Alloplastic augmentation of the mandibular angle.

PURPOSE: This article describes the use of a large-pore polyethylene implant for mandibular angle augmentation. PATIENTS AND METHODS: Patients with severe facial deformities who had previously undergone multiple surgical procedures and were now seeking esthetic improvement were included in this series. Their deficient mandibular angles and reduced ramus height were corrected with polyethylene implants appropriately sculptured and fixed to the mandible through extraoral incisions that preexisted in most patients. The surgical technique is described, and four representative cases are presented that illustrate the changes in facial contour and esthetics. RESULTS: Postoperative appearance was considered very satisfactory, and the patients' esthetic expectations were met to a great extent. The mandibular angle was well outlined, and facial contour and proportions were enhanced. CONCLUSION: This surgical procedure is recommended for mandibular angle augmentation when proper indications are strictly observed and surgical steps are accurately followed.

Blood supply to the oral and maxillofacial tissues following radiation therapy: a prospective ultrasonographic study.

In this prospective clinical study of the early radiation effects on blood supply to the mouth and face, 44 patients (31 men-13 women, mean age 63.4 yrs) with oral tumors underwent surgery and adjuvant postoperative radiotherapy with conventional fractionation (mean dose at the neck approximately equal to 50 Gy). Blood flow parameters 1 cm below the bifurcation of the common carotid artery (mean velocity time averaged, lumen diameter, resistivity index-RI) as well as perivascular reaction, were recorded on Color Doppler Imaging video tapes in a series of five consecutive examinations up to six months postirradiation. There were no statistically significant changes shown between the initial and follow-up examinations for any of the parameters investigated. There was no difference in blood flow between the ipsilateral (operated-irradiated) and contralateral side of the neck. Results did not seem to correlate with known vascular disease risk factors such as sex, arterial pressure, cholesterol levels, smoking and diabetes. After the effect of age was controlled, flow measurements remained statistically stable. Radiation dosage did not appear to influence carotid flow parameters. Perivascular reaction had the highest peak immediately postirradiation but regressed with time. This study suggests that therapeutic radiation of the neck at this dose level may not have important effects on the maxillofacial region blood supply for approximately eight months postoperatively; however, these patients should be closely evaluated for symptoms or signs of carotid artery lesions on a long-term basis.

Lingual thyroid: a new surgical approach--a case report.

Ectopic lingual thyroid is a rare developmental anomaly, presenting in the adult with obstructive symptoms during respiration, deglutition and speech. The main therapeutic issue after exact diagnosis is the restoration of thyroid function, and surgical intervention, when necessary, has to deal with problems related to the site and function of the ectopic gland. A case of a 25-year-old female with dyspnoea and dysphagia due to a 3 x 4 cm ectopic lingual thyroid, excised by an original peroral approach via a mandibular midline osteotomy, is reported. Our surgical technique is described and the diagnostic and therapeutic problems are reviewed.