Surgical ciliated cyst after a mandibular surgery: a particular case report and review of the literature

Background Surgical ciliated cyst is a rare clinicopathological lesion that appears in patients who undergo maxillofacial surgery. In this report we present a particular mandibular case and we discuss the etiopathogenesis and clinicopathological features of this pathology after reviewing the current literature, as well as the origin of its respiratory epithelial profile. Case presentation The patient is a 67-year-old male with an irregular radiolucency in a previously tooth extracted area of the mandible. The histopathological study revealed a cystic lesion with a connective wall with chronic inflammation, partially lined by a ciliated pseudostratified epithelium. PAS and CK19 stains showed the respiratory characteristics of this epithelium and confirmed the final diagnosis of mandibular surgical ciliated cyst. Conclusions Surgical ciliated cyst is an uncommon entity associated with maxillofacial surgical procedures with bone and nasal cartilage grafts. In our case, treatment with growth factors present in platelet-rich plasma could explain the respiratory changes observed in the cystic epithelial lining.”

Persistent Daytime Sleepiness after Successful Maxillary-Mandibular Advancement Surgery: A Clinical Case Report

Background: Continuous positive airway pressure is a cost-effective treatment of obstructive sleep apnea (OSA), but in case of craniofacial anomalies, which have a recognized role in OSA development, maxillary-mandibular advancement surgery is a recommended therapeutic option. Clinical Presentation: We describe a patient with severe OSA (apnea-hypopnea index = 42) treated by maxillary-mandibular advancement (MMA) surgery. Effective results were confirmed by polysomnography at 6 months post-surgery with normalization of the polysomnographic parameters (apnea-hypopnea index = 17) but due to persistent sleepiness, the patient was unable to resume his work. Conclusion: Maxillary-mandibular surgery can be a valid option for treating severe OSA associated with craniofacial anomalies. However, our results emphasize the need of critically assessing surgical approaches and the need to redefine success for OSA management.

Electromagnetic surgical navigation in patients undergoing mandibular surgery

The purpose of this study was to evaluate the feasibility of electromagnetic (EM) navigation for guidance on osteotomies in patients undergoing oncologic mandibular surgery. Preoperatively, a 3D rendered model of the mandible was constructed from diagnostic computed tomography (CT) images. Cutting guides and patient specific reconstruction plates were designed and printed for intraoperative use. Intraoperative patient registration was performed using a cone beam CT scan (CBCT). The location of the mandible was tracked with an EM sensor fixated to the mandible. The real-time location of both the mandible and a pointer were displayed on the navigation system. Accuracy measurements were performed by pinpointing four anatomical landmarks and four landmarks on the cutting guide using the pointer on the patient and comparing these locations to the corresponding locations on the CBCT. Differences between actual and virtual locations were expressed as target registration error (TRE). The procedure was performed in eleven patients. TREs were 3.2 ± 1.1 mm and 2.6 ± 1.5 mm using anatomical landmarks and landmarks on the cutting guide, respectively. The navigation procedure added on average half an hour to the duration of the surgery. This is the first study that reports on the accuracy of EM navigation in patients undergoing mandibular surgery.

Analysis of the critical dose of radiation therapy in the incidence of Osteoradionecrosis in head and neck cancer patients: a case series

Introduction Osteoradionecrosis (ORN) is a dramatic complication following radiation therapy (RT) for head and neck tumours. Symptoms include pain, trismus, and malodour. ORN can present with exposed necrotic bone, an orocutaneous fistula, and/ or a pathological fracture. Aims To analyse the RT dose responsible for the pathogenesis of ORN and its associated risk factors. Methods The data of 17 patients from 2005 to 2017 were retrospectively reviewed from the Pinnacle(3), WebPublication, and Electronic patient records (EPR) provided by Christie Hospital and Pennine Acute NHS Trust. Results The mean RT dose that ORN sites received was 57.3 Gy. The mean onset duration for ORN after RT was 640.6 days. six patients (35.2%) developed ORN following post-RT dental extractions. Conclusion RT dosages of >57.3 Gy significantly increase the likelihood of developing ORN. Mandibular surgery, post-RT dental extraction, concurrent smoking, and alcohol abuse all amplify the risk of developing ORN.

Target Registration Errors in Navigation-assisted Mandibular Surgery According to the Tracking Methods and the Type of Markers

Background: This study was conducted to evaluate the accuracy of navigation process according to the type of tracking methods and registration markers. The target registration errors (TREs) were measured at seven anatomical landmarks of the mandible for evaluation. Methods: Four different experiments were performed to obtain the TREs using two different tracking methods, the optical tracker (Polaris) and the electromagnetic (EM) tracker (Aurora), and two different types of registration markers, invasive and noninvasive markers. All comparisons of TREs were statistically analyzed using SPSS and Python-based statistical package (Pingouin). Results: The average TRE values obtained from the four different experiments were as follows: 1) 0.85 mm using invasive marker and Aurora, 2) 1.06 mm using invasive marker and Polaris, 3) 1.43 mm using noninvasive marker and Aurora, and 4) 1.57 mm using noninvasive marker and Polaris. All comparisons among the type of markers and the seven anatomical landmarks revealed statistically significant differences, except for the type of tracking system. Although the comparison between the modality of the tracking system showed no significant differences, the EM-based approach consistently demonstrated better performances than the optical type in all comparisons. Conclusions: This study demonstrates that, irrespective of the tracking modality, the invasive marker is a better choice in terms of accuracy. When using the noninvasive marker, it is important to consider the increased TREs. In the present study, the noninvasive marker caused a maximum increment of TREs of approximately 0.81 mm compared with the invasive marker. Furthermore, EM-based tracking using an invasive marker may result in the best accuracy for the mandible.