Alloplastic reconstruction of the temporomandibular joint.

The Proplast TMJ condylar implant, the glenoid fossa implant, and the TMJ interpositional implants should be singled out as having provided a new and more predictable mode of TMJ reconstruction. The use of these implants in cases of ankylosis, degenerative joint disease, orthognathic deformities, and traumatic injuries has greatly contributed to the success of these reconstructions. These implants represent the state of the art in TMJ reconstruction and increasing data from longer-term follow-up have shown a rate of success much higher than any previous implant used in the TMJ. TMJ reconstruction requires careful surgical planning, meticulous surgical technique, and intelligent perioperative care. Postoperative physical therapy is considered essential in the management of these patients. Complications related to reankylosis have been virtually eliminated, as no postoperative immobilization is required in most cases. Long-term stability of these implants, due to the ingrowth of tissue into Proplast, appears to be assured. Continued experience with the implants and close follow-up of reconstruction patients is necessary in the future to adequately assess the performance of the newer glenoid fossa and TMJ interpositional implants. Certainly, a new era in TMJ reconstruction has begun, resulting in increased benefits to the patients whom we all serve.

Alveolar pyogenic granuloma: review and report of a case.

A large exophytic bone-resorbing lesion was discovered in the oral cavity of an institutionalized 33-year-old male. An excisional biopsy under general anesthesia was performed. Frozen and permanent histologic sections confirmed a reactive gingival fibroma consistent with a pyogenic granuloma. This lesion is unusual in that it attained a very large size and caused marked remodeling of the alveolar bone of the mandible. Of interest as well, this highly vascular lesion was found to have numerous feeding vessels from the alveolar bone. A retained tooth root was encountered within the lesion, presumably the etiologic factor producing this lesion. A differential diagnosis is presented and discussed. The lesion should be of particular interest to otolaryngologists who deal with intraoral lesions and their treatment, since it illustrates an extreme presentation of a totally benign process.

Plasma cell myeloma: management of a mandibular fracture.

An interesting case of kappa light-chain plasma cell myeloma with pathologic mandibular fracture is presented. Traditional fracture management techniques were abandoned in view of the advanced state of this patient's disease. With the use of adjunctive radiotherapy and a soft diet, clinical union of the fractured mandible was achieved without immobilization.

Cystic complex composite odontoma. Report of two cases.

The two cases presented here involved complex composite odontomas that had become cystic. They were very different in appearance; the first case being almost classic and the second case showing more bizarre configuration and being associated with a much larger cystic cavity. Two different surgical approaches were used. In the first case a bone graft from the iliac crest was used to fill the extensive mandibular defect. In the second case, enucleation with good primary closure was thought to be sufficient since good bony margins were evident and the likelihood of pathologic fracture was considered minimal.

Postinjection infection-two unusual cases.

Two unusual forms of infection after local anesthesia have been presented. The first, a case of cellulitis, was thought initially to be a hypersensitivity reaction. The second, a case of impetigo, might prove difficult to diagnose because of its relative rarity.