Idiopathic noncondylar hemimandibular hyperplasia.

A female patient with 'idiopathic non-condylar hemimandibular hyperplasia' was followed from the age of 7.5-11.5 years. This rare disorder was characterised by an increase in volume of the right inferior ramus and mandibular body. It also included accelerated development and eruption of the teeth on the affected side, but no indication of enlargement of the condyle or the condylar neck. To date, review of the literature revealed several cases of hemimandibular hyperplasia and unilateral condylar hyperplasia, both of which present with enlargement of the condyle. However, the patient differed significantly from any previously reported cases, since she had no enlargement of the condyle. The above mentioned patient also differed from patients with hemihypertrophy, since the teeth were accelerated in development, but not hyperplastic. In addition, from histopathologic and radiographic examinations, as well as an angiogram, benign fibro-osseous and vascular lesions of the mandible were excluded. Although this is a single case report and neither the aetiology nor the pathogenesis is yet understood, it may suggest a new disorder of the mandible. Therefore, future reporting of similar cases should be encouraged.

Preliminary investigation of the biomechanics of internal fixation of sagittal split osteotomies with miniplates using a newly designed in vitro testing model.

PURPOSE: This article reports a preliminary study undertaken to investigate the biomechanics of internal fixation systems for sagittal split ramus osteotomy of the mandible with advancement, using a newly designed 3-point bovine rib testing model. MATERIALS AND METHODS: After 1 of 5 different miniplates internal fixation systems was placed, a vertical load was applied just below the superior border of sagittal split osteotomy gaps in bovine ribs positioned in a custom-made cradle using a compound cantilered bar device. Load/displacement data were gathered, and the mean elastic limits of the 5 miniplate designs were compared by using a 1-way analysis of variance (ANOVA) with Tukey multiple comparisons. RESULTS: The elastic limit of the rigid fixation system was higher when using a curved plate design than with a straight plate design. CONCLUSION: The 3-point bovine rib model used in this study is an inexpensive, discriminating, and reproducible method for testing internal fixation systems on sagittal ramus osteotomies under conditions that more accurately represent the human mandible in function.

Clinical criteria for the use of a decision-making framework for the medically compromised patient: hypertension and diabetes mellitus.

In this article, clinical criteria for the staging of disease severity in patients with hypertension and diabetes mellitus are presented. This paper is intended to supplement a previous article by the authors on the use of clinical criteria for the classification of patients with ischemic heart disease and chronic obstructive pulmonary disease and the use of a decision-making framework for the medically compromised patient. Hypertension and diabetes mellitus are discussed in terms of pathophysiology, risk factors, clinical manifestations of disease and disease progression. The article will allow practitioners to stage patients with hypertension and diabetes mellitus and to apply this staging to the previously established clinical decision-making framework for medically compromised patients.

A clinical decision making framework for the medically compromised patient: ischemic heart disease and chronic obstructive pulmonary disease.

The intent of this article is to assist dentists and their staff in the assessment of systemic disease, and establish a framework for clinical decision making that correlates medical risk with the anticipated complexity of the planned dental procedures. Two examples of systemic disease, ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD), are discussed in terms of pathophysiology, risk factors, clinical manifestations of disease and disease progression.

Comparison of maxillectomy patients with immediate versus delayed obturator prosthesis placement.

OBJECTIVE: To compare maxillectomy patients with immediate versus delayed placement of an obturator prosthesis in terms of patient outcomes. DESIGN: Retrospective review. OUTCOME MEASURES: The outcomes of 23 maxillectomy patients seen between 1975 and 1993 at St. Joseph's Health Centre in London, Ontario, were analyzed. METHODS: For 17 patients, a prosthesis was placed immediately as part of the operative procedure, and for 6 patients, an occlusive dressing only was placed. RESULTS: In all parameters studied (length of stay, i.v. requirements, swallowing, clear fluid diet and ambulation), the prosthesis group progressed more quickly and had a more rapid return to normal function. CONCLUSION: This study demonstrates the benefits of immediate prostheses for maxillectomy patients and justifies their continued use.

Oral manifestations of oxalosis secondary to ileojejunal intestinal bypass.

Oxalosis is a rare condition that may be either hereditary or acquired. It may be secondary to a number of primary causes, which include renal failure, oxalate poisoning, malabsorption syndromes, and in this case, ileojejunal bypass surgery. Systemic oxalate overload following such bypass surgery results from a defect in the enterohepatic circulation and from the loss of calcium and bile salts in the feces. The oxalate is then absorbed into the circulation, and the supersaturated solution precipitates in the systemic tissues. Reported cases of oral involvement are rare. This article presents a 2 1/2-year follow-up of such a patient and the resultant progressive and unrelenting nature of the disorder. As a result of our experience, we suggest early aggressive oral surgical management of the widespread oral lesions.