Prevalence, diameter and course of the maxillary intraosseous vascular canal with relation to sinus augmentation procedure: a radiographic study.

The aim of the study was to characterize the prevalence, diameter and course of intraosseous anastomosis between the posterior superior alveolar artery and the infraorbital artery (bony canal) involved in the sinus floor augmentation procedure. Data from 208 sinuses were analyzed from reconstructed computed tomography (CT) images. The presence of the intraosseous anastomosis in the lateral antral wall was detected using sagittal plane sections, in addition, the intraosseous course and the diameter of the bony canal were examined. The bony canal was identified in 114 (55%) of the 208 maxillary sinuses, with a mean distance of 16.9 mm from the alveolar ridge. From the examined canals, in 7% the diameter was 2-3 mm wide, in 22% 1-2 mm and in 26% it was less than 1 mm wide. Because only in 50% of cases the vessel was large enough to be detected by a CT scan, it is recommended, to place the superior border of the osteotomy up to 15 mm from the alveolar crest in A to C type ridges to avoid penetration of the artery.

Peripheral odontogenic tumours--differential diagnosis in gingival lesions.

Peripheral odontogenic tumours (POT) are rare benign focal overgrowths of the oral soft tissue, usually occurring in the gingiva. Between 1996-2000, 6 out of 406 excised gingival lesions were diagnosed as POT (1.5%). Tumours included peripheral odontogenic fibroma (2 patients), peripheral calcifying odontogenic cyst (2 patients), peripheral ameloblastoma (1 patient), and peripheral calcifying epithelial odontogenic tumour (1 patient). Review of the literature reveals that peripheral odontogenic fibroma and peripheral ameloblastoma were the most common POT. The purpose of this article was to analyse the clinical data of these tumours according to the presented cases and the literature review, to elucidate typical features of each tumour type and enhance easy identification.

[Augmentation of narrow ridges for implants rehabilitation--a review].

The quantity of alveolar bone decreases mainly because of periodontal disease or loss of teeth causing bone resorption in both vertical and horizontal directions. Inadequate width of the alveolar ridge affects many parameters of implants placement and the final restoration. Placement of an implant in a narrow ridge without bone graft may harm the final esthetics and the long-term success of the implant rehabilitation. The purpose of this article is to review the basic principles of bone grafting and to discuss various grafting techniques for widening of the narrow ridge.

Osteosarcoma of the jaw. The Chaim Sheba Medical Center experience.

OBJECTIVE: The purpose of this article is to present 14 cases of osteosarcoma of the jaw treated at our medical center from 1989 to 1998. These cases are discussed in the light of a comprehensive review of 774 cases reported in the English literature over the past 3 decades. Differences between osteosarcoma of the jaws and osteosarcoma of the long bones are examined. SUBJECTS AND METHODS: The patients ranged in age from 8 to 78 years, the mean age being 33 years. Each patient had a histopathologically established diagnosis of osteosarcoma of the jaw. Records were reviewed for epidemiologic data, treatment modalities, and survival. RESULTS: Of the 14 patients, 6 (42%) had tumors in the mandible and 8 (58%) had tumors in the maxilla. Of the mandibular tumors, 5 occurred in the body of the mandible; all maxillary tumors originated in the alveolar ridge and involved the maxillary sinus. The chief complaint was an intraoral or extraoral painless swelling. Histopathologic types included chondroblastic, osteoblastic, fibroblastic, and malignant fibrous histiocytoma-like. Pathologic grade was determined to be high (3 or 4) in 13 cases and low (1) in only 1 mandibular case. All patients underwent surgical resection and immediate reconstruction. Adjuvant therapy included postoperative radiation (5 patients), postoperative chemotherapy (2 patients), and preoperative chemotherapy and postoperative radiation (1 patient). CONCLUSIONS: The results of the present study support the literature indicating that osteosarcoma of the jaw differs from osteosarcoma of the long bones in its biological behavior even though they have the same histologic appearance. Because of differences in tumor characteristics, the introduction of chemotherapy did not dramatically alter the prognosis of osteosarcoma of the jaw. Early diagnosis and radical surgery are the keys to high survival rates.

Anatomic and radiologic course of the mandibular incisive canal.

The purpose of this article was to define the anatomic and radiographic courses of the incisive mandibular canal and discuss its clinical significance. The study group comprised of 46 hemimandibles fixed in formalin. After radiographic examination, the buccal cortical plate of the mandible was removed leaving the bony frame of the incisive bundle intact. The morphology of the bony walls of the canal was evaluated, as having complete, partial, or no cortical walls. The course of the intraosseous pathway of the canal and its diameter in four different locations were recorded. An incisive bundle was anatomically found in all hemimandibles, travelling within a canal with complete (n = 10), partial (n = 27), or no (n = 9) bony cortical borders. The diameter of the canal ranged from 0.48 mm to 2.9 mm. Radiographically, the canal was either well defined (n = 11, 24%), poorly defined (n = 15, 32%), or undetectable (n = 20, 44%). A statistically significant correlation was found between the anatomic structure of the incisive canal bony borders and its radiographic detectability (p = 0.043). No correlation was found between the anatomic and radiological width of the incisive canal diameter. An incisive canal with a large diameter could have an important role in successful osteointegration and prevention of postoperative sensory disturbances. According to the present study, the ability to interpret the incisive canal from conventional radiographs is limited. Therefore, it is recommended to use conventional tomographs or computerised tomographic dental scans for better imaging of the intermental foraminal area.

Anterior loop of the mental canal: an anatomical-radiologic study.

This study sought to characterize the anatomical dimensions of the anterior mental loop and to determine the accuracy of conventional radiographs in identifying its presence and dimensions. The study group consisted of 46 hemimandibles fixed in formalin. Radiographs of the area between the mental foramen and the midline were obtained and evaluated for each hemimandible, followed by dissection and physical examination of the same area. Anatomically, an anterior loop of the mental nerve was observed in only 13 hemimandibles (28%). The anterior extension of the loop ranged from 0.4 to 2.19 mm. No correlation was found between the radiographic image and the anatomical shape of the loop. Of the radiographically diagnosed loops, 40% were not seen in anatomical examination. In cases with a false radiologic loop, a correlation was found between the diameter of the origin of the incisive canal and the radiologic interpretation of the loop. The radiologic appearance or diagnosis of the anterior mental loop in cadaver mandibles does not disclose the true ramification of the inferior alveolar nerve to the mental and incisive nerve.

Surgical management of macroglossia due to primary amyloidosis.

A case of macroglossia due to primary amyloidosis is described, followed by a discussion of the various aspects of surgical intervention based on a literature review.

Incidence of secretory otitis media following maxillectomy.

OBJECTIVE: The purpose of this investigation was to determine the incidence and characteristics of secretory otitis media after maxillectomy procedures. STUDY DESIGN: Retrospective chart analysis was performed with the cases of 49 patients who underwent maxillectomy for tumor in the Departments of Otolaryngology-Head and Neck Surgery and Oral and Maxillofacial Surgery between the years 1990 and 1996. RESULTS: In 10 patients (20%), secretory otitis media manifested itself from 1 week to 6 months after surgery; 1 patient developed a central perforation with chronic otitis media. Nearly one third of patients who underwent total maxillectomy had secretory otitis media. Six patients (8 ears) required insertion of ventilation tubes. CONCLUSIONS: Patients undergoing total and partial maxillectomies are prone to occurrences of secretory otitis media. Insertion of ventilation tubes easily resolves the problem. Preoperative and routine postoperative patient follow-up should always include otoscopy and audiometry, and tympanometry should be performed when warranted.