinical deterioration. The narrative case matrix comprised 52 published patients (mean age, 64.7 years; range, 40–86 years), of whom 76.9% were male. Adenocarcinoma and its variants accounted for 69.2% of cases. Jawbone involvement occurred in 50.0%, oral soft-tissue involvement in 46.2%, and combined involvement in 3.8%. The mandible predominated among jawbone metastases, whereas the gingiva or alveolar mucosa predominated among oral soft-tissue lesions. Oral metastases from pulmonary carcinoma show substantial clinicopathologic heterogeneity and may mimic odontogenic, inflammatory, or primary oral malignant conditions. Timely biopsy and integration of clinical, imaging, histopathologic, and immunohistochemical findings are important for diagnosis and multidisciplinary oncologic management.
Bilateral fractures of the atrophic mandible in elderly patients pose a clinical challenge, particularly in the presence of systemic comorbidities and impaired healing capacity. In the present case, an elderly patient developed early, extensive postoperative wound dehiscence after surgical reduction and fixation. Initial management included debridement, systemic and topical antimicrobials, serial cleaning, and dressing changes. Because the dehiscence persisted, antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) were incorporated into a multimodal conservative protocol that also included warmed saline irrigation and occlusive dressings. Progressive tissue repair was observed, with complete wound closure after 12 aPDT/PBMT sessions and no loss of fracture stability or need for additional surgery. Because several interventions were administered sequentially and in combination, and this is a single case, the independent contribution of aPDT or PBMT cannot be determined. This report supports the success of a multimodal conservative strategy in a carefully selected patient but does not establish the efficacy of any individual therapy.
Facial fat grafting is a common procedure in plastic, aesthetic and maxillofacial surgery.Indications are facial rejuvenation, lip augmentation, correction of asymmetries or facial soft tissue volume defects and softening of scar tissue. Complications reported are scarce and usually temporary. Common side effects are bruising, swelling, feeling of numbness or altered sensation of the injected area. Uncommon complications such as bleeding and infection have been described. Transient hair loss at the fat-injected site is rarely reported as a complication of.of facial autologous fat grafting. We report a case of transient scalp alopecia following fat grafting of the temporal area in a reconstructive context. The aim of this case report is to make surgeons aware of this possible complication and its management as well as expose its differential diagnosis.
Diffuse sclerosing osteomyelitis (DSO) of the mandible is a rare condition, characterized by a chronic reaction to sterile inflammation of bone. DSO is distinguished from other forms of osteomyelitis by the absence of signs of infection, i.e. pus, fistula and sequestration, and can occur with or without symptoms. The exact cause is still poorly understood, resulting in different terminology, underdiagnosis, misdiagnosis, and delayed diagnosis, highlighting remaining difficulties in recognizing the spectrum of the disease across different medical specialties. Therefore, careful diagnosis is key in order to come to the proper treatment. DSO can lead to progressive deformation of the mandible and a remodeling resection may be necessary. This case-report describes a more than twenty years follow up. At the first intake, a then 44 year old female reported no symptoms other than the gradual enlargement and deformation of the mandibula over the preceding years and the progressive displacement of teeth in the right lower and upper jaw. Her complaints were of both aesthetic and functional nature. The first phase of the treatment consisted of stabilisation of the condition with several bisphosphonate treatments. The second phase was a surgical treatment with decortication, resection, placement of four dental implants accompanied by bisphosphonate treatment. The third phase consisted of rehabilitation with a fixed suprastructure. The follow-up period of eight years after the surgery, showed a stable situation.
Introduction Reconstruction of nasal defects using a paramedian forehead flap (PFF) is an essential procedure in rhinoplasty. The frontal flap is a pedicled transposition flap that provides optimal coverage of the nasal region. The authors report four cases of nasal tissue defect reconstruction using a frontal flap. Observation This was a series of four patients. The mean age was 27.5 years. Treatment was carried out in the ENT and Head and Neck Surgery Department of Yopougon University Hospital. These patients were admitted to our department for the management of nasal tissue loss resulting from various causes (trauma-related in 1 case, neoplastic in 1 case, sequelae of Noma in 2 cases). All underwent reconstruction of the nasal tissue loss using a paramedian myocutaneous forehead flap. Flap detachment was performed 3 weeks after reconstruction in all patients. No cases of necrosis were observed. The flaps survived well, as evidenced by good healing, good integration of the flap and a satisfactory aesthetic result. Conclusion The forehead flap is a valid option for treating nasal volume loss due to its reliability and accessibility. It is easy to harvest and yields satisfactory results.
Fibrous dysplasia is a benign developmental lesion characterized by substitution of normal bone by poorly organized woven bone and fibrous tissue. Three variants exist: monostotic, polyostotic, and syndromic, the latter associated with syndromes such as McCune-Albright and Mazabraud. Clinical manifestations include malocclusion, asymmetries, tooth displacement, and painless swelling. Radiologically, it presents as a homogeneous ground glass radiopacity in continuity with normal bone, with progression typically ceasing at skeletal maturity. This article introduces "Reverse pinart concept” a novel guided bone sculpting and minimally invasive technique for precise bone contouring using digital planning and patient-specific surgical guides. Applied at the Department of Surgery, School of Dentistry, University of Buenos Aires, the technique combined CT-based craniofacial 3D reconstruction with mirroring to define resection boundaries. This approach enables less extensive surgical access, reduces postoperative morbidity, prevents damage to adjacent structures, and achieves accurate symmetrical outcomes.
Alveogyl has been widely used as an intra-alveolar dressing for alveolar osteitis and post-extraction socket pain. However, retained fibres may occasionally persist within the extraction socket and act as a nidus for foreign body granulomatous inflammation, resulting in delayed or incomplete healing. We report a case of Alveogyl-associated foreign body granuloma in a 56-year-old woman who presented for implant placement at a previously extracted left mandibular first molar site. The extraction had been performed 9 months earlier, and the overlying mucosa appeared clinically healed. However, radiographic and intraoperative findings revealed an unhealed socket. During flap elevation, a pigmented intraosseous soft tissue mass was identified, raising the clinical possibility of a reactive lesion associated with displaced amalgam material. Histopathological examination showed a fibrous nodule containing abundant brownish fibrillar foreign material eliciting a foreign body giant cell reaction with chronic inflammation. The material was refractile under polarised light and highlighted by periodic acid–Schiff and Grocott methenamine silver stains. Correlation with the history of Alveogyl placement supported a diagnosis of foreign body granuloma secondary to retained Alveogyl material. Complete excision was followed by healing without complications and no evidence of recurrence. This case highlights the importance of considering retained Alveogyl material in non-healing post-extraction sockets, even when the overlying mucosa appears clinically healed.
Aim: To present a concurrent paradigm in which sausage guided bone regeneration (GBR) and implant placement are initiated at the orthodontic active-to-retention transition for severe developmental mandibular ridge atrophy, shortening treatment duration. Material & methods: A 21-year-old female with congenitally missing mandibular anterior teeth and right premolar (tooth 44 extracted due to caries), presenting with severe horizontal ridge deficiency, underwent three procedures coordinated with the end of active orthodontic treatment. At Month 0, four BEGO Semados® RS implants were placed at sites 32, 41, 44, and 45, followed by sausage GBR using a bovine pericardium membrane (Tutopatch®) with a 50:50 mix of anorganic bovine bone mineral (ABBM) and autograft. At Month 6, free gingival graft (FGG) and apically positioned flaps were performed at implant re-entry. At Month 8, implant-supported fixed prostheses were delivered, coinciding with completion of orthodontic retention. OPGs were obtained pre-operatively and at 31 months post-loading. Results: All implants achieved osseointegration. Re-entry at Month 6 confirmed substantial horizontal bone gain. FGG and apically positioned flaps established 4-5 mm of keratinized buccal mucosa bilaterally. Prosthesis delivery coincided with orthodontic retention completion, providing a permanent anterior stop and eliminating the need for a mandibular retainer. Radiography at 31 months post-loading confirmed stable crestal bone levels and complete graft consolidation. Total treatment duration was 9 months. Conclusion: Initiating sausage GBR and implant placement at the orthodontic active-to-retention transition is safe and clinically effective, shortening treatment duration. The implant-supported prosthesis enhances orthodontic stability. This protocol offers a reproducible, patient-centered solution for severe developmental mandibular ridge defects.
Background Polydeoxyribonucleotide (PDRN) has shown promise in wound healing, but the temporal dynamics of its effects on individual scar parameters remain unclear. This study aimed to analyze the time-dependent changes in vascularity, pigmentation, texture, and height of facial surgical scars following intradermal PDRN injections. Methods A prospective, assessor-blinded, split-scar controlled study was conducted on 15 patients (30 symmetrical facial surgical incisions). One scar received four intradermal PDRN injections (5.625 mg/3 mL) at day 0, day 2, day 7, and day 21, while the contralateral scar received standard care. Scar parameters were assessed using the modified Vancouver Scar Scale (mVSS) at three time points: session 1 (1 week), session 2 (1 month), and session 3 (3 months). Longitudinal changes within each scar group were analyzed using the Wilcoxon signed-rank test. Results In PDRN-treated scars, significant improvements were observed between session 1 and session 2 in vascularity (2.00 ± 0.655 to 1.20 ± 0.676; p = 0.006) and total mVSS (6.47 ± 0.640 to 5.40 ± 0.737; p = 0.003). Between session 2 and session 3, all parameters showed significant improvement: vascularity (1.20 ± 0.676 to 0.60 ± 0.507; p = 0.007), pigmentation (1.67 ± 0.488 to 1.07 ± 0.258; p = 0.003), texture (1.33 ± 0.488 to 1.00 ± 0.535; p = 0.025), height (1.20 ± 0.414 to 0.47 ± 0.516; p = 0.001), and total mVSS (5.40 ± 0.737 to 3.13 ± 0.990; p = 0.001). In control scars, significant improvements between session 2 and session 3 were observed in all parameters except texture. Conclusion PDRN demonstrates a time-dependent enhancement of facial scar quality, with early effects on vascularity followed by progressive improvements in pigmentation, texture, and height. The most pronounced improvements occur between the first and third months post-treatment.
Background Le Fort I osteotomy is commonly performed under controlled hypotensive anaesthesia. Bradycardia related to the trigeminocardiac reflex (TCR) is recognised, but asystole remains rare. Concurrent beta-blockade may further reduce chronotropic reserve and predispose to severe dysrhythmia. Case presentation A healthy 27-year-old man with skeletal Class III malocclusion underwent bimaxillary osteotomy (maxillary Le Fort I advancement and bilateral sagittal split osteotomy) after comprehensive orthodontic preparation. General anaesthesia was induced with an intravenous propofol/remifentanil technique, with relatively high anaesthetic requirements noted. To facilitate maxillary surgery, deliberate hypotension was requested (target mean arterial pressure 55 mmHg). In the 20 minutes preceding maxillary separation, incremental metoprolol and esmolol were administered for blood-pressure control. During completion of the left maxillary lateral wall cut and pterygoid separation with a fine osteotome, sinus bradycardia to approximately 30 beats per minute progressed to a sinus pause/asystolic episode. External chest compressions were commenced immediately; return of spontaneous circulation occurred within 30 seconds, with restoration of sinus rhythm at about 65 beats per minute and no requirement for vasoactive drugs. Surgery was completed uneventfully. A 12-lead ECG on ICU admission was normal, and recovery was otherwise typical, with stable occlusion and no further arrhythmias at follow-up. Conclusion Asystole during Le Fort I osteotomy is uncommon but may reflect an exaggerated trigeminocardiac response during pterygoid manipulation, potentiated by deliberate hypotension and beta-blockade. Maxillofacial surgeons and anaesthetists should anticipate this rare complication, optimise hypotensive strategies, and maintain a low threshold for interrupting surgery and initiating resuscitation.
Background Medication-related osteonecrosis of the jaw (MRONJ) is a known complication of long-term bisphosphonate therapy, most commonly affecting the mandible or maxilla. Involvement of a torus palatinus is rare with few cases documented in the literature. This case series highlights a rare presentation and its successful surgical management of total resection of the necrotic torus and reconstruction of the surgical defect using a vascularized local flap. Clinical presentation and management Two patients with a history of prolonged bisphosphonate use for osteoporosis presented with ulcerations and exposed bone along the hard palate. Clinical examination and imaging confirmed osteonecrosis of a torus palatinus with associated mucosal breakdown. Surgical intervention included total resection of necrotic mucosa and the necrotic torus palatinus, followed by reconstruction using a mucoperiosteal palatal island flap pedicled on the greater palatine vessels. Postoperative recovery was uncomplicated with successful flap integration and no evidence of recurrent disease. Conclusion The objective of this case series is to highlight the unique surgical and reconstructive approach employed in the management of medication-related osteonecrosis of the jaw occurring at the rare site of the torus palatinus. Compared to conservative measures or limited debridement, this series highlights the advantage of complete excision of necrotic torus palatinus in conjunction with vascularized tissue reconstruction. The use of a local vascularized flap, such as the palatal island flap, provides reliable soft tissue coverage and supports favorable postoperative healing over the site of necrosis.
Mandibular osteoradionecrosis (ORN) is challenging to reconstruct because irradiated tissues are fibrotic, poorly vascularized, and anatomically distorted. In segmental mandibular reconstruction, postoperative malalignment, particularly displacement of the residual mandibular segments and condyle, may compromise occlusion, function, and facial contour. A 74-year-old man developed advanced right mandibular ORN after chemoradiotherapy for oropharyngeal carcinoma. Conservative management failed, and segmental mandibulectomy with vascularized osseous reconstruction was indicated. Reconstruction was performed using a left fibula free flap guided by an in-housecomputer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated patient-specific instrument system. The system incorporated mandibular stabilizing bars, aligned screw holes, a fibular cutting guide, a fibular assembly guide, and a pre-bent titanium reconstruction plate. The mandibular guide was designed to preserve the spatial relationship between the residual mandibular segments during osteotomy and reconstruction, while the aligned screw-hole design facilitated transfer of the virtual surgical plan and reproducible plate positioning. Postoperative accuracy was assessed by three-dimensional superimposition of postoperative multi-detector computed tomography data onto the virtual surgical plan. The reconstructed fibular segment showed minor surface deviation, mostly within 3 mm, whereas the ipsilateral condyle showed medial displacement of approximately 7 mm. At 3 months, the patient maintained stable occlusion with a maximum mouth opening of 30 mm and no postoperative complications. This case demonstrates the technical feasibility of an in-house CAD/CAM-fabricated patient-specific instrument system for fibula free flap reconstruction in advanced mandibular ORN. However, this single case cannot determine whether these additional positioning features improve reconstruction accuracy or clinical outcomes compared with conventional custom cutting guides alone.
Transverse maxillary deficiency (TMD) often causes severe crowding, posterior molar crossbite, and buccal corridors. In late adolescence, the maxillary midpalatal suture (MPS) forms an interdigitation that prevents MPS expansion by rapid palatal expansion. Surgically assisted rapid maxillary expansion (SARME) is sometimes performed in orthodontic patients beyond late adolescence with skeletal TMD to achieve a favourable maxillary width. In the present case, SARME with posterior alveolar osteotomy was performed to correct the TMD prior to two-jaw surgery. The skeletal open bite and mandibular prognathism were corrected by Le Fort I maxillary osteotomy and sagittal split ramus osteotomy, resulting in improved occlusal relationships and facial profiles. Three-dimensional analysis of dental casts showed selective lateral expansion of the maxillary molar region and a stable palatal cross-sectional area, palatal width, and palatal volume during the retention period.
Florid cemento-osseous dysplasia (FCOD) is usually asymptomatic; however, extensive jaw expansion may compromise mastication, speech, and facial contour. We report a case of bimaxillary FCOD with marked mandibular expansion treated by digitally assisted bone contouring.A 45-year-old woman presented with progressive mandibular enlargement, masticatory disturbance, and speech difficulty. Computed tomography (CT) showed high-density osseous lesions involving the jaws, and histopathological examination confirmed FCOD. Because bilateral mandibular involvement precluded contralateral mirroring, preoperative CT data were used to create a three-dimensional (3D) printed model, on which the target contour and planned bone reduction area were simulated. During surgery, an optical navigation system was used to confirm the extent and depth of bone reduction. To minimize registration error caused by mandibular mobility, a dynamic reference frame was attached to a custom mandibular splint containing embedded aluminum markers, allowing direct tracking of mandibular movement. Intraoperative CT in a hybrid operating room verified the symmetry and safety of the contouring.Postoperatively, mastication, speech, and facial contour improved without neurosensory disturbance or infection. At the 2-year follow-up, these improvements were maintained, with no radiographic regrowth.
Stafne bone cavity (SBC) is a rare and typically asymptomatic concavity of the lingual mandibular cortex, most commonly located in the posterior region and usually associated with herniation of the submandibular gland. Anterior SBCs are exceptionally rare, and their occurrence as multiple lesions is even more uncommon. We report an extraordinarily rare case of three anterior mandibular SBCs associated with the sublingual gland, representing, to the best of our knowledge, a previously unreported presentation in the literature. A 46-year-old man was referred for evaluation of multiple radiolucencies in the anterior mandible detected on panoramic radiography. Computed tomography (CT) revealed three lingual cortical depressions without buccal cortical perforation. Magnetic resonance imaging (MRI) demonstrated homogeneous T1- and T2-weighted signals isointense to the sublingual gland, with clear continuity between each lesion and the ipsilateral sublingual gland. Despite these findings, irregular margins in part of one lesion raised concern for a neoplastic process, prompting biopsy. Histopathological examination confirmed normal mucous acini-rich sublingual gland tissue with mild periductal lymphocytic infiltration and no evidence of neoplasia or autoimmune disease. The final diagnosis was multiple sublingual gland-related SBCs. This case highlights that anterior SBCs may present as multiple lesions mimicking cystic or neoplastic conditions, necessitating careful differentiation from malignancy and other diseases. MRI is critical for noninvasive diagnosis through the identification of glandular continuity, whereas biopsy remains warranted when imaging findings are inconclusive. Careful follow-up is recommended owing to the potential for morphological change and the rare possibility of tumor coexistence.
Deep-lobe pleomorphic adenoma of the parotid gland with parapharyngeal space extension is uncommon and can be surgically demanding despite benign histology. We report a 36-year-old woman with a 2-year history of right parotid swelling. Magnetic resonance imaging showed a large multilobulated deep-lobe parotid mass extending into the parapharyngeal space, with contralateral airway deviation, internal jugular vein compression, and close contact with the carotid axis. After multidisciplinary discussion, catheter angiography demonstrated arterial supply from the internal maxillary artery and terminal branches of the external carotid artery. Selective preoperative embolization with polyvinyl alcohol particles, 300–500 μm, was performed 2 days before surgery. Tumor resection was undertaken through a transmandibular approach using a cervico-parotid incision with upper-neck extension, lower lip-chin split, and midline mandibulotomy, with early carotid control, ipsilateral submandibular gland removal, and facial nerve preservation. Complete excision was achieved in approximately 3 h, with an estimated blood loss of 200 mL and no transfusion. Histopathology confirmed pleomorphic adenoma with epithelial and myoepithelial elements in a myxoid stroma, duct-like structures, and focal squamous metaplasia, without malignant cytologic features. At 3 months, mild early Frey syndrome was noted, but swallowing, breathing, occlusion, and mandibular function were preserved. The fixation plate was removed uneventfully at 6 months, and 9-month photographs documented satisfactory facial contour and preserved dynamic facial movement.
