Fotios Tzerbos

Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years' experience

UNLABELLED Trauma and facial fractures in a population of children have been analysed in several studies mainly regarding their incidence and much less their treatment modalities. AIM The aim of this study was to retrospectively analyse the treatment methods and outcome of facial fractures in children and young adolescents during the last decade and to discuss findings and propose treatment protocols. PATIENTS AND METHODS Patients of the Paediatric Maxillofacial department, treated for fractures of the facial skeleton were included in the study. Open reduction and osteosynthesis plate fixation (titanium and resorbable material) was the main treatment method with conservative treatment saved for selected cases. Titanium plates were removed after bone healing. Intermaxillary fixation (IMF) was not used regularly in mandibular fractures, with the exception of condylar fractures. RESULTS 156 children and young adolescents with 208 fracture sites in total were treated. 139 fracture sites (66.8%) were treated with open reduction and 69 conservatively. The mandible was affected in 49.0% of the cases, the maxilla in 21.2% (both with the alveolar process fractures included), the zygomatic complex in 10.1%, the orbital walls in 9.6%. There were 38 alveolar process fractures. CONCLUSION The results of the fracture treatment verified the usefulness of open reduction and plate fixation in children. There was no need for wire suspension and only occasional need for IMF. Closed reduction was selectively applied in condylar fractures and dento-alveolar trauma.

Iliac crest morbidity following maxillofacial bone grafting in children: A clinical and radiographic prospective study

UNLABELLED Bone harvesting from the anterior iliac crest is commonly performed for grafting of maxillofacial defects. PURPOSE To evaluate the morbidity of the procedure in children and adolescents with clefts or maxillofacial defects after tumour removal. PATIENTS AND METHODS Between 2001 and 2008 36 consecutive patients who underwent iliac crest bone grafting using the trap-door technique were evaluated 6 months to 7 years postoperatively. Objective and subjective findings regarding the donor site mostly but also the recipient site were assessed by a standardized physical and radiological examination and a questionnaire. The donor site scar, neurosensory and motility function were evaluated clinically and osseous healing was investigated through radiographic examination of the ilium. RESULTS All respondent patients (29 out of the 36) tolerated the procedure well without major complications. Minor complications (mild pain and limp) were of short duration. No growth disturbances or contour deficits at the donor site were noted. No neurosensory or functional irregularities were detected. The donor site scar was considered aesthetically acceptable and most of the patients were satisfied with the functional outcome at the recipient site. CONCLUSIONS Bone harvesting from the anterior iliac crest was found to be a safe and reliable procedure for maxillofacial bone grafting in paediatric patients. No complications were encountered, the morbidity was minimal and the aesthetic outcome was good.

Granular cell ameloblastoma: an unusual histological subtype report and review of literature.

ABSTRACT Background Granular cell ameloblastoma is a rare histological subtype of ameloblastoma accounting for less than 5% of the total. The characteristic microscopic features of granular cells are attributed to the increased presence of lysosomes in the cytoplasm of the tumour cells. Methods A case of bone expansion in the mandible of 65 year old patient was examined on the basis of the clinical examination, radiographic imaging and microscopic features. A complete surgical removal was performed. Results The radiographic imaging characteristics were consistent with a locally aggressive jaw lesion. Histological examination of the tumour revealed typical features of granular cell ameloblastoma. The specimen margins were free of tumour and the postoperative course was uneventful. No evidence of recurrence was noticed during a 1.5 years follow-up period. Conclusions The rarity of the granular cell ameloblastoma subtype and the possibility of confusion with other odontogenic and non-odontogenic lesions with a granular cell component require an understanding of the salient features of this locally aggressive neoplasm. A literature review is provided focusing on emerging molecular parameters in the pathogenesis of these tumours and the differential diagnosis of oral lesions featuring granular cells.

Development of surgical techniques of secondary osteoplasty in cleft patients following 12 years experience

PURPOSE To evaluate the results of secondary osteoplasty in cleft patients, over a 12 years period, and to propose certain modifications and improvements of the cleft repair technique. MATERIALS AND METHODS Data were retrieved for all young patients treated from 2000 to 2011. Patients were divided in 3 groups, of 4 years duration each; parameters registered among others included peri-operative orthodontics, type of graft used, techniques applied and revisions required until final repair. RESULTS 65 patients (mean age 11.6 years) were included in the study. 80 cleft sites were treated. All clefts were finally repaired and bone continuity was achieved. Peri-operative orthodontics was applied in 84.6% of the cases. Bone grafts were harvested 60 times (84.5%) from the left anterior iliac crest and 11 times (15.5%) from the genial region of the mandible. During the 12 years period ameliorations and changes were made at the recipient site, regarding the technique applied and the type of the graft. Revision operations for additional bone grafting were required in 6 cases in all (6/80 or 7.5% of the cleft sites). A gradual reduction of the number of revision osteoplasties was recorded in the 3 time periods, attributed to the improvements afore mentioned. CONCLUSIONS Cleft bone repair, even in difficult bilateral cases, may be achieved with standardised preparation of the recipient site, adequate graft from the iliac crest, used in the form of both particulate bone and cortical plate on top, as well as full coverage of the graft.

Lymphatic malformations in children and adolescents.

Purpose This article aimed to present a series of surgically treated lymphatic malformations of the cervicofacial region in a population of children and adolescents during a 13-year period. Methods The medical records of all children and adolescents with cervicofacial lymphatic malformations, treated surgically at our department from 1998 to 2011, were reviewed retrospectively. Results Eighteen patients with 20 lymphatic malformations located within the soft tissues of the cervicofacial region were identified. All patients were submitted to surgical treatment (excision or resection with conventional scalpel or radiosurgery) to address complications (ulceration, bleeding, impaired mastication and feeding, airway obstruction) and/or aesthetic issues. Recurrence was noted in 2 of our patients. Conclusions Accurate diagnosis based on history, clinical examination, and adequate imaging techniques is the key to the optimal treatment of cervicofacial lymphatic malformations; surgical intervention remains the treatment of choice for these lesions.

Well-Differentiated Liposarcoma/Atypical Lipomatous Tumor of the Oral Cavity: Report of Three Cases and Review of the Literature

Atypical Lipomatous Tumor/Well Differentiated Liposarcoma (ALT/WDLS) is a soft tissue sarcoma of intermediate malignant behavior, most frequently affecting the retroperitoneum and lower extremities. Oral liposarcomas are very rare neoplasms, the most common histological subtype being ALT/WDLS. In this study, three additional cases of ALT/WDLS located on the tongue (2 cases) and the lower lip (1 case), respectively, are described. Analysis of the salient clinicopathologic features of 63 oral ALT/WDLS cases previously reported in the English language literature, as well as of the 3 cases presented in this study, indicates that the indolent biologic behavior of this tumor justifies its designation as a locally spreading malignant neoplasm, affording a rather conservative surgical approach.

Reactive Fibrous Hyperplasia of Peri-implant Mucosa

I mplant-related reactive lesions of the oral mucosa are uncommon, compared with tooth-related ones. Although their pathogenesis is undetermined, local irritating factors such as dental plaque, tartar, and trauma are thought to be involved. Most implant-related reactive lesions reported up to date are pyogenic granulomas (PG) and peripheral giant cell granulomas (PGCG), but 1 case each of hemangioma and parulis-like soft tissue tumor were also reported. The aim of this paper is to describe a case of a fibrous hyperplasia that developed around 2 healing caps and discuss its possible pathogenesis, differential diagnosis, and treatment. To the best of our knowledge, there is no report of implantrelated fibrous hyperplasia in the literature.

A Parulis-Like Soft Tissue Tumor in Relation With a Dental Implant: Case Report

R eactive lesions of peri-implant mucosa seem to be rare, judging from the number of published reports, and most of them represent pyogenic granulomas (PGs) or peripheral giant cell granulomas (PGCGs). Factors such as dental plaque accumulation due to inadequate oral hygiene, traumatic factors, and anatomic drawbacks are common etiologic factors for those lesions. We report a case of tumor on the covering mucosa of a dental implant consistent with parulis and discuss its possible pathogenesis, differential diagnosis, and management.

Endoplasmic Reticulum Stress-Associated Chaperones, Bip/GRP78 and Calnexin are Overexpressed in Keratocystic Odontogenic Tumours.

ABSTRACT Objectives Odontogenic keratocysts (OKCs) are developmental cysts that have been reclassified according World Health Organization (WHO), to keratocystic odontogenic tumours (KCOTs), a term that better reflects their neoplastic nature. The aim of present study is to evaluate the induction of stress of the endoplasmic reticulum and execution of the resulting unfolded protein response in keratinocystic odontogenic tumours. Material and Methods We analyzed by immunohistochemistry the expression of the chaperones BiP/GRP78 and calnexin in 24 cases of KCOTs. As controls, we have used 9 cases of periapical or radicular cysts (PACs) and 5 cases of Fibromas (FBs). The PACs and the FBs were included in the analysis, as PACs are the most common type of inflammatory odontogenic cysts of and FBs, as lesions of the connective tissue with unaffected epithelium. Results Analysis revealed a strong association between both BiP/GRP78 and calnexin expression and KCOTs: 18 out of 24 (75%) KCOTs expressed BiP/GRP78 as opposed to 1 out of 9 (13%) PACs, and none of 5 FBs evaluated (P < 0.001, x2-test). Calnexin was expressed in 11 out of 24 KCOTs (46%) but only one out of 9 (13%) PACs, and none of the 5 FBs analyzed (P < 0.001, x2-test). Conclusions Study results imply that induction of endoplasmic reticulum stress maybe of diagnostic value in keratocystic odontogenic tumours characterization. In addition to recent findings suggesting that endoplasmic reticulum stress plays a causative role in keratinization of epithelia, pharmacological interference with the execution of the unfolded protein response should be considered for the management of keratocystic odontogenic tumours.

Restoration-Guided Implant Rehabilitation of the Complex Partial Edentulism: a Clinical Report

ABSTRACT Background The hard and soft tissue deficiency is a limiting factor for the prosthetic restoration and any surgical attempt to correct the anatomic foundation needs to be precisely executed for optimal results. The purpose of this paper is to describe the clinical steps that are needed to confirm the treatment plan and allow its proper execution. Methods Team work and basic principles are emphasized in a step-by-step description of clinical methods and techniques. This clinical report describes the interdisciplinary approach in the rehabilitation of a partially edentulous patient. The importance of the transitional restoration which sets the guidelines for the proper execution of the treatment plan is especially emphasized along with all the steps that have to be followed. Results The clinical report describes the diagnostic arrangement of teeth, the ridge augmentation based on the diagnostic evaluation of the removable prosthesis, the implant placement with a surgical guide in the form of the removable partial denture duplicate and finally the special 2-piece design of the final fixed prosthesis. Conclusions Clinical approach and prosthesis design described above offers a predictable way to restore partial edentulism with a fixed yet retrievable prosthesis, restoring soft tissue and teeth and avoiding an implant supported overdenture.