Life-threatening haemorrhage after 750 Le Fort I osteotomies and 376 SARPE procedures

This study assessed the incidence, presenting symptoms, diagnosis, and management of patients with life-threatening postoperative haemorrhage after total Le Fort I osteotomy and surgically assisted rapid palatal expansion (SARPE). The medical records of 750 consecutive Le Fort I osteotomies and 376 consecutive SARPEs, both of which involved pterygomaxillary separation with a curved osteotome and a mallet, were analysed prospectively. Two cases of life-threatening haemorrhage were observed in the Le Fort I osteotomy group, both initiated on postoperative day 7. Anterior and posterior nasal packing were successful in one patient; the other required two embolizations for bleeding control (incidence of life-threatening postoperative haemorrhage: 2/750; confidence interval: 0.03-0.96%). In the SARPE group, one brisk epistaxis on the first postoperative day was controlled with anterior and posterior nasal packing under general anaesthesia. This haemorrhage was not considered life threatening (incidence of life-threatening postoperative haemorrhage: 0/376; confidence interval: 0-0.98%). In no case could the source of bleeding be established during re-explorative surgery or during diagnostic arteriography. The authors conclude that life-threatening haemorrhage is an exceptional finding after Le Fort I osteotomy; the observed incidence was 2/750, and life-threatening haemorrhage was not observed after SARPE in this series, despite the use of identical pterygomaxillary separation.     

Delayed infection after a zygoma fracture fixation with absorbable plates

A 48-year-old man who had received a bioresorbable plate fixation for a zygomatic bone fracture 13 months earlier visited our clinic complaining of sudden facial swelling. The facial computed tomographic scan showed the soft tissue swelling without any bony abnormality, and the symptoms did not improve after 1 week of antibacterial therapy. The patient had a diagnosis of a late infection caused by unresorbed plates, and exploratory surgery was performed. Partially resorbed plates and screws were seen, and we removed the remnants of such completely. The symptoms were relieved after the operation, and there was no recurrence during 8 months of follow-up.     

Life-threatening swelling after mandibular vestibuloplasty.

This case report illustrates the potential for severe hemorrhage which authors have alluded to in articles on the vestibuloplasty procedure. The surgeon must be prepared to deal not only with the hemorrhage, but also with the sudden and possible life-threatening swelling that may accompany the bleeding.     

Tapia's syndrome after repair of a fractured mandible

A 41-year-old gentleman underwent surgical repair of the fractured right parasymphisis and left condyle of his mandible. Post-operatively he developed hoarseness of voice and dyspnoea during speech, with deviation of the tongue on protrusion. After excluding intracranial and surgical causes, a clinical diagnosis of Tapia's syndrome was made.     

Rehydration of a reattached fractured tooth fragment after prolonged dehydration

Crown fractures of the anterior teeth are one of the most common outcomes of trauma to the orofacial region. The reattachment of dental fragments is a conservative treatment and should be considered a primary treatment choice in the restoration of anterior tooth fractures. This article presents a clinical technique for the restoration of a fractured maxillary lateral incisor by reattaching the tooth fragment that was kept in dry conditions for five days with the aid of adhesive dentistry. The esthetic compromise of white color (due to excessive dehydration of the segment) was reconciled after one month of service in the mouth by regaining the natural color by rehydration. The one-year clinical evaluation revealed a successful outcome for this technique, and the patient was pleased with the esthetic results of the conservative treatment modality.     

Chondromyxoid fibroma of the zygoma: a case report

Chondromyxoid fibroma is a rare benign tumour of chondral origin. It usually involves the long bones of the lower extremity, whilst involvement of craniofacial skeleton is extremely unusual. The second case of chondromyxoid fibroma of the zygoma described in literature is presented and the surgical resection of the lesion with tumour-free margins as the key factor for avoiding local recurrence of this tumour is emphasised.     

Primary tuberculous osteomyelitis of zygoma

Osteomyelitis of zygomatic bone is rare, and tuberculous osteomyelitis is even rarer. This is the case report of a 3-year-old child presenting with a discharging sinus and swelling on the zygoma, which was initially thought to be orbital cellulitis. After further examination, she was diagnosed as having tuberculosis of zygoma and responded to anti-tubercular chemotherapy.     

Life-threatening bite injury of the lower lip after use of metamizole

Introduction

Bite wounds of the oral mucosa heal after eliminating the causative irritant, but there are serious exceptions from the rule. We present the case of a 37-year-old woman with an ulcer of the mucosa of the lower lip, which had been present for 10 days, and leucopenia.

Discussion

Agranulocytosis after the use of metamizole is part from leukaemia and lues, a rare reason for non-healing ulcers of the mucosa of the oral cavity without fulminant signs for inflammation.

Conclusion

As this is a life-threatening disease, medical therapy must begin immediately.     

Life-threatening complications associated with acute monocytic leukaemia after dental treatment

It is highly recommended to conduct a prophylactic check for any dental problems on patients who suffer from leukaemia before chemotherapy begins. Bacteraemia caused by oral microflora may be very dangerous for patients with haematological malignancies. However, it should be noted that the prophylactic process itself might bring about life-threatening complications if there is only a short interval between dental treatment and the beginning of chemotherapy, or if the dental treatment is too aggressive. We present a case where this prophylactic procedure produced life-threatening complications for a patient with acute myeloid leukaemia.     

Fracture of the coronoid process, sphenoid bone, zygoma, and zygomatic arch after a firearm injury

A rare case of fracture of the coronoid process, sphenoid bone, zygoma, and zygomatic arch caused by a firearm is described. A 25-year-old man was hit in the face with a bullet, resulting in restricted mouth opening, difficulty chewing, and pain when opening the mouth. The clinical examination revealed a perforating wound in the right parotid region. A computed tomographic scan revealed a comminuted fracture of the left coronoid process with the bullet stopping in the intact left coronoid process. Treatment was bilateral coronoidectomy associated with speech therapy and was successful. Details of the clinical signs, computed tomography, treatment, and follow-up are presented.     

Patient-specific sub-periosteal zygoma implant for prosthetic rehabilitation of large maxillary defects after oncological resection

A 74-year-old woman needed a subtotal bilateral maxillectomy due to squamous cell carcinoma of the palate. Immediate and secondary reconstruction of the defect was not feasible, so the defect was closed with an obturator prosthesis wired to the zygoma complex. To improve the patient’s severely impaired speech and swallowing, a patient-specific sub-periosteal implant (psSPI) was designed that matched the remnants of the zygoma complex. First, the patient’s post-surgical anatomy was visualized through segmentation of the pre- and post-maxillectomy computed tomography data. Next, based on the data, a customized zygoma-supported framework was designed to support the obturator prosthesis. Surgical guides for intraoperative navigation were designed and three-dimensionally printed, along with an obturator prosthesis to fit the planned outcome situation. The preoperatively manufactured psSPI and obturator prosthesis matched the intraoperative conditions. The postoperative results were favourable; within a week after surgery the patient could speak and swallow normally without nasal leakage. No problems occurred during follow-up. These results indicate that a psSPI-retained prosthesis can be considered for the restoration of speech and oral functioning in cases with a largely compromised maxillary bone anatomy, accompanied by impaired oral functioning and no feasible conventional reconstruction options.     

颧骨内置弧线式骨牵张器的研制

目的研制颧骨内置弧线式骨牵张器,为实现颧骨弧线式牵张成骨提供器械。方法在干燥人体颅骨测量基础上,确定骨牵张器形态规格,并以钛合金材料制作完成,进一步利用人体干燥颅骨标本进行体外模拟,考察器械的可行性。结果自行研制的颧骨内置弧线式骨牵张器小巧轻便,与人体颧骨、上颌骨区域骨性结构匹配性良好,可以实现颧骨移动盘的改向、弧线式牵引。结论本颧骨内置弧线式骨牵张器,结构简捷,小巧轻便,可望实现内置弧线式颧骨牵张成骨修复部分上颌骨缺损,其是否具备临床应用可能性,有待进一步实验验证。     

Life-threatening hemorrhage after placement of an endosseous implant: report of case

This article reports an unusual but dangerous complication of implant surgery. Minimal perforations of the lingual plate and inferior border of the mandible had been considered previously to be benign occurrences. This report demonstrates the importance of managing acute airway problems resulting from perforations.     

Replantation of a vertically fractured maxillary central incisor after repair with adhesive resin

AIM: To describe the replantation of a vertically fractured root-filled maxillary central incisor after repair with adhesive resin. SUMMARY: Root-filled teeth with vertical root fractures are usually extracted as they generally have a poor prognosis. In this case, an 18-month follow-up of a replanted incisor with vertical root fracture is presented with clinical and radiographic documentation. KEY LEARNING POINTS: * Replantation of root-filled incisors with complete vertical root fracture after resin bonding might be a realistic alternative to extraction. * Practitioners should be aware of the possible disadvantages as well as advantages associated with failure of a replanted incisor with complete vertical root fracture.