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.

Prevalence of Taurodontism in a Tertiary Hospital in Ghana

Background: Taurodontism is one of the most significant deviations from the normal tooth morphology affecting the molars in both primary and permanent dentition. Taurodontism refers to the Enlargement of the pulp chamber, resulting in its bifurcation pushed toward the apex of a tooth’s root. This study evaluated the prevalence of Taurodontism from radiographs taken at the University of Ghana Dental School Oral Radiology Unit from January 2017 to December 2022. Methodology: In this cross-sectional study, panoramic and periapical radiographs of 1000 randomly selected patients who visited the Oral Radiology Unit from January 2017 to December 2022. Radiographs were evaluated for apically displaced pulp chamber. Data was statistically evaluated, and the chi-square test was employed to assess the prevalence of taurodontism in the upper and lower jaws (p Results: Taurodontism was found in 171 radiographs giving it a prevalence of 17.1% of which 57% (98 radiographs) were from females and 43% (73 radiographs) were from males. This finding was not significant (p > 0.05). Taurodontism occurred more in the maxilla (289 teeth, 80.7%) compared to the mandible molars (186 teeth, 64.3%) giving it a ratio of 1.6:1. This finding was highly significant (p Conclusion: Taurodontism is relatively common in the Ghanaian population affecting more females compared to males according to this study. Further studies using a large sample need to be carried out to determine its incidence in the general community.

鼻内镜下经鼻开窗术治疗大型上颌骨囊肿

上颌骨囊肿是常见的良性病变,根据组织来源和发病部位分为牙源性上颌骨囊肿和非牙源性上颌骨囊肿,其中以牙源性囊肿多见。非牙源性囊肿主要包括鼻腭囊肿、正中囊肿、鼻前庭囊肿等。临床上多有患侧面颊部及鼻翼隆起,表面骨质破坏吸收,触之有明显的囊性感。传统治疗方法为经唇龈切口行囊肿完整切除或加上颌窦病变刮除术,手术创伤较大且部分患者出现术后瘘口及复发。大型囊肿为直径>3.5 cm以上的囊肿[1],针对此种囊肿,

上颌骨囊肿患者鼻内镜开窗术后发生感染的因素分析及改进措施

目的探讨上颌骨囊肿患者鼻内镜开窗术后发生感染的因素,并分析改进措施。方法选择2017年9月~2020年12月于沧州市中心医院接受鼻内镜开窗术治疗的113例上颌骨囊肿患者为研究对象,依据术后感染情况,将患者分为感染组(n=17)和未感染组(n=96)。比较两组患者的临床资料;采用多因素Logistics回归分析上颌骨囊肿患者鼻内镜开窗术后感染的影响因素;Pearson检验分析各影响因素间的相关性;构建风险预测模型,并评价其预测效能。结果感染组患者伤口分型主要为污染伤口(P<0.05),初始囊腔大小显著大于未感染组(P<0.05),手术时间显著久于未感染组(P<0.05),术中出血量显著多于未感染组(P<0.05),术后24 h视觉模拟量表(VAS)评分显著高于未感染组(P<0.05),使用抗生素和无菌操作人数显著少于未感染组(P<0.05);在生化指标方面,感染组患者的白细胞计数(WBC)、C反应蛋白(CRP)和中性粒细胞比例(NEUT)也显著高于未感染组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示:手术时间、术中出血量、WBC、CRP、NEUT是影响上颌骨囊肿患者术后感染的独立危险因素(P<0.05),无菌操作是保护因素(P<0.05);手术时间、术中出血量、WBC、CRP、NEUT之间均呈明显正相关(P<0.05),分别与无菌操作呈明显负相关(P<0.05);根据独立影响因素构建预测模型,模型的AUC为0.827,模型预测的区分度和有效性均较好。结论手术时间、术中出血量、WBC、CRP、NEUT是影响上颌骨囊肿患者术后感染的独立危险因素,无菌操作是保护因素。术前准备充分,严格杀菌消毒,控制手术时间,减少术中出血量,对患者相关血液指标进行及时监测,有助于降低患者术后的感染率。

鼻内镜下上颌骨巨大脓囊肿切除1例

1 临床资料 患者,男,21岁,主诉左面颊部不适半年。查体：左面颊无明显隆起,唇齿龈无隆起,左鼻底膨隆明显（图1A）,左侧切牙、尖牙有残根,曲面断层不排除根尖囊肿的可能。鼻窦CT示左上颌骨腭突巨大囊肿,边界清晰,囊腔密度不均,突入左上颌窦腔约2/3,与左上颌窦未连通,腭骨鼻嵴、鼻中隔受压向右移位（图1B，图1C）。采用尖牙窝入路，唇齿龈切口，用美敦力鼻科磨钻造一直径约1cm骨孔，经该孔用0°和30°鼻内镜明视下操作，完全剥离囊壁，

原发上颌骨朗格汉斯组织细胞增多症1例

1临床资料患者,男性,17岁,因发现鼻背部肿块2个月入院。查体：外鼻无畸形;左侧鼻背处可见一个1cm×3cm大小肿块,质硬,无触痛。CT检查提示：左侧上颌骨可见软组织密度影,边缘欠清,周围骨质可见吸收,左侧上颌骨皮质欠连续,左眶周软组织略增厚（图1A）。

The impact of cleft lip and palate repair on maxillofacial growth

Surgical correction is central to current team-approached cleft treatment. Cleft surgeons are always concerned about the impact of their surgical maneuver on the growth of the maxilla. Hypoplastic maxilla, concaved mid-face and deformed dental arch have constantly been reported after cleft treatments. It is very hard to completely circumvent these postoperative complications by current surgical protocols. In this paper, we discussed the factors that inhibit the maxillofacial growth on cleft patients. These factors included pre-surgical intervention, the timing of cleft palate and alveolae repair, surgical design and treatment protocol. Also, we made a review about the influence on the maxillary growth in un-operated cleft patients. On the basis of previous researches, we can conclude that most of scholars express identity of views in these aspects： early palatoplasty lead to maxilla growth inhibition in all dimensions; secondary alveolar bone graft had no influence on maxilla sagittal growth; cleft lip repair inhibited maxilla sagittal length in patients with cleft lip and palate; Veau＇s pushback palatoplasty and Langenbeck＇s palatoplasty with relaxing incisions were most detrimental to growth; Furlow palatoplasty showed little detrimental effect on maxilla growth; timing of hard palate closure, instead of the sequence of hard or soft palate repair, determined the postoperative growth. Stilt, scholars hold controversial viewpoints in some issues, for example, un-operated clefts have normal growth potential or not, pre-surgical intervention and pharyngoplasty inhibited maxillofacial growth or not.

Radiation-induced osteosarcoma of the maxilla and mandible after radiotherapy for nasopharyngeal carcinoma

Background:The increasing incidence of radiation-induced osteosarcoma of the maxilla and mandible(RIOSM) has become a significant problem that can limit long-term survival.The purpose of this study was to analyze the association of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma(NPC).Methods:We reviewed the medical records of 53,760 NPC patients admitted to Sun Yat-sen University Cancer Center during the period August 1964 to August 2012.Of these patients,47 who developed RISOM and met inclusion criteria were included in this study.Two of these 47 patients refused treatment and were then excluded.Results:For all patients treated for NPC at Sun Yat-sen University Cancer Center during the study period,the total incidence of RIOSM after radiotherapy was 0.084%(47/53,760).Two patients(4.4%) had metastases at the diagnosis of RIOSM.Thirty-nine of the 45(86.7%) patients underwent surgery for RIOSM;most patients(24/39;61.5%) who underwent resection had gross clear margins,with 15 patients(38.5%) having either a gross or microscopic positive margin.All patients died.The 1-,2-,and 3-year overall survival(OS) rates for the entire cohort of 45 patients were 53.3%,35.6%and 13.5%,respectively.The independent prognostic factors associated with high OS rate were tumor size and treatment type.Conclusions:RISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely intervention.Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.

Effects of different types of palatal lateral excisions on growth and development of maxilla and dental arch

Objective:This study aimed to explore the effects of different types of palatal lateral excisions on the growth and development of the maxilla and dental arch, and to investigate the underlying mechanisms. Methods: A total of 112 3-week-old Sprague-Dawley (SD) male rats were randomly divided into a control and 3 experimental groups: the mucoperiosteal denudation group, the mucosal flap excision group, and the periosteum excision group. In the experimental groups, bilateral mucoperiosteal, mucosal flap and periosteum were excised respectively in the lateral one half of the palate. Four rats in each group were randomly chosen for sacrifice every two weeks. The maxilla was dissected following the excision. The widths of the maxilla and dental arch were measured and the histological phenomena were investigated at different phases. At the same time, 12 animals in each group were sequentially injected with calcein every two weeks. Three animals in each group, whose fluorescent labeling was used, were sacrificed for investigating bone formation at Week 8 following injection. Results: (1) Each experimental group presented the constriction of the maxilla and dental arch. The upper first molars in the experimental groups inclined medially. The mucoperio-steal denudation group showed the largest degree of effect followed by the periosteum excision group. The indices of the mucosal flap excision group, which retained the structures of the periosteum layer, had the most approximate values to the control group; (2) Different histological changes among the experimental groups were detected. The fibers penetrated into the palatal bone as Sharpey's fibers in the mucoperiosteal denudation group. The pattern of bone deposition was the bundle type. Sharpey's fibers were not found in the mucosal flap and periosteum excision groups and the depositions of palatal bone were the lamellar type as those in the control group; (3) The rates of bone deposition in the experimental groups decreased compared with the control group. The rates in different phases were the most approximate values to those of the control group in the mucosal flap excision group, which has the same structure of periosteum as the control group. Conclusion: There were different effects on the growth and development of the maxilla and dental arch in different types of palatal lateral excisions. Periosteum is important for bone for-mation and deposition pattern. The prevention of Sharpey's fibers forming and attaching to the palatine can effectively avert the following malformation.

Adenoid cystic carcinoma in the maxillary gingiva: a case report and immunohistochemical study

Gingival adenoid cystic carcinoma (ACC) is a rare malignancy. We describe the diagnosis and treatment of a 43 year- old woman who presented with a persistent oral ulcer for approximately 1 year, and subsequent pain in the left posterior maxillary region. Clinical examination revealed an ulcer in the left upper molar gingiva, with swelling in the region from the second premolar to the third molar. X-ray images demonstrated the involvement of the maxillary alveolar bone. The histopathological and immunohistochemical features were diagnostic of ACC. ACC is often presented as a gingival lesion; thus, it may easily be neglected by patients. The identification of this tumor using specific pathological analyses prevents misdiagnosis and enables clinicians to determine the appropriate treatment. In this case, no recurrence or distant metastasis was observed after 2 years of follow-up.

内镜下鼻内造口在上颌骨囊肿摘除术中的应用

颌骨囊肿是头颈颌面外科一种常见的良性病变。我科2009年7月-2011年7月收治以单侧鼻塞、面部肿胀或伴硬腭隆起就诊的囊肿直径〉4．0cm患者5例，在上颔骨囊肿摘除术中，利用鼻内镜辅助行术腔个性化鼻内造口引流，取得了满意的效果，现报道如下。

Posterior partially edentulous jaws, planning a rehabilitation with dental implants

AIM: To discuss important characteristics of the useof dental implants in posterior quadrants and the rehabilitation planning. METHODS: An electronic search of English articles was conducted on MEDLINE(PubM ed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review. RESULTS: One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations(bone quantity and density), radiographic techniques, implant selection(number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters. CONCLUSION: The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning.

Angiosarcoma of Maxillary Sinus: A Case Report

Purpose: To describe a rare malignancy involving the sinonasal cavities. To discuss the clinical, diagnostic, and treatment modalities. Study Design: A case report including histopathological, radiological analysis and review of literature. Method: A case report is described from a tertiary care centre. Histopathological and radiological details are reviewed. Results: This case report presents a 29 year old male with 3 days history of bleeding from the left nostril, blood stained saliva with post nasal discharge and head ache. Biopsy demonstrated poorly differentiated Angiosarcoma. On immune stains the tumor cells showed diffuse strong cytoplasmic membrane positivity with CD 31 and few cells are positive for CD34. FLI-1 is also positive. Conclusion: Angiosarcoma is a rare malignancy involving the sinonasal cavities. Multidisciplinary approach is essential to obtain clear diagnoses and appropriate treatment plans.

Application of computer-assisted navigation in treating congenital maxillomandibular syngnathia:A case report

BACKGROUND Congenital maxillomandibular syngnathia is an extremely rare disorder characterized by craniofacial malformations and inability to open the mouth adequately, which leads to problems with feeding, swallowing, and breathing as well as temporomandibular joint ankylosis. The main goal of the surgery is to release the ankylosis, establish functioning mandible, and prevent re-fusion.However, surgical procedures for this disease are rarely reported.CASE SUMMARY Here, we report a 7-mo-old girl with bilateral maxillomandibular syngnathia. The patient presented with difficulty in feeding, breathing, sounding, and swallowing and had developmental dysplasia. For treatment, we performed bone isolation by computer-assisted navigation and used silicone to fix the wound surface to prevent refusion of bone. To our knowledge, this is the only syngnathia case in the literature treated using computer-assisted navigation. With the guidance of precise navigation, we were able to minimize operation time by at least one hour,the patient's blood vessels, nerves, and tooth germs were well protected, and excessive bleeding was avoided. After six weeks, the patient showed improvement in mouth opening and no major issues of feeding.CONCLUSION Application of computer-assisted navigation can significantly improve accuracy,effectiveness, and surgical safety in correcting congenital maxillomandibular syngnathia.

Intraosseous venous malformation of the maxilla after enucleation of a hemophilic pseudotumor: A case report

BACKGROUND Hemophilic pseudotumor(HP)is a rare complication in patients with hemophilia.The lesion most frequently occurs in the long bones,pelvis,small bones of the hands and feet,or rarely in the maxillofacial region.Postoperative changes in HP are seldom arrested,whereas angiogenesis characterized by disturbed wound healing in HP may cause vascular malformations.CASE SUMMARY We report the case of an 11-year-old boy who was affected by maxillary intraosseous venous malformation.Enucleation of an HP without factor replacement was performed initially on the right side of the maxilla 3 years ago.The patient was referred to us because of painless swelling in the same location.Factor replacement and subtotal maxillectomy were performed.Pathological examinations revealed intraosseous venous malformation.CONCLUSION This study is the first to document the development of intraosseous venous malformation after enucleation of an HP in the maxillofacial region.Angiogenesis characterized by disturbed wound healing in patients with hemophilia may be pivotal in the pathogenesis of this condition.

Investigation of Peri-implant Status and Risk Variables for Implant Failure in Body of Maxilla after Oral Tumor Surgery

The aim of this study was to assess the peri-implant parameters and evaluate the clinical status with the survival of dental implants in body of maxilla after treatments of oral tumor. A follow-up examination included 27 patients who underwent the ablative tumor and （or） reconstructive surgery during a 5-year period. The follow-up protocol included clinical examination, radiological evaluation, and an interview using a standardized questionnaire. The reasons related to implant failure were studied by comparing the amount of failure with the value of marginal bone resorption, probing pocket depth, and plaque index using statistical t-test. The relationship between smoking and implant failure was analyzed statistically by chi-square test. The results showed among the 112 implants observed after implant loading, 29 have failed with the failure rate being 22.14 %. There was no significant correlation between the peri-implant status and the implant failure （P〉0.05）, however, the association of smoking and implant failure was statistically tested （P〈0.05）. It was suggested that the association of peri-implant status and implant failure in the maxilla after tumor surgery can＇t be statistically tested, however smoking was still a mainly significant factor.

Spindle Cell Carcinoma of the Maxilla: A Case Report of Rare Entity

Spindle cell carcinoma also known as sarcomatoid carcinoma is a rare highly aggressive tumor which is histologically different from squamous cell ca and mesenchymal cancers. Only hands full of cases have been reported in literature since 1957 and hence no proper treatment protocol has been devised yet. We present such a case of thirty-four-year-old female who presented with spindle cell carcinoma of the maxilla at our department and was treated with extensive surgery followed by chemotherapy and radiation therapy. Spindle cell carcinoma is generally associated with poor prognosis and hence literature supports use of post operative Chemo and Radiotherapy for better result and decrease chance of local recurrence.

Clinical Research of a Modified Midfacial Degloving in a Maxillectomy (with a Report of a Typical Case)

OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. The tumors were classified according to the 2002 AJCC system. The TNM staging of the cases was as follows： 1 T4aN0M0, 2 T3N0M0 and 5 T2N0M0. Of the 8 cases, 1 patient underwent extended maxillectomy; exenteration of the orbit; tumorectomy of the sphenomaxillary and infratemporal fossae. Two patients received a total maxillectomy, and 5 a partial resection of the maxilla. Postoperative pathological report： 4 well-differentiated squamous carcinoma, 2 moderately-differentiated squamous carcinoma, 1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma.RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation, resect the tumor within a safe margin, and leave no facial cicatricles. One patient died of intracranial metastasis 8 months after operation. We observed no recurrences or metastasis in other patients during the period of follow-up.CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided. It has an advantage of minimal invasive surgery

Evaluation of speech function on repairing defects of maxilla and palate with temporalis muscle flap

Objective： To evaluate the speech function on repairing defects of maxilla and palate with temporalis muscle flap after benign or malignant turmor resection. Methods： The lateral cephalogram and speech intelligibility were detected in 19 cases with the operations of repairing defects of maxilla and palate by temporalis muscle flap, and their recovery of the speech function were analyzed. Results： Among the 19 patients, there were 15 cases （78.00%） with complete velopharynx, 3 cases （15.80%） with mafiginal velopharynx, and 1 case （5.26%） with insufficient velopharynx. The average speech intelligibility was 94.3%, close to the normal speech intelligibility. Conclusion： The operation of repairing defects of maxilla and palate with temporalis muscle flap can reconstruct the phonatory structure, preserve the palate function and restore the speech function after operation.

A protocol used to manage maxillary hypoplasia in cleft lip and palate patients

Objectives: We report our experience and the protocol we used in managing maxillary hypoplasia in cleft lip and palate patients. Patients and methods: 14 adult cleft lip and palate patients with maxillary hypoplasia were evaluated clinically. Dental models and radiographs including (lateral cephalograms and orthopantographs) were obtained at the initial visit and upon completion of the presurgical orthodontic treatment. Patients with occlusal discrepancies larger than 6 mm and severe palatal scaring underwent Distraction osteogenesis (DO) to advance the maxilla. Patients with an occlusal discrepancy of 6 mm or less, underwent traditional orthognathic surgery including le fort I advancement and Bilateral sagittal split osteotomy (BSSO) to seat the mandible in occlusion. Results: Five patients underwent orthognathic surgery. Two of them underwent double jaw surgery. Three underwent single jaw conventional le fort l advancement. Four patients required bone grafting to repair the residual alveolar defect and to augment the midface deficiency. Nine patients with severe maxillary hypoplasia underwent maxillary advancement using distraction osteogenesis. Conclusion: Patients with a severe maxillary hypoplasia of 6 mm or more and excessive palatal scaring are successfully treated with DO. Conventional le fort I is reserved for patients with less severe maxillary hypoplasia. Both techniques gave promising results providing having followed the proper selection criteria.