Harvesting iliac bone graft: decreasing the morbidity.

OBJECTIVE: This is a review of modifications made to the classic technique for harvesting bone graft from the iliac crest. Prior techniques for harvesting iliac bone often resulted in significant postoperative pain, disability, and a cosmetically unacceptable scar and contour deformity. DESIGN: A retrospective review of patients who underwent bone graft harvest over a 7-year period was done. INTERVENTIONS: The modifications described use a skin incision medial to the anterior superior iliac crest. The medial aspect of the iliac crest is elevated along the midsagittal axis of the crest. The medial cap is reflected outward, exposing cancellous bone. RESULTS: A review of 51 patients demonstrated only two minor self-limiting complications. CONCLUSIONS: This procedure provides an abundant supply of both cortical and cancellous bone, an aesthetically acceptable scar, and decreased patient discomfort.

Distraction osteogenesis.

Distraction osteogenesis is a surgical technique originally used to lengthen the long bones without bone grafting. An osteotomy is created and by slowly separating the two segments with specially fabricated hardware, the biological distractant will grow with the bone and calcify into mature bone once the appropriate length has been achieved. Distraction techniques have been used in the human facial bone area for the past 10 years. This article reviews the basic uses of distraction osteogenesis, the pros and cons, and possible future techniques.

The oral and maxillofacial surgeon's role in the care of patients with cleft lip and palate deformities.

Perhaps no conditions other than cleft lip and palate and oral cancer assemble teams of dentists and physicians intensely focused on treatment and rehabilitation. The oral and maxillofacial surgeon's role is often pivotal especially in the 20-year term of care for the child born with a cleft lip and palate deformity (CLPD). Issues of basic orofacial functions of mastication, respiration and communication overlay human considerations of self-esteem and image. From the moment of birth the child with a CLPD is special and challenged. Early issues concern parent and family acceptance and insuring basic life functions. While not generally a part of the immediate surgical unit, the OMFS often provides surgical consultation, educational and emotional support for the family. A clear picture must be painted of the treatment that will unfold over the next two decades. Realistic optimism is the watchword. Indeed, today there is every reason to anticipate an outcome that will result in a balanced, functional and esthetic face.

Functional mandibular reconstruction: prevention of the oral invalid.

Composite mandibulectomy for carcinoma can create an "oral invalid," with difficulty in mastication. Functional reconstruction has fallen short of ideal. Three patients were seen with significant anatomic deficits and functional debilitations resulting from large composite mandibulectomies for oral carcinoma. Each patient underwent reestablishment of the mandibular arch with a vascularized iliac crest bone graft. Following complete healing, the dental arch was replaced with a fixed prosthesis by the technique of osseointegration. The creation of a fixed osseodental unit has allowed each of these individuals to return to a state of anatomic, functional, psychological, and social good health. Follow-up has been from 6 months to 2 years.

Central giant cell granuloma of the jaws: experiences in the management of thirty-seven cases.

This report reviews experiences in the management of 37 cases of central giant cell granuloma of the jaws. The statistical analysis includes location, age, sex, size on initial presentation, and other variables relating to incidence and distribution. The technique of curettage or curettage with peripheral ostectomy was used in all cases treated surgically, resulting in no evidence of disease in 21 out of 23 cases followed postoperatively for 2 or more years. Radiation therapy was curative in one instance. Preoperative endodontic therapy for teeth in the field of surgery has proved to be advantageous. The pathogenesis of the giant cell granuloma of the jaws is discussed.

Osseointegrated denture in a vascularized bone transfer: functional jaw reconstruction.

Total functional reconstruction of the lower jaw often falls short of ideal goals. While reconstructive techniques are available to close large defects with both hard and soft tissue, the insertion of a prosthetic dental appliance and the return to normal masticatory function are often technically impossible or not even attempted. Presented here is a case report of a patient successfully rehabilitated with a fixed dental appliance supported by jaw fixtures osseointegrated into a vascularized iliac crest mandibular reconstruction. At present, 6 additional patients have had mandibular reconstructions and are in various phases of functional dental rehabilitation. When these data are complete, a series report will be presented for publication.

The surgical management of the anophthalmic syndrome with the concomitant malunion of the zygomatico-maxillary complex: review of the literature and report of a case.

A case of anophthalmic syndrome complicated by a depressed malunited fracture of the zygomatico-maxillary complex is presented. The components of the syndrome and the approaches to treatment are also discussed. A Teflon sled, Proplast malar implant and ptosis correction acheived the desired results.

Mediastinal emphysema following Le Fort I osteotomy: report of a case.

Mediastinal emphysema is a rare but known complication of deep-space infection or maxillofacial trauma. In this case report, a healthy 17-year-old girl experienced chest pain on the third day after a Le Fort I maxillary osteotomy. An film x-ray of the chest showed air in the mediastinum. A discussion of the potential causes and management of this complication are presented.

Intraoperative management of a partially severed endotracheal tube during orthognathic surgery.

A potential hazard of orthognathic surgery is disruption to the endotracheal tube as it passes through the nasal cavity. Instrumentation necessary to the surgical procedure can inadvertently sever the tube either partially or completely necessitating one of several procedures to correct the situation. A case report is presented which describes a situation where the patient's endotracheal tube had been partially lacerated intraoperatively. Due to lack of patency in one nostril, a method for replacement was required that allowed the new tube to pass through the same nostril as the original tube without placing excessive forces on a surgically fractured maxilla. The mechanism for the replacement procedure as well as consideration of alternative approaches is discussed.

Oral presentations in non-Hodgkin's lymphoma: a review of thirty-one cases. Part III. Six cases in children.

This is the third in a series of articles dealing with oral presentations in non-Hodgkin's lymphoma. In this section the authors discuss the clinical and microscopic features of six cases occurring in children, four of which qualified as Burkitt's lymphoma.

Oral presentations in non-Hodgkin's lymphoma: a review of thirty-one cases. Part II. Fourteen cases arising in bone.

In a series of 31 patients with NHL presenting in the oral region, nine lesions were in the maxilla and 5 were in the mandible, for a total of 14 (45%) lesions that arose in bone. The most common locations were the posterior regions of the maxilla (7 cases) and mandible (4 cases). Diffuse subtypes clearly predominated, 13 out of 14 cases demonstrating this pattern. Six of the cases were in children, and 4 of these qualified as Burkitt's lymphoma. In general, it was found that the statistics relating to survival of patients with jawbone lymphoma correspond closely to the findings reported for skeletal lymphomas. Despite the high incidence of diffuse patterns, 6 of these 14 patients with NHL in bone were alive with no evidence of disease 3 years or longer.

Oral presentations in non-Hodgkin's lymphoma: a review of thirty-one cases. Part I. Data analysis.

Thirty-one patients with oral manifestations of non-Hodgkin's lymphoma have been studied with reference to age, sex, race, location of lesion in oral cavity, stage of disease on presentation, duration of disease at time of presentation, histologic type, modes of treatment, and survival. There were 6 children and 25 adults, ranging in age from 3 to 89 years. Only 2 of the 31 patients were black. Sex incidence was almost equal, with 17 females and 14 males. In 12 cases the oral findings alone represented the initial presentation of lymphoma. The maxilla, mandible, and palate accounted for 24 of the 31 cases. The preponderance of diffuse histologic patterns was striking (77.4 percent). Eighteen cases (58.0 percent) presented in Stage I or Stage II, indicating relatively limited extent of disease. More generalized involvement was found in the remaining thirteen cases (41.9 percent). Thus, although NHL may appear in the oral region as the first detected evidence of disease, in many patients a work-up will show that the process is widespread in distribution. In this brief series survival data coincide with the established principles that a poorer prognosis is associated with the diffuse histologic pattern, as well as certain identified histiocytic and poorly differentiated lymphocytic subtypes.

The utilization of the carbon dioxide laser in the treatment of recurrent papillomatosis: report of case.

The carbon dioxide laser is a relatively new mode of therapy in the treatment of oral lesions. In our experience, when the laser has been used, bleeding, scarring, and edema have been minimal. With the development of hand-held instrumentation, this useful tool can be added to the oral surgeon's armamentarium.

Mucoepidermoid carcinoma of the parotid gland: an intraoral presentation with widespread metastases.

A case of mucoepidermoid carcinoma originating in the parotid gland but manifesting itself intraorally with widespread metastases is presented. A description of the nature of the tumor, the histologic patterns, clinical staging and treatment is discussed. A possible source of diagnostic errors that can be made when tissue sampling is limited and not truly representative is presented.