Hiroshi Chikumaru

Osteosynthesis and simultaneous irregular trifocal distraction osteogenesis for segmental mandibular defect after tumor ablative surgery: a case report

OBJECTIVE This paper describes a case of secondary mandibular bone reconstruction performed to place dental implants. Osteosynthesis and simultaneous irregular trifocal distraction osteogenesis were documented. PATIENT The patient was a 51-year-old man with recurrent ameloblastoma of the mandible. Segmental mandibulectomy for tumor ablation and immediate mandibular reconstruction were performed. Because the volume of reconstructed bone was insufficient to place dental implants, trifocal distraction osteogenesis (vertical and horizontal distraction osteogenesis) was performed. Because the mandible had lost its continuity, osteosynthesis was performed simultaneously. RESULTS Through this procedure, the bone was well augmented. Absorption of the distracted bone was not seen. Adequate-length implants were placed. CONCLUSION Irregular trifocal distraction osteogenesis synchronized with osteosynthesis shortened the treatment period and produced stable bone augmentation for placement of dental implants. Therefore, this procedure could be indicated for complicated segmental mandibular bone defects.

Cartilaginous choristoma of the lower lip.

Choristoma is a tumor-like mass consisting of normal cells in an abnormal location. Cartilaginous choristoma, which is composed of ectopic cartilaginous tissue, very rarely presents in the oral cavity and most commonly in the tongue. Here we report an extremely rare case of cartilaginous choristoma of the lower lip.

Simple technique to identify Wharton's duct during endoscopically-assisted submandibular sialoadenectomy.

esection of the submandibular salivary glands for sialadeniis and benign tumour is usually done by open surgery through n incision 5–6 cm long in the submandibular region along natural crease in the skin.1,2 Possible complications are a ostoperative cervical scar and disturbance of the marginal andibular branch of the facial nerve.1 Endoscopicallyssisted submandibular sialoadenectomy through a short ncision can avoid such complications and has good cosetic results,3,4 but limited visibility can cause problems ecause the operative field contains some important anatomial structures such as the hypoglossal and lingual nerves, the nterior facial vein, and the facial artery. It is important to ifferentiate between the lingual nerve and Wharton’s duct n the upper and deep aspects of the submandibular gland o avoid accidental damage to the nerve, which results in psilateral sensory loss of the mobile tongue. This can be ifficult because the colour of both structures is similar. We escribe a simple technique to identify Wharton’s duct during ndoscopically-assisted submandibular sialoadenectomy. A 24-G intravenous catheter and a salivary duct probe 0.5 mm in diameter) are prepared preoperatively. The probe s threaded into the catheter and they are inserted into the rifice of Wharton’s duct under general anaesthesia. After he probe has been removed, 0.2 ml gentian violet is injected hrough the catheter to dye Wharton’s duct (Fig. 1).

Actinomyces-associated calcifications in a dentigerous cyst of the mandible.

Actinomyces-associated lesions in the jaw, such as radicular cyst and osteomyelitis, have been reported by many authors. The lesions are caused by infection from peripheral sites and can be seen to contain Actinomyces druses on pathologic examination. To our knowledge, no previous reports have described Actinomyces-associated calcification in the jaw, although the lesions in the jaw often include druses. We report here a rare case of Actinomyces-associated calcifications in a dentigerous cyst of the mandible.

Safe method of extraction to prevent a deeply-impacted maxillary third molar being displaced into the maxillary sinus

b In addition, the bur must be gripped by another instrument. As a safer method for removing deeply-impacted maxillary third molars, we extract them with the repositioning pin that emoval of impacted maxillary third molars is a common peration, usually for orthodontic indications. Displacement f the molar into the maxillary sinus or infratemporal fossa s a rare complication.1,2 However, there is the possibility f accidental displacement when the third molar is deeply mpacted, particularly if its roots are not developed and it lies long the maxillary sinus, or if its roots are developed but it s close to or in the maxillary sinus. We report a safe method f extraction to prevent its displacement into the maxillary inus. After a gingival flap has been raised and the crown of he deeply-impacted maxillary third molar exposed, we drill he crown with a small diamond bur. A repositioning pin s inserted into the handle of a miniscrewdriver (KLS Marin, Tuttlingen, Germany) (Fig. 1) that is used to reduce the ondylar fragment,3 and inserted clockwise into the drilling ole (Fig. 2). Because the pin is fixed tightly by this tapping, he tooth can be removed safely using an elevator and the pin ithout the risk of displacement (Figs. 3 and 4). Excessive force while using the elevator can cause dislacement of the tooth. Experienced and less experienced urgeons alike may encounter such a complication when emoving deeply-impacted maxillary third molars, and thereore a safe method of removal is necessary. Papadogeorgakis 4 t al. reported extraction by rotating a round bur wedged in he crown after drilling 5–7 mm deep into the dentino-enamel unction. However, the bur may loosen with this method

Primary Malignant Melanoma Arising in the Dorsum of the Tongue

Abstract Malignant melanoma of the oral cavity is uncommon, and the tongue is a particularly rare primary site. We report a case of malignant melanoma of the tongue in a 69-year-old Japanese man, who had undergone lower lobectomy of the right lung 1 year earlier for lung squamous cell carcinoma. The patient had noticed a grey-black pedunculated nodule on the dorsum of the tongue 3 months previously. No other primaries or metastases apart from recurrences of lung squamous cell carcinoma were observed. A palliative approach was adopted comprising chemotherapy and immunotherapy for the tongue tumour, as radical surgery for recurrent lung carcinoma was considered unfeasible. The patient died of lung carcinoma 6 months after completing the therapy. The size of the lingual tumour changed very little over this period, no problems with oral intake were reported, and quality of life was maintained. This report presents details of the case and reviews relevant literature.