Synovial chondromatosis of the temporomandibular joint: varying presentation in 4 cases.

Synovial chondromatosis is a rare condition in which cartilage is formed in the synovial membrane of a joint. The manifestations of this benign neoplastic process can mimic many common temporomandibular joint and parotid diseases. Four cases of synovial chondromatosis are presented. In each case, atypical presentation, coexisting joint disease, or both caused diagnostic confusion. The histories and physical examinations were initially consistent with more common joint diseases in each case. Imaging provided some insight into diagnosis and was a definitive indication for surgical treatment. Treatment by subtotal synovectomy and by removal of chondromatous nodules were undertaken in each case. No patient in our series has had recurrence of disease or symptoms after surgical treatment.

Giant cell tumor in the mandible: surgical treatment and implant-supported reconstruction--a clinical report.

Giant cell tumors of the jaw are extremely rare. The malignant variants of these tumors are distinguished by their rapid growth, pain, or tumor paraesthesia. The lesions generally manifest as multilocular radiolucencies of bone with well differentiated margins. If not diagnosed and treated, the lesions may resorb the alveolar ridge and displace the roots of the teeth. The learning objective of this article is to present the diagnosis of the lesion, mandibular resection, bone graft augmentation of the surgical site, implant placement, and restoration of oral function by implant-supported prosthesis. Multidisciplinary approach and cooperation are credited for the successful final result.

Nasal considerations in orthognathic surgery.

The functional correction of dentofacial deformities by orthognathic surgery produces major changes in facial appearance. Facial esthetics must therefore be equally appreciated by the orthodontist and the maxillofacial surgeon. The orthodontist must perform a thorough esthetic facial evaluation along with his usual orthodontic evaluation. The treatment plan must then be based on the esthetic evaluation and knowledge of the facial changes caused by orthodontic treatment and skeletal jaw surgery. Central to facial form is the nose. This article will outline the proper functional and esthetic evaluation of the nose in relation to the face. Nasal and upper lip changes associated with maxillary procedures will also be covered in detail. In light of these two areas, proper treatment planning and sequencing will be discussed.

An analysis of factors influencing stability of surgical advancement of the maxilla by the Le Fort I osteotomy.

Skeletal stability after maxillary surgical advancement was studied in 30 patients. Postoperative movement of all measured skeletal and dental points were on the average negligible. Equal stability was seen in maxillary advancement alone and with concomitant mandibular surgery. Eight cases examined individually showed larger than desired postoperative movements. In six of these cases the undesirable postoperative changes were secondary to undesirable preoperative orthodontic flaring of the incisors. The Begg orthodontic technique, because of its tendency to axially rotate teeth, was shown to produce more variability in tooth position than edgewise orthodontics. This study confirms that no preoperative flaring of the maxillary incisors should be attempted; instead, the teeth should be retracted and placed over basal bone with a normal axial inclination. Occlusal correction should then be accomplished by surgery. Suspension wires and bone grafting are sufficient to obtain skeletal stability in cases of maxillary advancement up to 11 mm. In cases where the surgery is more complex, rigid fixation is recommended.

A diagnostic adjunct in treatment planning for the dentofacial deformity patient.

The purpose of this article is to elucidate individual facial relationships using the concepts of the proportionate analysis as described by Moorrees and others. Diagnosis and treatment must be based upon dynamic orofacial and masticatory muscles as well as occlusal and temporomandibular joint functions in concert with esthetic considerations of the soft-tissue configuration. The Moorrees mesh offers a practical means for the study of proportionate relationships rather than linear and angular measurements.

Facial changes associated with surgical advancement of the lip and maxilla.

A study of maxillary advancements performed with concomitant nasolabial muscle reconstruction demonstrated a predictable soft tissue/osseous ratio of 1:0.9, with the lip moving forward on the average of 90% of the dentition. Lip shortening was not found in this group of patients.

Variations of total vertical maxillary excess.

The long-face syndrome is a well-recognized entity, yet the pathogenesis of this malformation remains obscure and variations are generally not recognized. Fifty lateral cephalometric radiographs of patients who underwent vertical maxillary reductions were studied using the architectural and structural analysis of Delaire. Several subgroups of vertical maxillary excess that had not been recognized previously were identified. The most common dysmorphic type was the classically described long-face syndrome; the next most common consisted of patients who had short upper lips, normal maxillas, and long faces secondary to vertical chin excess. In all, six different variations of vertical maxillary excess were identified. Concomitantly, in the majority of cases there was associated vertical mandibular chin excess. It is suggested that these variations may have differing pathogeneses.

Differential diagnosis and treatment planning of the surgical orthodontic class III malocclusion.

The decision to reposition the mandible posteriorly or the maxilla anteriorly in the treatment of Class III malocclusions depends upon multiple clinical, cephalometric, and biomedical considerations. In each case the decision must be made on teh basis of frontal and profile treatment objectives, occlusion, and the needs of the patient. In many instances, depending upon the magnitude of the disharmony, the treatment plan will be based upon the clinical judgment and experience of the surgeon and orthodontist. Surgery for the Class III patient is equally predictable and stable, whether the maxilla or the mandible is moved. This article discusses the diagnostic criteria by which one might evaluate and plan treatment for a patient with a Class III malocclusion and facial disharmony.

Arthroplasty of the temporomandibular joint with use of a vitallium condyle prosthesis: report of three cases.

We have devised a Vitallium intramedullary prosthesis to replace the deformed arthritic condyle in cases that require bilateral condylectomy or in rare long-term failures of a single condylectomy. Experience has led to modification of this prosthesis. Recently a rectangular stem that prevents rotation of the prosthesis in the condylar stub has been added (Fig 11). In bilateral condylectomies, replacement of only one side by the Vitallium condylar prosthesis is adequate, because it stabilizes the mandible by maintaining its original fulcrum in the temporomandibular joint. Three cases of replacement with the Vitallium condyle prosthesis are reported, with follow-up studies of two to three years postoperatively. The results to date have been gratifying.

Total mandibular alveolar osteotomy in the management of skeletal (infantile) apertognathia.

When intraoral access is adequate and other physical characteristics are satisfactory, total mandibular alveolar osteotomy can be used effectively to correct skeletal (infantile) apertognathia. The procedure, not frequently used, resulted in significant improvement of a massive open bite in a 15-year-old girl.