Current indications of mandibular condyle plate osteosynthesis: two cases reports

Introduction: Certain benign or malignant pathologies may require a mandibulectomy with resection of the condyle. The gold standard for this type of reconstruction is the microanastomosed fibular free flap. An immediate reconstruction technique using an osteosynthesis plate with condyle can be proposed. The aim of this article is to evaluate the indications and describe the complications of osteosynthesis plates with condyle, through the presentation of two clinical cases. Observation: Two patients were treated by radical hemi-mandibulectomy, with cervical curage, placement of an osteosynthesis plate with condyle, and coverage with flap of pectoralis major. Then they received radiation therapy with or without chemotherapy. No cases of erosion of the glenoid fossa or tympanal bone were found. Comments: Condyle osteosynthesis plates are an interesting alternative when a fibular flap cannot be performed for local (arteriopathy), carcinologic (poor prognosis), or general and anesthesic reasons. A tissue preservation protocol, with conformation and coverage of the plate must be undertaken to limit the risk of complications (infections, exposure and fracture of the plate, temporal bone erosion, heterotopic bone formations). Conclusion: Condyle osteosynthesis plates restore aesthetic and function immediately, temporarily or even permanently. Clinical and radiological follow-up must be established following this type of reconstruction.

Management of jaw fractures in oral surgery in public and private practice: a retrospective study from 2006 to 2017

Introduction: To date, no epidemiological studies on jaw fracture have examined its characteristics according to hospital status (public vs private). The aim of this study was to examine their differences in terms of patient- and injury-related variables. Methods: A retrospective study was conducted using patients' medical records in 2 types of hospital located in the northern area of Brittany (France). All patients hospitalized for jaw fracture between 2006 and 2017 were eligible. Comparisons between centres according to age, gender, anatomic location of fracture, mechanism of injury, and length of stay were undertaken using χ2, Fisher exact test, t-test, and Cochrane-Armitage trend test. Results: A total of 142 patients were included: 45.1% in the public and 54.9% in the private hospitals. Of them, 84.5% were men and the mean age was 32.0. Main causes of fractures were assault (56.3%), fall (30.3%) and road traffic accident (10%). A small number of patients had polytrauma (4.2%). The mean duration of stay was less than 2 days. Compared to patients who were admitted in private hospital, those who were likely to be admitted in public hospital were those: who had a jaw fracture in context of road traffic accident (18.8% vs 2.6%), with polytrauma (9.4% vs 0.0%) and maxilla fracture (9.4% vs 1.3%), and who had a longer stay (2.2 vs 1.1 days). Conclusion: This study showed that differences observed in characteristics of jaw fractures between public and private hospitals may be due to recruitment process: more severely affected patients are likely to be admitted in the public hospital.

Surgical strategy for patients with late-diagnosed minor form of cleidocranial dysplasia: three cases

Introduction: Cleidocranial dysplasia is a genetic disease affecting bone growth. Observations: 3 patients, aged 12, 14, and 15 followed an orthodontic and surgical treatment to solve an eruption issue of the permanent teeth. Temporary teeth were extracted and impacted teeth were progressively exposed by multiple surgeries under local anesthesia. Anchorages were placed on the teeth and a traction started, on incisors and molars first, then on premolars, and finally on canines. The treatments lasted for 6 to 8 years. Comments: These patients presented minor form of cleidocranial dysplasia which only affected the teeth. The difficulty of these cases lied in the lateness of their diagnosis and treatment. Adaptations had to be made to simplify treatment plans (shortened dental arch, premolar extractions, etc.).

Low-grade myofibroblastic sarcoma: a case report of a child

Introduction: Myofibroblastic sarcomas are malignant tumors characterized by the increased proliferation of myofibroblasts; they are rare and have been recently discovered. Observation: A 14-year-old adolescent had a large lesion in the inside of her right mandible. The diagnosis, after a difficult histological analysis, was low-grade myofibrosarcoma. The patient was treated with non-interruptive hemimandibulectomy. Discussion: Low-grade myofibroblastic sarcoma is one of four types of myofibroblastic sarcomas recognized by the WHO in the 2001 classification. This classification allows us to determine a prognosis based on histological characteristics of the lesion. Conclusion: In all cases of low-grade myofibroblastic sarcoma, the preferred treatment is curative surgical resection; but still poses a problem in the prosthetic rehabilitation of oral lesion.

[Focus: Drug-related osteonecrosis of the jaw]

Antiresorptives and antiangiogenics are treatments that have proven effective in oncology and the treatment of osteoporosis and they are increasingly prescribed. The care of these patients requires collaboration between the prescriber and the oral health professional to establish an optimized treatment plan. Therapeutic education of the patient is essential for him to understand the issues of good oral health and the adverse effects that can be caused by these treatments. The management is essentially based on the individual benefit/risk balance resulting from the general, local and inherent of the molecule risk factors. Management of drug-related osteonecrosis of the jaw should be as early as possible.

Oral and vulvo-vaginal lichenoid reactions due to mitotane (Lysodren): A case report

BACKGROUND

The purpose of pharmacovigilance (drug safety) is collection, detection, assessment, monitoring, and prevention of adverse effects with pharmaceutical products. It is meant to identify, characterize, prevent, or minimize actual or potential risks relating to medicinal products. To prevent these adverse effects and improve our practice, health professionals have a duty to report side effects to assess this risk and evaluate the benefit/risk requirements. Mitotane (Lysodren) is used for treating adrenocortical carcinoma. Currently, no side effects concerning oral and genital mucosa have been reported.

CASE SUMMARY

This case report is about a 50 years old woman. Six months after the initiation on mitotane treatment, she developed erosive lesions located on the oral and vaginal mucosa. These drug reactions were diagnosed as erosive lichen planus by the biopsy. This lichenoid lesions were resistant to the usual treatments, mitotane being at the time not replaceable.

CONCLUSION

This case describes an unreported adverse effect of mitotane, it is - to our knowledge - the 1st description of erosive lichenoid drug reaction due to Mitotane.

Primary Burning Mouth Syndrome: A Questionnaire Study of Neuropathic and Psychological Components

BACKGROUND

The pathophysiology of primary burning mouth syndrome (BMS) is extensively debated but poorly understood.

OBJECTIVE

The aim of the study was to evaluate neuropathic and psychological components of BMS in patients with primary BMS.

METHODS

Subjects were recruited through a consultation dedicated to mouth diseases, during which a diagnosis of primary BMS was assessed. Patients answered the abbreviated Douleur Neuropathique 4 questionnaire (DN4i), the Hospital Anxiety and Depression Scale (HADS) and the questionnaire de la douleur de Saint-Antoine (QDSA), the French version of the McGill pain questionnaire.

RESULTS

Thirty-five patients with primary BMS were included in the study: 31 % of them had a DN4i score in favour of neuropathic pain and 34.3 % had a HADS overall score in favour of anxiety and depressive disorder.

CONCLUSION

Both physiological and psychological aspects of BMS need to be actively investigated by clinicians to successfully manage these patients. The physiological and psychological aspects are not mutually exclusive. The DN4i and the HADS are easy-to-use tools and could be used in an initial assessment of BMS patients.