No effect of neuromuscular blockade on the temporomandibular joint position during general anesthesia.

In an attempt to determine the role that nondepolarizing neuromuscular blocking agents play in the intraoperative position of the mandibular condyle, occlusal checkbites were taken on 10 patients under general anesthesia before and after neuromuscular blockade with vecuronium. These checkbites were compared to checkbites taken preoperatively. Nondepolarizing neuromuscular blocking agents had no effect on condylar position recordings during general anesthesia. The results demonstrate that general anesthesia itself is by far the dominant factor in intraoperative condylar position changes.

Ankylosing spondylitis associated with temporomandibular joint ankylosis: report of a case.

Ankylosing spondylitis is a disease process that causes inflammatory changes of the involved joints. Often the first clinical indication of the condition is lumbosacral pain and discomfort with limited range of motion. Progressive synovial changes eventually involve all of the axial joints including the temporomandibular joint. Although temporomandibular joint dysfunction is usually found in patients with ankylosing spondylitis, there are only nine documented cases of true bony ankylosis. A case report and review of the literature of ankylosis spondylitis associated with true temporomandibular joint bony ankylosis is presented. Surgical treatment included a gap arthroplasty and placement of an interpositional Silastic implant.

Synovial chondromatosis of the temporomandibular joint diagnosed by magnetic resonance imaging: report of a case.

A case of synovial chondromatosis of the temporomandibular joint with extracapsular extension is described. Temporomandibular joint magnetic resonance imaging proved invaluable in establishing a definitive diagnosis.

Continuous infusion of methohexital and alfentanil hydrochloride for general anesthesia in outpatient third molar surgery.

Three anesthetic techniques were compared in this study: 1) Intermittent Brevital boluses supplemented with fentanyl and midazolam all titrated to patient movement, 2) constant infusion of Brevital supplemented with fentanyl and midazolam all delivered in calculated mg/kg doses based on total body weight, and 3) constant infusion of methohexital (Brevital) and alfentanil (Alfenta) supplemented by midazolam (Versed), droperidol, and glycopyrolate (Robinul) delivered in calculated mg/kg doses based on lean body mass. Nitrous oxide was delivered in all cases via nasal mask in a 30% to 50% concentration. The mean total dose of Brevital in group 1 (intermittent Brevital bolus) was 0.17 mg/kg/min (SD = 0.07), group 2 (Brevital infusion) was 0.23 mg/kg/min (SD = 0.06), and group 3 (alfentanil/Brevital infusion) was 0.12 mg/kg/min (SD = 0.07). Mean total dose of alfentanil in group 3 equaled 1.58 mcg/kg/min (SD = 0.73). In group 1, 94% of the patients experienced moderate to severe movement intraoperatively. Twenty-three percent of the patients in group 2, and only 7% of group 3 exhibited moderate to severe movement. Emergence in group 3 averaged 4.5 minutes (SD = 1.6). Three patients (7%) in group 3 had postoperative nausea. Additional subjective findings in group 3 included easier airway maintenance during administration of the anesthetic, lack of unpleasant emergence phenomena such as crying, and prompt readiness for discharge. It was concluded that continuous alfentanil and Brevital infusion satisfied the objectives of safety, stability, predictability, and rapid recovery, while improving operating conditions (less patient movement) when compared with more traditional anesthetic techniques.

The surgical correction of vertical maxillary excess (long face syndrome).

The surgical correction of vertical maxillary excess is a relatively new technique. Vertical maxillary excess (VME) may exist alone or in combination with a horizontal mandibular deficiency with or without an anterior open bite. The facial contour is characterized by a long, tapering face with anterior and posterior maxillary overgrowth, a narrow alar base, and lip in competence. Cephalometric analysis demonstrates steep mandibular and occlusal planes in relationship to the cranial base, and increase in facial height, and retroposition of the mandible. Evaluation of study models exhibits increased alveolar bone height, a high palatal vault, and a narrow maxillary arch. The dental relationship may be Class I, II, or III, with Class II being the most common. Orthodontic treatment before surgery consists of correct alignment of the teeth and removal of those dental compensations that preclude good dental interdigitation at surgery. Regardless of the surgical procedure, accurate preoperative planning based on careful evaluation of skeletal, dental, and soft tissue features in conjunction with correct orthodontic surgical sequencing is the key to a satisfactory result. The "downfracturing" or Le Fort I maxillary osteotomy for superior repositioning of the maxilla is the surgical procedure of choice for vertical maxillary excess. Two-, three-, or four-segment maxillary osteotomies can be done in conjunction with the Le Fort I osteotomy without jeopardizing healing capacity.

Recurrent ameloblastoma in autogenous rib graft. Report of a case.

Recurrent tumors in previously placed bone grafts are rare. A case of recurrent ameloblastoma in a rib graft 13 years after resection and reconstruction is presented. A review of the literature discloses only one cases of ameloblastoma recurring within a bone graft. Considering that the recurrence rate is substantial in these tumors, prudent planning and meticulous surgery is mandatory prior to any attempt at reconstruction to minimize the risk of failure due to recurrence.

Instrumentation for styloidectomy.

Instrumentation that prevents injury to the structures of the tonsillar fossa during styloidectomy was presented. We think that by using this instrumentation, in particular the antral curet, the potential hazards are greatly reduced, if not eliminated.

Chronic sclerosing osteomyelitis: treatment considerations in an atypical case.

Chronic sclerosing osteomyelitis has been frequently described in the literature but little has been recommended for the management of the resistant cases that fail to respond to conservative treatment. This report describes the long term management of a particularly aggressive case of CSO and indicates maxillary sinus disease as a possible etiologic factor in CSO of the maxillary alveolus. Treatment required in more extensive cases must be as aggressive as dictated by the entire disease process and the total medical evaluation.

A prototype articulator for planning orthognathic and craniofacial surgery.

Current techniques and hinge-type articulators do not provide sufficient information and versatility for the planning of orthognathic and craniofacial surgery. Dental articulators either require plaster of paris for mounting or they do not accommodate movement of both casts in all directions of space. A prototype articulator that satisfies movement of both casts in all directions of space is successfully being used as an adjunct in planning orthognathic and craniofacial surgery. There is a need for future development of sophisticated and accurate armamentarium that can be used as an aid in planning and designing surgical procedures.