Obstructive sleep apnoea: The role of the oral and maxillofacial surgeon

Obstructive sleep apnoea is a relatively common sleep disorder that is popularly associated with snoring and excessive daytime sleepiness. It is a disorder with serious implications that has only in the last two decades received the attention of clinical specialists. The aim of this article is to review the role of the dental profession in the recognition and management of this disorder.     

Temporomandibular disorders. Part 3. Surgical treatment

Surgery of the temporomandibular joint has a small but nonetheless important role in the overall management of temporomandibular disorders. Appropriate case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired outcome of treatment, such as relief of symptoms and improved function. In this, the third article in the series, a general overview of the current surgical treatment modalities for temporomandibular disorders will be presented.     

Central calcifying odontogenic cyst. Case report

A case of central (intraosseous) calcifying odontogenic cyst affecting the mandible is reported. The clinical, radiographic, and histological features are reviewed and discussed.     

Temporomandibular disorders. 2. Non-surgical treatment

There are many treatment modalities for temporomandibular disorders (TMD), most of which are effective in controlling symptoms, at least in the short term. The non-surgical treatment of temporomandibular disorders continues to be the most effective way of managing over 80 per cent of patients who present with symptoms of temporomandibular pain and dysfunction. In this, the second article in the series, a general overview of the current non-surgical treatment strategies for TMD will be presented.     

Mandibular osteomyelitis and pathologic fracture associated with metabolic catabolism induced by ''binge'' drinking. Case report

A case is reported where intermittent 'binge' drinking was associated with mandibular infection, pathologic fracture and failure of healing in a 30-year-old man.     

Management of fractured mandibles without the use of intermaxillary wire fixation

PURPOSE: The aims of this retrospective clinical study were to compare the management of unilateral angle fractures of the mandible using the traditional approach of open reduction with internal fixation (ORIF) and intermaxillary wire fixation (IMF) with the technique of ORIF without IMF. PATIENTS AND MATERIALS: Thirty-one patients who presented with isolated unilateral angle fractures of the mandible were randomly divided into 2 treatment groups. Both groups underwent open reduction with a single upper border miniplate and screw fixation (ORIF). Eleven of the 31 patients in the study had IMF to aid in the fracture reduction, and 20 patients had no IMF so the fracture was reduced by hand manipulation. Records of operating and discharge times, postreduction radiographs, and occlusal outcomes were examined and tabulated. RESULTS: Patients in both treatment groups were closely matched in terms of age, gender, site of injury (ie, isolated angle fracture of mandible), and incidence of teeth in the fracture line. The mean operating time for traditional ORIF with IMF of angle fractures of the mandible was 98.5 minutes, and these patients were discharged an average of 1.82 days after surgery. The mean operating time for ORIF of angle fractures of the mandible without the use of IMF was 40.2 minutes, and these patients were discharged an average of 1.35 days after surgery. Postoperative outcomes in terms of the postreduction anatomic alignment of the fractures and functional occlusion at 6 weeks were similar in the 2 treatment groups. CONCLUSIONS: We found that the use of IMF for the management of angle fractures of the mandible is unnecessary provided there is a skilled assistant present to help manually reduce the fracture site for plating. Discarding the use of IMF not only helps improve patient comfort but also reduces the operating time by up to 1 hour and accelerates discharge times by up to half a day.     

The Early Psychological Adjustment of Cleft Patients After Maxillary Distraction Osteogenesis and Conventional Orthognathic Surgery: A Preliminary Study

PURPOSE: To compare the early psychological changes of cleft lip and palate (CLP) and noncleft patients after maxillofacial corrective surgery, including maxillary distraction osteogenesis and conventional orthognathic surgery. MATERIALS AND METHODS: Nine CLP patients were compared with a group of 9 non-CLP patients having similar dentofacial deformities in a prospective longitudinal cohort study. Five of the CLP patients underwent maxillary distraction osteogenesis and 4 underwent conventional orthognathic surgery. A control group of 9 noncleft patients received conventional orthognathic surgery. All patients completed a set of questionnaires to enable their psychological profile to be assessed. The data were collected immediately before surgery (T1), and at 3 weeks (T2) and 12 weeks (T3) after surgery. RESULTS: The CLP patients treated with distraction osteogenesis were happier, but had a higher level of social anxiety and distress than the CLP patients receiving conventional orthognathic surgery. On the other hand, the CLP patients overall were happier, with lower social anxiety and distress, than the noncleft control group. The CLP patients showed a higher level of parental self-esteem than the noncleft patients. CONCLUSION: This preliminary study shows that CLP patients were generally happier, and had a higher level of parental support, than normal patients suffering from dentofacial deformities. Maxillary distraction osteogenesis seemed to induce a higher level of anxiety and distress in CLP patients than conventional orthognathic surgery in both cleft and noncleft patients.