International Journal of Oral & Maxillofacial Surgery - Articles in Press

Proinflammatory cytokines (IL-1β and TNF-α) and chemokines (IL-8 and MIP-1α) as markers of peri-implant tissue condition - Corrected Proof

2010-03-08

Abstract: Analysis of peri-implant crevicular fluid (PICF) offers a non-invasive means of studying the host response in peri-implant disease and may provide an early indication of patients at risk for active disease. This study examined the PICF levels of interleukin-1beta (IL-1β), tumour necrosis factor alpha (TNF-α), interleukin-8 (IL-8) and macrophage inflammatory protein-1alpha (MIP-1α) in patients with non-manifesting inflammation, early and late stages of mucositis. The study group comprised 90 adult healthy volunteers with endosseal titanium implants inserted. Samples were taken from peri-implant sulcus using a filter paper technique. Implant tissues were categorized clinically as healthy, early mucositis or advanced mucositis. Clinical manifestations were determined by: gingival index and bleeding on probing, plaque index and radiographic analyses. Cytokine concentrations were assesed using commercially available enzyme-linked immunosorbent assay kits. Patients from the control group (healthy patients) have significantly lower concentrations of IL-1β, TNF-α, IL-8 and MIP-1α in PICF compared with both groups with mucositis. Positive correlation was noted in the control group between IL-1β and TNF-α and between MIP-1α and IL-8 in the group with early mucositis. The results suggest that cytokines could be prognostic markers of implant failure.

Use of a temporary screw for alignment and fixation of sagittal mandibular condylar fractures with lateral screws - Corrected Proof

F.W. Meng, Y.P. Liu, K.J. Hu, L. Kong — 2010-03-08

Abstract: This study introduced and evaluated the clinical application of a temporary and lateral screw technique for open reduction and internal rigid fixation of sagittal mandibular condylar fractures. A preauricular approach was used to expose the fracture. A temporary screw was used to assist in the anatomical reduction, and a lateral lag screw in combination with a lateral position screw was used for internal rigid fixation. Six adult patients with sagittal condylar fractures and more than 5mm condylar height shortening were treated. The treatment outcomes were followed up clinically and radiographically for 8–27 months (mean 18 months) postoperatively. There were no complications associated with the operation. All patients recovered favorably with good occlusion, normal movement of the mandible, correct repositioning and rigid fixation of the fragment of the fracture and a good condyle shape on radiographs. The temporary and lateral screw technique is a simple, effective, fast, and minimally invasive surgical treatment for adult sagittal condylar fractures.

A response to “Amoxicillin prophylaxis is not associated with anaphylaxis” - Corrected Proof

F. Farbod — 2010-03-08

We thank you for your comments regarding our article analyzing the recent American Heart Association guidelines for antibiotic prophylaxis. It is satisfying to know that one's efforts at least elicit interest. We would suggest, however, that your comments to us are misdirected. Contrary to your interpretation, we offered neither our own opinions nor conclusions. Rather, we simply offered a review of the 2007 AHA Guideline and related current literature.

Can parents predict obstructive sleep apnea in children with syndromic or complex craniosynostosis? - Corrected Proof

N. Bannink, I.M.J. Mathijssen, K.F.M. Joosten — 2010-03-08

Abstract: Obstructive sleep apnea (OSA) is a clinical syndrome characterized by snoring, apneas and difficulty in breathing. These symptoms can be rated and a risk score (Brouillette score) can be calculated to estimate the likelihood of OSA. This study aimed at establishing the predictive value of the Brouillette score and observation by parents at home in children with syndromic or complex craniosynostosis, compared with ambulatory polysomnography. This prospective study included 78 patients (37 boys, mean age 7.3 years). Sensitivity and negative predictive values were calculated. Polysomnography showed clinically significant OSA in 11 children. The Brouillette score had a negative predictive value of 90% and a sensitivity of 55% in comparison with polysomnography. More than three-quarters of all patients snored. The single question ‘Is there difficulty with breathing during sleep?’ showed a sensitivity of 64% and a high negative predictive value of 91%. Thus, asking parents whether the child has difficulty in breathing during sleep can exclude the presence of clinical significant OSA and avoid polysomnography in children with syndromic and complex craniosynostosis.

A GERMAN PROBLEM! TNM-classification of the oral cavity—pT4a tumors are lost in translation - Corrected Proof

Samer George Hakim, Hans-Christian Jacobsen, Peter Sieg — 2010-03-08

Two weeks ago I received the definitive histopathologic report of one of my patients who underwent radical surgery for oral cancer. In anticipation of surgery some investigations were carried out showing evidence of mandible invasion, a fact which was already clinically suspected. Therefore, mandible resection was primarily planned and performed along with tumor excision and related neck dissection.

Parathyroid carcinoma radiographically mimicking a carotid body tumour - Corrected Proof

W. Ahmad, A.N. Kanatas, D.A. Mitchell — 2010-03-08

Abstract: Parathyroid carcinoma is a rare malignancy and is a cause of primary hyperparathyroidism in less than 1% of cases. The authors present a case in which a lesion, radiologically suggestive of a carotid body tumour, but with the peroperative appearance of a vagal schwannoma had the definitive pathological diagnosis of parathyroid carcinoma. Surgeons should be aware of unexpected malignant lesions involving the parathyroid glands.

Cone-beam CT in the assessment of mandibular invasion by oral squamous cell carcinoma: results of the preliminary study - Corrected Proof

A.W.F. Hendrikx, T. Maal, F. Dieleman, E.M. Van Cann, M.A.W. Merkx — 2010-03-08

Abstract: This preliminary retrospective study evaluates the diagnostic value of cone-beam computed tomography (CBCT), as a potential standard preoperative procedure, in assessing mandibular invasion by oral squamous cell carcinoma (OSCC) compared with conventional preoperative panoramic radiography (PR), magnetic resonance imaging (MRI) and histological examination of the resection specimen (the golden standard). Between September 2006 and September 2009, 23 patients with histology proven primary OSCC, adjacent to or fixed to the mandible were included. The tumours were classified into four groups, ranging from no bone invasion to evident bone invasion. Sensitivity and specificity for PR were 55% (95% CI [0.350;0.619]) and 92% (95% CI 0.737;0.984]), respectively, both were significantly lower than the 91% (95% CI [0.740;0.909]) and 100% (95% CI [0.845;1]), respectively, for CBCT. MRI showed 82% sensitivity (95% CI [0.608;0.941]) and 67% specificity (95% CI [0.474;0.779]). CBCT has the potential to become a new diagnostic tool in the OSCC screening procedure to predict mandibular invasion or erosion, but its value may be limited by its relatively low sensitivity. A prospective study will start on 64 patients (α=0.05; power 0.8; effect size 0.5) to improve these results statistically.

Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study - Corrected Proof

I. Aktas, S. Yalcin, S. Sencer — 2010-03-08

Abstract: This study examined the clinical and radiological effects of intra-articular tenoxicam injection following arthrocentesis and compared them with arthrocentesis alone in patients with disc displacement without reduction (DDwoR). 24 temporomandibular joints (TMJs) in 21 patients with DDwoR were studied. Patients were divided randomly into Group A in which only arthrocentesis was performed (14 TMJs in 14 patients) and Group AT which received arthrocentesis plus intra-articular injection of tenoxicam (10 TMJs in 7 patients). Patients were evaluated before the procedure, on postoperative day 7, then 2, 3, 4 weeks, and 2, 3, 4, 5, 6 months postoperatively. Intensity of joint pain was assessed using a visual analog scale. Maximum mouth opening was recorded at each follow-up. TMJ sounds and palpation scores were noted as positive or negative. Magnetic resonance imaging (MRI) was performed before and 6 months after treatment in both groups. Disc form, disc location during neutral position, reduction with movement, joint effusion, structures of the articular surfaces, and bone marrow anomalies were evaluated all in MRIs. Both treatments succesfully increased maximum mouth opening and reduced TMJ pain; there were no complications. Difference between the groups was not statistically significant and a larger controlled study is necessary to clarify this use of tenoxicam.

Neurosensory function following mandibular nerve lateralization for placement of implants - Corrected Proof

H.M. Hashemi — 2010-03-04

Abstract: This prospective cohort study investigates the types and duration of neurosensory disturbances (NDs) related to mandibular nerve (MN) lateralization for placement of implants. From March 2001 to March 2007, 87 patients underwent implant placement surgery with MN lateralization. All patients had panoramic radiograph and CT scans taken preoperatively. Patients completed questionnaires to report NDs 1 week after surgery, and at the end of each month within the year after surgery. All 87 patients (110 posterior segments, 23 bilateral and 64 unilateral) participated in the study. All patients reported NDs in the first week: anaesthesia in 81 sites, hypoesthesia in nine sites, burning in nine sites, pain in eight sites, pinching in two sites, and tickling in one site. The sites with NDs decreased to 29 sites (26%) at the end of first month, and to three sites (3%) at the end of the sixth month with no changes to the end of the year. 82 patients were satisfied with the result of nerve lateralization after 1 year. The mean time for full recovery of MN was 37±15 days. These findings indicate that concerning NDs, MN lateralization is a useful method for placing implants in the atrophic posterior mandible.

The repair of critical-size defects with porous hydroxyapatite/polyamide nanocomposite: an experimental study in rabbit mandibles - Corrected Proof

J.C. Zhang, H.Y. Lu, G.Y. Lv, A.C. Mo, Y.G. Yan, C. Huang — 2010-03-02

Abstract: This study was conducted to evaluate the healing of critical-size surgical defects after implantation of porous nano-hydroxyapatite/polyamide composite (nHA/PA) blocks based on a bilateral mandible model using adult New Zealand white rabbits. 15 rabbits were divided randomly into three groups according to the observation period: 4, 12 and 24 weeks. The defects on one side were implanted with nHA/PA blocks and the contralateral defects were kept empty as blank controls. A combination of macroscopic, radiographic, histological and histomorphometric studies were performed up to 24 weeks postoperatively and compared with normal healing. Large amounts of callus and active osteoblasts were found in the pore structure after 4 weeks of implantation, and the defects were completely occupied by neo-bone with density comparable with that of host bone at 24 weeks. Significant difference was found between nHA/PA groups and blank controls regarding X-ray opacity over the whole period and bone parameters at 4 weeks postoperation (P<0.05). The porous nHA/PA composite promotes bone formation over the extension of the defect, particularly in the early stage. Porous nHA/PA offers interesting potential for maxillofacial reconstructive procedures in load-free areas.

Angiolipoma in head and neck: report of two cases and review of the literature - Corrected Proof

2010-03-02

Abstract: Angiolipomas are either encapsulated or non-encapsulated fatty tumours. They are distinguished from other lipomas by the excessive degree of vascular proliferation and because they are mixed with mature adipocytes. They commonly occur in the trunk and extremities and are rare in the maxillofacial area. Only 36 cases in the head and neck have been reported in the literature. The authors report the first non-infiltrating intramasseterine angiolipoma, and a case of non-infiltrating angiolipoma of the cheek. These tumours appear as homogenous low-density areas on CT with no contrast enhancement. MRI gives better tumour delineation and clear definition of the location and longitudinal extent of the mass. Histopathology demonstrates mature adipose tissue and the proliferation of numerous small branching blood vessels. Management of angiolipomas requires complete surgical excision.

Jaw fractures diagnosed and treated at Malmö University Hospital: a comparison of three decades - Corrected Proof

F. Hallmer, J. Anderud, B. Sunzel, N. Güner, G. Andersson — 2010-03-02

Abstract: The aim was to report the distribution, frequency and aetiology of jaw fractures in patients treated at the University Hospital, Malmö, 1993–2003 and to compare two previous studies from 1952–1962 and 1975–1985. In 1993–2003, 461 patients, 137 women (mean age 42 years; range 15–82) and 324 men (mean age 28 years; range 17–59) were diagnosed and treated. Women were significantly older than men (P<0.001). The most frequent cause of jaw fractures was falls in women (45%). In men, interpersonal violence (46%) was most common followed by road traffic accidents (RTAs) (24%) mostly involving bicycles (14%). The frequency of falls in women and men was significantly different (P<0.001) as was the difference between violence in men and women (P<0.001). The proportion of fractures caused by RTAs was significantly higher in 1952–1962 than in 1993–2003 (P<0.001). There was a significant increase in the proportion of fractures caused by violence between the two studies (P=0.007). In 1993–2003 the proportion of fractures in women due to falls was significantly higher than in 1952–1962 (P=0.006). Violence has replaced RTAs as the main cause for jaw fractures in men; for women falling is the commonest cause.

Amoxicillin prophylaxis is not associated with anaphylaxis - Corrected Proof

Arthur H. Friedlander — 2010-03-02

In a recent issue of this journal Farbod et al. analyzed the American Heart Association's (AHA) guidelines for the prevention of infective endocarditis (IE) through antibiotic prophylaxis. After reviewing this document as well as others dealing with methods of preventing IE they concluded that adverse events stemming from antibiotic use exceeded the benefits of antibiotic prophylaxis. Unfortunately they bolstered their argument by raising the old and very incorrect canard that “prophylaxis with amoxicillin in a large unselected population, carries a risk of death from anaphylaxis that is five times greater than the risk of developing IE.”

FDG avid supraclavicular neck adenopathy of tubercular etiology masquerading as neck recurrence in differentiated thyroid carcinoma: potential source of false positive FDG-PET study - Corrected Proof

S. Basu, S. Menon — 2010-03-02

We would like to alert our surgical colleagues to the potential of obtaining false positive FDG-PET/CT (18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography) results in the presence of tuberculosis.

Mandibular intraosseous lipoma: clinical features of a condylar location - Corrected Proof

L.M. González-Pérez, J.L. Pérez-Ceballos, A. Carranza-Carranza — 2010-02-26

Abstract: Lipomas are common benign neoplasms affecting many adipose tissue-containing organs of the body, including bone. Central lesions in bone account for less than 1% of all lipomas. In the literature, intraosseous lipomas have been reported in various bones such as the frontal and parietal bones, ribs, ulna, phalanges of hand and foot, femoral neck, fibula and calcaneum. No preference has been described for gender or race. As far as the authors know, there have been no documented cases of intraosseous lipoma involving the temporomandibular joint. This report describes a rare case of mandibular intraosseous lipoma in the left condylar area associated with temporomandibular dysfunction.

Long-term stability of adolescent versus adult surgery for treatment of mandibular deficiency - Corrected Proof

W.R. Proffit, C. Phillips, T.A. Turvey — 2010-02-24

Abstract: In mandibular deficient patients, mandibular growth is not expected after the adolescent growth spurt, so mandibular advancement surgery is often carried out at 13 years. To test if the long-term stability for younger patients is similar to that for adult patients, the authors compared cephalometric changes from 1-year postsurgery (when changes due to the surgery should be completed) to 5-year follow up. 32 patients who had early mandibular advancement with or without simultaneous maxillary surgery (aged up to 16 for girls and 18 for boys), and 52 patients with similar surgery at older ages were studied. Beyond 1-year postsurgery, the younger patients showed significantly greater change in the horizontal and vertical position of points B and pogonion, the horizontal (but not vertical) position of gonion, and mandibular plane angle. 50% of younger patients had 2–4mm backward movement of Pg and another 25% had >4mm. 15% of older patients had 2–4mm change and none had >4mm. Long-term changes in younger patients who had two-jaw surgery were greater than for mandibular advancement only. Changes in younger groups were greater than for adult groups. Satisfaction with treatment and perception of problems were similar for both groups.

Risk factors contributing to symptomatic miniplate removal: a retrospective study of 153 bilateral sagittal split osteotomy patients - Corrected Proof

M. Kuhlefelt, P. Laine, L. Suominen-Taipale, T. Ingman, C. Lindqvist, H. Thorén — 2010-02-24

Abstract: Removal of miniplates is a controversial topic in oral and maxillofacial surgery. Originally, miniplates were designed to be removed on completion of bone healing. The introduction of low profile titanium miniplates has led to the routine removal of miniplates becoming comparatively rare in many parts of the world. Few studies have investigated the reasons for non-routine removal of miniplates and the factors that affect osteosynthesis after osteotomy in large numbers of patients. The aim of the present study was to investigate complications related to osteosynthesis after bilateral sagittal split osteotomy (BSSO) in a large number (n=153) of patients. In addition to the rates of removal, emphasis was placed on investigating the reasons and risk factors associated with symptomatic miniplate removal. The rate of plate removal per patient was 18.6%, the corresponding rate per plate being 18.2%. Reasons for plate removal included plate-related complications in 16 patients and subjective discomfort in 13 patients. Half of the plates were removed during the first postoperative year. Smoking was the only significant predictor for plate removal. Patients undergoing orthognathic surgery should be screened with regard to smoking and encouraged and assisted to cease smoking, at least perioperatively.

Comparison of zirconia and titanium implants after a short healing period. A pilot study in minipigs - Corrected Proof

B. Stadlinger, M. Hennig, U. Eckelt, E. Kuhlisch, R. Mai — 2010-02-22

Abstract: The aim of this animal study was to investigate and compare the osseointegration of zirconia and titanium dental implants. 14 one-piece zirconia implants and 7 titanium implants were inserted into the mandibles of 7 minipigs. The zirconia implants were alternately placed submerged and non-submerged. To enable submerged healing, the supraosseous part was removed, using a diamond saw. The titanium implants were all placed submerged. After a healing period of 4 weeks, a histological analysis of the soft and hard tissue and a histomorphometric analysis of the bone–implant contact (BIC) and relative peri-implant bone-volume density (rBVD; relation to bone-volume density of the host bone) was performed. Two zirconia implants were found to be loose. All other implants were available for evaluation. For submerged zirconia and titanium implants, the implant surface showed an intimate connection to the neighbouring bone, with both types achieving a BIC of 53%. For the non-submerged zirconia implants, some crestal epithelial downgrowth could be detected, with a resultant BIC of 48%. Highest rBVD values were found for submerged zirconia (80%), followed by titanium (74%) and non-submerged zirconia (63%). The results suggest that unloaded zirconia and titanium implants osseointegrate comparably, within the healing period studied.

Rehabilitation of totally atrophied maxilla by means of four zygomatic implants and fixed prosthesis: a 6–40-month follow-up - Corrected Proof

M. Stiévenart, C. Malevez — 2010-02-19

Abstract: The zygomatic implant is an alternative to bone grafting in extremely resorbed maxilla. This study evaluates the results of a consecutive cohort of 20 patients (mean age 56 years) with extremely resorbed maxillas provided with four zygomatic implants. The first 10 patients had a two-stage procedure, the next 10 next patients benefited from a one-stage surgical procedure and one of them had flapless guided surgery with Nobelguide® in development and immediate function. The same surgical drilling protocol, according to Branemark's procedure, was applied to all the patients. Except for one patient who lost three implants, 18 patients received a fixed Procera® implant bridge and another an overdenture retained by a screwed bar fixed on the four zygomatic implants. The cumulative survival rate after 40 months is 96%. Although bone augmenting procedures such as onlay grafts and sinus grafts are popular and well-documented, the four zygomatic implants procedure results in less morbidity, shorter delays between anatomical reconstruction and functional rehabilitation and can provide immediate or early loading with immediate function. Four zygomatic implants and a fixed bridge seem to be a valuable technique for the rehabilitation of extremely resorbed maxillas.

Prefabrication of vascularized bioartificial bone grafts in vivo for segmental mandibular reconstruction: experimental pilot study in sheep and first clinical application - Corrected Proof

2010-02-18

Abstract: The key elements for bioartificial bone formation in 3D matrices are large numbers of osteogenic cells and supplies of oxygen and nutrition. Vascularization becomes more important with the increasing size and complexity of seeded scaffolds required for clinical application in reconstructive craniomaxillofacial surgery. Prefabrication of vascularized bioartificial bone grafts in vivo might be an alternative to in vitro tissue engineering techniques. Two cylindrical β-TCP-scaffolds (25mm long) were intraoperatively filled with autogenous bone marrow from the iliac crest for cell loading and implanted into the latissimus dorsi muscle in 12 sheep. To determine the effect of axial perfusion, one scaffold in each sheep was surgically supplied with a central vascular bundle. Sheep were killed 3 months after surgery. Histomorphometric analysis showed autogenous bone marrow from the iliac crest was an effective source of osteogenic cells and growth factors, inducing considerable ectopic bone growth in all implanted scaffolds. Bone growth, ceramic resorption and angiogenesis increased significantly with axial perfusion. The results encourage the application of prefabricated bioartificial bone for segmental mandibular reconstruction in man. In clinical practice, vascularized bioartificial bone grafts could change the principles of bone transplantation with minimal donor site morbidity and no shape or volume limitations.

The effect of injectable calcium phosphate cement on bone anchorage of titanium implants: an experimental feasibility study in dogs - Corrected Proof

V. Arısan, A. Anıl, J.G. Wolke, K. Özer — 2010-02-15

Abstract: Calcium phosphate has high osteotransductive potential. The injectable form of calcium phosphate cement (ICAP) can be used as an adjunctive supportive agent for dental implants. The aim of this study was to assess the effect of an ICAP on the reverse torque resistance of titanium implants. Two implant beds (total 24) were prepared in each proximal tibia of 6 beagles. ICAP was injected into one of prepared implant beds (test) and the implant was inserted. The next implant was inserted without ICAP to serve as control. Three dogs were killed after 2 weeks and 3 after 12 weeks. Retrieved implants were subjected to reverse torque test. Results were analyzed with Student's t-test. Scanning electron microscope (SEM) was used for further evaluation. Mean torque values in 2-week healed implants were 52.48Ncm and 50.57Ncm for test and control implants, respectively (p=0.4). 12-week healed implants showed 81.61Ncm and 76.71Ncm for test and control implants, respectively (p=0.14). Results indicated no statistical difference between test and control implants for either healing time. SEM images of tested samples revealed close contact between the bone–ICAP–titanium surface. ICAP must be tested on further developed experimental models.

Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt - Corrected Proof

2010-02-11

Abstract: The study reports the authors’ experience in managing TMJ ankylosis in Delta Nile, Egypt (1995–2006) and compares the surgical modalities used. 101 patients (109 joints) were reviewed in this retrospective study. Pre- and postoperative assessment included history, radiological and physical examination, and mouth opening. Age, sex, aetiology, joint(s) affected, surgical modality, complications and follow up periods were evaluated. Various types (fibrous, fibro-osseous and bony) of TMJ ankylosis were diagnosed; trauma was the commonest aetiology. The patients’ age range was 2–41 years, 62% were female, and the follow up period ranged from 14 to 96 months. Average mouth opening was significantly increased from 5.3mm pre-operatively to 32.9mm 12 months postoperatively (P=0.0001). Marked improvement in mouth opening was documented when the ramus-joint complex was reconstructed using distraction osteogenesis (34.7mm), costochondral graft (34.4mm) and Surgibone (34.6mm). Gap arthroplasty showed least satisfactory mouth opening compared with other techniques (P=0.001). Minor and major complications were encountered in 33% of cases, including 5% recurrence rate. Early release of TMJ ankylosis; reconstruction of the ramus height with distraction osteogenesis or bone grafting combined with interpositional arthroplasty, followed by vigorous physiotherapy is successful for managing TMJ ankylosis.

Implant-retained nasal prosthesis for reconstruction of large rhinectomy defects: the Salisbury experience - Corrected Proof

M. Ethunandan, I. Downie, T. Flood — 2010-02-10

Abstract: The authors report their experience with 34 patients who had large full thickness nasal defects reconstructed with an implant-retained prosthesis. Their technique of modifying post-rhinectomy defects is described and factors influencing implant success are evaluated. 111 implants were placed to retain a nasal prosthesis. Age, sex and tumour histology did not affect the outcome. Smoking, extent of rhinectomy, use of radiotherapy (pre- and post-implant), hyperbaric oxygen, length and location of the implant and type of retention (bar/magnets) influenced implant success. The overall success rate was 89% (99/111); 94% in patients who did not receive radiotherapy and 86% in those who did. The prosthesis was in place in all patients (100%) at the time of last follow up. Post-rhinectomy defect modification enables adequate access for safe placement of long implants with good primary stability and helps the maintenance of good hygiene (further enhanced by the use of skin grafts). The authors think implant-retained prosthesis is a reliable option for reconstructing large full thickness rhinectomy defects. They suggest their technique of modifying the defect, use of long implants and magnets for retention is responsible for the high success rate of implants used to retain a nasal prosthesis.

The role of the disc in the healing of displaced subcondylar fracture in the growing period: an experimental study in rats - Corrected Proof

Z. Li, W. Zhang, Z.-B. Li — 2010-02-10

Abstract: The purpose of this study was to evaluate the role of the disc in the healing of condylar fractures in the growing period. 40 growing and adult male Wistar rats were randomized into 4 equal groups: growing rats suffering condylar fracture with disc damage; growing rats suffering condylar fracture without disc damage; adult rats suffering condylar fracture with disc damage; adult rats suffering condylar fracture without disc damage. 3 months after the operation all animals were killed and the outcomes were compared using mandible deviation measure, body weight evaluation and histological observation. In growing rats, when the disc was undamaged maintaining its relation to the condyle head, even though the condylar fractured fragment was displaced, the condyle healed and recovered almost to normality in 3 months. In the same condyle fracture form, once the disc was damaged and lost the normal relation with the condyle head, the outcome was unfavourable. The occurrence of damage to the disc and its attachment to the condyle head are important factors in the healing of condyle fractures in the growing period.

The treatment of dentinogenic ghost cell tumour - Corrected Proof

V. Wiwanitkit — 2010-02-08

I read the article on the treatment of dentinogenic ghost cell tumours (DCGT) by Sun et al. with great interest. In the article, Sun et al. reached to the conclusion that “Intraosseous DGCT should be treated by resection with an adequate safety margin, of at least 0.5cm, as recommended for ameloblastoma. Patients with a DGCT should remain in long-term follow-up.”

Extreme oral manifestations in a Marfan-type syndrome - Corrected Proof

2010-02-08

Abstract: A 12-year-old girl with an otherwise typical Marfan syndrome (Ghent criteria fulfilled) presented with highly unusual oral manifestations consisting of supernumerary teeth and severe dental crowding. Pathological examination of the supernumerary teeth revealed an elevated number of pulpoliths. No mutation in the FBN1, TGFBR1 and TGFBR2 genes was identified despite exhaustive screening, suggesting that another gene defect could explain this association of marfanoid features with dental abnormalities.

The treatment of dentinogenic ghost cell tumor - Corrected Proof

Guowen Sun, Enyi Tang — 2010-02-05

Thank you for the opportunity to respond to the letter regarding the article by Sun et al. on the treatment of the dentinogenic ghost cell tumor (DGCT). The DGCT is an extremely rare odontogenic tumor. According to Buchner's research of 215 cases of intraosseous calcifying odontogenic cysts, he found that the calcifying odontogenic cysts (COCs) account for 1-2% of all odontogenic tumors, and only 2–14% of COCs are solid tumors. These solid tumors were considered to be DGCTs. Thus based on even a large sample size of patients that may have DGCTs, it remains a very rare finding. Therefore, even though our 10 year experience of a sample size was small (N=7), the findings are of significance. Of the 7 patients, 5 had recurrences. All of these 5 patients had been initially treated conservatively using only curettage. Of the 2 patients that had been treated using aggressive local resection, no recurrences were found. So in our experiences it appears that intraosseous DGCTs should be treated similar to recommendations for ameloblastoma. We feel that enucleation is the appropriate treatment for most calcifying cystic odontogenic tumor (CCOT), but not for the DGCT.

The effect of platelet-rich plasma on early and late bone healing using a mixture of particulate autogenous cancellous bone and Bio-Oss®: an experimental study in goats - Corrected Proof

2010-02-03

Abstract: Platelet-rich plasma (PRP), containing various growth factors, may speed up wound and bone healing. Using osteoconductive alloplastic materials in reconstructive surgery, the amount of autogenous bone needed can be reduced. The purpose of this experiment was to study the effect of PRP on a mixture of autogenous bone and deproteinized bovine bone mineral (Bio-Oss®) particles in goats. Four, round, critical size defects were made in the foreheads of 20 goats. In all goats the defects were filled with a mixture of autogenous particulate cancellous bone and (Bio-Oss®) particles, in which 1ml of PRP was added in two of the four defects. The goats were allocated to four subgroups each containing five goats, which were killed after 1, 2, 6 and 12 weeks. The results of the histological and histomorphometric examination showed that early and late bone healing were not enhanced when PRP was used.

Congenital unilateral maxillo-mandibulo-zygomatic fusion (syngnathia): A case report in an 8-year-old boy - Corrected Proof

R. Halli, V. Kharkar, Y. Kini — 2010-01-25

Abstract: Congenital causes of limited mouth opening involving fusion of maxilla and mandible (syngnathia) are rare anomalies that often present as part of syndromes such as Van der Woude and popliteal pterygium syndrome. Surgical management involves division of the bony fusion or breakdown of the adhesions in the first few days of life. The authors present a case of maxillo-mandibulo-zygomatic fusion (syngnathia) in an 8-year-old boy, who underwent surgical intervention to achieve adequate jaw function.

Superolateral dislocation of the condyle: report of a rare case - Corrected Proof

H. Papadopoulos, R.S. Edwards — 2010-01-25

Abstract: Anterior dislocation of the mandibular condyle is commonly seen in patients with chronic dislocation of their temporomandibular joints. Posterior, superior and lateral dislocation is rare. Superolateral dislocation of an intact condyle, let alone intact mandible is uncommon, usually occurring after a traumatic insult to the mandible. The authors report on such a case, and its management.

Removal of a nasal bone intraosseous venous malformation and primary reconstruction of the surgical defect using open rhinoplasty - Corrected Proof

M.S. Yu, H.C. Kim, Y.J. Jang — 2010-01-25

Abstract: Primary intraosseous venous malformations are rare benign tumors that account for approximately 1% of all primary osseous tumors. They are rarely found in the midface. The authors report a case of an intraosseous venous malformation in a 28-year-old woman who presented with a bony lesion in the nasal bone. Treatment involved surgical excision via open rhinoplasty. Histopathology indicated an intraosseous venous malformation. 16 months postoperatively, there was no evidence of recurrence, the functional and cosmetic results were good, and the patient was satisfied with the treatment outcome.

Reply letter - Corrected Proof

Adrian Sugar — 2010-01-18

We thank Mr. Kyzas for his letter and comments regarding our recent publication. In his assessment of our randomised controlled trial (RCT), he fails to mention that randomised controlled trials (RCTs) in our specialty and especially on methods of treating facial trauma are a great rarity and therefore should not be dismissed so easily. The main reason that RCTs are so rare is that they are hard to fund and set up in such a way that they can achieve statistical significance and yet maintain the study design.

Imaging characteristics of arteriovenous malformations simulating vascular tumors of the temporalis muscle: a report of two cases - Corrected Proof

S. Geibprasert, N.F. Fanning, A. Pedroza, K.G. terBrugge — 2010-01-18

Abstract: Arteriovenous malformations (AVMs) of the temporalis muscle are an extremely rare subgroup of head and neck AVMs. The authors report two cases presenting with temporal fossa tumor-like lesions. MRI demonstrated enlargement of the temporalis muscle with hypointensity on T1, hyperintensity on T2 and moderate contrast enhancement. Angiography shows slow arteriovenous shunting with a dense capillary blush of the entire muscle before draining into facial veins. The arterial supply is characteristic of being restricted to the temporalis muscle.

Development of an in vitro model for radiation-induced effects on oral keratinocytes - Corrected Proof

T. Tobita, K. Izumi, S.E. Feinberg — 2010-01-18

Abstract: Changes in epithelial cell activity and the production of pro-inflammatory cytokines were examined utilizing an organotypic culture system as an in vitro model to study the effects of radiation on oral keratinocytes to simulate what is thought to occur in radiation-induced oral mucositis. Monolayer cultures of oral keratinocyte were irradiated by varying the dose. Cell injury was assessed using a colony forming efficiency (CFE) assay. Third passage oral keratinocytes were seeded onto AlloDerm® to form a 3D construct of an ex vivo produced oral mucosa equivalent (EVPOME) which was irradiated with 0, 1, 3 and 8Gy. Formalin-fixed sections of the EVPOME were used for histology and immunohistochemistry to examine proliferative capacity. Epithelial cell viability of EVPOME was measured by MTT assay. Spent culture medium was used to determine post-radiation pro-inflammatory cytokine production. Basal cells became more swollen and pyknotic as radiation increased, implying loss of cell viability also determined by MTT assay. The number of Ki-67 immunopositive cells and CFE showed negative correlation with radiation, indicating loss of cell proliferative capacity. The production of pro-inflammatory cytokines, IL-1α and IL-8, tended to increase in a radiation dose dependent manner. The EVPOME lacking submucosal cellular components was a useful model.

Excessive bleeding in the floor of the mouth after endosseus implant placement: a report of two cases - Corrected Proof

L. Dubois, J. de Lange, E. Baas, J. Van Ingen — 2010-01-15

Abstract: Placement of dental implants in the interforaminal region of the edentulous mandible is considered a safe and routine surgical procedure. Hemorrhage in the floor of the mouth has been reported as a rare, potentially life-threatening complication related to the placement of implants in this region. In this case report the authors present an immediate and a delayed case of massive bleeding in the floor of the mouth after implant placement. This highly vascularized region is vulnerable and bleeding can be induced easily by instrumentation, causing a vascular trauma, usually by perforation of lingual periostium. In almost all cases the expanding hematoma formation starts during surgery. The effect of the vasoconstrictive agent in the local anesthesic combined with an injury of the lingual arterio-venous plexus can result in delayed swelling, causing respiratory distress through obstruction of the upper airways.

Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases - Corrected Proof

L.K. Cheung, Y.Y. Leung, L.K. Chow, M.C.M. Wong, E.K.K. Chan, Y.H. Fok — 2010-01-11

Abstract: A prospective study of all lower third molar surgery performed in the outpatient extraction clinic of a teaching dental hospital was conducted from January 1998 through October 2005 to determine the incidence of subsequent neurosensory deficit due to inferior alveolar nerve (IAN) and lingual nerve (LN) injury, to examine possible contributing risk factors and to describe the pattern of recovery. 3595 patients were included (61% female, 39% male; age range, 14–82 years). Of the 4338 lower third molar extractions performed by various grades of operators, 0.35% developed IAN deficit and 0.69% developed LN deficit. Distoangular impaction was found to increase the risk of LN deficit significantly (p<0.001). Depth of impaction was related to the risk of IAN deficit (p<0.001). Undergraduates caused more LN deficits (p<0.001). Sex, age, raising of a lingual flap, protection of LN with a retractor, removal of distolingual cortex, tooth sectioning and difficulty in tooth elevation were not significantly related to IAN or LN injury. Postoperative recovery from IAN and LN deficits was noted most significantly at 3 and 6 months, respectively. By the end of the follow-up period, 67% of IAN deficits and 72% of LN deficits had recovered completely.

Paradental cyst mimicking a periodontal pocket: case report of a conservative treatment approach - Corrected Proof

M. Pelka, H. van Waes — 2009-12-11

Abstract: A 7-year-old boy presented with a periodontal problem related to an erupting lower molar. The tooth showed a 15mm deep periodontal pocket on the buccal aspect. A microbiological DNA test excluded a periodontal origin. The treatment consisted of local antimicrobial therapy and cleaning and filling of the pocket with AtridoxR. 2 years after therapy the pocket completely disappeared. Finding periodontal pockets on freshly erupted teeth with acute symptoms should suggest the diagnosis of a cyst. This could prevent surgical endodontal or periodontal therapy. This problem can be managed effectively with minimal therapy and local antibiotics.

Reactive lesions of peri-implant mucosa associated with titanium dental implants: a report of 2 cases - Corrected Proof

D.G. Olmedo, M.L. Paparella, D. Brandizzi, R.L. Cabrini — 2009-12-11

Abstract: The aim of this study was to report 2 novel clinical cases of reactive lesions of the peri-implant mucosa associated with titanium dental implants where metal-like particles were observed histologically. In both cases, the lesions were diagnosed as epulis, based on clinical evidence. Extirpation biopsies were carried out. Case 1 was diagnosed as pyogenic granuloma and case 2 as peripheral giant cell granuloma. The presence of metal-like particles in the tissues suggests that the etiology of the lesions might be related to the corrosion process of the metal structure. This is the first case of pyogenic granuloma to be reported in association with dental implants. All clinical cases of soft tissue lesions associated with implants should be reported to contribute to the understanding of the etiology and pathogeny of these lesions.

Recurring gnathodiaphyseal dysplasia in two Russian brothers - Corrected Proof

V.V. Roginsky, A.L. Ivanov, R.H. Khonsari — 2009-12-11

Abstract: Two Russian brothers presented with recurring benign facial bone tumors and progressive limb bowing. The association of fibro-osseous jawbone lesions and long-bone bowing with cortical thickening suggested the diagnosis of gnathodiaphyseal dysplasia, in the absence of arguments in favor of fibrous dysplasia. Gnathodiaphyseal dysplasia is a rare autonomic dominant syndrome due to a mutation of the TMEM16E gene. The extreme and recurring phenotype of these two patients illustrates the variable expressivity of this disease. Differential diagnosis with other benign facial bone tumors is discussed.

Colorimetric analysis of unstained lesions surrounding oral squamous cell carcinomas and oral potentially malignant disorders using iodine - Corrected Proof

K. Maeda, T. Suzuki, Y. Ooyama, K. Nakakuki, M. Yamashiro, N. Okada, T. Amagasa — 2009-12-07

Abstract: To determine whether the measurement of staining with 3% Lugol's solution provided efficient criteria for determining the area of resection for oral carcinomas and oral potentially malignant disorders, the authors analyzed the color of unstained lesions (USLs) in relation to histopathological findings. After vital iodine staining, USLs were seen in 48 of 54 patients (88.9%). A significant difference was seen in the value of lightness between stained lesions (SLs) and USLs for patients with moderate and severe epithelial dysplasia (P<0.001). The deviation between the macroscopically observable and the histopathological boundaries was −0.65±1.26mm (range: −4.36 to 1.52). Color charts prepared on the basis of values for lightness and hue reproduced the macroscopic color differences in USLs, suggesting that it may become possible to diagnose USLs histologically on the basis of the measured color values and use of color charts to help determine the resection area in surgery.

Air gun pellet remaining in the maxillary sinus for 50 years: a relevant risk factor for the patient? - Corrected Proof

T.V. Kühnel, C. Tudor, F.W. Neukam, E. Nkenke, P. Stockmann — 2009-12-04

Abstract: The authors report the case of a 62-year-old man referred to the department of oral and maxillofacial surgery because of a clinical suspicion of palate carcinoma. Incidentally, diagnostic radiology showed a metallic foreign body in the left maxillary sinus. Anamnestic data revealed that a shot from an air gun accidentally hit the patient's left cheek in 1957. The lead-containing air gun pellet was removed by endoscopic antrostomy and the diagnosis of squamous cell carcinoma was confirmed by histopathological examination. 50 years after the pellet's impact, toxicological blood analysis showed no increased blood lead level. It remains unclear whether the air gun pellet has a potential toxicological effect or is related to the development of the patient's oral carcinoma. In this context the article reviews the literature and discusses the necessity of removing metal-containing foreign bodies, the role of lead in chronic toxicity and its possible carcinogenic effect in humans.

Anatomical study of the pterygopalatine fossa pertinent to the maxillary nerve block at the foramen rotundum - Corrected Proof

L. Stojčev Stajčić, B. Gačić, N. Popović, Z. Stajčić — 2009-12-03

Abstract: The anatomy of the pterygopalatine fossa pertinent to the technique of maxillary nerve block at the foramen rotundum was investigated and the ability of inexperienced surgeons to apply the required angles of the injection needle to the sagittal plane in a clinical environment. In 85 dried human skulls the volume, length, width and depth of 159 intact pterygopalatine fossae were measured. The frequency of reaching the sphenopalatine foramen using a 20 G spinal needle advanced from the frontozygomatic angle through the pterygomaxillary fissure was determined. 49 oral surgery postgraduates aligned the injection needle with angles of 60° and 80° to the sagittal plane of a volunteer's head. The dimensions of the pterygopalatine fossa were inconsistent; volume (0.1–1cm3), width (1–9mm) and depth (6–22mm) showed the greatest variations. An enlarged sphenoidal process and a narrow pterygomaxillary fissure (<2mm) were found in 15% and 8%, respectively. The sphenopalatine foramen was reached successfully in 75%. Postgraduates in oral surgery were highly accurate in the assessment of the 60° and 80° angles to the sagittal plane. A previously described technique of blocking the maxillary nerve at the foramen rotundum was adjusted and recommendations given to overcome anatomical obstacles.

Biomechanics of mandibular reconstruction: a review - Corrected Proof

R.C.W. Wong, H. Tideman, L. Kin, M.A.W. Merkx — 2009-11-30

Abstract: Knowledge of the biomechanics of the mandible allows the surgeon to understand the forces acting on the mandible during function and the resulting deformation that can occur. This allows the appropriate selection and placement of osteosynthesis plates to neutralize these forces. Many methods have been proposed for mandibular reconstruction, each of which has strengths and weaknesses. Most papers evaluating these techniques have focused on survival rates and the quality of the grafted bones, and there have been few studies of the biomechanics (stress distribution and strength) of the various types of reconstructed mandibles. This paper reviews the biomechanics of the mandible and the various methods of reconstruction reported in past studies.

Letter to the Editor: “A randomised controlled trial comparing fixation of mandibular angle fractures with a single miniplate placed either transbuccally and intra-orally, or intra-orally alone” by Sugar et al/ Int. J. Oral Maxillofac. Surg. 2009; 38: 241–245 - Corrected Proof

Panayiotis A. Kyzas — 2009-11-26

I read with great interest the study of Sugar et al. Their aim was to compare the outcomes following fixation of mandibular angle fractures with a combined transbuccal and intra-oral technique, with the standard intra-oral technique. Although the study question is interesting, there are several limitations in this study.

Masticatory muscle function three years after surgical correction of class III dentofacial deformity - Corrected Proof

L.V.V. Trawitzki, R.O. Dantas, F.V. Mello-Filho, W. Marques — 2009-04-17

Abstract: Individuals with dentofacial deformities have masticatory muscle changes. The objective of the present study was to determine the effect of interdisciplinary treatment in patients with dentofacial deformities regarding electromyographic activity (EMG) of masticatory muscles three years after surgical correction. Thirteen patients with class III dentofacial deformities were studied, considered as group P1 (before surgery) and group P3 (3 years to 3 years and 8 months after surgery). Fifteen individuals with no changes in facial morphology or dental occlusion were studied as controls. The participants underwent EMG examination of the temporal and masseter muscles during mastication and biting. Evaluation of the amplitude interval of EMG activity revealed a difference between P1 and P3 and no difference between P3 and the control group. In contrast, evaluation of root mean square revealed that, in general, P3 values were higher only when compared with P1 and differed from the control group. There was an improvement in the EMG activity of the masticatory muscles, mainly observed in the masseter muscle, with values close to those of the control group in one of the analyses.