Journal of Oral and Maxillofacial Surgery

Clinical Trial Registration: Implications for Stakeholders

James R. Hupp — 2013-06-01

Although readers of the Journal of Oral and Maxillofacial Surgery (JOMS) are likely to be familiar with research conducted by clinical trials in which human subjects are used in experiments to test drugs, devices, and procedures, many may be unfamiliar with the growing number of journals that require authors of articles submitted for consideration to register their project at the inception of the research. Although the JOMS does not yet require such registration, it is taking its first step in that direction with a new recommendation now appearing in the Instructions for Authors (http://www.joms.org/authorinfo). The rationale behind clinical trial registration has evolved from previous attempts to monitor clinical research and shares the support of the international research community.

The Presence of Visible Third Molars Negatively Influences Periodontal Outcomes in the Maternal Oral Therapy to Reduce Obstetric Risk Study

Kevin L. Moss, Steven Offenbacher, James D. Beck, Raymond P. White — 2013-03-25

Purpose: To assess the relationship between the presence or absence of visible third molars and outcomes for periodontal inflammatory disease.Methods: Obstetric subjects, at enrollment in an institutional review board–approved, multisite study, Maternal Oral Therapy to Reduce Obstetric Risk (N = 1,798), were divided into 2 groups, those with no visible third molars (n = 692) and those with at least 1 visible third molar (n = 1,106), the predictor variables for this study. The principal outcome variables were the patient-level periodontal status of the first/second molars: mean periodontal probing depths, mean attachment levels, and mean extent scores. Periodontal disease severity also was assessed by criteria from the Oral Conditions and Pregnancy trial and the Centers for Disease Control and Prevention/American Academy of Periodontology. Outcomes according to the presence or absence of third molars were compared with χ2 statistics and multivariable analyses. Significance was set at P < .05.Results: Significantly more subjects had at least 1 third molar (62%) as compared with subjects with no visible third molar (38%) (P < .01). Ethnic characteristics of the 2 groups were similar. Overall, more subjects were white (61%), with most identifying their ethnicity as Latino. African-American subjects were well represented (37%). Subjects with a visible third molar were more likely to be significantly older, to be receiving medical assistance, and to have used tobacco before pregnancy. If subjects had at least 1 visible third molar, the mean first/second molar probing depths, attachment levels, and scores for bleeding on probing were significantly greater even after adjustment for covariates. On the basis of either Oral Conditions and Pregnancy criteria or Centers for Disease Control and Prevention/American Academy of Periodontology criteria, subjects were significantly more likely to have moderate or severe periodontal disease if a third molar was detected.Conclusion: If at least 1 visible third molar was detected in subjects in the Maternal Oral Therapy to Reduce Obstetric Risk study at enrollment as compared with no detected third molars, periodontal outcomes were significantly worse.

Tooth Extractions in Intravenous Bisphosphonate-Treated Patients: A Refined Protocol

2013-02-25

Purpose: The aim of this prospective hospital-based study was to refine a surgical protocol for tooth extractions in patients with a history of intravenous use of a potent bisphosphonate by modifying a previously reported protocol to produce a significantly shortened operating time.Patients and Methods: Prospective patients with a follow-up of at least 4 months were included. Tooth extractions were performed without a vestibular split-thickness flap; healing was stimulated by filling the extraction site with autologous plasma rich in growth factors (PRGF System, BTI Biotechnology Institute, Vitoria, Spain). Local and systemic infection control was obtained with dental hygiene and antibiotic therapy.Results: Sixty-three patients participated in the study. Two hundred two tooth extractions were performed. Differences between the present and previous protocols (the previous protocol used a vestibular flap) were analyzed and the surgical time proved significantly shorter for the present approach (P = .00).Conclusions: The proposed surgical protocol appears to be a better choice for patients treated with intravenous bisphosphonates who need tooth extraction, because it seems to be faster and simpler than the previously reported successful protocol.

Is it Safe to Perform Dental and Cardiac Valve Surgeries Concomitantly?

Din Lam, Kevin Wright, Benjamin Archer — 2013-03-28

Purpose: Conventionally, dental surgery and cardiac valve replacement surgery (VRS) have been performed separately. Disadvantages of this approach include increased anesthetic and infection risks and increased costs. The authors hypothesized dental surgeries performed immediately before VRS would have similar mortality and morbidity outcomes and significantly decreased costs compared with those performed independently of VRS.Materials and Methods: An institutional review board–approved retrospective study was completed comparing outcomes for 17 patients undergoing concomitant cardiac VRS and invasive dental procedures with outcomes for 16 patients undergoing similar procedures by a conventional approach.Results: The conventional group had a significant increase in ejection fraction (11% vs 6.7%; P < .05) and no difference in the incidence of prosthetic valve endocarditis or other cardiac complications. The concomitant group had longer overall operating room time (389 vs 328 min) but significantly shorter anesthesia time (428 vs 553 min) than the conventional group. Length of stay in the intensive care unit was similar (6.7 days) and overall hospital stays were shorter in the concomitant group (14.5 vs 18.2 days). Cost analysis showed the concomitant group's overall costs were significantly lower than those for the conventional group.Conclusion: There was no significant difference in cardiac outcomes between the concomitant and conventional groups. In addition, each patient in the concomitant approach saved an average of $6,669. Thus, concomitant dental surgery and cardiac VRS may be considered a safe and cost-effective approach that may lead to decreases in overall health care costs.

Palatal Approach to the Anterior Maxillary Sandwich Osteotomy

Robert E. Bell — 2013-03-28

Purpose: This report describes a technique used to increase vertical height and anterior prominence of the anterior maxilla.Patients and Methods: Two cases illustrate the palatal approach to segmental osteotomy with interpositional bone grafting (sandwich osteotomy) of the anterior maxilla. The palatal approach allows the segment to be moved anteriorly and inferiorly. This is in contrast to the buccal approach, in which the tight palatal tissue creates a vector of force toward the palate. The vascular pedicle for the segmental bone flap using the palatal approach is the labial mucosa and musculature.Results: The maxillary alveolar ridge in case 1 was advanced 4 mm anteriorly and 5 mm inferiorly. In case 2, the ridge was moved 4 mm anteriorly and 6 mm inferiorly. Cases 1 and 2 were later successfully restored with dental implants.Conclusion: The palatal approach to the anterior maxillary osteotomy was found to be effective in 2 cases that required anterior and inferior repositioning of the anterior maxilla.

Pamidronate Enhances Bacterial Adhesion to Bone Hydroxyapatite. Another Puzzle in the Pathology of Bisphosphonate-Related Osteonecrosis of the Jaw?

2013-03-13

Purpose: Bacterial colonization of the denuded bone in bisphosphonate-related osteonecrosis of the jaw suggests that bisphosphonates increase bacterial adhesion and biofilm formation. This study evaluated the adhesion of gram-positive and gram-negative bacteria on hydroxyapatite coated with pamidronate, one of the most potent bisphosphonates.Materials and Methods: Twenty-five Staphylococcus aureus and 25 Pseudomonas aeruginosa strains were cultured on pamidronate-coated and uncoated hydroxyapatite discs. After incubation, nonadherent bacteria were removed by rinsing and centrifugation. Formation of a biofilm was confirmed by confocal laser 3-dimensional and scanning electron microscopy. The number of bacterial colonies was counted using quantitative cultures and mean numbers were compared using the Mann-Whitney rank sum test (statistical significance defined as P ≤ .05). The Hartree-Fock method was used for the calculation of electron interactions between hydroxyapatite ions and pamidronate.Results: Fold increases in the number of colonies formed by S aureus and P aeruginosa in the presence of pamidronate compared with controls were 7.19 ± 4.127 and 2.87 ± 0.622, respectively. Hartree-Fock analysis showed that the reactive NH3+ group of pamidronate may act as a steric factor, facilitating anchoring of bacteria to the hydroxyapatite surface. Alternatively, the NH3+ group may attract bacteria by direct electrostatic interaction.Conclusions: Increased bacterial adhesion in the presence of bisphosphonates can promote osteomyelitis in patients with bisphosphonate-related osteonecrosis of the jaw. There may be increased infection rates when bisphosphonates are used for stabilization of prostheses in joint arthroplasty and in osteotomies and open fractures in patients treated with bisphosphonates.

Absence of Exposed Bone Following Dental Extraction in Beagle Dogs Treated With 9 Months of High-Dose Zoledronic Acid Combined With Dexamethasone

Matthew R. Allen, Tien-Min Gabriel Chu, Salvatore L. Ruggiero — 2013-02-04

Purpose: Factors contributing to osteonecrosis of the jaw with anti-remodeling drug treatment are unclear. Epidemiologic and experimental studies have suggested the combination of bisphosphonates and dexamethasone results in osteonecrosis of the jaw more often than either agent alone. The goal of this study was to assess the combination of these 2 drugs in a large animal model previously shown to be susceptible to exposed bone in the oral cavity when treated with bisphosphonates.Materials and Methods: Skeletally mature beagle dogs were untreated controls or treated with zoledronic acid (ZOL), dexamethasone (DEX), or ZOL plus DEX. ZOL and DEX were given at doses based on those used in humans. All animals underwent single molar extraction at 7 and 8 months after the start of the study. Extraction sites were obtained at month 9 for assessment of osseous healing using micro–computed tomography and histology.Results: No animals were observed to have exposed bone after dental extraction, yet 1 animal treated with ZOL and 1 treated with ZOL plus DEX had severely disrupted extraction sites as viewed by computed tomography and histology. These 2 animals had an intense periosteal reaction that was less obvious but still present in all ZOL-treated animals and absent from untreated animals. There was no significant difference in bone volume within the socket among groups at 4 or 8 weeks after healing, yet the ratio of surface to volume was significantly higher in animals treated with ZOL plus DEX at 8 weeks compared with control animals.Conclusions: These findings suggest a more complex pathophysiology to osteonecrosis of the jaw than is implied by previous epidemiologic studies and those in rodents and raise questions about the potential role of DEX in its etiology.

Sickle Cell Disease and Perioperative Considerations: Review and Retrospective Report

Adam C. Stanley, James M. Christian — 2013-02-22

Purpose: To review the current literature on sickle cell disease (SCD) and patient management in the perioperative setting and to retrospectively evaluate the treatment and complications of oral and maxillofacial surgical patients with SCD treated in the Regional Medical Center at Memphis.Materials and Methods: A literature review was performed, with the main search criteria of SCD, anesthesia, and oral and maxillofacial surgery. In addition, a retrospective record analysis was performed of patients with SCD seen at the Regional Medical Center over 9 years. Criteria recorded included the procedure, type of anesthesia, use of intravenous fluids, thermoregulation (use of warm fluids and blankets covering the patient), supplemental oxygen, antibiotic prophylaxis, and postoperative complications.Results: In total, 33 clinic visits were reviewed, with 29 patients and 21 procedures performed. Patients were managed quite differently each time, with no consistent protocol. Intravenous fluids were used in only 9 of 21 procedures, supplemental oxygen was recorded for 11 of 21 patients, and preoperative antibiotics were given to 14 of 21 patients. A small sample and the lack of an established protocol did not provide significant statistics.Conclusion: Patients with SCD are at risk for various perioperative complications, and it is imperative that the surgeons be educated and prepared so they can effectively manage these patients. No significant complications were found through the outpatient treatment of patients with SCD in this analysis. It may be concluded that treating patients with SCD in the outpatient setting is not contraindicated and may be a safe alternative to inpatient treatment or no treatment at all.

Floor-of-Mouth Dermoid Cysts: Report of 3 Variants and a Suggested Change in Terminology

Paul E. Gordon, William C. Faquin, Edward Lahey, Leonard B. Kaban — 2013-02-25

Purpose: Dermoid cyst is a frequently used descriptive term, but its definition changes according to the clinician (eg, dermatologists, neurologists, gynecologists, oral and maxillofacial surgeons, and plastic surgeons). It is sometimes used synonymously with teratoma. In oral and maxillofacial surgery, it is applied to describe congenital floor-of-mouth cysts of 3 histologic types: epidermoid, dermoid, and teratoid. This terminology is confusing and has led to some ambiguity in the literature. The purpose of this report is to document 3 cases illustrating the utility of a more specific term, congenital germline fusion cyst of the floor of the mouth.Patients and Methods: Patients who presented with floor-of-mouth swelling were evaluated by history, clinical examination, and imaging studies (magnetic resonance imaging and computed tomography).Results: Three cases (1 epidermoid variant, 1 dermoid variant, and 1 teratoid variant) are documented to illustrate the new terminology.Conclusion: Congenital germline fusion cyst is more reflective of the embryologic origins of the lesion than dermoid cyst and is inclusive of all 3 histologic variants.

An Unusual Lesion of the Tongue in a 4-Year-Old With Job Syndrome

2013-02-18

Job syndrome, also called hyperimmunoglobulin E syndrome, is a rare genetic immune disorder characterized by increased serum immunoglobulin E levels. Job syndrome has an autosomal dominant inheritance pattern with incomplete penetrance, although sporadic cases have been reported. The syndrome, first identified in 1966 by Davis, Schaller, and Wedgewood, presents with multiple skin, respiratory, and osseous manifestations.

Increased Levels of Interleukin-6 in Synovial Lavage Fluid From Patients With Mandibular Condyle Fractures: Correlation With Magnetic Resonance Evidence of Joint Effusion

2013-06-01

Purpose: The aim of the present study was to investigate the relation between magnetic resonance (MR) evidence of joint effusion and concentrations of proinflammatory cytokines, including interleukin (IL)-1β and IL-6, in washed-out synovial fluid samples obtained from patients with mandibular condyle fractures.Patients and Methods: Twenty-five joints in 23 patients with mandibular condyle fractures were examined. Computed tomography was used to determine the position of the fracture and MR examination was performed in all cases. Twenty-five joints underwent temporomandibular joint (TMJ) irrigation before surgical treatment for the fractures. The detection rates and concentrations of the tested cytokines were determined, and their relations to evidence of joint effusion and positions of the condylar fractures were analyzed.Results: Six TMJ fractures were found in the head, 10 in the upper neck, 4 in the lower neck, and 5 in the subcondyle. MR evidence of joint effusion was observed in 17 of 25 TMJs (68.0%). The detection rate and concentration of IL-6 were significantly higher in patients with MR evidence of joint effusion and those with high condylar fractures. Moreover, there was a correlation between joint effusion grade and IL-6 concentration.Conclusions: The present findings showed a correlation between MR evidence of joint effusion and concentration of IL-6 in washed-out synovial fluid samples collected from patients with mandibular condyle fractures. These results may provide support for arthrocentesis as a reasonable treatment modality for high condylar fractures.

Evaluation of the Relationship Between the Pattern of Midfacial Fractures and Amaurosis in Patients With Facial Trauma

2013-04-08

Purpose: To evaluate the relation between patterns and numbers of midfacial bone fracture patterns and amaurosis in traumatized patients.Materials and Methods: This is a cross-sectional study of traumatized patients with midfacial fractures who presented to Shahid Rajaee and Chamran hospitals (Shiraz, Iran) from 2010 through 2011. The predictor variable was midfacial fractures and the outcome variable was amaurosis. P < .05 was considered statistically significant.Results: The study was composed of 112 subjects. Prevalence of amaurosis was 6.25% (7 of 112). Le Fort III fracture was the only fracture pattern that had a significant association with amaurosis (P = .004). Nasoorbitoethmoid fracture was the second most correlative pattern, although this relation was not statistically significant.Conclusions: This study showed a meaningful relation between Le Fort III fractures and amaurosis in patients with facial trauma. There was also a high prevalence of nasoorbitoethmoid fracture in blinded patients.

Orthognathic Surgery for Correction of Patients With Mandibular Excess: Don’t Forget to Assess the Gonial Angle

2013-04-01

Purpose: To evaluate the gonial angle (GA) and associated factors that can contribute to stability after bilateral sagittal split ramus osteotomy setback and Le Fort I advancement osteotomy for the treatment of patients with mandibular excess.Materials and Methods: This retrospective study included 42 randomly selected, adult patients. Lateral cephalometric radiographs were obtained before and 1 week and 1 year after surgery. Patients in group 1 (n = 18) had a GA smaller than 125° and those in group 2 (n = 24) had a GA larger than 125°. Data were analyzed by analysis of variance and Pearson correlations. Multivariate linear regression analysis was used to identify factors that influenced postsurgical stability.Results: Mean surgical changes were similar in the 2 groups. The mandible was set back an average of 5.4 mm in group 1 and 6.4 mm in group 2, whereas the maxilla was advanced 2.5 mm in group 1 and 1.7 mm in group 2. Statistically significant postoperative changes were noted for group 1 only. Relapse was found at the innermost point of the contour of the mandible between the incisor tooth and bony chin and the pogonion for the horizontal landmarks; the innermost point of the contour of the maxilla between the anterior nasal spine and incisor tooth and the menton for the vertical landmarks; and the GA, the angle between the sella-nasion line and the innermost point of the contour of the mandible between the incisor tooth and bony chin, and the esthetic plane to the upper lip for the dimensional landmarks. No statistically significant changes were noted for group 2 (GA >125°).Conclusion: Patients with a preoperative GA smaller than 125° have a greater risk of relapse after receiving bilateral sagittal split ramus osteotomy setback and Le Fort I advancement for the treatment of mandibular excess. Patients with a preoperative GA larger than 125° appear to have a more predictable procedure.

Automated Continuous Distraction Osteogenesis May Allow Faster Distraction Rates: A Preliminary Study

2013-03-18

Purpose: To determine if automated continuous distraction osteogenesis (DO) at rates faster than 1 mm/day results in bone formation by clinical and radiographic criteria, in a minipig model.Materials and Methods: An automated, continuous, curvilinear distraction device was placed across a mandibular osteotomy in 10 minipigs. After 12 mm of distraction and 24 days of fixation, the animals were sacrificed and bone healing was evaluated. The continuous distraction rates were 1.5 mm/day (n = 5) and 3 mm/day (n = 5). A semiquantitative scale was used to assess the ex vivo clinical appearance of the distraction gap (3 = osteotomy not visible; 2 = <50% visible; 1 = >50% visible; 0 = 100% visible), stability (3 = no mobility; 2 and 1 = mobility in 1 plane or 2 planes, respectively; 0 = mobility in 3 planes), and radiographic density (4 = 100% of gap opaque; 3 = >75%; 2 = 50% to 75%; 1 = <50%; 0 = radiolucent). Groups of 4 minipigs distracted discontinuously at 1, 2, and 4 mm/day served as controls.Results: Automated, continuous DO at 1.5-mm/day and 3-mm/day had similar bone formation compared to discontinuous DO at 1-mm/day. The continuous DO 1.5-mm/day group had significantly higher scores for appearance and radiographic density compared with the discontinuous 4-mm/day group. The continuous DO 3-mm/day group had significantly higher scores for appearance and radiographic density compared with the discontinuous 4-mm/day group and greater stability compared with the discontinuous 2- and 4-mm/day groups.Conclusions: Results of this preliminary study indicate that continuous DO at rates of 1.5 and 3.0 mm/day produces better bone formation compared with discontinuous DO at rates faster than 1 mm/day.

Nasolacrimal Duct Obstruction After Maxillary Orthognathic Surgery

Sun Young Jang, Min Kyung Kim, Seok Min Choi, Jae Woo Jang — 2013-02-05

Purpose: To report cases of nasolacrimal duct obstruction (NLDO) after maxillary orthognathic surgery.Materials and Methods: The authors reviewed the clinical manifestations, dacryocystographic images, and orbital computed tomographic scans of 10 patients who were diagnosed with NLDO after undergoing maxillary orthognathic surgery.Results: Six of the 10 patients (60%) complained of epiphora immediately after the surgery. Bilateral (n = 2, 20%) or unilateral (n = 8, 80%) NLDO occurred in all patients involved in the study. Twelve eyes of 10 patients were examined, and dacryocystography showed that the obstruction was present in the distal ostium in 7 eyes (58.3%), the junction between the sac and duct in 3 eyes (25%), and the common canaliculus in 2 eyes (16.7%). Computed tomographic scans of all subjects showed that mucosal swelling and congestion around the distal NLD opening narrowed the space between the lateral nasal wall and the inferior turbinate of the affected side. Dacryocystorhinostomy was performed in 9 eyes (8 patients), with a success rate of 100%.Conclusions: The distal to proximal portion of the NLD can become obstructed after maxillary orthognathic surgery. This obstruction seems to be caused by secondary inflammatory changes associated with an indirect injury of the NLD. Therefore, clinicians should be aware of the possibility of NLDO after orthognathic surgery, which can be treated successfully with dacryocystorhinostomy.

Intraoperative Use of a Gamma Probe for the Treatment of Condylar Hyperplasia: Description of a New Technique

Carl Bouchard, Melinda Paris, Jean-Marc Villemaire — 2013-02-05

Purpose: The purpose of this article is to describe a new technique to perform a high condylectomy using a γ-probe.Materials and Methods: A 15-year-old female patient presented with right condylar hyperplasia. Because the condition was active, a high condylectomy was performed to stop the abnormal growth of the affected condyle. To resect an adequate amount of bone and prevent relapse, a γ-probe was used to guide bone removal. The patient was injected with technetium-99m methylene diphosphate 25 mCi 2 hours before she was brought to the operating room. Bone was removed from the superior aspect of the right condyle until the reading with the γ-probe was equivalent to normal bone.Results: Seven millimeters of bone was removed from the top of the condyle before the γ-emission from the remaining condyle was equivalent to the mandibular parasymphysis used as a control. No relapse was noted 9 months after surgery.Conclusion: The γ-probe may help a surgeon remove the correct amount of bone when performing a high condylectomy, especially in type II (vertical pattern) condylar hyperplasia.

Delayed Versus Immediate Reconstruction of Mandibular Segmental Defects Using Recombinant Human Bone Morphogenetic Protein 2/Absorbable Collagen Sponge

2013-03-13

Purpose: To compare the efficiency of recombinant human bone morphogenetic protein 2 (rhBMP2)/absorbable collagen sponge (ACS) in the delayed versus immediate reconstruction of mandibular segmental defects in a canine model.Methods: We randomized 11 dogs into 2 groups: immediate reconstruction (group 1, n = 6) and delayed reconstruction (group 2, n = 5). A 35-mm osteoperiosteal segmental defect was created on the left side of the mandible. Reconstruction with rhBMP2/ACS was carried out in the same setting in group 1 or at 4 weeks postoperatively in group 2. The contralateral side acted as an internal control. Animals were monitored both clinically and radiographically throughout the experiment. Twelve weeks after the application of rhBMP2/ACS, the quantity of bone formation was evaluated using regenerate mapping and histomorphometric analysis. Qualitative evaluation was performed based on bone mineral density and Vickers microhardness (μHV) testing.Results: Postoperative seromas were observed in 83.3% of group 1 dogs only. Group 1 showed significantly larger physical dimensions than group 2 in most regenerate zones. Successful regeneration was achieved in 83.3% of group 1 dogs (discontinuity defect was seen in 1 of 6 dogs in group 1). Meanwhile, none of the 5 dogs in group 2 could be considered to have undergone successful regeneration (3 dogs had discontinuity defects, bony union occurred only in the basal third in the fourth dog, and the last dog showed union with only a shell of bone). The percent bone area and percent defect filling were significantly higher in group 1 than in group 2 (percent bone area, 52.4% ± 5.6% in group 1 and 36.6% ± 11.2% in group 2 [P = .02]; percent defect filling, 56.3% ± 5.5% in group 1 and 38.5% ± 10.8% in group 2 [P = .01]). Group 1 showed higher bone mineral density (0.7 ± 0.3 mg/cm3 in group 1 and 0.4 ± 0.1 mg/cm3 in group 2, P = .1). Finally, μHV was significantly higher in group 1 (20.3 ± 2.6 μHV) than in group 2 (13.2 ± 2.4 μHV) (P = .01).Conclusions: Delaying the application of rhBMP2/ACS for 4 weeks attenuated the quantity and quality of regenerated bone in mandibular segmental defects.

Is There a Role for a Collagen Conduit and Anti-Inflammatory Agent in the Management of Partial Peripheral Nerve Injuries?

Rabie M. Shanti, Junad Khan, Eli Eliav, Vincent B. Ziccardi — 2011-07-25

Purpose: The purpose of this study was to investigate the effect of a collagen conduit and an anti-inflammatory agent in the treatment of acute partial sciatic nerve injuries in a rat chronic constrictive injury (CCI) model.Materials and Methods: Adult male Sprague–Dawley rats were divided into 5 groups: group 1 (nerve damage with no treatment), group 2 (nerve damage and collagen tube), group 3 (nerve damage and collagen tube treated with anti-inflammatory agent), group 4 (sham surgery), and group 5 (naive rat). Each group consisted of 10 study animals. The nerve injury model used was the CCI model. Behavioral responses to thermal and mechanical stimuli were tested at 3, 7, and 14 days after surgery. Transverse sections of nerve tissue were harvested at day 14 and evaluated by standard error of mean (SEM).Results: Tactile allodynia measurements showed initial increases in the threshold at day 3, followed by a significant decrease at day 7, and consistently remained lower than baseline by day 14. Heat allodynia measurements at day 3 showed a statistically significant decrease in threshold compared with the CCI group. However, at days 7 and 14, the threshold was not statistically different from the CCI group threshold. Groups with and without anti-inflammatory agents at day 7 showed a statistically significant decrease in threshold to both heat and tactile allodynia from day 3, indicating that groups with collagen and anti-inflammatory treatment had significant decreases in both heat and tactile allodynia. A similar relationship was observed at day 14. Transverse sections of nerve tissue evaluated by SEM of nerve tissue revealed a broad distribution of axons in group 1, with the greatest interaxonal distance in cross sections. Group 2 displayed less interaxonal distance compared with group 1, and group 3 had the least interaxonal distance.Conclusions: This study demonstrated a statistically significant decrease in pain secondary to the application of a collagen conduit and anti-inflammatory agent. Behavioral testing and SEM data also support the finding of a decrease in edema in the presence of a collagen conduit, with the greatest decrease being in the presence of both collagen conduit and anti-inflammatory agent.

A Retrospective Analysis of Squamous Carcinoma of the Buccal Mucosa: An Aggressive Subsite Within the Oral Cavity

Joshua E. Lubek, Donita Dyalram, Esther H.K. Perera, Xinggang Liu, Robert A. Ord — 2013-02-11

Purpose: Squamous carcinoma of the buccal mucosa is relatively uncommon in the North American population. It is considered an aggressive cancer, with difficulty in obtaining negative surgical margins and poor locoregional control. This single-institution retrospective analysis attempted to identify prognostic variables, treatment outcomes, and survival patterns of patients with buccal carcinoma.Materials and Methods: A retrospective chart review of all patients with buccal carcinoma treated in the Department of Oral and Maxillofacial Surgery, University of Maryland from 1992 through 2008 was conducted. Thirty newly diagnosed and previously untreated patients were reviewed and their outcomes data were analyzed.Results: Thirteen female and 17 male patients were identified (mean age, 64 yr). Eighteen patients had early-stage disease (stages I to II). Fifteen patients (50%) developed recurrence, with 13 patients developing local recurrence despite 80% of patients achieving negative surgical margins. The overall nodal metastasis rate was 43%, with an occult nodal rate of 32%. Overall 2- and 5-year survival rates were 69% and 53%, respectively. Thirty-nine percent of patients not receiving adjuvant therapy developed recurrence. Early recurrence tended to occur more commonly and was a poor prognostic indicator of successful salvage.Conclusions: Buccal carcinoma is an aggressive disease, with high rates of locoregional disease recurrence independent of surgical margin status. Elective neck dissection and adjuvant therapy should be considered for early-stage disease. Successful salvage is rare in cases of early recurrence.

Primary and Secondary Leiomyosarcoma of the Oral and Perioral Region—Clinicopathological and Immunohistochemical Analysis of a Rare Entity With a Review of the Literature

2013-02-22

Purpose: Leiomyosarcoma (LMS) rarely occurs in the head and neck region. These tumors present with a wide range of clinical features, so the diagnosis is predicated on conventional microscopic findings coupled with immunohistochemical analysis.Patients and Methods: Clinical and histologic data of 7 patients with LMS of the head and neck were recorded retrospectively. In addition to routine immunohistochemistry, staining for cell cycle regulator proteins p16 and p21 was performed.Results: Five LMSs (4 intraoral, 1 dermal cheek) occurred primarily in the oral and perioral region. Two LMSs (parietal and sinonasal) were diagnosed as metastases originating from the uterus and pelvis. Treatment of the primary LMSs consisted of radical tumor resection with clear margins. Distant metastases from LMSs were irradiated or excised as palliative treatment. Three of 5 patients (60%) with primarily excised LMS developed recurrence after an average of 7 months, with lung metastases occurring after 17 months. In 1 patient, cervical lymph node metastases were detected after 10 months. Of all patients, 5 died after an average survival period of 2.4 years. The mean survival period of the 5 patients with primary LMS of the head and neck was 3.3 years. All tumors were positive for vimentin and α-smooth muscle actin, with 57% of tumors showing positive nuclear expression of p16 and 71% of p21. Lack of p16 nuclear expression was associated with a shorter mean survival time (1.3 vs 4.3 yr for p16 positivity).Conclusion: Lung and cervical lymph node metastases often occur in LMS of the head and neck. Presurgical staging, including gynecologic examination, whole-body computed tomography, and sometimes positron-emission or computed tomography, to rule out LMS metastasis is mandatory. Surgical resection of the tumor should be given top priority. Lack of p16 reactivity may have a prognostic value for LMS because it was related to a trend toward poorer survival.

Low-Grade Fibromyxoid Sarcoma With Cystic Appearance and Osseous Metaplasia in the Cheek: A Case Report and Review of the Literature

Ke Fei He, Jun Jia, Yi Fang Zhao — 2013-03-18

Low-grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma, and it was first described by Evans in 1987. Four entities of low-grade fibrosarcoma have been described according to previous studies: 1) LGFMS; 2) hyalinizing spindle-cell tumor with giant collagen rosettes, as a variant of LGFMS; 3) sclerosing epithelioid fibrosarcoma, defined as epithelioid tumor cells arranged in nests and cords embedded within a sclerotic collagenous matrix; and 4) fibrosarcoma not otherwise specified, also designated as “fibrosarcoma, low-grade fibroblastic type.” A long-term follow-up clinicopathologic study reported by Evans showed that LGFMS had high rates of local recurrence (21 of 33) with the interval period ranging up to 15 years and distant metastasis (15 of 33) with the interval period ranging up to 45 years. It also showed that only the dedifferentiation was related to tumor behavior and patient survival. In addition, LGFMS often affects proximal extremities and the trunk, and it can be found in unusual locations, such as the perineum, chest wall, paravertebral region, small bowel mesentery, and thorax. However, there were only 4 cases reported in the maxillofacial region. No gender predilection in incidence was found, and the most common distant metastatic site was the lung.

Errata

2013-06-01

In “Biomaterials for Repair of Orbital Floor Blowout Fractures: A Systematic Review” (Gunarajah & Samman., J Oral Maxillofac Surg 71:550, 2013), an incomplete Table 5 was supplied. The correct version of Table 5: List of Retrieved Articles is given below. In addition, the financial disclosure should have been included: Conflict of Interest Disclosures: None of the authors reported any disclosures.

Erratum

2013-03-25

In “Primary Jaw Tumors in Children” (Abramowicz et al., J Oral Maxillofac Surg 71:47) an incorrect version of the article was published in the January issue; the corrected version has been posted online.

AAOMS Annual Meeting Special Lectures You Won't Want to Miss

2013-06-01

Keynote Lecturer, Robert M. Wachter, MD, will present “What We Need to Know and Do to Cure Our Epidemic of Medical Mistakes” on Wednesday, October 9, at 1:00 p.m. Dr Wachter is professor and associate chair of the Department of Medicine at the University of California, San Francisco. He also is chief of the Division of Hospital Medicine and chief of the Medical Service at UCSF Medical Center. He is the current chair of the American Board of Internal Medicine.

Masthead

2013-06-01

(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 Page

2013-06-01

AAOMS Author Disclosure Forms

2013-06-01

Journal of Oral and Maxillofacial Surgery

Clinical Trial Registration: Implications for Stakeholders

The Presence of Visible Third Molars Negatively Influences Periodontal Outcomes in the Maternal Oral Therapy to Reduce Obstetric Risk Study

Tooth Extractions in Intravenous Bisphosphonate-Treated Patients: A Refined Protocol

Is it Safe to Perform Dental and Cardiac Valve Surgeries Concomitantly?

Palatal Approach to the Anterior Maxillary Sandwich Osteotomy

Pamidronate Enhances Bacterial Adhesion to Bone Hydroxyapatite. Another Puzzle in the Pathology of Bisphosphonate-Related Osteonecrosis of the Jaw?

Absence of Exposed Bone Following Dental Extraction in Beagle Dogs Treated With 9 Months of High-Dose Zoledronic Acid Combined With Dexamethasone

Sickle Cell Disease and Perioperative Considerations: Review and Retrospective Report

Floor-of-Mouth Dermoid Cysts: Report of 3 Variants and a Suggested Change in Terminology

An Unusual Lesion of the Tongue in a 4-Year-Old With Job Syndrome

Increased Levels of Interleukin-6 in Synovial Lavage Fluid From Patients With Mandibular Condyle Fractures: Correlation With Magnetic Resonance Evidence of Joint Effusion

Evaluation of the Relationship Between the Pattern of Midfacial Fractures and Amaurosis in Patients With Facial Trauma

Orthognathic Surgery for Correction of Patients With Mandibular Excess: Don’t Forget to Assess the Gonial Angle

Automated Continuous Distraction Osteogenesis May Allow Faster Distraction Rates: A Preliminary Study

Nasolacrimal Duct Obstruction After Maxillary Orthognathic Surgery

Intraoperative Use of a Gamma Probe for the Treatment of Condylar Hyperplasia: Description of a New Technique

Delayed Versus Immediate Reconstruction of Mandibular Segmental Defects Using Recombinant Human Bone Morphogenetic Protein 2/Absorbable Collagen Sponge

Is There a Role for a Collagen Conduit and Anti-Inflammatory Agent in the Management of Partial Peripheral Nerve Injuries?

A Retrospective Analysis of Squamous Carcinoma of the Buccal Mucosa: An Aggressive Subsite Within the Oral Cavity

Primary and Secondary Leiomyosarcoma of the Oral and Perioral Region—Clinicopathological and Immunohistochemical Analysis of a Rare Entity With a Review of the Literature

Low-Grade Fibromyxoid Sarcoma With Cystic Appearance and Osseous Metaplasia in the Cheek: A Case Report and Review of the Literature

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