International Journal of Oral & Maxillofacial Surgery

Editorial Board

2012-05-01

The influence of a Le Fort I impaction and advancement osteotomy on smile using a modified alar cinch suture and V-Y closure: a prospective study

M.S.M. Muradin, A.J.W.P. Rosenberg, A. van der Bilt, P.J.W. Stoelinga, R. Koole — 2012-01-03

Abstract: A previous report from the authors’ department showed that a modified alar cinch suture combined with a muco-musculo-periosteal V-Y closure (mACVY) improves nasolabial mobility. To test if the improvements were equal to the range of nasolabial mobility in non-dysgnathic persons, a prospective study was carried out in 56 patients: 31 with mACVY, 25 with simple closing sutures (SCS) and 18 non-operated, angle class I volunteers. Standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively were used. The landmarks, alare, crista philtri and cheilion were analysed. The test has a standard deviation of 0.9mm. Intra-group changes, paired t-test, and inter-group differences, unpaired t-test (p<0.05) were statistically analysed. The results show significant preoperative differences in nasolabial mobility compared with the control group, for both groups. Postoperative mobility improved in both groups, but significantly with mACVY with horizontal movement of cheilion and alare, and the vertical movement of crista philtri and less so for the vertical movement of crista philtri with SCS. Postoperative inter-group differences in mobility were small and significant for SCS vs the control group. It can be concluded that using mACVY improves orofacial movement to the level of normal class I volunteers.

Skeletal and dental stability of segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up

C.U. Joss, A. Triaca, M. Antonini, S. Kiliaridis, A.M. Kuijpers-Jagtman — 2012-02-22

Abstract: 33 patients (27 females; 6 males) were retrospectively analysed for skeletal and dental relapse before distraction osteogenesis (DOG) of the mandibular anterior alveolar process at T1 (17.0 days), after DOG at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Skeletal correction (T3−T1) was mainly achieved through the distraction of the anterior alveolar segment in a rotational manner where the incisors were more proclined. The horizontal backward relapse (T4−T3) measured −0.8mm or 19.0% at point B (p<0.001) and −1.6mm or 25.0% at incision inferior (p<0.001). Age, gender, amount and type (rotational versus translational) of advancement were not correlated with the amount of relapse. High angle patients (NL/ML′; p<0.01) and patients with large gonial angle (p<0.05) showed significantly smaller relapse rates at point B. Overcorrection of the overjet achieved by the distraction was seen in a third of the patients and could be a reason for relapse. Considering the amount of skeletal relapse the DOG could be an alternative to bilateral sagittal split osteotomy for mandibular advancement in selected cases.

Soft tissue stability in segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up

C.U. Joss, A. Triaca, M. Antonini, S. Kiliaridis, A.M. Kuijpers-Jagtman — 2011-12-29

Abstract: This study evaluated soft tissue changes in adult patients treated with distraction osteogenesis (DOG) of the anterior mandibular alveolar process and related it to different parameters. 33 patients (27 females; 6 males) were analysed retrospectively before surgery at T1 (17.0 days), after surgery at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Statistical analysis was carried out using Kolmogorov–Smirnov test, paired t test, Pearson's correlation coefficient, and linear backward regression analysis. 2 years postoperatively (T4), the net effect of the soft tissue at point B′ was 100% of the advancement at point B whilst the lower lip (labrale inferior) followed the advancement of incision inferior to 46%. Increased preoperative age was correlated (p<0.05) with more horizontal backward movement (T4–T3) for labrale superior and pogonion′. Higher NL/ML′ angles were significantly correlated (p<0.05) with smaller horizontal soft tissue change at point B′. Gender and the amount of skeletal and dental advancement were not correlated with postoperative soft tissue changes (T4–T3). DOG of the anterior mandibular alveolar process is a valuable alternative for mandibular advancement regarding soft tissue change and predictability.

Modified miniplates for orthopaedic skeletal anchorage

J. Chaurand Lara, J.A. Facio Umaña — 2012-03-05

The use of temporary anchorage devices (TADs) in orthodontics has increased over recent years. One type of TAD, a modification of the titanium miniplate frequently used in orthognathic surgery for osteotomy or fracture fixation, has been used successfully as a skeletal anchorage device for various orthodontic applications. Most of these applications have focused on achieving dental movements, but recent case reports have demonstrated the use of TADs as an adjunct to orthopaedic treatment. Young patients with maxillary hypoplasia are usually treated with a facemask: heavy anterior traction is applied on the maxilla to stimulate its growth and to restrain or redirect mandibular growth. Titanium miniplates used for anchorage now offer the possibility to apply pure bone-borne orthopaedic forces between the maxilla and the mandible for 24h per day, avoiding dentoalveolar compensation.

Prognostic factors and treatment strategies for adult head and neck soft tissue sarcoma

2012-03-07

Abstract: Adult head and neck soft tissue sarcomas are rare and display a variety of histological types and clinical characteristics; they are also associated with a variety of mortality risks. The purpose of this study was to examine all patients treated at the Instituto Nacional de Cancerologia for head and neck sarcoma during a 5-year period. Fifty-one adult patients were examined and treated for head and neck sarcomas from 2004 to 2009. The 51 tumours were histologically re-evaluated by expert pathologists and classified as low, intermediate or high grade sarcomas. A multivariate analysis was performed to evaluate the surgical margins, histological grades, and clinical stages as prognostic factors for the disease. Adult head and neck soft tissue tumours are rare, and they are associated with poor prognosis for patients, especially at clinical stages III and IV. The average survival rate after 2 years is 45%, and most of these patients die because of disease progression and metastases.

Routine removal of the carotid sheath as part of neck dissection is unnecessary if grossly uninvolved as seen intra-operatively

2012-02-13

Abstract: The aim of this research was to determine the pathologic invasion of the carotid sheath (CS) when found grossly uninvolved during surgery, in patients undergoing neck dissection for head and neck squamous cell carcinoma (HNSCC). A prospective study was undertaken in 70 consecutive patients with biopsy proven HNSCC, without prior history of any treatment, undergoing neck dissection, in whom the CS was found grossly uninvolved intra-operatively, were included. A total of 80 neck dissections were performed. Supra-omohyoid neck dissections for clinically N0 neck and appropriate modified radical neck dissections for clinically N+ neck were carried out. 129 CS were dissected separately and thoroughly examined by well trained head and neck pathologists for tumour infiltration and the presence of lymphatic tissue. On microscopic examination, 27 patients were N0 status and the remaining 43 (61.4%) had at least one metastatic lymph node (N+). None of 129 CS specimens show the presence of normal lymphatic tissue or metastatic tumour deposits. The authors think that avoiding resection of the CS in the absence of gross invasion by nodal disease is possible without jeopardising oncologic safety. A preserved CS might offer protection to the important neurovascular structures and reduce significant morbidity.

Reconstruction of the nose with a new double flap technique: microvascular osteocutaneous femur and microvascular chondrocutaneous ear flap—first clinical results

A.J. Gaggl, H. Bürger, F.M. Chiari — 2012-03-06

Abstract: This study describes a new microvascular flap combination from the medial femur and ear to reconstruct the nose after subtotal resection and presents the first clinical results. In four patients a squamous cell carcinoma of the nose was registered. In three patients this was diagnosed for the first time while in the fourth patient it was the second relapse after two resections and local flap surgery. In every case, tumour resection ended up in an extended defect of the nose, cheek and upper lip region. For skeletal reconstruction and the inner lining of the nose, a microvascular osteocutaneous femur flap was used. After reconstructing the nasal skeleton, the remaining defect was covered by a microvascular composite flap from the left ear and preauricular region. Both flap pedicles were anastomosed to the facial vein and artery. In every case, the flaps healed without complications. There was no tumour relapse. 12 months after reconstruction, minor surgical corrections were made. The patients showed a satisfying functional and aesthetic result. The combination of a microvascular osteocutaneous femur flap and a microvascular ear flap can be used successfully for reconstructing the nose after subtotal resection.

Double-step transport distraction osteogenesis in the reconstruction of unilateral large mandibular defects after tumour resection using internal distraction devices

J.j. Wang, J. Chen, F.y. Ping, F.g. Yan — 2012-01-03

Abstract: One-step transport disc distraction osteogenesis (TDDO) is an effective method for the restoration of mandibular defects. This study aimed to investigate the feasibility of double-step TDDO in the reconstruction of unilateral mandibular segmental defects after tumour resection using internal distraction devices. Six patients with unilateral mandibular segmental defects were reconstructed successfully with this technique. In the double-step TDDO procedure, the mandibular body was lengthened first and then the mandibular ramus was restored. The distraction movement was set at a rate of 0.4mm twice per day. Dental rehabilitation followed distractor removal. The maximal amount of lengthening was 55mm in the mandibular body and 42mm in the mandibular ramus. The average amount of lengthening was 52mm in the mandibular body and 34mm in the mandibular ramus. The aesthetic and functional results were excellent in all patients. The implants were integrated successfully and dental restoration was satisfactory. In this study, double-step TDDO is a reliable method for reconstruction of mandibular defects after tumour resection, especially for large mandibular defects. This technique is an ideal method for dental rehabilitation, despite the long overall treatment time.

Craniofacial anomalies amongst births at two hospitals in Nairobi, Kenya

A. Odhiambo, E.C. Rotich, M.L. Chindia, F.G. Macigo, M. Ndavi, F. Were — 2012-03-05

Abstract: The pattern of congenital oral and craniofacial anomalies (CFAs) in the Kenyan population remains unknown. The objective of this study was to describe the pattern of occurrence of CFAs at two hospitals in Nairobi. A descriptive cross-sectional study at the Kenyatta National Hospital and Pumwani Maternity Hospital was carried out from November 2006 to March 2007. Mothers who delivered at the hospitals consented to an interview and physical examination of their babies within 48h of delivery. The anomalies were classified for type and magnitude. Data were analysed to determine the association of these anomalies with ages of the mothers, gender, weight, birth order, mode of delivery and birth status of the babies. During the study period, 7989 babies were born. The CFAs manifested in 1.8% of the total births and were more common in female (1.4%) than in male (1.0%) live births. 12.8% of stillbirths had CFAs, with lesions manifesting more in males (16.7%) than in females (6.9%). The commonest CFA was preauricular sinus (4.3/1000) followed by hydrocephalus (1.9/1000) then preauricular tags and cleft lip and palate (1.5/1000 and 1.3/1000 total births, respectively).

An effect comparison between Furlow double opposing Z-plasty and two-flap palatoplasty on velopharyngeal closure

Y. Dong, F. Dong, X. Zhang, F. Hao, P. Shi, G. Ren, P. Yong, Y. Guo — 2012-02-16

Abstract: The aim of this study was to compare velopharyngeal closure between patients who underwent Furlow palatoplasty and two-flap palatoplasty. A retrospective review of 88 patients with incomplete palate cleft was performed. 48 patients (17 males; 31 females) aged 2–28 years received Furlow palatoplasty. 40 patients (17 males; 23 females) aged 2–21 years received two-flap palatoplasty. Velopharyngeal function was categorized as adequate, marginal or inadequate. Complications associated with the operation were documented. Statistically significant differences were not found amongst sex distribution, age at operation, follow-up time, and preoperative speech intelligibility. After primary repairs using Furlow and two-flap palatoplasty, the surgeon's incidence of postoperative palatal fistula was 0%. The complications were not significantly different between the two groups. The authors achieved the lowest reported incidence of postoperative palatal fistulas in primary Furlow palatoplasty. The outcomes of the velopharyngeal closure were better in patients who received Furlow palatoplasty (P<0.05). Furlow palatoplasty was more effective than two-flap palatoplasty in obtaining perfect velopharyngeal closure. A probable explanation may be that Furlow palatoplasty can reposition and overlap the divergent palatal muscle and lengthen the soft palate.

The effect of steroid injection of the tongue base on reducing postoperative airway obstruction in cleft palate repair

M. Abdel-Aziz, A. Ahmed, N. Naguib, M.I. Abdel-Khalik — 2012-02-16

Abstract: Upper airway obstruction (UAO) is a well known complication of cleft palate repair. The aim of this study was to evaluate the efficacy of local tongue base steroid injection in preventing or reducing the lingual oedema that can cause UAO following palatoplasty. Thirty children with unilateral complete cleft palate were included. They were randomly divided into two equal groups. Children in group I received intravenous dexamethasone whilst children in group II received both intravenous dexamethasone and local betamethasone injected at the tongue base. Both groups underwent the same technique of palatoplasty, postoperative breathing was assessed and UAO was rated as mild, moderate or severe. Postoperative UAO developed in six cases (40%) in group I and in two cases (13%) in group II. In group I, it was mild in three cases, moderate in one case, and severe in two cases. In group II, it was mild in one case and moderate in another case. Despite the differences in the number and severity of the condition in both groups, comparison was statistically insignificant. Local steroid injection of the tongue base during cleft palate surgery reduced the incidence and severity of post-palatoplasty UAO.

Morphological features of the maxillary incisors roots and relationship with neighbouring anatomical structures: possible implications in endodontic surgery

S. Taschieri, T. Weinstein, G. Rosano, M. Del Fabbro — 2011-12-05

Abstract: The purpose of this study was to investigate the relationship between the root apex of the upper incisors and neighbouring anatomical structures as well as the morphology of the root-end foramen after apicoectomy. Fifty-seven patients requiring endodontic surgical treatment for a maxillary anterior root were enrolled. A preoperative diagnostic computed tomography (CT) scan was analysed to determine: the distance between the anterior wall of the nasopalatine duct and the central (CI-ND) incisor root 4mm from the apex; and the distance between the floor of the nasal cavity and the tip of either the central (CI-NF) or the lateral (LI-NF) incisor root. After apicoectomy, root-end foramen endoscopic pictures were taken in order to characterize their morphology. Fifty-nine central and 26 lateral incisors were evaluated. The average CI-ND was 4.71±1.26 (SD) mm. The average CI-NF was 10.62±2.25mm. The average LI-NF was 13.05±2.43mm. The foramen shape after apicoectomy was ovoid to circular in about 90% of cases in both central and lateral incisors. A sound knowledge of the anatomical relationships at the surgical site is essential for the clinician to perform a safe endodontic surgical procedure.

Comparison of pedicled buccal fat pad flap with buccal flap for closure of oro-antral communication

S. Nezafati, A. Vafaii, M. Ghojazadeh — 2011-12-22

Abstract: The aim of this study was to compare the clinical results of pedicled buccal fat pad flap (PBFPF) with the standard buccal flap in the closure of oro-antral fistula (OAF). Twenty-two patients aged 25–56 years with oro-antral communication were randomly divided into two groups using Rand List 1.2 software. In group 1, OAF was treated with the classic buccal sliding flap and in group 2 a pedicled buccal fat pad was used. All patients were visited 48h, 1 week and 1 month after surgery for assessment of primary (success of surgery) and secondary outcomes (pain, swelling, maximum mouth opening (MMO) reduction). Both methods were equally successful for the closure of OAF. The pain score was statistically greater in the experimental group (U=9, P=0.001). MMO was statistically less in the experimental group 2 and 7 days after surgery (P<0.001). 1 month after surgery, no statistically significant difference was found in MMO between the two groups (P=0.09). In general, the PBFPF group had more pronounced swelling than the control group. Despite the statistical evidence, none of the patients complained of pain and swelling following the PBFPF procedure.

Managing iatrogenic trigeminal nerve injury: a case series and review of the literature

T. Renton, Z. Yilmaz — 2012-02-13

Abstract: This study describes the management of 216 patients with post-traumatic iatrogenic lingual nerve injuries (LNIs; n=93) and inferior alveolar nerve injuries (IANI; n=123). At initial consultation, 6% IANI and 2% LNI patients had undergone significant resolution requiring no further reviews. Reassurance and counselling was adequate management for 51% IANI and 55% LNI patients. Systemic or topical medication was offered as pain relief to 5% of patients. Additional cognitive behaviour therapy (CBT) was offered to 8% of patients. Topical 5% lidocaine patches reduced pain and allodynia in 7% of IANI patients, most often used without any other form of management. A small percentage of IANI patients (4%) received a combination of therapies involving CBT, surgery, medication and 5% lidocaine patches. Exploratory surgery improved symptoms and reduced neuropathic area in 18 LNI and 15 IANI patients resulting in improved quality of life. In conclusion, the authors suggest a more diverse and perhaps holistic strategy for management of patients with iatrogenic trigeminal nerve injuries and recommend pragmatic assessment criteria for measurement of treatment success in these patients.

A comparison of biocompatibility and osseointegration of ceramic and titanium implants: an in vivo and in vitro study

2012-03-09

Abstract: This study compared the biocompatibility in vitro and the osseointegration in vivo of zirconium and titanium implants regarding implant surfaces and the bone–implant contacts. The different implant surfaces and the biocompatibility of zirconium versus titanium implants were determined by vitality and cytotoxic tests in vitro. The contact of the osteoblasts to the implant surface was determined by scanning electron microscopy (SEM). The in vivo study for osseointegration was performed in domestic pigs over 4 and 12 weeks. In each animal, 4 zirconium and 4 titanium implants (WhiteSky, BlueSky, Bredent, Germany) were inserted in the os frontale and analysed by histomorphometry. Cytotoxicity and SEM showed good biocompatibility in relation to the investigated implant materials. Histological results showed direct bone–implant contact of the implant surfaces. The zirconium implants showed a slight delay in osseointegration in terms of bone–implant contact as measured by histomorphometry (after 4 weeks, zirconium (59.3±4.6%) versus titanium (64.1±3.9%); after 12 weeks, zirconium (67.1±2.3%) versus titanium (73.6±3.2%). A statistically significant difference between the two groups was not observed. The results indicated similar biocompatibility and osseointegration for zirconium compared to titanium implants.

Fracture of the anterior segment of the atrophic mandible related to dental implants

M. Almasri, M. El-Hakim — 2012-02-10

Abstract: Implant placement in an anterior atrophic mandible is not an uncommon procedure. Fracture secondary to such implant placement is a rare complication. The authors discuss a case referred to their surgical centre and discuss the management approaches found in the English literature.

The use of undifferentiated bone marrow stromal cells for sciatic nerve regeneration in rats

R. Mohammadi, S. Azizi, N. Delirezh, R. Hobbenaghi, K. Amini, P. Malekkhetabi — 2011-12-09

Abstract: In recent years, cell transplantation has become a focus of attention and reliable outcomes have been achieved in regeneration of the sciatic nerve. The effect of undifferentiated bone marrow stromal cells (BMSCs) on peripheral nerve regeneration was studied using a rat sciatic nerve regeneration model. A 10-mm sciatic nerve defect was bridged using an inside-out vein graft (IOVG) filled with undifferentiated BMSCs (2×107cells/ml). In the control group, the vein was filled with phosphate buffer saline alone. The regenerated fibres were studied 4, 8 and 12 weeks after surgery. Assessment of nerve regeneration was based on functional (walking track analysis), histomorphometric and immuohistochemical (Schwann cell detection by S100 expression) criteria. The functional study confirmed significant recovery of regenerated axons in the IOVG/BMSC group (P<0.05). Quantitative morphometric analyses of regenerated fibres showed the number and diameter of myelinated fibres in the IOVG/BMSC group were significantly higher than in the control group (P<0.05). This demonstrates the potential for using undifferentiated BMSCs in peripheral nerve regeneration without the limitations of donor-site morbidity associated with isolation of Schwann cells. It also reduces costs because the interval between tissue collection and cell injection is reduced and the laboratory procedures are simpler compared to undifferentiated BMSCs.

Immunohistochemical characterization of wound healing at two different bone graft substitutes

M. Sager, D. Ferrari, M. Wieland, M. Dard, J. Becker, F. Schwarz — 2011-12-14

Abstract: The immunohistochemical characteristics of wound healing following application of a biphasic calcium phosphate or a collagen coated natural bone combined with a native collagen membrane in a dog model was assessed. Standardized buccal dehiscence-type defects were surgically created following implant bed preparation in 6 dogs. Following implant placement, defects were randomly filled with a collagen coated natural bone mineral (GBO), or a biphasic hydroxyapatite/beta tricalcium phosphate (SBC), and covered with a native collagen membrane. After 1, 4, and 9weeks’ submerged healing, dissected blocks were processed for immunohistochemical (collagen type I (CI), osteocalcin (OC), angiogenesis (TG)) analysis. At 1week, GBO and SBC granules were homogeneously surrounded by a well vascularized, non-mineralized tissue (NMT). CI and OC antigen reactivity was commonly observed adjacent to both bone graft substitutes. At 4 and 9weeks, SBC and GBO granules were completely integrated into a secondly formed network of spongiosa. At 9weeks, dissolution of some granules was observed in the SBC group. Adjacent to these granules, NMT was significantly increased and revealed a pronounced CI, OC and TG antigen reactivity. The initial pattern of bone regeneration and graft integration was comparable in both groups; bone remodelling was more pronounced with SBC.

Biomechanical effects of surgical cut direction in unilateral mandibular lengthening by distraction osteogenesis using a finite element model

A. Tehranchi, H. Behnia, M. Heidarpour, B. Toutiaee, M.J. Khosropour — 2011-12-16

Abstract: Although the precise prediction of the results before distraction is important, performing three-dimensional (3D) simulations for all distraction osteogenesis patients is not practical. Formulating general guidelines based on the factors affecting the 3D results of distraction treatment is recommended. This study was performed on a 3D mandible based on a finite element method. Three surgical cuts (oblique, vertical and horizontal) were made in the right side of the mandible. The amount and direction of movement of proximal and distal segments were evaluated after simulation of 15mm of distraction. In the distal segment, the maximum displacement in the pogonion occurred in the vertical cut. In the proximal segment, the maximum displacement occurred in the coronoid process in horizontal and oblique cuts in a superior direction. The condylar process rotated in the clockwise direction when the vertical cut was used and the coronoid process moved inferiorly. To make the gonial angle more prominent the vertical cut should be used. A horizontal cut is used to lengthen the ramus. Vertical and oblique cuts can be used in patients with long anterior facial height, but all other conditions being equal horizontal cuts are better used in short faced patients.

Assessment of silk fibroin for the repair of buccal mucosa in a rat model

Z. Ge, Q. Yang, X. Xiang, K.-Z. Liu — 2011-12-26

Abstract: This study evaluated the effectiveness of silk fibroin materials for wound repair confined to the buccal mucosa in a rat model by assessing several key clinical parameters and the associated local and systemic immune response. Ninety male SD rats were subjected to microscopic oral surgery to establish a full thickness wound on the buccal mucosa. Rats were randomly divided into three groups based on the treatments received: group A, covered with polyporous silk fibroin scaffold; group B, repaired with crosslinking silk fibroin film; and group C, control. Visual observation of the wounds suggests that wound shrinkage 5 days after the operation was significantly lower in both silk fibroin repaired groups (A and B) than that in the controls. The distribution of inflammatory neutrophils in group A was significantly lower than those in the control group throughout the entire study. The percentage of fibroblasts and capillary endothelia (CD34+), and the subgroups of peripheral lymphocytes (CD3+, CD4+, CD8+) were similar amongst the groups. The results revealed that placement of silk fibroin in an oral buccal defect can reduce the degree of wound shrinkage and enhance the growth of mucosal epithelial cells without any local or systemic immunological incompatibility.

Calendar of Events

2012-05-01