Introduction: Tori are benign hamartoma-like bone excrescences, usually asymptomatic. Their removal should not be systematic. Observation: A 62-year-old patient showed bilateral tori only leaving a 1.5 mm space for the lingual frenulum path between them. The direct functional consequence was a frequent blockage of the salivary caruncles below the tori. Tori resection was performed under local anaesthesia. Surgical outcome was simple with conventional analgesic treatment and oral care. Comfort and function were immediately restored. Discussion: The originality of this case does not lie in the nature of the lesions but in the uncommon size of their hypertrophy, which caused a lingual functional impairment. We have not found a similar case described in the literature.
Introduction: Projection of the maxillary third molar into the temporal or infra temporal fossa is a rare complication. There is no recommendation for the management of such complication. The aim of this work is to try establishing a removal protocol. Materials and methods: A systematic review of the literature was conducted using all cases reports of iatrogenic projection of the tooth into the temporal fossa or infratemporal fossa and how they were treated. The last search was conducted in July 2021. Results: 27 cases involving 28 teeth, published between 1986 and 2020 were included. Discussion: The intraoral approach seems to be preferred in the first instance for teeth in the infra temporal fossa and a cutaneous approach for teeth in the temporal fossa. This should be done within 3–6 weeks after projection to attempt removal. This allows the formation of a fibrous capsule and the downward migration of the tooth to facilitate removal. The use of complementary technological means can improve the chances of success. Conclusion: Resulting a flow chart, who is an aid to management of this type of situation, providing a clear idea of the approach to be taken.
Though odontogenic keratocysts (OKCs) are benign lesions, they have a high recurrence rate. Because of their aggressive behavior, they have been classified as tumors by the WHO until 2017. Main differential diagnoses are amelobastoma and dentigerous cyst. Anatomopathological examination can reach a final diagnosis. Several treatments have been proposed: curettage, resection, enucleation (alone or together with peripheral ostectomy) and decompression. Decompression aims to decrease the volume of the lesion of “large” OKCs, in order to prevent surgery-related fractures and to preserve the surrounding important anatomical structures such as the inferior alveolar nerve. It could lead to a complete regression. If not, secondary enucleation can be performed in better conditions: a reduced volume to remove, a thicker epithelium to detach, a lower risk to damage neighboring anatomic structures and a lower recurrence rate. Long-term follow-up however remains necessary. Nowadays, minimally invasive surgery prevails. And since OKC was returned into the odontogenic cysts group in the WHO classification, decompression should be considered as the first intention treatment. The purpose of this paper is to provide an update about OKC features and biological mechanisms, to review the different treatment options and to provide a step-by-step protocol for decompression.
Introduction: There is controversy regarding the use of pharyngeal packing in oral and nasal surgery. The primary objective of this study was to examine the association between pharyngeal packing, throat pain, and postoperative nausea and vomiting (PONV) in head and neck surgery. Material and methods: A systematic review of clinical studies published from January 2000 to August 2020 concerning the use of pharyngeal packing in head and neck surgery was conducted in the Medline, ScienceDirect and Cochrane Library databases. Throat pain and PONV were collected in each article, and a meta-analysis was performed. Results: A total of 10 clinical trials involving 877 patients were included in the meta-analysis. Pharyngeal packing did not significantly decrease PONV score either during the immediate (OR = 0.90, 95% CI: 0.59 to 1.38, p = 0.52, I2 = 0%) or the delayed postoperative period (OR = 0.88, 95% CI: 0.54 to 1.43, p = 0.28, I2 = 21%), but significantly increased the immediate postoperative throat pain score (MD = 0.68, 95% CI: 0.21 to 1.16, p = 0.19, I2 = 35%). Conclusion: This study suggests that the use of a pharyngeal packing to improve the preoperative aftermath in head and neck surgery should not be recommended.
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