Gary Warburton - Academia.edu (original) (raw)

Papers by Gary Warburton

Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology, May 1, 2022

International Journal of Oral and Maxillofacial Surgery, Apr 1, 2016

Self-inflicted head and neck gunshot wounds are a common modality of suicide in the USA. This stu... more Self-inflicted head and neck gunshot wounds are a common modality of suicide in the USA. This study reviewed all self-inflicted head and neck gunshot wound patients with complete records (n = 157) treated at a tertiary centre between 2002 and 2012 inclusive. The associations between mortality and patient/clinical variables were evaluated with the x 2 test or Fisher's exact test for statistical difference testing. Outcomes recorded were death (n = 92, 59%), discharge to longterm care/rehabilitation (n = 58, 37%), and discharge home (n = 7, 4%). The majority of patients were male (86.6%) and single/separated/divorced (55.5%). The mortality rate by site, in descending order, was temporal 82%, frontal scalp 69%, submental/intraoral 30%, and neck 25%. Involvement of the central nervous system (n = 127) resulted in a 70% mortality, but a lower mortality was observed among patients with an avulsion injury (P = 0.025). A tracheostomy within 24 h of admission was statistically associated with improved survival (P < 0.001), but confounding factors were found. Multivariate analysis revealed increasing age, temporal entry site, and the severity of central nervous system involvement to be positively associated with an increased mortality.

International Journal of Oral and Maxillofacial Surgery, Sep 1, 2020

Alloplastic total replacement of the temporomandibular joint (TMJ) was developed in recent decade... more Alloplastic total replacement of the temporomandibular joint (TMJ) was developed in recent decades. In some conditions, previous studies suggested the rationale behind alloplastic TMJ replacement rather than reconstruction with autogenous grafts. Currently, three prosthetic products are available and approved by the US Food and Drug Administration. Among these products, customized prostheses are manufactured, via computer aided design/ computer aided manufacturing (CAD/CAM) system for customized design; stock-type prostheses are provided in various sizes and shapes. In this report, two patients (a 50-year-old female who had undergone condylectomy for the treatment of osteochondroma extending to the cranial base on the left condyle, and a 21-year-old male diagnosed with left temporomandibular ankylosis) were treated using the alloplastic total replacement of TMJ using stock prosthesis. The follow-up results of a favorable one-year, short-term therapeutic outcome were obtained for the alloplastic total TMJ replacement using a stock-type prosthesis.

Craniomaxillofacial Trauma and Reconstruction, May 2, 2022

Study Design For certain condylar fractures, extracorporealization of the condylar segment may be... more Study Design For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we conducted a retrospective analysis of surgical outcomes. Objective For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we investigated the viability of this technique through a retrospective analysis of outcomes. Methods Twenty-six patients were treated using EVRO with extracorporealization of the condyle for both condylar fractures (18 patients) and osteochondroma (8 patients). Of the 18 trauma patients, 4 were excluded due to limited follow-up. Clinical outcomes were measured, including occlusion, maximum interincisal opening (MIO), facial asymmetry, incidence of infection, and temporomandibular joint (TMJ) pain. Radiographic signs of condylar resorption were investigated, quantified, and categorized using panoramic imaging. Results Average follow-up was 15.9 months. Average maximum interincisal opening was 36.8 mm. Four patients demonstrated mild resorption and one patient demonstrated moderate resorption. Two cases of malocclusion were attributed to failed repairs of other concurrent facial fractures. Three patients reported TMJ pain. Conclusions Extracorporealization of the condylar segment with EVRO to facilitate open treatment of condylar fractures is a viable treatment option when more conventional approaches prove unsuccessful.

Atlas of the oral and maxillofacial surgery clinics of North America, Sep 1, 2022

Temporomandibular joint reconstruction (TMJR) is often necessary for patients with severe and/or ... more Temporomandibular joint reconstruction (TMJR) is often necessary for patients with severe and/or refractory TMJ disease who have failed conservative treatment. TMJR aids to improve masticatory function and is associated with improved quality of life outcomes. Currently, alloplastic reconstruction is considered as the treatment of choice in most severe TMJ disorders due to its many advantages inclusive but not limited to early mobilization, stable longterm results, and significant improvement in jaw function. Broadly speaking, two types of TMJR prostheses are available for reconstruction: 1) stock, and, 2) custommade prostheses. The purpose of this article is to provide the reader with a brief overview of the basic principles and fundamentals of TMJR while referencing pertinent existing literature.

International Journal of Oral and Maxillofacial Surgery, 2019

British Journal of Oral and Maxillofacial Surgery, 2018

There are limited published data about the surgical management of self-inflicted facial gunshot w... more There are limited published data about the surgical management of self-inflicted facial gunshot wounds. The aim of this retrospective study was to review our management of subjects who initially survive such a wound and were admitted to a tertiary care trauma centre between 2002 and 2012. Only subjects with definitive evidence of a self-inflicted facial gunshot wound and who were admitted alive were included. Data collected included personal and clinical details, characteristics of the gunshot wound, and medical and surgical management. Types of operations and their duration were recorded, and primary reconstruction was divided into early (within the first 48 hours after presentation) or delayed (longer than 48 hours). Determinants of infection were assessed with univariate analysis. Seventy-six subjects (65 male and 11 female, mean (range) age 44 (18-83) years) were included in the study. Twenty-five patients needed an early surgical airway and five needed emergency intervention to control haemorrhage. Forty-five patients had primary reconstructions (28 early and 17 delayed) and 12 who were treated by delayed repair had a submental entry site to the wound. There were no significant differences in infection rates between those who had early, compared with those who had late, reconstructions. Early primary reconstruction can be successful for patients with self-inflicted facial gunshot wounds, particularly when the entry point of the bullet is in the upper and midface area. Delayed primary reconstruction was more common when the bullet entered the lower face.

International Journal of Oral and Maxillofacial Surgery, 2011

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is an uncommon benign entity ch... more Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is an uncommon benign entity characterized by the formation of calcified loose bodies within the joint. The standard treatment is arthrotomy of the affected joint and removal of the loose bodies. The aim of this study was to present the results of a large series of cases who were treated with arthroscopy. Retrospectively, 33 consecutive patients treated between April 2001 and April 2010 have been analyzed. The predominant symptoms were pain, limitation of mouth opening, and joint sounds. Obvious joint effusion was shown on magnetic resonance imaging (MRI) in 21 of 33 patients. The mass lesions were demonstrated on MRI in 29 of 33 cases. The presence of loose bodies was shown under arthroscope for all cases. Their diameter was from 0.5 mm to 15 mm. Synovial hyperplasia was noted in 12 of 33 patients. Bony erosion of either the glenoid fossa or eminence was discovered in 11 of 33 patients. Anterior disc displacement was seen in 15 patients. The loose bodies smaller than 3 mm were commonly removed with joint lavage or biopsy forceps in 26 patients. Fragmentation with forceps or an additional incision was applied to remove larger loose bodies for the other seven patients. No mass lesions were showed on postoperative MRI. The average follow-up period was 38 months. No recurrence was suspected clinically and radiologically. Arthroscopy is proved to be a useful method for management of SC of the TMJ which is confined to the superior joint space. Conflict of interest: None declared.

JDR clinical and translational research, Jan 20, 2023

Background: With addiction rates and opioid deaths increasing, health care providers are obligate... more Background: With addiction rates and opioid deaths increasing, health care providers are obligated to help stem the opioid crisis. As limited studies examine the comparative effectiveness of fixed-dose combination nonopioid analgesia to opioid-containing analgesia, a comparative effectiveness study was planned and refined by conducting a pilot study. Methods: The Opioid Analgesic Reduction Study (OARS) pilot, a stratified, randomized, multisite, double-blind clinical trial, was designed to test technology and procedures to be used in the full OARS trial. Participants engaged in the full protocol, enabling the collection of OARS outcome data. Eligible participants reporting to 1 of 5 sites for partial or full bony impacted mandibular third molar extraction were stratified by biologic sex and randomized to 1 of 2 treatment groups, OPIOID or NONOPIOID. OPIOID participants were provided 20 doses of hydrocodone 5 mg/acetaminophen 300 mg. NONOPIOID participants were provided 20 doses of ibuprofen 400 mg/acetaminophen 500 mg. OARS outcomes data, including pain experience, adverse effects, sleep quality, pain interference, overall satisfaction, and remaining opioid tablets available for diversion, were collected via surveys, electronic medication bottles, eDiary, and activity/sleep monitor. Results: Fifty-three participants were randomized with 50 completing the OARS pilot protocol. Across all outcome pain domains, in all but 1 time period, NONOPIOID was better in managing pain than OPIOID ( P < 0.05 level). Other outcomes suggest less pain interference, less adverse events, better sleep quality, better overall satisfaction, and fewer opioid-containing tablets available for diversion. Discussion: Results suggest patients requiring impacted mandibular third molar extraction would benefit from fixed-dose combination nonopioid analgesia. Knowledge Transfer Statement: Study results suggest fixed-dose nonopioid combination ibuprofen 400 mg/acetaminophen 500 mg is superior to opioid-containing analgesic (hydrocodone 5 mg/acetaminophen 500 mg). This knowledge should inform surgeons and patients in the selection of postsurgical analgesia.

Journal of Oral Biology and Craniofacial Research

Dislocation of the Temporomandibular Joint, 2018

Temporomandibular joint dislocation accounts for 3% of all joint dislocations [1]. Most oral and ... more Temporomandibular joint dislocation accounts for 3% of all joint dislocations [1]. Most oral and maxillofacial surgeons, as well as many dental and emergency professionals, are likely to encounter a patient with acute TMJ dislocation in their career. With a similar presentation to open lock or subluxation, understanding the difference in history, clinical, and radiographic presentations can lead to earlier diagnosis and subsequent treatment. This chapter will focus on providing an understanding of the anatomy and pathology, as well as reviewing the different manual reduction techniques that can be used in the office or operating room settings.

Journal of Clinical and Experimental Dentistry, 2020

Background: Juvenile ossifying fibroma (JOF) is an uncommon benign fibro-osseous lesion of the cr... more Background: Juvenile ossifying fibroma (JOF) is an uncommon benign fibro-osseous lesion of the craniofacial skeleton; compared to conventional ossifying fibroma (OF), JOF is characterized by local aggressiveness and propensity for recurrence. The biologic basis for this different biologic behavior between JOF and OF remains elusive. The aim of this study was to evaluate the immunohistochemical expression of MDM2, CDK4 and p53, molecules associated with bone oncogenesis, in the trabecular variant of JOF. Material and Methods: The study material consisted of five cases of trabecular JOF, affecting three male and two female patients with a mean age of 11.8 years. Three cases arose in the maxilla and two in the mandible. All cases were initially treated by enucleation; two cases recurred necessitating more aggressive treatment. Immunohistochemical study of MDM2, CDK4 and p53 was performed in all cases, as well as in five control cases of conventional OF. Results: CDK4 positivity was noted in all JOF cases; the staining pattern was diffuse and strong in 4 cases and focal and weak in one case. In contrast, 4 out of 5 cases of OF were weakly and focally CDK4 positive, the remaining one being negative. Immunostaining for MDM2 was observed in 3 JOF cases; all OF were MDM2 negative. All cases of OF and JOF were negative for p53, except for one focally positive JOF case. Conclusions: CDK4 and MDM2 expression in the trabecular variant of JOF is higher compared to conventional OF. In contrast, p53 expression is almost universally negative in JOF and OF. Despite some overlapping features, differential expression patterns of proteins involved in bone oncogenesis can elucidate the pathogenesis and may facilitate accurate diagnosis and prediction of behavior of bone tumors in the craniofacial region.

Open and arthroscopic surgeries of the temporomandibular joint (TMJ) are common and effective tre... more Open and arthroscopic surgeries of the temporomandibular joint (TMJ) are common and effective treatments for selected patients with TMJ disorders. However, complications inevitably occur, even in the hands of experienced TMJ surgeons. An understanding of the surrounding anatomy, as well as a knowledge of the potential complications, is essential and not only helps in avoiding these complications but also in their recognition and appropriate management, when they do occur. The TMJ is located in a complex anatomical region within the head and neck. It is bounded posteriorly by the external auditory canal and superiorly by the middle cranial fossa. Consequently these structures are at risk during open surgery and arthroscopy with the potential for serious complications.

Oral Oncology Supplement, 2005

Accordalg to epldenllologlcal studies the mail risk factors for upper gastroilteshnal (GI)-tract ... more Accordalg to epldenllologlcal studies the mail risk factors for upper gastroilteshnal (GI)-tract cancers are smoking and alcohol drHgang and additionally, these risk factors interact in a muRiplicative way to the cancer risk. However, there is controversial data of the association of cancer and the use of moast snuff. There is increasing evidence that acetaldehyde, the first nietabohte of ethanol is responsible for ethanol-associated carcilogenesis, because ethanol per se is not carcilogemc. Also tobacco smoke contains tngh concentrations of acetaldehyde, which is ranked one of the most toxic compounds in cigarette smoke. This study was aimed to Ilvestlgate the exposure of upper GI-tract to carcmogemc acetaldehyde originated from alcohol, smoking or moist snuff. Materials and Methods: 6 smokers, 4 moist snuff-users and 6 non-smokers, (all moderate alcohol consumers) mean age 26-t-1.4 years took part m the study. All volunteers ingested 0.8 gag b.wt of 10% (v/v) alcohol and thereafter sahva samples were collected for 160 man. Volmlteers who were smokers smoked one cigarette (an 5 mil tune) every 20 man and those who were snuff-users placed one sachet (lg) of moist snuff between their gum and cheek (for 15 nml time) every 30 nml. Collected sahvary samples were lmniechately analysed gas chromatographically. Results: After ethmlol ingestion in vwo sahvary acetaldehyde levels in non-smokers and snuff-users were mgmflcasltly lower than an snlokers. Adchtlonally, durang every cigarette smoking, m VlVO sahvary acetaldehyde was increased 10-fold (to 260LtM) over levels derived from ethaslol ingestion alone. There were no Ilcreased salivary acetaldehyde concentrataous due to snuffusilg. Conclusion: The carclnogemc acetaldehyde oraglnated from tobacco smoke is easaly chssolved to the sahva m smokers durilg active smoking. This markedly increased exposure caused by siliultasieous smokang and drmkang rmght explain the pathogenetlc mechanism behind nmltlphcatlve risk effect of alcohol drHflcilg and smokilg on the upper GI-tract carcinogenesis.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2005

Schimmelpenning syndrome (SS) is an unusual disease that is characterized by mucocutaneous, centr... more Schimmelpenning syndrome (SS) is an unusual disease that is characterized by mucocutaneous, central nervous system, ocular, and skeletal abnormalities. Nevus sebaceus, usually with broad involvement of the scalp and face, represents the classic skin finding associated with SS. We report a 6-year-old female with SS who presented with a variety of oral lesions, including a number of intraosseous jaw findings that have not been previously described in patients with the syndrome. These findings include bilateral central giant cell granulomas (CGCG)-one lesion involving the left maxilla, which perforated into the soft tissues, and a second distinct lesion involving the right anterior hard palate. Both CGCGs were diagnosed at the patient's initial presentation. Although there have been 2 published reports of CGCG identified in patients with the syndrome, in both cases the occurrence of the lesion was thought to represent a coincidental finding. We argue that CGCG represents a true clinical manifestation of SS. One year later, the patient presented again, this time with bilateral maxillary expansion. Microscopic review of the surgical specimens revealed bilateral benign fibro-osseous lesions, both complicated with foci of CGCG, typical appearing complex odontomas, and multiple malformed teeth containing melanin. A hybrid adenomatoid odontogenic tumor-odontoma involving the anterior mandible was also removed at that time. The findings of pigmented teeth and a hybrid odontogenic neoplasm are novel and have not been previously reported in patients with SS. Although the genetic defect associated with SS has not been characterized, it is intriguing to speculate that a common gene may be important in the pathogenesis of tooth development, maxillofacial benign fibro-osseous disease, and CGCG.

Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society

Tissue injury in the oral mucosa activates a cascade of transcriptional events important during t... more Tissue injury in the oral mucosa activates a cascade of transcriptional events important during the healing process that are not yet clearly defined. To characterize these events and identify potential gene targets for future studies, we used cDNA expression arrays in a clinical model of tissue injury. Mucosal biopsies were taken before third molar extraction, 2-4 hours postoperatively, or at 48 hours. Hybridization patterns were analyzed and validated using real-time polymerase chain reaction. Prior to extraction, the biopsied mucosal tissues were characterized by a panoply of genes that were constitutively expressed. After injury, analysis revealed differential expression of genes involved in transcription, inflammation, and remodeling. At 2-4 hours after injury, genes such as Fos, Jun, and early growth response protein were up-regulated, while genes responsible for intercellular adhesion were down-regulated. At 48 hours after injury, the gene profile had shifted toward tissue rem...

Oral Oncology, 2007

Various combinations of the SIBLING family of proteins have been found to be upregulated in many ... more Various combinations of the SIBLING family of proteins have been found to be upregulated in many human cancers and have been linked to different stages of tumor progression, including metastasis. Bone sialoprotein (BSP), osteopontin (OPN) and dentin matrix protein 1 (DMP1) specifically bind and activate MMP-2, MMP-3, and MMP-9, respectively. These proteases have also been shown to play important roles in oral squamous cell carcinoma (OSCC) invasion and metastasis. However, with the exception of OPN, there are no reports on the expression of the family of five SIBLING proteins in OSCC. This study examines the expression patterns of the SIBLING family (and MMP partners when known) in OSCC, correlating expression to outcome variables. Archived paraffin sections of 87 cases of primary OSCC were screened by immunohistochemistry for the SIBLINGs and their MMP partners. Three SIBLINGs (BSP, DSPP, and OPN), were expressed in OSCC, while DMP1 and MEPE expression were never observed. Furthermore, BSP and OPN were always expressed with their known MMP partners, MMP-2 and MMP-3,

Journal of Oral and Maxillofacial Surgery, 2003

Journal of Oral and Maxillofacial Surgery, 2005