Thin-plate spline graphical analysis of the mandible in mandibular prognathism.

The chin cup has been used to treat skeletal mandibular prognathism in growing patients for 200 years. The pull on the orthopedic-force chin cup is oriented along a line from the mandibular symphysis to the mandibular condyle. Various levels of success have been reported with this restraining device. The vertical chin cup produces strong vertical compression stress on the maxillary molar regions when the direction of traction is 20 degrees more vertical than the chin-condyle line. This treatment strategy may prevent relapse due to counter-clockwise rotation of the mandible. In this report, we describe a new strategy for using chin-cup therapy involving thin-plate spline (TPS) analysis of lateral cephalometric roentgenograms to visualize transformation of the mandible. The actual sites of mandibular skeletal change are not detectable with conventional cephalometric analysis. A case of mandibular prognathism treated with a chin cup and a case of dental Class III malocclusion without orthodontic treatment are described. The case analysis illustrates that specific patterns of mandibular transformation are associated with Class III malocclusion with or without orthopedic therapy, and that visualization of these deformations is feasible using TPS graphical analysis.     

Long-term survival of patients with mandibular osteosarcoma.

Osteosarcoma generally has a poor prognosis. Osteosarcoma of the mandible is rare and may have a less aggressive course. Three patients with osteosarcoma of the mandible were treated during the past 19 years at National Taiwan University Hospital. All were women, with an average age of 49 years. The patients were treated with radical excision of the tumor, with either pre- or postoperative radiotherapy. None of the patients received chemotherapy. Reconstruction with iliac osteocutaneous free flap, fibular osteoseptocutaneous free flap, or Leibinger reconstruction plate was performed to repair the facial defects resulting from tumor resection or radiation-induced necrosis. The three patients were alive and without evidence of recurrence at the time of writing, with follow-up periods ranging from 7 to 18 years. All had acceptable facial contour and satisfactory oromandibular function after reconstruction. These results support the effectiveness of wide resection with radiotherapy for treatment of mandibular osteosarcoma. With the availability of microsurgical reconstruction and biocompatible reconstruction plates, we advocate extensive ablation of this tumor. Long-term survival, good functional recovery, and acceptable facial contour can be expected.     

Morphometric analysis of mandibular growth in skeletal Class III malocclusion.

BACKGROUND: The craniofacial growth patterns of untreated individuals with skeletal Class III malocclusion have rarely been systemically investigated. This study used morphometric techniques to investigate the growth characteristics of the mandible in individuals with skeletal Class III malocclusion. METHODS: Lateral cephalometric head films of 294 individuals with untreated skeletal Class III malocclusion (134 males, 160 females) were selected and divided into five triennial age groups (T1-T5) and by gender to identify the morphologic characteristics and sexual dimorphism in changes of mandibular growth. Procrustes, thin-plate spline, and finite element analyses were performed for localization of differences in shape and size changes. Maximum and minimum principal axes were drawn to express the directions of shape changes. RESULTS: From T1 (age 6-8 years) to T4 (age 15-17 years), the distribution of localized size and shape changes of the mandible was very similar between the two genders. From T1 to T2 (age 9-11 years), significant lengthening of the condylar region was noted (23.4-39.7%). From T2 to T3 (age 12-14 years), the greatest size and shape change occurred at the condylar head (27.4-34.9%). From T3 to T4, the greatest size and shape changes occurred in the symphyseal region (23.6-42.1%). From T4 to T5 (age>or=18 years), significant sexual dimorphism was found in the distribution and amount of localized size and shape changes. Females displayed little growth increments during T4. Despite differences in the remodeling process, the whole mandibular configurations of both genders exhibited similarly significant upward and forward deformation from T4 to T5. CONCLUSION: We conclude that thin-plate spline analysis and the finite element morphometric method are efficient for the localization and quantification of size and shape changes that occur during mandibular growth. Plots of maximum and minimum principal directions can provide useful information about the trends of growth changes.     

Treatment of pregnancy sickness.

A double-blind comparison was undertaken between Debendox with 10mg of extra pyridoxine and placebo with 10mg of pyridoxine, in 56 women suffering from nausea and/or vomiting during the first 10 weeks of pregnancy. The results of treatment were assessed on the patient's own dialy records of:the time of nausea, the frequency of nausea, and the severity of nausea, retching and vomiting. There were statistically significant differences in favour of Debendox with extra pyridoxine in respect of the days of nausea all day (P les than 0-02), the severity of nausea (P less than 0-05) and the severity of retching (P less than 0.05).     

Treatment of cervical carcinoma.

A comparison of cervical carcinoma survived data is made between a large specialized cancer treatment center, M.D. Anderson, and a general regional medical center with 15,000 inpatient admissions and over 250,000 outpatient visits per year. End results are identical and did not depend on the percentage of time spent by the gynecologists or radiation therapists on problems of pelvic cancer.     

Comparison of the Gow-Gates mandibular block and inferior alveolar nerve block using a standardized protocol.

BACKGROUND: Although several previous studies have compared the efficacy of Gow-Gates mandibular block (GGMB) and inferior alveolar nerve block (IANB), the results remain controversial. This study used an objective, standardized and precise protocol to evaluate and compare the effectiveness and success rate of GGMB and IANB. METHODS: The study group consisted of 162 patients (93 males and 69 females) who were randomly allocated to receive GGMB or IANB for extraction of third molars. Both methods used 2.7 mL of 2% xylocaine for each patient. Pulpal and gingival tissue anesthesia of mandibular central incisors, canines, first premolars and first molars were evaluated at 0, 5, 10, 15 and 60 minutes after injection of local anesthetic solution using both an electric pulp tester and a sharp explorer. RESULTS: The success rates of pulpal anesthesia in the IANB group (central incisor, 6%; canine, 37%; first premolar, 54%; first molar, 88%) were not significantly different from the GGMB group (central incisor, 8.1%; canine, 37.1%; first premolar, 54.8%; first molar, 83.9%). All subjects achieved 100% lip numbness with both methods. At 60 minutes after injection, the success rates of gingival tissue anesthesia in canine buccal and lingual areas were higher in the IANB group (100% and 100%, respectively) than in the GGMB group (91.9% and 93.5%, respectively). In the molar buccal area, the success rates at 5 and 60 minutes after injection were higher in the IANB group (97% and 100%, respectively) than in the GGMB group (88.7% and 91.9%, respectively). Furthermore, the success rates in the molar lingual area at 10, 15 and 60 minutes after injection were higher in the IANB group (100%, 100% and 100%, respectively) than in the GGMB group (91.9%, 93.5% and 91.9%, respectively). Although IANB achieved higher success rates of gingival tissue anesthesia in some gingival areas, no significant difference between the two methods was found in overall efficacy. CONCLUSION: This study demonstrated that the efficacy of pulpal and gingival tissue anesthesia are not significantly different between the GGMB and IANB methods.     

Treatment of the premenstrual syndrome.

A placebo-controlled, randomized, double-blind, parallel group study in hospital and general practice has shown that a combination of belladonna alkaloids, ergotamine tartrate, and phenobarbitone (Bellergal) was effective in treating troublesome symptoms of the premenstrual syndrome of which fatigue, tender breasts, nervousness, irritability, lethargy and listlessness were improved to a statistically significant degree. The drug was given three times daily and caused no side effects.     

Treatment of hyperthyroidism in pregnancy.

One hundred and five consecutive pregnancies in 79 women affected by hyperthyroidism were observed during an 8-year period. All had received treatment either with carbimazole alone (Group I) or with the combination of carbimazole and propranolol (Group II). There were 72 pregnancies in Group I, 33 in Group II. Seventy-five pregnancies occurred whilst the mother was receiving antithyroid therapy and in the other 30 the diagnosis of hyperthyroidism was made following conception. The total fetal loss was 17.1%, with a spontaneous abortion rate of 5.5% in Group I and 24.2% in Group II. No congenital malformation or maternal deaths occurred. Carbimazole is safe and effective during pregnancy. Adding propranolol offers no further advantage and may indeed be detrimental.     

Treatment of Gardnerella vaginalis infection.

This review of the antibiotic sensitivity pattern of Gardnerella vaginalis culture isolates shows that the drugs found sensitive to G. vaginalis cultures include the new antimicrobial agents- ciprofloxacin, cefuroxine and ceftazidine, and some older antibiotics- ceftriaxone, cloxacillin, erythromycin, chloramphenicol and metranidazole. Streptomycin and augmentin showed intermediate sensitivity while penicillin, ampicillin, tetracycline and gentamycin exhibited resistance to G. vaginalis isolates. Metronidazole is currently the first-line drug of choice for the treatment of G. vaginalis and its related infections because of its effectiveness not just against G. vaginalis but also against anaerobes. It can be administered orally, parenterally and intravaginally as gel or sponge. The advantages and drawbacks to the use of these G. vaginalis - sensitive drugs, and the place of alternative drugs in the management of G. vaginalis - associated infections are discussed.     

Treatment of ovarian stromal tumors.

Fifty-one patients with granulosa-cell tumors and nine patients with Sertoli-Leydig-cell tumors have been treated at the M. D. Anderson Hospital. The most important prognostic finding was the stage of the tumor when first seen. Conservative surgery was utilized in young patients with lesions confined to one ovary. More advanced tumors were treated with maximal tumor resection and postoperative treatment with either irradiation or chemotherapy. Postoperative radiation was given when the tumor capsule had ruptured or residual tumor less than 2 cm. in diameter was present after surgery. Single-agent chemotherapy was ineffective in ovarian stromal tumors, but combination chemotherapy was found to be effective in advanced or recurrent stromal tumors. Actinomycin-D, 5-fluorouracil, and cyclophosphamide were effective in granulosa-cell tumors. Vincristine, actinomycin-D, and cyclophosphamide were effective in Sertoli-Leydig--cell tumors.