International Journal of Oral & Maxillofacial Surgery - Articles in Press

Intraoral approach arthroplasty for correction of TMJ ankylosis - Corrected Proof

E.C. Ko, M.Y. Chen, S. Lai — 2010-07-28

We appreciate Dr. Robiony's concerns expressed in his letter but feel that he has misunderstood the indications and surgical technique that we describe in our article. In our experience, if the ankylosed bony mass is small and limited to the original TMJ area, it can be removed easily and completely through an extraoral approach. However, if the ankylosed bony mass is large and involves part of the skull base and/or occupies the sigmoid notch area, we find removal of the mass and creation of a gap arthroplasty can be very difficult to perform through a conventional extraoral approach. In these types of select cases of very large bony masses, we find our described intraoral technique in which the narrowest part of the ankylosed bony mass, usually over the original condylar neck region, can be performed easily after cutting off the coronoid process.

Comparative evaluation of dento-alveolar distraction and periodontal distraction assisted rapid retraction of the maxillary canine: a pilot study - Corrected Proof

V.R. Kharkar, S.M. Kotrashetti, P. Kulkarni — 2010-07-26

Abstract: Distraction osteogenesis is a biological process of new bone formation between the surfaces of the bone segments that are gradually separated by incremental traction. A recent innovative use of distraction osteogenesis in orthodontic tooth movement is to move individual tooth segments rapidly thus reducing orthodontic treatment time. Six patients, comprising two groups, were compared using two different surgical techniques: dento-alveolar distraction and periodontal distraction to bring about rapid canine retraction using an indigenously designed intra-oral distractor. The aim was to assess and evaluate the best approach to reduce the overall orthodontic treatment time by means of distraction osteogenesis. The patients were assessed at regular intervals with intra-oral periapical radiographs and lateral cephalograms for gauging the time required for retraction, canine tipping, anchorage loss and external root resorption. Dento-alveolar distraction was superior to periodontal distraction in all areas of assessment.

When is a retrobulbar haemorrhage not a retrobulbar haemorrhage? - Corrected Proof

M. Allen, M. Perry, F. Burns — 2010-07-26

Abstract: Retrobulbar haemorrhage (RBH) is a well described condition which is said to be a common cause of acute proptosis following trauma, but the evidence for this is not strong. The authors reviewed 186 publications on the subject, finding 82 cases of RBH related to trauma. This analysis suggests that in over half of the cases described, RBH was never proven conclusively. In the authors’ experience RBH is not a common cause of acute proptosis following trauma and other causes need to be considered if patients are to be managed appropriately.

In vitro evaluation of conventional and locking miniplate/screw systems for the treatment of mandibular angle fractures - Corrected Proof

P.D. Ribeiro-Junior, O. Magro-Filho, K.A. Shastri, M.B. Papageorge — 2010-07-23

Abstract: This in vitro study evaluated the influence of the type of miniplate and the number of screws installed in the proximal and distal segments on the stability and resistance of Champy's osteosynthesis in mandibular angle fractures. Sixty polyurethane hemimandibles with bone-like consistency were randomly assigned to four groups (n=15) and sectioned in the mandibular angle region to simulate fracture. The bone segments were fixed by different osteosynthesis methods using 2.0mm miniplates and 2.0mm×6mm monocortical screws. In groups 1 and 2, two conventional (G1) or locking (G2) screws were installed in each bone segment using a conventional (G1) or a locking (G2) straight miniplate; in groups 3 and 4, three conventional (G3) or locking (G4) screws were installed in the proximal segment and four conventional (G3) or locking (G4) screws were installed in the distal segment using a conventional (G3) or a locking (G4) seven-hole straight miniplate. The hemimandibles were loaded in compressive strength until a 4mm displacement occurred between the segments, vertically or horizontally. Locking plate/screw systems provided significantly greater resistance to displacement than conventional ones (p<.01). Locking miniplates offered more resistance than conventional miniplates. Long locking miniplates provided greater stability than short ones.

Facial animation in patients with Moebius and Moebius-like syndromes - Corrected Proof

B. Bianchi, C. Copelli, S. Ferrari, A. Ferri, E. Sesenna — 2010-07-23

Abstract: Moebius syndrome, a rare congenital disorder of varying severity, involves multiple cranial nerves and is characterised predominantly by bilateral or unilateral paralysis of the facial and abducens nerves. Facial paralysis causes inability to smile and bilabial incompetence with speech difficulties, oral incompetence, problems with eating and drinking, including pocketing of food in the cheek and dribbling, as well as severe drooling. Other relevant clinical findings are incomplete eye closure and convergent strabismus. The authors report on 48 patients with Moebius and Moebius-like syndromes seen from 2003 to September 2007 (23 males and 25 females, mean age 13.9 years). In 20 cases a reinnervated gracilis transplant was performed to re-animate the impaired sides of the face. In this series, all free-muscle transplantations survived the transfer, and no flap was lost. In 19 patients complete reinnervation of the muscle was observed with an excellent or good facial symmetry at rest in all patients and whilst smiling in 87% of cases. In conclusion, according to the literature, the gracilis muscle free transfer can be considered a safe and reliable technique for facial reanimation with good aesthetic and functional results.

Parapharyngeal space tumors: 61 case reviews - Corrected Proof

M.V. Dimitrijevic, S.D. Jesic, A.A. Mikic, N.A. Arsovic, N.R. Tomanovic — 2010-07-20

Abstract: Parapharyngeal tumors account for 0.5% of head and neck tumors. They are difficult to diagnose because they have few symptoms and are surgically inaccessible. This retrospective study included 61 patients with parapharyngeal space tumors, treated in the last 20 years. The data, obtained from the medical records, included symptoms and clinical signs, diagnostic procedures, surgical approach, postoperative complications and histopathological findings. The most common symptoms were dysphagia, foreign body sensation, pain, and symptom-free patients. For precise tumor localization and its relation to adjacent structures, computerized tomography, magnetic resonance imaging and contrast angiography were used. All the patients were treated surgically. The commonest surgical approach was transcervical, followed by transoral and combined transcervical–transoral. Histopathological examination verified that the origin of these tumors was most frequently salivary or neurogenic.

Adenomatoid odontogenic tumour: review of the literature and an analysis of 33 cases from South Africa - Corrected Proof

A. Mohamed, A.S. Singh, E.J. Raubenheimer, M.M.R. Bouckaert — 2010-07-20

Abstract: The adenomatoid odontogenic tumour (AOT) is a benign lesion of odontogenic origin. It is a slow growing tumour that results in a painless expansion of the jaws. This is a retrospective review of the demographic, clinical and radiographic features of AOTs diagnosed in a black South African population over 20 years. Of the 746 odontogenic tumours diagnosed, 4% were AOTs. The patients’ ages ranged from 9 to 37 years with a mean age of 15 years. The highest incidence was in the second decade of life (85%). The female to male ratio was 5.6:1. The maxilla was more commonly affected than the mandible in a ratio of 1.5:1. The sizes of the lesions ranged from 2 to 7cm, with 60% involving an entire quadrant. All were of the central follicular type and appeared as well-demarcated radiolucent lesions. The canine was the most common impacted tooth. The treatment of choice was enucleation of the lesion, with no recurrences being reported.

Corrected Proof

David H. Perrott — 2010-07-16

The preface to this book had been started by the co-editor, Dr. Thomas Graber. However, due to his passing, the book and preface was completed by Dr. Rakoski in memory of Dr. Graber. Fourteen international orthodontists contributed sixteen chapters in writing the 416 page book.

Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth - Corrected Proof

Y.-F. Liao, N.K.K. Prasad, Y.-T. Chiu, C. Yun, P.K.-T. Chen — 2010-07-16

Abstract: Cleft size at the time of palate repair might affect the difficulty of surgical repair and, thus, indirectly postoperative maxillary growth. This retrospective study aimed to determine whether a correlation existed between the cleft size at the time of palate repair and the growth of the maxilla. Maxillary dental casts of 39 infants with non-syndromic complete unilateral cleft lip and palate, taken at the time of palate repair, were used to measure cleft size. Cleft size was defined as the percentage of the total palatal area. The later growth of the maxilla was determined using lateral and postero-anterior cephalometric radiographs taken at 9 years of age. The Pearson correlation analysis was used for statistical analysis. The results showed negative correlations between cleft size and the maxillary length (PMP–ANS, PMP–A) and the maxillary protrusion (S–N–ANS, SNA). These data suggest that in patients with complete unilateral cleft lip and palate there is a significant correlation between the cleft size at the time of palate repair and the maxillary length and protrusion. Patients with a large cleft at the time of palate repair have a shorter and more retrusive maxilla than those with a small cleft by the age of 9 years.

The effect of 1-stage versus 2-stage palate repair on facial growth in patients with cleft lip and palate: a review - Corrected Proof

I.-Y. Yang, Y.-F. Liao — 2010-07-16

Abstract: The purpose of this review was to evaluate the effect of 1-stage versus 2-stage palate repair with delayed hard palate closure on facial growth in patients with cleft lip and palate. A literature survey from the PubMed database from January 1966 to December 2007 used the medical subject headings terms ‘facial growth’, ‘cleft lip and palate’, ‘cephalometry’, and ‘1-stage palate repair’ in combination with ‘2-stage palate repair’ or ‘delayed hard palate closure’. The Cleft Palate-Craniofacial Journal from 1964 to November 2007 was hand searched. Controlled studies written in English were selected. Two reviewers selected and extracted the data independently and assessed the quality of the studies. On the basis of this search only nine studies were included in this review. All studies were retrospective and non-randomized. Six studies were cross-sectional, and three were longitudinal. Heterogeneity and methodological deficiencies in the studies prevented conclusions regarding stage of palate repair and facial growth. Further well-designed controlled studies and long-term studies are needed, and researchers should focus on the variation in hard palate repair timing before 3 years of age and consider patient speech.

Intraoral approach for arthroplasty for correction of TMJ ankylosis - Corrected Proof

Massimo Robiony — 2010-07-16

I would like to comment on the interesting article entitled “Intraoral approach for arthroplasty for correction of TMJ ankylosis” by Ko et al. In the article, Ko et al. claim the intraoral arthroplasty technique can avoid the complications that are seen when using the extraoral approach to TMJ arthroplasty.

Use of a replica graft tooth for evaluation before autotransplantation of a tooth. A CAD/CAM model produced using dental-cone-beam computed tomography - Corrected Proof

M. Honda, H. Uehara, T. Uehara, K. Honda, S. Kawashima, K. Honda, Y. Yonehara — 2010-07-14

Abstract: A 33-year-old man was referred by a local dentist for autotransplantation of the right mandibular third molar to the site of the left mandibular first molar. Before the operation, dental-cone-beam computed tomography was performed to measure the dimensions of the graft tooth and the bone volume of the socket. The three-dimensional (3D) structure of the graft tooth was created from the 3D imaging data. A replica of the graft tooth was produced using a stereolithographic CAD/CAM system before autotransplantation. A socket of the appropriate size and structure was created and the graft tooth was extracted immediately before grafting. This procedure shortened the time needed to fit the graft tooth into the socket and reduced injury to the periodontal membrane. The postoperative outcomes of autotransplantation of the tooth were good.

Arthroscopically guided removal of large solitary synovial chondromatosis from the temporomandibular joint - Corrected Proof

X.-Y. Cai, C. Yang, M.-J. Chen, B. Jiang, B.-L. Wang — 2010-07-14

Abstract: Synovial chondromatosis of the joint is a rare benign condition characterized by the formation of metaplastic cartilage in the synovium of the joint resulting in numerous attached and unattached osteocartilagenous bodies. Involvement of the temporomandibular joint (TMJ) is uncommon. Arthrotomy is usually applied to remove the larger particles and the affected synovial tissues. The authors report the case of a 48-year-old female with a large solitary synovial chondroma in the left TMJ. The larger mass was removed successfully via an additional incision in the anterior wall of external auditory meatus under the guidance of arthroscopy. The patient has been symptom-free for 5 years postoperatively.

Clinical study on prognostic factors for autotransplantation of teeth with complete root formation - Corrected Proof

2010-07-14

Abstract: Autotransplantation is often performed to replace a missing tooth, but tooth autotransplantation has been reported in fewer teeth with complete root formation than those with incomplete root formation. The aim of this prospective study was to evaluate the factors that affect the prognosis of autotransplantation of teeth with complete root formation. 109 patients with 117 transplants were studied. Of the 117 transplants investigated, 14 (12%) failed during the observation period. The overall 1-year survival rate was 96%; the 5-year survival rate was 84%. The major causes of failure were unsuccessful initial healing and replacement root resorption with periodontal inflammation. Factors significantly associated with unsuccessful transplantation, in single factor analysis, were age 40 years or more, molar tooth as donor, probing pocket depth to 4mm or more, history of root canal treatment, multi-rooted teeth and fixation with sutures. Pocket depth of 4mm or more and history of root canal treatment appeared to increase the risk of unsuccessful transplantation in multivariate analysis. It is suggested that the pocket depth of the donor tooth and history of root canal treatment are related to the healing of paratransplantal tissue and root resorption.

Biomechanical three-dimensional finite-element analysis of maxillary prostheses with implants. Design of number and position of implants for maxillary prostheses after hemimaxillectomy - Corrected Proof

S. Miyamoto, K. Ujigawa, Y. Kizu, M. Tonogi, G.-Y. Yamane — 2010-07-13

Abstract: The present study analyzed stress distributions in craniofacial structures around implant-supported maxillary prostheses. Using post-hemimaxillectomy computed tomography (CT) of a patient, the authors constructed a three-dimensional (3D) solid model using Digital Imaging and Communications in Medicine data (DICOM data) for maxillofacial and cranial bones. The effects of different prosthesis designs on stress distributions in craniofacial bones and osseous tissues around the implants were biomechanically investigated using 3D finite-element analysis. Maxillary prostheses were designed with 2 implants in the zygoma on the affected side and 2–3 implants in the maxillary alveolar bone on the unaffected side, without using a cantilever. Zygomatic implants provided suitable stress dispersal to the zygomatic and craniofacial bones on the affected side. This information is useful for designing maxillary prostheses.

Histological and histomorphometrical comparative study of β-tricalcium phosphate block grafts and periosteal expansion osteogenesis for alveolar bone augmentation - Corrected Proof

K. Yamauchi, T. Takahashi, K. Funaki, Y. Hamada, Y. Yamashita — 2010-07-08

Abstract: This study evaluated local tissue reaction around the β-tricalcium phosphate (β-TCP) block and compared results with β-TCP block grafting and periosteal expansion osteogenesis (PEO). The mandibular premolars were extracted from five dogs and buccal corticotomy was performed. Narrow alveolar ridge models were created at 4 weeks. The β-TCP block graft, such as veneer graft, was used on the right side and PEO using β-TCP block on the left side. Changes of alveolar width, histological findings and histomorphometrical analysis were evaluated. There were no problems with materials at any of the sites at any time. In both groups, the width increased after surgery and results were stable 8 weeks after surgery. Newly formed bone tissue was observed inside the β-TCP block in both sides. Histological findings differed especially at the division between mandibular bone and β-TCP block. Histomorphometric analyses revealed that β-TCP had been absorbed (mean decrease 28%) and new bone had formed (mean increase 43%) at 8 weeks postoperatively on both sides. The β-TCP block worked as a space-maker under the soft tissue, including the periosteum, and acted as a substitute for original bone. This bone substitute was effective material for bone augmentation in both methods.

Effect on the contour of bone and soft tissue one year after harvesting chin bone for alveolar cleft repair - Corrected Proof

E.A. Dik, A.P. de Ruiter, A. van der Bilt, R. Koole — 2010-07-08

Abstract: In this study the authors evaluate and quantify the residual bony defect in the mandibular symphysis and its effect on the soft tissue contour a minimum of 1 year after harvesting chin bone. 59 ASA I cleft lip and palate patients, aged 8–19 years were included. In all patients an autologous bone graft from the mandibular symphysis was harvested for transplantation to the alveolar cleft. Lateral cephalograms were used to measure the donor site defects, and the effects on the soft tissue contour. An evident residual defect was measured at the donor site 1 year after harvesting chin bone. A significant relation was seen between age at time of surgery and size of the defect 1 year postoperatively. In older patients a larger defect remained. Using the current surgical technique of harvesting chin bone, complete bony repair of the defect was not achieved. This study shows postoperatively persisting defects that comprise on average 14% of the original peroperative defects. A significant increase in soft tissue thickness was seen at the mandibular symphysis at a minimum of 1 year postoperatively. These changes in the soft tissue chin contour 1 year after harvesting bone are similar to normal growth changes.

Surgical treatment of ankyloglossia in babies—case report - Corrected Proof

A.R.G. Manfro, R. Manfro, M.C. Bortoluzzi — 2010-07-08

Abstract: Ankyloglossia is an anomaly that is characterized by the abnormal insertion of the lingual frenulum that hinders protrusion and elevation of the tongue towards the palate, due to the short and thick composition of the frenulum. In babies it can cause inefficient nursing at the mother's breast, inadequate transfer of milk and pain in the mother's breast, resulting in early weaning and weight loss. An 8-month-old baby boy was brought to the clinic by his mother because he found it difficult to suck and consequently avoiding breast feeding, and was apparently losing weight. During the clinical exam it was observed that the patient presented little mobility of the tongue. Owing to the degree of ankyloglossia and the features of malnutrition present, it was decided to carry out complete removal of the frenulum under general anesthesia. Although this procedure might increase the risk of morbidity, the possibility of recurrence and the need to perform further procedures are avoided; the main advantage is reducing aggravation of the clinical problems.

A rare cause of a parotid mass: spontaneous pseudoaneurysm of the superficial temporal artery - Corrected Proof

N.R. Woodhouse, G. Gok, S. Saha, D.C. Howlett — 2010-07-08

Abstract: The authors describe a rare presentation of a spontaneous pseudoaneurysm of the superficial temporal artery which mimicked a parotid neoplasm. The clinical presentation, possible aetiology, diagnosis, and management of this condition are discussed.

Analysis of thermal pain sensitivity and psychological profiles in different subgroups of TMD patients - Corrected Proof

J.W. Park, G.T. Clark, Y.K. Kim, J.W. Chung — 2010-07-07

Abstract: This study evaluated differences in pain sensitivities and psychological profiles among different temporomandibular disorder (TMD) pain subtypes. Evaluation was done on 36 normal subjects and 39 TMD patients with high Graded Chronic Pain scale scores. TMD patients were placed in three pain subgroups (myogenous, arthrogenous, mixed) using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I guidelines. RDC/TMD axis II profiles including depression and somatization were analysed. Cold pain threshold (CPT), heat pain threshold (HPT), and heat pain tolerance threshold (HPTT) were measured on three facial regions (anterior temporalis, masseter, TMJ) and a leg region (anterior tibialis). The arthrogenous pain subgroup showed significantly higher CPT and lower HPT and HPTT in the facial region, and lower HPTT in the anterior tibialis region compared with normal and myogenous pain subgroups. The myogenous pain subgroup had significantly higher somatization scores than normal and arthrogenous pain subgroups, and higher depression scores than normal subjects. The results suggest that peripheral and/or central sensitization are present in chronic arthrogenous pain more so than in myogenous pain, and this phenomenon appears to take place regardless of the patient's psychological profiles. These results may explain the underlying mechanism that aggravates TMD pain.

Temporary eyelash loss following dental treatment - Corrected Proof

S. Nezafati, S. Rahimi, H. Mohseni — 2010-07-05

Abstract: The isolated absence or loss of eyelashes (madarosis) is associated with many processes including systemic and local diseases. Madarosis of dental origin has not been reported. This paper is a report of the successful treatment of unilateral eyelash loss following root canal therapy of an upper posterior tooth.

Virtual restoration of anatomic jaw relationship to obtain a precise 3D model for total joint prosthesis construction for treatment of TMJ ankylosis with open bite - Corrected Proof

C. Zizelmann, P. Bucher, D. Rohner, N.-C. Gellrich, H. Kokemueller, B. Hammer — 2010-07-05

Abstract: Temporomandibular joint (TMJ) reconstruction with a TMJ Concepts total joint prosthesis (TMJ Concepts, Ventura, USA) requires a precise 3D model of the jaws in centric occlusion. The authors present a virtual procedure for repositioning the lower jaw in centric occlusion to obtain a precise stereolithographic model for TMJ reconstruction using a custom-made total joint prosthesis in a case of TMJ ankylosis and anterior open bite.

The sphenoidal spine and the sphenoidal tubercle - Corrected Proof

M.C. Rusu, R. Leonardi — 2010-07-05

An accurate knowledge of the human anatomy must rely on an adequate use of the anatomical terminology. Unfortunately, the modern anatomical nomenclature excluded an important amount of terms of the ‘ancient’ anatomy.

The sphenoidal tubercle - Corrected Proof

Z. Stajčić — 2010-07-05

We would like to thank to the authors of the Letter to the Editor regarding our article on the pterygopalating fossa anatomy in which they try to bring more accuracy into the world of science applied in oral and maxillofacial surgery. If the anatomical term sphenoidal tubercle is more accurate and denotes better for what we reported as the sphenoidal spine, we agree that the term we used should be replaced with the sphenoidal tubercle and sincerely hope that the readers will be spared of any confusion by reading our article with the supplement of letter: ‘The sphenoidal spine and sphenoidal tubercle’ in which this anatomical structure is clearly shown in their Fig. 1.

Total reconstruction of the temporomandibular joint. Up to 8 years of follow-up of patients treated with Biomet® total joint prostheses - Corrected Proof

A. Westermark — 2010-07-02

Abstract: 12 patients underwent temporomandibular joint (TMJ) reconstruction with Biomet total joint prostheses. Indications for TMJ reconstruction included ankylosis, rheumatoid arthritis, degenerative joint disease and condylar resorption. Five patients had unilateral procedures, seven had bilateral. The follow-up ranged between 2 and 8 years. Amongst the ankylotic patients the mean jaw-opening capacity increased from 3.8mm preoperatively to 30.2mm 1 year after surgery, and in most of those patients the opening capacity remained stable over the years. The other patients maintained a mean opening capacity of more than 35mm. Joint related pain and interference with eating were eliminated after TMJ reconstruction. There were no permanent facial nerve disturbance, no postoperative infections and no device related complications. The outcome supports prosthetic TMJ reconstruction as a useful treatment modality in patients with advanced TMJ disease.

The effect of age and sex on facial mimicry: a three-dimensional study in healthy adults - Corrected Proof

2010-07-02

Abstract: To assess sex- and age-related characteristics in standardized facial movements, 40 healthy adults (20 men, 20 women; aged 20–50 years) performed seven standardized facial movements (maximum smile; free smile; “surprise” with closed mouth; “surprise” with open mouth; eye closure; right- and left-side eye closures). The three-dimensional coordinates of 21 soft tissue facial landmarks were recorded by a motion analyser, their movements computed, and asymmetry indices calculated. Within each movement, total facial mobility was independent from sex and age (analysis of variance, p>0.05). Asymmetry indices of the eyes and mouth were similar in both sexes (p>0.05). Age significantly influenced eye and mouth asymmetries of the right-side eye closure, and eye asymmetry of the surprise movement. On average, the asymmetry indices of the symmetric movements were always lower than 8%, and most did not deviate from the expected value of 0 (Student's t). Larger asymmetries were found for the asymmetric eye closures (eyes, up to 50%, p<0.05; mouth, up to 30%, p<0.05 only in the 20–30-year-old subjects). In conclusion, sex and age had a limited influence on total facial motion and asymmetry in normal adult men and women.

Prefabricated nerve conduits advance histomorphological and functional outcomes in nerve regeneration of the sciatic nerve of the rat - Corrected Proof

J. Rustemeyer, U. Dicke — 2010-07-01

Abstract: Bridging a nerve defect is sometimes necessary to achieve nerve regeneration after injury. Different methods and conduit designs have been considered, but only isograft transplants or prefabricated conduits are available. This study presents a comparison of prefabricated conduits and isograft transplants in rats, with the aim of making suggestions for clinical settings. In rats of inbred strains LEW and DA, a 1.5cm defect of the sciatic nerve was reconstructed by isograft (n=10) or conduit (n=10). Untreated rats (n=10), sham-operated rats (n=10) and nerves of the non-operated contralateral limb served as controls. Regeneration was evaluated by histomorphological examination and with walking track analysis of the ankle stance angle (ASA) and the sciatic functional index (SFI). After 16 weeks, myelinization and ASA in the conduit group were significantly superior to that in the isograft group. There was no significant difference in SFI between the groups. Reconstruction in the isograft group showed a negative impact on the non-operated side. Conduits and isografts did not reach the morphological or functional levels of untreated or sham-operated animals. The results suggest preferential conduits should be used for nerve reconstruction.

Cancer genes alterations and HPV infection in oral squamous cell carcinoma - Corrected Proof

2010-06-28

Abstract: The aim of this study was to gain a better understanding of cancer genes contributing to oral squamous cell (OSCC) development and progression and correlate genetic changes to clinical parameters. Human papilloma virus (HPV) 16 detection is also included in the study. 60 samples of OSCC were analysed for c-erbB2 and c-myc amplification by dPCR, H-ras and p53 point mutations by PCR/SSCP. HPV was detected via amplification of its E1 and E6 genes. c-erbB2 was altered in 45%, c-myc in 35%, H-ras in 22% and p53 in 60% of samples. HPV was detected in 10% of cases. The frequency of p53 gene mutations showed a statistically significant association with tumour stage. Patients with c-erbB2 and H-ras alterations had lower survival than patients without these alterations. The number of detected genetic changes was remarkable but statistical association with tumour natural history was poor, indicating high clonal heterogeneity and multiple pathways of carcinogenesis.

Static and dynamic periosteal elevation: a pilot study in a pig model - Corrected Proof

C. Tudor, L. Bumiller, T. Birkholz, P. Stockmann, J. Wiltfang, P. Kessler — 2010-06-25

Abstract: The osteoinductive potential of periosteum and bone can be stimulated by elevating the periosteum in a distraction-like modus, but also by an ad-hoc elevation. This was tested and proved in an experiment in 9 Goettingen mini-pigs with elevation heights of 5, 10 and 15mm. Specially designed and perforated titanium meshes were implanted subperiosteally to compare the dynamic elevation procedure with static shielding. The cumulative results for bone formation underneath the mesh were 66% in dynamic and 67% in non-dynamic elevation. The cumulative results for mineralization of the bone regenerates in comparison with the underlying basal bone of the skull showed independently from the technique applied no difference bigger than 5%. No major difference in bone formation could be observed in this pilot study. The main advantages of dynamic periosteal elevation and static shielding are minimal invasion and morbidity. Periosteal elevation could be applied in cranio-maxillofacial surgery, in preimplantological augmentation and in reconstructive surgery of the skull; applications in other specialties may be possible.

Tessier type 3 oblique facial cleft with a contralateral complete cleft lip and palate - Corrected Proof

E. Gawrych, J. Janiszewska-Olszowska, H. Chojnacka — 2010-06-25

Abstract: Oblique facial clefts are extremely rare congenital deformities with a reported incidence of 0.24% of all facial clefts. This report presents a patient with a right-sided oblique cleft extending through the upper lip, the alar groove and the lower palpebra accompanied by a left-sided complete cleft lip and palate. Hypertylorism and bilateral microphthalmia as well as flexion wrist contractures were also present. Primary straight-line closure of the oblique cleft was undertaken followed by primary closure of the contralateral cleft lip. The treatment modality and 2 year follow-up results are presented.

Low grade marginal zone B-cell lymphoma presenting as local amyloidosis in a submandibular salivary gland - Corrected Proof

E. Perera, P. Revington, E. Sheffield — 2010-06-21

Abstract: An unusual case of a low grade marginal zone B-cell lymphoma is reported and the literature reviewed. This case demonstrates that a diagnosis of lymphoma must be considered when there is amyloidosis in an otherwise asymptomatic submandibular salivary gland mass.

Calibre-persistent labial artery: often misdiagnosed as a mucocoele - Corrected Proof

N.M.M.N.M. Rosdy, N.A. Firth, A.M. Rich — 2010-06-21

Abstract: The authors present five cases of calibre-persistent labial artery (CPLA) all of which were diagnosed clinically as a labial mucocoele. The purpose of this article is to bring this rarely reported lesion to the attention of clinicians.

Effect of bone block graft with rhBMP-2 on vertical bone augmentation - Corrected Proof

S.-J. Kim, H.-S. Shin, S.-W. Shin — 2010-06-21

Abstract: The effectiveness of vertical bone augmentation was evaluated in the cranial bone of 15 rabbits using a block of deproteinized bovine bone plus 10% porcine collagen (DBBB) and a cortico-cancellous human bone block (CHBB) with recombinant human bone morphogenetic protein-2 (rhBMP-2) in comparison with a guided bone regeneration (GBR) technique. The rabbits were divided into six groups: DBBB alone, DBBB/rhBMP-2, DBBB/membrane, CHBB alone, CHBB/rhBMP-2 and CHBB/membrane groups. After 12 weeks, the rabbits were killed. The CHBB groups showed higher values than the DBBB groups in terms of vertical height, the area of new bone fill and the maintained grafted area. In the CHBB groups, the CHBB/rhBMP-2 group revealed similar results to GBR. This animal study verifies that a CHBB with rhBMP-2 could be an alternative treatment option for vertical bone augmentation.

Effect of implant drill design on the particle size of the bone collected during osteotomy - Corrected Proof

S.-Y. Park, S.-Y. Shin, S.-M. Yang, S.-B. Kye — 2010-06-21

Abstract: The bone particles collected during osteotomy could be used as autogenous bone graft materials for implant placement surgery. This study examined the effect of drill design on the quantity and size of bone collected during the preparation of implant sites. Bone was collected during the in vitro preparation of bovine bone using three different implant system drills: parallel shape (Group 1), tapered shape (Group 2), and tapered and stepped shape (Group 3). Bone particles were sieved. The wet volume and dry weight were measured. The mean total wet volume collected per osteotomy was 0.199±0.0445ml and the dry weight was 0.0477±0.0087g. In all three groups, bone particles >500μm were harvested in larger amounts than particles 250–500 and <250μm. Group 3 drills produced smaller bone particles than Group 1 and 2 drills. The size differences were significant when Group 3 particles were compared with the particles produced by Group 1 drills. The differences in total dry weight of bone collected by the three drilling systems were not statistically significant. Drill design significantly influenced the size of bone particles collected during the preparation of implant sites.

Long-term results of trismus release in noma patients - Corrected Proof

P. Bisseling, J. Bruhn, T. Erdsach, A.M. Ettema, R. Sautter, S.J. Bergé — 2010-06-14

Abstract: Noma, also known as cancrum oris, is an infectious disease that results in a loss of orofacial tissue, due to gangrene of soft and bony tissue. It is especially seen in young children in the sub-Saharan region. Among the sequelae of patients who survive noma, trismus is one of the most disabling. This retrospective research studied the long-term results of trismus release in noma patients. Thirty-six patients could be traced in the villages and were included in the study. The mean mouth opening in this group was 10.3mm (95% CI: 7.0; 13.6mm) and the mean period after discharge from hospital was 43 months. Better mouth opening was observed in patients who continued physiotherapy after discharge, were older, and those with a ‘soft’ (vs. ‘hard’) inner and outer cheek on palpation. The result of trismus release in noma patients in the long term was extremely poor in this study.

Head and neck non-Hodgkin's lymphoma: a 20-year demographic study of 381 cases - Corrected Proof

S. Etemad-Moghadam, F. Tirgary, S. Keshavarz, M. Alaeddini — 2010-06-10

Abstract: Malignant lymphoma is a lymphoreticular malignancy with considerable geographic variation. The objective of the present study was to provide a preliminary report on patients with head and neck non-Hodgkin's lymphoma (NHL) in a selected Iranian population. In a retrospective review from 1981 through 2001, all cases of NHL occurring in the head and neck region were selected. Histological slides were reviewed and classified according to the Working Formulation. Clinical data including patients’ age, sex, initial anatomic site of disease and presenting symptoms were also recorded. Information on 381 cases of NHL was retrieved from the archived medical records; 281 cases were nodal and 100 extranodal. The mean age of the patients with nodal and extranodal disease was 39.3 and 47.7 years, respectively. A significant difference in gender was noted in the nodal group (P<0.001), but not in the extranodal cases. The most common site of involvement in the extranodal subjects was Waldayer's ring. According to histopathologic evaluation, 72% of the specimens were intermediate-, 14% were high-, and 12% were low-grade malignancies. Considering the relative frequency of head and neck lymphoma, establishment of a uniform reporting method seems necessary in order to compare different reports from various populations.

Primary tuberculosis of the TMJ: presentation of a case and literature review - Corrected Proof

C.A. Helbling, O. Lieger, W. Smolka, T. Iizuka, J. Kuttenberger — 2010-06-07

Abstract: Tuberculosis (TB) is a frequent health problem. The prevalence of extrapulmonary TB has increased in the last couple of years. Head and neck tuberculosis forms nearly 10% of all extrapulmonary manifestations of the disease. TB of the temporomandibular joint (TMJ) is rare; only a few cases have been reported. The clinical appearance of TB infection of the TMJ has been described as unspecific, resembling arthritis, osteomyelitis, cancer or any kind of chronic joint diseases. This article describes a 22-year-old woman with pain and left preauricular swelling. Magnetic resonance imaging and computed tomography showed an expansive process with destruction of the left condyle and condylar fossa. A fine needle aspiration examination of the swelling showed non-specific granulomatous inflammation. In the following days, a preauricular fistula developed, of which a swab and biopsy specimens were taken. Histological and microbiological examinations revealed an infection with Mycobacterium tuberculosis. The initial antituberculosis treatment consisted of a combination of four antibiotics and could be reduced to two antibiotics in the course of treatment. The treatment was completed successfully after 9 months.

Changes in peripheral blood lymphocyte phenotypes distribution in patients with oral cancer/oral leukoplakia in Taiwan - Corrected Proof

J.J. Lee, C.L. Lin, T.H.H. Chen, S.H. Kok, M.C. Chang, J.H. Jeng — 2010-06-07

Abstract: Oral squamous cell carcinoma (OSCC) is common in many Asian countries. The immunopathogenesis of OSCC is unclear. The authors analyzed the lymphocyte subtypes and surface activation markers in healthy Taiwanese people (n=130) and patients with OSCC (n=97)/oral leukoplakia (OL, n=28) using flow cytometry. Univariate analysis found an elevation in the percentage of CD56+ NK cells, CD4+/CD69+ T cells, CD19+/CD69+ B cells and CD56+/CD69+ NK cells in OSCC patients relative to healthy people. The CD19+ and CD19+/CD25+ lymphocyte subtypes decreased in OSCC patients. CD56+ NK cells increased in OL patients. CD56+/CD69+ NK cells were elevated in recurrent and advanced OSCC. Multivariate analysis revealed an increase in CD56+ NK and CD19+/CD69+ cells in OL patients relative to controls. CD19+ B cells declined during progression from OL to OSCC. Betel quid chewing, alcohol, smoking, tumour location and staging showed little effect on lymphocyte subtypes. These results suggest that alterations and activation of NK cells, T and B cells are important and associated with disease status in oral carcinogenesis.

Trehalose inhibits oral dryness by protecting the cell membrane - Corrected Proof

Y. Mori, F. Yano, N. Shimohata, S. Suzuki, U.I. Chung, T. Takato — 2010-06-07

Abstract: This study assessed the clinical efficacy and acceptability of trehalose solution for oral dryness caused by dental treatment. The efficacy of trehalose on oral dryness under drying conditions was assessed by measuring the surface area of the fungiform papillae and the moisture content of the tongue in seven healthy volunteers. Based on the data from this pilot study, a clinical study was performed, in which the efficacy of oral trehalose spray was evaluated on oral dryness in 10 patients undergoing root canal treatment. The effects of trehalose on cell viability were also assessed under drying conditions in vitro. Trehalose suppressed oral dryness and associated pain caused by dental treatment and protected cells from dryness-related damage. These results indicate that pretreatment application of trehalose solution on the oral mucosa is effective in preventing oral dryness caused by dental treatment.

The treatment of sublingual gland tumours - Corrected Proof

G. Sun, X. Yang, E. Tang, J. Wen, M. Lu, Q. Hu — 2010-06-07

Abstract: This study assessed the clinical and histological features and therapeutic efficacy of 25 cases of sublingual gland tumours from 1998 to 2008. There were 17 female patients and 8 male, the ratio of females to males was 2.1:1. The mean age was 48.6 years. 4 cases were benign tumours (16%). 21 cases were malignant sublingual gland tumours (84%) and of these, 18 were adenoid cystic carcinoma (86%). Adenoid cystic carcinoma was mainly of the histological type, and the other histological classifications included mucoepidermoid carcinoma, pleomorphic adenoma, myoepithelioma, oncocytoma and polymorphous low-grade adenocarcinoma. Sublingual gland tumours are rare and most are malignant. For malignant sublingual gland tumours, early diagnosis and aggressive surgical treatment, especially for tumours with nerve involvement, is the key to improving prognosis. Free radial forearm flap or pectoralis major myocutaneous flap are appropriate methods for mouth floor reconstruction. For benign sublingual gland tumours, the resection of tumour and sublingual gland is the preferred treatment.

Dentigerous cyst: a retrospective clinicopathological analysis of 2082 dentigerous cysts in British Columbia, Canada - Corrected Proof

L.L. Zhang, R. Yang, L. Zhang, W. Li, D. MacDonald-Jankowski, C.F. Poh — 2010-06-04

Abstract: The aim of this research is to analyze the prevalence of dentigerous cysts (DCs) in a population-based cohort in British Columbia, Canada, and to report unusual cases associated with DC. The database of the British Columbia Oral Biopsy Service was searched from 1998 to 2007. 2082 histologically confirmed DCs from 2029 patients were retrieved and retrospectively analyzed for incidence, age, gender and ethnicity. The results show that this is a common jaw cyst with male predilection, has a peak incidence in younger adults and is more common in Caucasians. Multiple DCs, representing 2.5% of the cases, are not associated with any syndromes or systemic conditions. 0.5% DCs were associated with other cysts or tumours at the same site or the opposite side of the jaw. The authors report the first series of cases presenting clinically as bilateral DCs, but histologically as an odontogenic tumour or another type of odontogenic cyst. DCs can co-exist with other more serious conditions, such as odontogenic keratocyst or cystic ameloblastoma. This association with more significant conditions indicates the importance of histologically confirming any jaw cyst, even when it presents clinically as a classic DC.

Facial palsy after inferior alveolar nerve block: case report and review of the literature - Corrected Proof

V. Chevalier, R. Arbab-Chirani, S.H. Tea, M. Roux — 2010-06-04

Abstract: Bell's palsy is an idiopathic and acute, peripheral nerve palsy resulting in inability to control facial muscles on the affected side because of the involvement of the facial nerve. This study describes a case of Bell's palsy that developed after dental anaesthesia. A 34-year-old pregnant woman at 35 weeks of amenorrhea, with no history of systemic disease, was referred by her dentist for treatment of a mandibular left molar in pulpitis. An inferior alveolar nerve block was made prior to the access cavity preparation. 2h later, the patient felt the onset of a complete paralysis of the left-sided facial muscles. The medical history, the physical examination and the complementary exams led neurologists to the diagnosis of Bell's palsy. The treatment and results of the 1-year follow-up are presented and discussed. Bell's palsy is a rare complication of maxillofacial surgery or dental procedures, the mechanisms of which remain uncertain.

Analysis of bone volume using computer simulation system for secondary bone graft in alveolar cleft - Corrected Proof

T. Shirota, H. Kurabayashi, H. Ogura, K. Seki, K. Maki, S. Shintani — 2010-06-04

Abstract: The purpose of this study was to measure the bone volume necessary for secondary bone grafting in the alveolar cleft using surgical simulation software based on three-dimensional computed tomography (CT) scan data, to compare this measurement with the actual volume of the bone graft, and to evaluate consistency. The subjects were 13 patients with cleft lip and palate who underwent CT using a cone-beam CT unit (CB-CT) 1 month before surgery, followed by bone grafting with particulate cancellous bone and marrow (PCBM) to close the cleft. The bone volume necessary for grafting was measured based on the CB-CT scan data. Correlation analysis, a test of the population mean between two samples, and Wilcoxon's signed rank test were conducted between these measurements and the actual bone volume (PCBM volume) used for grafting. SPSS was used for statistical analysis, and the level of significance was set below the 5% level. The results showed a significant correlation, with no significant differences between the two in all tests. These results suggest that measuring and preoperatively calculating the bone volume necessary for bone grafting with surgical simulation software using CB-CT scan data is beneficial.

Pseudodysplastic epithelial artefacts associated with oral mucosa CO2 laser excision: an assessment of margin status - Corrected Proof

2010-06-03

Abstract: Using a CO2 laser beam for biopsy is compromised by thermal cytological artefacts that could be critical when assessing dysplastic changes, as they may simulate cytological atypia. This study examined wounds caused by CO2 laser, evaluating their size and features, utilizing 25 Sprage rats randomly allocated to five groups: four glossectomized using a CO2 laser at 3, 6, 9 and 12W and a control group treated with a conventional scalpel. Samples were prepared in 4μm sections, stained, and studied double-blind by two pathologists. The artefacts identified included cellular and nuclear polymorphism, nuclear hyperchromatism and loss of intercellular adherence; they were mainly located in the basal and suprabasal layers of the oral epithelium. Number of artefacts per specimen did not differ between experimental groups. The width of epithelial damage adjacent to the laser incisions revealed 298.7±150.7μm of damaged tissue (range 100–750μm), with no differences between low (3W) and high wattages (6, 9 and 12W) (Xi−Xj=41.6; 95% CI=−125.1 to 208.4). No changes were observed in the control group. CO2 laser (3–12W) generates epithelial damage that can simulate light dysplasia with atypias mainly affecting basal and suprabasal layers that may lead to erroneous therapy.

Re: Atraumatic placement of circummandibular wires: a technical note - Corrected Proof

S. Thomas, V. Yuvaraj — 2010-06-01

Thank you for having the opportunity to reply on the letter-to-the editor ‘Atraumatic placement of circummandibular wires: A technical note.’ We really appreciate the interest shown to read our article. Irrespective of the fact that a similar technique may be claimed to be practiced and taught elsewhere in the world, such claims cannot be considered validated unless scrutinized and approved by a scientific committee. We as authors were neither aware, nor did we learn this technique from the sources you have mentioned. We would also like to further mention the fact that an extensive literature search, prior to submission failed to reveal the possibility of this technique being in vogue. Further the aberrations pointed out regarding the failure to mention the technique of wire removal or modifications in splint fabrication does not appear to be valid as it is beyond the objective of the manuscript to discuss anything, but an alternative method of introducing and placing circummandibular wires. The technique of wire removal as suggested in the response to our publication is very standard technique which is practiced universally and therefore needs no special mention.

Plasmablastic lymphoma of the oral cavity in immunocompetent patients: report of two cases - Corrected Proof

D.D. Rao, N. Aggarwal, V. Anehosur, H. Doddihal, M. Shiraganvi, K. Gopalkrishnan — 2010-06-01

Abstract: Plasmablastic lymphoma (PBL) is a diffuse large B-cell lymphoma, a new entity, the incidence of which is increasing, predominantly in the oral cavity of immunocompromised patients, most of whom are infected with human immunodeficiency virus (HIV); only four cases have been reported in non-HIV-infected patients. This report details two cases of PBL of the oral cavity in immunocompetent patients. In both cases, the tumour manifested as a solitary, firm mandibular swelling with dense infiltration of plasma and blastoid cells in the stroma with strong positivity for CD 138 and negativity for CD 20. The patients received radiotherapy and chemotherapy, which resulted in complete remission of the lesion. This is the only case report of two cases of PBL in the oral cavity in immunocompetent patients in which both patients received treatment and showed complete remission of the lesion.

Congenital fusion of the maxilla and mandible (congenital bony syngnathia) - Corrected Proof

I.E. El-Hakim, M.O. Al-Sebaei, S. Abuzennada, A.O. AlYamani — 2010-06-01

Abstract: A rare case of syngnathia (maxillomandibular fusion) is described in a 2-year-old boy who presented from a rural area of Saudi Arabia. The child had the problem since birth and had undergone two surgical attempts to release the fusion at another institution but both had failed and recurrence occurred. In the authors’ institute, the patient underwent two separate surgical procedures at the age of 2 and 3 years. Both procedures were followed by a period of aggressive physiotherapy, but the patient presented with re-fusion of the mandible and the maxilla 1 year after the first operation and 5 months after the second operation. It was decided to defer treatment until puberty. The cause of the relapse may be the high osteogenic potential because of his youth or the failure of the parents to maintain the active physiotherapy protocol because they live in a rural area and close follow-up was difficult. A possible genetic predisposition for bone formation at this site should be investigated.

Metastatic cutaneous carcinosarcoma to the tongue - Corrected Proof

N. Tanaka, S. Hidaka, M. Yamamura, H. Ohyama, M. Urade — 2010-05-31

Abstract: Carcinosarcoma is a rare malignant tumour composed of a mixture of carcinomatous and sarcomatous elements. Carcinosarcoma metastatic to the tongue is extremely rare. An 84-year-old woman presented with a rapidly growing mass on the tongue. She had a history of surgery for carcinosarcoma of the occipital skin 9 months before. An excisional biopsy of the tongue mass was performed, and the lesion was histopathologically diagnosed as carcinosarcoma. PET after diagnosis showed multiple hot uptakes in the whole body. The patient died of the disease 2 months after diagnosis. Therapies for patients with metastatic malignant tumours to the oral cavity are difficult, especially in aggressive case such as this. To the authors’ knowledge, this is the first case of metastatic carcinosarcoma to the tongue.

Removal of a self-knotted feeding jejunostomy tube in a patient with tongue base cancer - Corrected Proof

S.-C. Jwo — 2010-05-31

Abstract: The knotting of an intragastric tube is a rare complication, and knotting of a feeding jejunostomy tube is rarer, and the removal or replacement of the tube is difficult. There are many reports on the removal of intragastric knotted tubes, but these methods cannot be applied for the removal of knotted feeding jejunostomy tubes, which do not have a natural orifice as large as the mouth to facilitate the introduction of instruments to correct the complication or remove the knotted tube. This is a stressful situation and doctors have to adopt strategies to resolve this problem safely and effectively in the absence of strong evidence-based knowledge. The author presents the case of a patient with tongue base cancer with a nasogastric feeding jejunostomy tube that knotted during the therapeutic course and describes a simple method to remove the knotted tube using Kelly clamps without additional invasive surgery. A literature review to elucidate methods for the removal of a self-knotted nasogastric tube, especially that occurring in feeding jejunostomy, is also reported.

Giant cell angiofibroma of parapharyngeal space: a report of a new location for a rare tumour - Corrected Proof

L.M. González-Pérez, F. Sánchez-Gallego, J.J. Haro-Luna, P. Infante-Cossío — 2010-05-31

Abstract: Giant cell angiofibroma was first described as a distinctive orbital soft-tissue tumour in male adults; it is now recognized that this mesenchymal tumour can present in other anatomical regions. In this article, a case of giant cell angiofibroma of parapharyngeal space in a 25-year-old woman is described. Clinicopathologic features of this tumour are reviewed. To the authors’ knowledge, this is the first reported case of giant cell angiofibroma arising in the parapharyngeal space.