Endoscopically assisted enucleation and curettage of large mandibular odontogenic keratocyst

Navigation-based endoscopic enucleation (NBEE) of large mandibular cystic lesions involving the ramus

OBJECTIVE

The aim of this study was to present an innovative surgical protocol, navigation-based endoscopic enucleation (NBEE) for the treatment of large mandibular cystic lesions involving the mandibular ramus.

METHODS

Twelve patients who presented with a large mandibular cystic lesion involving the mandibular ramus were enrolled in this study. Preoperative planning and intraoperative navigation were performed in all 12 patients.

RESULTS

All patients in this study were treated with navigation-based endoscopic enucleation successfully. The follow-up period ranged from 7 to 10 months. Bone regenerated was found in all patients postoperatively. Three patients experienced temporary mandibular nerve palsy, and all relieved within 2 months. No pathological bone fracture was found during surgery.

CONCLUSIONS

The use of navigation-based endoscopic enucleation (NBEE) for the treatment of large mandibular cystic lesions involving the ramus proved to be an effective method for complete and precise enucleation of the cystic lesion that also preserved the surrounding tissue.

Ectopic teeth with disparate migration: A literature review and new case series

Purpose

Ectopic eruption can be defined as the emergence of a tooth in an abnormal location, where the tooth does not follow its typical eruption pathway. While ectopic eruption within the dentate region is well-documented in the literature, ectopic eruption in non-dentate regions is relatively rare. This study aimed to report 6 cases of ectopic teeth and present a systematic review of the English-language literature on ectopic teeth, emphasizing demographic characteristics, radiographic features, potential complications, and treatment options.

Materials and Methods

A literature search was conducted using the PubMed, Medline, Web of Science, and Cochrane databases. The demographic data and radiographic findings of patients presenting with ectopic teeth were recorded.

Results

The literature review yielded 61 cases of ectopic teeth, with patients ranging in age from 3 to 74 years. The findings from these previously reported cases demonstrated that the most common location for ectopic teeth was the maxillary sinus, which is consistent with this case series. The Pearson chi-square test was performed to evaluate the correlation between age and location of ectopic teeth, and the results were found to be statistically significant (P<0.05). However, no statistically significant relationship was observed between sex and the location of ectopic teeth.

Conclusion

The distinct features of these cases warrant reporting. This study presents the first case of supernumerary teeth in the condyle without any associated pathosis. Another notable characteristic is the pre-eruptive resorption of 2 inverted supernumerary teeth ectopically located in the palate, which predisposes to sinus opacification.

The dual-port endoscope-assisted cyst enucleation on the maxillofacial region

BACKGROUND

Endoscope-assisted surgery is a surgical method that has been used in oral and maxillofacial surgical fields. It provides good illumination, clear, and magnified visualization of the operative field. The purpose of this article is to describe the early clinical experiences to conduct minimally invasive surgery with endoscope-assisted enucleation of cysts on the jaw. It appears that this approach may be a superior alternative to the conventional approach.

METHODS

In this study, 24 patients (9 females, 15 males, average age 41.5) underwent endoscope-assisted cyst enucleation under general anesthesia. All operations were done by one surgeon. The cases were classified depending on whether bone penetration occurred at the cyst site. The cystic lesions were enucleated using an endoscope with a 0°, 1.9 mm diameter, or a 30°, 2.7 mm diameter. Two bony windows were used for the insertion of a syringe for irrigation, curettes, suction tips, sinus blades, surgical drills, and an endoscope. An additional small channel was made for the insertion of endoscopic instruments.

RESULTS

The 24 patients who underwent cyst enucleation were regularly observed for 3 to 12 months to evaluate for complications. Although some patients experienced swelling and numbness, these symptoms did not persist, and the patients soon returned to normal and there was no sign of recurrence.

CONCLUSIONS

The results of this study have suggested the possibility of minimally invasive surgery with endoscopes when it comes to cyst removal in the oral and maxillofacial region. Nevertheless, this study has limitations designed as a preliminary report focusing on the feasibility of endoscope-assisted cyst enucleation in the oral and maxillofacial regions.

Ectopic third mandibular molar: evaluation of surgical practices and meta-analysis

OBJECTIVES

To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an associated cyst or cutaneous fistula, and to determine the indications for a graft or osteosynthesis.

MATERIALS AND METHODS

A surgical practice questionnaire was distributed to oral and maxillo-facial surgeons attending a National Congress of the French Society of Stomatology, Maxillo-facial and Oral Surgery. A systematic review of the literature and meta-analysis was carried on Pubmed, Cochrane, Embase and ScienceDirect databases using the MeSH terms: "Ectopic teeth", "Third molar", "Mandibular". One hundred and forty-three surgeons answered the questionnaire and the meta-analysis included 66 articles.

RESULTS

From the questionnaire, the preferred surgical approach was intra-oral except when the ETMM was in the condyle, when it was extra-oral (69.5%; p < 0.001). In the meta-analysis, an extra-oral approach was only indicated when a cutaneous fistula was present (90% vs. 35.9%; p = 0.002), irrespective of ETMM location. In the questionnaire and meta-analysis, the presence of a cyst did not change the approach (p < 0.05). The indications for a graft or osteosynthesis were a condylar location (p < 0.001), while a cutaneous fistula decreased the indication (p = 0.04) and a cyst (p = 0.009) was only associated with a graft.

CONCLUSIONS

The preferential approach was intra-oral, except when the ETMM was condylar or a cutaneous fistula was present when an extra-oral approach was preferred. Osteosynthesis or a graft were more likely when the ETMM was in the condyle.

CLINICAL RELEVANCE

This study will help to orientate surgeons vis-à-vis ETMM treatment.

Endoscopic-assisted enucleation of large mandibular odontogenic cysts

OBJECTIVE

Traditional enucleation of large mandibular odontogenic cysts is an invasive method, which might be associated with several complications. The purpose of this study was to evaluate the clinical outcome of endoscope-assisted enucleation of large mandibular cysts.

STUDY DESIGN

Fifty-seven patients with large mandibular odontogenic cysts were enrolled in this study. Patients were divided into 2 groups as follows: (1) 25 patients who were treated with traditional enucleation and (2) 32 who underwent endoscope-assisted enucleation. Allogeneic bone grafting was applied in all cases.

RESULTS

All patients successfully underwent the operation. The follow-up period ranged from 16 to 28 months. Recurrence was found in 2 patients (8%) in the traditional enucleation group; no recurrence was observed in patients in the endoscope-assisted enucleation group. Permanent mandibular nerve palsy was found in 2 patients in the traditional enucleation group; only 2 cases of temporary mandibular nerve palsy were observed in the endoscope-assisted enucleation group.

CONCLUSIONS

Endoscope-assisted enucleation of large mandibular odontogenic cysts proved to be an effective treatment method, providing complete enucleation of the cystic lesion while preserving surrounding tissue.

Endoscopic enucleation of large jaw cysts: Promising outcomes

OBJECTIVE

To describe the endoscopic approach for management of large jaw cysts and assess the feasibility of endoscopic enucleation as well as analyze its outcome on a wide scale at Mansoura University Hospital MUH.

METHODS

This prospective cohort study was done on 23 consecutive cases presenting with different types of large jaw cysts in the period from January 2013 to July 2016 at ENT Department, Mansoura University Hospital. All patients, (16 maxillary & 7 mandibular) cysts, were managed endoscopically. Follow up ranged from 6 to 48 months.

RESULTS

All patients showed complete resolution of their symptoms postoperatively except for 2 maxillary case who didn't undergo an antrostomy and 1 mandibular indicated a second look.

CONCLUSION

Large jaw cysts lie at the border line of management options. Resection of the affected segment is a radical option but the most deforming. On the other hand, conservative procedures are prolonged and not definitive. To our knowledge this is the first case series of endoscopic enucleation of large maxillary and mandibular cysts, highlighting its advantages in variable types.

Ectopic Molar Removal from the Ramus/Condyle Unit: A Minimally Invasive Approach

Ectopic molars within the mandibular ramus/condyle unit, although rare, present a unique challenge to the surgeon. Multiple approaches have been described in the literature for their removal. A review of the English literature on the subject of mandibular ectopic molars and their epidemiology, etiology, indications for removal, and surgical techniques was completed. In addition, a case report is presented of an ectopic mandibular molar in the mid-ramus region which was removed via a minimally invasive, intraoral, technique combining the use of endoscopy and piezoelectric surgery. The authors advocate this technique as it offers the following advantages: avoidance of injury to branches of the facial nerve, unaesthetic scars, and sialocele formation; maximization of surgical field visualization with limited dissection; ability for safe sectioning of the tooth with minimal risks to adjacent structures; and precise bone removal, reducing the risk of iatrogenic or postoperative mandible fracture.

Endoscopic removal of a huge keratocystic odontogenic tumor in maxillary sinus

Keratocystic odontogenic tumor is derived from the proliferation of residues of the dental lamina. Keratocystic odontogenic tumors have high recurrence rate from 0% to 62%, depending on the locations and types of treatment. The controversy still exists about treatment methods ranging from simple curettage to highly invasive en bloc resection. Furthermore, there is no consensus on the most effective surgical technique. We report the first case of removal via endonasal endoscopic approach for a huge, expansile keratocystic odontogenic tumor in the maxillary sinus extending to contralateral central incisor.

Ectopic third molar in the mandibular condyle: a review of the literature

Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery.

Key words:Third molar, ectopic tooth, condyle, mandible.

Incidental discovery of odontogenic keratocyst in an edentulous patient: importance of routine pre-prosthetic radiographic evaluation

The most common modality of treatment for completely edentulous patients are conventional removable complete dentures. The protocol for fabrication of complete denture would involve a thorough clinical examination and radiographic investigation. As a routine, unless clinical findings suggest presence of remnant tooth structures, or the patient presents himself with symptoms, the radiographic investigations are overlooked. This case report presents one such situation wherein routine radiographic evaluation of a clinically asymptomatic edentulous individual prior to prosthetic rehabilitation revealed the presence of an odontogenic keratocyst of anterior maxilla substantiating the importance of such routine pre-prosthetic radiographic investigations.

Endoscope-assisted removal of intraosseous schwannoma with preservation of inferior alveolar nerve

The use of endoscopes in oral and maxillofacial surgery has been well documented. The advantage of no external scar and minimal invasiveness makes endoscopic technique gradually more popular. This article will describe a rare case of an intraosseous inferior alveolar nerve schwannoma and its removal using endoscope. The surgical technique and preservation of the inferior alveolar nerve will be described and illustrated. The advantages and disadvantages of the approach will be discussed.