Patient response to temporomandibular joint arthroscopy: preliminary findings in 24 patients.

A group of 24 patients who underwent TMJ arthroscopy with lysis of adhesions and lavage of 28 joints were evaluated for changes in symptoms and mandibular opening. The mean follow-up period was 7.5 months. The results revealed a general improvement in pain, joint noise, and hypomobility following TMJ arthroscopy. Measurement of mandibular opening revealed a mean increase of 5.9 mm. These results suggest that TMJ arthroscopy appears to be an excellent modality for the palliation of symptoms of TMJ pain, joint noise, and hypomobility.

Porous hydroxyapatite as a bone graft substitute in alveolar ridge augmentation: a histometric study.

Following bilateral alveolectomy, the ridge form was restored in 10 dogs with blocks of porous HA matrix and bicortical iliac autografts. The specimens were retrieved after 11 to 17 months and undecalcified sections were prepared for microscopy and histometry. Within the HA implants, bone ingrowth extended throughout the pores. This bone appeared mature and well vascularized. The autografts united to the mandible. However bone ingrowth into the cancellous spaces of the grafts was minimal or absent. Measurement of implant and graft cross-sectional areas showed the maintenance of alveolar ridge form to be equally permanent for the 2 materials over the 1.5 year duration of the study. The implant specimens were composed of 43.1% HA matrix, 45.2% bone and 11.7% soft tissue. The HA matrix had a surface area averaging 9.3 mm2/mm3 that was 91.1% covered with bone ingrowth. Although this study supported the thesis that a porous HA matrix can function as a bone graft substitute, it is noted that the unyielding nature of the implant blocks, compared to granules, requires a solution to the challenge of long-term denture support without ulceration before it can be used with clinical confidence.

Osteomyelitis of the mandible as a complicating factor in Paget's disease of bone.

A case of osteomyelitis of the mandible in a patient with extensive Paget's disease of bone is presented. The changes in the bone with Paget's disease makes the diagnosis, clinical assessment and management of the osteomyelitis in such patients a difficult task.

Disphosphonate dynamic imaging of experimental bone grafts and soft tissue injury. Radionuclide bone imaging.

Bone imaging provides two significant advantages over previously available methods for assessing bone processes. First, as scanning is non-invasive, it offers the operator the ability to sequentially follow any area of bone without altering it as would a biopsy. The second advantage is the ability of bone imaging to provide current information about the bone being scanned rather than having to deal with the delay that is inherent in conventional radiography. Recent developments in radiopharmaceuticals and instrumentation have made bone imaging a potentially practical clinical tool for the detection and assessment of benign as well as malignant processes affecting bone. This paper presents the results of the use of technetium 99m diphosphonate bone imaging in experimental canine mandibular autografts and surgical soft tissue injury. The implication of these results for the clinical situation will be discussed.

Orofacial odontogenic infections.

Clinical manifestations of odontogenic orofacial infections are protean and are largely dictated by complex microbiota and anatomic routes of spread. Complications such as suppurative mediastinal or intracranial extension, retropharyngeal spread and airway obstruction, pleuropulmonary involvement, and hematogenous dissemination indicate the potentially serious nature of these infections. In this review we emphasize the pathogenetic mechanisms of infection, the principles of antimicrobial therapy, and the need for early surgical intervention.

Comparison of ilium to rib for bone grafting in defects of canine mandibular alveolar fidge.

The behavior of iliac and rib grafts in surgically created defects in canine alveolar ridges was investigated. Despite the greater amount of potentially osteogenic tissue in the iliac graft, no significant qualitative differences were noted in the bony remodeling for a year. However, the rib grafts did form a mature superior cortical border significantly more rapidly, leading to speculation on the advantages of rib over iliac graft in alveolar ridge grafting.

Necrotizing fasciitis.

Necrotizing fasciitis is a relatively uncommon severe soft tissue infection that is characterized by rapid widespread superficial fascial necrosis with undermining of surrounding soft tissue. Recent advances in anaerobic culture techniques have allowed identification of anaerobic organisms, which are now considered to have a vital role in the pathogenesis of this soft tissue infection. Therapy requires both rapid institution of a high level of antibiotics and a radical surgical incision and drainage procedure. All of the aerobic and anaerobic organisms isolated in the reported case of necrotizing fasciitis arising from a periapically infected mandibular third molar demonstrated in vitro sensitivity to penicillin.

Metastatic chondrosarcoma to the maxilla: review of the literature and report of case.

Metastatic tumors to the jaw are relatively uncommon. When they occur, the primary tumor is most likely to be an adenocarcinoma from the breast, lung, or kidney. Metastatic tumors most frequently involve the mandible rather than the maxilla. The route of metastasis is considered hematogenous, although spread via lymphatic channels or the vertebral venous plexus may occur. An unusual instance of primary chondrosarcoma of the scapula metastasizing to the maxilla and to various soft tissue sites from tumor emboli, probably arising from an extensive metastatic lesion of the left atrium of the heart, has been presented.