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.     

Histologic investigation of pulpal changes following maxillary and mandibular alveolar osteotomies in the dog

An animal study was done to investigate pulpal responses after creation of dentoalveolar segments in the maxilla and mandible. The animals were sacrificed after one, four, and eight weeks. Histologic examination of the pulps showed micromorphologic changes, but they were generally not sufficiently severe to lead to devitalization.     

Healing of reimplanted freeze-treated maxillary bone

A study was conducted to investigate bone healing and revascularization associated with resecting, freezing, and reimplanting the total maxilla. Remodeling was variable. Some maxillas totally sloughed, whereas others healed in part, with only local areas of bone necrosis.     

Management of the premaxilla in bilateral clefts

Surgical management of the premaxilla in patients with bilateral clefting has been a controversial and perplexing problem. This paper discusses method and timing of treatment and proposes a philosphy of surgical management. By proper timing of repositioning procedures and bone grafting, more tissue can be salvaged and a more satisfactory functional result can be obtained.     

Modified LeFort II procedure for simultaneous correction of maxillary and nasal deformities

An approach to correction of nasomaxillary dysplasia is described. Where midfacial hypoplasia is managed by surgical anteropositioning of the affected skeletal parts, this technique permits management of the associated nasal dysmorphia as well. The one-stage correction is performed with the midfacial skeleton entirely degloved, under direct vision. Details are described, and diagnostic and treatment considerations of two patients are given.     

Effective treatment of the postoperative maxillary cyst by marsupialization

The postoperative maxillary cyst occurs as a delayed complication after radical surgical intervention in the maxillary sinus. The recommended procedures for treating this entity have been enucleation followed by formation of an antronasal window, primary closure, or open packing. To prevent recurrence and unnecessary tissue destruction from surgery, marsupialization was performed in eight unilocular postoperative maxillary cysts. With the exception of a case in which the long-term results could not be obtained, the cysts disappeared in four months to two and a half years. Possible indications for marsupialization of the postoperative maxillary cyst are discussed.     

A retrospective study of alveolar cleft grafting

A surgical technique for the bone graft repair of alveolar clefts is described, and an evaluation of the conditions of 30 patients who have undergone that procedure is reported. Evaluation was made specifically for the preoperative and postoperative presence of oronasal fistula, postoperative eruption of previously unerupted teeth into the graft, soft and hard tissue periodontal status, and radiographic evidence of bone fill in the previous cleft defect resulting in alveolar segmental stabilization.     

A technique for osseous restoration of deficient edentulous maxillary ridges

A technique for maxillary bone grafting to augment the atrophic ridge is presented, and the results from 15 cases followed from three to ten years are briefly described. Loss of postoperative ridge height ranged from 10-20% in this sample. It appears that the tendencies to postoperative resorption that occur when autogenous particulate cancellous bone grafts are employed to restore atrophic mandibles are not operative in the maxilla.     

Malignant transformation of inverted papilloma of the maxillary sinus

The transformation of inverted papilloma into squamous cell carcinoma is a rare pathologic entity of the head and neck. It produced an interesting and difficult case from both diagnostic and surgical aspects.     

The role of the intraosseous osteosynthesis wire in sagittal split osteotomies for mandibular advancement

Two groups of 20 patients who were treated for mandibular hypoplasia by surgical lengthening of the mandible using the bilateral sagittal split ramus osteotomy were followed pre- and postoperatively using serial lateral cephalograms. One group of patients was treated without internal fixation and the second group, with superior border intraosseous osteosynthesis wiring. Both groups were evaluated for postoperative skeletal and occlusal changes and the results were compared. A notably greater amount of relapse was observed in the group of patients in whom no intraosseous wiring was used.     

Management of postoperative hemorrhage following the Le Fort I maxillary osteotomy

The assessment and management of patients with postoperative hemorrhage following Le Fort I osteotomies is discussed. The results of a questionnaire to investigate this complication, as well as the authors' protocol for dealing with this problem, are presented. Three illustrative case histories are also presented.     

Long-term radiographic evaluation of hydroxylapatite-augmented mandibular alveolar ridges

From six months to four years after alveolar ridge augmentation was performed, the vertical ridge heights of 74 Class III and Class IV alveolar ridge deficiency patients, who had undergone augmentation with hydroxylapatite with or without autogenous cancellous bone, were measured using panoramic radiographs adjusted for magnification errors. No statistically significant decreases in vertical ridge heights were seen when only hydroxylapatite was used, nor were there significant differences between the two types of hydroxylapatite particles used. Unlike other bone onlay procedures, the use of autogenous bone and HA together did not result in significant decreases in vertical ridge height.     

Experiences with microsurgical reconstruction of the inferior alveolar nerve

In select cases, immediate or delayed inferior alveolar nerve reconstruction is indicated. The current state of the art indicates that when nerve reconstruction is to be undertaken, optimal results are achieved via microsurgical instrumentation. Specific technical and biologic considerations that have been found to be relevant in microsurgical reconstruction of the inferior alveolar nerve are discussed.     

Histochemical study of the masseter muscle in patients with vertical maxillary excess

This study was designed to examine the morphologic properties of the masseter muscle in individuals with vertical maxillary excess (VME). The deep surface of the anterior aspect of the superficial masseter was biopsied in nine patients at the time of corrective surgery. Individual muscle fibers were classified as slow-twitch-oxidative (SO), fast-twitch-oxidative-glycolytic (FOG), or fast-twitch-glycolytic (FG) based on staining characteristics using a battery of histochemical procedures. Most patients had normal tissue, although there were considerable differences in size and distribution of the three fiber types. Generally, SO fibers were the largest and most prevalent type of fiber. Two individuals, however, demonstrated evidence of muscle pathology that primarily affected the FG fiber population. Histochemical evidence of muscle pathology has not previously been reported in patients with VME, and the pattern of SO dominance observed in these patients may be different from the distribution that would be seen in the masseter of a person free of craniofacial deformities.