Mandibular condyle reconstruction with fibula free-tissue transfer

September 7, 2012     Eric J. Moore, MD; Steven S. Hamilton, MD


We conducted a study to evaluate functional and cosmetic outcomes following reconstruction of the mandibular condyle with direct placement of a vascularized free fibula. We retrospectively reviewed the cases of all patients who had undergone hemimandibulectomy and condyle resection with immediate reconstruction at the Mayo Clinic in Rochester, Minn., between Nov. 1, 2005, and Jan. 31, 2007. We found 7 such cases, all of which occurred in men aged 32 to 61 years (mean: 50.7). Six of these patients had a malignancy and 1 had osteomyelitis. Postoperatively, 6 patients had no difficulty with occlusion, which was rated as “good” or “excellent” at their 6-month follow-up visit; the other patient had an open-bite deformity, but he was able to masticate solid food and maintain an oral diet. Cosmesis was generally satisfactory, and all patients maintained intelligible speech. We conclude that free fibula transfer with direct seating of the fibula into the condylar fossa followed by aggressive physiotherapy provides acceptable functional reconstruction of the mandibulectomy-condylectomy defect.

An expansile mandibular mass as the initial manifestation of hepatocellular carcinoma

February 1, 2011     J. Clinton Lasiter, MD, Benjamin D. Liess, MD, Robert P. Zitsch III, MD, and Jessica Wieberg, MD


Hepatocellular carcinoma (HCC) is one of the most frequently encountered malignancies. Distant metastasis is a common sequela, occurring in approximately 50% of cases. Metastasis to the oral cavity is very rare. Careful immunohistochemical evaluation is critical in differentiating HCC from other metastatic malignancies. An understanding of the possibility that HCC may initially present as a mandibular metastasis is crucial to guide management. We describe the case of a 76-year-old man with a 3- to 4-month history of a painless, slowly enlarging, left-sided jaw mass. Biopsy findings were consistent with HCC. While the patient was a known hepatitis C carrier, the presence of HCC had been previously unknown. Additional workup revealed a large hepatic lesion. In view of his poor health, the patient elected to forgo chemotherapy, and he entered a hospice facility. This case provides an illustration that an isolated mandibular mass may represent the initial presentation of HCC. Subsequent identification of the primary tumor via radiographic and pathologic evaluations is important for the guidance of further management.

Malignant fibrous histiocytoma of the mandible

September 30, 2010     Lana E. Brahmakulam, DO and Bosco E. Noronha, MD, FRCS(Eng), FRCE(Ire)


Malignant fibrous histiocytoma (MFH) of the mandible is rare. We describe a case of MFH of the mandible with metastatic disease to the lungs. To our knowledge only 30 cases have been reported prior to the present case. In previously reported cases, there was a strong tendency for the posterior portion of the mandible to be affected by MFH; ours is only the second reported case involving the anterior portion of the mandible. We review the diagnosis, pathology, and treatment of this rare malignancy.

Paget disease and chronic osteomyelitis of the mandible

March 31, 2010     Hootan Zandifar, MD, Jason S. Hamilton, MD, Ryan F. Osborne, MD, Ron E. Walsh, NP, and Robert M. Kellman, MD

Carcinoma of the prostate presenting as a painful parotid mass with mandibular invasion: A case report

December 1, 2009     Christian S. Head, MD, Khashayar Hematpour, MD, Joel Sercarz, MD, Quang Luu, MD, and Carol J. Bennett, MD


Prostate cancer metastatic to the parotid gland is exceedingly rare, as only 10 cases have been previously reported in the literature. Symptoms may mimic a parotid infection or suggest a primary parotid tumor. We report a new case of carcinoma of the prostate metastatic to the parotid. The tumor was painful and had invaded the mandible. Fine-needle aspiration of the mass and immunohistochemical staining for prostate-specific antigen confirmed the diagnosis. The patient died 1 month later of an unrelated cause.

Surgical treatment is warranted in aggressive central giant cell granuloma: A report of 2 cases

March 1, 2009     Jason Roberts, MD, Carol Shores, MD, and Austin S. Rose, MD


Central giant cell granuloma (CGCG) is a benign but locally destructive lesion of the mandible or maxilla that presents most often in the second and third decades of life. Reports of treatment include curettage or complete en bloc resection and nonsurgical approaches such as intralesional steroid injections, interferon alfa-2a, and calcitonin. We describe the cases of 2 young adults with CGCG of the maxilla involving the palate. The first patient, an 18-year-old man, was initially treated with a partial maxillectomy via a facial degloving approach and a postoperative series of transoral intralesional steroid injections to the site of the residual hard palate disease. The partial maxillectomy achieved a near-total debulking of the mass and immediate cosmetic improvement, and the steroid injections resulted in initial regression of the residual disease. However, the patient experienced a recurrence 8 months postoperatively, so a bilateral total inferior maxillectomy via a facial degloving approach was performed with subsequent placement of an obturator. No recurrence was seen 15 months following revision surgery. In view of the incomplete resolution of disease with the use of steroid injections in the first patient, we treated the second patient, a 22-year-old woman, with a subtotal maxillectomy without steroid injection. No recurrence of disease was noted 12 months postoperatively. We conclude that a combination of partial surgical resection and intralesional steroid injection may not be sufficient for the treatment of large CGCGs of the maxilla. Complete surgical resection should be considered for the initial treatment of CGCG, particularly in aggressive cases.

Gorham disease of the mandible: Radiographic findings and radiotherapy response

June 1, 2008     Thomas B. Skidmore, MD, Christopher M. Lee, MD, Thomas M. Abbott, MD, Richard H. Wiggins III, MD, Gregory E. Anderson, DDS, Jonathan D. Tward, MD, and Ying Hitchcock, MD


Gorham disease, a rare condition of unknown etiology, is characterized histologically by bone disintegration and endothelial proliferation. We describe serial imaging findings, the treatment course, and radiotherapy response in a patient with pathologically confirmed Gorham disease involving the right mandible. Progressive mandibular resorption was managed initially with multiple surgical resections and reconstruction, followed by external-beam radiotherapy, which was an effective treatment method in this case. The patient's reconstructed mandible is functional and he is asymptomatic. Our literature review provides further insights regarding the clinical, radiologic, and pathologic behavior of this entity and examines the available treatment strategies.

Synovial chondromatosis of the temporomandibular joint space

May 31, 2005     Jason S. Hamilton, MD; Sean Jones-Quaidoo, MD; Ryan F. Osborne, MD

Infantile cortical hyperostosis of the mandible

June 30, 2004     Santiago Restrepo, MD; Ana Maria Sánchez, MD; Enrique Palacios, MD, FACR

Ossifying fibroma of the jaw

June 30, 2004     Francis H. Gannon, MD; Lester D.R. Thompson, MD

Organ of Chievitz

April 1, 2004     Liron Pantanowitz, MD; Jaime Antonio Tschen, MD
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