A new mandibulotomy technique for the dentate patient.

Past mandibulotomy techniques, useful for surgical access to pathology of the head and neck, are complicated by postoperative malocclusion when performed on dentate patients. Malocclusion results from closure of the gap created by the saw blade during reconstruction. A new method of mandibulotomy bicortically splits the symphysis using an osteotome, with modifications to spare healthy dentition. The bicortical split osteotomy allows the hemimandibular segments to be approximated, accurately aligned, and rigidly fixed with three bone screws and a dental arch bar.

Osseo-integrated implant treatment of a patient with rapidly progressive periodontitis. A case report.

The case report presented describes placement of osseointegrated fixtures in a patient with a probable history of rapidly progressive periodontitis. A 12-year history is presented. The post-operative sequelae of placing fixtures in a fully edentulous maxilla and partially edentulous mandible were the worst seen by the Implant Team at Emory University. The hypothesis presented is that patients with aggressive forms of periodontal disease should be subjected to appropriate mechanical and antimicrobial therapy to produce a healthy oral flora before any implants are placed.

Fatty change in the human temporomandibular joint disc. Light and electron microscopy study.

Joint pain has been associated with fatty infiltration of the knee articulation. The purpose of this study is to report on the histopathological findings, especially fatty changes, that are seen in surgical specimens from the temporomandibular joints (TMJ) of patients that had persistent pain after non-surgical therapy. Forty plicated TMJ retrodiscal samples from 25 patients were used in this study. The patients were previously treated with splints for variable periods but not less than 2 months. The specimens were obtained by 2 surgeons using standard TMJ plication techniques. Control disc specimens were obtained from normal appearing cadaveric TM joints. Samples were immediately immersed in glutaraldehyde and processed for light and electron microscopic examination. The specimens were composed mainly of moderately dense tissue with cells that appeared fibroblastic and intermittent chondrocytic type cells. Fatty change, exclusively in association with the perivascular areas, was observed in 27 of 40 specimens. Electron microscopy showed fibroblasts, as well as large fat inclusions adjacent to elastin macroglobules. Fatty infiltration of the TMJ has been interpreted as a degenerative change. It is postulated that kinins and prostaglandins generated in the fat pads can pass freely in tissue fluid to adjacent, highly innervated structures thus leading to joint pain. It is further postulated that the finding of associated elastin with fatty deposition is similar to the atherosclerotic changes encountered in large blood vessels and the aorta.

Esthetic evaluation of frontal labial morphology after double V-Y closure following Le Fort I osteotomy.

Ten orthognathic surgery patients who had their maxillary circumvestibular incision closed with a double V-Y closure were compared with 10 unoperated controls. Pre- and post-operative frontal photographs were presented to nine oral and maxillofacial surgeons and nine orthodontists. The examiners answered a set of questions designed to evaluate changes in maxillary exposed vermilion height, contour of the Cupid's bow, and the final esthetic result. Results of the study show that any changes in the definition of Cupid's bow or the vermilion height with double V-Y closure are difficult to discern clinically and that this procedure produces an esthetically acceptable outcome.

Carotid-cavernous sinus fistula accompanying an isolated mandibular fracture.

A patient who developed carotid-cavernous sinus fistula associated with an isolated mandibular fracture is reported, and the etiology, diagnosis, and treatment of this condition and the associated abducens nerve palasy are discussed.

Granulocytic sarcoma of the mandible.

The case is presented of a 54-year-old black man with a mass apparently involving only the soft tissue retromolar trigone on panoramic and mandibular series radiographs. A granulocytic sarcoma involving the mandible was diagnosed on biopsy with the aid of histochemical stains, immunologic cell surface markers, and electron microscopy. The autopsy also revealed involvement of the ribs and liver.

Comparative study of alloplastic materials for temporomandibular joint disc replacement in rabbits.

Young adult, white New Zealand rabbits underwent either sham surgical procedures or discectomy. In the animals that underwent discectomy, either reinforced silicone or polytetrafluoroethylene-aluminum oxide (PTFE-Al2O3) implants were placed in the glenoid fossa. During gross sectioning, the silicone implants could be easily displaced from the specimen, while the PTFE-Al2O3 implants were firmly anchored. Histologically, fragmentation of the implants was seen in the silicone group; 21.4% of the implants placed were torn. Foreign body giant cell reactions reached a peak after eight weeks. Associated fibrosis and foreign body giant cell reactions were seen, resulting in a thickened capsule and resorption of the condyle and articular fossa. In the PTFE-Al2O3 group there was marked osteoclastic activity, with resorption and severe degenerative changes in both the condyle and glenoid fossa. The foreign body giant cell reaction was severe at all time intervals and increased with time. Tearing of the implant was observed in 46.2% of the joints. These results indicate a need for further evaluation of these materials as disc replacements in humans.

How We Manage Mandibular Fractures.

In brief: Mandibular fractures occasionally are sports-related injuries. Diagnosis is based on clinical signs and symptoms and is confirmed with various radiographic views of the mandible. The nature of the fracture and the presence or absence of teeth determine the type of treatment used. Treatment modalities include temporary stabilization with subsequent open or closed reduction using one of a variety of techniques. Rigid internal fixation of fractures-a recently developed technique-may eliminate the need for prolonged immobilization of the jaw and permit early function of the jaw.