Journal of Oral and Maxillofacial Surgery

Hi-Fi Simulation—Rehearsing for Success

James R. Hupp — 2012-05-01

I am old enough to remember the 1960s when audio systems were nicknamed hi-fi's. Originally, the term was used as a shortened version of high fidelity to indicate the ability to accurately reproduce the sounds of audio performances by recording and playback devices. The 1960s were the era of vinyl recordings (records) and the availability of records in monaural or stereophonic formats. Although we would struggle to avoid scratching or leaving fingerprints on the vinyl surface, we did not seem to mind the inherent high-frequency “hiss” of this then-considered high-fidelity form of music recording. High fidelity was redefined with the advent of magnetic tape cassettes, and even further with the arrival of digital formats in the form of compact disks. Although audiophiles still debate the true fidelity of compact disks compared with analog formats, there is little dispute that the fidelity of recorded music to an actual performance has dramatically improved over the past 4 decades.

Comments on “Single-Cannula Technique for Operative Arthroscopy Using Holmium:YAG Laser”

Andrew B. Slavin — 2012-05-01

I read with interest the article by Stringer and Park entitled “Single-Cannula Technique for Operative Arthroscopy Using Holmium:YAG Laser” in the January 2012 of the Journal. shows a photo of the device I invented in 1992 and patented in 1994. I allowed the patent to expire after 7 years when I realized that the commercial application of the device was very limited. It is true that the device makes operative arthroscopy much easier. However, as the authors gain more experience in the technique, they will find that its scope of use is somewhat limited and triangulation and multiport arthroscopy are absolutely necessary to complete the procedure. If the curious reader simply searches the Internet for “dual-channel cannula for temporomandibular joint arthroscopy,” they will find my patent. It is incumbent upon authors to check for “prior art” before claiming that an idea is theirs. Hopefully, in the future, they will check their references more carefully.

In reply

Dale E. Stringer, Chan M. Park — 2012-05-01

We would like to extend an apology to Dr Slavin for omitting reference to his patent from 1994 in our article “Single-Cannula Technique for Operative Arthroscopy Using Holmium:YAG Laser.” We never claimed in our article that the idea is our novel idea, because we are fully aware that it is not. We simply described a technique that we use. In fact, we would also like to offer an apology to Honda et al, who published their article entitled “Developments of the New Instruments for TMJ Arthroscopic Surgery” in Dental Materials Journal in 1992, for omission from our references. They described a dual-channel cannula for temporomandibular joint arthroscopy that is similar to Dr Slavin's design. We would like to argue that our design is somewhat different from Dr Slavin's design, because his design uses a triple port as opposed to our dual port. With respect to limitations of a single-cannula technique, we wholeheartedly agree that there are limitations to the single cannula versus a triangulation technique, and that is clearly mentioned in our article.

Toward a More Uniform Use of OMS

Daniel L. Orr — 2012-05-01

I was in residency training in the late 1970s when the AAOS morphed to the AAOMS; shortly after, the ACOS became the ACOMS. This was a logical step at the time considering what our scope was then and remains now. Our journal and board subsequently switched from the JOS to the JOMS and from the ABOS to the ABOMS. The abbreviation changes also led to the development of the familiar acronyms we currently use. Although the AAOMS-“AMOS” relation is a small stretch, “A-BOMS,” and “A-COMS” are logical, efficient, and accurate.

Changes Over Time in the Prevalence of Caries Experience or Periodontal Pathology on Third Molars in Young Adults

2012-02-13

Purpose: To assess the prevalence of caries experience and periodontal pathology on third molar teeth compared with first and second molars and teeth more anterior from subjects who had data collected over time in a longitudinal clinical study. Patients and Methods: Healthy subjects with 4 asymptomatic third molars and data for at least 4 years after enrollment were included in these analyses. The presence or absence of caries experience on the occlusal surface of the third molars and any surface of the first or second molars was assessed using a visual-tactile caries examination. Full mouth periodontal probing, 6 sites per tooth, was conducted as a measure of clinical periodontal status. The primary outcome measures were at least 1 periodontal probing depth of at least 4 mm versus none, and caries experience versus no caries experience. The prevalence of caries experience and periodontal pathologic findings at follow-up and the relationship of the occurrence between the third molars and teeth more anterior in the mouth were examined using McNemar's statistics. Results: The follow-up was a median of 6.9 years (interquartile range 4.6 to 7.7 years) for 179 subjects, with a mean age of 29 years. More subjects were female (54%) and white (80%). At follow-up, 85% of the subjects had caries experience detected on the first or second molars, and only 50% had a third molar affected. In contrast, at follow-up, the presence of at least 1 periodontal probing depth of at least 4 mm was marginally more prevalent on the third molars than on the first or second molars (56% and 50%, respectively). Fewer subjects had third molars free of caries experience and periodontal pathology at follow-up compared with at enrollment (28% versus 38%, respectively). Conclusions: The prevalence of both third molar caries experience and third molar periodontal pathology increased from baseline to the follow-up examination. At follow-up, the prevalence of caries experience was greater on the first or second molars than on the third molars, and periodontal pathology were greater on the third molars than on the more anterior teeth.

Clinical and Dental Computed Tomographic Evaluation 1 Year After Coronectomy

2012-01-03

Purpose: Coronectomy is performed when contact between the mandibular third molar apex and the inferior alveolar nerve is suspected. The efficacy of coronectomy compared with conventional tooth extraction has been recognized in recent years. However, few studies have reported the postoperative prognosis of roots remaining in the bone or surrounding tissue. Therefore, a clinical evaluation was performed with dental computed tomographic imaging of the coronectomy sites 1 year after the procedure. Patients and Methods: This study investigated 101 patients (116 teeth) who underwent a coronectomy from March 2006 through December 2009. They were recalled 1 year later for a clinical evaluation and dental computed tomographic imaging of the coronectomy sites. The clinical evaluation was based on palpation and macroscopic findings. Results: In 99.2% (115 teeth) of the studied cases, the soft tissue distal to the mandibular second molar was healthy and the retained roots were covered by bone. In 1 case (0.8%), an eruption of roots into the oral cavity was observed; however, no inflammation was observed in the nearby soft tissue. In all 116 teeth, no transmission images indicative of periapical lesions, which usually result from necrosis of the pulp, were observed in the apical area of the retained roots. Conclusions: The absence of transmission images indicative of periapical lesions and the presence of bone covering more than 99.2% (115 teeth) of the retained roots showed a safe postoperative course at the 1-year follow-up after coronectomy.

Endoscopic Removal of Bilateral Supernumerary Intranasal Teeth

2012-05-01

Supernumerary teeth occur in 0.1% to 1% of the general population. Dentists and oral-maxillofacial surgeons (OMSs) sometimes encounter a supernumerary tooth, and the most common is the mesiodens; a supernumerary intranasal tooth is very rare. Bilateral supernumerary intranasal teeth are extremely rare, and the literature contains only a few reports. Because most intranasal teeth are found by otolaryngologists based on patients presenting with nasal symptoms, dentists and OMSs have less opportunity to treat them. We report a rare case of bilateral supernumerary intranasal teeth removed under endoscopic guidance.

Maxillary Third Molar: Patterns of Impaction and Their Relation to Oroantral Perforation

Asher Ah Tong Lim, Chin Wee Wong, John C. Allen — 2012-04-12

Purpose: The objectives of this study were to examine 1) the patterns of the impacted maxillary wisdom tooth and 2) the proximity of the impacted maxillary wisdom tooth to the maxillary sinus in relation to oroantral perforation during the removal of a maxillary wisdom tooth. Materials and Methods: This retrospective study reviewed the clinical records and dental pantomograms of patients who underwent the removal of maxillary wisdom teeth under general anesthesia over a 6-month period. Using a modified version of the Archer classification of impacted maxillary wisdom teeth, types of impaction were classified according to depth, angulation of impaction, and proximity to the floor of the sinus. Clinical records showed the occurrence of oroantral perforation. Results: In total, 845 maxillary wisdom teeth were removed; 66.8% were by routine extraction and 33.2% were removed surgically. The most common type of impaction was vertical followed by mesioangular. Most impacted teeth were at the level between the occlusal and cervical level of the adjacent second molar. Only 7 of the 278 excised wisdom teeth produced an oroantral perforation. Only 0.9% of all cases with a close sinus approximation showed an oroantral perforation. Statistical analysis with the Fisher exact test showed statistically significant associations of depth of impaction (P < .001), eruption status (P = .001), and long-axis position (P < .001) to the occurrence of an oroantral perforation. Sinus approximation showed no association with the occurrence of an oroantral perforation (P = 1.000). Conclusion: The depth of impaction of the maxillary wisdom tooth is a possible predictor of the possibility of oro-antral perforation if removal of the tooth is required. Due to the limitation of the radiograph, it is not a reliable to use radiographic close proximity of the sinus to predict the occurrence of oro-antral perforation when the maxillary wisdom tooth is removed.

Logistic Regression Analysis of Risk Factors for the Development of Alveolar Osteitis

Diego Halabí, José Escobar, Carlos Muñoz, Sergio Uribe — 2012-02-10

Purpose: To assess risk factors for alveolar osteitis. Materials and Methods: A prospective nested case-control study was conducted in an urban community dental clinic in Valdivia, Chile. A cohort of 1,355 patients who underwent dental extractions was included. Eight predictor variables (risk factors), namely patient gender, hygiene, tooth location, previous surgical site infection, traumatic extraction, systemic diseases, alcohol consumption, and tobacco use, were considered in a risk factor model. A binary regression logistic analysis was performed to determine significant associations. Results: In total 1,302 participants completed the follow-up. Eighty incident case patients with alveolar osteitis and 80 matched control patients were included. A statistically significant association was found between traumatic extraction (odds ratio [OR], 13.1; 95% confidence interval [CI], 5.4 to 31.7), tobacco smoking after extraction (OR, 3.5; 95% CI, 1.3 to 9.0), previous surgical site infection (OR, 3.3; 95% CI, 1.4 to 7.7), and the development of alveolar osteitis. Conclusions: Previous surgical site infection, traumatic extraction, and tobacco smoking are associated with an increased risk of alveolar osteitis.

Small Bolus of Esmolol Effectively Prevents Sodium Nitroprusside-Induced Reflex Tachycardia Without Adversely Affecting Blood Pressure

2012-02-24

Purpose: Hypotensive anesthesia with sodium nitroprusside (SNP) often is associated with reflex tachycardia. The purpose of this study was to investigate whether a small bolus of esmolol could counteract SNP-induced reflex tachycardia and sympathetic activation without affecting blood pressure. Materials and Methods: Using a time-series study design, 27 healthy young patients scheduled for mandibular osteotomy were enrolled in this study. General anesthesia was maintained with 2% sevoflurane and 67% nitrous oxide in oxygen. SNP was administered to decrease the mean arterial pressure to 55 to 65 mm Hg. When heart rate (HR) increased reflexively to higher than 95 beats/min from SNP-induced hypotension, esmolol 0.5 mg/kg was given. Blood pressure and HR were measured, and the low-frequency component (0.04 to 0.15 Hz) of systolic blood pressure variability and high-frequency component (0.15 to 0.4 Hz) of HR variability were calculated to evaluate the autonomic condition. Data were analyzed using 1-way analysis of variance after multiple comparisons or t test. P < .05 was considered statistically significant. Results: Of the 27 patients analyzed, 19 patients (70%) required esmolol. In these patients, SNP caused an increase in the low-frequency component of systolic blood pressure variability and a decrease in the high-frequency component of HR variability, leading to tachycardia (HR range, 95.9 ± 7.3 to 106.7 ± 7.4 beats/min; P < .001). Esmolol suppressed the effects of SNP on the low-frequency component of systolic blood pressure variability and high-frequency component of HR variability, resulting in an immediate decrease in HR to 86.9 ± 6.2 beats/min (P < .001), whereas mean arterial pressure remained unchanged. Conclusions: A small bolus of esmolol can suppress reflex tachycardia without significantly changing mean arterial pressure. Thus, esmolol restores the autonomic imbalance induced by SNP during hypotensive anesthesia.

Osseointegrated Implant Rehabilitation of Irradiated Oral Cancer Patients

2011-07-22

Purpose: The aim of this study is to analyze implant survival in patients who received radiotherapy treatment for oral malignancies and in patients who had suffered mandibular osteoradionecrosis. Materials and Methods: We reviewed retrospectively 225 implants placed in 30 patients who had received radiotherapy as part of the oncologic treatment. Radiation doses ranged between 50 and 70 Gy. 39 implants were placed after a combined treatment of radiotherapy and chemotherapy. Data referred to tumour type and reconstruction, presence of osteoradionecrosis, region of implant installation and type of prostheses were recorded. Survival rates were calculated with cumulative Kaplan-Meier survival curves and compared between different groups with a log-rank test. Results: 152 osseointegrated implants were placed in patients who presented previous reconstruction procedure. Five patients developed osteorradionecrosis as a complication of the radiotherapy treatment. Once osteoradionecrosis had healed in these patients, 41 implants were installed. The overall 5 year survival rate in irradiated patients was 92.6%. Irradiated patients had a marginally significantly higher implant loss than non-irradiated patients. (p = 0.063). The 5 year survival rate in the osteoradionecrosis group was of 48.3% and in the non-osteoradionecrosis group 92.3%, with a statistically significant difference between both groups. (p = 0.002). Conclusion: Osseointegrated implants enhance oral rehabilitation in most irradiated patients, even being an acceptable option for patients who had suffered osteoradionecrosis. Totally implantsupported prostheses are recommended after irradiation providing functional, stable and aesthetically satisfactory rehabilitation.

Comparative Evaluation of Antimicrobial Effects of Er:YAG, Diode, and CO2 Lasers on Titanium Discs: An Experimental Study

Emre Tosun, Ferda Tasar, Robert Strauss, Dolunay Gulmez Kıvanc, Cem Ungor — 2012-01-30

Purpose: This study examined carbon dioxide (CO2; 10,600 nm), diode (808 nm), and erbium (Er):yttrium-aluminum-garnet (YAG; 2,940 nm) laser applications on Staphylococcus aureus contaminated, sandblasted, large-grit, acid-etched surface titanium discs and performed a comparative evaluation of the obtained bactericidal effects and the applicability of these effects in clinical practice. Materials and Methods: This study was carried out in 5 main groups: Er:YAG laser in very short pulse (VSP) emission mode, Er:YAG laser in short pulse (SP) emission mode, diode laser with a 320-nm fiber optic diode laser with an R24-B handpiece, and CO2 laser. After laser irradiation, dilutions were spread on sheep blood agar plates and, after an incubation period of 24 hours, colony-forming units were counted and compared with the control group, and the bactericidal activity was assessed in relation to the colony counts. Results: The CO2 laser eliminated 100% of the bacteria at 6 W, 20 Hz, and a 10-ms exposure time/pulse with a 10-second application period (0.8-mm spot size). The continuous-wave diode laser eliminated 97% of the bacteria at 1 W using a 10-second application with a 320-μm optic fiber, 100% of the bacteria were killed with a 1-W, 10-second continuous-wave application with an R14-B handpiece. The Er:YAG laser eliminated 100% of the bacteria at 90 mJ and 10 Hz using a 10-second application in a superpulse mode (300-ms exposure time/pulse). The Er:YAG laser also eliminated 99% to 100% of the bacteria in VSP mode at 90 mJ and 10 Hz with a 10-second application. Conclusions: The results of this study show that a complete, or near complete, elimination of surface bacteria on titanium surfaces can be accomplished in vitro using a CO2, diode, or Er:YAG laser as long as appropriate parameters are used.

Rehabilitation of Reabsorbed Maxillae With Implants in Buttresses in Patients With Combination Syndrome

2012-05-01

Purpose: To assess the success and marginal bone loss, after 1 year of loading, of implants placed in anatomic buttresses of atrophic maxillae to rehabilitate patients with combination syndrome. Materials and Methods: A case series retrospective study of 22 patients with combination syndrome who were treated with implants in anatomic buttresses in the atrophic maxilla was performed. The inclusion criteria were Classes IV and V Cawood and Howell maxillary atrophy, rehabilitation with implants placed in anatomic buttresses, the presence of anterior remnant teeth in the mandible, and a minimum follow-up of 12 months after implant loading. The criteria of Buser et al were used to evaluate implant success, and marginal bone loss was measured on periapical radiographs. Statistical analysis was performed to relate implant success and marginal bone loss to gender, degree of maxillary atrophy, implant technique, and prosthesis type. Results: A total of 18 patients fulfilled the inclusion criteria. A total of 117 implants were placed; 32 were placed with the conventional technique in the alveolar ridges with enough height and width, 35 were positioned palatally, 30 were tilted in the frontomaxillary buttress, 10 were placed in the pterygomaxillary area, 6 were placed in the nasopalatine canal, and 4 were zygomatic implants. The follow-up ranged from 1 to 7 years after implant loading. Of the 117 implants, 7 failed, for an implant success rate of 94%. The mean marginal bone loss was 0.63 mm. A statistically significant relation was found between bone loss and implant placement technique and the level of maxillary atrophy, being greater in tilted implants and in Class V Cawood and Howell maxillary atrophy. Conclusions: Implants in anatomic buttresses allow rehabilitation of atrophic maxillae in patients with combination syndrome. The implant success rate was high, and a mean marginal bone loss of 0.63 mm was recorded.

Does Cytokine Profiling of Aspirate From Jaw Cysts and Tumors Have a Role in Diagnosis?

Antonia Kolokythas, Maria Karas, Thomas Sarna, William Flick, Michael Miloro — 2011-08-01

Purpose: The objective of the present study was twofold: first, to assess aspirates for use in cytokine profiling and second, to initiate pilot analyses to determine whether the cytokine profiling can serve as an aid in the diagnosis of jaw lesions. Materials and Methods: The aspirates from 12 benign odontogenic cysts and tumors of the jaw were collected and randomized, and a formal incisional biopsy was performed to establish the tissue diagnosis. The biopsies revealed keratocystic odontogenic tumor, ameloblastoma, and dentigerous cyst. The cystic aspirate was analyzed using the Q-Plex Human Cytokine Screen to detect cytokine expression and determine the level of expression for each pathologic entity. An array of 16 cytokines was investigated, including interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, IL-23, interferon-γ, tumor necrosis factor (TNF)-α, and TNF-β. Tables were developed to determine the ratio of expression for the candidate cytokine pairs that were differentially expressed among the 3 pathologic entities encountered. One-way analysis of variance was used to search for significant differences in the ratio of expression of the candidate pairs among the 3 entities. Results: Cytokines expressed by the 3 distinct jaw lesions were detected in the aspirate without the need for tissue biopsy. Cytokine profiling of these entities is possible owing to differential expression of the various cytokines studied. The ratio of expression was significant (P < .05) for 15 pairs of cytokines: IL-5/IL-1α, IL-4/IL-2, IL-8/IL-4, TNF-β/IL-6, IL-23/IL-6, TNF-α/IL-23, TNF-α/TNF-β, TNF-α/IL-8, TNF-β/IL-5, TNF-β/TNF-α, TNF-β/IL-13, IL-12/IL-23, IL-13/IL-15, IL-15/IL-2, and IL-6/IL-2. A comparison of the mean values indicated a “high/low” expression value for each lesion type for the 15 cytokine pairs. Conclusions: Cytokines, expressed by the 3 groups of jaw lesions, can be detected in the cystic aspirate, and a comparison of the ratio of the expression of the aspirates demonstrated a differential expression pattern of cytokines among the 3 groups. These ratios could assist in establishing a prompt and accurate diagnosis of lesions that might be difficult to discern clinically and radiographically. The use of a simple, minimally invasive aspiration procedure can help to establish an accurate diagnosis.

Effects of Pamidronate on Human Alveolar Osteoblasts In Vitro

2011-08-19

Purpose: Administration of bisphosphonates has recently been associated with the development of osteonecrotic lesions of the jaw (ONJ). To elucidate the potential contributions of osteogenic cells to the development and regeneration of ONJ, we have isolated primary cells from human alveolar and long/iliac bones, and examined the effects of pamidronate on cell viability, proliferation, osteogenesis, and wound healing. Materials and Methods: Primary human osteoblasts and bone marrow stromal cells were isolated from alveolar and iliac/long bone and marrow tissue. Cellular proliferation, alkaline phosphatase activity, apoptosis (terminal deoxynucleotidyl transferase dUTP nick end labeling, caspase-3, and 4,6-diamidino-2-phenylindole dihydrochloride assays) and wound healing in an in vitro scratch assay were assessed after exposure to pamidronate at a range of clinically relevant doses. Results: Primary alveolar osteoblasts proliferated at significantly higher rates than long/iliac bone osteoblasts in vitro. Upon exposure of alveolar osteoblasts and long/iliac bone marrow stromal cells to pamidronate for more than 72 hours, we have observed significantly decreased cell viability, proliferation, osteogenesis, and in vitro wound healing at ≥6 × 10−5 mol/L pamidronate, with the induction of apoptosis in approximately 20% of cell population. Conclusions: The remodeling activity of alveolar bone, indicated by higher proliferation of alveolar osteoblasts, could be negatively affected by exposure to high concentrations of pamidronate over extended periods. The absence of anabolic effects of pamidronate on alveolar osteoblasts and the induction of apoptosis in osteogenic cells could negatively affect bone balance at this site and contribute to osteonecrosis of the jaw.

Review of 43 Osteomas of the Craniomaxillofacial Region

Paolo Boffano, Fabio Roccia, Paola Campisi, Cesare Gallesio — 2011-08-08

Purpose: To present and discuss the demographic and clinical aspects and the management of 44 cases of osteomas of the craniomaxillofacial region. Materials and Methods: A retrospective chart review was performed of all cases of osteoma diagnosed from 2000 through 2010. The data collected included age at diagnosis, gender, lesion location, presenting symptoms, type of osteoma, treatment, and outcomes. Results: Forty-two patients with 43 osteomas were diagnosed during the study period. Their mean age was 48 years. The male-to-female ratio was 0.4:1. Twenty-one patients were asymptomatic, whereas 10 patients complained about headache and neuralgia, and 11 patients presented with facial asymmetry. Only 21 symptomatic osteomas were surgically removed after histologic diagnosis, whereas for the asymptomatic lesions a careful follow-up was maintained. Conclusions: The slow growth of osteomas allows a conservative attitude toward asymptomatic lesions. Thus, when surgery is performed, it is extremely important to plan a surgical approach that minimizes any damage to the adjacent structures.

Panoramic Radiographs of Head and Neck Cancer Patients Are Often Evidence of Carotid Artery Atherosclerotic Lesions: A Sign of High-Risk Comorbid Illness

Arthur H. Friedlander, Tracey Tajima, Neal R. Garrett — 2011-08-22

Purpose: The purpose of this study was to estimate the prevalence and identify the risk factors for calcified carotid artery plaque (CCAP) in patients with squamous cell carcinoma of the head and neck. Materials and Methods: Radiographs of 48 consecutive patients were evaluated for CCAP and their medical histories reviewed for the anatomic extent of cancer (staging) and atherogenic risk factors (age, extent of alcohol and tobacco use, body mass index, hypertension, dyslipidemia, and diabetes mellitus). Results: Unilateral or bilateral CCAPs were found in 52.1% of subjects (mean age, 61.5 years). Hypertension was seen in a larger percentage (60%; P = .049) of subjects with CCAP on their radiographs compared with those without CCAP (30.4%). No other atheroma risk factors or stage of cancer differed significantly between those with and those without CCAP. Conclusion: Panoramic radiographs of patients with squamous cell carcinoma of the head and neck show a very high rate of CCAP, a marker of comorbid vascular diseases that may cause treatment complications and affect overall survival.

Aneurysmal Bone Cyst: A Radiolucent Lesion of the Mandible. Report of 3 Cases

Claudio Marchetti, Patrizia Bacchini, Nicolà Tomasetti, Franco Bertoni — 2011-08-08

Aneurysmal bone cysts (ABCs) are benign bone lesions that may arise de novo in bone or rarely in soft tissue. Typically, there is no definite pre-existing lesion (primary ABC). Areas similar to ABCs are associated with different benign conditions, including fibrous dysplasia, giant cell tumors, chondroblastoma, chondromyxoid fibroma and, rarely, malignant bone tumors, such as osteosarcoma (secondary ABCs). The recognition of any underlying process is important in understanding the clinical situation.

Pulmonary Metastasis in a 65-Year-Old Man With Mandibular Ameloblastoma: A Case Report and Review of the Literature

2011-08-12

Ameloblastoma is the second most common odontogenic neoplasm after odontoma, accounting for 1% of all jaw tumors. Although the 1992 World Health Organization classification characterizes ameloblastoma as a benign but locally invasive epithelial odontogenic neoplasm, its aggressive biologic behavior evokes wide differences of opinion among investigators concerning its position in the neoplastic spectrum. This has led some investigators to refer to ameloblastoma as a low-grade malignant tumor because it is prone to recur, capable of aggressive local invasion, and capable of metastasizing to distant sites.

Intracranial Free Tissue Transfer for Massive Cerebrospinal Fluid Leaks of the Anterior Cranial Fossa

Jared Inman, Yadranko Ducic — 2012-02-13

Purpose: The management of large skull base defects with refractory cerebrospinal fluid (CSF) leaks treated with intracranially placed free tissue transfers was examined. Materials and Methods: A retrospective review of all cases of CSF leak presenting to the senior author from 1997 to 2008 in a private tertiary care referral practice was performed. Patients with intracranially placed free flaps were specifically examined for this review. Results: In total 109 patients with skull base defects larger than 4 cm2 or intractable CSF leaks were identified. Eighty-eight patients underwent reconstruction with local tissue flaps or free tissue grafts. Persistent massive leaks were repaired with 11 intracranial free tissue transfers. CSF fistulas were successfully closed in each instance, with no cases of flap failure or major complications. Conclusions: Intracranial placement of nonskin-bearing free tissue is an excellent treatment alternative for massive CSF leaks and refractory CSF fistulas related to large skull base defects.

Nasal Endoscopy-Assisted Reconstruction of Orbital Floor Blowout Fractures Using Temporal Fascia Grafting

Zhipeng Yan, Zhongyou Zhou, Xiujun Song — 2012-02-27

Purpose: To present the experience and outcomes of an endoscopy-assisted reconstruction of isolated orbital floor blowout fractures using temporalis fascia grafting. Materials and Methods: A retrospective chart review of 32 patients who underwent repair of orbital floor fractures using temporalis fascia grafting from January 1, 2004, through December 1, 2009, was conducted. All procedures were performed through an upper buccal sulcus incision and a transmaxillary endoscopic approach to the orbital floor. The area of displaced bone fragments was limited to 2 cm2 in all patients in this study. The parameters evaluated before and after surgery included visual acuity, extraocular motility and diplopia, and exophthalmometry. All patients underwent computed tomography before and 6 months after surgery. Results: None of the 32 patients had a postoperative clinical infection or obvious inflammation. Visual acuity was better than or equal to 20/100 in 43% of patients before surgery compared with 76% of patients after surgery. All patients had diplopia before surgery; only 3 had diplopia 6 months after surgery. Enophthalmos was observed in all patients before surgery, and 4 patients still displayed enophthalmos at 6 months after surgery. No sagging of the reconstructed orbital floor was found on computed tomograms 6 months after surgery. Conclusions: This retrospective study is the first to show that the temporalis fascia is a reliable implant for the repair of orbital floor defects smaller than or equal to 2 cm2.

Traumatic Optic Neuropathy After Maxillofacial Trauma: A Review of 8 Cases

2011-12-19

Purpose: To study the incidence and prognostic factors of traumatic optic neuropathy in maxillofacial trauma cases. Material And Method: Eight patients diagnosed with traumatic optic neuropathy among 354 cases of maxillofacial trauma treated from December 2008 through May 2011 were included in this retrospective study. Factors at the time of trauma, clinical findings, computed tomographic findings, and interventional modalities were studied for any improvement in vision. Results: Of 354 maxillofacial trauma cases, 8 cases (2.25%) were diagnosed with traumatic optic neuropathy. Patients' ages ranged from 21 to 60 years. The causes of trauma were road traffic accidents in 7 patients and surgery for zygomaticomaxillary complex (ZMC) fractures in 1 patient. All patients had ZMC fracture; 1 patient had Le Fort II, mandible condyle, and ramus fractures and 2 had associated cranial bone fracture. Six patients were administered steroid therapy; 1 patient showed improvement in visual acuity. Two patients underwent decompression by a lateral orbital approach; 1 patient showed an improvement in visual acuity. In 2 other patients, a spontaneous recovery was observed. Four of the 8 patients underwent open reduction and fixation of the maxillofacial fractures. Of the remaining patients, 1 patient had a nondisplaced ZMC fracture that was treated without surgical intervention and the other 3 patients refused any surgical intervention. Conclusions: The present findings showed the occurrence of traumatic optic neuropathy in association with ZMC, Le Fort II, and cranial bone fractures. Additional risk factors such as a history of a loss of consciousness, injury to the superolateral orbital region, fracture of the optic canal, evidence of orbital hemorrhage, and evidence of blood within the posterior ethmoidal cells should be considered during the evaluation.

Leonard Buttons: A Reliable Method of Intraoperative Intermaxillary Fixation in Bilateral Mandibular Fractures

Naseem Ghazali, M. Emre Benlidayi, Neilufer Abizadeh, Robert P. Bentley — 2012-01-24

Purpose: To retrospectively audit outcomes of using Leonard buttons (LBs) as intraoperative intermaxillary fixation in conjunction with open reduction–internal fixation of bilateral mandibular fractures. Patients and Methods: Seventy-seven patients were included in this study. The fracture reduction score was obtained from postoperative radiographs by use of 3-tiered scoring system. Medical case notes were obtained for clinicodemographic data, including operation length, postoperative occlusion scores, periodontal status, and complications. Results: The cohort predominantly comprised male patients (87%), with a mean age of 26 years. The major cause of injury was interpersonal violence (87%). The fracture pattern most treated was angle-parasymphysis fracture (70.1%). The mean length of follow-up was 83.81 ± 79.33 days. The mean overall reduction score was 6.95 ± 1.03 in the LB group and 6.40 ± 1.68 in the arch bar (AB) group (P = .275). When the occlusion scores were evaluated, the difference between the 2 groups was statistically significant (P = .027). The mean operation length was shorter in the LB group compared with the AB group (142.05 ± 32.31 minutes vs 161.00 ± 24.04 minutes, P = .013). Oral hygiene was poor in 7 patients in the LB group (11.3%) and in 5 patients in the AB group (33.3%) (P = .05). No significant correlation was observed between number of LBs placed with overall reduction and occlusion scores. No significant relation was observed for number of LBs and periodontal status, infection, and nonunion. Conclusions: This pilot study suggests that LBs are able to achieve equally good reduction as ABs but have better occlusion scores, with a shorter operating time, and show better gingival health. LBs are a viable alternative to ABs in providing intraoperative intermaxillary fixation for bilateral mandibular fractures. However, further prospective, randomized studies should be undertaken to obtain conclusive evidence.

Fixation of Le Fort I Osteotomies With Poly-dl-Lactic Acid Mesh and Ultrasonic Welding—A New Technique

Daniel J. Meara, Michael R. Knoll, Jon D. Holmes, D. Mark Clark — 2011-07-25

Purpose: This report describes a technique for use of resorbable mesh (Resorb-X) and an ultrasonic sonotrode unit (SonicWeld Rx) to bond a pin (SonicPin Rx) to the mesh and underlying bone for Le Fort I osteotomy fixation, precluding the need to tap, shortening the time needed for fixation, and eliminating many disadvantages of titanium. In total, 659 cases have been performed from October 2005 through December 2010. This study examined the first 103 consecutive Le Fort osteotomies performed with this resorbable system and thus those with the longest follow-up. Materials and Methods: One hundred three consecutive patients who had completed growth and presurgical orthodontics were operated on using the Resorb-X plating system and SonicWeld Rx. Intraoperative adverse events were monitored and a minimum 12-month postoperative follow-up for complications was completed. Results: One patient (0.9%) had maxillary mobility at initial postoperative evaluation that resolved without malocclusion. Two patients (1.9%) exhibited signs of residual soreness and swelling in the maxilla, attributed to sterile abscess formation. At last follow-up, all patients demonstrated a clinically stable maxilla with correction of their malocclusion. Conclusion: Use of ultrasonic-aided pins in fixation of resorbable mesh plates, in Le Fort I osteotomies, is a viable technique and superior resorbable plating system because it is easy to use, results in adequate fixation strength, and shortens time of application by eliminating the need for tapping. In addition, this resorbable system eliminates many disadvantages associated with using all-titanium fixation.

Distraction Osteogenesis of Maxilla and Midface in Postradiotherapy Patients

Jitske W. Nolte, Johan Jansma, Alfred G. Becking — 2011-08-08

Although distraction osteogenesis (DO) is widely used, there is minimal information on its use in patients after radiotherapy. The mutilating effects of ablative head and neck surgery, and insufficient development of the craniofacial skeleton after childhood head and neck malignancies, frequently necessitate complex reconstruction techniques. The simultaneous expansion of soft tissue that comes with bony lengthening during DO is a unique phenomenon. In selected cases, it causes less morbidity and better esthetic results than any other surgical procedure. The effects of radiotherapy on the outcome of DO are still not clear. There are only a few case reports describing DO of the human craniofacial skeleton after radiotherapy. Most of these reports have dealt with mandibular DO. Only 1 case of postradiotherapy midface DO has been described thus far. Grover et al presented a patient with radiation-induced orbital zygomatic hypoplasia, which was treated using a rigid external distraction device. Several animal studies have been performed to explore the advantages of hyperbaric oxygen in postradiation DO, but these studies were confined to mandibles. In the present article, 2 patients are presented with radiation-induced midfacial hypoplasia after childhood malignancies. These patients were successfully treated with rigid external DO in combination with hyperbaric oxygen (HBO) therapy.

A Quantitative Approach to Orbital Decompression in Graves' Disease Using Computer-Assisted Surgery: A Compilation of Different Techniques and Introduction of the “Temporal Cage”

2011-07-15

Purpose: Since 1911, when Dollinger first described surgical orbital decompression, many different techniques and approaches have been described, including 1-, 2-, and 3-wall decompressions with orbital fat removal. The indications for surgical treatment have been widened and include additional to optic neuropathy severe proptosis causing exposure keratopathy and disfigurement. Popular techniques for surgical decompression are the transantral or transpalpebral approach to the medial wall and orbital floor. Sometimes theses approaches are combined with lateral canthotomy incisions for access to the lateral wall (“3-wall decompression”). This report shows a compilation of different techniques using computer-assisted surgery for a 3-wall decompression with the introduction of the “temporal cage” in patients suffering from Graves' disease and the combination with zygomatic bone osteotomy. Patients and Methods: Twelve patients suffering from Graves' disease presented for surgical treatment in our clinic. For surgical planning, a computed tomographic scan with navigation markers was carried out. The navigation was planned with voxel-based navigation software (VoXim or BrainLab). Results: Of the patients, 1 had unilateral and 11 had bilateral decompressions. Of the 11 patients with bilateral procedures, 1 patient underwent simultaneous and 10 underwent sequential procedures. The 3-wall decompression in all cases was performed by transconjunctival approach. Temporary double vision could be observed in all cases. There was a significant reduction in proptosis. Conclusion: It was concluded that this approach and the computer-assisted surgery would be the operation of first choice when there is an indication for orbital decompression.

Morphologic Evaluation and Classification of Facial Asymmetry Using 3-Dimensional Computed Tomography

Chaehwan Baek, Jun-Young Paeng, Janice S. Lee, Jongrak Hong — 2011-07-15

Purpose: A systematic classification is needed for the diagnosis and surgical treatment of facial asymmetry. The purposes of this study were to analyze the skeletal structures of patients with facial asymmetry and to objectively classify these patients into groups according to these structural characteristics. Patients and Methods: Patients with facial asymmetry and recent computed tomographic images from 2005 through 2009 were included in this study, which was approved by the institutional review board. Linear measurements, angles, and reference planes on 3-dimensional computed tomograms were obtained, including maxillary (upper midline deviation, maxilla canting, and arch form discrepancy) and mandibular (menton deviation, gonion to midsagittal plane, ramus height, and frontal ramus inclination) measurements. All measurements were analyzed using paired t tests with Bonferroni correction followed by K-means cluster analysis using SPSS 13.0 to determine an objective classification of facial asymmetry in the enrolled patients. Kruskal-Wallis test was performed to verify differences among clustered groups. P < .05 was considered statistically significant. Results: Forty-three patients (18 male, 25 female) were included in the study. They were classified into 4 groups based on cluster analysis. Their mean age was 24.3 ± 4.4 years. Group 1 included subjects (44% of patients) with asymmetry caused by a shift or lateralization of the mandibular body. Group 2 included subjects (39%) with a significant difference between the left and right ramus height with menton deviation to the short side. Group 3 included subjects (12%) with atypical asymmetry, including deviation of the menton to the short side, prominence of the angle/gonion on the larger side, and reverse maxillary canting. Group 4 included subjects (5%) with severe maxillary canting, ramus height differences, and menton deviation to the short side. Conclusion: In this study, patients with asymmetry were classified into 4 statistically distinct groups according to their anatomic features. This diagnostic classification method will assist in treatment planning for patients with facial asymmetry and may be used to explore the etiology of these variants of facial asymmetry.

Rigid Fixation of Intraoral Vertico-Sagittal Ramus Osteotomy for Mandibular Prognathism

Kazuma Fujimura, Kazuhisa Bessho — 2011-07-29

The standard surgical treatment for prognathism is sagittal split ramus osteotomy (SSRO) if the proximal and distal segments of the ramus require fixing with screws or metal plates. In this procedure, however, it is frequently difficult to avoid neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) when the posterior margin of the ramus curves inward or when the ramus is thin (A, B). This report describes a new alternative procedure, intraoral vertico-sagittal ramus osteotomy (IVSRO), a modification of SSRO and intraoral vertical ramus osteotomy (IVRO). One of the main advantages of IVSRO is that it avoids IAN damage, because the ramus can be split parallel to the original sagittal plane posterior to the point between the mandibular canal and the lateral cortical bone plate immediately in front of the antilingular prominence. Another advantage of IVSRO is that the area in which screws can be inserted is relatively large, if the subcoronoid area on the distal segment and subcondylar area on the proximal segment are used. The 2 segments can be fixed in these areas with bicortical bone screws, with or without a cheek incision (C). This report introduces rigid fixation of IVSRO for mandibular prognathism.

Effect of Open Rhinoplasty on the Smile Line

Reza Tabrizi, Hoori Mirmohamadsadeghi, Danadokht Daneshjoo, Samira Zare — 2011-07-25

Purpose: Open rhinoplasty is an esthetic surgical technique that is becoming increasingly popular, and can affect the nose and upper lip compartments. The aim of this study was to evaluate the effect of open rhinoplasty on tooth show and the smile line. Patients and Methods: The study participants were 61 patients with a mean age of 24.3 years (range, 17.2 to 39.6 years). The surgical procedure consisted of an esthetic open rhinoplasty without alar resection. Analysis of tooth show was limited to pre- and postoperative (at 12 months) tooth show measurements at rest and the maximum smile with a ruler (when participants held their heads naturally). Statistical analyses were performed with SPSS 13.0, and paired-sample t tests were used to compare tooth show means before and after the operation. Results: Analysis of the rest position showed no statistically significant change in tooth show (P = .15), but analysis of participants' maximum smile data showed a statistically significant increase in tooth show after surgery (P < .05). In contrast, Pearson correlation analysis showed a positive relation between rhinoplasty and tooth show increases in maximum smile, especially in subjects with high smile lines. Conclusion: This study shows that the nasolabial compartment is a single unit and any change in 1 part may influence the other parts. Further studies should be conducted to investigate these interactions.

M-Shaped Genioplasty: A New Surgical Technique for Sagittal and Vertical Chin Augmentation: Three Case Reports

2011-07-28

Several surgical techniques are available for correcting and giving harmony to the lower third of the face. In this respect, some well-known techniques seek to correct the shape and size of the chin using different kinds of chin implants or osteotomies in an effort to move it and change its spatial location, thus determining a new facial contour.

Hemimaxillofacial Dysplasia (Segmental Odontomaxillary Dysplasia): Case Study With 11 Years of Follow-Up From Primary to Adult Dentition

Charles P. Minett, Tom D. Daley — 2011-07-18

In 1987, Miles et al described 2 otherwise healthy patients, 3.5 and 15 years of age, who exhibited congenital mild facial asymmetry and unilateral enlargement of the maxillary gingiva and alveolar bone. One patient had hypoplastic teeth in the affected quadrant and missing premolars, and the other patient had hypoplasia of only the premolars. The older patient also exhibited hypertrichosis of skin in the affected area. The investigators suggested the term hemimaxillofacial dysplasia (HD) for this condition. In 1990, Danforth et al described 8 patients with similar features, but without known skin changes, and proposed the term segmental odontomaxillary dysplasia (SOD), which they believed to be a more accurate descriptor. In 1996, DeSalvo et al reported a case involving a 7-year-old girl, using the term SOD, associated with an area of hypopigmentation of the upper lip on the affected side. Also, in 1996, Packota et al detailed the maxillary radiographic features of 12 cases of SOD, including bony sclerosis with thickened vertical trabeculae in the affected area, missing premolars, delayed eruption of adjacent teeth, and a small maxillary sinus on the affected side. In 2004, Welsch and Stein reported on 1 patient with Becker's nevus of the skin and recommended the acronym HATS (hemimaxillary enlargement, asymmetry of the face, tooth abnormalities, and skin findings) to add yet another term for this condition. Other cases containing skin lesions have been reported under the designation HD and SOD and without reported skin lesions under the designation SOD. The term “hemimaxillofacial dysplasia” (HD) has been used in the present report.

Lip Competence in Class III Patients Undergoing Orthognathic Surgery: An Electromyographic Study

Carlos Nicolet, Daniela Muñoz, Antonio Marino, Andrea Werner, Juan Argandoña — 2012-05-01

Purpose: The aim of this study was to compare the presurgical and postsurgical electromyographic (EMG) activities of the lips in patients with skeletal Class III treated with combined orthognathic surgery and contrast these data with those obtained from a control group with skeletal Class I. Patients and Methods: Ten patients with skeletal Class III underwent the registration of EMG activity before an orthognathic surgical procedure and 4 months after surgery. The results were compared with a control group of 11 healthy patients with skeletal Class I and clinical and EMG lip competence. EMG activity was recorded from the upper orbicularis oris and mentalis muscles during swallowing, lips in contact (LC), and lips apart (LA) using bipolar surface electrodes. The competence condition was assessed by determining the difference in the EMG activity of the mentalis muscle (LC-LA ≤0 for lip competence). Results: Patients with skeletal Class III showed greater EMG activity than the control group before and after surgery. Patients with skeletal Class III showed a significantly greater difference in LC-LA than the control group before surgery for the 2 muscles (P < .05). No significant difference was found between the skeletal Class III group after surgery and the control group for the mentalis muscle (P > .05). Conclusions: Four months after treatment with orthognathic surgery, patients with skeletal Class III and an initial muscle activity pattern of lip incompetence different from the control group (P < .05) showed EMG values compatible with lip competence. These values were similar to the control group.

Closure of the Alveolar Cleft by Bone Segment Transport Using an Intraoral Tooth-Borne Custom-Made Distraction Device

Ayman F. Hegab — 2012-03-09

Purpose: The fact that bone transportation generates not only bone but also surrounding soft tissues makes it an ideal technique for tissue regeneration. This study evaluates bone segment transport using an intraoral tooth-borne distraction device for alveolar cleft closure. Materials and Methods: Patients with an alveolar cleft were enrolled in the study. They were treated at the Al-Azhar University Hospital, Cairo, Egypt, between 2004 and 2007. Anterior transportation of the posterior dentoalveolar segment was performed by use of an intraoral tooth-borne custom-made distractor. Clinical evaluations included the following: preoperative and postoperative intraoral photographs, vitality testing of the teeth in the transport segment, cast analysis, and measurement of tooth mobility. Radiographic evaluations included occlusal films, orthopantomography, and computed tomography and 3D computed tomography for volumetric and densitometric evaluations of the distracted bone. Results: After distraction was completed, the transported segments were positioned 1 to 4 mm superior to the occlusal plane. The radiographic evaluation showed residual triangular bone deficits that were closed through gingivoperiosteoplasty or bone grafting. Once the transported segments came in contact with the alveolar bone of the normal side, the intervening fibrous tissue at the docking site was removed, and docking-site surgery was then performed. The results obtained from both clinical examinations and radiographic imaging showed complete closure of the alveolar clefts. Conclusions: Maxillary alveolar bone transport offers an alternative technique in the latest treatment of the alveolar cleft.

Skeletal Differences in Patients With Temporomandibular Joint Disc Displacement According to Sagittal Jaw Relationship

Il-Hyung Yang, Beom-Seok Moon, Seung-Pyo Lee, Sug-Joon Ahn — 2011-12-12

Purpose: The present study was designed to analyze the skeletal differences in patients with temporomandibular joint (TMJ) disc displacement (DD), according to the sagittal jaw relationship. Materials and Methods: We implemented a cross-sectional study design and enrolled a sample of Korean women older than age 17 years. The subjects were classified into 3 groups according to the magnetic resonance images of the bilateral TMJs: bilateral normal disc position (BN), bilateral disc displacement with reduction, and bilateral disc displacement without reduction. Each group was subdivided into 2 groups using the mandibular body length to anterior cranial base ratio as a sagittal jaw parameter: normal-size mandible (NM) and oversized mandible (OM). Seventeen variables from the lateral cephalograms were analyzed using 2-way analysis of variance to analyze the differences in skeletal characteristics with respect to the mandible size and TMJ DD status. Results: The subjects with TMJ DD generally had a short ramus height and clockwise rotation of the ramus and mandible compared with those with BN in both OM and NM groups. However, significant differences were present in the skeletal characteristics of the TMJ DD patients between the NM and OM groups. Significant backward positioning and rotation of the ramus and mandible were found between BN and bilateral disc displacement with reduction or bilateral disc displacement without reduction in the OM group, while those of the ramus and mandible were found between BN and bilateral disc displacement with reduction or bilateral disc displacement without reduction in the NM group. Conclusions: The results of our study suggest that the skeletal characteristics associated with TMJ DD are differently represented according to the sagittal jaw relationship.

The Role of Maxillary Osteotomy in the Treatment of Arhinia

Roberto Brusati, Giacomo Colletti — 2012-02-27

Purpose: Arhinia is a very rare malformation, and only 41 cases are described in the literature. Given its rarity, there is no standardized surgical protocol. This article describes our preferred treatment, which underlines the importance of maxillary osteotomy for obtaining satisfactory results. Methods: We observed 3 girls with arhinia, 2 of whom were treated by a 2-step surgical protocol. During the first phase, the patients underwent maxillary osteotomy with the creation of a new epithelium-lined nasal cavity. A skin expander was also placed in the forehead. During the second step, an external nose was created in both patients from the expanded forehead flap with local perinasal flaps and costochondral grafts. Results: Both reconstructions were viable and esthetically acceptable. No internal nose restenosis was observed. Conclusions: On the basis of our experience, maxillary osteotomy should be considered part of an integrated approach in treating arhinia.

“Cotton Wool Roll” Technique in Orthognathic Planning

Farhad B. Naini — 2012-02-13

It is said that hindsight is always 20/20. As such, nothing is as important as the actual result of an orthognathic surgical procedure in demonstrating the appropriateness of the original treatment plan. Therefore, any diagnostic modality that permits simulation of a potential final operated result is extremely useful in the treatment planning stages of orthognathic surgery. This is part of the reason so many different treatment planning software modalities are now available on the market.

Primary Oral Mucosal Melanoma: Advocate a Wait-and-See Policy in the Clinically N0 Patient

Xin Wang, He-Ming Wu, Guo-Xin Ren, Jie Tang, Wei Guo — 2011-07-25

Purpose: Oral mucosal melanoma (OMM) is a rare disease associated with a very poor prognosis. Because well-established treatment protocols for OMM are in short supply, prognostic information regarding recent treatment modalities for this disease were sought. Patients and Methods: A retrospective chart review was performed of 61 patients who were treated for OMM from 1998 through 2005. The clinical features and treatment modalities were identified and correlated with the outcomes. Results: There were 41 male and 20 female patients (ratio, 2.1:1) with a mean age of 54.1 years. The mean follow-up was 31.9 months, and the overall 2-year and 5-year survival rates were 51.1% and 30.3%, respectively. According to the seventh edition of the American Joint Committee on Cancer staging system, there were 31 patients (50.8%) with stage III tumors. A more advanced stage and a tumor of at least 2 cm were associated with worse survival (P < .001 and P = .036, respectively). Elective lymph node dissection and biochemotherapy were not associated with a higher total survival rate (P = .53 and P = .76, respectively). Conclusions: OMM has a male predilection. The seventh edition of the American Joint Committee on Cancer stage and tumor size are effective prognostic parameters for patients with OMM. The American Joint Committee on Cancer staging system provides useful information for predicting the ultimate outcome and should be used as the primary staging system. Elective node dissection and adjuvant biochemotherapy offer no additional advantage in increasing the patient survival rate. A wait-and-see policy is advocated for patients with clinical stage N0 cancer.

Keratinocytes of Tissue-Engineered Human Oral Mucosa Promote Re-Epithelialization After Intraoral Grafting in Athymic Mice

2011-08-01

Purpose: The objective of this study was to investigate the role of grafted oral keratinocytes in a transplanted ex vivo–produced oral mucosa equivalent (EVPOME) in the regeneration and/or healing process of the oral mucosa at the recipient site. Materials and Methods: The EVPOME was developed in a serum-free defined culture system without a feeder layer. EVPOME is composed of a stratified layer of human oral keratinocytes that are seeded onto a human cadaveric dermis, AlloDerm (LifeCell, Branchburg, NJ). Intraorally grafted EVPOMEs in athymic mice (BALB/c) were excised, contiguous with the surrounding oral mucosa, on days 5, 7, 14, and 21 after grafting. Serial sections were stained with hematoxylin-eosin and immunohistochemically analyzed for cytokeratin 17 (CK17) expression to distinguish the human-cultured EVPOME epithelial keratinocytes from murine oral keratinocytes. Results: All EVPOME epithelial cells showed intense immunoreactivity for CK17, whereas mouse buccal mucosal epithelial cells did not show CK17 immunoreactivity. The grafted EVPOME maintained a stratified epithelial layer for up to 5 days after grafting. By day 7 after grafting, a portion of the EVPOME epithelial layer peeled away from the AlloDerm, and a thin, CK17-immunonegative epithelial layer extended from the adjacent thick epithelial layer of the mouse and contacted the CK17-immunopositive EVPOME epithelium. From days 14 to 21 after grafting, the stratification of the CK17-immunonegative continuous mouse epithelium increased compared with earlier time points and showed a similar appearance to the epithelium of the adjacent mouse mucosa. In contrast, no epithelial coverage of the AlloDerm that was grafted without keratinocytes was observed for up to 21 days after grafting. The grafted AlloDerm without cells resulted in tissue necrosis that was accompanied by a dramatic infiltration of inflammatory cells by day 14. Conclusions: These findings suggest that grafting of EVPOME with viable oral keratinocytes onto an intraoral mucosal wound plays an active role in promotion of re-epithelialization of the oral wound during the subsequent healing process.

University of Washington Oral and Maxillofacial Surgery Program

Michael Wasson, Jasjit K. Dillon — 2012-02-27

The University of Washington (UW) was founded on May 20, 1861, as “The Territorial University” (), with 30 students initially enrolled. Since that day, the university has developed into the leading university of the Pacific Northwest, with more than 42,000 students currently enrolled. Founded in 1946, the UW School of Medicine is ranked first nationally for primary care and ninth for research. The UW School of Dentistry was established in 1945. It has a long history of being one of the premier dental schools in the country and continues to be a leader in clinical education and research.

A Rare Occurrence of Hepatocellular Carcinoma Metastasis to the Mandible: Report of a Case and Review of the Literature

Seung Yu, Abraham Estess, William Harris, Jasjit Dillon — 2012-02-27

Hepatocellular carcinoma (HCC) is the sixth most common cancer globally, with 626,000 new cases per year, and is the third leading cause of global cancer-related mortality, with 598,000 deaths per year. In the United States, HCC is the ninth leading cause of cancer-related deaths. From 2001 through 2006, 48,596 cases of HCC were reported in the United States according to the Surveillance, Epidemiology and End Results Program from the Centers for Disease Control and Prevention. The incidence of HCC is estimated to be 3 per 100,000 individuals, with an expectation for increasing numbers in coming years because of the higher incidence of hepatitis C infection during the 1960s through the 1990s.

Reconstruction of Major Full Cheek Defects With Combined Extensive Pedicled Supraclavicular Fasciocutaneous Island Flaps and Extended Vertical Lower Trapezius Island Myocutaneous Flaps After Ablation of Advanced Oral Cancer

Wei-liang Chen, Zhao-hui Yang, Da-ming Zhang, Zhi-Quan Huang, Song Fan, Lei Wang — 2011-08-19

Purpose: The present clinical study assessed the feasibility of extensive pedicled supraclavicular fasciocutaneous island flaps combined with extended vertical lower trapezius island myocutaneous flaps for large, full-thickness cheek defect reconstruction after ablative oral cancer surgery. Patients and Methods: A retrospective review of data from consecutive patients requiring extensive pedicled supraclavicular fasciocutaneous island flaps and the extended vertical lower trapezius island myocutaneous flap to provide both an inner and an outer lining for major full-thickness cheek defects after oncologic resection. Results: Eight patients had advanced oral squamous cell carcinoma. All patients had combined bone and extensive soft-tissue defects. The extensive pedicled supraclavicular fasciocutaneous island flap with a skin paddle measuring 10 × 8 cm to 14 × 10 cm and the extended vertical lower trapezius island myocutaneous flap with a skin paddle measuring 25 × 10 cm to 15 × 8 cm were used to reconstruct the major through-and-through defects. No major complications occurred in any patient. The patients were followed up for 6 to 20 months; 6 patients were living with no evidence of disease, 1 was living with disease, and 1 had died of local recurrence. Conclusions: The combined use of the extensive pedicled supraclavicular fasciocutaneous island flap with an extended vertical lower trapezius island myocutaneous flap to reconstruct major through-and-through cheek soft defects is reliable and an excellent alternative to other pedicles, even microsurgical free flaps, for patients who have previously undergone radiotherapy and surgery of the head and neck.

Pigmented Squamous Cell Carcinoma of Oral Mucosa: Clinicopathologic Study of 3 Cases

2011-07-25

Squamous cell carcinoma (SCC) of the skin and mucosa occasionally show pleomorphic histologic forms. One of these rare pleomorphic forms is pigmented SCC (PSCC). Although melanin pigments are widely distributed in the skin and in certain types of mucosa, PSCC is rarely seen. Only 12 cases of PSCC in the oral mucosa have been reported. Clinically, the differential diagnosis of PSCC with dark pigmentation often includes melanoma and other melanocyte lesions. However, PSCC is not always accompanied by dark pigmented lesions on the overlying epithelium, although many melanin pigments and melanocytes can be found intermingled with the tumor cells. Although only 1 case of metastasis has been reported, and no tumor recurrence has been reported in each follow-up term, the potential malignancy of PSCC in oral mucosa is still unknown. The present report describes the clinical and histopathologic features of PSCC.

Microvascular Reconstruction of the Mouth, Jaws, and Face: Experience of an Australian Oral and Maxillofacial Surgery Unit

Gary R. Hoffman, Shofiq Islam, Robert L. Eisenberg — 2012-05-01

Purpose: Microvascular reconstruction of oncologic surgical and traumatic defects has been globally practiced by plastic and orthopedic surgical disciplines since the early 1970s. During the past 20 years, reconstructive techniques have been progressively incorporated into the purview of oral and maxillofacial and otolaryngology-head and neck surgeons, particularly those practicing in Europe, the United Kingdom, and China. There has also been a steady increase in the adoption of these techniques in North America, South America, and Japan. Materials and Methods: We reviewed our experience (during a 5-year period) with microvascular reconstruction of postablative defects in the oral and maxillofacial region. To our knowledge, resection and neck dissection (or neck exploration in benign free tissue transfer); undertaken by an oral and maxillofacial surgeon), and free tissue transfer reconstruction (undertaken by otolaryngology head and neck and oral and maxillofacial surgeons) of ablative defects of the mouth, jaws, and face (managed within an Australian head and neck cancer multidisciplinary care team) have not been previously reported. Results: The study cohort comprised 107 patients who underwent 109 microvascularly anastomosed free tissue transfers. Of the 107 patients, 79 were males and 38 were females. The median age was 62 years (range 15 to 87). The clinicodemographic analyses and the range of complications observed in this patient cohort are reported. The overall flap success rate in our study was 97%. Conclusions: The surgical outcomes of our study compare favorably with those previously reported.

Botulinum Toxin A in the Treatment of Myofascial Pain and Dysfunction: The Case Against Its Use

Daniel M. Laskin — 2012-05-01

Since the Food and Drug Administration approval of botulinum toxin (BT) for the temporary treatment of blepharospasm and strabismus in 1989 and for the treatment of cervical dystonia in 1984, it has been used clinically to treat a variety of other conditions possibly involving muscle spasm or hyperactivity. These have included low back pain, whiplash-associated neck pain, chronic migraine of cervical origin, chronic tension-type headache, facial tics, orofacial dyskinesia, masseteric hypertrophy, bruxism, and myofascial pain. Despite its wide application, the literature supporting its efficacy in many of these conditions is weak, consisting mainly of uncontrolled, open-label studies rather than double-blinded, randomized clinical trials. The purpose of this report is to present the arguments against the use of BT in the management of myofascial pain and dysfunction (MPD) involving the muscles of mastication.

Use of Botulinum Toxin A for Treatment of Myofascial Pain and Dysfunction

Heshaam M. Fallah, Shama Currimbhoy — 2012-05-01

Since its introduction in 1992, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) has been used to classify patients with TMD based on physical diagnosis (Axis I) and pain-related disability and psychological status (Axis II). This system has allowed the standardization of diagnostic criteria for TMDs and has been validated for research and clinical use. Myofascial pain is the first group of disorders under the physical diagnosis axis of the RDC/TMD and is defined by 3 main criteria: report of pain at rest or during function, pain on palpation at 3 or more defined sites, and at least 1 palpable painful site having the same laterality as the patient's perception of pain. Myofascial pain is further subclassified in relation to the limitation of mouth opening. A recent meta-analysis of the epidemiology of Axis I found that myofascial pain affects almost half of patients presenting for TMD treatment. Despite the widespread prevalence of myofascial pain disorders, no universal treatment approach has been determined.

Limiting Resident Work Hours: The Case for the 80-Hour Work Week

Larry L. Cunningham, Salam O. Salman, Eli Savit — 2011-07-25

The 80-hour work week has been a standard for all medical residencies since 2003. Currently there is no restriction on work hours for dental residencies accredited by the Commission on Dental Accreditation. However, many oral maxillofacial surgery (OMS) programs are based primarily in hospitals, and all have hospital affiliations. Because of this, many OMS program directors voluntarily comply with the Accreditation Council for Graduate Medical Education (ACGME) Guidelines for Medical Residencies. This article discusses the rationale for limiting resident work hours.

Perspective on Work-Hour Restrictions in Oral and Maxillofacial Surgery: The Argument Against Adopting Duty Hours Regulations

Elda L. Fisher, George H. Blakey — 2011-07-28

In 2003, the American College of Graduate Medical Education (ACGME) initiated regulations on resident work hours (). These regulations have stemmed from 1 inciting event that occurred in New York in 1984, the Libby Zion case. In this circumstance, an on-call intern in her first year of training after medical school and supervised by a second-year resident made a series of improper judgments in Ms Zion's care. First, the patient was already regularly taking a monamine oxidase inhibitor presumably for depression on admission, and the intern prescribed Demerol for her symptoms. Second, the intern, after receiving a call later in the evening from the floor nurse reporting severe agitation and fever, did not go to evaluate the patient, but instead prescribed over the phone restraints and haloperidol for the drug's calming effect. Finally, no one recognized that the patient's temperature elevation to 106 F was a result of serotonin syndrome, an excess of this neurotransmitter. Libby Zion died less than 24 hours after her admission to the hospital emergency room. Because of this tragedy and the subsequent media exposure highlighting concerns about overworked residents with too many demands on their time, the ACGME instituted mandatory limitations on residents' work hours. Noncompliance with the new work-hour restrictions subjected residency programs to potential loss of accreditation. The regulations were initially criticized as arbitrary, but since 2003 the regulations have been modified to take into account new data on resident quality of life, and empirical data from nonmedical industries. After a study conducted by the Institute of Medicine on the subject, effective July 2011, ACGME regulations restrict upper-level residents to an 80-hour work week, include mandatory on-site supervision of junior residents at all times, and limit first-year residents to 16 hours of continuous work. Residency program directors and their participating hospitals will be held accountable for meeting these new requirements.

The Adult Suicide-Prone Patient: A Review of the Medical Literature and Implications for Oral and Maxillofacial Surgeons

Arthur H. Friedlander, Susan C. Rosenbluth, Robert T. Rubin — 2011-07-11

Purpose: Suicide is the 11th most common cause of death among American adults. Some individuals who commit suicide may have been treated by oral and maxillofacial surgeons in the days preceding the event. Because suicide often is preventable, in this report we review methods that are useful in identifying individuals at risk of imminent suicide and give suggestions for obtaining interventional assistance. Methods: A Medline search using the key terms “suicide,” “adult,” and “oral surgery” was conducted. Articles selected were published in peer-reviewed journals. Results: Individuals who have told their surgeon they have no further reason to live, have developed a suicide plan, have secured a lethal device, and have previously made such an attempt are at extreme risk and require immediate intervention. Additional risk factors include being white, aged older than 45 years, and unemployed; living alone, with poor social supports; having a current mental illness or history of mental illness, including substance abuse; and having a family history of suicide. Specialty-specific patients at highest risk are those treated for oral cancer and cosmetic issues and those with adverse surgical outcomes. With regard to assessment of these individuals, the modified SAD PERSONS acronym can assist surgeons in documenting the presence of major risk factors associated with adult suicide and in facilitating communication with emergency personnel. Conclusions: Suicide is a potentially preventable public health problem. Oral and maxillofacial surgeons can be key in elucidating clinically significant suicide potential in their patients and referring them for timely intervention.

Subsequent Publication of Oral and Maxillofacial Surgery Meeting Abstracts

Joseph L. Rodriguez, Daniel M. Laskin — 2011-05-02

Purpose: Previous studies in various medical specialties have shown that fewer than 50% of abstracts presented at meetings are subsequently published. The purpose of the present study was to determine the publication rate of abstracts presented at the annual meetings of the American Association of Oral and Maxillofacial Surgeons. Materials and Methods: The titles and authors of the abstracts from all oral abstract session presentations and posters by American contributors were collected from the Final Programs of the American Association of Oral and Maxillofacial Surgeons annual meetings for 2006 to 2009. A PubMed search for published articles through December 2010 was then performed using the authors' names, abstract titles, and key words. Results: A total of 311 abstract presentations were done at the 4 annual meetings. Of these, only 85 (24%) were subsequently published. No difference was found between abstracts from oral or poster presentations. Most of the articles were published in the Journal of Oral and Maxillofacial Surgery. Conclusion: Because of deficiencies that can occur in abstracts and the need to disseminate the information they contain, it is important to take the appropriate measures to ensure that full articles are subsequently published.

News and Announcements

2012-05-01

Register by July 1 for Best Selection, Best Value The 94th AAOMS Annual Meeting, Scientific Sessions and Exhibition will convene September 10-15, 2012 in picture-perfect San Diego, CA. Members of the AAOMS and the International Association of Oral and Maxillofacial Surgeons who register for the AAOMS 2012 Annual Meeting by July 1 will save $200 on the meeting registration fee. The fee increases $100 on July 2 and another $100 on August 1. Early registrants also have the best chance of securing their first choice of educational sessions because tickets to limited attendance courses are distributed on a first-come, first-served basis.

Reader's Circle Continuing Education Program

2012-05-01

Readers now have the opportunity to participate in the Reader's Circle Program via the JOMS Web site. By using the electronic system, readers will be able to immediately access the answers and receive CE credit. We will continue to offer the print version of Reader's Circle, but highly encourage all readers to use the online version.

Masthead

2012-05-01

(ISSN 0278-2391) is published monthly by Elsevier Inc, for the American Association of Oral and Maxillofacial Surgeons, 360 Park Avenue South, New York, NY 10010-1710. Business Office: 1600 John F. Kennedy Blvd, Ste 1800, Philadelphia, PA 19103-2899. Periodicals postage paid at New York, NY and additional mailing offices.

Editorial Board

2012-05-01

AAOMS Author Disclosure forms

2012-05-01

Journal of Oral and Maxillofacial Surgery

Hi-Fi Simulation—Rehearsing for Success

Comments on “Single-Cannula Technique for Operative Arthroscopy Using Holmium:YAG Laser”

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Toward a More Uniform Use of OMS

Changes Over Time in the Prevalence of Caries Experience or Periodontal Pathology on Third Molars in Young Adults

Clinical and Dental Computed Tomographic Evaluation 1 Year After Coronectomy

Endoscopic Removal of Bilateral Supernumerary Intranasal Teeth

Maxillary Third Molar: Patterns of Impaction and Their Relation to Oroantral Perforation

Logistic Regression Analysis of Risk Factors for the Development of Alveolar Osteitis

Small Bolus of Esmolol Effectively Prevents Sodium Nitroprusside-Induced Reflex Tachycardia Without Adversely Affecting Blood Pressure

Osseointegrated Implant Rehabilitation of Irradiated Oral Cancer Patients

Comparative Evaluation of Antimicrobial Effects of Er:YAG, Diode, and CO2 Lasers on Titanium Discs: An Experimental Study

Rehabilitation of Reabsorbed Maxillae With Implants in Buttresses in Patients With Combination Syndrome

Does Cytokine Profiling of Aspirate From Jaw Cysts and Tumors Have a Role in Diagnosis?

Effects of Pamidronate on Human Alveolar Osteoblasts In Vitro

Review of 43 Osteomas of the Craniomaxillofacial Region

Panoramic Radiographs of Head and Neck Cancer Patients Are Often Evidence of Carotid Artery Atherosclerotic Lesions: A Sign of High-Risk Comorbid Illness

Aneurysmal Bone Cyst: A Radiolucent Lesion of the Mandible. Report of 3 Cases

Pulmonary Metastasis in a 65-Year-Old Man With Mandibular Ameloblastoma: A Case Report and Review of the Literature

Intracranial Free Tissue Transfer for Massive Cerebrospinal Fluid Leaks of the Anterior Cranial Fossa

Nasal Endoscopy-Assisted Reconstruction of Orbital Floor Blowout Fractures Using Temporal Fascia Grafting

Traumatic Optic Neuropathy After Maxillofacial Trauma: A Review of 8 Cases

Leonard Buttons: A Reliable Method of Intraoperative Intermaxillary Fixation in Bilateral Mandibular Fractures

Fixation of Le Fort I Osteotomies With Poly-dl-Lactic Acid Mesh and Ultrasonic Welding—A New Technique

Distraction Osteogenesis of Maxilla and Midface in Postradiotherapy Patients

A Quantitative Approach to Orbital Decompression in Graves' Disease Using Computer-Assisted Surgery: A Compilation of Different Techniques and Introduction of the “Temporal Cage”

Morphologic Evaluation and Classification of Facial Asymmetry Using 3-Dimensional Computed Tomography

Rigid Fixation of Intraoral Vertico-Sagittal Ramus Osteotomy for Mandibular Prognathism

Effect of Open Rhinoplasty on the Smile Line

M-Shaped Genioplasty: A New Surgical Technique for Sagittal and Vertical Chin Augmentation: Three Case Reports

Hemimaxillofacial Dysplasia (Segmental Odontomaxillary Dysplasia): Case Study With 11 Years of Follow-Up From Primary to Adult Dentition

Lip Competence in Class III Patients Undergoing Orthognathic Surgery: An Electromyographic Study

Closure of the Alveolar Cleft by Bone Segment Transport Using an Intraoral Tooth-Borne Custom-Made Distraction Device

Skeletal Differences in Patients With Temporomandibular Joint Disc Displacement According to Sagittal Jaw Relationship

The Role of Maxillary Osteotomy in the Treatment of Arhinia

“Cotton Wool Roll” Technique in Orthognathic Planning

Primary Oral Mucosal Melanoma: Advocate a Wait-and-See Policy in the Clinically N0 Patient

Keratinocytes of Tissue-Engineered Human Oral Mucosa Promote Re-Epithelialization After Intraoral Grafting in Athymic Mice

University of Washington Oral and Maxillofacial Surgery Program

A Rare Occurrence of Hepatocellular Carcinoma Metastasis to the Mandible: Report of a Case and Review of the Literature

Reconstruction of Major Full Cheek Defects With Combined Extensive Pedicled Supraclavicular Fasciocutaneous Island Flaps and Extended Vertical Lower Trapezius Island Myocutaneous Flaps After Ablation of Advanced Oral Cancer

Pigmented Squamous Cell Carcinoma of Oral Mucosa: Clinicopathologic Study of 3 Cases

Microvascular Reconstruction of the Mouth, Jaws, and Face: Experience of an Australian Oral and Maxillofacial Surgery Unit

Botulinum Toxin A in the Treatment of Myofascial Pain and Dysfunction: The Case Against Its Use

Use of Botulinum Toxin A for Treatment of Myofascial Pain and Dysfunction

Limiting Resident Work Hours: The Case for the 80-Hour Work Week

Perspective on Work-Hour Restrictions in Oral and Maxillofacial Surgery: The Argument Against Adopting Duty Hours Regulations

The Adult Suicide-Prone Patient: A Review of the Medical Literature and Implications for Oral and Maxillofacial Surgeons

Subsequent Publication of Oral and Maxillofacial Surgery Meeting Abstracts

News and Announcements

Reader's Circle Continuing Education Program

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