Imaging approach for jaw and maxillofacial bone tumors with updates from the 2022 World Health Organization classification

Jaw and maxillofacial bone lesions encompass a wide variety of both neoplastic and non-neoplastic pathologies.These lesions can arise from various tissues,including bone,cartilage,and soft tissue,each presenting distinct challenges in diagnosis and treatment.While some pathologies exhibit characteristic imaging features that aid in diagnosis,many others are nonspecific.This overlap often necessitates a multimodal imaging approach,combining techniques such as radiographs,computed tomography,and magnetic resonance imaging to achieve a diagnosis or narrow the diagnostic considerations.This article provides a comprehensive review of the imaging approach to jaw and maxillofacial bone tumors,including updates on the 2022 World Health Organization classification of these tumors.The relevant anatomy of the jaw and dental structures that is important for accurate imaging interpretation is discussed.

Prenatal ultrasound diagnosis of fetal maxillofacial teratoma:Two case reports

BACKGROUND Facial teratoma is a rare benign tumor that accounts for about 1.6%of all teratomas and can be diagnosed by prenatal ultrasound(US).The purpose of this report was to describe our experience with the diagnosis of fetal facial teratoma by prenatal US at second trimester to provide a reference for clinical diagnosis of fetal maxillofacial teratoma.CASE SUMMARY We present two cases of patients with abnormal fetal facial findings on US at second trimester of pregnancy in our department.Case 1 was a 31-year-old G3 P1+1 female,with US revealing a heterogeneous echogenicity of 32 mm×20 mm×31 mm on the fetal face,most of it located outside the oral cavity and filling the root of the oral cavity.Case 2 was a 29-year-old G1P0 female,with fetal head and neck US revealing a cystic-solid echo mass measuring 42 mm×33 mm×44 mm,the upper edge of the lesion reaching the palate and filling the oral cavity.The contours of the lesions were visualized using three-dimensional(3D)US imaging.Both patients decided to give up treatment.Biopsies of the lesions were performed after induction of labor,and diagnosed as maxillofacial teratoma.CONCLUSION Fetal maxillofacial teratomas can be diagnosed by US in early pregnancy,allowing parents to expedite treatment decisions.

Effect of Wearing a Maxillofacial Prosthesis on Masticatory Rhythm Improvement in Mandibulectomy Patients

Background: Recording jaw movement rhythms in patients with jaw defects is challenging using conventional tracking devices. However, masticatory rhythm is crucial for masticatory performance and nutritional intake. This study aimed to explore the impact of using a maxillofacial prosthesis to restore masticatory rhythm in mandibulectomy patients with a novel wearable device. Methods: Twelve patients who underwent mandibulectomy and were rehabilitated with maxillofacial prosthesis were recruited. Chewing rate, cycle durations, coefficient of variation of cycle durations (CV), changing times of skin morphology on the back of the ear pinna area (SM), and masticatory performance were measured during gum chewing without and with a denture using a wearable jaw movement rhythm tracking device. A paired t-test and the Pearson correlation coefficient were used for statistical analysis. Results: The chewing rate increased by 8.6 cycles/min with dentures (P P = 0.01). The CV and SM decreased with dentures (P = 0.004 and P = 0.01, respectively). Significant correlations were found between the CV and SM without dentures (P = 0.004). Conclusion: 1. Wearing maxillofacial prostheses can improve masticatory rhythm in patients who undergo mandibulectomy with Eichner B2 occlusal supports. 2. The wearable device is available for measuring masticatory rhythm in patients with jaw defects in clinics. 3. Changing times of the skin morphology on the back of the ear pinna indicate jaw movement stability through a simpler process than the coefficient of variation of cycle durations.

Maxillofacial Surgery Education: Where Is It Heading?

Oral and maxillofacial surgery have a long history dating back to ancient civilizations such as the Egyptians. Since then, surgeons have treated craniofacial trauma and alveolodental fractures. In 1846, Hullihen performed a mandibular body osteotomy to correct prognathism, marking a significant milestone in the field. Over time, the specialty has evolved significantly. The field of craniofacial surgery has undergone several phases, including its involvement in conflicts during world wars and the treatment of craniofacial fractures and discrepancies. The process of learning and teaching specialties has evolved differently in various countries throughout the 20th century. Currently, there is no uniformity in the training and registration of specialized professionals, resulting in distinct scenarios. Considering the accessibility of scientific knowledge through technology and globalization, it is crucial to provide an objective overview of the current state of education in the field. This paper focuses on effective professional training as the primary subject of residency courses in this specialty. A proposal is presented for education, emphasizing the significance of providing quality professional training that is tailored to the specific legislation of each country.

The WhatsApp Application as a Teledentistry Tool in Oral and Maxillofacial Surgery in Cameroon

Introduction: Technological advances have greatly influenced the healthcare sector. The ability to transmit information and deliver services using telecommunication tools continues to transform the way healthcare is delivered around the world. The aim of this study was to highlight the epidemiological, clinical and therapeutic profile of oral and maxillofacial surgery patients consulted using the WhatsApp application. Methodology: This was a three-year descriptive study with a retrospective data collection, from 2021 to 2023, of WhatsApp communications between our team and oral and maxillofacial surgeons in Cameroon. In this study, the type/content of messages received, the epidemiological data of practitioners and patients, the various pathologies diagnosed and the procedures performed were evaluated. Results: 319 communications were received for a total of 146 cases. Written messages associated with images (photographs and/or X-rays) were the most frequently received, at 85.62%. Hospitals in urban areas were the most represented at 93.84%. Oral health professionals in the private sector sent more messages (65.75%). In terms of diagnoses, tumour and cystic pathologies were the most common (28.08%), followed by impacted/retained teeth (22.6%). Patients were referred to our hospital for treatment in 62.33% of cases. Conclusion: The WhatsApp application is an easy-to-use telecommunications tool. It facilitates exchanges between practitioners and improves patient care in oral and maxillofacial surgery.

Robust ACO-Based Landmark Matching and Maxillofacial Anomalies Classification

Imagery assessment is an efficient method for detecting craniofacial anomalies.A cephalometric landmark matching approach may help in orthodontic diagnosis,craniofacial growth assessment and treatment planning.Automatic landmark matching and anomalies detection helps face the manual labelling lim-itations and optimize preoperative planning of maxillofacial surgery.The aim of this study was to develop an accurate Cephalometric Landmark Matching method as well as an automatic system for anatomical anomalies classification.First,the Active Appearance Model(AAM)was used for the matching process.This pro-cess was achieved by the Ant Colony Optimization(ACO)algorithm enriched with proximity information.Then,the maxillofacial anomalies were classified using the Support Vector Machine(SVM).The experiments were conducted on X-ray cephalograms of 400 patients where the ground truth was produced by two experts.The frameworks achieved a landmark matching error(LE)of 0.50±1.04 and a successful landmark matching of 89.47%in the 2 mm and 3 mm range and of 100%in the 4 mm range.The classification of anomalies achieved an accuracy of 98.75%.Compared to previous work,the proposed approach is simpler and has a comparable range of acceptable matching cost and anomaly classification.Results have also shown that it outperformed the K-nearest neigh-bors(KNN)classifier.

Etiology, Prevalence, and Management of Oral and Maxillofacial Soft Tissue Injuries in Children at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

Background: Maxillofacial injury may vary from simple soft tissue lacerations to complex fractures of the orofacial region. Soft tissue injuries, whether isolated or in combination with other injuries, form part of the frequent traumatic craniofacial injuries seen at the emergency department. The force of impact and the injury type is directly related to the severity of the injury sustained. This study aimed to analyze the etiological factors, prevalence, and management of oral and maxillofacial soft tissue injuries at the Komfo Anokye Teaching Hospital. Methods: This was a prospective study that involved children presenting with oral and maxillofacial injuries at the Accident and Emergency Department and the Oral and Maxillofacial Surgery unit of the Komfo Anokye Teaching Hospital in Kumasi between the period of April to October 2020 (6 months). Patient selection was by convenience sampling targeting all children with injuries who met the inclusion criteria. Inclusion criteria were children below the age of 18 years whose parents or caregivers consent to participation. Children with maxillofacial injuries as a result of burns were excluded from the study. Results: During the study period a total of 134 children were reviewed with oral and maxillofacial injuries at KATH. Of these, 107 (78.9%) were recorded cases of orofacial soft tissue injuries. There were 63 (58.9%) males and 44 (41.1%) females and the male-to-female ratio was 1.5:1. The age range of patients studied was 8 months – 17 years, with mean age ± SD being 9.5 ± 5.3 years. Road Traffic Crash (50.5%) was the most common etiology of which Motor cycle crash constituted 24.3% and Pedestrian knockdown was 19.6%. Falls (42.1%) were the next most common etiology. The lips (19.8%) and the forehead (18.5%) were the most frequently injured sites on the face whiles the tongue (3.3%) had the most injuries intraorally. Laceration (45.7%) was the most frequent injury reviewed, followed by abrasions (35.8%). Most of the soft tissue injuries underwent primary closure (56.3%). A complication rate of 21.2% was recorded in this study and hypertrophic scarring (11.3%) was the most observed.

Management of Maxillofacial Gunshot Trauma in the Stomatology and Maxillofacial Surgery Departments of Ouagadougou

Introduction: Maxillofacial ballistic trauma is a serious injury that is difficult to manage, with significant complications and after-effects. The authors report their experience in managing this type of trauma in the context of insecurity linked to terrorism. Patients and Methods: This was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2018 to December 31, 2022 in the stomatology and maxillofacial surgery departments of the university hospitals of Ouagadougou. Results: In 5 years, 52 patients were collected, i.e. 10.4 cases per year. The mean age of the patients was 31.46 ± 15.41 years, and the sex ratio was 3. In 67.31% of patients, these injuries were the result of shootings during terrorist attacks. The jugal (36.54%) and chin (32.69%) regions were the most affected. The mandible (36.54%) and zygomatic bones (28.85%) were the most injured bones in these traumas. All patients underwent surgical treatment, and 25% suffered secondary complications. All patients retained at least one sequela. Conclusion: Maxillofacial injuries caused by ballistic trauma are true emergencies that can be life-threatening and functionally disabling. Their management is delicate and the outcome is uncertain, hence, the prevention is important.

Evaluation of Postoperative Psychological Distress and Its Driving Factors in Patients with Oral and Maxillofacial Malignant Tumors

Objective:To explore and analyze the evaluation and driving factors of postoperative psychological pain inpatients with oral and maxillofacial malignant tumors.Methods:Relevant data were collected from 80 patients with oral and maxillofacial malignant tumors who attended the outpatient clinic for follow-up consultations between May 2021 to May 2023.The patients used the psychological distress thermometer(DT)to circle words that best described their experiences in the past week,assigning a numerical value(0-10)to indicate their pain level on each day.The scoring results were employed to assess the psychological pain in these patients.A self-developed patient basic information questionnaire was utilized to record demographic details.Logistic regression analysis was employed to evaluate patients two weeks after surgery,focusing on the assessment of psychological distress and the identification and location of driving factors.Results:Following evaluation,the results revealed that the average postoperative DT score for the 80 patients with oral and maxillofacial malignant tumors was 4.53±1.98 points.Scores<4 points indicated no psychological pain(Group N)in 48 cases,while scores≥4 points indicated psychological pain(Group Y)in 32 cases.The differences in postoperative DT scores among patients with varying educational levels,fears and worries about disease progression,economic problems,sleep problems,level of hope,and oral pain were statistically significant(P<0.05).Multiple linear regression analysis results indicated that education level,fear and worry about disease progression,economic problems,sleep problems,level of hope,and oral pain are driving factors of postoperative psychological pain in patients with oral and maxillofacial malignant tumors(P<0.05).Conclusion:The postoperative psychological pain level in patients with oral and maxillofacial malignant tumors is at a moderate level.Educational level,fear and worry about disease progression,economic problems,sleep problems,level of hope,and oral pain were identified as driving factors for postoperative psychological pain in these patients.

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

BACKGROUND Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions.Clinically,if early odontogenic infections such as acute periapical periodontitis,alveolar abscess,and pericoronitis of wisdom teeth are not treated timely,effectively and correctly,the infected tissue may spread up to the skull and brain,down to the thoracic cavity,abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck.Severe multi-space infections are formed and can eventually lead to life-threatening complications(LTCs),such as intracranial infection,pleural effusion,empyema,sepsis and even death.CASE SUMMARY We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions.One week before admission,due to pain in the right lower posterior teeth,the patient placed a cigarette butt dipped in the pesticide"Miehailin"into the"dental cavity"to relieve the pain.Within a week,the infection gradually spread bilaterally to the floor of the mouth,submandibular space,neck,chest,waist,back,temporal and other areas.The patient had difficulty breathing,swallowing and eating,and was transferred to our hospital as an emergency admission.Following admission,oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology,thoracic surgery,general surgery,hematology,anesthesia and the intensive care unit to assist with treatment.The patient was treated with the highest level of antibiotics(vancomycin)and extensive abscess incision and drainage in the oral,maxillofacial,head and neck,chest and back regions.Unfortunately,the patient died of septic shock and multiple organ failure on the third day after admission.CONCLUSION Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions,which can result in multiple LTCs.The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.

Robotic surgical systems in maxillofacial surgery:a review

Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.

Biomaterial-based strategies for maxillofacial tumour therapy and bone defect regeneration

Issues caused by maxillofacial tumours involve not only dealing with tumours but also repairing jaw bone defects.In traditional tumour therapy,the systemic toxicity of chemotherapeutic drugs,invasive surgical resection,intractable tumour recurrence,and metastasis are major threats to the patients’lives in the clinic.Fortunately,biomaterial-based intervention can improve the efficiency of tumour treatment and decrease the possibility of recurrence and metastasis,suggesting new promising antitumour therapies.In addition,maxillofacial bone tissue defects caused by tumours and their treatment can negatively affect the physiological and psychological health of patients,and investment in treatment can result in a multitude of burdens to society.Biomaterials are promising options because they have good biocompatibility and bioactive properties for stimulation of bone regeneration.More interestingly,an integrated material regimen that combines tumour therapy with bone repair is a promising treatment option.Herein,we summarized traditional and biomaterial-mediated maxillofacial tumour treatments and analysed biomaterials for bone defect repair.Furthermore,we proposed a promising and superior design of dual-functional biomaterials for simultaneous tumour therapy and bone regeneration to provide a new strategy for managing maxillofacial tumours and improve the quality of life of patients in the future.

Development and application of rapid rehabilitation system for reconstruction of maxillofacial soft-tissue defects related to war and traumatic injuries

Background: Maxillofacial war injuries usually cause severe facial organ defects and deformities, handicapping the patient's daily activities, even result in a tendency to commit suicide. The application of maxillofacial prosthesis is an alternative to surgery in functional–aesthetic facial reconstruction. Computer aided design and computer aided manufacturing has opened up a new approach to the fabrication of maxillofacial prosthesis. An intelligentized rapid simulative design and manufacture system for prosthesis was developed to facilitate the prosthesis fabrication procedure.Methods: Maxillofacial prosthesis rapid simulation design and rapid fabrication system consists of three components: digital impression, intelligentized prosthesis designing, and rapid manufacturing. The patients' maxillofacial digital impressions were taken with Structured-light 3D scanner; and then the 3D model of prostheses and their negative molds could be designed in specific software; finally, with the resin molds fabricated by rapid prototyping machine, the prostheses could be produced directly and quickly.Results: Fifteen patients of maxillofacial defect caused by traumatic injuries received prosthesis rehabilitation provided by the established system. The contour of the prostheses coordinated properly with the appearance of the patients, and the uniform-thickness border sealed well to adjacent tissues. All the patients were satisfied with their prostheses.Conclusions: The rapid simulative rehabilitation system of maxillofacial defects has been approaching completion. It could provide advanced technological reservation for the Army in the issue of maxillofacial defect rehabilitation.

Oral and maxillofacial pain as the first sign of metastasis of an occult primary tumour:A fifteen-year retrospective study

BACKGROUND Metastatic adenocarcinoma of the jaw(MAJ)is a rare disease that accounts for 1%-3%of all oral and maxillofacial malignant tumours.Oral and maxillofacial pain may be the first symptom of metastatic spread of an occult primary tumour.Therefore,early identification of oral and maxillofacial pain by dental professionals is critical.AIM To explore the clinical and computerized tomography(CT)features of MAJ with oral and maxillofacial pain as the first symptom.METHODS The medical records of all patients who were treated in our hospital between January 2006 and February 2020,and diagnosed with MAJ with oral and maxillofacial pain as the first symptom,were reviewed retrospectively.Clinical data were collected on age,sex,medical history,clinical manifestations,site of metastasis,and site of the primary lesion.CT features were analysed in detail,and a radiological classification scheme comprising five types:Osteolytic,osteoblastic,mixed,cystic,and alveolar bone resorption was proposed.RESULTS The primary sites of MAJ were the lungs(n=6),liver(n=4),kidneys(n=2),prostate(n=1),and gastric cardia(n=1).Five tumours were classified as the osteolytic type,all with a permeative margin(100%,P<0.05),and three were classified as the mixed type,mostly with a moth-eaten margin(80%,P<0.05).The cystic(n=3)and alveolar bone resorption(n=1)types had geographic margins,and the osteoblastic type(n=1)had sclerotic margins.Moreover,nine tumours showed periosteal reaction and five showed a localised soft tissue mass,while the occurrence of jaw expansion was relatively rare.CONCLUSION MAJ has complex clinical and CT features.Oral and maxillofacial pain may be the first sign of a primary tumour affecting other sites.

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as inpatients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.

Early Post-Operative Complications in Surgeries Pertaining Oral and Maxillofacial Region in MNH, Tanzania

The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.

The Osteogenic Capacity of Human Amniotic Membrane Mesenchymal Stem Cell (hAMSC) and Potential for Application in Maxillofacial Bone Reconstruction <i>in Vitro</i>Study

Amniotic membrane of human placenta is a source of abundant mesenchymal stem cell (hAMSC) which makes it a potential source of allogeneic multipotent cell for bone healing. However, much has to be explored about its isolation procedure and the osteogenic differentiation potential. The aims of this study are to establish the procurement procedure of human amniotic membrane, the isolation and culture of hAMSC, the MSC phenotypic characterization, and the in vitro osteogenic differentiation of hAMSC. Results of the study are as follows. The quality of human amniotic membrane would be best if procured from Caesarean operation under highly aseptic condition to avoid fungal and bacterial contamination on the culture. Isolation procedure using modified Soncini protocol yielded large amount of MSC with high proliferative capacity in culture medium. Characterization of hAMSC showed that the majority of the target cells exhibited specific MSC markers (CD105 and CD90) with a small number of these cells expressing CD45, the marker of hematopoeitic cells. The in vitro osteogenic differentiation of hAMSC followed by Alizarin Red staining showed that osteoblastic differentiation was detected in a significantly high number of cells. This study concludes that hAMSCs isolated from human amniotic membrane have the capacity for in vitro osteogenesis which makes them be one of the potential allogeneic stem cells for application in maxillofacial bone reconstruction.

Multi-disciplinary treatment of maxillofacial skeletal deformities by orthognathic surgery combined with periodontal phenotype modification:A case report

BACKGROUND Maxillofacial deformities are skeletal discrepancies that cause occlusal,functional,and esthetic problems,and are managed by multi-disciplinary treatment,including careful orthodontic,surgical,and periodontal evaluations.However,thin periodontal phenotype is often overlooked although it affects the therapeutic outcome.Gingival augmentation and periodontal accelerated osteogenic orthodontics(PAOO)can effectively modify the periodontal phenotype and improve treatment outcome.We describe the multi-disciplinary approaches used to manage a case of skeletal ClassⅢmalocclusion and facial asymmetry,with thin periodontal phenotype limiting the correction of deformity.CASE SUMMARY A patient with facial asymmetry and weakness in chewing had been treated with orthodontic camouflage,but the treatment outcome was not satisfactory.After examination,gingiva augmentation and PAOO were performed to increase the volume of both the gingiva and the alveolar bone to allow further tooth movement.After orthodontic decompensation,double-jaw surgery was performed to reposition the maxilla-mandibular complex.Finally,implant placement and chin molding were performed to restore the dentition and to improve the skeletal profile.The appearance and function were significantly improved,and the periodontal tissue remained healthy and stable.CONCLUSION In patients with dentofacial deformities and a thin periodontal phenotype,multi-disciplinary treatment that includes PAOO could be effective,and could improve both the quality and safety of orthodontic-orthognathic therapy.

Preterm neonate with a large congenital hemangioma on maxillofacial site causing thrombocytopenia and heart failure:A case report

BACKGROUND We report a rare case of a large congenital hemangioma(CH)in the maxillofacial region in a female neonate that caused thrombocytopenia and heart failure.With close multidisciplinary collaboration,the congenital hemangioma was successfully resected with good results.CASE SUMMARY The patient was delivered at gestational age of 36 wk by cesarean section due to cephalopelvic disproportion and lack of onset of labor(birth weight:2630 g).A right-sided facial tumor was detected in the fetus during routine antenatal ultrasound examination of the mother at 32 wk of gestation.Physical examination revealed a 7 cm×7 cm×3 cm hard,dull purple-colored mass on the right maxillofacial region.The mass was tense and had prominent surface telangiectasias.Laboratory investigations revealed reduced hemoglobin and platelet count,and increased activated partial thromboplastin time,prothrombin time,and thrombin time.International normalized ratio,fibrin degradation products,and D-Dimer levels were significantly increased.Thromboelastography showed increased alpha angle,mean amplitude,and the clot formation speed.Thyroid-stimulating hormone level was significantly elevated.The patient was administered prednisone,propranolol,euthyrox,vitamin K1,milrinone,and digoxin.After operation,cefepime was administered for anti-infection and propranolol was prescribed at discharge.CONCLUSION We report a rare case of CH in the right maxillofacial region causing thrombocytopenia and heart failure.

Clinical evaluation of implants in patients with maxillofacial defects

AIM: To show the efficacy of reconstruction and rehabilitation of large acquired maxillofacial defects due to tumor resections and firearm injuries. METHODS: The study group comprised of 16 patients(10 men and 6 women) who were operated on because of their maxillofacial defects under local and general anesthesia between June 2007 and June 2011. Prosthetic treatment with the aid of dental implants was performed for all of the patients. Eight patients received an implant supported fixed prosthesis; six patients received implant supported overdentures and two patients received both. Patients were followed up postoperatively for 1 to 4 years. Implant success and survival rates were recorded. Panoramic radiographs were taken preoperatively, immediately after surgery, immediately after loading and at every recall session. Peri-implant and prosthetic complications were recorded. Subjects were asked to grade their oral health satisfaction after treatment according to 100 mm visual analog scale(VAS) and the oral health related quality oflife of the patients was measured with the short-form Oral Health Impact Profile. RESULTS: Five implants(3 in the mandible, 2 in the maxilla) in five patients were lost, while the other 53 survived, which brings an overall survival rate of 91.37% on the implant basis, but 68.75% on patient basis. All the failed implants were lost before abutment connection and were therefore regarded as early failures. For all failed implants, new implants were placed after a 2 mo period and the planning was maintained. The mean marginal bone loss(MBL) was 1.4 mm on the mesial side and 1.6 mm on the distal side of the implants. Five of the implants showed MBL > 2 mm(mean MBL = 2.3 mm) but less than 1/2 of the implant bodies and therefore were regarded as not successful but surviving implants. The VAS General Comfort mean score was 85.07, the VAS Speech mean score was 75.25 and the VAS Esthetics mean score was 82.74. No patient reported low scores(score lower than 50) of satisfaction in any of the evaluated factors. The mean of OHIP-14 scores was 5.5. CONCLUSION: Although further follow up and larger case numbers will give more information about the success of dental implants as a treatment modality in maxillofacial defects patients, the actual results are encouraging and can be recommended for similar cases.