Salvage of the mandibular staple bone plate following bone infection

Two cases of previously unreported complications associated with implantation of a mandibular staple bone plate are presented. One was a proven case of chronic osteomyelitis, and the other had a close clinical and radiographic resemblance to osteomyelitis. It is suspected in both cases that complications were due to the use of a dull twist drill that caused local tissue injury. Differences in the clinical courses are believed to be related to the degree of oral hygiene after surgery, with a more severe infection occurring in the patient who maintained extremely poor home care. There is the possibility that some degree of osteoporosis was present in the same patient that may also have influenced the clinical course. While the salvage of implants in areas of osteomyelitis is controversial, it was shown to be justifiable in these cases. Crucial to such salvage is the selection of an antibiotic that is effective against the organisms involved and safe for prolonged use. Cefotaxime and clindamycin were used in the cases reported and proved to be effective and without adverse effect. Although it will take time to see to what degree bone refills the affected areas, it appears at present that the resorptive process has ceased and that bone regeneration is in progress. Prevention of the complications reported here is believed to be possible with the use of sharp drills, slow drilling speed, copious cool irrigation, appropriate antibiotic prophylaxis, and meticulous oral hygiene.     

Mandibular intraosseous lipoma

A case has been presented of an intra-alveolar lipoma occurring in the mandible and involving an impacted third molar in a 51-year-old white man. The lesion was asymptomatic. Treatment consisted of surgical removal of the impacted tooth and the lipoid tissue.     

Squamous odontogenic tumor related to an unerupted lower canine

A new case of squamous odontogenic tumor (SOT) is presented. This is the seventeenth case of SOT to be reported and the first reported case related to a lower unerupted canine. A review of the literature reveals the extreme variability of the clinical and radiologic features of this tumor. Conversely, the microscopic characteristics of SOT are clearly defined: numerous islands of benign squamous epithelium scattered in an apparently mature connective tissue, absence of peripheral columnar cells with palisading nuclei, and absence of stellate reticulum. Keratin pearl formation, intraepithelial microcyst formation, and calcification are present to a variable extent. A circular arrangement of fibroblasts and fibrous condensation and/or hyalinization are observed around some epithelial islands, suggesting a reaction of the connective tissue to the epithelial proliferation. The observation of small epithelial islands near the apical surface of the retained tooth supports the theory that the tumor originates from Malassez's rests. The treatment of choice seems to be conservative, with thorough enucleation, but it should be borne in mind that multifocal cases have been described.     

Adenomatoid odontogenic tumor in a black African population: report of thirteen cases

The records of the Cancer Registry of University College Hospital in Ibadan, Nigeria, were reviewed for the incidence of adenomatoid odontogenic tumor from 1961-1982. Thirteen cases of the tumor were found. Clinical, histologic, and radiologic features of the 13 cases are reported. Many features were similar to previous reports of this tumor, but an increased ratio of males to females and preference for the mandible was observed. It is suggested that these factors may be peculiar to Nigerians. A few cases showed an unusual posterior location of tumor.     

Osteoradionecrosis: A new concept of its pathophysiology

The classic sequence in the pathogenesis of osteoradionecrosis of the jaws has been accepted as radiation, trauma, and infection. This paper challenges this sequence and offers a new one more accurately describing the biochemical and cellular pathology. The clinical data are based on 26 consecutive cases of osteoradionecrosis from which 12 en bloc resection specimens were cultured and stained for microorganisms. Review of the histories and treatments, as well as the microbial assays, indicates that microorganisms play only a contaminant role in osteoradionecrosis and that trauma is only one mechanism of tissue breakdown leading to the condition. The sequence suggested by this study is as follows: (1) radiation, (2) hypoxic-hypocellular-hypovascular tissue, (3) tissue breakdown, and (4) chronic non-healing wound.     

Diagnosis and treatment of lateral pharyngeal space infections

The lateral pharyngeal space is composed of an anterior and posterior compartment. Infection may involve both compartments; however, each compartment may be involved individually with distinctly different clinical findings. This article reviews infections of the lateral pharyngeal space and their treatment.     

The canalicular adenoma: considerations on differential diagnosis and treatment

The canalicular adenoma is an uncommon, benign salivary gland neoplasm that usually occurs in or near the upper lip of elderly patients. A histologic study of 49 tumors revealed that they are often multifocal, may infiltrate their capsule, and are occasionally unencapsulated. Based on these findings, the method of treatment, as well as a differential diagnosis of minor salivary gland lesions, is discussed.     

Osteoinduction in young and old rats using demineralized bone powder allografts

The process of inducing differentiated and undifferentiated cells to become osteogenic using demineralized bone powder (DBP) is a well-known phenomenon in developmental biology. The aim of this study was to examine whether age has an effect on the process of bone induction. DBP was implanted in the subcutaneous thoracic tissue of young rats (28-56 days) and old rats (14 months or older), and the animals were examined seven, 12, 20, and 60 days after implantation. The amount of newly induced bone in the implant was quantitatively measured using histomorphometry and 45Ca uptake. Undecalcified and decalcified specimens were processed for histologic examination using several stains that demonstrate osteoid. Both the young rats and the old rats formed bone in response to the DBP implants. In old animals the induced bone appeared to be less in quantity, it formed at a slower rate, and it exhibited less bone marrow cellularity than did the bone in young animals.     

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.     

Simultaneous maxillary advancement and closure of bilateral alveolar clefts and oronasal fistulas

A technique for simultaneous maxillary advancement with closure of alveolar clefts and oronasal fistulas in the patient with secondary cleft deformities and a Class III pattern of malocclusion resulting from maxillary hypoplasia is described. A case in which this technique was used is reported.     

Fracture of the glenoid fossa and dislocation of the mandibular condyle into the middle cranial fossa

Reported cases of dislocation of the mandibular condyle into the middle cranial fossa have been rare, and treatment modalities have varied. The case presented represents an instance of successful closed reduction. Numerous factors should be considered when determining the technique of reduction. Primary goals in selecting the method of treatment are stabilization of the neurologic status, control of the bone fragments in the brain, reduction of the occlusion, maintenance of ramus height for facial symmetry, preservation of growth potential, and assurance of satisfactory long-term function of the mandible.     

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.