Microsurgical reconstruction of the infraorbital nerves

The pathogenesis of damage to and the microsurgical anatomy of the infraorbital nerve are reviewed. Indications for surgery and a microsurgical technique for decompression and scar removal or anastomosis of the nerve are presented. Results from seven surgical cases indicate a high degree of successful regeneration, with complete return of sensation occurring in six cases.     

Evaluation of hydroxylapatite root implants in baboons

To determine if there is a need for close conformation of a hydroxylapatite implant to the root socket for successful prevention of alveolar ridge resorption after tooth extraction, second premolars and lateral incisors of six mature baboons were extracted bilaterally, and custom-fitted root replicas or half-length, plug-shaped forms of hydroxylapatite were implanted in the fresh sockets. Results showed that precise fit, as achieved by a custom-fitted implant, was not necessary for success. All implants were completely accepted, with evidence of new bone formation continuing for up to six months, the duration of the study. No resorption of the alveolar ridge was observed by gross or microscopic examination.     

Intraoral skeletal fixation appliance

The intraoral skeletal fixation appliance is introduced as a new and versatile instrument in oral and maxillofacial surgery. The device is described and its uses in maxillofacial pathologic conditions, maxillofacial trauma, and orthognathic surgery are discussed. Case presentations are included to illustrate the clinical feasibility and effectiveness of the intraoral skeletal fixation appliance.     

Long-term results of subperiosteal implants combined with cancellous bone grafts

Twenty-three subperiosteal implants combined with cancellous bone grafts were done at the University of Washington over a four-year period. A modification of the original technique as used with 19 of the patients is described, as well as the follow-up evaluation. The greatest problem occurred at the mucosal-metal junction, resulting in multiple infections and some failures. This technique appears to be comparable with the simple subperiosteal implant but not significantly better.     

External fixation of the unstable zygomatic arch fracture

Fixation of unstable zygomatic arch fractures may be accomplished with a relatively noninvasive approach using 24-gauge wire and modification of a readily available material, the orthopedic finger splint.     

Comparison of silastic and proplast implants in the temporomandibular joint after condylectomy for osteoarthritis

This study was undertaken to compare the long-term stability of Silastic and Proplast when used as alloplastic implants following high condylectomy. Twelve patients with osteoarthritis of the temporomandibular joint (TMJ) were treated either unilaterally or bilaterally. The follow-up period ranged from one to four years. In all ten TMJs that received Silastic implants and in ten that received Proplast implants, there were no discernible differences relative to comfort, masticatory function, or TMJ mobility. Although Silastic and Proplast had similar functional characteristics, Proplast implants had better long-term stability than the Silastic implants.     

A comparison of porous composite PTFE/graphite and PTFE/aluminum oxide facial implants in primates

Comparison of tissue ingrowth density values for Proplast I and its aluminum oxide analog, Proplast II, when implanted on the primate infraorbital rim and inferior border of the mandible, showed no difference between the two test materials. A similar comparison of local cellular response ratings showed slightly less response to Proplast II. Microscopic and clinical examination did not otherwise reveal any significant differences in biologic reaction to these materials.     

Bone repair in the mandible: a histologic and biometric comparison between rigid and semirigid fixation

This study was undertaken to compare the influence of rigid with semirigid fixation after experimental mandibular fractures in monkeys. Although semirigid fixation resulted in more external callus formation after six weeks, rigid formation produced a denser and stronger bone scar. The significance of these findings is discussed in relation to orthognathic surgical treatment planning.     

High-frequency jet ventilation in oral and maxillofacial surgery

The oral and maxillofacial surgeon faces many situations in which maintenance of the patient's airway can be a problem. Facial trauma, severe infection, and trismus all can compromise the airway and pose a dangerous situation. The use of high-frequency jet ventilation (HFJV) via transtracheal puncture offers excellent airway protection with minimal patients discomfort prior to induction of anesthesia. The use of a large, cuffed endotracheal tube for blind awake nasal intubation, or in conjunction with tracheostomy, can be eliminated in many situations. HFJV offers minimal trauma to nasal passages and larynx while preventing aspiration. During emergence, discomfort is reduced to a minimum, and the patient can communicate verbally. These same advantages apply to patients who receive outpatient oral surgery. Therefore, in the choice of an anesthetic technique, HFJV should be a definite consideration.     

Microsurgical reconstruction of the lingual nerve

The surgical anatomy and common causes of lingual nerve damage are reviewed. Surgical indications for decompression, neurorrhaphy, and nerve grafting are discussed based on the review of 18 cases.     

Repair of the adult temporomandibular joint meniscus with an autogenous dermal graft

A surgical procedure for the successful repair of the temporomandibular joint meniscus is described. Twenty-three patients have been treated by this procedure, with both objective and subjective improvement. The procedure is accomplished with minimal technical difficulty and minimal cosmetic defect.     

Myxoma of the oral soft tissues

Twenty-one cases of myxomas and myxofibromas reported in the literature are reviewed, and a new case is presented. The pathogenesis, clinical picture, differential diagnosis, and histopathology of this rare neoplasm are discussed.     

Surgical management of patients with osteogenesis imperfecta

Osteogenesis imperfecta is a multifaceted disease not only of skeletal but also of metabolic involvement. A discussion of the pathophysiology and metabolic aspects of the disease is presented, as well as information about anesthetic and surgical management. A case report involving late hemorrhage subsequent to a Le Fort I osteotomy is presented to illustrate the complications that can occur in patients with osteogenesis imperfecta.     

Clinical and anatomic observations on the relationship of the lingual nerve to the mandibular third molar region

The position of the lingual nerve in the mandibular third molar region was measured and photographed in 34 cadaver dissections and 256 cases of third molar extraction. In 17.6% of the dissections the lingual nerve was found at the level of the alveolar crest or higher. Horizontally the nerve contacted the lingual plate of the third molar in 62% of the specimens. Of 256 patients, the nerve was visualized above the height of the lingual plate of the lower third molar in 12 (4.6%). These results document the vulner-ability of the lingual nerve as it passes medially to the mandibular third molar.