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

Transconjunctival approach in orbital traumatology: A review of 56 cases - Corrected Proof

Giorgio Novelli, Luca Ferrari, Davide Sozzi, Fabio Mazzoleni, Alberto Bozzetti — 2010-07-23

Summary: Aim: The aim of this study is to analyze the transconjunctival approach in the treatment of orbital fractures and to evaluate the indications, the advantages of the surgical approach, and the occurrence of possible complications.Materials and methods: From 2005 to September 2009 we used a transconjunctival approach on 53 patients for a total of 56 cases of orbital fractures (three cases with bilateral floor fractures), 54 cases of acute trauma, and two outcomes of previous fractures. We evaluated the incidence of intra or postoperative complications and in the postoperative follow-up we investigated the presence of: entropion, ectropion, scleral show, trichiasis, conjunctival granuloma, mobilization or exposure of orbital reconstruction material.Results: In 56 cases we had four temporary postoperative complications and no long-term complications; two cases of trichiasis and two cases of partial entropion were treated only with medical therapy. All complications, as described in the literature, were transitory and did not require corrective surgery.Conclusion: The transconjunctival approach is the most effective surgical access, not only to the medial orbital wall, but also to the orbital floor, as it does not interfere with the lachrymal drainage system and gives as wide a visualization of the orbital floor as does the palpebral approach. This surgical approach is simple to perform and gives good functional and aesthetic results.

Arthrocentesis and stabilizing splint are the treatment of choice for acute intermittent closed lock in patients with bruxism - Corrected Proof

Walid A. Ghanem — 2010-07-05

Summary: This study aimed to evaluate the long-term outcome of arthrocentesis and stabilizing splints for the treatment of acute closed lock in patients with bruxism. This study included 20 female patients who were divided into two equal groups and who underwent temporomandibular joint (TMJ) arthrocentesis. Patients in the first group wore a full coverage stabilizing splint following arthrocentesis. The second group underwent arthrocentesis only. The scores for preoperative maximal mouth opening (MMO), protrusive movement (PM), contra-lateral (CL) movement (CLM) and visual analogue scale (VAS) scores for pain and dysfunction were compared with the follow-up scores obtained by the questionnaire and clinical examination. Statistical evaluation of the baseline and follow-up data was made with the t-test. The follow-up period was 12 months. There was a significant (P<0.001) increase in the MMO, CL and PMs during the longer-term follow-up period for group 1, while there was a significant decrease (P<0.019) in these parameters for group 2. The pain and dysfunction levels at follow-up were significantly (P<0.001) lower than the preoperative values. Ninety percent of patients in group 2 showed pain and dysfunction scores that increased significantly (P<0.001) and ranged from moderate to severe. The overall success rate was 90% for group 1 and 30% for group 2. In conclusion, arthrocentesis and a stabilizing splint are the treatment of choice for acute closed lock of short duration in young patients with bruxism.

Microvascular reconstruction of mandibular defects in paediatric patients - Corrected Proof

2010-07-05

Summary: Background: During mandibular reconstruction in paediatric patients special consideration must be given to the issues related to growth when restoration of the mandibular and maxillary relationship is essential for correct development of the facial skeleton, a dynamic process whereby mandibular and maxillary growth are strongly correlated. Wide resections, irradiated fields, infection at the recipient site, and scars are strong indications for using revascularized bone-containing free flaps.Methods: Five patients were reviewed, with a follow-up ranging from 5 to 11 years. Measurements were performed on frontal and lateral views to assess mandibular angle symmetry, midline deviation and facial angle. Measurements were also made on orthopantomograms to assess differences in growth between the normal and reconstructed sides.Results: Optimal functional and aesthetic results were obtained.Conclusions: The data suggest that the reconstructed mandible undergoes growth, and that even if this process is unpredictable, it can be sufficient to allow appropriate development of the face.

Face perception in patients with unilateral cleft lip and palate and patients with severe Class III malocclusion compared to controls - Corrected Proof

2010-06-28

Summary: Although there is principal agreement that increased facial asymmetry is associated with decreased facial attractiveness, there are no studies analysing face perception in patients with a unilateral cleft lip and palate (CLP) (uCLP) compared to orthognathic Class III patients.To this end, three-dimensional (3D) data on the faces of 30 adults with a complete uCLP, 20 orthognathic patients with a severe skeletal Class III, and 20 adults with a skeletal Class I as a control group were generated. The 3D asymmetry of the facial soft-tissue was analysed. These data were compared with subjective ratings for attractiveness carried out by 100 laypersons.Compared to the controls, uCLP patients and orthognathic patients had a significantly higher facial asymmetry. No difference was found between uCLP patients and orthognathic patients.The attractiveness ratings showed that uCLP patients and orthognathic patients were rated less attractive compared to the controls. However, although there were no differences in the facial asymmetry between uCLP patients and orthognathic patients, the uCLP patients were rated significantly less attractive.This leads to the conclusion that not only the extent of asymmetry has an influence on attractiveness but also the location of asymmetry. For clinical use, these findings underline the importance of accurate as possible surgical reconstruction of the nasal morphology in uCLP patients.

Fibro-osseous dysplasia localized to the zygomatic arch: Case report - Corrected Proof

Pietro Boni, Andrea Ferri, Domenico Corradi, Enrico Sesenna — 2010-06-28

Summary: Fibrous dysplasia is an osseous growth disorder, producing immature bone characterized by the replacement of normal bone with fibro-osseous connective tissue. The therapy is surgical, but the diagnosis of fibrous dysplasia of the craniofacial bones is not in itself an indication for treatment. The authors present a rare case of a zygomatic arch localization of fibrous dysplasia causing considerable facial asymmetry and social impairment. The clinical and radiological features are presented, the surgical procedure and indications are then described and the histopathological findings are discussed.

Anterolateral thigh skinfold thickness and the European head and neck cancer patient: A prospective study - Corrected Proof

2010-06-28

Summary: The purpose of this study was to objectively assess this widely recognised problem of the bulky adipocutaneous Anterolateral thigh flap in the European population that may have implications in the reconstruction of head and neck cancer patients. We report 50 cases that underwent specific prospective thigh skinfold thickness assessment as part of assessment of suitability for ALT flap reconstruction following cancer ablation. The null hypothesis was that thigh skinfold thickness and circumference in an oral cancer population do not differ significantly from published sino-Asian norms. This study confirms anthropometrically the suspicion that European thigh skinfold thickness in a head and neck cancer population is greater than sino-Asian comparators.

Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: Not just a sporadic coincidence – a multi-centre study - Corrected Proof

2010-06-28

Summary: Introduction: Bisphosphonates (BPs) are powerful drugs that inhibit bone metabolism. Adverse side effects are rare but potentially severe such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, research has primarily focused on the development and progression of BRONJ in cancer patients with bone metastasis, who have received high dosages of BPs intravenously. However, a potential dilemma may arise from a far larger cohort, namely the millions of osteoporosis patients on long-term oral BP therapy.Patients and methods: This current study assessed 470 cases of BRONJ diagnosed between 2004 and 2008 at eleven different European clinical centres and has resulted in the identification of a considerable cohort of osteoporosis patients suffering from BRONJ. Each patient was clinically examined and a detailed medical history was raised.Results: In total, 37/470 cases (7.8%) were associated with oral BP therapy due to osteoporosis. The majority (57%) of affected individuals did not have any risk factors for BRONJ as defined by the American Association of Oral and Maxillofacial Surgery. The average duration of BP intake of patients without risk factors was longer and the respective patients were older compared to patients with risk factors, but no statistical significant difference was found. In 78% of patients the duration of oral BP therapy exceeded 3 years prior to BRONJ diagnosis.Discussion: The results from this study suggest that the relative frequency of osteoporosis patients on oral BPs suffering from BRONJ is higher than previously reported. There is an urgent need to substantiate epidemiological characteristics of BRONJ in large cohorts of individuals.

Delayed soft tissue recurrence after treatment of ameloblastoma in a black African: Case report and review of the literature - Corrected Proof

Ezekiel Taiwo Adebayo, Benjamin Fomete, Emmanuel Oladepo Adekeye — 2010-06-28

Summary: Introduction: Ameloblastoma is rare worldwide. Delayed treatment can result in significant morbidity from facial deformity and infiltration of adjacent tissues. Mortality can occur from invasion of vital structures in the head and neck, super infection, recurrent and even distant metastases. Recurrence after radical treatment is not common.Case report: This paper presents a case of soft issue recurrence in the chin 21 years after radical resection of the mandible for ameloblastoma. The iliac crest bone grafted to the site was not involved in the tumour recurrence. Conclusion. Radical surgical resection is accepted treatment for solid/multicystic ameloblastoma. However, the surgical review should be for life as recurrence can occur after a long interval.

Cervical necrotizing fasciitis of odontogenic origin involving the temporal region – A case report - Corrected Proof

2010-06-18

Summary: Necrotizing fasciitis (NF) is a soft-tissue infection, usually polymicrobial, that causes necrosis of fascia and subcutaneous tissue while sparing skin and muscle. We report a case of cervical NF complicating dental infection in a 50-year-old woman, who presented with infection involving mucosa of the right mandible and temporal muscle, and masticator spaces, requiring extensive surgery and antibiotic therapy. Prompt diagnosis and immediate aggressive surgical debridement of all compromised tissues are critical to reducing morbidity and mortality in these rapidly progressive infections.

Ideal proportions in full face front view, contemporary versus antique - Corrected Proof

M.Y. Mommaerts, B.A.M.M.L. Moerenhout — 2010-06-14

Summary: Aim: To compare the facial proportions of contemporary harmonious faces with those of antiquity, to validate classical canons and to determine new ones useful in orthofacial surgery planning.Material and methods: Contemporary beautiful faces were retrieved from yearly polls of People Magazine and FHM. Selected B/W frontal facial photographs of 31 men and 74 women were ranked by 20 patients who had to undergo orthofacial surgery. The top-15 female faces and the top-10 male faces were analyzed with Scion Image software. The classical facial index, the Bruges facial index, the ratio lower facial height/total facial height and the vertical tri-partite of the lower face were calculated. The same analysis was done on pictures of classical sculptures representing seven goddesses and 12 gods.Results: Harmonious contemporary female faces have a significantly lower classical facial index, indicating that facial height is less or facial width is larger than in male and even than in antique female faces. The Bruges index indicates a similar difference between ideal contemporary female and male faces.The contemporary male has a higher lower face (48%) compared to total facial height than the contemporary female (45%), although this is statistically not significant (P=0.08).The lower facial thirds index remained quite stabile for 2500 years, without gender difference. A good canon for both sexes today is stomion–gnathion being 70% of subnasale–stomion.Conclusion: The average ideal contemporary female face is shorter than the male face, given the fact that interpupillary distance is similar. The Vitruvian thirds in the lower face have to be adjusted to a 30% upper lip, 70% lower lip-chin proportion. The contemporary ideal ratios are suitable to be implemented in an orthofacial planning concept.

Parry–Romberg syndrome: volumetric regeneration by structural fat grafting technique - Corrected Proof

Luigi C. Clauser, Riccardo Tieghi, Giuseppe Consorti — 2010-06-11

Summary: The use of adipose tissue transfer for correction of maxillo-facial defects was reported for the first time at the end of the 19th century and has since been the subject of numerous studies.Structural Fat Grafting (SFG) differs from other fat grafting techniques in both the harvesting and placement of the fat. The main indications for SFG are for the restoration and rejuvenation of the face. Recent applications include the correction of localised tissue atrophy, loss of substance due to trauma, post-tumour, congenital complex craniofacial deformities, burns, and hemifacial atrophy.The authors describe a case of a 20-year-old woman with right Parry–Romberg syndrome (PRS) treated over many years with many different surgical reconstructive techniques with poor results. After five SFG (three complete procedures and two minor revisions) over three years, the authors obtained a good aesthetic result with complete patient satisfaction.SFG can be an excellent technique for facial reconstruction and re-contouring, with natural and long-lasting results.

Reduction of bone resorption by the application of platelet-rich plasma (PRP) in bone grafting of the alveolar cleft - Corrected Proof

Eriko Marukawa, Hidekazu Oshina, Gaichi Iino, Keiichi Morita, Ken Omura — 2010-06-09

Summary: Objective: We evaluated the effectiveness of platelet-rich plasma (PRP) on the regeneration of autogenous cancellous bone and marrow grafted in the alveolar cleft.Design: Twenty patients with alveolar clefts were examined; 6 were the control group and received cancellous bone and marrow grafts without PRP, while the remaining 14 comprised the PRP group and received grafts with PRP. Prior to surgery, 50ml of blood was withdrawn and 5ml of PRP gel produced through centrifugal separation. The bone graft mixed with PRP was then packed into the alveolar cleft. Postoperative bone density was assessed as the aluminium-equivalent value on occlusal X-ray films in a qualitative analysis. Quantitative evaluation of regenerated bone was made with computed tomography and panoramic radiographs at 1 month, 6 months and 1 year after surgery.Results: Satisfactory bone bridging formation was observed in all patients without any complications. The bone density of the PRP group was lower than that of the control group at 1 week, but the same after 1 month. The added PRP reduced the resorption of regenerated bone postoperatively.Conclusion: Autogenous cancellous bone grafting with PRP, which significantly reduces postoperative bone resorption, is a reliable technique for alveolar bone grafting of cleft patients.

Oral nodular fasciitis: Report of a case of the buccal mucosa - Corrected Proof

2010-06-07

Summary: Nodular fasciitis is a benign, reactive, proliferative spindle-cell lesion, usually located at the subcutaneous tissues or muscle fascia. Clinically, it manifests as a soft-tissue mass with well-defined margins and fixed to the adjacent structures. Because of its rapid growth rate, rich cellularity and relatively high mitotic activity, nodular fasciitis is sometimes misdiagnosed as a sarcoma. Accurate diagnosis is based only on histopathological examination. A rare case of nodular fasciitis of the buccal mucosa in a 50-year-old female patient is presented.

Mandibular nerve block can improve intraoperative inferior alveolar nerve visualization during sagittal split mandibular osteotomy - Corrected Proof

2010-06-04

Summary: Introduction: The main procedure specific complication of sagittal split osteotomy of the mandibular ramus (SSOMR) is inferior alveolar nerve (IAN) injury. This can be produced by poor intraoperative visibility of the IAN due to bone bleeding. In our centre, mandibular nerve blocks (MNBs) are usually performed for intra- and post-operative analgesia. We observed that MNB seems to decrease intraoperative bleeding and thus to improve IAN visibility. Our study was performed to evaluate the effect of MNB on intraoperative bleeding during SSOMR and, secondarily, on the duration of this procedure.Material and methods: Patients scheduled for bilateral SSOMR under general anaesthesia were prospectively randomized into two groups. The Block group received bilateral MNB (5mL ropivacaine 0.5% for each block) and the Control group sham MNBs (bilateral cutaneous puncture, without block). The operations were carried out under a standardised general anaesthetic. Post-operatively, the surgeon, blinded to group allocation, assessed intraoperative bone bleeding using a Numerical Rating Scale (NRS) (0: no bleeding, perfect visibility to 100: major bleeding, no visibility). Osteotomy duration, intraoperative anaesthetic requirements, and pain score in the recovery room were also recorded. Results are expressed as median [25–75th percentiles].Results: Nineteen patients were included in each group. Osteotomy under MNB had a decreased intraoperative bone bleeding score compared with controls (20 [0–40] versus 55 [20–80], p=0.0002). They had a dry surgical field more frequently (29% versus 5%, p=0.01), and a shorter mean time for the osteotomy (15 [12.25–17.75] versus 17.5 [15–21]min, p=0.009). Block patients had reduced intraoperative opioid consumption (770 [678–1430] versus 2310 [1908–3058]mcg of remifentanil, p=0.0001), and lower pain scores in the recovery room (0 [0–2] versus 3 [1–5], p=0.12).Conclusion: MNB decreases intraoperative bone bleeding during SSOMR under general anaesthesia. Three hypotheses to explain this result are discussed.

Sleep-related disordered breathing in children with syndromic craniosynostosis - Corrected Proof

2010-06-03

Summary: Background: Syndromic craniosynostosis patients are at risk for sleep-related disordered breathing (SRDB) but the role of polysomnography (PSG) in assessing these patients has not been fully explored. Our aim was to evaluate the prevalence or severity of SRDB in children with syndromic craniosynostosis or the impact of treatments on their SRDB.Methods: We conducted a retrospective review of all patients with syndromic craniosynostosis referred between 1996 or 2008 for an initial PSG to rule out SRDB. For those with SRDB, we reviewed the interventions post PSG.Results: 35 patients (18 females) were included. Specific diagnoses were Crouzon’s (n=18), Apert’s (n=14), Pfeiffer (n=2) or Saethre-Chotzen (n=1) syndromes. Their mean age was 4.5 years or their mean body mass index (BMI) was 16.9kg/m2. Of these patients, 26/35 (74%) had evidence of SRDB. The median obstructive apnoea index was 6.6/h (range 0.5–36.4/h) or median central apnoea index was 1.0/h (range 0.0–66.4/h). A total of 16 children had interventions to treat SRDB, of which 14/16 had a follow up PSG or only 10/14 (x%) had a significant improvement of their SRDB.Conclusion: This review confirms a high prevalence SRDB in this referred population. Despite various interventions, complete resolution of SRDB could not be achieved.

Clinical characteristics and treatment of multiple site comminuted mandible fractures - Corrected Proof

Zhi Li, Zu-Bing Li — 2010-06-02

Summary: Multiple site comminuted mandibular fractures are the result a concentrated and prolonged force on a region of the mandible. The purpose of this retrospective study was to investigate the clinical characteristics of these fractures in China, as well as review our experience with these types of fractures. Twenty-one patients treated for multiple site comminuted mandibular fractures were included in the study. The case records were reviewed, with particular attention to the patient’s gender, age, aetiology of injury, area and extent of comminution, concomitant injuries and treatment methods. Sixteen of the 21 patients were males. Ages ranged between 18 and 48 years, with a mean of 34.81 years. Traffic accidents were responsible for the majority (42.86%) of the fractures. Concomitant injuries were uncommon. Treatment was with open reduction with rigid internal fixation and maxillo-mandibular fixation. We recommend that fixation and reconstruction of the mandible with reconstruction plates should be the treatment of choice and MMF should be used as an adjunct.

Two cases of emergent endovascular treatment for carotid blowout syndrome after free flap reconstruction for neck cancer - Corrected Proof

Masaki Fujioka, Hideaki Takahata — 2010-06-02

Summary: Carotid blowout is a devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. For patients with bleeding originating in the internal or common carotid artery, treatment options are limited. These include the endovascular remodelling strategies using a stent or embolization of the aneurysm with coils.We describe two cases of pseudoaneurysmal rupture in the common carotid artery with massive bleeding in patients with head and neck malignancies and a history of long-term radiation treatment. They underwent immediate coil embolization and wall stent deployment and, which resulted in the successful control of bleeding. Although these endovascular treatments often result in recurrent carotid blowout syndrome, they can be useful and effective in treating emergent carotid rupture in patients for whom balloon occlusion test is contraindicated.

Bilateral synovial chondromatosis of the temporomandibular joint - Corrected Proof

2010-06-02

Summary: Purpose: To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data.Patients and methods: A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ.Results: SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians’ lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy.Conclusion: SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.

Iatrogenic transposition of the Parotid duct into the maxillary sinus after tooth extraction and closure of an oroantral fistula. A case report - Corrected Proof

Matthias Neuschl, Susanne Kluba, Michael Krimmel, Siegmar Reinert — 2010-05-24

Summary: Case report: We report the clinical course of a patient with a rare iatrogenic surgical complication of transposition of the Parotid duct into the maxillary sinus after tooth extraction.Discussion: Oroantral fistula occurs most frequently following maxillary molar or premolar extraction. Closure of an oroantral fistula is frequently closed using the buccal mucoperiosteal flap first described by Rehrmann in 1936. Transposition of the Parotid duct is a rare surgical complication of this technique.Conclusion: Differential diagnosis of nonspecific discharge from the nose should take this rare cause into account as it is a common symptom of this complication. A careful and full patient history and the correlation of nasal secretion with food intake can lead to the diagnosis.

Analysis of lip motion using principal component analyses - Corrected Proof

Katsuaki Mishima, Tomohiro Yamada, Tatsushi Matsumura, Norifumi Moritani — 2010-05-24

Summary: Objectives: The aim of this study was to quantitatively determine lip movement characteristics during the phonation of Japanese vowels.Materials and methods: Lip motions of 14 normal individuals during the phonation of five Japanese vowels, /a/, /i/, /u/, /e/, and /o/ were analyzed. Using our developed motion analyzing system, range images were produced across the whole sequence during lip motions, and virtual grids were fitted onto surfaces. Principal component analyses were applied with three-dimensional coordinates of intersections for virtual grids regarded as variables.Results and conclusion: The fourth and fifth principal component scores were shown to be parameters that control mouth opening and the retraction of the corners of the mouth, respectively. Discriminate analyses show it is possible to distinguish motion during the phonation of /u/ from that of other vowels.

Functional and aesthetic reconstruction of extensive oral ablative defects using temporalis muscle flap: A case report and a sort review - Corrected Proof

Ioannis George-Akrivos Michaelidis, Ioannis Michael Hatzistefanou — 2010-05-20

Summary: Purpose: Temporalis muscle flap (TMF) provides a reliable solution in reconstruction of extensive intraoral ablative defects, providing a valuable alternative to more complex and extensive reconstructive procedures, combining excellent functional and aesthetic rehabilitation with minimal complications. In this article is described in detail the TMF surgical technique with attention to specific methods useful for preventing facial nerve injury and donor-site deformity.Materials and methods: It is presented the case of a patient with malignant tumour in the region of the upper jaw, palate and inferior half of the nasal cavity, who underwent extensive surgical excision and the resultant defect was successfully reconstructed with TMF.Results: The reconstructive procedure resulted in excellent immediate and long-term functional (aspiration, feeding and speech) and aesthetic results. During the 5-year follow-up period no complications associated with the flap or the temporal implant, used for donor-site reconstruction were encountered and no local recurrence or tumour metastasis was observed.Conclusion: The TMF is a reliable, technically easy and anatomically sound technique, which combines excellent aesthetic and functional results with minimal complications, if performed correctly.

Maxillofacial fractures due to work-related accidents - Corrected Proof

2010-05-18

Summary: One hundred and three patients with maxillofacial fractures due to work-related accidents were analysed. Ninety-nine patients (96.1%) were male and 4 (3.9%) were female. The average age was 46.8 years (range 18–75 years). The injuries were most commonly sustained during construction (42 patients, 40.8%) followed by agriculture and forestry (31 patients, 30.1%) and manufacturing (15 patients, 14.6%). Being struck by an object was the main cause of injury (43 patients, 41.7%) followed by fall from one level to another (31 patients, 30.1%). Fifty-four patients (52.4%) had fractures in the mandible, 41 (39.8%) in the midface, and 8 (7.8%) in both the mandible and the midface. The most common sites for fractures were the condyle and symphysis in the mandible and zygoma in the midface. The facial injury severity scale ranged from 1 to 6 with an average of 1.99±1.18. There was no difference in the nature of the work being undertaken or the cause of the injury.Fractures in other sites were observed in 22 patients (21.4%). Open reduction and fixation was the most frequent treatment for mandibular fractures (25 patients, 40.3%) followed by maxillomandibular fixation (19 patients, 30.6%). Observation was most commonly used for midface fractures (18 patients, 36.7%) followed by open reduction and fixation (15 patients, 30.6%) and transcutaneous reduction (8 patients, 16.3%).

Acute compartment syndrome following fibula flap harvest for mandibular reconstruction - Corrected Proof

2010-05-17

Summary: Donor site morbidity for free fibula osteofasciocutaneous flaps has rarely been reported in the literature. We report on a case of acute compartment syndrome (ACS) in a 22-year-old male, following fibula flap harvest for mandibular reconstruction and arising after post-ischemic reperfusion damage. Dissection during this patient’s surgery was unusually difficult. The skin defect was covered with a loose dressing while waiting for secondary grafting. Intracompartmental pressures measured by the Wick catheter technique confirmed the diagnosis of ACS.ACS is an unexpected complication after fibula flap harvest since the three compartments of the leg are opened during surgery. Only four cases of ACS have been reported in the literature. Analysis of this serious complication might lead to changes in the routine use of the pneumatic tourniquet in some selected cases. New automatic tourniquet systems might also be advantageous in such cases.

Introduction of e-learning in dental radiology reveals significantly improved results in final examination - Corrected Proof

2010-05-10

Summary: Purpose: Because a traditionally instructed dental radiology lecture course is very time-consuming and labour-intensive, online courseware, including an interactive-learning module, was implemented to support the lectures. The purpose of this study was to evaluate the perceptions of students who have worked with web-based courseware as well as the effect on their results in final examinations.Materials and methods: Users (n3+4=138) had access to the e-program from any networked computer at any time. Two groups (n3=71, n4=67) had to pass a final exam after using the e-course. Results were compared with two groups (n1=42, n2=48) who had studied the same content by attending traditional lectures. In addition a survey of the students was statistically evaluated.Results: Most of the respondents reported a positive attitude towards e-learning and would have appreciated more access to computer-assisted instruction. Two years after initiating the e-course the failure rate in the final examination dropped significantly, from 40% to less than 2%.Conclusions: The very positive response to the e-program and improved test scores demonstrated the effectiveness of our e-course as a learning aid. Interactive modules in step with clinical practice provided learning that is not achieved by traditional teaching methods alone. To what extent staff savings are possible is part of a further study.

Posttraumatic subperiosteal orbital hematoma - Corrected Proof

Dinko Leović, Vedran Zubčić, Mirta Kopić, Marko Matijević, Davorin Đanić — 2010-05-10

Summary: Background: Subperiosteal orbital hematoma (SOH) is a rare finding after midface trauma, causing compartment syndrome within the orbit. It should be consideration in the differential diagnosis of any case of proptosis and vertical globe displacement.Patients: We present two patients with SOH treated by surgical evacuation and drainage.Results: In both the hematomas resolved completely and uneventfully.Conclusion: Being a safe and simple method, surgical decompression combined with drainage enables complete evacuation of the blood clot and prevents possible sequelae. This method should be considered even in cases without significant visual impairment.

Clinical, histological and histomorphometrical study of maxillary sinus augmentation using cortico-cancellous fresh frozen bone chips - Corrected Proof

Alessandro Acocella, Roberto Bertolai, Joseph Nissan, Roberto Sacco — 2010-05-10

Summary: Background: Insufficient bone volume in the posterior maxilla can be a major problem when placing dental implants. One of the goals of sinus augmentation procedures is the creation of sufficient volume of vital bone for the subsequent insertion and complete osseointegration of implants placed in the posterior maxilla.The aim of the present study was a clinical, histological and histomorphometrical analysis of maxillary sinus augmentation using human fresh frozen bone (FFB) allografts for maxillary sinus lift augmentation procedures.Methods: Fifteen patients were treated with maxillary sinus augmentation using FFB. After three months, a bone biopsy was taken before implant placement in order to evaluate the healed bone from a histological and histomorphometrical point of view. After further three months, all implants were osseointegrated according to radiographic and clinical examinations. Abutment connection was performed and the patients received prosthetic restoration of the missing teeth.Results: Histologically all the specimens showed signs of active remodelling and all the tissues were free of inflammatory cells. After 12 months of assessment, no implants had failed.Conclusion: Our findings suggest that FFB is a biocompatible material that can be successfully used for maxillary sinus augmentation.

Unusual case of a conservatively treated pathological fracture after sequestrectomy in a patient with long-term oral bisphosphonate use - Corrected Proof

Sophie C.C. Kuijpers, Erik W. van Roessel, J.P. Richard van Merkesteyn — 2010-05-04

Summary: Bisphosphonates are used in the management of metastatic bone disease, Paget’s disease of bone and osteoporosis. A long-term complication of these drugs is bisphosphonate-related osteonecrosis of the jaws (BRONJ). Treatment of BRONJ can be quite challenging, and remains a topic of debate.We report the case of a 74-year-old woman who had used Fosamax® (alendronate sodium) orally for four years. After 3½ years she developed pain, swelling, and a fistula in the left mandible. After exploration and sequestrectomy in combination with antibiotic treatment, osteolysis with a pathological fracture developed. Given the extent of the disorder and a decrease in complaints after the surgery, a non-surgical approach was chosen with continuation of the antibiotic treatment for 10 weeks, a soft diet and not wearing of dentures. During follow-up complaints subsided, the intra-oral fistula disappeared and the fracture healed.This is the first report of healing of a BRONJ patient stage III with pathological fracture. It illustrates the remaining healing potential of the bisphosphonate-treated bone.

Bisphosphonate-related osteonecrosis of the jaws: A review of 34 cases and evaluation of risk - Corrected Proof

Athanassios Kyrgidis, Konstantinos Vahtsevanos — 2010-05-03

We read with great interest the paper “Bisphosphonate-related osteonecrosis of the jaws: A review of 34 cases and evaluation of risk” by Kos et al. in the Online First section of the Journal of Cranio-Maxillofacial Surgery (). The paper reports the experience of a single centre in treating 34 patients with bisphosphonate (BP) related osteonecrosis of the jaws (ONJ) (). We would like to compliment the authors with their work, but we feel that important information may be missing from the discussion.

Future of local bone regeneration – Protein versus gene therapy - Corrected Proof

J. Fischer, A. Kolk, St. Wolfart, C. Pautke, P.H. Warnke, C. Plank, R. Smeets — 2010-05-03

Summary: The most promising attempts to achieve bone regeneration artificially are based on the application of mediators such as bone morphogenetic proteins (BMPs) directly to the deficient tissue site. BMPs, as promoters of the regenerative process, have the ability to induce de novo bone formation in various tissues, and many animal models have demonstrated their high potential for ectopic and orthotopic bone formation. However, the biological activity of the soluble factors that promote bone formation in vivo is limited by diffusion and degradation, leading to a short half-life. Local delivery remains a problem in clinical applications. Several materials, including hydroxyapatite, tricalcium phosphate, demineralised bone matrices, poly-lactic acid homo- and heterodimers, and collagen have been tested as carriers and delivery systems for these factors in a sustained and appropriate manner. Unfortunately these delivery vehicles often have limitations in terms of biodegradability, inflammatory and immunological rejection, disease transmission, and most importantly, an inability to provide a sustained, continuous release of these factors at the region of interest. In coping with these problems, new approaches have been established: genes encoding these growth factor proteins can be delivered to the target cells. In this way the transfected cells serve as local “bioreactors”, as they express the exogenous genes and secrete the synthesised proteins into their vicinity. The purpose of this review is to present the different methods of gene versus growth factor delivery in tissue engineering. Our review focuses on these promising and innovative methods that are defined as regional gene therapy and provide an alternative to the direct application of growth factors. Various advantages and disadvantages of non-viral and viral vectors are discussed. This review identifies potential candidate genes and target cells, and in vivo as well as ex vivo approaches for cell transduction and transfection. In explaining the biological basis, this paper also refers to current experimental and clinical applications.

The rare phenomenon of vascular pedicle ossification of free fibular flap in mandibular reconstruction - Corrected Proof

2010-05-03

Summary: Ossification of the vascular pedicle in the vascularized free fibular flap (VFFF) has been only previously described twice for jaw reconstruction. A case of severe trismus secondary to periosteal osteogenesis following VFFF for maxillary reconstruction, and four cases of ossification of the vascular pedicle in VFFF for maxillary and mandibular reconstruction have been respectively described. Etiology remains unclear, although presence of periosteum in continuity with bone seems to play a major role. Hormonal stimuli, stress over the bone, and corticosteroid therapy have been proposed as determinant factors, although no clear correlation has been already established. No histologic studies concerning the generation of new bone around the vascular pedicle in VFFF are nowadays present. We report a new case of vascular pedicle ossification of VFFF following mandibular reconstruction, this being the third report in the literature, and focus on histologic examination of the specimen.

Length of the drilling holes of zygomatic implants inserted with the standard technique or a revised method: A comparative study in dry skulls - Corrected Proof

2010-04-30

Summary: Aim: This study aimed to evaluate the length of the holes drilled for the placement of zygomatic implants using two surgical techniques: the original Brånemark and the Exteriorized (extrasinus) protocols. The most frequent implant length used and position where the implants emerged in the zygomatic bone were recorded.Materials and methods: Both surgical techniques for inserting zygomatic implants were performed on the right and left sides of 18 dry adult skulls. The depth of the drilling holes in the zygomatic bone for placement of zygomatic implants and the corresponding implant length were measured. The position where the implant emerged was recorded using a standardized division of the zygomatic bone surface into 13 sections ().Results: The Exteriorized technique showed significantly longer drilling holes for zygomatic implants than the Brånemark technique (P<0.001). For both techniques, the most commonly used implant lengths were 30 and 35mm, and the most frequent position where the implants emerged were sections 9 and 12.Conclusions: The results suggest that the Exteriorized technique increases the length of the drilling holes in the zygomatic bone, which may provide higher initial mechanical stability for zygomatic implants than the original Brånemark technique.

Initial results of the treatment of diffuse sclerosing osteomyelitis of the mandible with bisphosphonates - Corrected Proof

2010-04-28

Summary: Objective: Diffuse sclerosing osteomyelitis (DSO) of the mandible is characterised by recurrent pain, swelling of the cheek and trismus. Treatment is difficult and symptoms often recur. Recently case reports and small series have reported good results after treatment with bisphosphonates.Study design: Seven patients suffering from treatment resistant DSO were treated with intravenous bisphosphonates. Diagnosis was based on clinical, radiological and histopathological examination. Symptoms had been present for between 20 and 167 months (mean 78). Patients were admitted, laboratory tests and Technetium-scans were performed. Pamidronate was administered intravenously up to four times a year. Follow-up varied from 18 to 46 months (mean 30).Results: In all patients, symptoms and the need for analgesic drugs diminished considerably. One patient remained free of symptoms after one treatment. In two patients a switch in bisphosphonate was made based on a decreased response. All patients showed a decrease in uptake in the DSO-area on the Tc-scans when comparing pre- and post-treatment. One patient was lost to follow-up.Conclusion: In therapy-resistant DSO bisphosphonate treatment may be a good option.

A comparison of craniofacial cephalometric morphology and the later need for orthognathic surgery in 6-year-old cleft children - Corrected Proof

Arja Heliövaara, Jorma Rautio — 2010-04-28

Summary: Objectives: To compare 6-year-old children with unilateral cleft lip and palate (UCLP) and children with unilateral cleft lip and a separate cleft palate (CL+CP), cephalometrically and to evaluate the need for orthognathic surgery of these children in later life.Materials and methods: One hundred and seven cleft children (67 UCLP, 40 CL+CP) were compared retrospectively using lateral cephalograms taken at a mean age of 6.2 years (range 5.7–7.3). The need for maxillary or bimaxillary osteotomies in these patients was evaluated from the hospital records at the mean age of 18.1 years (range 15.6–20.5).Results: The craniofacial morphology of children with UCLP and CL+CP was similar except for a more retrusive maxilla in children with UCLP. The frequency of orthognathic surgery was 40% (27/67) in the UCLP group and 18% (7/40) in the CL+CP group. The patients who needed orthognathic surgery (UCLP and CL+CP combined) had smaller mean values of ANB angle at the age of 6 years when compared to those who did not (1.8 versus 3.9°). None of the children whose ANB angle was greater than 4.5 needed orthognathic surgery whereas all the children whose ANB angle was less than −1 needed osteotomies.Conclusion: Six-year-old children with UCLP have more retruded maxillae and require orthognathic surgery later in life more often than the children with CL+CP.

Osteoporosis influences the early period of the healing after distraction osteogenesis in a rat osteoporotic model - Corrected Proof

Seiko Tatehara, Youji Miyamoto, Masaaki Takechi, Yukihiro Momota, Tetsuya Yuasa — 2010-04-26

Summary: Introduction: Despite the clinical adoption of distraction osteogenesis (DO), studies examining the bone healing process at the distraction gap in osteoporotic bone are limited. We examined the effect of osteoporosis in the ovariectomized rat on DO.Material and methods: Mid-diaphyseal osteotomies were performed on the femurs of ovariectomized (OVX) rats. External distractors were placed on these rats and also on sham-ovariectomized rats. After a 7-day latency period, distraction was carried out at a rate of 0.5mm/day for 10 days. The bone volume (BV) of the distraction gap was measured by Micro-focused X-ray computed tomography (micro-CT) at 0, 2, and 4 weeks after completion of the distraction, and the distraction gap was examined histologically.Results: The BV of the distraction gap in the OVX group was significantly lower than that in the sham group at 2 and 4 weeks after completion of distraction (p<0.01). On histological examination, the distraction gap in the OVX group was filled with scattered smaller bone trabeculae than those seen in the sham group at 4 weeks after completion of distraction. Osteoclast numbers at the distraction gap in the OVX group were significantly increased when compared to the sham group (p<0.01).Conclusion: Bone turnover with osteoclast predominance in ovariectomized rats is likely to be the cause of a reduction in new bone formation at the distraction gap.

The importance of a differential diagnosis between true hemifacial microsomia and pseudo-hemifacial microsomia in the post-surgical long-term prognosis - Corrected Proof

2010-04-26

Summary: Long-term results after surgical treatment of the mandibular asymmetry in growing children with hemifacial microsomia (HFM), whether with osteotomies or distraction osteogenesis, have mostly shown a tendency towards the recurrence of the asymmetry. In contrast, in the literature we find sporadic case reports where the long-term post-surgical follow-up of patients diagnosed as HFM, are surprisingly stable. All these reports refer to patients who have substantially no soft tissue involvement, but only severe mandibular ramus and condyle deformities. The phenotypes of these cases are unexpectedly similar. The authors suggest, that it is possible that all of these cases might be isolated hemimandibular hypoplasias, misdiagnosed as HFM, which present a normal functional matrix and, therefore, tend to grow towards the original symmetry. Differential diagnosis between true HFM and this HFM-like isolated hemimandibular hypoplasia (pseudo-HFM) is of great importance given the very different prognosis and it is possible through the collaboration between not only surgeons and orthodontists, but also of geneticists and dysmorphologists.

Elusive penetrating foreign body to the neck causing partial epiglottic airway obstruction - Corrected Proof

Jeethendra Rao, Ahmed Messahel, Katie Grimes, Kevin Sanders — 2010-04-26

Summary: We present a case of a penetrating foreign body to the neck, which was difficult to detect, causing partial epiglottic and laryngeal outlet airway obstruction, and subsequent intubation challenges. A systematic approach with rapid access to contrast enhanced CT scanning allowed successful airway and haemorrhage control, removal of a wooden stake from the patient’s neck, initially undetected at primary and secondary assessments.

Application of PRP gel alone or in combination with guided bone regeneration does not enhance bone healing process: An experimental study in rabbits - Corrected Proof

2010-04-26

Summary: Introduction: The aim of this study was to assess the hypothesis that application of platelet-rich plasma (PRP) gel in mandibular defects in rabbits, alone or in combination with guided bone regeneration (GBR) techniques, could enhance the bone healing process.Materials and methods: Thirty New Zealand white rabbits were used. Three groups of 10 animals each were assigned, and the animals were sacrificed after 12 weeks. During the operation, a rotating trephine bur was used to create circular defects 10-mm in diameter in the region anterior to the jaw angles. In group human fascia lata (HFL), a human fascia lata membrane was used. In group PRP, PRP gel was used to fill the defect, and in group HFL+PRP, PRP was used to fill the defect which after that was covered with a human fascia lata membrane.Results: In general, none of the control sides and the PRP treated sides had full development of bone or filling of the defect through bone bridging. Conversely, the sides on which the fascia lata membrane or the combination of membrane and PRP had been applied were characterized mostly by development of newly formed bone that bridged the gap.Conclusions: Our results suggest that the application of PRP gel alone or in combination with GBR does not enhance bone healing process.

Healing of displaced condylar process fracture in rats submitted to protein undernutrition - Corrected Proof

Lucimar Rodrigues, Luciana Corrêa, João Gualberto C. Luz — 2010-04-26

Summary: Introduction: This study evaluated the healing of mandibular condylar fracture in rats submitted to experimental and protein undernutrition (8% of protein) by means of histological analysis.Material: Forty-five adult Wistar rats were divided into three groups of 15 animals: a fracture group, who were submitted to condylar fracture with no changes in diet; an undernourished fracture group, who were submitted to a low protein diet and condylar fracture: an undernourished group, kept until the end of experiment, without condylar fracture. Displaced fractures of the right condyle were created under general anaesthesia. The histological study comprised fracture site and temporomandibular joint evaluations.Results: The undernourished fracture group showed significant weight loss. There was a marked decrease in the values of serum proteins and albumin in the undernourished fracture group. Histological analysis showed that protein undernutrition lead to atrophy of the condylar fibrocartilage. Fractures in undernutrition presented a delay in callus formation due to more extensive devitalized bone areas, and after 3 months there were still bone formation areas, while fibrous ankylosis occurred in the articular space.Conclusion: It was concluded that mandibular condyle fractures in rats with protein undernutrition had impaired callus formation, as well as fibrous ankylosis into the temporomandibular joint.

The influence of local administration of simvastatin in calvarial bone healing in rats - Corrected Proof

2010-04-26

Summary: Some authors have associated the use of statins, hypolipidemic drugs, and new bone formation. The aim of this work was to evaluate the effect of locally administered simvastatin on bone healing. Bone calvarial defects 5mm in diameter were made in 64 rats. The animals were divided into four groups according to the graft material: the control group, in which the defects were not treated, the SIM-1 group, which received a sponge of collagen soaked with simvastatin (2.2mg/50μl), the SIM-2 group, which received a sponge of collagen soaked with simvastatin (0.5mg/50μl), and the carrier (CAR) group, which received a sponge of collagen and water. The animals were sacrificed after 30 or 60 days. The skulls were removed, and radiographic densitometry and histometric analyses of the bone defect area were performed. Local crust formation was clinically verified in SIM-1 and SIM-2 animals. After statistical analysis (p<0.05) of bone area data, we observed no significant differences among the groups after 30 days. After 60 days, however, there was less bone formation in the CAR and SIM-2 groups. The SIM-2 group also presented with lower radiographic densities after 60 days. According to the methodology used, we conclude that locally administered simvastatin was detrimental to the repair of defects in the calvaria of rats.

Value and reliability of anthropometric measurements of cranial deformity in early childhood - Corrected Proof

2010-04-26

Summary: Objectives: Since the “back to sleep” campaign initiated by the American Pediatric Society in 1992, an increasing incidence of positional cranial deformity in early infancy has been widely observed. Anthropometric caliper measurements present the most practical tool for diagnosis and decision making although their value is being controversially discussed in literature.Patients and methods: Our study included 30 randomly chosen infants who had been diagnosed with plagiocephaly, brachycephaly, or a combination of both conditions. The 10 patients in each group were then measured anthropometrically by three examiners. The following parameters were measured six times in a standard manner and with a standard head position by each examiner: circumference, length, width, and oblique distance from the fronto-temporal area (ft) to the lambdoid suture on each side of the head (ld). Inter- and intra-observer variabilities for every value were statistically evaluated by a variance components estimation procedure.Results: Both inter- and intra-observer agreement had very low variability. Overall, mean inter-observer variability was lower than 0.182mm2, and mean intra-observer variability was lower than 1.131mm2. Altogether, interobserver variability as well as intraobserver variability had a maximum of about 2 mm measurement variance.Conclusions: Standardized measurements are highly reproducible to quantify early childhood head deformity. Standard head position is indispensable for reliable measurement. Repeatability of anthropometric measurements is essential to define diagnoses and severity codes and to develop treatment concepts.

Viability of crushed human auricular and costal cartilage chondrocytes in cell culture - Corrected Proof

Fuat Buyuklu, Evren Hizal, Zerrin Yilmaz, Feride Iffet Sahin, Ozcan Cakmak — 2010-04-26

Summary: The amount or quality of available septal cartilage may be inadequate for grafting in some rhinoplasty patients. In such cases, auricular or costal cartilage may provide an additional source of cartilage. Crushed septal cartilage has been shown to be useful for dorsal onlay grafts. We aimed to investigate the effect of different degrees of crushing on the viability of human auricular and costal cartilage. Ten auricular and 10 costal cartilage grafts were obtained from 20 patients during secondary rhinoplasty. Each graft was sectioned into five pieces. One of the pieces was left intact and the remaining four were prepared as slightly, moderately, significantly, and severely crushed. Viability and proliferation rates of chondrocytes in cell cultures were evaluated. Mean viability rates on day 1 for intact, slightly crushed, moderately crushed, significantly crushed, and severely crushed auricular cartilages were 70%, 67%, 65%, 58%, and 45%; while those for costal cartilages were 65%, 63%, 59%, 55%, and 53%, respectively. There was no statistically significant difference between the viability rates of the similarly crushed auricular and costal cartilage groups on days 1, 2, 3 and 10. The viability of crushed human auricular and costal cartilage grafts depends on the degree of crushing applied.

Temporomandibular joint chondrosarcoma: Case report - Corrected Proof

2010-04-26

Summary: Tumours of the temporomandibular joint (TMJ) often mimic common conditions of the TMJ, such as TMJ dysfunction syndrome, leading to a delay in the diagnosis.Chondrosarcoma of the TMJ is a rare tumour, with only 18 cases described in the literature. The initial surgical attempt at removal is of important, as aggressive excision offers the best chance for successful treatment. Chondrosarcoma present at the surgical resection margins has a poor prognosis. We present a case of chondrosarcoma of the right TMJ. In our case, combined diagnostic techniques consisting of a panoramic radiograph, computed tomography (CT) and magnetic resonance imaging (MRI) made an accurate preoperative assessment possible and significantly influenced the treatment provided.

Treatment with individual orbital wall implants in humans – 1-Year ophthalmologic evaluation - Corrected Proof

2010-04-23

Summary: Background: In 2009 a method of creating individual, patient specific orbital wall implants using rapid prototyping (RP) was shown in a preliminary human study. That study showed that it is financially viable to produce anatomical models and that this technology could be used in the repair of orbital floor fractures.Materials and methods: In this study, 24 consecutive subjects who had sustained orbital fractures (14 males, 6 females) without any coexisting central nervous system or globe injury were assessed post-operatively. The first series of 12 patients, recruited during the period 2005–2006, were treated with classical method (CM) of forming titanium mesh by manual manipulation, based on individual subjective assessment of the extent and shape of damaged orbital walls. The following 12 cases, recruited between 2007 and 2008, were treated with patient specific titanium mesh implants designed with an RP method. Early (2 weeks) and late (12 months) follow-up was performed. Patients were evaluated by binocular single vision (BSV) test and an assessment of eye globe motility.Results: The superiority of the RP treatment method over CM was shown on the basis of early results when BSV loss area and reduction of vertical visual disparity (VVD) in upgaze were considered. Better outcomes for the RP group were confirmed in the late follow-up results which showed a reduction of BSV loss area, correction of primary globe position and a very significant improvement in upgaze.Conclusions: One-year post-operatively, functional assessment of pre-bent individual implants of the orbital wall has shown the technique to be a predictable reconstruction method. Nevertheless longer follow-up and an increase in the number of cases treated are required for the full evaluation of the technique.

Aesthetic and functional radical surgery in young patients with stage one or two tongue cancer: A preliminary report - Corrected Proof

2010-04-23

Summary: Introduction: The effect of an initial radical cure and the post-operative quality of life in young patients with stage one or two tongue cancer seems to be more important than in old patients. The aim of this study was to achieve both optimal surgical effectiveness and improved post-operative quality of life for young patients with stage one or two tongue cancer.Materials and methods: 7 patients under 40 years of age with T1-T2N0M0 squamous cell carcinoma of tongue underwent aesthetic and functional radical surgery in which reconstruction of the defect in the oral cavity and conservation of the main functional organs in neck with good scar aesthetics in the face and neck were performed. The outcomes were assessed clinically.Results: No tumour recurrence was found in the tongue, floor of mouth or neck at the end of follow-up (at least 37 months). The appearance of the tongue and oral function was retained; function in face, neck and shoulder was maintained; a satisfactory cosmetic appearance of the face and neck was achieved.Conclusions: Aesthetic and functional radical surgery could ensure radical cure and unchanged, or improved post-operative, quality of life in young patients with stage one or two tongue cancer.

Giant pilomatricoma involving the parotid: Case report and literature review - Corrected Proof

Gerhard S. Mundinger, Derek M. Steinbacher, Justin A. Bishop, Anthony P. Tufaro — 2010-04-23

Summary: Introduction: Pilomatricomas greater than 5cm in dimension (i.e. “giant” pilomatricomas) are uncommon, especially in the cheek. A brief review of the literature is presented.Case report: We report a rare case of a giant pilomatricoma of the right cheek immediately overlying and involving the lateral lobe of the parotid gland. The tumour was removed with preservation of the facial nerve. A cervicofacial fasciocutaneous advancement flap was used to reconstruct the surgical defect.Conclusion: Pilomatricoma should be considered in the differential diagnosis of large cheek tumours. Giant pilomatricomas involving the parotid gland can be excised without sacrificing the facial nerve and the resultant surgical defect reconstructed with excellent cosmesis in a single-stage procedure.

Intraoperative control of resection margins in advanced head and neck cancer using a 3D-navigation system based on PET/CT image fusion - Corrected Proof

2010-04-09

Summary: Local recurrent of disease in advanced carcinomas of the head and neck is strongly correlated with the presence of positive or close resection margins after operative treatment. The purpose of this study is to present a new method of assessing resection margins intraoperatively using image-guided surgery based on positron emission tomography/computed tomography (PET/CT) image fusion.In 6 patients who underwent surgical treatment of head and neck stage for T4a–T4b carcinomas PET/CT image fusion was done on the workstation of a 3D-navigation system. Intraoperative image-guided navigation of the defect following surgical ablation of the tumour was performed in every patient.Intraoperative navigation of the ablative defect showed an unsafe resection margin in 4 patients.In three of these patients additional image-guided resection allowed local control of the tumour to be achieved. In one patient additional resection was not possible due to skull base invasion. The histopathological exam of the four tumour specimens confirmed positive or close resection margins.The current results suggest that intraoperative control of the surgical margins using a 3D-navigation system based on PET/CT image fusion can be a useful tool to assess and improve local control in advanced cancer of the head and neck.

Influence of rhBMP-2 on bone formation and osseointegration in different implant systems after sinus-floor elevation. An in vivo study on sheep - Corrected Proof

2010-04-09

Summary: Background: Several studies have reported certain bone morphogenic proteins (BMPs) to have positive effects on bone generation. Although some investigators have studied the effects of human recombinant BMP (rhBMP-2) in sinus augmentation in sheep, none of these studies looked at the placement of implants at the time of sinus augmentation. Furthermore, no literature could be found to report on the impact that different implant systems, as well as the positioning of the implants had on bone formation if rhBMP-2 was utilized in sinus-lift procedures.Purpose: The aim of this study was to compare sinus augmentation with rhBMP-2 on a poly-d, l-lactic-co-glycolic acid gelatine (PLPG) sponge with sinus augmentation with autologous pelvic cancellous bone in the maxillary sinus during the placement of different dental implants.Materials and methods: Nine adult female sheep were submitted to bilateral sinus-floor elevation. In one side (test group) the sinus lift was performed with rhBMP-2 on a PLPG-sponge, while the contralateral side served as the control by using cancellous bone from the iliac crest. Three different implants (Bränemark®, 3i® and Straumann®) were inserted either simultaneously with the sinus augmentation or as a two staged procedure 6 weeks later. The animals were sacrificed at 6 and 12 weeks for histological and histomorphometrical evaluations during which bone-to-implant contact (BIC) and bone density (BD) were evaluated.Results: BD and BIC were significantly higher at 12 weeks in the test group if the implants were placed at the time of the sinus lift (p<0.05). No difference was observed between the different implant systems or positions.Conclusions: The use of rhBMP-2 with PLPG-sponge increased BIC as well as BD in the augmented sinuses if compared to autologous bone. Different implant systems and positions of the implants had no effect on BIC or BD.

Pullout strength of a biodegradable free form osteosynthesis plate - Corrected Proof

2010-04-08

Summary: The Inion® Free Form Plate is a newly designed biodegradable plate. After drilling through the plate and tapping, a biodegradable screw can be inserted, followed by removal of the screw head. As an alternative a countersink screw can be used.Aim of the study was to compare the mechanical properties of the 1.4mm Free Form Plate with the 2.0mm conventional shaped plate.Mechanical testing of the plate pullout strength was conducted for the Inion® Free Form Plate fixed with an Inion OTPS™ 2.0×20mm Screw. In addition, the failure mode was reported.Overlapping confidence levels were found with regard to the yield load, first peak load and maximum load, when comparing the Free Form Plate and the conventional 4-hole plate. The Free Form Plate fixed with a screw with head and countersink showed the highest stability at maximum load. The results of the mechanical stability testing showed no significant differences between the tested plates. The main failure mode was a failure of the screw shaft.The results of the current investigation imply that the 1.4mm Free Form Plate could be used as an alternative to the 2.0mm conventional shaped plate.

Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years' experience - Corrected Proof

Ioannis Iatrou, Nadia Theologie-Lygidakis, Fotios Tzerbos — 2010-04-02

Summary: Trauma and facial fractures in a population of children have been analysed in several studies mainly regarding their incidence and much less their treatment modalities.Aim: The aim of this study was to retrospectively analyse the treatment methods and outcome of facial fractures in children and young adolescents during the last decade and to discuss findings and propose treatment protocols.Patients and methods: Patients of the Paediatric Maxillofacial department, treated for fractures of the facial skeleton were included in the study. Open reduction and osteosynthesis plate fixation (titanium and resorbable material) was the main treatment method with conservative treatment saved for selected cases. Titanium plates were removed after bone healing. Intermaxillary fixation (IMF) was not used regularly in mandibular fractures, with the exception of condylar fractures.Results: 156 children and young adolescents with 208 fracture sites in total were treated. 139 fracture sites (66.8%) were treated with open reduction and 69 conservatively. The mandible was affected in 49.0% of the cases, the maxilla in 21.2% (both with the alveolar process fractures included), the zygomatic complex in 10.1%, the orbital walls in 9.6%. There were 38 alveolar process fractures.Conclusion: The results of the fracture treatment verified the usefulness of open reduction and plate fixation in children. There was no need for wire suspension and only occasional need for IMF. Closed reduction was selectively applied in condylar fractures and dento-alveolar trauma.

Xeroderma pigmentosum: a review and case series - Corrected Proof

Fawzia M.A. Butt, Jeremiah R. Moshi, Sira Owibingire, Mark L. Chindia — 2010-03-26

Summary: Xeroderma pigmentosa (XP) is a condition inherited as an autosomal recessive trait and is characterized by photosensitivity, pigmentary changes, premature skin ageing and malignant tumour development resulting from the defect in DNA repair. The management of complications of XP, especially orofacial tumours entails an enormous surgical challenge to the clinicians. We present five cases of XP.