Oral and Maxillofacial Surgery Research Papers (original) (raw)

Long-term success of distraction osteogenesis depends on the ability of the surrounding soft tissues to tolerate distraction forces and to adapt to the resulting increase in skeletal length and volume. The hypothesis tested in this study... more

Long-term success of distraction osteogenesis depends on the ability of the surrounding soft tissues to tolerate distraction forces and to adapt to the resulting increase in skeletal length and volume. The hypothesis tested in this study was that mandibular elongation by distraction induces myocyte proliferation. Unilateral mandibular angle osteotomies were performed in 16 Yucatan minipigs. The hemimandibles were lengthened using semiburied distraction devices (Synthes Maxillofacial, Paoli, PA) with 0-day latency, 1, 2, or 4 mm/d distraction rates, and a neutral fixation period of twice the gap size in days. In 2 additional animals, the dissection and osteotomies were performed, and distraction devices were placed without activation (sham control). At the end of neutral fixation, tissues were taken from masseter muscle overlying the osteotomy and the equivalent region on the unoperated side (contralateral control). Proliferation of myocytes was estimated using immunohistochemical localization with antibodies against proliferating cell nuclear antigen (PCNA). Muscle overlying the distracted mandible showed 6-fold more PCNA-positive myocytes (16.8% +/- 11.3%) than the contralateral control side (2.8% +/- 1.1%, P < .0001). In the 2 sham-control animals, there was a low index of PCNA-positive myocytes on both the osteotomy (2%, 5%) and the contralateral sides (1%, 2%). The results of this study suggest that distraction of the porcine mandible by the protocol described induces myocyte proliferation in the masseter muscle. A proliferative response may contribute to improved long-term stability of mandibular expansion by distraction osteogenesis.

Background: Several prognostic models have been developed to stage hepatocellular carcinoma (HCC) but there is no general consensus on which is the most reliable. We compared three prognostic indices (Okuda, CLIP, and BCLC scoring... more

Background: Several prognostic models have been developed to stage hepatocellular carcinoma (HCC) but there is no general consensus on which is the most reliable. We compared three prognostic indices (Okuda, CLIP, and BCLC scoring systems) in a large series of cirrhotic patients with HCC undergoing nonsurgical treatment in terms of their ability to classify patients into different risk groups Methods: We retrospectively studied 268 Italian patients with HCC. A total of 146 patients were treated with ablation, 132 with percutaneous ethanol injection, and 14 with radiofrequency ablation; 103 underwent transcatheter arterial chemoembolisation and 19 had supportive care alone. Factors determining survival were analysed by univariate and multivariate analysis using the Kaplan-Meier method and Cox proportional hazard regression models. Okuda, CLIP, and BCLC scores evaluated before treatment were applied. Results: Median survival was 25.7 months. In a multivariate analysis, portal vein thrombosis, a fetoprotein, total bilirubin, and tumour size were significant predictors of survival. Okuda, CLIP, and BCLC scores were all able to predict survival (p,0.001). They identified two, four, and six risk groups, respectively, with a median survival ranging from 27 to 19 months for Okuda, 30 to 5 months for CLIP, and 43 to 7 months for BCLC. Conclusions: Both CLIP and BCLC scores were more effective than the Okuda score in stratifying patients into different risk groups with early-intermediate HCC. However, the BCLC scoring system gave a better prediction of prognosis in patients with disease diagnosis at a very early stage.

In the modern implantology, bone grafting has become a frequent procedure to reconstruct alveolar bone resorption and defects in edentulous areas. The aim of this prospective clinical study was to evaluate the viability of a new bone... more

In the modern implantology, bone grafting has become a frequent procedure to reconstruct alveolar bone resorption and defects in edentulous areas. The aim of this prospective clinical study was to evaluate the viability of a new bone graft technique using autogenous bone block, kept in place by the strength of soft tissue and periosteum, to increase width in the partial edentulous maxilla, to allow the installation of dental implants. Bone graft procedures were realized in 29 patients, using onlay bone block with subperiosteal tunneling technique in 41 atrophic edentulous areas. Clinical biometry using digital calipers and photographs data were taken. The main analyzed aspect was the bone augmentation aiming implant placement. The follow up period ranged from 5 to 9 months when implants were installed. Aspects concerning soft tissue healing, technical facility comparing to conventional techniques and the behavior of bone blocks grafted with no fixation devices were observed. The one-way analyses of variance (ANOVA), following by Tukey's test, demonstrated a significant difference (p < 0.05) for the initial average measurements (2.95 mm + −0.79) and final average measurements (6.64 mm + −0.99), with resorption rate of 6.21% after the bone repair period. The success rate for this technique was 97.5% (1 failure out of 41 grafted areas). The results of this study demonstrated that the subperiosteal tunneling technique promoted good bone graft healing, with less resorption rate when comparing to conventional techniques, using a much more simple technique, with less surgical time, morbidity and minor costs.

Purpose The purpose of this paper was to describe a case of unviable alveolar repositioning of an intruded tooth into the nasal cavity and to bring the subject of intrusive tooth injury among patients with dentoalveolar fractures to the... more

Purpose The purpose of this paper was to describe a case of unviable alveolar repositioning of an intruded tooth into the nasal cavity and to bring the subject of intrusive tooth injury among patients with dentoalveolar fractures to the attention of trauma surgeons.

Multiple variations in the technique of cleft reconstruction have been proposed. Outcome studies are lacking which demonstrate clear benefit in any one technique. There is good literature, however, on surgical approaches to be avoided. We... more

Multiple variations in the technique of cleft reconstruction have been proposed. Outcome studies are lacking which demonstrate clear benefit in any one technique. There is good literature, however, on surgical approaches to be avoided. We will discuss the management of the cleft alveolar defect. We will review the complex anatomy, discuss growth and development, and review the surgical technique of cleft reconstruction and graft harvest. We will also review the literature-old and new-and focus on outcome studies to provide practitioners with information that can be used readily in their practice.

Aggressive fibromatosis is a benign spindle cell tumor with locally infiltrative behavior and tendency to recur. It has overlapping features with other spindle cell lesions and hence it is pertinent to be distinguished from them as they... more

Aggressive fibromatosis is a benign spindle cell tumor with locally infiltrative behavior and tendency to recur. It has overlapping features with other spindle cell lesions and hence it is pertinent to be distinguished from them as they have different treatment modalities. We report a rare case involving the mandible of a two-month old infant with histopathological, immunohistochemical and imaging features.

Osteonecrosis of the jaw (ONJ) is a serious complication associated with bisphosphonate therapy, but its epidemiology in the setting of oral bisphosphonate therapy is poorly understood. The present study examined the prevalence of ONJ in... more

Osteonecrosis of the jaw (ONJ) is a serious complication associated with bisphosphonate therapy, but its epidemiology in the setting of oral bisphosphonate therapy is poorly understood. The present study examined the prevalence of ONJ in patients receiving chronic oral bisphosphonate therapy.We mailed a survey to 13,946 members who had received chronic oral bisphosphonate therapy as of 2006 within a large integrated health care delivery system in Northern California. Respondents who reported ONJ, exposed bone or gingival sores, moderate periodontal disease, persistent symptoms, or complications after dental procedures were invited for examination or to have their dental records reviewed. ONJ was defined as exposed bone (of >8 weeks' duration) in the maxillofacial region in the absence of previous radiotherapy.Of the 8,572 survey respondents (71 ± 9 years, 93% women), 2,159 (25%) reported pertinent dental symptoms. Of these 2,159 patients, 1,005 were examined and an additional 536 provided dental records. Nine ONJ cases were identified, representing a prevalence of 0.10% (95% confidence interval 0.05% to 0.20%) among the survey respondents. Of the 9 cases, 5 had occurred spontaneously (3 in palatal tori) and 4 occurred in previous extraction sites. An additional 3 patients had mandibular osteomyelitis (2 after extraction and 1 with implant failure) but without exposed bone. Finally, 7 other patients had bone exposure that did not fulfill the criteria for ONJ.ONJ occurred in 1 of 952 survey respondents with oral bisphosphonate exposure (minimum prevalence of 1 in 1,537 of the entire mailed cohort). A similar number had select features concerning for ONJ that did not meet the criteria. The results of the present study provide important data on the spectrum of jaw complications among patients with oral bisphosphonate exposure.

Purpose: To evaluate the dimension and duration of pain reduction in patients with facial neuralgias after localization, decortication, and curettage of histologically confirmed inflammatory jawbone lesions of the newly identified form of... more

Purpose: To evaluate the dimension and duration of pain reduction in patients with facial neuralgias after localization, decortication, and curettage of histologically confirmed inflammatory jawbone lesions of the newly identified form of alveolar avascular osteonecrosis called neuralgia-inducing cavitational osteonecrosis (NICO).

Purpose: The purpose of the study was to obtain information on factors leading to perioperative dissatisfaction of patients who undergo orthognathic surgery for dentofacial deformities. Materials and Methods: A total of 44 patients who... more

Purpose: The purpose of the study was to obtain information on factors leading to perioperative dissatisfaction of patients who undergo orthognathic surgery for dentofacial deformities. Materials and Methods: A total of 44 patients who underwent orthognathic surgery between January 1, 2003, and September 30, 2005, were included in this study. All patients completed 21-item questionnaires, which were analyzed using the frequency distribution and the 2 test. Results: The patients lost 6.4% of their body weight after 1-jaw surgery and 6.7% after 2-jaw surgery. The patients returned to their everyday life 4.8 weeks after 1-jaw surgery and 5.2 weeks after 2-jaw surgery. Restoration of sensory function after jaw surgery required almost 10 weeks. Conclusion: Written information about possible sequelae and the recovery period and patients' consent to the surgical procedure may be helpful in proper communication, which may reduce patients' perioperative dissatisfaction.

Weaver syndrome is a rare disorder, characterized by accelerated growth, advanced osseous maturation and distinct craniofacial features. Macroglossia and hypothyroidism are seldom mentioned in the literature as clinical findings... more

Weaver syndrome is a rare disorder, characterized by accelerated growth, advanced osseous maturation and distinct craniofacial features. Macroglossia and hypothyroidism are seldom mentioned in the literature as clinical findings associated with the syndrome. This paper describes a patient with Weaver syndrome, referred for consultation and treatment of macroglossia, who also suffered from congenital hypothyroidism. This is the first reported case of Weaver syndrome treated with partial glossectomy (tongue reduction). The paper describes the clinical findings of the syndrome, emphasizing the difficulty in identifying it, the indications for partial glossectomy and the authors' recommended operative technique.

A 51-year-old woman was referred to us with the chief complaint of swelling and pain in the left preauricular region of 3 months' duration. Computed tomography showed a hypodense ovoid lesion causing erosion of the lateral aspect of... more

A 51-year-old woman was referred to us with the chief complaint of swelling and pain in the left preauricular region of 3 months' duration. Computed tomography showed a hypodense ovoid lesion causing erosion of the lateral aspect of the left condyle (Fig. 1). Fine-needle ...

Purpose: Differential diagnosis of osteoradionecrosis and bisphosphonate-related osteonecrosis of the jaw is primarily based on medical history, rather than pathogenesis or histopathology. This report aims to redress this shortcoming by... more

Purpose: Differential diagnosis of osteoradionecrosis and bisphosphonate-related osteonecrosis of the jaw is primarily based on medical history, rather than pathogenesis or histopathology. This report aims to redress this shortcoming by demonstrating the advantages of tetracycline bone fluorescence as an aid to characterize osteonecrosis entities according to differential histopathologies. Furthermore, this technique facilitates the means to determine extent of necrosis and to optimize surgical therapy. Patients and Methods: Two patients with extended osteonecrosis of the lower jaw (osteoradionecrosis or bisphosphonate-related osteonecrosis of the jaw) were treated with partial mandibulectomy. After preoperative administration of doxycycline for 10 days, bone fluorescence was monitored intraoperatively to determine the resection boundaries. Results: Fluorescence analysis correlated well with the specific histopathologic features of the 2 osteonecrosis entities. Bone fluorescence was predominantly observed in the cortical bone and cancellous bone regions in osteoradionecrosis and bisphosphonate-related osteonecrosis of the jaw, respectively. Margins of the osteonecrosis (and the resection) could be determined under fluorescence guidance; however, bone bleeding did not correlate with bone fluorescence in both osteonecrosis entities. Conclusions: Given that viable but not necrotic bone displays tetracycline fluorescence, a notion that reflects the histopathology, more precise characterization of the 2 osteonecrosis types is enabled. Furthermore, even in extended cases of osteonecrosis requiring partial mandibulectomy, bone fluorescence helps to pinpoint the margins of resection and thus signifies an improvement of surgical therapy of extended osteonecrosis.

In a 4-year period, 40 compact aluminum oxide ceramic implants fixed with titanium plates and screws were used: 24 for the correction of mandibular defects, 9 for temporomandibular joint replacement, and 7 for augmentation of facial... more

In a 4-year period, 40 compact aluminum oxide ceramic implants fixed with titanium plates and screws were used: 24 for the correction of mandibular defects, 9 for temporomandibular joint replacement, and 7 for augmentation of facial contour. During the 1 to 4 years following the operations, it was not necessary to remove any aluminum oxide joint or implant used for contour correction. In 5 of the 24 cases of mandibular reconstruction, however, it was necessary to remove the ceramic. In 3 cases, this was due to recurrence of the tumor, and in 2 cases the cause was dermal necrosis.

Purpose: The purpose of this article is to report our experience in the management of 18 patients with melanotic neuroectodermal tumor of infancy involving the maxillary alveolus. Patients and Methods: All patients presented with hard... more

Purpose: The purpose of this article is to report our experience in the management of 18 patients with melanotic neuroectodermal tumor of infancy involving the maxillary alveolus. Patients and Methods: All patients presented with hard nontender swelling involving the upper alveolus with facial deformity. Analysis included hematocrit, coagulation profile, serum creatinine, and screening for vanillyl mandelic acid and catecholamines. Imaging studies included x-ray of the maxilla and chest, ultrasound of the abdomen, computed tomography scan (1990 to 1999), and magnetic resonance imaging (after 1999). All surgeries were performed using endotracheal anesthesia, and complete gross excision of the tumor was achieved with coverage of the defect with mucoperiosteal flaps. All specimens were subjected to histopathology and immunohistochemistry. Results: The expansion of the alveolus produced by the tumor improved in 4 to 6 months. Subsequent dentition was affected by the removal of involved tooth buds during the operation. All the patients are in regular follow-up (maximum 206 months) and there has been no local recurrence or distant metastasis. Mean follow-up time was 130.8 months (95% confidence interval, 168.8-210.6). Overall survival at 17 years was 85.6%. Median survival could not be established due to statistically insignificant sample size, while mean survival time was 189.7 months (95% confidence interval, 103.7-157.8). Conclusions: In the absence of metastatic disease, melanotic neuroectodermal tumors of infancy can be successfully managed by local excision.

Purpose: Despite adequate treatment, enophthalmos due to intraconjunctival corticosteroid injection and enlargement of the bony orbit after trauma remains a frequent complication. The use of alloplastic material in addressing this problem... more

Purpose: Despite adequate treatment, enophthalmos due to intraconjunctival corticosteroid injection and enlargement of the bony orbit after trauma remains a frequent complication. The use of alloplastic material in addressing this problem is restricted because it may result in allergic reactions and is not cost-effective. The use of retro-orbital intraconal injection is the most effective method for maximum augmentation. An inexpensive and minimally invasive alternative that also allows for reoperation when needed would be a preferred intervention. Materials and Methods: We used 24 white rabbits (New Zealand) in our study. The animals were divided into 2 groups: a fat group and a saline solution group. The first group was subjected to retrobulbar fat injection, and the second group underwent physiologic saline solution injection. The volume of the retrobulbar area was measured and statistically evaluated both before and after the injections. Sonographically measured retrobulbar volumes were then statistically analyzed. Results: When the saline solution and fat groups were compared, no significant difference was observed between the preinjection volumes of the orbits. However, after injection, there was a significant difference between volumes. A statistically significant difference was shown between retroorbital volumes calculated before the injection in the fat group and volumes calculated immediately after injection and in the following 4 months (right retro-orbital volume of 1.291 cm 3 Ϯ 0.031 cm 3 before injection and 2.656 cm 3 Ϯ 0.040 cm 3 in the fourth month, P Ͻ .05). Conclusions: Volume augmentation by fat injection is superior to complicated surgical methods because of the advantages of decreased morbidity, rapid rehabilitation, and ease of reinjection. Using fat tissue as a filling material is more reliable, easier, and cheaper in comparison to other implantable materials.

Purpose: Temporomandibular joint dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. The purpose of this... more

Purpose: Temporomandibular joint dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. The purpose of this study was to compare 2 types of treatment for chronic mandibular dislocations, eminectomy and miniplates, evaluate the results of these surgeries, and make a critical review of the literature. Patients and Methods: The sample was obtained from the records of Oswaldo Cruz Hospital (Recife, Brazil) and comprised cases submitted to chronic mandibular dislocation treatment by eminectomy and by use of miniplates between 2000 and 2006. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of dislocations, recurrence rate, and presence of facial nerve paralysis. Results: After eminectomy, the mean maximal mouth opening was 48.4 Ϯ 8.5 mm preoperatively and 41.3 Ϯ 5.0 mm postoperatively. After the use of miniplates, it was 42.75 Ϯ 11.53 and 45.62 Ϯ 8.52 mm, respectively. There was no facial nerve paralysis after either treatment. Recurrence occurred with miniplates (11.11%) but not with eminectomy. Conclusion: Eminectomy had less chance of recurrence without creating articular damage, and with miniplates, the chance of recurrence increased because there is always the possibility of the miniplate fracturing.

Melnick-Needles Syndrome (MNS) is a congenital syndrome associated with severe architectural disorder of the skeletal system that can cause significant effects on the craniofacial skeleton including poor aesthetics, impaired speech and... more

Melnick-Needles Syndrome (MNS) is a congenital syndrome associated with severe architectural disorder of the skeletal system that can cause significant effects on the craniofacial skeleton including poor aesthetics, impaired speech and masticatory problems. The authors report a case of a female patient who experienced masticatory constraint, hindered speech and functional problems related to a severe bite dysfunction due to the mandibular hypoplasia and the underlying bony architectural disorder associated with MNS. The patient underwent bilateral sagittal split osteotomy (BSSO) to correct her skeletal malocclusion and improve the characteristic aesthetics and speech. The inherent bony abnormalities with their altered collagen structure presented unique challenges to orthognathic surgery in this patient with an unpredictable bone healing process. In MNS patients a fragile trabecular bone structure and an increased bleeding tendency is thought to delay or forestall wound healing. The patient was treated successfully with BSSO and monocortical plate fixation following a well-established algorithm from orthodontic preparation to surgical protocol. A very satisfying outcome has been achieved, concerning functional rehabilitation and aesthetic improvement. A review of the literature revealed that little is known about bone regeneration and fracture healing in cases with MNS.

Myospherulosis is a unique, inflammatory, granulomatous lesion, which results from the action of lipid substances on extravasated erythrocytes. Petrolatum-based antibiotic ointments are the most frequent etiologic agents of iatrogenically... more

Myospherulosis is a unique, inflammatory, granulomatous lesion, which results from the action of lipid substances on extravasated erythrocytes. Petrolatum-based antibiotic ointments are the most frequent etiologic agents of iatrogenically acquired lesions. Six intraoral cases of myospherulosis are presented, including the first reported case in oral soft tissues. The literature of reported cases is summarized and the epidemiology, histopathology, and ultrastructure of the lesions are discussed. Predisposing events and recommendations for future use of petrolatum-based antibiotic ointments are presented.

This study tested hyperbaric oxygen (HBO) as an adjunct to surgery and antibiotics in the treatment of bisphosphonate-related osteonecrosis of the jaw (ONJ) and evaluated its effects on gingival healing, pain, and quality of life. The... more

This study tested hyperbaric oxygen (HBO) as an adjunct to surgery and antibiotics in the treatment of bisphosphonate-related osteonecrosis of the jaw (ONJ) and evaluated its effects on gingival healing, pain, and quality of life. The investigators implemented a randomized controlled trial and enrolled a sample composed of patients with ONJ, where the predictor variable was HBO administered at 2 atm twice a day for 40 treatments as an adjunct to conventional therapy of surgery and antibiotics versus conventional therapy alone. Over the next 24 months, oral lesion size and number, pain, and quality of life were assessed. Forty-six patients (mean age, 66 yrs; 57% women) contributed data to the trial. There were no statistically significant differences in the distribution of variables used to assess randomization success between the HBO and standard treatment groups. Seventeen of 25 HBO-treated patients (68%) improved versus 8 of 21 controls (38.1%; P = .043, χ(2) test). Mean time to improvement was 39.7 weeks (95% confidence interval [CI], 22.4 to 57.0 weeks) for HBO-treated patients versus 67.9 weeks (95 CI, 48.4 to 87.5 weeks) for controls (P = .03, log-rank test). However, complete gingival healing occurred in only 14 of 25 HBO-treated patients (52%) versus 7 of 21 controls (33.3%; P = .203, χ(2) test), and time to healing was 59 weeks (95% CI, 42.8% to 75.8%) for HBO-treated patients versus 70 weeks (95 CI, 52.2% to 88.36%) for controls (P = .32, log-rank test). Pain decreased faster for HBO-treated subjects (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01, linear regression). Quality-of-life scores for physical health (P = .002) and perceived health (P = .043) decreased at 6 months for control group but for not the HBO group. ONJ is multifactorial and no single treatment modality is likely to reverse it; however, it is treatable and even advanced presentations can improve with intensive multimodal therapy. Clinically, HBO appears to be a useful adjunct to ONJ treatment, particularly for more severe cases, although this study was underpowered to fully support this claim.

Oral and Maxillofacial Surgeons have increasing opportunities to train in head and neck oncologic and reconstructive surgery. The development of a fellowship training programs within our speciality has had a transformative effect on the... more

Oral and Maxillofacial Surgeons have increasing opportunities to train in head and neck oncologic and reconstructive surgery. The development of a fellowship training programs within our speciality has had a transformative effect on the speciality. This survey by the commitee on Maxillofacial Oncology and Reconstructive is aimed to evaluate the impact of fellowship training on the careers of the fellows and speciality from 2005-2015.

Purpose: The aim of this study is to present a clinical series of patients with trigeminal neuropathy and their treatment. Patients and Methods: We present a retrospective study of 15 cases of idiopathic trigeminal neuropathies, with... more

Purpose: The aim of this study is to present a clinical series of patients with trigeminal neuropathy and their treatment. Patients and Methods: We present a retrospective study of 15 cases of idiopathic trigeminal neuropathies, with unilateral involvement of 1 or more divisions of the trigeminal nerve. The clinical, radiologic, and laboratory data of the patients, in addition to the treatment and clinical evolution, were reviewed. The patients were followed up for a mean of 34.4 months (range, 12-120 months). Results: The study consisted of 11 women and 4 men. The numbness was predominantly located in the innervated mental area and extended in some cases to the first and second trigeminal divisions. Seven patients had slight continuous discomfort in association with the numbness, one of whom had added bouts of typical neurogenic pain. Of the 15 cases, 8 (53%) had acute idiopathic trigeminal neuropathies and fully recovered within 3 months and 7 (47%) were chronic cases, without full recovery after 3 months. Mild pain was felt by 57% of the chronic patients and 37% of the acute patients; treatment with amitriptyline achieved complete or partial improvement in over half of these patients. Conclusion: Of the idiopathic trigeminal neuropathies, half were acute and half were chronic. Mild pain presented more frequently in the chronic patients and was relieved with amitriptyline.

Purpose: To evaluate the perceptions and motivation of young full-time academic oral and maxillofacial surgeons who chose a career in academia and their experiences as faculty members. Materials and Methods: An 11-item questionnaire was... more

Purpose: To evaluate the perceptions and motivation of young full-time academic oral and maxillofacial surgeons who chose a career in academia and their experiences as faculty members. Materials and Methods: An 11-item questionnaire was sent to the chairman of all nonmilitary American Dental Association-accredited oral and maxillofacial surgery training programs (total of 90 training programs), requesting that this questionnaire be completed by all full-time faculty who completed surgical residency between 1997 and 2003. Results: Forty-eight completed surveys were included in this study.

Purpose: Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) is an emerging problem with few therapeutic options. Our pilot study of BP-ONJ investigated a possible role for hyperbaric oxygen (HBO 2 ) therapy. Patients and... more

Purpose: Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) is an emerging problem with few therapeutic options. Our pilot study of BP-ONJ investigated a possible role for hyperbaric oxygen (HBO 2 ) therapy. Patients and Methods: A total of 16 patients, ranging in age from 43 to 78 years, with BP-ONJ were treated with adjunctive HBO 2 between July 2003 and April 2006. Staging was based on the size and number of oral lesions. Clinical response after treatment and at distant follow-up; the odds of remission, stabilization, or relapse; and time to failure analysis were calculated. Results: The median time on BP therapy before appearance of ONJ symptoms was 18 months, and that from symptom onset to HBO 2 therapy was 12 months. Fourteen of 16 patients (87.5%) improved in stage. The size and number of ONJ lesions were decreased after HBO 2 therapy (P Ͻ .001 and P ϭ .008, respectively; Wilcoxon signed-rank test). Immediately after HBO 2 therapy, 7 of 16 patients (44%) were in remission and 8 (50%) had stabilized; however, stabilization without remission was sustained in only 2 patients. At follow-up, 10 of the patients (62.5%) were still in remission or had stabilized. The 7 patients who continued on BP treatment during HBO 2 therapy had a shorter time to failure (8.5 months; 95% confidence interval [CI] ϭ 7.1 to 9.8) than those who discontinued the drug (20.1 months; 95% CI ϭ 17.5 to 23.9; P ϭ .006 by the log-rank test). Clinical response was not associated with cancer type or malignancy remission status. Conclusions: Adjunctive HBO 2 therapy may benefit patients with BP-ONJ; however, the outcome is improved with cessation of BP administration.

To evaluate treatment outcomes following oral and maxillofacial surgery, pre-and post-treatment three-dimensional (3D) photographs of the patient's face can assessed, but this procedure is accurate only if the face is captured with the... more

To evaluate treatment outcomes following oral and maxillofacial surgery, pre-and post-treatment three-dimensional (3D) photographs of the patient's face can assessed, but this procedure is accurate only if the face is captured with the same facial expression every time. The purpose of this prospective study was to determine variations in the face at rest; 100 3D photographs of the same individual were acquired at different times. Initially, 50 3D photographs were obtained; 25 using a wax bite to ensure similar occlusion between subsequent photographs and 25 without wax bite. This procedure was repeated 6 weeks later. Variation of the face at rest was computed. The influence of time and wax bite was investigated. Different anatomical regions were investigated separately. A mean variation of 0.25 mm (0.21-0.27 mm) was found (standard deviation 0.157 mm). No large differences were found between different time points or use of wax bite. Regarding separate anatomical regions, there were small variations in the nose and forehead regions; the largest variations were found in the mouth and eyes. This study showed small overall variation within the face at rest. In conclusion, different 3D photographs can be reproduced accurately and used in a clinical setting for treatment follow-up and evaluation.

This study is an anatomical study designed to benefit surgeons working in the region of the maxillary sinus. This paper investigates ethnic and gender variations in the shape of the maxillary sinus in dried crania from the Raymond Dart... more

This study is an anatomical study designed to benefit surgeons working in the region of the maxillary sinus. This paper investigates ethnic and gender variations in the shape of the maxillary sinus in dried crania from the Raymond Dart collection of human skeletons. The paper claims that an estimate of the area of the medial antral wall of the maxillary sinus is one of the best ethnic/gender group predictors. Helical, multislice computed tomography was performed using 1mm coronal slices length, depth, width and volume measurements for each sinus were taken. Classification by shape and estimated area of medial wall was attempted. Shape classification was found to be unsuccessful whilst medial wall classification into ethnic/gender groupings gave encouraging results. The area of the medial wall is related to ethnic/gender groups.

Purpose: To assess quality of life (QOL) and psychiatric morbidity in successfully treated oral cavity squamous cell cancer (OC-SCC) survivors and their wives. Patients and Methods: Thirty-one men successfully treated for OC-SCC (mean,... more

Purpose: To assess quality of life (QOL) and psychiatric morbidity in successfully treated oral cavity squamous cell cancer (OC-SCC) survivors and their wives. Patients and Methods: Thirty-one men successfully treated for OC-SCC (mean, 3.7 years since diagnosis; UICC stages I to IV) together with their wives were assessed by questionnaires referring to QOL (WHOQOL-BREF), physical complaints (EORTC QOL-H&N35), and symptoms of anxiety and depression (HADS). Prevalence of psychiatric disorders was assessed by the Mini International Neuropsychiatric Interview (M.I.N.I.). Results: Irrespective of tumor stage, a considerably high global QOL both in OC-SCC survivors and their wives could be detected when compared with an age-matched cancer-free population. No significant difference between the mean scores of 4 domains of the QOL (exception: environmental domain) was found between patients and their wives. In patients, lower QOL was associated with more physical complaints (social eating, swallowing, and pain) and higher levels of psychological distress (HADS); whereas in wives, QOL was found to be related to levels of psychological distress. In the M.I.N.I., a high prevalence of psychiatric disorders, particularly anxiety disorders, was found in wives (38.7%); but was lower in patients (16.2%). Patients and wives diagnosed with a psychiatric disorder reported significantly lower QOL. Conclusion: Both in OC-SCC patients and their wives a considerably high overall QOL can be found. "Social eating," "swallowing," and "sexuality" in patients and psychiatric disorders in wives seem to be strongly related to global QOL. The high prevalence of anxiety disorders in wives, however, should alert clinicians and the health care community. Thus, surgical improvement of somatic problems and treatment of psychiatric disorders should be addressed in individuals reporting an impaired global QOL.

Please cite this article in press as: Pansani TN, et al. Effects of low-level laser therapy on the proliferation and apoptosis of gingival fibroblasts treated with zoledronic acid, Int J Oral Maxillofac Surg (2014), http://dx.Abstract.... more

Please cite this article in press as: Pansani TN, et al. Effects of low-level laser therapy on the proliferation and apoptosis of gingival fibroblasts treated with zoledronic acid, Int J Oral Maxillofac Surg (2014), http://dx.Abstract. Low-level laser therapy (LLLT) has been indicated as an adjuvant therapy for bisphosphonate-induced osteonecrosis. However, the effects of LLLT on bisphosphonate-treated cells are not yet clear. This study evaluated the effects of LLLT on the proliferation and apoptosis of gingival fibroblasts treated with zoledronic acid (ZA). Cells were exposed to ZA at 5 mM for 48 h. Irradiation was performed using a laser diode prototype (LaserTABLE, InGaAsP; 780 nm AE 3 nm, 25 mW) at 0.5 or 3 J/cm 2 , three times every 24 h. Cell proliferation and apoptosis were evaluated by fluorescence microscopy. Data were analyzed by Mann-Whitney test at the 5% level of significance. ZA decreased cell proliferation to 47.62% (interquartile range (IQR) 23.80-57.14%; P = 0.007) and increased apoptosis of gingival fibroblasts to 27.7% (IQR 20.9-33.4%; P = 0.0001). LLLT increased cell proliferation compared with non-irradiated cells, at 0.5 J/cm 2 (57.14%, IQR 57.14-71.43%; P = 0.003) and at 3 J/cm 2 (76.19%,; P = 0.0001), but did not increase cell proliferation in ZA-treated cells. Irradiated fibroblasts presented lower apoptosis rates than the ZA-treated cells, but apoptosis was no different in ZA-treated cells compared to those that were ZA-treated and also irradiated.

Šedý: Piezosurgery prevents brain tissue damage: an experimental study on a new rat model. Int.

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Your article is protected by copyright and all rights are held exclusively by Association of Oral and Maxillofacial Surgeons of India. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".

The aim of this study was to compare upper lip movement and its dimensional changes after maxillary advancement via Le Fort I osteotomy, using V-Y advancement versus simple continuous closure. The study investigates dimensional changes in... more

The aim of this study was to compare upper lip movement and its dimensional changes after maxillary advancement via Le Fort I osteotomy, using V-Y advancement versus simple continuous closure. The study investigates dimensional changes in the superior and inferior portions of the upper lip, as well as changes in lip length, resulting from the procedure. The study group consisted of 35 patients who had undergone 1-piece Le Fort I osteotomy for maxillary advancement of 3 to 6 mm with less than 3 mm of vertical changes. Fixation was performed by rigid monocortical plating. Closure of soft tissue was achieved using V-Y advancement in 17 patients and simple continuous suturing in 18 patients. Lateral cephalometric radiographs were taken and measured preoperatively and then 6 months after surgery. The magnitude of upper lip movement was 88.89% of the maxillary advancement in the simple continuous suturing group and 90.77% in the V-Y advancement group. The superior portion of the upper lip thickened by 2.08 mm and 2.35 mm in the 2 groups, respectively. The inferior portion of the upper lip thickened by -1.94 mm and -1.14 mm, respectively. The upper lip shortened by 0.79 mm in the simple continuous suturing group and lengthened by 1.10 mm in the V-Y advancement group. Upper lip movement and dimensional changes differ when simple continuous suturing and V-Y advancement closure are used.

O processo de construção de protótipos biomédicos surgiu da união das tecnologias de prototipagem rápida e do diagnóstico por imagens. No entanto, este processo é complexo, em função da necessária interação entre as ciências biomédicas e... more

O processo de construção de protótipos biomédicos surgiu da união das tecnologias de prototipagem rápida e do diagnóstico por imagens. No entanto, este processo é complexo, em função da necessária interação entre as ciências biomédicas e a engenharia. Para que bons resultados sejam obtidos, especial atenção deve ser dispensada à aquisição das imagens por tomografia computadorizada e à manipulação dessas imagens em softwares específicos. Este artigo apresenta a experiência multidisciplinar de um grupo de pesquisadores com a aquisição e a manipulação de imagens por tomografia computadorizada do complexo maxilofacial, visando à construção de protótipos biomédicos com finalidade cirúrgica.