A comparison of surgery and orthodontics in "borderline" adults with Class II, division 1 malocclusions.

From a pool of 108 former patients, discriminant analysis was used to identify a homogeneous borderline prognostic subgroup of 27 adult orthodontic and 26 adult surgical Class II patients who, before treatment, were similar with respect to the characteristics on which the orthodontic/surgical decision appears to have been based. The fact that some had been treated orthodontically, whereas others had been treated surgically, was taken as empirical evidence that the patients in this stratum were equally susceptible to the two treatments and that the actual choice was largely a function of whose office they happened to contact. The former orthodontic patients were recalled an average of 7.1 years after treatment, the former surgical patients, 4.7 years after surgery. Each subject was evaluated with respect to skeletal and dental stability, profile esthetics, and temporomandibular function. Although there were dramatic differences in the nature of the correction (dental versus skeletal), both groups of patients generally thought that their profiles had been improved by treatment. As judged by data generated from visual analogue scales, the mean difference between the orthodontic and surgical patients' evaluations of their treatments was small and nonsignificant. Moreover, the "borderline" Class II orthodontic and surgical patients showed no significant differences in craniomandibular function and incisor stability. There was, however, one profound difference between treatments: 3 of the 26 surgical patients underwent extensive relapse, probably as a result of condylar resorption. From the standpoint of estimated probabilities and utilities for the various outcomes, the present results imply that orthodontics would be the better choice for the borderline adult Class II patient, whereas surgery would be appropriate for the more severely affected patient.

Condylar osteochondroma manifesting as Class III skeletal dysplasia: diagnosis and surgical approach.

This is a case report of a 21-year-old man who had a gradually progressive Class III malocclusion and crepitation of the right temporomandibular joint. Routine TMJ tomograms revealed a radiopaque-radiolucent lesion of the right mandibular condyle with a compensatory anteroinferior displacement of the left mandibular condyle. Nuclear bone scans confirmed increased asymmetric technetium 99 tracer uptake in the region of the right temporomandibular joint. A two-stage surgical approach was undertaken; this consisted of excision of the condylar lesion to correct the Class III malocclusion and posterior crossbite and a LeFort I osteotomy to correct the slight transverse maxillary cant and anterior open bite. A histopathologic diagnosis confirmed osteochondroma of the mandibular condyle.

Correction of condylar displacement following intraoral vertical ramus osteotomy.

Fifteen patients who demonstrated condylar sag after intraoral vertical ramus osteotomy for the correction of mandibular prognathism were treated nonsurgically to establish the desired postoperative occlusion. A mean inferior displacement of 3.33 mm and anterior displacement of 2.18 mm were observed tomographically after surgery. Postoperatively, a geometric splint was constructed to compensate for the magnitude of condylar displacement and was used to replace the original splint to hold the distal segment in an overcorrected position. Skeletal fixation was maintained for 5 to 6 weeks. Tomographic evaluation of the temporomandibular joint (TMJ) during maxillomandibular fixation showed a slight superior (1.03 mm) and posterior (0.51 mm) movement of the condyle in the fossa. After release of fixation and removal of splint, a further superior (2.05 mm) and posterior (1.01 mm) repositioning of the condyle was observed. This later movement correlated with the placement of light class III elastic traction to seat the condyles into the glenoid fossae and establish a class I occlusion. Temporomandibular joint tomograms confirmed complete seating of the condyles in the fossa and lateral cephalograms demonstrated a corresponding change in the position of the mandible to the desired postoperative position. This technique has been effective in preventing postoperative malocclusion resulting from condylar sag.

Maintenance of condyle-proximal segment position in orthognathic surgery.

Twenty patients underwent bilateral sagittal ramus osteotomy for the correction of mandibular retrognathia. A condylar positioning device (CPD) was used intraoperatively in 10 patients to maintain preoperative condyle-proximal segment position, while the CPD was not used in the other 10 patients. Postoperatively, the condyle-proximal segment positions in both groups were compared and evaluated for vertical, horizontal, and rotational changes. A significant improvement (P less than .05) was observed in the vertical and horizontal condylar position in the group in which the CPD was used. However, there was no significant difference in proximal segment rotation.

Composite temporalis pedicle flap as an interpositional graft in temporomandibular joint arthroplasty: a preliminary report.

Fifteen temporomandibular joint patients were evaluated preoperatively and postoperatively to evaluate the effectiveness of a composite (fascia, muscle and periosteum) temporalis pedicle flap as an interpositional disc replacement. A modified Craniomandibular Index (CMI) and Symptom Severity Index (SSI) were used to assess clinical and subjective symptoms. Eighteen months postoperatively there was a significant reduction in the CM and SS indices (P less than .001), with significant clinical improvement of the mandibular range of motion (P less than .05). However, a significant reduction of translation (P less than .01) was evident indicating that the increased mandibular opening was owing to a compensatory rotational movement. This study indicates that the composite temporalis pedicle flap is a good autogenous tissue for the reconstruction of the temporomandibular joint.

Condylar position in superior maxillary repositioning and its effect on the temporomandibular joint.

Twenty-nine patients (58 joints) were tomographically evaluated for condylar position and assessed for temporomandibular joint function following superior maxillary repositioning with mandibular autorotation. Seventy-six percent of the condyles showed postoperative posterior repositioning, whereas tomographic measurement of the joint spaces revealed significantly posterior condylar position (P less than .01) relative to the preoperative position. Pre- and postoperative comparative values of condylar displacement from absolute concentricity based on the Pullinger index also showed posterior condylar repositioning postoperatively (P less than .001). However, there was no correlation between condylar position and the presence of temporomandibular joint symptoms in both the asymptomatic and symptomatic groups.

Ocular hypertelorism, facial basal cell carcinomas, and multiple odontogenic keratocysts of the jaws.

Dentists should be aware of the multiple jaw cysts of NBCS that may develop in patients as young as 7 to 8 years. As the jaw cysts frequently are the initial symptom, dentists have the opportunity to detect the syndrome early, before the patients seek medical treatment. Any young patient with multiple odontogenic keratocysts in the jaws can develop other conditions characteristic of the disease. A careful family history should be taken, and the patient should be monitored closely for subsequent clinical manifestations of the disease.

Effect of tar condensate from smoking tobacco and water-extract of snuff on the oral mucosa of mice with latent herpes simplex virus.

Upper lips were inoculated with virus to establish a latent infection in the trigeminal ganglia. During the latent period, tobacco smoke tar condensate or water-extract of snuff were topically applied to the primary inoculation site for two or three consecutive months. Tar condensate induced re-activation of latent HSV in the ganglia of 10 to 20 per cent of animals but snuff extract did not. Infectious virus was also detected in lips after the chronic application of tar condensate in 10 per cent of animals. Three months' exposure to tobacco produced epithelial dysplasia and other changes in a significant number of latent HSV-infected mice, whereas tobacco alone did not induce dysplasia in the labial epithelium of uninfected mice.

Oral cancer induced in hamsters with herpes simplex infection and simulated snuff dipping.

A number of epidemiologic studies indicate that snuff dipping is associated with an increased incidence of oral cancer in human beings. Since inactivated herpes simplex virus (HSV) has been shown to induce malignant changes in vitro and in vivo and is partially inactivated by snuff water extract, we examined the histopathologic changes of hamster buccal pouches after exposure to repeated HSV inoculation combined with long-term simulated snuff dipping. One hundred twenty-five Syrian hamsters were divided into seven groups, and the buccal pouches were inoculated with HSV-1, HSV-2, or culture medium. The mock and HSV inoculations were done once a month for 6 consecutive months. In an effort to determine the effect of snuff on the mock- or HSV-inoculated buccal pouches, a consistent amount of a commercially available snuff was placed into both the right and left pouches twice a day in half of the animals. At the end of the 6 months of simulated snuff dipping (4 weeks after the final mock or viral inoculation), the hamsters were killed and the buccal pouches were removed for the histopathologic evaluation. Neither simulated snuff dipping nor HSV infection alone induced neoplastic changes in hamster buccal pouches. However, HSV infection in combination with simulated snuff dipping resulted in epithelial dysplasia and invasive squamous cell carcinoma in more than 50% of the animals.

Combined effect of herpes simplex virus and tobacco on the histopathologic changes in lips of mice.

In the present study we have examined the combined effect of HSV-1 inoculation and tobacco application (snuff water extract or smoking tar condensate) on the histopathologic changes of mouse labial mucosa. Two months' exposure to tobacco or HSV-1 inoculation alone did not induce dysplasia in the epithelium of labial mucosa, while HSV-1 inoculation combined with snuff water extract or smoking tar condensate produced epithelial dysplasia and other histomorphologic changes (that is, hyperkeratosis, increased granular cell layer thickness, acanthosis, and increased inflammatory cell infiltration in a significant number of animals). This result indicates that HSV-1 and tobacco could possibly act synergistically in the development of precancerous oral lesions and oral cancer.

Effects of smokeless tobacco and snuff on oral mucosa of experimental animals.

The effects of smokeless tobacco on oral mucosa were studied in 60 Syrian hamsters. Histologic study of the buccal pouch mucosa revealed no significant pathologic changes at either ten or 20 weeks after the start of the experiment. However, studies on epithelial whole mounts revealed a statistically significant decrease in mitotic activity and a statistically significant increase in the number of Langerhans' cells in animals subjected to daily use of tobacco or snuff for 20 weeks.

Experimental development of herpes simplex virus infection in hamster buccal pouch.

In the present study, we have developed an intraoral herpes simplex virus type 1 (HSV-1) infection model in the hamster buccal pouch. This animal model could be used for further oral cancer research related to herpes simplex virus infection.