Augmentation of an atrophic edentulous mandible by interpositional grafting with hydroxylapatite

The clinical use of densely sintered calcium hydroxylapatite as a substitute for autogenous bone in interpositional grafting of an atrophic edentulous mandible is described. Results indicate this material appears to be a successful bone substitute for use in the rebuilding of the atrophic mandible.     

Aneurysmal bone cyst of the mandible

Aneurysmal bone cyst is a multilocular cystlike lesion in the bone which is filled with blood. In 1942, Jaffe and Lichtenstein¹ separated a cystic lesion containing numerous pools of blood from other cysts, and in 1950 Lichtenstein² proposed the name “aneurysmal bone cyst” for this entity. He stated that the aneurysmal bone cyst usually occurred in vertebrae, clavicle, rib, and limb bones and produced eccentric bone expansion with numerous pools of blood. The histologic findings showed that spongy bone and marrow were replaced by a fibrous tissue in which hemorrhage, giant cell reaction, and reparative new bone formation were observed.Lichtenstein³ reported statistically that vertebrae and limb bones were commonly affected, constituting about 60% of the total number of cases. Studies by Biesecker et al⁴ and Ruiter et al⁵ showed almost the same result. The aneurysmal bone cyst rarely affects the craniofacial bones. Biesecker reported only two cases in the mandible in 66 cases, and Ruiter reported one case in the maxilla in 105 cases. Daugherty⁶ mentioned that only 2% of these lesions were in the facial bones.     

Revascularization of autogenous skin grafts placed on irradiated tissue

Vascular changes in rat skin after irradiation were examined microangiographically. Revascularization of the skin transplanted during the chronic stage after irradiation was also studied. The results obtained through these examinations revealed higher vascular densities at the acute and the subacute stages, and low values at the chronic stages compared with those of the control. Furthermore, when the skin grafts were transplanted to the irradiated beds in the chronic stage, primary revascularization was scant, and the inhibited capillary proliferation in the recipient sites prevented new vessel penetration. This explains to why grafts transplanted to previously irradiated beds fail to survive.     

Recurrent aneurysmal bone cyst of the mandible

A case of aneurysmal bone cyst is presented, which demonstrates the surgical findings and recurrence potential of this lesion.     

Frozen femoral head allogeneic bone grafts for orthognathic surgery

Bone grafts are occasionally required in orthognathic surgery procedures. Allogeneic grafts are desirable because they decrease patient morbidity. Fresh frozen bone obtained during total hip replacement has been used in 12 orthognathic operations. Observations for one to three years have showed very good results.     

The effect of porcine skin and autogenous epithelial grafts on the contraction of experimental oral wounds

Autogenous oral mucosa and skin grafts have been used clinically in vestibuloplasty to limit sulcus regression. However, these procedures require an additional surgical site and therefore increase morbidity. This study was designed to determine whether fresh porcine skin grafts would be as effective as skin or palatal mucosal grafts for controlling oral wound contraction. Standard sized experimental wounds were produced in dogs and, after grafting, were studied grossly and histologically for five to 60 days. All of the grafted sites showed less contraction than the control wounds, which were allowed to heal by secondary epithelialization. These findings suggest that porcine skin could serve as an effective biologic oral dressing following vestibuloplasty.     

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.     

Metastatic adenocarcinoma from the colon to the mandible

Published reports of metastatic adenocarcinoma from the colon or rectum to the mandible are extremely rare. Only eight cases had been reported from 1884 to the time this article was written. A case is presented where a metastatic lesion was found to be histologically similar to the known primary tumor in the cecum. The patient first noted dental pain, isolated to his mandibular left second bicuspid, 10 months after a primary tumor was diagnosed. Subsequently, the tooth was extracted, and it was only after the extraction site failed to heal that a biopsy was performed which confirmed a metastatic lesion. Retrospective study of the pre-extraction radiograph confirmed the presence of a suspicious area in the osseous structure of the man-dible at the time of extraction. It must be emphasized that in patients with a positive history of malignancy, metastatic disease must be considered in the differential diagnosis of oral and dental symptoms, and that need for biopsy should be considered with all surgical procedures, including simple extractions.     

Early results of secondary bone grafts in 106 alveolar clefts

Eighty-three patients with cleft lip and cleft palate were treated by secondary bone grafts to the 106 alveolar clefts. In 98% of the alveolar clefts, the graft was successful and the oronasal fistula was closed. There were only occasional other complications, all but one of which were minor and did not affect the final result. Morbidity was low. Compared with older patients, the pre-teen group of patients not only had no complications of consequence but experienced less morbidity. The 100% success rate and the lower morbidity in the pre-teen group of patients thus favor operating on patients at the younger age.     

Ameloblastoma of the mandible treated by resection, preservation of the inferior alveolar nerve, and bone grafting

The results of five cases of ameloblastoma of the mandible treated by resection, preservation of the inferior alveolar nerve, and immediate bone grafting are reported. The incisions in all cases healed by first intention. Lip sensation on the operated side returned to normal in four to six weeks in four cases and slight numbness persisted to the eighth week in one case. All patients were followed postoperatively for 13-15 years. In one case the tumor recurred in the mucous membrane seven years after surgery at the original intraoral site and invaded the underlying bone graft. The indications and contraindications for surgery and details of the procedures, including measures to prevent recurrence, are presented.     

Rhabdomyosarcoma of the left mandible

Rhabdomyosarcoma is a relatively uncommon tumor in the oral cavity. About 81 cases of intraoral rhabdomyosarcoma have been described in the literature since 1854.^1–3 The authors recently encountered a case of embryonal rhabdomyosarcoma of the left mandible, which was diagnosed by means of electron microscopy and immunohistochemical techniques.     

Metastatic thyroid carcinoma of the mandible

Two cases of thyroid carcinoma with metastatic involvement of the mandible are described. The importance of considering occult carcinoma of the thyroid when metastatic lesions are found in the mandible is emphasized.     

Bilateral pseudoankylosis of the temporomandibular joint due to synostoses between the mandible and maxilla

The occurrence of pseudoankylosis of the temporomandibular joints secondary to maxillary-mandibular synostoses is rare. These authors know of only two cases, previously reported and both were unilateral. A case is presented that is bilateral and symmetrical with a possible familial component.