• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.2
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• pp.186-195
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• 1994

Fibromatosis is benign fibroblastic proliferative lesion with abundant collagenous neo-formation located principally in the abdominal wall and in the upper and lower extremities (Masson & Soule, 1966). Wilkins and Waldron, in 1975, suggested that the title aggressive fibromatosis was a more appropriate term, reflecting the invasive characteristics of the disease. Synonyms listed were extra-abdominal desmoid, juvenile fibromatosis, aggressive infantile fibromatosis and congenital fibrosarcoma. A total of 12% of all fibromatosis arise in head and neck. Fibromatosis of the oral cavity is uncommon and is even more rare when in involve the mandibule. It is a locally aggressive fibrous tissue tumor, generally does not metastasize, but may cause considerable morbility and even death due to local infiltration. The degree of microscopic cellularity is variable, not only from tumor to tumor but also from area to area in the same tumor. Some tumors present with proliferation of mature fibroblasts and a dominating collagenous component : others may show a lack of the tumor in both types. The common histologic denominator appears to be cellular interlacing bundles of elongated fibroblasts, showing little or no mitotic activity and no pleomorphism. Mitosis are not a consistent index of malignancy when found in younger age groups. Fibromatosis still posses difficult problems of diagnosis and treatment. It is frequently recurrent and infliltrates neighbouring tissues. These lesion infliltrate widely and replace muscle, fat, and even bone with fibrous tissue of varying cellularity. Lesion representing fibromatosis in the oral cavity must be carefully evaulated by both surgeon and pathologists to ensure proper diagnosis and treatment planning. When these lesions involve bone, surgeon must be aware of the lesion's potential to perforate the cortex and expand while remaining hidden from the surgeon's view. Careful and precise clinical correlation with histologic appearance is essential to preclude misdiagnosis of fibrosarcoma yet provide surgical treatment plan that provides adequate local excision and long-term follow up. As regards cause, little is known. It is attributed to trauma or alteration in the sex hormone(Carlos, et al, 1986). Clinially, the lesion is reported to be not painful in most cases, but capable of rapid growth. The treatment is essentially surgical excision with wide margin of adjacent uninvolved tissue. Radiotherapy, hormone treatment or chemotherapy are of no use (WIkins et al, 1975 ; Majumudar and Winiarkl, 1978). We report a case of aggressive fibromatosis of 15-year-old with a lesion in the soft tissue of the parotid area that invaded the underlying bone of the mandibular body.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.5
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• pp.408-413
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• 2009

Odontogenic keratocyst (OKC) is a epithelial developmental cyst which were first described by Phillipsen in 1956. The frequency of OKC has been reported to vary from 3% to 11% of odontogenic cysts. The most characteristic clinical aspect of OKC is the high frequency of recurrence. The mechanism of recurrence is thought to be related to residues of cyst epithelium and an intrinsic growth potential following excision. And since the lining of the OKC is thin and friable, removal of the cyst in one piece may sometimes be difficult. Complete removal of the cyst lining without leaving behind remnants attached to the soft tissue or bone is necessary to avoid recurrence. Therapeutic approaches vary in different studies from marsupialization and enucleation, which may be combined with adjuvant therapy such as cryotherapy or Carnoy's solution, to marginal or radical resection. The recurrent rate varies from approximately 20% to 62%. And OKC in the angle-ramus region of the mandible had a higher tendency to recur, because of the difficulty in accessing and removing OKC from the ramus. By employing a sagittal splitting of the mandible a good surgical access was provided and cyst could be removed completely. We present an illustrative case of a small, lobulated OKC that involved ramus on mandible, and a review of the contemporary literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.5
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• pp.386-393
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• 2009

Objectives: This study was performed to evaluate course of the inferior alveolar canal in the mandibular ramus and to find safety zone when ramal bone is harvested. Patients and Methods: From January, 2009 to February, 2009, the 20 patients who visited in the Department of Oral and Maxillofacial Surgery, Sanbon Dental Hospital. Wonkwang University and the Conebeam CT was taken of various chief complaints, were selected. The patients who had left and right mandibular first molar and incisor missing, jaw fracture and bone pathology were excluded. The R point was defined as the point which occlusal plane was crossed to the mandibular anterior ramus(external oblique ridge). In the cross-sectional coronal and axial views, the inferior alveolar canal position to the R point, buccal bone width(BW), alveolar crest distance(ACD), distance from alveolar crest to occlusal plane(COD) and inferior alveolar canal to sagittal plane(CS) were measured and horizontal distance(HD), vertical distance(VD) and nearest distance(ND) were measured. Results: The inferior alveolar canal is located $6.19{\pm}1.21\;mm$ from the R point. Horizontal distance from the R point were $13.07{\pm}2.45\;mm$, vertical distance from the R point were $14.24{\pm}2.41\;mm$ and nearest distance from the R point were $10.12{\pm}1.76\;mm$. The course of the inferior alveolar canal was positioned within $0.61{\pm}0.68\;mm$. The distance from external buccal bone to the inferior alveolar canal was increased from the R point anteriorly. Conclusions: It is considered that the mandibular ramus from the R point to 10 mm anteriorly can be harvested safely at ramal bone grafting.

• The Journal of Korean Academy of Prosthodontics
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• v.61 no.1
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• pp.82-89
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• 2023

The tongue is one of the most common sites of oral cancer. Glossectomy is known as the gold standard for tongue cancer treatment. However, surgical removal can lead to reduced mobility of the tongue and the patients may have difficulty performing normal oral functions like swallowing and pronunciation. Therefore, additional prosthetic consideration to supplement the function of the impaired tongue is needed for oral rehabilitation of such patients. Palatal augmentation prosthesis helps the tongue to reach the palate by lowering the position of the palatal polished surface. The oral functions of the patients with limited tongue mobility can be improved by the prosthesis. In this case, palatal augmented maxillary denture and conventional mandibular denture were fabricated for the completely edentulous patient with reduced tongue mobility after glossectomy due to tongue cancer. As a result, the oral functions of the patient were improved with the prosthesis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.4
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• pp.350-359
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• 2005

Sagittal split ramus osteotomy(SSRO) has been commonly performed in the mandibular prognathism. The previous studies of the mandibular anatomy for SSRO have mostly been used in dry skull without consideration of age, sex or jaw relationship of patients. This study was performed to evaluate the location of mandibular canal and the anatomy of ramus, such as the location of mandibular lingula and the ramal bone marrow, which were associated with SSRO procedures, in the patients with mandibular prognathism and normal young adults by using computerized tomographs(CT) and 3D images. The young adults at their twenties, who were considered to complete their skeletal growth, and seen in the Department of Orthodontics and Oral and Maxillofacial Surgery in Chonnam National University Hospital between March 2000 and May 2003, were selected. This study was performed in 30 patients (15men, 15women) who were diagnosed as skeletal class I normal relationship, and another 30 patients (15men, 15women) who were diagnosed as skeletal class III relationship upon clinical examination and lateral cephalometric radiographs. The patients were divided into 2 groups : Class I group, the patients who had skeletal class Ⅰ normal relationship(n=30, 15men, 15women), and Class III group, the patients who had skeletal class III relationship(n=30, 15men, 15women). Facial CT was taken in all patients, and pure 3D mandibular model was constructed by V-works version 4.0. The occlusal plane was designed by three points, such as the mesiobuccal cusp of both mandibular 1st molar and the incisal edge of the right mandibular central incisor, and used as a reference plane. Distances between the tip of mandibular lingula and the occlusal plane, the sigmoid notch, the anterior and the posterior borders of ramus were measured. The height of ramal bone marrow from the occlusal plane and the distance between mid-point of mandibular canal and the buccal or lingual cortex of the mandible in the 1st and 2nd molars were measured by V-works version 4.0. Distance(Li-OP) between the occlusal plane and the tip of mandibular lingula of Class III Group was longer than that of Class I Group in men(p<0.01), but there was no significant difference in women between both groups. Distance(Li-SN) between the sigmoid notch and the tip of mandibular ligula of Class III group was longer than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(Li-RA) between the anterior border of ramus and the tip of mandibular lingula of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Distance(Li-RP) between the posterior border of ramus and the tip of mandibular lingula of Class III Group was slightly shorter than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(RA-RP) between the anterior and the posterior borders of ramus of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Longer the distance(SN-AN) between the sigmoid notch and the antegonial notch was, longer the vertical ramal length above occlusal plane, higher the location of mandibular lingula, and shorter the antero-posterior ramal length were observed(p<0.01). Height of ramal bone marrow of Class III Group was higher than that of Class I Group in men and women(p<0.01). Distance between mandibular canal and buccal cortex of Class III Group in 1st and 2nd lower molars was shorter than that of Class I Group in men and women (p<0.05 in 1st lower molar in men, p<0.01 in others). These results indicate that there are some anatomical differences between the normal occlusal patients and the mandibular prognathic patients, such as the anterior-posterior length of ramus, the height of ramal bone marrow, and the location of mandibular canal.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.4
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• pp.253-268
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• 1993

The author studied on the 109 cases of ameloblastoma which had been diagnosed with biopsy during the period of 1962 to 1992 at the Kyungpook National University Hospital, Kyemyung University Hospital, Youngnam University Hospital, Catholic Medical School Hospital, Pusan National University and Maryknoll Hospital. This study contains the statistical analysis of the treatment method according to the clinicopathological findings such as sex, age, location, chief complaints, duration, radiographic findings, size and recurrence. The results were as follows : 1. The incidence rate was 59.7% in male and 40.3% in female. 2. At the time of diagnosis, the age of the patients ranged from 9 to 69 years(average 31.4years). The cases of 72.4% were in the 2nd, 3rd, and 4th decades of life. 3. The majority of cases occurred in the mandible 88.9%, especially in the mandiblar angle area 57.8%. 4. The most prevalent chief complaints was swelling 58.7%. 5. As regards duration, the cases less than 1 year appeared 49.5% and average duration is 31.34months. 6. Unilocular type showed 43.1% and multilocular type appeared 56.9%. 7. Conservative treatment was performed 39.4% and radical treatment was employed 60.6%. 8. There were variations of lesional sizes between 2.0cm and 15cm(average 6.26cm). 9. The recurrence rate is 29.4%. 10. The frequency of treatment was not in association with sexes, locations, chief complaints and sizes. 11. Radical treatment was performed more frequently in cases of older age group(above 20 years old), multilocular cases, above average duration(31.34 months) group and recurrent cases (P<0.05).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.5
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• pp.404-416
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• 2006

Purpose : This study was to clarify the changes in mandibular condyle after unilateral mandibular distraction osteogenesis throughout histological changes and expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2). Materials & Methods : Intraoral distractors were placed via submandibular incision in 8 dogs. Two unoperated animals served as controls. Distraction was performed five days after osteotomy as a rate of 0.5 mm twice per day for 10 days. Two animals were sacrificed on 7, 14, 28, and 56 days after completion of distraction, respectively. Ipsilateral condyles were harvested and processed for histological and immunohistochemical examinations. Results : The condyle cartilage is separated into four layers: fibrous layer, proliferative layer, hypertrophic layer, and calcified layer. At 7 days and 14 days after distraction, the condylar cartilage showed the decreased thickness of the articular cartilage and reduced cellularity. At 28 days after distraction, there was an increase in cellularity of fibrous, proliferative, and hypertrophic layer. However, it demonstrated reduced cellularity compared to the control. At 56 days of after distraction, the articular cartilage was an almost normal histologic structure. Positive Safranin-O staining, indicative of sulfated proteoglycans, was examined in the condylar cartilge of nonloaded control. At 7 days and 14 days after distraction, the sulfated proteoglycans is almost completely depleted from the noncalcified part of the condylar cartilage. At 28 days after distraction, there was an increase in Safranin-O staining intensity. However, the staining intensity of the experimental condyle was weaker than that of the control. At 56 days of after distraction, the condylar cartilage showed almost normal Safranin-O staining pattern. In control condyle, MMP-2 immunostaining was seen in fibrous, proliferative, and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in fibrous and proliferative layer. At 7 days and 14 days after distraction, strong MMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, MMP-2 immunostaining was seen in the fibrous and hypertrophic layer of condylar cartilage, however, their immunoactivity was reduced. At 56 days after distraction, MMP-2 immunoreactivity showed almost normal immunostaining pattern. In control condyle, TIMP-2 immunostaining was primarily seen in fibrous and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in proliferative layer. At 7 days after distraction, very weak TIMP-2 immunoreactivity appeared in fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 14 days after distraction, weak TIMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, TIMP-2 immunoreactivity was increased in the fibrous and hypertrophic layer of condylar cartilage. At 56 days after completion of distraction, TIMP-2 immunoreactivity showed almost normal immunostaining pattern. Conclusions : The results show that short-term outcome of physiologic distraction osteogenesis may lead to degenerative changes in the condylar cartilage. These alterations in the condylar cartilage may be considered as a pressure-related degeneration of the cartilage tissue. However, the long-term results suggest that the condylar cartilage display repair activity after mandibular distraction osteogenesis.