Palatogram Assessment of Maxillary Complete Dentures

Phonetics, esthetics, function, and comfort form the foundation of a successful dental prosthesis. A review of the mechanics of speech as well as common speech problems encountered with a removable maxillary prosthesis are presented. The use of a palatogram to aid the clinician in the assessment and resolution of speech problems associated with a maxillary denture is demonstrated.     

Does H2-receptor antagonist alter the renal function of cyclosporine-treated kidney grafts?

Histamine-type 2 antagonists (H₂-blockers) as represented by cimentidine have been shown to adversely affect renal allograft function, particularly when coadministered with cyclosporine, currently a major immunosuppressant. To determine whether or not a newer and more powerful H₂-blocker, famotidine, would produce similar adverse effects, we assessed seven cyclosporine-treated renal allograft recipients with regard to changes in their renal function on or off the H₂-blocker over a one-week period. Neither the administration nor withdrawal of famotidine (20–40 mg/day) resulted in any significant changes in serum creatine, BUN, urine output or cyclosporine trough levels, suggesting that famotidine can be safely administered as an H₂-blocker to cyclosporine-treated renal allograft recipients.     

Primary management of maxillofacial hard and soft tissue gunshot and shrapnel injuries

PURPOSE: A 10-year retrospective study was undertaken of all patients treated for facial gunshot and shrapnel wounds at our medical center to evaluate the outcomes and assess the results of simultaneous management to treat the hard and soft tissue injuries primarily. PATIENTS AND METHODS: A total of 44 patients were treated. Medical documentation of the patients was compiled. All maxillofacial gunshot, shrapnel, and warfare injuries were treated by the oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by pertinent consultant specialists. Patients ranged in age from 8 to 53 years, with a mean age of 24.7 years. Maxillofacial hard and soft tissue injuries were treated definitively in the first operation except when gross contamination, infection, extensive comminution, or general condition precluded this. RESULTS: There were 2 shotgun, 28 bullet, 10 shrapnel, 3 land mine, and 1 breech block injuries. Overall postadmission mortality in this series was 2.2%. Of the 97.7% of the patients who had an injury to the underlying craniofacial skeleton, all required surgical intervention. The soft tissue and underlying bony injuries were addressed concomitantly (in a single stage at the time of primary surgical debridement) in 86.3% of the patients. Nine percent of the patients had a tracheostomy emergently for management of the airway, 6.8% had an intracranial injury, and 2.2% of them required neurosurgery. In the series, 4.5% of the patients had neck wounds that required exploration. Comprehensive treatment was rendered in 1 to 3 major operations (average, 1.5). CONCLUSION: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary treatment of hard and soft tissue injuries of the face at the time of surgical debridement was possible in the majority of our patients. This minimized the number of admissions and did not bear a higher complication rate than other reported series that advocate multiple staged operations to treat such injuries despite the fact that, in our series, flaps were also mobilized for wound closure in the primary phase.     

Resolution of homonymous visual field loss documented with functional magnetic resonance and diffusion tensor imaging.

A 68-year-old man developed right homonymous hemianopic paracentral scotomas from acute infarction of the left extrastriate area. He was studied over the ensuing 12 months with visual fields, conventional MRI, functional MRI (fMRI), and diffusion tensor imaging (DTI). As the visual field defect became smaller, fMRI demonstrated progressively larger areas of cortical activation. DTI initially showed that the lesioned posterior optic radiations were completely interrupted. This interruption lessened in time and had disappeared by one year after onset. fMRI and DTI are innovative measures to follow functional and structural recovery in the central nervous system. This is the first reported application of these imaging techniques to acute cerebral visual field disorders.     

Mandibular displacement in Angle Class II, Division 2 malocclusion

The effect of the treatment of Angle Class II, Division 2 malocclusion was studied in 22 children by x-ray cephalometry and by recording the relation between the retruded and the intercuspal mandibular positions. The treatment was performed in three phases. In the first phase the upper incisors were proclined, and the deep bite was corrected with an upper removable plate. In the second phase the distal occlusion was corrected with an activator. The result was retained in the third phase with a second activator designed for retention. The relation between the retruded (RCP) and the intercuspal (ICP) mandibular positions was recorded with wax bites and dental casts mounted in a modified gnathothesiometer. The anteroposterior distance between RCP and ICP was large before the start of the treatment. The distance was unchanged after proclination of the upper incisors and correction of the deep bite but decreased after correction of the distal occlusion and increased again somewhat during the retention phase. The proclination of the upper incisors and the correction of the deep bite (phase one of the treatment) did not result in mandibular anterior positioning. This fact and the results of the recordings of the relation between RCP and ICP were interpreted as evidence that the mandible is not posteriorly displaced in Class II, Division 2 malocclusion.