Journal of Oral and Maxillofacial Surgery

Maxillofacial Health, Beauty, and Chi: Andy Gump and the Avatars

Leon A. Assael — 2010-03-01

This month in JOMS, read about Andy Gump. Both Drs Aziz and Pogrel independently researched this iconic figure and have interesting and remarkably contrasting findings from their research. Also, even if you are pop culture challenged, see the blockbuster movie Avatar. As an oral and maxillofacial surgeon the lessons of both experiences will resonate in your practice and patient management.

Oral and Maxillofacial Surgery Residency Program at Emory University

Steven M. Roser, Martin B. Steed — 2010-03-01

In 1939 Dr H. James Harpole organized and began an advanced training program in oral surgery in Atlanta, GA, initially based at Grady Memorial Hospital () and the Atlanta Veterans Affairs hospital. Upon returning from service in World War II, Dr Harpole directed and was appointed Chief of Oral and Maxillofacial Surgery at Grady. He was also given a full-time joint appointment in the Department of Oral Surgery at the Emory School of Dentistry and in the Department of Surgery at the Emory School of Medicine, Atlanta, Georgia. Dr Harpole retired from the dental school in 1975 but continued as a consultant in oral surgery and plastic surgery at Grady Memorial for several years.

Bullet Embolus to the Pulmonary Artery After Gunshot Wound to the Face: Case Report and Review of Literature

Chris Jo, Martin B. Steed, Vincent J. Perciaccante — 2009-11-19

Gunshot wounds to the face can have devastating effects on local and distant tissues. The amount of local damage is directly proportional to the kinetic energy transmitted by the missile. Distant injuries, not in the path of the bullet, can be incurred by a pressure wave created by the temporary cavity, a secondary projectile, aspiration of the missile or bony fragments, and embolization of the bullet, which is a rare phenomenon. Embolization, aspiration, and ingestion of the missile should be suspected when there is an entry wound but no exit wound and no missile is found on x-ray in the expected area after a gunshot wound to the head and neck. Bullet embolism to the heart after gunshot wound of the mandible has been reported in the literature. There are several case reports of bullet embolization to the pulmonary artery after sustaining gunshot wounds to the chest, abdomen, and/or extremities. The purpose of this article is to present a case of bullet embolization to the pulmonary artery after a gunshot wound to the face, fracturing the mandible along its course, to review the literature, and to offer a strategy for managing such injuries.

Characteristics of Implant Failures in Patients With a History of Oral Bisphosphonate Therapy

2010-03-01

Purpose: This study examines the pattern of implant failures reported in a large cohort of patients who received oral bisphosphonate therapy.Materials and Methods: A total of 8,572 individuals who received oral bisphosphonate drugs returned a dental survey that obtained information pertaining to implant placement and related complications. Among the 589 individuals reporting dental implants, 16 reported implant failures that were verified by dental records. Implant placement, timing of failure, and bisphosphonate duration were ascertained to determine the characteristics of implant loss in the setting of oral bisphosphonate exposure.Results: Among the 16 patients (all women, aged 70.2 ± 7.6 yrs) there were 26 implant failures; 8 had failure of 12 implants in the maxilla and 9 had failure of 14 implants in the mandible. Early failure (≤1 yr after placement) was experienced by 8 patients (8 implants), whereas late failures (>1 yr after placement) occurred in 10 patients (18 implants); 2 patients had both early and late failures.Conclusions: Overall, few patients reported implant failures. However, among these, there were more late than early failures and a slightly higher proportion of failures in the mandible versus the maxilla. Further studies should investigate the role of chronic bisphosphonate therapy in implant survival and long-term implant osseointegration.

Effect of Zoledronic Acid on Osseointegration of Titanium Implants: An Experimental Study in an Ovariectomized Rabbit Model

2010-03-01

Purpose: Zoledronic acid (ZA), a new-generation intravenous bisphosphonate, exhibits the greatest affinity for bone mineral with the longest retention, thereby leading to its ability to be dosed at annual intervals in the treatment of osteoporosis. The purpose of this preliminary study was to evaluate the effects of systemic administration of a single dose of ZA on osseointegration and bone healing around titanium dental implants.Materials and Methods: Thirty-six female New Zealand rabbits (aged 6-12 months) were used in this study. Rabbits were randomly assigned to 1 of 3 groups: sham control group (SH), ovariectomy group (OVX), and OVX and ZA group (OVX + ZA). Animals in the OVX and OVX + ZA groups were subjected to bilateral ovariectomy, whereas animals in the SH group were sham operated. Eight weeks later, 1 implant was placed in each tibia of the animals. ZA was administered in the OVX + ZA group during the implantation, whereas the OVX and SH groups received saline solution infusions. All of the subjects were sacrificed 8 weeks after the implantation, and tibial specimens were harvested. Histomorphometric bone-to-implant contact analysis, resonance frequency analysis, removal torque testing, and digital radiographic absorptiometry were administered, and the data were statistically analyzed.Results: Histomorphometric, resonance frequency, and radiodensitometric analyses showed significant improvement in osseointegration of implants in the OVX + ZA group compared with the OVX group. However, the differences in removal torque results between the groups were not statistically significant.Conclusions: The results of this study suggest that systemic ZA administration may improve osseointegration of titanium implants placed in estrogen-deficient states of bone.

Clinical Evaluation of Implants in Radiated Fibula Flaps

Thomas J. Salinas, Valmont P. Desa, Alexander Katsnelson, Michael Miloro — 2010-03-01

Purpose: The success of osseointegrated implants in the radiated fibula flap used for mandibular reconstruction is variable, and there are few long-term data available in the literature. The purpose of this study is to evaluate implant success in radiated fibula flaps and the native mandible after ablative tumor surgery.Materials and Methods: The medical records of 44 patients who underwent resection and reconstruction of the mandible from 1994 to 2006 were reviewed retrospectively. A total of 206 implants were placed; 144 were placed in a fibula flap, and 92 were placed in the native mandible. Before implant placement, 22 patients (50%) received adjuvant tumoricidal doses of radiation therapy (>6,000 cGy). All patients who received radiation received a standard regimen of 20 preoperative and 10 postoperative hyperbaric oxygen treatments. The follow-up period ranged from 4 to 108 months (mean, 41.1 months). Comparisons were made between groups regarding long-term implant success based on several variables.Results: Implants were considered to be successful if there was no radiographic evidence of peri-implant bone loss and if they were clinically osseointegrated. Of 206 implants, 31 failed, with an overall success rate of 85%. The success rate of implants placed in fibula flaps was 82.4%, and the success rate in native mandibles was 88%. Most of the failures in the fibula (90%) occurred within the first 6 months after implant placement, whereas most of the failures in the mandible occurred after 6 months. The cumulative survival rate was 91.9%, and there was no difference in survival between implants placed in the fibula versus the native mandible or depending on whether the patient received radiation therapy.Conclusion: Acceptable long-term implant success rates may be achieved in the radiated mandible with vascularized fibula flap reconstruction.

Implant Treatment in Patients With Severe Hypodontia: A Retrospective Evaluation

2010-03-01

Purpose: The aim of this retrospective study was to evaluate the result of implant treatment in patients with severe hypodontia and compare some basic characteristics of patients with severe hypodontia who received conventional dental treatment or no treatment at all with those who were treated in combination with endosseous implants.Patients and Methods: All patients who had been referred to an academic center of special dental care between 1990 and 2008 and who had been classified at their first visit as having “oligodontia” or “severe hypodontia” were selected from the hospital's database. Their charts were reviewed, and surgical treatment details and outcomes of the implants were registered from those patients who received endosseous implants.Results: Of the 294 patients who met the inclusion criteria, 44 patients were treated in combination with endosseous implants. The cumulative chance of implant survival of the 214 placed implants after 5 years was 89.8% (SE, 2.6%), with a mean observation period of 2.9 years (minimum, 0.1 years; maximum, 18.3 years). No implants failed thereafter. Patients who received implants were missing fewer teeth and were treated more recently compared with those who received conventional restorative treatment or no treatment at all.Conclusion: Considering the compromised anatomic situation and the complexity of treatment, a 5-year survival rate of 89.8% in patients with severe hypodontia, as seen in this study, is regarded as acceptable.

Island Osteoperiosteal Flap for Alveolar Bone Reconstruction

2010-03-01

The island osteoperiosteal flap (I-flap) is introduced as a modified alveolar split bone grafting technique used to gain width and modify the facial or buccal bone plate position. Three case examples are shown as well as animal histology indicating the possible development of this new surgical procedure as an adjunct for alveolar augmentation and implant therapy.

Evaluation of the Smile: Facial and Dental Considerations

Antoine J. Panossian, Michael S. Block — 2010-03-01

Purpose: The purpose of this article is to establish an evidence-based evaluation of the esthetic region of the mouth, by reviewing normal values for the face, the smile line, and the teeth.Materials and Methods: A Medline search was performed to find evidence-based data on accepted normal ranges of facial and dental proportions. The information found was organized following a sequence of physical examinations, which then was used to develop a decision tree for diagnosis and treatment planning.Conclusions: By following this evaluation algorithm, clinicians will be able to document a standard set of data that will reveal skeletal and dental dysmorphia, which can then follow a well-organized sequence of treatment to re-establish facial and dental harmony.

Characteristics of Head and Neck Cancer Patients Referred to an Oral and Maxillofacial Surgeon in the United States for Management

Jon D. Holmes, R. Andrew Martin, Rajesh Gutta — 2010-03-01

Purpose: The purpose of this study was to report the characteristics of patients with head and neck cancer, excluding cutaneous malignancies, referred to an oral and maxillofacial surgeon in the United States for management.Materials and Methods: We performed a retrospective chart review of all head and neck cancer patients referred to the senior author's oral and maxillofacial surgery practice over 12 consecutive months. Data were extracted from the patients' comprehensive record and included demographics, social history, site, histologic diagnosis, staging, treatment, and referral patterns.Results: A total of 90 patients, 51 men and 39 women (male-female ratio, 1.3:1), with a mean age of 64.4 years (range, 32-91 years) were referred with head and neck cancer, excluding skin cancer, over the 12-month period and were included in the study. Regarding ethnicity, 88.8% of the patients were white, 11.1% African American, and 1.1% Asian. Most of the patients, 84.4%, were referred from within the state, but only 21.1% of these resided within the metropolitan area of the senior author's practice. Of the patients in the study population, 95.5% had either private or state-provided/federally provided insurance. Social history showed that 59.9% of patients were current or past smokers, 31.1% were nonsmokers, and 8.8% were smokeless tobacco users, and only 18.8% admitted to alcohol use. Approximately 80% of patients were initially evaluated by a general dentist, oral and maxillofacial surgeon, or periodontist, and 93% of referrals were from other oral and maxillofacial surgeons. Over 90% of lesions were located in the oral cavity, and only 6.6% were oropharyngeal primary cancers. Squamous cell carcinoma made up 89% of the lesions, whereas minor salivary gland and metastatic carcinomas comprised the other 11%. At the time of diagnosis, 64.4% of the lesions were early stage (I/II) and 35.6% were late stage (III/IV). Analysis of treatment modalities showed that 87.8% underwent surgery, excluding biopsy, as part of their therapy. Of these, 83.5% were treated with surgery only, whereas the others received both surgery and some form of adjuvant therapy. Five patients were treated with concurrent chemoradiation therapy.Conclusion: Our results suggest that patients referred to an oral and maxillofacial surgery practice for management of head and neck cancer are different from those described in previous reports regarding demographics, social history, site, and stage of disease at diagnosis and treatment. This finding may be explained by the unique referral pattern for oral and maxillofacial surgeons treating head and neck cancer.

Individual Design and Rapid Prototyping in Reconstruction of Orbital Wall Defects

Wei Tang, Lijuan Guo, Jie Long, Hang Wang, Yunfeng Lin, Lei Liu, Weidong Tian — 2010-03-01

Purpose: We examined the application of individual digital design and rapid prototyping in the reconstruction of orbital wall defects for different stages of orbital volume (OV) changes.Patients and Methods: Patients with unilateral post-traumatic orbital defects underwent individual digital design and rapid prototyping to manufacture specific titanium mesh implants to create ideal OV recovery. Features of orbital wall fracture deformities and OV changes were analyzed and measured with 3-Dimensional Medical Surface Rendering image software system.Results: Most cases involving enophthalmos and diplopia were rectified, except for 5 cases of enophthalmos and 2 cases of diplopia with fresh fractures and 11 cases of enophthalmos and 7 cases of diplopia cases with old fractures. Ocular movements and facial malformations were improved. The OV values between the uninjured and injured sides had a significant deviation (P < .05). The degree of enophthalmos had no significant deviation with OV changes pre- and postoperatively in the early fracture stages. The degree of enophthalmos in the old fracture stages had a significant deviation with OV changes pre- and postoperatively.Conclusions: This study showed that orbital wall fractures can be diagnosed in early fracture stages and that the degree of long-term enophthalmos can be predicted with 3-Dimensional Medical Surface Rendering software. Our results suggest that early-stage orbital wall fractures should recover OV as early as possible, and that advanced stage orbital wall fractures should overcorrect OV. The degree of accuracy and rational of OV reconstruction can be improved by appropriate individual digitalization design and rapid prototyping technology.

Simultaneous Correction of Bilateral Temporomandibular Joint Ankylosis With Mandibular Micrognathia Using Internal Distraction Osteogenesis and 3-Dimensional Craniomaxillofacial Models

Ping Feiyun, Liu Wei, Chen Jun, Xu Xin, Shi Zhuojin, Yan Fengguo — 2009-12-03

Purpose: The present study evaluated the simultaneous correction of bilateral temporomandibular joint ankylosis with mandibular micrognathia using internal distraction osteogenesis (DO) with the help of a 3-dimensional craniomaxillofacial model technique.Materials and Methods: A total of 16 patients (age 18 to 43 years) with bilateral temporomandibular joint ankylosis and mandibular micrognathia were included in the present study. Obstructive sleep apnea and hypopnea syndrome was diagnosed in all patients preoperatively. Three-dimensional craniomaxillofacial models of the 16 patients were constructed using computed tomography and a rapid prototype technique. Simulation surgery and individual internal DO was performed on the models. The treatment included simultaneous DO of the mandibular body and transport DO for temporomandibular joint arthroplasty. The distraction was started on the seventh day after surgery. The distraction rate was 0.8 mm/day. The patients began active mouth opening postoperatively. Distracters were kept in place for 4 months after distraction completion and then removed. Polysomnography, cephalometry, and computed tomography were performed at 6 months postoperatively.Results: The obstructive sleep apnea and hypopnea syndrome was cured, and the micrognathia was corrected in all patients. The average mouth opening increased from 4.6 mm preoperatively to 33.5 mm postoperatively. The average range of the sella-nasion-supramental angle increased from 68.7° preoperatively to 77.6° postoperatively. Bone formation in the distraction gaps was observed. The follow-up period was 29.7 months (range 6 to 52). No complications or recurrence of temporomandibular joint ankylosis or micrognathia occurred in any patient during the follow-up period.Conclusions: Bilateral temporomandibular joint ankylosis accompanied by mandibular micrognathia and obstructive sleep apnea and hypopnea syndrome can be corrected effectively by simultaneous internal DO. The application of preoperative simulation surgery using 3-dimensional craniomaxillofacial model has many advantages for planning the surgical method and precise operation. Our preliminary results have shown that it is a safe, effective, and feasible technique.

The Use of the Temporalis Myofascial Flap in Oral Cancer Patients

Imad Abu-El Naaj, Yoav Leiser, Ronit Liberman, Micha Peled — 2009-11-30

Purpose: The purpose of this article is to present our experience using the simple, reliable, and predictable temporalis myofascial flap (TMF) in rehabilitation and reconstructive surgery in cancer patients who are older and whose health is compromised in a way that precludes the use of microvascular free flaps.Patients and Methods: Our series includes 10 patients (8 men and 2 women), ranging in age from 62 to 85 years (mean, 73.4 years). A full-thickness anteroinferiorly based TMF was used in 5 patients for palatal reconstruction, 3 patients for buccal lining reconstruction, and 2 patients for reconstruction after resection of facial skin and buccal mucosa.Results: The TMF survival rate in this study was excellent, with an 80% success rate (2 minor complications). Complications included 1 case of a partial distally necrotic flap that resolved after local debridement and did not require further flap manipulation and 1 case of transient, spontaneously resolved facial nerve (temporal branch) palsy and limited mouth opening (<20 mm), which also resolved after judicious physiotherapy.Conclusions: The TMF was found in this study to have a fairly low complication rate, was relatively easy to use, and had a predictable outcome. The proximity and reliability of the myofascial flap make it a favorable and highly recommended candidate for oral and maxillofacial reconstructive surgery in elderly patients, who usually have relatively poor recovery potential and decreased physiologic reserves.

Survival and Patterns of Relapse in Patients With Oral Tongue Cancer

2009-11-27

Purpose: To evaluate the survival and patterns of relapse for patients with squamous cell carcinoma (SCC) of the oral tongue.Patients and Methods: Between 1999 and 2007, 50 patients with SCC of the oral tongue were treated at the University of Colorado Denver. Of the 50 patients, 38 had newly diagnosed SCC of the oral tongue (13 with stage I-II and 25 with stage III-IV disease), and 12 presented with locally recurrent SCC. Of the 50 patients, 49 were treated with initial surgery and 1 with definitive chemoradiotherapy. Adjuvant radiotherapy or chemoradiotherapy was administered to 42 patients after surgery. Of the 13 patients with newly diagnosed stage I-II disease, 7 did not receive adjuvant therapy. The actuarial locoregional control, freedom from distant relapse, and survival were determined using the Kaplan-Meier method, and comparisons were made using the log-rank test.Results: The median follow-up was 29 months (range 4 to 95) for living patients. The 2-year locoregional control and freedom from distant relapse rate was 58% and 83%, respectively. Locoregional control was particularly low among patients with stage I-II disease, for whom the 2-year locoregional control rate was only 35%. The median survival time and 2-year survival rate for all patients was 42 months and 65%, respectively. The 2-year survival rate for patients with stage I-II oral tongue cancer was 77% compared with 52% for patients with stage III-IV disease (P = .04).Conclusions: Despite aggressive therapy, patients with SCC of the oral tongue have a low rate of local tumor control and survival, particularly among those with stage I-II disease. These patients should be considered for inclusion in clinical trials evaluating novel postoperative therapies.

Midazolam More Effectively Suppresses Sympathetic Activations and Reduces Stress Feelings During Mental Arithmetic Task Than Propofol

Rie Tsugayasu, Toshiyuki Handa, Yuzuru Kaneko, Tatsuya Ichinohe — 2009-12-04

Purpose: The aim of the present study was to examine the effect of intravenous midazolam and propofol sedation on autonomic nervous activities during psychological stress, and whether these results are associated with changes in subjective stress feelings.Materials and Methods: Seven healthy male volunteers were included in a randomized crossover manner. The heart rate (HR), HR variability, arterial oxygen saturation, and bispectral index value were continuously monitored. A mental arithmetic task for 7 minutes was given with or without intravenous sedation with midazolam or propofol. A bispectral index value of 75 to 85 and an Observer's Assessment of Alertness/Sedation score of 4 were the targeted sedation level in both groups. HR variability was assessed using the power spectral analysis (low-frequency [LF] and high-frequency [HF] components and LF/HF ratio). The faces anxiety scale was used to grade their stress feelings after each mental arithmetic task.Results: During the mental arithmetic task with intravenous sedation, no differences were found in the bispectral index values, arterial oxygen saturation, or the results of the mental arithmetic task between the 2 groups. The HR, LF/HF ratio, and normalized unit LF increased, and the normalized unit HF decreased in both groups. However, the percentage of changes in LF/HF ratio, normalized unit LF, and normalized unit HF were smaller in the midazolam group. In addition, the reduction in faces anxiety scale was greater in the midazolam group.Conclusions: These results suggest that midazolam more effectively suppresses sympathetic nervous activation and reduces subjective stress feelings during a mental arithmetic task than propofol.

Treatment of Oral Leukoplakia With Carbon Dioxide and Potassium-Titanyl-Phosphate Lasers: A Comparison

Bernard Lim, Andrew Smith, Arun Chandu — 2010-03-01

Purpose: To determine whether the treatment of oral leukoplakia with potassium-titanyl-phosphate (KTP) lasers versus CO2 lasers results in lower recurrence rates.Materials and Methods: Retrospective data were collected from the records of 30 patients (mean age 75.6 years) with 35 primary oral leukoplakia who had their lesions ablated by KTP laser, and 45 patients (mean age 59.9 years) with 59 primary oral leukoplakia who had CO2 laser treatment. The recurrence rates of lesions between these 2 groups was then compared.Results: A statistically significant (P = .049) reduction in recurrence rates for those patients treated with KTP lasers versus CO2 lasers was found.Conclusion: The use of KTP lasers for the treatment of oral leukoplakia may result in lower recurrence rates than when using CO2 lasers.

Success of Zygomatic Plate-Screw Anchorage System

Tamer Eroğlu, Burçak Kaya, Alev Çetinşahin, Ayça Arman, Sina Uçkan — 2010-03-01

Purpose: To evaluate the success of zygomatic plate-screw anchorage and to define the key points that help to improve the success of this system.Materials and Methods: A total of 74 zygomatic plate-screw anchors were applied to 37 patients from 2 groups receiving orthodontic treatment. The first group consisted of 19 patients, and the zygoma anchors were applied bilaterally to distalize the maxillary buccal segment. The second group consisted of 18 patients, and the zygoma anchors were applied bilaterally to stabilize the maxillary molars during maxillary canine retraction. The orthodontic force was applied 1 week after the insertion of the plates. In the first group, 450 g of direct force and in the second group 150 g of indirect force were applied to the zygomatic plates. The success rate of the zygomatic plate-screw anchorage system was evaluated.Results: One plate was lost and the others remained stable all through the orthodontic treatment. Mild gingival inflammation was observed in 1 patient (2 plates), and pus formation was detected in 1 patient (2 plates). One plate was covered because of mucosal hypertrophy.Conclusion: Zygomatic plate-screw anchorage system is a reliable technique to obtain orthodontic anchorage and may eliminate the need for extraoral force. However, the surgical insertion technique, position of the plates, and oral hygiene status of the patients certainly influence the success of the system.

Clinical and Anatomic Study on the Ducts of the Submandibular and Sublingual Glands

2010-03-01

Purpose: To investigate the relationship between the ducts of the submandibular gland (SMG) and sublingual gland (SLG) and discuss its clinical application relating to SMG radiologic examinations and transfer.Materials and Methods: The microanatomy of the SMG and SLG was investigated by use of 30 adult cadavers through anatomic dissection by use of a microscope. The relationship between the SMG and SLG ducts was observed and recorded during operations of microvascular autologous SMG transfer in 63 cases of severe keratoconjunctivitis sicca.Results: There were 3 patterns of SLG and SMG duct anatomic variation: 1) The SMG and SLG have their own respective ducts that secrete separately at the orifices of the ducts in the floor of the mouth. 2) The SLG has a major duct that joins the duct of the SMG. 3) The SLG only has many fine ducts (7-15) that secrete in the floor of the mouth.Conclusions: The anatomy of the ducts of the SMG and SLG is quite complicated. More attention should be paid to the anatomy of the ducts during surgery or imaging procedures related to the SMG.

Clinical Follow-Up Examination of Surgically Treated Fractures of the Condylar Process Using the Transparotid Approach

2010-03-01

Purpose: The surgical approaches for the open treatment of condylar process fractures have been controversial. In our study, we evaluated the morbidity of the transparotid approach during 2 years of follow-up.Patients and Methods: A total of 48 patients with condylar process Class II and IV fractures according to classification of Spiessl and Schroll, were included in the present study. Of the 48 patients, 16 were female and 32 male. The patient age range was 16 to 79 years (average 36.52). All patients were treated using the transparotid approach, with rigid internal fixation using miniplates. Follow-up examinations were performed for a minimum of 6.5 months and a maximum of 25 months (average 12.16) after surgical treatment. At the follow-up examination, the patients completed the Mandibular Function Impairment Questionnaire, and the examiner completed the Helkimo index. X-rays taken before, directly after, and 6 months after surgery were compared.Results: None of our patients had problems with wound healing; 2 patients developed a fistula of the parotid gland; and 4 patients developed palsy of the facial nerve that was completely reversible after 6 weeks. The results of the Mandibular Function Impairment Questionnaire and the Helkimo index revealed only a few subjective and objective problems after 6 months.Conclusions: The transparotid approach to condylar process fractures is most appropriate for strongly displaced Class II fractures. Especially for very old patients with dementia, for whom maxillomandibular fixation is contraindicated, this approach is very appropriate. Another benefit to this type of patient is the short operating time, with an average of 45 minutes.

Epistaxis During Nasotracheal Intubation: A Comparison of Nostril Sides

Takuro Sanuki, Motoko Hirokane, Junichiro Kotani — 2009-11-23

Purpose: It is commonly believed that for preventing epistaxis during nasotracheal intubation (NTI), the right nostril should be used. However, there is no real evidence as to which nostril should be used. In this study, we tested our hypothesis that epistaxis during NTI is more frequent and severe using the left nostril rather than the right, provided that patency appears equal on both sides of the nose.Patients and Methods: A total of 54 patients who were scheduled for elective oral surgery, in which NTI was indicated to optimize the surgical approach, were recruited into this study. The nostril used for NTI was chosen randomly.Results: Epistaxis occurred significantly more frequently (44.4%) when the left nostril was used for NTI than when the right nostril was used (11.1%; P = .014). Although there were no statistical differences in the incidence of mild epistaxis between the 2 nostrils (P = .467), severe epistaxis was significant more frequent with the left (22.2%) than with the right nostril (0.0%; P < .023).Conclusions: Our data show that epistaxis during NTI is more frequent and severe with the left nostril than the right. Hence, when deciding which nostril to use for NTI, the right nostril should be used if patency appears equal on both sides of the nose.

Analgesic Effects of Intra-Articular Morphine in Patients With Temporomandibular Joint Disorders: A Prospective, Double-Blind, Placebo-Controlled Clinical Trial

Christoph M. Ziegler, Jan Wiechnik, Joachim Mühling — 2010-03-01

Purpose: A number of reports have shown a direct analgesic effect of opioids by way of the peripheral receptors. Nevertheless, only a very few studies have reported using opioids in the temporomandibular joint (TMJ), and nearly all of them were connected to surgical patient groups. The present study was designed to evaluate the analgesic efficacy and safety of repeated intra-articular morphine applications compared with a local anesthetic and saline solution in the management of TMJ pain.Patients and Methods: A total of 48 patients with articular pain related to the TMJ were entered in a clinical, prospective, randomized, double-blind, single-center study. The analgesic effect of repeated intra-articular infiltration with morphine (5 or 10 mg morphine sulfite), bupivacaine 0.5% (Carbostesin; AstraZeneca, London, UK), and isotonic saline solution as a placebo in the TMJ was examined. The efficiency after 3 injections of the same substance with an interval of 48 hours between each application was measured using a pain relief scale, visual analog scale, pain intensity scale, and the potential need for accessory peripheral analgesics (paracetamol).Results: All patients showed, independent of the treatment group, pain relief within 60 minutes after the first injection. Patients with saline and Carbostesin reported almost complete pain recurrence before the second injection. At 1 week after the last and third injection, the 10-mg morphine group still showed a distinct effect, with 16.7% reporting complete (no pain) and 41.7% distinct pain relief. In addition, 33.3% had a poor response and 8.3% had no improvement. None of the other groups reported complete improvement; however, 25% of the patients who received 5 mg morphine had distinct pain relief, and 50% had at least poor pain relief. In the Carbostesin group, distinct improvement was reported by 8.3%, with a poor response in 41.7%, and no effect in the remaining 50%. Patients treated with saline had a poor response in 16.7%, but most (83.3%) reported no improvement 1 week after treatment.Conclusions: Independent of the applied substances, initial pain relief can be registered in the TMJ: either from the arthrocentesis effect or at least the placebo effect. Morphine at a dosage of 10 mg showed the best and most long-lasting analgesic efficiency. Morphine, in general (5 and 10 mg), and, with limitations, Carbostesin were more or less efficient for postoperative pain control but without distinct effects in the long term. With regard to our results, we can recommend intra-articular morphine application at a dose of 10 mg for pain management. Carbostesin showed no promising long-term effects.

Surgical Approach to Impacted Mandibular Third Molars—Operative Classification

Imad Abu-El Naaj, Refael Braun, Yoav Leiser, Micha Peled — 2009-12-23

Purpose: The aim of the present study is to suggest a convenient way to classify the position of the impacted third mandibular molar relative to the mandibular canal and to suggest indications for the use of each surgical approach for mandibular third molar extraction.Materials and Methods: The presented new typing system, Third Molar Classification (TMC), is a simple and easy-to-apply method for the surgical management of mandibular third molars and can be extended for any ectopic or impacted mandibular tooth. There are 3 major types of third molar positions. The second type is subdivided further into 2 subtypes. In the present study, 9 patients with high-risk mandibular third molars were treated according to the present classification and are presented and discussed. Patients typed as TMC IIb were treated with a sagittal split osteotomy approach and patients typed as TMC III were treated with an extraoral approach.Results: The operative classification was successfully implemented in very rare cases of deeply impacted mandibular third molars. In 3 of 9 cases (33%) minor complications included some degree of hypoesthesia using the extraoral approach; these complications resolved spontaneously without the need for any intervention.Conclusions: The present study describes the use of a new surgical classification system for treatment planning in all types of mandibular third molar extractions. We believe that the present classification could help the oral and maxillofacial surgeon in decision-making and limit the possible risks that are present when attempting to extract impacted mandibular third molars.

Third Molar Caries Experience in Middle-Aged and Older Americans: A Prevalence Study

2010-03-01

Purpose: To assess the prevalence of third molar caries experience in a middle-aged and older population and the relationship of these findings to caries experience in teeth more anterior in the mouth.Patients and Methods: Data from 6,550 Dental Atherosclerosis Risk in Communities study participants aged 52 to 74 years who underwent a clinical examination for coronal caries experience were available for these analyses. Subjects with visible third molars (N = 2,003) were divided based on third molar coronal caries experience on at least 1 third molar: no carious/decayed coronal surface (DS) or at least 1 coronal DS and no filled coronal surface (FS) or at least 1 coronal FS. Coronal DS and FS were also calculated for more anterior teeth. Covariates included ethnicity, gender, age, body mass index, education, income, smoking status, and diabetes diagnosis. Subject level outcomes for third molar and more anterior teeth were compared by descriptive statistics and χ2 or t tests with statistical significance set at P less than .05. Multivariate modeling was performed to adjust outcome variables for covariates.Results: Third molar caries experience was detected in 77% of subjects and was significantly associated with caries experience in more anterior teeth and white race (P < .01). Caries experience was detected in only third molars in 1% of subjects, and 1% of subjects were caries free. Subjects with less education (20%) and lower income (19%) were significantly more likely to have DS detected compared with subjects with more education (6%) and higher income (5%) (P < .01). Conversely, subjects with more education (75%) and higher income (77%) were significantly more likely to have FS detected compared with subjects with less education (55%) and lower income (60%) (P < .01).Conclusions: Third molar coronal caries experience was significantly associated with caries experience in teeth more anterior in the mouth in this middle-aged and older population.

Mandibular Ramus/Coronoid Process Grafts in Maxillofacial Reconstructive Surgery

Saar Amrani, George E. Anastassov, Andre H. Montazem — 2010-03-01

Purpose: To evaluate the utility of autogenous extended mandibular ramus and coronoid process bone grafts for maxillofacial reconstructive surgery.Patients and Methods: Twelve patients aged 23 to 76 years (mean, 52) who underwent extended ramus/coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or iatrogenic nasal deformity. All patients had either unilateral or bilateral combined coronoid process-mandibular ramus bone grafts for their reconstruction. There was 1 nasal reconstruction, 2 unilateral mandibles, 1 bilateral mandible, 4 unilateral maxillas, 1 unilateral maxilla and mandible combined, and 1 bilateral maxilla and mandible combined.Results: The procedure was considered a success when the patient's deformities were reconstructed ad integrum and when there were no failures of the dental implants placed in the augmented areas as of the longest follow-up. All patients were successfully reconstructed. There was 1 infection at a donor site that resolved with local care and oral antibiotics. All but 1 of the maxillary and mandibular alveolar augmentations underwent endosteal implant placement approximately 4 to 6 months following grafting. The nasal reconstruction restored normal function and symmetry.Conclusion: Using both the coronoid process of the mandible and the mandibular ramus as a source for autogenous bone graft can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

Complication Rates in the Operative Treatment of Mandibular Angle Fractures: A 10-Year Retrospective

2010-03-01

Purpose: Large-scale studies assessing complication rates and correlation of complications are still missing considering different fracture locations in the mandible. In the present retrospective study, complication rates of mandibular angle fractures treated by open reduction were assessed.Materials and Methods: Three hundred twenty-two patients (259 men, 63 women) with 335 surgically treated mandibular angle fractures were included in this study.Results: Fractures were caused by fights (46.6%), falls (19.2%), traffic accidents (14.6%), sports (11.9%), wisdom tooth removal (7.3%), and 0.9% other causes. Successful treatment occurred in 93.69% of fractures with 1 open reduction and in 6.31% with 2 open reductions. Of surgically treated patients, 71.47% (238) were completely free of complications. A detailed complication correlation matrix is given in the text. Ninety-five fractures treated with 1 miniplate, 170 with 2 miniplates, and 70 with other osteosynthesis concepts were compared regarding osteosynthesis failure and pseudarthrosis.Conclusion: Similar osteosynthesis failure rates were shown for 1 miniplate and 2 miniplates.

Andy Gump and His Deformity

Shahid R. Aziz — 2010-03-01

The “Andy Gump deformity” is a euphemism for an anterior mandibular defect that creates the appearance of an absent chin and lower lip and severely retrognathic lower jaw (). Most commonly, this defect is due to ablative head and neck cancer surgery; however, this deformity is also used to describe bilateral body fractures of the edentulous and atrophic mandible or a severely retrognathic mandible. In all cases patients with this deformity are at risk for airway compromise, cosmetic embarrassment, excessive drooling, mastication difficulties, and speech impairment. Reconstruction is difficult but has become more successful over time with improved surgical technology.

Who Was Andy Gump?

M. Anthony Pogrel — 2010-03-01

October 2009 represents the 50th anniversary of the last appearance of Andy Gump in newspapers. Because the deformity that was named after him is seen much less frequently today, owing to advances in reconstructive surgery (), a number of generations of oral and maxillofacial surgeons have been (and in some cases gone) since Andy Gump's demise. Thus, the current generation of oral and maxillofacial surgeons seem very unsure as to who he was. If asked directly, some of them will say “he was a cartoon character” but know little more about him. Because the so-called Andy Gump deformity is something we still discuss from time to time, it might be of interest for the new generation of oral and maxillofacial surgeons to know something of the story behind Andy Gump.

Treatment of Arteriovenous Malformation of the Mandible With Resection and Immediate Reconstruction

Hidemi Oka, M. Anthony Pogrel, Christopher F. Dowd, Janice S. Lee — 2009-11-23

Arteriovenous malformation (AVM) of the mandible is a rare entity but one that has significant potential for fatality due to massive hemorrhage. Current treatment has involved surgical resection of the mandible in conjunction with adjunctive endovascular embolization to help control hemorrhage. However, jaw resection is deforming and often leaves a significant defect requiring subsequent bone grafting and replacement of lost teeth. We report an endovascular and surgical technique to treat central AVMs of the mandible that permits resection and complete removal of the intraosseous lesion yet prevents facial deformity by preserving the mandibular bone contour and permitting reconstruction of the dentition and restoration of function.

Microsurgical Upper Lip Replantation: A Case Report

Alessandro Baj, Giada A. Beltramini, Francesco Laganà, Aldo B. Giannì — 2009-12-03

Lip amputation is rare, and systematic microsurgical replantation is necessary to achieve morphofunctional restoration of the traumatized structure in a single surgical operation. We describe a case of right hemilip and labial filter avulsion, resulting from a dog bite. The amputated section was revascularized by arterial microanastomosis, whereas no venous anastomosis was performed, because no venous blood vessel was identified. Venous drainage was obtained through the postoperative application of leeches together with anticoagulant and antibiotic therapy. The esthetic and functional results were good in terms of form, color, scarring, and the restoration of lip function and sensitivity.

Congenital Cervical Teratoma: A Case Report

2009-11-19

Cervical teratomas represent approximately 3% of all congenital teratomas, and occur in approximately 1 in 20,000 to 1 in 40,000 live births. In the head and neck region, they are most commonly found in the cervical area, followed by the nasopharynx. Teratomas are derived from multipotent primitive germ cells that have the ability to differentiate into a variety of tissues. In addition, teratomas have a heterogeneous histologic appearance that may include cystic or solid areas with organoid patterns, as well as mature or immature components.

Benign Cementoblastoma of the Anterior Maxilla

2010-03-01

Benign cementoblastoma, first described by Dewey in 1927, is an odontogenic tumor of mesenchymal origin characterized by proliferation of the cellular cementum. It is a rare odontogenic tumor that almost always occurs in the premolar or molar region and more commonly in the mandible than in the maxilla. We present an unusual case of benign cementoblastoma in the anterior maxilla.

Extranodal Natural Killer T-Cell Lymphoma, Nasal Type, With Minimal Osseous Involvement: Report of a Case and Literature Review

2009-12-04

Extranodal natural killer/T-cell lymphoma (ENKTCL) is a rare form of Epstein-Barr virus (EBV)–associated non-Hodgkin lymphoma (NHL). The nose and paranasal sinuses are the most commonly reported sites of initial involvement. ENKTCL is reported most frequently in East Asian populations and is notably rare in Western populations. The purposes of this case report are to describe an atypical presentation of ENKTCL involving primarily the soft tissues of the midface and to highlight the vigilance required in diagnosing this cause of nonresolving facial swelling.

Infiltrating Angiolipoma of a the Oral Cavity: Report of a Case and Literature Review

2009-11-30

Benign lipomatous tumors are classified into 5 groups: 1) lipoma; 2) variants of lipoma; 3) heterotopic lipomas, hamartomatous lesions; 4) infiltrating or diffuse neoplastic or non-neoplastic proliferations of mature fat; and 5) hibernoma. Angiolipoma is a variant of lipoma and is distinguished in the noninfiltrating and infiltrating type. Infiltrating angiolipoma most often occurs in the trunk and extremities and is rare in the head and neck region. Some authors believe that infiltrating angiolipoma could represent diffuse angiomatosis associated with fat, rather than a neoplasm. Review of the literature revealed only 8 cases of infiltrating angiolipoma, of which 3 cases were located in the oral cavity.

Cervical Support Collar: A Substitute to the Jaw Thrust/Chin Lift Methods of Airway Management During Oral Maxillofacial Surgeries

Philip M. Kleffner, Patrick C. Collins, Chad P. Collins — 2010-03-01

Outpatient single-surgeon–provided intravenous sedation is a safe, cost-effective means of providing anesthesia for numerous oral and maxillofacial surgical procedures. The sedation allows for increased comfort for the patient and can make difficult procedures less stimulating and more routine for patient and surgeon. When sedation is used, it is extremely important that proper airway management techniques are used. Two very basic techniques to maintain airway patency in the sedated patient are the jaw thrust and chin lift methods. The jaw thrust method consists of grasping the angles of the mandible and advancing them forward to increase the opening of the pharynx. The chin lift method consists of advancing the mandible forward by grasping just under the mental protuberance and opening up the pharynx that way. The job of manually maintaining airway patency is routinely designated to the Oral and Maxillofacial Surgery Anesthesia Assistants Program trained surgical assistant who stands at the head of the patient. To more safely administer anesthesia and avoid fatigue by the assistant for longer procedures, we have developed the following method to assist with airway management.

Nasal Base Modification in Asian Patients

Sang-Ha Oh, Da-arm Kim, Jae Yong Jeong — 2010-03-01

The nasal characteristics of white persons and Asian persons represent the extremes of a spectrum. Typically, the common complaints of Asian patients include a dorsum that is wide and lacks anterior height and a tip that projects poorly and is not well defined. Large amounts of subcutaneous fat, thick skin, and a wide, flattened crura contribute to poor tip projection. Asians also have more excessive alar flaring and a wider nasal base.

Chin Augmentation With Thin Cortical Bone Concomitant With Advancement Genioplasty

2010-03-01

The chin plays a prominent role in establishing, not only esthetics, but also function. An incompetent lip seal and tension of the mentalis muscle in swallowing can be important symptoms. Genioplasty is one of the options for addressing the chin deformity and dysfunction caused by morphologic deficiencies. Postoperative complications can include resorption of grafted bone and a deep labiomental fold. Lateral wings of the genial segment are apt to be resorbed, occasionally leading to the so-called witch's chin appearance, if combined with a deep labiomental fold. To overcome this problem, various strategies have been reported. We describe a novel method to augment the chin structure with a desirable labiomental fold using thin cortical bone alone. Surgeons generally depend on radiography or computed tomography to evaluate genioplasty. However, we had the opportunity to see firsthand the actual state of bony union in these cases when subsequent anterior subapical alveolar osteotomy was performed several months later. We report 2 cases in which substantial bone augmentation was achieved.

Automated 3-Dimensional Airway Analysis From Cone-Beam Computed Tomography Data

Stephen A. Schendel, David Hatcher — 2010-03-01

The analysis and 3-dimensional (3D) imaging of the airway have become more common as technological developments in both imaging and computer analysis have advanced and converged during the past few years. These advances have been especially beneficial for the ability to understand and diagnose obstructed sleep disordered breathing (OSDB) and its relationship to the craniofacial anatomy. The improved availability of cone-beam computed tomography (CBCT), 3D imaging, and computer simulation in dentofacial analysis and treatment planning has facilitated the use of this method for evaluation of the airway. The currently available diagnosis and treatment planning methods for OSDB have limitations despite inclusion of the patient's sleep history, nasendoscopy, polysomnography, and conventional imaging. A precise anatomic analysis of the airway that could be correlated with the severity of OSDB and be easily obtainable would be valuable for diagnosis and treatment planning. At present, the airway calculation from computed tomography data requires time-consuming manual data segmentation, the accuracy of which could be questionable. Automatic data segmentation has the ability to provide rapid and reliable airway analysis results.

Hypotensive Anesthesia Monitoring Using a Noninvasive Arterial Line During Orthognathic Surgery

Matthew J. Madsen, Paul S. Tiwana — 2010-03-01

Hypotensive anesthesia has a 3-fold benefit during orthognathic surgery. First, it has been well-documented that there is decreased blood loss. Second, less blood improves the quality of the surgical field; and third, improved visualization decreases the duration of procedure. To achieve a hypotensive state, the anesthesiologist must ensure an appropriate patient preoperative evaluation, proper positioning, and monitoring during the surgery, and adequate fluid therapy in patients undergoing induced hypotension during orthognathic surgery.

Is Exposure of the Jawbone Mandatory for Establishing the Diagnosis of Bisphosphonate-Related Osteonecrosis of the Jaw?

Noam Yarom, Stefano Fedele, Towy Sorel Lazarovici, Sharon Elad — 2010-03-01

The American Association of Oral and Maxillofacial Surgeons recently updated its position paper on bisphosphonate-related osteonecrosis of the jaw (BRONJ). We applaud the efforts that were made in comprehensively reviewing and revising the official position of the organization.

Is a Modification of Kaban's Protocol in Treating Temporomandibular Joint Ankylosis Appropriate?

Nakul Uppal, Mohan Baliga, Arvind Ramanathan — 2010-03-01

Contemplating a recent conference where distraction osteogenesis was hotly criticized and fiercely defended during a debate, we are inspired to highlight a particular surgical indication where the philosophy of osteodistraction might offer benefits over conventional protocol. The hallmark of temporomandibular joint (TMJ) ankylosis is functional and esthetic disability. The restoration of oral opening in this condition is by osteoarthrectomy with interpositional arthroplasty using fascia of the temporalis muscle. Kaban also proposed reconstruction with a costochondral graft stabilized with fixation. This would restore the vertical height of the ramus of mandible, but the costochondral component, unlike a normal graft, would actively cause further growth of the mandible. The use of costochondral grafts has led to donor site morbidity and even failure because in a child the tendency for overgrowth of the mandible is unpredictable. TMJ prostheses have not demonstrated expected longevity or performance.

In reply

Leonard B. Kaban — 2010-03-01

I welcome the opportunity to comment on the above letter regarding the protocol for management of temporomandibular joint (TMJ) ankylosis first published in the Journal in 1990. In this 7-step protocol, Kaban et al emphasized a conceptual approach for surgical management of ankylosis that included 1) complete excision of the ankylotic mass; 2) ipsilateral coronoidectomy; 3) contralateral coronoidectomy when necessary to achieve complete mobility; 4) lining of the TMJ with native disc, when possible, or a temporalis myofascial flap; 5) reconstruction of the ramus/condyle unit with a costochondral graft; 6) early mobilization of the jaw; and 7) aggressive physical therapy. I would like to make 2 general points in commenting on the letter.

In Reply to a Letter to the Editor

Paul W. Poeschl — 2010-03-01

I mainly agree with the comments made in the letter to the editor in terms of using the buccal fat pad in the irradiated maxilla. Whenever radio-osteonecrosis is suspected, it would probably be better to plan for a larger surgical procedure and a different pedicled or free flap to achieve safe closure of the defect. I would recommend the use of the buccal fat pad in irradiated patients only for the closure of small oroantral communications if the presence of radio-osteonecrosis can be precluded by diagnostic methods before surgery. From my experience, I am not sure whether hyperbaric oxygenation would really help in these cases, but it surely is worth a try.

Our Specialty

Michael J. Grau — 2010-03-01

I am perplexed why our specialty has not addressed a growing problem. Dentistry now has 2 specialties who are experts in oral surgery: oral and maxillofacial surgeons and the other specialty, well you know who it is. Oral surgeons have paid their dues for the privilege of doing what we do. How is a competing specialty now the expert on every oral surgical procedure? Why does our specialty legitimize the competing specialty by inviting them to lecture at national meetings? An oral surgeon has training as a resident with skin grafts and burn patients. Why does an oral surgeon need a lecture from a competing specialty about how to graft a piece of dead collagen? Oral surgeons fix complicated fractures with plates and screws but need a competing specialty to show us how to place an implant. Don't think it's a problem. My son completed dental school 2 years ago. He related a story. A classmate needed her 4 first bicuspid teeth removed. She was referred by the orthodontic clinic to the other specialty clinic because they were more gentle. I had a patient I saw for an examination visit for third molars. She returned 6 months later. She had seen the other specialist for another problem. The other specialist told her she could remove her third molars. To top it off, her fee was $700 more than mine. I believe in fairness to the public that we should inform the public that there is only one oral and maxillofacial surgery specialty, in whose hands the public is the safest.

Cost of 3-Dimensional Imaging-Based Surgery

Viroj Wiwanitkit — 2010-03-01

I read the recent publication by Schendel et al with great interest. Schendel et al mentioned that 3-dimensional (3D) imaging and computer simulation could be used effectively for planning office-based procedures, and this technique was helpful for treatment planning for correction of a facial deformity. In addition, Schendel et al also noted that “The end result is improved patient care and decreased expense.” It is acceptable that 3D imaging and simulation technology can help achieve a better plan for performing a procedure. However, the cost of the system is of concern. According to the study by Schendel et al, the cost identification was not done fully and no comparison was done between the new 3D imaging-based technology and the classic approach. Nevertheless, in assessing the cost of the 3D imaging-based system, one must also include the cost of implementing the system (ie, software, hardware, IT connection, place setting, personal training). I suggest the need for a complete assessment of the cost-effectiveness and cost utility of the new 3D-based approach compared with the classic approach.

Editorial Response

David M. Lambert — 2010-03-01

Thank you for your timely editorial (J Oral Maxillofac Surg 67:1789, 2009) in response to the new AAOS Information Statement. In view of the paucity of evidence to support antibiotic prophylaxis for joint replacement patients, not to mention the AHA's positional change for SBE prophylaxis, I read your closing paragraph with great interest: “Until clinical scientific evidence is available, the reader should note that the AAOS paper is kindly subtitled: ‘An educational tool based on the opinions of the authors.' That leaves oral and maxillofacial surgeons free to form their own opinions and to act based upon the levels of evidence available, and in the best interests of their patients.”

News and Announcements

2010-03-01

The 92nd AAOMS Annual Meeting, Scientific Sessions and Exhibition will convene September 27 through October 2, 2010, in Chicago, IL. Symposia sessions begin Thursday, September 30, with back-to-back sessions on the topic of dental implants: “Immediate Implants in Extraction Sites” will be presented from 7:15 am to 9:15 am, and the symposium on “Immediate Loading Full Arch” follows from 9:45 am to 11:45 am.

Reader's Circle Continuing Education Program

2010-03-01

Masthead

2010-03-01

Editorial Board

2010-03-01

Notice to Contributors

2010-03-01

AAOMS Author Disclosure Forms

2010-03-01

Journal of Oral and Maxillofacial Surgery

Maxillofacial Health, Beauty, and Chi: Andy Gump and the Avatars

Oral and Maxillofacial Surgery Residency Program at Emory University

Bullet Embolus to the Pulmonary Artery After Gunshot Wound to the Face: Case Report and Review of Literature

Characteristics of Implant Failures in Patients With a History of Oral Bisphosphonate Therapy

Effect of Zoledronic Acid on Osseointegration of Titanium Implants: An Experimental Study in an Ovariectomized Rabbit Model

Clinical Evaluation of Implants in Radiated Fibula Flaps

Implant Treatment in Patients With Severe Hypodontia: A Retrospective Evaluation

Island Osteoperiosteal Flap for Alveolar Bone Reconstruction

Evaluation of the Smile: Facial and Dental Considerations

Characteristics of Head and Neck Cancer Patients Referred to an Oral and Maxillofacial Surgeon in the United States for Management

Individual Design and Rapid Prototyping in Reconstruction of Orbital Wall Defects

Simultaneous Correction of Bilateral Temporomandibular Joint Ankylosis With Mandibular Micrognathia Using Internal Distraction Osteogenesis and 3-Dimensional Craniomaxillofacial Models

The Use of the Temporalis Myofascial Flap in Oral Cancer Patients

Survival and Patterns of Relapse in Patients With Oral Tongue Cancer

Midazolam More Effectively Suppresses Sympathetic Activations and Reduces Stress Feelings During Mental Arithmetic Task Than Propofol

Treatment of Oral Leukoplakia With Carbon Dioxide and Potassium-Titanyl-Phosphate Lasers: A Comparison

Success of Zygomatic Plate-Screw Anchorage System

Clinical and Anatomic Study on the Ducts of the Submandibular and Sublingual Glands

Clinical Follow-Up Examination of Surgically Treated Fractures of the Condylar Process Using the Transparotid Approach

Epistaxis During Nasotracheal Intubation: A Comparison of Nostril Sides

Analgesic Effects of Intra-Articular Morphine in Patients With Temporomandibular Joint Disorders: A Prospective, Double-Blind, Placebo-Controlled Clinical Trial

Surgical Approach to Impacted Mandibular Third Molars—Operative Classification

Third Molar Caries Experience in Middle-Aged and Older Americans: A Prevalence Study

Mandibular Ramus/Coronoid Process Grafts in Maxillofacial Reconstructive Surgery

Complication Rates in the Operative Treatment of Mandibular Angle Fractures: A 10-Year Retrospective

Andy Gump and His Deformity

Who Was Andy Gump?

Treatment of Arteriovenous Malformation of the Mandible With Resection and Immediate Reconstruction

Microsurgical Upper Lip Replantation: A Case Report

Congenital Cervical Teratoma: A Case Report

Benign Cementoblastoma of the Anterior Maxilla

Extranodal Natural Killer T-Cell Lymphoma, Nasal Type, With Minimal Osseous Involvement: Report of a Case and Literature Review

Infiltrating Angiolipoma of a the Oral Cavity: Report of a Case and Literature Review

Cervical Support Collar: A Substitute to the Jaw Thrust/Chin Lift Methods of Airway Management During Oral Maxillofacial Surgeries

Nasal Base Modification in Asian Patients

Chin Augmentation With Thin Cortical Bone Concomitant With Advancement Genioplasty

Automated 3-Dimensional Airway Analysis From Cone-Beam Computed Tomography Data

Hypotensive Anesthesia Monitoring Using a Noninvasive Arterial Line During Orthognathic Surgery

Is Exposure of the Jawbone Mandatory for Establishing the Diagnosis of Bisphosphonate-Related Osteonecrosis of the Jaw?

Is a Modification of Kaban's Protocol in Treating Temporomandibular Joint Ankylosis Appropriate?

In reply

In Reply to a Letter to the Editor

Our Specialty

Cost of 3-Dimensional Imaging-Based Surgery

Editorial Response

News and Announcements

Reader's Circle Continuing Education Program

Masthead

Editorial Board

Notice to Contributors

Table of Contents

AAOMS Author Disclosure Forms