Per- and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon.

Per- and post-operative indicators in 25 patients who had lower third-molar surgery performed by 4 general practitioners (GP) in their own practices were compared with those of a control group of 25 patients operated on by an oral surgeon. The preoperative variables age; sex; general health; use of medications, alcohol, and tobacco; and depth, position, and presence of infection of the third molar were considered in individual matching of the patients. The operations performed by the GPs lasted 17.9 min (p = 0.0001) longer than those of the oral surgeon. Increased rates of postoperative alveolitis (p = 0.03) and secondary healing (p = 0.0005) were found in the GP patient group, as was a tendency for increased postoperative pain and consumption of strong analgesics. The number of days unable to work was 1.9 in the GP group, compared with 0.6 in the surgeon group (p = 0.0012). No differences in swelling and trismus were found.

Immune response to nickel and some clinical observations after stainless steel miniplate osteosynthesis.

Fifteen patients undergoing internal fixation for mandibular fractures were examined for delayed type hypersensitivity (DTH) reaction to nickel before and after implantation of stainless steel miniplates. A lymphocyte transformation test (LTT) was used to measure the immune response before implantation and at removal of plates and screws. The clinical complications during fracture healing were also recorded. The results show that the in vitro LTT may be useful in nickel hypersensitivity testing. A significant increase in lymphocyte transformation was found as a response to nickel stimulation (0.5 microgram Ni/ml) at removal of the implants. We conclude that, despite an increase in LTT after stainless steel implantation, no adverse clinical complications related to DTH could be recorded after short-time observation.

Sensory impairment following sagittal split osteotomy for correction of mandibular retrognathism.

Sagittal split osteotomy of the mandibular ramus is performed in close proximity to the inferior alveolar nerve and may result in postoperative neurosensory disturbances. Intraoperative strain on the nerve and other complications in 25 patients undergoing bilateral sagittal split osteotomy were recorded. Neurosensory testing was carried out before and after surgery. The patients reported sensory disturbances in 54% of sites 4 days postoperatively and 42% and 34% of sites at 9 weeks and 6 months, respectively. Objective assessments showed an incidence of 34% at 4 days, 20% at 9 weeks, and 8% at 6 months. Sensory disturbance was closely related to the degree of intraoperative strain on the nerve.

[Tumors of the posterior hard palate]. / Hevelse lateralt i den hårde gane.

The palatal mucosa is a representative area when reviewing etiology of the wide variety of oral tumours. The most important are of cystic, neoplastic or inflammatory nature. A case of malignant lymphoma occurred as a firm, painless swelling in the lateral posterior hard palate in a 69 year old woman. The tumour was initially diagnosed and treated as an abscess. Weeks later the swelling persisted and the patient was referred to the Department of oral surgery and oral medicine. University of Bergen. Incisional biopsy revealed the true nature of the process. Following cytostatic and radiation therapy, total regression of the tumour took place. The prognosis is considered favourable. The paper surveys the etiology of tumours of the posterior hard palate.

Positioning and mobility of the mandibular condyle after surgical correction of the asymmetric, prognathic mandible.

Following the extraoral vertical subcondylar osteotomy in the correction of the highly asymmetric and prognathic mandible, only insignificant radiographic changes were observed in the temporomandibular joint 12 months postoperatively. Slight morphologic alterations of the condylar seating were demonstrated at occlusion, but there was no significant difference in condylar position between the two sides of the surgically corrected asymmetric mandible. The condylar axis did not deviate from the preoperative situation, and condylar axis did not deviate from the preoperative situation, and condylar mobility was fully resumed 12 months postoperatively. The extraoral vertical subcondylar osteotomy procedure is applicable in the treatment of combined mandibular asymmetry and prognathism and does not create morphologic changes that differ in the two temporomandibular joints.

Infantile fibrosarcoma in the mandible: case report.

A case of an infantile fibrosarcoma in the mandible is described. The primary tumor was seen in a 2.5 yr-old boy. In spite of repeated surgical interventions the tumor recurred five times during a 15-yr period, but no metastases have been observed. The difficulty in arriving at a correct histopathologic diagnosis on an unusual tumor in the oral region is demonstrated by the fact that 16 consulted pathologists suggested a long list of different tumors. The treatment of choice seems to be radical surgery. The patient has remained well and without recurrence for the last 7 yr.

Clear cell odontogenic carcinoma: report of three cases with pulmonary and lymph node metastases.

Three cases of a newly described rare odontogenic tumor are reported. One patient died with pulmonary metastases, one had an associated odontogenic cyst and one exhibited regional lymph node metastasis. The cases lend support to the odontogenic origin and metastatic capability of the clear cell odontogenic tumor. The authors recommend aggressive therapy and believe that the tumor should be considered a clear cell odontogenic carcinoma.

[Evaluation of symptoms and clinical findings in patients in the oral surgery/medicine department in a university clinic]. / Polikliniske pasienter i oral kirurgi/oral medisin.

The paper present a survey of data of 353 outpatients from the Department of oral surgery and oral medicine, Dental faculty, and the Department of maxillofacial surgery, Haukeland Hospital, University of Bergen, collected and evaluated during two separate weeks (weeks 9 and 47) in 1985. The patients are described according to age, sex, risk factors due to general diseases, symptoms and clinical findings. Out of a total of 353 patients 15 were hospitalized, 3 of them needing urgent help and 12 treated according to long-time plans. The remaining patients were all treated as outpatients. A relatively high frequency of risk patients was found, especially among patients above 50 years of age. This group of patients is expected to increase in the future. The authors emphasize the importance of accurate anamnestic data, especially in regard to drug-treatment and -consumption. Hence, it should be emphasized that accurate anamnestic data and critical evaluation of patients within oral surgery and oral medicine are of increasing importance to the dentist.

Congenital epulis in the newborn.

Neoplasms in the oral cavity are generally recognized during the routine examination of the newborn. Lesions arising on the alveolar processes of the jaws may interfere with nursing and respiration. This paper reviews the congenital epulis (CE) in the newborn. A case of CE arising on the maxillary alveolar process is reported. Due to the indication for removal of these benign tumours in the neonatal period they should be recognized as early as possible.

The surgical technique of vertical subcondylar osteotomy for correction of mandibular prognathism. A 10-year survey.

In the period 1975-1985 extraoral vertical, subcondylar osteotomies of the mandibular ramus (EVSO) were performed in 203 patients with mandibular prognathism at Haukeland University Hospital, Bergen. Refinements of this surgical technique are described. Clinical and surgical observations were analyzed as to preoperative orthodontic treatment, operation time, pre-/post-operative complications, and hospital stay. The findings confirm that the EVSO procedure is a safe technique, with minimal discomfort and morbidity for the patients. Even though intraoral procedures are the trend for surgical correction of mandibular prognathism at present, there are substantial indications for the use of EVSO.

Correction of jaw deformities subsequent to treatment of acromegaly.

In acromegaly, growth of facial bones and changes of oral and laryngeal mucosa are well accepted facts. Orthognathic surgical procedures should in these cases be postponed until the acromegalic process is well controlled. 2 cases of mandibular osteotomies (patients aged 61 and 38 years) are reported. The surgical procedures and the postoperative course of these patients were uneventful and did not deviate from those of otherwise healthy patients.

Oral aspects of osteopetrosis.

The characteristic feature of osteopetrosis is a lack of osteoclastic activity, leading to a series of somatic problems for afflicted persons. The life span of osteopetrotic patients has increased in recent years, thereby making oral aspects of the disease more evident. Four children with malignant osteopetrosis, born between 1967 and 1975, were examined. In all patients the anterior teeth were of normal shape, and erupted on schedule. Primary molars and all permanent teeth were greatly distorted, and remained totally or partly embedded in basal bone. Vertical growth of alveolar ridge was very limited. Where a fenestration of overlaying mucosa had occurred, a localized progressive osteitis developed, leading to soft tissue inflammation and, in two cases, extraoral mandibular fistulas. Peridontal attachment was very poor, spontaneous exfoliation had occurred in all patients. In two children tooth germs and necrotic bone were surgically removed. No beneficial effect of the treatment was observed. Large doses of antibiotics were needed to control recurring infections. No means of curing progressive osseous destruction of mandibular bone has been found. The general prognosis is poor.

Surgical treatment of chronic hyperplastic sinusitis and maxillary sinus empyema of oral/dental origin.

Twelve patients with maxillary hyperplastic sinusitis or maxillary sinus empyema of oral/dental etiology have been treated according to a modified surgical technique. The treatment was initiated by several oro-nasal irrigations and drainage facilitated by an intact semilunar hiatus. This was followed by a surgical procedure including conservative curettage of inflamed sinus mucosa, adequate closure of the oro/antral communication, with establishment of a postoperative oral antrostomy. This antrostomy, through the canine fossa, was established by a vacuum drain, enabling continuous postoperative irrigation and aspiration. The rationale for this technique is discussed. A total of 12 patients operated according to this technique are described. Complete clinical and radiographic healing in all patients was observed over a postoperative period ranging from 6-12 months.

Benign cementoblastoma.

A review of 44 patients with benign cementoblastomas is presented. An additional case is reported. This patient appears to be of particular interest due to radiographic records 18 months prior to admission. In this period the tumor appeared to grow very slowly.

Ameloblastic fibro-odontoma.

An ameloblastic fibro-odontoma in a 14-year-old girl is reported. The case has clinical interest because of the location and the size of the tumor which was surgically enucleated. The different views about clinical, radiographical and histopathological characteristics and the classification of this benign tumor are discussed. The postoperative course was uneventful and the case has been controlled for 3 years without recurrence.

Gardner's syndrome, diagnosis and treatment. Report on a family.

We have examined 15 members of a family with Gardner's syndrome. In the first and second generations, 4 (possibly 5) of 6 members died of cancer of the colon/rectum. Two of them were known to have plyposis coli. Three members of the third generation had the complete triad of Gardner's syndrome with polyposis coli, soft tissue and hard tissue tumours. Three of 5 children in the fourth generation, aged between 7 and 11 years, probably have polyposis coli, and 2 of them have stigmata of Gardner's syndrome. All members of any family with Gardner's syndrome should be examined regularly at 2--3 year intervals from an age of about 10 years until the diagnosis is established, or if polyposis does not develop, up to the age of 40 years. Proctocolectomy is recommended at the age of 18--20 years or later as soon as the diagnosis is determined.