Journal of Oral and Maxillofacial Surgery

Dad

Leon A. Assael — 2010-09-01

Please forgive me this small hubris of personal reflection, but my father passed away on the 4th of July, and honestly I can think of little else at this time. I will try to convey to you, dear JOMS reader, a bit of why in essence we have our professions, our Journal, our specialty, and indeed our civilization. It is about that peculiar human institution: family.

Complications of Frontal Sinus Fractures With Emphasis on Chronic Craniofacial Pain and Its Treatment: A Review of 43 Cases

L. Anthony Sivori, Reny de Leeuw, Isaac Morgan, Larry L. Cunningham — 2010-09-01

Purpose: Frontal sinus fractures constitute 5% to 12% of all facial fractures. The optimal management of frontal sinus fractures is controversial but involves preserving the function of the nasofrontal ducts when feasible. We reviewed the postoperative complications of a series of 43 patients treated surgically for frontal sinus fractures.Materials and Methods: The data from 43 patients treated from 2000 to 2006 were reviewed. The information reviewed included patient age and gender, mechanism of injury, type of frontal sinus injury, associated facial injuries, treatment method, and complications. The institutional review board approved the present study.Results: The average patient age was 32.5 years; 36 were men and 7 were women. Of the 43 patients, 23 (53.5%) had had anterior table fractures and 20 (46.5%) had had both anterior and posterior table fractures. Postoperative complications occurred in 7 patients (16.3%). Of these 7 patients, 2 experienced continued headache and pain and required surgical removal of infected hardware, 3 also experienced frequent headaches and pain in the frontal-temporal region, 1 had a post-traumatic deformity, and 1 developed periorbital cellulitis and abscess formation within the frontal sinus.Conclusion: Frequent headaches and complaints of continued pain were the most common complications experienced by our series of patients. We also reviewed treatment strategies for postoperative follow-up and treatment of chronic pain.

Effect of Substance P in Mandibular Osteotomies After Amputation of the Inferior Alveolar Nerve

Haitao He, Yinghui Tan, Maojin Yang — 2010-06-18

Purpose: The aims of this experiment were to study the effect and possible mechanism of substance P (SP) in the mandibular osteotomy healing process through inferior alveolar nerve (IAN) amputation.Materials and Methods: Thirty-two adult China white rabbits were randomly divided into 2 groups (experimental and control). An osteotomy in the left mandible was created and concomitantly the experimental group underwent IAN amputation. The rabbits were sacrificed 7, 14, 21, and 28 days after operation, and specimens were collected and stained with hematoxylin and eosin and for immunohistochemistry to observe the expression of SP in bone callus and the process of osteotomy healing. Semiquantitative analysis on immunohistochemically stained slices was performed using computer image analysis.Results: There was a larger amount of fibrous callus formation, relatively immature woven bone callus, and a smaller proportion between matured bone callus and woven bone in the group subjected to IAN amputation than in the controls at each stage, especially in the late stages. Immunoreactivities of SP occurred weakly 7 and 14 days after operation and became stronger gradually in the late stage in the experimental group. Stronger immunoreactivities of SP occurred 7 and 14 days after operation and less on day 21 after trauma and became strongest on day 28 after trauma in the control group. The strongest immunoreactivities at each stage occurred on day 28 after trauma in both groups.Conclusion: SP secreted by IAN may be very important to initiate and modulate the process of repair and remodeling of bone.

Acinic Cell Carcinoma of Minor Salivary Glands: A Clinicopathologic Study of 21 Cases

Jessica E. Omlie, Ioannis G. Koutlas — 2010-06-24

Purpose: Acinic cell carcinoma (ACC) is an infrequent type of malignant salivary gland tumor. Approximately 16% of all ACCs occur in the mouth according to several small studies. This study was undertaken to 1) report on the clinicopathologic characteristics of 21 intraoral examples, 2) reconfirm the reported indolent behavior of these tumors, and 3) verify the synchronous or metachronous occurrence of other malignancies with ACC.Materials and Methods: Twenty-one patients with intraoral ACC were identified in the previous 27 years. Demographic data and histomorphologic characteristics were evaluated and follow-up information was sought.Results: Fifteen patients (68%) were male and 6 female. Seven cases (33.3%) occurred in the buccal mucosa, 6 in the palate (28.6%), 5 involved the upper lip (23.8%), 2 the retromolar mucosa (9.5%), and 1 the lower lip (4.8%). The mean age of patients was 50 years, with the youngest being 13 and the oldest 73. The duration was known in 9 patients and varied from 4 months to longer than 15 years. The size of the tumors varied from 0.6 to 1.6 cm. Where reported, lesions were asymptomatic. Histologically, different patterns that included microcystic, papillary cystic, follicular and solid, and combinations of these types characterized the lesions. Follow-up information was obtained in 12 patients. Eleven patients did not report recurrence or metastatic disease. The follow-up extended from 10 months to 17 years. One patient had 2 recurrences due to erroneous diagnosis that led to inappropriate treatment. After properly diagnosed and treated, this patient has been free of tumor for 4 years. Of interest were the metachronous occurrence of lymphoma in 1 patient and the synchronous occurrence of renal cell carcinoma in another.Conclusion: This study confirms the indolent behavior of ACC of minor salivary glands and previous reports on the occasional synchronous or metachronous association of malignant salivary gland tumors with other malignancies.

Postoperative Condylar Position by Sagittal Split Ramus Osteotomy With and Without Bone Graft

Myoung Geun Kang, Kyoung In Yun, Chang Hyun Kim, Je-Uk Park — 2010-06-18

Purpose: The purpose of the present study was to determine how the condylar position is affected by the bone graft in the intersegmental space created by sagittal split ramus osteotomy.Patients and Methods: We compared the position of the condyle after sagittal split ramus osteotomy, without the bone graft (control group, n = 30) and with the bone graft (study group, n = 30) using computed tomography with a 2-mm thickness. Using 3-dimensional images and a 3-dimensional computer program, the pre- and postoperative displacement and rotation of the condyle in the axial (rotation and mediolateral movement of the condyle) and sagittal plane (anteroposterior and superoinferior movement of the condyle and rotation of the proximal segment) were measured. In addition, the relationship of the amount of rotation and backward movement of the mandible and the change in the condylar position was analyzed. For the statistical analysis, the t test (P = .05) and Wilcoxon rank sum test were used.Results: No statistically significant differences were found in any of the measurements of the 2 groups. Nevertheless, the mediolateral movement (P = .051) showed a relatively greater apparent difference, although the difference was not statistically significant. The condylar displacement had no relationship to the rotation of the mandible. However, the condylar displacement in relation to the amount of backward movement of the mandible was significant, especially when it was greater than 10 mm of setback.Conclusions: Using a bone graft in the intersegmental gap of a sagittal split ramus osteotomy is considered an effective clinical method to secure the desirable intersegmental position because it helps to maintain the space with ease. Especially in cases with greater than 10-mm setback of the mandible, it prevents excessive condylar displacement.

Comparison of Titanium and Biodegradable Miniplates for Fixation of Mandibular Fractures

2010-01-25

Purpose: The purpose of the present study was to compare the use of biodegradable miniplates and titanium miniplates for the fixation of mandibular fractures.Patients and Methods: BioSorb FX biodegradable plates and screws and titanium miniplates were used in 91 patients (65 males and 26 females; age range 11 to 69 years) for the treatment of mandibular fractures. The clinical and radiographic findings were recorded at 1, 3, 6, and 12 months after surgery.Results: The overall complication rate was 4.41%. In the biodegradable plate group, infection occurred in 2 cases (4.26%) and was resolved by incision and drainage and antibiotics. In the titanium plate group, infection occurred in 1 case and plate fracture in 1 case (4.56%). The fractured plate was removed, and a new titanium miniplate was applied using a trocar. The infection was resolved with antibiotics. No adverse tissue reactions, malocclusions, or malunions occurred during the observation period.Conclusions: Our results have shown that the rate of morbidity is very low with the use of biodegradable plates and titanium plates, suggesting that biodegradable and titanium plates have the potential for successful use in the fixation of mandibular fractures.

Evaluation of the Application of Computer-Aided Shape-Adapted Fabricated Titanium Mesh for Mirroring-Reconstructing Orbital Walls in Cases of Late Post-Traumatic Enophthalmos

Yi Zhang, Yang He, Zhi Yong Zhang, Jin Gang An — 2010-06-07

Purpose: Computer-aided individually shape-adapted fabricated titanium mesh for the mirroring-reconstruction of the orbit is a promising method for the correction of post-traumatic enophthalmos. The purpose of this study was to evaluate the application of this technique and assess the treatment outcomes.Patients and Methods: Twenty-one patients with delayed treatment of unilateral impure orbital fracture and post-traumatic enophthalmos were included in this study. Computed tomography–based mirroring-reconstruction images of the orbit were obtained for each individual to fabricate anatomically adaptive titanium mesh by computer-aided design and computer-aided manufacturing techniques. After exposing the areas of orbital defect and reducing the herniated soft tissue, the titanium mesh was inserted to reconstruct the internal orbit with a mean deep extension of 29.33 mm. Measurements were performed to assess the change in the degree of enophthalmos and orbital volume before and after surgery. Paired samples t test and Pearson correlation coefficient were employed for statistical analysis.Results: Follow-up examinations revealed that the degree of enophthalmos decreased to less than 2 mm in 11 patients, 2 to 4 mm in 9 patients, and remained greater than 7 mm in 1 patient. Statistical analysis revealed that post-traumatic enophthalmos in this series was 4.05 ± 2.02 mm, which was associated with an orbital volume increment of 6.61 ± 3.63 cm3, with a regression formula of enophthalmos = 0.446 × orbital volume increment + 2.406. Orbital reconstruction effected a orbital volume decrease of 4.24 ± 2.41 cm3 and enophthalmos correction of 2.01 ± 1.46 mm, the regression formula being enophthalmos = 0.586 × orbital volume decrease + 0.508. After surgery, the degree of unresolved enophthalmos was 2.03 ± 1.52 mm, and the retained orbital volume expansion was 2.23 ± 2.86 cm3, and the regression formula was enophthalmos = 0.494 × orbital volume expansion + 1.415.Conclusion: Application of the individual fabricated titanium mesh for orbital reconstruction reduced the trauma-induced orbital volume increment by 65% and corrected 50% of severe late enophthalmos. Additional augmentation of orbital contents was required for further correction. The related treatment parameters were suggested.

Expression of TGF-β1, Osteonectin, and BMP-4 in Mandibular Distraction Osteogenesis With Compression Stimulation: Reverse Transcriptase-Polymerase Chain Reaction Study and Biomechanical Test

2010-06-14

Purpose: This study compared the levels of transforming growth factor-β1 (TGF-β1), osteonectin, and bone morphogenetic protein-4 (BMP-4) expression in regenerated bone in a rabbit mandible that had undergone conventional distraction osteogenesis (DO) with those in regenerated bone from a modified DO technique with compression stimulation.Materials and Methods: A total of 42 rabbits were used in this reverse transcriptase-polymerase chain reaction study. In the control group, distraction was performed at 1 mm/day for 8 days. In the experimental group, overdistraction was performed for 10 days, followed by a 3-day latency period and 2 days of compression to achieve the same amount of DO. Three rabbits per subgroup were killed at 0, 5, 13, 20, 27, 34, and 41 days after the initial osteotomy. The levels of TGF-β1, osteonectin, and BMP-4 in the bone regenerates were measured by reverse transcriptase-polymerase chain reaction. A biomechanical microhardness test was also performed in 8 rabbits as a separate experiment.Results: Reverse transcriptase-polymerase chain reaction revealed a greater level of TGF-β1 in the experimental group immediately after applying the compression force that continued for 2 weeks. The level then decreased to that of the control group at 3 weeks. The greater level of osteonectin in the experimental group after compression than that in the control group continued for 3 weeks. In the experimental group, the level of BMP-4 increased immediately after compression. However, the level in the control group decreased. The microhardness ratio of distracted bone to normal bone on the cortex was statistically different at 0.47 in the control group and 0.80 in the experimental group (P = .049) at 55 days after osteotomy.Conclusion: The effectiveness of the new DO technique with compression stimulation was confirmed by the gene expression study and the biomechanical test findings.

Use of Coblation in Arthroscopic Surgery of the Temporomandibular Joint

Min Jie Chen, Chi Yang, Shan Yong Zhang, Xie Yi Cai — 2010-04-12

Purpose: To evaluate the effectiveness of Coblation in temporomandibular joint (TMJ) arthroscopic surgeries and to preliminarily evaluate the clinical effects.Materials and Methods: Arthroscopic Coblation, combined with disc suturing, was performed in 419 TMJs from July 2001 to March 2007 by use of the ArthroCare System 2000 radiofrequency machine (ArthroCare, Sunnyvale, CA). All patients had stage II to V internal derangement, according to the classification of Wilkes. Besides disc suturing, the technique of Coblation was used in procedures of adhesion ablation, anterior release, chondroplasty, and discoplasty. All patients were followed up for 3 months and evaluated based on immediate arthroscopic findings, by clinical examination, and by magnetic resonance imaging examination.Results: During the TMJ arthroscopic surgeries, the adhesion, unhealthy disc, and cartilage were ablated completely. The surface of the cartilage and disc were smooth without cautery damage and hemorrhage. During the clinical follow-up period, 76.37% of TMJs (320/419) had excellent results and 16.47% (69/419) had good results. The success rate was 92.84%. Masseter muscle atrophy occurred in 4 patients, and 30 TMJs required second arthroscopic surgeries or open surgeries.Conclusions: The technique of Coblation has proved to be an effective and minimally invasive option for the treatment of TMJ internal derangement, with advantages such as offering a high degree of precision and control, causing little or no thermal damage to surrounding tissue, leaving smooth anatomic surfaces, and achieving hemostasis of smaller blood vessels.

Superficial Parotidectomy Versus Retrograde Partial Superficial Parotidectomy in Treating Benign Salivary Gland Tumor (Pleomorphic Adenoma)

Omri Emodi, Imad Abu El-Naaj, Arye Gordin, Sharon Akrish, Micha Peled — 2010-06-18

Purpose: Of all benign salivary gland tumors of the parotid gland, pleomorphic adenoma (mixed tumor) is the most common. It accounts for 60% to 70% of all benign tumors of the parotid gland. This neoplasm arises in patients in the fourth to sixth decade of life, with a female predominance. The surgical excision of this lesion continues to be the subject of major debate. The goal is to avoid facial disability yet attain complete resection without perforation of the capsule/pseudocapsule. The purpose of our study is to compare 2 surgical techniques performed at the Ear, Nose, and Throat and Maxillofacial Departments, Rambam Medical Center, Haifa, Israel, and determine which is preferable in treating this lesion.Patients and Methods: We reviewed 48 patients who underwent excision of pleomorphic adenoma of the parotid gland between 1996 and 2005 at Rambam Medical Center: 18 were treated surgically with the classical superficial parotidectomy (SP) technique, using an anterograde approach, and 30 were treated with retrograde partial superficial parotidectomy (PSP). We compared the 2 surgical techniques in terms of surgical time, histopathologic size of the lesion, amount of excised healthy parotid tissue, histologic margin, and the preservation of the capsule/pseudocapsule. We also made clinical records of temporary or definitive injury to the facial nerve, which branches of the facial nerve were temporarily or definitively injured, the occurrence of Frey syndrome, esthetic satisfaction, and the amount of recurrence or infection after surgery.Results: Of the 48 patients, 19 (39.6%) were male and 29 (60.4%) were female, with a mean age (± SD) of 43.8 ± 16.97 years (median, 50 years; range, 12-79 years). We found a significant difference (P = .029) in mean surgical time (± SD): 171 ± 49.7 minutes (median, 165 minutes) when performing the classical SP and 145 ± 42.7 minutes (median, 130 minutes) when performing the retrograde PSP. Much more healthy parotid tissue was taken out with the classical procedure (mean, 51.4 ± 13.6 mm; median, 50 mm) than with the retrograde PSP technique (mean, 39.2 ± 11.8; median, 35 mm) (P = .01). There was a significant difference (P = .0003) in facial nerve injuries: 39% of patients did not report any facial deficit in the SP group compared with 90% in the PSP group. In the SP group, only 3 patients reported a permanent deficit, and in the PSP group, only 3 patients had a temporary deficit (compared with 8 in the SP group). The main injuries occurred in the mandibular branch with both techniques: 6 SP and 2 PSP. There was no difference in esthetic satisfaction: 72.2% of patients in the SP group and 80% in the PSP group had no esthetic complaints. In the SP group, patients mainly complained about swelling (3 patients), and in the retrograde PSP group, the main complaint was depression (4 patients). Frey syndrome was found in 9 patients in the retrograde PSP group and 4 in the classical SP group (with an overall rate of 27.7%). The lesion recurred in only 2 patients—1 in each group.Conclusion: With both of the techniques, we found satisfactory results. In the majority of cases, retrograde PSP is a superior technique to the classical SP, although Frey syndrome is more often observed with the former.

A Retrospective Analysis of Peripheral Odontogenic Fibroma in an Iranian Population

Mojgan Alaeddini, Sara Salehizadeh, Fereshteh Baghaii, Shahroo Etemad-Moghadam — 2010-06-18

Purpose: The aim of this study was to assess the relative frequency of peripheral odontogenic fibroma (POdF) in an Iranian population and to compare the obtained data with previous reports.Materials and Methods: Archival material was retrospectively analyzed from 1967 to 2007, and all microscopic slides of lesions considered in the differential diagnosis of POdF were retrieved. A diagnosis of POdF was made according to the criteria described by the World Health Organization in 2005. Demographic data, including age, gender, site of involvement, and previous history of POdF, were recorded for all samples with a diagnosis of this neoplasm.Results: Nineteen POdFs were identified, which accounted for 0.14% of the archival cases. One of these tumors was a recurrence, diagnosed 12 months earlier. All cases were of the epithelium-rich or World Health Organization histologic subtype and most tumors occurred in the mandible. No significant difference in the prevalence of POdF was found between the studied variables. Among the 18 primary neoplasms, follow-up was possible for 2 to 13 years in 6 cases, and none developed recurrence.Conclusion: Similar to previous investigations, this study shows that POdFs are uncommon odontogenic lesions. Detailed information on POdF is limited because of its rarity; therefore, this study may provide additional data for further investigations and may enable better understanding of this tumor.

Prognostic Factors and Outcome Analysis of Submandibular Gland Cancer: A Clinical Audit

2010-06-11

Purpose: To retrospectively review a long-term, single-institution experience of subjects with submandibular gland malignancies treated with definitive locoregional therapy with an aim to identify clinicopathologic variables that correlate with outcomes.Materials and Methods: A comprehensive chart review of 47 patients presenting to the institute from 1993 to 2005 with a histologic diagnosis of submandibular salivary gland cancer was performed to extract demographic data, clinicopathological characteristics, and treatment details. Clinical and pathologic factors were correlated with locoregional control, distant metastases free survival, and disease-free survival using log-rank test and Cox proportional hazards model for univariate and multivariate analysis, respectively.Results: With a median follow-up of 29 months (interquartile range, 13 to 64 months), the actuarial 5-year locoregional control, distant metastasis-free survival, and disease-free survivals of the entire cohort were 80.5%, 86.1%, and 71.8%, respectively. Overall stage grouping (P = .008), perineural invasion (P = .04), and radiotherapy dose (P = .033) were significant predictors of locoregional control. Overall stage grouping (P = .014) and T stage (P = .05) also affected disease-free survival. Extraglandular involvement showed a trend toward poorer outcome.Conclusions: Submandibular gland cancer is a rare disease with histologic diversity and variable clinical behavior. Overall stage grouping and perineural invasion remain the most significant predictors of outcome. Adequate doses of adjuvant radiotherapy improve locoregional control in high-risk patients.

Ameloblastic Carcinoma: A Multicenter Nigerian Study

2010-06-11

Purpose: To obtain a national profile on the prevalence and management of ameloblastic carcinoma in Nigerians.Materials and Methods: Data were collected from the case files of patients with a histologic diagnosis of ameloblastic carcinoma from 4 tertiary referral centers in Nigeria from January 1980 to December 2008.Results: Twenty patients were seen within the study period. There were 11 male and 9 female patients, with a male-to-female ratio of 1.2:1. Their ages ranged from 16 to 85 years (mean ± SD, 41.63 ± 19.8 years). The duration of the lesion before presentation was 6 months to 4 years. Twelve cases occurred in the posterior mandible alone, 1 case occurred in the anterior mandible alone, and 4 cases involved the anterior and posterior mandible. The posterior part of the maxilla was involved in 3 cases. A majority of the cases (17) occurred de novo, and 3 patients presented with carcinoma ex-ameloblastoma. Treatment included surgical resection with or without neck dissection. Eight patients declined treatment after diagnosis. Surgery was planned for 12 patients, but 2 patients died of intractable bleeding episodes before surgery. Mandibulectomies and maxillectomies were performed for 10 patients. Follow-up was carried out for 5 patients. Recurrence ranged from 6 to 96 months after the first surgery. Overall deaths recorded involved 6 patients. Three patients died within 3 years after the initial surgery and 1 patient died about 8 years after the initial surgery. One patient is still alive and well 1 year after surgery.Conclusion: Ameloblastic carcinoma is an uncommon malignancy. Most cases occur in the mandible and arise de novo. Early diagnosis and radical local excision remain the mainstay of treatment.

Accurate Reconstruction of Discontinuous Mandible Using a Reverse Engineering/Computer-Aided Design/Rapid Prototyping Technique: A Preliminary Clinical Study

2010-06-14

Purpose: To improve the reconstructive surgical outcome of a discontinuous mandibular defect, we used reverse engineering (RE), computer-aided design (CAD), and rapid prototyping (RP) technique to fabricate customized mandibular trays to precisely restore the mandibular defects. Autogenous bone grafting was also used to restore the bony continuity for occlusion rehabilitation.Patients and Methods: Six patients who had undergone block resection of the mandible underwent reconstruction using a custom titanium tray combining autogenous iliac grafts. The custom titanium tray was made using a RE/CAD/RP technique. A virtual 3-dimensional model was obtained by spiral computed tomography scanning. The opposite side of the mandible was mirrored to cover the defect area to restore excellent facial symmetry. A bone grafting tray was designed from the mirrored image and manufactured using RP processing and casting. The mandibular defects were restored using the trays in combination of autologous iliac grafting. An implant denture was made for 1 of the 6 patients at 24 weeks postoperatively for occlusion rehabilitation.Results: The trays fabricated using this technique fit well in all 6 patients. The reconstructive procedures were easy and time saving. Satisfactory facial symmetry was restored. No severe complications occurred in the 5 patients without occlusion rehabilitation during a mean 50-month follow-up period. The reconstruction in the patient with occlusion lasted for only 1 year and failed eventually because of bone resorption and infection.Conclusions: Mandibular reconstruction was facilitated using the RE/CAD/RP technique. Satisfactory esthetic results were achieved. However, the rigidity of the cast tray could cause severe stress shielding to the grafts, which could lead to disuse atrophy. Therefore, some modification is needed for functional reconstruction.

Aneurysmal Bone Cysts of the Jaws: Analysis of 17 Cases

Zhi-Jun Sun, Yi-Fang Zhao, Rui-Li Yang, Roger A. Zwahlen — 2010-01-28

Purpose: Aneurysmal bone cysts (ABCs) are benign osteolytic lesions that occur relatively rarely in the jaws. The aim of the present study was to investigate the clinical and radiographic characteristics, pathologic features, and treatment results of ABCs of the jaws (JABCs).Materials and Methods: A retrospective analysis of a 20-year database, including 17 cases of JABC, was performed.Results: A total of 17 patients, 9 males and 8 females, aged 7 to 47 years (mean 20.4, median 14), were included. Of the 17 lesions, 15 (88.2%) were located in the mandible and 2 (11.8%) in the maxilla. A painless (12 of 17, 70.6%) or painful (3 of 17, 17.6%) swelling was the most common clinical finding. The pathologic analyses revealed that 13 JABCs (76.5%) were secondary in nature, including 11 cases associated with ossifying fibroma. Radiologically, the lesions frequently presented as multilocular (58.8%), well-defined (70.6%) radiolucencies (82.4%). Two lesions (11.8%) recurred.Conclusions: Our results suggest that most JABCs are secondary in nature and frequently associated with ossifying fibroma. The patients with JABCs presented with various clinical and radiographic features and therefore often posed a diagnostic dilemma. Resection is the preferred treatment of JABCs.

Accuracy and Reproducibility of a 3-Dimensional Stereophotogrammetric Imaging System

Marcio de Menezes, Riccardo Rosati, Virgilio F. Ferrario, Chiarella Sforza — 2010-06-21

Purpose: To test the accuracy and reproducibility of a 3-dimensional (3D) stereophotogrammetric imaging system for measuring the facial soft tissues of healthy subjects.Materials and Methods: Three-dimensional soft tissue facial landmarks were obtained from the faces of 10 adult subjects, by use of a 3D stereophotogrammetric imaging system (Vectra; Canfield Scientific, Fairfield, NJ). Sixteen linear measurements were computed. Systematic and random errors between operators, calibration steps, and acquisitions were calculated.Results: No systematic errors were found for all performed tests (P > .05, paired t test). The method was repeatable, and random errors were always lower than 1 mm, except for the distance from cheilion to cheilion. Repeated sets of acquisition showed random errors up to 0.91 mm, without systematic biases.Conclusion: The 3D stereophotogrammetric imaging system can assess the coordinates of facial landmarks with good precision and reproducibility. The method is fast and can obtain facial measurements with few errors.

Replacement of the Condyle and Ascending Ramus by a Modular Endoprosthesis in Macaca fascicularis—Part 4: Evaluation of the Temporomandibular Joints

Bee Tin Goh, Shermin Lee, Henk Tideman, John A. Jansen, Paul J.W. Stoelinga — 2010-06-09

Purpose: To assess, using cone-beam computed tomography and histologic examination, whether the fixation of a condyle–ascending ramus mandibular modular endoprosthesis results in a physiologic condylar replacement in Macaca fascicularis.Materials and Methods: The right condyle and ascending ramus were resected in 8 adult monkeys and replaced with a modular endoprosthesis, fixed with polymethyl methacrylate bone cement (Palacos). Four monkeys were sacrificed at 3 months and another 4 at 6 months postoperatively. The reconstructed and contralateral temporomandibular joints were harvested en bloc and studied using cone-beam computed tomography and descriptive histologic examination. Heterotopic bone formation was quantified using a modified grading scale. The condyle cartilage thickness in the contralateral temporomandibular joint was measured using histomorphometric methods. The results were compared with those of the unoperated control monkeys.Results: Bone resorption in the glenoid fossa and pathologic changes in the articular disc were noted on the reconstructed side in most specimens. Nevertheless, cone-beam computed tomography findings, histologic findings, and condyle cartilage thickness measurements of the contralateral temporomandibular joint were not significantly different from those of the control specimens.Conclusion: Replacement of the condyle and ascending ramus using a modular endoprosthesis in Macaca fascicularis resulted in adaptive remodeling of the glenoid fossa at up to 6 months postoperatively. Long-term studies are required to further assess the potential of this mode of reconstruction.

Fine-Needle Aspiration Cytology of Salivary Gland Lesions: A Systematic Review

Giuseppe Colella, Rosangela Cannavale, Federica Flamminio, Maria P. Foschini — 2010-06-28

Purpose: The aim of this study was to provide a systematic review of fine-needle aspiration (FNA) cytology on salivary gland lesions.Materials and Methods: A review of the literature was carried out using PubMed, SCIRUS, and the Cochrane Central Register of Controlled Trials (CENTRAL). The present study included only data correlating cytological and histological diagnoses.Results: Of the patients, 484 received a histological diagnosis of malignant tumor; cytological diagnosis was concordant in 387 (79.95%), discordant in 97 (20.04%). A total of 1,275 patients received a histological diagnosis of benign tumor; cytological diagnosis was concordant in 1,219 (95.608%) and discordant in 56 (4.39%). In all, 154 patients received a histological diagnosis of non-neoplastic lesion; cytological diagnosis was concordant in 145 (94.156%) and discordant in 9 (5.84%).Conclusion: FNA is a safe diagnostic tool that has a reliable sensitivity and specificity for the assessment of salivary gland pathology. FNA cytology may be useful in routine preoperative diagnostic testing.

Minimally Invasive Surgically Assisted Rapid Palatal Expansion With Limited Approach Under Sedation: A Report of 283 Consecutive Cases

Federico Hernandez-Alfaro, Javier Mareque Bueno, Artur Diaz, Carles Martí Pagés — 2010-06-28

Purpose: An adequate transverse maxillary dimension is one of the critical aspects of a functional and stable occlusion. Surgically assisted rapid palatal expansion consists of a surgical liberation of the sites of resistance combined using orthopedic forces. Most technical descriptions advocate the use of general anesthesia with hospital admission.Materials and Methods: Between March 2000 and July 2008, surgery was performed on 283 consecutive cases with transverse skeletal maxillary hypoplasia. The incision ran horizontally to reach the level of the laterals. Osteotomies of lateral walls and pterygoid disjunction were performed in all cases. A V–Y closure was performed in 2 layers. Patients were discharged after recovery from sedation.Results: One hundred seventy-two of the 283 patients were male. Mean age was 18.3 years. Mean surgical time from incision to last suture was 19 minutes. Expanders were Hyrax in 221 cases and Haas in 61, and a bone-borne expander was used in 1 case. At the 1-year follow-up visit, mean expansion was 8.0 at the canines and 8.9 at the mesiovestibular cuspid of the first molar. General anesthesia has been classically advocated for these procedures, the argument being that pterygomaxillary disjunction was too traumatic to be performed under sedation. The surgical technique used sought to attain a balance between maximum mobilization of the maxilla with a complete liberation of all the buttresses and minimum morbidity to avoid further complications.Conclusions: The new technique that we report seeks to combine both aspects and allows for rapid intervention with local anesthesia plus sedation and a minimal approach with a total liberation of the maxillary resistances (piriform aperture pillars, zygomatic buttresses, midpalatal suture, and pterygoid junctions). The minimal approach and incision used in the technique guarantee vascular support to the maxilla via the vestibular corridors.

Clinical Evaluation of Polyvinylpyrrolidone Sodium Hyalonurate Gel and 0.2% Chlorhexidine Gel for Pain After Oral Mucosa Biopsy: A Preliminary Study

Pia López-Jornet, Fabio Camacho-Alonso, Ascensión Martinez-Canovas — 2010-06-11

Purpose: To study the symptoms of patients during the 7 days after incisional biopsy of the oral mucosa and the application of polyvinylpyrrolidone-sodium hyalonurate (Aloclair) gel or 0.2% chlorhexidine digluconate gel.Materials and Methods: A total of 90 consecutive patients with lesions requiring histopathologic analysis were studied. These patients were divided randomly into 3 groups. Group I (control group) received no topical treatment. For group II, the site of surgical intervention was treated topically with polyvinylpyrrolidone sodium hyalonurate (Aloclair; Sinclair Pharma, Surrey, United Kingdom) gel 3 times daily for 1 week. Group III was treated the same as group II but with 0.2% chorhexidine digluconate gel. Using a visual analog scale, we determined the interval at which the postoperative pain was maximal, and which parts of the mouth experienced the most postoperative complications.Results: The most intense peaks of maximal pain were recorded in the control group, with the maximal pain occurring 2 hours (median 2.2, range 0 to 8.5) after surgery, after which it tended to diminish gradually during the week of the study period. The maximal level of pain was significantly lower in groups II and III than in the control group (P = .048 and P = .054, respectively). The lip was the site most likely to experience maximal pain.Conclusion: Topical application of polyvinylpyrrolidone sodium hyalonurate and chlorhexidine digluconate decreases the symptoms of oral mucosa biopsy.

Quality of Life of Patients With Tongue Cancer 1 Year After Surgery

Zhao-hui Yang, Wei-liang Chen, Hong-zhang Huang, Chao-bin Pan, Jin-song Li — 2010-06-14

Purpose: To study the changes and factors affecting the quality of life (QOL) of patients with tongue cancer 1 year after primary surgery.Patients and Methods: A total of 289 consecutive patients with tongue cancer who had undergone primary surgery from 2003 to 2008 at our hospital were recruited. Patient QOL was evaluated using the University of Washington Quality of Life Questionnaire, version 4. Statistical analysis was conducted using a paired-samples t test and multiple stepwise linear regression with Statistical Package for Social Sciences, version 11.5 (SPSS, Chicago, IL).Results: At 1 year after surgery, the appearance, activity, speech, swallowing, shoulder function, salivary, and taste domain scores were significantly lower than the preoperative scores (P < .05). However, the pain, anxiety, and mood scores were significantly better 1 year after surgery (P < .05). The overall QOL had increased greatly 1 year after surgery but did not reach the pretreatment level. Multiple stepwise linear regression analysis showed that the main factors affecting QOL were radiotherapy, advanced clinical stage (P < .05), socioeconomic status, and patient age. Radiotherapy, advanced clinical stage (P < .05), socioeconomic status, and age (P < .05) were independently associated with QOL.Conclusions: The patients with tongue cancer who have been diagnosed and treated early might have a better QOL. A greater socioeconomic status can also improve the QOL of patients with tongue cancer after primary surgery.

Factors Associated With Free Flap Complications After Head and Neck Reconstruction and the Molecular Basis of Fibrotic Tissue Rearrangement in Preirradiated Soft Tissue

Sooyeon Lee, Christin Thiele — 2010-06-07

Purpose: Several factors are associated with free flap complications in head and neck reconstruction after radiotherapy. The present study aimed to identify the correlation between irradiation and the healing of wounds after microvascular free flap transfer and to clarify the molecular mechanisms for the differences in healing between irradiated and nonirradiated patients.Patients and Methods: A retrospective study of 81 cases of microvascular free flap transfer was conducted. Tissue samples were obtained from 3 different regions of the patients (nonirradiated oral mucosa, irradiated skin, and nonirradiated skin). Expression of transforming growth factor-β1 was monitored by immunohistochemistry and immunoblot analysis. The levels of matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1 were investigated qualitatively and quantitatively.Results: Multivariate analysis revealed that only preoperative irradiation was a significant predictor of free flap complications (P = .006), with a 4 times greater risk (odds ratio 4.141). It was also shown that patients with an advanced tumor stage and those who had received chemotherapy after radiotherapy were twice as likely to develop free flap complications. Transforming growth factor-β1 was overexpressed in free flaps for as long as 6 months after radiotherapy. It was remarkably observed in the granulation tissue in the preirradiated skin. Moreover, extracellular matrix remodeling regulated by transforming growth factor-β1 was detected with decreased matrix metalloproteinase-1 and increased TIMP-1 expression in the irradiated skin.Conclusion: The healing of surgical wounds created by microvascular free flap transfer correlated negatively with preoperative radiotherapy. Extracellular matrix remodeling was also detectable in the free flap for up to 6 months after radiotherapy completion.

Micro-Computed Tomography and Histologic Evaluation of the Interface of Hydrogel Expander and Underlying Bone: Influence of Pressure Distributors on Bone Resorption

2010-07-02

Purpose: Tissue expanders lead to changes in the underlying bone and can cause bone resorption. We investigated whether the insertion of mechanical devices that distribute the load on the bone can influence these effects.Materials and Methods: A total of 28 Lewis rats were assigned to 1 of 4 groups. Hydrogel expanders were placed subcutaneously either directly on the calvaria, on titanium mesh, or on a titanium plate. The fourth group of rats served as the controls. The bone quality and thickness were assessed beneath, and at the periphery of, the expanders using micro-computed tomography and histologic examination.Results: Micro-computed tomography images were obtained before and 21 days after insertion. The images revealed a significant decrease in hydroxyapatite density beneath the expanders in the group with only expanders. This decrease was reduced with the use of titanium mesh and completely prevented with the use of titanium plates. Histologic examination revealed a significant decrease in bone density and marked lacunae beneath the hydrogel expanders in the group with only expanders. In contrast, the titanium mesh decreased the size of the lacunae, and the titanium plates completely prevented both the formation of lacunae and the decrease in bone thickness.Conclusion: The bone resorption caused by hydrogel expanders can be diminished using titanium mesh and completely prevented by the insertion of a titanium plate.

Oral Pyogenic Granuloma: A Retrospective Analysis of 293 Cases in a Brazilian Population

2010-04-23

Purpose: The purpose of this study was to retrospectively analyze the clinical, demographic, and pathologic properties of oral pyogenic granuloma occurring in a Brazilian population.Patients and Methods: We retrieved an archival number of 293 cases that were diagnosed as having oral pyogenic granuloma at the Service of Pathological Anatomy, Discipline of Oral Pathology, Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Brazil, during a 38-year period, from 1970 to 2008. The records were reviewed, and information on gender, age, race, lesion site, predisposing factors, clinical features, and clinical diagnosis, treatment, and recurrence was collected.Results: There was a female predilection, and the female-to-male ratio was 2.38:1. The mean age of the patients was 27 years. A high degree of occurrence was observed in the second decade of life. White patients were most commonly affected (44.7%). The most frequently involved site was the gingiva (83%), with a higher prevalence in the maxilla. The majority of cases were symptomatic and showed bleeding; the lesions were described as nodules (71.9%) with a soft consistency (62.3%) and a red surface (73.2%). The base was pedunculated in 61.1% of cases, and the mean size was 1.3 cm. The recurrence rate was 8.2% of cases.Conclusion: The clinical, demographic, and pathologic features of oral pyogenic granuloma in the Brazilian population in this study were similar to those in studies of populations from other countries.

Soft Tissue Reduction During Open Treatment of Intracapsular Condylar Fracture of the Temporomandibular Joint: Our Institution's Experience

Minjie Chen, Chi Yang, Dongmei He, Shanyong Zhang, Bin Jiang — 2010-06-24

Purpose: To evaluate the effect of soft tissue reduction during open surgery of intracapsular condylar fracture (ICF) of the temporomandibular joint (TMJ).Materials and Methods: A total of 129 patients (164 TMJs) with ICF were treated from June 2004 to May 2009. Osteosynthesis was performed by different methods without stripping the lateral pterygoid muscle (LPM). The disc was reduced with or without transecting adhesions, release of the epimysium of the LPM, and anchorage to the condyle. Retrodiscal tissue tear was repaired. The patients were evaluated by computed tomography, magnetic resonance imaging, and clinical signs pre- and postoperatively.Results: Inferomedial displacement of the condylar segment and disc occurred in 97.6% of cases. Adhesion of the superior joint space was found in 37 of 160 TMJs (23.1%). Retrodiscal tissue tear combined with disc displacement was found in 119 of 160 TMJs (74.4%). The condylar stump was found to be superolaterally displaced in 30.6% (49/160) and laterally dislocated out of the fossa in 41.9% (69/160). A lateral capsular tear was observed in 87 of 160 TMJs (54.4%). The condylar fragments and the discs were reduced and fixed completely with preservation of the attachment of the LPM. Coronal CT revealed that 95.6% (130/160 cases) of ICFs were correctly reduced and fixed. Postoperative magnetic resonance imaging showed that the disc was reduced to its normal position in 40 of 42 TMJs. Long-term complications of 45 patients included fibrous ankylosis in 1 case (0.8%), mouth opening limitation (<2.5 cm) in 5 cases, (3.9%), condyle resorption in 3 cases (2.3%) that needed plate removal, facial nerve injury in 3 cases (2.3%), TMJ click in 2 cases (1.6%), mouth open with deviation in 7 cases (5.4%), and malocclusion in 1 case (0.8%).Conclusion: Anatomic reduction of soft tissue was of benefit for biomechanical function of the TMJ and decreased the complications of open surgery.

Repair of Whole Rabbit Facial Nerve Defects Using Facial Nerve Allografts

Min Hu, Lihai Zhang, Yu Niu, Hongxi Xiao, Peifu Tang, Yan Wang — 2010-06-24

Purpose: To investigate the feasibility of repairing whole facial nerve defects with chemically extracted acellular whole facial allografts nerves and its effect on motor conductivity recovery.Materials and Methods: Whole nerve defects (branches and trunk) were made in 4 rabbit groups (n = 18), and the nerve defect was bridged using 1) acellular facial nerve allografts, 2) facial nerve isografts, 3) acellular peroneal nerve allografts, and 4) peroneal nerve isografts. Six months later, cell morphology, nerve microbeam distribution, angiogenesis, and collagen were observed in the distal and center of the grafts with special trichrome staining. The regenerated nerve fibers and Schwann cells in the anastomosis site were immunohistochemically stained. Nerve axon numbers and passing rates were analyzed with computer-captured images. The regenerated nerve ultrastructure was analyzed by transmission electron microscopy.Results: Regenerated nerve fibers and vessels were found in the grafts, with no differences between groups A and B. Groups C and D had poor nerve continuity with little vascular regeneration. The distal segments of nerve transplants in groups A and B showed strong positive neurofilament staining, higher than in groups C and D. In groups A and B, many long spindle-shaped Schwann cells proliferated longitudinally in the nerve transplant, but less in groups C and D. Myelinated nerve fibers were found in the distal facial nerve. There were no differences between groups A and B in fiber number and myelin sheath thickness, which were much lower than normal, whereas little myelin sheath regeneration was observed in groups C and D.Conclusion: Chemically extracted acellular whole facial nerve allografts are feasible for repairing whole facial nerve defects.

Corticosteroid Administration in Oral and Orthognathic Surgery: A Systematic Review of the Literature and Meta-Analysis

Anne E.B. Dan, Torben H. Thygesen, Else M. Pinholt — 2010-06-30

Purpose: This study evaluated the effect of corticosteroid (CS) administration on edema, analgesia, and neuroregeneration in conjunction with surgical dental extraction, orthognathic surgery, and the risk of developing side effects.Materials and Methods: A systematic search of the literature was made. The primary predictor variable was CS administration and the outcome variables were edema, pain, and infection. A meta-analysis was performed. The risk of other side effects was evaluated through a simple review.Results: In oral surgery, most clinical trials showed a significant decrease in edema (P < .0001) after CS, and local injection of methylprednisolone ≥25 mg was expected to result in a significant decrease in edema. Regarding the analgesic effect, several clinical trials showed a decrease in pain after CS (P < .0001). Further, CS administration resulted in a slightly higher risk of infection (relative risk, 1.0041), but with a P value of .89. CS could be administered with no increased risk of infection. In orthognathic surgery, methylprednisolone ≥85 mg administered intravenously seemed sufficient to produce a significant decrease in edema, and several trials pointed toward a neuroregeneration effect, but no statistical analysis could be performed. Regarding the risk of other side effects, in oral surgery, a minimal risk of chronic adrenal suppression was seen; in orthognathic surgery, an elevated risk of avascular osteonecrosis, steroid-induced psychosis, and adrenal suppression was seen. There were no reports of decreased healing.Conclusion: These findings suggest that the administration of CS in oral surgery decreases edema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects.

Factors of Importance for the Functional Outcome in Orthognathic Surgery Patients: A Prospective Study of 118 Patients

Jesper Øland, John Jensen, Birte Melsen — 2010-07-09

Purpose: The aim of this study was to assess the influence of orthognathic surgery on patients' stomatognathic function and, further, to evaluate how post-treatment function relates to satisfaction.Patients and Methods: A total of 118 adult patients (51 men and 67 women) who were treated with orthognathic surgery were examined before and a minimum of 12 months after the surgical intervention. The stomatognathic function was evaluated with Helkimo's Anamnestic and Clinical Dysfunction index. The former was also used to assess a control group of 47 individuals with the same age and gender distribution and with no history of or present need for orthodontic treatment.Results: A total of 76 patients (64.4%) reported severe dysfunction at the beginning of the treatment, and 24 patients (20.3%) reported severe dysfunction at the end of the treatment. Clinical assessment showed that 36 patients (30.5%) had severe dysfunction symptoms upon inclusion versus only 5 (4.2%) at the final examination. However, 3 patients (2.5%) without clinical dysfunction at the time of inclusion developed mild dysfunction during treatment, and 8 patients (6.8%) developed increased dysfunction during treatment. The patients' functional status after treatment and their degree of satisfaction with the treatment were positively correlated. Although a general improvement was verified, the functional status of those who were treated never reached that of the control group.Conclusion: This study indicates that orthognathic surgery improves patients' stomatognathic function in most cases, and that patients' satisfaction correlated with perceived, reported, and measured function at the end of the treatment.

Radiographic Findings in Bisphosphonate-Treated Patients With Stage 0 Disease in the Absence of Bone Exposure

2010-09-01

Purpose: Radiographic features in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) are well described, but less is known in bisphosphonate-exposed individuals with stage 0 disease (clinical symptoms without exposed necrotic bone) considered at risk for BRONJ. We sought to characterize radiographic findings in a subgroup of patients with concerning clinical symptoms and bisphosphonate exposure to identify imaging features that may presage development of BRONJ.Materials and Methods: A dental symptom survey was returned by 8,572 Kaiser Permanente Health Plan members receiving chronic oral bisphosphonate therapy, and 1,005 patients reporting pertinent dental symptoms or complications after dental procedures were examined. Those without BRONJ but with concerning symptoms were referred for clinical evaluation, including imaging. Among the subset who received maxillofacial imaging, we identified those with stage 0 disease and abnormal radiographic features.Results: There were a total of 30 patients without exposed bone but with concerning symptoms who received maxillofacial imaging (panoramic radiography or computed tomography) in the context of clinical care. Among these 30 patients, 10 had stage 0 disease with similar radiographic features of regional or diffuse osteosclerosis in clinically symptomatic areas, most with extension beyond the involved site. Other findings in these 10 patients included density confluence of cortical and cancellous bone, prominence of the inferior alveolar nerve canal, markedly thickened and sclerotic lamina dura, uniform periradicular radiolucencies, cortical disruption, lack of bone fill after extraction, and a persisting alveolar socket. None had exposed bone develop during 1-year follow-up. The remaining 20 patients had normal or localized radiographic findings consistent with odontogenic pathology.Conclusion: In 10 of 30 symptomatic patients referred for clinical evaluation and imaging, a consistent finding was conspicuous osteosclerosis in clinically symptomatic areas characteristic of stage 0 disease. These data support the need to better understand radiographic features associated with bisphosphonate exposure and to determine whether osteosclerosis is a specific finding indicative of the risk for progression to BRONJ.

Serologic Bone Markers for Predicting Development of Osteonecrosis of the Jaw in Patients Receiving Bisphosphonates

2010-09-01

Purpose: Osteonecrosis of the jaw is a well-documented side effect of bisphosphonate (BP) use. Attempts have recently been made to predict the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We prospectively investigated the predictive value of serum levels of C-terminal telopeptide of collagen I (CTX), bone-specific alkaline phosphatase, and parathyroid hormone for the development of BRONJ.Patients and Methods: Data on the demographics, comorbidities, and BP treatment were collected from 78 patients scheduled for dentoalveolar surgery. Of the 78 patients, 51 had been treated with oral BPs and 27 had been treated with frequent intravenous infusions of BPs. Blood samples for CTX, bone-specific alkaline phosphatase, and parathyroid hormone measurements were taken preoperatively. Surgery was performed conservatively, and antibiotic medications were prescribed for 7 days.Results: Of the 78 patients, 4 patients taking oral BPs (7.8%) and 14 receiving intravenous BPs (51.8%) developed BRONJ. A CTX level less than 150 pg/mL was significantly associated with BRONJ development, with an increased odds ratio of 5.268 (P = .004). The bone-specific alkaline phosphatase levels were significantly lower in patients taking oral BPs who developed BRONJ. The parathyroid hormone levels were similar in patients who did and did not develop BRONJ.Conclusion: The incidence of BRONJ after oral surgery involving bone is greater among patients receiving frequent, intravenous infusions of BPs than among patients taking oral BPs. Although the measurement of serum levels of CTX is not a definitive predictor of the development of BRONJ, it might have an important role in the risk assessment before oral surgery.

Surgical Technique for Secondary Correction of Unilateral Cleft Lip-Nose Deformity: Clinical and 3-Dimensional Observations of Preoperative and Postoperative Nasal Forms

2009-11-16

Purpose: Despite recent developments in cleft surgery, a surgical method for secondary correction of unilateral cleft lip-nose deformity has not yet been established. The purpose of this study was to describe the surgical techniques for secondary correction of unilateral cleft lip-nose deformity with 3-dimensional (3D) observations of preoperative and postoperative nasal forms.Patients and Methods: Secondary corrections of unilateral cleft lip-nose deformity were performed on 13 patients with a complete unilateral cleft lip and palate, and these patients were followed up for 1 year to more than 3 years. All patients were treated by open rhinoplasty through a bilateral reverse-U incision and transcolumellar incision, correction of the columella base with/without septoplasty, nasal tip cartilage graft, and medial-upward advancement of nasolabial components with vestibular expansion by free mucosal graft. Preoperative and postoperative nasal forms were observed by use of photos and 3D data obtained serially.Results: The postoperative nasal forms were improved in all patients. The preoperative 3D color images indicated asymmetry of the alar groove and nasal tip visually. The top of the alar groove on the cleft side was dislocated distally and downwardly, resulting in a small snub ala. The postoperative 3D color images showed symmetric nasal forms with the adequately recovered nasal tip projection and the appropriate circle of the nasal ala groove on the cleft side. There were no serious postoperative complications.Conclusions: Repositioning of the nasalis muscle and sufficient expansion of the nasal vestibule as well as reconstruction of nasal cartilages are important for correction of unilateral cleft lip-nose deformity.

Digital Subtraction Angiography-Guided Percutaneous Sclerotherapy of Venous Malformations With Pingyangmycin and/or Absolute Ethanol in the Maxillofacial Region

2010-04-12

Purpose: The present study evaluated the safety and efficacy of digital subtraction angiography-guided percutaneous sclerotherapy of venous malformations (VMs) with pingyangmycin and/or absolute ethanol in the maxillofacial region. We present our safe and novel method for treating venous malformations.Patients and Methods: A total of 20 patients (21 locations) diagnosed with VMs were enrolled in the present trial. Evaluated by preoperative digital subtraction angiography, the lesions were categorized into 4 types according to the venous drainage features. Of the 20 patients, 5 had type I VMs, 5 had type II, 6 had type III and 3 had type IV VMs. One patient had type I and type III VMs in different locations of the maxillofacial region. For types I and II lesions, pingyangmycin sclerotherapy was performed. Multistage sclerotherapy with absolute ethanol and pingyangmycin was performed on types III and IV lesions.Results: After evaluation and guided by preoperative digital subtraction angiography, all the patients were treated successfully and safely. Of the 20 patients, the clinical outcome was excellent in 13, good in 6, and fair in 1. No disease recurrence was noted during the follow-up evaluations (range 6 to 25 months, median 13.55). The complications were fever in 5 patients after the first session of sclerotherapy, incomplete facial paralysis in 1, swelling in 1, and ulceration in 3. No major complications were observed.Conclusions: Digital subtraction angiography-guided phlebography of VMs in the maxillofacial region is one of the approaches to classify VMs using anatomic and hemodynamic features. A strong association was seen between the type of VM and the approach of sclerotherapy. Percutaneous sclerotherapy using pingyangmycin and/or absolute ethanol is a safe and effective method of treating symptomatic VMs.

Augmentation in Proximity to the Incisive Foramen to Allow Placement of Endosseous Implants: A Case Series

Gerry M. Raghoebar, Laurens den Hartog, Arjan Vissink — 2010-06-28

Purpose: To assess whether augmentation in the proximity of the incisive foramen with an intraoral bone graft to allow for reliable placement of implants is achievable, not jeopardizing the nasopalatine nerve and vessels in a way causing patients’ distress.Patients and Methods: Five patients who had lost a central maxillary incisor due to trauma, and in whom a deficiency of bone at the palatal side was present in the proximity of the incisal canal, were augmented with autogenous cancellous bone harvested from the retromolar region. After a healing period of 3 months, implants were inserted. Patients’ acceptance, complications, and postoperative morbidity of the procedure were prospectively evaluated by standardized clinical and radiographic examinations up to 12 months after augmentation.Results: At the time of implant surgery, in all cases there was sufficient bone for insertion of the implants with adequate primary stability. Up to now (follow-up of 12-15 months) no fixtures have been lost and all peri-implant tissues have a healthy appearance. All patients were satisfied.Conclusion: Augmentation in the proximity of the incisive foramen to enable implant placement appears to be feasible, both from the perspective of the patient and the professional.

Influence of Thin Mucosal Tissues on Crestal Bone Stability Around Implants With Platform Switching: A 1-year Pilot Study

Tomas Linkevicius, Peteris Apse, Simonas Grybauskas, Algirdas Puisys — 2010-06-07

Purpose: The aim of this pilot study was to determine what effect thin mucosal tissues can have on crestal bone stability around implants with platform switching.Materials and Methods: Twelve 2-piece implants, consisting of 6 implants with horizontally matching implant-abutment connection (control) and 6 implants with platform switching (test) were placed in 4 patients. The mean age of the patients was 43 years (range, 37 to 56 yrs). Mucosal tissue thickness at implant sites was measured to be 2 mm or less. Implants were restored with 5 splinted crowns and single 3-unit fixed partial denture. Intraoral radiographs were obtained and crestal bone changes were measured at implant placement and after a 1-year follow-up post-treatment. The statistical significance level was set to P less than .05.Results: Bone loss around the test implants was 1.81 ± 0.39 mm on the mesial site and 1.70 ± 0.35 mm on the distal aspect. Control implants overcame marginal bone resorption equaling 1.60 ± 0.46 mm on the mesial site and 1.76 ± 0.45 mm on distal measurement. No statistically significant difference was found between control and test implants either mesially (F[1,10] = 0.746; P = .408) or distally (F[1,10] = 0.080; P = .783).Conclusion: Within the limitations of this pilot study it can be concluded that implants with platform switching did not preserve crestal bone better in comparison with implants with traditional implant-abutment connection if, at the time of implant placement, thin mucosal tissues were present.

Oral Rehabilitation of a Maxillectomy Defect Using Bone Transport Distraction and Dental Implants

2010-06-21

Bone transport distraction is a reliable procedure in various maxillofacial bony defect reconstruction techniques. It is minimally invasive and it eliminates donor site morbidity. We introduce a new surgical technique for maxillary backward bone transport distraction reconstruction performed in a 77-year-old woman with a posterior partial maxillary defect. Transport distraction was successful for posterior maxillary alveolar bony regeneration, which helped close an oroantral fistula. One month after the distraction device was removed, 3 dental implants were placed in the reconstructed alveolus, followed by successful oral functional rehabilitation by use of an implant-anchored prosthesis. Two and a half years have passed since the patient's dental implant–based prosthesis was activated, and the functional occlusal reconstruction by use of bone transport distraction and dental implants after repair of the maxillectomy defect has proven to be effective with patient satisfaction.

Immediate and Delayed Lateral Ridge Expansion Technique in the Atrophic Posterior Mandibular Ridge

2010-06-28

Purpose: The lateral ridge expansion technique is used to expand the narrow edentulous ridge for implant placement. The staged approach can be used to split the mandibular ridge to decrease the risk of malfracture during osteotomy. The present study reports the clinical results of a surgical technique that expands a narrow mandibular ridge using an immediate and a delayed lateral expansion technique.Materials and Methods: A total of 32 patients with a narrow edentulous posterior mandibular ridge of 2 to 4 mm were included in the present study, and 84 implants were placed. Of the 32 patients, 23 were treated with an immediate lateral expansion technique and 9 with a delayed lateral expansion technique.Results: Of the 23 patients who underwent the immediate lateral expansion technique, a malfracture of the thin buccal cortical plate occurred during ridge splitting in 5 patients. All buccal segments of the 9 patients who underwent the delayed lateral expansion technique fractured as planned at the inferior horizontal corticotomy line favorably. After 4 to 5 months, all implants were stable and surrounded by bone, and ossification of the osteotomy line was obvious.Conclusions: The lateral ridge expansion technique is effective for horizontal augmentation in the severely atrophic posterior mandibular ridge. The delayed lateral ridge expansion technique can be used more safely and predictably in patients with high bone quality and thick cortex and a narrower ridge in the mandible.

Modified Flapless Dental Implant Surgery for Planning Treatment in a Maxilla Including Sinus Lift Augmentation Through Use of Virtual Surgical Planning and a 3-Dimensional Model

Sakineh Nikzad, Abbas Azari, Amanollah Ghassemzadeh — 2010-06-24

Purpose: The concept of “prosthetic-driven implantology” may be considered a turning point in the history of modern dental implantology. On the basis of this sophisticated approach, the available bone and the optimal prosthetic position of the future restoration are checked before surgical intervention. However, the major drawback of today's prosthodontic discipline is that it is inherently 2-dimensional in nature, which may prevent the appropriate treatment; this problem can be overcome by the 3-dimensional capability of a computer-assisted approach when performed judiciously. It was proposed that this technique has the potential to provide a high level of safety and accuracy in comparison to traditional surgical procedures.Materials and Methods: Using a novel approach, we performed modified flapless implant surgery accompanied by a simultaneous sinus-lifting procedure. The technique used a 3-dimensional life-sized computer-aided design/computer-aided manufacturing (CAD/CAM) model prepared from the computed tomography images for prosthetic/surgical diagnosis and treatment planning.Results: The procedure of implant planning, model surgery, and sinus floor augmentation in this sophisticated flapless surgical approach has the potential to provide substantial benefits for both patients and practitioners.Conclusions: The versatility of the described technique not only allows more accurate implementation of the treatment plan to the patient's mouth but also may offer many additional significant benefits, including the use of custom surgical guides, life-sized bone model manipulation, and surgical rehearsal, all of which are very difficult to achieve with current traditional procedures.

Flapless and Traditional Dental Implant Surgery: An Open, Retrospective Comparative Study

Paul Rousseau — 2010-09-01

Purpose: Osseointegrated dental implantation is traditionally performed by a flap approach that involves soft tissue flap reflection, but this technique is associated with several drawbacks. Conversely, the flapless method requires only minimal removal of soft tissue but is not suitable for all patients. The objective of this study was to compare the flapless (FL) method of implant placement with the traditional flap (TR) method with regard to achievement of success, change in bone level, and overall safety.Patients and Methods: In this single-center, open, retrospective, investigator-driven, nonrandomized, comparative study, patients were pre- or intraoperatively assigned to the FL or TR treatment. The primary success criteria were the absence of mobility, radiolucency, pain, and infection.Results: The FL method was applied to 174 implants (46%) in 121 patients and the TR method to 203 implants (54%) in 98 patients. At visit 1, implantation was rated successful in 171/174 (98.3%) implants with the FL method and in 200/203 (98.5%) with the TR method. Success rate remained constant until visit 2. The difference between the 2 groups in the rate of success was not significant. Similarly, no significant difference was observed for mean time to last follow-up for success.Conclusions: Based on pre- or intraoperative decision-making, patients eligible for FL surgery can benefit from a less straining procedure without affecting the high success rate of dental implant surgery. The FL approach is a predictable procedure when patient selection and surgical technique are appropriate.

Hereditary Angioedema in Oral Surgery: Overview of the Clinical Picture and Report of a Case

2010-09-01

Angioedema is a pathologic condition first described by Quincke and Osler. It can be genetically determined or acquired, and it is caused by a vascular reaction induced by deficiency or functional alteration of the C1 inhibitor (C1-INH), an enzyme involved in the regulation of complement, contact, fibrinolytic, and coagulation systems.

Control of Life-Threatening Head and Neck Hemorrhage After Dental Extractions: A Case Report

2010-06-18

A 54-year-old man presented to the North Central Bronx Hospital Dental Clinic (Bronx, NY) on October 30, 2007, with a complaint of pain in his right mandible. The patient's vital signs were unremarkable on presentation with a blood pressure of 140/75 mm Hg and a pulse rate of 85 beats/min. The patient reported having a stroke 10 years previously that was managed with aspirin therapy for 7 years. The patient denied taking any medications. He had no known drug allergies but admitted to occasional alcohol use. He denied any drug or tobacco use on the medical intake questionnaire and during the initial consultation. He noted a history of bruising easily but reported having previous dental extractions without incident. A panoramic radiograph () showed multiple nonrestorable teeth (maxillary right third molar, maxillary right first premolar, maxillary right canine, maxillary left second premolar, maxillary left first molar, mandibular left first premolar, mandibular right second molar, and mandibular right third molar) with bone loss consistent with generalized periodontal disease. Clinical examination showed gross caries and gross mobility of the maxillary right third molar, maxillary right first premolar, maxillary right canine, maxillary left second premolar, maxillary left first molar, mandibular right second molar and mandibular right third molar, as well as a fractured crown and an exposed endodontic metal post in the root of the mandibular left first premolar. The mandibular right second and third molars were painful on palpation.

Hybrid Verrucous Squamous Carcinoma of the Oral Cavity: Treatment Considerations Based on a Critical Review of the Literature

Antonia Kolokythas, Thomas M. Rogers, Michael Miloro — 2010-05-21

In 1948, Ackerman first described the characteristics of verrucous carcinoma (VC), a variant of epidermoid malignancy of the oral cavity, that has since been referred to as “Ackerman's tumor.” Before Ackerman, Fridell and Rosenthal reported 8 cases of squamous cell carcinoma (SCC) with a papillary appearance involving the buccal mucosa and the alveolar ridge. The specific clinical features of this entity are its indolent course, predilection for elderly men, and the buccal mucosa and lower gingiva being the most common sites involved. Risk factors including smokeless and inhaled tobacco, alcohol use, and poor oral hygiene are strongly associated with development of VC. As a group, these tumors have distinct clinical and histologic features; recently, an association of VC with human papilloma viruses (HPV) types 6, 11, 16, and 18 has been confirmed by detection of viral DNA, polymerase chain reaction (PCR) and DNA slot-blot hybridization. The diagnostic challenges of these cancers are encountered commonly when biopsies are superficial and fail to reveal the tumor's characteristics. Local treatment failures and high recurrence rates are typical responses of these tumors with local excision. They are most appropriately treated with surgical resection with generous margins, followed by radiation therapy, if indicated. A coexistence of verrucous with SCC, hybrid tumors, has been reported to occur in about 20% of cases. Surgery is considered the standard treatment for VC. Specific treatment recommendations for the hybrid tumors, verrucous squamous carcinomas (VSC), are not clear.

Endovascular Treatment of Hemorrhagic Alveolar Artery Pseudoaneurysm After Tooth Extraction: A Case Report

Michael F. Stiefel, Min S. Park, Cameron G. McDougall, Felipe C. Albuquerque — 2010-06-18

Tooth extraction is a common procedure that is routinely performed and is associated with very few risks. The formation of a pseudoaneurysm as a direct result of dental extraction has not been widely reported in published studies. Pseudoaneurysms are rare and can be difficult to diagnose. However, they can be potentially life-threatening. Pathologically, pseudoaneurysms differ from true aneurysms in that the wall is composed of fibrous connective tissue. A false aneurysm results when blood from a damaged arterial wall is extravasated into the surrounding connective tissue. If unrecognized or untreated, a clot forms and then liquefies. The pseudoaneurysm enlarges because of additional bleeding. If it continues to grow, it can result in life-threatening hemorrhage. Endovascular treatment using coils or particulate agents is the treatment method of choice.

Glomus Tumor: Report of a Rare Case Affecting the Oral Cavity and Review of the Literature

2010-06-18

The glomus apparatus, first discovered in 1862 by Sucquet and confirmed by Hoyer in 1877, is an arteriovenous anastomosis located in the stratum reticularis of the dermis, particularly prevalent on the palm and digits of the hand, as well as on the ventral surface of the feet. Functionally, when this apparatus is constricted, heat is conserved, and when patent, heat is lost; thereby, the glomus apparatus contributes to thermal regulation.

Lobar Collapse Immediately After Orthognathic Surgery

Shahid R. Aziz, Neil Agnihotri, Vincent B. Ziccardi — 2010-06-21

Atelectasis is commonly seen in patients during the first 24 hours after general anesthesia. Although often associated with immediate postoperative fever, it can also result in clinically significant oxygenation and ventilation complications that have far greater consequences. In the maxillofacial surgical patient, this can be particularly concerning because decreased air exchange is already a risk because of the nature of the surgery and the potential need for maxillomandibular fixation (MMF) and nasal intubation. As such, atelectasis after maxillofacial surgery is an immediate postoperative complication that requires immediate diagnosis and treatment. In the following case, we review multilobar collapse after orthognathic surgery.

Genial Tubercle Fracture: A Case Report and Review of the Literature

James M. Ryan, David Ross, George Obeid — 2010-06-24

Mandibular fractures are relatively common injuries after trauma. The diagnosis is determined from the clinical and radiologic examination findings. The clinical evaluation may reveal changes in occlusion, hypoesthesia, gingival lacerations, and possibly floor of the mouth elevation and/or ecchymosis, depending on the location of the fractures. A variety of radiographic modalities are available for the diagnosis of mandibular fractures. Some investigators have recommended panoramic radiography alone; a panoramic radiograph in addition to a view from 90°; or a mandibular series that includes right and left lateral oblique views, a posteroanterior cephalogram, and reverse Towne's. The use of computed tomography (CT) has been recommended by some investigators to avoid the oversight of potentially life-threatening injuries. Typically, the severity of the clinical presentation of the injuries will guide the clinician regarding the type of radiograph indicated. CT might be indicated for very severe fractures and if other maxillofacial fractures are suspected; however, a panoramic radiograph might be all that is necessary if no other injuries or airway issues are suspected.

Melanotic Neuroectodermal Tumor of Infancy: Report of 2 Cases

2010-06-21

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, benign, pigmented tumor that usually occurs during the first year of age. Slightly more than 365 cases have been reported worldwide, with most (approximately 92.8% to 93%) arising in the head and neck regions, especially in the maxilla. Occasionally, MNTIs have also been described in other sites, such as the skull, brain, and epididymis. Initially, an odontogenic origin was proposed as its etiopathogenesis; however, ultrastructural and immunohistochemical studies have shown that the tumor cells originate in the neural crest. Although MNTI is believed to be a benign tumor, it often grows very fast, has aggressive behavior, and has a high rate of recurrence. Included in the clinical features of the tumor are its blue or blue-black appearance and, occasionally, an ulcerated surface. The present study reports on 2 cases of MNTI and presents their radiographic, histopathologic, and immunohistochemical findings. We also focused on the clinical features and reviewed the published studies.

Anesthesia Abstracts

2010-09-01

Both anesthesiologists and oral and maxillofacial surgeons are involved in the management of patients with compromised airways. Over the past several years, there have been various forms of instrumentation developed to facilitate intubation. The Pentax-AWS video laryngoscope (PAS; Airway Scope, Hoya Co, Tokyo, Japan) is a rigid video laryngoscope that is combined with a disposable transparent blade. The laryngoscope has an imaging charge-coupled device and a light-emitting diode light attached to its tip, as well as a 2.4-inch color liquid crystal display monitor that can be adjusted to allow visualization from different angles and positions. A tracheal tube can be attached to the blade. The laryngoscope has a sighting device that aligns the endotracheal tube with the glottis, which can then be advanced along the interlocking guides within the blade toward the glottis to facilitate intubation. The patient's neck also does not need to be hyperextended with this device. In this study 10 anesthesiologists were presented with 3 different situations in which they had to intubate a manikin: manikin supine, not in the sniffing position, with no restriction to head; manikin supine with head against wall; and manikin at 45° with access only directly facing the individual. The participants were assessed regarding 3 criteria: ability to visualize the glottis, ability to intubate, and ability to ventilate the manikin. The ability to visualize the glottis was significantly faster with the PAS for all 3 groups. The ability to intubate and ventilate was significantly shorter with the PAS for the latter 2 groups. Two of 10 participants and 5 of 10 participants were unable to intubate the manikin using the Macintosh laryngoscope for the supine manikin with head to wall and 45° manikin, respectively. All participants were able to intubate and ventilate the manikins with the PAS. The authors do note that there are limitations in this study. The manikin's oropharynx was dry, and in an actual situation, the manikin's oropharynx may be filled with blood, saliva, vomitus, or sputum that may make visualization difficult. In addition, the maximum width of the Pentax blade is approximately 2.5 cm, which is greater than that of the Macintosh blade and, therefore, the PAS may not be able to be used in all situations.

The View From the Third Rail

Pushkar Mehra, David A. Cottrell, Richard D'Innocenzo — 2010-09-01

We read with interest your editorial titled “The View From the Third Rail” in the April issue of the Journal of Oral and Maxillofacial Surgery. You have written an excellent editorial on a very controversial topic.

News and Announcements

2010-09-01

Although the early registration deadline has come and gone, registration is still open for the AAOMS 2010 Annual Meeting, Scientific Sessions and Exhibition, which will convene September 27 through October 2 in Chicago, IL.

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2010-09-01

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2010-09-01

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2010-09-01

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2010-09-01

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2010-09-01

Journal of Oral and Maxillofacial Surgery

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Complications of Frontal Sinus Fractures With Emphasis on Chronic Craniofacial Pain and Its Treatment: A Review of 43 Cases

Effect of Substance P in Mandibular Osteotomies After Amputation of the Inferior Alveolar Nerve

Acinic Cell Carcinoma of Minor Salivary Glands: A Clinicopathologic Study of 21 Cases

Postoperative Condylar Position by Sagittal Split Ramus Osteotomy With and Without Bone Graft

Comparison of Titanium and Biodegradable Miniplates for Fixation of Mandibular Fractures

Evaluation of the Application of Computer-Aided Shape-Adapted Fabricated Titanium Mesh for Mirroring-Reconstructing Orbital Walls in Cases of Late Post-Traumatic Enophthalmos

Expression of TGF-β1, Osteonectin, and BMP-4 in Mandibular Distraction Osteogenesis With Compression Stimulation: Reverse Transcriptase-Polymerase Chain Reaction Study and Biomechanical Test

Use of Coblation in Arthroscopic Surgery of the Temporomandibular Joint

Superficial Parotidectomy Versus Retrograde Partial Superficial Parotidectomy in Treating Benign Salivary Gland Tumor (Pleomorphic Adenoma)

A Retrospective Analysis of Peripheral Odontogenic Fibroma in an Iranian Population

Prognostic Factors and Outcome Analysis of Submandibular Gland Cancer: A Clinical Audit

Ameloblastic Carcinoma: A Multicenter Nigerian Study

Accurate Reconstruction of Discontinuous Mandible Using a Reverse Engineering/Computer-Aided Design/Rapid Prototyping Technique: A Preliminary Clinical Study

Aneurysmal Bone Cysts of the Jaws: Analysis of 17 Cases

Accuracy and Reproducibility of a 3-Dimensional Stereophotogrammetric Imaging System

Replacement of the Condyle and Ascending Ramus by a Modular Endoprosthesis in Macaca fascicularis—Part 4: Evaluation of the Temporomandibular Joints

Fine-Needle Aspiration Cytology of Salivary Gland Lesions: A Systematic Review

Minimally Invasive Surgically Assisted Rapid Palatal Expansion With Limited Approach Under Sedation: A Report of 283 Consecutive Cases

Clinical Evaluation of Polyvinylpyrrolidone Sodium Hyalonurate Gel and 0.2% Chlorhexidine Gel for Pain After Oral Mucosa Biopsy: A Preliminary Study

Quality of Life of Patients With Tongue Cancer 1 Year After Surgery

Factors Associated With Free Flap Complications After Head and Neck Reconstruction and the Molecular Basis of Fibrotic Tissue Rearrangement in Preirradiated Soft Tissue

Micro-Computed Tomography and Histologic Evaluation of the Interface of Hydrogel Expander and Underlying Bone: Influence of Pressure Distributors on Bone Resorption

Oral Pyogenic Granuloma: A Retrospective Analysis of 293 Cases in a Brazilian Population

Soft Tissue Reduction During Open Treatment of Intracapsular Condylar Fracture of the Temporomandibular Joint: Our Institution's Experience

Repair of Whole Rabbit Facial Nerve Defects Using Facial Nerve Allografts

Corticosteroid Administration in Oral and Orthognathic Surgery: A Systematic Review of the Literature and Meta-Analysis

Factors of Importance for the Functional Outcome in Orthognathic Surgery Patients: A Prospective Study of 118 Patients

Radiographic Findings in Bisphosphonate-Treated Patients With Stage 0 Disease in the Absence of Bone Exposure

Serologic Bone Markers for Predicting Development of Osteonecrosis of the Jaw in Patients Receiving Bisphosphonates

Surgical Technique for Secondary Correction of Unilateral Cleft Lip-Nose Deformity: Clinical and 3-Dimensional Observations of Preoperative and Postoperative Nasal Forms

Digital Subtraction Angiography-Guided Percutaneous Sclerotherapy of Venous Malformations With Pingyangmycin and/or Absolute Ethanol in the Maxillofacial Region

Augmentation in Proximity to the Incisive Foramen to Allow Placement of Endosseous Implants: A Case Series

Influence of Thin Mucosal Tissues on Crestal Bone Stability Around Implants With Platform Switching: A 1-year Pilot Study

Oral Rehabilitation of a Maxillectomy Defect Using Bone Transport Distraction and Dental Implants

Immediate and Delayed Lateral Ridge Expansion Technique in the Atrophic Posterior Mandibular Ridge

Modified Flapless Dental Implant Surgery for Planning Treatment in a Maxilla Including Sinus Lift Augmentation Through Use of Virtual Surgical Planning and a 3-Dimensional Model

Flapless and Traditional Dental Implant Surgery: An Open, Retrospective Comparative Study

Hereditary Angioedema in Oral Surgery: Overview of the Clinical Picture and Report of a Case

Control of Life-Threatening Head and Neck Hemorrhage After Dental Extractions: A Case Report

Hybrid Verrucous Squamous Carcinoma of the Oral Cavity: Treatment Considerations Based on a Critical Review of the Literature

Endovascular Treatment of Hemorrhagic Alveolar Artery Pseudoaneurysm After Tooth Extraction: A Case Report

Glomus Tumor: Report of a Rare Case Affecting the Oral Cavity and Review of the Literature

Lobar Collapse Immediately After Orthognathic Surgery

Genial Tubercle Fracture: A Case Report and Review of the Literature

Melanotic Neuroectodermal Tumor of Infancy: Report of 2 Cases

Anesthesia Abstracts

The View From the Third Rail

News and Announcements

Reader's Circle Continuing Education Program

Masthead

Editorial Board

Notice to Contributors

Table of Contents

AAOMS Author Disclosure Forms