Precision of Proximal Segment Repositioning Using Digitally Planned Custom Made guide in Sagittal Split Ramus Osteotomy

Background: Orthognathic surgery is widely used surgical procedure. The most common used orthognathic surgical procedure is bilateral sagittal split osteotomy (BSSO) that is used for managing skeletal mandibular excess, deficiency or asymmetry. Objective: To   correct functional and aesthetic problems. Patients and Methods: A total of (12 patients) 24 condyles have been included in our study all with cl II malocclusion, open bites and asymmetry, both genders males and females, their age ranges between18 to 40 years, all the cases had preoperative and postoperative CT scans. Results: By comparing pre and post operative CT scans regarding condylar positions for both groups. The results revealed that there was less movement of condylar head in group with device and direction of movement was more favorable. Conclusion: This study showed that the Digitally Planned Custom Made guide was useful in repositioning condyles with minimal movement post operatively and more favorable direction of movement

Extranodal Natural Killer/T-cell Lymphoma in a Child with a Prior History of Nasal Trauma: a Case Report

Introduction: Facial lesions usually have a benign self-limited prognosis, but in rare cases they have a poor outcome. Extranodal natural killer/T-cell lymphoma (ENK/TCL) is a rare aggressive lesion presenting with a midline facial lesion that can easily be misdiagnosed. Diagnosis is often difficult and requires a thorough clinical examination and the use of immunohistochemistry for analysis of biopsies. Such malignancies affecting the head and neck area provide an interesting but difficult diagnosis. The purpose of this article is to report a severe case of ENK/TCL-nasal type in a boy with a previous history of nasal trauma. Case presentation: An 11-year-old boy was referred to the maxillofacial unit of Sulaimany Teaching Hospital, Iraq, with midline facial destruction. The patient stated that about 6 months prior he had fallen down and suffered nasal trauma; 3 months after the trauma, an asymptomatic ulcer appeared and gradually increased in size. Two biopsies were performed with no conclusive results. In the third biopsy, histology showed atypical lymphoid tissue surrounded by intense necrosis. The diagnosis was confirmed by immunohistochemistry. The treatment of choice was chemotherapy followed by radiotherapy. The patient had a satisfactory response but 2 months later during chemotherapy the patient unfortunately died from a pulmonary embolism. Conclusion: Suspicious midline ulcerative lesions in the head and neck region must have ENK/TCL considered in the differential diagnosis and repeated biopsies may be necessary to confirm the diagnosis

Extranodal Natural Killer/T-cell Lymphoma in a Child with a Prior History of Nasal Trauma: a Case Report

Introduction: Facial lesions usually have a benign self-limited prognosis, but in rare cases they have a poor outcome. Extranodal natural killer/T-cell lymphoma (ENK/TCL) is a rare aggressive lesion presenting with a midline facial lesion that can easily be misdiagnosed. Diagnosis is often difficult and requires a thorough clinical examination and the use of immunohistochemistry for analysis of biopsies. Such malignancies affecting the head and neck area provide an interesting but difficult diagnosis. The purpose of this article is to report a severe case of ENK/TCL-nasal type in a boy with a previous history of nasal trauma. Case presentation: An 11-year-old boy was referred to the maxillofacial unit of Sulaimany Teaching Hospital, Iraq, with midline facial destruction. The patient stated that about 6 months prior he had fallen down and suffered nasal trauma; 3 months after the trauma, an asymptomatic ulcer appeared and gradually increased in size. Two biopsies were performed with no conclusive results. In the third biopsy, histology showed atypical lymphoid tissue surrounded by intense necrosis. The diagnosis was confirmed by immunohistochemistry. The treatment of choice was chemotherapy followed by radiotherapy. The patient had a satisfactory response but 2 months later during chemotherapy the patient unfortunately died from a pulmonary embolism. Conclusion: Suspicious midline ulcerative lesions in the head and neck region must have ENK/TCL considered in the differential diagnosis and repeated biopsies may be necessary to confirm the diagnosis

A Rare Case of Gorlin-Goltz Syndrome Presented to the Emergency Department as Facial Swelling

Introduction: Gorlin-Goltz syndrome (GGS), also known as basal cell nevus syndrome, is a very rare autosomal dominant inherited disorder that is characterized by the development of numerous basal cell carcinoma. This article reports a case of GGS, emphasizing its clinical and radiographic manifestations. Case presentation: We report here the case of a 35-year-old man who visited the maxillofacial emergency department due to left facial swelling. According to his clinical and radiographic examination we diagnosed him with GGS with no family history. The patient has multiple odontogenic keratocysts, rib anomalies, calcifications of the falx cerebri, lower jaw prognathism, frontal bossing, macrocephaly, and thick eyebrows. Conclusion: A definitive diagnosis of GGS should be made by a multidisciplinary team including a maxillofacial surgeon and medical specialists. Early diagnosis, treatment, and regular follow up are important to decrease complications, including oromaxillofacial deformation and destruction, and possible malignancy

A novel approach for underpreparation protocol in dental implant with low bone quality depending on hounsfield unit presurgically

Objective: The purpose of this research was to adapt a normal or undersized implant preparation protocol for different bone densities depending on the density measure (Implant stability quotient ISQ, Newton centimeter NCM) and from Cone Beam Computed Tomography reading pre-surgically. To eliminate the need for practice and experience in inserting implants in poor bone quality areas to enhance implant primary stability and survival rate. Material and methods: Fifty-nine patients were selected for inclusion in the study. A total of fifty-nine implants were placed. Insertion torque data were recorded, resonance frequency analysis measurements were taken at first stage surgery, and Hounsfield Unit HU was assessed before surgery and kept hidden to prevent bias. The implant preparation protocol divided the patients into two groups whether standard or undersized, which was determined according to the tactile sensation of the operator. Depending on primary stability measures (ISQ, NCM) samples were divided into 4 subgroups. Finally, HU measurements were taken from subgroups with high stability measures to assess whether to do a standard or underprepared surgical preparation. Result:  the result showed a positive and strong correlation with a high significance between ISQ, HU, and insertion torque

The effect of field number on intensity modulated radiation therapy plan quality in head and neck cancer

Background: Radiotherapy of head and neck cancer is a difficult process because of the complex anatomy and close proximity of various organs at risk (OARs). This study aimed to assess the impact of field number of intensity modulated radiation therapy (IMRT) technique on the quality of the treatment of the head and neck cancer patient.. Methods and materials: The CT scans of thirteen head and neck cancer patients were selected at the Zhianawa Cancer Center (ZCC).  The Monaco treatment planning system (TPS) V5.51.10 with the Monte Carlo (XVMC) algorithm V1.6 were utilized to generate nine and eleven field IMRT plans, all plans were carried out on an ELEKTAMLCi2 linear accelerator. The effect of field number was assessed by planning target volume (PTV) coverage, homogeneity index (HI), conformity index (CI), OARs dose, the monitor units (MUs), and delivery time. Results: The 11F-IMRT had improved tumor coverage and better spared ipsilateral and contralateral optic nerves, on the contrary the doses to the were above acceptance limit value. The CI of 11F-IMRT was better than 9F-IMRT, while the HI was similar. The 9F-IMRT had a reduced treatment time by 37.7 %, although increased MUs by 12.8%.&nbsp

Surgical management of Stenson’s duct injury by using double J stent urethral catheter

Background: Parotid duct or gland injury can be caused by assault with a knife, bottle, electrical-saw, road traffic accident, or rarely gunshot and fractures of the facial skeleton. The injury can be in the form of laceration, ductal exposure, total cutting, or crushing of the duct. These conditions are difficult to diagnose because of complex anatomy and variable forms of the injury. A successful management of parotid duct injuries depends on early diagnosis and appropriate intervention; improper surgery may lead to complications such as sialocele or salivary fistula Case report: A 27-years-old man was presented to the maxillofacial unit, complaining of bleeding over the right side of his face after accidental exposure to a chain-saw three hours before admission. On examination, a 6 cm deep lacerated wound was found over the right buccal area, suspecting facial nerve-buccal branch and parotid duct injury. Under general anesthesia the parotid duct injury diagnosed, microsurgical anastomosis of the cut-ends of the parotid duct performed using the double J catheter. Sutures and JJ stent removed seven and twenty postoperative days respectively. After a proper supportive treatment a complete healing of the duct was obtained with normal amount of saliva. Conclusions: Herein, we described an easy yet efficient technique in management of parotid duct injury using a JJ stent which is often used for urethra. We think that use of JJ stent is a valuable technique to be used in the diagnosis and surgical repair of the parotid duct during traumatic facial and/or parotid injuries

Extranodal Natural Killer/T-cell Lymphoma in a Child with a Prior History of Nasal Trauma: a Case Report

Introduction: Facial lesions usually have a benign self-limited prognosis, but in rare cases they have a poor outcome. Extranodal natural killer/T-cell lymphoma (ENK/TCL) is a rare aggressive lesion presenting with a midline facial lesion that can easily be misdiagnosed. Diagnosis is often difficult and requires a thorough clinical examination and the use of immunohistochemistry for analysis of biopsies. Such malignancies affecting the head and neck area provide an interesting but difficult diagnosis. The purpose of this article is to report a severe case of ENK/TCL-nasal type in a boy with a previous history of nasal trauma. Case presentation: An 11-year-old boy was referred to the maxillofacial unit of Sulaimany Teaching Hospital, Iraq, with midline facial destruction. The patient stated that about 6 months prior he had fallen down and suffered nasal trauma; 3 months after the trauma, an asymptomatic ulcer appeared and gradually increased in size. Two biopsies were performed with no conclusive results. In the third biopsy, histology showed atypical lymphoid tissue surrounded by intense necrosis. The diagnosis was confirmed by immunohistochemistry. The treatment of choice was chemotherapy followed by radiotherapy. The patient had a satisfactory response but 2 months later during chemotherapy the patient unfortunately died from a pulmonary embolism. Conclusion: Suspicious midline ulcerative lesions in the head and neck region must have ENK/TCL considered in the differential diagnosis and repeated biopsies may be necessary to confirm the diagnosis