Hideto Saijo

In a 21-year-old male with bilateral cleft lip who developed marked venous congestion of a lip switch flap, we returned the grafted flap to the donor site to improve blood circulation of the flap and then re-transplanted it, which prevented flap necrosis. Here, we report the procedure and case.

Odontogenic myxoma is a benign odontogenic tumor with locally aggressive behavior, and is relatively rare in the oral cavity. There are currently no clear surgical management guidelines for odontogenic myxoma, and a variety of approaches may be used. This study evaluated the literature concerning the surgical management of odontogenic myxoma, and reports the long-term outcome of a case managed by using a more conservative surgical approach. We managed a 40-year-old Japanese man with odontogenic myxoma in the right mandible by enucleation and curettage, a relatively conservative approach that has proved to have been justified by a lack of recurrence over 10 years. Our strategy was compared with others reported in the literature, which was identified by a PubMed search using the term “odontogenic myxoma”. Articles without full text or with missing data were excluded. The age and sex of patients, the tumor location (maxilla/mandible), treatment (conservative/radical), recurrence, and follow-up period were compared in the reported cases that we evaluated. From the initial 211 studies identified, 20 studies qualified as mandibular cases of odontogenic myxoma. Recurrence was reported in three cases that had been treated with a more conservative surgical approach. Enucleation and curettage has proved an effective approach in several cases in ours there has been no recurrence more than 10 years after surgery but the risk of recurrence appears to be higher. We discuss the important factors that must be considered when determining the correct management approach to odontogenic myxoma.

Hard tissue reconstruction is very useful for bony defects of the maxillofacial region. Autogenous bone, allogeneic bone, and artificial bone have been used to reconstruct maxillofacial bone; however, the use of autogenous bone involves high surgical invasiveness because of the need to harvest the bone. The use of allogeneic bone is associated with infections, raises ethical concerns, and is not widely used in Japan. Artificial bone has several advantages, including no need for bone harvesting, excellent biocompatibility, and a relatively easy surgical procedure. Use of artificial bone avoids the much greater invasiveness of harvesting bone, and several types of artificial bone have been developed. Design requirements for artificial bone include surgical manipulability, structural compatibility with the defective area, support properties, and the ability to induce bone regeneration; however, no artificial bone meeting all these requirements has yet been developed. Artificial bone is used in many patients in our medical center, and we have been active in developing the next generation of artificial bone with better properties. In this article, we present a case history and discuss the future development of artificial bone for use in maxillofacial reconstruction.