International Journal of Oral & Maxillofacial Surgery - Articles in Press

BMP4 localization and PCNA expression during distraction osteogenesis of the porcine mandible - Corrected Proof

G.M. Hansen, M.E. Lawler, W.B. Williams, M.J. Troulis, L.B. Kaban — 2012-01-27

Abstract: This study characterized sequential molecular and cellular events in the porcine mandibular distraction osteogenesis (DO) wound. Nineteen Yucatan minipigs were divided into three treatment groups: Group A, unilateral mandibular distraction with 0 day latency, 1mm/day rate for 12 days, 24 days fixation (n=16); Group B, acute lengthening 12mm (n=2); Group C, sham control (n=1). Group A was further divided by death date: mid-DO (n=5), end-DO (n=4), mid-fixation (n=5) and end-fixation (n=2). Groups B and C were killed on postoperative day 36, corresponding to end-fixation. Specimens were stained for proliferating cell nuclear antigen (PCNA) and bone morphogenetic protein-4 (BMP4). Cellular proliferation (PCNA) was assessed quantitatively and BMP4 staining was assessed on a semi-quantitative scale. Progenitor cell proliferation was greatest during mid-DO and decreased from end-DO through end-fixation. Proliferation in the acute lengthening group was elevated relative to sham control and comparable to end-DO. BMP4 staining intensity (localized to the periosteal cambium layer) was greatest during mid- and end-DO, decreased at mid-fixation and was undetectable at end-fixation. Progenitor cell proliferation and BMP4 expression are greatest during mid-DO and decrease progressively thereafter. At the time of death of the acute lengthening group, only increased cell proliferation was demonstrated.

Total alloplastic temporomandibular joint replacement: the Czech-Slovak initial experience - Corrected Proof

V. Machon, D. Hirjak, M. Beno, R. Foltan — 2012-01-27

Abstract: In 2004, total alloplastic temporomandibular joint (TMJ) replacement began in the Czech Republic and Slovakia. This paper presents initial subjective and objective data compiled between 2005 and 2009 from those cases. Data were collected from 27 patients (38 joints) reconstructed with the Biomet-Lorenz stock and custom TMJ prostheses during a mean follow-up period of 24 months. The variables of pain and mouth opening were evaluated pre- and postoperatively. Patients classified pain on a scale of 0–5 (none – unbearable). The extent of opening was investigated by a physician (the distance between the points of the incisors on the upper and lower jaw was measured). The most common indication for replacement was ankylosis. There was an improvement in pain score in 15 patients. 4 patients reported worsening of pain and 8 patients did not complain of pre- or postoperative pain. Mandibular opening increased from a mean of 17.7mm preoperatively to a mean of 29.1mm postoperatively. There were complications related to the surgery, but no significant complications related to the devices. Total alloplastic TMJ replacement appears to be a safe and effective method of reconstruction in the patients in this initial study.

Prolonged matrix metalloproteinase-3 high expression after cyclic compressive load on human synovial cells in three-dimensional cultured tissue - Corrected Proof

Y. Akamine, K. Kakudo, M. Kondo, K. Ota, Y. Muroi, H. Yoshikawa, K. Nakata — 2012-01-24

Abstract: Excessive mechanical stress is thought to be a factor in the development of joint disorders through the expression of matrix metalloproteinases (MMPs) and related cytokines. Although studies revealed that mechanical stress on the synovium induces MMP expression, it is still not known which MMPs prolonged high level expression. The authors focused on MMP-3, which is one of the major factors in joint disorders such as rheumatism and temporomandibular joint disorders. They examined mRNA and protein levels of MMP-3, other MMPs and related cytokines after loading stress. Human synovial cells were seeded onto a collagen scaffold and different magnitudes of cyclic compressive load were applied for 1h. Time-dependent mRNA and protein levels for catabolic genes were examined after loading. mRNA expressions of MMP-1, MMP-3, MMP-9, IL-6, IL-8 and IL-1β increased after excessive compression. In particular, only mRNA of MMP-3 was up-regulated and maintained at a high level for 24h after excessive loading. The concentrations of MMP-3, IL-6 and IL-8 in culture media after loading increased with excessive compression. These results may account for the pathomechanism of MMP-3 induced by cyclic load on synovial cells in joint disorders.

Intraoral carcinosarcoma on the floor of the mouth mimicking a benign lesion - Corrected Proof

C.B. Gallo, S.E.V. Cury, D.S. Pinto, D.A. Migliari, N.N. Sugaya — 2012-01-24

Abstract: Carcinosarcoma is a rare malignant disease with aggressive behaviour rarely producing oral manifestations. This article reports a case of an intraoral carcinosarcoma affecting a 71-year-old black male; the diagnosis was made by histopathological and immunohistochemical analyses. Computed tomography scanning showed metastatic masses in the lungs. The patient was underwent a chemotherapy protocol regimen, but died as a consequence of the disease within 10 months of diagnosis. Distinctive characteristics of this presentation were the location of the lesion (floor of the mouth) and its clinical features resembling a benign lesion. A brief review of intraoral carcinosarcoma cases in the literature is also presented.

Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes? - Corrected Proof

P. Suton, I. Lukšić, D. Müller, M. Virag — 2012-01-24

Abstract: The aim of this study was to analyse patterns of metastatic spread from cutaneous head and neck melanoma, which are said to be highly variable. The medical records of 145 patients with pathologically proven metastatic melanoma were reviewed retrospectively. The location of pathologically positive lymph nodes was compared with clinically predicted spread, and patients with metastatic disease in areas outside of predicted drainage patterns were considered aberrant. There were 33 curative and 73 elective neck dissections. 21 of 77 patients undergoing parotidectomy had positive results for metastases. Clinical prediction proved to be correct in 33 of 45 cases (73.3%). Two patients with lateralized melanomas were initially seen with contralateral metastases. Six of 45 patients (13.3%) developed contralateral metastases after neck dissection. Patients with clinical involvement of the parotid gland were at high risk of occult neck disease (40%). Patients undergoing neck dissection for primaries originating in face, forehead, coronal scalp, periauricular area, and upper neck should be considered for parotidectomy. Patients with posterior scalp and posterior neck primaries should be considered for selective neck dissection in conjunction with posterior lymphadenectomy. In patients with coronal scalp and periauricular primaries, a complete neck dissection including parotidectomy is the recommended approach.

The identification of mood and anxiety concerns using the patients concerns inventory following head and neck cancer - Corrected Proof

A. Kanatas, N. Ghazali, D. Lowe, S.N. Rogers — 2012-01-20

Abstract: The aim of this study was to investigate the concurrent use of the Patient Concerns Inventory (PCI) and the University of Washington Quality of life instruments (UW-QOL), as a means of identifying mood and anxiety concerns in patients following head and neck cancer treatment. From August 2007 to July 2009, 204 patients (454 clinic appointments) attending one consultant's oncology review clinic completed the UW-QOLv4 and PCI prior to their consultation. Before entering consultations, 17% (79/454) of patients reported problems with mood and 20% (89/454) reported problems with anxiety on the UW-QOL. Regarding the items raised by patients using the PCI prior to consultation, ‘mood’ was raised in 10% (46/454), ‘anxiety’ in 13% (58/454) and ‘depression’ in 10% (44/454) of cases. In 32% (145/454) of consultations, 44% (89/204) patients had reported significant anxiety or mood problems on the UW-QOL, or highlighted issues of anxiety, mood and/or depression on the PCI for discussion. Patients completing the PCI were more often referred to the clinical psychologist and to the emotional support worker. The results showed that the combination of the UW-QOL questionnaire and the PCI provide a practical means of screening for psychological distress in clinics.

Finite element analysis of bone–implant biomechanics: refinement through featuring various osseointegration conditions - Corrected Proof

D. Kurniawan, F.M. Nor, H.Y. Lee, J.Y. Lim — 2012-01-20

Abstract: A refinement technique is proposed for developing finite element models capable of simulating peri-implant bone conditions for bone types II, III, and IV at various degrees of osseointegration. The refined models feature a transition region between bone (cortical and cancellous) and implant and designate it partially to fully osseointegrated by assigning corresponding fractions of the bulk bone's elastic properties to this region. Bone is assumed to be transversely isotropic. The refined technique is implemented in a case study, in which osseointegrated (25–100%) peri-implant bone, type II, III, or IV with an implant attached, is loaded with a 100MPa occlusal load. The biomechanics of this peri-implant bone was simulated and analysed. Results showed that the less dense bone must support higher stress and strain, especially at the cortical region. Higher degree of osseointegration induced higher stress but lower strain. Both the bone type and the osseointegration condition significantly affected the stress–strain relation. For minimum stress and strain, denser and more osseointegrated peri-implant bone is desirable. When bone failure criteria were set, based on the yield strength and strain of the bone, a higher degree of osseointegration was needed for the less dense peri-implant bone to be considered safe.

Pectoralis major flap for head and neck reconstruction in era of free flaps - Corrected Proof

2012-01-20

Abstract: The aim of this study was to evaluate factors affecting the selection of pectoralis major flap in the era of free tissue reconstruction for post ablative head and neck defects and flap associated complications. The records of patients who underwent various reconstructive procedures between July 2009 and December 2010 were retrospectively analysed. 147 reconstructive procedures including 79 free flaps and 58 pectoralis major flaps were performed. Pectoralis major flap was selected for reconstruction in 21 patients (36%) due to resource constrains, in 12 (20%) patients for associated medical comorbidities, in 11 (19%) undergoing extended/salvage neck dissections, and in 5 patients with vessel depleted neck and free flap failure salvage surgery. None of the flaps was lost, 41% of patients had flap related complications. Most complications were self-limiting and were managed conservatively. Data from this study suggest that pectoralis major flap is a reliable option for head and neck reconstruction and has a major role even in this era of free flaps. The selection of pectoralis major flap over free flap was influenced by patient factors in most cases. Resource constraints remain a major deciding factor in a developing country setting.

Bipaddled submental artery flap - Corrected Proof

A. Ramkumar, N.J. Francis, R. Senthil Kumar, S. Dinesh Kumar — 2012-01-19

Abstract: Oral cancer is a major public health problem in India. Most patients present with locally advanced disease requiring complex resection and reconstruction strategies. Costs, operating time and availability of expertise are major issues that influence efficient health delivery, especially in developing countries such as India. Technically simple and widely reproducible techniques may be used successfully where applicable, to overcome these issues. The submental artery flap is a well described and acceptable alternative to the radial artery forearm free flap in oral cavity reconstruction. Researchers have demonstrated its technical ease of performance and reproducibility amongst trainees. Here the authors describe the bipaddled submental artery flap, a modification of the standard flap, which can be used to provide lining as well as skin cover for a full thickness cheek defect. Two skin paddles are fashioned taking advantage of the vascular anatomy of the submental vessels.

Abstracts from international literature - Corrected Proof

2012-01-18

Abstracts from international literature - Corrected Proof

2012-01-18

Abstracts from international literature - Corrected Proof

2012-01-17

Abstracts from international literature - Corrected Proof

2012-01-16

Abstracts from international literature - Corrected Proof

2012-01-16

Abstracts from international literature - Corrected Proof

2012-01-16

Suppurative osteomyelitis, bisphosphonate induced osteonecrosis, osteoradionecrosis: a blinded histopathologic comparison and its implications for the mechanism of each disease - Corrected Proof

R.E. Marx, R. Tursun — 2012-01-13

Abstract: Statistically, significant numbers of central bone specimens of suppurative osteomyelitis of the jaws (SOJ), bisphosphonate induced osteonecrosis of the jaws (BIONJ), and osteoradionecrosis of the jaws (ORNJ) were compared. All three evidenced the common finding of necrotic bone with empty osteocytic lacunae, Haversian and Volkmann canals, but each showed a distinctive histopathologic pattern indicating a different disease mechanism and treatment options. Suppurative osteomyelitis was characterized by intense marrow inflammation and marrow vessel thrombosis with retention of viable osteoclasts and periosteum. Bisphosphonate induced osteonecrosis was characterized by an empty marrow space with empty Howship's lacunae and an absence of osteoclasts but viable periosteum. Osteoradionecrosis was characterized by a collagenous hypocellular, hypovascular marrow space and nonviable periosteum. Histologic evidence in SOJ indicates a microorganism provoked intense inflammation and marrow vascular thrombosis creating an environment conducive to continual bacterial proliferation. BIONJ is seen as a non-inflammatory drug toxicity to bone by osteoclastic death leading to over suppression of bone renewal, and ORN as another non-inflammatory condition caused by a high linear energy transfer that impairs or kills numerous cell types in the field of radiation including periosteum, bone, and all soft tissue.

Microbiological investigation of retrodiscal tissues from patients with advanced internal derangement of the temporomandibular joint - Corrected Proof

M. McIntosh, G. Dimitroulis — 2012-01-13

Abstract: The aim of this study was to investigate the presence of bacteria in samples of retrodiscal tissues taken from patients suffering from advanced internal derangement of the temporomandibular joint (TMJ). 12 fresh retrodiscal tissue samples were taken from 12 consecutive patients who underwent unilateral TMJ discectomy for advanced TMJ internal derangement (Wilkes stage IV). The retrodiscal tissue samples were stained and cultured for the presence of micro-organisms in microbiology laboratories. No evidence of bacteria or other micro-organisms was found in any of the tissue specimens procured from the TMJ. This study failed to identify the presence of bacteria or other micro-organisms in fresh retrodiscal tissue specimens of the TMJ in patients with advanced TMJ internal derangement.

Trauma induced eagle syndrome - Corrected Proof

A. Koivumäki, M. Marinescu-Gava, J. Järnstedt, G.K. Sándor, J. Wolff — 2012-01-13

Abstract: Eagle syndrome is characterized by secondary calcification and elongation of the styloid process. Eagle syndrome is often associated with sharp, intermittent pain along the path of the glossopharyngeal nerve located in the hypopharynx and at the base of the tongue. In some cases, the stylohyoid apparatus can compress the internal and/or the external carotid arteries and their perivascular sympathetic fibres, resulting in a persistent pain radiating throughout the carotid territory. The pathogenesis of the syndrome is not understood. The authors report the case of a 52-year-old woman with post traumatic Eagle syndrome-like pain and pseudoarthrosis of the stylohyoid ligament.

Psychological profiles in patients with recurrent aphthous ulcers - Corrected Proof

Mahmoud K. AL-Omiri, J. Karasneh, E. Lynch — 2012-01-12

Abstract: The aim of this study was to investigate the psychological profiles of patients with recurrent aphthous ulcers (RAUs). 50 patients (27 men and 23 women, mean age 31.44±9.95 years) with diagnosed RAUs participated in this study. 50 controls who matched the patients in age and gender were also recruited. The participants’ personality and psychological profiles were assessed using the Hospital Anxiety and Depression Scale (HAD) and the Neuroticism-Extraversion-Openness Five Factor Inventory (NEO-FFI). Data analysis showed that females had higher HAD anxiety scores than males in both patients and controls. Patients’ age, intensity of pain and number, position, duration, and frequency of ulcers had no relation to HAD and NEO-FFI scores. Patients reported higher levels of anxiety in comparison to controls, but both reported comparable depression scores. Patients’ NEO-FFI scores were not different from those reported by controls and the psychological profiles of patients and controls were similar. In conclusion; stressful situations and conditions (i.e. anxiety) rather than personality profiles and stable psychological traits were related to the occurrence of recurrent aphthous ulcers.

Determination of trigeminocardiac reflex during rhinoplasty - Corrected Proof

E. Yorgancilar, R. Gun, M. Yildirim, S. Bakir, Z. Akkus, I. Topcu — 2012-01-12

Abstract: In most rhinoplasty procedures, osteotomies are usually required. The osteotomy areas are innervated by sensory branches of the trigeminal nerve. The trigeminocardiac reflex (TCR) is clinically defined as the sudden onset of parasympathetic activity during stimulation of the trigeminal nerve. When an osteotomy is performed or external pressure is applied over the nasal bone, the infraorbital nerve may send signals via this nerve. The aim of this prospective study is to determine the blood pressure changes and occurrence of TCR during rhinoplasty. one hundred and eight patients were enrolled into the study. Lidocaine and adrenaline combination (LAC) was injected only into the left lateral osteotomy sites. All patients underwent median, right-side, then left-side lateral osteotomies and nasal pyramid infracture. The haemodynamic changes were recorded. A 10% or more decrease in the heart rate from baseline was considered a TCR. TCR was detected in nine patients following lateral osteotomies and nasal pyramid infracture procedures (8.3%). The authors determined that LAC injection prior to osteotomy did not prevent TCR. Manipulation at or near the infraorbital nerve during rhinoplasty may cause TCR, even if local anaesthetic infiltration is used.

Clinicopathological features of salivary and non-salivary adenoid cystic carcinomas - Corrected Proof

2012-01-10

Abstract: Adenoid cystic carcinoma (ACC), commonly from salivary glands, is known for its insidious local growth and usually protracted clinical course. ACC developing from non-salivary glands (i.e., non-salivary ACC) is heterogeneous, and its clinicopathological features remain poorly defined. Patients treated for ACC in a single institution between 1995 and 2007 were included in this study. Immunohistochemical evaluation of Ki-67, E-cadherin, p16, and cyclinD1 was performed. The prognostic significance of clinical and immunophenotypic markers was evaluated. 83 cases of salivary ACC and 24 cases of non-salivary ACC were included. The expression levels of Ki-67 (54.8%), E-cadherin (90.4%), p16 (32.9%), and cyclinD1 (19.2%) between ACCs present at various sites were not different. Sinonasal, lacrimal, and tracheobronchial ACCs had significantly worse outcomes than those of ACC of the major salivary glands. Postoperative radiotherapy reduced the recurrence rate of patients with a negative resection margin (P=0.028). Older age (age >60 years), advanced stage, positive resection margin, high histological grade, and high expression of Ki-67 were significantly correlated with poor prognosis. In conclusion, the site of origin plays a role in the prognosis of ACC, in which positive resection margin and advanced stage are possible factors underlying the differences in outcomes.

Keratocystoma of the parotid gland: a clinicopathological study and literature review - Corrected Proof

X.-F. Huang, W. Li, X.-D. Yang, W.-H. Jiang, X.-H. Chen, Q.-G. Hu — 2012-01-05

Abstract: The authors investigated the clinicopathological characteristics of keratocystoma of the parotid gland. Two cases of parotid gland keratocystoma in the files of Nanjing Stomatological Hospital were analysed. These slowly growing parotid gland tumours occurred in two women aged 29 and 49 years. The cut surface showed multilocular cystic lesions filled with keratin materials. Histologically, there were multi-cystic spaces and solid epithelium islands, containing keratinized lamellae. Without cytological atypia, the lining stratified squamous epithelium showed apparent keratinization through an orthokeratotic or parakeratotic pathway. No skin appendage formation was observed. Both cases immunoreactively stained positively for AE1/AE3 and CK5/6 but negatively for CK8/18, S-100 and Calponin. There was no evidence of recurrence 3 or 4 years after superficial parotidectomy. The data from these two cases and cases previously published suggest that keratocystoma of the parotid gland is a benign cystic neoplasm. Surgical resection is apparently sufficient for cure.

The use of intra-osseous versus extra-osseous distraction devices in atrophic mandibles - Corrected Proof

F.B.T. Perdijk, G.J. Meijer, Ch. Krenkel, R. Koole — 2012-01-04

Abstract: To allow for implant placement in severe atrophic edentulous mandibles, distraction osteogenesis can be used to gain sufficient bone height. The efficacy of extra-osseous and intra-osseous devices is evaluated. In this retrospective study, 45 patients treated with an extra-osseous device (EOD) were compared with 43 patients treated with an intra-osseous device (IOD). From a statistical point of view, both patient groups were comparable for age and sex ratio. The IOD group gained more bone height (9.8mm) than the EOD group (6.0mm). A significantly higher degree of backward tilting of the device was observed in the EOD group (12.1°), compared with the IOD group (3.0°). There were also significantly more fractures of the basal bone segment and sensory disturbances of the chin area in the EOD group than in the IOD group. The IOD group scored significantly better on bone height gained, backward tilting of the device, occurrence of fractures, and postoperative sensory disturbances. Despite the fact that the mean preoperative bone height for the IOD group was substantially higher (18.6mm) than for the EOD group (11.9mm), it may be concluded that for augmentation procedures of the edentulous mandible, the IOD is more favourable.

Response to: S. Richardson, N.A. Agni, Z. Pasha, Modified Turkish delight: morcellized polyethylene dorsal graft for rhinoplasty [Int. J. Oral Maxillofac. Surg. 40 (2011) 979–982] - Corrected Proof

A. Vaidhyanathan, S.G. Reddy, R.R. Reddy — 2012-01-04

We read with interest the article by Richardson et al. on morcellized porous polyethylene dorsal grafts for rhinoplasty. The technique does appear to be very innovative. We recognize that there are several forms of alloplastic implants that can be used as improvizational material. However, we do have a few concerns regarding the particulate polyethylene graft used by the authors.

A hyperbaric oxygen chamber for animal experimental purposes - Corrected Proof

U.M. Djasim, L. Spiegelberg, E.B. Wolvius, K.G.H. van der Wal — 2012-01-03

Abstract: Facilities for hyperbaric oxygen therapy that are suitable for animal experimental research are scarce. In this paper, the authors introduce a hyperbaric oxygen chamber that was developed specifically for animal experimental purposes. The hyperbaric oxygen chamber was designed to meet a number of criteria regarding safety and ease of use. The hyperbaric oxygen chamber conforms to 97/23/EC (Pressure Equipment Directive), Conformity Assessment Module G Product Group 1. It provides easy access, and can be run in manual mode, semi-automatic mode and full-automatic mode. Sensors for pressure level, oxygen level, temperature, humidity and carbon dioxide level allow full control. This state-of-the-art hyperbaric oxygen chamber for animal experimental purposes permits the investigation of the biological mechanisms through which hyperbaric oxygen therapy acts at a fundamental level.

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

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

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

Carcinoma ex pleomorphic adenoma of the upper lip - Corrected Proof

D. Dyalram, T. Huebner, J.C. Papadimitriou, J. Lubek — 2012-01-03

Abstract: Carcinoma ex pleomorphic adenoma (CXPA) is a rare salivary gland malignancy most often reported within the parotid gland. Of the salivary gland tumours that occur within the minor salivary glands at least 50% are reported to be malignant. This proves to be inaccurate when describing salivary gland tumours within the upper lip which are usually benign. A Medline search of the English language literature yields only one case report of a CXPA located within the upper lip. The authors present a second case report of CXPA within the upper lip and a review of its pathologic features and management.

Epithelial-myoepithelial carcinoma with high grade transformation - Corrected Proof

S. Yang, X. Chen — 2012-01-03

Abstract: Epithelial-myoepithelial carcinoma (EMC) is a rare low-grade salivary gland malignancy of presumed intercalated duct origin comprising 1% of all salivary gland tumours. High grade transformation (HGT) in EMC is a recently recognised entity with only a few cases reported in the literature. The authors report an additional case of EMC with HGT involving the submandibular gland. The patient was a 60-year-old woman who requested examination of the rapid growth of a mass in the left submandibular area, which she had first noticed 20 years previously. Histologically, the tumour had two distinct carcinomatous components. One component had features of a low grade EMC. The second component consisted of polygonal cells, arranged in a solid and nested pattern, with marked nuclear pleomorphism, brisk mitotic activity, and frequent necrosis. The Ki-67 labelling index of the EMC component was 9%, and that of the high grade component was 40%. The patient developed multiple pulmonary metastases 15 months after surgery. The aggressive behaviour of EMC with HGT suggests that it is important to recognise this variant of EMC to avoid misdiagnosis and inappropriate treatment.

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

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

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

A simpler method of improving visibility of the temporomandibular joint space using a polyether block - Corrected Proof

C.J. Perumal — 2011-12-30

With interest, I have read the article by Huang, regarding a simple method to expand the joint space for temporomandibular joint (TMJ) surgery which is a welcome alternate method of increasing the visibility of the TMJ space. It would have been more appropriate to refer to the method as: a simple method to improve visibility of the joint space than to “expand” the joint space. Promoted by the paper, I would like to report a possible alternate technique based on similar methods with added advantages.

Bismuth subgallate as a topical haemostatic agent at the palatal wounds: a histologic study in dogs - Corrected Proof

2011-12-30

Abstract: This study evaluated the early recovery process of the palatal wounds of dogs using bismuth subgallate. Five healthy adult male dogs underwent eight 5-mm partial-thickness punch biopsies in two paired columns on the palatal mastigatory mucosa. For the haemostasis, one side received moistened gauze pressure (test group 1), and the other received bismuth subgallate (test group 2). A description of the epithelium and connective tissue repair was made at 3, 7, 14 and 21 days. During the first days, a mass of disorganized tissue covered the connective tissue, in which there was intense chronic inflammation, and migration of epithelium cells from the edges towards the central region to close to the wound was seen. The final evaluation demonstrated well organized epithelial and connective tissues in all the samples. Epithelium thickness was measured at 0, 14 and 21 days, from images of the digitalized histological sections. In comparisons between the test groups, the bismuth subgallate group was slightly better than the saline group, but no statistically significant difference was found at 21 days. It was possible to conclude that bismuth subgallate did not interfere in the tissue repair of the palatal mastigatory mucosa in dogs.

Multifocal cutaneous metastases from squamous cell carcinoma of hard palate - Corrected Proof

J. Sun, Q. Gao, V.T.W. Fan — 2011-12-30

Abstract: Distant metastases from oral squamous cell carcinoma are unusual, but generally occur in lungs, bone, and liver. Cutaneous metastasis is extremely rare, and it often reflects an advanced stage with sinister prognosis. The authors report an 81-year-old male patient with multifocal cutaneous metastases from a recurrent squamous cell carcinoma of the hard palate 5 months after primary treatment.

Custom-made intraoral mandibular distraction as treatment for neonatal airway obstruction - Corrected Proof

B.I. Pluijmers, M.J. Koudstaal, E.B. Wolvius, K.G.H. van der Wal — 2011-12-30

Abstract: Hypoplastic mandible related airway obstruction therapy may vary from non-surgical to surgical, depending on the severity of the obstruction. Since its introduction in 1992, distraction osteogenesis (DO) has been used to lengthen the mandible. A new intraoral device is presented here. It has no need of screw fixation, whilst placement and activation are intraoral, leading to simple placement and removal. Seven cases with hypoplastic mandible related airway obstruction were treated between 2001 and 2008 with intraoral DO at the authors’ institution. Six patients had a tracheostomy and one received continuous positive airway pressure (CPAP). After the distraction phase, five patients could be decanulated and in one case CPAP was no longer required. In one case the desired effect was not achieved. The findings suggest that early mandibular DO leads to damage to the permanent tooth buds resulting in missing teeth. The effectiveness of mandibular DO regarding early discharge of the patient is shown, leading to an overall cost reduction. Knowledge of alternative modalities such as mandibular DO in case of hypoplastic mandible related airway obstruction in neonatal healthcare should lead to early referral to a dedicated maxillofacial surgeon, possibly avoiding long-term airway support or tracheotomy.

Comparative study of the effect of dexamethasone injection and consumption in lower third molar surgery - Corrected Proof

K. Boonsiriseth, B. Klongnoi, N. Sirintawat, C. Saengsirinavin, N. Wongsirichat — 2011-12-30

Abstract: The aim of this study was to compare the effect of intramuscular (IM) injection and consumption of 8mg dexamethasone in patients after lower third molar (LTM) surgery. 20 healthy Thai patients, average age 20 years, with bilateral LTM removal were recruited for this study, a double blinded, paired sample clinical trial. The washout period was 1 month after the first operation. Clinical assessment of facial swelling, pain and maximum mouth opening were measured before and after operation for 7 days. No significant difference was found in facial swelling between IM injection and consumption of 8mg dexamethasone after LTM surgery (paired t test P>0.05). The visual analogue scale scores for pain assessment showed no significant difference between IM injection and consumption of dexamethasone (paired t test P>0.05). The results conclude that IM injection or consumption of dexamethasone after LTM surgery can be used to control facial swelling, pain and trismus.

Pneumoparotitis: a diagnostic challenge - Corrected Proof

M. Ghanem, J. Brown, M. McGurk — 2011-12-30

Abstract: Pneumoparotitis is a rare cause of recurrent parotid swelling and its diagnosis can be challenging if the patient does not present with typical symptoms and is not in a risk group for parotitis. Several diagnostic techniques have been described in the literature including plain radiography, sialography and CT scanning. This report suggests that ultrasound is an efficient diagnostic aid and should be routinely used for the diagnosis of this condition.

Single dose intramuscular injection dexamethasone on preoperative lower impacted third molar surgery - Corrected Proof

2011-12-30

Abstract: This study aimed to investigate the effects of dexamethasone intramuscular injection 1h preoperatively, in reducing facial swelling, pain and trismus after lower impacted third molar (LITM) surgery. Twenty healthy Thai patients with both LITM surgical extraction were enrolled in the study. The washout period was 1 month after the first operation. Clinical assessment of the facial swelling, pain and trismus were measured before and after operation for 7 days and the patient's total analgesic consumption was recorded. The level of significance used in the statistical decisions was P<0.05. Preoperative intramuscular injection of single-dose 8mg dexamethasone reduced postoperative swelling after LITM surgical extraction significantly on the second postoperative day, but immediately after surgery and on day 7 after the surgical extraction, no significant difference was found between the dexamethasone and control groups. Dexamethasone also reduced postoperative pain after LITM surgical extraction significantly on postoperative days 2 and 7. Additionally, the amount of paracetamol decreased significantly. There were no significant differences in trismus in the study and control groups 7 days after LITM operation. Single-dose intramuscular injection of dexamethasone can reduce postoperative facial swelling and pain, without affecting trismus after LITM surgical extraction.

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

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

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

Diagnostic value of ultrasound-guided core needle biopsy in patients with salivary gland masses - Corrected Proof

J. Pfeiffer, G.J. Ridder — 2011-12-29

Abstract: The salivary glands are unique in the diversity and complexity of their pathologies. Because fine needle aspiration cytology and frozen section are associated with major diagnostic difficulties, the authors analyzed the use of core needle biopsy (CNB) for the histologic assessment of salivary gland lesions. A systematic observational clinicopathologic quality assessment study was performed over 81 months including 161 CNB procedures in 76 patients with salivary gland pathologies. Adequate samples containing the target tissue were obtained in 73 patients. These samples revealed malignant disease in 45 (62%) patients, benign disease in 26 (36%) patients, and were inconclusive in 2 (3%) patients. Follow-up uncovered no false-positive or false-negative results. On the basis of secondary histologic and clinical follow-up, the statistical parameters were calculated as follows: sensitivity 94%; specificity 100%; accuracy 96%; positive predictive value 100%; negative predictive value 90%. The advantages and potential limitations of CNB in patients with salivary gland masses are discussed. CNB is a reliable biopsy technique for the assessment of salivary gland pathologies, although limitations remain for the subclassification of some neoplastic lesions. The authors recommend CNB as the biopsy technique of choice for a selection of indications.

Assessment of silk fibroin for the repair of buccal mucosal in a rat model - Corrected Proof

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

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

Skeletal stability after inferior maxillary repositioning without interpositional graft - Corrected Proof

S.E. Santos, R.W.F. Moreira, M. de Moraes, L. Asprino, M.M. Araujo — 2011-12-23

Abstract: True vertical maxillary deficiency is a characteristic of short face syndrome. In these patients, inferior repositioning of the maxilla (IRM) is indicated to improve facial aesthetics and function, but this procedure has been described as the most unstable. The aim of this study was to evaluate the long term, post surgical stability of IRM, fixed with four 2.0mm L-shaped miniplates, without any type of graft. A cephalometric study was performed, analysing linear measurements (anterior nasal spine, the A point, top of the incisor, top of the buccal-mesial cusp of the first molar, and posterior nasal spine on an X–Y coordinate system) traced immediately preoperatively, immediately postoperatively and at least 6 months post operatively. Eight young adult patients who underwent IRM were studied. The average results of this study were: surgical movement of 4.65mm at I point, 5.32mm at anterior nasal spine (ANS) point, and 4.70mm at A point and relapses of 1.60mm (35%), 2.23mm (43%) and 2.10mm (46%), respectively. It was concluded, that IRM using this type of internal rigid fixation without graft is unstable.

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

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

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

Elongated coronoid process: CT-based quantitative analysis of the coronoid process and review of literature - Corrected Proof

F. Tavassol, S. Spalthoff, H. Essig, M. Bredt, N.-C. Gellrich, H. Kokemüller — 2011-12-22

Abstract: Impingement of the enlarged coronoid processes against the medial surfaces of the zygomatic arches and posterior surfaces of the body of the zygomatic bones results in mechanical restriction of the mouth opening. The authors introduce a helpful tool for easy assessment and estimatation of the length of the coronoid process, measured on the CT scans of 40 patients (20 adults, 20 adolescents) and report a case of a 13-year-old boy suffering from restricted mouth opening caused by bilateral hyperplasia of the coronoid process. The CT based analysis resulted in a mean length of the coronoid process of 13.02mm in adults and 12.43mm in adolescents. The 13-year-old boy had a length of nearly 2cm. For comparison, a coronoid/condyle ratio was developed. This ratio showed a value of 0.78 for all patients compared with a value of about 2.0 for the boy. The literature review revealed comparable results to the reported case. Most of the patients were adolescent, male and presented a median history of 2years until correct diagnosis.

Two-needle vs. single-needle technique for TMJ arthrocentesis plus hyaluronic acid injections: a comparative trial over a six-month follow up - Corrected Proof

L. Guarda-Nardini, G. Ferronato, D. Manfredini — 2011-12-19

Abstract: The aim of the study was to compare the effectiveness of five weekly two-needle arthrocentesis plus hyaluronic injections vs. the same protocol performed with a single-needle technique in patients with inflammatory-degenerative disorders of the temporomandibular joint (TMJ). 80 patients with TMJ osteoarthritis were randomly assigned to the two-needle or single-needle protocol and followed up for 6 months after treatment. Several outcome parameters, such as maximum pain at rest and maximum pain on chewing, subjective chewing efficiency, limitation in jaw function, jaw range of motion in mm, were recorded at baseline and multiple follow up assessments. Both treatment groups recorded significant improvement with respect to baseline levels in almost all outcome variables. The rate of improvement was not significantly different between the treatment protocols in any of the outcome variables (p-values between 0.143 and 0.970). No between-group differences emerged for the perceived subjective efficacy (p=0.321) and the treatment tolerability (p=0.783). The present investigation did not support the existence of significant differences in the treatment effectiveness for inflammatory-degenerative TMJ disorders of a cycle of five weekly injections of arthrocentesis plus hyaluronic acid injections performed according to the classical two-needle or the single-needle technique.

Effects of different mandibular fracture patterns on the stability of miniplate screw fixation in angle mandibular fractures - Corrected Proof

Z.O. Pektas, B. Bayram, C. Balcik, T. Develi, S. Uckan — 2011-12-19

Abstract: The aim of the present study was to evaluate the effects of horizontally favourable and unfavourable mandibular fracture patterns on the fixation stability of titanium plates and screws by simulating chewing forces. Favourable and unfavourable mandibular fractures on 22 sheep hemimandibles were fixed with 4-hole straight titanium plates and 2.0mm×7mm titanium screws according to the Champy technique. Hemimandibles were mounted with a fixation device in a servohydraulic testing unit for compressive testing. Displacement values under 20, 60, 100, 120, 150, 200N, maximum displacements, and maximum forces the model could resist before breakage were recorded and compared. The authors found no statistically significant differences between the groups for the displacement values in the force range 60–200N (60, 100, 120, 150 and 200N). Statistically significant differences for maximum displacement values (displacement values at the breaking forces) between the groups were found (P<0.05). There was no evidence for the need to apply different treatment modalities to mandibular fractures regardless of whether the factures are favourable or not.

Diffuse tenosynovial giant cell tumour of the temporomandibular joint - Corrected Proof

A. Tel, A. Spinzia, M. Boggio — 2011-12-16

Abstract: Tenosynovial giant cell tumour (TGCT) is a rare benign proliferative disorder of the synovium characterised by destructive invasion by synovial-like mononuclear cells. Two variants have been distinguished: a localized (TGCT-L) and a diffuse (TGCT-D) type. TGCT usually affects adults with a peak incidence in the fifth and sixth decades of life and is more often seen in women than in men. One of the most common soft tissue tumours of the hand (finger joints and tendon sheaths), it is exceedingly uncommon in the head or neck. Only three cases of TGCT-D have been described in the literature. This report presents a case of TGCT-D in the temporomandibular joint.

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

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

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

The retromandibular transparotid approach to mandibular subcondylar fractures - Corrected Proof

L. Yang, P.M. Patil — 2011-12-14

Abstract: The aim of this study was to evaluate the safety, utility and morbidity associated with the treatment of mandibular subcondylar fractures using the retromandibular transparotid approach and to evaluate the stability of a single 2mm miniplate fixation system for such fractures. Forty-two cases with 48 mandibular subcondylar fractures were analysed prospectively for 12 months and evaluated for functional results, scar, postoperative complications and stability of fixation. There were three cases of suboptimal occlusal status, two cases of haematoma that were drained and resolved, eight patients with facial nerve weakness which resolved in a few weeks, and three cases of salivary fistulae that resolved after treatment. All cases showed stable osteosyntheses. Maximal postoperative interincisal distance was 32–61mm (mean 44mm). Four patients had deflection on opening, while clicking on opening or chewing was observed in five patients. The postoperative scars were well accepted by all patients. The results of this study suggest that a retromandibular approach will facilitate accurate reduction and fixation of subcondylar fragments with a good cosmetic result and minimal complications. A single 2mm miniplate fixation provides stable results.

Adaptability of stock TMJ prosthesis to joints that were previously treated with custom joint prosthesis - Corrected Proof

S. Abramowicz, M. Barbick, S.P. Rose, M.F. Dolwick — 2011-12-14

Abstract: The purpose of this study was to determine if a temporomandibular joint (TMJ) replaced by a custom joint prosthesis could have been replaced by a stock joint prosthesis. Stereolithic models of patients treated with TMJ Concepts® patient fitted joint prosthesis (e.g. custom) were obtained. Biomet Microfixation® TMJ prostheses (e.g. stock) were adapted to these models. Intra-operative insertion of prosthesis, fit and size of stock joints were simulated and evaluated. Adaptability and stability of condyle and fossa as well as their articulation were recorded. 20 models consisting of 34 joints were examined by two oral and maxillofacial surgeons who were blinded to the patient's diagnosis. Overall, 77% of the stock TMJ system fit the stereolithic models. 3mm or less of bone modification was necessary to achieve an acceptable fit. In the majority of the cases examined, a stock TMJ prosthesis had good anatomical adaptation to stereolithic models of patients previously treated with custom TMJ prosthesis, so a stock TMJ prosthesis could have been an acceptable option for these patients. Further prospective clinical studies to compare both systems are necessary.

Immunohistochemical characterization of wound healing at two different bone graft substitutes - Corrected Proof

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

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

Stability of the miniplate osteosynthesis used for sagittal split osteotomy for closing an anterior open bite: an experimental study in mini-pigs - Corrected Proof

2011-12-12

Abstract: Bilateral sagittal split osteotomy of the mandible with counterclockwise rotation of the occlusal plane alone has traditionally been considered the least stable treatment method. Two miniplates on each side of the osteotomy may resolve this problem. The authors compared early vertical and transverse stability of a simple mandibular advancement (group A), mandibular advancement with counterclockwise rotation (CCW) stabilized with one miniplate (group B), and two miniplates (group C) on mini-pig mandibles mounted on a custom-made loading unit. Two miniplates markedly increased the resistance to vertical bite forces. On a 100-N load, a median of dislocation of 0.53mm, 0.46mm, and 0.23mm was achieved in groups A, B, and C, respectively. The difference was statistically significant between groups A and B in comparison with group C. The results of transverse displacement were not statistically significant. The use of two miniplates in larger shifts, as well as in CCW cases, increases stability in the vertical direction.