Ephraim Rikhotso

Interim reconstruction and space maintenance of mandibular continuity defects preceding definitive osseous reconstruction

The use of space maintenance in mandibular defects as an interim measure before definitive osseous reconstruction may prevent problems associated with delayed reconstruction including increased technical difficulty, contracture of soft tissues that limits the volume of the final reconstruction, and the potential for iatrogenic injury to adjacent anatomical structures. The use of a condyle/ramus spacer made of medical grade, ultrahigh-molecular-weight polyethylene, and a flexible body spacer made of high quality, inert, non-toxic medical and food grade silicone rubber, was tested in 38 patients with mandibular defects after the resection of benign but locally aggressive disease, advanced osteomyelitis, and injuries. The spacer was retained for a maximum of 8 weeks, and was then removed through an extraoral approach before definitive reconstruction with a particulate corticocancellous bone graft. One of the 38 patients failed to attend for follow up and returned 7 months later with severe, generalised sepsis that required removal of the spacer and exclusion from the study. Of the remaining 37 patients, 32 healed uneventfully, 1 required removal of the spacer 2 weeks after implantation for intraoral wound dehiscence, and 4 had mild to moderate disturbances of wound healing that required either minor revision or local wound care until removal at the time of reconstruction. The use of a spacer promotes wound healing and simplifies and expedites secondary reconstruction of mandibular defects.

Central adenoid cystic carcinoma of the mandible with odontogenic features: Report of a case

Primary intraosseous salivary‐type adenocarcinomas are rare neoplasms of uncertain histogenesis. The prevailing theories suggest origin from heterotopic salivary glands, odontogenic rests, or cystic epithelium.

Subcutaneous Calcinosis as Late Sequela of Radiotherapy to the Neck

r g The late adverse effects after radiotherapy to the head and neck region include radiation-induced malignancy and changes in the irradiated tissues, leading to chronic xerostomia, radiation caries, osteoradionecrosis, trismus, and dysphagia. Cranial nerve palsy, ocal cord palsy, sensorineural hearing loss, laryngeal steochondronecrosis, extracranial carotid stenosis, adiation myelopathy, and meningioma have also een reported as head and neck postirradiation seuelae. Radiotherapy can also induce dystrophic calcification by causing tumor necrosis and thus providing the milieu necessary for calcification. Although the data are replete with this form of dystrophic calcium deposition that occurs within the tumor after radiotherapy for various malignancies, heterotopic calcification in the subcutaneous tissue, also known as subcutaneous calcinosis, occurs far less frequently as a part of the late effects of radiotherapy. This form of dystrophic calcification develops after a long period of postirradiation latency. It is limited to the subcutaneous tissue and is linked to the late radiation effects of the overlying skin, notably cutaneous atrophy, telangiectasias, depigmentation, fibrosis, and cutaneous fistulas. The development of subcutaneous alcinosis as a late sequel of radiotherapy was first escribed in 1987 by Vainright et al and has since een described predominantly after chest wall irradition for breast cancer. To our knowledge, this is he first report to document the occurrence of this

Total Alloplastic Joint Reconstruction in a Patient With Temporomandibular Joint Ankylosis Following Condylar Dislocation Into the Middle Cranial Fossa.

PURPOSE Traumatic dislocation of the mandibular condyle into the middle cranial fossa is an extremely rare complication of maxillofacial injury. Management case of the of dislocation of the mandibular condyle complicated by bilateral temporomandibular joint ankylosis is presented. MATERIALS AND METHODS A 17year old male patient presented to the outpatient clinic complaining of inability to open his mouth following a motor vehicle accident 6 months prior. Examination revealed bilateral TMJ ankylosis following left condylar head fracture and dislocation of the right condylar head into the middle cranial fossa. Bilateral total alloplastic TMJ reconstruction was performed. RESULTS MIO at a three-year follow-up was 35mm, occlusion was intact and the patient was functioning optimally.