Odontogenic-Like Pain in Partial Edentulism: An Unusual Presentation of Diffuse Large B-Cell Lymphoma of the Mandible

Primary bone lymphoma is a rare entity and it usually occurs in long bones. Primary mandibular involvement is very rare, and it usually shows unspecific features, mimicking odontogenic inflammatory lesions. We present the unusual case of a diffuse large B-cell lymphoma (DLBCL) of the right mandibular body in a 91-year-old woman, who presented with acute pain in the mandibular region initially suspicious for odontogenic abscess. No significant findings were seen on orthopantomography (OPG) and her almost complete edentulism made the diagnosis of abscess unlikely. Computed tomography and magnetic resonance images showed an expansive mass around the right mandibular body with erosion of cortical bone and involving the right mandibular canal and nerve. Final diagnosis of DLBCL was pathologically proven. The presence of odontogenic-like pain in nearly complete edentulism should be suspicious for malignancy, and it needs further diagnostic workup despite the absence of signs on OPG.

Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report

Background The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. Case presentation A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient’s mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. Conclusions The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.

Is the Mandibular Condyle Involved in Medication-Related Osteonecrosis of the Jaw? Audit of a Single Tertiary Referral Center and Literature Review

Background: Medication-related osteonecrosis of the jaw (MRONJ) may manifest as exposed mandible bone. Recent reviews of the incidence of MRONJ report primarily as exposed cortical bone of the mandibular body, ramus, and symphysis with no reports of condylar involvement. Objective: The aim of this study is to analyze the topographical incidence of MRONJ, comorbidities, demographics data, and clinical characteristics of patients diagnosed with MRONJ between 2014 and 2019 in the Maxillo-Facial Surgery Department University of Campania “Luigi Vanvitelli”, and compare these results with published reports. Methods: Data on 179 patients were collected for the study, including gender, age, underlying malignancy, medical history, and specific lesion location-identifying premaxilla and posterior sectors area involvement for the maxilla and symphysis, body, ramus, and condyle area for the mandible. A literature review was performed in order to compare our results with similar or higher sample sizes and find if any condylar involvement was ever reported. The research was carried out on PubMed database identifying articles from January 2003 to November 2020, where MRONJ site distribution was discussed, and data were examined to scan for condylar localization reports. Results: 30 patients had maxillary MRONJ, 136 patients had mandibular MRONJ, and 13 patients had lesions located in both maxilla and mandible. None of the patients reported condylar involvement, neither as a single site nor as an additional localization. Literature review results were coherent to our findings showing no mention of condylar MRONJ. Conclusion: Results do not show reports of condylar involvement in MRONJ. Although the pathophysiology of the disease has not been fully elucidated, two possible explanations were developed: the first one based on the condyle embryogenetic origin; the second one based on the bisphosphonate and anti-resorptive medications effects on the different vascular patterns of the mandible areas.

Primary Intraosseous Synovial Sarcoma in the Mandible

Synovial sarcoma (SS) is a rare malignant mesenchymal tumor that mainly occurs in body extremities, being uncommon in the head and neck region. In the present study, we described a case of primary intraosseous SS arising in the mandible of a 22-year-old young male. The patient reported a painful swelling on the left side of the mandible for the last 7 months. Imaging exams showed the presence of an expansive and multilocular radiolucent lesion, extending from the left condyle to the mandibular body. The clinic diagnostic hypotheses were ameloblastoma or malignant neoplasm. Histologically, the lesion was characterized by a proliferation of spindle cells exhibiting vesicular nuclei and evident nucleolus. Neoplastic cells were positive for AE1/AE3, cytokeratin 7, vimentin, CD-99, and TLE-1 and negative for CD-34, S-100, SMA, and HHF-35. A combination of clinical, histologic, and immunohistochemical characteristics supported the diagnosis of SS. The patient was referred for treatment, and preoperative exams did not reveal any other tumor foci in the body of the patient. The final diagnosis was of a primary intraosseous SS of the mandible.

Incidence and Effects of Posterior Cranial Vault Deformation in Adult Females With Skeletal Class III Malocclusion

BackgroundThe precise characteristics of posterior cranial vault deformation are difficult to identify using a two-dimensional analysis. Recently, three-dimensional analysis using computed tomography (CT) data and software analysis has enabled us to examine the craniofacial structure precisely. To identify the deformation in the cranial vaults by a three-dimensional analysis and examine its effects on other structures, CT data of skeletal mandibular protrusion cases without lateral deviation of pogonion (Pog) were examined.MethodsThirty-two adult female patients with skeletal mandibular protrusion who visited Meikai University Hospital were included in this study. CT images were taken before orthognathic surgeries, and the craniofacial structures were examined threedimensionally.The lateral deviation of Pog was less than 3 mm in all cases.Genetic/congenital anomaly cases, endocrine disorders, or cases with severe trauma or temporomandibular disorder were excluded.ResultsMany cases had three-dimensional deformations in the cranial vaults. The cranial vaults with unilateral posterior deformation had posteriorly positioned mandibular fossae on the same sides. Mandibular body lengths were related to the position of the mandibular fossae, and the posterior mandibular fossae tended to have longer mandibular body lengths on the same sides. Masseter muscles with larger volumes were related to longer mandibular body lengths.ConclusionsMandibular body lengths can compensate for the bilateral difference in the position of the mandibular fossae to avoid lateral deviation of the Pog. The masseter muscles are likely one of the factors related to the bilateral differences in the mandibular body length.

Effect of Tooth Agenesis on Mandibular Morphology and Position

Congenital missing teeth (OMIM #106600) is the most common dental abnormality. The aim of the study was to evaluate the effects of tooth agenesis on the total mandibular length, length of the mandibular body and alveolar process, and the mandibular anteroposterior position. The material was obtained from the Department of Orthodontics, Medical University of Warsaw. The study group included 116 patients aged 9–18 years with a congenital absence of at least two permanent tooth buds in the maxilla and/or mandible (mean: 6.2 teeth missing/patient). All patients were Caucasians: 68 (59%) females and 48 (41%) males. The control group included 115 patients without tooth agenesis matched with the age and gender of the study group. A cephalometric analysis was performed, and it was focused on assessing anteroposterior mandibular measurements. This assessment was based on 17 measurements (12 linear and 5 angular). Statistical analysis of the cephalometric measurements between the study group and the control group showed significant changes regarding selected mandibular measurements. Tooth agenesis does not affect the total length of the mandible and the length of the mandibular body, but it might reduce the length of the mandibular arch length and result in a more retrusive mandibular position.

Orthopantomography and use of Mandibular Indices for the Evaluation of Gender Distribution in Navi Mumbai Population - A Retrospective, Single Blind Study

Introduction: The study of forensic sciences often leaves the forensic expert to draw conclusions from any and every material available in determining the identity of the deceased. The initial step in identifying a person is to determine their gender based on their adult skeleton. The human skeleton displays sexual dimorphism, of which the skull is most dimorphic providing an accurateness of 92%. However, in certain situations where the skull may not be found intact, the mandible plays a vital role. The mandible's thick covering of compact bone helps keep it from exploding during a mass tragedy. Dimorphism in the mandible is gender specific and is mainly reflected in its shape and size. The mandible is also easily radiographed and specific linear measurements of the mandibular rami as seen on an OPG are useful indices for gender determination. Aims: To examine the efficacy of mandibular rami measures such as maximum ramus breadth, maximum ramus height, minimum ramus breadth, condylar height, coronoid height, mandibular body length and gonial angles on the right and left side of an OPG in determining gender. Materials and methods: 110 digital OPG’s (55 males, 55 females) of a Navi Mumbai population were obtained retrospectively from a reputed dental college and hospital. The OPG’s were taken using Xtropan 2000 OPG machine, 10x12 PSP plates, exposure parameters of 75 Kvp, 8 mas, 13 sec, and KODAK CR 7400 digitizer. Master View 3.0 software was used on the desktop computer to measure the mandibular ramus's width and thickness. Maximum ramus breadth, Maximum Ramus height and lowest ramus breadth of the mandibular rami, as well as the height of the condyle and the coronoid bone, and the length of the mandibular body and gonial angles on the right and left sides of the mouth, were all measured. Using a statistical formula, the measurements were substituted and gender was estimated. Result: We used the IBM SPSS v 21.0 statistical software for social sciences to do our statistical study. p0.05 was deemed statistically significant, with a 5% margin of error and a 20% margin of error, giving the study an 80 percent power. In the study group, 51 of the 55 men were expected to be males, while 49 of the 55 females were anticipated to be females, while 6 of the 55 females were predicted to be males. Conclusion: This research shows that the mandibular ramus is a useful tool for determining gender, and digital panoramic imaging yielded the best accurate linear measures. There was considerable sexual dimorphism in the mandibular ramus in the chosen Navi – Mumbai subpopulation, and the combination of 8 factors demonstrated an accuracy of 91.81 percent and was helpful for gender determination.

Dental implant displacement into the mandibular body: a case report

Posterior mandible region is considered a highly predicable place for primary stability during dental implant placement. Although, this region can present a significant decrease in bone density, which can lead to implant dislocation during insertion. The present case reports an unusual dislocation of dental implant in a 59 old healthy patient's mandible and a secure solution for this kind of complication. During the drilling, bone quality type IV was observed. In sequence, implant was abruptly inserted in the perforation site and dropped into the bone marrow. Panoramic radiograph showed the implant inside bone marrow, close to mandibular base. The implant was removed through the surgical site. The screw of the implant prosthesis transfer was used to reach the displaced implant. A second implant with the same dimensions as the first one, differing by the external hexagon, was inserted into the same implant site. Therefore, the authors strongly recommend the use of the presented technique prior to osteotomy on mandibular body, reserving the second in the impossibility of reaching the internal connection of the displaced implant.

Surgical treatment of mandibular fracture resulting from first molar extraction: case report

Extraction is one of the most common procedures performed by dental surgeons in their daily clinical practice. Among the trans and postoperative complications associated with this procedure can be mentioned the occurrence of trismus, infections, edema, alveolitis, paresthesia or fractures. The purpose of this study was to report a clinical case of a mandibular fracture associated with first molar extraction, approaching its main risk factors and treatment. Patient JSS, 24 years old, female, was referred to the service of Maxillofacial Surgery due to complications resulted from the extraction of element 36. On physical examination, was observed the presence of fragment mobility, communication of bone tissue with the oral environment and pain complaint was reported by the patient. Computed tomography showed the presence of a fracture in the region of the mandibular body on the left side. The planned surgical proposal was the intraoral debridement of bone fragments, extraoral access in the base of the mandible, fixation of the fracture with plate 2.4 and intraoral and extraoral access suture. During the surgical procedure, it is of great importance that the dental surgeon be aware to the signals emitted by the patient, such as clicks associated with severe pain, profuse bleeding or crackling as these symptoms may be the result of mandibular fracture. When any of these signs are found during the operation, the professional must investigate the occurrence of a possible fracture. It is concluded that in addition to performing a good preoperative evaluation, the dental surgeon must carry out a correct planning of the surgical act based on the basic principles of the surgical technique.