Custom implants for the reconstruction of craniofacial defects have gained importance due to better performance over their generic counterparts. This is due to the precise adaptation to the region of implantation, reduced surgical times and better cosmesis. Application of 3D modeling in craniofacial surgery is changing the way surgeons are planning surgeries and graphic designers are designing custom implants. Advances in manufacturing processes and ushering of additive manufacturing for direct production of implants has eliminated the constraints of shape, size and internal structure and mechanical properties making it possible for the fabrication of implants that conform to the physical and mechanical requirements of the region of implantation. This article will review recent trends in 3D modeling and custom implants in craniofacial reconstruction.

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Introduction: Parry-Romberg syndrome (PRS) is a progressive, irreversible disorder characterized by facial lipoatrophy. The patients' physical and psychological well-being is highly affected. The choice of graft for correction of PRS is dictated by numerous factors. This qualitative study aims to present the patients choice of graft for PRS. Materials and Methods: Reports of experience of patients surgically treated for PRS in the period of 2000-2011 are presented. Result: A total of 36 patients who had undergone the PRS treatment with fat grafts fulfilled the criteria and were included for the study. Of them 17 (47.2%) were males and 19 (52.8%) were females. For these patients, grafts were obtained from the abdomen in 22 (61.1%) and 14 (38.9%) from the gluteal region. Female PRS patients preferred to have the scar in their gluteal region rather than abdominal region. Similarly, in their immediate postoperative period, most of the patients were apprehensive about the over correction but where satisfied with the long term results of the surgery. Discussion: Female PRS patients whose donor site was gluteal region had better perception than those with abdominal grafting. Similarly in immediate postoperative period, they felt that their outcome was not satisfactory. The morphology and metabolic activity of gluteal adipocytes are unique and probably accounts for the better survival rates.

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Introduction: Chondromyxofibroma (CMF) is exceedingly rare, accounting for 0.5% of the 10,065 bone tumors categorized by Unni and Inwards and 1.6% of their catalog of benign bone tumors. Only 2 of the 50 chondromyxoid fibromas included in their study occurred in the skull. Chondromyxoid fibroma of the maxillofacial region is typically seen in patients in the 2nd-3rd decade of life with slight female predominance. It is more commonly seen in the maxilla and is unusual in the sphenoid and ethmoid sinuses. The tumor is composed of hypocellular chondroid or myxochondroid tissue with multinucleated giant cells. Case Report: A 30 year old Nigerian house wife was seen at the Oral and Maxillofacial clinic of the Dental and Maxillofacial Department of the Federal Medical Centre Lokoja with a 4 year history of Rt mandibular swelling which was initially slow growing and painless and difficulty in eating. The whole lesion was removed and result confirmed the previous biopsy of chondromyxofbroma of the jaw. Conclusion: Patients with CMF need close monitoring due to high rate of recurrence with cases of malignant transformation at rate of 1-2%, and this seems to have occurred following irradiation.

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Ameloblastic carcinoma (AC) is a rare primary odontogenic tumor that has histological features of both ameloblastoma and carcinoma. A total number of 92 case reports speak about its rare incidence, affecting mostly the mandible as a locally destructive lesion. The maxilla is affected even more rarely as only 35 cases have been reported until 2012 in scientific literature. The clinical course of AC is generally aggressive, with extensive local bone destruction. The most common clinical features include swelling, pain, trismus, significant bone resorption with tooth mobility, dysphonia and intraoral fistula. We report two cases of AC with aggressive behavior.

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Craniofacial soft tissue reconstruction may be required following trauma, tumor resection, and to repair congenital deformities. Recent advances in the field of tissue engineering have significantly widened the reconstructive armamentarium of the surgeon. The successful identification and combination of tissue engineering, scaffold, progenitor cells, and physiologic signaling molecules has enabled the surgeon to design, recreate the missing tissue in its near natural form. This has resolved the issues like graft rejection, wound dehiscence, or poor vascularity. Successfully reconstructed tissue through soft tissue engineering protocols would help surgeon to restore the form and function of the lost tissue in its originality. This manuscript intends to provide a glimpse of the basic principle of tissue engineering, contemporary, and future direction of this field as applied to craniofacial surgery.

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Background: Although the periorbital region forms less than 1% of the total body surface, it has a very complex anatomy; therefore, it requires a detailed approach. In this work, we aim to present the clinical applications and related literature for the algorithm of the technique which will be applied, according to the location of the defect, in choosing the surgery treatment method. Factors affecting the results and different treatment methods of the anatomical region, including its difficult reconstruction, will also be included. Materials and Methods: A review of 177 periorbital region defect reconstructions was performed. Results: As a treatment method, in 76 (43%) patients primary closure was chosen, 39 (22%) patients had grafts and in 62 (35%) patients a flap was chosen as a treatment alternative. With respect to postoperative complications, there were a total of 6 (3.38%) patients observed with venous congestion. In 11 (6.21%) patients ectropion developed, in 1 (0.56%) patient minimal space between the eyelids while monitoring recovery was observed and in 1 (0.56%) patient, flap loss was observed due to a circulatory disorder. Conclusions: The aim of reconstruction is to repair the defect suitable to normal physiological and anatomical values. As a result, before the surgical treatments in this difficult anatomical region, the defect width and anatomical localization must be evaluated. The most suitable reconstruction method must be identified, using an evaluation of the algorithm and the required functional and esthetical results can be obtained with intraoperative flexible behavior and a change of method, when necessary.

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Background: The timing of removal of mandibular third molars (M3) in Sagittal Split Osteotomy (SSO) has been an issue of contention. The aim of this retrospective study is to identify the incidence of unfavorable fractures during SSO with the presence of M3 and to identify the association between unfavorable fractures with the factors specifically related to the M3. Materials and Methods: Retrospective analysis of consecutive bilateral sagittal split osteotomy (BSSO) patient's treatment records of 208 patients treated by a single surgeon was analyzed. The position of M3, fracture details, and demographics were collected. Descriptive statistics and Chi-square tests were employed in SPSS package. A P ≤ 0.05 was taken as significant. Results: There were altogether 416 SSO performed. M3 was completely impacted in 88.9% of all instances, and in 85.6% of the instances, the bulk of the M3 was identified to be above the external oblique ridge. In 59.4% of the cases, M3 was positioned in alignment with the arch as observed during surgery. There were about 27 (6.5%) instances of unfavorable splits. A statistically significant relationship was observed with M3 root morphology and axial position of M3. Discussion: This study for the first time has confirmed the spatial positioning of M3 as one of the several causes of unfavorable splits during SSO. An impacted M3 that lies below the oblique ridge, distoangularly/vertically oriented, with divergent/supernumerary root would cause unfavorable splits when the spreader is not used properly. Potential causes and influencing factors of the unfavorable splits are discussed.

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Chondrosarcoma of mandibular condyle is an extremely rare clinical entity with only 18 cases reported till date. We report a rare case of central myxoid chondrosarcoma in a 7 year old male child with a complaint of slow growing bony hard swelling of left mandibular condyle. Panoramic radiography and CT scan revealed a 5x3cm osteosclerotic and osteolytic lesion with cortical perforation on the medial side of the left mandibular condyle with a cortical expansion of lateral side. Segmental mandibulectomy with disarticulation of the left condyle was done. To the best of our knowledge it is the first case of chondrosarcoma of the paediatric mandibular condyle to be reported. The etiopathogenesis, clinical, radiological diagnosis and various treatment modalities of chondrosarcoma are discussed

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Granulocytic sarcoma (GS) is a rare extramedullary malignant tumor composed of immature myeloid cells. It is strongly associated with acute myeloid leukaemia, chronic myeloproliferative diseases. Occurrence of GS in the oral cavity is extremely uncommon. Present case reported an unusual occurrence of GS without leukemia involving maxillary sinus of a child. The patient underwent chemotherapy followed by radiotherapy with complete remission. A long-term follow-up of the patient was carried without any evidence of recurrence with special focus on diagnostic difficulties. The present case highlights the perplexity in diagnosing such lesions with emphasis on the need of careful interpretation of all clinical, radiographic, histopathological and immunohistochemical details as it is one of the most frequently misdiagnosed disorder.

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Objectives: The primary aim of this study is to evaluate the success rate of immediately inserted dental implants in sinus lift and the secondary aim is to assess the reliability of performing simultaneous surgery for sinus lift, grafting and implant placement in situations of very low residual bone heights (<4 mm) in the posterior maxillae. Materials and Methods: A series of consecutive patients who sought dental implant rehabilitation were included in this study. The sinus lift cases were selected and divided into two groups based on the maxillary alveolar height, ≥4 mm of radiographically measurable bone height (Group 1) and < 4 mm of bone height (Group 2). Results: A total of 13 implants were installed in Group 1, whereas 8 implants were installed in Group 2. The success rate for dental implants in the sinus lifts reached 95.2% after a period of 24 months of evaluation, at 100% for Group 1 (bone height ≥ 4 mm) and 87.5% for Group 2 (bone height with < 4 mm). Besides the differences between the percentages of success, statistical differences were not reached when the groups were compared (Fisher's exact test, P = 0.38). Conclusions: Despite the limitations of this study, including its low number of participants, the results indicate that simultaneous surgery for sinus lifting, grafting and dental implants in posterior maxillae with very low bone heights (<4 mm) can be performed safely, although with lower success rates than found in patients with higher residual bone heights (>4 mm).

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Treatment of a wide alveolar cleft with initial application of segmental distraction osteogenesis is reported, in order to minimise cleft size prior to secondary alveolar bone grafting. The lesser maxillary segment was mobilised with osteotomy at Le Fort I level and, a novel distractor, facilitated horizontal movement of the dental/alveolar segment along the curvature of the maxillary dental arch. Following a latency period of 4 days distraction was applied for 7 days at a rate of 0.5 mm twice daily. Radiographic, ultrasonographic and clinical assessment revealed new bone and soft tissue formation 8 weeks after completion of the distraction phase. Overall the maxillary segment did move minimising the width of the cleft, which allowed successful closure with a secondary alveolar bone graft.

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Mandibular nerve has an important role in the field of oral maxillofacial surgery. Furthermore, several anatomical variations can be found and are clinically relevant mainly in procedures involving the posterior mandible. The unknown of these anatomical variations of the inferior alveolar nerve have been implicated with complications in the performance of surgical procedures and anesthesia in dental and maxillofacial practice. The present paper reports a rare anatomical variation of inferior alveolar nerve mimicking a recurrence of keratocystic odontogenic tumor.

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Ossifying fibroma is a benign bone neoplasm often considered to be a type of fibro-osseous lesion. Its origin is believed to be from periodontal membrane, and it shows more predilection toward females. Mandible is more commonly affected than maxilla. This bone tumor consists of highly cellular, fibrous tissue that contains varying amounts of calcified tissue-resembling bone, cementum, or both. Radiographically, the lesions are either completely radiolucent or mixed, depending on the amount of calcification, or are completely radiopaque and surrounded by a radiolucent rim. Ossifying fibroma requires radical surgery, because of the tendency for recurrence and possibility of malignant transformation. Here, we have presented a case of massive ossifying fibroma of mandible in an 80-year-old female.

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Purpose: A two stage approach of ridge splitting and lateral expansion in the mandible to achieve enough bone width for the purpose of dental implants is presented. Materials and Methods: A total of 13 consecutive patients with 16 long-span edentulous areas of the mandibular ridge were included in this study and 42 dental implants were inserted. Corticotomy of a rectangular buccal segment was carried out followed by 3 weeks of recovery; the mandibular ridge was stretched laterally, leaving the buccal periosteum attached to the lateralized segment. In this modification, there was no need for the use of grafted foreign materials to fill the defect and neither the use of barrier membranes, since it was treated practically as a fresh extraction site. To prevent the undesirable movement of the lateral plate, a small chip (2-3 mm in diameter) of bone spacer was properly fixed. The dental implants were placed 3-5 months later on. Results: Approximately, 86% of the expanded areas were successful in providing an adequate width to accommodate an implant. The average gain in width was 3.22 ± 0.97 mm. All intended implants were inserted. Prosthetic loading with fixed prosthesis was successfully implemented in all cases. Conclusion: This modified technique is a simple and short procedure with satisfactory results and minimal morbidity. Of note, this approach is devoid of foreign materials usage and has a low rate cost, therefore, should be employed more often.

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Epidermoid cysts (EC) in the head and neck region could be considered a rare condition representing only 6.9% of all ECs occurring in the body. They occur rarely in children and neonates. We present a case of sublingual EC in a Nigerian neonate.

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Purpose: The aim of the following study is to prospectively evaluate the use of a single Arbeitsgemeinschaft für Osteosynthesefragen (AO) 2.0-mm locking reconstruction plate for linear non-comminuted mandibular fractures without the use of a second plate. Materials and Methods: This study consisted of a sample of 10 patients who reported to the department with fractures of the mandible and were treated over a period of 24 months from November 2010 to November 2012. Out of these, there were 8 male patients and 2 female patients. There were four cases of isolated parasymphysis fractures, 1 of the case had a parasymphysis fracture associated with subcondylar fracture, 4 had a body fracture and 2 had a symphysis fracture. Results: All patients had satisfactory fracture reduction and a successful treatment outcome without major complications. Only one patient (10%) developed minor complications. Conclusion: The study has demonstrated that treating linear non-comminuted mandibular fractures with a single AO 2.0-mm locking reconstruction plate provides excellent stability at the fracture site which in turn leads to sound bone healing and early functional rehabilitation.

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The conventional implant prosthesis planning process currently involves confirmation of two-dimensional anatomical findings or the quantity and quality of bones using panoramic X-ray images. The introduction of computed tomography (CT) into the field has enabled the previously impossible confirmation of three-dimensional findings, making implant planning in precise locations possible. However, artifacts caused by the presence of metal prostheses can become problematic and can result in obstacles to diagnosis and implant planning. The most updated version of SimPlant ^® Pro has made it possible to integrate plaster cast images with CT data using optical scanning. Using this function, the obstacles created by metal prostheses are eliminated, facilitating implant planning at the actual intraoral location. Furthermore, a SurgiGuide ^® based on individual patient information can be created on plaster casts, resulting in easier and more precise implant insertion.

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Metastatic tumors to the jaws and oral tissues are rarely encountered, accounting for less than 1% of all malignant tumors affecting the mouth. Although, metastasis to the mandible from a pulmonary carcinoma is extremely rare, when it does occur it mimics more common pathoses such as odontogenic cysts, osteomyelitis, space infections making its diagnosis even more challenging. Metastasis should be taken into account especially in patients with chronic history of smoking and sudden onset of paresthesia. The rarity of such cases has also resulted in there being no definitive consensus on managing them.

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Mandibular trauma are a frequent injury of maxillofacial skeleton due to the mandible's prominence and relative lack of support. Maxillofacial injuries can be complex and can involve the skin and soft-tissues as well as bones resulting in fractures. Although, several cases of severe crush injury of the lower jaw have already been presented but total avulsion of mandible has rarely been reported. As with any facial fracture, consideration must be given for the need of emergency treatment to secure the airway or to obtain hemostasis if necessary before initiating definitive treatment. We presents a case report of completely avulsed mandible along with soft-tissue of midface region in pediatric patient following trauma, which was attempted to manage or repaired by successful microvascular surgical technique. Unfortunately, we lost the patient in next postoperative day due to cardiac complication. Avulsion of the lower jaw may further complicate the obstructive nature of the upper airway. Multi-specialty involvement in their management may be needed for management of such type of avulsion injury.

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Introduction: Orthodontic treatment plays a major role in cosmetic dentistry. A harmonious facial balance is normally the end point in comprehensive orthodontic outcomes. In order to achieve this goal, correct diagnosis of asymmetry should be done starting from the outer facial morphology forms and progressively moving to the dental occlusion. The prime importance of measuring mandibular asymmetry is its tremendous effect on the occlusion. Objective: The aim of this study was to measure mandibular asymmetry in a cohort Class I molar relationship comparing right and left sides using new three-dimensions (3D) imaging technique with the aid of 3D software (in vivo 5.2.3 [San Jose, CA]). Materials and Methods: 35 DICOM files were initially collected retrospectively and seven were excluded due to (1) condylar resorption, (2) history of trauma and (3) unclear DICOM file. A new coordinate system was set for the mid-sagittal plane (MSP), Frankfort horizontal plane and frontal plane (FP). Each cone beam computed tomography (CBCT) was appraised using 16 evaluation criteria bilaterally. Five mandibular landmarks were selected: Condylion_R, Gonion_R, Menton, Gonion_L and Condylion_L. Using these points, the mandible was further divided into four parts: (1) Ramus length right side, body of the mandible right side, body of the Ramus left side and Ramus length left side. The angles between each line and the three different planes were acquired in order to compare each line from a 3D aspect. Mean and standard deviation were calculated for the 28 CBCTs. Results: Significant bilateral differences were reported in the angle between the ramus length and MSP and the ramus length and the FP (P < 0.05). Significant lateroanterior shift of the mandibular ramus on the left side in comparison with the right side. Conclusion: Viewing an object using three different angles between the four parts of the mandible and each plane is a valid method to replicate the actual object.

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Objective: The objective of the following study is to evaluate the results of strip craniectomy with distraction osteogenesis, using the intraoral distractor devices, as a modality of treatment for craniosynostosis. Materials and Methods: Two cases of cranial synostosis were selected for this study. The cases were operated for strip craniectomy with distraction osteogenesis using a pair of miniaturized intraoral distractor devices. Distraction was carried out after a latency period of 4 days at a rate of 0.5 mm twice a day. Total separation of osteotomized segments achieved was in the range of 25-28 mm. Results: Both patients were evaluated clinico-radiologically at 3, 6 and 12 months postoperatively. There was an increase in the occipital frontal circumference with improvement in the contour of the skull. Both the cases showed marked improvement of bowel habits, bladder control and cognitive behavior. Radiologically copper-beaten appearance reduced considerably suggesting improved intracranial pressure. Conclusion: Combination of distraction osteogenesis with strip craniectomy for the management of craniosynostosis is an effective treatment modality with promising results.

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Inferior alveolar nerve block (IANB) anesthesia is a common local anesthetic procedure. Although IANB anesthesia is known for its safety, complications can still occur. Today immediately or delayed occurring disorders following IANB anesthesia and their treatment are well-recognized. We present a case of a patient who developed a symptomatic abscess in the pterygoid region as a result of several inferior alveolar nerve injections. Clinical symptoms included diffuse pain, reduced mouth opening and jaw's hypomobility and were persistent under a first step conservative treatment. Since image-based navigated interventions have gained in importance and are used for various procedures a navigated surgical intervention was initiated as a second step therapy. Thus precise, atraumatic surgical intervention was performed by an optical tracking system in a difficult anatomical region. A symptomatic abscess was treated by a computed tomography-based navigated surgical intervention at our department. Advantages and disadvantages of this treatment strategy are evaluated.

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The present paper describes the clinical and pathological features of epithelial-myoepithelial carcinoma (EMC) of the parotid gland. This rare tumor represents <1% of all salivary gland tumors and arises most commonly in the parotid gland, but it has also been described in the submandibular gland, minor salivary glands and palate. EMC is considered to be a low-grade malignant tumor that may commonly recur locally after resection in 23-50% of cases. The complex and varied morphological expression of this neoplasm has attracted numerous investigators, who have presented valuable but often contradictory data. After an in-depth analysis of the clinicopathological aspects of EMC, we speculate that adequate resection with negative soft-tissue margins is the minimum recommended and necessary therapy.

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