Solitary skin-colored nodule on a child’s face

Sir, A healthy, six-year-old boy presented with a slowly grown dome-shaped nodule on the mandibular angle region present for two years. The patient’s past medical and family history were unremarkable. A physical examination revealed a solitary, 1.3 × 1 cm, firm, painless, flesh-colored tumor (Fig. 1). Dermoscopy showed branching, serpentine vessels on a pink background (Fig. 2a). These features disappeared when slight pressure was exerted on the dermoscope and the tumor exhibited a central, white, structureless area (Fig. 2b). An excisional biopsy was performed. A microscopic examination showed a well-circumscribed, paucicellular dermal tumor composed of eosinophilic collagen bundles separated by clefts and forming a storiform pattern. Scattered fibroblasts were found among the collagen bundles. The overlying epidermis was slightly flattened (Fig. 3). The diagnosis of solitary sclerotic fibroma was established. Sclerotic fibroma (SF), also known as storiform collagenoma, is a rare benign skin tumor. It usually manifests itself as an asymptomatic, slowly growing, white-to-skin-colored papule or nodule [1]. It was first described in patients with Cowden’s disease, yet may also occur sporadically [2]. There were no mucocutaneous features of Cowden’s disease (tricholemmomas, oral fibromas, acral keratoses, palmar pits, and gingival and palatal papules) in the patient and her family members. Dermatofibroma, the main differential diagnosis of SF, usually exhibits hyperplastic changes of the epidermis instead of atrophy, and the boundaries of the lesion are unclear [2]. Only two papers have been published describing the dermoscopic findings of SF, consisting of a white background with peripheral arborizing vessels [3]. A white background may be related to an increased dermal collagen density. It is also described in dermatofibroma, typically with a peripheral pigmentation network. Although dermoscopy may improve the clinical diagnosis of SF, histopathological analysis is required.

Medical Image Three-Dimensional Simulation Technology in Hospital Clinical Practice

We performed three-dimensional reconstruction of facial CT scan images of patients with mandibular angle hypertrophy to explore the related factors of mandibular angle hypertrophy. At the same time, the article uses the results of three-dimensional reconstruction to simulate the clinical operation and obtain the final operation method. It was found that all patients were able to obtain the proper surgical plan from the three-dimensional reconstructed images and can get the hypertrophy factor of the mandibular angle. For this reason, we conclude that computer reconstruction simulation technology can obtain the tissue changes before and after osteotomy of mandibular angle hypertrophy and get the cause of hypertrophy. Three-dimensional reconstruction simulation technology is the best auxiliary diagnosis plan for the selection of mandibular angle surgery.

Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review

Objective There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation. Methods PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II). Results Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04–20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I ( P = .043). Conclusions For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.

Age and sex estimation using fractal analysis in Brazilian adults: a discriminant analysis

This study assessed the accuracy of fractal analysis (FA) to estimate chronological age and sex in Brazilian adults for forensic investigations. The gender-balanced sample comprised lateral cephalometric radiographs of 120 individuals, stratified according to age (20-29, 30-39, 40-49, 50-59 years) and sex (female and male). A trained calibrated examiner measured the fractal dimension (FD) of the mandibular ramus and mandibular angle. Linear regression and multiple logistic discriminant analysis were carried out to explore the accuracy of FA. For all analyses, p-values < .05 indicated statistical significance. Overall, mean FD values were 1.49±0.10 for the mandibular ramus and 1.48±0.09 for mandibular angle. Results were more accurate in males than females for discriminating age and sex. The multiple discriminant analysis indicated that FA distinguished sex in 61.7% males and 58.3% females. In addition, the mean difference between actual and predicted value was 9.5 years and 10.1 years for men and women, respectively. Fractal analysis accurately identified sex- and age-related differences in the trabecular pattern of the mandible of Brazilian adults, confirming its utility for forensic investigations. Further studies investigating other populations are needed to assess the accuracy of FA for Forensic Dentistry.

Bone apposition at the mandibular angles as a radiological sign of bruxism: a retrospective study

Background The main objective of this investigation was to determine on panoramic radiographs the prevalence of macroscopically visible alterations (bone apposition in combination with directional change) in the mandibular angle region in bruxism patients. Another aim was to describe and detect different morphological characteristics of the jaw angles. Methods Two hundred panoramic radiographs were studied: 100 images of adults with clinically diagnosed bruxism (73 women, 27 men, age range 21–83 years), 100 images of a comparison group consisting of adolescents (66 girls, 34 boys, age range 12–18 years). Results The morphological changes of the 400 jaw angles could be classified into four degrees. In the adult group, almost half of mandibular angles showed bone apposition. Conversely, the prevalence in the control group was zero. The localization of the appositions corresponds to the insertions of the masseter and medial pterygoid muscles at the mandibular angle. Conclusions The bone apposition at the mandibular angles should be interpreted as a functional adaptation to the long-term increased loads that occur during the contraction of the jaw closing muscles due to bruxism. Hence, radiologically diagnosed bone apposition may serve as an indication or confirmation of bruxism.