Journal of Oral and Maxillofacial Surgery - Articles in Press

Does Elastic Therapeutic Tape Reduce Postoperative Swelling, Pain, and Trismus After Open Reduction and Internal Fixation of Mandibular Fractures? - Corrected Proof

2013-05-15

Purpose: The aim of the present study was to investigate whether the application of elastic therapeutic tape (Kinesio Tape [KT]) prevents or decreases swelling, pain, and trismus after open reduction and internal fixation of mandibular fracture, thus improving patients' postoperative morbidity.Materials and Methods: To address the research purpose, the investigators designed and implemented an open-label, monocentric, parallel-group, randomized clinical trial. Patients were prospectively assigned for treatment of unilateral mandibular fractures and randomly allocated to receive treatment with or without KT application. KT was applied directly after surgery and maintained for 5 days postoperatively. Facial swelling was quantified using a 5-line measurement at 6 specific time points. Pain score was assessed using a 10-level visual analog scale; mouth opening was measured. In addition, all patients were asked to evaluate overall satisfaction and swelling (2 groups) and the effect of the tape on movement and comfort (KT group only).Results: The study included 26 patients (11 female and 15 male; mean age, 43 yr; standard deviation, 18.5 yr). Application of KT after surgery for mandibular fracture had a statistically significant influence on tissue reaction and swelling, decreasing the incidence of swelling and turgidity by more than 60% during the first 2 days after surgery. Although KT had no significant influence on pain control, patients in the KT group perceived significantly lower morbidity.Conclusion: The present results showed that KT after open reduction and internal fixation of mandibular fracture is a promising, simple, less traumatic, and economical approach for managing postoperative swelling that is free from systemic adverse reactions, thus improving patients' quality of life.

Single-Step Resection and Reconstruction Using Patient-Specific Implants in the Treatment of Benign Cranio-Orbital Tumors - Corrected Proof

2013-05-15

Purpose: The aim of this study was to evaluate surgical outcomes using patient-specific prostheses produced by computer-aided design and manufacturing for primary reconstruction in patients with benign cranio-orbital tumors. Polyetheretherketone was used to manufacture the implants.Materials and Methods: The present study included 3 patients who underwent fronto-orbito-pterional craniotomy using individual custom-made surgical guides. Patient-specific polyetheretherketone prostheses were used for reconstruction during the same surgery. All patients underwent esthetic examination (facial and orbital symmetry, globe projection and position), ophthalmologic examination (diplopia with the Hess-Lancaster test, visual field and acuity), and radiologic evaluations (computed tomography and magnetic resonance imaging) during the preoperative and follow-up periods. Operating time and short- and long-term complications were recorded.Results: The immediate and long-term morphologic results were satisfactory; in particular, ocular globe position and projection were correct. After 25 to 31 months, none of the patients developed implant-related complications, such as infection, extrusion, or malposition. Two-year postoperative computed tomograms and magnetic resonance images showed no recurrences.Conclusion: Single-step resection and reconstruction with computer-aided designed and manufactured implants is a challenging new technique that decreases operative time and morbidity. The implants adequately restore an anatomically complex area with satisfactory cosmetic results.

Effects of Allogenous Periosteal-Derived Cells Transfected With Adenovirus-Mediated BMP-2 on Repairing Defects of the Mandible in Rabbits - Corrected Proof

Mingxia Sun, Wanye Tan, Ketao Wang, Zuoqing Dong, Huahai Peng, Fengcai Wei — 2013-05-14

Purpose: This report describes the effect of periosteal-derived cells transfected with adenovirus-mediated bone morphogenetic protein-2 (BMP-2) on the repair of mandibular defects in rabbits.Materials and Methods: Periosteal-derived cells were transfected with a replication-defective adenoviral vector encoding BMP-2, and the expression of BMP-2 was examined in transfected cells using in situ hybridization and enzyme-linked immunosorbent assay. In addition, the proliferation ability and activity of alkaline phosphatase of transfected cells were examined using the 3-[4,5-dimethylthiazol-2-Yl]-2,5-diphenyltetrazolium bromide method and enzymology, respectively. In vitro critical-size defects (about 10 × 6 mm) were made bilaterally in each rabbit mandible, and individual sites were implanted with tissue-engineered bone modified with an adenovirus construct encoding the recombinant human BMP-2 gene (Ad-BMP-2), tissue-engineered bone without modification, single bioactive glass ceramic, or no implants (control). New bone formation was evaluated by histochemical stain.Results: BMP-2 expression in the supernate of infected cells was detected from the first day after Ad-BMP-2 transfection and remained at a high level for at least 2 weeks. Alkaline phosphatase expression in transfected cells was significantly greater than in uninfected cells. The group of Ad-BMP-2–modified periosteal-derived cells formed more new bone than the other group at any time point.Conclusion: Gene-modified tissue-engineered bone grafts have greater osteogenic potential than single tissue-engineered bone and single bioactive glass ceramic graft. Ex vivo Ad-BMP-2 transfer to periosteal-derived cells can increase bone formation in critical-size bone defects. Further studies are needed to determine if modified engineered cells can be developed for safe and effective clinical applications.

Oral Myiasis—A Case Report - Corrected Proof

Vikas Singla — 2013-05-06

Myiasis, a term introduced by William Hope in 1840, refers to the invasion of tissues and organs of animals and human wounds and certain body cavities by the dipteran larvae, which manifests as subcutaneous furunculoid or boil-like lesions. Oral myiasis is a rare pathology and a risk to the patient's life. A higher incidence is seen in rural areas, affecting the tropical and subtropical zones of Africa and America. It can be secondary to medical or anatomic conditions, such as cancrum oris, neglected mandibular fracture, cerebral palsy, mouth breathing, anterior open bite, incompetent lips, and use of mechanical ventilation. Myiasis also has been described after tooth extraction. All these conditions more easily allow the infestation of human tissues. Myiasis affecting the orodental complex is rare. This case report describes oral myiasis in a 25-year-old male patient who was a gardener by profession. The lesion was treated with turpentine oil, which forced the larvae out, and irrigated with normal saline solution.

Multiple-Parameter Evaluation Demonstrates Low Donor-Site Morbidity After Submental Flap Harvesting - Corrected Proof

2013-05-06

Purpose: The objective of this study was to implement a scoring system to analyze the authors' experience of donor-site morbidity after harvesting a submental flap for the reconstruction of surgical defects at the head and neck region after oncologic resection.Materials and Methods: A retrospective case series study was conducted of patients who underwent reconstruction with a submental flap at the Tri-Service General Hospital (Taipei, Taiwan) from 2008 through 2012. Five parameters representing donor-site morbidity (whistling, smiling, neck extension, beard change, and esthetic outcome) were evaluated with a scoring system developed by a blinded panel of 2 clinicians and the patients. Scores were analyzed and compared between patient subgroups.Results: Twenty-two patients (20 men and 2 women; mean age, 56 yr) underwent reconstruction with a submental flap after head and neck tumor ablation. Primary lesion sites included the oral cavity (13 patients), pharynx (6 patients), larynx (1 patient), neck (1 patient), and sinus (1 patient). The means of all 5 parameters evaluated were higher than 8 on a scale of 0 to 9 (whistling, 8.7; smiling, 8.7; beard change, 8.9; neck extension, 8.2; esthetic outcome, 8.2), showing that submental flap harvesting led to low donor-site morbidity.Conclusions: Donor-site morbidity after submental flap harvesting was evaluated with a scoring system measuring 5 parameters, namely whistling, smiling, beard change, neck extension, and esthetic outcome. In general, donor-site morbidity was very low. This implemented system and these findings will be helpful in future reconstructive surgical planning and management.

Odontogenic Infection Due to Aerococcus viridans: A Case Report - Corrected Proof

Xiaowen Jiang, Shoukang Yang, Guoliang Sun — 2013-05-06

Odontogenic infections, the most frequent infections in humans, may spread to the maxillofacial and neck region, with serious complications. Usually, the common pathogenic bacteria are derived from normal flora of the oral cavity.

3-Dimensional Facial Simulation in Orthognathic Surgery: Is It Accurate? - Corrected Proof

Stephen A. Schendel, Richard Jacobson, Sadri Khalessi — 2013-05-03

Purpose: The purpose of this study was to measure the accuracy of 3D computer simulation of soft tissue changes after orthognathic surgery.Materials and Methods: Consecutive patients who underwent orthognathic surgery were studied by photogrammetric facial scanning and cone-beam computed tomography before and after surgery. The photogrammetric scan was then fused to the cone-beam computed tomogram, creating a patient-specific image. The surgery was simulated in 3D form and the simulated soft tissue face was compared with the actual facial scan obtained 6 months postoperatively. Absolute millimeter differences between the simulated and actual postoperative changes in selected cephalometric skin markings were computed.Results: The study was composed of 23 subjects (mean age, 31 yr; 13 women and 10 men). Eighteen different cephalometric landmarks were measured (total, 28). For 15 landmarks, the difference between actual and simulated measurements was smaller than 0.5 mm. Only 3 landmarks had a difference of 0.5 mm, and these were in the region of the labial landmarks.Conclusion: Based on the present study, 3-dimensional computer surgical simulation of the soft tissue of the face for routine orthognathic surgery is accurate enough for routine clinical use.

p16 Immunohistochemistry Can Be Used to Detect Human Papillomavirus in Oral Cavity Squamous Cell Carcinoma - Corrected Proof

2013-05-03

Purpose: Human papillomavirus (HPV) is of etiologic significance in the development of oral squamous carcinoma and is noted to result in p16 overexpression. Identification of HPV is clinically important because the presence of HPV has prognostic and epidemiologic associations. Detection of HPV by polymerase chain reaction (PCR) is expensive and not widely accessible. The authors examined p16 immunohistochemistry (IHC) as a surrogate marker for high-risk HPV and its use as an alternative test to PCR.Patients and Methods: A retrospective cohort of patients with oral squamous cell carcinoma underwent surgery and then analysis with p16 IHC and HPV PCR. The p16 IHC staining intensity was graded from 0 to 3+, and these results were compared with PCR. Descriptive and frequency statistics were performed by comparing HPV PCR results with p16 IHC, patient age, gender, and outcome.Results: Eighty-one cases were included in the study. Forty-four study patients were men and 37 were women (mean age, 63.9 yr). Forty-five cases (55.6%) had 0 staining, 22 cases (27.2%) had 1+ staining, and 7 cases (8.6%) had 2+ staining. Seven cases (8.6%) had 3+ staining, all of which were positive for HPV serotype 16 by PCR. Three of 7 HPV PCR-positive cases had keratinization typical of an oral cavity location and not the basaloid growth of HPV oropharyngeal tumors. There was a statistical correlation (P < .001) among HPV PCR positivity, 3+ staining, and younger age.Conclusion: p16 3+ staining correlates with HPV PCR positivity. p16 IHC is a technically simple and widely available test, and this study establishes the use of p16 IHC as an alternative test to HPV PCR. Given the clinical significance of HPV in oral squamous carcinoma, p16 IHC should be performed in all cases and included in the pathology report.

Lower Concentrations of B-Vitamin Subgroups in the Serum and Amniotic Fluid Correlate to Cleft Lip and Palate Appearance in the Offspring of A/WySn Mice - Corrected Proof

Konstanze Scheller, Thomas Röckl, Christian Scheller, Johannes Schubert — 2013-05-03

Purpose: The pathogenesis and prevention of cleft lip and palate (CL/P) have been studied mainly in clinical and animal experiments. A prophylactic poly–B-vitamin substitution during the first months of pregnancy has provided the most encouraging results for the prevention of CL/P recurrence in families at risk. In vitro studies of the palatal organ in an A/WySn mouse model have confirmed the positive influence of B-vitamins on palatal development. The present animal study was performed to analyze different B-vitamin concentrations in the serum and amniotic fluid of A/WySn mice according to the appearance of CL/P in their offspring.Material and Methods: Concentrations of different B-vitamins (B1, B2, B3, B5, B6, and folic acid) in serum and amniotic fluid were analyzed by high-performance liquid chromatographic detection. Immunohistochemical staining against thiamin-1 receptor was performed on histologic midface sections of A/WySn fetuses with (n = 12) and without (n = 14) CL/P.Results: Vitamin B5 (P < .001) and folic acid (P < .004) concentrations in the amniotic fluid of dams with CL/P were significantly lower than in dams without CL/P. Serum concentrations of folic acid (P = .5) and B5 (P = .4) showed no difference between the 2 groups. Dams with CL/P had significantly lower thiamine concentrations in serum (P = .01) and amniotic fluid (P < .001). Histologic midface sections presented high thiamin-1 receptor expression in the palatal shelf of fetuses with CL/P.Conclusion: A decreased use or uptake of some B-vitamin subgroups (B1, B5, and folic acid) in amniotic fluid and serum (vitamin B1) was correlated to an increased cleft appearance in A/WySn mice. The high thiamin-1 receptor expression in the palatal tissue of mouse fetuses with CL/P may be caused by a decreased availability of vitamin B1.

Computational Fluid Dynamic Analysis of the Posterior Airway Space After Maxillomandibular Advancement for Obstructive Sleep Apnea Syndrome - Corrected Proof

2013-05-03

Purpose: This study evaluated the soft tissue change of the upper airway after maxillomandibular advancement (MMA) using computational fluid dynamics.Materials and Methods: Eight patients with obstructive sleep apnea syndrome who required MMA were recruited into this study. All participants underwent pre- and postoperative computed tomography and then MMA by a single oral and maxillofacial surgeon. Upper airway computed tomographic datasets for these 8 patients were created with high-fidelity 3-dimensional numerical models for computational fluid dynamics. The 3-dimensional models were simulated and analyzed to study how changes in airway anatomy affect the pressure effort required for normal breathing. Airway dimensions, skeletal changes, apnea-hypopnea index, and pressure effort of pre- and postoperative 3-dimensional models were compared and correlations were interpreted.Results: After MMA, laminar and turbulent air flows were significantly decreased at every level of the airway. The cross-sectional areas at the soft palate and tongue base were significantly increased.Conclusions: This study showed that MMA increased airway dimensions by increasing the distance from the occipital base to the pogonion. An increase of this distance showed a significant correlation with an improvement in the apnea-hypopnea index and a decreased pressure effort of the upper airway. Decreasing the pressure effort will decrease the breathing workload. This improves the condition of obstructive sleep apnea syndrome.

Functional Effects of Local Administration of Thyroid Hormone Combined With Chitosan Conduit After Sciatic Nerve Transection in Rats - Corrected Proof

2013-05-03

Purpose: To assess the local effect of triiodothyronine (T3) on peripheral nerve regeneration in a rat model of sciatic nerve transection.Materials and Methods: Forty-five male healthy white Wistar rats were divided randomly into 3 experimental groups (n = 15): sham operation, control (CHIT), and T3 treatment (CHIT/T3). In the sham-operated group, the left sciatic nerve was exposed under anesthesia through a gluteal muscle incision and the muscle was sutured after homeostasis. In the CHIT group, the left sciatic nerve was exposed the same way and transected proximal to the tibioperoneal bifurcation, leaving a 10-mm gap. Each proximal and distal stump was inserted into a chitosan conduit, which was filled with phosphate buffered solution 10 μL. In the CHIT/T3 group, the defect was bridged using a chitosan conduit filled with T3 10 μL. Each group was subdivided into 3 subgroups of 5 animals each and studied 4, 8, and 12 weeks after surgery. Data were analyzed statistically by factorial analysis of variance and the Bonferroni test for pairwise comparisons.Results: Behavioral testing and sciatic nerve function study confirmed a faster and better recovery of regenerated axons in the CHIT/T3 group than in the CHIT group (P < .05). Gastrocnemius muscle mass was significantly larger in the CHIT/T3 group than in the CHIT group. Morphometric indices of regenerated fibers showed that the number and diameter of the myelinated fibers were significantly larger in the CHIT/T3 group than in the CHIT group. Immunohistochemistry showed that the locations of reaction to S-100 were clearly more positive in the CHIT/T3 group than in the CHIT group.Conclusions: The response to local treatment showed that thyroid hormone influenced and improved the functional recovery of peripheral nerve regeneration.

Sudden Hearing Loss After Dental Treatment - Corrected Proof

Leyla Kansu, Ismail Yilmaz — 2013-05-03

A 66-year-old man presented with impaired balance, tinnitus, sensation of blockage, and hearing loss in his left ear, which developed after dental treatment for dental pain 4 days previously. Treatment of the carious left upper second molar tooth had included pulp extirpation, canal expansion, and tooth filling under local anesthesia with articaine and epinephrine. Impaired balance decreased spontaneously within 3 days of dental treatment, but tinnitus and hearing loss persisted. Pure tone audiogram showed profound sensorineural hearing loss in the left ear, with a downslope from 40 to 100 dB, and an abnormal speech discrimination score (50%). Treatment included intravenous prednisolone, intratympanic dexamethasone, and oral betahistine and trimetazidine. The patient had improved hearing and resolution of tinnitus. Sudden hearing loss is rare after dental treatment, and awareness of this complication may prompt early referral for treatment and may improve recovery and prognosis.

Combination of Zoledronic Acid and Targeted Therapy Is Active But May Induce Osteonecrosis of the Jaw in Patients With Metastatic Renal Cell Carcinoma - Corrected Proof

2013-05-03

Purpose: To investigate the efficacy and safety of zoledronic acid (ZA) combined with targeted therapy (TT).Materials and Methods: A retrospective study was performed in patients with metastatic renal cell carcinoma treated with ZA and TT.Results: Twenty-one patients received ZA and TT to prevent skeletal-related events and no pretherapy oral and maxillofacial (OM) examination (cohort A). Six patients (29%) developed osteonecrosis of the jaw (ONJ), which was observed only in patients receiving sunitinib and ZA. Sixteen patients received TT and ZA for hypercalcemia and no pretherapy OM examination (cohort B). In these patients, no ONJ was observed. Nine patients received ZA and TT and pretherapy OM examination (cohort C). One patient (11%) developed ONJ during sunitinib and ZA treatment. Mean skeletal morbidity rates were 0.8 for cohort A and 1.2 for cohort C. In the combined cohort (A plus C; n = 30), 47% developed skeletal-related events, 7% pathologic fracture, 7% medullary compression, and 37% progression of bone metastases. Patients who developed ONJ had a significantly improved median survival of 31.6 months compared with 14.5 months in patients without ONJ (P = .039).Conclusion: The combination of ZA and TT resulted in high, clinically meaningful activity. ONJ may be exacerbated by concomitant ZA and sunitinib. Regular OM examinations before and during treatment are recommended.

Metastatic Leiomyosarcoma of the Oral Region From a Uterine Primary: A Case Report and Review of the Literature - Corrected Proof

2013-04-26

Oral metastases of systemic malignancies represent 1% of all oral malignant tumors and usually result in a dismal prognosis. Breast and lung cancers are the most common primary cancers in metastatic disease to the jawbone and oral soft tissue, respectively. Leiomyosarcoma (LMS) is an infrequent soft tissue sarcoma that very seldom metastasizes to the oral region, often in the context of advanced disease. The authors present a case of LMS metastatic to the attached mandibular retromolar gingiva that represented the first sign leading to a diagnosis of primary uterine malignancy. Only 9 cases have been specifically reported in the literature, and no effort to collect information concerning all the features of this rare event has been performed previously.

How Well Do We Manage the Odontogenic Keratocyst? - Corrected Proof

Brian E. Kinard, Sung-Kiang Chuang, Meredith August, Thomas B. Dodson — 2013-04-26

Purpose: To answer the clinical question: Among patients treated for odontogenic keratocysts (OKCs), what is the overall 5-year disease-free rate and what factors are associated with disease recurrence?Materials and Methods: The investigators implemented a retrospective cohort study and enrolled a sample composed of patients presenting for the evaluation and management of previously untreated OKCs. The predictor variables were grouped into demographic, medical, radiographic, and operative categories. The primary outcome variable was time to lesion recurrence. Data analyses were performed using univariate and bivariate or multivariate Cox proportional hazards models.Results: The study sample was composed of 31 patients (31 OKCs) with a mean age of 41.0 years. Of the 31 OKCs treated, 19 (61.3%) were treated with decompression with or without residual cystectomy and 12 (38.7%) were treated with enucleation with or without adjunctive therapy. There were 8 recurrences in 8 patients, with a median time to recurrence of 17.8 months (interquartile range, 13.4 to 26.4 months). The 5-year disease-free estimate was 51.2% (95% confidence interval, 37.2%-65.2%). Multiloculated lesions were 33.6 times more likely to recur than unilocular lesions.Conclusion: This may be the first study looking at disease recurrence after treatment of OKCs using appropriate statistical analyses for a time-dependent outcome (disease recurrence). The risk for recurrent disease is higher in this report than in many other studies and raises the issue that other reports may have underestimated the risk for recurrent disease owing to inappropriate statistical methods for assessing time-dependent outcomes.

Anatomic Considerations for Posterior Iliac Crest Bone Procurement - Corrected Proof

2013-04-26

Purpose: The aim of this study was to identify the relative anatomic locations of relevant vital structures at risk for injury during posterior iliac crest bone graft procurement.Materials and Methods: Twenty-one cadavers yielded 39 intact posterior ilia for dissection. The posterior superior iliac spine (PSIS) was used as the primary reference landmark. Measurements were made to the medial branch of the superior cluneal nerves, the superior branch of the middle cluneal nerves, the sciatic notch, and the superior gluteal vessels. Distances from the spinal midline to the superior cluneal nerves were recorded.Results: The average distances from the PSIS to the superior and middle cluneal nerves, greater sciatic notch, and superior gluteal vessels were 5.7 cm (standard deviation, 1.22 cm), 6.55 cm (standard deviation, 1.53 cm), 5.3 cm (standard deviation, 0.71 cm), and 5.4 cm (standard deviation, 0.95 cm), respectively. The most medial superior cluneal nerve was identified at 3.0 to 4.9 cm from the PSIS in 23% of cases, at 5.0 to 6.9 cm from the PSIS in 61.5% of cases, and farther than 7.0 cm from the PSIS in 15.4% of cases.Conclusions: This study illustrates that the most medial superior cluneal nerve is often closer to the PSIS than previously described and the same holds true for the greater sciatic notch and superior gluteal vessels. Knowledge of the anatomic locations of these important structures should allow the surgeon to avoid or decrease the complication rate of bone procurement from the posterior ilium.

Assessment of Angiogenic Markers and Female Sex Hormone Receptors in Pregnancy Tumor of the Gingiva - Corrected Proof

2013-04-26

Purpose: Oral pregnancy tumors (OPTs) arise on the inflamed gingiva of women after the first trimester of pregnancy. The expression of angiogenic markers and female hormone receptors was assessed.Materials and Methods: Immunohistochemistry was used to analyze the expression of estrogen and progesterone receptors and the expression of angiogenic factors, such as vascular endothelial growth factor (VEGF) and its receptor, fibroblast growth factor (FGF), and hypoxia inducible factors 1α and 3α (HIF1α and HIF3α). Experimental groups included 9 OPTs, 10 oral pyogenic granulomas from nonpregnant women of the same age, and 9 oral pyogenic granulomas from postmenopausal women.Results: VEGF expression in stromal histiocytes and endothelial cells of small vessels was positively correlated in the OPT group (P < .05 by χ2 test). VEGF receptor also was overexpressed in stromal histiocytes and endothelial cells of OPTs compared with oral pyogenic granulomas from nonpregnant and postmenopausal women (P < .005 by χ2 test). No correlation was detected among estrogen and progesterone receptors, FGF and HIF1α and HIF3α (ER and PgR respectively) in the 3 experimental groups.Conclusions: VEGF-associated angiogenesis is most likely involved in the pathogenesis of the lesion. These results imply that local inhibition of VEGF activity could be an adjuvant therapeutic approach for OPTs to control hemorrhage, which can be massive at the surgical excision of such lesions during pregnancy.

Early Screening in Patients With Head and Neck Cancer Identified High Levels of Pain and Distress - Corrected Proof

Nigel Gordon Maher, Benjamin Britton, Gary Russell Hoffman — 2013-04-22

Purpose: Pain and distress are recognized as the fifth and sixth vital signs in cancer care, respectively, as debilitating symptoms that are frequently under-recognized. The aim of this study was to document, using touch-screen technology, levels of pain and distress in patients with head and neck cancer before their assessment at a head and neck multidisciplinary referral clinic.Materials and Methods: A cross-sectional study over a 4-year period (2008 through 2011) was conducted for patients attending a head and neck oncology multidisciplinary team clinic in the Hunter New England referral district of Australia. Predictor variables were cancer stage and site. Cancer sites divided into 8 different regions, with distinction made for cutaneous versus noncutaneous sites. Outcome variables consisted of pain and distress levels. Pain was assessed using a Numerical Rating Scale of 0 to 10, and distress was assessed using the Distress Thermometer and PSYCH-6 scales. In the context of a screening study and for statistically comparing pain with other variables, pain was regarded as any score higher than 0. Clinically significant distress represented a Distress Thermometer score higher than 3 and a PSYCH-6 score of at least 3. Data analysis consisted of descriptive statistics, variance contrasts, and 2-tailed Pearson correlations.Results: Four hundred thirty-six patients were included in the study, with an equal number of cutaneous and noncutaneous cancer sites. Thirty-four percent of patients reported having pain, and 13% had clinically significant distress. Tumor stage did not significantly affect pain or distress scores.Conclusions: There is a high level of pain and distress reported by patients with head and neck cancer before their assessment and management is discussed.

Second Primary Squamous Cell Carcinoma Arising in a Skin Flap: A Case Report and Literature Review on Etiologic Factors and Treatment Strategy - Corrected Proof

Reiko Tokita, Sachiho Nagashio, Atsushi Shinohara, Hiroshi Kurita — 2013-04-22

The number of reports describing malignant tumors arising in flaps has been increasing recently. This report describes the case of a patient who had a second squamous cell carcinoma (SCC) in the center of the skin island of a forearm flap raised approximately 6 years previously. Histopathologic examination suggested human papillomavirus infection and “mucosalization” of the flap. In addition, the authors review previous cases, with special attention to etiologic factors and surgical strategies. There might be a causal relation between second primary SCC in the flap and the carcinogenic effect (chronic inflammation) induced by the environment surrounding the squamous epithelium of the flap. If environmental factors have greatly contributed to the occurrence of a tumor, there is a potential for tumor occurrence in the remaining flap. There also might be a potential for generating second primary SCC in these foci. The results suggested that total resection of the flap might be recommended in the surgical resection of second primary SCC arising in a flap.

Tilted Trans-Sinus Implants for the Treatment of Maxillary Atrophy: Case Series of 35 Consecutive Patients - Corrected Proof

2013-04-22

Purpose: To evaluate tilted trans-sinus implants for rehabilitation of the atrophic maxilla.Materials and Methods: A case series of 35 patients (32 consecutive edentulous and 3 partially edentulous patients) treated with trans-sinus dental implants is presented. Edentulous patients received 4 or 6 implants depending on anatomic conditions and a 12-unit final restoration; partially edentulous patients received 2 implants supporting a 3-unit partial fixed bridge.Results: Thirty-five patients (14 men, 21 women) underwent rehabilitation. Thirty-two patients with 190 implants placed received a full-arch fixed prosthesis supported by axial and trans-sinus tilted implants. Three patients each received 2 implants with a 3-unit fixed restoration. The mean age at surgery was 59.2 ± 9.5 years. The cumulative survival rate was calculated only for the full-arch fixed prosthesis group and was 98.42%. Crestal bone loss averaged 0.9 ± 0.4 and 0.8 ± 0.5 mm for the axial and tilted implants, respectively, at the 12-month evaluation. Biological complications at the implant level were 1 case of peri-implantitis and 3 cases of mucositis; no patient developed sinus infections. The prosthetic complications encountered were screw loosening in 17.5% of cases and chipping of the esthetic part in 30% of cases. These complications were easily resolved chairside and did not lead to prosthetic failure.Conclusions: Trans-sinus tilted implants and sinus membrane distal displacement appear to be a viable minimally invasive alternative for the treatment of maxillary atrophy.

Diagnosis of Dental Abnormalities in Children Using 3-Dimensional Magnetic Resonance Imaging - Corrected Proof

2013-04-22

Purpose: To assess the feasibility of magnetic resonance imaging (MRI) of dental abnormalities in children.Materials and Methods: The study included 16 patients (mean age, 10.8 yr) prospectively selected from 1,500 orthodontic patients. The selected patients included 3 with a mesiodens, 9 with supernumerary teeth other than a mesiodens, 1 with gemination, 1 with dilacerations, 1 with transmigration, and 1 with transposition. Three-dimensional (3D) images were acquired on a 1.5-T MRI scanner using a 3D turbo spin echo pulse sequence with a voxel size of 0.8 × 0.8 × 1 mm. The measurement time was 4 to 5 minutes.Results: Using natural MRI contrast, the teeth, dental pulp, mandibular canal, and cortical bone could be clearly delineated. The position and shape of malformed teeth could be assessed in all 3 spatial dimensions.Conclusion: MRI was found to be a well-tolerated imaging modality for the diagnosis of dental abnormalities in children and for orthodontic treatment and surgical planning. Compared with conventional radiography, dental MRI provides the advantage of 3-dimensionality and complete elimination of ionizing radiation, which is particularly relevant for repeated examinations in children.

Observation of Osseous Healing After Intraoral Vertical Ramus Osteotomy: Focus on Computed Tomography Values - Corrected Proof

2013-04-22

Purpose: The purpose of this study was to observe long-term osseous healing of the cleavage space between bone fragments after intraoral vertical ramus osteotomy using computed tomographic (CT) values.Patients and Methods: CT examinations were performed to observe long-term osseous healing immediately after intraoral vertical ramus osteotomy and at 6 months, 1 year, and 2 years postoperatively. Bone fragments were observed on the interior and lateral sides. CT values between bone fragments were used to measure the range of each point within a 1.7- × 1.7-mm square, and the mean of the measurements was calculated.Results: CT values between bone fragments increased significantly over time at 1 month, 6 months, 1 year, and 2 years after surgery.Conclusions: Osseous healing in the cleavage between bone fragments after intraoral vertical ramus osteotomy was successful according to CT values.

Robotic-Assisted Neck Dissection in Submandibular Gland Cancer: Preliminary Report - Corrected Proof

Chul-Ho Kim, Yoon Woo Koh, Dae Kim, Jae Won Chang, Eun Chang Choi, Yoo Seob Shin — 2013-04-17

Purpose: Robot-assisted neck dissection (ND) in patients with head and neck cancer has been developed as a plausible substitute for conventional surgery and it provides an excellent cosmetic outcome. The authors hypothesized that surgery for submandibular gland (SMG) cancer could be achieved with a gasless retroauricular (RA) approach using the robotic system. This study evaluated the feasibility of robot-assisted ND using an RA approach for SMG cancer.Patients and Methods: Primary tumor resection with robot-assisted ND using an RA incision was performed in 6 patients with SMG cancer.Results: All cases of robot-assisted ND combined with primary tumor resection were conducted successfully without any significant intraoperative complication, need for an additional incision, or conversion to open conventional ND. The amount and duration of drainage, length of hospital stay, number of retrieved lymph nodes, and complications were generally acceptable. The postoperative scar was completely hidden by the auricle and hair.Conclusions: Robot-assisted ND with primary tumor excision using an RA approach is a feasible and useful method, with excellent cosmetic results, for surgical treatment of selected cases of SMG cancer.

A Simplified Approach to the External Lateral Nasal Osteotomy: A Technical Note - Corrected Proof

2013-04-17

Lateral osteotomy is usually performed to narrow a wide nasal base, widen a narrow nasal base, straighten deviated nasal bones, or close an (iatrogenic) open roof deformity. Based on the approach used, nasal osteotomy can be classified as external or internal. Although nasal osteotomy is an essential part of cosmetic rhinoplasty, it can be very difficult for young surgeons to perform external osteotomy. This article focuses on external osteotomy and its essential concepts. In addition, a new splint-guide method is introduced, which can help young surgeons perform external osteotomy in a very safe and predictable manner.

Oral Health Risk Factors for Bisphosphonate-Associated Jaw Osteonecrosis - Corrected Proof

2013-04-15

Purpose: To investigate the role of oral health, including periodontitis, as a risk factor for bisphosphonate-associated jaw osteonecrosis (ONJ).Materials and Methods: This cross-sectional study compared cases with an ONJ history to controls. All had a history of bisphosphonate treatment for malignancy. Participants underwent oral examination, gingival crevicular fluid (GCF) sampling, and phlebotomy. Serum was analyzed for biochemical parameters, bone markers, and immunoglobulin G titers against 4 periodontitis-associated bacteria. Cytokine levels were determined in GCF using a multiplex assay.Results: Caries development was comparable between groups. Periodontitis was significantly associated with ONJ using the US National Center for Health Statistics periodontitis definition (P = .002), at least 1 site with a probing depth of at least 4 mm (P = .003), and the percentage of sites per participant with a probing depth of 4 to 5 mm (P = .044). Immunoglobulin G titer against Porphyromonas gingivalis and GCF interleukin-1β level were also significantly associated with ONJ (P = .018 and P = .044, respectively).Conclusion: In participants with a history of bisphosphonate treatment for malignancy, periodontitis was associated with ONJ when measured using clinical parameters, serum immunoglobulin G titers against P gingivalis, and GCF interleukin-1β levels, suggesting that periodontitis and associated bacteria are potentially important in ONJ pathophysiology.

Alteration of Masticatory Electromyographic Activity and Stability of Orthognathic Surgery in Patients With Skeletal Class III Malocclusion - Corrected Proof

Ellen Wen-Ching Ko, Chiung Shing Huang, Lun-Jou Lo, Yu-Ray Chen — 2013-04-08

Purpose: The purposes of this study were to 1) investigate longitudinal changes in electromyographic masticatory activity subsequent to orthognathic surgery (OGS) in patients with skeletal Class III malocclusion, and 2) compare masticatory muscle activity and skeletal factors in patients with stable versus relapsed mandibular positions after OGS.Materials and Methods: A consecutive series of patients with skeletal Class III malocclusion who underwent 2-jaw OGS (35 patients, 17 men and 18 women; age, 24.5 ± 5.0 yr) were included. Lateral cephalometric films were obtained preoperatively (T1), 1 month after OGS (T2), and at completion of orthodontic treatment (T3). Serial cephalometric tracings and analyses were obtained. Surface electromyograms of the anterior temporalis and masseter muscles were recorded at T1, T2, and T3 (6 mo after OGS). Resting tonus, maximum voluntary clench with habitual intercuspation and on cotton pads, and maximum muscle firing were evaluated. Percentage of overlapping coefficient and torque coefficient were calculated. Patients were categorized further into stable and relapse groups according to the sagittal relapse rate of mandibular setback. These surface electromyographic variables were compared between the 2 groups.Results: On average, the mandible showed a significant setback of 10.19 mm and a relapse of 1.12 mm (10.99%). Surgical relapse did not correlate with gender or genioplasty. Serial surface electromyographic data indicated a significant decrease from T1 to T2 that then recovered from T2 to T3. No significant difference between T1 and T3 was noted. Percentage of overlapping coefficient was significantly decreased after OGS. The torque coefficient did not differ significantly from T1 to T3. The relapse group (relapse, >11%; n = 15) had a greater resting tonus of the anterior temporalis muscle at T3, a larger percentage of overlapping coefficient at T1, and a greater maximum voluntary clench of the masseter muscles at all times than in the stable group (n = 20). The relapse group exhibited a greater decrease in facial height (2.18 mm) from T2 to T3 than did the stable group (0.5 mm).Conclusion: A larger sagittal relapse of mandibular setback occurred in patients with greater masticatory muscle activity. Modifications in surgical design and overcorrection should be considered in patients with greater masticatory muscle activity before OGS.

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

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.

A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial Comparing the Efficacy of Systemic Enzyme Therapy for Edema Control in Orthognathic Surgery Using Ultrasound Scan to Measure Facial Swelling - Corrected Proof

Vikram Shetty, Amit Mohan — 2013-04-08

Purpose: To evaluate the effectiveness of systemic enzyme therapy for the control of edema in patients who undergo bimaxillary orthognathic surgery.Materials and Methods: Thirty patients were included in this double-blinded, randomized, control trial. Before surgery, each patient was allotted a code (study or control group). Nine anthropometric points were selected. Thickness of the soft tissue at each of these points was measured using an ultrasound device. These measurements were performed on the day before surgery and 1, 5, and 15 days after surgery. The study group was given a twice-daily dose of systemic enzyme therapy from the first postoperative day for 5 days; the control group was given placebo. The percentage of difference in the thickness of the soft tissue was calculated at each of the 9 points on postoperative days 1, 5, and 15. These data were analyzed and compared using the Mann-Whitney test.Results: The statistical evaluation showed a significant difference in soft tissue thickness between the 2 groups, especially on days 5 and 15, at most assessed points.Conclusion: The results of this study suggest that systemic enzyme therapy significantly decreases postoperative edema in orthognathic surgery, precluding long-term corticosteroid use.

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

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.

Use of Intraoperative Fluorescent Angiography to Assess and Optimize Free Tissue Transfer in Head and Neck Reconstruction - Corrected Proof

2013-04-01

Purpose: Composite tissue defects in the head and neck region present unique challenges. Definitive head and neck reconstruction of these cases is often complicated by complex 3-dimensional defects that may require multiple flap or chimeric flap procedures. These advanced techniques can have serious repercussions should poor perfusion of the flap cause flap failure, which can be devastating.Materials and Methods: A retrospective review was completed for those complex reconstructions using free tissue transfers and fluorescent indocyanine green angiography (Lifecell SPY Elite imaging, Lifecell Corporation, Bridgewater, NJ) at Walter Reed National Military Medical Center over a 24-month period. Data analyzed included flap type (myocutaneous, osteocutaneous, or fasciocutaneous), flap success and failure rates, and complications. These also were compared with data from the institution before the study period and the incorporation of SPY technology.Results: Sixty-one free flaps, including 11 head and neck flaps, were performed. The head and neck flaps included 1 latissimus, 3 gracilis, 1 vastus lateralis, 4 anterior lateral thigh, and 2 fibular flaps. The overall success rate was 98.4%; 1 flap was lost (1.6%) and 2 flaps developed partial flap necrosis (3.3%). Where SPY Elite was used, there was no unpredicted partial flap necrosis. The only total flap loss was related to a hypercoagulable condition.Conclusions: Free tissue transfer can be technically challenging, especially in complex head and neck reconstruction. An algorithmic approach using SPY Elite imaging aids in pedicle location, angiosomal assessment, anastomotic flow visualization, and cutaneous and osteocutaneous flap perfusion assessment. This objective tool can assist the reconstructive surgeon in avoiding perfusion-related complications and total and partial flap losses, thus improving patient outcomes.

3-Dimensional Computed Tomographic Analysis of the Pharynx in Adult Patients With Unrepaired Isolated Cleft Palate - Corrected Proof

Yi Xu, Shufan Zhao, Jiayu Shi, Yan Wang, Bing Shi, Qian Zheng, Lun-Jou Lo — 2013-04-01

Purpose: This study investigated 3D differences of the pharynx in adult patients with unrepaired isolated cleft palate (ICP) versus normal adults using cone-beam computed tomography (CBCT).Patients and Methods: CBCT data of 32 adult patients with nonsyndromic unrepaired ICP and 30 normal controls were acquired. Image processing and analyses were performed using Mimics (Materialise NV, Leuven, Belgium). Linear, planar, and volumetric measurements and comparisons were performed between patients with ICP and controls. Interobserver and intraobserver reliabilities of 3D pharyngeal analysis were determined by the Pearson correlation coefficient. Statistical analyses comparing patients with ICP to normal adults were performed using independent-samples t test, with the significance threshold set at P = .05.Results: Interobserver and intraobserver reliabilities were high. Pearson correlation coefficients ranged from 0.992 to 0.999 for interobserver measurements and from 0.994 to 0.999 for intraobserver measurements. Anterior height (P = .000), total depth (P = .003), and floor length (P = .034) of the bony nasopharynx; posteroanterior diameter of the pharyngeal airway at the palatal plane (P = .000); cross-sectional area of the pharyngeal airway at the palatal plane (P = .000); total volume (P = .031); volume above the palatal plane (P = .024); and the volume between the palatal plane and the plane of the most anterior point on the inferior margin of the outline of the body of the second cervical vertebra (P = .022) were larger in patients with ICP.Conclusions: This imaging study showed an enlarged nasopharynx in the sagittal plane and increased nasopharyngeal airway volume at the palatal plane in patients with ICP.

Use of a Modified Removable Partial Denture as a Marsupialization Stent in a Pediatric Patient - Corrected Proof

Steven J. Wiemer, Chase A. Pruitt, David J. Rallis, Christopher F. Viozzi — 2013-04-01

Marsupialization is a proved and effective therapy for treating dentigerous cysts in children and young adults. Impacted teeth associated with dentigerous cysts have been reported to erupt after marsupialization provided space is maintained for eruption. Important benefits of marsupialization include the ability to preserve adjacent anatomy and the low associated morbidity compared with other invasive treatment options. This preservation is imperative when treating younger patients, particularly when the cyst is large and close to structures such as the maxillary sinus, inferior alveolar nerve, and adjacent developing dentition. Despite the success of marsupialization in treating dentigerous cysts in young patients, most current stenting devices are crude conversions from other equipment and supplies. This report describes a custom technique that involved marsupialization of a dentigerous cyst in the right posterior mandible of an 8-year-old boy using a modified removable partial denture (MRPD).

Application of Angular Measurements in the Correction of the Asymmetric Chin - Corrected Proof

Augusto Pary — 2013-03-28

Osseous genioplasty is an important surgical option for the correction of true chin asymmetry or to disguise a mandibular asymmetry when a mandibular ramus osteotomy is not indicated. Linear measurements are traditionally obtained in genioplasty planning to guide the amount of surgical repositioning of the chin, especially in cases of chin midline shifts. However, for asymmetries in which there is a cant of the chin’s inferior border, rotation of the osteotomized bone segment is usually necessary to level it; therefore angular measurements might be preferred over linear measurements to measure the rotational movement accurately. Nevertheless, to date, the importance of angular measurement in genioplasty planning has never been studied.

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

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.

Fine Needle Aspiration of Parotid Tumors: Diagnostic Utility From a Clinical Perspective - Corrected Proof

2013-03-28

Purpose: The utility of fine needle aspiration (FNA) for parotid tumors is limited owing to its low diagnostic accuracy. In this study, the authors sought to analyze and interpret FNA results for parotid tumors from a clinical perspective.Materials and Methods: Parotid tumors subjected to preoperative FNA and subsequent complete excision were the subject of this study. Patient demographics, medical records, FNA findings, and final pathology of 158 consecutive cases were analyzed.Results: The accuracy of FNA was 77.8%. The positive predictive value and likelihood ratio for malignancy were 90.0% and 52.8% (95% confidence interval, 7.02-397), respectively. The positive predictive value and likelihood ratio for benign pathology of Warthin tumor plus pleomorphic adenoma were 97.8% and 7.67% (2.03-29.0), respectively.Conclusions: The FNA diagnosis of Warthin tumor or pleomorphic adenoma is reliable and can be safely regarded as a benign tumor. Based on the high positive predictive value and likelihood ratio, FNA of the parotid gland can offer valuable information in surgical planning and patient counseling in many centers.

Intra-Arch Elastics Technique: A Novel Method for Controlling the Abutment/Soft Tissue Interface During Implant Reconstruction of the Orofacial Region - Corrected Proof

Kyle S. Ettinger, Kevin L. Rieck, Thomas J. Salinas, Kevin Arce — 2013-03-28

In the past 30 years, composite microvascular free tissue transfer has become a popular and highly successful option for the reconstruction of defects in the head and neck region. However, inherent shortcomings exist with free tissue transfer in that the imported tissue often fails to adequately replicate the characteristics of the native tissues. This can lead to difficulties when attempting reconstruction from a surgical and prosthetic standpoint. Endosseous implants are often required to adequately retain prostheses, and management of the peri-implant soft tissues represents a critical challenge for the oral and maxillofacial surgeon. This report describes a novel technique for controlling the implant-abutment-soft tissue interface and the advantages of this technique as it pertains to orofacial reconstruction.

Palatal Approach to the Anterior Maxillary Sandwich Osteotomy - Corrected Proof

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.

Intraosseous Leiomyosarcoma of the Mandible: A Case Report - Corrected Proof

2013-03-28

Leiomyosarcomas are rare smooth muscle tumors that can occur anywhere in the body. These tumors rarely occur in the head and neck owing to the limited amount of smooth muscle in the region. The clinical diagnosis of leiomyosarcoma is challenging because of the nonspecific presentation of the disease. The most definitive diagnosis is based on tissue biopsy or surgical resection and histopathologic confirmation. A case of intraosseous leiomyosarcoma of the mandible and a review of the literature are presented.

Esthetic Outcome After Soft Tissue Reconstruction of the Face Using Deep Dissection and Composite Facelift Technique - Corrected Proof

2013-03-28

Purpose: Large defects in the face resulting from the excision of malignant tumors, trauma, and congenital malformation pose a significant challenge to reconstructive surgeons. Achieving good esthetic and functional outcomes is often very demanding.Patients and Methods: A facelift technique was used in 47 patients (25 female, 22 male; age range, 17.5 to 82.3 years; mean age, 49.3 years) to replace lost tissue of the face from 2009 through 2012. The minimum defect size was 2 cm in diameter and the maximum was 8 cm. To achieve tension-free coverage with a reliable blood supply, a deep-plane dissection, including the skin and superficial musculoaponeurotic system (SMAS), was performed. The deep sub-SMAS dissection was extended into the neck and the contralateral part, as needed. A thick flap was created and composite lifting was performed.Results: No significant deformity concerning the lower eyelids, nose, and lip was registered. Most scars could be placed in hidden regions and became undetectable after a year. The facial nerve function remained intact in all patients.Conclusion: Using these facelift techniques, including the incision, sub-SMAS dissection for volumetric positioning of the skin, and the SMAS flap, the closure of extensive facial defects with excellent functional and esthetic results is conceivable.

Quality of Life After Maxillectomy and Prosthetic Obturator Rehabilitation - Corrected Proof

Radhika Chigurupati, Neelam Aloor, Richard Salas, Brian L. Schmidt — 2013-03-28

Purpose: Surgical resection of midface neoplasms and subsequent reconstruction have been shown to have significant negative effects on quality of life (QOL). The purpose of this pilot study was to assess individuals' health-related QOL after maxillectomy and reconstruction with a prosthetic obturator.Materials and Methods: The QOL of 25 of 43 patients who underwent maxillectomy and prosthetic obturator reconstruction at the University of California–San Francisco was assessed using 3 questionnaires: University of Washington Quality of Life version 4 (UWQOL), Obturator Functioning Scale (OFS), and Mental Health Inventory (MHI).Results: The response rate to the QOL questionnaires was 92% (23 of 25 patients). Time elapsed from maxillectomy and prosthetic obturator reconstruction to the QOL survey response ranged from 0.3 to 6.6 years (mean, 2.7 years; standard deviation [SD], 1.9 years). The post-treatment mean QOL scores were 77.3 (SD, 13.6) for UWQOL, 72.0 (SD, 12.6) for OFS, and 4.5 (SD, 0.9) for Mental Health Inventory. Individuals who received adjuvant radiation scored lower for speech and appearance (OFS, P = .05, P = .03, respectively) as well as for saliva and overall QOL (UWQOL, P = .02, P = .08, respectively). There was a strong correlation between QOL scores in OFS and UWQOL questionnaires (r = 0.78, P < .001).Conclusion: The results of this pilot study suggest that postoperative radiation therapy was the strongest variable affecting QOL in patients with maxillectomy and prosthetic obturator reconstruction. There is further need for a multicenter trial with a larger sample to identify how factors affecting QOL of patients after maxillectomy might influence the choice of reconstruction.

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

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.

Anatomic Study for the Horizontal Cut of the Sagittal Split Ramus Osteotomy - Corrected Proof

2013-03-25

Purpose: The purpose of this study was to determine the posterior extension of trabecular bone and the height at which both the lateral and medial cortical bone layers of the mandibular ramus merge, using a reference point on the anterior margin of the mandibular ramus.Materials and Methods: A total of 80 adult human mandibles were studied. Starting at reference point X, we marked a line running from the anterior margin to the posterior margin of the mandibular ramus on the medial aspect of the study samples. On 2 vertical sections of the right ramus, the level at which both the medial and lateral cortical bone layers merged was determined—H1 and H2, respectively. On the horizontal cross section of the left mandible at point X, the posterior extension of trabecular bone was determined.Results: The median values of H1 and H2 were 10.45 mm and 4.52 mm, respectively. The median value of H2 was inversely proportional to the width of the ramus. The mean extension of trabecular bone posterior to point Z (where the upper margin of the lingula merges into the continuous medial aspect of the ramus) was 17.17 mm, bearing no correlation with the ramus width.Conclusion: Point X is a safe and easy-to-find anatomic reference to establish the level of a sagittal split ramus osteotomy (SSRO) horizontal cut. The wider the mandibular ramus, the closer to the mandibular foramen the SSRO horizontal cut should be performed. An SSRO horizontal cut should not be performed farther than 4 mm above line X. A safe posterior limit for the SSRO horizontal cut could not be determined.

Florid Follicular Lymphoid Hyperplasia of the Hard Palatal Mucosa Managed With Intralesional Steroids: A Case Report and Review of the Literature - Corrected Proof

Ida Anjomshoaa, Lionel A. Bulford, Harry Dym, Sook-Bin Woo — 2013-03-25

Follicular lymphoid hyperplasia of the palate is a benign lymphoproliferative lesion of unknown pathogenesis. It presents usually in female patients as a painless, firm, well-demarcated, usually nonulcerated, slow-growing lesion on the palate that histopathologically may resemble a lymphoma. The authors describe a patient with this condition that was successfully treated with intralesional steroid injections. Previously reported cases were reviewed to assess the results of various treatment modalities and disease-free outcome. A nonsurgical approach to the management of follicular lymphoid hyperplasia may have better patient acceptance and satisfaction without recurrence.

Industrial-Grade Silicone Injections Causing Intermittent Bilateral Malar Swelling: Review of Safety and Efficacy of Techniques and Products Available - Corrected Proof

Austin C. Seward, Daniel J. Meara — 2013-03-25

Silicone and other fillers have become a popular aid to increase soft tissue density, decrease static skin rhytids, and treat muscle wasting, particularly in the face. As a result, injectable silicone has become popular in patients with the human immunodeficiency virus (HIV). It has been postulated that highly active antiretroviral therapy detrimentally induces the physiologic process of fat atrophy of the temporal and buccal fat pads of the face and regional fat wasting of the arms, legs, and buttocks and that HIV protease inhibitors may induce fat atrophy by binding and inhibiting homologous human proteins that are involved in fat metabolism. The classic hollowed-out facial appearance linked to HIV positivity can have detrimental social implications in infected patients who are otherwise very functional. In consequence, facial implantation, fat transplantation, and dermal and subcutaneous fillers have been used to aid in the restoration of facial appearance. This report describes the case of a patient who underwent multiple rounds of silicone injections and complained of intermittent facial swelling and pain long after the injections. The authors report on the safety of specific medical-grade injectable fillers and techniques found to be safely effective, especially in the HIV-positive population.

Carcinoma of the Oral Tongue: A Case Series Analysis of Prognostic Factors and Surgical Outcomes - Corrected Proof

Nilda Süslü, Ali Şefik Hoşal, Tuğba Aslan, Bülent Sözeri, Anıl Dolgun — 2013-03-25

Purpose: To identify factors affecting the clinical course and survival of patients with squamous cell carcinoma of the tongue.Materials and Methods: One hundred thirty-eight patients who were treated with surgical excision of primary tongue cancer and neck dissection were analyzed retrospectively. The study had a median follow-up period of 23 months. Univariate and multivariate statistical analyses for prognostic risk factors were performed using the Cox regression method. Survival curves were processed with the Kaplan-Meier method.Results: The 138 patients (73 male, 65 female) had a median age of 60 years. The 5-year overall, disease-specific, and relapse-free survival rates were 81%, 73%, and 71%, respectively. Tumor thickness greater than 8 mm was the only independent prognostic factor indicating a poor prognosis in overall survival (P = .049). Presence of involved lymph nodes indicated a tendency toward a poorer prognosis in disease-specific survival (P = .026) and relapse-free survival (P = .043).Conclusions: The present findings indicated that tumor thickness greater than 8 mm and lymph node metastasis were independent predictors of worse survival in patients with squamous cell carcinoma of the tongue. Because similar regional recurrence rates were observed in selective and radical neck dissections, supraomohyoid neck dissection is supported as a primary treatment for patients with clinical N0 tumor.

Trisomy 7 as Sole Aberration in Peripheral Ameloblastoma of the Mandible - Corrected Proof

Esther Manor, Bertha Delgado, Ben Zion Joshua, Peter A. Brennan, Lipa Bodner — 2013-03-25

Peripheral ameloblastoma (PA) is a rare, extraosseous odontogenic tumor with histologic features similar to those of the more common intraosseous ameloblastoma. The exact nature and tumorigenesis of PA are unclear. Although there are some reports on the cytogenetics of intraosseous ameloblastoma, to the authors' knowledge, there are no studies on the cytogenetic analysis of PA. The cytogenetic analysis of a PA occurring in the gingiva of a 56-year-old man is presented. Trisomy 7 was the only cytogenetic aberration.

Infantile Cortical Hyperostosis (Caffey Disease): A Case Report and Review of the Literature—Where We Are After 70 Years? - Corrected Proof

Ramanojam Shandilya, Kiran S. Gadre, Jyoti Sharma, Priscilla Joshi — 2013-03-25

Infantile cortical hyperostosis (ICH), also known as Caffey disease, Caffey-Silverman syndrome, or Smyth syndrome, is a genetic disorder represented by an infantile episode of massive, subperiosteal, new bone formation that typically involves diaphysis of the long bones, mandible, and clavicles. The disease begins in early infancy and usually is self-limiting. It is characterized by unusual irritability, soft tissue swelling, and cortical hyperostosis. A clinical triad includes fever, soft tissue swelling, and hyperirritability. The condition has been diagnosed in utero; however, infants remain asymptomatic for several weeks before onset. The average age of onset is 9 weeks. Most cases show spontaneous regression after a few months and hyperostosis becomes imperceptible 12 months after the soft tissue swellings and fever subside. However, Bowman et al reported a case with persistent mandibular enlargement at 3 years of age. Caffey reported mandibular asymmetry in 1 patient at 4 years 9 months of age. The authors report a case of a 3-month-old female infant that initially was attributed to an inflammatory and infective process, but later turned out to be ICH.

Erratum - Corrected Proof

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.

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

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.

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

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.