Odontogenic Keratocyst With Moderate Epithelial Dysplasia: A Rare Entity

We present a rare case of odontogenic keratocyst (OKC) with moderate epithelial dysplasia in a 47-year-old male patient. He presented with a history of pain and swelling on the right side of his face for the past three months. The radiograph revealed multi-locular radiolucency involving the ramus, coronoid process, and condylar process of the right mandible. We have discussed the cytology, incisional biopsy, radiological investigations, surgical management, reconstruction, excisional biopsy report, and follow-up of this rare entity.

Patterns of Postoperative Trismus Following Mandibulectomy and Fibula Free Flap Reconstruction

The factors that contribute to postoperative trismus after mandibulectomy and fibula free flap reconstruction (FFFR) are undefined. We retrospectively assessed postoperative trismus (defined as a maximum interincisal opening ≤35 mm) in 106 patients undergoing mandibulectomy with FFFR, employing logistic regression to identify risk factors associated with this sequela. The surgical indication was primary ablation in 64%, salvage for recurrence in 24%, and osteonecrosis in 12%. Forty-five percent of patients had existing preoperative trismus, and 58% of patients received adjuvant radiation/chemoradiation following surgery. The overall rates of postoperative trismus were 76% in the early postoperative period (≤3 months after surgery) and 67% in the late postoperative period (>6 months after surgery). Late postoperative trismus occurred more frequently in patients with ramus-involving vs. ramus-preserving posterior mandibulotomies (82% vs. 46%, p = 0.004). A ramus-involving mandibulotomy was the only variable significantly associated with trismus >6 months postoperatively on multivariable logistic regression (OR, 7.94; 95% CI, 1.85−33.97; p = 0.005). This work demonstrates that trismus is common after mandibulectomy and FFFR, and suggests that posterior mandibulotomies that involve or remove the ramus may predispose to a higher risk of persistent postoperative trismus.

Morphological Investigation of Mandibular Lingula: A Literature Review

Purpose: The purpose of the study was to review the literature on the shape of the mandibular lingula. Methods: English articles published from 1970 to 2021 in databases (PubMed, Web of Science, and Embase) were selected. Articles meeting the search strategy were evaluated based on the eligibility criteria (participants aged 18 years and over). Dry mandibles and cone beam computed tomography (CBCT) images were used as research materials. The shapes of mandibular lingula were classified as triangular, truncated, nodular, and assimilated. Results: Based on the eligibility criteria, 10 articles (six with dry mandibles and four with CBCT images) were selected for full-text reading and detailed examination. In the dry mandible group, triangular, truncated, nodular, and assimilated lingula were observed on 446, 398, 232, and 69 sides, respectively. In the CBCT group, nodular, truncated, triangular, and assimilated lingula were observed on 892, 517, 267, and 88 sides, respectively. Therefore, the most common lingula types in the dry mandible and CBCT groups were different. The assimilated type was the least common in both groups. Conclusion: In the dry mandible group, the most common lingula type was triangular, followed by truncated, nodular, and assimilated types. In the CBCT group, the most common lingula type was nodular, followed by truncated, triangular, and assimilated types. There were no significant differences in lingula types between the left and right sides of the mandible.

Analysis of clinical characteristics and management of ectopic third molars in the mandibular jaw: a systematic review of clinical cases

OBJECTIVE

To perform a systematic review of the characteristics of ectopic mandibular third molar (EMTM) in terms of its clinical presentation, radiographic findings, associated lesions, management and post-operative complications.

MATERIALS AND METHODS

We searched the Pubmed, Medline, Embase and EBSCO databases for full-text, peer-reviewed journal publications from January 1965 to August 2020. Data extraction was done using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

RESULTS

Our search yielded 45 case reports involving 48 EMTM teeth. The mean age of the patients was 46.3 years with an age range of 22-80 years. Thirty-two cases were seen in women as compared to 13 cases in men. The majority of the cases (42) were unilateral, with only three bilateral cases. Among the 48 EMTM teeth, 21 were seen in the condylar region followed by 13 in the ramus, seven in the sigmoid notch, three in the angle and two each in the coronoid process and the lower border of the mandible. Twenty-five EMTM teeth had histopathologically confirmed dentigerous cysts, eight teeth had chronic infection/inflammation/granulation tissue, two had radicular cysts, two had infected cysts, two teeth had normal follicular spaces, and associated lesions were not mentioned for nine teeth. The most common symptoms were swelling (33 teeth) and pain (29 teeth), and six teeth were asymptomatic. Surgical removal through intraoral approach was carried out for 27 teeth, while an extra-oral approach was adopted in 15 teeth, a spontaneous regression of the pericoronal radiolucency was noticed in one tooth, four teeth were not treated and choice of treatment was not mentioned for one tooth. Mild transient paraesthesia was frequently observed; however, serious post-surgical complications were not reported.

CONCLUSIONS

The present review found that EMTM can present with complex clinicopathological characteristics, with a majority of the cases being asymptomatic in the beginning and turning out to be symptomatic with lesions at later stages, requiring surgical intervention.

Mandibular Ramus as a Strong Expressor of Sex Determinations: A Digital Radiographic Study

Background:

This study aimed to assess the effectiveness of mandibular ramus in gender identification in Haryana population.

Materials and Methods:

One hundred patients were assessed. Panoramic radiological examination was done. Following parameters were recorded: MAX. RM. WDTH (Maximum ramus breadth), MIN. RM. WDTH (Minimum ramus breadth), CND. HGT. RM (Condylar height), PRJ. HGT. RM (Projective height of the ramus), and CRND. HGT. RM (Coronoid height). All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software version 16.0.

Results:

There is significant difference found in males and females in maximum ramus width, minimum ramus width, condylar height, and coronoid height and between male and females in condylar height and coronoid height. Furthermore, there was statistical significant difference between male and females in coronoid height.

Conclusion:

Mandibular ramus can be used for gender assessment as a part of forensic investigation.

Mandibular Ramus Fractures: A Proposed Classification

Aims

The purpose of this article was to study and devise a classification of fracture patterns of the mandibular ramus to facilitate management.

Methods

Mandibular ramus fracture demographics in literature were reviewed along with evaluation of the patients diagnosed with mandibular ramus fractures who had reported to the emergency/outpatient clinic of our Institute in the last 5 years. Epidemiology of these ramus fractures was studied, and these ramus fractures were categorized into repetitive patterns on the basis of radiological observations in an effort to achieve a simplified classification.

Results

A total of 1372 trauma patients were diagnosed with mandibular fractures, of which an incidence of 2.4% was recorded for ramus fractures. These were predominantly in males and mainly due to road traffic accidents commonly in people driving two-wheeler vehicles (64%). Ramus fractures seldom occur in isolation. Five predictable fracture patterns were observed and accordingly classified as types I to V. Type I was the most common and type IV the least. Open reduction was done in 45.5% patients with non-compression plating systems. Satisfactory aesthetic and functional outcomes were achieved in all patients.

Conclusion

The mandibular ramus fractures although rare need to be well understood and demarcated. The classification highlights the importance of this mandibular buttress and focuses on the importance of its technically and anatomically more complicated fracture treatment. Future studies are needed to compare the modalities of management.

Systematic review of hormonal and genetic factors involved in the nonsyndromic disorders of the lower jaw

Mandibular disorders are among the most common birth defects in humans, yet the etiological factors are largely unknown. Most of the neonates affected by mandibular abnormalities have a sequence of secondary anomalies, including airway obstruction and feeding problems, that reduce the quality of life. In the event of lacking corrective surgeries, patients with mandibular congenital disorders suffer from additional lifelong problems such as sleep apnea and temporomandibular disorders, among others. The goal of this systematic review is to gather evidence on hormonal and genetic factors that are involved in signaling pathways and interactions that are potentially associated with the nonsyndromic mandibular disorders. We found that members of FGF and BMP pathways, including FGF8/10, FGFR2/3, BMP2/4/7, BMPR1A, ACVR1, and ACVR2A/B, have a prominent number of gene-gene interactions among all identified genes in this review. Gene ontology of the 154 genes showed that the functional gene sets are involved in all aspects of cellular processes and organogenesis. Some of the genes identified by the genome-wide association studies of common mandibular disorders are involved in skeletal formation and growth retardation based on animal models, suggesting a potential direct role as genetic risk factors in the common complex jaw disorders. Developmental Dynamics 248:162-172, 2019. © 2018 Wiley Periodicals, Inc.

Role of Orthopantamograph in Forensic Identification: A Retrospective Study Among Chennai Population

Context

Identification of unknown corpse can be established by their body features and belongings; when the features are distorted, it becomes a challenge for the forensic experts. Orthopantamograph (OPG) analysis is a simple, noninvasive, economic, and reliable method to sort for identification of the unidentified.

Aim and Objective

The aim of this study was to assess the efficacy of OPG in age and sex determination. The objective of our study was to evaluate various measurements on the mandibular ramus and to correlate them with the age and sex of an individual.

Settings and Design

A retrospective study was conducted using 150 OPGs that were taken in the Department of Oral Medicine and Radiology using Orthophos XG3 OPG machine. The mandibular ramus measurements were carried out using WebPlot Digitizer v 4.1. The measurement was statistically assessed.

Statistical Analysis Used

SPSS version 20 was used for discriminate analysis, correlation, and regression analysis.

Results

The male population showed higher values of ramus measurements compared to the female population. A regression equation was positively drawn to estimate the age of the unknown individual.

Conclusions

Coronoid height is the main predictive factor in age estimation of an individual irrespective of the gender whereas gonial angle is the extrapolative tool in gender prediction.

Caudal mandibular fracture repair using three-dimensional printing, presurgical plate contouring and a preformed template to aid anatomical fracture reduction

Case summary

Two cats were presented with mandibular fractures following head trauma. Following a CT scan, both were diagnosed with fractures of the ramus. The CT scans were used to print three-dimensional (3D) models of the mandibular fractures, which were used to pre-contour stainless steel mini-plates. These were fixed to the models and the screw positions used to produce a stainless steel template. The template was used as a pattern during surgery to drill holes in the ramus so that the pre-contoured mini-plates could be fixed in the exact same position as they had been on the 3D model. The fractures healed in both cats achieving normal jaw function and occlusion.

Relevance and novel information

Conventional techniques used to treat caudal mandibular fractures in cats, such as maxillomandibular fixation and bignathic encircling and retaining device (BEARD), are associated with significant patient morbidity and postoperative complications. Internal rigid fixation is difficult because of small bone size, requirement for considerable plate contouring and difficulty in achieving accurate anatomical reduction of caudal mandibular fractures. These are the first reported cases of mini-plate fixation of caudal mandibular fractures in cats using 3D models, pre-contouring of bone plates and the use of a template to facilitate accurate plate positioning, which may provide an alternative technique suitable for fixing caudal mandibular fractures in cats.

Assessment of the most reliable sites in mandibular bone for the best deoxyribonucleic acid yield for expeditive human identification in forensics

Background:

In recent years, the techniques used to identify human remains post accidents, trauma or in case of criminal investigation have been expanded, improved and rendered more complex by the emergence of technologies based on deoxyribonucleic acid (DNA) analysis. In the head and neck area, tooth has been proven to be the best quantitative source for DNA but in certain cases where the mandible specimen is edentulous or the tooth is extensively destroyed with caries, large dental restorations, mobile, or if they show any perimortem or postmortem fractures, sampling of such tooth specimen is usually avoided. In such situations, bone is considered the next best site for DNA analysis. Mandible being the largest, strongest and dense cortical bone is the most prominent facial bone that can be easily disarticulated. It can be analyzed for the best short tandem repeat (STR) segment qualitative amplification using polymerase chain reaction (PCR) technique for forensic analysis which can be used for gender and age determination.

Aim:

The aim of this study is to determine the best site for optimum quantitative and qualitative yield of DNA for amplification using specific and standard STR segment by conventional PCR technique.

Methodology:

Fifteen mandibular samples exposed to different environmental conditions were collected. Bone pieces of 1 cm × 1 cm were cut from each mandible from three sites, i.e., the ramus, angle and body, wherein the genomic DNA was isolated and was subjected to PCR using restricted number of 25 cycles.

Results:

The STR segment D3S1358 from clone RP11-438F9 used for the study showed very good amplification in restricted number of PCR cycles in the ramus region with number of repeats in every 15^th genomic region.

Conclusion:

This study highlights the use of mandibular bone for the expeditive human identification. As per the study, the ramus of the mandible gave high quantitative and qualitative yield of DNA with thick amplification band of the STR segment as compared to the body and angle of the mandible. Thus ramus of the mandible can be preferred over other sites for molecular forensic investigations.

Correlating the clinical assessment of impacted mandibular third molars with panoramic radiograph and intraoral periapical radiograph

Aims And Objectives:

This study was conducted to compare the clinical assessment of impacted third molars of mandible with panaromic radiograph (OPG) and intraoral periapical radiograph (IOPA) and to assess the efficacy of IOPA and. Moreover, we corroborated the OPG and IOPA findings of impacted mandiblar third molar root apex to inferior alveolar canal.

Materials and Methods:

A total of 200 patients with pericoronitis were examined who were indicated for surgical extraction, among which 50 patients were selected for the study. All the patients underwent a radiographic survey with a digital OPG and IOPA of impacted mandibular third molars, along with clinical survey for anatomic relationship, type of impaction, space available, position in relation to second molar, number of roots, root curvature, and proximity of nerve canal. The data was subjected to statistical analysis. The Statistical Package for Social Sciences version 4.0.1 software was used for analyzing the collected data.

Results:

The study revealed that IOPA was more accurate in determining a majority of the factors affecting the third molar surgery, including relationship of the external oblique ridge (IOPA vs OPG = 96%:90%), anteroposterior relation with ramus (IOPA vs OPG = 70%:66%), vertical depth of impaction (IOPA vs OPG = 72%:68%), number of roots (P = 0.013), morphology of roots (IOPA vs OPG = 96%:90%); however, OPG was found to be accurate in evaluating the type of impaction (IOPA vs OPG = 88%:94%), canal relation, along with root of impacted molar (IOPA vs OPG = 74%:86%).

Conclusion:

To conclude, although IOPA has a marginal angle over OPG in assessing various parameters, only the number of roots have a greater accuracy (P < 0.0013) in IOPA than with OPG. However, the OPG is the better choice to be considered when the patient is associated with trismus.

Indications and outcome of mandibular condylar and ramus surgeries

BACKGROUND

Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles.

PATIENTS AND METHODS

Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry) and function (occlusion, Jaw movements). Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations.

RESULTS

There were a total of 27 procedures done either on the condyle or ramus in 23 (100%) patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6%) patients, 14 (60.9%) patients had Ameloblastoma, 1 (4.3%) had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6%) patients, five procedures for ankylosis in 3 (13.0%) patients and four procedures were done for dislocation in 2 (8.6%) patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory.

CONCLUSION

Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.