Showing papers in "Journal of oral surgery in 1980"

Soft tissue cephalometric analysis for orthognathic surgery

Abstract: A soft tissue cephalometric analysis designed for the patient who requires surgical-orthodontic car was developed to complement a previously reported dentoskeletal analysis. To make it clinically practical, the analysis has been reduced to its most relevant and significant measurements. Used along with other diagnostic aids, this soft tissue evaluation will enable the clinician to achieve good facial esthetics for his or her patients.

Results after mandibular advancement surgery: an analysis of 87 cases

Abstract: Clinical results and stability after mandibular advancement surgery were evaluated in a multi-institutional study of 87 individuals Skeletal and dental stability were evaluated by a computer morphometric technique and clinical results were determined by recall of patients Analyses of multiple variables were performed to determine factors that contributed to optimum treatment results or relapse, or both, after mandibular advancement It was found that the mandible can be advanced successfully in all types of mandibular deficiency Problems primarily related to surgical technique, such as postoperative condylar distraction, were consistently associated with relapse Position of the proximal segment and the use of skeletal fixation were important in preventing relapse, but the value of suprahyoid myotomies and cervical collars was not proved Significant postural changes of the head and cervical spine were observed after surgery

Effect of internal irrigation on frictional heat generated from bone drilling.

Abstract: Frictional heat generated during bone drilling was reduced by internal irrigation compared with external or no irrigation This was based on an in vitro study using two bur designs at low rotational speeds to prepare experimental cavities to varying depths

A convenient animal model for testing bone substitute materials.

Abstract: There is consijerable interest in developing substitute materials for bone to perform the functions of autogenous bone grafts. However, a persistent problem is finding a suitable animal model in which to test the biodegradable implants. This paper reviews the requirements of an ideal animal model for this purpose and discusses the shortcomings of existing procedures. A technique is described that uses the cranial vault of the rabbit and allows accurate radiologic and histologic assessment of implant resorption and ingrowth of new bone.

Sleep apnea syndrome: correction with surgical advancement of the mandible.

Abstract: Mandibular retrognathism is occasionally associated with sleep apnea syndrome Most cases of this disorder have, until now, been treated with permanent tracheotomies One patient with this syndrome was treated with surgical advancement of the mandible with bilateral C osteotomies and iliac corticocancellous grafts Complete reversal of the sleep apnea symptoms and return of the sleep EEG to normal resulted after surgery Although further study needs to be done, mandibular advancement would appear to be a preferable alterantive to tracheotomy for such patients

Ameloblastoma of the jaws: a survey of 109 Nigerian patients.

Abstract: A survey of 109 cases of ameloblastoma of the jaws in black Africans from Nigeria is presented. The neoplasms were removed by radical resection or by en bloc excision with preservations of the inferior border of the mandible. In selected cases, reconstruction was done using autogenous bone grafts or a Bowerman-Conroy prosthesis. Where the mandibular symphysis was not resected, adequate functional and esthetic results were achieved without reconstruction. All the bone grafts were successful, but most of the Bowerman-Conroy prostheses were rejected because of either infection or mechanical failure. Eight-year follow-up data were recorded; 35 patients were lost to follow-up, and of the 74 who were followed up, 31 (41.9%) were free of the disease for five years or more. Although complete excision was achieved in all the cases, there were three recurrences subsequent to segmental resections.

The maxillary ameloblastoma: an analysis of 24 cases.

Abstract: Twenty-four cases of maxillary ameloblastoma from the files of the dental and oral division of the Armed Forces Institute of Pathology and the US Army Institute of Dental Research were reviewed. Clinical findings showed an average age of 45.6 years, a male-to-female ratio of 2.4:1, and an equal racial distribution between whites and blacks. Eighty-eight percent of the tumors occurred distal to the maxillary canine. A slowly enlarging mass was the primary clinical sign in more than 90% of the cases. Recurrences were seen in eight of the 16 cases on which follow-up information was received. The majority of the tumors had a mixed follicular histologic pattern. Therapy should consist of either surgical block excision or hemimaxillectomy. The surgeon must carefully weigh the potential danger of the neoplasm against the deformity and disability caused by the surgical procedure.

1978 anesthesia morbidity and mortality survey: Southern California Society of Oral and Maxillofacial Surgeons.

Abstract: The morbidity and mortality experience with outpatient general anesthesia of the Southern California Society of Oral and Maxillofacial Surgeons was surveyed for a second five-year period. One hundred percent of the active members responded with data on educational background, time in practice, and equipment and drugs in use, as well as with morbidity and mortality data. No deaths resulting from anesthetics were reported during this survey period. The decreasing occurrence of problems is attributed to improved training, careful monitoring of patients, and preparation for anesthesia emergencies through mandatory in-office peer evaluation.

Biomechanical considerations in the surgical correction of mandibular deficiency

Abstract: A two-dimensional model is presented that allows calculation of mechanical advantage for the human masseter and temporalis muscles. Ten patients with high-angle mandibular deficiency and vertical maxillary excess had greatly reduced mechanical advantages with an anticipated elevated muscle activity. Superior repositioning of the maxilla with mandibular advancement, however, increased the overall mechanical efficiency of the masticatory system. When compared with mandibular advancement alone, the bimaxillary procedure resulted in a 13% increase in the mechanical advantage of the temporalis muscle and a 21% increase for the masseter muscle. This model suggests that various surgical procedures designed to correct facial disharmonies may have either desirable or undesirable effects on jaw biomechanics and long-term stability. Biomechanical influences are important considerations for the clinician in planning surgical procedures to correct dentofacial deformities.

Expectations of patients from orthognathic surgery.

Abstract: Fifty-two patients were interviewed before and six months after corrective orthognathic surgery. These patients expected either a functional (39%), esthetic (17%), or combined functional and aesthetic (44%) outcome. All were satisfied with the functional change and 92% were satisfied with the esthetic change. Because almost all patients reported that the outcome of surgery was as expected, it seems unnecessary for the surgeon to be concerned about not recognizing hidden motives on the part of the patient. Some dissatisfaction was expressed with certain unexpected happenings during the surgical experience. If surgeons provide more detailed explanations of what to expect from the process of surgery, they can decrease this type of psychological trauma and increase the satisfaction of their patients.

Solitary peripheral osteoma of the jaws: report of case and review of literature.

Abstract: Solitary osteomas of the jaws are uncommon. Only 12 previous case reports provided acceptable clinical and histologic data. One new case is added. Most of the tumors occurred in the mandible; only three were intraoral. Histologically, eight were compact and five were cancellous osteomas.

Ludwig's angina: report of two cases and review of the literature from 1945 to January 1979.

Abstract: Two cases of Ludwig's angina treated successfully led us to review the main English language literature from 1945 to January 1979. The most common cause of Ludwig's angina is dental, and the organism cultured most often is streptococcus. However, other avenues of infection and numerous pathogens have been implicated in this disease. Penicillin remains the preferred primary antibiotic, with combinations of this drug and other antibiotics being used by various authors. In both the pre-antibiotic and antibiotic era, the airway remains the prime concern of the surgeon in the management of this potentially life-threatening disease. Of the 75 cases reviewed, there were seven deaths, but four of these patients had pre-existing fatal systemic problems and Ludwig's angina was not the cause of death. The other three deaths were due to Ludwig's angina, yielding a 4% mortality rate. Thus, aggressive management of Ludwig's angina, with respect to airway, antibiotics, and early surgical intervention, has resulted in a significant drop in the mortality rate of this disease which once led "almost uniformly to a fatal ending."

Skeletal and dental changes after surgical correction of mandibular prognathism.

Abstract: Fifty cases of surgically corrected mandibular prognathism have been followed up and analyzed cephalometrically. This anatomy of relapse of the proximal and distal segments is described, as well as changes in the axial inclinations of the incisors. The physiopathology that may explain these spatial changes is advanced.

The effects of glossectomy on intelligibility of speech and oral perceptual discrimination.

Abstract: The effects on the intelligibility of speech and oral perceptual ability after glossectomy were studied in 20 patients. The intelligibility, rate of speech, and oral form discrimination ability were measured as they varied by the extent of surgical ablation. The results indicated that speech and oral discrimination ability are more severly impaired in patients who undergo more extensive surgical excision. The rate of speech of most of the patients was slower than normal. The results were interpreted to reflect the value of residual oral tissue. The amount of lingual and adjacent tissue to be excised may be regarded as a rough index of the effect such surgery will have on oral communication.

Revascularization and healing of onlay particulate autologous bone grafts in primates.

Abstract: Two sizes of bone chips were compared to determine the size that revascularizes faster and what effect this has on the resorption of the graft. To accomplish this, autologous chips of iliac corticocancellous bone of either 2 X 2 X 2 mm or 5 X 5 X 2 mm were placed in the mandibular cortex of monkeys bilaterally. In general, the small-particle graft was quicker to revascularize, showed more osteoclastic activity, and therefore resorbed much more quickly and completely than did the large-particle graft. The resultant net gain in alveolar ridge contour was, therefore, less with the small-particle grafts.

The ilium as a source of autogenous bone for grafting: clinical considerations.

Abstract: The surgical anatomy and morbidity associated with ilium surgery for the obtaining of bone graft material have been presented. A recommended surgical approach has been introduced, and the advantages and disadvantages of this technique and others are discussed.

Pediatric fractures of the facial skeleton: a survey of 85 cases from Kaduna, Nigeria.

Abstract: A survey of 1,447 cases of fractures of the facial skeleton from Kaduna, Nigeria, showed that 85 cases (5.9%) occurred in children younger than 13 years. The lowest incidence recorded was in the group of patients younger than age 3 but there was a gradual increase up to the age of 13 years, with the highest incidence occurring in the 12- to 13-year-old age group. The male-to-female ratio was 2.1 to 1. The site distribution in descending order of frequency was body of the mandible, mandibular condylar process, angle of the mandible, malar and nasal complexes, maxilla, and ascending ramus of the mandible. Most of the fractures were immobilized by simple methods, and union was achieved within two to six weeks. Of the 12 fractures of the condylar process, ankylosis of the temporomandibular joint developed in six; in addition, two had mandibular undergrowth.

Effects of hypotensive anesthesia in anterior maxillary osteotomy.

Abstract: Deliberate hypotension, as a means of reducing loss of blood, providing a more ideal operative field, and shortening operating time, has been used in other surgical disciplines, such as neurosurgery, vascular surgery, and orthopedic surgery. This controlled study compared the effects of hypotensive and normotensive anesthesia on loss of blood, quality of surgical field, and length of surgery in one type of orthognathic surgical procedure--the anterior maxillary osteotomy.

Hypothalamic-pituitary-adrenal suppression after short-term dexamethasone therapy for oral surgical procedures.

Abstract: Ten patients were given dexamethasone therapy for prevention of postoperative complications after oral surgical procedures. The hypothalamic-pituitary-adrenal response of the patients was measured by their response to a single-dose metyrapone test. A significant difference was found between preoperative values of 11-deoxycortisol and values three days postoperatively. No difference was found when comparing preoperative values of 11-deoxycortisol with values seven days postoperatively. There appears to be an initial suppression of the normal feedback mechanism of the hypothalamic-pituitary-adrenal axis followed by a complete return of normal functioning by the seventh postoperative day. The amount of surgical stress involved in these routine oral surgical procedures is of an insufficient magnitude to overcome this hypothalamic-pituitary-adrenal suppression of the negative feedback mechanism caused by dexamethasone therapy. The presence of adequate amounts of synthetic steroids at a cellular level appears to prevent manifestations of adrenal insufficiency despite suppression of endogenous production of steroids.

Maxillary malignant ameloblastoma with intraorbital extension: report of case.

Abstract: The case of an aggressive and malignant ameloblastoma of the maxilla in a 22-year-old Nigerian man has been presented. The features that may lead to the development and diagnosis of malignancy in this type of tumor are briefly described and discussed. The relatively young age of this patient, especially in an environment in which medical advice is sought very late, is noteworthy.

Infection following intraoral surgical correction of dentofacial deformities: a review of 140 consecutive cases.

Abstract: Prophylactic antibiotics are often administered during orthognathic surgery to prevent infection. A total of 140 consecutive patients who underwent "clean" intraoral maxillary and mandibular orthognathic surgery and received antibiotics in the preoperative period are reviewed with respect to postoperative infection. In four patients, infections developed, two of which were related to alloplastic implants. The microorganisms cultured from the infections were species not normally found in oral infections. One patient had an antibiotic-induced anaphylactic reaction. The theory and applicability of antibiotic prophylaxis for intraoral orthognathic surgery are discussed.

Le Fort I advancement with segmental palatal osteotomies in patients with cleft palates.

Abstract: A modification of the Henderson-Jackson technique of Le Fort osteotomy and oronasal fistula closure is presented. The primary advantage of the procedure is that the palatal osteotomy allows precise positioning of the collapsed cleft dentoalveolar segment with negligible relapse.

Central squamous cell carcinoma of the mandible.

Abstract: A rare case of primary central squamous-cell carcinoma of the mandible is reported. Etiology, pathogenesis, clinical features, differential diagnosis and treatment are discussed, and literature on the subject is reviewed.

Speech considerations with maxillary advancement procedures.

Abstract: Advancement of the maxilla has the potential to cause hypernasal speech, especially in patients with repaired cleft palates. Findings in three patients whose speech was at risk with maxillary advancement procedures are discussed, as well as their management. Diagnostic guidelines for identifying patients whose speech may be adversely affected by maxillary advancement are also presented.

Surgical treatment of bony ankylosis in a child using a composite cartilage-bone iliac crest graft.

Abstract: A previously unreported approach to the treatment of temporomandibular ankylosis in the child is reported. The procedure involves using the iliac crest and fixing it to the zygomatic portion of the temporal bone, with the cartilagenous portion facing the stump of the mandibular ramus. The procedure is easier to accomplish than a costochondral graft, does not require maxillomandibular fixation, and offers the possibility of appositional growth. In our case, opening has been maintained and growth sustained in a five-year-old child for 18 months without physiotherapy.