Maxillary and mandibular odontogenic myxomas: case report

Maxillary myxomas are rare benign odontogenic tumors with a high potential for infiltration and destruction. Clinical and radiological manifestations are variable and non-specific and often lead to confusion with other benign and malignant lesions. We present here two cases of odontogenic myxoma of different localization (maxilla and mandible). In both cases, the patient presented with a progressively enlarging facial swelling without any neurologic disturbance or lymph nodes. On computed tomography, the lesions appeared as a large unilocular, homogeneous image causing a cortical thinning and rupture along with repression of surrounding tissues. The clinical and radiological features were poorly suggestive of precise nature, and only histological examination of biopsy specimen was able to reveal the diagnosis of myxoma. Given the large size of the tumors and the locally aggressive pattern, we have opted for large maxillecetomy and marginal mandibulectomy. In conclusion, myxoma is a slow growing but locally aggressive tumor that the clinician should keep in mind. As there is a lack of consensus regarding their treatment, we can suggest a conservative treatment for small non-extensive lesions, which consists of enucleation and curettage of the tumor; and a radical excision in case of large tumors given the high risk of recurrence.

Mandibular nerve schwannoma: a case report

Benign schwannomas are uncommon and their intraosseous location is even rarer counting for less than 1% of all benign primary bone tumors. They exceptionally occur in the oral cavity with the tongue being the most common site of involvement. We report here a case of intramandibular schwannoma derived from the inferior alveolar nerve, in a 57-year-old patient with a 3 months history of inferior left lip paresthesia. The oral examination showed a firm, painless and non-pulsatile swelling located in the inferior vestibule. The panoramic X-ray revealed a circumscribed and homogeneous radiolucent image. Treatment consisted of total excision of the tumor with preservation of the nerve bundles. The histological examination confirmed the diagnosis of schwannoma. The patient recovered a normal sensory function 6 months post-operatively without any recurrence up to 2 years after surgery. The treatment of intramandibular schwannoma is basically surgical with the conservative approach being the most advocated by majority of authors.

The role of humanitarian missions in surgical training for maxillofacial surgery residents: SOS Face Marrakesh experience

Resident´s participation in humanitarian work has been controversial, while it´s recognized by some authors to bring significant value to the resident´s education. Herein, we aim to provide an evidence of the role of humanitarian missions in the surgical training as part of residency program, through report of a 10 years experience of SOS FACE Marrakesh, a non-benefit association within maxillofacial surgery department of Marrakesh. Its operating mode is to organize humanitarian missions coupled to targeted surgical training program, which is framed by educational objectives using a pedagogic portfolio. As a result, 60.6% of the residents felt an improvement in surgical skills, and the evaluation of residents before and after the targeted training showed an increase of 57% in average clinical knowledge, especially the diagnosis part. In conclusion, humanitarian work helps to improve surgical skills in addition to enhancement of human values and we suggest incorporating volunteerism in residency programs.

Oral amelanotic malignant melanoma: a case report

Amelanotic malignant melanoma is an extremely rare and aggressive oral tumor. Herein we report the case of a 42-year-old woman presented with a painful growth in anterior maxillary region. Intra-oral examination showed a non-pigmented exophytic mass occupying the anterior maxillary sector. Incisional biopsy with immunohistochemistry examination revealed a malignant melanoma as it strongly expressed melan A and S-100. Facial computed tomography showed extension to the maxillary bone and hard palate. After thoraco-abdominal computed tomography revealing absence of metastasis, tumor resection was performed respecting 2cm security margin. Oral localization of malignant melanoma is rare especially its amelanotic variant. Lack of pigmentation makes the diagnosis more difficult, usually resulting in treatment delay and making the prognosis even worse. Early detection by histological and immunochemistry examination combined to wide resection are the keys to improving the survival for patients with oral amelanotic melanoma.

Natal teeth: report of two cases

Presence of teeth at birth or within a month post-delivery is a rare condition. We report here 2 cases to highlight their clinical features and discuss their possible treatment. A 7- days old female newborn with two mandibular central incisors, noticed by the parents at birth, with complaint of continuous crying, inability to suck milk and causing discomfort to the mother. The left incisor was highly mobile justifying its extraction. The second case was a female newborn referred 2 hours after delivery, for a brownish highly mobile mandibular incisor noticed by the pediatrician. Extraction was immediately made to avoid the danger of aspiration. This phenomenon can lead to complications either local such as pain on suckling or general such as undernutrition or asphyxia by aspiration. The decision to maintain or remove these teeth should be assessed in each case independently, based on degree of mobility and interference with breastfeeding.

Odontogenic cervico-facial cellulitis during pregnancy: about 3 cases

Pregnancy is considered as a risk factor for development, severity, and complications of odontogenic infections. Without adequate treatment, the infection can spread and threaten both the mother's and the foetus lives. We aim to analyze the predisposing factors, diagnostic and therapeutic aspects of cervico-facial cellulitis during pregnancy, through a descriptive retrospective study conducted at oral and maxillofacial surgery department of Mohamed VI university hospital center at Marrakesh, between June 2017 and June 2019. A total of three patients; all patients were at their last trimester were recruited. Every patient was immediately given intravenous antibiotics, drainage was carried out under local anesthesia, and the causing tooth was removed. During hospitalization, one patient was referred to the gynaecology department for preterm labor, while the remaining two patients were discharged after the pus drainage has stopped. The possible compromise of oral health during pregnancy is well known, however severe odontogenic infections are rarely considered in the literature. It is essential to aggressively treat the gravid patient to minimize the risk of infection spreading to the facial spaces. Moreover, poor oral health in pregnancy has been implicated in adverse birth outcomes, specifically prematurity. We recommend upgrading communication between obstetrician and dentists so that regular routine dental visits are planned for pregnant patients during early stages of pregnancy in order to identify and manage the problem as early as possible.