Distinct patterns of angiogenesis in oral and skin wounds.

Clinical observation suggests that oral mucosal wounds heal faster than skin; however, little is known about the site-specific differences. Since fetal skin wounds heal rapidly, but are less vascular than adult wounds, we hypothesized that less robust wound angiogenesis might be observed in healing oral mucosa. This study investigated angiogenesis in equivalent-size oral and skin murine wounds. Change in wound bed vascularity was significantly lower in oral wounds than in skin. Also, vascular endothelial growth factor (VEGF) levels were less in oral than cutaneous wounds. Because keratinocytes are a prominent source of VEGF in wounds, we compared VEGF production by oral and epidermal keratinocytes in vitro. Significantly higher levels of VEGF protein and mRNA were observed in epidermal keratinocytes than in oral keratinocytes after 18 hrs of hypoxia. This study demonstrates distinct angiogenesis patterns in oral and skin wounds and intrinsic site-specific differences in VEGF production by keratinocytes.

Irradiated bone and its management.

There are two undeniable attributes of radiotherapy: its value in controlling head and neck malignancies and the progressive damage it inflicts on all treated tissues. It is fortunate that over the past decade, we have developed techniques and treatments that counteract, at least in part, the negative effects of radiotherapy on bone. Some of these measures are purely preventive and must be employed before or during radiation therapy to be successful. They include limiting the total radiation dose to less than 7000 Rads, appropriately shielding structures that do not require radiation, sparing one or more major salivary glands to minimize xerostomia, limiting fraction dosages to less than 200 Rads, obtaining pre-radiation dental evaluations, and performing dental extractions before radiotherapy begins. Additionally, treatments have been devised to prevent ORN following radiotherapy. They consist of patient participation in aggressive dental maintenance programs, oral fluoride treatments, and the use of preextraction hyperbaric oxygen when unhealthy teeth need to be removed. Should radiation-induced complications develop in spite of these efforts, treatments have been developed that effectively deal with ORN, namely, hyperbaric oxygen (the Marx protocol) and prolonged courses of intravenous antibiotics. Finally, when ORN results in mandibular loss and deformity, these defects can be effectively reconstructed with either corticocancellous particulate bone grafts or microvascular osseous tissue transfers, depending on the clinical situation. Much can be done to prevent and treat radiation-induced complications involving bone, and it remains the responsibility of the head and neck surgeon to make sure that these measures are utilized. When all priorities in treating ORN are considered, differentiating a radiation-induced wound healing problem from a delayed tumor recurrence remains paramount. This differentiation should always be the first step in the treatment of any radiation-induced wound.

Use of INR to assess degree of anticoagulation in patients who have dental procedures.

Dental professionals frequently treat patients who are receiving anticoagulation therapy. Proper treatment may require adjustment of the anticoagulant dose usually on the basis of the patient's current prothrombin time. This test has been shown to be less accurate than previously thought. The international normalized ratio is another method that attempts to standardize the degree of anticoagulation and to improve reproducibility of results. This system is slowly being implemented in laboratories in the United States. Practitioners who treat patients taking anticoagulants need to be aware of this system in order to make appropriate management decisions.

Procurement of dermal graft from the suprapubic or inguinal fold region with primary linear closure.

OBJECTIVE: To report on two cosmetically advantageous sites for the harvesting of dermal grafts. The traditional method of dermal graft harvest using a dermatome may leave an unsightly defect. MATERIALS AND METHODS: Thirty-eight dermal grafts were harvested from either the inguinal fold or the suprapubic region. A freehand harvesting technique was used. The patients were all female and were having concurrent temporomandibular joint procedures. The donor sites were monitored for cosmetic result, patient satisfaction, and complications. RESULTS: All donor site wounds were determined to be cosmetically acceptable. The scars were well placed in anatomic skin folds. One complication, a seroma, was reported. CONCLUSIONS: Freehand graft harvest with primary closure provides an acceptable defect. The use of this technique in anatomically advantageous areas successfully conceals the resultant scar for heightened cosmesis.

Treating oral sarcoidosis.

Oral sarcoidosis is rare and can be confused with various other lesions. Two case reports of sarcoidosis involving the lips are presented along with a discussion of sarcoidosis and treatment options.

Occult supraorbital and frontal fracture.

The frontal region is the most common site of maxillofacial trauma in the pediatric population. Forces of enough magnitude to burst skin may also cause supraorbital and frontal bone injury. Undiagnosed skull fractures can result in grave sequelae. In cases involving blunt frontal trauma, it is important to suspect possible underlying injuries to avoid these complications. A case of a late-diagnosed, depressed supraorbital and frontal bone fracture is presented.

Use of a nasogastric tube as a guide for endotracheal reintubation.

A method for using a sterile nasogastric tube as a guide over which to extubate and then to reintubate patients if necessary has been presented. This technique can be useful when extubating patients in MMF or patients with compromised airways.

Mandibular movement during autorotation as a result of maxillary impaction surgery.

With increasing use of maxillary surgery to reduce vertical dimension, it would be appropriate to evaluate methods of predicting autorotation of the mandible. Experimental data derived from edentulous patients using metallic implants embedded in occlusal wax rims matched geometrically analyzed clinical data accumulated from twenty-three patients treated by maxillary impaction procedures. The center of rotation of mandibular autorotation during maxillary surgical impaction has been represented in the literature as the center of the condyle. Our evidence with lateral head films taken in centric occlusion supports a different instantaneous center of rotation located within the mastoid region. Modification of prediction tracing techniques by orthodontists and oral surgeons engaged in maxillary surgery could be indicated.