Journal of Cranio-Maxillo-Facial Surgery - Articles in Press

Unilateral non-occlusion secondary to a ganglionic cyst of the temporomandibular joint (TMJ) - Corrected Proof

Manfred A.A. Suhr, Alberto Mager — 2012-05-11

Abstract: Ganglionic and synovial cysts of articular joints are the most common benign soft tissue tumours in the hand and the wrist. Although used synonymously, the histology and pathogenesis are different. In the temporomandibular joint (TMJ), ganglionic and synovial cysts are very rare. We describe a case and present a review of the literature.

Posterior calvarial distraction in craniosynostosis – An evolving technique - Corrected Proof

2012-05-07

Abstract: Background: Posterior advancement of the occiput is an established surgical option for the treatment of raised intracranial pressure (ICP) secondary to craniocerebral disproportion in syndromic craniosynostoses. Distraction osteogenesis has gained popularity in a variety of craniofacial procedures to achieve greater advancement in the anterior craniofacial skeleton, but has only relatively recently been used in the posterior calvarium. We report the Oxford Craniofacial Unit’s experience of using distraction techniques to expand the occiput.Methods: We preformed a retrospective casenote review of all patients with syndromic craniosynostoses who underwent posterior distraction at our centre from 2007 to 2010, as identified by the Oxford Craniofacial Database.Results: Ten syndromic patients underwent posterior distraction (mean age of 18.1months). Successful calvarial expansion (mean advancement of 19.7mm) was achieved in all patients clinically and radiologically. There were 6 minor and 1 major complications.Conclusions: Posterior distraction was successfully performed in 10 patients including babies as young as 3months of age. It achieved a reduction in turricephaly, an improvement in the cephalic index, and a resolution of raised ICP. We have customised our surgical technique to address individual patient needs. The use of distraction techniques in the occiput appears to increase the reliability of expansion in this region.

Medical online consultation service regarding maxillofacial surgery - Corrected Proof

2012-05-03

Abstract: Objective: The University Hospital of Zurich provides a medical online consultation service since 1999. Our aim was to characterise the users of an online consultation with queries regarding maxillofacial surgery, to analyse the content of their questions and to study the actions by the internet doctors with the ambition of defining whether the telemedical consultation is a useful tool in this surgical field.Materials and methods: The procedure of inductive category development described by MAYRING was used. A professional text analysis program MAXQDA supported the process of analysis. 204 questions were evaluated.Results: Men sent 37% of the questions, 48% originated by women, mean age was 38years. Often they asked for information about medical therapies or pharmaceuticals (n=74) and about specific disease or an injury (n=26). The three most common maxillofacial surgery topics were sinusitis (n=21), aphthae in the mouth (n=17) and basal cell carcinoma (n=14).Conclusions: Online consultation is not only understood as a first contact with the healthcare system but also as a centre to get professional further and detailed information and advice after a doctor visit, especially about chronic diseases and infections. Online consultation can complement the traditional healthcare and conventional physician–patient relationship in maxillofacial surgery.

CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery - Corrected Proof

2012-05-01

Abstract: A surgical guide is projected to aid the repositioning of the mandibular segments in their original locations, and a reconstruction bone plate is provided to support the fibula free flap. Computer-aided mandibular reconstruction involves three steps: virtual surgical planning, CAD/CAM and rapid-prototyping procedures for the design and manufacture of the customised surgical device and surgery. The duration of the reconstructive phase (<1.5 h intraoperative time) was reduced in comparison with traditional secondary mandibular reconstruction. The bone plate permitted the maximal restoration of the original facial and mandibular contours and the more precise positioning of the residual mandibular ramus in comparison with conventional procedures. No complication was noted during the mean follow-up period of 12 months. The protocol presented in this paper offers some benefits: 1) The virtual environment permitted ideal preoperative planning of mandibular segment repositioning in secondary reconstruction; 2) Intraoperative time was not consumed by approximate and repeated bone plate modelling; 3) Using CT data obtained before primary surgery, the reconstruction bone plate was designed using the original external cortical bone as a template to reproduce the ideal mandibular contour; 4) Prototyped resin models of the bone defect allowed the surgeon to train preoperatively by simulating the surgery.

Function of blood monocytes among patients with orofacial infections - Corrected Proof

2012-04-30

Abstract: Few data are available on the significance of the integrity of the innate immune system among patients with orofacial infections. This was assessed in the present study. Peripheral blood mononuclear cells (PBMCs) were isolated from 23 patients with orofacial infections before surgical debridement and from 12 healthy volunteers. PBMCs were stimulated with bacterial endotoxin (LPS) and with Pam3Cys. Concentrations of interleukin (IL)-1β, IL-6 and tumor necrosis factor-alpha (TNFα) were estimated in supernatants by an enzyme immunoassay. Concentrations of estimated cytokines released from PBMCs of healthy volunteers and of patients did not differ. Intensity of cytokine release after stimulation was related with the time until complete resolution of the infection (p: 0.046). It is concluded that adequate functions of blood monocytes are associated with favorable outcome after surgery for orofacial abscesses. It seems, however, that impairment of monocyte function predisposes to infection persistence.

Prevention points for plate exposure in the mandibular reconstruction - Corrected Proof

2012-04-23

Abstract: Introduction: The rate of complications for mandibular reconstruction after segmental mandibulectomy is higher with reconstruction plates than with vascularised bone grafts. We have experience of over 100 patients using reconstructive plates for reconstruction immediately after segmental mandibulectomy and have considered factors contributing to plate exposure.Patients and methods: Seventeen cases utilised our prevention methods in which reconstructive plates were used for mandibular reconstruction were reviewed. The flaps used with reconstruction plates were rectus abdominis myocutanenous flaps in 10 cases, anterolateral thigh flaps combined vastus lateralis muscle in four cases, and the omentum in one case; no flap was transferred in two cases.Results: In only one of 17 cases was a plate exposed at 3months postoperatively. No plate exposure occurred during the follow-up period in the other 16 cases. Because no flap had been transferred in the patient with plate exposure, a possible contributing factor was the persistence of dead space beneath the plate.Conclusion: This series suggests that factors other than flap selection contribute to the exposure of reconstructive plates. Use of a reconstruction plate is a useful reconstructive method, especially for patients who cannot tolerate transfer of a vascularised bone graft.

Re: Pontes HA, Pontes FS, Lameira AG, Salim RA, Carvalho PL, Guimarães DM, Pinto Ddos S Jr.: Report of four cases of ameloblastic fibro-odontoma in mandible and discussion of the literature about the treatment. J Craniomaxillofac Surg 40(2): e59–e63, 2012 Feb. Epub 2011 Apr 15 - Corrected Proof

Peer W. Kämmerer, Susanne Wriedt, Bilal Al-Nawas — 2012-04-23

We thank the authors for the above publication that we read with interest. They conclude on the basis of four case reports, together with the current literature, that smaller ameloblastic fibro-odontomas (AFO) may be enucleated with preservation of the involved teeth. Because of possible recurrences, it is recommended that more extensive tumours are enucleated together with involved teeth. It is possible that a follow-up of 0–14months may be too short to allow this conclusion (). Recurrences of AFO are extremely rare () and may also occur after extended and ablative surgery (). So it can be argued that preservation of involved teeth should be also considered for larger tumours.

The modular endoprosthesis for mandibular body replacement – Part 1: Mechanical testing of the reconstruction - Corrected Proof

Raymond C.W. Wong, Henk Tideman, Matthias A.W. Merkx, John Jansen, Suk Meng Goh — 2012-04-20

Abstract: Introduction: In this paper we present the results of the mechanical testing of a new generation modular endoprosthesis, which has been designed to improve the results of mandibular reconstruction.Materials and methods: The new cementless endoprosthesis consists of a male part, a female part (both with screws on the stems), connected via a dove-tailed connection and secured with a coronal screw.The endoprosthesis was fitted into standardized blocks of synthetic bone (Synbone AG, Malans, Switzerland). The set-up was fixed to an ElectroPuls testing machine at one end and loaded at the other end 25mm away. Three specimens were loaded continuously until failure to determine the average load to failure of the construct. Five specimens were then loaded cyclically between 10 and 150N until either failure or 500,000 cycles. A finite element analysis was also performed on the set-up.Results: Of the five specimens in the fatigue testing, only one survived while the other four either were bent or fractured at the stem of the clamped portion. The specimen that survived had very good bony contact with the prosthesis at the lower border. The connection of the modules via the dove-tailed design did not show any loosening. Finite element analysis showed areas of stress concentration at the superior surface of the stems to 188.8MPa. This was well below the yield strength of titanium alloy of 897MPa. Statistical analysis performed for specimens 1 to 4 to calculated lower tolerance bounds on cycles to failure, representing the estimated minimum achievable cycles to failure at 90, 95, and 99% of the population at 90 and 95% confidence levels, showed that the estimated mean cycles to failure was 10,132 cycles at the mean, minimum and maximum loads of 120N and 18.4N respectively.Conclusion: Good bony contact seems to be essential at the lower border for long-term survival of the reconstruction. Small gaps increase the bending forces and thus shear stresses at the stem. The new design of the modular endoprosthesis is prone to stress concentrations at the superior surface of the stems. This is accentuated by the sharp screw threads of the stems. The loosening of the module connection seemed to have been stopped with the dove-tailed design.

The modular endoprosthesis for mandibular body replacement. Part 2: Finite element analysis of endoprosthesis reconstruction of the mandible - Corrected Proof

Raymond C.W. Wong, Henk Tideman, Matthias A.W. Merkx, John Jansen, Suk Ming Goh — 2012-04-19

Abstract: Introduction: Problems with loosening of the modules for the modular endoprosthesis were encountered in animal studies for mandibular body replacement. We performed a finite element analysis to look at the stress distribution and areas of stress concentration in a human sized mandible. Variations were made to the stem and defect length to look at how the forces changed. The hypothesis was: (1) reconstruction with a modular endoprosthesis did not lead to areas of stress concentration beyond the material strength of cortical bone and titanium alloy; (2) changes in dimensions of the endoprosthesis did not cause a corresponding linear increase to the stresses.Materials and methods: The endoprosthesis was modelled to create a male, female part with stems and a connection screw (Case I). The stem length was halved (Case II) and defect length doubled (Case III). Geometric data of a human sized mandible were obtained, a continuity defect created digitally at the right molar area and the models combined. Boundary conditions were set and the model loaded to get a bite force of 300 N at the incisor region. An intact mandible was used as a control.Results: The right side of the reconstructed mandible became less rigid and flexed more. The highest stresses were within the endoprosthesis at two areas of stress concentration: (1) shear stress at the superior surface of the stems close to the junction of the stem and the module body; (2) compressive stresses at the bottom bevel of the dove-tailed connection. The stress distribution for Case I and II did not differ much except for the magnitude which was slightly higher for Case II. There was a tendency for outward bending at the module connection for Case III which potentially might cause loosening of the module connection. Displacements of the mandible were less than 1 mm throughout.Conclusion: The endoprosthesis with its present dimensions would be expected to perform adequately at a bite force of 300 N. An increase in defect length caused a tendency for bending at the stem and the module connection. With a decrease in stem length, there were little differences except a slight increase in magnitude.

Bovine hydroxyapatite (Bio-Oss®) induces osteocalcin, RANK-L and osteoprotegerin expression in sinus lift of rabbits - Corrected Proof

2012-04-18

Abstract: Purpose: The aim of this study was to analyze and compare the expression of osteocalcin, RANK-L, osteoprotegerin, in sinus lift procedures using bovine hydroxyapatite (HA).Material and methods: Twenty four male rabbits underwent bilateral sinus lift procedures were distributed into two groups, according to the sinus filling material: Group 1) autogenous bone graft; and Group 2) bovine HA. All groups were sacrificed after 14 and 30 days, for microscopic and immunohistochemistry analysis.Results: At 14 days after surgery, discrete osteogenesis was observed in the highly vascularized granulation tissue surrounding HA particles, as well as woven bone deposition on the biomaterial surface. Following 30 days, well organized bone trabeculas were seen surrounding the HA granules presenting areas of osteogenic activity. Morphometric findings did not show remarkable differences between groups. Bovine HA induced similar osteocalcin, RANK-L, osteoprotegerin immunoexpressivity when compared to autogenous bone graft group for both periods evaluated in this setting.Conclusion: Taken together, these data are consistent with the notion that HA has a similar biological behavior to autogenous bone graft in sinus lift of rabbits.

Dento-osseous anomalies associated to familial adenomatous polyposis mimicking florid cemento-osseous dysplasia - Corrected Proof

2012-04-18

Abstract: Familial adenomatous polyposis (FAP) is a colorectal cancer syndrome characterized by the development of multiple polyps of the colon and rectum with high risk of malignant transformation. The extraintestinal manifestations such as dento-osseous changes are associated with FAP. This is a case report of a 36-year-old female patient who was referred for dental treatment with the initial diagnosis of florid cemento-osseous dysplasia (FCOD). However, the association of the imaging dento-osseous findings with the medical history confirmed the diagnosis of FAP. The paper illustrates the clinical characteristics and imaging findings associated with FAP, and also discusses misdiagnosis based exclusively on imaging features.

Osteogenic potential of human umbilical cord-derived mesenchymal stromal cells cultured with umbilical cord blood-derived autoserum - Corrected Proof

2012-04-16

Abstract: Objective: Osteogenesis in the bone defect at the site of an alveolar cleft is important to enable patients with cleft lip and palate to acquire dental articulation. The presence of umbilical cord-derived mesenchymal stem cells has been reported. In this study, we used autoserum derived from the umbilical cord blood (UCB) of neonates in an attempt to examine the osteoblastic differentiation potential of umbilical cord-derived mesenchymal stromal cells (UC-MSCs) in nude mice.Materials and methods: UCB, hydroxyapatite, and rhBMP were used as the supply source of autoserum, scaffold, and osteoinductive growth factor, respectively. MSCs, obtained from Wharton's jelly and cultured for 3–4weeks to induce their differentiation into osteoblasts, were implanted subcutaneously into the dorsum of male nude mice for 6weeks before the assessment by real-time reverse transcriptase chain reaction of osteoblast marker expression.Results: UCB-derived autoserum was a viable source for the culture and implantation of UC-MSCs. The osteoblastic differentiation potential of UC-MSCs was demonstrated in nude mice by performing immunohistochemical staining and by the presence of osteoblast marker expression.Conclusions: Our results confirm the osteogenic potential of UC-MSCs and provide basic evidence for the realization of regenerative medicine using autologous tissues.

Segmental stability of resorbable P(L/DL)LA-TMC osteosynthesis versus titanium miniplates in orthognatic surgery - Corrected Proof

Alexander Ballon, Katharina Laudemann, Robert Sader, Constantin Alexander Landes — 2012-04-16

Abstract: After two decades of the use of resorbable miniplates, new polymer compositions for resorbable osteosynthesis are still being developed to make the handling and outcome of operations even more predictable and give higher stability to the repositioned segments. This study investigates a new resorbable osteosynthesis system in orthognathic patients.50 patients were treated with P(L/DL)LA-TMC resorbable osteosynthesis and compared to a group of 50 patients treated with titanium miniplates. Segmental stability and relapse were measured comparing preoperative, postoperative and follow-up lateral cephalograms.Throughout this study, resorbables appeared to be as stable as titanium miniplates except in maxillary elongation and mandibular setback. Here, the titanium miniplates showed significantly higher stability than resorbable plates.P(L/DL)LA-TMC osteosynthesis seem to have less strength against compressive forces after maxillary elongation and they are less resistant to the forces the tongue exerts, pressing against the mandible after setback. It can therefore be concluded that the resorbable osteosynthesis can be used in the same situations as titanium miniplates except in maxillary elongation and mandibular setback.

Three dimensional comparative measurement of polyurethane milled skull models based on CT and MRI data sets - Corrected Proof

2012-04-16

Abstract: Objective: Due to the increase in the number and complexity of surgical procedures, available to craniomaxillofacial surgeons, allied to the rapid progress of technological developments, the use and production of 3D models has become important, especially for planning complex cases. The radiation exposure of additional CT based examinations is always subject to debate, so the feasibility of producing 3D models for surgical planning based on MRI imaging has been raised.Material and methods: 12 male and 3 female patients (n=15) between 47 and 84years of age (mean age=65) were selected in a prospective study. Both magnetic resonance and computed tomography data sets of the facial bones were collected. Two milled models per patient were prepared: one based on the MRI scan and one based on the CT scan. The milled models were compared in a coordinative surveying procedure within 7 representative distances using a tentative measurement method.Results: Difference values between CT and MRI based models ranged from 0.1mm to 5.9mm. On average MRI based models were smaller by 0.381mm (SD 1.176mm) than those on CT based. The accuracy of models based on MRI data was similar to those based on CT data. MRI based three dimensional milled models provide precise structure accuracy.

The treatment of mandibular condyle fractures: A meta-analysis - Corrected Proof

Panayiotis A. Kyzas, Arfaan Saeed, Oliver Tabbenor — 2012-04-16

Abstract: Background: The treatment for mandibular condyle fractures remains controversial. Conservative management (CM) and open reduction/internal fixation (ORIF) are both used, but the evidence to support superiority of one method over the other has not been assessed.Methods: We performed a meta-analysis of studies comparing CM versus ORIF in patients with condyle fractures. The primary outcome was post-treatment function; we looked at the status of the post-treatment occlusion, mouth opening, protrusion, facial height, pain and the presence of postoperative ankylosis. Furthermore, in studies evaluating ORIF, adverse effects such as facial nerve weakness and scarring, were also recorded.Results: Twenty (20) studies enrolling 1596 patients were eligible. These included four randomized controlled trials (RCTs) and 16 non-randomized case series. Only 1186 of these patients were analyzed by the studies; the reasons for exclusion were rarely clarified. All four RCTs were prospective but the majority (69%) of the remaining studies were retrospective. The inclusion criteria were described in all four RCTs; however, this was not the case in half of the remaining studies (44%). Only four (20%) studies were blinded. Across all included studies, we recorded great variation between treatment protocols, follow-up periods, and outcomes measured. This precluded any quantitative synthesis. In nine studies (45%) the superiority of ORIF over CM reached statistical significance. The incidence of facial nerve weakness following ORIF averaged 6% and it was temporary for the majority of the patients. The identified RCTs were small (160 patients) and suffered from a number of methodological shortcomings. All of them reached statistically significant conclusions favoring ORIF over CM.Conclusion: The current meta-analysis suggests that ORIF for condylar fractures may be as good or better than CM. The morbidity associated with the operation is low. However, the available evidence is of poor quality and not strong enough to change clinical practice.

Changes in temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and without asymmetry - Corrected Proof

2012-04-16

Abstract: The purpose of this study was to examine the changes in the temporomandibular joint (TMJ) and ramus after sagittal split ramus osteotomy (SSRO) with and without Le Fort I osteotomy.The subjects consisted of 87 Japanese patients diagnosed with mandibular prognathism with and without asymmetry. They were divided into 2 groups (42 symmetric patients and 45 asymmetric patients). The TMJ disc tissue was assessed by magnetic resonance imaging (MRI) and the TMJ space, condylar and ramus angle were assessed by computed tomography (CT) preoperatively and postoperatively.Medial joint space on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0043), and coronal ramus angle on the non-deviation side in the asymmetry group was significantly larger than that in the symmetry group preoperatively (P = 0.0240). The horizontal condylar angle on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0302), posterior joint space on the non-deviation side in the symmetry group was significantly larger than that in the asymmetry group postoperatively (P = 0.00391).The postoperative anterior joint space was significantly larger than the preoperative value on both sides in both groups (the deviation side in the symmetry group: P = 0.0016, the non-deviation side in the symmetry group: P < 0.0001, the deviation side in the asymmetry group: P = 0.0040, the non-deviation side in the asymmetry group: P = 0.0024). The preoperative disc position could was not changed in either group.These results suggest that significant expansion of anterior joint space could occur on the deviation side and non-deviation side in the asymmetry group as well as on both sides in the symmetry group, although disc position did not change in either group.

Application of custom-made bioresorbable raw particulate hydroxyapatite/poly-l-lactide mesh tray with particulate cellular bone and marrow and platelet-rich plasma for a mandibular defect: Evaluation of tray fit and bone quality in a dog model - Corrected Proof

Akira Matsuo, Hidetoshi Takahashi, Harutsugi Abukawa, Daichi Chikazu — 2012-04-16

Abstract: The purpose of this study was to evaluate tray fit and bone quality of particulate cancellous bone and marrow (PCBM) mandibular reconstruction using custom-made bioresorbable forged composites of a raw particulate hydroxyapatite/poly-l-lactide (HA/PLLA) tray in a dog model. Mesh sheets of HA/PLLA were formed in a tray shape according to the mandible stereolithographs of 14 beagle dogs. Platelet-rich plasma (PRP) was obtained from venous blood, and PCBM was harvested from the iliac crest. Bone defects were made bilaterally on the lower borders of the mandible. The PCBM and PRP were mixed and compressed into the defects and a custom-made HA/PLLA or a manually adopted titanium tray was fixed by screws. Tray fit and bone qualities were evaluated using computed tomography, microfocus computed tomography and confocal laser scanning microscopy. In buccal side, there is no significant difference with tray fit between the HA/PLLA and the titanium type, but in lingual side, it was better in the HA/PLLA type than that of the Ti type. Bone volume fraction (BV/TV) had markedly increased on the HA/PLLA side at 12 months. In conclusion, the custom-made HA/PLLA tray was easily and accurately adapted to the mandible, and had achieved sufficient bone quality by 12 months.

Mandibular reconstruction in the rabbit using beta-tricalcium phosphate (β-TCP) scaffolding and recombinant bone morphogenetic protein 7 (rhBMP-7) – Histological, radiographic and mechanical evaluations - Corrected Proof

2012-04-16

Abstract: This investigation assesses the histological, radiographic and mechanical properties of regenerated bone in a unilateral critical-size osteoperiosteal mandibular continuity defect in the rabbit model, following the application of beta-tricalcium phosphate (β-TCP) scaffolding and recombinant human bone morphogenetic protein 7 (rhBMP-7). The study was carried out on nine cases; in six cases the critical-size defect was filled with rhBMP-7 in the β-TCP scaffolding, and in three cases the β-TCP was used alone. The cases were sacrificed 3 months post-operatively. Histologically the overall mean of the percentage of regenerated bone volume in the cases that received rhBMP-7 was 29.41% ± 6.25%, which was considerably greater than the 6.35% ± 3.08% in the cases treated with β-TCP alone. Mechanical testing of the cases treated with rhBMP-7 gave failure moments (55 mNm–2.040 Nm) that were consistently greater than those treated with β-TCP alone (0 mNm–48 mNm). In some cases the mechanical properties of the regenerated bone were comparable to those of untreated bone. RhBMP-7 in prefabricated β-TCP scaffolding appeared, radiographically and histologically, to be an effective method for bone regeneration in mandibular critical-size defects in the rabbit model. This points towards possible future clinical applications.

Pulmonary metastases from an Ameloblastoma: Case report and review of the literature - Corrected Proof

Dong-yuan Luo, Chong-jin Feng, Jun-bing Guo — 2012-04-16

Abstract: Ameloblastomas have a high recurrence rate, and because of their biological tendency towards local invasion are considered borderline tumours. Despite this, reports of metastasis of these tumours are rare. This report presents a patient with mandibular ameloblastoma that recurred 29 years after surgery and metastasized to both lungs. Because of the large range of the area of metastasis, complete surgical resection of the tumours was impossible. After confirming the diagnosis by biopsy of the pulmonary lesions the pulmonary metastases were not treated actively. Observation over 4 years showed no obvious change in the lung metastasis. Recent cases are summarized and analyzed in this paper, with respect to its occurrence, pathological types, methods of treatment and other related aspects.

Surgical induction of TMJ bony ankylosis in growing sheep and the role of injury severity of the glenoid fossa on the development of bony ankylosis - Corrected Proof

Ying-Bin Yan, Yi Zhang, Ye-Hua Gan, Jin-Gang An, Jiang-Ming Li, E. Xiao — 2012-04-16

Abstract: Objective: The purpose of this paper is to summarize our experiences in creating an animal model of TMJ bony ankylosis based on 2 sequential experiments.Methods: Two sequential experiments were performed with the aim of creating a model of TMJ bony ankylosis. Seven growing sheep were used in the first experiment, in which 1 was served as a control animal. Condylar fracture with disc preservation was performed on the control side. On the contralateral side, condylar fracture, excision of the lateral 2/3 disc and injury to the glenoid fossa were performed to induce bony ankylosis. Three animals were sacrificed respectively at 3 and 6months after surgery. In the second experiment, 7 growing sheep were used. The only difference of modeling between the 2 experiments was that more serious injury to the glenoid fossa was made in the ankylosis-induced side in experiment 2. Three, 2, and 2 animals were sacrificed respectively at 1, 3, and 6months postoperatively. The TMJ complexes were examined by computed tomography (CT) and histological evaluation.Results: In experiment 1, only fibrous ankylosis was observed in the ankylosis-induced side both at 3 and 6months postoperatively. In experiment 2, CT and histological evaluation showed that the outcomes of the ankylosis-induced side were fibrous-bony ankylosis, fibrous-bony ankylosis, and bony ankylosis respectively at 1, 3, and 6months after surgery.Conclusion: Through summarizing the differences of the modeling and the different outcomes in the 2 experiments, we concluded that severe damage to the glenoid fossa played an important role in the development of TMJ bony ankylosis.

Innovation in anterior mandibular alveolar distraction osteogenesis: Introduction of a new bone-borne distraction device and first clinical results - Corrected Proof

Joachim Anton Obwegeser, Philipp Metzler, Christine Jacobsen, Wolfgang Zemann — 2012-04-16

Abstract: Segmental distraction osteogenesis of the anterior mandibular alveolar process (frontblock) is a sufficient method to avoid extractions in patients with dental crowding and to decompensate retroalveolism. Up to now dental-borne devices were used, but limitate the indications for front-block distraction.A new bone-borne distraction device for mandibular alveolar front-block movement is introduced in this study. The distractor allows sufficient segmental transport without loading on the teeth. Clinical evaluations of 7 patients have been performed including the feasibility and predictability of the distraction, postoperative pain and patients’ discomfort. The results indicate that this technique is a promising strategy in the correction of dental crowding, correcting the curve of Spee and to decompensate mandibular retroalveolism even in patients with impaired periodontal health and a thin mandibular symphysis.

Timing of palate repair affecting growth in complete unilateral cleft lip and palate - Corrected Proof

2012-04-09

Abstract: Objective: To evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times.Design: This study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student’s t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level.Results: The data showed that UCCLPs who had palatoplasty between 7 and 12years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4years of age, and UCCLPs who had palatoplasty at 4–12years had smaller Y-axis angle than those operated on before 4years of age.Conclusions: The maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4–12years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4years. UCCLPs operated using the von Langenbeck technique at 4–12years had better head-face morphology than those operated on before 4years. There was no difference in facial morphology among UCCLPs with palate repair at 4–12years.

Hereditary characteristic of isolated congenital vomer aplasia - Corrected Proof

2012-04-09

Abstract: Malformation of the inner nose is often found in conjunction with different types of cleft palate or may be seen with severe and complex craniofacial anomalies. Among such malformations, however, isolated vomer aplasia is rarely reported in the literature. This study sets forth our findings that congenital vomeral defect of the nasal septum is an isolated disorder with hereditary characteristics.Between 2001 and 2009, nine cases of isolated congenital vomeral bone defect were detected on endoscopic examination of patients referred to our clinic with nasal and otologic complaints. The files of these patients were reviewed and vomer aplasia was identified as an isolated hereditary condition with concomitant sinonasal symptoms.The defect of the posteroinferior part of the nasal septum was defined as a genetic disease presenting with no significant medical problems. Chromosomal analysis of these patients may help to reveal the relationship of this anomaly with different malformations of the maxillofacial complex.

Treatment of mandibular angle fractures – Linea obliqua plate versus grid plate - Corrected Proof

2012-04-09

Abstract: Objectives: To compare treatment outcomes, handling and long term results between two osseo-fixation systems for mandibular angle fractures – the external oblique ridge (external oblique) plate and the grid plate.Material and methods: Sixty patients with mandibular angle fracture were analyzed regarding their operative treatment: 30 patients were treated with an external oblique plate and compared to 30 patients treated with a grid plate on the vestibular cortex.The follow up period was at least 1year for both groups and the following complications were noted: infection, abnormality in fracture healing, nonunion, pain, hypoaesthesia and dysocclusion.Results: The overall average operation time (from intubation to extubation) was 102.1min (±44.1min). Single sided fractures treated with the grid plate needed in average 81.07min (±37.9min) of operation time while single sided fractures treated with the external oblique plate needed 89.3min (±42.2min). In multiple mandibular fractures, no significant change in the operation time between either plating system was found (118.8±35.2min).After the follow up period fracture healing was considered clinically complete in all patients, but complications occurred significantly more often in the external oblique group (13.3%; N=8) than in the grid plate group (0%; N=0).Conclusion: Isolated mandibular angle fractures can be more effectively treated using grid plates than using other osteosynthesis techniques. It is an easy to use alternative to conventional miniplate systems with good clinical outcome and fewer complications. An angulated burr and screwdriver has to be used to put on the plate laterally.

Epidermal choristoma arising on the midline gingiva as a congenital epulis: A case report - Corrected Proof

2012-04-09

Abstract: We report an extremely rare case of epidermal choristoma in the midline of the maxillary gingiva. A 2-month-old Japanese boy presented with a polypoid mass in the midline of the maxillary gingiva. The initial clinical diagnosis was congenital epulis. Microscopic examination revealed a granular cell layer and melanin pigmentation within the basal cell layer. Furthermore, sebaceous glands and hair follicles were observed within the connective tissue. The histological diagnosis was therefore epidermal choristoma, based on clinical microscopic observations.

Management of mandibular interforaminal fractures using 3 dimensional locking and standard titanium miniplates – A comparative preliminary report of 10 cases - Corrected Proof

Manoj Kumar Jain, K. Sankar, C. Ramesh, Ramakrishna Bhatta — 2012-04-09

Abstract: Purpose: The aim of this follow up clinical study was to compare and evaluate the effectiveness of 2mm 4 holed 3-dimensional (3D) locking titanium miniplates over standard miniplate fixation using Champy’s technique in the management of interforaminal mandibular fractures.Patients and methods: A prospective randomized double blind clinical trial was carried out in patients with well defined inclusion and exclusion criteria. Patients were followed for a period of 2 months at the intervals of 1 week, 2 weeks, 4 weeks, 6 weeks and 2 months by a blinded senior oral surgeon for wound dehiscence, infection, postoperative occlusion, significant postoperative complications, need for post-operative inter maxillary fixation and radiological evaluation of reduction, fixation.Result: 10 patients were enrolled in both the groups in this preliminary report with no case of clinically significant postoperative complications. In comparison, 3D locking plates were economical, easy to adapt, required less operating time, and provided better stability. However, 2 patients in group 1 (3D locking plates) with severely displaced unfavourable fractures required 6 holed plates or more for adequate stability.Conclusion: Because of its added advantages and encouraging results in comparison to standard miniplate, we suggest use of 3D 4 holed locking 2mm titanium miniplate for the management of isolated moderately displaced mandibular fractures in inter mental foramen region.

Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible - Corrected Proof

2012-04-06

Abstract: Objective: The purpose of this clinical study was to explore the optimal method of reconstruct mandible defects individually and immediately.Study design: Three-dimensional model simulation technique and vascularized fibular osteomyocutaneous flap were used to repair 15 cases of mandible defects, which were caused by ameloblastoma. A three-dimensional computed tomography (CT) images were converted to a virtual model using CAD software and the 3-dimensional (3D) simulated resin models of skeleton and ﬁbula were used to design the osteotomies, bone segment replacement and titanium mesh shaping preoperatively.Results: Fibula ﬂaps were alive and no complication occurred. The patients were satisﬁed with the results both esthetically and functionally.Conclusions: This preliminarily clinical study and case demonstrated that CAD/CAM-assisted technique with surgical treatment offers an individual anatomical reconstruction of the mandible in ameloblastoma patients. The procedures guarantee intraoperatively an exact placement of the preformed mesh even for precise reconstruction of extensive mandible defects.

Groningen temporomandibular total joint prosthesis: An 8-year longitudinal follow-up on function and pain - Corrected Proof

2012-04-06

Abstract: Total temporomandibular joint replacement is a surgical procedure for patients with severe temporomandibular joint afflictions affecting quality of life, which have not responded beneficially to previous conventional surgery. The aim of this study was to assess the long-term outcome of the Groningen temporomandibular joint (TMJ) prosthesis in patients with chronic pain and mutilated temporomandibular joints following multiple surgical procedures, with respect to prosthesis failure, the patient's postoperative level of satisfaction and longitudinal changes in maximum mouth opening, functional mandibular impairment and pain. Eight female patients were studied in whom Groningen TMJ prostheses were inserted, two unilaterally and six bilaterally.The Groningen TMJ prosthesis was mechanically successful during 8years of follow-up in seven out of eight patients with a disc dislocation being seen in one patient (7%). Patients were satisfied, despite the limited improvement of the maximum mouth opening, and pain scores.Although the decline of MFIQ scores during 8years of follow-up was significant compared to baseline (p=0.027), the effects of the prosthesis on maximum mouth opening, function and pain were limited. This may be due to persistent chronic pain and the adverse effects of multiple previous surgical procedures.

Mixture of hyaluronic acid, chondroitin 6 sulphate and dermatan sulphate used to completely regenerate bone in rat critical size defect model - Corrected Proof

Philippe Zanchetta, Nicole Lagarde, Arnaud Uguen, Pascale Marcorelles — 2012-04-05

Abstract: Skeletal bone losses are mainly filled with autologous graft or artificial materials. Osteoblasts are essential to maintain bone homeostasis and bone repair through a matrix synthesis. We have previously demonstrated that adherence and regenerative matrix composition are fundamental to bone healing, even in critical situations. In this work the critical size defect technique was used to evaluate the systemic activity on bone regeneration of a novel mixture of extracellular polysaccharides. A 5mm diameter hole was made in each parietal bone of male Wistar rats. The right parietal bone hole was filled with a mixture of hyaluronic acid, chondroitin 6 sulphate, and dermatan sulphate mixed with 2.5% NaCl solution, while the left hole was left free of material and untreated and considered as control. Twenty-one days after surgery, the holes and surrounding tissues were examined visually, using X-rays, and by histological staining. Using the matrix substitute, bone healing was almost complete after 21days in the treated hole and always complete in the control side due to some systemic effect. Neovascularization was also observed along with organized trabecular bone on both sides. No abnormal bone growth or connective tissue abnormalities were noted. At the end of the experiment, 95.1% (±3.2) bone healing (n=20) was observed on the treated side; conversely, healing bone and histological structure were better on the control side.

Adults with congenital or acquired facial disfigurement: Impact of appearance on social functioning - Corrected Proof

2012-03-29

Abstract: This study evaluates the impact of congenital and acquired facial disfigurement on social functioning in adults and whether this differs from adults without facial disfigurement. Moreover, the predictive value of objective and subjective appearance on social functioning is explored.Fifty-nine adults with severe congenital facial disfigurement, 59 adults with traumatically acquired facial deformities in adulthood, and 120 adults without facial disfigurement, completed the Scale for Interpersonal Behaviour, Social Avoidance and Distress Scale, and Visual Analogue Scale for facial appearance satisfaction.The impact of congenital and acquired facial disfigurement on social functioning in adults is similar and significantly differed from the reference group. The level of stress evoked by interpersonal behaviour, and social anxiety and distress were not significantly different between the groups. Only the patient’s subjective appearance was a predictor of social functioning.Avoiding stress caused by stigmatization and uncertainty about reactions of others, leads to less frequent interpersonal behaviour in adults with facial disfigurement. The fact whether the deformity is congenital or acquired in adulthood has no influence on social functioning. Patient’s satisfaction with facial appearance is more important than the objective severity of the deformity; in this context realistic expectations of the patient considering additional surgery are important.

The platysma myocutaneous flap (PMF) for head and neck reconstruction: A retrospective and multicentric analysis of 91 T1–T2 patients - Corrected Proof

2012-03-26

Abstract: The platysma myocutaneous flap (PMF) was first applied to intraoral reconstructions in 1978. PMF is not only an alternative to microvascular flaps but it also represents an excellent reconstructive choice especially in cases where free tissue transfer cannot be carried out.Failure and complications rate have been described as varying from 18 to 45% and this is why this flap should not be used in specific cases such as in the presence of cervical metastases and in cases of mandibulectomy and simultaneous reconstruction with alloplastic materials.The purpose of this study is to examine the experience and results obtained in three different and independent institutes where PMF has been adopted in 91 patients for head and neck cancer reconstructions.The authors report their departments’ separate but simultaneous experiences with PMF for small and middle-size soft tissue defects in a 10-year period.

Asynchronous idiopathic bone cavity: A case report - Corrected Proof

2012-03-23

Abstract: Idiopathic bone cavity (IBC) is a non-odontogenic intra-osseous lesion that affects the jaws and others bones. The aetiology of IBC remains unknown. IBC is frequently observed as a single radiolucent area with a corticated, well-defined border, a scalloped shape and a minimal effect on the surrounding structures. A case report of asynchronous IBC in a 17-year-old woman is presented. The first lesion occurred in the mandibular symphysis region, and the second IBC occurred in the right mandibular ramus. Both lesions were surgically treated, and the patient has been disease-free for 5 years.

The reliability of cone-beam computed tomography (CBCT) – Generated frontal cephalograms - Corrected Proof

So-Jin Kim, Soo-Byung Park, Yong-Il Kim, Bong-Hae Cho, Dae-Seok Hwang — 2012-03-23

Abstract: Background: The purpose of this study was to evaluate the reliability of measurements from cone-beam computed tomography (CBCT)-generated frontal cephalogram.Materials and methods: CBCT and conventional posteroanterior (PA) cephalograms were taken from 30 adult patients. CBCT image was set according to the Frankfurt-Horizontal (FH) plane as the horizontal plane and the midsagittal reference (MSR) plane. The CBCT frontal cephalograms were generated using the orthogonal Raycast method (group CTraycast), the orthogonal maximum intensity projection (MIP) method (group CTMIP) after the head reorientation according to the reference planes, and the generator tool provided by the employed 3-dimensional (3D) imaging software (group CTgenerator), respectively. The differences between the CBCT-generated frontal cephalograms and conventional PA cephalograms (group PAceph) were compared by paired t-test (p<0.05).Results: The significant differences were shown in two measurements for group CTraycast, in 12 measurements for group CTMIP, and in eight measurements for group CTgenerator. It was confirmed that the CBCT frontal cephalograms, generated by means of the Raycast method (Group CTraycast), were more comparable to the conventional PA cephalograms in their measurements than were the others (Groups CTMIP, CTgenerator).Conclusion: This study may well suggest that frontal cephalograms derived by 3D CBCT reorientation can be effectively employed in clinical applications.

Comparison of various approaches for the treatment of fractures of the mandibular condylar process - Corrected Proof

2012-03-23

Abstract: Fractures of the mandibular condyle process are the most common fractures of the lower jaw. Unfortunately, the type of treatment is still a matter of debate.Purpose: The aim of this investigation was to compare the outcome of different treatment approaches regarding function and surgical side-effects.Patients and methods: 111 fractures of the mandibular condyle representing all types according to the classification of Spiessl and Schroll were included. Both closed reduction (CR) and open reduction with internal fixation (ORIF) including the retromandibular/transparotid, submandibular, preauricular and intraoral approach were performed. The clinical examination included functional and aesthetic aspects at least 1 year after the fracture.Results: The majority of fractures (45%) were classified into Type II and IV according to Spiessl and Schroll followed by fractures without any displacement or dislocation (29.7%). The submandibular approach showed the worst outcome regarding permanent palsy of the facial nerve and hypertrophic scarring. No significant differences between the various approaches were detected in the functional status in any diagnosis group.Conclusion: Inferior condylar neck fractures benefit from ORIF by an intraoral approach whereas in high condylar neck fractures the retromandibular/transparotid approach shows the best results. Fractures of the condylar head were almost all treated by CR and our results cannot contribute to the debate of CR vs. ORIF in this type of fracture.

A hematogenous spread brain abscess invading the right damaged temporomandibular joint - Corrected Proof

J. Klatt, M. Heiland, A. Gröbe, M. Westphal, R. Schmelzle, P. Pohlenz — 2012-03-22

Abstract: We report a rare case of a brain abscess which drained spontaneously in a temporomandibular joint damaged by osteoarthritis. The female patient presented to our hospital with a severe headache and pain in the temporomandibular joint. She showed elevated inflammatory parameters with unknown cause. Magnetic resonance imaging of her whole body revealed a large temporal brain abscess extending into the glenoid fossa of the temporomandibular joint. The brain abscess was incised and drained by neurosurgeons in our hospital and in the same operation we resected the articular disc and the affected part of the right temporomandibular joint. Histological examination confirmed a chronic arthrosis in the resected bone of the temporomandibular joint and an inflammatory abscess in the resected brain tissue.The patient recovered well and the inflammation resolved as seen in postoperative investigations. Magnetic resonance imaging a month later confirmed local consolidation in the brain with no sign of residual inflammation.

Neurosensory disturbances one year after bilateral sagittal split osteotomy of the mandibula performed with separators: A multi-centre prospective study - Corrected Proof

2012-03-22

Abstract: Bilateral sagittal split osteotomy (BSSO) is an effective and commonly used treatment to correct mandibular hypo- and hyperplasia. Hypoesthesia of the inferior alveolar nerve (IAN) is a common complication of this surgical procedure. This prospective multi-centre study aimed to determine the incidence of neurosensory disturbances of the IAN after BSSO procedures performed without the use of chisels. Our study group comprised 158 patients, with a follow-up period of 1 year, who underwent BSSO (with or without Le Fort I) that incorporated the use of sagittal split separators and splitters but no chisels. The percentage of BSSO split procedures that resulted in IAN damage was 5.1%. The percentage of patients (without genioplasty) who experienced IAN damage was 8.9%. The concomitant genioplasty in combination with BSSO was significantly associated with hypoesthesia. Peri-operative removal of the wisdom tooth or a Le Fort I procedure did not influence post-operative hypoesthesia. We believe that the use of splitting forceps and elevators without chisels leads to a lower incidence of persistent post-operative hypoesthesia 1 year after BSSO of the mandible, without increasing the risk of a bad split.

The sequential hypothesis of impaction of maxillary canine – A hypothesis based on clinical and radiographic findings - Corrected Proof

Anand K. Sajnani, Nigel M. King — 2012-03-22

Abstract: The aetiology of impacted maxillary canines remains obscure. Numerous researchers have focused on identifying specific and non-specific aetiological factors responsible for canine displacement. Currently, the two most popular hypotheses that have gained consensus worldwide are the guidance theory and the genetic theory. However, no single hypotheses, can completely explain the aetiology of impaction of maxillary canines. This retrospective study was used to develop and postulate the aetiology of both buccally and palatally impacted maxillary canines. The study was conducted on a sample of 533 patients for whom the pattern and distribution of the impacted maxillary canines, sex differences, the dental age of the patients, dental anomalies and various geometric measurements which were made on the panoramic radiographs were recorded. Based on these findings, the sequential hypothesis of impaction of the maxillary canine was postulated. The hypothesis states that both buccally and palatally impacted canines have similar aetiological factors leading to their impaction. It is suggested that genetic mechanisms strongly influence the potential of the maxillary canine to be impacted and the guidance from the lateral incisor and the stage of development plays a vital role in determining the ultimate position of the impacted canine.

Wave technique for treatment of lower lip cancer - Corrected Proof

Attilio Carlo Salgarelli, Cristina Magnoni, Pierantonio Bellini — 2012-03-22

Abstract: Purpose: This article reports the authors’ experience with treatment of lower lip cancer using the wave technique.Patients and methods: Twenty-one patients (16 males, 5 females) were treated using the wave technique between September 2009 and October 2010. Patients undergoing the procedure had tumors that were classified as either T1N0M0 or T2N0M0. Lateral defects less than 2 cm in size are generally treated with unilateral flaps, and median defects are closed with bilateral symmetric flaps. If the defect is paramedian and greater than 2 cm in width, two asymmetric flaps are used.Results: No recurrence was observed during a 6- to 32 months follow-up (mean 19 months). All patients showed excellent esthetic results with no microstomia.Conclusions: We modified the straight lines of the staircase technique into round lines of the wave technique, resulting in an esthetic improvement. The goal of the broken lines and round lines is to create less visible scars. The wave technique can be used to close defects of up to two-thirds of the lower lip.

Craniofacial fibrous dysplasia (CFD) of the maxilla in an 11-year old boy: A case report - Corrected Proof

2012-03-21

Abstract: We present the case of a surgically treated 11-year old boy with a diagnosis of craniomaxillofacial fibrous dysplasia (CFD) in the maxillary sinus. When first seen in the outpatient clinic of our department he had minimal symptoms. After initial radiological diagnostics by computed tomography scans (CT-scans) the patient was treated operatively by radical excision of the tumor. The radiographs showed the typical intramedullary located and well-defined lesions, which eroded the cortical bone with the typical appearance of fibrous dysplasia. The histopathology showed the typical curved extending fibrous trabeculae in C, O and Y-shape which were embedded in a moderately cellular morphologically inconspicuous stroma, confirming the initial suspicion of fibrous dysplasia of the maxillary bone. Cone beam tomography was a valuable tool in determining the re-ossification of bone at the affected side. Local resection can be curative in limited disease.

Assessing quality of life in patients with head and neck cancer in Spain by means of EORTC QLQ-C30 and QLQ-H&N35 - Corrected Proof

2012-03-19

Abstract: Objectives: The aim of this project was to evaluate the quality of life in patients undergoing treatment for head and neck cancer in the Murcia region (Spain).Materials and methods: The Quality of Life (QoL) of patients suffering head and neck cancer was assessed using Spanish translations of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Head and Neck Cancer Module (QLQ-H&N35). The questionnaires’ scales and single items were compared according to age, sex, tumour location, stage of cancer and treatment type.Results: Of the 109 patients who met the study’s inclusion criteria, 94 completed the questionnaire. Quality of life was found to be associated with patient age (with patients <65years obtaining higher scores) and also with tumour location. With regard to the stage of cancer, early stages obtained better scores than advanced ones. Patients who underwent surgical treatment combined with adjuvant radiotherapy and chemotherapy generally showed lower scores.Conclusions: The routine use of quality of life questionnaires among cancer patients enables health practitioners to discover in which areas and to what extent patients find their lives affected by the treatment they receive and its consequences. This allows health practitioners to provide information and treatments which are better adapted to patient needs. These results are similar to those obtained in populations from the north and centre of Europe.

Mucormycosis of the head and neck - Corrected Proof

2012-03-19

Abstract: Introduction: Mucormycosis of the head and neck is a rare disease increasingly occurring in immunocompromised patients. We report on two cases with different outcomes.Case reports: A 63-year-old female presented with a recently developed deformation of her right cheek and nose combined with a loosening of the teeth. Further examination revealed mucormycosis of the maxilla. Hemimaxillectomy and secondary bony reconstruction with oral rehabilitation were performed.The second patient was a 54-year-old male who suffered from multiple myeloma. After receiving an allogeneic haematopoietic stem cell transplant, he developed a necrotizing infection of the right midface. Histopathological investigation confirmed the diagnosis of mucormycosis. The patient died one day after radical surgical resection.Discussion: These two cases demonstrate the variability of mucormycosis. Although slow progression of the disease is possible, a high level of attentiveness and expedient treatment are necessary due to the high risk of a devastating course.

Analysis of the cytokine profiles of the synovial fluid in a normal temporomandibular joint: Preliminary study - Corrected Proof

2012-03-19

Abstract: The purpose of this study was to compare the cytokine profiles of the synovial fluid from the temporomandibular joint (TMJ) spaces of normal individuals and temporomandibular disorder (TMD) patients. Thirty-four patients with planned orthognathic surgery did not present abnormalities of the TMJ on magnetic resonance images and radiographs and did not show the symptoms identified by the Research Diagnostic Criteria for TMD (RDC-TMD); as a result, they were assigned to the control group. Twenty-two patients who sought treatment for TMD during the same period were assigned to the TMD group. Synovial fluid was collected from superior TMJ spaces, and cytokine expression was analysed by an enzyme-linked immunosorbent assay (ELISA). Significant differences were tested using Fisher's exact test (p<0.05). Granulocyte Macrophage Colony stimulating Factor (GM-CSF), interferon (INF), interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10 and tumour necrosis factor (TNF)-α were detected in the TMD group, whereas no cytokines were detected in the control group. The most prevalent cytokines in the TMD group were IL-1β, IL-6 and GM-CSF. IL-4 and IL-5 were not detected in either the TMD group or in the control group. None of the cytokines that were detected in patients with TMD were found in the articular spaces of normal individuals.

Congenital infiltrating lipomatosis of the face with associated involvement of the TMJ structures. Case report and review of the literature - Corrected Proof

T. Keramidas, G. Lagogiannis, V. Vlachou, N. Katsikeris — 2012-03-19

Abstract: We report a case of congenital infiltrating lipomatosis of the face (CILF) with right TMJ ankylosis causing asymmetry and reduced mouth opening. The management involved soft tissue debulking combined with a right TMJ arthroplasty and is explained in detail. A review of the relevant literature revealed the rarity of this condition. The diagnosis of CILF remains challenging. The currently accepted treatment strategy is less aggressive as facial asymmetry tends to recur. Infiltration of the facial structures from adipose tissue requires several surgical procedures in most cases. Bony hypertrophy on the affected side has been a common finding in reported cases. There have been no previous reports of TMJ ankylosis associated with this condition. CILF is a benign condition with a good long term prognosis. After 2years of follow up our patient, has maintained full function despite facial asymmetry.

Surgical decompression in endocrine orbitopathy. Visual evoked potential evaluation and effect on the optic nerve - Corrected Proof

2012-03-19

Abstract: Endocrine orbitopathy (EO) represents the most frequent and important extrathyroidal stigma of Graves disease. This chronic autoimmune condition involves the orbital contents, including extraocular muscles, periorbital connective-fatty tissue and lacrimal gland. The increase of fat tissue and the enlargement of extraocular muscles within the bony confines of the orbit leads to proptosis, and in the most severe cases optic neuropathy, caused by compression and stretching of the optic nerve. The congestion and the pressure of the enlarged muscles, constrict the nerve and can lead to reduced sight or loss of vision with the so called “orbital apex syndrome”. Generally surgical treatment of EO, based on fat and/or orbital wall expansion, is possible and effective in improving exophthalmos and diplopia.Since there are limited reports focussing on optic neuropathy recovery after fat and/or orbital walls decompression the Authors decided to perform a retrospective analysis on a series of patients affected by EO.The study population was composed of 10 patients affected by EO and presenting to the Unit of Cranio Maxillofacial Surgery, Center for Craniofacial Deformities & Orbital Surgery St. Anna Hospital and University, Ferrara, Italy, for evaluation and treatment. A complete Visual Evoked Potentials (VEP) evaluation was performed. There were seven women and three men with a median age of 55years. Optic nerve VEP amplitude and latency were recorded as normal or pathological. Abnormal results were scored as moderate, mild and severe. Differences in VEP pre and post-operatively were recorded as present or absent (i.e. VEP Delta). Pearson chi square test was applied.There were 20 operated orbits. The first VEP evaluation was performed 3.2months before surgery and post-operative VEP control was done after a mean of 18.7months. Fat decompression was performed in all cases and eight patients had also bony decompression.VEP amplitude and latency were affected in 10 and 15 cases before operation and six and nine after surgery, respectively. VEP amplitude and latency significantly improved after orbital decompression.Fat and orbital wall decompression are of paramount importance not only to improve exophthalmos and diplopia in patients affected by EO but also as rescue surgery for severe cases where optic neuropathy caused by stretching of the optical nerve is detected by VEP. Imaging and functional nerve evaluation are mandatory in all cases of EO.

Dexrazoxane shows cytoprotective effects in zoledronic acid-treated human cells in vitro and in the rabbit tibia model in vivo - Corrected Proof

G.F. Draenert, D.O. Huetzen, P.W. Kämmerer, V. Palarie, V. Nacu, W. Wagner — 2012-03-19

Abstract: Introduction: Bisphosphonates are important and effective drugs in oncology and osteoporosis therapy. They accumulate in the bone matrix becoming released and active by bone resorption. This leads to effective inhibition of tumor cells and bone degradation. A side effect of bisphosphonates similar to other drugs like denosumab is osteonecrosis of the jaws (ONJ). This problem mostly occurs after tooth extraction.We studied the cytoprotectant dexrazoxane known from anthracycline chemotherapy for cytoprotection in nitrogen-containing bisphosphonate treated cells and in the rabbit tibia model to evaluate a possible value in ONJ management.Materials & methods: Human osteoblasts (HOB) P2 cells and Human ginigiva fibroblasts (HGF) P2 cells were treated with zoledronic acid (50μmol/L) and the cytoprotectant dexrazoxane (600μmol/L). Analysis included cell viability testing with MTT assay and morphology analysis using CellTracker™ Green CMFDA. A biomaterial carrier (Bio-Oss Collagen) was implanted in the rabbit tibia of 6 female chinchilla bastard rabbits on both sides with drill hole defects (d: 3.2mm). Implants were loaded with 25nmol zoledronic acid, with and without 300nmol dexrazoxane and unloaded in a control group. Analysis included histological examination of undecalcified samples with toloudine blue staining after 10days.Results: In vitro experiments showed a significantly higher MTT activity in cells treated with zoledronic acid together with dexrazoxane compared to the same cells treated with the bisphosphonate alone in t-test (HOB: p=0.0003; HGF: p below 0.0001) and one-way ANOVA. Cell morphology changes were consistent with these results. In vivo results showed newly formed bone trabeculae directly growing towards the implanted hydroxylapatite particles and cortical bone interface resorption activities in the control and the experimental group only.Conclusion: The study suggests a possible value of this patented technology for ONJ therapy and prevention with local or systemic application.

Ethical questions raised by the first allotransplantations of the face: A survey of French surgeons - Corrected Proof

Philippe Pirnay, Roy Foo, Christian Hervé, Jean-Paul Meningaud — 2012-03-19

Abstract: Introduction: More than any other allograft, the allotransplantation of the face has a symbolic character, which raises a large number of questions. The objective of this article is to make an analysis through a survey carried out among French surgeons.Methods: A file of 909 e-mail addresses of surgeons was created so as to send out a questionnaire regarding 10 ethical issues.Results: Beyond the technical prowess, the surgeons ethical reflection initially focused on the notion of consent to donation and care. They attached equal importance to all ethical questions. They spontaneously raised the issue of over-mediatization of these first transplants and the place of the transplant surgeons and their patients in the medical information.Conclusion: Over two thirds of the surgeons attached importance to ethical issues regarding the donor and recipient of a facial allograft. Some of the principal questions facing facial transplantation is of an ethical nature as it is an unprecedented procedure that is challenged by the axiom to first do no harm and the need of modern medicine to limit risk to as close to zero as possible. For the non-specialist, accepting psychologically the face of another individual appears to be a real issue. Contrary to that, the main demand expressed by the facial transplant recipients appears to be related to facial functions rather than appearance.

Postoperative stability following maxillary downward movement with Le Fort I inclined osteotomy at the lateral nasal cavity wall - Corrected Proof

Hoon Joo Yang, Soon Jung Hwang — 2012-03-19

Abstract: Downward movement of the maxilla is regarded as one of the less stable long-term orthognathic surgical procedures. To increase postoperative stability with direct bone contact, the conventional Le Fort I osteotomy was modified with an inclined osteotomy at the lateral nasal cavity wall. The aim of this study was to evaluate the postoperative stability of the new method for Le Fort I inclined osteotomy for downward maxillary movement.The study included 27 patients with anterior vertical deficiency of the maxilla who underwent Le Fort I inclined osteotomy for downward maxillary movement. Patients were classified into two groups according to the amount of downward movement. The amounts of relapse (cephalometric changes) of the two groups were compared and statistically analyzed.The mean amount of relapse was about 1 mm. The tendency of relapse was not increased by a large initial downward movement with Le Fort I inclined osteotomy. Le Fort I inclined osteotomy was used safely for downward movement in order to increase bone height at the piriform aperture area and resulted in direct bone contact, suggesting it is a useful technique for maintaining postoperative stability. A further study with a larger number of patients is necessary.

Osteo-odonto-keratoprosthesis – A maxillofacial perspective - Corrected Proof

Vinod Narayanan, Natarajan Nirvikalpa, Srinivas K. Rao — 2012-03-19

Abstract: The OOKP (osteo-odonto-keratoprosthesis) is the treatment of choice for conditions like Stevens–Johnson syndrome, ocular cicatricial pemphigoid, trachoma, multiple failed grafts and chemical burns which are not amenable to penetrating keratoplasty. The OOKP is an autograft which replaces the cornea with a polymethacrylate cylinder mounted on a tooth-bone complex. The aim of this paper was to retrospectively analyze the records in 26 patients undergoing OOKP surgery between 2007 and 2011. The paper describes our experience with the procedure, with emphasis on its oral and maxillofacial aspects and management of associated complications. The aetiology of blindness in 23 patients was Stevens–Johnson's syndrome and chemical burns in three. Twenty-two patients had their maxillary canines, two had mandibular canines and two had maxillary first premolars as the choice of donor tooth. An oroantral fistula developed in four patients. One patient needed to undergo a surgical procedure for closure of the same. Roots of adjacent teeth were exposed in 12 patients. Twenty-four patients underwent both stages of the procedure with 19 being visually rehabilitated successfully. There was no improvement in the vision of four patients. One patient was lost to follow-up. Two patients have yet to undergo Stage 2.

Oral findings associated with primary hyperoxaluria type I - Corrected Proof

K.T. Mitsimponas, T. Wehrhan, S. Falk, F. Wehrhan, F.W. Neukam, K.A. Schlegel — 2012-03-15

Abstract: In the present paper we report the oral findings of a patient who was diagnosed with hyperoxaluria.Hyperoxalurias can basically be classified as primary and secondary, with the first being inborn errors of metabolism and the second a result of excessive oxalate intake.Primary hyperoxalurias form a rare group of metabolic diseases that are inherited in the autosomal recessive fashion. The affected genes code for specific hepatic enzymes that are involved in glyoxylate metabolism and their deficiency results in overproduction of oxalate.Two different types are described: Primary hyperoxaluria type I results from a deficiency of peroxisomal enzyme alanine–glyoxylate aminotransferase and the more rare type II from a deficiency of cytosolic enzyme d-glycerate dehydrogenase.Since oxalate is primarily excreted through the kidneys, abnormally high concentration of oxalate in the urine occurs. This can in turn result in recurrent kidney stones and parenchymal renal damage and end-stage renal disease (ESRD). Inability to further excrete oxalate through the kidneys leads to its deposition in various organs (oxalosis).Several oral findings have been described in patients with oxalosis, most important of whose are bone resorption in the jaws, external root resorption and rapidly progressive dental mobility, as well as dental pain associated with deposition of oxalate in the dentine and the pulp.

Isolation and characterization of multipotent postnatal stem/progenitor cells from human alveolar bone proper - Corrected Proof

2012-03-15

Abstract: In the search for an ideal minimally-invasive multipotent postnatal stem cells’ source, the aim of the present study was to isolate and characterize multipotent postnatal stem/progenitor cells from the human alveolar bone proper tissue of the oral cavity. Cells were isolated from human alveolar bone parts, immunomagnetically sorted using STRO-1 antibodies and characterized flow cytometrically for the expression of CD14, CD34, CD45, CD73, CD90, CD105, CD146/MUC18 and STRO-1 surface markers. Colony-formation and multilineage differentiation potential were tested. Mineralized tissue marker expression was examined using real time polymerase chain reaction (PCR).The cells were plastic-adherent and showed colony-formation. Cells expressed the surface markers CD73, CD90, CD105, STRO-1 and CD146/MUC18, while lacking the expression of the hematopoietic markers CD14, CD34 and CD45. Cells could be differentiated into osteoblastic, adipocytic and chondroblastic lineages. Unstimulated cells expressed alkaline phosphatase (ALP), type I, III and V collagens, osteonectin and osteocalcin in a very distinctive pattern. This study presents a practical and minimally-invasive scheme for the isolation of multipotent postnatal stem/progenitor cells from the human alveolar bone tissue of the oral cavity.