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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 6  |  Issue : 1  |  Page : 23-25

Modified access osteotomy for a rare pterygoid plate osteoma: A technical note


Department of Surgical Oncology, Kilpauk Medical College, Government Royapettah Hospital, Chennai, Tamil Nadu, India

Date of Web Publication23-Apr-2019

Correspondence Address:
Subbiah Shanmugam
Department of Surgical Oncology, Kilpauk Medical College, Government Royapettah Hospital, Chennai - 600 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_6_19

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  Abstract 


Osteomas are benign bone tumors which are rarely seen in the maxillofacial region. This is a technical note of modified access osteotomy for a rare pterygoid plate osteoma with good cosmetic and functional results.

Keywords: Modified access osteotomy, osteomas, pterygoid


How to cite this article:
Shanmugam S, Govindasamy G, Hussain SA, Thanikachalam R. Modified access osteotomy for a rare pterygoid plate osteoma: A technical note. J Dent Res Rev 2019;6:23-5

How to cite this URL:
Shanmugam S, Govindasamy G, Hussain SA, Thanikachalam R. Modified access osteotomy for a rare pterygoid plate osteoma: A technical note. J Dent Res Rev [serial online] 2019 [cited 2019 Jul 16];6:23-5. Available from: http://www.jdrr.org/text.asp?2019/6/1/23/256807




  Introduction Top


Treatment of various pathologies which occurs in the facial skeleton and skull base poses a great surgical challenge owing to the anatomical complexity, difficulty in access, and proximity of vital structures. A multidisciplinary approach is often required in these situations to prevent damage to the vital anatomic structures and complete removal of the lesions. This article describes in detail about the modified access osteotomy for a rare pterygoid plate osteoma excision with good cosmetic and functional outcomes.


  Case Report Top


A 16-year-old female patient came with complaints of swelling inside the oral cavity for 1 month. On examination, the patient had a bony swelling behind the right side of the soft palate and posterior pillar. Computed tomography paranasal sinus (plain and contrast) showed a large osteoma in the right pterygoid bone (3.2 cm × 3.6 cm) [Figure 1].
Figure 1: Preoperative computed tomography showing the osteoma

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Technique

  • Under general anesthesia with left nasotracheal intubation
  • Incision: Weber–Fergusson incision with subciliary Diffenbach extension [Figure 2] was put.
  • Upper cheek flap raised up to 1 cm from incision
  • By preserving orbital rim, maxillary osteotomy was done to pedicle the maxillary bone with the upper cheek flap
  • Anterior wall of maxillary sinus osteotomized and the incision continued to the hard palate
  • Hard palate was incised in the midline up to soft palate–hard palate junction. In the upper part of the incision, zygoma was exposed [Figure 3] and osteostomized
  • Maxilla along with skin was retracted laterally. A 5 cm × 4 cm osteoma in the right pterygoid plate causing bulging of the soft palate was confirmed
  • Pterygoid bone with attached tumor was visualized and removed in toto. Maxillary antral mucosa was scraped out
  • Maxilla was repositioned and fixed with zygoma laterally and medially with contralateral maxilla with three-hole angle dental plates and six-hole straight plates
  • Upper cheek flap was closed in layers after stabilizing the maxilla with upper (19 gauge SS wire) arch bar.
Figure 2: A standard Weber–Fergusson maxillectomy incision is used, with a lateral (Diffenbach) extension

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Figure 3: Osteoma exposed by modified access osteotomy with maxillary swing

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Videos for the entire procedure: Video 1.



Histopathology of the mass was consistent with osteoma. Postoperative period was uneventful. On follow-up, the patient had good occlusion and esthetic results [Figure 4] and [Figure 5].
Figure 4: Postoperative photograph

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Figure 5: Postoperative X-ray

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  Discussion Top


The term “transfacial” has been employed to describe any procedure that mobilizes the midface through a facial incision irrespective of the extent of midface disassembly used. The modified transfacial lateral rotation technique as described by Hernández Altemir[1] gives good access to the retromaxillary area. In contrast to transmaxillary techniques which resect parts of the maxilla, no dental structures are sacrificed, there is no risk of necrosis of the maxilla and no second stage reconstruction is necessary. We used this technique with maxillary swing to gain wide exposure to remove the osteoma. The zygoma and maxilla are mobilized pedicle on the overlying soft tissues. The vascularization of the pedicle on which the maxilla is based is mainly secured by the facial and transverse facial arteries. Mobilization of these bones as free fragments is avoided if possible, in order to reduce the risk of infection and resorption. Osteomas are rare benign tumors of bone commonly seen in the maxillofacial skeleton. It is characterized by proliferation of either compact or cancellous bone in an endosteal or periosteal location.[2] The most common site is the frontal sinus, followed by the ethmoidal and maxillary sinuses. Peripheral osteoma has been described rarely in the temporal bone and pterygoid plates.[3] The modified access osteotomy technique (modified transfacial lateral rotation technique) with maxillary swing which gave wide exposure for removal of the osteoma without much morbidity.


  Conclusion Top


This technical note deals with use of modified access osteotomy for surgical removal of a rare pterygoid plate osteoma and the good functional and cosmetic outcome following surgery.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to thank Dr. Rajendran Appadurai, MDS, Oral and Maxillofacial Surgery, associate professor, Tamil Nadu Government Dental College and Hospital, Chennai, and Dr. Lingeshwar Deenadayalan, MDS, assistant professor, Department of Prosthodontics, Tamil Nadu Government Dental College and Hospital, Chennai, for intraoperative assistances.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hernández Altemir F. Transfacial access to the retromaxillary area. J Maxillofac Surg 1986;14:165-70.  Back to cited text no. 1
    
2.
Frölich MA. Mandibular osteoma: A case of impossible rigid laryngoscopy. Anesthesiology 2000;92:261-2.  Back to cited text no. 2
    
3.
Lew D, DeWitt A, Hicks RJ, Cavalcanti MG. Osteomas of the condyle associated with Gardner's syndrome causing limited mandibular movement. J Oral Maxillofac Surg 1999;57:1004-9.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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