Chronic factitious illness: recognition and management of deception

Factitious disease is often manifested in the head and neck region. It is only when the oral and maxillofacial surgeon is aware of the existence of this syndrome and has been unable to correlate a patient's history and signs and symptoms with known diseases that factitious illness may be suspected as the diagnosis. Three case histories that help to demonstrate the variety of ruses used by patients to feign illness are presented. The expertise of a psychiatrist will often help to substantiate the diagnosis, but in many instances the main aspects of treatment will remain in the hands of the original clinician. It is important for clinicians to realize that patients with chronic factitious illness are extremely manipulative and unwilling to admit to their fabrications.     

Spatial arrangement of collagen fibrils in the articular cartilage of the mandibular condyle: A light microscopic and scanning electron microscopic study

To determine the spatial arrangement of collagen fibrils in articular cartilage of the human mandibular condyle, ten healthy condyles obtained at necropsy were examined by light microscopy and scanning electron microscopy (SEM). Observations using light microscopy showed the existence of four different zones. The organization and alignment of the collagen fibrils were different in every zone and varied from layers to bundles of fibrils running parallel, obliquely, or radially to the articular surface. Observations using scanning electron microscopy revealed a thin, surface layer of disorganized small fibrils with a cotton-wool appearance and a well-organized architecture of collagen fibrils in every zone. It was concluded that the organization of collagen fibrils in articular cartilage shows a three-dimensional network with a special system in every zone.     

The frequency and distribution of skeletal and dental components in Class II orthognathic surgery patients

In an effort to identify the skeletal and dental relationships of Class II malocclusion, lateral cephalograms of 253 adult orthognathic surgery patients (76 male, 177 female) who had a Class II molar and cuspid relationship were traced. One hundred and four of the subjects had had presurgical orthodontic treatment and 148 had not. The most common combination of variables found in this study population was a retrusive maxilla, protrusive maxillary incisors, protrusive mandibular incisors, a retrusive mandible, and a long lower facial height.     

Dynamic vascular changes in free skin grafts

Vascular changes in full-thickness skin grafts in rats were examined at various intervals after grafting using microangiography. The grafted skin and its bed showed dynamic vascular changes that were considered to be related to release of an " angiogenetic factor" produced by the skin under oxygen-deficient conditions such as ischemia. The first filling of contrast medium in the grafts was observed 24 hours after grafting. Both primary and secondary revascularization were observed.     

Effect of splinting on abutment tooth movement

The effect of splinting on abutment tooth movement was investigated in an in vitro study. An acrylic resin mandibular model with missing molars and a removable partial denture framework were constructed. The roots of the premolars and edentulous ridges were coated with silicone rubber. A modified Ney surveyor was used for load application, and abutment tooth movement measurements were made with a macroperiodontometer. Four conditions were tested by applying unilateral loadings: 1. Single abutments of both sides 2. Load side double abutment 3. Nonload side double abutment 4. Double abutments of both sides The results showed that a significant decrease in the magnitude of movement resulted when the abutment teeth were splinted.     

Removal torque and force to failure of non-axially tightened implant abutment screws

Statement of problem

Components have been introduced that allow the screw channel of an implant crown to be angled lingually and the screws to be tightened in a non-axial direction to the implant. Information is lacking as to how the removal torque value (RTV) and force to failure (FTF) of these components compare with those of conventional screws.

Long-term evaluation of meniscectomy of the temporomandibular joint

Meniscectomy for treatment of pain and dysfunction of the temporomandibular joint is a controversial operation because of the possible late complications of limitation of movement and pain. Therefore, the long-term results of this operation were clinically and radiologically investigated in a sample of 15 patients that had had meniscectomies performed during the period from 1947-1960 (mean follow up, 29 years). On clinical examination, all patients were free of pain, none had subjectively experienced dysfunction, and all but one could open their mouths more than 39 mm. Two thirds of the operated joints were crepitant. Radiologically all joints showed structural hard-tissue changes, mainly the presence of osteophytes and flattening of the condyle and tubercle. Absence of joint space was seen in half of the joints. The results indicate that meniscectomy relieves joint pain and eliminates subjectively perceived dysfunction in the long term despite the presence of clinical and radiologic signs of degenerative joint disease; however, as the condition of many patients who have temporomandibular joint disorders improves over time without surgery, there is a need for a controlled study on the value of meniscectomy.     

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.