Cutaneous necrosis of the jaw secondary to spondolytic kyphosis of the spine

312 Metabolic support and nutrition management that aims to correct hyperglycaemia, ketoacidaemia and acidosis metabolic are given to the patient. Findings: After treatment, the patient’s condition began to improved, vital sign was stable, leukocyte, C-reactive protein and activated partial thromboplastin time was decreased, and swelling was reduce. Blood glucose, ketoacidaemia, and acidosis metabolic level was also corrected. The patient was discharged on postoperative 15 days in good condition. Conclusion: Submandibular abscess with sepsis and ketoacidosis complication in severe infection with comorbidity possibility. Management include resuscitation physiologic support, source control, metabolic support and nutrition. http://dx.doi.org/10.1016/j.ijom.2017.02.1050 Total maxillectomy for treatment of bisphosphonates osteonecrosis: diagnosis and reconstruction. Report of two cases C.E.X.S. Ribeiro da Silva ∗ , A.C. Rodriguez, D.M. Costa, M. Martins, V. Oliveira, R. Murad Neto Instituto de Ensino, Pesquisa e Difusão Prevent Senior, Brazil Bisphosphonate-related osteonecrosis of the jaw is a condition that has been described in the literature for about 15 years and is caused by the use of bisphosphonate therapies for treatment and or prevention of various bone diseases. It is characterised by bone necrosis of the jaws decreasing local vascularisation with or without the presence of trauma in the region. It is known that the surgical procedures as the installation of osseointegrated implants can contribute significantly to its occurrence. We aim to report two cases of female patients using bisphosphonates orally and developed extensive necrosis compromising the entire superior jaws. This paper was carried out through the compilation of clinical data, surgical procedures and rehabilitation of these patients. Both used the alendronate sodium for more than five years, held osseointegrated implants placed in the upper jaw and had extensive necrosis that committed all of the maxilla, requiring its complete removal. Complete bone resections of maxilla and the rehabilitation of patients were carried out, giving back in this way the possibility of social interaction of both. We conclude that in cases of extensive osteonecrosis, it is possible the complete removal of the upper jaw bone with its reconstruction, in order to allow better quality of life for patients with this condition. http://dx.doi.org/10.1016/j.ijom.2017.02.1051 A case report of absence of the left submandibular gland, secondary to gland obstruction due to a sialolith and a review of the literature S.A. Rizvi ∗ , E. Pappa Queen’s Hospital, United Kingdom Sialolithiasis (salivary stones) is the most common disease of the salivary glands and more than 80% occur in the submandibular gland or its duct. The symptoms develop as a consequence of obstruction of the duct and include swelling and pain, which is usually manifested during meal. However, the incidence of a sialolith,

occurring in a patient with isolated absence of a unilateral submandibular gland is rare. The case we present is therefore of an unusual nature. The case is of a medically fit and well, 52-year-old male referred to our Oral and Maxillofacial Surgery Department by his general dental practitioner. The referral was regarding an incidental radio-opacity seen around the left angle of the mandible on an orthopantomogram. The patient had previously experienced episodes of recurrent swellings during meal times previously but was asymptomatic for many years. A computed tomography scan of the neck showed an 18 mm × 18 mm sialolith in the duct and interestingly, also revealed that the left submandibular gland was absent. The patient who was unable to recall having ever had any surgery, agreed to have the sialolith removed, which was carried out via a transoral approach. In conclusion, a review of the literature, which has been provided strongly advocates that the cause of the absent submandibular gland in this case to be due to salivary gland atrophy instead of congenital absence, although it cannot be confirmed. http://dx.doi.org/10.1016/j.ijom.2017.02.1052 Cutaneous necrosis of the jaw secondary to spondolytic kyphosis of the spine S. Roberts ∗ , G. Vithlani, E. Brizman Royal Free London NHS Foundation Trust and Kings College London, United Kingdom In a London foundation trust, an immobile 96-year-old female suffering with significant kyphosis of the thoracic and cervical spine was admitted under orthopaedics. On examination she was found to have a facial ulcer thought be related to chronic pressure from the head resting on the chest. She then developed a necrotic ulcer of the left hemimandible with a corresponding ulcer overlying the manubrium. Pressure ulcers typically arise from the impact of shearing forces, the burden of load bearing areas and chronic immobility. Typical sites for such ulcers include; the heels, the lumbar and sacral spine, greater trochanter and medial epicondyle. With only one other published example this unusual case study documents a chronic ulcer that spans the hemimandible proceeding submentally to the left angle of the mandible. The ulcer penetrated deep to the bone but fortunately without any sign of osteomyelitis. In this case the ulcer was managed though conservative measures. The author explores in depth the risk factors leading to such ulcers and the various management options available in clinical practice. http://dx.doi.org/10.1016/j.ijom.2017.02.1053 Intraorbital mucocele: case report and review of literature A. Sada ∗ , D. Cebreros, O. Garcia, L. Miragall, M. Marques, M. Puche Department of Oral and Maxillofacial Surgery, Hospital Clinico Universitario, Valencia, Spain Background: Mucoceles are benign, slow-growing lesions defined as mucus-filled cystic formations, capable of bony