External mandibular fixation for gunshot fractures: report of 2 cases.

High-energy ballistic injuries may cause comminuted facial fractures. Treatment of such fractures might be challenging because of in-fection and soft- and hard-tissue loss. These cases may not be amenable to open reduction and internal fixation. We present 2 cases of gunshot fractures, for which external fixation was used as a surgical step before definitive treatment. With the use of external fixation, existing infection had been controlled and soft tissues had been restored, which allowed oral rehabilitation with reconstruction plates and autogenous bone grafting, if needed.

Nasal Airway Function After Prophylactic Intranasal Surgery for Excessive Maxillary Superior Repositioning: A Retrospective Cohort Study Using the Nasal Obstruction Symptom Evaluation Scale.

PURPOSE: The purpose of this study is to evaluate the degree of nasal airway function after simultaneous intranasal corrective surgery and bimaxillary surgery in patients with excessive superior maxillary repositioning. MATERIALS AND METHODS: A retrospective cohort study was conducted on consecutive LeFort I superior repositioning patients who also underwent simultaneous intranasal surgery to prevent airway obstruction between 2015 and 2019. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to all participants before the operation and after 1 year. RESULTS: Fifteen patients (n=12 females; n=3 males) among 440 bimaxillary orthognathic surgery patients were enrolled with inclusion criteria of maxillary impaction between 8 and 12 mm. All subjects underwent at least LeFort I osteotomy, septoplasty, bilateral inferior turbinectomy, and bilateral sagittal split osteotomy. Two patients received custom-made total joint prosthesis. The primary outcome variable investigated was nasal function. The mean preop Nasal Obstruction Symptom Evaluation score was 24.33 and the mean postop score was 5. CONCLUSIONS: Intranasal procedures performed simultaneously with 8 mm or more maxillary impaction improves postoperative functional outcome in terms of nasal airway patency and breathing. Partial inferior turbinectomies and septoplasty should be performed consistently to avoid nasal obstruction if the impaction of upper jaw exceeds 8 mm.

Ectopic Tooth in Mandibular Canal, Maxillary Sinus, and Mandibular Condyle.

Eruption of tooth into place other than tooth-bearing region is defined as ectopic eruption. Although ectopic eruption of tooth is rare, there have been cases in the maxillary sinus, mandibular condyle, nasal cavity, chin, palate, and orbital floor. Due to ectopic teeth's rarity and lack of consensus for its treatment, incidence was entitled to be added to literature and discussed. It was reported that odontogenic tumors and cysts can develop around the ectopic tooth. Thus, ectopic teeth can be followed up regularly in case of no signs and symptoms. If the patient has unusual orofacial pain, undiagnosed nasal discharge, maxillary sinusitis, preauricular pain, preauricular fistula, trismus, and lip paresthesia, the patient should be evaluated in terms of ectopic tooth. Whether the patient has signs and symptoms related to ectopic tooth, early intervention for the removal of ectopic tooth along with accompanying lesion is the treatment of choice. Specialists choose intervention way based on their experience. When selecting the intervention, minimally invasive and less morbid way should be preferred. Intraoral approach rather than extraorally should be the first choice to prevent unesthetic scar and damage to facial nerve.

Comparison of bicortical, miniplate and hybrid fixation techniques in mandibular advancement and counterclockwise rotation: A finite element analysis study.

OBJECTIVE: This study aims to evaluate biomechanical stability and stress distribution of five different fixation types with finite element analysis using 10-mm advancement with or without counterclockwise rotation of the mandible. MATERIALS AND METHODS: After sagittal split osteotomy, 10-mm advancement was performed in the first group and 10-mm advancement and 10-degree counterclockwise rotation were performed in the second group. One miniplate (M-1), two-miniplate (M-2), one miniplate and a bicortical screw (H), l-shaped bicortical screw (B-1), and inverted l-shaped bicortical screw (B-2) systems were placed. Totally, 120 N force was applied to the models at a 45-degree angle from the lower edge of the symphysis. RESULTS: The highest values on fixation were seen with miniplate, while the mean values were obtained with bicortical screw system. The highest values on bone were achieved using bicortical screws. One miniplate (M-1) showed both the highest and mean displacement. The highest values in counterclockwise-rotated models increased in all parameters, compared to non-rotated models. CONCLUSION: In cases in which passive alignment between segments and adequate bone contact are ensured, inverted l-shaped bicortical screw, two-miniplate, or hybrid systems are recommended.

Retrospective Analysis of Zygomatic Implants for Maxillary Prosthetic Rehabilitation.

PURPOSE: The aim of this study was to evaluate 141 zygomatic implants for the reconstruction of severely atrophic maxillae. MATERIALS AND METHODS: In this retrospective case series study, zygomatic implants were placed under general anesthesia. Inclusion criteria were as follows: ASA I or ASA II, age older than 18 years, inadequate bone for restoration with conventional implants, alternative augmentation procedures considered either inappropriate or contraindicated, absence of a medical condition related to implant failure, and providing written consent. Zygomatic implants used in the study consisted of three different brands: NobelZygoma, Southern Implants System, and Implantswiss. RESULTS: The study included 45 patients, in whom 141 zygomatic implants were placed. The mean age of the patients was 51.76 (range: 23 to 72) years. Three patients were rehabilitated with removable prostheses, 19 patients with fixed prostheses, and 23 patients with hybrid prostheses. The overall complication rate was 5.67% (two zygomatic implants developed infection [1.4%], one zygomatic implant developed peri-implantitis [0.7%], three zygomatic implants developed sinusitis [2.1%], and two zygomatic implants showed unsuccessful prosthetic rehabilitation [1.4%]). The follow-up period ranged from 6 to 36 months. CONCLUSION: Clinical complications of zygomatic implants are acceptable, and their survival rates are similar to those of endosteal implants. Zygomatic implants can contribute to prosthetic rehabilitation.

Vestibuloplasty with Retroauricular Skin Grafts for Dental Implant Rehabilitation in Vascularized Fibula Grafts: Two Case Reports.

The aim of this study was to present the use of retroauricular full-thickness skin grafts in vestibuloplasty surgeries for dental implant rehabilitation in vascularized fibula grafts. Two patients underwent mandibular reconstruction with vascularized fibula grafts due to mandibular gunshot injuries. Inadequate sulcus gaps secondary to mandibular soft tissue deficiencies were managed by full-thickness autologous skin grafts harvested from the retroauricular region. Dental rehabilitation was achieved by implants placed in free fibula grafts. In both cases, complete graft survival was achieved. Cosmetic and functional outcomes were satisfactory. Owing to its high resiliency and elasticity and its thin and hairless structure, full-thickness retroauricular skin graft is an effective treatment modality in the management of intraoral soft tissue deficiencies. Patients with gunshot injuries present great functional and esthetic demands, and every report presenting new treatment modalities is helpful in the management of the condition.

Retromandibular transparotid approach for subcondylar mandibular fractures: A retrospective study.

BACKGROUND: The aim was to evaluate the effectiveness and complications of retromandibular transparotid approach performed for the reduction of dislocated subcondylar fractures. METHODS: Fourteen patients with subcondylar mandibular fractures were evaluated (8 male, 6 female, age range 19-43 years). The primary predictor variable in the present study was time (preoperative vs postoperative). The primary outcome variables were inflammatory complication, facial nerve deficit (House and Brackmann classification), and presence of parotid fistula. The secondary outcome variables were occlusal disturbances, maximal interincisal opening (MIO), and temporomandibular joint (TMJ) pain (VAS). RESULTS: Excellent occlusion and function was observed postoperatively. One salivary fistula occurred after surgery but was healed after 3 weeks. No inflammatory complication was observed. Three patients had grade III and one patient had grade II facial nerve deficit, all recovered in 6 weeks. All patients were free of pain and no malocclusion was observed. MIO was ranging from 34 to 58 mm (mean 44.4 mm) after 6 months. CONCLUSION: The retromandibular transparotid approach is feasible and safe. It facilitates reduction and fixation of subcondylar fractures with functional outcomes and rare complications.

Implant Rehabilitation for Extremely Atrophic Maxillae (Cawood Type VI) with Le Fort I Downgrafting and Autogenous Iliac Block Grafts: A 4-year Follow-up Study.

PURPOSE: The aim of this 4-year retrospective follow-up study was to investigate treatment outcomes, including implant survival rate and marginal bone loss, in patients with maxillary Cawood type VI atrophy pattern who underwent Le Fort I downgrafting and iliac block augmentations for implant rehabilitation. MATERIALS AND METHODS: Retrognathic edentulous Class III patients with severe maxillary resorption (Cawood VI) were enrolled. Reconstructive procedures performed included Le Fort I maxillary osteotomy, iliac block grafting, labial sulcoplasties, and dental implant placement. Panoramic radiographs were used to assess marginal bone loss. The Nobel Biocare Replace and GMI Frontier dental implant systems and fixed partial dentures were used for dental rehabilitation. Statistical analyses were made using NCSS 2007 statistical software, with significance set at P < .05. RESULTS: Ten patients (six men and four women) with a mean age of 50.4 ± 12.55 years underwent maxillary osteotomy (advancement: 9 ± 1.4 mm; inferior repositioning: 8 ± 1.0 mm) and iliac block sandwich grafting (posterior ilium: n = 3; anterior ilium: n = 7) from 2009 to 2015. Nine patients were treated with a two-stage protocol. The mean graft healing period was 5.9 ± 0.73 months. A total of 98 implants were placed, 80 in maxillae and 18 in mandibles. The Nobel Biocare Replace system was used in two patients (n = 29 implants) and GMI Frontier system was used in eight patients (n = 69 implants). Implant numbers in the maxilla were: 6 implants in 2 patients, 8 implants in 6 patients, and 10 implants in 2 patients. The mean follow-up period was 47.8 ± 3.4 months. The success rate was 93.75%, with a 6.25% fail ratio (n = 9 implants) at a follow-up of 4 years. Marginal bone resorption was 1.8 ± 1.0 mm at the postoperative year 1 and 3.75 ± 0.85 mm at postoperative year 4. Marginal resorption in the 8-implant group was found to be higher than that in the 6-implant group and 10-implant group at the postoperative year 1 (P = .045, P = .026, P < .05, respectively). CONCLUSION: Le Fort I osteotomy and simultaneous iliac block grafting (downgrafting) is a valuable option for implant rehabilitation in extremely atrophic maxillae (Cawood VI). It showed a high survival rate (93.75%) at 4 years of follow-up in this study.

A Rare Case of a Lost Suture Needle during Third Molar Surgery.

The authors report a case that is started with a simple upper third molar's surgical extraction and a broken 3.0 suture needle tip incident occurred. Broken fragment's localization has been detected with 3D cone beam computed tomography (CBCT). Needle tip has been reached with the help of CBCT vision. CBCT's benefits have been discussed on these types of cases and further migration of the needle tip during surgical procedure is reported.

Complications related to surgically assisted rapid palatal expansion.

OBJECTIVE: The goals of this retrospective clinical study were to identify surgically assisted rapid palatal expansion (SARPE) complications and assess their incidence, with the aim of informing surgeons and orthodontists of the risks of this widely used procedure before they recommend it to patients. STUDY DESIGN: Between June 2008 and July 2010, 60 patients (23 women and 37 men) underwent SARPE according to a defined multidisciplinary protocol at the University of Marmara, Istanbul, Turkey. RESULTS: Twelve patients (20%) suffered from nasal bleeding. Of these 12, 2 patients suffered late-onset bleeding beginning on postoperative day 8, and in the other 10, nasal bleeding was insignificant. Three patients reported excessive lacrimation postoperatively. Minor problems related to pain and numbness were all temporary. CONCLUSIONS: SARPE procedures have traditionally been reported to be associated with low morbidity, especially in comparison with other orthognathic surgical procedures. However, many complications have been reported.

Does ultrasonic resorbable pin fixation offer predictable results for augmentation eminoplasty in recurrent dislocations?

PURPOSE: To assess the outcome of interpositional calvarial block grafting fixed with an ultrasonic resorbable system (SonicWeld, KLS Martin, Mühlheim, Germany) for augmentation eminoplasty in chronic recurrent condylar dislocations. PATIENTS AND METHODS: We designed and implemented a retrospective cohort study. Eight female patients (mean age 48 years) were treated. The primary predictor variable was time (preoperative vs postoperative). The primary outcome variable was cessation of dislocation. The secondary outcome variables were the height of the articular eminences (HAE), maximum interincisal opening, pain score (visual analog scale [VAS]), postoperative magnetic resonance imaging (MRI) findings, and facial nerve paralysis. RESULTS: All 8 patients had been experiencing recurrent dislocations a mean of 10 times each month preoperatively. None of the patients had experienced a dislocation at 2 years postoperatively. The preoperative mean HAE was 5.75 and the VAS score for pain was 72.5. The mean vertical HAE was 15.75 mm, and the mean VAS score for pain was 11.2 at 12 months postoperatively. Complete resorption of the SonicWeld pins was observed on the first year follow-up computed tomography scans. Of the 8 patients, 3 presented with disc displacement without reduction and 2 with disc displacement with reduction on the postoperative MRI scan, and none of the patients had a facial nerve deficit at 24 months of follow-up. CONCLUSIONS: Fixation of cortical calvarial grafts using the ultrasonic resorbable system for augmentation eminoplasty provided sufficient stabilization and favorable outcomes. Degradation of the osteosynthesis material and the absence of intermaxillary fixation were the most advantageous parts of the technique.

Maxillary ameloblastoma mimicking an oroantral fistula.

BACKGROUND: The aim of this current report is to present an unusual case of a maxillary ameloblastoma mimicking an oroantral fistula. CASE REPORT: A left subtotal maxillectomy via Weber-Ferguson-type incision was performed. The patient tolerated the procedure well, the postoperative course was uneventful, and the patient was discharged 3 days after surgery with a mild paraesthesia of the right infraorbital nerve distribution. The infraorbital nerve paraesthesia has resolved 5 months after resection. The patient has been followed-up for 3 years without recurrence. DISCUSSION: Ameloblastoma is a well-known pathology of the maxillofacial region. However, unusual manifestations of this tumor can represent a serious challenge for diagnosis.

Evaluation of temporomandibular joint disc-repositioning surgery with Mitek mini anchors.

PURPOSE: The aim of this study is to evaluate outcome of Mitek mini anchors (DePuy Mitek, Raynham, MA) in TMJ discopexy and assess patient satisfaction based on MRI findings. PATIENTS AND METHODS: 7 patients suffered from significant pain and dysfunction diagnosed on MRI findings as anterior disc displacement without reduction selected for this study. Anchor stability, assessment of positional changes and roofing were evaluated by postop MRI and OPTGs. Satisfaction was assessed with VAS. Preop and postop maximum interincisal opening measurements were compared. RESULTS: There was significant difference between preop and posto P values of MIO and VAS. All 7 patients noted complete absence of pain at the postop 1-year follow-up. Only 1 patient had postop clicking but showed remarkable improvement of jaw functions (MIO). The articular disk was observed at its normal position in 6 patients except one patient whom MRI confirmed postop partial roofing. OPTGs reveal neither radiologic changes around the mini anchors in the condylar head nor any positional shifts. CONCLUSION: Disc repositioning with Mitek mini anchors represent improvement in post-op VAS scores and clinical findings (MIO) based on comparison preop and postop MRI scans and panoramic films. However, our study group consists of limited number of patients, further studies with more number of cases are required to evaluate the outcomes.

A study of impacted love: kissing molars.

INTRODUCTION: "Kissing" or "rosetting" of molars refers to contacting occlusal surfaces of impacted permanent mandibular second, third, and, very rarely, fourth molars. It is a rare phenomenon. AIM: The aim of this study was to assess the incidence, dental involvement type, associated pathologies and treatment outcomes of kissing molars in all patients who underwent lower third molar surgery between March 2008 and October 2011, at a military hospital in Turkey. METHODS: The panoramic radiographs of the patients who underwent extraction of lower third molars at Marmara University Faculty of Dentistry, Gulhane Military Medical Academy and Surgical Infirmary at Commando Troop No. 5 Gokceada between March 2008 and October 2011 were analysed retrospectively. The patients found to have kissing molars (KM), were classified according to the teeth involved and associated pathologies were evaluated. RESULTS: Among nine patients (five female, four male) with a mean age of 27.4 years who were found to have KM, one presented with rosetting of first and second lower molars (Class I), six with rosetting of second and third lower molars (Class II), and two with rosetting of lower third and fourth molars (Class III). Three of the KM presented with dentigerous cyst formation and two with granulamatous changes of the adjacent dental follicle. Following surgical removal, three patients presented with mild paraesthesia of the lower lip, which resolved 3 to 6 months after the operation. CONCLUSIONS: KM is a rare phenomenon. Early surgical therapy is essential as this condition can cause serious complications, including formation of pathologies such as dentigerous cyst or destruction of the adjacent bone.

Anthropometry of the medial canthal ligament related to naso-orbitoethmoidal fractures.

OBJECTIVE: Medial canthal ligament (MCL) and lacrimal system are often associated with naso-orbitoethmoidal fractures. The MCL anchors tarsal plate to medial orbit and has an important role in lacrimal pump system. The purpose of this study was to describe the anatomy of the MCL and present the anthropometric measurements on cadaveric specimens. METHODS: Dissections were performed on 14 formalin-fixed cadavers. The length, thickness, width of the MCL, width of the nasal dorsum, and intercanthal distance were measured with a digital caliper. A surgical microscope and an digital photo camera were used in all dissections. Means, SDs, and paired-samples t test were computed. RESULTS: The mean lengths of the right and left MCLs were measured as 8.01 (SD, 2.27) and 7.93 (SD, 2.43) mm. The mean thicknesses of the right and left MCLs were 1.63 (SD, 2.41) and 1.75 (SD, 2.44) mm. The mean widths of the right and left MCLs were 4.20 (SD, 0.75) and 4.17 (SD, 0.61) mm. The intercanthal distance was 31.7 (SD, 1.7) mm. The width of the nasal dorsum was measured as 14.37 (SD, 1.9) mm. Length and thickness differed on both sides. Asymmetric insertion of medial canthi was observed in 5 specimens. CONCLUSIONS: Reconstruction of traumatic telecanthus requires reaproximation of medial canthi and the displaced nasoethmoid bony fragment with transnasal wiring or microplates. Identification and reconstruction of detached medial canthi could be accomplished successfully with anatomic familiarity of the region. The most developed and firmly adherent was the anterior limb of the MCL. Reattachment of that part seems to be adequate for repair of a detached canthus.

The efficacy of mylohyoid nerve anesthesia in dental implant placement at the edentulous posterior mandibular ridge.

The aim of this study is to evaluate the anesthetic efficacy of mylohyoid and buccal nerve anesthesia at the posterior edentulous mandible versus regional anesthetic block to the inferior alveolar nerve in dental implant surgery. The study was composed of 2 groups. In the first group (group A), 14 voluntary adults (7 female and 7 male) received local infiltrations of 1 mL articaine HCl 4% with epinephrine 1/200,000 to the ipsilateral mylohyoid and buccal nerves. In the second group (group B, control; 9 female and 5 male adults), the inferior alveolar and the buccal nerve blocks were performed. Visual analog scales were obtained from patients to determine the level of pain during incision, drilling, implant placement, and suturing stages of implant surgery. A combination of buccal and mylohyoid nerve block offered an acceptable level of anesthesia. Two patients from group A stopped the ongoing surgery and had extraregional anesthesia by inferior alveolar nerve block. In group B, patients were operated on successfully. Local anesthetic infiltrations of the mylohyoid and the buccal nerve may be considered alternative methods of providing a convenient anesthetic state of the posterior mandibular ridge.

Diagnostic importance of MRI and CT scans for synovial osteochondromatosis of the temporomandibular joint.

Since synovial chondromatosis (SC) clinically mimics symptoms of internal derangements of the TMJ, the diagnostic value of MRI and CT, overlooked for years, is discussed in the presented case. Multiple amorphous calcifications in the left infratemporal fossa and upper synovial compartment of the TMJ were detected on the CT and MRI scans. The patient underwent open TMJ arthrotomy and removal of 15 calcified loose bodies. SC may be diagnosed radiographically when sclerosis of the glenoid fossa, soft tissue edema, and intraarticular radio-opaque loose bodies are detected. Advanced imaging of the TMJ, such as MRIs and CTs, are indispensible methods to obtain differential diagnoses for long-standing suspicious pathologies of the temporomandibular joint.

Rigid external maxillary distraction and rhinoplasty for pyknodysostosis.

AIM: This article reports the treatment of an 33-year-old female patient with pyknodysostosis by rigid external distraction II midface distraction system. STUDY DESIGN: The patient with pyknodysostosis described in this report had severe midfacial hypoplasia. Correction of this by use of routine orthognathic surgery would require osteosynthesis and bone grafting. Risk of infection and/or nonunion after such a surgical procedure was considered too great, and therefore the possibility of treatment by distraction osteogenesis of the maxilla was evaluated. The rigid external distraction II midface distraction system was used to relocate the hypoplastic maxilla at anterior-inferior projection. CONCLUSIONS: Distraction osteogenesis should be considered as the primary reconstructive method for maxillofacial deformities in patients with sclerosing bone dysplasias, since this is the second reported case treated successfully with rigid external distraction.

Focal osteoporotic hematopoietic bone marrow defect formation around a dental implant: a case report.

Focal osteoporotic bone marrow defects usually appear as asymptomatic radioluencies in the edentulous posterior mandible of middle-aged women. The exact causative factor in the majority of focal osteoporotic bone marrow defects is still unknown. Because of their radiological similarity with many intraosseous lesions, accurate diagnosis is possible only with histopathological examination. A focal osteoporotic bone marrow defect that occurred 2 years postoperatively apical to an implant is presented with clinical, radiographic, and histopathologic features. According to the literature scan, this is the first case report of this phenomenon caused by a dental implant. Int J Oral Maxillofac Implants 2011;26:e1-e4.