Journal of Oral and Maxillofacial Surgery - Articles in Press

Relationship Between Inferior Alveolar Nerve Canal Position at Mandibular Second Molar in Patients With Prognathism and Possible Occurrence of Neurosensory Disturbance After Sagittal Split Ramus Osteotomy - Corrected Proof

2010-08-27

Purpose: To elucidate the relationship between the anatomic position of the inferior alveolar nerve (IAN) at the mandibular second molar and the occurrence of neurosensory disturbances of the IAN after sagittal split ramus osteotomy (SSRO) in patients with mandibular prognathism. Also, the present study evaluated the difference in anatomic position of the IAN between patients with and without mandibular prognathism.Patients and Methods: Computed tomography images were taken of 28 patients with mandibular prognathism and 30 without prognathism. On these scans, the IANs from the mandibular second molar region to the mandibular foramen in the mandibular ramus were identified. The present study was designed as a cross-sectional study. The distance from the buccal aspect of the IAN canal to the outer buccal cortical margin of the mandible in the mandibular second molar regions was measured on the computed tomography images. Also, the linear distance between the superior aspect of the IAN canal and the alveolar crest in these regions was calculated. In addition, we investigated the presence or absence of contact between the IAN canal and the inner buccal cortical margin of the mandible from the mandibular second molar to the mandibular foramen in the mandibular ramus. Next, we examined whether neurosensory disturbances occurring after SSRO were related to the position of the IAN at the mandibular second molar.Results: A significant difference was found in the occurrence of neurosensory disturbances of the IAN after SSRO between men and women (χ2 test, P < .05). For the distance from the buccal aspect of the IAN canal to the outer buccal cortical margin of the mandible in the mandibular second molar region, a significant difference was found between groups with and without neurosensory disturbances (Student's t test, P < .01). The shorter the distance from the buccal aspect of the IAN canal to the outer buccal cortical margin, the more frequent the occurrence of neurosensory disturbances of the IAN.Conclusions: The present results have demonstrated that gender and the anatomic position of the IAN canal at the mandibular second molar are significantly related to the occurrence of neurosensory disturbances of the IAN after SSRO. Therefore, surgeons should clearly inform patients of the increased possibility of neurosensory disturbances after SSRO when the patients are female and are found to have a shorter distance from the buccal aspect of the IAN canal to the outer buccal cortical margin.

Intraoral Dermoid Cyst in an Infant: A Case Report - Corrected Proof

Marc Pan, Yuko C. Nakamura, Matthew Clark, Sidney Eisig — 2010-08-27

Dermoid cysts are developmental lesions that can occur in different organs. Dermoid cysts in the head and neck region result from congenitally included ectoderm that has been trapped during fusion of the first and second branchial arches. This occurs during the fourth week of embryonic development. About 7% of all dermoid cysts found in the body are formed in the head and neck region, and of these, about 23% occur in the floor of the mouth. The majority of the dermoid cysts on the floor of the mouth occur in the midline, and though rare, they can also occur in the lateral location. Dermoid cysts on the floor of the mouth usually appear as soft nonfluctuant masses, occasionally adhering to the hyoid bone in children. Its presence on the hyoid bone in children may cause an upward displacement of the tongue, resulting in interference with deglutition and speech, and in severe cases it may jeopardize the airway. Treatment is surgical excision to relieve symptoms and prevent infection. An intraoral incision may be used for small cysts, whereas large cysts may require an external approach. An external approach will both avoid intraoral contamination and allow better visualization of surrounding structures.

Intraoral Split-Thickness Skin Grafts: A New Approach Using Vinyl Polysiloxane - Corrected Proof

Jonathon S. Jundt, Kyle W. Odom, James W. Wilson — 2010-08-27

Multiple approaches for immobilizing skin grafts intraorally have been described in the literature. In 1975, Goshgarian and Miller described a parachute stent technique that secures intraoral skin grafts via transcutaneous sutures. In 1981, Friedlander and Miller described a technique using eye patches and a denture soft liner, securing the split-thickness skin graft (STSG) to the cheek using transbuccal bolster sutures. Since then, many materials have been used, including foam, gauze, sutures, silicone, foam rubber pads, and eye patches, in addition to a myriad of different bolstering techniques. Typical problems with current methods include debris accumulation, graft mobility, lack of stent rigidity, cutaneous pressure sores from bolster sutures, and early graft contracture. Vinyl polysiloxane (VPS), also known as polyvinyl siloxane, is an addition silicone used extensively in dentistry for dental impressions, and its use has been reported in the literature as a temporary obturator for orocutaneous fistulas. The method described in this case report secures and protects the graft site intraorally, saves time intraoperatively, maintains the integrity of the graft, allows for early opening and mobilization, and is comfortable for the patient postoperatively. The purpose of this article is to introduce a technique using VPS to immobilize and protect an STSG intraorally.

Use of the Internal Mammary Artery Perforator Flap for Repair of Pharyngocutaneous Fistulas in the Vessel-Depleted Neck - Corrected Proof

Phil Pirgousis, Rui Fernandes — 2010-08-27

The first clinical report of the internal mammary artery perforator (IMAP) island flap was by Yu et al for tracheostoma and anterior neck reconstruction. They presented the successful use of this perforator island flap in 2 patients, based on the second and third IMAPs, respectively. Since the introduction of perforator flaps by Koshima and Soeda in 1989, an explosion of perforator-based flaps has occurred, many of these predominantly used as free flaps. Equally versatile is their more recent use as pedicled island flaps, particularly for trunk and extremity reconstructions. Apart from that by Yu et al, few other reports exist for the application of this perforator island flap in head and neck reconstruction. In this report, we describe our experience with the use of the IMAP island flap in 2 patients for repair of pharyngocutaneous fistulas, an application not previously reported in the literature.

A Longitudinal Study of Functional Outcomes After Surgical Resection and Microvascular Reconstruction for Oral Cancer: Tongue Mobility and Swallowing Function - Corrected Proof

Lindsay Brown, Jana M. Rieger, Jeffrey Harris, Hadi Seikaly — 2010-08-27

Purpose: Controversy exists regarding physiologic outcomes related to the tongue after radial forearm free flap (RFFF) reconstruction of hemiglossectomy defects. The purpose of this study is to report swallowing and tongue mobility outcomes for patients with RFFF reconstruction of the anterior two thirds of the tongue.Materials and Methods: Swallowing and tongue mobility were assessed at 4 different time points over the course of 1 year of treatment for 15 patients who underwent RFFF reconstruction of the anterior two thirds of the tongue. Preoperative swallowing function in the treatment group was compared with a patient group that had no involvement of the tongue. A comparison group of 14 patients with nasopharyngeal cancer was used to compare preintervention function in patients with and without lesions of the tongue.Results: No differences existed between the experimental and comparison groups before intervention. Two significant differences were found for swallowing ability and tongue mobility in the experimental group. Some of the measures at 1 month postoperatively were significantly different from some of the preoperative measures for liquid swallows and posterior-tongue mobility. All measures returned to baseline by the study's end.Conclusion: Although some minor deficits exist in swallowing and tongue mobility after RFFF reconstruction, it appears that these problems are no longer evident 12 months postoperatively.

Rationale for Early Versus Late Intervention With Arthroscopy for Treatment of Inflammatory/Degenerative Temporomandibular Joint Disorders - Corrected Proof

Howard A. Israel, David A. Behrman, Joel M. Friedman, Jennifer Silberstein — 2010-08-27

Purpose: The goal of this study was to determine if there were differences in outcomes of arthroscopic surgery in patients with inflammatory/degenerative temporomandibular joint (TMJ) disease who underwent early surgical intervention versus late surgical intervention.Materials and Methods: The study population included 44 consecutive patients who met the criteria for TMJ operative arthroscopy who were divided into early and late intervention groups. The time between the onset of symptoms and the performance of arthroscopy was used to determine entry into the early versus late intervention group. All groups were evaluated for changes in preoperative versus postoperative pain levels based on visual analog scale (VAS) scores and maximum interincisal opening distance. Statistical analyses included the Student t test to determine if there were significant differences between preoperative and postoperative assessments in the early and late intervention groups.Results: The mean time between onset of symptoms in the early intervention group (21 patients) was 5.4 months compared with 33 months in the late intervention group (23 patients). All patient groups had statistically significant decreases in pain and improvement in maximum interincisal opening distance after arthroscopy. The early intervention group had a mean decrease in VAS pain scores of 5.14 compared with the late intervention group with a mean decrease in VAS pain scores of 2.84, and this difference was significant (P = .012). The early intervention group had a mean increase in maximum interincisal opening of 12.38 mm compared with the late intervention group with a mean increase of 7.70. Although statistical significance was not achieved for increases in maximum interincisal opening between the early and late intervention groups (P = .089), the difference between the 2 groups was suggestive of a trend. There were no surgical complications for either group; however, 2 patients in the late intervention group developed persistent chronic neuropathic pain, requiring pain management.Conclusions: TMJ arthroscopy reliably decreased pain and increased the maximum interincisal opening distance in the early and late intervention groups. The early intervention group had better surgical outcomes than the late intervention group. Arthroscopic surgery should be considered early in the management of patients with inflammatory/degenerative TMJ disease.

Use of Living Cell Construct to Enhance Bone Reconstruction: Preliminary Results - Corrected Proof

Michael S. Block — 2010-08-27

Patients who have chronic problems with their teeth or implants might need bone and soft tissue reconstruction but present with a compromised tissue bed. Examples include patients who have undergone multiple apicoectomies with chronic drainage and bone loss, patients with implant-related bone loss and gingival recession with chronic exudate or inflammation, and patients with combinations of soft and hard tissue loss from chronic dental disease. These patients require bone graft reconstruction for implant placement. These patients also have significant soft tissue deficiencies. With severe soft tissue compromise, hard tissue grafting can be difficult to perform because of the lack of graft coverage and poor blood supply from the compromised tissue bed.

Unilateral Cheek Swelling in an Infant: Case Report of an Unusual Presentation of Internal Bleeding Caused by Vitamin K Deficiency - Corrected Proof

Yoshinari Myoken, Yoshinori Fujita, Tatsumi Sugata, Naoto Fujita — 2010-08-20

Unilateral acute swelling of the cheek with no history of trauma or infection may present a diagnostic challenge, especially in infants. We report an infant with internal bleeding caused by vitamin K deficiency in a very uncommon location, the unilateral cheek. To date, most cases of vitamin K deficiency bleeding (VKDB) have been reported to manifest intracranial hemorrhage, gastrointestinal bleeding, and thymus bleeding. In particular, intracranial hemorrhage is the most common presentation and accounts for approximately 50% of cases. In Japan, oral administration of vitamin K prophylaxis at birth, on the sixth day, and 1 month after birth has been recommended since 1981. Although the incidence of VKDB has dramatically decreased by virtue of this prophylactic administration of vitamin K, it still occurs even in infants receiving vitamin K prophylaxis.

A Prospective Study on the Effect of Modified Alar Cinch Sutures and V-Y Closure Versus Simple Closing Sutures on Nasolabial Changes After Le Fort I Intrusion and Advancement Osteotomies - Corrected Proof

2010-08-20

Purpose: The purpose of this study was to determine whether a modified alar cinch suture and V-Y closure (mACVY) have a beneficial effect on labial form after Le Fort I intrusion and advancement osteotomies and whether they result in excessive upward nasal tip rotation. Both are possible effects compared with simple closing sutures (SCS).Patients and Methods: A prospective study was carried out on 56 patients, 31 with mACVY and 25 with SCS. Lateral cephalograms taken immediately before and 18 months after operation were used, measuring horizontal and vertical changes of the following landmarks: anterior and posterior nasal spine, A-point, incision superior, pronasale, subnasale, labiale superior, and stomion superior, as well as angular changes of sella-nasion-pronasale, and changes in upper vermilion exposure. Statistical analysis was performed on intragroup, paired t test, and intergroup differences, unpaired t test (P < .05).Results: The horizontal and vertical changes of labiale superior were significantly larger for mACVY versus SCS, and the angle sella-nasion-pronasale increased in mACVY versus SCS. However, no significant difference was found for vertical changes of the nasal tip. Upper vermilion exposure increased with mACVY versus SCS.Conclusion: mACVY has a beneficial effect on labial form, and excessive upward rotation of the nasal tip is prevented.

Facial Surface Changes After Cleft Alveolar Bone Grafting - Corrected Proof

Michael Krimmel, Nils Schuck, Margit Bacher, Siegmar Reinert — 2010-08-20

Purpose: The aim of this study was to assess the 3-dimensional facial surface changes after cleft alveolar bone grafting with digital surface photogrammetry.Patients and Methods: In a prospective study, 22 patients with cleft lip and palate underwent alveolar bone grafting. Before the procedure and 6 weeks postoperatively and before the continuation of orthodontic treatment, 3-dimensional images were taken with digital surface photogrammetry. Seven standard craniofacial landmarks on the nose and the upper lip were identified. Their spatial change because of bone grafting was assessed. Statistical analysis was performed with analysis of variance and t test.Results: A significant increase in anterior projection on the operative side (P < .05) was found for the labial insertion points of the alar base (subalare). No significant changes were detected for the position of the labial landmarks.Conclusion: Our results show 3-dimensionally that there is a positive influence of the alveolar bone graft on the projection of the alar base on the cleft side.

Application of Virtual Surgical Planning for Total Joint Reconstruction With a Stock Alloplast System - Corrected Proof

2010-08-20

Surgical management of temporomandibular joint (TMJ) ankylosis can be challenging because of altered anatomy and proximity to key structures including the middle cranial fossa, middle ear, and branches of the external carotid artery. Navigation-guided resection has been used to improve the margin of safety. Computer-assisted design/computer-assisted manufacturing technology has been developed for the surgical simulation and planning of complex craniofacial procedures. However, we are not aware of its use in managing more complex TMJ reconstruction. This modality offers the potential to improve safety and outcomes.

Epithelial Inclusion Cyst After Maxillomandibular Screw Placement: A Case Report - Corrected Proof

2010-08-20

In recent years, maxillomandibular fixation (MMF) screws have been widely used for anchorage in the treatment of maxillofacial fractures. These screws have many advantages over the conventionally used arch bar and continuous wire system: they are not time-consuming to place, their placement causes no traumatic damage to teeth or periodontal tissue, and oral hygiene can be easily maintained.

Use of Bovine Hydroxyapatite With or Without Biomembrane in Sinus Lift in Rabbits: Histopathologic Analysis and Immune Expression of Core Binding Factor 1 and Vascular Endothelium Growth Factor - Corrected Proof

2010-08-20

Purpose: Considering the clinical discussion on the necessity of using a barrier membrane in the osteotomy area of sinus lift procedures to prevent fibrous tissue formation in this area and as a physical limit, the aim of this study was to analyze and compare the use of bovine hydroxyapatite (HA) with and without a biologic membrane by histopathologic analysis and immune expression of core binding factor 1 and vascular endothelium growth factor in the sinus lift in rabbits.Materials and Methods: Sixteen male rabbits underwent bilateral sinus lift procedures and were divided into 2 groups according to the sinus filling material: group 1 received bovine HA (Bio-Oss; Geistlich Pharma AG, Wohlhusen, Switzerland) and group 2 received bovine HA and a nonporous polytetrafluorethylene membrane. All groups were sacrificed after 7, 14, 30, and 60 days for microscopic, histomorphometric, and immunohistochemical analyses.Results: Microscopic analysis showed a similar bone repair pattern between the tested groups. New bone formation, soft tissue, and the remaining material were analyzed by histomorphometric analysis. No statistically significant differences (P > .05) were detected between groups for all periods analyzed. In addition, no remarkable differences were noticed in core binding factor 1 or vascular endothelium growth factor immune expression.Conclusion: Taken together, these results show that using a biologic membrane does not improve bone repair induced by bovine HA, as shown by histopathologic and immunohistochemical analyses.

Use of Antibiotics in the Treatment of Mandible Fractures: A Systematic Review - Corrected Proof

Panayiotis A. Kyzas — 2010-08-20

Purpose: The use of prophylactic antibiotics in the treatment of mandible fractures is common practice. The evidence supporting this practice has not been formally assessed for quality. The purpose of this study was to evaluate this empirically.Materials and Methods: Randomized and nonrandomized trials evaluating the possible impact of the prophylactic use of antibiotics in patients with mandible fractures were identified. Data were extracted on characteristics of studies and patients, including treatment, fracture location, time from injury to treatment, antibiotics used (type, route, dosage, duration), and complications (infection, malunion, reoperation). Randomized controlled trials (RCTs) were further evaluated for issues of reported methodological quality.Results: There were 31 eligible studies (5,437 patients). Of these, 9 were prospective RCTs; the remaining 22 were retrospective case series. Information about the time between injury and definite treatment was provided by 10 studies (31%). The type of antibiotic used was not defined in 13 of 31 studies (42%). Half of the studies (15 of 31 [48%]) did not describe the route of administration and did not comment on the duration of the antibiotic course. The vast majority (23 of 31 [74%]) did not describe the dosage of the antibiotics used. Most of the RCTs were small, had not adequately described the mode of randomization, and did not present intention-to-treat analyses. None of them presented power calculations or ensured allocation concealment. There was not a single mention about number needed to treat. The amount and quality of the available data precluded formal quantitative synthesis, despite scattered signals that prophylactic antibiotics may be better than nothing in preventing infection.Conclusion: The overall evidence to support the use of prophylactic antibiotics in mandible fractures is of poor quality. Large RCTs are needed to guide clinical practice.

Optimal Degree of Mouth Opening for Laryngeal Mask Airway Function During Oral Surgery - Corrected Proof

2010-08-20

Purpose: This study was performed to determine the optimal degree of mouth opening in anesthetized patients requiring laryngeal mask airway (LMA) during oral surgery.Patients and Methods: A single, experienced LMA user inserted the LMA in 15 patients who were scheduled for elective oral surgery. Oropharyngeal leak pressure, intracuff pressure, and fiberoptic assessment of the LMA position were sequentially documented in 5 mouth conditions—opening of 1.4 (neutral position), 2, 3, 4, and 5 cm—and any resulting ventilatory difficulties were recorded.Results: Oropharyngeal leak pressure with the mouth open 4 cm (21.8 ± 3.2 cm H2O, P = .025) and 5 cm (27.3 ± 7.2 cm H2O, P < .001) was significantly higher than in the neutral position (18.1 ± 1.5 cm H2O), as was intracuff pressure (neutral position, 60.0 ± 0 cm H2O; 4 cm, 72.6 ± 5.1 cm H2O [P < .001]; and 5 cm, 86.9 ± 14.4 cm H2O [P < .001]). LMA position, observed by fiberoptic bronchoscopy, was unchanged by mouth opening, being similar in the 5 mouth conditions (P = .999). In addition, ventilation difficulties (abnormal capnograph curves or inadequate tidal volume) occurred in 2 of 15 patients (13%) and 7 of 15 patients (53%) (P < .001) with the mouth opening of 4 and 5 cm, respectively.Conclusions: This study showed that a mouth opening over 4 cm led to substantial increases in oropharyngeal leak pressure and intracuff pressure of the LMA, warranting caution, because gastric insufflation, sore throat, and ventilation difficulties may occur. A mouth opening of 3 cm achieves acceptable airway conditions for anesthetized patients requiring LMA.

Current Thoughts on Treatment of Patients Receiving Anticoagulation Therapy - Corrected Proof

Eron Aldridge, Larry L. Cunningham — 2010-08-20

It is common for oral and maxillofacial surgeons to treat patients who are receiving oral anticoagulation therapy (OAT). The standard of care for patients taking warfarin has been to admit them to the hospital, discontinue their anticoagulation therapy, and use bridging therapy with intravenous heparin until surgery. Heparin is then discontinued 6 hours before surgery and resumed postoperatively. Warfarin administration is also resumed postoperatively, and the heparin administration can be discontinued when the international normalized ratio (INR) has reached the therapeutic level. Such procedures are typically required for 3 to 4 days before surgery so that the patient's INR can normalize. The standard of care for patients receiving antiplatelet therapy has been to discontinue their medication 10 days before surgery and then to restart the medication 24 to 48 hours later. The published data have suggested that a modification of this standard might provide patients receiving anticoagulation and their surgeons a safer and more efficient perioperative course. We have presented a review of this topic, including a brief description of the more commonly encountered anticoagulant and antiplatelet medications, a review of the recent published data on local hemostatic agents, and the current recommendations for the surgical treatment of these patients.

Salmonella-Infected Submandibular Gland Cyst: Case Report and Review of the Literature - Corrected Proof

Antonia Kolokythas, Tarkan Sidal, Ryan Sheppard, Michael Miloro — 2010-08-20

Salmonellae are non-encapsulated gram-negative motile bacteria that may typically be associated with one of the following 5 groups of infections: enteric fever, septicemia without localization, focal disease (with or without septicemia), gastroenteritis, and asymptomatic carrier stage. Extraintestinal focal infections after bacteremia may involve any organ and mainly depend on the mode of dissemination: blood-borne or lymphatic. Neck abscesses and parotid involvement, though rare, are found throughout the literature involving mostly immunocompromised individuals or pediatric patients. Currently, there are no cases of isolated Salmonella infection involving the submandibular gland reported in the literature. We report a unique case of a submandibular gland cyst infected with Salmonella and present a review of the existing literature relevant to Salmonella infections of the head and neck.

Efficacy of Pre- and Postirradiation Hyperbaric Oxygen Therapy in the Prevention of Postextraction Osteoradionecrosis: A Systematic Review - Corrected Proof

Gabriel W. Fritz, John C. Gunsolley, Omar Abubaker, Daniel M. Laskin — 2010-08-20

Purpose: There is still considerable controversy regarding whether hyperbaric oxygen (HBO) therapy used preoperatively and postoperatively will prevent osteoradionecrosis in previously irradiated patients undergoing tooth extraction. The purpose of this systematic review was to evaluate the best evidence available in an attempt to find an answer to this question.Materials and Methods: The literature search on Medline covered the period from January 1948 to March 2008. Included were randomized clinical trials, prospective studies without randomization, case-control studies, retrospective studies, and observational studies with and without control groups. This search retrieved 696 citations, which was reduced to 14 acceptable publications based on an assessment of methodologic quality. They included 1 randomized clinical trial, 8 cohort-controlled studies, and 5 observational studies. These were analyzed for radiation dose, type of radiation, use of adjunctive cancer treatments, number and location of extractions, method of extraction, HBO protocol, and use of adjunctive therapy besides HBO.Results: Most of the studies had a small sample size, lacked specific inclusion and exclusion criteria, did not report the interval between radiation and extraction, and provided limited information on the method of extraction. There was also variation in HBO protocols, radiation dosage, the use of antibiotics, and the use of adjunctive cancer therapy.Conclusion: On the basis of the best available evidence, there is currently insufficient information to show that the use of HBO reduces the incidence of osteoradionecrosis in irradiated patients requiring tooth extraction.

Action of Nicotine and Ovariectomy on Bone Regeneration After Tooth Extraction in Rats - Corrected Proof

2010-08-20

Purpose: The purpose of this study was to evaluate the effects of nicotine and ovariectomy on alveolar bone regeneration after exodontias in rats.Materials and Methods: For 30 days, sham ovariectomized (OVX)/NaCl, sham OVX/nicotine, OVX/NaCl, and OVX/nicotine animals were given 2 daily injections of saline or hemisulfate of nicotine. After this period, exodontic procedures were carried out and treatment continued up to the time of euthanasia on days 7 and 14 when the alveoli were removed for further analyses.Results: The data confirmed that nicotine significantly delays the alveolar regeneration process after dental extraction in rats and showed that the association of nicotine with ovariectomy exacerbates these results.Conclusion: These results indicate that nicotine potentiated the effect of estrogen deficiency on bone regeneration induced by ovariectomy.

Bone Regeneration After Radiotherapy in an Animal Model - Corrected Proof

Wen Biao Zhang, Li Wu Zheng, Denial Chua, Lim Kwong Cheung — 2010-08-20

Purpose: The study aimed to evaluate dosage-dependent effects of irradiation on bone regeneration and established a radiation-compromised rabbit model of mandibular distraction osteogenesis.Materials and Methods: Twenty-three rabbits were divided randomly into 7 groups. Group A served as the control group, whereas experimental groups B, C, D, E, F, and G received preoperative irradiation at doses of 6.5, 7.0, 7.5, 8.0, 8.5, and 9.0 Gy, respectively, for 5 fractions. After 1 month, all rabbits underwent osteotomy and distraction osteogenesis with 7 days of latency, 11 days of active distraction at a rate of 0.9 mm/d, and 4 weeks of consolidation; rabbit mandibles were subsequently subjected to histologic, radiographic, and micro–computed tomography analysis.Results: With increasing doses of irradiation, bone regeneration was markedly hampered. Radiographically, the high-dose groups (8.5 and 9.0 Gy) presented obscure cortical lines. Histologically, in the 8.5- and 9.0-Gy groups, cortical bones were not completely formed, and in the medullary cavity, there existed a large amount of fibrous tissue.Conclusion: Radiotherapy compromises bone regeneration during distraction osteogenesis, and the adverse effect is dose dependent.

Critical Computed Tomographic Diagnostic Criteria for Frontal Sinus Fractures - Corrected Proof

2010-08-20

Purpose: Diagnosis and treatment of frontal sinus fractures (FSFs) have progressed over the previous 30 years. Despite advances in computed tomography, there is no current diagnostic uniformity with regard to classification and treatment. We developed a statistically valid treatment protocol for FSFs based on injury pattern, nasofrontal outflow tract (NFOT) injury, and complication(s). These data outlined predictable injury patterns based on specific computed tomographic findings critical to the diagnosis and ultimate treatment of this potentially fatal injury.Materials and Methods: A retrospective review was conducted on patients with FSF from 1979 to 2005 under institutional review board approval. All computed tomographic scans were reviewed by the authors and fractures categorized by location, displacement, comminution, and degree of NFOT injury.Results: One thousand ninety-seven patients with FSF were identified, 87 expired and 153 had inadequate data, leaving a group of 857 patients. Simultaneous displacement of anterior-posterior tables constituted the largest group (38.4%). NFOT injury occurred in most patients (70.7%) and was strongly associated with anterior (92%) and posterior (88%) table involvement (comminuted 98%). Sixty-seven percent of patients with NFOT injury had obstruction. Five hundred four patients (59.6%) had surgery with 10.4% complications and 353 patients were observed with 3.1% complications. All but 1 patient with complications had NFOT injury (98.5%).Conclusions: Predictable patterns of injury based on specific computed tomographic data play a pivotal role in classification and surgical management of potentially fatal frontal sinus injuries. Radiologic diagnosis of NFOT injury in FSFs, particularly obstruction, plays a decisive role in surgical planning.

Treatment of Avulsed Teeth by Oral and Maxillofacial Surgeons - Corrected Proof

Paul Krasner — 2010-08-20

The incidence of traumatic dental injuries ranges from 23.5% to 27.1% in the general population. The incidence of dental trauma in children and adolescents is higher, and by the time students complete high school, it is estimated that 33% will have had a dental injury. With the increase in girls' participation in sports activities, the number of dental injuries has dramatically increased. Of all 12-year-old children, 16.3% will have an injury to a permanent tooth each year. Dental injuries can occur in any setting and at any time. When these dental injuries occur after hours (with “after hours” being defined as between 5:00 pm and 8:00 am), many patients present to a hospital emergency department for treatment and an oral surgeon is the professional who is usually called.

Microsurgical Repair of the Peripheral Trigeminal Nerve After Mandibular Sagittal Split Ramus Osteotomy - Corrected Proof

2010-08-20

Purpose: Injuries to the inferior alveolar nerve (IAN) and lingual nerves (LNs) have long been known complications of the mandibular sagittal split ramus osteotomy (SSRO). Most postoperative paresthesias resolve without treatment. However, microsurgical exploration of the nerve may be indicated in cases of significant persistent sensory dysfunction associated with observed or suspected localized IAN or LN injury. We report the demographics and outcome of microsurgical exploration and repair of peripheral branches of the trigeminal nerve injured because of the SSRO.Materials and Methods: A retrospective chart review was completed on all patients who had microsurgical repair of peripheral trigeminal nerve injuries caused by mandibular SSRO and were operated on by the senior author (R.A.M.) between March 1986 and December 2005. A physical examination, including standardized neurosensory testing (NST) as described by Zuniga et al, was completed on each patient preoperatively. All patients were followed periodically after surgery for at least 1 year with NST repeated at each visit. NST results obtained at the last patient visit were used to determine the final level of recovery of sensory function. Sensory recovery was evaluated using guidelines established by the Medical Research Council scale. The following data were collected and analyzed: age of patient, gender, nerve injured, chief sensory complaint (numbness, pain, or both), duration (months) from injury to surgical intervention, intraoperative findings, surgical procedure, and neurosensory status at final evaluation. Given the retrospective nature of this study, the research was exempt from our institutional review board ethics committee.Results: There were 54 (n = 54) patients (8 males and 46 females) with an average age of 36.9 years (range, 16 to 55 years) and a follow-up of at least 12 months. The most commonly injured/repaired nerve was the IAN (n = 39), followed by the LN (n = 14), and the long buccal nerve (n = 1). In 31 patients (57.4%), the chief sensory complaint was numbness, while 20 patients (37%) complained of pain and numbness, and 3 patients (5.5%) complained of pain without mention of numbness. The average time from nerve injury to repair was 9.4 months (range, 3 to 50 months). The most common intraoperative finding was a discontinuity defect (n = 18, 33.3%), followed by partial nerve severance (n = 15, 27.8%), neuroma-in-continuity (n = 11, 20.3%), and compression injury (n = 10, 18.5%). The most frequent surgical procedure was autogenous nerve graft reconstruction of the IAN using the sural or great auricular nerve (n = 22, 40.7%), followed by excision of a neuroma with or without neurorrhaphy (n = 13, 24.1%). All the LN injuries (n = 14) were partial or complete severances, of which 2 were reconstructed with autogenous nerve grafts and the other 12 underwent neurorrhaphy. The long buccal nerve injury required excision of a proximal stump neuroma without neurorrhaphy. After a minimum of 1-year follow-up, NST showed that 8 nerves (14.8%) showed no sign of recovery; 19 nerves (35.2%) had regained “useful sensory function,” and 27 nerves (50%) showed full recovery as described by the Medical Research Council scale.Conclusions: Microsurgical repair of the IAN or LN injured during the SSRO can be considered in patients with persistent, unacceptable sensory dysfunction in the distribution of the involved nerve. Modifications of surgical technique may be helpful in reducing the incidence of such injuries. Based on our experience, an algorithm for evaluation and treatment is presented.

Registration of 3-Dimensional Facial Photographs for Clinical Use - Corrected Proof

2010-08-13

Purpose: To objectively evaluate treatment outcomes in oral and maxillofacial surgery, pre- and post-treatment 3-dimensional (3D) photographs of the patient's face can be registered. For clinical use, it is of great importance that this registration process is accurate (< 1 mm). The purpose of this study was to determine the accuracy of different registration procedures.Materials and Methods: Fifteen volunteers (7 males, 8 females; mean age, 23.6 years; range, 21 to 26 years) were invited to participate in this study. Three-dimensional photographs were captured at 3 different times: baseline (T0), after 1 minute (T1), and 3 weeks later (T2). Furthermore, a 3D photograph of the volunteer laughing (TL) was acquired to investigate the effect of facial expression. Two different registration methods were used to register the photographs acquired at all different times: surface-based registration and reference-based registration. Within the surface-based registration, 2 different software packages (Maxilim [Medicim NV, Mechelen,Belgium] and 3dMD Patient [3dMD LLC, Atlanta, GA]) were used to register the 3D photographs acquired at the various times. The surface-based registration process was repeated with the preprocessed photographs. Reference-based registration (Maxilim) was performed twice by 2 observers investigating the inter- and intraobserver error.Results: The mean registration errors are small for the 3D photographs at rest (0.39 mm for T0-T1 and 0.52 mm for T0-T2). The mean registration error increased to 1.2 mm for the registration between the 3D photographs acquired at T0 and TL. The mean registration error for the reference-based method was 1.0 mm for T0-T1, 1.1 mm for T0-T2, and 1.5 mm for T0 and TL. The mean registration errors for the preprocessed photographs were even smaller (0.30 mm for T0-T1, 0.42 mm for T0-T2, and 1.2 mm for T0 and TL). Furthermore, a strong correlation between the results of both software packages used for surface-based registration was found. The intra- and interobserver error for the reference-based registration method was found to be 1.2 and 1.0 mm, respectively.Conclusion: Surface-based registration is an accurate method to compare 3D photographs of the same individual at different times. When performing the registration procedure with the preprocessed photographs, the registration error decreases. No significant difference could be found between both software packages that were used to perform surface-based registration.

Aggressive Central Giant Cell Granuloma of the Mandible - Corrected Proof

2010-08-13

An 11-year-old Egyptian boy presented with mild pain in his left lower jaw accompanied by swelling. Clinical examination showed a hard, tender mandibular enlargement extending from the chin to the left molar area. The orthopantomogram (OPG) showed poorly defined multilocular radiolucency involving the mandibular body from the right lateral incisor to the left first molar (A). There were discrete signs of resorption of root apices of the adjacent teeth. Computed tomography examination disclosed a large expansive osteolytic lesion with a soap bubble appearance and erosion of both vestibular and lingual mandibular cortices (B).

Use of Temporalis Fascia as an Interpositional Arthroplasty in Temporomandibular Joint Ankylosis: Analysis of 8 Cases - Corrected Proof

2010-08-13

Purpose: Different interpositional materials have been used to prevent recurrence after gap arthroplasty in temporomandibular joint ankylosis. In this study, the versatility of the temporalis fascia as an interpositional arthroplasty was evaluated.Materials and Methods: Eight cases of unilateral temporomandibular joint ankylosis were evaluated, with a follow-up of 11 months to 6 years.Results: Patients had a preoperative maximal interincisal opening of 1 to 9 mm (mean, 2.75 mm). During the last follow-up observation after surgery, patients had a maximum interincisal opening of 32 to 40 mm (mean, 36.5 mm). Deviation to the affected side was observed in all cases. Paresthesia or anesthesia of the temporal branch of facial nerve was absent in all cases. Periodic panoramic radiographs showed that the intra-articular space was well maintained because of interposed tissue, without signs of relapse. There were no signs of reankylosis in any patient.Conclusion: The findings of this study show that the temporalis fascia is a good alternative for interpositional arthroplasty.

Musical Intervention Reduces Patients' Anxiety in Surgical Extraction of an Impacted Mandibular Third Molar - Corrected Proof

Yu- Kyoung Kim, Soung-Min Kim, Hoon Myoung — 2010-08-13

Purpose: Patients undergoing impacted mandibular third molar (IMTM) extraction often have severe perioperative anxiety, which may lead to increased perceptions of pain and vital sign instability throughout surgery. Intraoperational musical interventions have been used during operations to decrease patient anxiety levels. We investigated the anxiolytic effects of musical intervention during surgical extraction of an IMTM. We tested the hypothesis that musical intervention would have positive effects on patients' vital signs, anxiety levels, and perceptions of pain.Patients and Methods: We recruited 219 patients with IMTM surgery to participate in this study. Participants were randomly assigned to a music-treated group (106 subjects) or a control group (113 subjects). In a preoperative meeting, patient demographic data were collected, and the patients' favorite songs were selected. For the music-treated group, their selected music was played from the time of arrival to the operating room until the end of the operation. Perioperative anxiety and perceptions of pain were assessed using the Dental Anxiety Scale and the Visual Analog Scale, respectively. Patients' vital signs (blood pressure, heart rate, and respiratory rate) were monitored throughout the surgery. One-way analysis of covariance using perioperative anxiety as a covariant was performed to compare intraoperative anxiety levels and perioperative perceptions of pain between the 2 groups. Repeated measures analysis of variance was used to compare changes in vital signs across surgical stages between the 2 groups.Results: Vital signs changed significantly throughout surgery according to the stage of the procedure. For both groups, vital signs increased from baseline and reached peak values at the time of the initial incision and then decreased quickly and plateaued within normal limits. There were no significant differences between groups in blood pressure; however, the music-treated group showed a significantly smaller change in heart rate than the control group. The music-treated group reported significantly less intraoperative anxiety than the nonmusic-treated control group when controlling for preoperative anxiety levels (F = 4.226, P < .05).Conclusion: These results support the hypothesis that the use of patient-chosen music during surgical extraction of an IMTM significantly lowers patient intraoperative anxiety levels.

Improving Esthetic Results in Benign Parotid Surgery: Statistical Evaluation of Facelift Approach, Sternocleidomastoid Flap, and SuperficialMusculoaponeurotic System Flap Application - Corrected Proof

Bernardo Bianchi, Andrea Ferri, Silvano Ferrari, Chiara Copelli, Enrico Sesenna — 2010-08-13

Purpose: The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed.Patient and Methods: From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant.Results: No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference (P < .0001) for all groups. Also, when group 2 was compared with groups 3 and 4, the difference was highly significantly different statistically (P = .0018 for group 3 and P = .0005 for group 4). Finally, when groups 3 and 4 were compared, the difference was not statistically significant (P = .3467).Conclusion: Partial parotidectomy is the real key point for improving esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely used for parotid benign tumor resection. The use of a facelift incision alone led to a high statistically significant improvement in the esthetic outcome. When the facelift incision was used with reconstructive techniques, such as the sternocleidomastoid muscle flap or the superficial musculoaponeurotic system flap, the esthetic results improved further. Finally, no statistically significant difference resulted comparing the use of the superficial musculoaponeurotic system and the sternocleidomastoid muscle flap.

Oral Mucoceles: A Clinicopathologic Review of 1,824 Cases, Including Unusual Variants - Corrected Proof

Angela C. Chi, Paul R. Lambert, Mary S. Richardson, Brad W. Neville — 2010-08-13

Purpose: To review the clinicopathologic features of oral mucoceles, with special consideration given to unusual variants and exclusion of salivary duct cysts.Materials and Methods: This was a retrospective consecutive case review of all oral mucoceles diagnosed by the Medical University of South Carolina, Oral Pathology Biopsy Laboratory, from 1997 to 2006. The following data were recorded: patient demographics, clinical features (anatomic location, color, size, and consistency), clinical impression, history of trauma, history of periodic rupture, and occurrence of unusual mucocele variants.Results: During the study period, 1,824 oral mucoceles were diagnosed. Of these cases, 1,715 represented histopathologically confirmed cases that were not recurrences. There was no significant gender predilection, and the average age was 24.9 years. The most common locations were the lower labial mucosa (81.9%), floor of mouth (5.8%), ventral tongue (5.0%), and buccal mucosa (4.8%); infrequent sites included the palate (1.3%) and retromolar area (0.5%). The lesions most often were described as blue/purple/gray or normal in color. The mean maximum diameter was 0.8 cm (range, 0.1 to 4.0 cm). In 456 cases, a history of trauma was reported, and in 366 cases a history of periodic rupture was reported. Unusual variants included superficial mucoceles (n = 3), mucoceles with myxoglobulosis (n = 6), and mucoceles with papillary synovial metaplasialike change (n = 2).Conclusions: Our results confirm the findings of previous investigators regarding the major clinicopathologic features of oral mucoceles. Special variants of oral mucoceles occur infrequently, although it is important to recognize these variants to avoid misdiagnosis.

Castleman's Disease of the Neck: Report of 4 Cases With Unusual Presentations - Corrected Proof

Lei Jiang, Liang Yu Zhao, Yuan Liu, Yun Fu Zhao — 2010-08-13

In 1956, Castleman et al first described the clinicopathologic entity of mediastinal lymphoid hyperplasia with hyalinization of follicles and interfollicular vascular formation. Subsequent reports described additional sites of disease, and different names were used for this entity, including Castleman's disease (CD) and angiofollicular or giant lymph node hyperplasia. CD represents a morphologically distinct form of lymph node hyperplasia rather than a neoplasm or hamartoma. The etiology and pathogenesis of CD are not completely understood. Microscopically, 2 major categories have been described. The first, designated as hyaline vascular type, shows large follicles scattered in a mass of lymphoid tissue. The follicles show marked vascular proliferation and hyalinization of their abnormal germinal centers. Many large cells with vesicular nuclei present in the hyaline center are follicular dendritic cells. There is a tight concentric layering of lymphocytes at the periphery of the follicles (corresponding to the mantle zone), resulting in an onion skin appearance. The second major morphologic category of CD is known as the plasma cell type. It is characterized by a diffuse plasma cell proliferation in the interfollicular tissue. The hyaline vascular changes in the follicles are inconspicuous or absent. CD is clinically heterogeneous with either solitary CD (SCD) or multicentric CD (MCD). More than 90% of the cases are of the hyaline vascular type, and the remainder are of the plasma cell type. The former usually presents with asymptomatic solitary mass and can mostly be treated effectively with surgery, whereas the plasma cell type often has a more aggressive course and tends to be MCD with systemic symptoms (including fever, night sweats, weight loss, and recurring infections) and multiple peripheral lymphadenopathies. CD with severe systemic manifestations and poor prognosis is frequently associated with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes), renal or pulmonary complications and malignancies, such as Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin lymphoma, and follicular dendritic cell sarcoma.

Biomechanical Stress Distribution on Fixation Screws Used in Bilateral Sagittal Split Ramus Osteotomy: Assessment of 9 Methods via Finite Element Method - Corrected Proof

2010-08-13

Purpose: The aim of this study was to assess the biomechanical stress tolerance of screws used in 9 fixation methods after bilateral sagittal split ramus osteotomy to determine which configuration leads to lesser force load on the cortical bone at fixation points.Materials and Methods: A 3-dimensional computerized model of a human mandible with posterior teeth was generated. The bilateral sagittal split ramus osteotomy was virtually performed on this model. The separated model was assembled with 9 fixation methods: single screw, 2 screws one behind the other, 2 screws one below the other, 3 screws in an L configuration, 3 screws in an inverted backward L configuration, miniplate with 2 screws, miniplate with 4 screws, 2 parallel plates (upper + lower border), and square miniplate with 4 screws. Then, 75-, 135-, and 600-N vertical loads were applied on the posterior teeth of these models. The stress distribution on the screw sites on the buccal cortex was measured by the finite element method.Results: In this model all the fixation methods withstood forces between 75 and 135 N. However, the single-screw and the 2-hole miniplate models showed that the stress distributions in the configurations were intolerable when 600 N of posterior force was applied. The results of this study indicated that the inverted backward L configuration with 3 bicortical screws was the most stable.Conclusion: Although this study indicated that the inverted backward L configuration with 3 bicortical screws was the most stable pattern, most of the patterns had adequate stability for clinical applications (mean, 125 N).

Soft Tissue Profile Changes After Bilateral Sagittal Split Osteotomy for Mandibular Setback: A Systematic Review - Corrected Proof

2010-08-13

Purpose: To evaluate the ratio of soft tissue to hard tissue in bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation.Materials and Methods: A literature search was performed using PubMed, Medline, CINAHL, Web of Science, the Cochrane Library, and Google Scholar Beta. From the original 766 articles identified, 8 articles were included. Two articles were prospective and 6 retrospective. The follow-up period ranged from 1 year to 12.7 years for rigid internal fixation. Two articles on wire fixation were found to be appropriate for inclusion.Results: The differences between short- and long-term ratios of the lower lip to lower incisors for bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation were quite small. The ratio was 1:1 in the long term and by trend slightly lower in the short term. No distinction was seen between the short- and long-term ratios for mentolabial fold. The ratio was found to be 1:1 for the mentolabial fold to point B. In the short term, the ratio of the soft tissue pogonion to the pogonion showed a 1:1 ratio, with a trend to be lower in the long term. The upper lip showed mainly protrusion, but the amount was highly variable.Conclusions: This systematic review shows that evidence-based conclusions on soft tissue changes are difficult to draw. This is mostly because of inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measurements. Well-designed prospective studies with sufficient samples and excluding additional surgery, ie, genioplasty or maxillary surgery, are needed.

Alveolar Ridge Augmentation Using Lingual Tori - Corrected Proof

Jae H. Jun, Zachary Peacock, M. Anthony Pogrel — 2010-08-13

The prosthetically guided placement of dental implants in atrophic alveolar ridges will often necessitate bone augmentation in a staged fashion. Several bone augmentation techniques including onlay bone grafts have been shown to have high success rates when dental implants are placed in the grafted sites. Of all the available extraoral and intraoral sites for harvesting bone grafts, the mandibular ramus and symphysis have been the most commonly used donor sites during in-office procedures because of their decreased associated potential morbidity and excellent success rates. Intraoral exostoses can provide a viable alternative cortical bone graft source. These benign outgrowths of bone are often removed as a separate outpatient surgical procedure because of inferences with prostheses or for other reasons. There have been 5 case reports showing harvested intraoral exostoses used as onlay grafts for alveolar ridge deficiencies. We present a case using a similar technique in a patient who presented with a horizontally deficient anterior mandibular alveolar ridge and extensive lingual tori and desired implant therapy.

Giant Cell Granuloma With Aneurysmal Bone Cyst Change Within the Mandible During Pregnancy: A Management Dilemma - Corrected Proof

2010-08-09

Central giant cell granuloma (CGCG) is a benign osteolytic lesion typically arising within the mandible or maxilla. CGCG has an annual incidence of 1.1 per 1 million persons, and it accounts for 7% of all benign tumors affecting the mandible. CGCG has a propensity to develop in young female patients, with 60% of cases occurring in patients who are under 30 years of age. Rapid growth has been reported to occur during pregnancy, suggesting that these tumors may be under hormonal control. Studies to date have only identified estrogen receptors in peripheral giant cell granulomas of the gingiva, and no progesterone receptors have yet been identified.

Oral Candidal Colonization in Cleft Patients as a Function of Age, Gender, Surgery, Type of Cleft, and Oral Health - Corrected Proof

Ma'amon A. Rawashdeh, Jafar A.M. Ayesh, Azmi M.-G. Darwazeh — 2010-08-06

Purpose: To assess the colonization rate of oral Candida species and the influence of age, gender, oral health status, number of surgeries, and type of cleft.Patients and Methods: A prospective study of 60 patients with cleft and 60 control subjects was carried out at the Cleft Centre at King Abdullah University Hospital and the Maxillofacial Unit at Jordan University of Science and Technology between October 2007 and June 2008. Oral health was assessed using the Gingival, Plaque, and Decayed, Missing, and Filled (DMFT/dmft) indexes using World Health Organization criteria. A culture swab was obtained from the tongue and buccal and palatal mucosae. Candida albicans and other Candida species were identified using the germ tube test and the automated biochemical test panel VITEK.Results: The colonization rate of Candida in patients with cleft (63.3%) was significantly higher than in healthy control subjects (18.3%). The colonization rate of Candida and the distribution of C albicans varied with age but were not significantly associated with gender in patients with cleft and healthy controls. The candidal colonization rate was highest in patients with cleft who had at least 3 surgeries (78.2%) and in patients with bilateral clefts (77.7%). Patients with cleft had a significantly poorer health status than healthy controls; however, this was not influenced by the type of the cleft or the number of surgeries.Conclusion: Patients with cleft had a significantly higher rate of oral candidal colonization compared with control subjects, which varied with age, type of cleft, and the number of surgical interventions. Oral health status was significantly poorer in patients with cleft.

Acinic Cell Carcinoma of Minor Salivary Glands: A Clinical and Immunohistochemical Study - Corrected Proof

2010-08-05

Purpose: Acinic cell carcinoma is a rare malignant tumor of salivary glands. The purpose of this study is to evaluate the clinical outcome of acinic cell carcinoma in a group of 11 patients, who were treated in our clinic, and to discuss the management as well as the immunohistochemical features and prognosis of this carcinoma.Materials and Methods: The study included 11 patients with acinic cell carcinoma of the minor salivary glands who were treated in our clinic. The patients were 7 women and 4 men. The patients' age ranged from 46 to 83 years. The distribution of the primary sites was buccal mucosa (4) maxilla/maxillary sinus, etc, (2), hard palate (1), junction of soft/hard palate (1), lower lip (1), labio marginal sulcus (1), and vestibular sulcus and mandible (1). All patients were treated with surgery. Adjuvant radiotherapy was used in 3 patients. Immunohistochemical assay of expression of Ki-67, p53, EGFR, and c-erbB-2/neu markers was performed on specimens of all tumors.Results: The mean follow-up range was 2 to 15 years. Of the 11 patients, 7 were alive (2, 3, 4, 5, and 15 years after the initial therapy). Two patients died of another cause free of the disease 9 and 10 years after the initial treatment, and 2 patients died of the disease (local recurrence, distant metastases 2 and 3 years later). Overexpression of immunohistochemical markers was evident for tumors with widespread metastases.Conclusions: Acinic cell carcinoma is a rare malignant tumor of the salivary glands, characterized by an indolent clinical course with the potential for both local recurrence and distant metastases. The immunohistochemical analysis of proliferation markers provides additional prognostic information for this tumor.

Ameloblastic Carcinoma of the Maxilla: A Report of 2 Cases - Corrected Proof

2010-08-05

Ameloblastic carcinoma is a rare, odontogenic malignancy of the jaws, and its presence in the maxilla is less common than in the mandible. Elzay classified malignant odontogenic tumors, and Slootweg and Muller provided definitions and nomenclature used to distinguish ameloblastic carcinoma from malignant ameloblastoma. Ameloblastic carcinoma is defined by its histologic presentation, which combines histopathologic features of ameloblastoma and malignancy (ie, a lack of differentiation, increased mitosis, hyperchromatism, and perineural or perivascular invasion) that might or might not include metastasis. It can develop de novo (primary type) or by malignant transformation of an ameloblastoma (secondary type) with a distinction between carcinoma ex intraosseous ameloblastoma and carcinoma ex peripheral ameloblastoma. Malignant ameloblastoma is described as a metastasizing ameloblastoma presenting with benign histologic characteristics in primary and secondary tumors. In 2007, Hall et al revealed that ameloblastic carcinoma with a significant clear cell population recurred twice as often as the non–clear cell ameloblastic carcinoma group, with consequent lowered overall survival.

Boundary-Lubricating Ability and Lubricin in Synovial Fluid of Patients With Temporomandibular Joint Disorders - Corrected Proof

Lili Wei, Haofei Xiong, Bo Li, Yong Cheng, Xing Long — 2010-08-05

Purpose: This study was conducted to measure the boundary-lubricating ability and lubricin concentration of synovial fluid (SF) from patients with different stages of temporomandibular joint disorders (TMDs) and establish relationships between them.Patients and Methods: According to the imaging and clinical findings, TMD patients were divided into 3 subgroups: displaced disc with reduction, displaced disc without reduction, and osteoarthritis. The boundary-lubricating ability of SF was determined by the coefficient of friction (COF) of SF in vitro with a friction apparatus. The lubricin concentrations were quantified by enzyme-linked immunosorbent assays.Results: The COF of SF in TMD patients was significantly higher than that of healthy control subjects, but no observed difference was found among patient subgroups. Furthermore, a significant decline in lubricin concentrations was found in the group with osteoarthritis, whereas there was no significant change in the other groups. However, a significant correlation was not found between the COF and the lubricin concentrations in our study.Conclusions: These findings showed that distinct changes in lubricin and boundary-lubricating ability in the SF occurred with different stages of TMDs.

Mycobacterium lentiflavum—A Cause of Infections in the Head and Neck: Case Report and Literature Review - Corrected Proof

Jerome Philip, Satyajeet Bhatia, Adrian Sugar, Nidhika Berry, Michael Ruddy — 2010-08-05

Cervical lymphadenitis in children is the most common presentation of atypical mycobacterial infection. Mycobacterium lentiflavum is one of the species that has been recently identified and has shown multiple drug resistances. The treatment of these atypical mycobacterial infections is primarily surgical excision. We present a case of M lentiflavum and a review of the literature of atypical mycobacterial infections of the head and neck and their management.

Squamous Cell Carcinoma Recurrence Around Dental Implants - Corrected Proof

Joke De Ceulaer, Michèle Magremanne, Andy van Veen, Jan Scheerlinck — 2010-08-05

Purpose: The role of dental implants as part of functional and esthetic oral rehabilitationafter ablative intraoral tumor surgery has been established. The purpose of this article is to highlightthe phenomenon of tumor recurrence around dental implants.Materials and Methods: Twenty-one consecutive cases of patients all treated surgically for squamous cell carcinoma of the oral mucosa between January 2003 and December 2007 were reviewed, regardless of staging. Dental rehabilitation was established by means of oral implants. Fifty-six implants were placed either during tumor ablation surgery (16 patients) of afterward (5 patients). Radiotherapy was given according to the guidelines of the NWHNT (Netherlands Working group on Head and Neck Tumors).Results: In the group of simultaneous implantation, 3 patients developed local recurrence around oneof the implants. No recurrence was found in the group implanted in second stage surgery. Localrecurrence around a dental implant is a severe oncological setback that drew our attention.Conclusion: Influence on radiation fields and errors in surgical techniques are discussed, as well as the possibility of inducing changes in sensitized mucosa. Because of the small number of patients, no conclusions can be drawn. Further multicentered examinations should be performed.

Comparison of Treatment Outcomes Associated With Early Versus Late Treatment of Mandible Fractures: A Retrospective Chart Review and Analysis - Corrected Proof

2010-08-05

Purpose: We conducted outcomes assessment for all patients who had undergone treatment of mandible fractures at Tufts Medical Center across the 2 specialties of oral and maxillofacial surgery and otolaryngology. The aim of the present study was to determine whether a correlation existed between the development of postoperative complications and late treatment of mandible fractures (defined as treatment provided >48 hours after the time of injury).Patients and Methods: All patients with mandible fractures treated at Tufts Medical Center between January 1, 2003 and January 1, 2008, underwent chart review to document the relevant data, including the time of fracture, time of treatment, and complications recorded during postoperative follow-up. The only patients included in the review were those who had follow-up data with good documentation.Results: Our dataset included 92 patients, with a mean age of 28.74 years. The injury scores, compared between the early and late treatment and complication and noncomplication groups, were equivocal. Of our 92 treated patients, 19 (20.7%) had ≥1 postoperative complication. Of the 19 patients with any complication, 10 had undergone early treatment and 9 had been treated after 48 hours. Of our late treatment group, 25% developed ≥1 complication. The overall complication rate for the early group was 18%.Conclusions: Our study did not reveal a statistically significant difference in the development of postoperative complications after mandible fracture repair between the early and late treatment groups. Our study seemed to have a result similar to that of some of the earlier studies investigating the same variable.

Biomechanical Analysis Comparing Natural and Alloplastic Temporomandibular Joint Replacement Using a Finite Element Model - Corrected Proof

Michel Mesnard, Antonio Ramos, Alex Ballu, Julien Morlier, M. Cid, J.A. Simoes — 2010-08-05

Purpose: Prosthetic materials and bone present quite different mechanical properties. Consequently, mandible reconstruction with metallic materials (or a mandible condyle implant) modifies the physiologic behavior of the mandible (stress, strain patterns, and condyle displacements). The changing of bone strain distribution results in an adaptation of the temporomandibular joint, including articular contacts.Materials and Methods: Using a validated finite element model, the natural mandible strains and condyle displacements were evaluated. Modifications of strains and displacements were then assessed for 2 different temporomandibular joint implants. Because materials and geometry play important key roles, mechanical properties of cortical bone were taken into account in models used in finite element analysis.Results: The finite element model allowed verification of the worst loading configuration of the mandibular condyle. Replacing the natural condyle by 1 of the 2 tested implants, the results also show the importance of the implant geometry concerning biomechanical mandibular behavior. The implant geometry and stiffness influenced mainly strain distribution.Conclusion: The different forces applied to the mandible by the elevator muscles, teeth, and joint loads indicate that the finite element model is a relevant tool to optimize implant geometry or, in a subsequent study, to choose a more suitable distribution of the screws. Bone screws (number and position) have a significant influence on mandibular behavior and on implant stress pattern. Stress concentration and implant fracture must be avoided.

Predictors of Risk Tolerance Among Oral Surgery Patients - Corrected Proof

2010-08-05

Purpose: This study attempts to provide insight on how the treatment preference for a mandible fracture and treatment received and its consequences are related to the patient's risk tolerance, as measured by the Standard Gamble (SG).Patients and Methods: Data from a prospective cohort study of 203 subjects receiving treatment at the former King/Drew Medical Center in Los Angeles, CA, for either a mandible fracture (n = 98) or third molar removal (n = 105) were examined. Subjects were interviewed at 4 time points: on admission to the medical center and at 3 monthly follow-up visits. Risk tolerance for hypothetical treatment scenarios is measured by use of the SG, a health-value utility measure assessing the tradeoff between good outcomes and serious complications associated with treatment. Separate regression analyses with subsets of predictors (sociodemographic, psychosocial health, and clinical characteristics) were conducted and then synthesized by use of the significant predictors in separate analyses.Results: For fracture subjects, there was a noticeable rise in the SG reports from admission to the 1-month follow-up. Their greater risk tolerance was associated with being older, receiving surgery, having a lower post-traumatic stress disorder score, and having a swollen jaw or face. For third molar subjects, SG did not change substantively over the course of the study. Predictors of greater risk tolerance for third molar subjects included the jaw or face being swollen and having to use less pain medication.Conclusions: Findings from this study show a preference for less invasive treatment, with the majority of both groups preferring wiring, and support the theory that treatment choices differ between subjects with different health states. Factors associated with risk tolerance include the patient's age, treatment received, psychosocial health state, experience with previous treatment, and value for oral health quality of life.

A Comparative Study on the Extractions of Partially Impacted Mandibular Third Molars With or Without a Buccal Flap: A Prospective Study - Corrected Proof

2010-08-05

Purpose: The present report describes a flapless extraction method for partially impacted mandibular third molars and compares the effects of flap and flapless extractions of the teeth in terms of postoperative pain, swelling, and pocket depth of the second molar.Patients and Methods: A prospective study was performed of 27 patients who underwent bilateral extraction of partially impacted mandibular third molars. Two molars in the same patient were extracted on each side, either with or without a buccal flap.Results: The postoperative pain, swelling, and pocket depth of the second molar were all significantly greater on the side that underwent flap extraction than on the side that underwent flapless extraction (P < .05).Conclusions: Our results support the clinical use of flapless extractions when the distal surface of the crown is completely anterior to the anterior border of the mandibular ramus and the occlusal surface of the impacted tooth is level or nearly level with the occlusal plane of the second molar.

Evaluation for Clinical Predictors of Positive Temporal Artery Biopsy in Giant Cell Arteritis - Corrected Proof

2010-08-05

Purpose: To examine the clinical predictors of a positive temporal artery biopsy (TAB) among patients suspected of having giant cell arteritis.Patients and Methods: We conducted a retrospective study of all consecutive patients who underwent TAB by a single surgeon (K.L.R.) at the Department of Oral Maxillofacial Surgery from April 30, 2002, to June 29, 2006. The medical records were reviewed for the clinical symptoms, laboratory findings, biopsy results, and final diagnosis. The variables of interest as predictors of positive biopsy findings were analyzed using logistic regression analysis.Results: During the study period, 82 patients underwent TAB. Histologic evidence of arteritis was present in 22 patients (26.8%). Two (2.4%) were diagnosed with giant cell arteritis clinically but had negative TAB findings. The patients presenting with weight loss or jaw claudication were more likely to have a positive TAB finding (odds ratio 4.50, 95% confidence interval 1.45 to 13.93; and odds ratio 3.71, 95% confidence interval 1.28 to 10.76, respectively). No laboratory findings were predictive of a positive TAB finding. Prednisone use before TAB also was not associated with a decreased likelihood of a positive finding.Conclusions: Patients suspected of having giant cell arteritis were more likely to have a positive TAB finding if they presented with weight loss or jaw claudication. In the present series, corticosteroid therapy before biopsy did not affect the rate of positive TAB findings.

Comparing 3-Dimensional Virtual Methods for Reconstruction in Craniomaxillofacial Surgery - Corrected Proof

Stefano Benazzi, Sascha Senck — 2010-08-05

Purpose: In the present project, the virtual reconstruction of digital osteomized zygomatic bones was simulated using different methods.Materials and Methods: A total of 15 skulls were scanned using computed tomography, and a virtual osteotomy of the left zygomatic bone was performed. Next, virtual reconstructions of the missing part using mirror imaging (with and without best fit registration) and thin plate spline interpolation functions were compared with the original left zygomatic bone.Results: In general, reconstructions using thin plate spline warping showed better results than the mirroring approaches. Nevertheless, when dealing with skulls characterized by a low degree of asymmetry, mirror imaging and subsequent registration can be considered a valid and easy solution for zygomatic bone reconstruction.Conclusions: The mirroring tool is one of the possible alternatives in reconstruction, but it might not always be the optimal solution (ie, when the hemifaces are asymmetrical). In the present pilot study, we have verified that best fit registration of the mirrored unaffected hemiface and thin plate spline warping achieved better results in terms of fitting accuracy, overcoming the evident limits of the mirroring approach.

Bone Healing After Bur and Er:YAG Laser Ostectomies - Corrected Proof

Gustavo Lisboa Martins, Edela Puricelli, Carlos Eduardo Baraldi, Deise Ponzoni — 2010-08-05

Purpose: Ostectomies, performed by different methods, are often necessary in oral and maxillofacial surgery. Rotatory and reciprocating devices are most frequently used but have disadvantages, such as noise, vibration, and the potential for inducing thermal damage. Laser systems are interesting alternatives to these procedures. We analyzed bone healing in a rat model after mandibular ostectomy with a surgical bur or noncontact erbium:yttrium-aluminum-garnet laser using different energy levels.Materials and Methods: Four groups of 5 rats each underwent ostectomy of the bone cortical of the mandibular body, with irrigation, using a surgical bur or erbium:yttrium-aluminum-garnet laser with different energy parameters. A metal plate was used for morphologic standardization of the cavities. The samples collected after 7, 14, 45, 60, and 90 days were analyzed by optical microscopy.Results: The ostectomies performed with surgical burs resulted in bone healing from the cortical endosteum and remaining trabecular bone. The cortical endosteum was repaired after 45 days, followed by bone remodeling. After laser irradiation, healing involved bone neoformation from the external cortical surface and endosteum. Surface regions with thermal damage were observed after laser treatment in the 3 conditions used up to day 60, followed by bone remodeling.Conclusions: Laser ostectomies resulted in a thin layer of thermal damage. Bone healing was faster when surgical burs were used, with similar results reached after 90 days.

In Vitro Oral Biofilm Formation on Triclosan-Coated Sutures in the Absence and Presence of Additional Antiplaque Treatment - Corrected Proof

2010-08-05

Purpose: This study evaluated the in vitro plaque inhibitory effect of triclosan-coated polyglactin 910 sutures in the absence and presence of an additional antiplaque agent commonly used after oral surgery.Materials and Methods: Triclosan-coated sutures were incubated for 4 hours in freshly collected human saliva and, when appropriate, subsequently treated with an antiplaque rinse containing chlorhexidine-cetyl pyridinium as active components. Sutures without a triclosan-coating served as a control.Results: Triclosan-coated sutures harbored similar amounts of plaque as did uncoated sutures. Exposure to the antiplaque rinse caused significant decreases in viable organisms for uncoated and triclosan-coated sutures. However, after application of the antiplaque rinse, more micro-organisms were found on triclosan-coated than on uncoated sutures.Conclusion: Sutures coated with triclosan do not provide a sufficient antimicrobial effect to prevent in vitro colonization by oral bacteria, whereas use in combination with a chlorhexidine-cetyl pyridinium–containing antiplaque rinse appears to be counterproductive.

Pattern of Lymphatic Spread From Carcinoma of the Buccal Mucosa and its Implication for Less Than Radical Surgery - Corrected Proof

Manoj Pandey, Mridula Shukla, C.S. Nithya — 2010-08-05

Purpose: With emerging evidence, focus is shifting to conservative neck procedures aimed at achieving good shoulder function without compromising oncologic safety.Patients and Methods: Retrospective analysis of 100 consecutive neck dissections for carcinoma of the buccal mucosa was carried out to evaluate the pattern of lymphatic spread. Pathologic results were correlated with clinical/radiologic findings. Survival was calculated with the Kaplan-Meier method and log-rank test.Results: Only 36 patients were found to harbor metastasis in the lymph nodes on pathologic examination. Most of these were present in levels I and II only. Skip metastasis was not detected in any patient. None of the patients was found to have involvement of level V nodes, whereas 1 patient had involvement of level IV. Thirty-four patients developed recurrences; 3-year disease-free survival was 48%.Conclusions: Lymphatic spread from carcinoma of the buccal mucosa is low. Involvement of level IV is seen in only 1% of patients. A more conservative approach to the neck in patients with carcinoma of the buccal mucosa is recommended.

Comparative Study of the Prognosis of an Extracorporeal Reduction and a Closed Treatment in Mandibular Condyle Head and/or Neck Fractures - Corrected Proof

2010-08-05

Purpose: The objective of this study was a comparison of the prognosis between an extracorporeal reduction technique and closed treatment of a mandibular condyle fracture. The relationship between condylar resorption and several clinical variables was also studied.Patients and Methods: Seventy-one patients who had a mandibular condyle fracture took part in this study. Thirty-five patients (female: 7, male: 28, age: 30.46 ± 14.27 years) were treated by extracorporeal reduction, and 36 patients (male: 24, female: 12, age: 24.28 ± 9.99 years) were treated using a closed treatment. The presence of complications such as condylar resorption, malocclusion, nerve disorder, and disc displacement was evaluated with panoramic radiographs and clinical examinations 12 months after treatment. The relationships between the complications and other clinical variables were evaluated statistically.Results: The anatomic site and fracture type were closely related to condyle resorption in the bivariate analysis. Condylar head fractures showed significantly higher condyle resorption than condylar neck fractures (P = .023). A complex or compound fracture showed significantly higher condyle resorption compared with a simple fracture (P = .006). Patients who had a complex/compound fracture were 34.366 times more likely to have condyle resorption compared with those who had a simple fracture (P = .002). The patient's age and treatment method were also significant predictors for condyle resorption.Conclusion: Fracture type was the strongest predictor of condylar resorption. Because treatment method and patient age were also related to the prognosis, the optimal treatment for mandibular condylar head and/or neck fractures should be individualized according to the patient's condition.