Versatility of Dieffenbach’s Modification of Weber Fergusson’s Approach for Treatment of Maxillary Pathologies

Objective

The aim of the study is to evaluate the usage of Dieffenbach’s modification of Weber–Fergusons approach in the treatment of lesions involving maxilla.

Study

In this study five different maxillary pathologies were approached through Dieffenbach’s modification of Weber–Fergusons approach. Partial and subtotal procedures were performed depending on the type of pathology and the extent of the lesion which was assessed both clinically and radiologically. The study evaluates the easy exposure of the site, post operative complications like scar formation and infra orbital nerve parasthesia.

Results

There were two subtotal maxillectomy procedures and three partial maxillectomy procedures approached through Dieffenbach’s modification of Weber–Fergusson’s approach. All the cases recovered well in the post operative healing period without noticeable scarring. There was parasthesia in three cases which subsided in 3 months.

Conclusion

The approach through Dieffenbach’s modification of Weber–Fergusons incision gave better visibility and accessibility to the lesions of maxilla. Because there is direct access to the pathology, the inadvertent resection of the un-involved structures is prevented thus minimizing the morbidity.     

Three-dimensional analysis of changes of the malar–midfacial region after LeFort I osteotomy and maxillary advancement

Aim

It has been the objective of the present prospective study to assess visible volume changes of the facial soft tissue after LeFort I osteotomy with advancement and to determine the soft-tissue-to-hard-tissue ratios of advancement.

Patients and methods

Twenty adult patients (ten female, ten male, mean age 33.9?±?14.9 years) received a LeFort I osteotomy with advancement because of a maxillary protrusion. Lateral skull radiographs and optical three-dimensional (3D) scans of the facial surface were assessed preoperatively and 12 months after surgery. The lateral skull radiographs were used to carry out standard linear and angular cephalometric measurements. The pre- and postoperative optical 3D surface scans were registered. A well-defined area in the malar region was used to determine the visible volume changes for each side separately. The mean accommodation vector that transforms the preoperative into the postoperative surface was assessed for each facial half separately. The soft-tissue-to-hard-tissue ratios between the incision superius and the labrale superius, the maximal parasagittal advancement of soft tissue, and the accommodation vectors were calculated.

Results

A mean advancement of the incision superius of 5.3?±?2.1 mm was accompanied by a volume increase of 5.2?±?4.1 cm³ in the right malar–midfacial region and 4.6?±?4.7 cm³ on the left side, respectively, revealing a symmetrical volume change (p?=?0.370). The soft-tissue-to-hard-tissue ratios were 80?±?94% for labrale superius and incision superius, 56?±?79% (right) and 51?±?56% (left) for accommodation vector and incision superius and 97?±?79% (right) and 98?±?89% (left) for maximal parasagittal advancement of soft tissue and incision superius.

Discussion

The determination of volume changes and accompanying accommodation vectors complete the cephalometric analysis during the follow-up of patients undergoing LeFort I osteotomy. The data show that maxillary advancement leads to a more pronounced shifting of the soft tissues in the malar–midfacial area than of the upper lip. The new parameters will help to assess normative soft tissue data based on 3D imaging with a view to an improved three-dimensional prediction of the operative outcome of orthognathic surgery away from the midline.     

Three-dimensional observation of the mouse embryo by micro-computed tomography: Meckel’s cartilage, otocyst, and/or muscle of tongue

Three-dimensional observation during embryogenesis is possible with micro-computed tomography, but there are no observations of organ size. In this paper, three examples of three-dimensional observation of organs by micro-CT are tried. At 13.0 days post-coitum, mouse embryos were fixed in 4% paraformaldehyde for 24 h and stained enbloc by osmium tetroxide overnight. The embryos were then embedded in paraffin using standard methods for 24 h. Specimens were analyzed by micro-computed tomography and image processing was performed. The entire Meckel's cartilage and its relation in the mandible, as well as the complex structure of the otocyst, are easily visualized. Although it is difficult to extract detailed structures of the tongue muscles, it is possible to identify the inner and external tongue muscles. Relation among the organs and other are easily visualized. Three-dimensional observation by micro-computed tomography is an important technology for visualization of embryogenesis and could be used in organ culture.     

Malignant tumors of Stensen’s duct

A rare case of squamous cell carcinoma arising in Stensen’s duct is reported. The literature concerning malignant neoplasia originating in this site is reviewed, with attention given to the histopathologic diversity of neoplasms occurring in the duct, criteria for determination of origin in the duct, and outcomes of therapy. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:73-7)     

Association between a child’s caries experience and the mother’s perception of her child’s oral health status

BackgroundMothers play a primary role in the health of their children. This role may be of particular importance for children in Appalachia who have increased caries relative to children in other regions of the United States. The authors examined the degree to which a child’s caries experience was in concordance with the mother’s perception of the health of her child’s teeth, and how concordance varied by sociodemographic factors.MethodsThe authors obtained cross-sectional data on mother-child dyads with children younger than 6 years through the Center for Oral Health Research in Appalachia study. They interviewed and clinically examined a community-based sample of 815 mother-child dyads from Pennsylvania and West Virginia. They used an unadjusted zero-inflated negative binomial model to estimate the association between a mother’s perception of her child’s oral health status and her child’s caries. The authors compared sociodemographic factors between concordant and nonconcordant mother-child dyads using χ² tests.ResultsThe mother’s perception of her child’s oral health status was associated with the child’s caries experience (P < .001). Two-thirds of mother-child dyads showed concordance between the mother’s perception of her child’s oral health status and the child’s caries experience (n = 522, 64%). Concordance was associated with younger child age and the child having dental insurance (P < .01).Conclusions and Practical ImplicationsOn average, mothers accurately perceived their child’s caries experience. This accuracy was higher for younger children and children with dental insurance. The mother’s awareness of her child’s oral health status could be used to develop effective prevention and treatment strategies, particularly for young children vulnerable to caries.     

Hogan’s modification of the Sanvenero-Rosselli velopharyngoplasty

Purpose

A competent velopharyngeal mechanism is essential for the production of intelligible speech and the secondary procedure of the posterior pharyngeal flap may be necessary in some patients to achieve this goal. The purpose of this study was to examine short and long-term results between the Sanvenero-Rosselli and Hogan’s modification of the cranially based velopharyngoplasty.

Methods

During a 20-year period, 17 patients underwent secondarily a posterior pharyngeal flap to treat velopharyngeal incompetence. All the patients were treated in the same institution and under the supervision of the same stuff surgeon. Nine patients were operated on according to the Sanvenero-Rosselli method and eight according to Hogan’s modification, which consists of the preparation of two mucosal flaps on the dorsal side of the soft palate. Both mucosal flaps are sutured at the base of the pharyngeal flap and cover its raw surface.

Results

Comparing the post-operative condition of the patients in two groups to their pre-operative state, it was observed that speech and comprehensibility were significantly improved, but Hogan’s technique produced better speech results.

Conclusions

According to our limited experience, additional surgical effort to create mucosal flaps on the nasal surface of the soft palate in Hogan’s technique is compensated for by the reliable and substantial advantages that this technique holds, compared to Sanvenero-Rosselli’s original proposition.     

Semi-quantitative analysis of salivary gland scintigraphy in Sjögren’s syndrome diagnosis: a first-line tool

Clinical Oral Investigations - The aim of this study was the assessment of semi-quantified salivary gland dynamic scintigraphy (SGdS) parameters independently and in an integrated way in order to...     

Three-dimensional architectural and structural analysis—a transition in concept and design from Delaire's cephalometric analysis

The aim of this study was to present a systematic sequence for three-dimensional (3D) measurement and cephalometry, provide the norm data for computed tomography-based 3D architectural and structural cephalometric analysis, and validate the 3D data through comparison with Delaire's two-dimensional (2D) lateral cephalometric data for the same Korean adults. 2D and 3D cephalometric analyses were performed for 27 healthy subjects and the measurements of both analyses were then individually and comparatively analyzed. Essential diagnostic tools for 3D cephalometry with modified definitions of the points, planes, and measurements were set up based on a review of the conceptual differences between two and three dimensions. Some 2D and 3D analysis results were similar, though significant differences were found with regard to craniofacial angle (C1–F1), incisal axis angles, cranial base length (C2), and cranial height (C3). The discrepancy in C2 and C3 appeared to be directly related to the magnification of 2D cephalometric images. Considering measurement discrepancies between 2D and 3D Delaire's analyses due to differences in concept and design, 3D architectural and structural analysis needs to be conducted based on norms and a sound 3D basis for the sake of its accurate application and widespread adoption.     

Jacob’s disease: Report of a case

Purpose: Jacob’s disease (JD) is an uncommon disorder that presents as pseudojoint formation between the enlarged mandibular coronoid process and the zygoma, resulting in mouth opening limitation (MOL). Intraosseous lipoma (IOL) usually presents in the long bone, but it is very rare in the mandible. The authors present a rare case of JD and coexisting IOL in the same anatomical area and discuss diagnosis and surgical intervention. Clinical presentation and intervention: The patient was a 39-year-old Korean female with MOL. Magnetic resonance imaging showed a large lobulated mass with fat-specific signal intensity. A combined extraoral and intraoral approach was used to resect the large mass. Histopathologic examination revealed a degenerated lipomatous tumor replacing the marrow cavity, with cartilaginous cap formation on the articular surface. Conclusion: Postoperatively, the patient showed uneventful healing and resolution of MOL.     

(iii) Ewing’s sarcoma of bone

Ewing’s sarcoma is a primitive malignant bone tumour consisting of small, blue, round malignant cells that may show varying degrees of neural differentiation. It accounts for approximately 5% of all malignant bone tumours and arises most frequently in children or adolescents. Despite significant progress with the use of intensive multiagent chemotherapy and local control measures (survival rates have increased from 10–15% to 65–70% in the last 40 years), a significant proportion of patients still die of disease progression. Clinical and biological prognostic factors should be used to guide the therapeutic choices for each patient. The treatment of Ewing’s sarcoma of bone is currently based on combined therapy with neoadjuvant chemotherapy, radiation therapy and surgical resection of the primary tumour. Survival in primary metastatic Ewing’s sarcoma is poor (less than 30%) and new therapies are needed for these patients.     

Comprehensive analysis of 225 Castleman’s diseases in the oral maxillofacial and neck region: a rare disease revisited

Clinical Oral Investigations - The aim of the present study was to comprehensively summarize the epidemiological, clinicopathological characteristics, treatments as well as prognosis of...