Foreign-body granuloma occurring in the mandible subsequent to orthognathic surgery: a case report

The prevalence of foreign bodies in jaw bones on panoramic radiography

Objective:

Foreign bodies can be deposited in the oral cavity either by traumatic or iatrogenic injury. The most common foreign bodies of iatrogenic origin encountered are restorative materials, like amalgam, and root canal fillings. The aim of this study was to determine the prevalence of foreign bodies detected with panoramic radiography in the jawbones, as well as to evaluate the etiology and characteristics of these pathologies.

Materials and Methods:

From March 2012 to January 2014, 11,144 panoramic radiographs were taken and retrospectively reviewed. The number, characteristics, location of the foreign bodies, age, and gender of the patients were recorded.

Results:

Of the 11,144 patients reviewed, 62 of them have a foreign body with a frequency of 0.6%. The patients who had a foreign body were between 14 and 81 years old. Female patients showed more foreign bodies than male patients. Among the 62 patients, 63 filling materials, one stapler, and five shrapnel were detected. Only 8 patients had symptoms associated with foreign bodies and these foreign bodies excised surgically.

Conclusion:

If possible, these pathologies must be removed at the time of detection to prevent further complications; however, in asymptomatic cases, according to location and the characteristic of the foreign body, they can be kept under observation without performing any operations.

Perioperative complications following sagittal split osteotomy of the mandible

INTRODUCTION

The aim of this study was to review complications in a series of 1264 consecutive patients who were operated in a single centre during a 20-year-period.

MATERIAL AND METHODS

Complications were documented, their incidences calculated and compared with data from the literature.

RESULTS

In 35 patients (2.8%) infection developed requiring extraoral incision and drainage; in 27 patients (2.1%) the inferior alveolar nerve was inadvertently cut; 18 patients (1.4%) had to undergo re-operation due to bending or fracture of osteosynthesis material; 15 patients (1.2%) suffered from bleeding complications; in 12 patients (0.9%) an unfavourable split occurred. In 8 patients (0.6%) foreign bodies were left in situ; in 7 patients a partial weakness of the facial nerve occurred, which was permanent in 1 patient. Six patients (0.5%) with a significantly higher age than average (mean: 33.6 years in comparison with 23.1 years) developed non-union at the site of osteotomy, and the mandible had to be bone grafted. Two patients (0.2%) developed osteomyelitis, and in one patient airway problems led to a need for tracheostomy (0.1%).

CONCLUSION

Although some of these complications of bilateral sagittal split with osteotomy carry severe limitations in health related quality of life, it remains an overall safe procedure, demanding, however, comprehensive informed consent. Good knowledge of technical reasons for these complications should help to reduce their incidence.

[Incorporation of multiple foreign bodies due to borderline personality disorder]

BACKGROUND

Autoaggressive behaviour is one of the pathognomonic characteristics in patients with borderline personality disorder. Clinical symptoms of such behaviour can be the self-induced incorporation of foreign bodies. In the head and neck area, this form of autoaggressivity causes primary or secondary infectious complications with different clinical manifestations. Below follows a description of diagnosis, therapy and follow-up of such a case, comparing our own findings with the corresponding literature.

CASE REPORT

A 24-year-old woman with manifest borderline personality disorder was referred to the Department of Maxillofacial Surgery after developing a swelling in the infra-auricular region. After antibiotic therapy failed to reduce inflammatory symptoms, local revision was performed including excision of two metallic foreign bodies. Comprehensive radiological evaluation identified multiple foreign bodies in the head and neck region and lower arms. A total of 76 metallic foreign bodies was removed surgically. During early surgical follow-up and subsequent psychiatric treatment, the patient incorporated new foreign bodies.

DISCUSSION

The case reported represents a pattern of foreign body incorporation which is unusual based on review of the literature but characteristic for patients with borderline personality disorder. Diagnostics and therapy require an individual concept which only can be implemented in close co-operation with psychiatrists. Secondary clinical benefit derived from surgical diagnostics and therapy as well as the possibility of autoaggressive relapse have to be taken into consideration.