Maxillary arch width in unoperated adult bilateral cleft lip and alveolus and complete bilateral cleft lip and palate.

OBJECTIVES: To study maxillary arch width in adult patients with bilateral cleft lip and alveolus (BCLA) or with complete bilateral cleft lip and palate (BCLP), who have not had any surgery. SETTING AND SAMPLING POPULATION: Eighteen patients with BCLA, 13 patients with BCLP, and 24 controls from remote areas of Indonesia collected over 10 years. MATERIALS AND METHODS: Dental casts were digitized three-dimensionally using an industrial coordinate measuring machine (CCM) (Zeiss Numerex; Carl Zeiss, Stuttgart, Germany). Transversal distance between molars was measured on the tip of the distobuccal cusp and the tip of the mesiobuccal cusp, and for premolars and canines, the tip of the buccal cusps was recorded. Means and standard deviations were calculated for all variables. t-Test was used to determine whether the mean values of the cleft groups showed significant differences from each other and from the controls. Level of significance was set at p < 0.05. RESULTS: Transversal arch dimensions in the BCLA group were comparable to the controls except at the canine level. Intercanine distance, which is close to the alveolar cleft, was 4.3 mm (SE 1.4) smaller in the BCLA group (p = 0.002). In the BCLP group, a comparable pattern was found. At the canine level, mean transversal width was 7.2 mm (SE 1.9) smaller compared to the control group, but no significant differences were found in the other transversal dimensions. CONCLUSIONS: Small differences are found in transversal dimensions in patients with BCLA and BCLP compared to a control group. Differences are most outspoken in the area near the cleft.

Maxillary arch width in unoperated adult of the unilateral cleft lip and alveolus patients.

BACKGROUND: The transversal measurement on the dento-alveolar fragments of the maxilla, in the unoperated adult patients with unilateral cleft lip and alveolus are rare and have not been well documented and archived in the scientific journals. The effect of the congenital malformation is obvious in the Unilateral Cleft Lip and Alveolus (UCLA) patients and is well documented. OBJECTIVES: The aim of this study is to investigate whether there are any influences of the final transversal development of the maxilla based on the location and extent of the defect in patients with UCLA. METHODS: 168 adult unoperated UCLA patients (study group) and 24 non cleft patients (control group) participated in this study. Plaster of Paris (POP) casts were made of the maxillary dentition and mesurement were taken using coordinate measuring machine (CCM) (Zeiss Numere, Carl Zeiss, Stuttgart, Germany). RESULT: The mean values of maxillary transverse measurement of first premolar through the second molar of the UCLA and control group patients showed no statistically significant difference. The inter-canine distance was significantly smaller in the UCLA patients than non-cleft patients CONCLUSIONS: The maxillary inter-canine distance in untreated UCLA patients were significantly different from that of non cleft patients. There is narrow and constricted maxillary growth in UCLA patients causing maxillary morphological changes and cosmetic facial changes.

Growth characteristics of large mandibular ameloblastomas: report of 5 cases with implications for the approach to surgery.

The aim of this study was to establish surgical guidelines based on the growth pattern of ameloblastomas in relation to the possible infiltration of the cortical bone, the inferior alveolar nerve, the periosteal layer and the surrounding soft tissues. Five male patients with voluminous mandibular ameloblastomas were treated by means of radical surgery. Ameloblastomas showed an invasive growth pattern in the cancellous bone with small tumour nests at a maximum distance of 5mm away from the bulk of the tumour. Expansive and invasive growth in the Haversian canals was observed. There was no invasion of the inferior alveolar nerve. The mucoperiosteal layer was invaded but not perforated. No invasion was observed in the surrounding soft tissues of the periosteum and in the skin tissue. A local resection with a surgical margin of spongious bone of 1cm is suggested. When the tumour is radiologically closer than 1cm to the inferior border of the mandible, a continuity resection is mandatory. A conservative approach concerning the inferior alveolar nerve is suggested. Removal of an excess of perimandibular soft tissue is not indicated. The overlying attached mucosal surface should however be excised together with the underlying bone.

The adult unoperated cleft patient: absence of maxillary teeth outside the cleft area.

OBJECTIVE: The purpose of this study was to investigate the possible absence of teeth in the postcanine region of the upper jaw of the unoperated adult cleft patient. METHOD: The study was performed on 266 dental casts of fully unoperated adult cleft patients. The patients were divided into four groups according to the type of the cleft: unilateral cleft lip and alveolus, unilateral cleft lip and palate, bilateral cleft lip and alveolus, and bilateral cleft lip and palate. RESULTS: No absence of permanent teeth in the canine and postcanine area of the upper jaw could be found. CONCLUSION: The results are in contradiction with the established hypothesis that absence of teeth outside the cleft area of the maxilla is due to an unknown congenital factor. On the contrary, the findings support the hypothesis that surgery for the closure of the hard palate in early childhood is the most important etiological factor for the absence of teeth outside the cleft area in the early operated cleft patient. The superficial position of the tooth germs (at the time of the palatal surgery), especially those of the premolars, supports this hypothesis.

Median cleft of the lower lip associated with lip pits and cleft of the lip and palate.

OBJECTIVE: In this case report, we present an unusual combination of three congenital malformations: median cleft of the lower lip, lip pits, and unilateral cleft of the lip and palate without familial occurrence. CONCLUSIONS: From an etiological point of view, this combination of malformations could have happened during the late embryogenic period. Why this combination is uncommon is not known.

Experimental degenerative temporomandibular joint disease.

As a possible cause of osteoarthrotic changes of the temporomandibular joint (TMJ), trauma has often been suggested in the literature. Very few authors have tried to test the reliability of this theory by animal experiments. Sixty Wistar albino rats, divided into two main groups, were used in this investigation. In the first group of 10 rats, a trauma of the articular cartilage was inflicted. In the second group, small defects were made on different segments of the articular disk only, avoiding damage to the remaining components of the TMJ. The traumas of the articular cartilage almost completely healed within the experimental period. When the disk was damaged, besides degeneration of the disk itself, changes of the condylar head, similar to changes observed in arthrotic human material, were found.

Dental arch dimensions in unoperated adult cleft-palate patients: an analysis of 37 cases.

In surgically treated patients with clefts of the lip, alveolus, and/or palate, the vertical, transversal, and sagittal development of the maxilla is influenced by intrinsic, functional, and iatrogeneous (surgical) factors. To evaluate the effect of intrinsic and functional factors on dental arch development, we examined and compared unoperated adult individuals with different types of clefts. Dental casts of 37 Indonesian adults with unoperated unilateral clefts were studied: 15 subjects with unilateral cleft lip and alveolus (median age: 24 years) and 22 subjects with complete unilateral cleft of lip, alveolus, and palate (median age: 25 years). Dental arch dimensions were measured and evaluations of arch form were made. The Student's t-test showed that arch width and arch depth were significantly smaller in the complete-cleft group. There is a tendency for the smaller segment to be positioned more cranially in the complete-cleft group. Our conclusion was that subjects with an unoperated complete-cleft lip, alveolus, and palate develop an arch form that is significantly different from that in subjects with unoperated cleft lip and alveolus.

Residual cementoblastoma of the mandible.

An unusual case of a residual cementoblastoma in a 24-yr-old man is described. The final diagnosis has been based on the history and the clinical, radiographic and histologic features. The lesion has been removed in toto. During the ten-year follow-up no signs of recurrence have been noticed.

The anatomical effects of surgically repositioning the disc in the temporomandibular joint of rats. An experimental study.

A sample of 16 rats was used as experimental material to evaluate the effect of surgical repositioning of the disc of the temporomandibular joint according to the technique described by McCarty and Farrar (1979) and its variation according to Leopard (1984). The animals were killed 6 weeks postoperatively. Macroscopic and microscopic examination revealed that in all rats treated according to the procedure of McCarty and Farrar (1979) the disc had completely disappeared. The underlying condyle was deformed to a mushroom shape and the cartilage of the condyle was thickened. In seven of eight rats operated on according to the technique of Leopard, the same results were observed. It is concluded that surgical repositioning of the disc according to these techniques represents a method of disc removal.

Systemic bone diseases and reduction of the residual ridge of the mandible; primary hyperparathyroidism. A preliminary report.

Twenty-five edentulous patients with established hyperparathyroidism were evaluated to establish a possible relation between extreme reduction of the height of the mandible and systemic bone loss. As an important parameter of the severity of the systemic bone loss, the level of the intact biologically active molecule of the parathormone was used. In this study no relation between hyperparathyroidism and reduction of the residual alveolar ridge could be established. In only two patients the reduction could be classified as "severe." Furthermore the level of the active, intact, circulating parathormone or the duration of the hyperparathyroidism could not be identified as an important factor in relation to the local phenomenon of reduction of the alveolar ridges.

Effects of experimental defects of the articular disc of the temporomandibular joint in rats.

Triangular defects were made in different locations of the disc in rat temporomandibular joints. After 3 months the following effects were observed. Central defects had become rounded without gross changes in the mandibular head. Peripheral defects were enlarged towards the centre, occasionally accompanied by condylar hyperplasia. Microscopically the cartilagenous covering of the mandibular head in all operated cases was characterized by thickening, dispersion of cells normally closely packed in the intermediate zone, and the constant appearance of a tear parallel to the surface.

Autologous versus homologous bone grafting in osteotomies, secondary cleft repairs and ridge augmentations: a clinical study.

To compare the clinical results, complications and morbidity of osteotomies, secondary cleft repairs and ridge augmentations in which frozen femoral head homologous bone or autologous bone was used, a series of 61 patients with follow-up periods of 1 to 6 years has been reviewed. Long-term clinical observation shows that, with a correct indication and surgical technique, frozen homologous bone is a good alternative to autologous bone in clinical grafting procedures.

Oral manifestations in Cowden's syndrome. Report of four cases.

Cowden's syndrome or multiple hamartoma and neoplasia syndrome is a hereditary disorder combining multiple hamartomas of many organs. These hamartomas are derived from ectodermal, mesodermal, and endodermal tissues and may undergo spontaneous malignant changes. Small papular cutaneous lesions and papillomatous outgrowth and papular lesions of the oral mucosa are the most predominant features of the syndrome. Since the orocutaneous lesions often precede the associated malignant degenerations, they may serve as a diagnostic signal for the probably developing neoplasia in other organs. The presence of extensive papillomatous and papular lesions in the oral mucosa combined with skin lesions should therefore alert the clinician to suspect the presence of Cowden's syndrome, the early diagnosis of which is important in order that the concomitant malignant changes might be discovered at the earliest possible moment. Four cases of Cowden's disease are presented, with emphasis on the oral manifestations of this syndrome.

Unusual healing of a fracture of an atrophic mandible. Report of a case.

Fractures of an atrophic edentulous mandible may present a serious problem in oral surgical treatment. A case is described in which a traumatic mandibular fracture, initially treated by means of a Gunning type of splint, and a subsequent spontaneous fracture on the opposite side were treated without mechanical fixation.

Lipoma of the tongue.

A case of an enormous lipoma of the tongue is presented. The absence of dentoalveolar changes and the complete adaption of the functions of the tongue are discussed briefly.