International Journal of Oral & Maxillofacial Surgery - Articles in Press

A comparative study of the effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery - Corrected Proof

O.D. Osunde, R.A. Adebola, B.D. Saheeb — 2012-05-16

Abstract: The aim of this prospective randomized study was to evaluate the effect of not using sutures on postoperative pain, swelling and trismus after lower third molar surgery. 80 patients with impacted lower third molars were referred for surgical extraction (42 males; 38 females; aged 18–38years). The patients were randomly divided into two equal groups (sutures n=40; suture-less n=40). In the experimental group, the flaps were replaced without suturing. The control group was selected using the same criteria and treated under the same surgical protocol as the experimental group, except that the flaps were apposed using multiple sutures. Pain, swelling and trismus were evaluated at 24h, 48h and 1week postoperatively in both groups. The operation time was found to be significantly longer in the multiple sutures group (p<0.05). There was significantly less pain, swelling and trismus at 24h and 48h, respectively, in the suture-less group (p<0.05). There was no significant difference between the two treatment groups in terms of pain, swelling and trismus, at 1week postoperatively (p>0.05). There is less postoperative pain, swelling and trismus with the suture-less technique in third molar surgery.

Ki-67 expression predicts radiosensitivity in oral squamous cell carcinoma - Corrected Proof

C. Freudlsperger, K. Freier, J. Hoffmann, M. Engel — 2012-05-16

Abstract: The prognostic relevance of Ki-67 expression in oral squamous cell carcinoma (OSCC) is still controversial. As proliferating cells are more susceptible to ionizing radiation, the authors investigated if a high proliferation rate reflected by Ki-67 expression, predicts radiosensitivity in OSCC patients. In 52 patients with OSCC who received primary surgery followed by radiation therapy, the proliferation rate was assessed by Ki-67 immunhistochemistry and correlated to recurrent free survival and overall survival. Low proliferative carcinomas showed a significantly shorter mean time to recurrence of 27.5 months compared to 49.5 months of high proliferative tumours (p=0.048). The 5-year survival rate of low proliferative tumours was 49% compared to 80% for high proliferative tumours (p=0.042). This study indicates that tumours with high proliferative activity are more susceptible to radiation therapy. Ki-67 might be used as a marker to predict the response to radiation therapy in patients with OSCC.

Strategies for surgically assisted rapid maxillary expansion according to the region of transverse maxillary deficiency - Corrected Proof

M.D. Pereira, R.A.M. de Abreu, G.P.R. Prado, L.M. Ferreira — 2012-05-14

Abstract: This study evaluated different techniques for surgically assisted rapid maxillary expansion (SARME) according to the type of transverse maxillary deficiency using computed tomography (CT). Six adult patients with bilateral transverse maxillary deficiencies underwent SARME. The patients were equally divided into three groups: Group I, maxillary atresia in both the anterior and posterior regions; Group II, greater maxillary atresia in the anterior region; and Group III, increased maxillary atresia in the posterior region. In Group I, a subtotal Le Fort I osteotomy was used. In Group II, a subtotal Le Fort I osteotomy was used without pterygomaxillary suture disjunction. In Group III, a subtotal Le Fort I osteotomy was used with pterygomaxillary suture disjunction and fixation of the anterior nasal spine with steel wire. The midpalatal suture opening was evaluated preoperatively and immediately after the activation period using CT. For Group I, the opening occurred parallel to midpalatal suture; for Group II, the opening comprised a V-shape with a vertex on the posterior nasal spine; and for Group III, the opening comprised a V-shape with a vertex at the anterior nasal spine. The conclusion was that the SARME technique should be individualized according to the type of transverse maxillary deficiency.

One year postoperative hard and soft tissue volumetric changes after a BSSO mandibular advancement - Corrected Proof

2012-05-14

Abstract: In this study, cone beam computed tomography (CBCT) and three dimensional (3D) stereophotogrammetry are used to compare the 3D skeletal and soft tissue changes caused by a bilateral sagittal split osteotomy (BSSO) 1 year after a mandibular advancement. Eighteen consecutive patients with a hypoplastic mandible were treated with a BSSO according to the Hunsuck modification. Preoperatively and 1 year postoperatively, a CBCT scan was acquired and a 3D photograph. The pre- and postoperative CBCT scans were matched using voxel based registration. After registration, the mandible could be segmented in the pre- and postoperative scans. The preoperative scan was subtracted from the postoperative scan, resulting in the hard tissue difference. To investigate the soft tissue changes, the pre- and postoperative 3D photographs were registered using surface based registration. After registration the preoperative surface could be subtracted from the postoperative surface, resulting in the overall volumetric difference. As expected, a correlation between mandibular advancent and volumetric changes of the hard tissues was found. The correlation between advancement and soft tissues was weak. The labial mental fold stretched after surgery. This study proved that using 3D imaging techniques it is possible to document volumetric surgical changes accurately and objectively.

Robotic sialoadenectomy of the submandibular gland via a modified face-lift approach - Corrected Proof

A. De Virgilio, Y.M. Park, W.S. Kim, S.Y. Lee, J.H. Seol, S.-H. Kim — 2012-05-14

Abstract: The purpose of this study was to describe and analyse the advantages and disadvantages of submandibular gland (SMG) resection using a robotic surgical system through a modified face-lift approach. The authors performed robotic sialoadenectomy of the SMG on 5 patients using the daVinci robot system through a modified face-lift approach. Three robotic arms were inserted through a modified face-lift incision; a face-down 30-degree endoscopic arm and two operative arms. The right arm was equipped with a harmonic scalpel and the left arm with a Maryland forceps. In all patients, robotic sialoadenectomy of the SMG was completed successfully. Diagnoses were sialolithiasis in two patients, pleomophic adenoma in two patients, and ranula in one patient. The mean robotic operative time was 90.2min (range 62–185min) and that for setting the robotic system was 8.2min (range 5–15min). No significant intra-operative or postoperative complications were observed. All patients were satisfied with the outcome and especially the cosmetic results at their last follow-up visit. In the authors opinion robotic sialoadenectomy of the SMG is technically feasible and secures a better cosmetic outcome than endoscopic submandibular resection.

Primary salivary gland-type carcinomas of the nasopharynx: Prognostic factors and outcome - Corrected Proof

2012-05-14

Abstract: Primary salivary gland-type carcinomas of the nasopharynx (SNPC) are a rare malignancy with diverse clinical behaviour and different prognoses. Previous studies have reported on limited patient populations, and few long-term studies have outlined outcomes and prognostic factors. Controversy exists regarding the treatment policy for SNPC. The aim of this study was to define management approaches, therapeutic outcomes, and prognostic factors for SNPC. The medical records of 54 patients with SNPC at one institution between 1963 and 2006 were reviewed. Patient records were analysed for management approaches, outcomes, and prognostic factors. After a median follow-up of 61.3 (1.8–245.2) months, the 2-, and 5-year overall survival rates (OS), loco-regional failure free survival rates (LRFFS) and distant failure free survival rates (DFFS) were 84.6% and 61.3%, 74.4% and 55.4%, and 92.0% and 70.0%, respectively. Multivariate analyses indicated that lymph node metastases, date of treatment, and surgical treatment were independent factors for DFFS, whereas histological subtypes and distant metastases were independent factors affecting OS. The optimal treatment policy for patients with SNPC might be surgery plus radiotherapy.

Accuracy assessment of prototypes produced using multi-slice and cone-beam computed tomography - Corrected Proof

2012-05-14

Abstract: The objective of this study was to assess and quantify the dimensional error of prototypes produced using multi-slice and cone-beam computed tomography (MSCT and CBCT). Titanium screws were inserted into a dry skull at different points of the midface. The skull was scanned using MSCT (LightSpeed16®) with pixel size 0.3mm and CBCT (i-CAT Cone-Beam 3D™) with voxel sizes 0.25 and 0.4mm. Prototypes were printed (fabricated) using a ZPrinter 310® device. Both the dry skull (gold standard) and the prototypes were measured using a Mitutoyo 3D coordinate measuring system with three perpendicular axes (X, Y, and Z). The prototype produced from MSCT data presented a mean dimensional error of 0.62%; the two models produced with CBCT images yielded errors of 0.74% with voxel size 0.25mm and 0.82% with voxel size 0.40mm. No significant differences in dimensional errors were observed across the prototypes (p=0.767; Friedman's non-parametric test). Prototypes produced from CBCT data using voxel sizes of 0.25 and 0.4mm, and also the one produced from MSCT data using pixel size 0.3mm, showed acceptable dimensional errors and can therefore be used in the fabrication of prototypes in dentistry.

Finite element analysis of different surgical approaches in various occlusal loading locations for zygomatic implant placement for the treatment of atrophic maxillae - Corrected Proof

M.I. Ishak, M.R. Abdul Kadir, E. Sulaiman, N.H. Abu Kasim — 2012-05-11

Abstract: The aim of this study was to compare two different types of surgical approaches, intrasinus and extramaxillary, for the placement of zygomatic implants to treat atrophic maxillae. A computational finite element simulation was used to analyze the strength of implant anchorage for both approaches in various occlusal loading locations. Three-dimensional models of the craniofacial structures surrounding a region of interest, soft tissue and framework were developed using computed tomography image datasets. The implants were modelled using computer-aided design software. The bone was assumed to be linear isotropic with a stiffness of 13.4GPa, and the implants were assumed to be made of titanium with a stiffness of 110GPa. Masseter forces of 300N were applied at the zygomatic arch, and occlusal loads of 150N were applied vertically onto the framework surface at different locations. The intrasinus approach demonstrated more satisfactory results and could be a viable treatment option. The extramaxillary approach could also be recommended as a reasonable treatment option, provided some improvements are made to address the cantilever effects seen with that approach.

Effects of anodized implants coated with Escherichia coli-derived rhBMP-2 in beagle dogs - Corrected Proof

2012-05-10

Abstract: This study evaluated the effects of Escherichia coli-derived rhBMP-2 (ErhBMP-2) coated onto anodized implants to stimulate bone formation, osseointegration and vertical bone growth in a vertical bone defect model. Six young adult beagle dogs were used. After a 2-month bone healing period, anodized titanium implants (8mm in length) were placed 5.5mm into the mandibular alveolar ridge. Eighteen implants coated with ErhBMP-2 (BMP group) and another 18 uncoated implants (control group) were installed using a randomized split-mouth design. The implant stability quotient (ISQ) values were measured. Specimens were fabricated for histometric analysis to evaluate osseointegration and bone formation. The ISQ values at 8 weeks after implant placement were significantly higher in the BMP group than in the control group (p<0.05). Histological observations showed that the changes in bucco-lingual alveolar bone levels were higher in the BMP group than in the control group (p<0.05). The ErhBMP-2 coated anodized implants can stimulate bone formation and increase implant stability significantly on completely healed alveolar ridges in dogs. Further studies evaluating the effects of ErhBMP-2 on osseointegration in the bone–implant interface are warranted.

Central cystadenocarcinoma of the mandible - Corrected Proof

R. Takei, K. Tomihara, N. Arai, M. Noguchi — 2012-05-10

Abstract: Papillary cystadenocarcinoma (PCAC) of the salivary gland is a rare malignant tumour and occurs in major and minor salivary glands. PCAC of the mandible is exceptionally rare; only 2 cases have been reported. In this study, the authors report a case of PCAC within the mandible. The patient presented with a painful right mandibular mass that had gradually increased in size. The lesion appeared radiographically as a well-demarcated multilocular radiolucent area, similar to an odontogenic cystic lesion. The authors present a case of PCAC with reference to the relevant literature.

Clinical and pathological characteristics of polymethylmethacrylate and hyaluronic acid in the rat tongue - Corrected Proof

2012-05-10

Abstract: Adverse effects on the oral mucosa after the use of dermal fillers have been increasingly reported due to their increased use for facial aesthetics. The objective of this study was to evaluate the clinical and histologic effects of two types of product, 10% polymethylmethacrylate and 20mg/ml hyaluronic acid, locally and at long distance, examining initial and late reactions. Each substance was randomly and separately injected in rats’ tongues (polymethylmethacrylate, n=16; hyaluronic acid, n=18). They were compared with the control group (n=16) at 3 observation times (7, 60 and 90 days) for clinical analysis, intensity of local inflammatory response (haematoxylin and eosin staining), amount of newly formed blood vessels and macrophages (immunohistochemical assays), density of collagen fibres (picrosirius staining) and systemic migration of the product to the liver and kidney (haematoxylin and eosin staining). The results showed inflammation triggered by the injection of the material, suggesting that both substances cause responses in local tissue, although there was biocompatibility with hyaluronic acid. This research highlights the importance of experimental studies on this subject, since adverse reactions have been observed routinely in dental practice.

Effect of low level laser therapy and zoledronate on the viability and ALP activity of Saos-2 cells - Corrected Proof

Hilal Bayram, Halime Kenar, Ferda Taşar, Vasıf Hasırcı — 2012-05-09

Abstract: A limited number of clinical studies indicate the supportive role of low level laser therapy (LLLT) on medical and/or surgical approaches carried out in treatment modalities for bisphosphonate related necrosis of jaws (BRONJ), the most common side effect of bisphosphonates used to inhibit bone resorption. The purpose of this study was to investigate the effects of LLLT on cell proliferation and alkaline phosphatase (ALP) activity of human osteoblast-like cells (Saos-2) treated with different doses of zoledronate, the most potent bisphosphonate. Saos-2 cells were treated with different concentrations of zoledronate and were irradiated with diode laser (wavelength 808nm, 10s, 0.25 or 0.50W). Cell numbers and ALP activity of the cells were determined. LLLT mildly increased the proliferation rate or ALP activity, while zoledronate reduced both. When applied together, LLLT lessened the detrimental effects of zoledronate and improved cell function and/or proliferation. Based on the results of this study, it was concluded that LLLT has biostimulative effects on Saos-2 cells, even after treatment with zoledronate. LLLT may serve as a useful supportive method for BRONJ treatment through enhancement of healing by osteoblasts.

Three-dimensional analysis of dentolabial relationships: effect of age and sex in healthy dentition - Corrected Proof

R. Rosati, M. De Menezes, A. Rossetti, V.F. Ferrario, C. Sforza — 2012-05-09

Abstract: Morphological changes in three-dimensional (3D) dentolabial relationships during ageing were assessed in healthy individuals. 38 subjects with healthy dentition were analysed. They were divided into a youthful group (21–34 years, mean 26 years, SD 4) and an older group (45–65 years, mean 53 years, SD 5). Stone labial and dental models were made, digitized and 3D virtual reproductions of dentolabial morphology were obtained. From the digital reconstructions, the relative positions of the labial commissure and of the maxillary dental clinical crowns in the vertical direction were obtained. Sex and age effects were compared using two-way analysis of variance. Lip position relative to the teeth was significantly different in youthful and older subjects (P<0.01). No statistically significant effects of sex in dentolabial relationship were demonstrated, but a sex×age effect was found in the anterior labial segments (P<0.05). The perioral soft tissues drop down in older subjects and the soft tissue descends on the entire labial arch. These differences may help the clinician when estimating, planning and evaluating surgical, orthodontic and prosthetic treatments.

The use of buccal fat pad flap in the treatment of osteoradionecrosis - Corrected Proof

S. Nabil, R. Ramli — 2012-05-07

Abstract: The use of buccal fat pad in the management of osteoradionecrosis has not been described previously. A series of 10 consecutive cases of osteoradionecrosis treated with a combination of sequestrectomy and buccal fat pad is presented. The data were obtained by reviewing operative and medical records. The combination of sequestrectomy and buccal fat pad flap was successful in 86% of cases of stage II osteoradionecrosis and in 0% of cases of stage III. The overall success rate was 60%. Based on the result of this series, this treatment regime appeared to be beneficial in stage II osteoradionecrosis.

Superficial parotidectomy for chronic parotid sialadenitis - Corrected Proof

R. Sharma — 2012-05-07

Abstract: Chronic sialadenitis (CS) of the parotid gland is an insidious inflammatory disorder which tends to progress and may lead to the formation of a fibrous mass. This is a review of the author's experience of superficial parotidectomy (SP) with duct ligation for non-specific CS of the parotid gland not responding to conservative management. 21 patients (11 females; 10 males) with intractable non specific CS underwent SP with duct ligation. The mean duration of symptoms was 1.93 years (SD 0.48). Fine needle aspiration cytology and magnetic resonance imaging were carried out prior to SP to rule out benign or malignant tumours. The mean duration of observation was 1.71 years (SD 0.39). Six patients (28.57%) developed temporary facial nerve palsy. Three (14.28%) patients developed Frey's syndrome. Paresthesia of the ear lobe was found in all cases. One case (4.76%) each of sialocoele and hypertrophic scar was found. There was complete resolution of symptoms in all the cases. The histopathological report confirmed three cases (14.28%) of mild CS and 18 cases (85.72%) of CS of greater degree. SP along with ligation of the duct is a safe and effective treatment for non-specific CS of the parotid gland.

Morbidity and mortality associated with tracheotomy procedure in a university medical centre - Corrected Proof

D. Oreadi, E.R. Carlson — 2012-05-03

Abstract: This prospective study assessed the morbidity and mortality associated with 192 consecutive tracheotomies. Complications were assessed including intraoperative and/or postoperative bleeding, infection, tracheoinnominate fistulae, tracheoesophageal fistulae, dislodgement of the tracheotomy tube, pneumothorax, wound infection and obstruction of the airway. 16% of the tracheotomy procedures resulted in complications. 22 tracheotomy procedures (11%) resulted in postoperative bleeding, 6 procedures (3%) had intraoperative bleeding which exceeded an estimated blood loss of 5cc and 2 procedures (1%) developed a tracheoesophageal fistula. One patient (0.5%) experienced airway distress related to obstruction of the airway proximal to the tracheotomy tube. No patients required a return to the operating room to manage their complication, no patients developed a tracheoinnominate fistula and none of the tracheotomy sites became infected. The post tracheotomy ventilator wean to trach-collar supplemental oxygen protocol was accomplished with a mean of 6 days in 119 patients for whom data was available. Results demonstrate that the open tracheotomy procedure is a safe and frequently life saving manoeuvre in situations with an unsecured airway, and it provides better outcomes in patients requiring long term ventilatory support. Mortality rates are low and its potential morbidity is exceeded by its benefits.

Masticatory efficiency in class II and class III dentofacial deformities - Corrected Proof

2012-05-03

Abstract: Masticatory efficiency may be impaired in individuals with dentofacial deformities. The objective of the present study was to determine the condition of masticatory efficiency in individuals with dentofacial deformities. 30 patients with class II (DG-II) and 35 patients with class III (DG-III) dentofacial deformity participated in the study, all had an indication for orthognathic surgery. 30 volunteers (CG) with no alterations of facial morphology or dental occlusion and with no signs or symptoms of temporomandibular joint dysfunction also participated. Masticatory efficiency was analysed using a bead system (colorimetric method). Each individual chewed 4 beads, one at a time, over 20s measured with a chronometer. The groups were compared in terms of masticatory efficiency using analysis of variance (ANOVA), with the level of significance set at P<0.05. Masticatory efficiency was significantly greater in CG (P<0.05) than in DG-II and DG-III in all chewing tasks tested, with no significant difference between DG-II and DG-III (P>0.05). It was observed that the presence of class II and class III dentofacial deformity affected masticatory efficiency compared to CG, although there was no difference between DG-II and DG-III.

Evaluation of bone volume changes after sinus floor augmentation with autogenous bone grafts - Corrected Proof

M. Arasawa, Y. Oda, T. Kobayashi, K. Uoshima, H. Nishiyama, H. Hoshina, C. Saito — 2012-05-01

Abstract: The aim of this study was to establish an objective method for quantitative evaluation of bone volume change after sinus augmentation. 11 sinuses in 9 patients were evaluated by computed tomography images taken before treatment (T0), and 3 months (T1) and at least 1 year (T2) after sinus augmentation. Based on the 3D digital subtraction technique, augmented bone images were extracted and bone volumes were calculated from voxel numbers of the extracted images. The mean augmented bone volumes at T1 and T2 were 2.46cm3 and 1.85cm3, respectively. These bone volume changes were statistically significant and the mean bone volume change±SE was −24.8%±6.1%. Loss of augmented bone was observed in all except one of the patients. The correlation coefficient between bone volume change and elapsed time was −0.64, which was statistically significant and indicated that bone resorption progressed with elapse of time after sinus augmentation. The authors’ method of analysis enabled visualization of augmented bone and objective assessment of bone volume change. Within the limited number of cases, the present investigation demonstrated a significant decrease in augmented bone volume between 3 and 23 months after surgery.

Reconstruction of large mandibular and surrounding soft-tissue defects using distraction with bone transport - Corrected Proof

N. Zwetyenga, F. Siberchicot, A. Emparanza — 2012-05-01

Abstract: Reconstruction of large bone and soft-tissue defects of the inferior third of the face is possible using various surgical techniques. Patients who require these procedures need to be in good general health, may have sequelae linked to donor sites, and require several interventions to achieve good aesthetic and functional results. The aim of this study was to report outcomes in patients with large mandibular and soft-tissue defects treated using osteogenic distraction with bone transport. Between 2001 and 2008, 14 patients had distraction with bone transport. Most patients were men (92.1%). The mean age was 43.1 years. The average mandibular bone reconstruction was 13.6cm. The mean duration of distraction was 2.3 months. No infections occurred, and in all cases reconstruction of soft tissues was obtained. Two patients had non-union and underwent reconstruction using an iliac bone graft. Patients with sufficient bone height (57.1%) had dental implants. 44 implants were inserted, two of which were lost. 36 implants were activated. Six patients had satisfactory oral rehabilitation with implant-supported prostheses. Osteogenic distraction with bone transport allows total or partial restoration of oral function, provides an acceptable appearance, and enables patients to resume a reasonable quality of life.

Coronoidectomy, masticatory myotomy and buccal fat pad graft in management of advanced oral submucous fibrosis - Corrected Proof

M.C. Kothari, N. Hallur, B. Sikkerimath, S. Gudi, C.R. Kothari — 2012-05-01

Abstract: The purpose of this study is to evaluate coronoidectomy, masticatory myotomy and buccal fat pad graft in advanced (Stage III–IV) oral sub mucous fibrosis (OSF). 10 patients with clinically and histologically confirmed advanced OSF underwent surgery entailing bilateral coronoidectomy, masticatory muscle myotomy and closure with a pedicled buccal fat pad graft followed by vigorous mouth opening exercises. The result was evaluated using the interincisal distance at maximum mouth opening as the objective outcome measure over a follow up period of 12 months. Results showed a mean interincisal opening of 14.7mm preoperatively and 32.5mm at 12 months postoperatively. Relapse was encountered in one patient who did not cooperate with the postoperative exercise regime. Results suggest this regime is effective.

Signs and symptoms of parotid gland carcinoma and their prognostic value - Corrected Proof

D. Stodulski, B. Mikaszewski, C. Stankiewicz — 2012-04-30

Abstract: The aim of this study was to analyse signs and symptoms present in patients with parotid gland carcinoma and to assess their prognostic value. A retrospective study of data from 131 patients who were treated surgically was performed. Evaluation of prognostic factors was possible in 109 patients who completed a minimum 5 year follow up. The most common sign and symptoms were parotid mass (96.9%), pain (40.4%), enlarged cervical lymph nodes (32.0%), facial nerve palsy (20.6%) and overlying skin infiltration (19.8%). In 20% of all cases there were no symptoms of tumour malignancy. The average duration of symptoms suggesting malignancy was 4 months. In univariate analysis, the strongest prognostic value was found for facial nerve palsy; it reduced nearly tenfold (9.7) the 5-year disease-free survival. The subsequent poor prognostic factors were: skin infiltration, enlarged cervical lymph nodes, tumour fixation and tumour size (>4cm). Pain and the dynamics of tumour growth were not statistically significant for survival rate. Significant difference in 5-year disease free survival rate was found between the groups of patients, according to the number of symptoms suggesting malignancy. The multivariate analysis showed that only facial nerve palsy and skin infiltration were independent prognostic factors.

Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review - Corrected Proof

M. Clementini, A. Morlupi, L. Canullo, C. Agrestini, A. Barlattani — 2012-04-30

Abstract: This study assessed the success rate of implants placed in horizontal and vertical guided bone regenerated areas. A systematic review was carried out of all prospective and retrospective studies, involving at least five consecutively treated patients, that analysed the success rate of implants placed simultaneously or as second surgery following ridge augmentation by means of a guided bone regeneration (GBR) technique. Studies reporting only the survival rate of implants and studies with a post-loading follow up less than 6 months were excluded. From 323 potentially relevant studies, 32 full text publications were screened and 8 were identified as fulfilling the inclusion criteria. The success rate of implants placed in GBR augmented ridges ranged from 61.5% to 100%; all studies, apart from three, reported a success rate higher than 90% (range 90–100%). The data obtained demonstrated that GBR is a predictable technique that allows the placement of implants in atrophic areas. Despite that, studies with well-defined implant success criteria after a longer follow-up are required.

Effects of maxillary advancement and impaction on nasal airway function - Corrected Proof

F. Pourdanesh, R. Sharifi, A. Mohebbi, A. Jamilian — 2012-04-30

Abstract: The effects of Le Fort I osteotomy on the nasal airway are controversial. This study aimed to evaluate nasal airway changes after Le Fort I. 25 patients underwent conventional Le Fort I osteotomy and were separated into three groups depending on the type of surgery they underwent. 11 patients needed maxillary impaction, 9 underwent maxillary advancement, and 5 had both maxillary impaction and advancement. Rhinological examinations, anterior rhinomanometry and acoustic rhinometry were carried out 1 week before surgery and 3 months after that. Wilcoxon and χ2 tests were used for data analysis. The samples included 19 females and 6 males with a mean age of 22.4±3.32 years. Rhinomanometric assessment showed that total nasal airflow was increased from 406±202ml/s to 543±268ml/s in all three groups. Significant decrease in nasal airway resistance was seen in all three groups. Acoustic rhinometry revealed a significant decrease in total nasal volume but an increase in the cross-sectional areas of isthmus nasi (IN) and inferior concha. The rhinomanometric measurements showed improvements in the total nasal airflow after Le Fort I osteotomy with alar base cinch suture in cases where the impaction was not higher than 5.5mm.

An accurate maxillary superior repositioning technique without intraoperative measurement in bimaxillary orthognathic surgery - Corrected Proof

S. Omura, S. Kimizuka, T. Iwai, I. Tohnai — 2012-04-27

Abstract: This article describes a simple and accurate technique for maxillary superior repositioning without any intraoperative measurement using reference points that can be the source of error in bimaxillary orthognathic surgery. A bilateral straight locking miniplates (SLMs)/screw system secured to the maxilla and mandible maintains the three-dimensional relationship between the mandible and the skull base precisely like the incisor pin of an articulator in model surgery. The maxilla can then be accurately moved into the planned position identical to that in model surgery by the SLMs technique.

Maxillary stability after Le Fort I osteotomy using three different plate systems - Corrected Proof

K. Ueki, K. Okabe, A. Moroi, K. Marukawa, M. Sotobori, Y. Ishihara, K. Nakagawa — 2012-04-27

Abstract: The purpose of this study was to compare postoperative changes in maxillary stability after Le Fort I osteotomy in three groups: with an unsintered hydroxyapatite (u-HA)/poly-l-lactic acid (PLLA) plate; a PLLA plate; and a titanium plate. Subjects comprised 60 Japanese patients diagnosed with mandibular prognathism. All patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. All patients were randomized in groups of 20 to a u-HA/PLLA group, a PLLA plate group and a titanium plate group. Changes in postoperative time intervals between the plate groups were compared using lateral and posteroanterior cephalography. The uHA/PLLA group had significantly larger values than the PLLA group regarding change of mx1-S perpendicular to SN between 3 and 12 months (T3) (P=0.0269). The uHA/PLLA group had a significantly larger value than the PLLA group regarding change of S–A perpendicular to SN between baseline and 1 month (T1) (P=0.0257). There was no significant difference in the other measurements. This study suggests that maxillary stability with satisfactory results could be obtained in the u-HA/PLLA, PLLA plate and titanium plate groups, although there was a slight difference between the u-HA/PLLA and PLLA plate systems in Le Fort I osteotomy.

Anatomic measurement of the depth and location of the sublingual fossa - Corrected Proof

Y. Uchida, M. Goto, A. Danjo, Y. Yamashita, A. Kuraoka — 2012-04-25

Abstract: The purpose of this study was to measure the depth and location of the sublingual fossa, a potential site of sublingual bleeding/lingual cortical perforation during endosseous implant placement in the mandibular interforaminal region (MIR), to clarify anatomical variation. Using the mandibles of 37 Japanese cadavers, the lingual depth (LD) between the lingual surface and the line perpendicular to the inferior margin of the mandible (IMM), as well as the vertical distance (VD) between the lingual surface and the IMM or the mental foramen (MF) level, were measured at defined points and lines within the MIR. The definite sublingual fossa (SF) was identified by the LD (≥1.0mm) and the VD, and the depth and location of the SF were determined. The depth ranged between 1.0mm and 5.8mm, and the vertical location ranged between 9.2mm and 15.7mm from the IMM and between 2.2mm and 6.1mm from the MF level. These results revealed certain tendencies in the depth and location of the SF but the variation was substantial. The SF should be identified in each case as accurately as possible by CT before implant placement in the MIR to minimize the risk of the potential complications.

Evaluation of neurosensory alterations via clinical neurosensory tests following anterior maxillary osteotomy (Bell technique) - Corrected Proof

A. Gulses, Y.S. Aydintug, M. Sencimen, G.R. Bayar, C.H. Acikel — 2012-04-25

Abstract: Neurosensory deficits are the most common complication following orthognathic surgery. Le Fort I and sagittal split ramus osteotomies have been widely studied but there is a lack of data about the neurosensory alterations resulting from anterior maxillary osteotomy (AMO). This paper evaluates the neurosensory alterations in cutaneous regions including lower eyelid, cheek, nose, upper lip and vestibular and palatal mucosal areas using simple clinical tests following AMO performed with Bell's incision so patients can be properly informed about the extent of sensory loss and its rate of recovery following AMO. Twenty-four sides of 12 patients (eight females; four males) with a mean age of 14.20±1.86 years (range 12–17 years) were examined. Pin prick sensation, light touch sensation, static and dynamic two-point discrimination tests were used. Following AMO, vestibular mucosa, upper lip, nose and cheek were the most commonly affected sites. No alterations were detected in lower eyelid and palatal mucosa. The neurosensory deficits in cheek, nose and upper lip resolved 10 days after surgery. The vestibular mucosa showed normal sensation on day 30. In conclusion, following AMO, neurosensory alterations can occur, but it will resolve spontaneously in 30 days.

Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial - Corrected Proof

2012-04-23

Abstract: The aim of this study was to compare the analgesic and anti-inflammatory effects of preoperative and postoperative administration of ibuprofen after the surgical removal of impacted lower third molars. A triple-blind, randomized, placebo-controlled clinical trial of 120 patients requiring the surgical removal of lower third molars was performed. The subjects were randomized into the experimental group (patients were administered 600mg of ibuprofen (p.o.) 1h before the surgical procedure, followed by placebo just after the end of the operation) or into the control group (subjects received the same medication but the administration sequence was reversed). Pain was assessed using visual analogue scales, and consumption of rescue analgesic. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening. There were no significant differences between the two study groups regarding postoperative pain, rescue analgesics consumption, facial swelling and trismus. There was a slightly higher need for rescue analgesics in the experimental group. The preoperative intake of ibuprofen does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to the postoperative administration of the same drug.

Obstructive sleep apnoea in Treacher Collins syndrome: prevalence, severity and cause - Corrected Proof

2012-04-23

Abstract: This cohort study in 35 patients (13 children) evaluates the prevalence, severity and anatomical cause of obstructive sleep apnoea syndrome (OSAS) in patients with Treacher Collins syndrome. Ambulatory polysomnography was performed cross-sectionally to determine OSAS prevalence and severity. All upper airway related surgical interventions were evaluated retrospectively. In 11 patients, sleep endoscopy, and flexible and rigid endoscopy were applied to determine the level of anatomical obstruction of the upper airway. The overall prevalence of OSAS in Treacher Collins patients was 46% (54% in children; 41% in adults). Thirty-eight upper airway related surgical interventions were performed in 17 patients. Examination of the upper airway revealed various anatomical levels of obstruction, from the nasal septum to the trachea. Most significant obstruction was found at the level of the oro/hypopharynx. OSAS in Treacher Collins patients is an important problem so all patients should be screened for OSAS by polysomnography. Endoscopy of the upper airways was helpful in determining the level of obstruction. Surgical treatment at one level will not resolve OSAS in most patients because OSAS in Treacher Collins has a multilevel origin. Non-invasive ventilation (continuous positive airway pressure or bilevel positive airway pressure) or tracheotomy should be considered as a treatment modality.

Static and dynamic loading of mandibular condyles and their positional changes after bilateral sagittal split advancement osteotomies - Corrected Proof

2012-04-23

Abstract: This study analysed the effects of change of direction of masseter (MAS) and medial pterygoid muscles (MPM) and changes of moment arms of MAS, MPM and bite force on static and dynamic loading of the condyles after surgical mandibular advancement. Rotations of the condyles were assessed on axial MRIs. 16 adult patients with mandibular hypoplasia were studied. The mandibular plane angle (MPA) was <39° in Group I (n=8) and >39° in Group II (n=8). All mandibles were advanced with a bilateral sagittal split osteotomy (BSSO). In Group II, BSSO was combined with Le Fort I osteotomy. Pre and postoperative moment arms of MAS, MPM and bite force were used in a two-dimensional model to assess static loading of the condyles. Pre and postoperative data on muscle cross-sectional area, volume and direction were introduced in three-dimensional dynamic models of the masticatory system to assess the loading of the condyles during opening and closing. Postsurgically, small increases of static condylar loading were calculated. Dynamic loading decreased slightly. Minor rotations of the condyles were observed. The results do not support the idea that increased postoperative condylar loading is a serious cause for condylar resorption or relapse.

Two different opinions on a published systematic review - Corrected Proof

Y. Wu, C. Li, J. Pan — 2012-04-20

We read the published systematic review by Mattos et al. with interest. The authors used the methods of systematic review and meta-analysis to explore the changes in the airway of adult patients who underwent orthognathic surgery to correct anteroposterior osseous discrepancies. This article provided much clinical evidence for clinicians and we think it will play an important role in clinical decision making.

Orthodontic measurements and nasal respiratory function after surgically assisted rapid maxillary expansion: an acoustic rhinometry and rhinomanometry study - Corrected Proof

2012-04-20

Abstract: The present study sought to assess nasal respiratory function in adult patients with maxillary constriction who underwent surgically assisted rapid maxillary expansion (SARME) and to determine correlations between orthodontic measurements and changes in nasal area, volume, resistance, and airflow. Twenty-seven patients were assessed by acoustic rhinometry, rhinomanometry, orthodontic measurements, and use of a visual analogue scale at three time points: before surgery; after activation of a preoperatively applied palatal expander; and 4 months post-SARME. Results showed a statistically significant increase (p<0.001) in all orthodontic measurements. The overall area of the nasal cavity increased after surgery (p<0.036). The mean volume increased between assessments, but not significantly. Expiratory and inspiratory flow increased over time (p<0.001). Airway resistance decreased between assessments (p<0.004). Subjective analysis of the feeling of breathing exclusively through the nose increased significantly from one point in time to the next (p<0.05). There was a statistical correlation between increased arch perimeter and decreased airway resistance. Respiratory flow was the only variable to behave differently between sides. The authors conclude that the SARME procedure produces major changes in the oral and nasal cavity; when combined, these changes improve patients’ quality of breathing.

Hemimandibulectomy and vascularized fibula flap in bisphosphonate-induced mandibular osteonecrosis with polycythaemia rubra vera - Corrected Proof

N. Ghazali, J.C. Collyer, J.V. Tighe — 2012-04-20

Abstract: This report presents the successful management of an advanced and refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) by hemimandibulectomy and an osteocutaneous fibula flap reconstruction in a patient with polycythaemia rubra vera, a rare haematological condition in which there is increased risk of thrombosis and haemorrhage. Union of the vascularized bone with the mandible depends on obtaining a BRONJ-free margin and rigid fixation of the bony ends. Magnetic resonance imaging can provide accurate delineation of necrotic bone and area of osteomyelitis. Placement of a 1cm margin beyond this can envisage a BRONJ-free margin. Aggressive medical management of polycythaemia rubra vera by venesection, asprin and cytoreduction therapy along with anticoagulant prophylaxis against thromboembolic events in the first 2 weeks following major surgery can provide the basis of a good surgical and flap outcome. Nevertheless, the possibility of unpredictable haemorrhage must be considered throughout.

The impact of case reports in oral and maxillofacial surgery - Corrected Proof

S. Nabil, N. Samman — 2012-04-19

Abstract: This review examines the effect of publishing case reports on journal impact factor and future research. All case reports published in the four major English language oral and maxillofacial surgery journals in the two year period, 2007–2008, were searched manually. The citation data of each case report were retrieved from the ISI online database. The number, percentage and mean citations received by case reports and their relation to the 2009 journal impact factor were analysed. Case reports which received more than 5 citations were also identified and all of the citing articles retrieved and analysed. Thirty-one percent of all articles published in major oral and maxillofacial journals in 2007–2008 were case reports. Case reports had a low citation rate with a mean citation of less than 1. There were 38 (7.2%) case reports with more than 5 citations and 30% of the citing articles were also case reports. The publication of case reports negatively affected journal impact factor and correlated directly with the percentage of case reports published within a journal. Case reports reporting recent topics, describing new treatment/diagnosis method and with a literature review were more likely to receive citations.

Hydroxyapatite coating for titanium fibre mesh scaffold enhances osteoblast activity and bone tissue formation - Corrected Proof

2012-04-18

Abstract: This study investigated the bone regeneration properties of titanium fibre mesh as a tissue engineering material. A thin hydroxyapatite (HA) coating on the titanium fibre web was created using the developed molecular precursor method without losing the complex interior structure. HA-coated titanium fibre mesh showed apatite crystal formation in vitro in a human osteoblast culture. Titanium fibre mesh discs with or without a thin HA coating were implanted into rat cranial bone defects, and the animals were killed at 2 and 4 weeks. The in vivo experience revealed that the amount of newly formed bone was significantly higher in the HA-coated titanium fibre mesh than in the non-coated titanium fibre mesh 2 weeks after implantation. These results suggest that thin HA coating enhances osteoblast activity and bone regeneration in the titanium fibre mesh scaffold. Thin HA-coating improved the ability of titanium fibre mesh to act as a bone regeneration scaffold.

Response to ‘Two different opinions on a published systematic review’ - Corrected Proof

C.T. Mattos, G.N.L. Vilani, E.F. Sant’Anna, A.C.O. Ruellas, L.C. Maia — 2012-04-18

We appreciate the interest of Wu et al. in our systematic review and we wish to discuss some aspects raised in their letter. The method we used in the meta-analysis, which compared pre- and postoperative data with the assumption of preoperative data as a control group, was rendered necessary by the lack of selected studies presenting a control group. In such a case, control must be perceived as a self controlled situation before treatment, not as a non-treated sample.

Presentation of a cone-beam CT scanning protocol for preprosthetic cranial bone grafting of the atrophic maxilla - Corrected Proof

J. De Ceulaer, G. Swennen, J. Abeloos, C. De Clercq — 2012-04-18

Abstract: The use of autologous calvarian split thickness bone grafts is a well accepted preprosthetic surgical procedure for reconstruction of the severely atrophied maxilla. Although generally accepted as being a superior bone graft regarding long-term stability, the reported risks in the literature may dissuade the surgeon. A modified cone-beam computed tomography (CBCT) scanning protocol (extended field of view starting from 1cm below the occlusal plane up to the limit of the cranial vault, 0.4 voxel) is proposed that allows assessment of both the cranial donor site as the maxillary receptor site and the sinus conditions with a single scan. Issues regarding quality of the data, radiation dose and clinical practicability are discussed.

Value of high-resolution ultrasound in the differential diagnosis of scaphocephaly and occipital plagiocephaly - Corrected Proof

2012-04-17

Abstract: Secondary to the increase in deformational plagiocephaly a growing number of infants with cranial deformity present to craniofacial teams. Computed tomography (CT) is diagnostic, but uses ionizing radiation. The purpose of this study was to evaluate ultrasound as a screening test for the patency of cranial sutures in scaphocephaly and occipital plagiocephaly. The cranial sutures of 54 infants with this cranial deformity were assessed by ultrasound. Sutures were read as patent or fused if a hypoechoic gap could or could not be demonstrated between the hyperechoic clavarial bones, respectively. Seven children suffered from true craniosynostosis of either the sagittal or the lambdoid suture. In five cases the ultrasound findings were diagnostic for a fused suture, in two cases the results were inconclusive. Forty-seven infants presented with deformational plagiocephaly. Ultrasound examination demonstrated patent sutures in 45 cases and was inconclusive in two cases. Sonography of the cranial sutures is a good screening tool to distinguish fused from patent cranial sutures in scaphocephaly and occipital plagiocephaly and avoids the radiation exposure associated with CT examinations.

Long-term evaluation of the stability of reconstructed condyles by transport distraction osteogenesis - Corrected Proof

E. Xiao, Y. Zhang, J. An, J. Li, Y. Yan — 2012-04-17

Abstract: This retrospective longitudinal study evaluated the long-term stability of reconstructed condyles by transport distraction osteogenesis of the mandibular ramus in patients with unilateral temporomandibular joint (TMJ) ankylosis. 7 patients were followed up for 16–92 months (mean 39.4 months). The mean age of the patients at the time of distraction was 22.9 years (range 7–44 years). Maximal mouth opening and panoramic radiographs were recorded preoperatively, at the time of device removal and several years after removal of distraction device. At follow-up, cone beam CT images of the TMJ were obtained to confirm the changes of the reconstructed condyle. Absolute height (Co–Inc) and relative height (Co–Inc/Co–Go) of the reconstructed condyle and the asymmetric difference ratio (AR) were examined to assess the changes of condylar height and mandibular symmetry. The mean maximal mouth opening was stable during the period of follow-up. The mean absolute height and relative height of the reconstructed condyle decreased significantly (P<0.05). Although no significant difference was found, the mandibular asymmetry difference ratio increased by 16.7%. These results suggested that the heights of reconstructed condyles were not stable in the long-term, and the mandible tended to be asymmetrical.

Comparison of five different fixation techniques of sagittal split ramus osteotomy using three-dimensional finite elements analysis - Corrected Proof

F.R.L. Sato, L. Asprino, P.Y. Noritomi, J.V.L. da Silva, M. de Moraes — 2012-04-17

Abstract: The aim of this study was to compare the mechanical stress over hemimandible substrate and hardware after sagittal split ramus osteotomy (SSRO) fixed with five different techniques using three-dimensional (3D) finite element analysis. A 3D finite element model of a hemimandible was created and a 5mm advancement SSRO was simulated on a computer model. The model was fixed with five different techniques: 3 linear 60° screw arrangement; 3 linear 90° screw arrangement; 3 inverted L screw arrangement; 1 conventional miniplate; and 1 locking miniplate with four monocortical screws. Load was applied until 3mm displacement was reached and the results were compared with previous mechanical and photoelastic tests, thus analysing the mechanical stresses developed in the proximity of miniplates and screws and within the fixation system itself. The maximum principal stress values demonstrate a lower mechanical stress rate in bone and in the fixation system with the inverted L arrangement, followed by the linear 90° and linear 60° arrangements. The locking miniplate/screw system presented lower maximum principal stress and better stress distribution compared with the conventional system. Under the conditions tested, the reversed L arrangement provided the most favourable stress dissipation behaviour.

Changes in facial appearance after maxillomandibular advancement for severe obstructive sleep apnoea hypopnoea syndrome in Chinese patients: a subjective and objective evaluation - Corrected Proof

S.-r. Liu, H.-l. Yi, J. Guan, B. Chen, H.-m. Wu, S.-k. Yin — 2012-04-16

Abstract: This study evaluates the outcome and change in facial appearance after maxillomandibular advancement (MMA) in Chinese adults with severe obstructive sleep apnoea hypopnoea syndrome (OSAHS). Twelve patients underwent MMA with adjunctive procedures for severe OSAHS. All underwent physical examination, Epworth Sleepiness Scale evaluation, cephalometry, polysomnography, and facial photographic assessment before and 6 months after MMA. The aesthetic plane (relationship of nose, lips, and chin) was used to judge soft tissue facial profile change after MMA. Postoperative cephalometric data were compared with normal occlusive standards and aesthetic norms. Pre- and postoperative aesthetic appearance was evaluated by 100 lay people using a 10-point visual analogue scale. The maxillomandibular complex (MMC) was advanced 5–10mm (mean 7.4mm). The success rate was 83%. All patients were satisfied with the functional and aesthetic results. Postoperative SNA, SNB, and posterior airway space increased and mandibular plane-to-hyoid distance decreased significantly in all patients. The lower lip was closer to EP than the preoperative and normal occlusive standard. In 11 of 12 patients, the lay aesthetic scores were significantly higher postoperatively. MMA is effective for Chinese adults with severe OSAHS. In most patients, facial appearance was more attractive after MMC advancement of 5–10mm.

The influence of pore size on osteoblast phenotype expression in cultures grown on porous titanium - Corrected Proof

2012-04-10

Abstract: This study investigated the effect of pore size on osteoblastic phenotype development in cultures grown on porous titanium (Ti). Porous Ti discs with three different pore sizes, 312μm (Ti 312), 130μm (Ti 130) and 62μm (Ti 62) were fabricated using a powder metallurgy process. Osteoblastic cells obtained from human alveolar bone were cultured on porous Ti samples for periods of up to 14 days. Cell proliferation was affected by pore size at day 3 (p=0.0010), day 7 (p=0.0005) and day 10 (p=0.0090) in the following way: Ti 62

Torus mandibularis bone chips combined with platelet rich plasma gel for treatment of intrabony osseous defects: clinical and radiographic evaluation - Corrected Proof

K.S. Hassan, A.S. Alagl, A. Abdel-Hady — 2012-04-09

Abstract: The use of platelet rich plasma (PRP) gel in combination with torus mandibularis offers a potentially useful treatment for periodontal osseous defects. Whether this combination enhances the outcome of periodontal regenerative therapy is not known. This study compared the effectiveness of torus mandibularis bone chips alone and when combined with autogenous PRP gel in treating periodontal osseous defects. 24 sites from 12 patients were selected using a split mouth design and determined by a double-blind, randomized, controlled clinical trial. Both sites received a full-thickness mucoperiosteal flap; one intrabony defect was filled with torus mandibularis bone chips alone and the other with torus mandibularis bone chips mixed with PRP gel. There was a 57% gain in the clinical attachment level and 60% reduction in the probing depth for torus mandibularis alone compared to 72% and 68% for sites treated with torus mandibularis and PRP gel (p≤0.01). There was a statistically significant difference in the bone dentistry and the marginal bone loss at sites with PRP gel compared to those without gel (p≤0.01). The use of mandibular tori as autogenous bone graft combined with PRP gel showed a significant improvement in the clinical outcome of periodontal therapy than mandibular tori alone.

Vascularized free tissue transfer for reconstruction of ablative defects in oral and oropharyngeal cancer patients undergoing salvage surgery following concomitant chemoradiation - Corrected Proof

K. Arce, R.B. Bell, J.K. Potter, M.J. Buehler, B.E. Potter, E.J. Dierks — 2012-04-09

Abstract: The purpose of this study was to determine whether chemotherapy delivered concurrently with external beam radiation therapy for loco-regionally advanced head and neck cancer affects the rate or severity of postoperative complications in patients who underwent salvage surgery for recurrent or persistent disease with simultaneous microvascular free flap reconstruction. The primary study group consisted of patients with head and neck malignancies that had undergone surgical salvage with microvascular free flap reconstruction for persistent or recurrent disease following definitive radiation or concomitant chemoradiation treatment. A group of demographically matched patients who underwent microvascular free flap reconstruction for non-malignant and malignant conditions who never received radiation were randomly selected to serve as a control group. The study cohort was divided according to radiation treatment. The overall success rate of flap reconstruction was 92%, with an overall complication rate of 23%. Concurrently administered chemotherapy did not appear to affect the type of or the complication rate. The results of this investigation indicate that microvascular free flap reconstruction of head and neck defects is highly predictable, results in relatively few major complications, and suggests that neither radiation alone nor concomitant chemoradiation has a statistically significant effect on overall flap survival or complication rate.

Arthroscopic electrothermal capsulorrhaphy for the treatment of recurrent temporomandibular joint dislocation - Corrected Proof

Daniel E. Torres, Joseph P. McCain — 2012-04-09

Abstract: Acute temporomandibular joint dislocation is a common occurrence that is generally treated by conservative therapy. In some patients, this can become a chronic recurrent condition. This recurrent temporomandibular joint dislocation (RTD) can significantly decrease the patient's quality of life and require some form of surgical intervention for correction. The purpose of this study is to present a minimally invasive alternative treatment for RTD using operative arthroscopy. 11 patients treated for recurrent temporomandibular dislocation between 2004 and 2010 were retrospectively analyzed. Electrothermal capsulorrhaphy was performed using a standard double puncture operative arthroscopy with a Hol:YAG laser and/or electrocautery. Postoperatively the patients were monitored for 6 months to 6 years. Of the 11 subjects, 2 suffered a recurrence of temporomandibular dislocation and required open arthrotomy for correction. The other 9 patients had no signs of recurrence or any significant postoperative loss of function. Electrothermal capsulorrhaphy is an effective and minimally invasive method for the treatment of RTD.

Frontofacial advancement by internal distraction devices. A technical modification for the management of craniofacial dysostosis in early childhood - Corrected Proof

N. Adolphs, M. Klein, E.-J. Haberl, H. Menneking, B. Hoffmeister — 2012-04-09

Abstract: Normal craniofacial growth is characterized by a different growth pattern of neuro- and viscerocranium. In craniofacial dysostosis (CFD) syndromes there is complex disturbance of this physiological growth pattern. Modern surgical management of CFD is staged with respect to the severity of the deformity, the age and the development of the patient. Early single stage management of anterior cranial vault deformity and midfacial retrusion in children affected by syndromic craniosynostosis is possible when anterior cranial vault remodelling is performed together with gradual Le Fort III midfacial advancement. One pair of internal distraction devices, placed in accordance with the midfacial growth vector after initial cranial vault remodelling, can be sufficient for this purpose. Technical aspects of this modified frontofacial advancement procedure are presented and discussed based on a case report with a postoperative follow up time of 50 months.

Changes in posterior airway space, pulmonary function and sleep quality, following bimaxillary orthognathic surgery - Corrected Proof

2012-04-05

Abstract: Bimaxillary orthognathic surgery (BOS) is commonly used in the correction of severe Class III deformities (mandibular prognathism with maxillary retrognathism). The postural response of the pharyngeal airway after mandibular setback and maxillary advancement procedures is clinically crucial for maintaining optimum respiration. Patients might suffer from obstructive sleep apnoea, postoperatively. The aim of this study was to determine the effects of BOS on pharyngeal airway space, respiratory function during sleep and pulmonary functions. 21 male patients were analysed using cephalometry, spirometry for pulmonary function tests, and a 1 night sleep study for full polysomnography before and 17±5 months after BOS. The data show that the hyoid bone repositioned to the inferior, the tongue and soft palate displaced to the posterior, narrowed at the oropharynx and hypopharynx and widened at the nasopharynx and velopharynx levels significantly (p<0.05). The alterations indicated decreased airway resistance and better airflow. As a consequence of polysomnography evaluation, the sleep quality and efficiency of the patients improved significantly after BOS. Patients who undergo BOS should be monitored with pulmonary function tests and polysomnography pre- and postoperatively to detect any airway obstruction.

Intra-articular loose osteochondroma of the temporomandibular joint - Corrected Proof

P. Graziano, A. Spinzia, V. Abbate, A. Romano — 2012-04-05

Abstract: Osteochondroma or osteocartilaginous exostosis is one of the most common benign bone tumours. It usually develops in the metaphyses of long flat bones, but rarely occurs in the oral and maxillofacial area, where it is generally associated with the coronoid process or the condyle. Loose osteochondromas inside the joint are generally a rare pathology usually described in large joints. The authors present a case of an intra-articular loose osteochondroma of the temporomandibular joint (TMJ), which represents the first case of such a pathological entity in the literature. The authors suggest that it should be considered in any differential diagnosis of loose bodies described in the TMJ.

Life-threatening haemorrhage after 750 Le Fort I osteotomies and 376 SARPE procedures - Corrected Proof

C. Politis — 2012-04-05

Abstract: This study assessed the incidence, presenting symptoms, diagnosis, and management of patients with life-threatening postoperative haemorrhage after total Le Fort I osteotomy and surgically assisted rapid palatal expansion (SARPE). The medical records of 750 consecutive Le Fort I osteotomies and 376 consecutive SARPEs, both of which involved pterygomaxillary separation with a curved osteotome and a mallet, were analysed prospectively. Two cases of life-threatening haemorrhage were observed in the Le Fort I osteotomy group, both initiated on postoperative day 7. Anterior and posterior nasal packing were successful in one patient; the other required two embolizations for bleeding control (incidence of life-threatening postoperative haemorrhage: 2/750; confidence interval: 0.03–0.96%). In the SARPE group, one brisk epistaxis on the first postoperative day was controlled with anterior and posterior nasal packing under general anaesthesia. This haemorrhage was not considered life threatening (incidence of life-threatening postoperative haemorrhage: 0/376; confidence interval: 0–0.98%). In no case could the source of bleeding be established during re-explorative surgery or during diagnostic arteriography. The authors conclude that life-threatening haemorrhage is an exceptional finding after Le Fort I osteotomy; the observed incidence was 2/750, and life-threatening haemorrhage was not observed after SARPE in this series, despite the use of identical pterygomaxillary separation.

Blocking the Na+/H+ exchanger 1 with cariporide (HOE642) reduces the hypoxia-induced invasion of human tongue squamous cell carcinoma - Corrected Proof

C. Lv, X. Yang, B. Yu, Q. Ma, B. Liu, Y. Liu — 2012-04-05

Abstract: The Na+/H+ exchanger 1 (NHE1) plays a significant role in acidifying the tumour microenvironment, potentially contributing to the tumour's malignant potential. The mechanism by which NHE1 mediates cell invasion and migration, especially in human tongue squamous cell carcinoma (hTSCC), is unknown. In this study, the authors demonstrated that inhibition of NHE1 by cariporide (HOE642) suppressed the invasion and migration of Tca8113 cells under hypoxic conditions. Hypoxia also promoted the production of MMP-9, and the suppressive role of cariporide was enacted through the downregulation of MMP-9. The data demonstrated that NHE1 plays a role in hTSCC invasion and that NHE1 might be a new target for hTSCC treatment.