International Journal of Oral & Maxillofacial Surgery

Editorial Board/Reviewing Committee

2010-07-01

Maxillary distraction versus orthognathic surgery in cleft lip and palate patients: effects on speech and velopharyngeal function

H.D.P. Chua, T.L. Whitehill, N. Samman, L.K. Cheung — 2010-04-23

Abstract: This clinical randomized controlled trial was performed to compare the effects of distraction osteogenesis (DO) and conventional orthognathic surgery (CO) on velopharyngeal function and speech outcomes in cleft lip and palate (CLP) patients. Twenty-one CLP patients who required maxillary advancement ranging from 4 to 10mm were recruited and randomly assigned to either CO or DO. Evaluation of resonance and nasal emission, nasoendoscopic velopharyngeal assessment and nasometry were performed preoperatively and at a minimum of two postoperative times: 3–8 months (mean 4 months) and 12–29 months (mean 17 months). Results showed no significant differences in speech and velopharyngeal function changes between the two groups. No correlation was found between the amount of advancement and the outcome measures. It was concluded that DO has no advantage over CO for the purpose of preventing velopharyngeal incompetence and speech disturbance in moderate cleft maxillary advancement.

Speech intelligibility of children with unilateral cleft lip and palate (Dutch cleft) following a one-stage Wardill–Kilner palatoplasty, as judged by their parents

2010-04-26

Abstract: This study determined the intelligibility (words, sentences and story telling) of 43 children (mean age 4.9 years) with unilateral cleft lip and palate who received a Wardill–Kilner palatoplasty, as judged by their parents and determined the influence of age and gender. A comparison with normative data for intelligibility of 163 Dutch speaking children was made. Each child and the parents completed The Dutch intelligibility test. Measures reported include group mean intelligibility percentages for words, sentences and story telling for children aged 2.5–5.0 and 5.0–7.6 years. A significant correlation between age of the children and intelligibility was measured. No significant gender-related differences were found. An interesting finding is the absence of significant difference in intelligibility percentage between the children with cleft palate and the normative data for story telling. The reported intelligibility percentages provide important prognostic reference information for surgeons who perform palatoplasty and speech pathologists who assess the speech production of children with cleft palate.

Preemptive effect of ketoprofen on postoperative pain following third molar surgery. A prospective, randomized, double-blinded clinical trial

T. Kaczmarzyk, J. Wichlinski, J. Stypulkowska, M. Zaleska, J. Woron — 2010-03-25

Abstract: The authors examined whether ketoprofen administered 60min before surgical extraction of the lower wisdom teeth provides effective postsurgical analgesia and reduces rescue analgesic intake compared with ketoprofen administered 60min after surgery or placebo. The 96 patients were placed into three groups: pre-group (ketoprofen 60min preoperatively); post-group (ketoprofen 60min postoperatively); and no-group (placebo). Study interventions had a significant effect on pain sensations in the 12h after surgery. The initial onset of pain was significantly delayed only in the post-group. Pain intensity at the first onset of pain was significantly lower only in the post-group. Patients in the pre- and post-groups required significantly less rescue analgesic than those in the no-group. Ketoprofen administered after third molar surgery provides more effective pain control than ketoprofen administered before the surgery or placebo.

Quantitative skeletal evaluation based on cervical vertebral maturation: a longitudinal study of adolescents with normal occlusion

L. Chen, J. Liu, T. Xu, X. Long, J. Lin — 2010-05-03

Abstract: The study aims were to investigate the correlation between vertebral shape and hand–wrist maturation and to select characteristic parameters of C2–C5 (the second to fifth cervical vertebrae) for cervical vertebral maturation determination by mixed longitudinal data. 87 adolescents (32 males, 55 females) aged 8–18 years with normal occlusion were studied. Sequential lateral cephalograms and hand–wrist radiographs were taken annually for 6 consecutive years. Lateral cephalograms were divided into 11 maturation groups according to Fishman Skeletal Maturity Indicators (SMI). 62 morphological measurements of C2–C5 at 11 different developmental stages (SMI1–11) were measured and analysed. Locally weighted scatterplot smoothing, correlation coefficient analysis and variable cluster analysis were used for statistical analysis. Of the 62 cervical vertebral parameters, 44 were positively correlated with SMI, 6 were negatively correlated and 12 were not correlated. The correlation coefficients between cervical vertebral parameters and SMI were relatively high. Characteristic parameters for quantitative analysis of cervical vertebral maturation were selected. In summary, cervical vertebral maturation could be used reliably to evaluate the skeletal stage instead of the hand–wrist radiographic method. Selected characteristic parameters offered a simple and objective reference for the assessment of skeletal maturity and timing of orthognathic surgery.

Complaints related to mandibular function impairment after closed treatment of fractures of the mandibular condyle

E.T. Niezen, R.R.M. Bos, L.G.M. de Bont, B. Stegenga, P.U. Dijkstra — 2010-04-30

Abstract: This study analysed the relationship between complaints and mandibular function after closed treatment of fractures of the mandibular condyle in a prospective study. In a 1-year follow-up, complaints were assessed during physical examination and function was assessed using the mandibular function impairment questionnaire (MFIQ), scoring range 0–68. Data from 114 patients (41 women, 73 men), mean age 28.1 years (SD 13.3), were available. On average the MFIQ scores were low 3.4 (SD 7.3). Ten patients (9%) experienced pain and 45 (39%) patients had a MFIQ score>0. Mean mouth opening was 51.9mm (SD 8.4). Occlusion was perceived as moderate or poor by 24% of the patients. In the logistic regression analysis mandibular function impairment (MFIQ score>0) was entered as a dependent variable. Risk factors for mandibular function impairment were: pain, perceived occlusion (moderate or poor), absolute difference between left and right horizontal movements and age. A protective factor was mouth opening. The results of this study show that complaints (i.e. pain, perceived occlusion, reduced mouth opening, difference between left and right lateral movements and increased age) are predictors of mandibular function impairment after closed treatment of fractures of the mandibular condyle.

Orbital form analysis: problems with design and positioning of precontoured orbital implants: A serial study using post-processed clinical CT data in unaffected orbits

L. Kamer, H. Noser, A. Schramm, B. Hammer — 2010-04-26

Abstract: Inter-individual size and shape (form) variation for the orbital floor and medial wall was assessed and compared with its posterior partition. Reconstruction of the posterior partition is known to be a surgical challenge in complex orbital defect repair when using standard manual implant contouring and positioning techniques. The size variation of both regions was assessed, alone and combined, in statistical form analysis using three-dimensional computer models of left and mirrored right orbits, obtained from 70 clinical computed tomography (CT) scans of adult European Caucasians with unaffected orbits. Major shape and size variability for both regions was observed, but to a larger extent for the entire orbital floor and medial wall, with males having significantly larger regions but with no differing shape patterns. Statistical modeling was used to identify characteristic shape patterns in given orbits. The size, shape and positioning of precontoured implants are decisive criteria for the adequate repair of complex orbital defects. The results indicate that optimal form conditions for prefabricated implants exist in a restricted area corresponding to the transition of the posterior orbital floor and medial wall.

Bisphosphonate coating might improve fixation of dental implants in the maxilla: A pilot study

J. Abtahi, P. Tengvall, P. Aspenberg — 2010-05-10

Abstract: This pilot study evaluates the clinical stability of bisphosphonate-coated dental implants placed using a two-stage surgical procedure in five patients. Each patient received seven regular Brånemark implants, one of which was coated with bisphosphonate in a fibrinogen matrix. The coated implant was inserted where the bone was expected to have the least favourable quality. The level of the marginal bone around each implant was measured by intraoral periapical radiographs and implant stability was recorded using resonance frequency measurements. Frequency values (ISQ) were obtained peroperatively before flap closure and after 6 months at abutment connection. At abutment connection the bisphosphonate-coated implants were removed en bloc in two patients for histological examination. An animal experiment had previously confirmed that gamma-sterilization did not reduce bioactivity of the bisphosphonate coating. In each patient, the bisphosphonate-coated implant showed the largest improvement in ISQ level of all implants. Their values at the start tended to be lower, and the absolute value at 6 months did not differ. No complications occurred with the coated implants. Histology showed no abnormalities. Improvement in ISQ values was an expected effect of the bisphosphonate coating, but could be due to the choice of insertion site. This finding warrants a randomized, blinded study.

Relevance of human papilloma virus (HPV) infection to carcinogenesis of oral tongue cancer

S.Y. Lee, N.H. Cho, E.C. Choi, S.J. Baek, W.S. Kim, D.H. Shin, S.-H. Kim — 2010-04-22

Abstract: Human papilloma virus (HPV) infection is controversial as a causative factor in oral tongue cancer. This study aimed to clarify whether HPV directly affects the carcinogenesis and biological behaviour of oral tongue cancer by analyzing HPV prevalence, the physical status of the virus and clinicopathological parameters. Archival tissue was obtained from 36 patients diagnosed with T1 and T2 oral tongue cancer and 25 normal controls. HPV genotyping chip and real-time polymerase chain reaction were used to determine the prevalence, phenotype and physical status of HPV to clarify whether HPV directly affects oncogenesis. The results were also compared with clinicopathological parameters. HPV was detected in 36% (13/36) of oral tongue cancer patients, compared with 4% (1/25) of the control. In the HPV-positive group of oral tongue cancers, HPV-16 was the most common type and its prevalence rate was 85% (11/13). Of the HPV-16 infected oral tongue cancers, the integration rate of HPV-16 was 55% (6/11). The HPV-16 positive group showed shallower stromal invasion than the HPV-16 negative group (p=0.045). HPV-16 may be one of the causative factors in early squamous cell oral tongue carcinoma and be associated with its depth of invasion.

The feasibility and significance of preservation of the lobular branch of the great auricular nerve in parotidectomy

J. Hu, W. Ye, J. Zheng, H. Zhu, Z. Zhang — 2010-04-22

Abstract: This study was designed to evaluate the feasibility and significance of preserving the lobular branch of the great auricular nerve (GAN) during parotidectomy. Ninety-three patients with benign tumour undergoing parotidectomy were separated randomly into three groups. Thirty-one patients underwent a parotidectomy with the main trunk of GAN sacrificed (group A), 29 patients had the posterior-auricular branch preserved (group B), and 33 patients had the lobular branch preserved (group C). The operating times were recorded. Tactile sensitivity and pain sensitivity were evaluated preoperatively and at 1 week, 1 month, 3 months, 6 months and 1 year after surgery. Eighty-three patients were followed-up. Preservation of the lobular branch required no extra operating time. In group C, sensitivity in the lobular region reached preoperative levels by 6 months after surgery. In the other groups, recovery of sensory function in the lobular region was partial. Patients with the lobular branch of GAN preserved had significantly better sensory recovery in the lobular region 1 year after surgery (P<0.05). These results demonstrate that preservation of the lobular branch of GAN is technically feasible during parotidectomy. The preservation of the lobular branch of GAN guarantees improvement of postoperative sensitivity of the lobular region.

Effect of bone to implant contact percentage on bone remodelling surrounding a dental implant

Z. Lian, H. Guan, S. Ivanovski, Y-C. Loo, N.W. Johnson, H. Zhang — 2010-04-26

Abstract: Dental implants are an effective, safe and predictable solution for patients suffering from tooth loss, but implant placement changes the normal mechanical environment of the jawbone leading to bone density redistribution and ‘remodelling’, in order to adapt to the new environment. Many bone remodelling theories assume the presence of 100% contact between bone and implant, which is inconsistent with clinical reality. About 50–80% bone–implant contact is commonly seen with clinically successful implants. The influence of different percentages of bone–implant contact on bone remodelling has not been investigated adequately. This study aims to evaluate this influence using a newly proposed remodelling algorithm through a 2D finite element model. Four different degrees of bone–implant contact (25, 50, 75 and 100%) are considered and their influences on the density distribution of the jawbone are evaluated. The predicted results indicate that no matter what the initial percentage of bone–implant contact (25–100%), the final outcome is about 58–60% contact when an equilibrium state is reached by bone remodelling. The results are consistent with clinical observations and findings.

Comparison of vacuum and conventional wound dressings for full thickness skin grafts in the minipig model

S.T. Becker, H.-O. Rennekampff, I. Alkatout, J. Wiltfang, H. Terheyden — 2010-04-22

Abstract: The aim of this study was to compare vacuum and conventional dressings and to follow revascularization with laser-Doppler spectroscopy and histological evaluations. In six minipigs, full thickness skin grafts were harvested on both sides of the back and transplanted to the contralateral site. One site was covered with a classical cotton dressing, the other with a vacuum dressing. For 10 days, oxygen, haemoglobin, flow and velocity levels were measured by laser-Doppler spectroscopy. Data were analyzed with ANOVA. Histological evaluation included haematoxylin and eosin (H&E) as well as CD31 immunohistochemical staining. Oxygen levels were significantly reduced in the vacuum dressing group compared with the classic dressing group during the first 3 days after transplantation. Haemoglobin levels were slightly, but significantly, higher in the vacuum dressing group over the whole observation period. On the second and third day after transplantation single capillaries were detectable in the histological evaluation. Starting from the fourth day, capillary number increased. Similar results for the classical pressure dressing and the vacuum dressing were observed. The present experimental model provides a standardized and reliable test system for evaluating revascularization of full thickness skin grafts in conjunction with growth factors and other enhancers of revascularization.

Cyanoacrylate in nerve repair: transient cytotoxic effect

T. Landegren, M. Risling, J.K.E. Persson, A. Sondén — 2010-05-03

Abstract: Cyanoacrylate adhesive has been suggested as an alternative to suturing when repairing severed peripheral nerves. The authors examined the cytotoxic effect of ethyl-cyanoacrylate on the human neuroblastoma cell line SH-SY5Y and compared it with the effects of butyl-cyanoacrylate (Histoacryl®), an adhesive approved for skin closure. Ethyl-cyanoacrylate or butyl-cyanoacrylate was applied in confluent SH-SY5Y cultures. Immediately, at 24h and at 7, 14, 21 and 28 days, cultures were photographed and analysed digitally. At corresponding intervals, cell death was quantified using a 51Cr release assay. In cultures exposed to ethyl-cyanoacrylate or butyl-cyanoacrylate, cell death was observed predominantly in conjunction with the adhesive, causing a halo devoid of cells. Surviving cells showed neurodegenerative properties with loss of neuritis and reduction of body size up to 3 days post exposure. The inhibition halo diminished over time in both groups and at 28 days cells reached the margin of the adhesive in the ethyl-cyanoacrylate group. 51Cr assay indicated significant cell death in exposed cultures, which rapidly decreased during the first 14 days. No significant differences were found between the adhesives. This study demonstrates that ethyl-cyanoacrylate and butyl-cyanoacrylate have a transient cytotoxic effect, which may explain the promising results when using cyanoacrylate for nerve repair.

Peripheral blood dendritic cells and vascular endothelial growth factor in oral squamous cell carcinoma: correlation analysis and in vitro study

Z.-Y. Wang, P.-H. Shi, X.-F. Huang, Z.-C. Hua, Y.-Y. Hou, W. Han, Q.-G. Hu — 2010-04-15

Abstract: Vascular endothelial growth factor (VEGF) may cause functional deficiency in dendritic cells (DCs) in vitro. The roles of peripheral blood dendritic cells (PBDCs) and VEGF in patients with oral squamous cell carcinoma (OSCC) are not well understood. The authors analysed the correlation between VEGF and PBDC in 81 OSCC patients. They assessed the effect of VEGF on DC function in vitro. VEGF levels were significantly increased in OSCC patients compared with control subjects (P<0.05), but PBDC levels were significantly lower (P<0.05). VEGF expression in TNM I–II (67%) and T1–T2 (74%) was significantly lower, compared with TNM III–IV (88%, P<0.05) and T3–T4 (89%, P<0.05). Increased VEGF expression in primary tumours was significantly correlated with elevated serum VEGF levels, but reduced PBDC levels. In vitro cultured DC exposed to VEGF showed significantly decreased expression of functional proteins, enhanced endocytosis activity, and elicited weaker proliferation of T cells, compared with that of free VEGF (P<0.01). These findings suggest that decreased PBDC and elevated VEGF occur in OSCC patients. Higher VEGF levels may affect precursor cells, resulting in decreased numbers of functional DC.

Innovative procedure for computer-assisted genioplasty: three-dimensional cephalometry, rapid-prototyping model and surgical splint

R. Olszewski, K. Tranduy, H. Reychler — 2010-04-23

Abstract: The authors present a new procedure of computer-assisted genioplasty. They determined the anterior, posterior and inferior limits of the chin in relation to the skull and face with the newly developed and validated three-dimensional cephalometric planar analysis (ACRO 3D). Virtual planning of the osteotomy lines was carried out with Mimics (Materialize) software. The authors built a three-dimensional rapid-prototyping multi-position model of the chin area from a medical low-dose CT scan. The transfer of virtual information to the operating room consisted of two elements. First, the titanium plates on the 3D RP model were pre-bent. Second, a surgical guide for the transfer of the osteotomy lines and the positions of the screws to the operating room was manufactured. The authors present the first case of the use of this model on a patient. The postoperative results are promising, and the technique is fast and easy-to-use. More patients are needed for a definitive clinical validation of this procedure.

Syndromic micrognathia and peri-natal management with the ex-utero intra-partum treatment (EXIT) procedure

B.J. Costello, T. Hueser, D. Mandell, D. Hackam, T.L. Prosen — 2010-03-19

Abstract: Many advances in healthcare are built on advances in technology. In the case of fetal medicine, technology has availed an entirely new patient population. The authors report a case of severe micrognathia and Pierre Robin Sequence that was diagnosed prenatally. Antenatal planning and treatment were instituted via the Fetal Diagnosis/Treatment Team to avoid loss of the neonate's airway. An EXIT procedure was utilized to ensure a secure airway. The benefits of team care for these types of deformities are highlighted including the importance of craniomaxillofacial specialists.

Pseudoankylosis of the temporomandibular joint caused by zygomatic malformation

C.E. Baraldi, G.L. Martins, E. Puricelli — 2010-03-15

Abstract: Temporomandibular joint (TMJ) pseudoankylosis is characterized by limited mouth opening and mandibular movements, resulting from factors outside the joint. The authors present a case of TMJ pseudoankylosis caused by congenital zygomatic malformation and hyperplasia of the coronoid process. Treatment with coronoidectomy and postoperative physiotherapy achieved favorable results.

Multiple-site osteosarcomas of the jaw in a single patient. A true case of a metachronous lesion?

2010-03-15

Abstract: A case of multiple-site osteosarcomas in the jaw of a 56-year-old patient is reported. The disease occurred consecutively at three different sites (left maxilla, left mandible, right mandible) separated by time intervals of 12 and 18 months, respectively. Metachronous osteosarcomas of the long bones is a rare form of osteosarcoma and implies multiple lesions appearing at different times, each one behaving clinically as a primary lesion. The pathogenesis of this disease is unknown as it is unclear whether the lesions represent independent primary tumours or metastatic disease.

Oral metastasis from primary transitional cell carcinoma of the renal pelvis: report of a case

Y. Zhang, Z.-Y. Gu, Z. Tian, C. Yang, X.-Y. Cai — 2010-03-17

Abstract: Transitional cell carcinoma of the renal pelvis is initially a slow growing tumor arising from the transitional epithelium of the mucous membrane of the renal pelvis. Recurrences occur in two forms: superficial bladder cancer and distant metastases. The common metastasis is in the lung, liver, brain and bone. Oral metastasis is seldom reported. The authors report an unusual case of transitional cell carcinoma of the renal pelvis metastasized to the oral cavity and lung simultaneously in a 74-year-old man, which occurred 1 year after a left nephroureterectomy. The patient underwent six courses of chemotherapy (gemcitabine, oxaliplatin, fluorouracil and nedaplatin), and received radiotherapy for the oral lesion. The symptoms were alleviated, but the tumor recurred in the oral cavity 2 years later. Brain and liver metastases were confirmed by CT. Repeated radiotherapy for oral metastasis was performed, but the patient died 4 years after the initial nephroureterectomy due to multiple metastases.

Japanese

2010-07-01

Clinical usefulness of real-time tissue elastography in the evaluation of cervical lymph node metastases in patients with oral cancerS. Taira, Y. Nikkuni, T. Hayashi, et al. Jpn J Head Neck Cancer 2008: 34: 518–525.

Russian

2010-07-01

Osteosynthesis devices for the treatment of severe cranio-maxillofacial traumas in young adultsN.I. Ivanshtenko, V.P. Ippolitov Klinicheskaya Stomatologuia 2007: 3: 56–59

Turkish

2010-07-01

The Effects of Magnetic Field Intensity on Regeneration of Injured Peripheral NervesS Güneş, B. Büyükakilli, H. Ankarali Turkiye Klinikleri Tıp Bilimleri Dergisi 2008: 28: 857–66

Results of monitoring fasciocutaneous, myocutaneous, osteocutaneous and perforator flaps: 4-year experience with 166 cases

D. Chubb, W.M. Rozen, M.W. Ashton — 2010-03-24

We would like to congratulate Holzle et al. on their long-term study involving the use of simultaneous laser-Doppler flowmetry and tissue spectrophotometry in the postoperative monitoring of 166 consecutive flaps. Such studies of postoperative monitoring devices are difficult to compile, requiring a standardized approach to patient selection and monitoring protocols. While many features of this study will prove highly useful in both clinical practise and research, there are a number of points in the study which we feel warrant discussion.

F. Hölzle — 2010-03-22

We thank the authors for their detailed comment on our publication. In our article we focused on the benefits of the monitoring system O2C in terms of the early detection of vascular compromise and the prevention of unnecessary operative reexploration of flaps that would otherwise be required. These flaps seemed compromised in clinical examination, but recovered without operative intervention when this was not indicated by O2C monitoring. In these 7 out of 24 cases the O2C was a valuable tool in helping to reduce costs and avoiding further operations. Since these flaps survived, we feel it is appropriate to include these non revision cases (i.e. clinical false positives) into the overall flap salvage rate. This results in a total flap salvage rate of 54%. The false positive and false negative rates were 0% as pointed out in the text in the results section.