Journal of Oral and Maxillofacial Surgery - Articles in Press

Treatment of Irradiated Mandibles With Mesenchymal Stem Cells Transfected With Bone Morphogenetic Protein 2/7 - Corrected Proof

Wen Biao Zhang, Li Wu Zheng, Daniel Tsin Tien Chua, Lim Kwong Cheung — 2012-05-14

Purpose: The study aimed to evaluate whether mesenchymal stem cells transfected with bone morphogenetic protein (BMP) 2/7 could increase bone regeneration after radiotherapy using a rabbit model of mandibular distraction osteogenesis. Materials and Methods: Twelve rabbits were randomly assigned to the sham control, radiotherapy control, nontransfected mesenchymal stem cells (MSCs), and MSCs transfected with BMP-2/7 groups. All rabbits, except those in the sham control group, received preoperative radiation of 9 Gy for 5 fractions. One month after radiotherapy, all rabbits underwent unilateral mandibular distraction at a rate of 0.9 mm/d for 11 days. At the end of active distraction, MSCs combined with bovine collagen were injected into the distraction zone. After 4 weeks of consolidation, the mandibular samples were collected and subjected to radiographic, microcomputed tomographic, and histologic examinations. Results: By radiographic examination, animals injected with nontransfected MSCs or MSCs encoding BMP-2/7 exhibited more bone formation than the control groups. Histologic examination showed that the group with MSCs encoding BMP-2/7 had a more mature medullary cavity than the nontransfected MSCs group. Conclusions: MSCs encoding BMP-2/7 can increase bone healing in irradiated mandibular bone.

Clinical and Pathologic Characteristics and Surgical Management of Benign Fibrous Histiocytoma of the Mandible: A Case Report - Corrected Proof

2012-05-14

Benign fibrous histiocytomas (BFHs) of the bone are unusual mesenchymal neoplasms arising from fibroblasts and histocytes. These fibroblasts and histocytes are arranged in a storiform pattern; thus, BFHs are often confused with histologically similarly fibrohistiocytic lesions such as nonossifying fibromas (NOFs), fibrous cortical defects, and metaphyseal fibrous defects. BFHs of the soft tissues are well-recognized entities; however, BFHs occurring in the bone are rare. Thus, few unique pathologic features that might aid in the diagnosis and treatment have been described. BFHs of bone appear most often in the long bones, with histologic characteristics identical to BFHs in the soft tissue. However, lesions arising in the jaws are so rare only a few cases have been reported. Our case report describes the clinicopathologic characteristics and surgical management of a BFH in the mandible. BFH of the flat bones have distinct clinical, radiologic, and pathologic characteristics and require unique surgical management.

Osteoplasty Flap Technique for Repair of Latent (30-Year) Post-Traumatic Frontal Sinus Mucocele: Case Report and Review of the Literature - Corrected Proof

Chan M. Park, Enrico Stoffella, Jason Gile, Jeffrey Roberts, Alan S. Herford — 2012-04-30

Mucoceles are benign, slow-growing lesions defined as mucus-filled pseudocystic formations. Paranasal mucoceles predominantly affect the frontal sinus (60% to 65%), followed in frequency by the ethmoidal (20% to 30%), maxillary (10%), and sphenoid (2% to 3%) sinuses. Mucoceles usually arise because of sinus ostium obstruction, preceded by infection, fibrosis, inflammation, trauma, surgery or tumors such as osteomas. Mucoceles arising from the frontal sinus present with a variety of clinical signs, including decreased visual acuity, visual field abnormalities, proptosis, ptosis, periorbital swelling, displacement of the globe, restricted ocular movements, and choroidal folds. We describe a case of orbital involvement from a mucocele of the frontal sinus 30 years after the initial trauma, with a review of the published data concerning the etiology, diagnosis, and treatment planning.

Global Doctor Opinion Versus a Patient Questionnaire for the Outcome Assessment of Treated Temporomandibular Disorder Patients - Corrected Proof

Gregory M. Ness, Daniel M. Laskin — 2012-04-30

Purpose: Accurately assessing treatment outcomes has become increasingly important for maintaining hospital privileges. When these assessments are based on the judgment of the treating doctor, there is often an inherent positive bias. As a result, there has been increased interest in using patient-based assessments. The purpose of this study was to compare doctor's and patient's assessments of the outcomes of treatment in a series of patients with various temporomandibular disorders (TMDs). Materials and Methods: Fifty-two consecutive TMD patients were initially given a questionnaire designed to evaluate their pain, problems eating and sleeping, the occurrence of headache and earache, the presence of temporomandibular joint pain and/or jaw stiffness in the morning, and interference with daily activity. The patients then filled out the same questionnaire at each post-treatment visit, and the findings were compared with the baseline information. At each visit, the treating doctor also recorded a global evaluation of the patient's progress as excellent, good, fair, or poor. Results: Comparison of the doctor's global evaluation with the patient's evaluation based on the questionnaire showed a discrepancy in 44% of the cases. When there was a discrepancy, the doctor scored the improvement better than the patient 54.5% of the time and worse than the patient 45.5% of the time. Conclusions: The results of this study confirm the unreliability of using a global opinion by the treating doctor for outcome assessment in patients with various TMDs.

Does a Pulsed Mode Offer Advantages Over a Continuous Wave Mode for Excisional Biopsies Performed Using a Carbon Dioxide Laser? - Corrected Proof

2012-04-30

Purpose: Animal studies of excisional biopsies have shown less thermal damage when a carbon dioxide (CO2) laser (10.6 μm) is used in a char-free (CF) mode than in a continuous-wave (CW) mode. The authors' aim was to evaluate and compare clinical and histopathologic findings of excisional biopsies performed with CW and CF CO2 laser (10.6 μm) modes. Materials and Methods: This prospective randomized controlled clinical trial included 60 patients with similar fibrous hyperplasias of the buccal plane willing to undergo excisional CO2 laser biopsy. Patients were randomly allocated to the CW (5 W) or CF (140 Hz, 400 μs, 33 mJ) group. Duration of surgery, intra- and postoperative complications, and the width (micrometers) of the histopathologic collateral thermal damage zone were registered as primary outcome variables. Secondary outcome variables were pain (patients filled in a visual analog scale [VAS]) and analgesic intake (recorded by patients). Results: The study group consisted of 36 women and 24 men with a median age of 50.5 years. Median durations of surgery were 74.5 seconds in the CW group and 83.5 seconds in the CF group. Intraoperative venous bleeding occurred in 16.7% of patients in the CW group and in 13.3% of patients in the CF group. Median areas of histopathologic collateral damage zones were similar in the CW group (166.5 μm) and the CF group (162.5 μm). There was no statistically significant difference between the VAS values of the 2 groups. Analgesic intake was recorded by 16.7% of patients in the CW group and by 6.7% of patients in the CF group (P = .23, not significant). No statistically significant correlation was found between areas of thermal damage zones and postoperative VAS scores. Conclusions: In contrast to previous animal studies, no significant difference was found in the widths of thermal damage zones between the CW and CF groups. The VAS values and analgesic intake were low in the 2 groups. The 2 CO2 laser modes are appropriate for the excision of intraoral mucosal lesions. A safety border of at least 1 mm is recommended regardless of the laser mode used.

Effect of Different Methods for Decontaminating Tooth Enamel After Contact With Blood Before Bonding Orthodontic Buttons - Corrected Proof

2012-04-30

Purpose: To evaluate the best method for decontaminating tooth enamel contaminated by contact with blood before bonding orthodontic buttons. Materials and Methods: The labial surfaces of 195 bovine incisors initially received prophylaxis, followed by 37% phosphoric acid etching, adhesive application, and light polymerization. After this, the labial surfaces of all teeth were contaminated with blood. The teeth were then randomly divided into 13 groups (n = 15), comprising the control group (treated according to the manufacturer's recommendations) and 12 experimental groups treated by the following decontamination methods: group 1, no decontamination; group 2, washing with distilled water; group 3, washing with physiologic solution; group 4, jets of air; group 5, gauze; group 6, cotton wool; group 7, distilled water plus jets of air; group 8, distilled water plus gauze; group 9, distilled water plus cotton wool; group 10, physiologic solution plus jets of air; group 11, physiologic solution plus gauze; and group 12, physiologic solution plus cotton wool. Results: No statistical differences were shown between the control group and groups 4, 7, 10, and 11 (P > .05). The lowest bond strength values were shown in group 1, in which no decontamination was performed, and groups 6 and 12, which were decontaminated with cotton wool and physiologic solution plus cotton wool, respectively. Conclusions: The best method of decontaminating enamel contaminated with blood is washing with physiologic solution, followed by drying with jets of air and gauze or drying with jets of air only.

Juvenile Mandibular Chronic Osteomyelitis: 3 Cases and a Literature Review - Corrected Proof

Gitte Obel, AnneLise Krogdahl, Torben Thygesen, Christian Godballe — 2012-04-30

Juvenile mandibular chronic osteomyelitis (JMCO) is a rare inflammatory bone disease of unknown etiology. It affects the mandible, causing recurrent pain, swelling, and trismus, generally without any infectious agents being isolated from the involved areas. The absence of pus formation, fistula, and sequestration is characteristic. The onset is insidious, with the disease developing over the course of a few days to several weeks. There is no acute state, and the course may be cyclical, with symptom-free intervals. The disease can cause major diagnostic and therapeutic problems, mainly because of the many possible differential diagnoses. Radiographically, the lesions appear as sclerotic areas with osteolytic elements, a periosteal reaction, and widening of the mandible. Histologically, nonspecific chronic inflammatory changes of the mandibular bone are found. Therapeutic considerations include nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, hyperbaric oxygen treatment, and/or surgery (decortications).

Ameloblastic Fibrosarcoma of the Mandible: Treatment, Long-Term Follow-Up, and Subsequent Reconstruction of a Case - Corrected Proof

Roseanna Noordhoek, Marvin E. Pizer, Daniel M. Laskin — 2012-04-30

Ameloblastic fibrosarcoma (AFS) is a very rare malignant odontogenic tumor that is considered the malignant counterpart of the ameloblastic fibroma. Histologically, the mesenchymal portion of the tumor shows the malignant features of sarcoma whereas the epithelial component is normal. These tumors either present de novo or arise from a pre-existing ameloblastic fibroma.

Congenital Mucocele in the Tongue: Report of a Case - Corrected Proof

Takahiro Kaneko, Norio Horie, Tetsuo Shimoyama — 2012-04-23

Ultrasonography during gestation to evaluate fetal condition has been established as a routine in obstetric units. As a consequence, various malformations and congenital diseases have come to be detected prenatally, including those involving the maxillofacial region. In particular, mucous cysts, teratomas, enteric duplication cysts, lymphangioma, and thyroid-lingual thyroglossal cysts have been reported as cystic lesions of the oral cavity. Oral congenital diseases detected in the fetus have mostly been reported in obstetrics and pediatrics, with reports from oral and maxillofacial units a rarity. We describe a case of congenital mucocele diagnosed on prenatal ultrasonography that presented as a cystic lesion in the tongue.

Does Swallowing Function Recover in the Long Term in Patients With Surgically Treated Tongue Carcinomas? - Corrected Proof

2012-04-23

Purpose: The present study aimed to measure postsurgical swallowing function in patients 5 years after the surgical treatment of tongue carcinoma. Patients and Methods: Using a retrospective cohort study design, the investigators enrolled postsurgical patients treated for tongue carcinomas in Hokkaido University Hospital. The primary outcome variable was oropharyngeal swallow efficiency (OPSE) determined by videofluoroscopic evaluation, and OPSE at follow-up was compared with that at discharge. Other variables included current nutritional status (body mass index, serum albumin), dietary intake, self-rating of current swallowing function, and occurrence of pneumonia. Statistical analysis used the paired t test and the Spearman rank correlation. Results: Swallowing function was assessed in 20 patients (11 men and 9 women) who underwent the surgical treatment of tongue carcinomas; the median age was 70 years (range, 56 to 90 yrs). The mean OPSE values for liquid and paste at follow-up were 26.6 ± 21.2 and 21.9 ± 22.5, respectively. The mean values for the body mass index and serum albumin at presentation were 22.2 ± 3.4 kg/m2 and 4.5 ± 0.3 g/dL, respectively. All patients had a full oral intake of foods, with a mean self-rated value of 6.4 ± 2.5, a value acceptable to the patients. Pneumonia requiring hospitalization did not occur in these patients. Conclusions: The long-term follow-up of patients after the surgical treatment of tongue carcinomas showed acceptable levels of oral function and nutritional status despite objective measurements of poor swallowing efficiency assessed using videofluoroscopy.

Comparative Study of Different Osteotomy Modalities in Maxillary Distraction Osteogenesis for Cleft Lip and Palate - Corrected Proof

Hongbo Yu, Xudong Wang, Bing Fang, Steve Guofang Shen — 2012-04-23

Purpose: Conventional maxillary distraction osteogenesis and anterior maxillary segmental distraction were applied in the treatment of severe maxillary hypoplasia secondary to cleft clip and palate. The aim of the present study was to compare the difference between these 2 osteotomy modalities used for rigid external distraction. Patients and Methods: Ten patients with severe maxillary hypoplasia secondary to CLP were enrolled in our study. They were randomly divided into 2 groups. Conventional maxillary distraction osteogenesis was performed in 5 patients and anterior maxillary segmental distraction in 5 patients. The preoperative and postoperative lateral cephalograms were compared, and cephalometric analysis was performed. The independent sample t test was used to evaluate the differences between the 2 groups. Results: All patients healed uneventfully, and the maxillae moved forward satisfactorily. The sella-nasion-point A angles, nasion-point A–Frankfort horizontal plane angles, overjets, and 0-meridian to subnasale distances had increased significantly after distraction osteogenesis. Significant differences were found in the changes in palatal length between the 2 groups (P < .05). A mean increase of 7.50 mm in palatal length was found in the anterior maxillary segmental distraction group. No significant difference in the changes in palatopharyngeal depth or soft palatal length was found. Conclusions: With the ability of increasing the palatal and arch length, avoiding changes in palatopharyngeal depth, and preserving palatopharyngeal closure function, anterior maxillary segmental distraction has great value in the treatment of maxillary hypoplasia secondary to CLP. It is a promising and valuable technique in this potentially complicated procedure.

Periapical Tissue Response After Use of Intermediate Restorative Material, Gutta-Percha, Reinforced Zinc Oxide Cement, and Mineral Trioxide Aggregate as Retrograde Root-End Filling Materials: A Histologic Study in Dogs - Corrected Proof

2012-04-23

Purpose: To investigate the periapical tissue response of 4 different retrograde root-filling materials, ie, intermediate restorative material, thermoplasticized gutta-percha, reinforced zinc oxide cement (Super-EBA), and mineral trioxide aggregate (MTA), in conjunction with an ultrasonic root-end preparation technique in an animal model. Materials and Methods: Vital roots of the third and fourth right mandibular premolars in 6 healthy mongrel dogs were apicectomized and sealed with 1 of the materials using a standardized surgical procedure. After 120 days, the animals were sacrificed and the specimens were analyzed radiologically, histologically, and scanning electron microscopically. The Fisher exact test was performed on the 2 outcome values. Results: Twenty-three sections were analyzed histologically. Evaluation showed better re-establishment of the periapical tissues and generally lower inflammatory infiltration in the sections from teeth treated with the intermediate restorative material and the MTA. New root cement on the resected dentin surfaces was seen on all sections regardless of the used material. New hard tissue formation, directly on the surface of the material, was seen only in the MTA sections. There was no statistical difference in outcome among the tested materials. Conclusions: The results from this dog model favor the intermediate restorative material and MTA as retrograde fillings when evaluating the bone defect regeneration. MTA has the most favorable periapical tissue response when comparing the biocompatibility of the materials tested.

Analysis of 3D Soft Tissue Changes After 1- and 2-Jaw Orthognathic Surgery in Mandibular Prognathism Patients - Corrected Proof

2012-04-23

Purpose: Orthognathic surgery has the objective of altering facial balance to achieve esthetic results in patients who have severe disharmony of the jaws. The purpose was to quantify the soft tissue changes after orthognathic surgery, as well as to assess the differences in 3D soft tissue changes in the middle and lower third of the face between the 1- and 2-jaw surgery groups, in mandibular prognathism patients. Materials and Methods: We assessed soft tissue changes of patients who have been diagnosed with mandibular prognathism and received either isolated mandibular surgery or bimaxillary surgery. The quantitative surface displacement was assessed by superimposing preoperative and postoperative volumetric images. An observer measured a surface-distance value that is shown as a contour line. Differences between the groups were determined by the Mann-Whitney U test. The Spearman correlation coefficient was used to evaluate a potential correlation between patients' surgical and cephalometric variables and soft tissue changes after orthognathic surgery in each group. Results: There were significant differences in the middle third of the face between the 1- and 2-jaw surgery groups. Soft tissues in the lower third of the face changed in both surgery groups, but not significantly. The correlation patterns were more evident in the lower third of the face. Conclusion: The overall soft tissue changes of the midfacial area were more evident in the 2-jaw surgery group. In 2-jaw surgery, significant changes would be expected in the midfacial area, but caution should be exercised in patients who have a wide alar base.

Sialoendoscopy-Assisted Sialolithectomy for Submandibular Hilar Calculi - Corrected Proof

Deng-Gao Liu, Lan Jiang, Xiao-Yan Xie, Zu-Yan Zhang, Lei Zhang, Guang-Yan Yu — 2012-04-23

Purpose: To assess the clinical effects of endoscopy-assisted sialolithectomy for submandibular hilar calculi. Materials and Methods: The present study was undertaken in 70 patients with symptomatic stones in the hilum of submandibular glands who underwent endoscopy-assisted sialolithectomy from December 2005 through March 2011 in the Peking University School and Hospital of Stomatology. The operative data were analyzed retrospectively. All patients were followed periodically postoperatively. Submandibular gland function was investigated by postoperative symptoms, clinical examinations, sialography, and scintigraphy. Results: Submandibular stones were successfully removed in 65 patients, with a success rate of 92.9%. Temporary lingual nerve injury occurred in 1 patient. Two patients developed ranulae and underwent an uneventful sublingual gland excision. During a mean follow-up of 23 months (range, 6 to 55 mo), 52 of 65 patients were symptom free, whereas 11 patients complained of occasional swelling of the affected gland at mealtimes and 2 patients developed a recurrent stone. Thirty patients underwent postoperative sialography. The sialographic appearances included 4 types: 1) approximately normal; 2) the main duct was significantly dilated at the hilum, but no persistent contrast was seen on the functional film; 3) the main duct was significantly dilated in the hilar region, and persistent contrast was seen at the dilated hilum of the functional film; 4) the main duct was dilated or strictured, and persistent contrast was seen on the functional film. Three of the 4 patients who underwent scintigraphy exhibited good function. Conclusions: Sialoendoscopy-assisted sialolithectomy is a safe and effective gland-preservation technique for patients with hilar stones of the Wharton's duct.

Adult Sporadic Burkitt Lymphoma of the Oral Cavity: A Case Report and Literature Review - Corrected Proof

2012-04-23

Burkitt lymphoma (BL) is a high-grade B-cell non-Hodgkin lymphoma with the highest cell proliferation rate of any known malignancy. This malignant lymphoid neoplasm arises through reciprocal chromosomal translocations of the cellular-myelocytomatosis (C-MYC) proto-oncogene with different immunoglobulin (IG) heavy-chain genes, resulting in C-MYC overexpression; this in turn leads to monoclonal proliferation of immature B cells. Clinically, BL occurs mostly in children and is classified into 3 clinical variants or subtypes: endemic, sporadic, and immunodeficiency associated. However, it is relatively rare in middle-aged or elderly adults. Primary involvement of the oral soft tissue in adults is extremely rare. To the authors' knowledge, the English-language literature includes only 3 case reports of adult sporadic BL (sBL) with primary involvement of the oral soft tissue. Observation studies germane to adult sBL and primary involvement of the oral soft tissue are listed in . A case of primary oral sBL in an adult is presented.

Osteonecrosis of the Jaws Unrelated to Bisphosphonate Exposure: A Series of 4 Cases - Corrected Proof

2012-04-23

Osteonecrosis of the jaws (ONJ) is an entity that has received much attention in recent years because of multiple case reports of exposed bone in patients with a history of bisphosphonate (BP) exposure. The term ONJ generally means death of bone without implying specific causation. The American Association of Oral and Maxillofacial Surgeons gives 3 criteria for the diagnosis of BP-related ONJ: 1) The patient must have a history of BP exposure. 2) The patient must have an area of exposed bone in the maxillofacial region that has persisted for greater than 8 weeks. 3) The patient must not have a history of radiation to the head and neck region.

Complications Following Surgically Assisted Rapid Palatal Expansion: A Retrospective Cohort Study - Corrected Proof

Bryce J.D. Williams, Shama Currimbhoy, Alessandro Silva, Felice S. O'Ryan — 2012-04-20

Purpose: To examine the prevalence of complications and characterize the associated clinical findings in patients undergoing surgically assisted rapid palatal expansion (SARPE). Materials and Methods: A retrospective evaluation was conducted of all patients who underwent SARPE from January 2004 through December 2008 at Kaiser Permanente Oakland Medical Center. Medical records were abstracted, and demographic factors and relevant comorbidities were identified. Clinical features of patients with complications (surgical and/or dental) after SARPE were characterized. Results: One hundred thirty-one patients comprised the study sample and 11 patients were excluded. Of the remaining 120 patients (median age, 29.5 yrs; interquartile range, 22.0 to 39.0 yrs), 51.7% were women, 41 developed at least 1 complication, 33 had surgical complications, 18 had dental and/or periodontal problems, and 10 developed both surgical and dental or periodontal problems. Asymmetric and/or inadequate expansion was the most frequent surgical complication, found in 13.3% of the study cohort, and gingival recession (8.3%) was the most common dental complication. Two patients developed catastrophic periodontal bone defects resulting in loss of the central incisors; these patients had eccentric interdental osteotomies that caused separation of the bone from the root surface of the central incisors followed by postoperative osteotomy site infections. Conclusions: Overall, the present findings suggest that, although major complications after SARPE were rare, asymmetric or inadequate expansion and dental and/or periodontal problems primarily involving the central incisors accounted for most complications. Future prospective and long-term follow-up studies are needed to identify individual risk factors that may predispose patients to adverse outcomes after SARPE.

Computer-Aided Design and Computer-Aided Manufacturing Locating Guides Accompanied With Prebent Titanium Plates in Orthognathic Surgery - Corrected Proof

Shizhu Bai, Hongtao Shang, Yanpu Liu, Jinlong Zhao, Yimin Zhao — 2012-04-20

In orthognathic surgery, maxillary segment repositioning is essential for esthetic and functional outcomes when a Le Fort I osteotomy is involved. The intermediate wafer has been used extensively to reposition the maxilla segment during surgery. The procedure for fabricating intermediate splints requires several manual steps that can be time-consuming and may produce errors. In addition, the correct position vertical to the skull base of the maxillary segment must be adjusted intraoperatively by the surgeon because the intermediate wafer can be used only to ensure transverse and sagittal repositioning.

Minipig Model of Maxillary Distraction Osteogenesis: Immunohistochemical and Histomorphometric Analysis of the Sequence of Osteogenesis - Corrected Proof

Maria E. Papadaki, Leonard B. Kaban, Maria J. Troulis — 2012-04-20

Purpose: To document the sequence of bone formation in a minipig model of Le Fort I distraction osteogenesis (DO) using immunohistochemistry and histomorphometry. Materials and Methods: Female Yucatan minipigs (N = 9) in the mixed-dentition stage underwent bilateral maxillary DO. The distraction protocol was 0 days of latency, with a distraction rate of 1 mm/d for 12 days and 24 days of fixation. Specimens were harvested and divided between the central incisors (18 hemi-maxillae) at the end of DO (n = 6), at mid-fixation (n = 6), and at the end of fixation (n = 6). Sections, including the advancement zone, were stained with hematoxylin-eosin, collagen II, CD34, proliferating cell nuclear antigen, and tartrate-resistant acid phosphatase. Light and fluorescence microscope images (original magnification ×200) were obtained, and percentage of surface area (PSA) of the advancement zone occupied by fibrous tissue, vessels, proliferating cells, osteoid, and bone was determined. An intact maxilla served as the control. Results: At the end of DO, in the advancement zone, the PSA (mean values) of proliferating cells was 33.16%; fibrous tissue, 52%; vessels, 4.35%; and new bone, 5.45%. At the end of fixation, the PSA of proliferating cells decreased to 10.53%, fibrous tissue to 2.3%, and vessels to 1.5% whereas the PSA of new bone increased to 44.9%. Conclusions: The results of this study indicate that the progression of osteogenesis in the maxillary DO wound begins with intense cellular proliferation and vascular fibrous tissue formation and progresses to mature, cancellous bone by the end of fixation. The PSA occupied by mature bone is significantly less than in the control maxilla at the end of fixation. This is consistent with the sequence in the mandibular DO wound.

Reactivation of Distraction Length Using External Distractors - Corrected Proof

Thomas Hierl, Alexander Hemprich, Heike Huempfner-Hierl — 2012-04-16

Distraction osteogenesis is an established procedure to cope with marked skeletal retrusion or deficiency. A principal theoretical problem with this method is the given length of the distractor unit. Regarding mandibular distraction, some devices allow reactivation of the distractor. For maxillary and midfacial distraction osteogenesis, to date, no report on how to achieve this has been found, creating the rationale for this technical note. Midfacial and maxillary distraction osteogenesis is an accepted therapy for maxillary retrusion and hypoplasia. External, halo-borne devices have been used for more than 15 years as a technical means for that purpose. Under most conditions, a distractor spindle length of over 3 cm will be sufficient for maxillary protraction. Under certain circumstances, however, this length will not be sufficient. A possible reason is subtotal osteotomy, which necessitates higher forces. Therefore forward bending of the extraoral connection rods instead of pure protraction will result, consuming spindle unit length. A further possible reason necessitating resetting is sutural distraction. Within sutural distraction, no osteotomies are performed and miniplate-based anchoring devices are fixed to the maxilla and inferior zygoma. Because high forces are needed initially, which again lead to an initial bending of the extraoral rods, the spindle unit length may be exhausted before the desired outcome has been reached.

Coronectomy of the Lower Third Molar Is Safe Within the First 3 Years - Corrected Proof

Yiu Yan Leung, Lim Kwong Cheung — 2012-04-12

Purpose: There is no long-term evaluation on the safety of coronectomy of the lower third molar. The aim of this study was to investigate the 3-year morbidity of coronectomy of the lower third molars and to monitor the behavior and migration pattern of the retained roots after coronectomy. Materials and Methods: This was a prospective cohort study. Patients with lower third molars with specific radiographic sign(s) showing proximity of the roots to the inferior alveolar nerve who underwent coronectomy in a previous randomized clinical trial were reviewed postoperatively in the first week and the third, sixth, 12th, 24th, and 36th months. The morbidities of infection, pain, root eruption, reoperation to remove the root, and the development of any pathology were recorded. The pattern of any root migration was analyzed. Results: Ninety-eight patients (35 men and 63 women; mean age, 25.7 yrs; standard deviation, 7.9 yrs) with 135 coronectomies completed the 36-month review. None presented with infection or pain from the postoperative third month onward. Root eruption causing sensitivity occurred in 3% (4/135) of the sample and the erupted roots were removed. None of the reoperated cases presented with a postoperative inferior alveolar nerve deficit. No pathology developed in any of the retained roots after coronectomy. Root migration was noted in most cases in the first 12 months, and all roots stopped migrating from the 24th month onward. The mean root migration at 36 months was 2.8 mm (standard deviation, 1.4 mm). Conclusions: This study confirms that retained roots after coronectomy in the lower third molars produce no complications in terms of infection, pain, or the development of pathologies within the first 3 years. Root eruption can occur in a very small percentage of patients and may require reoperation to remove the root.

Extranodal Non-Hodgkin Lymphomas of the Oral Cavity and Maxillofacial Region: A Clinical Study of 58 Cases and Review of the Literature - Corrected Proof

2012-04-12

Purpose: Approximately one third of non-Hodgkin lymphomas (NHLs) arise in tissues other than the lymph nodes. The purposes of this study are to evaluate the clinical outcome of NHLs of the oral cavity and maxillofacial region in a group of 58 patients who were diagnosed in our clinic and to discuss the clinical, histologic, and immunohistochemical features of these malignant neoplasms, as well as the prognosis. Materials and Methods: The study included 58 patients with extranodal NHLs of the oral cavity and maxillofacial region. There were 32 male and 26 female patients. The patients' ages ranged from 7 to 81 years. The most frequent sites of occurrence were the salivary glands (24 patients) and intraoral mucosa (21 patients). Other sites were the paranasal sinus (3 patients), Waldeyer ring (4 patients), bone of the jaws (3 patients), and orbit (3 patients). The histologic subtype was extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT) in 21 patients, diffuse large B-cell lymphoma (DLBCL) in 19, chronic lymphocytic leukemia in 10, mantle cell lymphoma in 4, follicular lymphoma in 2, Burkitt lymphoma/leukemia in 1, and B-cell acute lymphocytic leukemia (B-ALL) in 1. Of the DLBCL cases, 13 were stage IIE and 6 were stage IE. All the MALT lymphomas were stage IE. Results: The mean follow-up was 5 years after the initial diagnosis. A better prognosis was found in patients with MALT lymphomas (19 of 21 patients are alive) compared with those with DLBCLs (10 of 19 patients are alive). Conclusions: MALT lymphomas have a more favorable outcome (about 90%) in comparison with DLBCLs. Careful examination of the oral cavity and neck by the maxillofacial surgeon is essential for the diagnosis and staging of lymphomas.

Atypical Fibroxanthoma—A Retrospective Immunohistochemical Study of 42 Cases - Corrected Proof

Mark Singh, Rebecca Mann, Velupillai Ilankovan, Kudair Hussein, Corrado D'arrigo — 2012-04-12

Purpose: Atypical fibroxanthoma is a cutaneous dermal malignancy that presents on the sun-damaged skin of elderly people. It requires a definitive diagnosis, from a high-grade sarcoma to a nonmesenchymal neoplasm. The recommended treatment protocol differs from similar histologically related tumors; thus, a diagnosis of atypical fibroxanthoma should fulfill strict histologic and immunohistochemical stain criteria. The use of these standards will exclude other skin malignancies, including malignant fibrous histiocytoma, angiosarcoma, malignant melanoma, and squamous cell carcinoma. This study was performed with the aim of identifying key immunostains to develop diagnostic criteria. Materials and Methods: Forty-two cases were studied retrospectively over a 10-year period using a panel of immunostains. Results: The average age at presentation was 78 years, with a male predominance. The scalp was found to be the most common site of occurrence, although other investigators have found the forehead, cheeks, nose, and ears as the prevailing sites of presentation. Conclusions: An extensive panel of immunohistochemical stains can be used to prove a diagnosis of atypical fibroxanthoma.

Computer-Aided Design/Computer-Aided Manufacturing Implant Guide Used in Flapless Surgery for Auricular Prosthesis - Corrected Proof

Shizhu Bai, Yunpeng Bi, Yan Dong, Zhihong Feng, Yimin Zhao — 2012-04-12

The bone-anchored implant-retained craniofacial prosthesis system is a viable alternative to conventional reconstructive surgery and offers significant improvement in the quality of life when compared with the support systems previously available for these types of prostheses. Ideal placement of bone-integrated implants to retain the prosthesis is critical for a successful final prosthetic restoration. The implant abutments and retentive elements should be hidden under the prosthesis and will not interfere with the esthetic contours of the final result. Several sources have described the importance and use of surgical templates for the optimal placement of extraoral implants. Marking the proposed location for the implants with a dye through holes in an acrylic ear is the general method, but it does not provide a full guide for the implants' insertion.

Submental Liposuction Versus Formal Cervicoplasty: Which One to Choose? - Corrected Proof

Tirbod Fattahi — 2012-04-12

Purpose: Esthetic rejuvenation of the submental area is a fairly common concern of patients seeking cosmetic surgery. There are several techniques used to obtain esthetic results. A common dilemma is the proper determination as to which procedure, liposuction versus formal cervicoplasty, is more appropriate. This manuscript describes the factors involved in the aging process of the submental area, as well as the inherent advantages of formal cervicoplasty over liposuction. Materials and Methods: A comprehensive review of the intrinsic and extrinsic aging process is described, and advantages and disadvantages of liposuction as well as cervicoplasty are detailed. Results: On the basis of the specific factors leading to the fullness of the anterior neck/submental area, proper rejuvenation technique must include platysmaplasty, in addition to liposuction. Isolated liposuction is only beneficial in an isolated group of cosmetic patients. Conclusions: Formal cervicoplasty, including open liposuction and platysmaplasty, is a superior operation compared with isolated liposuction of the submental area. Whereas liposuction does have a role in cosmetic surgery of the submental area, it is not a comprehensive procedure and does not address all of the anatomic components leading to submental fullness.

Dental Extraction in a Hemophilia Patient Without Factor Replacement Therapy: A Case Report - Corrected Proof

Branislav V. Bajkin, Nebojsa V. Rajic, Sanja B. Vujkov — 2012-04-12

Hemophilia is a congenital bleeding disorder caused by the deficiency of coagulation factor VIII (hemophilia A) or IX (hemophilia B). According to the degree of factor deficiency, hemophilia is classified as severe (<1 IU/dL), moderate (2-5 IU/dL), or mild (6-40 IU/dL).

Saliva and Blood Concentration of Cefuroxime in Patients Undergoing Maxillofacial Surgery - Corrected Proof

2012-03-29

Purpose: To investigate the penetration of cefuroxime into the parotid saliva after short-term intravenous administration in patients undergoing various maxillofacial surgical procedures. Patients and Methods: A total of 12 patients, 10 males and 2 females, with a mean age of 41 ± 21.2 years, participated in the present study. Each patient received 1.5 g of intravenous cefuroxime every 8 hours. Blood and parotid saliva samples were collected concomitantly, on the third day of therapy, just before the infusion of the first morning dose, and 0.5 hour after its end. All samples were analyzed using high-performance liquid chromatography. Results: The cefuroxime concentration in plasma and saliva before infusion was 2.08 ± 1.05 mg/L and 0.46 ± 0.33 mg/L, respectively. At 30 minutes after the end of infusion, the corresponding concentrations were 55.54 ± 20.24 mg/L and 14.50 ± 7.85 mg/L. The saliva/plasma ratio was 0.25 ± 0.18 before and 0.26 ± 0.12 after the infusion. Conclusions: Cefuroxime is excreted in saliva in high levels shortly after infusion but is detected in far lower levels 8 hours after infusion. Taking into consideration the minimum inhibitory concentration values of common pathogens, we have concluded that the saliva concentrations of the drug are sufficient against some, but not all, pathogens involved in the oral-maxillofacial area.

Dental Implant Distractor Combined With Free Fibular Flap: A New Design for Simultaneous Functional Mandibular Reconstruction - Corrected Proof

2012-03-12

Purpose: The purpose of the present study was to present a new method that combines the use of the fibular flap and a custom-made vertical distractor/dental implant device into 1 surgical procedure for simultaneous functional mandibular reconstruction. Patients and Methods: The present retrospective case series included 10 patients who were treated using the fibular flap and dental implant distractor (DID) in a single-stage procedure. These 10 patients were treated within a 3-year period (from 2005 to 2007). Results: Of the 10 patients included in the study, 5 were males and 5 were females. The mean age of the sample was 33.8 years (range 17 to 48). The cumulative survival rate of the fibular flaps was 100%. The mean vertical bone height attained with the DID device was 11.4 mm. The mean period from the first operation to the start of dental implant loading was 6.3 months. The cumulative survival rate of the dental implants was 93.75%. Conclusions: The use of the DID in the fibular flap for mandibular reconstruction is advantageous because it combines vertical distraction osteogenesis of the fibular flap and dental implantation into a single procedure. Implants placed in the reconstructed areas were found to integrate normally, with survival rates comparable to those with 2-stage operations. As such, this novel DID technique can be used for single-stage reconstruction and rehabilitation of segmental mandibular defects in selected patients.

A Rare Case of Osteonecrosis in the Premaxilla Following Meningococcal-Induced Disseminated Intravascular Coagulation - Corrected Proof

Jagdip Singh Kalsi, Amina Abdel-Karim, Anthony Edward Brooke — 2012-03-09

Osteonecrosis of the jaws has become somewhat synonymous with a well-described presentation after treatment with bisphosphonates. Many other causes of exposed jaw bone exist, including long-term steroid use, hepatitis, human immunodeficiency virus, herpes zoster virus, excessive alcohol use, malnutrition, gingivitis and periodontitis, mucositis, infectious osteomyelitis, sinusitis, periapical pathology, temporomandibular joint disease, osteoradionecrosis, neuralgia-inducing cavitational osteonecrosis, bone tumors or metastases, trauma, and benign sequestration of the lingual plate.

Risk Factors for Third Molar Occlusal Caries: A Longitudinal Clinical Investigation - Corrected Proof

Kimon Divaris, Elda L. Fisher, Daniel A. Shugars, Raymond P. White — 2012-03-09

Purpose: To study the third molar occlusal caries incidence and identify related patient-level sociodemographic, dental behavior, and clinical risk factors. Patients and Methods: A prospective cohort study was used to study caries risk (crude increment and incidence rate) on retained and erupted to the occlusal plane third molars among a moderate-size (n = 215) group of healthy (American Society of Anesthesiologists class I and II) young adults (median age, 26 years) followed up for a mean of 4.6 years. Clinical data were gathered by calibrated examiners using visual-tactile and radiographic diagnostic methods on all molar teeth. The covariates included age at enrollment, gender, race, income, education, frequency of dental visits, oral hygiene behaviors, and smoking. Summary statistics and visual methods were used for data description. The analyses relied on bivariate and multivariate methods using generalized estimating equations, extensions of Poisson modeling. Results: Of the 215 patients, 33% developed occlusal caries on 1 or more retained third molars. The incidence rate was 0.11 (95% confidence interval 0.09 to 0.13) third molar “increments”/person-year. Those with any molar caries at baseline were 80% more likely to have a new third molar caries lesion at the end of follow-up compared with those with caries-free molars (prevalence ratio, 1.80; 95% confidence interval, 1.08 to 3.00). The third molar caries rate was halved for every approximately 9 years of the subjects' baseline age. Favorable oral hygiene behaviors and better socioeconomic status were associated with decreased caries risk. However, independent of other covariates, smoking increased the third molar caries risk twofold. Conclusions: Younger patients from lower socioeconomic strata, smokers, and those with poor oral hygiene behavior are at an increased risk of occlusal caries development on their retained third molars.

Ultrasonography for Detection of Disc Displacement of Temporomandibular Joint: A Systematic Review and Meta-Analysis - Corrected Proof

Chunjie Li, Naichuan Su, Xianrui Yang, Xiao Yang, Zongdao Shi, Longjiang Li — 2012-03-09

Purpose: To assess the diagnostic efficacy of ultrasonography in detecting disc displacement of the temporomandibular joint. Materials and Methods: MEDLINE (using OVID, 1950 to April 2011), EMBASE (1980 to April 2011), and the Chinese Biomedical Literature Database (1978 to April 2011) were searched electronically. In addition, relevant journals and reference lists of the included studies were manually searched for any eligible studies on diagnostic accuracy. Two authors performed the study inclusion, data extraction, and risk of bias assessment in duplicate. Meta-analysis was performed with MetaDisc 1.4. Results: Fifteen studies were included in this meta-analysis; 6 studies had a low risk of bias, 6 studies an unclear risk, and 3 studies a high risk. Meta-regression indicated that the detected results were not influenced by the types of ultrasonography, image dimensions, types of transducer, and ultrasonic image of the disc (P > .05). The Q* values of ultrasonography for the closed- and open-mouth positions were 0.79 and 0.91, respectively. The diagnostic efficacy of disc displacement with reduction had a sensitivity of 0.76, a specificity of 0.82, a positive likelihood ratio of 3.80, a negative likelihood ratio of 0.36, a diagnostic odds ratio of 10.95, an area under the curve of 0.83, and a Q* of 0.76. The diagnostic efficacy of disc displacement without reduction had a sensitivity of 0.79, a specificity of 0.91, a positive likelihood ratio of 80.5, a negative likelihood ratio of 0.25, diagnostic odds ratio of 36.80, an area under the curve of 0.97, and a Q* of 0.92. Conclusions: The diagnostic efficacy of ultrasonography is acceptable and can be used as a rapid preliminary diagnostic method to exclude some clinical suspicions. However, positive ultrasonographic findings should be confirmed by magnetic resonance imaging. Also, the ability of ultrasonography to detect lateral and posterior displacements is still unclear. More high-quality studies are needed to assess the diagnostic efficacies of some specific ultrasonographic methods. Standards and criteria for ultrasonographic techniques in the diagnosis of disc displacement should be established in the future.

Is Adjuvant Laser Therapy Effective for Preventing Pain, Swelling, and Trismus After Surgical Removal of Impacted Mandibular Third Molars? A Systematic Review and Meta-Analysis - Corrected Proof

2012-03-09

Purpose: To assess the efficacy and safety of low-level laser energy irradiation (LLEI) for decreasing pain, swelling, and trismus after surgical removal of impacted mandibular third molars (IMTMs). Materials and Methods: MEDLINE, EMBASE, and the Central Register of Controlled Trials of the Cochrane Library were searched from their inception, and conference proceedings, cross-references, and gray literature were searched for the last 5 years for randomized and quasi-randomized controlled trials that evaluated the effects of any type of LLEI, compared with active or inactive treatments, in patients undergoing surgical removal of IMTMs. Risk of bias in included studies was assessed by 2 independent evaluators using the Cochrane Risk of Bias tool. A random-effects model meta-analysis was used to estimate the mean difference of trismus between the groups. Heterogeneity was assessed using Cochran χ2 and I2. Results: Ten eligible trials were included in this systematic review. The included studies overall had a moderate risk of bias. Because of heterogeneity in the intervention and outcomes assessments, pain and swelling outcomes were only qualitatively summarized and indicated no beneficial effects of LLEI over placebo. Patients receiving LLEI had an average of 4.2 mm (95% confidence interval, 1.2 to 7.2) and 5.2 mm (95% confidence interval, 1.8 to 8.2) less trismus than patients receiving no active treatment on the second and seventh day after the surgery, respectively. Conclusions: There was no benefit of LLEI on pain or swelling and a moderate benefit on trismus after removal of IMTMs. It is necessary to standardize the intervention and outcomes assessment and to conduct adequately powered, well-designed trials to evaluate the efficacy of LLEI.

Sarcoidosis Presenting as a Lytic Lesion of the Mandible - Corrected Proof

2012-03-09

Sarcoidosis is a systemic granulomatous disease of unknown etiology that presents with pulmonary manifestations in most patients. The lungs and thoracic lymph nodes are almost always involved, resulting in acute or insidious respiratory symptoms; however, nearly every organ system can be affected. Extrathoracic sites of involvement include the lymph nodes, eyes, bone marrow, spleen, liver, kidneys, salivary glands, skin, and mucous membranes. Bone involvement in sarcoidosis varies from 3% to 13%, with the small bones of the hands and feet most frequently affected. Bony involvement in the head and neck is rare and is usually a manifestation of disease chronicity. However, we report a case of sarcoidosis presenting as a lytic bony lesion of the mandible discovered on imaging in a patient without systemic or pulmonary complaints.

Midazolam Is Associated With Delay in Recovery and Agitation After Ambulatory General Anesthesia for Dental Treatment in Patients With Disabilities: A Retrospective Cohort Study - Corrected Proof

2012-03-01

Purpose: Some patients with intellectual disabilities (IDs) who undergo total intravenous anesthesia (TIVA) have complications associated with the anesthesia such as prolonged recovery. The purposes of this study were to estimate the frequency of TIVA complications among patients with IDs and to identify factors associated with TIVA complications. Materials and Methods: This study was designed as a retrospective cohort study. Study samples were selected from the clinical records of patients with IDs who underwent ambulatory general anesthesia in a special dental clinic at the Okayama University Hospital, Okayama, Japan. Predictor variables were patient background, anesthesia-related variables, and dental treatment. Outcome variables were delayed recovery and the complication of agitation. Factors affecting delayed recovery and complications were examined with multivariable analysis. Results: We enrolled 106 cases (81 male and 25 female patients) in this study. The mean age was 23.9 years. Serious complications were not observed in any cases. The amount of intravenous midazolam was an independent determinant of delayed recovery. Oral midazolam contributed to delayed recovery, although it is very useful for induction in patients with a high level of fear. Oral midazolam and a younger age were independent predictors of agitation. Conclusions: Intravenous midazolam may not have an advantage in ambulatory general anesthesia. Oral midazolam contributes to delayed recovery and is an independent predictor of agitation.

Platelet-Rich Plasma Promotes Angiogenesis of Prefabricated Vascularized Bone Graft - Corrected Proof

2012-02-27

Purpose: The objective was to assess the impact of platelet-rich plasma (PRP) on angiogenesis and bone formation of tissue-engineered bone in the prefabricated stage. Materials and Methods: Both thighs of New Zealand white rabbits were used as prefabricated vascularized bone grafts using a combination of bone mesenchymal stem cells and vascular bundles in a titanium cage filled with β-tricalcium phosphate ceramic. PRP was applied in the test group, and the same procedure was performed in the control group without the application of PRP. After 4, 8, and 12 weeks, delayed static bone scanning with technetium-99m methylene diphosphonate was performed before sacrifice, and the tissue-engineered bone samples were collected for immunohistochemical analysis using a monoclonal antibody against CD31 and histologic analysis. Results: The results showed superior angiogenesis in the PRP group compared with the control group at each time point as determined by bone scintigraphy and immunohistochemical examinations. The results of histologic analysis also showed that there was more bone formation in the PRP group than in the control group at each time point. Conclusions: The application of autologous PRP was an effective strategy for increasing angiogenesis and bone formation in tissue-engineered bone and had potential significance for clinical applications.

Interval Between Injury and Lingual Nerve Repair as a Prognostic Factor for Success Using Type I Collagen Conduit - Corrected Proof

Mohammed S. Erakat, Sung-Kiang Chuang, Rabie M. Shanti, Vincent B. Ziccardi — 2012-02-27

Purpose: The purpose of the present study was to investigate the role of a type I collagen nerve conduit in the repair of lingual nerve injuries compared with those lingual nerve repairs performed without a collagen membrane and to identify the prognostic factors for functional sensory recovery (FSR). Materials and Methods: This was a retrospective cohort study evaluating a sample derived from the population of patients who had undergone lingual nerve microsurgery from March 17, 2000, to February 23, 2010 by the same surgeon (V.B.Z.) with complete records available, including follow-up assessments. The primary outcome variable was the interval to successful FSR according to the British Medical Research Council criteria for FSR. The predictor variables were categorized into demographic, surgical, and clinical sensory testing. Appropriate descriptive statistics and univariate and multivariate Cox proportional hazards survival statistics were computed in analyzing the patient age at lingual nerve injury repair (in years), gender, timing of surgical intervention, mechanism of injury, specific surgical procedures, and application of a type I collagen conduit. Results: The study cohort included 41 patients with 42 lingual nerve injuries who underwent surgical repair. Their mean age was 28.3 ± 8.3 years (range 13 to 44), with 88% females (n = 32). In the multivariate model, the injury to surgery interval per 1-month increase (hazard ratio 1.23, 95% confidence interval 1.02 to 1.48, P = .029) and injury to surgery interval of 9 months or longer (hazard ratio 4.67, 95% confidence interval 1.04 to 20.87, P = .04) remained significantly associated statistically with successful FSR. Conclusions: The results of the present study have demonstrated that the injury to surgery interval is the most significant prognostic factor in the repair of lingual nerve injuries. The use of the collagen membrane demonstrated a greater level of FSR compared with those treated without the use of the membrane. However, the results from the collagen conduit were not statistically significant.

Do Histologic Criteria Predict Biologic Behavior of Giant Cell Lesions? - Corrected Proof

2012-02-27

Purpose: To determine whether the clinical behavior of giant cell lesions (GCLs) or their anatomic location can be differentiated by histologic criteria alone. Materials and Methods: We performed a retrospective study of patients with GCLs treated at Massachusetts General Hospital between 1993 and 2008. Predictor variables were histologic parameters: number of giant cells (GCs) per high-power field, number of nuclei per GC, GC size, stromal cellularity, stromal type, presence of hemorrhage and reactive osteoid, and blinded pathologists' prediction of location and behavior. Outcome variables were clinical behavior (aggressive or nonaggressive) and GCL location, that is, maxillofacial (MF) or axial/appendicular (AA). Descriptive and bivariate statistics were computed with statistical significance set at P ≤ .05. Results: The sample included 88 subjects: 41 MF GCLs (35 aggressive) and 47 AA GCLs (28 aggressive). Aggressive AA lesions had more GCs per high-power field, larger mean GC size, and increased stromal cellularity, and they more frequently had a mononuclear stroma when compared with aggressive MF lesions (P < .05). There were no significant histologic differences between aggressive and nonaggressive MF lesions or between nonaggressive MF and nonaggressive AA lesions. Aggressive AA lesions had more nuclei/GC than nonaggressive AA lesions (P = .03). Using histologic criteria only, blinded pathologists predicted clinical behavior in only 45% of cases (κ = 0.19, P = .09). They predicted a lesion's location in 82% of cases with fair agreement (κ = 0.44, P < .01). Conclusions: Results of this study indicate that histologic differences between aggressive and nonaggressive GCLs are insufficient for pathologists to differentiate them consistently regardless of location.

Metachronous Manifestation of Carcinoma Ex Pleomorphic Adenoma in a Buccal Minor Salivary Gland and the Contralateral Parotid Gland: A Case Report and Review of the Literature - Corrected Proof

2012-02-27

Carcinoma ex pleomorphic adenoma (Ca-ex-PA) has been defined as a pleomorphic adenoma from which an epithelial malignancy is derived. It is also known as carcinoma arising in a benign mixed tumor, carcinoma ex benign pleomorphic adenoma, carcinoma arising in a pleomorphic adenoma, and malignant mixed tumor. In files of the Armed Forces Institute of Pathology reviewed since 1970, Ca-ex-PA accounted for 9.5% of all pleomorphic adenomas and 6% of all malignant salivary gland tumors.

Inductive, Scaffold-Based, Regenerative Medicine Approach to Reconstruction of the Temporomandibular Joint Disk - Corrected Proof

2012-02-27

Purpose: A device composed of extracellular matrix (ECM) was investigated as an inductive template in vivo for reconstruction of the temporomandibular joint (TMJ) disk after discectomy. Materials and Methods: A scaffold material composed of porcine-derived ECM was configured to mimic the shape and size of the TMJ. This device was implanted in a canine model of bilateral TMJ discectomy. After discectomy, 1 side was repaired with an ECM scaffold material and the contralateral side was left empty as a control. At 6 months after implantation, the joint space was opened, the joints were evaluated for signs of gross pathologic degenerative changes, and newly formed tissue was excised for histologic, biochemical, and biomechanical analysis. Results: The results showed that implantation of an initially acellular material supported the formation of site-appropriate, functional host tissue that resembled that of the native TMJ disk. Furthermore, this prevented gross degenerative changes in the temporal fossa and mandibular condyle. No tissue formation and mild to severe gross pathologic changes were observed in the contralateral controls. Conclusions: These results suggest that an ECM-based bioscaffold could represent an off-the-shelf solution for TMJ disk replacement.

Stability After Mandibular Setback: Mandible-Only Versus 2-Jaw Surgery - Corrected Proof

William R. Proffit, Ceib Phillips, Timothy A. Turvey — 2012-02-27

Purpose: The objective of this study was to evaluate whether changes in the technique for mandibular setback surgery since the introduction of rigid internal fixation have improved postoperative stability in Class III correction with setback alone and 2-jaw surgery. Patients and Methods: Cephalometric (skeletal and dental) outcomes for 17 patients with mandibular setback alone were compared with outcomes in 83 patients with 2-jaw surgery for Class III correction. Demographic characteristics in the 2 groups were similar, and the mean amount of setback (−4.7 mm) was the same; however, given a mean maxillary advancement of 4.9 mm, the 2-jaw patients had a greater total Class III correction. Results: Greater than 4 mm of posterior movement of the gonion at surgery and a resulting significant change in ramus inclination were found in 8 of the mandible-only patients (47%) but only 1 of the 2-jaw patients (1%). Postoperatively, the mean changes for the 2 groups were similar, with mean forward movement of the chin (pogonion) of 2.8 mm in both groups, but the mechanism was different. In the mandible-only patients, the major reason for forward movement of the chin was recovery of ramus inclination. In the 2-jaw group, about half the change in chin position was because of forward movement of the gonion; the other half was because of small upward movement of the maxilla that allowed upward-forward rotation of the mandible. In both groups there was a significant correlation (r = 0.42, P < .0001) between postoperative change in the position of the chin and gonion. Conclusions: Despite improvements in surgical techniques for mandibular setback since 1995, postoperative stability still leaves something to be desired, but there is better control of the ramus position when 2-jaw surgery is performed.

Platyhelminthes in Tongue—A Rare Case and Review - Corrected Proof

2012-02-24

Humans are the only known definitive host of the tapeworm Taenia solium and become a carrier by eating undercooked pork contaminated with “Cysticercus cellulosae” (cysticerci). Pigs act as an intermediate host and acquire cysticercosis by ingestion of eggs or proglottids from human feces, which develop into cysticerci within tissue, mostly without causing clinical symptoms in the host. Cysticercosis occurs in humans in a context of “fecal peril” by ingestion of egg-contaminated soil, water, vegetation, or auto-infestation. It has been reported in the published data that the separation of swine from humans, healthy cooking, and hygienic practices would lead to the eradication of the disease. However, cysticercosis is still a major public health problem in endemic regions, with more than 50 million infected people and is now a re-emerging disease in industrialized countries owing to human migration. It is the second most common cause of seizures in tropical countries. We report a case of oral cysticercosis in a 28-year-old woman who presented with a painless swelling in the ventral portion of the tongue. An excisional biopsy was performed, and histopathologic examination revealed a cystic cavity containing the tapeworm.

Ultrasound-Guided Intralesional Photocoagulation of Intramuscular Vascular Malformation in the Masseter Muscle - Corrected Proof

2012-02-24

Intramuscular vascular malformations are rare anomalies accounting for less than 1% of all vascular lesions. Because of their anatomic location, surgical intervention usually is the choice of treatment. However, a vascular malformation of the masseter muscle requires a large extraoral incision to access the lesion. The major drawbacks of this procedure include the development of postoperative facial scars and the risk of injury to the facial nerve. Treatment of vascular malformations by intralesional laser photocoagulation (ILP) was first reported by Apfelberg in 1995. Subsequently, Achauer et al developed ILP using an 18-gauge angiocatheter to deliver a bare fiber into the vascular malformation that minimizes cutaneous damage. Although their report showed that ILP was effective, the accuracy of intralesional puncture remains uncertain if the lesion is not superficially visible. In the present case, a bare fiber was delivered into an intramuscular vascular malformation of the masseter muscle using an ultrasound-guided method.

What Are Orthognathic Patients' Expectations of Treatment Outcome—A Qualitative Study - Corrected Proof

Fiona S. Ryan, Matthew Barnard, Susan J. Cunningham — 2012-02-24

Purpose: Patient's expectations of treatment outcome are one of the key determinants of satisfaction. The aim of this study was to evaluate orthognathic patients' expectations of the outcome of orthognathic treatment. Methods: This study was a cross-sectional qualitative study involving in-depth interviews with patients with dentofacial deformities. Patients who were about to commence orthognathic treatment were recruited from new-patient clinics. Inclusion criterion were patients of any ethnicity 16 years or older who were about to commence orthognathic treatment to correct a dentofacial deformity. Exclusion criteria were patients who had previously received orthognathic treatment, who were younger than 16 years, and those with congenital craniofacial anomalies or acquired defects. The data were analyzed using a framework approach to management and critical qualitative theory, which involved identifying the main themes and subthemes. Results: Eighteen adult patients 18 to 40 years old were interviewed; 9 were women and 9 were men. Most were Caucasian and 6 were from the black and minority ethnic group. Participants' expectations could be divided broadly into 2 main categories: expectations of actual physical changes and expectations of the effects that these physical changes would indirectly have on them (nonphysical changes). In addition, a typology of patients, based on expectations, was identified, whereby patients could be classified as metamorphosizers, pragmatists, shedders, or evolvers, together with implications and suggestions for practice. Conclusions: These findings represent a new insight into the complex issues of managing patient expectations and satisfaction. The clinical relevance of identifying expectations is not just to ration treatment or identify those who will make good or bad candidates for treatment, but to be able to offer them additional support to enhance satisfaction with the outcome. This highlights the need for a qualitative methodology to complete the full circle of evidence-based practice.

Infected Facial Tissue Fillers: Case Series and Review of the Literature - Corrected Proof

2012-02-20

Since 2007, 21 female and 1 male patient aged 25 to 55 years, who either did not have any obvious causative infection source or, despite the presence of nonvital teeth, did not display typical symptoms of odontogenic infection, were treated for acute facial inflammation. All these patients admitted previous application of injectable soft tissue fillers (ISTFs) performed in either private plastic surgery and dermatology practices or cosmetic salons. The period between injection and infection varied from 1 week to 6 years. The injected substance remained unknown in many cases. Of the 22 patients, 3 were diagnosed with facial cellulitis, 4 with periorbital abscess, and 15 with a buccal space abscess. ISTFs provide an attractive option in facial rejuvenation. With their increasing use, the prevalence of complications is also expected to increase. Infectious complications of ISTFs were previously unknown in Kuwait. Although these products are primarily meant for treatment of the aging face, the age pattern of our patients suggests their frequent misuse and spurious indications. Especially worrisome is the recently observed application of fillers in cosmetic salons. We believe that the use of ISTFs should be regulated and their administration in nonmedical facilities prohibited. Patients with an atypical course of facial inflammation should be questioned about a history of cosmetic procedures.

Molecular Methods for Diagnosis of Odontogenic Infections - Corrected Proof

2012-02-13

Purpose: Historically, the identification of microorganisms has been limited to species that could be cultured in the microbiology laboratory. The purpose of the present study was to apply molecular techniques to identify microorganisms in orofacial odontogenic infections (OIs). Materials and Methods: Specimens were obtained from subjects with clinical evidence of OI. To identify the microorganisms involved, 16S rRNA sequencing methods were used on clinical specimens. The name and number of the clones of each species identified and the combinations of species present were recorded for each subject. Descriptive statistics were computed for the study variables. Results: Specimens of pus or wound fluid were obtained from 9 subjects. A mean of 7.4 ± 3.7 (standard deviation) species per case were identified. The predominant species detected in the present study that have previously been associated with OIs were Fusobacterium spp, Parvimonas micra, Porphyromonas endodontalis, and Prevotella oris. The predominant species detected in our study that have not been previously associated with OIs were Dialister pneumosintes and Eubacterium brachy. Unculturable phylotypes accounted for 24% of the species identified in our study. All species detected were obligate or facultative anaerobes. Streptococci were not detected. Conclusions: Molecular methods have enabled us to detect previously cultivated and not-yet-cultivated species in OIs; these methods could change our understanding of the pathogenic flora of orofacial OIs.

Cavernous Sinus Thrombosis: Current Therapy - Corrected Proof

Valmont Desa, Ryan Green — 2012-02-13

Cavernous sinus thrombosis represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical. However, most of the literature involves case-specific discussions. The purpose of this article was to review the literature and present current recommendations for the treatment of cavernous sinus thrombosis.

Molecular Analysis of 16S rRNA Genes Identifies Potentially Periodontal Pathogenic Bacteria and Archaea in the Plaque of Partially Erupted Third Molars - Corrected Proof

J.M. Mansfield, J.H. Campbell, A.R. Bhandari, A.M. Jesionowski, M.M. Vickerman — 2012-02-13

Purpose: Small subunit rRNA sequencing and phylogenetic analysis were used to identify cultivable and uncultivable microorganisms present in the dental plaque of symptomatic and asymptomatic partially erupted third molars to determine the prevalence of putative periodontal pathogens in pericoronal sites. Materials and Methods: Template DNA prepared from subgingival plaque collected from partially erupted symptomatic and asymptomatic mandibular third molars and healthy incisors was used in polymerase chain reaction with broad-range oligonucleotide primers to amplify 16S rRNA bacterial and archaeal genes. Amplicons were cloned, sequenced, and compared with known nucleotide sequences in online databases to identify the microorganisms present. Results: Two thousand three hundred two clones from the plaque of 12 patients carried bacterial sequences from 63 genera belonging to 11 phyla, including members of the uncultivable TM7, SR1, and Chloroflexi, and difficult-to-cultivate Synergistetes and Spirochaetes. Dialister invisus, Filifactor alocis, Fusobacterium nucleatum, Porphyromonas endodontalis, Prevotella denticola, Tannerella forsythia, and Treponema denticola, which have been associated with periodontal disease, were found in significantly greater abundance in pericoronal compared with incisor sites. Dialister invisus and F nucleatum were found in greater abundance in sites exhibiting clinical symptoms. The archaeal species, Methanobrevibacter oralis, which has been associated with severe periodontitis, was found in 3 symptomatic patients. Conclusions: These findings have provided new insights into the complex microbiota of pericoronitis. Several bacterial and archaeal species implicated in periodontal disease were recovered in greater incidence and abundance from the plaque of partially erupted third molars compared with incisors, supporting the hypothesis that the pericoronal region may provide a favored niche for periodontal pathogens in otherwise healthy mouths.

Airway Growth and Development: A Computerized 3-Dimensional Analysis - Corrected Proof

Stephen A. Schendel, Richard Jacobson, Sadri Khalessi — 2012-02-13

Purpose: The present study was undertaken to investigate the changes in the normal upper airway during growth and development using 3-dimensional computer analysis from cone-beam computed tomography (CBCT) data to provide a normative reference. Methods: The airway size and respiratory mode are known to have a relationship to facial morphology and the development of a malocclusion. The use of CBCT, 3-dimensional imaging, and automated computer analysis in treatment planning allows the upper airway to be precisely evaluated. In the present study, we evaluated the growth of the airway using 3-dimensional analysis and CBCT data from age 6 through old age, in 1300 normal individuals. Results: The airway size and length increase until age 20 at which time a variable period of stability occurs. Next, the airway at first decreases slowly in size and then, after age 40, more rapidly. Normative data are provided in the present study for age groups from 6 to 60 years in relation to the airway total volume, smallest cross-sectional area and vertical length of the airway. Conclusions: This 3-dimensional data of the upper airway will provide a normative reference as an aid in the early understanding of respiration and dentofacial anatomy, which will help in early treatment planning.

Extrapulmonary Small Cell Neuroendocrine Carcinoma of the Paranasal Sinuses: A Case Report and Review of the Literature - Corrected Proof

Guang Han, Zhaohua Wang, Xiaofang Guo, Mingwei Wang, Huijing Wu, Dong Liu — 2012-02-13

Primary small cell neuroendocrine carcinoma of the paranasal sinuses is an extremely rare and distinctive tumor with aggressive clinical behavior. We report on a patient who had a small cell neuroendocrine carcinoma of the ethmoid sinus with invasion of the upper aspect of the right maxillary sinus and medial aspect of the right orbit. After 2 cycles of chemotherapy that were unsuccessful, he underwent radiotherapy with complete tumor remission. Local recurrence was not identified after 11 months of follow-up; however, distant metastasis developed 2 months after radiotherapy. The natural history, pathologic features, and choice of therapy for this rare neoplasm are discussed, along with a review of the published data.

Vascular Lesions: GLUT-1 Expression as a Diagnostic Tool to Discriminate Tumors From Malformations - Corrected Proof

2012-02-13

Vascular lesions constitute a widely heterogeneous group of tumors and malformations. For head and neck vascular anomalies, most studies have not attempted to make the differential diagnosis between true hemangiomas and vascular malformations, because an accurate diagnosis remains a challenge for physicians. The successful treatment of vascular anomalies depends on a profound knowledge of their biologic behavior and correct classification. Recently, specific immunohistochemical markers such as erythrocyte-type glucose transporter protein 1 have been described to differentiate hemangiomas from vascular malformations. This report describes 2 cases of intramuscular vascular anomalies involving the masseter muscle histologically diagnosed primarily as cavernous hemangiomas and presents the imaging and pathologic findings. Ample surgical excision was performed through an intraoral approach. Immunohistochemistry showed no uptake of glucose transporter protein 1. The literature was reviewed and the designation intramasseteric vascular malformation for this entity is proposed.