Levatorplasty, a new technique to treat hypernasality: anatomical investigations and preliminary clinical results.

BACKGROUND: Velopharyngoplasty is the most commonly used operative technique for the treatment of velopharyngeal insufficiency. By attaching a posterior pharyngeal flap to the velum, a nonphysiological situation is created in the upper airway. PURPOSE: The aim of this investigation was to find a new surgical approach to physiological reconstruction of the velopharyngeal sphincter. MATERIAL: Anatomical investigations were performed in four cadavers. From this study a new surgical technique was developed and called 'levatorplasty': the musculus longus capitis was taken to create a new muscular loop leading to (a) an augmentation of the posterior wall, (b) a medial shift of the lateral pharyngeal wall; and (c) stretching of the velum posteriorly. Thus, the velopharyngeal space was reduced and a physiological closure of the nasal airway space could be obtained. STUDY DESIGN: The levatorplasty was employed in nine cleft palate patients with velopharyngeal insufficiency. Pre- and postoperatively the velopharyngeal closure was evaluated by phonetic and radiological examination. RESULTS: The operation was easily performed without major complications. A concentric constriction with decrease of the velopharyngeal space was achieved and a definitive decrease of nasalance and hypernasality resulted. CONCLUSION: Long-term follow-ups have to verify whether these results will be stable. They also have to be compared with functional improvements following velopharyngoplasty or pharyngoplasty. Of special interest will be evaluation of the altered mobility of the lateral pharyngeal walls.     

超声骨刀在口腔种植中应用效果的初步探讨

【摘要】 目的 本研究通过观察、比较超声骨刀和传统球钻在Onlay植骨、上颌窦提升、骨劈开等手术中的临床应用效果,探讨超声骨刀在种植手术中的优越性及操作要点。方法 2006—2012年在常州市口腔医院种植科就诊,需要进行植骨手术的78例患者,总计80个术区,分别使用超声骨刀和传统球钻在Onlay植骨、上颌窦提升、骨劈开等手术中进行切骨操作;超声骨刀组42例,传统球钻组38例。分别于术后6 h、24 h、3 d进行复查,采用 VAS记录术后疼痛水平,利用SPSS11.5统计软件将临床数据采用等级资料秩和检验进行统计学分析。结果 超声骨刀组在术后6 h VAS均值为（3.98±2.16）、24 h VAS均值（2.35±1.86）,传统球钻组在术后6 h VAS均值为（4.79±1.95）、24 h VAS均值（3.21±1.76）,术后6小时、术后24小时两组间疼痛反应差异有统计学意义（p＜0.05）。结论 与传统球钻相比,采用超声骨刀进行种植植骨手术可以降低植骨术后短期疼痛发生率。     

Levatorplasty, a new technique to treat hypernasality: anatomical investigations and preliminary clinical results

Background: Velopharyngoplasty is the most commonly used operative technique for the treatment of velopharyngeal insufficiency. By attaching a posterior pharyngeal flap to the velum, a nonphysiological situation is created in the upper airway. Purpose: The aim of this investigation was to find a new surgical approach to physiological reconstruction of the velopharyngeal sphincter. Material: Anatomical investigations were performed in four cadavers. From this study a new surgical technique was developed and called 'levatorplasty': the musculus longus capitis was taken to create a new muscular loop leading to (a) an augmentation of the posterior wall, (b) a medial shift of the lateral pharyngeal wall; and (c) stretching of the velum posteriorly. Thus, the velopharyngeal space was reduced and a physiological closure of the nasal airway space could be obtained. Study design: The levatorplasty was employed in nine cleft palate patients with velopharyngeal insufficiency. Pre- and postoperatively the velopharyngeal closure was evaluated by phonetic and radiological examination. Results: The operation was easily performed without major complications. A concentric constriction with decrease of the velopharyngeal space was achieved and a definitive decrease of nasalance and hypernasality resulted. Conclusion: Long-term follow-ups have to verify whether these results will be stable. They also have to be compared with functional improvements following velopharyngoplasty or pharyngoplasty. Of special interest will be evaluation of the altered mobility of the lateral pharyngeal walls. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.     

Alveolar ridge augmentation using a new design of inflatable tissue expander: surgical technique and preliminary results

Ridge augmentation with particulate hydroxyapatite (HA) is compromised by the propensity for the HA particles to disseminate throughout any surgically created space within the tissues. Several techniques designed to overcome this problem have been described, including the use of inflatable tissue expanders. Some of the residual problems related to this technique are attributable to aspects of expander design and surgical technique. This paper which describes a new design of tissue expander which is completely submerged in use, also describes in detail the surgical technique associated with it. Preliminary results are discussed.     

Intraoral biopsy technique for direct immunofluorescence studies.

A wedge biopsy technique is described for use when oral manifestations of vesiculoerosive disease are suspected. The resultant soft tissue specimens are submitted for both light microscopic and direct immunofluorescence studies. This technique offers the advantage of obtaining highly diagnostic, mirror-image soft tissue specimens from a single perilesional site while minimizing postsurgical morbidity to the patient.     

A new root canal instrument and instrumentation technique: a preliminary report

Cleaning and shaping the root canal system has been and continues to be a challenge for even the most experienced endodontist. Curved, narrow canals, in particular, cause difficulties for the beginner as well as the specialist. A new instrument designed to incorporate new concepts was developed to ameliorate the problems in cleaning and shaping root canal systems. This new instrument has been given the name of SW (Senia and Wildey). The new SW instrument uses controlled right and left rotational forces. This motion was used to clean and shape simulated root canals in plastic blocks and root canals in extracted teeth. Instrumentation appeared to be easier, faster, and more precise than with conventional instruments, especially in curved canals where there was remarkable reduction of canal transportation. A mechanical version of the SW instrument was also developed. It was used to flare the coronal portion of the root canal system.     

Intraoral grafting of an ex vivo produced oral mucosa equivalent: a preliminary report

The objective of this study was to assess the efficacy of the use of an ex vivo produced oral mucosa equivalent (EVPOME) for intraoral grafting procedures. Autogenous keratinocytes were harvested from a punch biopsy 4 weeks prior to surgery, placed in a serum-free culture system and seeded onto a human cadaveric dermal equivalent, AlloDerm. Thirty patients with either a premalignant or cancerous lesion were triaged into two groups, depending on the stage of disease: Group 1: EVPOME or Group 2: AlloDerm, control without an epithelial layer. Clinically, EVPOME grafts were easy to handle and showed excellent compliance on grafting. Both, EVPOME and AlloDerm grafts, showed a 100% take rate. At 6 days post-grafting, the EVPOME clinically showed changes indicating vascular ingrowth and had cytologic evidence of the persistence of grafted cultured keratinocytes on the surface. The EVPOME grafts had enhanced maturation of the underlying submucosal layer associated with rapid epithelial coverage when compared to the AlloDerm grafts at biopsies taken at 28 days post-grafting. In summary, EVPOME appears to be an acceptable oral mucosal substitute for human intraoral grafting procedures and results in a more favorable wound healing response than AlloDerm alone.     

Intraoral application of microcolpohysteroscopy. A new technique for clinical examination of oral tissues at high magnification

Colposcopy is an established technique for diagnosis in gynecology. A recently developed optical instrument is the contact microcolpohysteroscope for macroscopic examination of the cervical mucosa. This article evaluates the application of the contact microcolpohysteroscope for examination and recording of the surface topography of the hard and soft tissues of the oral cavity. This is a promising, noninvasive method of observation of tissue surfaces at high magnification. Modifications of the method for oral use are described, and potential applications for diagnosis and research in dentistry are proposed.     

Intraoral endoscopically assisted treatment of temporomandibular joint ankylosis: preliminary report

Temporomandibular joint (TMJ) ankylosis is characterized by the formation of a bony or fibrous mass that replaces the normal articulation. To avoid a possible re-ankylosis it is mandatory to perform a radical, complete resection of the bony/fibrous mass. We treated a patient affected by right temporomandibular joint ankylosis performing the osteotomy of the ankylotic mass through a preauricular and intraoral approach under endoscopic control. Then a temporalis muscle and fascia flap were used as the interpositional material. Through the endoscope it was easy to check the medial aspect of the resection and suture the flap. At 1-year follow-up the patient had significantly increased maximal mouth opening. No evidence of relapse of the joint ankylosis was shown by radiological studies. Intraoral endoscopic assistance may be useful to make the removal of the ankylotic mass safer, and the anchorage of the temporalis muscle and fascia flap more accurate, reducing the risk of re-ankylosis.     

Simplified technique for immediate implant insertion into extraction sockets: report of technique and preliminary results

A technique is presented for placement of implants at the time of tooth extraction in the precisely desired positions, regardless of extraction socket morphology. To date, 162 implants have been placed utilizing this technique. One was mobile at uncovery and removed. The other implants have been successfully in function, as defined by the Albrektsson Criteria, for up to 7 years, yielding a cumulative success rate of 99.4%.     

Composite resin veneers: a new technique.

A new technique for the fabrication of composite resin direct veneers is presented. In this technique, a transparent acrylic resin matrix is fabricated before preparation of the facial surface of the tooth, to allow the adequate reproduction of contour, shape, and surface texture originally exhibited by the tooth. Advantages, as well as limitations, of the procedure are also presented.     

Intraoral reconstruction with the nasolabial island flap. A modified technique

The nasolabial flap has been used for intraoral reconstruction since last century. In this paper, a modification is proposed in order to increase the amount of skin available in male patients. Simple closure of the donor area is not possible and a cheek rotation flap is suggested for closure.     

Intraoral fluoride releasing device: a new clinical therapy for dentine sensitivity

BACKGROUND: Dentinal sensitivity (DS) occurs frequently in adult populations in western countries. The purpose of this work was to assess the effectiveness of a new intraoral fluoride releasing device (IFRD) in reducing the level of pain in patients with primary or postsurgical dentine sensitivity. METHODS: A total of 49 individuals were selected for this study, 15 of whom had post-periodontal surgery dentine sensitivity and 34 with primary sensitivity. An IFRD was applied to 39, while 10 received a placebo device. All individuals in the control group suffered from primary sensitivity. The IFRD used in this study consists of sodium fluoride encased in an acrylic polymer which releases fluoride at a rate of approximately 0.04 mg/day. All patients were asked to rinse with cold water (10 degrees C) and to indicate the level of pain on a 0 to 10 visual analog scale, 0 equalling "no pain" and 10 "maximum bearable pain." All subjects were evaluated once a week during 4 months. Statistical analysis of dentine sensitivity was performed as a univariate study, in relation to the main factors: age, gender, and primary sensitivity or postsurgical etiology. RESULTS: Symptoms decreased dramatically in all treated patients. The level of sensitivity did not change during the first week after IFRD application, but decreased significantly within the fourth week and remained absent through the duration of the treatment (P <0.01). Difference in sensitivity with respect to different etiology was significant only after 4 weeks (P= 0.01), while there was no statistical difference with respect to age or gender. CONCLUSIONS: This paper is an initial study to evaluate the effectiveness of the IFRD. The method is fast, painless, inexpensive, and it appears to be suitable as a routine treatment. The presented data support the conclusions at this stage and warrant more comprehensive evaluation.     

Sinus floor augmentation at the time of maxillary molar extraction: technique and report of preliminary results.

A technique is described for accomplishing both localized sinus augmentation and guided bone regeneration at the time of maxillary molar extraction. One hundred nine sites were treated in 92 patients. Of these, 102 procedures (94.0%) were successful and 7 (6.0%) were partially successful. Success was defined as the ability to ideally position an implant at least 10 mm in length and 4.8 mm in width without perforating the floor of the sinus or generating an implant fenestration or dehiscence. Partially successful procedures required an additional osteotome sinus lift at the time of implant placement.     

Bilateral simultaneous augmentation of the maxillary sinus floor with particulated mandible. Report of a technique and preliminary results

This paper describes a surgical technique that permits the achievement of bilateral simultaneous augmentation of the maxillary sinus floor with the use of autologous bone harvested from the mandibular symphysis alone. Out of a group of 26 partially edentulous patients consecutively treated for sinus augmentation in an 18-month period, eight needed a bilateral procedure and were treated with the same surgical protocol. None of the patients had residual molar teeth, crestal bone height was reduced to 4 mm or less. Bone was harvested from the chin in blocks with a trephine bur, 11 or 9 mm in diameter, it was then particulated with a bone mill. Sinus augmentation and implant placement were done simultaneously in both sides of the maxilla. Implant-supported fixed partial dentures were inserted 6 months after the procedure. 44 ITI solid screw implants were placed in the grafted sinuses with a mean of 2.75 implants on each side. Mean follow-up was 19 months. In all patients needing a bilateral sinus lift, the procedure could be successfully completed. All implants were stable at abutment connection. All implants are stable at the latest follow-up, and all prosthesis are still working. In all implants, a clear bone-to-implant contact was visible. No peri-implant radiolucency has been noticed so far. It is concluded that bilateral augmentation of maxillary sinus floor with particulated mandible associated with simultaneous ITI implant insertion is feasible. It is a safe and effective procedure that can be accomplished in an out-patient environment with only minor discomfort for the patient.     

Tacks: a new technique for craniofacial fixation.

Biodegradable fixation in craniofacial surgery provides secure fixation while eliminating much of the concern over intracranial migration of metallic plates and screws. One limitation of present biodegradable systems, however, is the need for tapping the drill hole before screw insertion. Herein, a new method of rigid, biodegradable fixation with tacks (Macrapore, Inc., San Diego, CA) is described. The tacks are made of a 70:30 ratio of the L and DL form of polylactic acid (L,DL-PLA). Degradation times range from 18 to 36 months. Newer prototypes are nearly developed for more rapid dissolution times. From April 1999 to February 2000, tack fixation has been applied in 100 patients (51 males, 49 females aged 3 months to 61 years). Indications for operation were craniosynostosis (n = 33); craniofacial trauma or post-traumatic deformities (n = 11); cleft lip and palate (n = 13); craniofacial syndromes (n = 18); other diagnoses (n = 11). Patients underwent fronto-orbital advancement with cranial reshaping; monobloc osteotomy, open reduction-internal fixation of fractures; hypertelorbitism repair; cranioplasty; stabilization of grafts; major cranial reconstruction; zygomatic advancement; alveolar cleft repair; and iliac bone graft donor site protection. Tacks were also used for temporalis muscle and lateral canthal suspension. Follow-up ranged from 16 to 28 months. Complications occurred in 7 patients, 4 of whom had infections and during debridement had biodegradable implants removed. None of the complications appeared to be related to the use of tacks. The tacks are carried in a specially designed holder and may be placed by hand or with the light tap of a mallet on the tack driver. An automatic driver has been developed. Overall, the performance of the tacks has been excellent. They are easily handled by the nursing personnel and rapidly inserted by the surgeon. Stability appears to be excellent. At this time, it is probably preferable to employ tap and screws for orthognathic surgery or other osteotomies with substantial load bearing.     

Intraoral melanoacanthoma: a reactive melanocytic hyperplasia. Case report

Melanoacanthoma was originally described as a benign skin tumor of keratinocytes and dendritic melanocytes. There is now evidence that the intraoral lesions are unlike those occurring on skin. This article documents the reactive and reversible nature of the oral condition in a patient with these lesions.