A Giant Plunging Sublingual Dermoid Cyst Excised by Intraoral Approach

OBJECTIVE

Dermoid and epidermoid cysts are rare cysts of the head and neck region, which should be considered in differential diagnosis of sublingual mass, constituting 0.01 % of all oral cavity cysts. There are suspected theories regarding the basis of the pathology.

CASE REPORT

30-year-old male referred to our clinic with a chief complaint of sublingual mass which had been present for many years but the lesion enlarged over the past 3 years. MRI examination revealed a giant cystic mass which was 3.6 × 3.9 mm in diameter and medially located at sublingual region.

TREATMENT AND PROGNOSIS

Intraoral approach was preferred for surgery and no recurrence or complaints were detected during follow-up period.

CONCLUSION

When a cystic mass is detected on the floor of oral cavity, we must consider dermoid cysts for differential diagnosis. Surgery is the only treatment. If possible, intraoral approach should be preferred because of its perfect cosmetic results.

Use of an occlusal splint and intraoperative imaging with an intraoral approach in the management of mandibular subcondylar fractures

INTRODUCTION

To evaluate the feasibility of safely managing subcondylar fractures using an original surgical procedure combining an intraoral approach, the use of a custom-made occlusal overlay splint, and intraoperative imaging.

MATERIALS AND METHODS

Condylar fragment was freed from surrounding soft tissues, was laterally exposed to the ramus, and a miniplate was fixed in place for osteosynthesis. An overlay splint maintaining the dental occlusion was used to facilitate reduction and stabilization during fixation. Intraoperative monitoring by cone-beam computed tomography (CBCT) was performed before completing the fixation.

RESULTS

Between November 2018 and June 2019, 10 patients were treated using this procedure. The median length of the proximal condylar fragment was 29 mm (range 24-39 min). Five patients had an associated mandibular fracture. The median duration of the condylar fracture surgery was 54.5 min (range 38-79 min). All patients had satisfactory reduction and osteosynthesis with no complications.

CONCLUSION

It is feasible to safely manage subcondylar fractures with this surgical procedure that could facilitate open reduction using intraoral approaches. Occlusal splints maintain downward pressure on the rami bilaterally and symmetrically, helping to anatomically reposition condylar process fractures. Intraoperative imaging is used to monitor this step.

Our Experience with Intraoral Submandibular Gland Excision

The aim of this paper is to present our experience with intraoral approach for submandibular gland excision in terms of effectiveness and safety in patients with chronic sialadenitis. This is a prospective study carried out from November, 2016 to April, 2018 analyzing 13 patients of chronic sialadenitis. The indication of intraoral approach was either failed attempt to remove the stone endoscopically, chronic sialadenitis or benign tumor. The surgical triangle was used as the landmark for hilar area and gland was dissected close to the capsule and removed via intraoral incision and preserving the sublingual gland. We were successfully able to remove the submandibular gland via intraoral approach in 10 cases. Two patients had to undergo transcervical gland excision and one patient refused for transcervical approach. Intraoral excision of submandibular gland is a safe and viable approach to be utilized in carefully selected patients. The major advantages being avoidance of transcervical scar and of injury to marginal mandibular branch of facial nerve.

Intraoral versus transcervical approaches in mandibular reconstruction with free flaps: A retrospective study

This study aims to investigate the clinical and functional differences between intraoral and transcervical approaches for segmental mandible resection and reconstruction with free flaps. Patients diagnosed as benign and low-grade mandibular malignant tumors without neck dissections were retrospectively reviewed and divided into intraoral and transcervical groups. Patients of intraoral group underwent intraoral mandibulectomy and vascular anastomosis was performed through a 2-cm submandibular incision, while traditional submandibular approach was used in transcervical group. Clinical characteristics of two groups were assessed including body mass index (BMI), defect types and number of fibular segments, as well as perioperative variables such as operation time, blood loss, drainage volume. The score of appearance, swallowing and speech using the University of Washington Quality of Life Questionnaire (UW-QOL) was recorded and analyzed 6-month postoperatively. A total of 14 patients in intraoral group and 21 patients in transcervical group was collected, respectively. In intraoral group, intraoperative blood loss and postoperative drainage volume were significantly reduced in comparison with transcervical group (p = 0.0146, p = 0.0017; respectively). The score of appearance was 87.50 ± 12.97 in intraoral group, which was significantly higher than 64.29 ± 12.68 in transcervical group (p < 0.0001). Similar results were found in patients of subtype Class II mandibular defect between two groups. However, patients of intraoral group had a significant increase in operative time and a comparable amount of intraoperative blood loss (p = 0.0472, p = 0.1434; respectively). Within the limitations of the study it seems that an intraoral approach combined with a 2-cm submandibular incision should be preferred over a transcervical approach for segmental mandibulectomy and free flap reconstruction whenever appropriate.

Management of Infraorbital Rim Fracture Through Intraoral Approach

Purpose

The aim of our study was to evaluate the feasibility of an intraoral approach in the management of infraorbital rim fracture.

Patients and Methods

A total of 12 patients of which four were female and five were male with isolated unilateral zygomaticomaxillary complex (ZMC) fractures, essentially involving the infraorbital foramen (right or left), were included in this study. Indications for surgical intervention were cosmetic deformity, disturbance of vision, persistent paresthesia, or impaired mandibular movement. All the patients were subjected to thorough preoperative evaluation. A three-point fixation was performed in all the patients. Various parameters such as time required for exposure and the amount of accessibility were assessed intraoperatively, while the stability of the fixation and paresthesia pertaining to the distribution of the infraorbital nerve were assessed postoperatively.

Results

A total of 12 patients with a mean age of 35.75 ± 12.7 years were included in the study. The mean time recorded for exposure and fixation was 21.33 ± 2.8 min. The accessibility was rated as "excellent" in 92% (11 patients) of the operated cases and rated "satisfactory" in 8% (1 patient) of the operated cases. The fixation was found to be stable in 100% of the cases. By the end of 8 months, normal mechanoreceptor response was elicited in 42% (five patients) of the cases and normal nocireceptor response was elicited in 92% (11 patients) of the cases.

Conclusion

The intraoral approach for fixation of the infraorbital rim is versatile and can be mastered even by novice surgeons. The virtual lack of complications and short learning curve make this approach an invincible modus operandi in a surgeon's repertoire.

Transbuccal Approach in Management of Mandible Angle Fracture

With expanding dimensions and an eminent member of trauma team many Ear Nose Throat specialists are exposed to Oro-maxillofacial trauma. Mandibular angle is a difficult region to operate owing to its unique anatomy. Anglefractures form around 30-40% of the mandibular fracture. Open reduction and internal plating is the management of choice in most angle fractures and various approaches have been described in literature. We conducted a study of trans-buccal approach for management of mandibular angle fractures. It was a non-randomised observational study. 57 patients of mandible angle fractures were included in the study. The ORIF was done in these pts under general anaesthesia after careful surgical planning using trans-buccal approach. This approach included an intraoral exposure with stab incision for the trans-buccal passage of drill and screw diver. Out of 57 cases in our study 33 were males and 24 were females. 23/57 patients were in age group 25-35 years whereas 19/57 patients were in age group 15-25 years All 57 patients had good fracture healing. Occlusion dysfunction was seen in only 1 case. Infection was seen 3 cases while intraoral exposure of plates occurred in 2 cases. Average mouth opening was 43.3 mm at 6 weeks with progressive improvement on follow up. Extraoral scar healed well with very good cosmesis in all cases. We strongly suggest the use of transbuccal approach for ORIF in mandibular angle fractures owing to the ease of procedure, comfort of surgeon and less complication rate.

Buccal Fat Reduction: Indications, Surgical Techniques, Complications

In this article, we present the anatomy, diagnosis, surgical technique, and postoperative care of the buccal fat pad removal. Anatomy knowledge and careful surgical technique are the primary considerations for a successful procedure with a low incidence of complications. The technique's main characteristics are the intraoral approach using blunt dissection and suction-assisted buccal fat pad extraction.

Modified trident technique for surgical approach to facial lipoma

INTRODUCTION

Lipomas are the most common tumors of mesenchymal origin throughout the body. Although they have low incidence in the oral cavity, they surgical approach can be challenging.

CASE REPORT

10-year-old male with a giant lipoma in the buccal and masticator space, an intraoral surgical approach was chosen using by modifying trident technique of Ramírez-Oropeza.

DISCUSSION

The main advantages and limitations of this intraoral approach are examined.

CONCLUSIONS

An intraoral approach was selected because of less possibility of injuring the facial nerve, better esthetic results and less invasive, obtaining excellent results.

A true branchial fistula in the context of branchiootic syndrome: challenges of diagnosis and management

BACKGROUND

The presence of a branchial fistula with communication both internally and externally: a 'true' branchial fistula is rare, and may arise in the context of autosomal dominant conditions such as branchiootic syndrome and branchiootorenal syndrome.

STUDY

We discuss the case of a true branchial fistula, which recurred after initial surgical excision, in a patient with branchiootic syndrome. The residual tract was dissected in a second operation through stepladder neck incisions and removed in toto via an intraoral approach. No renal abnormalities were detected on investigation with ultrasound.

DISCUSSION

Incomplete excision of a branchial sinus is likely to cause recurrence however intraoperative visualisation of the tract can can sometimes prove challenging. An combined intraoral and external approach aids delineation and tract definition when there is a true branchial fistula and can therefore facilitate a complete excision. Suspicion of an hereditary aetiology should be raised in patients with bilateral or preauricular features, or a positive family history, which may then prompt additional renal and genetic investigation.

Anatomical study to determine a new approach to treat benign masses located in the anterior condyle region: a case report

A 22-year-old male patient presented to the clinic with severe pain in the preauricular area with an inability to completely occlude the jaw. Facial computed tomography and magnetic resonance imaging revealed a well-defined lesion that was tentatively diagnosed as a benign tumor or cystic mass. Surgical approach of a lesion in the condyle is delicate and problematic as many vulnerable anatomical structures are present. There are several methods for surgery in this area. Typically, an extraoral approach is dangerous because of potential injuries to nerves and arteries. The intraoral approach also presents difficulties due to the lack of visibility and accessibility. On occasion, coronoidectomy may be performed. The goal here was to determine an easier and safer new surgical approach to the condyle. We reached the anterior part of the pterygoid plate in the same method as in Le Fort I surgery. From this point, through the external pterygoid muscle, approaching the anterior aspect of the condyle is relatively easy and safe, with minimal damage to the surrounding tissues. Pus was drained at the site, and the lesion was diagnosed as an abscess. Pain and inability to close the mouth resolved without recurrence.