International Journal of Oral & Maxillofacial Surgery

Editorial Board

2012-01-01

Editorial

N. Samman — 2012-01-01

I am honored to have been given the privilege of editing the International Journal of Oral and Maxillofacial Surgery (IJOMS), a responsibility that is very exciting and at the same time somewhat daunting.

Platelet rich plasma for the prevention of osteoradionecrosis. A double blinded randomized cross over controlled trial

M.D. Batstone, J. Cosson, L. Marquart, C. Acton — 2011-07-22

Abstract: Osteoradionecrosis of the jaws is a complication of radiotherapy and controversy remains about the management of teeth in the field of radiotherapy. Platelet rich plasma has been advocated in multiple surgical sites, both bone and soft tissue, to promote healing and reduce complications. A randomized double blinded controlled trial was performed on patients receiving bilateral radiotherapy that affected the mandible who required pre treatment dental extractions. One side received platelet rich plasma and the other acted as a control. Twenty-two patients were recruited over 12 months and over a 5-year period following treatment three developed osteoradionecrosis (14%). Platelet rich plasma failed to show any benefit in the prevention of osteoradionecrosis. Nor was there any benefit in pain scores or mucosal healing on sides that were treated with platelet rich plasma. Platelet rich plasma fails to show a benefit in the prevention of osteoradionecrosis. The rate of osteoradionecrosis is high compared to other published series and the prophylactic removal of molar teeth should be questioned as a preventative measure.

Navigation-assisted localisation and resection of subclinical metastatic malignant melanoma of unknown primary based on 18-fluorodeoxyglcose positron emission tomography computed tomography fusion imaging

N. Ghazali, J.C. Collyer, J. Tighe — 2011-10-24

Abstract: A technical application using a stereotactic navigation system with fusion images of [18F]-2-fluorodeoxyglucose (FDG) positron tomography and computed tomography (PET-CT) in the case of a metastatic melanoma of unknown primary site is described. A 50-year-old woman presented with a slow, growing level V neck lump which was cytologically proved to be a metastatic melanoma despite the absence of prior or existing history of skin malignancy. Whilst detailed physical examination failed to yield the site of the primary lesion, full body FDG-PET images isolated FDG-avid subclinical scalp lesions. Fused PET-CT data provided the navigation system with accurate localisation of the subclinical metastatic lesion. Histopathological examination of the navigation-guided resection specimen confirmed that the lesion was excised with acceptable margins. This case illustrates the feasibility of navigation-assisted resection of a subclinical malignant melanoma lesion and may have a role to play in the management of the melanoma of unknown primary.

Evaluation of postoperative function in patients undergoing reconstruction following resection of superior and lateral oropharyngeal cancer: long-term outcomes of reconstruction with the Gehanno method

2011-11-07

Abstract: Resection of the superior or lateral wall of the cancer-affected oropharynx can often lead to disturbed nasal breathing, dysphagia, and dysarthria. The authors used the Gehanno method to reconstruct these surgical defects and achieved favourable functional recovery soon after surgery. The present study was undertaken to analyze the long-term outcome and usefulness of this method. Reconstruction was carried out using the Gehanno method in 36 patients during the 10-year period between 1997 and 2007. Both short-term and long-term evaluations of the postoperative function were performed in 12 of the 36 cases. The postoperative function was favourably maintained in all 12 cases, but gradual deterioration was noted in some cases in which the forearm flap had been used for reconstruction. Conventionally, the forearm flap is considered suitable for the reconstruction of complex structures such as the oropharynx because of its excellent flexibility. The results suggest that if the forearm flap is used for reconstruction using the Gehanno method, the surrounding tissue is likely to undergo change over time. The rectus abdominis myocutaneous flap should be considered as the first-choice flap for reconstruction using the Gehanno method.

Solitary plasmocytoma: ghost tumour?

M. Meziane, M. Boulaadas, L. Essakalli, M. Kzadri, A. Harmouch — 2011-07-20

Abstract: Solitary plasmocytoma is a rare tumour that belongs to the myeloid dysplasia group. The authors present an unusual evolution of this pathology through a clinical case. A 42-year-old patient was diagnosed with solitary nasosinusal plasmocytoma following biopsy of the right nasal fossa process; several weeks after this the tumour spontaneously regressed. Extramedullar plasmocytoma is a myeloid dysplasia that seldom evolves into multiple myeloma. Spontaneous regression has been described for some malignancies, implying immunological factors, but not previously for extramedullary plasmocytoma.

Fronto-facial monobloc distraction in syndromic craniosynostosis. Three-dimensional evaluation of treatment outcome and facial growth

E.W.-C. Ko, P.K.-T. Chen, I.C.-H. Tai, C.S. Huang — 2011-11-17

Abstract: The objectives of this study were to investigate the treatment effect and stability of fronto-facial monobloc distraction osteogenesis. Five consecutive patients who underwent monobloc distraction were included (aged 4.8–18.4 years). Three patients had Crouzon syndrome, one had Apert syndrome, and one had Pfeiffer syndrome. The evaluation included clinical records, serial cephalograms for at least 1-year follow up (average 24.6 months). The treatment and post-treatment changes were measured. The intracranial volume, upper airway volume and globe protrusion were calculated from CT before and after treatment. After distraction, the supraorbital region was advanced 15.3mm forward, the midface demonstrated forward advancement of 17.7mm, 22.1mm and 23.1mm at orbitale, anterior nasal spine and A point, respectively. The downward movement was 2–3mm at maxillary level. The intracranial volume increased 11%; the upper airway volume increased 85% on average. Globe protrusion reduced 3.7mm on average, which was 20% of underlying skeletal movement. Facial growth demonstrated forward remodelling of the supraorbital region, mild downward but no further forward growth of the midface. Monobloc distraction is effective for relieving related symptoms and signs through differential external distraction at different vertical levels of the face.

A comparison of results using nasoalveolar moulding in cleft infants treated within 1 month of life versus those treated after this period: development of a new protocol

V. Shetty, H.J. Vyas, S.M. Sharma, H.F. Sailer — 2011-10-24

Abstract: The objectives of this study were to: evaluate the effects of nasoalveolar moulding (NAM) in complete unilateral cleft lip and palate infants presenting for treatment at different ages; propose a new NAM protocol in these patients; improve the predictability of NAM. Study groups comprised: group I (n=15) treated with NAM within 1 month of age; group II (n=15) treated with NAM between 1 and 5 months of age. Control: group III (n=15) comprised of non-cleft 18-month old children. A standard protocol was followed. Patients were evaluated before initiation of NAM, before cheiloplasty and at 18 months. 7 linear anthropometric measurements were compared using dento-facial models. Statistical analysis before and after NAM revealed that group I patients demonstrated 81%, 198%, 69% and 145% improvement in intersegment distance, nasal height, nasal dome height and columella height respectively; whilst group II patients demonstrated 51%, 33%, 21% and 38% improvement for the same. At 18 months, group I patients closely resembled group III patients. This study concluded that the effects of NAM were most significant in group I. Group II patients also benefited from NAM, although to a lesser extent. This study validates the use of NAM in infants presenting late for treatment.

Interdental distraction osteogenesis for the management of alveolar clefts: archwise distraction

N. Erverdi, N. Küçükkeleş, C. Şener, B.U. Selamet — 2011-12-06

Abstract: Bone grafting is a successful protocol for cleft repair but it is very challenging to close large gaps using local gingival tissue. In the last decade, interdental distraction osteogenesis has been introduced as a successful treatment protocol for repairing such large clefts. In this article a new method for closing the alveolar cleft is introduced and one case is presented. A tooth supported distractor which was specially designed to be inserted on to the main arch wire was used for the distraction. The aim was to distract the tooth segments through the curve of the dental arch and achieve complete closure of the gaps. The distractor introduced had several advantages: it is simple to apply, activate and remove; there is no need for a second operation; it is an outpatient procedure. In the case reported, a very large gap was successfully closed using this protocol whilst maintaining the ideal arch form and generating new bone behind the distracted segments.

A variant of the Ekman-Westborg and Julin trait

D. Guvenc, A.Y. Gokbuget, S. Cintan, F. Seymen — 2011-11-18

Abstract: Ekman-Westborg and Julin is a trait that shows multiple macrodontia and multituberculism affecting only the teeth with no other anomalies (E-WJ). The aim of this report is to present a case which appears to manifest all the clinical signs of the E-WJ trait including odontoma formation. A 18-year-old girl with gingival inflammation particularly in the maxillary insicor area was referred to the authors’ department. Panoramic, periapical and cephalometric radiographs were examined and complex odontoma associated with unerupted maxillary permanent lateral incisors was revealed. Intraoral examination revealed anterior crossbite, Angle Class III type malocclusion with mandibulary prominence and macrodontia of teeth 37, 12, 11 and 21. The patient was accepted as a new sporadic case of E-WJ. More case reports are needed to elucidate the causes and pathogenesis of this condition.

Submental intubation: a literature review

J.S. Jundt, D. Cattano, C.A. Hagberg, J.W. Wilson — 2011-09-19

Abstract: A literature review was performed to analyse the evidence supporting submental intubation and to aid in the development of a new airway algorithm in craniofacial surgery patients. A systematic search of Pub Med, OVID, the Cochrane Database and Google Scholar between January 1984 and April 2011 was performed. Measured variables included the outcome, complications, publishing specialty journal and method of intubation including technique modifications, indications for the procedure, devices utilized and the total procedure time to complete the submental intubation. Of the 842 patient cases from 41 articles represented in the review, the success rate was 100%. Minor complications were reported in 60 patients and included superficial skin infections (N=23), damage to the tube apparatus (N=10), fistula formation (N=10), right mainstem bronchus tube dislodgement/obstruction (N=5), hypertrophic scarring (N=3), accidental extubation in paediatric patients (N=2), excessive bronchial flexion (N=2), lingual nerve paresthesia (N=1), venous bleeding (N=2), mucocele (N=1), and dislodgement of the throat pack sticker in the submental wound (N=1). The average reported time to complete a submental intubation was 9.9min. Submental intubation is a safe, effective and time efficient method for securing an airway when increased surgical exposure or restoration of occlusion is a priority.

Management of paediatric mandibular condylar fractures with screw-based semi-rigid intermaxillary fixation

Y. Wu, X. Long, W. Fang, B. Li, Y. Cheng, M. Deng, H. Cai, Z. Gong — 2011-10-19

Abstract: This study was designed to evaluate the feasibility and safety of screw-based semi-rigid intermaxillary fixation (IMF) combined with a specially designed occlusal splint in the conservative treatment of paediatric mandibular condylar fractures. Thirteen paediatric patients with 20 sides of condylar fractures treated with semi-rigid IMF were analyzed retrospectively. Semi-rigid IMF was achieved by inserting self-drilling IMF screws into the anterior alveolar bone of the maxilla and mandible suspended with elastic bands. An occlusal splint with a molar fulcrum was used for functional repositioning of the condylar fragment. After 4 weeks, the screws and occlusal splint were removed. During a mean period of 28.6 months’ follow-up, the patients’ maximal mouth opening increased to a mean of 37.69mm. Clinical and radiological examinations revealed satisfactory results in facial symmetry and condylar remodelling. No clinical symptoms or radiographic evidence showed dental injuries associated with screw insertion. This study suggests that this method might be a safe, easy, and effective management of paediatric condylar fractures.

Trans-tragal incision for improved exposure of diacapitular and condylar neck fractures

M. Pau, M. Feichtinger, K.E. Reinbacher, P. Ivancic, H. Kärcher — 2011-11-17

Abstract: The authors present a modification of the preauricular approach that improves the exposure of the condyle whilst reducing diacapitular and condylar neck fractures. The incision is a combination of the hockey-stick and endaural incisions. Its inferior part runs within the ear on the posterior face of the tragus; the tragal cartilage is transected together with the retrotragal skin and included in the anterior skin flap. Between May 2009 and December 2010, 16 patients with diacapitular or condylar neck fractures were treated with this approach. All patients showed good occlusion postoperatively and satisfactory aesthetic results. No infection or cartilage necrosis was observed in this series. This approach improves the exposure of the condylar head during the reduction of diacapitular and condylar neck fractures, ensuring easier internal fixation and good cosmetic results.

Transient finite element analysis of a traumatic fracture of the zygomatic bone caused by a head collision

A. Schaller, C. Voigt, H. Huempfner-Hierl, A. Hemprich, T. Hierl — 2011-10-14

Abstract: Midfacial fractures rank first concerning maxillofacial traumatology. Collisions of two heads or head to object are the main causes for these fractures. An investigation based on a transient simulation using the finite element method was performed. A biomechanical head model was created and tested. A transient collision of two heads was simulated. The results were compared to a typical real patient case. This comparison revealed an identical fracture pattern, which can be interpreted as a clinical match of the simulation. The results of this study show the validity of biomechanical investigations, which may serve as a method to better understand maxillofacial fracture patterns. These results will be used for the optimization of fracture therapy or trauma prevention in the future.

Anatomic study of the mandibular foramen, lingula and antilingula in dry mandibles, and its statistical relationship between the true lingula and the antilingula

2011-09-28

Abstract: The authors verified the anatomical location of the mandibular foramen, lingula and antilingula in dry mandibles, aiming to obtain information that could be used when performing mandibular osteotomies. Forty-four mandibles (88 sides) were evaluated. The distances were measured using a sliding calliper, with the mandibles fixed in a reproducible position. Results showed that the mandibular foramen is on average 5.82mm below the lingula. Regarding the statistical comparison between the mandibular foramen entrance and the antilingula position, there is no correlation between the position of those two structures in the studied sample. The mandibular foramen is slightly posterior in relation to the centre of the ramus. The lingula is an important anatomic landmark for ramus surgery, and for determining the distance to the mandibular foramen entrance. The use of the antilingula as a landmark for the position of the vertical ramus osteotomy is not recommended.

Evaluation of risk of injury to the inferior alveolar nerve with classical sagittal split osteotomy technique and proposed alternative surgical techniques using computer-assisted surgery

G. Wittwer, W.L. Adeyemo, J. Beinemann, P. Juergens — 2011-09-19

Abstract: Neurosensory disturbance after sagittal split osteotomy is a common complication. This study evaluated the course of the mandibular canal at three positions using computed tomography (CT), assessed the risk of injury to the inferior alveolar nerve in classical sagittal split osteotomy, based on the proximity of the mandibular canal to the external cortical bone, and proposed alternative surgical techniques using computer-assisted surgery. CT data from 102 mandibular rami were evaluated. At each position, the distance between the mandibular canal and the inner surface of the cortical bone was measured; if less than 1mm or if the canal contacted the external cortical bone it was registered as a possible neurosensory compromising proximity. The course of each mandibular canal was allocated to a neurosensory risk or a non-neurosensory risk group. The mandibular canal was in contact with, or within 1mm of, the lingual cortex in most positions along its course. Neurosensory compromising proximity of the mandibular canal was observed in about 60% of sagittal split ramus osteotomy sites examined. For this group, modified classic osteotomy or complete individualized osteotomy is proposed, depending on the position at which the mandibular canal was at risk; they may be accomplished with computer-assisted navigation.

Cone-beam computed tomography evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with Class III skeletal deformities: bimaxillary surgery and mandibular setback surgery

S.-B. Park, Y.-I. Kim, W.-S. Son, D.-S. Hwang, B.-H. Cho — 2011-10-24

Abstract: The purpose of this study was to evaluate the volumetric change of the upper airway space in 36 Class III patients who had undergone bimaxillary surgery or isolated mandibular setback, and, further, to analyse the relation between post-surgical stability and airway change using cone-beam computed tomography (CBCT). A three-dimensional (3D) CBCT examination was performed at three stages: T0 (before surgery), T1 (an average of 4.6 months after surgery), and T2 (an average of 1.4 years after surgery). The results showed that the volumes of the oropharyngeal and hypopharyngeal airways decreased significantly 4.6 months post-surgery in the mandibular setback group (p<0.05), and these diminished airways had not recovered 1.4 years post-surgery. In the bimaxillary surgery group, the volume of the oropharyngeal airway also decreased. A Spearman correlation analysis showed that the anteroposterior length of the hypopharyngeal area had a correlation with post-surgical stability in the isolated mandibular surgery group, and that the cross-sectional area of the nasopharynx was correlated with maxillary relapse only in the bimaxillary surgery group (p<0.05).

Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future

A. Khadka, J. Hu — 2011-11-17

Abstract: Temporomandibular joint (TMJ) ankylosis is characterized by difficulty or inability to open the mouth due to fusion of the temporal and the mandible, resulting in facial symmetry/deformity, malocclusion and dental problems. The only treatment option for TMJ ankylosis is surgical with or without condylar reconstruction. Various autogenous grafts are available for condylar reconstruction after freeing the ankylotic mass such as costochondral, sternoclavicular, fibular, coronoid, and metatarsophalangeal. Costochondral graft is preferred by surgeons, but distraction osteogenesis is slowly gaining popularity and may ultimately become the standard procedure, providing a cost-effective approach with low morbidity and excellent functional outcomes. Tissue engineering is another budding field which has shown promising results in animal studies but has not been applied to humans. To date, there is no ideal autogenous graft for condylar reconstruction that satisfies the complex anatomy and the myriad of functions of a missing condyle.

Correlation between clinical diagnosis based on RDC/TMD and MRI findings of TMJ internal derangement

J.W. Park, H.H. Song, H.S. Roh, Y.K. Kim, J.Y. Lee — 2011-10-14

Abstract: This study was conducted to investigate the value of magnetic resonance imaging (MRI) in the diagnostic process based on the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) by evaluating agreement between RDC/TMD and MRI diagnosis of disc displacement (DD) and correlation amongst MRI findings such as DD, joint effusion (JE), degenerative change and superior lateral pterygoid muscle (SLPM) attachment. Randomly selected MRIs of 200 joints from 100 TMD patients differentiated into RDC/TMD group II representing DD by clinical examination were reviewed retrospectively. The results show that Cohen's kappa value was 0.336 showing overall disagreement between RDC/TMD group II and MRI diagnoses (P<0.001). The Cohen's kappa value for group IIa, DD with reduction (DDWR), was −0.223 (P<0.01) showing disagreement, whilst the value was 0.546 for group IIb, DD without reduction (DDWOR) with limited opening, and 0.490 for group IIc, DDWOR without limited opening, showing moderate agreement (P<0.001). JE was detected with a higher probability as the state of DD advanced (P<0.001) and when degenerative joint changes were present (P<0.05). The difference of DD according to SLPM attachment was insignificant. MRI could be used when clinical examination cannot predict the true position of the disc.

Arthroscopic lysis and lavage in patients with temporomandibular anterior disc displacement without reduction

V. Machoň, J. Šedý, K. Klíma, D. Hirjak, R. Foltán — 2011-09-02

Abstract: The authors prospectively analysed 50 patients with chronic anterior disc displacement without reduction, who underwent arthroscopic lysis and lavage of the temporomandibular joint (TMJ). Patients with symptoms lasting less than 1 year were assigned to Group A (n=28) and patients with symptoms lasting more than 1 year to Group B (n=22). The most common problems were inflammatory changes of synovial and retrodiscal tissue (Group A, 71%; Group B, 82%). Fibrous adhesions were present in 14% of Group A patients and 45% of Group B patients. Degenerative changes of the disc and articular surface were present in 4% of Group A patients and 32% of Group B patients. Mouth opening increased 123% from baseline in Group A, and 112% in Group B (P<0.05). Pain decreased significantly in both groups (Group A, 2.5 points; Group B, 1.68 points; P<0.05). In conclusion, almost all patients with chronic anterior disc displacement without reduction benefited from arthroscopic lysis and lavage of the TMJ. Patients with a shorter duration of symptoms problems benefited more than those with a longer duration. Arthroscopic lysis and lavage of the TMJ is safe and beneficial in chronic anterior disc displacement without reduction.

Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft in animals: a systematic review

T. Jensen, S. Schou, A. Stavropoulos, H. Terheyden, P. Holmstrup — 2011-10-14

Abstract: The objective of the present systematic review was to test the hypothesis of no differences between the use of Bio-Oss or Bio-Oss mixed with autogenous bone as graft for maxillary sinus floor augmentation (MSFA) applying the lateral window technique, as evaluated in animals. A MEDLINE (PubMed), Embase, and Cochrane Library search in combination with a hand-search of relevant journals was conducted by including animal studies published in English from 1 January 1990 to 1 June 2010. The search provided 879 titles and 14 studies fulfilled the inclusion criteria. The volumetric stability of the graft improved significantly with increased proportion of Bio-Oss. Bone regeneration, bone-to-implant contact (BIC), biomechanical implant test values, and biodegradation of Bio-Oss after MSFA with Bio-Oss or Bio-Oss mixed with autogenous bone have never been compared within the same study in animals. Thus, the hypothesis of no differences between the use of Bio-Oss and Bio-Oss mixed with autogenous bone as graft for MSFA could neither be confirmed nor rejected based on existing animal studies.

Effect of autologous bone marrow-derived cells associated with guided bone regeneration or not in the treatment of peri-implant defects

2011-09-19

Abstract: This study investigated the effect of bone marrow-derived cells associated with guided bone regeneration in the treatment of dehiscence bone defects around dental implants. Iliac-derived bone marrow cells were harvested from dogs and phenotypically characterized with regard to their osteogenic properties. After teeth extraction, three implant sites were drilled, dehiscences created and implants placed. Dehiscences were randomly assigned to: bone marrow-derived cells, bone marrow-derived cells+guided bone regeneration, and control (no treatment). After 3 months, implants with adjacent tissues were processed histologically, bone-to-implant contact, bone fill within the threads, new bone area in a zone lateral to the implant, new bone height, and new bone weight at the bottom of the defect were determined. Phenotypic characterization demonstrated that bone marrow-derived cells presented osteogenic potential. Statistically higher bone fill within the threads was observed in both bone marrow-derived cells+guided bone regeneration bone marrow-derived cell groups compared with the control group (P<0.05), with no difference between the groups treated with cells (P>0.05). For the other parameters (new bone area, bone-to-implant contact, new bone height and new bone weight), only the bone marrow-derived cells+guided bone regeneration group presented higher values compared with the non-treated control (P<0.05). Bone marrow-derived cells provided promising results for peri-implantar bone regeneration, although the combined approach seems to be relevant, especially to bone formation out of the implant threads.

Mini-implant insertion based on tooth crown references: a guide-free technique

S. Estelita, G. Janson, K. Chiqueto, D. Garib — 2011-08-26

Abstract: Mini-implant insertion requires accurate surgical technique. This study shows an insertion technique using only tooth crown references; its scientific basis is evaluated radiographically. The sample consisted of 213 inter-radicular septa, evaluated in 53 bitewing radiographs. The proximal contour of adjacent tooth crowns was used to define septum width. The midpoint of the septum width was linked to the interdental contact point to determine septum midline. The distances from septum midline to mesial and distal teeth were measured to evaluate the septum midline centralization degree in two different septum heights. The difference between mesial and distal distances represented the septum midline deviation degree. The mesial and distal distances were compared by t-tests, and the septum midline deviation was correlated with septum height using Pearson's correlation test. The mesial and distal distances were not statistically different in the midpoint of the septum height, but they were different at the apical septum height. There was a moderate correlation (r=0.45) between septum midline deviation and septum height. The tooth crown references evaluated on interproximal radiographs determine a high centralization degree of the septum midline on which the insertion site could be defined. The greater centralization degree was observed at the coronal septum area.

Calendar of Events

2012-01-01