Lambros Zouloumis

Primary tuberculosis of the oral cavity

Two cases of primary tuberculosis of the mouth are reported. Painless ulceration of long duration and enlargement of the regional lymph nodes that did not respond to conservative and antibiotic therapy were the main manifestations of the disease in both cases. In the first case the tubercle ulcer was located in the lower buccogingival sulcus of a 17-year-old girl. In the second case the lesion occurred as a chronic periodontal inflammation around the gingiva of the left lower second molar tooth. When the tooth was extracted, a painless ulceration appeared around the socket, which was filled by granulation tissue. Histopathologic examination; bacteriologic, serologic, and blood tests; and chest x-ray film confirmed the diagnosis. Predisposing factors that might favor primary inoculation of tubercle bacilli into oral mucosa are also discussed. Finally we emphasize that in such cases it is essential to attempt to locate a possible primary site elsewhere in the body before oral tuberculosis is considered the primary disease.

The inferiorly and superiorly based nasolabial flap for the reconstruction of moderate-sized oronasal defects

PURPOSE The usefulness of the inferiorly or superiorly based nasolabial flap for the unilateral or bilateral reconstruction of local extraoral and intraoral defects was evaluated. PATIENTS AND METHODS In a 10-year period, 22 flaps were used in 15 patients to cover defects of the floor of the mouth, nose, and chin. Fourteen bilateral and two unilateral flaps were inferiorly based, and six unilateral flaps were superiorly based. RESULTS Dehiscence, which occurred in one case, and obstructive sialadenitis which occurred in another, were the main complications. CONCLUSION The nasolabial flap is a useful procedure for the reconstruction of moderate-sized oronasal defects because of its simple elevation, proximity to the defect, and versatility.

Correction of open bite by maxillary osteotomy. A comparison between bone plate and wire fixation.

A clinical and cephalometric standardized study of surgical correction of open bite deformity was performed on 19 individuals. The mode of fixation of the maxilla after surgical correction was by direct wires in 9 of the patients combined with suspension wires to the infraorbital rim and in 10 patients plate fixation. The follow-up time was 18 months and the results in both groups were clinically and cephalometrically stable in the short (2 and 6 months) and medium terms (18 months). No statistically significant difference was found between the groups regarding tendency to relapse. It was, however, concluded that the advantages of plate fixation both on clinical grounds and for patient comfort are factors in favour of using miniplates for maxillary surgical procedures.

Congenital lipoma of the tongue. Report of a case

A case of a congenital lipoma of the tongue in a 20-day old female infant is reported. The tumor was completely removed and follow-up showed excellent healing without recurrence.

Retrotuberosity versus submentosubmandibular and median submental intubation: patients with maxillofacial surgery.

OBJECTIVE In certain maxillofacial trauma cases, nasotracheal intubation is contraindicated and the standard method of orotracheal intubation interferes with maxillomandibular fixation. In such cases alternative techniques, such as submental, submentosubmandibular, and retromolar intubation have been used. STUDY DESIGN We reviewed 8 patients who underwent median submental intubation, 7 patients who underwent submentosubmandibular intubation, and 10 patients who underwent a retromolar intubation with an armored endotracheal tube secured in place with a circumdental wire. The tube was positioned in the retromolar region behind the most posterior maxillary tooth. RESULTS In the group of patients who underwent median submental intubation, 1 presented difficulty in performing a median submental intubation. No complications were recorded in the rest of the patients. CONCLUSIONS Submental and submentosubmandibular intubation are useful methods with low morbidity. However, both are invasive techniques compared with retrotuberosity intubation secured in place with a circumdental wire placed around the most posterior maxillary tooth.

Tooth Multi-Sectioning with the Use of Magnification, for Extraction of a Deeply Impacted Lower Second Molar with Entrapment of the Inferior Alveolar Nerve: Report of a Case

Summary Inferior alveolar nerve injury is one of the most serious complications of mandibular molar surgery and may lead to litigation for mal-practice. Entrapment of the inferior alveolar nerve to roots of an impacted mandibular molars is extremely rare. The aim of this case report is to stress the importance of tooth multi-sectioning with the use of magnification for the safe removal of a deeply impacted second molar with entrapment of the inferior alveolar nerve in its proximal root.

Hogan’s modification of the Sanvenero-Rosselli velopharyngoplasty

PurposeA competent velopharyngeal mechanism is essential for the production of intelligible speech and the secondary procedure of the posterior pharyngeal flap may be necessary in some patients to achieve this goal. The purpose of this study was to examine short and long-term results between the Sanvenero-Rosselli and Hogan’s modification of the cranially based velopharyngoplasty.MethodsDuring a 20-year period, 17 patients underwent secondarily a posterior pharyngeal flap to treat velopharyngeal incompetence. All the patients were treated in the same institution and under the supervision of the same stuff surgeon. Nine patients were operated on according to the Sanvenero-Rosselli method and eight according to Hogan’s modification, which consists of the preparation of two mucosal flaps on the dorsal side of the soft palate. Both mucosal flaps are sutured at the base of the pharyngeal flap and cover its raw surface.ResultsComparing the post-operative condition of the patients in two groups to their pre-operative state, it was observed that speech and comprehensibility were significantly improved, but Hogan’s technique produced better speech results.ConclusionsAccording to our limited experience, additional surgical effort to create mucosal flaps on the nasal surface of the soft palate in Hogan’s technique is compensated for by the reliable and substantial advantages that this technique holds, compared to Sanvenero-Rosselli’s original proposition.

Benign fibroxanthoma of the mandible

Histiocytomas constitute a large group of tumors, the classification of which created a lot of confusion in the past. For this reason, various attempts were carried out during the last years so that a widely accepted classification system could be defined. Fibroxanthomas, according to contemporary data, are classified into benign histiocytomas and they are mostly located at the skin of extremities. They are rarely localized in the area of the head and neck, where they are found commonly in soft tissue. Fibroxanthomas located at the bones of oral and maxillofacial region are extremely rare. The purpose of this paper is to present a case of a fibroxanthoma located at the mandible as well as to analyze the histological findings of the lesion on which the diagnosis and differential diagnosis were based.