Journal of Oral and Maxillofacial Surgery - Articles in Press

Effectiveness of Fibrin Adhesive in Facial Nerve Anastomosis in Dogs Compared With Standard Microsuturing Technique - Corrected Proof

2012-01-30

Purpose: Epineural suturing is the most common technique used for peripheral nerve anastomosis. In addition to the foreign body reaction to the suture material, the surgical duration and difficulty of suturing in confined anatomic locations are major problems. We evaluated the effectiveness of fibrin glue as an acceptable alternative for nerve anastomosis in dogs. Methods: Eight adult female dogs weighing 18 to 24 kg were used in the present study. The facial nerve was transected bilaterally. On the right side, the facial nerve was subjected to epineural suturing; and on the left side, the nerve was anastomosed using fibrin adhesive. After 16 weeks, the nerve conduction velocity and proportion of the nerve fibers that crossed the anastomosis site were evaluated and compared for the epineural suture (right side) and fibrin glue (left side). The data were analyzed using the paired t test and univariate analysis of variance. Results: The mean postoperative nerve conduction velocity was 29.87 ± 7.65 m/s and 26.75 ± 3.97 m/s on the right and left side, respectively. No statistically significant difference was found in the postoperative nerve conduction velocity between the 2 techniques (P = .444). The proportion of nerve fibers that crossed the anastomotic site was 71.25% ± 7.59% and 72.25% ± 8.31% on the right and left side, respectively. The histologic evaluation showed no statistically significant difference in the proportion of the nerve fibers that crossed the anastomotic site between the 2 techniques (P = .598). Conclusions: The results suggest that the efficacies of epineural suturing and fibrin gluing in peripheral nerve anastomosis are similar.

Proposal of a Presurgical Algorithm for Patients Affected by Obstructive Sleep Apnea Syndrome - Corrected Proof

2012-01-30

Purpose: To propose an algorithm for the preoperative management of patients with obstructive sleep apnea syndrome (OSAS) and review the surgical outcomes in such patients. Materials and Methods: This prospective cohort study involved 71 patients with OSAS who underwent presurgical upper airway endoscopy and cephalometry before being assigned to treatment categories based on the site(s) of obstruction, the pattern of collapse, the characteristics of the soft tissue, the air space between the base of the tongue and the posterior wall of the pharynx, and the severity of OSAS. Six months after surgery, they were followed up using polysomnography and the Epworth Sleepiness Scale. The pre- and postsurgical data were compared using a paired Student t test. Results: The mean preoperative apnea/hypopnea index of the 71 patients (61 male and 10 female) was 40.98 events/hour (range, 14.7 to 87.6 events/hr), and the mean postoperative apnea/hypopnea index was 13.96 events/hour (range, 0 to 20 events/hr). The difference was statistically significant (P < .001). Conclusions: This algorithm was developed on the principle that every patient with OSAS should be considered individually. In the authors' opinion, taking into account the number, site(s), pattern, and degree of the collapse/obstruction is a reasonable means of ensuring the correct diagnosis and treatment.

Relatively Rare Entity of Avascular Necrosis of Maxillary Bone Caused by Gaucher's Disease—A Case Report - Corrected Proof

N. Senthil Kumar, Reena Rachel John, Elangovan Rethish — 2012-01-30

Avascular necrosis is cellular death of bone components due to interruption of the blood supply. Without the vascular supply, the bone tissue dies and the bone collapses. It can affect any bone, but most commonly affects the epiphysis of the long bones. The disease can affect just one bone, more than one bone at the same time, or more than one bone at different times.

Titanium Mesh as an Alternative to a Membrane for Ridge Augmentation - Corrected Proof

Soobok Her, Taeheon Kang, Matthew J. Fien — 2012-01-30

Purpose: The purpose of the present study was to determine the rate and extent of complications associated with using titanium mesh for bone regeneration and to identify which factors might be associated with postoperative complications, such as infection, soft tissue exposure, and graft failure. Materials and Methods: A retrospective study design was used to analyze the treatment outcomes of 27 consecutive surgical sites in the maxilla and mandible that were treated with bone grafting in conjunction with fixation of titanium mesh. The primary study variable was whether the surgical sites treated with titanium mesh presented with any postoperative complications such as exposure of the titanium mesh and/or graft failure. A secondary study variable was whether treatment with bone grafting and fixation of titanium mesh provided the necessary bone augmentation required for subsequent dental implant placement. The predictor variables of maxillary versus mandibular surgical site and the type of bone graft material used were studied to determine whether any relationship exists between these variables and the aforementioned postoperative complications. Results: A total of 27 consecutive sites in the maxilla and mandible that required substantial bone augmentation and were treated with titanium mesh were evaluated for 6 to 24 months after surgical treatment. Exposure of titanium mesh was seen in 7 (26%) of the 27 surgical sites evaluated. No significant difference in the exposure rate was seen between the maxilla and mandible or according to the type of graft material used. All 69 implants placed were in function, and the success rate was 100%. Conclusions: The findings from the present study indicate that substantial bone augmentation can be achieved using titanium mesh in conjunction with bone grafting. Furthermore, exposure of titanium mesh during healing does not necessarily compromise the final treatment outcome.

Low-Grade Mucoepidermoid Carcinoma of the Palate—A Previously Unreported Case of Metastasis to the Liver - Corrected Proof

2012-01-30

Intraoral low-grade mucoepidermoid carcinoma (MEC) is not known to metastasize to the liver. This type of malignant salivary gland tumor is comparatively rare and has a well-defined set of parameters guiding histolopathologic grading into low to high grade. Although distant and regional lymph node metastases have been reported in about 15% of all MEC cases, tumors diagnosed as low grade have only very rarely been implicated. We present a case, as yet unreported, in which cervical lymph node and hepatic metastatic spread occurred from a primary low-grade MEC of the hard palate. A 33-year-old man presented with a 4-week history of painful, right-sided palatal ulceration crossing the midline. Imaging revealed cervical lymph node involvement and metastatic liver deposits. Tissue diagnosis supported a low-grade palatal MEC with histologic identical hepatic metastases. We examined the clinical features of this rare case, reviewed the published data, and discuss the histologic features and treatment of such patients.

Clinical Features and Outcomes of Head and Neck Castleman Disease - Corrected Proof

2012-01-30

Purpose: To increase the understanding of head and neck Castleman disease (CD) and to improve its diagnosis and management. Patients and Methods: A retrospective study was performed on the medical records of 14 patients with cervical CD treated at the Sun Yat-sen University Cancer Center from January 2000 through December 2009. The predictor variables were age, gender, site, size, and treatment modality. The outcome variables were survival time and recurrence. Results: Neck level II (9/14) was the most common site for CD. On computed tomogram, all 14 cases appeared as nodular and cylindrical-shaped lesions growing along the neck. Computed tomogram showed a uniform density and clear margins of the lesions. Thirteen cases with hyaline-vascular type CD showed significant enhancement on enhancing computed tomographic scans. One case with plasma-cell type CD accompanied by Hodgkin lymphoma showed mild heterogeneous enhancement and a strong vascular shadow inside the lesion. Thirteen patients with unicentric CD underwent regional resection. Follow-up time ranged from 14 to 132 months, during which none of the patients relapsed. Conclusions: The results of this study suggest that head and neck CD has a low incidence and that the most common site is unilateral level II. Regional resection was the first choice for the treatment of unicentric CD. Overall, chemotherapy was associated with a poor prognosis in patients with multicentric CD. Future studies will focus on the early diagnosis and treatment of multicentric CD. Long-term follow-up is also necessary.

Comparative Evaluation of Antimicrobial Effects of Er:YAG, Diode, and CO2 Lasers on Titanium Discs: An Experimental Study - Corrected Proof

Emre Tosun, Ferda Tasar, Robert Strauss, Dolunay Gulmez Kıvanc, Cem Ungor — 2012-01-30

Purpose: This study examined carbon dioxide (CO2; 10,600 nm), diode (808 nm), and erbium (Er):yttrium-aluminum-garnet (YAG; 2,940 nm) laser applications on Staphylococcus aureus contaminated, sandblasted, large-grit, acid-etched surface titanium discs and performed a comparative evaluation of the obtained bactericidal effects and the applicability of these effects in clinical practice. Materials and Methods: This study was carried out in 5 main groups: Er:YAG laser in very short pulse (VSP) emission mode, Er:YAG laser in short pulse (SP) emission mode, diode laser with a 320-nm fiber optic diode laser with an R24-B handpiece, and CO2 laser. After laser irradiation, dilutions were spread on sheep blood agar plates and, after an incubation period of 24 hours, colony-forming units were counted and compared with the control group, and the bactericidal activity was assessed in relation to the colony counts. Results: The CO2 laser eliminated 100% of the bacteria at 6 W, 20 Hz, and a 10-ms exposure time/pulse with a 10-second application period (0.8-mm spot size). The continuous-wave diode laser eliminated 97% of the bacteria at 1 W using a 10-second application with a 320-μm optic fiber, 100% of the bacteria were killed with a 1-W, 10-second continuous-wave application with an R14-B handpiece. The Er:YAG laser eliminated 100% of the bacteria at 90 mJ and 10 Hz using a 10-second application in a superpulse mode (300-ms exposure time/pulse). The Er:YAG laser also eliminated 99% to 100% of the bacteria in VSP mode at 90 mJ and 10 Hz with a 10-second application. Conclusions: The results of this study show that a complete, or near complete, elimination of surface bacteria on titanium surfaces can be accomplished in vitro using a CO2, diode, or Er:YAG laser as long as appropriate parameters are used.

Nasolabial Soft Tissue Changes After Le Fort I Advancement - Corrected Proof

Sivabalan Vasudavan, Yasas S.N. Jayaratne, Bonnie L. Padwa — 2012-01-30

Purpose: To identify the nasolabial soft tissue changes that occur after Le Fort I advancement. Materials and Methods: A prospective study of patients who had Le Fort I advancement at the Children's Hospital Boston from 2005 to 2007. The pre- and postoperative anthropometeric nasolabial measurements were recorded by a single examiner. Results: A total of 37 patients with a mean age of 18.6 years at the time of operation and a mean follow-up of 12.6 months were recruited. Nearly one half of the study sample (16 of 37) had cleft lip/palate. Direct anthropometry showed a reduction of the nasal length by 1.3 mm while the nasal tip protrusion increased by 1.1 mm. The nasofrontal angle decreased by 9.8° and the upper lip moved forward by 4.15 mm, reflecting the advancement in the maxilla. The height of the cutaneous upper lip increased by 0.4 mm. No significant differences were found in the soft tissue response observed between the cleft and noncleft subjects. Conclusions: Le Fort I advancement produces elevation of the nasal tip, as seen by a reduction in the nasal length, an increase in the nasal tip protrusion, and a concomitant reduction in the nasofrontal angle. Additionally, the cutaneous lip height increased, most likely due to an unfurling of the upper lip.

Preoperative Incisional and Intraoperative Frozen Section Biopsy Techniques Have Comparable Accuracy in the Diagnosis of Benign Intraosseous Jaw Pathology - Corrected Proof

2012-01-30

Purpose: To compare the accuracy of intraoperative frozen section (FS) and preoperative incisional biopsy (IB) techniques to diagnose benign intraosseous jaw lesions. Materials and Methods: This is a retrospective cohort study composed of subjects with benign intraosseous jaw lesions. The predictor variable was the technique for establishing a preliminary diagnosis of the lesion, preoperative IB or intraoperative FS. The outcome variable was the accuracy of the biopsy technique when compared with the final histologic diagnosis and was classified as concordant or discordant. The comparative diagnostic accuracy of the techniques was assessed with the χ2 test. Results: A total of 71 subjects met inclusion criteria. The mean age was 39 years (range, 5 to 85 years), and 58% (41) were male patients. Of the subjects, 20 (28%) underwent IB. In 14 (70%) of these, the results of biopsy agreed with the final diagnosis. 51 (72%) underwent intraoperative FS and in 31 (62%) of these, the results of biopsy agreed with the final diagnosis. The difference in diagnostic accuracy between IB (70%) and FS (61%) was statistically insignificant (P = .48). Sources of biopsy error included sampling error (46%), insufficient epithelial tissue (15%), inflammation (15%), pathologist's experience (8%), and artifact (4%). Conclusions: Preoperative IB and intraoperative FS provide comparable accuracy of diagnosis in patients with benign intraosseous jaw pathology. Sampling error was the most common reason for discordant results.

Multiple Impacted Teeth and Associated Pericoronal Tissue Abnormality in Tuberous Sclerosis Complex - Corrected Proof

Kelly R. Magliocca, Indraneel Bhattacharyya, Rolf B. Wolfrom, Donald M. Cohen — 2012-01-30

Tuberous sclerosis complex (TSC), also known as Bourneville disease or tuberous sclerosis, is a multisystem disease characterized by the formation of hamartomatous growths, caused by inactivating mutations at 1 of 2 genetic loci. TSC 1 is located at chromosome 9q34, the product of which is known as hamartin. Tuberous sclerosis complex 2 (TSC2) is a gene located on chromosome 16p13 and is more commonly implicated in cases of sporadic TSC. The TSC2 product is known as tuberin, and TSC2 mutations may be associated with more severe disease. These genetic alterations induce the development of hamartomas in multiple organ systems. Analysis suggests an autosomal dominant mode of transmission, but many cases arise spontaneously.

High-Grade Supraclavicular Soft Tissue Sarcoma as Secondary Malignancy After Successful Treatment of Acute Myeloid Leukemia: Case Report and Literature Review - Corrected Proof

2012-01-27

It is well known that the treatment protocols for hematopoetic neoplasms carry a high risk of long-term oncogenicity. However, few reports have been published of sarcomas as secondary malignancies. An unusual case report of a soft tissue sarcoma appearing as a secondary cancer is presented, with a review of the published data. The present report involves a soft tissue sarcoma of the neck that occurred 18 years after curative treatment of acute myeloid leukemia by induction chemotherapy and bone marrow transplantation. Consecutive graft-versus-host disease affected the cervical skin. Soft tissue sarcomas appearing as secondary tumors are rare in oncology. The presented case describes the appearance of a sarcoma 18 years after curative treatment of acute myeloid leukemia. This is only the second case of this type reported in published studies.

Malignant Ameloblastoma: Concurrent Presentation of Primary and Distant Disease and Review of the Literature - Corrected Proof

Aaron J. Berger, Ji Son, Nikhil K. Desai — 2012-01-27

Malignant ameloblastoma is a rare tumor of odontogenic origin with a metastatic focus. Distant metastatic disease is found most commonly in the lungs. A review of the literature shows that most cases of malignant ameloblastoma involve a disease-free period from primary tumor extirpation to the discovery of metastasis. This report describes the case of a 56-year-old man presenting with ameloblastoma of the maxilla and a solitary pulmonary metastasis concurrently. This represents a rare case in which there is a simultaneous diagnosis of primary ameloblastoma and a metastatic lesion. Appropriate workup for ameloblastoma includes surveillance for metastatic disease. Surgical resection of primary and distant disease is recommended. Chemotherapy and radiation may play a role in palliation when resection of metastatic disease is not feasible.

Sliding Anterior Hemitongue Flap for Posterior Tongue Defect Reconstruction - Corrected Proof

David K. Lam, Allen Cheng, Karim E. Berty, Brian L. Schmidt — 2012-01-27

Posterior tongue defects present a unique reconstructive challenge. The various reconstructive options available for treating the defect created by a posterior hemiglossectomy frequently result in a distorted tongue and functional impairment. This paper describes a novel sliding anterior hemitongue flap to allow reconstruction of moderate resection defects (i.e. for T1-T2 tongue squamous cell carcinomas) of the posterior tongue. By mobilizing the anterior tongue, near normal mobility and tongue length are maintained. This surgical technique may be performed alone intraorally or in combination with a neck dissection.

Foreign Body Reaction to Facial Dermal Fillers: Case Report - Corrected Proof

Whitney Florin, Louis Mandel — 2012-01-27

We present a patient who developed a delayed granulomatous reaction after injections of hyaluronic acid and bovine collagen glutaraldehyde that were introduced 6 and 4 years, respectively, previous to her present visit. She was a healthy 65-year-old woman, who was seen in November 2010 at the Columbia University Salivary Gland Center with a tentative diagnosis of a left buccal facial swelling caused by a “blocked parotid duct.” The swelling was only slightly painful and had developed 1 month previously after a periodontal surgical procedure that involved the maxillary left quadrant. Questioning indicated that the swelling did not fluctuate in size nor had it changed its configuration since its sudden inception 2 days after the periodontal surgery. Visibly, the swelling was slightly erythematous. Palpation caused only mild discomfort and revealed the swelling to be quite firm in tone. The lesion involved the left facial buccal tissues, with its extraoral center corresponding to the intraoral location of the parotid duct orifice. The swelling was diffuse, with no definitive outline. It measured approximately 3 cm horizontally and 3.5 cm in height. Posteriorly, palpation of the left parotid gland revealed the gland to be painless, normal in tone, and not swollen. No swelling or discomfort was evident on the right side. No trismus was present.

Optimal Care for Eyelid Contraction After Radiotherapy: Case Report and Literature Review - Corrected Proof

2012-01-24

Radiotherapy represents a major problem in facial surgery. Orbital and periorbital radiation therapy causes a contraction of the soft tissues. Scarring with ectropion is the most severe complication, with shrinking of the anterior lamella, skin dystrophy, muscle atrophy, and alteration of the remaining soft tissues. Goals for reconstruction include correction of distorted orbitofacial tissues and the restoration of orbital structures. The management of these patients is not standardized. We suggest systematically using a combined approach of surgery and lipofilling to restore the orbital deformity and dystrophy, respectively. For this purpose, we present the case of a 65-year-old woman with asymmetry of the orbital regions and severe lower eyelid cicatricial ectropion due to multiple radiation treatments in childhood for an extensive cavernous hemangioma of the right side of the face. We performed a reconstructive procedure using a tarsal strip technique in association with contralateral upper eyelid graft to correct the extensive retraction of the right lower eyelid and lid asymmetry. Subsequently, the patient underwent lipofilling to correct the post-radiotherapy dystrophy. Skin texture, softness, and elasticity greatly improved with further symmetrization. The combined treatment with surgery and lipofilling can significantly improve the functional and cosmetic outcome of shortened and dystrophic eyelids with a successful result with regard to post-radiotherapy retraction.

Mandibular Condylar Growth in Growing Rats After Experimentally Displaced Condylar Fracture With Associated Attachment Damage and Disc Displacement: An Observation by Polychrome Sequential Labeling - Corrected Proof

Zhi Li, Zu-Bing Li — 2012-01-24

Purpose: The purpose of this study was to evaluate mandibular condylar growth in growing rats after experimentally displaced condylar fracture with associated attachment damage and disc displacement by means of polychrome sequential labeling. Materials and Methods: We randomized 30 growing male Wistar rats into 3 equal groups: rats with experimentally displaced condylar fractures with associated attachment damage and disc displacement (experimental group); rats with experimentally displaced condylar fractures without associated attachment damage and disc displacement (control group); and rats that received no operative intervention (negative control group). Polychrome sequential labeling was used to establish chronologically oriented condylar growth characteristics in these rats. Three months after the operation, the specimens were obtained, fixed, dehydrated, and embedded in acrylic resin for fluorescence microscopy observation. In addition, the lateral-medial diameter (in millimeters) and mineral apposition rate (in micrometers per day) of condyles were measured and analyzed across the 3 groups. Results: The results showed condylar growth disturbance in the experimental group rats, presenting with no obvious and regular bone growth lines in the anamorphic condyle. However, in the control group and negative control group rats, the condylar growth was normal. Regarding the lateral-medial diameter and mineral apposition rate, there was a significant difference between the experimental group and control group, as well as between the experimental group and negative control group; however, there was no significant difference between the control group and negative control group. Conclusions: The occurrence of associated attachment damage and disc displacement in condylar fractures should be considered an important factor influencing the condylar growth after fracture.

Surgical Site Infection in Elderly Oral Cancer Patients: Is the Evaluation of Comorbid Conditions Helpful in the Identification of High-Risk Ones? - Corrected Proof

2012-01-24

Purpose: This study was performed to gain some knowledge on the possible relation between surgical site infection (SSI) and geriatric patients who undergo surgical treatment of oral squamous cell carcinoma and to identify the risk factors in this specific population. Patients and Methods: A retrospective study from 2004 through 2010 at the Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine was conducted. The primary outcome variable was the presence of SSIs. Twenty-seven variables of the patients concerning general characteristics, comorbidities, disease information, and treatment options were investigated. A multivariate analysis using logistic regression was implemented to find SSI risk factors. Results: The data of 376 patients (183 men, 48.7%; 193 women, 51.3%) older than 65 years with the diagnosis of oral squamous cell carcinoma were included in the present analysis. In multivariate logistic regression analysis, 6 parameters were identified for a significant and independent association with the development of SSI: body mass index (P = .0086); diabetes (P < .0001); American Society of Anesthesiologists score (P = .0127); Adult Comorbidity Evaluation-27 score (P = .0392); operation time (P = .0003); and reconstruction with pectoralis major myocutaneous flaps or free flaps (P < .0001). Conclusions: Special attention to SSIs should be given to elderly patients with oral squamous cell carcinoma. The authors advocate a preoperative evaluation of comorbidities and the selection of high-risk elderly patients for a more effective prevention of SSIs.

Leonard Buttons: A Reliable Method of Intraoperative Intermaxillary Fixation in Bilateral Mandibular Fractures - Corrected Proof

Naseem Ghazali, M. Emre Benlidayi, Neilufer Abizadeh, Robert P. Bentley — 2012-01-24

Purpose: To retrospectively audit outcomes of using Leonard buttons (LBs) as intraoperative intermaxillary fixation in conjunction with open reduction–internal fixation of bilateral mandibular fractures. Patients and Methods: Seventy-seven patients were included in this study. The fracture reduction score was obtained from postoperative radiographs by use of 3-tiered scoring system. Medical case notes were obtained for clinicodemographic data, including operation length, postoperative occlusion scores, periodontal status, and complications. Results: The cohort predominantly comprised male patients (87%), with a mean age of 26 years. The major cause of injury was interpersonal violence (87%). The fracture pattern most treated was angle-parasymphysis fracture (70.1%). The mean length of follow-up was 83.81 ± 79.33 days. The mean overall reduction score was 6.95 ± 1.03 in the LB group and 6.40 ± 1.68 in the arch bar (AB) group (P = .275). When the occlusion scores were evaluated, the difference between the 2 groups was statistically significant (P = .027). The mean operation length was shorter in the LB group compared with the AB group (142.05 ± 32.31 minutes vs 161.00 ± 24.04 minutes, P = .013). Oral hygiene was poor in 7 patients in the LB group (11.3%) and in 5 patients in the AB group (33.3%) (P = .05). No significant correlation was observed between number of LBs placed with overall reduction and occlusion scores. No significant relation was observed for number of LBs and periodontal status, infection, and nonunion. Conclusions: This pilot study suggests that LBs are able to achieve equally good reduction as ABs but have better occlusion scores, with a shorter operating time, and show better gingival health. LBs are a viable alternative to ABs in providing intraoperative intermaxillary fixation for bilateral mandibular fractures. However, further prospective, randomized studies should be undertaken to obtain conclusive evidence.

Evaluation of the Inferior Alveolar Canal for Cysts and Tumors of the Mandible—Comparison of Multidetector Computed Tomography and 3-Dimensional Volume Interpolated Breath-Hold Examination Magnetic Resonance Sequence With Curved Multiplanar Reformatted Reconstructions - Corrected Proof

2012-01-24

Objective: To evaluate the mandibular canal using volume interpolated breath-hold examination (VIBE) sequencing in patients with cysts and tumors of the mandible. Materials and Methods: Twenty-five patients with mandibular cysts and tumors were recruited for a study in the authors' institution to compare the role of multidetector row computed tomography with magnetic resonance imaging (MRI) in jaw lesions. Of these 25 patients, VIBE was performed in 12 patients (age range, 16 to 52 yrs; 11 male and 1 female patients) and formed the study group. The status (normal/destroyed/attenuated) and position of the inferior alveolar canal (normal/displaced) on panoramic reconstructed computed tomographic (CT) images and curved multiplanar reformatted (MPR) images reconstructed from VIBE images were analyzed. The contralateral normal mandibular canal was used as the control in these patients. Results: In all 12 patients, the inferior alveolar canal on the normal side was visualized as a hyperintense structure in relation to the hypointense bone on the curved MPR VIBE images. In 9 patients, the inferior alveolar canal was equally well visualized on panoramic CT and curved MPR VIBE images. In 2 patients, the inferior alveolar canal was better visualized on curved MPR VIBE images; in 1 patient, the course of the mandibular canal was better seen on panoramic CT images. Conclusions: MR reconstructions with VIBE sequencing as source images provide images comparable to CT reconstructed images for evaluation of the mandibular canal. Three-dimensional (3D) VIBE sequencing can be added to the MR protocol to visualize the inferior alveolar neurovascular bundle. 3D VIBE sequencing increases the diagnostic capabilities of MRI when used to image mandibular cysts and tumors.

Intra-Articular Corticosteroid Injections to the Temporomandibular Joints Are Safe and Appear to Be Effective Therapy in Children With Juvenile Idiopathic Arthritis - Corrected Proof

2012-01-24

Purpose: The purpose of this study was to evaluate the safety and efficacy of intra-articular corticosteroid injections (IACIs) of the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA) when administered by an oral and maxillofacial surgeon without imaging guidance. Materials and Methods: This was a retrospective study of children with JIA, seen at a single center, who were selected based on having received IACIs of the TMJ. All subjects received the intervention, which consisted of referral to a single oral and maxillofacial surgeon for TMJ IACI with 5 to 10 mg triamcinolone hexacetonide, under general anesthesia. Primary outcomes assessed in all subjects were the safety of the procedure and efficacy as determined by the change in maximal incisal opening (MIO). In addition, a subset of 31 subjects underwent repeat magnetic resonance imaging of the TMJ, permitting analysis of the change in the acute and chronic findings of arthritis in those patients. Results: Sixty-three patients (68% female) received 137 IACIs. The mean age for diagnosis of JIA was 8.5 years, and the mean age at presentation for TMJ injections was 10 years. The injections were well tolerated: only 1 patient developed the steroid complication of hypopigmentation, and none developed degeneration or ankylosis. In terms of efficacy, the mean MIO increased from 40.8 ± 0.93 to 43.5 ± 0.90 mm (P = .001); in addition, changing the unit of analysis to individual joints, in patients who underwent repeat magnetic resonance imaging examination, 51% of TMJs showed magnetic resonance imaging evidence of improvement of arthritic changes, of whom 18% had complete resolution of TMJ arthritis. Conclusions: The results indicate that IACI of the TMJ can be safely performed by experienced oral and maxillofacial surgeons without a requirement for computed tomographic guidance. In addition, these results show that IACI may be effective in the management of TMJ arthritis, although further studies are required.

Use of Autologous Skin Equivalents With Artificial Dermal Matrix (Integra) in Donor Site Coverage in Radial Forearm Free Flaps: Preliminary Cases - Corrected Proof

2012-01-24

Purpose: The radial forearm flap is one of the most commonly used methods for intraoral reconstruction in oral carcinoma surgery. One of its disadvantages is the residual functional and unaesthetic defect in the donor site. The objective of this report is to describe preliminary cases of a novel method to cover such donor sites based on the use of autologous skin equivalents (ASEs) and an artificial dermal matrix (Integra, Prim, Barcelona, Spain). Materials and Methods: The donor sites of 2 patients were treated with the artificial dermal matrix after raising a radial forearm flap. A skin biopsy and a blood sample were taken to construct an ASE. After 3 weeks, the ASE was applied over the dermal template and left to heal. The functional and esthetic results were recorded. Results: Good functional and esthetic results were achieved, with correct wrist motility, although a natural skin color could not be achieved. Neither the Integra nor the ASE was rejected. Total wound coverage was achieved at 4 months, and completely normal skin was observed at 6 months. Conclusions: This technique of combining an artificial dermal matrix with an ASE could be an alternative method to cover the donor sites of radial forearm flaps.

Late Solitary Metastasis of Renal Cell Carcinoma to the Submandibular Gland - Corrected Proof

Sam M. Serouya, Linda A. Dultz, Seth J. Concors, Beverly Wang, Kepal N. Patel — 2012-01-24

Metastatic renal cell carcinoma to the head and neck is rare. Most reported cases of metastases to the head and neck involve the thyroid and parotid glands. Metastasis to other salivary glands is exceedingly rare. This report describes a case of a solitary metastasis of renal cell carcinoma to the submandibular gland 9 years after nephrectomy. To the authors' knowledge, this is the first case successfully diagnosed preoperatively using a combination of fine-needle aspiration and clinical history. The patient subsequently underwent a submandibular gland resection with preservation of the facial nerve branches. For the 3 years since resection of the submandibular gland, the patient has been free of disease.

Simple Bone Cyst of the Mandibular Condyle in a Child: Report of a Case - Corrected Proof

2012-01-16

The simple bone cyst is a relatively unusual lesion that occurs in the jaws and in the long bones of the skeleton. In general, the lesion is asymptomatic and often discovered by chance during routine radiographic examination. The nature and etiology have not been established conclusively, and this fact is reflected by the different terms used to describe the condition. These terms include traumatic bone cyst, hemorrhagic bone cyst, solitary bone cyst, and progressive bone cavity. Most simple bone cysts of the jaw are located in the body or symphysis of the mandible. Only a few cases have been reported in the mandibular condyle. This report describes a case of a simple bone cyst in the mandibular condyle in a child.

Is Lag Screw Fixation Superior to Plate Fixation to Treat Fractures of the Mandibular Symphysis? - Corrected Proof

Edward Ellis — 2012-01-03

Purpose: The purpose of this investigation was to evaluate outcomes for patients treated with lag screw or plate and screw fixation for fractures of the mandibular symphysis. Patients and Methods: The investigator implemented a retrospective cohort study and enrolled a sample of patients with symphysis fractures. The primary predictor variable was treatment group categorized as lag screw or plate fixation of the fracture. The primary outcome variables were postoperative complications. Other variables collected were grouped into demographic, anatomic, radiographic, and preoperative variables. Appropriate descriptive and bivariate statistics were computed and statistical significance was set at P < .05. Results: Eight hundred eighty-seven patients met the inclusion criteria. Four hundred seventy-six were treated with bone plates and 411 were treated with lag screws. There were no significant differences in demographic data for the 2 groups. There were no statistically significant differences in occlusal or osseous healing outcomes. However, there were significant differences in treatment outcomes for several variables, including wound dehiscence, plate exposure, and the need for hardware removal between the groups. Conclusions: Plating and lag screw techniques showed very good outcomes. There were more intraoperative difficulties placing lag screws than bone plates, but the application of lag screws was associated with fewer postoperative complications.

Reconstruction of Alveolar Defects Using Titanium-Reinforced Porous Polyethylene as a Containment Device for Recombinant Human Bone Morphogenetic Protein 2 - Corrected Proof

Kristopher L. Hart, Dylan Bowles — 2012-01-03

Purpose: The use of recombinant human bone morphogenetic protein 2 (rhBMP-2) in a collagen carrier is a proven alternative to autogenous bone grafting for certain cases. One of the principle limitations of rhBMP-2 at present, however, is the lack of a reliable rigid containment system to prevent soft tissue collapse of the collagen carrier sponge. The present case series describes the use of titanium-reinforced porous polyethylene as a containment device for rhBMP-2–grafted alveolar defects. Patients and Methods: A case review was performed of 8 patients who had undergone rhBMP-2 bone grafting using porous polyethylene as the containment device. Eight maxillary and two mandibular alveolar defects were grafted using rhBMP-2 and titanium-reinforced porous polyethylene as a soft tissue barrier. One patient received autologous ramus bone in addition to the rhBMP-2. All patients were followed up by clinical examination and periodic radiographic studies for 6 months to 2 years. Implant-borne prostheses were fabricated on all successful grafts. Results: Of the 10 grafted alveolar defects, 2 (20%) resulted in early exposure of the containment devices, were removed, and resulted in no bone formation one of the 10 defects (10%) became exposed 3 months postoperatively and resulted in only moderate bone formation. In the 7 nonexposed cases (70%), bone formation was excellent, and implants were successfully placed. Conclusions: Titanium-reinforced porous polyethylene might be a useful alternative containment device for rhBMP-2–grafted alveolar defects. The exposure rate of 30% in the present case series is comparable to that for titanium alone. Modifications to the shape and thickness of the material might improve its use in alveolar reconstruction and further reduce the incidence of exposure. Further studies are needed; however, titanium-reinforced porous polyethylene could become a new addition to the armamentarium of clinicians grafting alveolar defects.

Spindle Cell Lymphoma of the Oral Cavity: A Case Report and Review of the Literature - Corrected Proof

2012-01-03

Prominent spindle cell or sarcomatoid morphology is an infrequent finding in lymphomas. Anaplastic large cell lymphoma with the T- or null-cell phenotype is the most common type of lymphoma to exhibit sarcomatoid features. However, spindle cell variants of B-cell lymphomas have rarely been reported. Many such cases have been described as cutaneous spindle cell B-cell lymphomas, which typically present as solitary or clustered skin nodules with a predilection for the skin of the head, neck, and back. The origin of spindle cell B-cell lymphomas is uncertain, with previous investigators favoring classification as a variant of follicular lymphoma or diffuse large B-cell lymphoma. The present report describes the first well-documented case of spindle cell B-cell lymphoma arising within the oral cavity. In addition, the literature is reviewed for spindle cell B-cell lymphomas involving the head and neck region, in addition to other sites.

Myofibromas of the Jaws in Children - Corrected Proof

2012-01-03

Purpose: Controversy exists as to the most appropriate treatment strategy for myofibromas of the jaws: en bloc resection versus enucleation. The purpose of the present study was to evaluate the treatment outcomes in children with these uncommon benign tumors. Materials and Methods: We performed a retrospective chart review of pediatric patients with jaw myofibromas. The predictor variables included patient demographics, clinical presentation, imaging characteristics, pathologic features, treatment, and follow-up. The outcome variable was cure or recurrence. The descriptive statistics were computed. Results: A total of 12 patients (mean age 6.7 years) met the inclusion criteria. There were 2 presentations: exophytic soft tissue mass in dentoalveolar segment (n = 5); and intraosseous mass (n = 7). No distinct histopathologic differences were found between the 2 groups. Exophytic myofibromas displayed rapid growth, tooth displacement and/or mobility, bony expansion, and/or cortical thinning/perforation. Most were treated by resection. The intraosseous lesions were asymptomatic and/or incidentally discovered. They were treated by enucleation and curettage. The mean follow-up for the 2 groups was 6.5 and 3.9 years, respectively. There were no recurrences. Conclusions: The results of the present study indicate that there are 2 clinical presentations of myofibromas of the jaws in children: an aggressive exophytic type and a nonaggressive intraosseous type. They are histopathologically indistinguishable.

Actinomycotic Brain Abscess and Subdural Empyema of Odontogenic Origin: Case Report and Review of the Literature - Corrected Proof

Christopher J. Haggerty, Gabriel C. Tender — 2012-01-03

Actinomyces are gram-positive, nonacid-fast, branching filamentous prokaryotic microorganisms with anaerobic or microaerophilic requirements. Actinomyces species are part of the normal flora of the oropharyngeal cavity, specifically concentrated in the tonsillar crypts, the surface of carious teeth, and the gingival pocket. Actinomycosis is rarely a pathologic concern because of the organism's low virulence and does not appear to be an opportunistic disease because there is no specific predisposition toward immunocompromised individuals. Direct trauma, tooth extraction, root canal therapy, and periodontal or periapical abscesses compromise the integrity of the oral mucosa and are believed to be the most common mechanisms of pathogenesis.

Clinical and Dental Computed Tomographic Evaluation 1 Year After Coronectomy - Corrected Proof

2012-01-03

Purpose: Coronectomy is performed when contact between the mandibular third molar apex and the inferior alveolar nerve is suspected. The efficacy of coronectomy compared with conventional tooth extraction has been recognized in recent years. However, few studies have reported the postoperative prognosis of roots remaining in the bone or surrounding tissue. Therefore, a clinical evaluation was performed with dental computed tomographic imaging of the coronectomy sites 1 year after the procedure. Patients and Methods: This study investigated 101 patients (116 teeth) who underwent a coronectomy from March 2006 through December 2009. They were recalled 1 year later for a clinical evaluation and dental computed tomographic imaging of the coronectomy sites. The clinical evaluation was based on palpation and macroscopic findings. Results: In 99.2% (115 teeth) of the studied cases, the soft tissue distal to the mandibular second molar was healthy and the retained roots were covered by bone. In 1 case (0.8%), an eruption of roots into the oral cavity was observed; however, no inflammation was observed in the nearby soft tissue. In all 116 teeth, no transmission images indicative of periapical lesions, which usually result from necrosis of the pulp, were observed in the apical area of the retained roots. Conclusions: The absence of transmission images indicative of periapical lesions and the presence of bone covering more than 99.2% (115 teeth) of the retained roots showed a safe postoperative course at the 1-year follow-up after coronectomy.

Long-Term Donor-Site Morbidity After Microsurgical Fibular Graft: Is There a Difference Between the Medial Approach and the Lateral Approach? - Corrected Proof

2012-01-03

Purpose: Microvascular fibula harvesting for osseous reconstruction is a valuable aid in maxillofacial surgery. We assessed whether the lateral and the medial harvesting techniques differed with respect to long-term donor-site morbidity. Materials and Methods: We conducted a retrospective cohort study of patients who had undergone free fibula harvesting at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany, between 1987 and 2008. The primary predictor variable was the surgical approach. The primary and secondary outcome variables were the American Orthopaedic Foot & Ankle Society score and the result of the Short Form 36 Health Survey on quality of life, respectively. Other variables were age, gender, harvest length, operation time, and specific impairments and surgical complications. Statistical analysis was performed with SPSS, version 14.0 (SPSS, Chicago, IL); P < .05 was considered significant. Results: The 42 patients had a mean age of 55.5 years. The mean follow-up period was 81 months (range, 7-174 months). In the medial group, the mean American Orthopaedic Foot & Ankle Society score was 94.4 points and the total number of impairments was 34, as compared with 85.6 points and 46 impairments, respectively, in the lateral group. This tendency for less morbidity with the medial approach was only found in female patients. The Short Form 36 scores were not statistically different between the 2 surgical approaches. Conclusions: The medial approach led to less functional impairment of the foot and ankle. Our results support the medial approach as a viable alternative, especially in women, but only in cases when a skin paddle is not necessary.

Operative Management of Temporomandibular Joint Ankylosis: A Systematic Review and Meta-Analysis - Corrected Proof

Alexander Katsnelson, Michael R. Markiewicz, David A. Keith, Thomas B. Dodson — 2012-01-03

Purpose: Two common treatments of temporomandibular joint ankylosis are gap arthroplasty and ankylosis resection and reconstruction of the ramus–condyle unit with a costochondral graft. The purpose of the present study was to answer the following clinical question: “Among patients with temporomandibular joint ankylosis, do those patients who undergo gap arthroplasty, compared with those who undergo ankylosis resection and ramus–condyle unit reconstruction with a costochondral graft have better postoperative mandibular range of motion?” Methods: A systematic search of the published data was performed to identify eligible studies. The primary predictor variable was treatment type (ie, gap arthroplasty or ankylosis resection and ramus–condyle unit reconstruction). The main outcome was the change in maximal incisal opening postoperatively. A random effects model was used to compute the pooled weighted mean difference between the pre- and postoperative maximal incisal opening in both treatment groups. Results: Four studies met the inclusion criteria. Those undergoing gap arthroplasty had a significantly greater maximal incisal opening than the group undergoing ankylosis resection and ramus–condyle unit reconstruction. The weighted mean difference between the 2 groups was 2.4 mm (95% confidence interval 0.9 to 4.0; P = .002). Conclusions: Subjects with temporomandibular joint ankylosis who underwent gap arthroplasty had significantly better postoperative maximal incisal opening than those undergoing ankylosis resection and ramus–condyle unit reconstruction with a costochondral graft.

A Study of Epidemiologic and Recurrence Factors of Oral Cancer - Corrected Proof

2012-01-03

Purpose: To analyze the epidemiologic characteristics and recurrence factors of oral squamous cell carcinoma (OSCC) in northwest China. Patients and Methods: Patients with OSCC whose first visits to the Stomatology Hospital of the Fourth Military Medical University from January 2007 through December 2008 were investigated. The epidemiologic risk factors and recurrence of OSCC were studied with logistic regression and a Cox regression model. Results: The mean age of all 414 patients with OSCC was 58.16 ± 9.92 years; 67.15% were men, 43.24% were cigarette smokers, and 26.09% came from rural areas. In addition, 49.03% of these patients were diagnosed at an early stage. One hundred forty-seven patients developed recurrence of the disease, and the median progression-free survival was 7.3 months (range, 1.1 to 32.5 mo). The recurrence rate was approximately 35.5%. Conclusion: The study indicated that smoking habit, older age, and living in rural areas were the high-risk epidemiologic factors for OSCC. Smoking habit and late clinical stage were the high-risk factors for the recurrence of OSCC.

Caldwell-Luc Operation Without Inferior Meatal Antrostomy: A Retrospective Study of 50 Cases - Corrected Proof

Yu-Chen Huang, Wen-Ho Chen — 2012-01-03

Purpose: In the standard Caldwell-Luc operation, an inferior meatal antrostomy is performed to promote sinus drainage. However, inferior meatal antrostomy has been criticized for its additional operation time and wound, early loss of the opening, and risk of injury to the nasolacrimal duct. This study retrospectively reviewed the results of the Caldwell-Luc operation without inferior meatal antrostomy in the treatment of odontogenic maxillary sinusitis or odontogenic sinus disease. Patients and Methods: The records of 50 patients who had an odontogenic sinus disease and underwent the Caldwell-Luc operation without inferior meatal antrostomy were reviewed. The data included the patient's age, gender, surgical indications, surgical condition, and complications. Results: From April 2004 to October 2010, there were 27 male patients and 23 female patients aged 14 to 70 years (mean, 37 years) who underwent the modified Caldwell-Luc operation. The surgical indications included intrasinus odontogenic cysts (44%), oroantral fistulae with chronic sinusitis (44%), odontoma (4%), odontogenic sinusitis (4%), and foreign bodies in the maxillary sinus (4%). The patients were successfully treated with minimal complications. Conclusions: The modified Caldwell-Luc operation provides easier postoperative care and involves fewer complications. It is not necessary to create the inferior meatal antrostomy in the Caldwell-Luc operation when treating odontogenic sinus disease.

Commissural Symmetry in Unilateral Transverse Facial Cleft Patients: An Anthropometric Study - Corrected Proof

Jingto Li, Kun Liu, Jiayu Sbi, Yan Wang, Qian Zbeng, Bing Sbi — 2012-01-03

Purpose: To evaluate the commissural symmetry and commissural migration among patients with unilateral transverse facial cleft. Patients and Methods: From 2006 to 2009, 31 patients with unilateral transverse facial cleft were repaired with superiorly based vermillion-mucosal flap and orbicularis oris reconstruction. Linear closure and superiorly rotated and inferiorly rotated Z-plasty were randomly chosen for skin closure. An anthropometric method was used immediately after the repair and at the follow-up examination to evaluate the commissural symmetry in both horizontal and vertical directions. Results: A total of 21 patients was followed-up for 19 months on average. Satisfactory horizontal symmetry was obtained right after surgery; however, the new commissure was generally lower than the unaffected commissure. At the follow-up examination, no significant lateral commissural displacement was observed; however, the commissural droop on the cleft side became more noticeable. Conclusions: The anthropometric method used was convenient and reliable for facial symmetry analysis. Rectangular vermillion-mucosal flap and proper muscle reconstruction could prevent the lateral commissural migration caused by skin scar contracture. Both horizontal and vertical symmetry should be considered for macrostomia repair.

Effect of Rigid Fixation on Orthodontic Finishing After Mandibular Bilateral Sagittal Split Setback: The Case for Miniplate Monocortical Fixation - Corrected Proof

Heon Jae Cho — 2011-12-26

Purpose: This report reviews the diagnosis and management of patients with Class III skeletal patterns and discusses the rationale for monocortical plate fixation after bilateral sagittal split osteotomy for surgical precision, stability, and postsurgical management of patients with setback. Materials and Methods: Two cases with significant Class III sagittal skeletal discrepancies were identified. The cases, which required maxillary advancement and mandibular setback surgery, are presented to describe the rationale and advantages for the monocortical rigid fixation method. Conclusions: Monocortical plate fixation after bimaxillary surgery for the correction of Class III skeletal malocclusions has the advantages of excellent stability and latent postsurgical adjustability, qualities that are essential for favorable treatment outcomes.

Retrospective Study of Tracheostomy Indications and Perioperative Complications on Oral and Maxillofacial Surgery Service - Corrected Proof

Alan C. Haspel, Vincent F. Coviello, Mark Stevens — 2011-12-26

Purpose: Tracheostomy is an extremely common procedure performed by a variety of surgical specialties. The purpose of the present study was to review the intraoperative and perioperative management and complications, present our surgical technique, and discuss the role of our service in providing this care within a large community hospital setting. Patients and Methods: The 112 patients in our retrospective study were divided into 3 subsets: those referred by medical specialties, tumor/reconstructive surgery patients, and trauma victims. Cases of percutaneous dilational and intensive care unit bedside tracheostomy were excluded. Intraoperative and immediately postoperative complications were included. Bleeding complications were defined as those necessitating a return to the operating room. The patients were followed up for a 24-hour period postoperatively. Results: The medical referral, tumor/reconstructive, and trauma patients made up 55%, 29%, and 16% of the included patients, respectively. The overall complication rate was 2.7%. Conclusions: Conventional open tracheostomy in an operating room is associated with a low complication rate. The low incidence of perioperative bleeding can be attributed to the use of electrocautery in the division of the thyroid isthmus. This service provided an exceedingly safe and efficient surgical treatment by focusing on precise surgical protocols in an operating room setting. Intense coordination of consultation response, operating room scheduling, and communication with other services involved in these patients' care is critical to develop and maintain the privilege to provide this treatment. Our report can be used to educate the medical community regarding the role of an oral and maxillofacial surgery service in providing tracheostomy.

Clinical Application of a Hyperdry Amniotic Membrane on Surgical Defects of the Oral Mucosa - Corrected Proof

2011-12-26

Purpose: The aim of this study was to evaluate the usefulness of a hyperdry amniotic membrane (AM), a novel preservable human amnion, as a wound-dressing material for surgical defects of the oral mucosa. Materials and Methods: A hyperdry AM was used in the treatment of 10 patients who had developed secondary defects in the tongue and buccal mucosa after the surgical removal of cancerous or precancerous lesions. The effectiveness of the hyperdry AM was assessed by scoring its operability during the surgical procedure and by the hemostatic status, pain relief, feeding situation, epithelialization, and scar contracture in the postoperative period. Its usefulness was evaluated by considering its effectiveness and safety based on the absence of wound infection and graft rejection. Results: The membrane was found to be easy to handle as an oral-dressing material. It adhered well to the bare connective and muscular tissues. One lingual case showed slight postoperative bleeding, which astriction then stopped. No remarkable adverse effects were observed in the process of wound healing. The average score of the patients was 11.2 points (10 to 13 points) in the present evaluation, with 14 being the highest possible score. Conclusions: This study showed the clinical usefulness of the hyperdry AM as an intraoral wound-dressing material. Although the number of cases was small, the results suggested that the hyperdry AM is biologically acceptable to oral wounds and could be a suitable clinical alternative for the repair of the oral mucosa.

Osteonecrosis of the Maxilla Associated With Cancer Chemotherapy in Patients Wearing Dentures - Corrected Proof

2011-12-19

Osteonecrosis of the jaw (ONJ) in patients with cancer and hematologic diseases associated with chemotherapy, but not receiving treatment with bisphosphonates (BPs), is a very rare condition. However, as long-term survival of patients receiving chemotherapy increases, the occurrence of this serious complication may also increase. We identified 2 patients in our department who presented with maxillary osteonecrosis (ON) as a complication of aggressive cancer chemotherapy. They had exposed necrotic bone in close relation to the misuse of removable dental prostheses. We are presenting these cases to point out that cancer chemotherapy in patients wearing dentures may lead to an increased risk of ON, which may require prophylactic measures to ensure proper maintenance of dental prostheses.

Risk Factors Affecting Hemorrhage After Tooth Extraction in Patients Undergoing Continuous Infusion With Unfractionated Heparin - Corrected Proof

Yoshinari Morimoto, Hitoshi Niwa, Kazuo Minematsu — 2011-12-19

Purpose: To identify the risk factors affecting the incidence of postoperative hemorrhage (POH) associated with tooth extraction in patients undergoing continuous infusion with unfractionated heparin. Patients and Methods: In the present retrospective study, the medical records of patients who had undergone tooth extraction during continuous infusion of unfractionated heparin were reviewed. The primary predictor variables were demographics (age, gender), heparin dose and degree of anticoagulant effect (activated partial thromboplastin time [APTT]), total number of extracted teeth and number of extracted teeth per occasion, and type of tooth extraction (simple extraction or surgical extraction). The primary outcome variable was the incidence of POH. The incidence of POH in each APTT category was also evaluated. The Mann-Whitney U test, χ2 test, or Fisher exact test were used for comparison between the non-POH and POH groups and the incidence of POH stratified by the categorized APTT values. Logistic regression analysis was then used to detect the factors affecting POH. The level of statistical significance was P < .05. Results: Tooth extraction was performed on 35 occasions in 31 patients. POH occurred 10 times (28.6%). The comparison of the POH group (10 occasions) and non-POH group (25 occasions) showed that the median APTT value in the POH group (62 seconds) was significantly prolonged compared with that in the non-POH group (42 seconds). The incidence of POH was significantly greater in the group with an APTT of 57 seconds or greater. Logistic regression analysis revealed that the APTT was the only factor related to the occurrence of POH. Conclusions: The results of the present study suggest that POH in tooth extraction occurs often in patients with an APTT of 57 seconds or greater when the continuous heparin infusion cannot be stopped.

Microsurgical Repair of the Inferior Alveolar Nerve: Success Rate and Factors That Adversely Affect Outcome - Corrected Proof

2011-12-19

Purpose: The objectives of this study were to determine the likelihood of regaining functional sensory recovery (FSR) after microsurgical repair of the inferior alveolar nerve (IAN), and which variables significantly affected the outcome of that surgery in a large series of patients. Materials and Methods: This was a retrospective cohort study that evaluated all patients who had undergone microsurgical repair of the IAN by 1 of the senior surgeons (R.A.M.) from March 1986 through December 2005. The requirements for inclusion of a patient in the study included the availability of a complete chart record and a final follow-up visit at least 12 months after surgery. All other patients were excluded. The predictor variables were categorized as demographic, etiologic, and operative. The final outcome variable was the level of recovery of sensory function as determined by standardized neurosensory testing at the last postoperative visit of each patient and based on guidelines established by the Medical Research Council Scale. Risk factors for surgical failure to achieve useful sensory function were determined from analysis of descriptive statistics, including patient age, patient gender, etiology of nerve injury, chief sensory complaint (numbness, pain, or both), time from injury to surgical intervention (in months), intraoperative findings, and surgical procedure. Logistic regression methods and associated odds ratios were used to quantify the association between the risk factors and improvement. Receiver operator characteristic curve analysis was used to find the threshold of those variables that significantly affected patient outcome. Results: In total, 167 patients (41 male and 126 female patients; mean age, 38.7 years [range, 15-75 years]) underwent 186 IAN repairs (19 patients sustained bilateral IAN injuries). The mean time from injury until surgery was 10.7 months (range, 0-72 months). Successful recovery from neurosensory dysfunction (FSR, defined by the Medical Research Council Scale as ranging from useful sensory function to complete sensory recovery) was observed in 152 repaired IANs (81.7%). With increasing duration from date of injury to IAN repair, the likelihood of FSR decreased (odds ratio, 0.898; P < .001). The odds of achieving FSR exhibited a linear decline between the date of nerve injury and its repair, with a significant drop in rate of successful outcome (FSR) occurring beginning at 12 months after injury. There was also a significant negative relationship between increasing patient age and improvement (odds ratio, 0.97; P = .015), with a threshold drop of achieving FSR at 51 years of age. The cause of the injury, the operative findings, and the type of operation performed to repair the nerve had no significant effect on the likelihood of the patient regaining FSR. The presence of pain after nerve injury did not affect the likelihood of achieving FSR after repair in a statistically significant manner (P = .08). In those patients who did not have pain as a major complaint before nerve repair, pain did not develop after microneurosurgery. Conclusions: Microsurgical repair of an IAN injury resulted in successful restoration of an acceptable level of neurosensory function (FSR) in most patients (152 of 186 repairs [81.7%]) in this study. The likelihood of regaining FSR was inversely related to both time between the injury and its repair and increasing patient age, with significant threshold drops at 12 months after nerve injury and at 51 years of age, respectively.

Treatment Modalities of Neurosensory Deficit After Lower Third Molar Surgery: A Systematic Review - Corrected Proof

Yiu Yan Leung, Polly Pok-Lam Fung, Lim Kwong Cheung — 2011-12-19

Purpose: To conduct a systematic review to answer the clinical question, “What are the available treatment modalities and their outcomes of neurosensory deficit after lower third molar surgery?” Materials and Methods: A systematic search, including a computer search of several databases with specific keywords, a reference search, and a manual search of 3 key maxillofacial journals were performed. Relevant articles were then evaluated and those that fulfilled the 6 predetermined criteria were chosen to enter the final review. The various treatment modalities and their outcomes of neurosensory deficit after lower third molar surgery, in the selected studies in the final review, were analyzed. Results: Ten articles entered the final review. Six treatment modalities of lingual nerve or inferior alveolar nerve deficit after lower third molar surgery were identified. External neurolysis, direct suturing, autogenous vein graft, and a Gore-Tex tube as a conduit were the 4 surgical treatments. Significant improvement after surgical treatment ranged from 25% to 66.7%. Acupuncture and low-level laser therapy were 2 available nonsurgical treatment modalities that were found to have produced significant improvement in sensation after treatment in more than 50% of subjects. There was insufficient information to determine the best timing of treatment of nerve injury after third molar surgery. Conclusions: Four surgical treatments and 2 nonsurgical treatments were identified in the management of neurosensory disturbance after lower third molar surgery. Most treatments showed an improvement in sensation but the outcomes were variable. Complete recovery was uncommon in all kinds of available treatments.

Concomitant Removal of Mandibular Third Molars During Sagittal Split Osteotomies Minimizes Neurosensory Dysfunction: Comment - Corrected Proof

Joseph E. Van Sickels — 2011-12-19

I applaud the authors of this report for addressing this controversial topic in a well-performed clinical study. As with almost all clinical studies, there are a number of variables that are included in the sample that might or might not affect the outcome of the results. Among these are patient age, number of surgeons involved in the surgery, and concomitant procedures performed, such as a genioplasty. It is hoped that additional variables, other than the primary one being studied, are randomized in the samples so they will not affect the results. The authors are obviously very experienced surgeons, because their time to split a mandible with or without third molars was 12.4 ± 5.1 and 11.6 ± 5.3 minutes, respectively. Expeditious surgery alone will minimize the morbidity that the patient has after a surgical procedure.

Analysis of Propofol and Low-Dose Ketamine Admixtures for Adult Outpatient Dentoalveolar Surgery: A Prospective, Randomized, Positive-Controlled Clinical Trial - Corrected Proof

Joseph E. Cillo — 2011-12-19

Purpose: The purpose of this study was to evaluate the hemodynamic stability and efficacy of 3 different propofol-ketamine admixtures compared with a propofol–saline solution admixture for continuous-infusion intravenous general anesthesia in outpatient adult dentoalveolar surgery. Patients and Methods: This was a prospective, randomized, positive-controlled clinical trial between a propofol–saline solution admixture and 3 propofol-ketamine admixtures comprising 4 groups: group A (control), propofol and saline solution; group B, 10:1 propofol-ketamine ratio; group C, 5:1 propofol-ketamine ratio; and group D, 3:1 propofol-ketamine ratio. The bispectral index (BIS) was used to monitor all patients for time to induction (BIS <70) to recovery time (BIS >90). The outcome variables—noninvasive systolic, diastolic, and mean blood pressures; pulse; and BIS—were recorded at baseline and every 5 minutes during surgery. One-way analysis of variance and χ2 analysis were conducted on the groups to determine statistical significance, set at P < .05. Post hoc pair-wise comparisons with Bonferroni adjustments were conducted on statistically significant groups. Results: A total of 64 adult patients (37 men and 27 women; mean age, 27.3 years) who had dentoalveolar surgery under intravenous general anesthesia in an outpatient oral and maxillofacial surgery clinic setting were enrolled in this study. There were statistically significant differences between mean values of groups only for mean systolic blood pressure and mean blood pressure in groups A and D (127 mm Hg vs 146 mm Hg and 96 mm Hg vs 109 mm Hg, respectively). There were statistically significant differences in percent change from baseline measurements only between groups A and D for systolic blood pressure (−6.9% vs +1.3%), diastolic blood pressure (−5.4% vs +0.7), and mean arterial pressure (−0.5% vs +2.6%). All mean percent changes from baseline were within 20% of baseline. There were statistically significant differences between groups for number of boluses but not time to surgery start, movement on injection, or length of surgery. Statistically significant differences in recovery times were found between all groups except between groups A and C and groups C and D. There were no incidences of postoperative nausea or vomiting in the immediate postoperative period. Conclusions: Through maintenance of hemodynamic stability and faster recovery time, the group B admixture (10:1 propofol-ketamine ratio) provided the greatest benefit for continuous intravenous general anesthesia in adults undergoing dentoalveolar surgery in an outpatient clinic setting.

Use of Recombinant Bone Morphogenetic Protein 2 in Free Flap Reconstruction for Osteonecrosis of the Mandible - Corrected Proof

2011-12-19

Purpose: Osteoradionecrosis of the mandible is a debilitating consequence of radiation therapy for head-and-neck malignancy. It can result in pain, bone exposure, fistula formation, and pathologic fracture. Recombinant human bone morphogenetic protein 2 (rhBMP-2) has shown promise in reconstruction of bone defects. The purpose of this study is to determine whether the addition of rhBMP-2 at the union of vascularized bone and native bone improves surgical outcomes in patients with osteonecrosis of the mandible. Materials and Methods: This study was a retrospective analysis of patients who were treated between 2006 and 2010 for osteonecrosis of the mandible. Patients requiring definitive reconstruction after failure of a course of conservative management were included. Patients were divided into 2 cohorts depending on whether rhBMP-2 was used during the reconstruction. The primary outcome measure was defined as stable mandibular union. Results: Seventeen patients were included. The development of malunion was similar in both groups (13% for rhBMP-2 group vs 11% for non–rhBMP-2 group). Infectious complications were similar between the groups (25% in rhBMP-2 group vs 56% in non–rhBMP-2 group, P = .33). The rates of hardware removal were similar for the 2 groups (33% in non–rhBMP-2 group vs 25% in rhBMP-2 group, P = .10). No cancer recurrences were observed in patients receiving rhBMP-2. Conclusions: The use of rhBMP-2 is safe in free flap reconstruction of the mandible, but its ability to significantly improve patient outcomes, as measured by rates of malunion, reoperation, or infection, is still unknown.

Optimal Cutoff Point in Tumor Thickness Measurement by Ultrasonography: From Histopathologic Standpoint - Corrected Proof

Sachin C. Sarode, Gargi S. Sarode, Swarada Karmarkar — 2011-12-19

Recently, high-resolution diagnostic intraoral ultrasonography (USG) has been used in the literature for the determination of tumor thickness (TT). TT is thought to be one of the important predictive markers for lymph node (LN) metastasis in early oral squamous cell carcinoma. The advantage of USG is that it is a real-time, rapid, repeatable, noninvasive, radiation-free method. TT also allows the operator/observer to distinguish the tumor mass from the surrounding tissue. It is even more reliable than computed tomography scans and magnetic resonance imaging when dealing with very thin lesions. Of late, USG has been found to be an accurate and reliable tool for assessing surgical clearance for tongue carcinoma. We believe that this type of investigation will be helpful in developing countries where the organizational structure and economic factors limit the use of computed tomography scans and magnetic resonance imaging. However, in the literature, there is no consensus on the optimum cutoff point for predicting LN metastasis by use of USG. In 2005 Pentenero et al showed cutoff points ranging from 2 to 10 mm as prognostic factors in their review. Later, Lodder et al reviewed the studies published after 2005 and observed cutoff values ranging from 1.5 to 13 mm. It is unclear why these studies have shown such inconsistent results with reference to the cutoff measurement point.

The Supraclavicular Artery Flap: A Versatile Flap for Neck and Orofacial Reconstruction - Corrected Proof

Peter M. Nthumba — 2011-12-19

Purpose: The supraclavicular skin is thin and pliable; it closely resembles that of the neck and facial skin, making it the perfect source of tissue for neck and orofacial reconstructions. The author sought to provide a concise compilation of the use of the supraclavicular artery flap, including surgical landmarks, modifications, uses, common complications, and anomalies, and experience with the use of the flap in a sub-Saharan African country. Materials and Methods: A literature search was performed on the Internet and PubMed for anatomic and clinical studies/reports in the English language on the supraclavicular artery flap with a minimum of 10 subjects and sufficient data on postoperative complications. Results: Five anatomic studies (2 of which included clinical cases) and 12 clinical series qualified for inclusion. These articles included 146 flaps from 73 cadaveric studies and 376 supraclavicular flaps in patients (including a series of 22 flaps by the present author). The supraclavicular artery was present in 99% of anatomic dissections and was a branch of the transverse cervical artery in 91% of anatomic dissections. Safe margins for elevation of the supraclavicular artery flap were delimited anteriorly by the clavicle, posteriorly by the superior border of the trapezius, and distally by the insertion of the deltoid muscle. Common flap complications included tip and partial flap necroses. The flap was used successfully in nononcologic and oncologic reconstructions, even with concurrent neck dissection. Conclusions: The pedicled supraclavicular fasciocutaneous flap is emerging as a versatile reconstructive tool for the neck and orofacial regions. It is an excellent option, especially in resource-poor environments and in patients in whom free flaps may be technically difficult. Anatomic and clinical studies have shown it to be consistently reliable, with excellent color matching for the face and neck regions, and have established reliable surgical landmarks, modifications, uses, common complications, and anomalies.

Does Attribution of Blame Influence Psychological Outcomes in Facial Trauma Victims? - Corrected Proof

2011-12-19

Purpose: The relative importance of different variables and specific post-traumatic psychological reactions after facial injuries is poorly understood. The aim of the present study was to assess the association between the subjective attribution of blame and anxiety and depression in facial trauma victims. Materials and Methods: We undertook a comparative cross-sectional study of psychological outcomes in a cohort of adult patients who have sustained a facial injury. The primary predictor variable was the attribution of blame (self-blame vs blame-others). The main outcome variable was the Hospital Anxiety and Depression Scale (HADS) scores. We also considered several demographic and other clinical variables to assess their relationship with the nature of blame attribution. Cochran-Mantel-Haenszel statistics were used to assess the relationship between the primary predictor and outcome variables, adjusted for age, gender, and confounding factors. Results: The sample consisted of 102 facial trauma victims (77 men and 25 women). Of the 77 patients, 63 attributed blame for their injuries to someone else and 39 patients attributed blame to themselves. Psychometric scores suggestive of anxiety and the depressive state were significantly greater in the “blame-others” group than in the “self-blame” group (HADS-Anxiety 22% vs 13%, HADS-Depression 17% vs 8%). The prevalence of psychomorbidity in the blame-others group was approximately twice that found in the self-blame group (odds ratio 2.2). Facial trauma patients who blamed others for their injury were predominantly younger men (P = .01) and typically victims of intentional trauma (P < .001). Conclusions: The results of the present study suggest that external attribution of blame for facial injury is associated with poor postinjury psychiatric outcomes.

Adverse Events Reported After the Use of Recombinant Human Bone Morphogenetic Protein 2 - Corrected Proof

Emily Jane Woo — 2011-12-19

Purpose: The US Food and Drug Administration has approved recombinant human bone morphogenetic protein 2 (rhBMP-2) (Infuse Bone Graft; Medtronic Sofamor Danek, Minneapolis, MN) as an alternative to autogenous bone graft for sinus augmentations and for localized alveolar ridge augmentations for defects associated with extraction sockets. The objective of this analysis was to characterize adverse events reported after the use of rhBMP-2 in oral and maxillofacial procedures. Materials and Methods: The US Food and Drug Administration's Manufacturer and User Facility Device Experience database contains reports of adverse events involving medical devices. The publicly available version of the database was searched for reports for the brand name Infuse Bone Graft. Descriptive statistics were used to summarize the procedures and adverse events. Results: As of April 30, 2011, the Manufacturer and User Facility Device Experience database contained 83 reports of adverse events after oral and maxillofacial operations involving rhBMP-2. Of these reports, 55 (66.3%) described off-label uses, such as reconstruction of the mandible after fracture or cancer or alveolar cleft repair. The most commonly reported adverse events included local reactions, graft failure, infections, and other wound complications. Of the reports, 25 (30.1%) stated that the patient required additional surgery to address the reported adverse event. Conclusions: Serious adverse events, some of which may require a second operation, can occur after the use of rhBMP-2 in oral and maxillofacial procedures. In this analysis graft, failure and pseudarthrosis were more commonly reported after off-label uses of rhBMP-2 than approved uses.

Does Grafting of Third Molar Extraction Sockets Enhance Periodontal Measures in 30- to 35-Year-Old Patients? - Corrected Proof

Khalid S. Hassan, Hesham F. Marei, Adel S. Alagl — 2011-12-19

Purpose: This study was designed to evaluate the use of xenograft plus a membrane as grafting material for periodontal osseous defects distal to the mandibular second molar compared with nongrafted extraction sites after removal of impacted mandibular third molars. Materials and Methods: We performed a single-blind, randomized, controlled clinical trial, and the sample comprised of subjects at high risk for the development of periodontal osseous defects distal to the second molar after third molar extraction (aged 30-35 years), pre-existing osseous defects distal to the second molar, and horizontal third molar impaction. The predictor variable was the treatment status of the second molar osseous defects. The third molar extraction sites were grafted with an anorganic xenograft plus a membrane. The other sites received a full-thickness flap and extraction of the third molar without placement of the grafting materials. The outcome variables were the change in gingival index, pocket probing depth, and clinical attachment level on the distobuccal aspect of the second molar preoperatively and at 3, 6, 9, and 12 months after surgery. Data were statistically analyzed by multivariate analysis of variance, and the statistical significance was set at P < .05. Results: The study was composed of 28 sites that were selected by use of a split-mouth design for each patient, and this was randomly determined through a biased coin randomization. Twelve months after third molar removal, there was a statistically significant gain in the clinical attachment level and a reduction in the probing pocket depth in the grafted sites compared with the nongrafted sites (P < .001). Moreover, there was a significant difference in the alveolar bone height during the monitoring periods for the grafted sites compared with the nongrafted sites (P < .001). Conclusions: Grafting of osseous defects distal to mandibular second molars with an anorganic xenograft plus a membrane predictably resulted in a significant reduction in the probing pocket depth, clinical attachment level gain, and bone fill, which suggests that grafting the extraction sites with an anorganic xenograft plus a membrane could prevent periodontal disease in the future.

Ameloblastic Fibrosarcoma: Report of a Case, Study of Immunophenotype, and Comprehensive Review of the Literature - Corrected Proof

Jonathan Lai, Nick Blanas, Kevin Higgins, Hagen Klieb — 2011-12-19

Ameloblastic fibrosarcoma (AFS) is a rare odontogenic neoplasm exhibiting a benign ameloblastomatous epithelial component admixed within a sarcomatous mesenchyme. It is considered the malignant counterpart of ameloblastic fibroma (AF) and can arise de novo or from transformed AF. AFS is a locally aggressive tumor that seldom metastasizes. According to the World Health Organization classification, AFS is considered an odontogenic sarcoma. Other entities that fall under this category include ameloblastic fibrodentinosarcoma (AFDS), ameloblastic fibro-odontosarcoma (AFOS), and odontogenic carcinosarcoma (OCS). AFDS and AFOS are considered counterparts of AFS because they share the same histologic features, but they have additional dysplastic dentin and enamel and dentin, respectively. OCS has both a malignant ameloblastomatous component and a malignant mesenchyme. Clinically, all assume the same locally aggressive course as AFS. Previous studies have considered AFDS, AFOS, and AFS as 1 entity known as ameloblastic sarcoma. However, in the context of this report, we will consider AFS as an entity that possesses ameloblastomatous epithelium within a sarcomatous mesenchyme, with no evidence of dentin or enamel elements present ().