Distraction Osteogenesis in a Tessier 6 Cleft After Fronto-Orbito-Zygomatic Osteotomy - A Case Report.

The Rationale: Craniofacial clefts are rare malformations. According to their localization, 15 types are classified. Patient Concerns: They referred to impaired eyelid function, lateral protection of the eye-bulb, and aesthetic appearance. Diagnosis: A three-dimensional-computerized tomography scan and a stereolithographic model led to the diagnosis of a rare intraorbital Tessier 6 cleft. Treatment: A newly designed lateral orbital rim osteotomy, presurgically simulated on a stereolithographic model, was performed to forward position the lateral orbital rims bilaterally by osteodistraction. Outcomes: Both lateral orbital rims were distracted anteriorly for around 12 mm over a period of 9 weeks, without any side effects to the patient. Take-away Lessons: In this intraorbital Tessier 6 cleft, an improved eyelid function with better lateral protection of the eye bulb and more favorable aesthetic appearance was achieved with this novel lateral orbital rim osteotomy.

Holoprosencephaly with Clefts: Data of 85 Patients, Treatment, and Outcome: Part 2: Management, Surgical Treatment, and Unexpected Aspects of Holoprosencephaly Cleft Patients.

CONTEXT: Cleft patients with holoprosencephaly (HPE) provide a wide clinical spectrum. Besides accessory agenesis of facial tissue structures, spanning from a single central incisor to the columella, up to the entire prolabium-premaxilla complex, brain deformities with various functional deficits may prevail, just like normal brain development. Making a precise diagnosis, just like choosing the most appropriate treatment plan often is challenging. A literature and chart review comprising 85 HPE cleft cases at the Cleft Clinic of the University of Pretoria, South Africa, was performed. It yielded pertinent diagnostic criteria and collected information about pregnancy history, brain development and survival rate as well as the initial perioperative management and the course of postsurgical midfacial growth. AIMS OF PART 2: The aim is to highlight how the here presented classification system of HPE cleft patients according to their clinical picture may facilitate the most appropriate treatment protocol. MATERIALS AND METHODS: The classification system elaborated in Part I due to diagnostic criteria facilitated establishing classification related treatment protocol for 85 cleft cases with HPE. RESULTS: According to diagnostic criteria, HPE cleft cases can be subdivided into (1) columella complex agenesis (Ag-Colum), (2) prolabium-premaxilla-columella complex agenesis in cleft lip-alveolus deformities (Ag-CLA), (3) prolabium-premaxilla-columella complex agenesis in complete hard and soft palate clefts (Ag-CLAP), and (4) "standard" uni-or bilateral CLA or CLAP (HPE-Std-cleft), including cases with an atrophic premaxilla with or without single central incisors. Relevant treatment protocols according to the particular classification are highlighted with figures and intra-operative pictures. CONCLUSION: This paper addresses the following aspects in cleft patients with HPE: A subdivision into four groups, the 3-in-1 surgical approach, the anteriorly directed midfacial growth and maternal HIV infection.

Holoprosencephaly with Clefts: Data of 85 Patients, Treatment and Outcome: Part 1: History, Subdivisions, and Data on 85 Holoprosencephalic Cleft Patients.

CONTEXT: Cleft patients with Holoprosencephaly (HPE) constitute a controversy due to a variable facial appearance. HPE appearance varies from only a columella to a prolabium-premaxilla complex agenesis up to a common unilateral or bilateral cleft lip and palate with a single central incisor, various brain deformities, and/or even normal brain development. It is challenging to designate such various appearances, to understand their etiopathogenesis, and to choose the most appropriate management. Literature was reviewed for diagnostic criteria, pregnancy history, clinical findings, brain development, survival rate, initial perioperative management, and postsurgical midfacial growth in cleft patients with HPE. The findings were compared with a clinical database of 85 cleft patients with HPE at the Department of Maxillofacial and Oral Surgery, University of Pretoria. AIMS OF PART 1: The aim of the study is to overcome disparities widely existing among clinicians regarding definitive diagnostic criteria, especially in cases with a common appearance of a uni- or bilateral cleft lip alveolus or cleft lip, alveolus and palate deformity, and cases presenting facial structural agenesis. MATERIALS AND METHODS: A literature search related to diagnostic criteria was compared to results of a cleft HPE database from a single tertiary institution. RESULTS: HPE cleft cases can be allocated to one of the following subdivisions: (1) columella complex agenesis (Ag-Colum), (2) prolabium-premaxilla-columella complex agenesis in cleft lip-alveolus deformities (Ag-CLA), (3) prolabium-premaxilla-columella agenesis in cases with complete cleft lip alveolus palate (Ag-CLAP), and (4) standard type (holoprosencephaly in patients with a standard cleft) with uni- or bilateral CLA or CLAP, hard and soft palate cleft (hPsP), and atrophic premaxillae, with or without single central incisor. Further, incidence, variation in brain development, and appearances in HPE cleft patients of different races and gender, epilepsy, and early death are discussed. Conclusion: This paper adds new data and facts to the existing literature related to cleft lip and palate patients suffering from HPE.

Orthognathic Relevant Scales of FACE-Q: Translation and Validation for Hong Kong Chinese Patients.

BACKGROUND: A validated questionnaire is needed to study a more holistic outcome assessment including postsurgical aesthetic satisfaction and psychosocial changes in orthognathic patients. The aim of this study was to determine the reliability and validity of 9 orthognathically relevant translated FACE-Q scales among Hong Kong Chinese orthognathic patients. METHODS: Two hundred fifty adult Cantonese-speaking patients of 18 years or older who underwent orthognathic treatment were recruited in the Prince Philip Dental Hospital of Hong Kong. Nine of an overall of 40 independent FACE-Q scales were selected and translated into Hong Kong Chinese. The reliability, validity, and test-retest reliability were examined using Cronbach's alpha, paired t test and Pearson's correlation coefficients. RESULTS: The Hong Kong Chinese version of the 9 FACE-Q scales was obtained by forward-backward translation. One hundred eight male (mean age, 25.57 ± 4.49) and 142 female (mean age, 24.61 ± 4.54) patients were recruited for the reliability and validation process. The internal consistency (0.89-0.97) and the test-retest reliability (0.73-0.90) were found to be high. The validity of the translated questionnaires was comparable with that of the original FACE-Q. CONCLUSION: The results presented here prove that the 9 translated FACE-Q scales are reliable and valid instruments for research and clinical purposes in Hong Kong Chinese orthognathic patients.

Pierre Robin sequence: Subdivision, data, theories, and treatment - Part 1: History, subdivisions, and data.

CONTEXT: The disorder currently accepted as Pierre Robin syndrome/anomaly/sequence (PRS) has been plagued by controversy ever since initially being described. Controversy exists not only about the appropriate terminology and etiopathogenesis of the disorder but also about its management. Therefore, clinical findings and treatment outcomes of a large database of 266 PRS cases were compared with the current state of knowledge in scientific literature related to history, clinical description, diagnostic criteria, epidemiology, theories of oligohydramnios, mandibular catch-up growth, midfacial hyperplasia, and the timing of management. AIMS OF PART 1: Display disparities of the widely published subject of PRS that exist within the literature. SUBJECTS AND METHODS: A literature search related to diagnostic criteria was compared to findings of one of the largest PRS databases worldwide. RESULTS: Regarding diagnostic criteria two subdivisions, the Fairbairn-Robin triad (FRT) and the Siebold-Robin sequence (SRS) can be clearly distinguished. Both present with micrognathia and glossoptosis, the former with, the latter, however, without a palatal cleft. CONCLUSIONS: According to clear diagnostic criteria, PRS has to be subdivided in the future into FRT and SRS cases, as they may require different treatment approaches.

Pierre Robin sequence: Subdivision, data, theories, and treatment - Part 2: Syndromic and nonsyndromic Pierre Robin sequence.

CONTEXT: The disorder currently accepted as Pierre Robin syndrome/anomaly/sequence (PRS) has been plagued by controversy ever since initially being described. Controversy exists not only about the appropriate terminology and etiopathogenesis of the disorder but also about its management. Clinical findings and treatment outcomes of a large database of 266 PRS cases were compared with the current state of knowledge in the scientific literature, relating to history, clinical description, diagnostic criteria, epidemiology, theories of oligohydramnios, mandibular catch-up growth, midfacial hyperplasia, and the early management. AIMS OF PART 2: Contribute to the sparse scientific knowledge about pathogenesis and involved genetics. SUBJECTS AND METHODS: An analysis of this large database was conducted focusing on genetic involvement, family history, and the incidence of additional syndromes. RESULTS: Beside of differences related to clinical signs of dyspnea, feeding problems and mortality rates, various concomitant syndromes, and genetic abnormalities were found in cases of Fairbairn-Robin triad (FRT) and Siebold-Robin sequence (SRS), in addition to differences in relation to clinical signs of dyspnea, feeding problems, and mortality rates. CONCLUSION: Multiple FRT cases presented with various concomitant syndromes and genetic abnormalities, but only one type occurred in two SRS cases. The latter presented a significantly different mortality rate when compared to the FRT subgroup.

Pierre Robin sequence: Subdivision, data, theories, and treatment - Part 3: Prevailing controversial theories related to Pierre Robin sequence.

CONTEXT: The disorder currently accepted as Pierre Robin syndrome/anomaly/sequence (PRS) has been plagued by controversy ever since initially being described. Controversy exists not only about the appropriate terminology and etiopathogenesis of the disorder but also about its management. Therefore, clinical findings and treatment outcomes of a large database of 266 PRS cases were compared with the current state of knowledge in the scientific literature related to history, clinical description, diagnostic criteria, epidemiology, theories of oligohydramnios, mandibular catch-up growth, midfacial hyperplasia, and the early management. AIM: The aims of Part 3 debate the controversial biological theories relating to PRS. MATERIALS AND METHODS: Oligo-/poly-hydramnios, mandibular catch-up growth, and midfacial hyperplasia, the three in the literature most prevailing theories related to PRS, have been compared and discussed with the findings provided by this large database of 266 Siebold-Robin sequence (SRS) and Fairbairn-Robin triad (FRT) cases. RESULTS: History and clinical findings evaluated in this database refute the first two theories. Although manifold midfacial appearances were demonstrated in FRT cases, a third of all SRS cases presented with mid-facial hyperplasia. CONCLUSION: The three main biological theories regarding PRS could not be verified after thorough analysis of the database.

Pierre Robin sequence: Subdivision, data, theories, and treatment - Part 4: Recommended management and treatment of Pierre Robin sequence and its application.

CONTEXT: The disorder currently accepted as Pierre Robin syndrome/anomaly/sequence (PRS) has been plagued by controversy ever since initially being described. Controversy exists not only about the appropriate terminology and etiopathogenesis of the disorder but also about its management. Therefore, clinical findings and treatment outcomes of a large database of 266 PRS cases were compared with the current state of knowledge in the scientific literature related to history, clinical description, diagnostic criteria, epidemiology, theories of oligohydramnios, mandibular catch-up growth, midfacial hyperplasia, and early management. AIMS OF PART 4: To provide a systematic treatment protocol for Fairbairn-Robin triad (FRT) and Siebold Robin sequence (SRS) patients based on clinical findings and experience with 266 PRS cases. SUBJECTS AND METHODS: A plethora of treatment modalities and their outcome in literature have been compared to those applied in this database and their outcomes. RESULTS: The management of SRS/FRT depends on various factors including compromised airways, feeding difficulties, as well as the sequence of the reconstructive ladder. CONCLUSION: Based on the novel PRS subdivisions, a stepwise sequential treatment approach is outlined, addressing the particular needs of each disorder systematically.

The Oropharyngeal Airway in Young Adults with Skeletal Class II and Class III Deformities: A 3-D Morphometric Analysis.

OBJECTIVES: 1) To determine the accuracy and reliability of an automated anthropometric measurement software for the oropharyngeal airway and 2) To compare the anthropometric dimensions of the oropharyngeal airway in skeletal class II and III deformity patients. METHODS: Cone-beam CT (CBCT) scans of 62 patients with skeletal class II or III deformities were used for this study. Volumetric, linear and surface area measurements retroglossal (RG) and retropalatal (RP) compartments of the oropharyngeal airway was measured with the 3dMDVultus software. Accuracy of automated anthropometric pharyngeal airway measurements was assessed using an airway phantom. RESULTS: The software was found to be reasonably accurate for measuring dimensions of air passages. The total oropharyngeal volume was significantly greater in the skeletal class III deformity group (16.7 ± 9.04 mm3) compared with class II subjects (11.87 ± 4.01 mm3). The average surface area of both the RG and RP compartments were significantly larger in the class III deformity group. The most constricted area in the RG and RP airway was significantly larger in individuals with skeletal class III deformity. The anterior-posterior (AP) length of this constriction was significantly greater in skeletal class III individuals in both compartments, whereas the width of the constriction was not significantly different between the two groups in both compartments. The RP compartment was larger but less uniform than the RG compartment in both skeletal deformities. CONCLUSION: Significant differences were observed in morphological characteristics of the oropharyngeal airway in individuals with skeletal class II and III deformities. This information may be valuable for surgeons in orthognathic treatment planning, especially for mandibular setback surgery that might compromise the oropharyngeal patency.

The evolution of dental journals from 2003 to 2012: a bibliometric analysis.

Bibliometrics are a set of methods, which can be used to analyze academic literature quantitatively and its changes over time. The objectives of this study were 1) to evaluate trends related to academic performance of dental journals from 2003 to 2012 using bibliometric indices, and 2) monitor the changes of the five dental journals with the highest and lowest impact factor (IF) published in 2003. Data for the subject category "Dentistry, Oral Surgery & Medicine" was retrieved from the Journal Citation Reports (JCR) published from 2003 to 2012. Linear regressions analysis was used to determine statistical trends over the years with each bibliometric indicator as the dependent variable and the JCR year as the predictor variable. Statistically significant rise in the total number of dental journals, the number of all articles with the steepest rise observed for research articles, the number of citations and the aggregate IF was observed from 2003 to 2012. The analysis of the five top and five bottom-tire dental journals revealed a rise in IF however, with a wide variation in relation to the magnitude of this rise. Although the IF of the top five journals remained relatively constant, the percentile ranks of the four lowest ranking journals in 2003 increased significantly with the sharpest rise being noted for the British Journal of Oral & Maxillofacial Surgery. This study revealed significant growth of dental literature in absolute terms, as well as upward trends for most of the citation-based bibliometric indices from 2003 to 2012.

Fracture of the vomero-premaxillary junction in a repaired bilateral cleft lip and palate patient.

Although dental trauma is common in bilateral cleft lip and palate (BCLP), patients' reports on bony fractures of the vomero-premaxillary junction cannot be found. The aim of this report is to illustrate clinical findings and the technique of fracture fixation in a child suffering from a fractured vomero-premaxillary junction as well as subsequent columella lengthening. A 4-year-old girl with a repaired BCLP presented with an open mucosal laceration and fractured vomero-premaxillary junction. Open reduction and fixation of the dislocated premaxilla was performed under general anesthesia. Fractured bone pieces of the vomero-premaxillary junction were removed and sharp bone edges at the vomer and the premaxilla were grinded. The repositioned premaxilla was fixed to the lateral alveolar arches with two mucoperiosteal sutures on each side. Additional columella lengthening was performed 2 years later. All family members were very happy about the new aesthetics of the girl. Although rare, fractures of the vomero-premaxillary junction present several challenges to clinicians related to anatomical, physiological, and psychological issues. Immediate and minimal invasive treatment strategies are recommended when managing such cases.

Columella pressure necrosis: a method of surgical reconstruction and its long-term outcome.

Nasal continuous positive airway pressure (nCPAP) in premature babies may rarely lead to necrosis of the columella. Subsequent functional and cosmetic impairments require surgical corrections to restore nasal anatomy and architecture. The objective of this report is to document the technique of reconstruction in a baby with columella necrosis due to nCPAP treatment. A 21-month-old baby was referred to the oral and maxillofacial unit with a necrotic columella following nCPAP ventilation in a neonatal intensive care unit. Nearly 75% of the vertical columella length was affected. A neocolumella was created using tissues mobilised from the nasal sill region. This report provides a detailed description of a columella reconstruction technique which is valuable to restore aesthetics and function.

Correlation between volume of herniated orbital contents and the amount of enophthalmos in orbital floor and wall fractures.

PURPOSE: To analyze the correlation between the volume of herniated orbital contents and the amount of enophthalmos in orbital floor and wall fractures. MATERIALS AND METHODS: Patients with secondary enophthalmos due to unilateral orbital floor and wall fractures were recruited. Computed tomography-assisted measurements of both orbits as well as of the amount of enophthalmos were performed. The following volumes were calculated: 1) the overall volume of both the healthy and fractured orbit, 2) the volume of herniated orbital contents at the orbital walls, 3) the volume of herniated orbital contents anterior and posterior to the vertical eyeball equator. The amount of enophthalmos was also measured by computed tomography. Multifactor linear regression analysis was performed to obtain correlations between the amount of enophthalmos and the measured volumes. RESULTS: Twenty-three patients were included. The average enophthalmos was 4.0 mm (SD = 1.49). Although correlation between volume differences of healthy and fractured sides was not statistically significant, the overall volume of the herniated orbital contents was significantly correlated (P < .05) with the amount of enophthalmos. Regarding the specific orbital sites of herniation, the orbital floor was detected to be most significantly correlated to the amount of enophthalmos (P < .05), although only the herniation posterior to the vertical eyeball equator. CONCLUSION: The overall volume of herniated orbital contents correlated significantly with the amount of enophthalmos. The orbital floor was detected to be the site most significantly correlated with the amount of enophthalmos (although only if herniation occurred posterior to the vertical eyeball equator). Only the volume of herniated soft tissues posterior to the eyeball equator showed correlation with the amount of enophthalmos.

Influence of nicotine on the biological activity of rabbit osteoblasts.

OBJECTIVES: To assess the influence of nicotine on the proliferation and gene expression of osteogenic and angiogenic mediators of osteoblasts. MATERIAL AND METHODS: Rabbit primary osteoblasts were exposed to various concentrations of nicotine (0.001, 0.1 and 10 µmol/l). The cell proliferation was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. The gene expression of transforming growth factor (TGF)-ß(1), bone morphogenetic protein (BMP)-2, platelet-derived growth factor (PDGF)-AA and vascular endothelial growth factor (VEGF) was evaluated using real-time reverse transcription - polymerase chain reaction. RESULTS: The osteoblast proliferation was inhibited by nicotine at the concentration of 0.001-10 µM at 48 and 72 h of culture, but with no significant effect at 24 h. The expression of TGF-ß(1), BMP-2, PDGF-AA and VEGF was inhibited by nicotine at the concentrations of 0.1 and 10 µM, but with no significant difference at the low concentration of 0.001 µM. CONCLUSIONS: Nicotine suppresses osteoblast proliferation and inhibits the expression of some key osteogenic and angiogenic mediators in the in vitro experimental model. These inhibitory effects of nicotine on the osteoblast activity may reflect, to a certain degree, the overall detrimental effects of tobacco use on the survival rate of dental implants.

Coping processes relevant to posttraumatic growth: an evidence-based review.

OBJECTIVE: This study aims to perform an evidence-based review on the quantitative data regarding coping processes related to posttraumatic growth in the field of oncology to facilitate understanding of posttraumatic growth in oral cavity cancer (OCC) patients. MATERIAL AND METHODS: Pubmed, Medline, and PsycINFO were used for the search and the reference list checked for each selected article. Full articles meeting the inclusion criteria were retrieved. Only English articles were included. RESULTS: The initial search yielded 934 publications; 64 "potentially relevant papers" and 21 "effective" papers formed the basis of this review. Personality traits and social support lead to development of positive coping methods in cancer patients. Overriding influences are benefit finding and meaning making. Specific coping processes were identified to be significantly associated with posttraumatic growth in patients suffering from different cancers and a need for additional prospective research regarding specific processes and outcomes among oral cavity cancer patients. A proposed theoretical model based on the evidence of management of other cancer research fields is suggested for patients with OCC. CONCLUSION: An evidence-based review of coping strategies related to posttraumatic growth was performed which identified key coping strategies and factors that enhance coping processes. A conceptual model of coping strategies to enhance posttraumatic growth in OCC patients based on the scientific evidence attained is suggested to provide a more holistic approach to OCC management.

Influence of mandibular reconstruction on patients' health-related quality of life.

PURPOSE: To evaluate and compare the influence of different types of mandibular reconstruction on health-related quality of life (HR-QoL) of nonrecurrence patients. PATIENTS AND METHODS: We recruited 252 patients who underwent mandibular reconstruction between 1994 and 2007 for this cross-sectional study. They were classified into groups based on reconstruction technique: free bone graft (FBG) group, particulate bone cancellous marrow graft (PBCMG) group, reconstruction plate (RP) group, and microvascular free flap group. The University of Washington Head and Neck Quality of Life Questionnaire and 5 supplemental domains regarding the donor sites were used to evaluate and compare HR-QoL among the groups. RESULTS: The outcomes of the University of Washington Head and Neck Quality of Life Questionnaire differed significantly among the groups (P < .0001). The results of the additional donor site domains also differed greatly among the groups (P < .0001). Appearance, chewing, activity, appearance-donor site, and function-donor site were the domains that were most frequently chosen by the patients as the most important issues. Most of the patients rated their HR-QoL as somewhat better compared with their experience the month before they underwent reconstruction. The HR-QoL and overall quality of life (QoL) during the past 7 days were rated as very good in the FBG group and PBCMG group and good in the RP group and microvascular free flap group. CONCLUSIONS: HR-QoL of patients in the FBG and PBCMG groups did not differ significantly with regard to any of the domains, and these 2 groups consistently had the highest mean scores. Both groups differed significantly from the RP group, which tended to report the lowest mean scores for the domains.

The roles of hope and optimism on posttraumatic growth in oral cavity cancer patients.

To investigate the association of the positive coping strategies, hope and optimism, on posttraumatic growth (PTG) in oral cavity (OC) cancer patients. A retrospective cross-sectional study was conducted and performed in the outpatient station of the Oral and Maxillofacial Surgery at the University of Hong Kong, Hong Kong SAR, PR China. Fifty patients successfully treated for OC cancer were recruited after their informed consents had been obtained during the review clinic. During their regular follow-up controls in the outpatient clinic, the patients compiled the posttraumatic growth inventory (PTGI) questionnaire, hope scale (HS) and the life orientation scale-revised (LOT-R). Hope and optimism correlated significantly positive with PTG and accounting together for a 25% variance of posttraumatic growth. Hope positively correlated with posttraumatic growth (r=.49, p<.001) as well as optimism (r=.31, p<.05). When compared to unmarried patients, married patients showed high levels of PTG and hope (married participants: mean=53.15, SD=11.04; unmarried participants: mean=41.00, SD=6.36; t (48)=2.403, p<.05). Hope and optimism represent important indicators for PTG in OC cancer patients. An intact dyad relationship seems to be important for hope and consecutive higher levels of PTG when compared to unmarried patients. Supportive psychological treatment strategies related to these two coping factors might be beneficial for OC cancer patients.

Posttraumatic growth: a novel concept in oral cavity cancer care?

Recently the importance of posttraumatic growth (PTG), a phenomenon of positive psychological growth beyond baseline values, has been discovered in the field of oncology. An evidence based review of the literature regarding PTG was performed, both to support its understanding and to consider its application within the research field of oral cavity (OC) cancer. A Pubmed, Medline, PsycINFO search from the earliest date until April 2010 was carried out. Full articles meeting the inclusion and exclusion criteria were reviewed. The search yielded 852 papers, 91 'potentially relevant papers' and 29 'effective papers', the latter of which formed the basis of this review. PTG was assessed in twenty-eight studies with the Posttraumatic Growth Inventory and in only one study with the Perceived Benefits Scale (PBS). PTG in cancer patients has been reported in five main domains (i) appreciation of life, (ii) relating to others, (iii) increased personal sense, (iv) sense of new possibilities and (v) positive spiritual change. Socio-demographic factors, stressor characteristics and coping strategies influence and predict the development PTG. In the past decade an increasing interest in the concept of PTG in the field of oncology has emerged. This evidence based review presents PTG to the research community in the field of OC cancer, appraises its modification capacity of the treatment outcome in other cancer research fields and hypothesizes its eventual benefit in the field of OC cancer research.

Long-pulsed Nd: YAG laser treatment in vascular lesions of the oral cavity.

Yet no universally accepted treatment protocol for oral hemangiomas and vascular malformations exists. This study determines the long-term clinical outcome after long-pulsed Nd:YAG laser treatment in 121 previously untreated patients (78 females, 43 males; mean age, 19 years) with oral hemangioma or vascular malformations. The end point was 100% vessel clearing after 1 to 3 sessions.The power of the laser was set at 6.5 W per pulse, the pulse widths ranged between 30 and 60 milliseconds. With an optical fiber diameter of 600 microm, the wavelength was constantly 1064 nm. Dynamic cooling device was set at 10 to 20 and 10 to 15 times before and after pulse, respectively. Whereas 77% of lesions were cleared totally after a single session only, 23% required an overall of 2 to 3 sessions. Tissue sloughing occurred in all patients. The mean follow-up period of 13 months (minimum, 6 months; maximum, 24 months) showed neither functional nor cosmetic shortcomings. Long-pulsed Nd:YAG laser treatment proved to be an effective and valuable method for the treatment of oral hemangiomas and vascular malformations.

Psammomatoid juvenile cemento-ossifying fibroma of the maxilla.

Both the trabecular and the psammomatoid juvenile cemento-ossifying fibromas (COFs) are specific entities among the COFs being distinguished because of their age predilection, site involvement, and clinical behavior. A case of a large-size juvenile COF of histologic psammomatoid pattern is shown. The clinicoradiographic and histologic findings as well as the treatment strategy are presented and discussed.