The facial plethysmograph: a new instrument to measure facial swelling volumetrically

A critical review of methods used to evaluate postoperative facial swelling is presented. A new, noninvasive method using a feeler arm to trace and measure facial contours is described. The overall accuracy and reproducibility of this method was tested by measuring acrylic "mock swellings." The results suggest that the method was accurate to within 5% in measuring swellings of known volume. The reproducibility of replicate measures also showed a low level of error (3.3%). This device may provide a unique method for the systematic study of treatments designed to minimize postoperative facial swelling.     

The use of drains in oral and maxillofacial surgery: A review and a new approach

The use of drains in oral and maxillofacial surgery is reviewed and discussed. Their relative advantages and disadvantages and potential complications are explained, and principles for wound drainage are developed. Use of the Jackson-Pratt drainage system, a versatile type of suction that minimizes the complications associated with wound drainage, is described.     

Alveolar ridge augmentation using nonresorbable hydroxylapatite with or without autogenous cancellous bone

A four-year prospective evaluation of the use of nonresorbable, particulate hydroxylapatite (HA) to augment deficient alveolar ridges was performed. The material was used alone and in combination with finely crushed autogenous cancellous bone. Implants were delivered subperiosteally by syringe injection, usually using local anesthesia for Class I to Class III ridges and general anesthesia for Class III and Class IV ridges. The improved ridge height and width were stable. Postoperative resorption with significant loss of ridge height, frequently seen with rib and iliac crest onlayed grafts, was not observed with HA augmentation. Permanent denture construction began as early as three weeks postoperatively and by four to six weeks if HA was combined with autogenous cancellous bone. It was possible to place mandibular staple implants simultaneously or following HA augmentation. Visor osteotomy techniques were improved by use of HA to produce a wider, more convex stable ridge. Although skin, mucosa, or dermal vestibuloplasties were performed as early as three months postoperatively in a small number of patients, there appeared to be a lesser need for vestibuloplasty after HA augmentation than after onlay bone grafting. In addition, prosthodontists performed fewer denture relines after HA augmentation than after onlay bone grafts. The authors believe the most significant factor accounting for these observations is the firm, nonmobile mucosal base resulting from augmentation with HA. The resultant stable, soft tissue base and improved ridge height and contour have contributed to a comfortable, retentive, stable denture for these patients. The prosthetic and surgical procedures are easier to perform and have produced superior, more permanent results than onlay bone grafts and alloplasts. Preliminary studies also point to exciting possibilities for use of HA as a bone substitute/marrow extender in maxillary and mandibular defects, cysts, and clefts and in osteotomies for orthognathic surgery.     

Experimental study of dermal grafts for reconstruction of oral mucosa

Mucosal defects in the oral cavities of 35 dogs were repaired with reversed dermal grafts, full-thickness skin grafts, and dermal grafts. Comparative observations were made for up to two years to analyze the healing processes. The reversed dermal grafts were covered by surrounding mucosal epithelium and formed normal mucosal tissue that maintained its characteristics for two years. Histologic and scanning electron microscopic examination revealed that the epithelial appendages underwent degeneration, presumably through being embedded by the grafting of the dermis inside out. Epithelialization of the dermal grafts occurred from both surrounding mucosal epithelium and ancillary skin appendages. The full-thickness skin grafts maintained their original structure and function over the two-year observation period. It appears from this investigation that the reversed dermal graft method has definite advantages over full-thickness skin grafting and dermal grafting.     

Revision of facial scars with geometric broken line closure

Secondary revision of a facial scar remains a challenging endeavor for surgeons who undertake such treatment. Even though esthetic landmarks, antitension lines, meticulous closure, and prolonged splinting are taken into consideration, the scar never completely disappears. Therefore, the goal in secondary revision of a facial scar is to make it as inconspicuous as possinle. The geometric broken line closure is a technique that greatly facilitates achievement of this goal.     

The effects of immobilization on the rabbit temporomandibular joint

While the effects of immobilization of joints covered with hyaline cartilage have been widely studied, the effects on the fibrous tissue-covered temporomandibular joint have not been studied as extensively. This study was designed to determine the short-term effects of immobilization on the rabbit temporomandibular joint. Nineteen rabbits were placed in maxillomandibular fixation. The temporomandibular joints were studied histologically after periods of from ten to 28 days. Significant thinning was observed as early as after ten days, as was degeneration of the cartilage. Degeneration became progressively more severe as the duration of the immobilization increased. Reparative events began appearing after 28 days. These findings suggest that although initially immobilization produces destructive changes, the changes may well be reversible.     

Simultaneous occurrence of dermoid and heterotopic intestinal cysts in the floor of the mouth of a newborn

Congenital cysts of the floor of the mouth are rare. The simultaneous appearance in a newborn of two different types of epithelial-lined cysts is reported. It is the first such case to be reported in the literature.     

Mandibular fracture fixation and reconstruction using the lower-border threaded rod: an eleven-year follow-up study

Twenty-five cases in which a lower border threaded rod was used for fracture fixation and mandibular reconstruction were reviewed. These cases were performed during the last 11 years and have been followed for periods of up to five years and ten months. The fixation technique, originally reported in 1978, is well tolerated and provides excellent mechanical stability when enhanced security of fixation is indicated. Three unusual cases are reported in detail.     

Healing of mandibular ridge augmentations using hydroxylapatite with and without autogenous bone in dogs

Dog mandibles were augmented with either hydroxylapatite (HA) alone or HA combined with autogenous bone. Within the limited time frame of this experiment (16 weeks) the group which received HA alone did not demonstrate the induction of bony ingrowth further than 1-2 mm into the augmented ridge. However, the animals augmented with HA combined with autogenous bone demonstrated an active, lamellar-type bony ingrowth, maturing bony haversian systems, and vascular elements forming throughout the entire area, extending to the overlying soft tissue interface. The clinical assessment of both types of augmented ridges (HA and HA and bone) were similar; both formed hard, firm ridges at approximately the same rate. This observation is consistent with human clinical experience with HA or HA mixed with bone. However,for patients who have severe mandibular atrophy and for whom increased mandibular bony bulk is crucial, a combination of HA and bone should be advantageous because of the increased extent of bony ingrowth.     

The image intensifier in oral and maxillofacial surgery

The mobile image intensifier has been found useful in the removal of foreign bodies from both intraoral and extraoral sites. The safety of the machine has been verified, and a technique for its application is described. Additional uses for the machine are stated.     

Blood loss with use of the Shaw scalpel for the treatment of oral cancer

The Shaw scalpel was used in seven radical operations for oral cancer. The amount of bleeding and postoperative exudate and the occurrence of postoperative complications were compared with that from 12 operations performed with the conventional steel scalpel. The blood loss during the radical neck dissection performed with the Shaw scalpel was 39% of the control value, and no blood transfusions were necessary. There was no increase in the amount of postoperative exudate in the Shaw scalpel group compared with the control group. Skin incision with the Shaw scalpel was accompanied by superficial wound dehiscences in three patients, which healed without any treatment.     

Isolated fracture of the first rib associated with facial trauma

Isolated fractures of the first rib are rare and often, though not always, indicative of severe trauma. The causes of first rib fracture are various, as are the sometimes serious complications of such a fracture. Since the oral and maxillofacial surgeon is involved many times in the primary care of the trauma patient, he must consider the possibility of first rib fracture and be alerted to the possible sequelae.