Histopathological Interpretation of TMJ Osteophyte: Report and Review

Introduction

Osteophytes are osseocartilaginous structures which are commonly found in common degenerative joint diseases. It can be free or attached to nature. There is a paucity of information in the literature regarding the histopathological interpretation of osteophytes in Temporomandibular Joint (TMJ).

Purpose

To report the incidental finding of osteophytes in cases of chronic protracted TMJ dislocation.

Material and Method

To present case of an elderly 72-year-old female and a 35-year-old male with chronic protracted TMJ dislocation who were treated surgically for their condition with an incidental finding of an osteophyte in TMJ intraoperatively.

Result

The histopathological examination revealed fibrocartilaginous core tissue surrounded by bone formation due to dystrophic calcification.

Conclusion

The microscopic examination is mandatory in order to study and understand the pathophysiology of an osteophyte. This study presents rare histopathological evidence of an osteophyte. It reflects the process of its formation and the possibilities of fate of an osteophyte in TMJ.

An in vivo study to assess and compare the angular, linear, and depth deviation as well as the difference in bone density of implants placed using computer-aided design/computer-aided manufacturing fabricated three-dimensional guides versus the implants placed using bone pen kit in maxillary and mandibular ridges

Aim

The aim is to assess and compare angular, linear, and depth deviation and difference in bone density of dental implants placed using computer aided design/computer aided manufacturing (CAD/CAM) fabricated surgical guides versus implants placed using Bone Pen Kit. Till now, no original research exists in the search engines such as Pubmed, Google Scholar, Science Direct, and Research Gate on this kit.

Settings and Design

In vivo- Randomised control trial.

Materials and Methods

Twenty clinical cases were selected and split into two distinct groups. Group 1 involved the placement of 10 implants using CAD/CAM fabricated three dimensional guides and Group 2 involved the placement of 10 implants using Bone Pen Kit. Four deviation parameters were evaluated, which included: (a) Angular deviation, (b) Linear deviation at implant platform, (c) Linear deviation at implant apex, and (d) Depth deviation and difference in bone density before and after implant placement was also evaluated.

Statistical Analysis Used

SPSS software version 23 was utilized for the analysis of the data. The comparison was made using the Whitney test, and Wilcoxon signed rank test.

Results

When comparing angular deviation, the results indicated a statistically significant difference with a P < 0.05. The values observed for angular and linear deviation in Group 2 were significantly greater than those in Group 1. No statistically significant difference in depth and linear deviation was found at the implant platform among the two groups. Bone density before and after implant placement was significantly higher in Group 1.

Conclusions

(1) Angular and linear deviation at the apex in Group 2 exhibited higher values in comparison to Group 1, (2) No difference in depth and linear deviation at the implant platform was found among the two groups, and (3) There was no difference in change in bone density among two groups.

Marginal Bone Level Measurements of Unsplinted Implants Used for Mandibular Overdentures: A Six-Month Randomized Prospective Clinical Study Comparing Early and Delayed Loading Protocols

Background and purpose Implant-supported mandibular overdentures are a good alternative for patients having poor retention of mandibular conventional dentures. The aim of this prospective study was to evaluate and compare the results between early loading and delayed loading of mandibular overdentures on two unsplinted implants. Materials and methods  A total of 14 completely edentulous male patients in the age group of 50-60 years were selected for the study. Two 3.5×13 mm implants were placed in the mandibular interforaminal region. The patients were divided into two groups: (i) the test group in which the overdenture was connected after one week of surgery, and (ii) the control group, in which the overdenture was connected three months after surgery. Marginal bone levels were evaluated at baseline (during loading), three months, and six months post loading. Unpaired 't' test was used for the comparison of intergroup measurements.  Results No implants were lost. Marginal bone resorptions showed no statistically significant differences between the two groups over six months period after loading. Conclusion The results of this prospective clinical study suggested that there was no significant difference in the clinical and radiographic state of patients treated with implant-supported mandibular overdentures loaded either one week or three months after implant surgery.

A Clinical Re-Evaluation of an Unexplored Technique for Post Gap Arthroplasty Retrognathic Mandible

Aims

The current manuscript explores the viability of reverse sagittal split osteotomy technique for correction of ankylotic cases with post gap arthroplasty mandibular retrognathia to achieve socially acceptable esthetic results.

Method

Reverse sagittal split osteotomy which was introduced by Collins et al in 1983 was performed with certain modifications on two cases to correct mandibular hypoplasia in post gap arthroplasty cases. The paper also highlights intraoral as well as extraoral approach for performing the osteotomy along with better management of bad split under direct vision.

Result

It was observed that the reverse sagittal split technique for advancement of mandible in cases of tmj ankylosis-induced dentofacial deformity provided better proximal control, reduced chances of bad split, greater range of advancement (11-14 mm) with esthetically acceptable results. The osteotomy cuts on lateral surface of mandible make the procedure effectively easier and quicker with better control over proximal segment and management under direct vision.

Conclusion

When Distraction Osteogenesis and conventional orthognathic is not a choice in management of dentofacial deformity of post-release ankylosis cases due to the poor proximal control and concern over bad split, reverse sagittal split can be an appropriate choice to manage these deformities without any donor site morbidity.

A Rare Lesion at Rare Location: A Surgeon's Enigma

Leiomyosarcoma of palate is a rare malignant spindle cell tumour in oral cavity. It is often misdiagnosed with other benign lesions like nodular fasciitis, clinical and histological similarity of rapid growth, rich cellularity, as the pathogenesis is unknown, which can make diagnosis and management challenging. The non-specific clinical, radiologic and pathological presentation of spindle cell tumours causes diagnostic difficulty due to similarities to granulation tissue, benign or malignant lesions in histologic and imaging features. Nevertheless, differentiation is important because the prognosis and treatment varies according to the type of tumor. NF is frequently evaluated by biopsy and also immunohistochemistry (IHC) which is very essential in cases of non-regressing lesions after biopsy. The present case report highlights the clinical and histopathologic challenges in a rare case of nodular fasciitis in the palate which initially diagnosed as granulation tissue and later confirmed as Grade l leiomyosarcoma on IHC.

Comparison Between Conventional Titanium Miniplates and Indigenous Detachable Custom made 3D Titanium Plates (VAS 3D Bone Plate) for Fixation of Mandibular Fracture in Mental Foramen Region: A Randomized Clinical Trial and Finite Element Analysis

Purpose

To overcome limitation of 3D plate for fracture fixation in mental foramen region, by designing an indigenous custom made detachable 3D titanium plate (VAS 3D bone plate) and comparing it with two miniplate fixations for fractures of aforementioned region.

Methodology

Finite element analysis (FEA) of VAS plate and randomised clinical trial was performed and compared with miniplates. Twenty fractures in 19 patients with fracture in mental foramen region were divided randomly into two groups (Group I-fixation by miniplates and Group II with VAS plate) and evaluated for ease of fixation, neurosensory deficit, bite forces, occlusion and adequacy of fracture fixation.

Results

FEA of VAS plate revealed better performance for stress distribution, deformation and rigidity. A total of 20 mental foramen region fractures in 19 patients (18 male and 1 female) were treated. Group II had better results for bite forces and lingual control. Except for two patients with screw exposure in Group II and transient neurosensory deficit (resolved by 6 months), no other complications were observed. Ease of fixation was significantly better in miniplate group.

Conclusion

VAS plate was successful in providing satisfactory fixation and was observed to be better in terms of lingual control and masticatory efficiency.

A Three-dimensional Finite Element Analysis of Effect of Abutment Materials on Stress Distribution around Peri-Implant Bone in Immediate and Delayed Loading Conditions

Introduction: Osseointegration is important for successful dental implant treatments. Abutment materials affect the load transfer to the implant and surrounding bone thus determining the long term implant survival. Aim: Stress analysis around peri-implant hard tissue with different abutment materials and their comparative evaluation in immediate and delayed loading conditions using finite element analysis. Material and Methods: An in-vitro experimental study was carried out on a root form titanium grade IV Implant, assembled with an abutment Ø4.0-0.5GH and this test model was Threedimensional (3D) scanned, reconstructed on Computer-aided design software CREO. Six abutment groups: Group 1- Zirconia with DL (Delayed Loading), Group 2- Polyether Ether Ketone (PEEK) with DL, Group 3- Titanium grade Extra Low Interstitial (ELI) with DL, Group 4- Zirconia with IL (Immediate Loading), Group 5- PEEK with IL, Group 6- Titanium Grade ELI with IL, were loaded from vertical, horizontal and oblique direction. Von Mises and principal stress analysis was done on the implant and the peri-implant bone using the finite element method and the statistical analysis was done. Results: For delayed loading group, highest stresses were generated in group 1 (462.88 MPa), followed by group 3 (413.72 MPa) and least in group 2 (319.38 MPa). For immediate loading, highest to lowest stresses were in group 4 (694.32 MPa), Group 6 (620.58 MPa) and group 5 (479.07 MPa). The principal stress analysis showed significant difference between all groups in cancellous bone and cortical bone except between titanium and customised zirconia abutment in cortical bone in delayed loading (p=0.0846) and in immediate loading (p=0.1125). Conclusion: Change in abutment materials significantly affects the stress generated in and around the implant thus more studies must be carried out to reach a consensus on the most optimal material encouraging least dissipation in peri-implant hard tissues.

Evaluation of stability and esthetic outcome following rigid fixation of a new sagittal genioplasty technique - A clinical study

Background

Routine and popular conventional genioplasty procedure is often curvilinear, requires lower border extension below, and behind the mental foramen, which after advancement has a tendency to produce step deformity, butt contact, hence nonunion, instability, and increased relapse tendencies. The present technique is aimed to study the new sagittal genioplasty technique and its efficacy to overcome the above-mentioned drawbacks of conventional genioplasty. This technique also aids in correcting mild-to-moderate breathing irregularities.

Materials and Methods

A total of 10 patients included in this study. The comparative analysis of the displacement of the chin in vertical and horizontal directions following surgery was evaluated by measuring the difference between preoperative, immediate postoperative, 3 and 6 months postoperative on lateral cephalometric radiographs.

Results

The study of new sagittal chin advancement results showed an advantage over conventional technique in terms of esthetics outcome (no jowl), easy to perform without damaging the mental nerve, superior healing with less relapse, and better surface area contact.

Conclusion

In this study, the new technique of sagittal genioplasty overcomes the disadvantages of conventional genioplasty. However, this technique is best suited for patients who require straight or moderately vertical augmentation advancement genioplasty and is not suitable for asymmetry corrections, i.e., centering genioplasty and double sliding genioplasty.

Analysis between Retromandibular and Periangular Transmasseteric Approach for Fixation of Condylar Fracture - A Prospective Study

Introduction:

Condylar fractures make up for an average of 17.5%–52% of all mandibular fractures. The aim of the present study was to compare the ease, success, and complications between retromandibular and periangular transmasseteric approaches when used for open reduction and internal fixation of condylar fractures.

Materials and Methods:

A total 20 cases with condylar fracture, ten each for retromandibular and periangular transmasseteric approach, were included in the study. Patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Postoperative occlusion, maximum mouth opening, range of movement, facial nerve function, visibility, convenience of plating, and time taken for exposure, fixation, and closure were recorded. Incidence of complications such as wound dehiscence, wound infection, hematoma, sialocele formation, Frey's syndrome, and hypertrophic scars were also evaluated.

Results:

The mean exposure time in the retromandibular approach was 10 min 31 s and 9 min 17 s in the periangular transmasseteric approach. The incidence of facial nerve injury was 2 of 10 patients in the retromandibular group and 3 of 10 patients in the periangular transmasseteric group, all of which resolved within 6 months. The incidence of sialocoele was 2 of 10 in the retromandibular group. The time taken for exposure of the fracture site was statistically significant between the two approaches (P = 0.048) with longer time required for retromandibular approach.

Discussion:

It can be summarized that both the approaches are comparable and well suited for surgical management of condylar fractures. It was observed that in displaced condylar neck fractures, greater difficulty was experienced in the periangular transmasseteric approach than the retromandibular approach.

Coronoid process and residual ankylotic mass as an autograft in the management of ankylosis of the temporomandibular joint in young adolescent patients: a retrospective clinical investigation

The aim of this non-randomised investigation was to assess the feasibility of using autogenous grafts (such as coronoid process and the resected ankylotic mass) in reconstruction of the condyle after gap arthroplasty for ankylosis of the temporomandibular joint (TMJ). Sixteen patients (23 joints) operated on between 2007 and 2009 were studied and postoperative measurements of maximum interincisal opening, bite force, range of movement, and infection were recorded. After a mean (SD) follow up of 55 (2.25) months mouth opening improved from 3 (3.84) mm to 33 (1.66) mm in patients treated with coronoid graft, while in patients treated with an ankylotic mass after a mean (SD) follow up of 58 (1.58) months it increased from 4 (2.64) mm to 26 (8.04) mm. Bite force six months postoperatively ranged from 18.25kg/cm(2) - 27.5kg/cm(2) after reconstruction with the coronoid process and 18.5kg/cm(2) - 23.25kg/cm(2) after reconstruction with the ankylotic mass. One patient developed reankylosis postoperatively and another developed infection, in both of which the ankylotic mass had been used. Both were managed successfully. Both the ankylotic mass and the coronoid process gave satisfactory results and seem to be options for reconstruction. However, the coronoid process graft was better than residual ankylotic mass in terms of masticatory efficiency, bite force, and range of movement.

Ultrasonography for the volumetric analysis of the buccal fat pad as an interposition material for the management of ankylosis of the temporomandibular joint in adolescent patients

The aim of this study was to analyse preoperatively with ultrasound the minimum volume of buccal fat that would be required for interposition of a pad after gap arthroplasty, and to emphasise the value of such a pad in the management of ankylosis of the temporomandibular joint (TMJ) during a short term follow up. Nineteen patients with ankylosis of the TMJ (22 joints) were selected, whose mean (SD) mouth opening was 4.9 (3.7) mm. In 10 joints in which the mean (SD) volume of the buccal fat pad was 0.7 (0.2) ml, the harvested buccal fat was inadequate for interposition, so they were treated with other materials. The remaining 12 joints had a mean (SD) volume of 1.1 (0.3) ml, which gave enough fat for interposition after gap arthroplasty. Investigation with ultrasound at 15 days and 6 months postoperatively showed that the fat pad was viable and the volume had shrunk by 28%. The 6-month postoperative computed tomographic (CT) scan showed little or no heterotopic calcification. We conclude that a buccal fat pad with a preoperative mean (SD) volume of 1.1 (0.3) ml is easy to harvest as interposition material. At a mean follow up of the 12 joints after 31 (range 24-36) months there was progressive improvement in mouth opening with a mean (SD) of 32.5 (5.0) mm, which established that a pedicled buccal fat pad is a stable, efficient, viable soft tissue barrier in the management of ankylosis of the TMJ.

Non-traumatic Occulomotor Nerve Palsy: A Rare Case Report and Discussion on Etiopathogenesis

The ghost of the past has emerged as the horror of today. The fear of weakness/loss of eyesight following extraction is a common thinking amongst the orthodox people of Indian subcontinent. Occulomotor nerve paralysis following dental extraction is a rare complication. Although these ophthalmic complications in routine practice are rare, some time they do occur and pose difficulty to explain. Occulomotor nerve palsy is amongst the rare reported cases of ocular complication. Here we report a case of spontaneous recovery of occulomotor nerve palsy in an elderly diabetic patient and brief discussion on its etiopathogenesis.

Adolescent Mandibular Central Odontoameloblastoma: A Rare Case Report

Odontoameloblastoma is a rare odontogenic tumour, characterised by simultaneous occurrence of an ameloblastoma and a compound or complex odontoma in the same tumoral mass. The tumour is seen in first three decades and affects mandible or maxilla equally, commonly found posterior to the canines. The management is similar to unicystic ameloblastoma and odontoma excision. A long term follow up is a must to observe the recurrence. Here we present a rare case of odontoameloblastoma in a 17 year old male, presenting as an asymptomatic anterior mandibular swelling with chief complaint of missing lower front teeth.

Some modifications of the Furlow palatoplasty in wide clefts--a preliminary report

OBJECTIVES

Authors encounter a large percentage of wide cleft palates while operating in a Third World situation. They define the terms wide clefts and unrepairable clefts in terms of measurement. They describe their technique, which they developed to deal with wide clefts. They describe some previously unreported modifications. They also report the velar lengthening obtained.

METHODS

A total of 77 cases of primary cleft palate repaired with this technique by a single author, during the period May 2006 to February 2009, were selected for the study. These were divided into two groups on the basis of measurements. Group B consisted of all clefts deemed wide or unrepairable. Group A consisted of all other cleft palates. Difference in fistula rate was studied. Velar lengthening was measured in all patients.

OBSERVATIONS

Two fistulae occurred in Group B. The overall fistula rate for the series was 2.6%. The series consisted of 44% wide clefts, which included one case of unrepairable cleft. Lengthening in the velum ranged from 20% to 155%. Statistically significant correlations were found between narrow clefts and age group 0 to 1 year (p = .0094) and Veau Group 4 with wide clefts (p = .0194).

CONCLUSIONS

The Furlow technique as originally described has shortcomings. The authors describe their technique of incorporating the Furlow repair, which enables them to use it as a primary palatoplasty, in a scenario consisting of a large percentage of wide clefts in an older age group, thereby minimizing the fistula rate while increasing palatal length.

Eagle's Syndrome- A case report

Eagle’s syndrome represents a group of symptoms that includes recurrent throat pain, globus hystericus, dysphagia, reffered otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of stylohyoid or stylomandibular ligament. We present a case of 21 yrs old female having chief complaint of bilateral preauricular tenderness since one year. Her clinical signs resembled the presentation of Eagle’s Syndrome, which were radiologically confirmed by Orthopantomogram and Computed Tomography. Patient underwent surgical excision of caudal part of the elongated styloid process (styloidectomy). Postoperatively 10 months later, the patient had significant reduction of pain.  DOI: http://dx.doi.org/10.3126/ijls.v8i3.10228 International Journal of Life Sciences Vol.8(3): 2014: 1-4

Postextraction bleeding following a fever: a case report

Postoperative hemorrhage is one of the few serious complications that can occur as a result of dental procedures. We report a case of an elderly patient with postextraction bleeding caused by dengue hemorrhagic fever (DHF). Although a major sequel of DHF is bleeding secondary to thrombocytopenia, prolonged hemorrhage as a result of extraction of tooth has not been reported. In the current scenario of emerging and reemerging infections worldwide, dengue is gaining global prominence. This case documents the course and progression of this disease from a dental perspective and highlights the as yet unreported capacity of causing oral complications after dental treatment.

Comparative analysis of osteosynthesis of mandibular anterior fractures following open reduction using 'stainless steel lag screws and mini plates'

INTRODUCTION

The purpose of this study was to compare the outcome of open treatment of mandibular fracture (symphysis or parasymphysis) using lag screw or mini plate clinically as well as radiologically in young (age range 12-45 years) and healthy individuals of poor socioeconomic status.

METHOD

This prospective study was conducted on 30 patients diagnosed as cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups--Group A: Two 2.5 mm stainless steel lag screws were placed in 15 patients. Group B: Two 2.5 mm stainless steel mini plates were placed in 15 patients for the fixation of fractures. Subsequent follow up was done on 2nd, 4th, 6th and 8th week postoperatively. During every follow up patient was assessed clinically for infection, malocclusion, loosening of plate/screw, sensory disturbance, plate fracture, malunion/non-union, devitalisation of associated dentoalveolar segment and masticatory efficiency. Radiographs were taken if necessary and patients were further assessed for any complaint. Pain was objectively measured using a visual analogue scale, bite force was measured using a bite force transducer at biweekly interval. The data collected was subjected to unpaired t test and paired t test for statistical analysis.

RESULTS

During follow up period a significant improvement in bite force was present in both the groups, with more improvement seen in the lag screw group (p < 0.01). There was a significant pain reduction present in the lag screw group (p < 0.01) and also masticatory efficiency showed a steadier improvement in lag screw group while mini plate group patients showed a tendency to masticate only food items of medium hard consistency.

CONCLUSION

The sample size is small to conclude lag screws are better than mini plates but the result of our study provides a basis for further studies done to conclude that the application of LAG SCREW is an effective, inexpensive, quick treatment modality to accelerate healing of fresh, displaced mandibular anterior fracture.

The post-auricular approach for gap arthroplasty - a clinical investigation

Objective of this prospective study was to evaluate and compare posterior auricular approach for surgery of temporomandibular joint ankylosis with preauricular approach. These evaluations were done on the basis of certain parameters like incidences of facial nerve injury, time taken to expose ankylotic mass, haemorrhage and quality of exposure of joint and surrounding structures. This study was conducted among 15 patients of temporomandibular joint ankylosis. A total number of 30 joints were operated. These joints were divided in two groups i.e. Group A - preauricular group, Group B - postauricular group. Fifteen joints were operated in each group. Age of patients was in range of 4-65 years. All the patients were operated under general anesthesia. Preoperative, intraoperative and postoperative evaluations were done according to parameters. Patients were recalled up to 3 months for observations. Results have shown that in postauricular group incidences of facial nerve injury was significantly less, more time was taken to expose the ankylotic mass, incidences of haemorrhage was more and exposure of structures anterior to joint was difficult. Whereas preauricular approach is less time consuming, incidence of facial nerve damage is higher, exposure of structures anterior to joint is good and intraoperative incidences of haemorrhage is less.

Wooden foreign body embedded in the zygomatic region for 2 years

We report a case of retained wooden foreign body in the zygomatic region which posed a considerable diagnostic difficulty and was the source of persistent draining sinus and other distressing symptoms. The patient was not aware of the foreign body in the maxillofacial region. In such cases a thorough history of the patient is of utmost importance. The case has been described to highlight the problems associated in managing unlikely foreign bodies at unusual facial sites when there is a possibility that radiolucent material is embedded in the wound.

Dental management in autosomal recessive (intermediate) osteopetrosis: a case report

Osteopetrosis (Albers-Schonberg disease) is the name given to a group of diseases that affect the growth and remodeling of bones. It is characterized by overgrowth and sclerosis of bone, resulting in thickening and narrowing of the marrow cavities throughout the skeleton. The exact cause is unknown, although failure of bone resorption related to defective osteoclasts is considered to be the basis of the problem. These patients present a significant challenge to the dentist for management of jaw and dental problems, as the disease process demands special strategies which are often at variance with conventional dentistry. The purpose of this paper was to report the management and follow-up of a child with intermediate autosomal recessive osteopetrosis who primarily complained of dental problems.

Unusual causes of trismus: a report of two cases

Chronic inability to achieve normal mouth opening can be a symptom of several diseases. Mostly the causes of inability to open mouth are articular and sometimes the cause may be extra-articular. In the two cases which are being reported in this article the causes of limited mouth opening are extra-articular and that too from rare pathologies, of which one case is of OKC of the coronoid process and the other case is of myositis ossificans of the buccinator and medial pterygoid muscle. Both the cases had adequate mouth opening both intraoperatively and at long term follow up.