Ankylosis of the mandible: analysis of 76 cases

A survey of 76 cases of ankylosis of the mandible in Nigerians is presented. Etiology, clinical features, radiographic findings, anesthetic techniques, surgical treatment, complications, and results are discussed. The operative technique used in each case depended on the site, extent, and type of ankylosis. Five-year follow-up data are reported. Of the 47 patients who were followed, the postoperative interincisal opening was retained in 25 (53.2%), varying degrees of reduction of mouth opening were observed in 17 (36.2%), and ankylosis recurred in five (10.6%). Lack of jaw opening exercise was believed to be responsible for relapse.     

The use of fibrin sealant in oral and maxillofacial surgery

A fibrin sealing system is described and its application in various oral and maxillofacial surgical procedures is discussed. The system produces hemostasis, promotes wound healing, and serves as a tissue adhesive.     

The wide world of craniofacial surgery

Craniofacial surgery as applied to congenital defects is outlined. Special attention is drawn to recent developments. The use of craniofacial techniques in the treatment of craniosynostosis, acute trauma, post-traumatic deformities, and tumors is described.     

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.     

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.     

The use of hyperbaric oxygen therapy in bony reconstruction of the irradiated and tissue-deficient patient

Eighteen bony reconstructions of the mandible or maxilla using a newly defined and specific hyperbaric oxygen protocol are reported. Eleven of 12 grafts in irradiated tissue met six rigid criteria for a 91.6% rate of success. All six grafts into scarred and deficient tissue beds also met the same criteria, for an overall success rate of 94%. The rationale for emphasizing preoperative tissue preparation using hyperbaric oxygen is discussed, as are the mechanisms of action of hyperbaric oxygen on a biochemical, cellular, and tissue level. Neovascularity and neocellularity are demonstrated histologically by human biopsy specimens, and this is suggested as being the reason for the excellent results of reconstruction in irradiated and/or deficient tissue beds.     

The biometry of mandibular osteotomy repair

The healing of experimental mandibular osteotomies in monkeys was monitored by biometric testing. Results indicate that full strength returns to the osteotomy site in 20 weeks. The implications for the treatment of osteotomies and fractures of the mandible in humans are discussed.     

The oral manifestations of 4p- syndrome

The oral manifestations of 80 reported cases of 4p- syndrome are analyzed and a new case is reported. Results indicate that the common pattern of cheilognathopharyngeal disorders in 4p- syndrome is an isolated cleft palate or a high-arched palate with micrognathia. Cases of cleft lip are only about 10% of the total. The significance of other reported aberrant phenomena cannot yet be estimated.     

The relation of tooth extraction to anginal attack

This clinical study retrospectively compared the relationship of anginal attack during dental extractions with factors such as blood pressure, heart rate, rate-pressure product, and electrocardiographic findings. The anesthetic procedure produced the greatest change in the various parameters. No direct relationship could be observed between anginal attack and doses of lidocaine, epinephrine, and premedicative drug or time required for treatment.     

The effects of immobilization on the primate temporomandibular joint: a histologic and histochemical study

The effects of prolonged immobilization on the primate temporomandibular joint (TMJ) condylar cartilage are reported. After eight weeks of immobilization, changes were assayed histochemically using the specific glycosaminoglycan (GAG) stain safranin O. Following the immobilization period, the articulating cartilage showed marked thinning, disorganization, and loss of the superficial GAG stain. After two weeks of remobilization, further thinning had occurred and GAG staining was nearly absent. Sections from condyles of animals sacrificed serially from two weeks to eight months after immobilization showed a gradual return to the thickness and GAG content of the control animals' condyles. But even at this stage, GAG staining was less marked than in the controls, and zonal reorganization was incomplete. These results suggest that TMJ immobilization is not wholly benign procedure.     

The use of ultrasonography in the diagnosis of neck lumps

The role of ultrasonography in the diagnosis of neck lumps is explained with particular reference to branchial cysts, chemodectomas, and abscesses.     

The use of transarterial microembolization in the management of hemangiomas of the perioral region

The management of oral and perioral hemangiomas depends on several clinical factors. Surgery of these benign lesions can at times be disfiguring, especially when the lips, muscles, or the maxilla and mandible are involved. In addition, by the very nature of these lesions, surgical treatment may be associated with excessive intra- and perioperative blood loss. A series of five patients who had hemangiomas in the perioral region and who were initially treated with transarterial microembolization, preoperatively in two cases and as the only treatment in three cases, is presented. The technique of microembolization is described and recommendations for its use are given.     

The use of the fibrin adhesion system for local hemostasis in oral surgery

In 144 patients with bleeding disorders and in 11 patients with normal coagulation, 517 wound sealings were performed using the fibrin adhesion system (FAS) with the primary object of local hemostasis. Excellent results were obtained in patients with bleeding disorders caused by impaired thrombocyte function or anticoagulant therapy. Replacement therapy or the withdrawal of anticoagulant medication was thereby avoided. Ultimate hemostasis in patients with hemophilia was achieved by fibrin sealing in combination with low-dose replacement therapy with clotting factor concentrates. Though the risk of hepatitis transmission cannot be completely ruled out, the advantages, such as excellent tissue tolerance, complete resorption, and a wide spectrum of practical uses, speak in favor of the use of this physiologic tissue adhesive.     

The class III syndrome

A discussion of the esthetic relationships involved with Class III malocclusion is presented, and a suggested method of treatment is outlined. Three case reports illustrate the syndrome and its correction.     

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.     

The role of suprahyoid myotomy in surgical advancement of the mandible via sagittal split ramus osteotomies

The suprahyoid muscles have been implicated as primary effectors of relapse following surgical advancement of the deficient mandible. Accordingly, suprahyoid myotomy and/or the use of cervical collars have been recommended as adjunctive procedures to minimize postoperative relapse. This computerized morphometric evaluation of 16 patients revealed that suprahyoid myotomy is not essential to skeletal stability following surgical advancement of the mandible.     

Use of scopolamine for dental anesthesia and analgesia techniques

A review of the English literature on the pharmacologic effects of scopolamine is presented and indications for the current use of the drug in dental anesthesia and analgesia are evaluated. The authors conclude that the role of scopolamine in the production of conscious sedation for outpatient dental surgery should be reevaluated in the light of contemporary findings.     

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.