Odontogenic myxoma involving the orbit in a 3-year-old boy: removal, reconstruction and review of the literature

We present a rare case of a 3-year-old boy with an odontogenic myxoma (OM) involving the orbita. Including our case, only nine cases of OM have been reported to involve the eye in children.There is no gold standard for treatment of OM in children with orbital involvement. The recurrence rate of OM in children seems low, which advocates for less invasive surgery. A gentle resection of the OM was carried out. The floor and medial wall of the orbit was reconstructed immediately using a non-resorbable Medpor implant with passive adaptation. Reconstruction with a Medpor implant in children has rarely been reported in the literature. No clinical or radiological recurrence was observed 24 months after surgical removal, and the patient presented with symmetric appearance and normal vision.

Reconstruction of the maxilla using a fibula graft and virtual planning techniques

Use of a vascularised free fibula flap has been a popular method of osseous reconstruction because of its adequate length and acceptance of dental implants. In this article we describe a case of maxillary reconstruction in which virtual planning techniques and rapid prototyping were used to insert a microvascular osteomyocutaneous fibula graft, Medpor implant, and immediate dental implants.

[Odontogenic myxoma of the maxilla in a three-year-old boy]

A three-year-old boy presented with a painless mass in the nasolabial fold and ipsilateral increased tearing. A diagnosis of odontogenic myxoma (OM) was established by biopsy, and the tumour was excised using a combined oral and transconjuctival approach. In small children OM occurs almost exclusively in the maxilla. Orbital involvement is very rare, and to our knowledge reconstruction with a Medpore sheet has not previously been reported. At post-operative follow-up normal eye function and an excellent cosmetic result was observed. OM should be considered in a midfacial mass.

Corticosteroid administration in oral and orthognathic surgery: a systematic review of the literature and meta-analysis

PURPOSE

This study evaluated the effect of corticosteroid (CS) administration on edema, analgesia, and neuroregeneration in conjunction with surgical dental extraction, orthognathic surgery, and the risk of developing side effects.

MATERIALS AND METHODS

A systematic search of the literature was made. The primary predictor variable was CS administration and the outcome variables were edema, pain, and infection. A meta-analysis was performed. The risk of other side effects was evaluated through a simple review.

RESULTS

In oral surgery, most clinical trials showed a significant decrease in edema (P < .0001) after CS, and local injection of methylprednisolone > or =25 mg was expected to result in a significant decrease in edema. Regarding the analgesic effect, several clinical trials showed a decrease in pain after CS (P < .0001). Further, CS administration resulted in a slightly higher risk of infection (relative risk, 1.0041), but with a P value of .89. CS could be administered with no increased risk of infection. In orthognathic surgery, methylprednisolone > or =85 mg administered intravenously seemed sufficient to produce a significant decrease in edema, and several trials pointed toward a neuroregeneration effect, but no statistical analysis could be performed. Regarding the risk of other side effects, in oral surgery, a minimal risk of chronic adrenal suppression was seen; in orthognathic surgery, an elevated risk of avascular osteonecrosis, steroid-induced psychosis, and adrenal suppression was seen. There were no reports of decreased healing.

CONCLUSION

These findings suggest that the administration of CS in oral surgery decreases edema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects.

Surgical risk factors and maxillary nerve function after Le Fort I osteotomy

PURPOSE

Data on intraoperative risk factors for long-term postoperative complications after Le Fort I osteotomy (LFO) are limited. The aim of this study was to describe prospectively the overall postoperative changes in maxillary nerve function after LFO, and to correlate these changes with a number of possible intraoperative risk factors.

PATIENTS AND METHODS

Twelve men and 13 women (mean +/- standard deviation: aged 25+/-10 years) participated in 4 sessions: 1 before LFO (baseline), and the rest at 3, 6, and 12 months after LFO. At each session, somatosensory sensitivity was assessed for the skin, oral mucosa, and teeth, using quantitative sensory tests at either 1 cutaneous point or on a 5 x 5 point matrix reproduced on the skin. In addition, all patients were asked to report their perceived differences in somatosensory sensitivity and their overall satisfaction with the LFO.

RESULTS

The thresholds of tactile stimuli on the gingiva and palate were increased 12 months after LFO (P< .001). Significant increases in 2-point discrimination detection thresholds (P< .01) and increased sensitivity to heat (P< .01) and cold (P< .001) in the infraorbital region were also recorded 12 months after LFO. Correspondingly, self-reported complaints of changed sensation under the eyes (P< .01), upper lip (P< .01), gingiva (P< .001), palate (P< .01), and teeth (P< .01) were reported during the entire postoperative period. Intraoperative risk factors were identified and correlated with postoperative changes in somatosensory sensitivity. Segmentation of the maxilla was associated with an increase in tactile thresholds at the palate and gingiva (P< .05), as were self-reported complaints involving the palate and gingiva (P< .001), whereas maxillary impaction was related to lower-tooth pulp pain thresholds when compared with maxillary lowering (P< .01). All patients expressed satisfaction with LFO, despite signs of somatosensory disturbances in up to 64% of patients.

CONCLUSION

Numerous changes in postoperative somatosensory function are to be expected after LFO. In most patients, these changes are minor, and some are dependent on intraoperative procedures. Nonetheless, all patients reported satisfaction with the surgical results, and would recommend the procedure to others.

Sensory action potentials of the maxillary nerve: a methodologic study with clinical implications

PURPOSE

Recently, recording of sensory nerve action potentials (SNAPs) of the inferior alveolar nerve (IAN) was described and is used as a diagnostic test of traumatic neuropathic trigeminal disorders. The technique is limited to IAN damage; therefore, we adapted the technique to the maxillary nerve, which is also frequently injured by either trauma or orthognathic surgery.

PATIENTS AND METHODS

Fourteen healthy volunteers participated in this methodologic study in which the infraorbital nerve (ION) was stimulated with 2 needle electrodes. The SNAPs were recorded from the maxillary nerve with a unipolar needle electrode close to the foramen rotundum.

RESULTS

The mean latency of the SNAPs was 0.73 ms (95% CI, 0.55 to 0.85 ms) with a 0.08+/-0.09 ms interside difference. The mean baseline to peak amplitude was 31.3+/-7.0 microV (95% CI, 24.2 to 38.3 microV) with a 6.5+/-32.4 microV interside difference. Repeated tests within a session test demonstrated no significant differences in the latency data (ANOVA: P= .225) or amplitude data (ANOVA: P= .44). Stimulus-response curves indicated that the SNAPs saturated at 5.1+/-4.4 mA stimulus intensity. In 1 subject, stimulation of the mental nerve elicited SNAPs (latency: 1.6 ms; amplitude 38 microV) in accordance with published values. A local anesthetic block of the ION was associated with a distinct decay of the SNAP in 1 subject.

CONCLUSION

We suggest that SNAPs of the maxillary nerve can be a valuable technique for a comprehensive examination of the trigeminal system.

Spatial and temporal assessment of orofacial somatosensory sensitivity: a methodological study

AIMS

To evaluate the sensitivity and reproducibility of a multimodal psychophysical technique for the assessment of both spatial and temporal changes in somatosensory function after an infraorbital nerve block.

METHODS

Sixteen healthy volunteers with a mean (+/- SD) age of 22.5 +/- 3.4 years participated in 2 identical experimental sessions separated by 2 weeks. The subjects rated the perceived intensity of standardized nonpainful tactile, painful pinprick, warm, and cold stimuli applied to 25 points in 5 x 5 matrices in the infraorbital region of each side. The reproducibility of single points was tested, and a mean difference of 1.4 +/- 0.5 was found. A 0-50-100 numerical rating scale (NRS) with 50 denoting "just barely painful" was used. A modified ice hockey mask with adjustable settings was developed as a template to allow stimulation of the same points in the 2 sessions. Assessment of somatosensory function was carried out before the injection (baseline) and after 30 and 60 minutes on both the anesthetized and contralateral (control) side. In addition, the applicability of the psychophysical techniques was tested in pilot experiments in 2 patients before maxillary osteotomy and 3 months afterward.

RESULTS

The overall analysis of mean NRS scores, number of points, and center-of-gravity coordinates for all stimulus modalities showed no significant main effects of session. Post-hoc tests for all stimulus modalities demonstrated significantly lower mean NRS scores and significantly more points (hyposensitivity) at 30 and 60 minutes postinjection compared to baseline values on the injection side (Tukey tests: P < .002). In the 2 maxillary osteotomy patients, the psychophysical techniques could successfully be applied, and bilateral hyposensitivity to all stimulus modalities was demonstrated at the 3-month follow-up.

CONCLUSION

The present findings indicate that the psychophysical method is sufficiently reproducible, with no major differences between sessions in healthy subjects. All stimulus modalities demonstrated adequate sensitivity. Furthermore, measurement of points in 5 x 5 matrices allowed a spatial description of somatosensory sensitivity. This method may be valuable for studies on changes in somatosensory sensitivity following trauma or orthognathic surgery on the maxilla.