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The objective of this study was to describe the authors' long-term experience with the management of odontogenic keratocysts (OKCs). All OKC cases treated at the study centre between 1999 and 2015, with a minimum of 5 years of follow-up by December 2019, were reviewed retrospectively. Operative procedures including decompression/marsupialization, enucleation (E), E+Carnoy's solution (CS), E+CS+peripheral ostectomy (PO), and resection were assessed for complete resolution, partial resolution, and recurrence rates. In the parakeratinized non-syndromic group, E+CS+PO resulted in the lowest recurrence rate among the minimally invasive procedures (4.3%), while enucleation resulted in the highest rate (60%). Regarding the other modalities, recurrence was 12.5% for decompression, 11.5% for marsupialization, 16.7% for E+CS, 26.7% for E+PO, and 0% for resection. In the syndromic group, marsupialization resulted in a significantly higher recurrence (23.1%), while E+CS+PO cases showed no recurrence. No recurrence was observed in the orthokeratinized group patients treated with marsupialization or with E+CS. Based on clinico-radiographic features and observed results, it is concluded that OKC, although having a high recurrence rate, is a benign lesion and responds well to conservative procedures in most cases. Radical procedures should be reserved for unresponsive lesions and those with extensive tissue destruction.

A tapered mandibular contour is popular with Far Eastern Asians. This study describes a safe and accurate method of using preoperative virtual surgical planning (VSP) and an intraoperative ostectomy guide to maximize the esthetic outcomes of mandibular symmetry and tapering while mitigating injury to the inferior alveolar nerve (IAN). Twelve subjects with chief complaints of a wide and square lower face underwent this protocol from January to June 2015. VSP was used to confirm symmetry and preserve the IAN while maximizing the surgeon's ability to taper the lower face via mandibular inferior border ostectomy. The accuracy of this method was confirmed by superimposition of the perioperative computed tomography scans in all subjects. No subjects complained of prolonged paresthesia after 3 months. A safe and accurate protocol for achieving an esthetic lower face in indicated Far Eastern individuals is described.

Factors associated with the diagnosis, aetiology, and treatment of mandibular fractures occurring during the postoperative period following the removal of a lower third molar are discussed. The following databases were searched using specific key words: PubMed/MEDLINE, LILACS, Embase, and Scopus. The search yielded 124 cases. Sex, age, side, tooth position and angulation, bone impaction, relationship between the tooth and the inferior alveolar nerve, local pathological conditions, aetiology of the fracture, symptomatology, and time between surgery and fracture, as well as any displacement of the fracture and the treatment of the fracture, were evaluated. Data were tabulated and the χ2 statistical test was applied (P 35 years, with teeth in positions II/III and B/C, complete bony impaction, and local bone-like alterations, were found to have a higher frequency of fracture and pericoronitis (P

The aim of this study was to evaluate the incremental improvement in mouth opening following coronoidectomy. Twenty-three patients with unilateral temporomandibular joint (TMJ) ankylosis (Sawhney types I-III) were assessed preoperatively; physical and radiological examinations were done (panoramic radiography and computed tomography). Data including demographic and clinical parameters were recorded. Patients with bilateral ankylosis, recurrent cases, and those with Sawhney type IV TMJ ankylosis were not included. The improvement in mouth opening was measured after ostectomy, after ipsilateral coronoidectomy, and after contralateral coronoidectomy. The improvements in mouth opening at each stage were analysed using the Student's t-test and Pearson's correlation coefficient. There was a marked improvement in maximal incisal opening (MIO) from 5.7 ± 4.2mm to 23.7 ± 5.9 mm after removal of the ankylotic bony mass. MIO was significantly increased after ipsilateral coronoidectomy (31.6 ± 7.4mm), and after contralateral coronoidectomy, a mean MIO of 39.4 ± 11.2mm was achieved. At more than 1 year of follow-up, all patients showed improved mouth opening. In conclusion, coronoidectomy plays an important role in improving mouth opening in the treatment of TMJ ankylosis.

The aim of this case series study was to illustrate the bone lid technique implemented using piezoelectric surgery to access mandibular alveolar bone diseases and to assess the clinical and radiographic outcomes. The technique was used to treat 21 consecutive patients with various conditions: cysts in six cases, impacted teeth with associated cysts in nine, keratocystic odontogenic tumours in three, impacted teeth in two, and an endodontic lesion in one. The bone lid was fashioned using piezoelectric surgery and a thin osteotomy insert. After the surgical procedure, the bone lid was replaced and fixed with miniplates. On clinical and radiological follow-up at 12 months, the outcome measures were bone lid integration and alveolar bone volume recovery. Any complications were also documented. The lesion and bone lid healed completely in 19 cases; one patient experienced permanent mild paresthesia and one experienced trauma-induced bone lid necrosis. Computed tomography volumetric analyses conducted on 11 cases indicated a mean recovery of 93.8% of the volume of bone lost. Based on healthy biological reasoning, the bone lid technique with piezoelectric surgery and rigid fixation may be considered a valid alternative to ostectomy for the purposes of bone tissue healing.

This systematic review was undertaken to determine the overall and detailed recurrence rate of keratocystic odontogenic tumour in relation to specific treatment methods. Online electronic databases were searched to identify articles published in English language from 1956 to 2010. Articles were independently appraised by two reviewers in three separate rounds. Any disagreement was settled by discussion with a third judge. Of 1568 potentially relevant articles, 168 articles related to the treatment of keratocystic odontogenic tumour/parakeratinised type of odontogenic keratocyst and its recurrence rate entered the second round for evaluation. Fourteen papers entered the third round for critical appraisal. Two retrospective reviews entered the final analysis. One hundred eight lesions were found in the material analysed. Six treatment modalities were identified. The recurrence rates were 0% for resection, 0% for enucleation with peripheral ostectomy and Carnoy's solution, 18.18% for enucleation with peripheral ostectomy, 26.09% for enucleation alone, 40% for marsupialisation, and 50% for enucleation with Carnoy's solution. The overall recurrence rate was 23.15%. The present review discusses the methodological weaknesses of many of the studies analysed. No high quality evidence was obtained to evaluate recurrence rates related to treatment modalities of keratocystic odontogenic tumour.

This study aimed to determine the appropriate long-term management for ameloblastoma and the role of enucleation in the management of the subtypes of ameloblastoma (solid ameloblastomas, cystic ameloblastomas and peripheral ameloblastomas). They differ in their degrees of aggressive behavior and recurrence rates. This is an evidence-based study with review of relevant articles from PubMed, EMBASE and the Cochrane Library. Articles were categorized for quality according to the Oxford Center of Evidence-Based Medicine (CEBM). 58 articles met the inclusion criteria; their evidence level varied from IIA to V. No randomized control trials were identified. Solid and multicystic ameloblastomas have a high recurrence rate (60-80%) with simple enucleation and require more aggressive treatment. The treatment of choice is resection with 1-cm margins. This may require segmental resection in the mandible, and partial maxillectomy in the maxilla. For the unicystic ameloblastoma recurrence rates are high for simple enucleation. The intraluminal subtype of unicystic ameloblastoma may do well with enucleation, but the intramural subtype may not, and since these cannot be identified preoperatively more aggressive treatment is recommended, including peripheral ostectomy or enucleation with subsequent treatment of the surrounding bone with liquid nitrogen, Carnoy's solution, or similar physicochemical modality. The peripheral ameloblastoma has a different origin and responds to local excision.

The most common complications after surgical extraction of the third mandibular molar are trismus, oedema or swelling, local pain, dysphagia and infection. The aim of this comparative, double-blind, randomized clinical trial was to evaluate the efficacy of two sustained release amoxicillin/clavulanate regimens in the reduction of infection after third molar extractive surgery. A total of 225 patients were randomized into three equal groups: placebo, prophylaxis with single pre-surgical dose of two tablets amoxicillin/clavulanate 1000/62.5mg, and pre-emptive post-surgery therapy with two tablets amoxicillin/clavulanate 1000/62.5mg BID for 5 days. A higher rate of infection ( P =0.006) was found among patients receiving placebo (16%) than those receiving single-dose prophylaxis (5.3%) or 5-day pre-emptive therapy (2.7%). A relationship between both the duration (13.8% for long versus 7.4% for medium versus 1.6% for short) and difficulty (12.7% with ostectomy versus 3.5% without ostectomy; P =0.011) of surgical procedure and incidence of subsequent infection was also observed. Both prophylactic and therapeutic regimens versus placebo achieved greater reduction of pain after surgery on day 3 ( P =0.001). Logistic regression analysis revealed a risk of infection of 24%, 9% and 4% for ostectomy with placebo, prophylaxis and pre-emptive treatment, respectively, whereas it was 7%, 2% and 1% if ostectomy was not performed. Pre-emptive therapy with the oral sustained release amoxicillin/clavulanate formulation reduced the rate of subsequent infection in patients undergoing ostectomy. Prophylaxis was beneficial in simpler procedures and may be indicated in cases where ostectomy is not performed.

The most appropriate management for the lesion now known as the keratocystic odontogenic tumour (previously known as the odontogenic keratocyst) remains controversial. This article reviews the different management protocols adopted by one surgical unit over the last 30 years and the results obtained from the different treatment modalities. A current treatment protocol consisting of initial decompression followed by aggressive curettage and peripheral ostectomy with methylene blue staining appears to be successful, but our longest follow-up is only 6 years.

While coronoidotomy and coronoidectomy remain established procedures in maxillofacial surgery, exceptionally enlarged coronoids pose a special challenge, as their intraoral retrieval may be difficult or impossible. Classical coronoidotomy alone in such situations may risk reattachment and recurrence of trismus. The technique described allows creation of sufficient gap and interpositioning at the coronoid base, allowing achievement of satisfactory mouth opening while minimising the risk for reattachment and relapse.

Encountering patients who are fearful and anxious is common in dental practice and these factors can increase the complexity of dental procedures. A prospective cohort study was performed to assess whether patient anxiety influences the difficulty of impacted lower third molar extraction and to identify other predictive factors of surgical difficulty; 102 extractions done under local anaesthesia were assessed. Several preoperative variables were recorded (demographic, anatomical, and surgical) and patient anxiety was assessed through the use of various questionnaires. Extraction difficulty was measured using the operation time (OT) and a 100-mm visual analogue scale (difficulty VAS) completed by the surgeon. Patients with deep impacted third molars that required bone removal and tooth sectioning showed higher levels of preoperative anxiety. Significant correlations were found between questionnaire scores and the surgical difficulty (OT and difficulty VAS). OT was also related to age, depth of impaction, third molar angulations, proximity of the third molar roots to the mandibular canal, hard and soft tissue coverage, and the need to perform an ostectomy and tooth sectioning. Impacted lower third molar extraction is significantly more difficult in anxious patients. Other demographic, radiological, and surgical factors were also found to be significantly related to the surgical difficulty.

Mandibular angular ostectomy defects in 12 sheep were bridged with a titanium plate system (THORP), designed according to the screw-plate-locking principle. Two screw designs (hollow and solid) and two rough (plasma-coated, sand-blasted)-surface and one smooth (anodized)-surface structure were tested in a critical two-screw anchorage model. Fixation with two screws only per fragment was successful in only one-third of the cases. The fixation results were superior for screws with a rough surface, either sand-blasted or plasma-coated. The hollow-screw design did not seem to offer special advantages over the solid screws with identical surface structure. In the successful cases, the bone-screw contact was maintained continuously over a period of 8 weeks, and anchorage was even enhanced by reinforcement of the cancellous structures. In the unsuccessful cases, peri-implant bone resorption seemed to be related to jeopardized bone perfusion in the vicinity of the implants. It is presumed that a plating system with locked screws has the advantage that only two screws will hold a relatively short condylar process. This study proved the assumption to be questionable. However, in view of the problems related to prosthetic replacement of the temporomandibular joint, an attempt to salvage the articular portion may still be justified in selected cases, even if the chance of success is as low as 30%.

Intraoral transmental suction lipectomy (TMSL) is performed by entering the suction canula through the chin osteotomy/ostectomy gap into the sub- and/or supraplatysmal fat tissue layers. The aim of the study was to know patients' and operators' satisfaction with the procedure, and to know the kind and frequency of the complications. Twenty patients were consecutively treated and reviewed after a minimum of 5 years. All were satisfied with the overall results. It proved difficult to differentiate between the results of the liposuction and those of the genioplasty and/or orthognathic profile correction. From a surgeon's point of view, 11 showed excellent, nine good and one moderate results. Complications included one local subcutaneous infection, four transient neurosensory disturbances at the lower lip and two marginal branch weaknesses. All complications were resolved by the time of the long-term follow-up appointment. TMSL offers the psychological advantage of being performed without skin incision. Cosmetic results and complications are similar to those obtained with the transcutaneous liposuction techniques.

Cleft palate (CP) is one of the most common human congenital deformities, and acquired palate defects after trauma or tumour resection are also common. In this study, distraction osteogenesis (DO) for CP and other palatal bone defects was evaluated. Twenty cats were assigned randomly to 3 groups of (1) 15, (2) 3 and (3) 2 cats. In groups 1 and 2, a rectangular ostectomy, in the posterior of the palatal bone shelf, was performed in the sagittal axis to establish the CP defect model. At the same time, a pure titanium intraoral distractor was fixed to molar teeth with brackets and to the palatal bone shelf across the defect with titanium miniscrews bilaterally. Four weeks later, a secondary transport disc (TD) osteotomy was performed, and gradual DO treatment started at 0.4mm twice a day, after 6 days of latency. DO was performed until the TD reached the opposite margin over the gap in 5-6 days. Three cats each of group 1 were killed at 2, 4, 6, 8 and 12 weeks after completion of DO. In group 2, the bone and soft-tissue defects were untreated until death 6 weeks later. Group 3 cats (control) were killed after 6 weeks. The TD successfully recombined with the opposite palatal bone stump, and proportional expansion of the overlay mucoperiosteal flap was achieved. Intramembranous bone formation was revealed: parallel collagen bundles gradually deposited on new bone trabeculae while the proliferative osteoblasts produced bone matrix. The bone defect was finally reconstructed by de novo osteogenesis. The control group was observed to have no spontaneous repairing. These results suggest that the CP defect was reconstructed by osteogenesis in situ, and the soft tissues expanded simultaneously to achieve functional correction. The intraoral distractor provided both effective distraction and stability.

Odontogenic keratocyst now officially known as keratocystic odontogenic tumuor, treatment has been part of numerous discussions over the years. Based on a literature review, more aggressive treatment like resection or enucleation supplemented with carnoy’s solution with or without peripheral ostectomy results in a lower recurrence rate. However, reported recurrence rate after marsupilization followed by enucleation is not significantly higher than that after aggressive modalities. We are presenting a case series of 21 patients (27 KCOT’S) of size varying from 2 to 15 cm (average of 10 cm) anteroposteriorly treated by various modalities at our center. Long term follow up results shows 29% recurrence, all of them recurring within first two years which is consistent with published data. We want to stress upon the fact that histology, age of patient and extent play an important role in deciding final treatment modality. Although the future treatment may involve molecular based modalities and hence eliminate need for aggressive surgical management but as of now in our experience most effective treatment are enucleation supplemented with carnoy’s solution or marsupilization with later cystectomy and more ablative surgery in rare cases. All these possibilities will be discussed in the presentation for best possible treatment for complex pathology like odontogenic keratocysts.