Results of oral implant-supported prostheses after mandibular vertical alveolar ridge distraction: a propos of 54 sites.

OBJECTIVE: The aim of this study was to present retrospective long-term results of oral implant-supported prostheses after mandibular vertical alveolar ridge distraction. STUDY DESIGN: Patients who had alveolar mandibular distraction before oral rehabilitation from 1999 to 2009 were retrospectively reviewed. RESULTS: Fifty-four distractions were performed in 25 women and 12 men with a mean age of 51.7 years. Seventeen patients had bilateral distraction. Most of the distracted sites were posterior. Global major complications were major misdirection (3.7%), fracture (3.7%), and permanent alveolar nerve paresthesia (1 patient). All of the patients experienced osseous improvement. Mean height of the distraction was 11.7 mm. A total of 127 implants were inserted with survival and success rates, respectively, of 100% and 96.2% (mean follow-up of 62 months). All of the patients had satisfactory oral rehabilitation. CONCLUSIONS: Mandibular alveolar vertical distraction could be a reliable and effective procedure with precise indications. A less complicated implant distractor may simplify the procedure.

Cytomegalovirus-induced gammadelta T cells associate with reduced cancer risk after kidney transplantation.

An increase in the number of blood gammadelta T cells follows cytomegalovirus (CMV) infection in kidney transplant recipients. These cells react against CMV-infected cells and tumor epithelial cells in vitro. We hypothesized that these CMV-induced gammadelta T cells play a protective role against cancer in kidney transplant recipients. We performed a longitudinal case-control study involving 18 recipients who developed cancer between 2 and 6 yr after transplantation and 45 recipients who did not. The median percentage of gammadelta T cells among total lymphocytes in patients with malignancies was significantly lower compared with that in control patients at 6, 12, and 18 mo before the diagnosis of cancer. Patients with a gammadelta T cell percentage of more than 4% were protected from cancer. An increase of the Vdelta2(neg) gammadelta T cell subset significantly associated with lower incidence of cancer only in recipients who experienced pre- or postgraft CMV infection. Finally, a retrospective follow-up of 131 recipients for 8 yr revealed that CMV-naive recipients had an approximately 5-fold higher risk of cancer compared with CMV-exposed patients. In summary, these results suggest a protective role of CMV exposure against cancer in kidney transplant recipients.

Treatment of mandibular fractures with Michelet technique: manual fracture reduction without arch bars.

PURPOSE: In our Bordeaux maxillofacial surgery unit, we have used the Michelet technique described for 40 years: manual fracture reduction and semi-rigid miniplate osteosynthesis fixation. No maxillomandibular fixation (MMF) with arch bars or with screws was used for reduction during osteosynthesis. The aim of this work was to evaluate results of this unknown manual reduction method. MATERIALS AND METHODS: A total of 184 patients were reviewed. We recorded epidemiology of mandible fracture, clinical and radiologic evaluation before and after surgery, and treatment. Anatomic and functional manual reductions were the basic principle: manual maxillomandibular immobilization (functional) and manual fracture reduction (anatomic). In cases of condylar fractures without severe displacement, MMF with cortical bone screws was indicated (orthopedic treatment). Physiotherapy was also possible (functional treatment). RESULTS: In all, 315 mandible fractures sustained by 184 patients were reviewed into the study. Of the patients, 80% were treated by osteosynthesis: 54% by osteosynthesis treatment alone, 26% by osteosynthesis and orthopedic treatments. The average time required for osteosynthesis or osteosynthesis and orthopedic treatment was 56 minutes. We observed 0.67% of disturbed occlusion, 0.67% of pseudarthrosis, and 0.67% of bilateral temporomandibular joint internal derangement. CONCLUSIONS: Manual fracture reduction suppresses systematic MMF using arch bars during osteosynthesis of mandible fractures. Operating time and risk of complications are reduced. Functional results seem to be similar to that reported in the literature.

Neoadjuvant polychemotherapy in locally advanced Merkel cell carcinoma.

BACKGROUND: A 72-year-old man presented with a Merkel cell carcinoma (MCC) of the left cheek with concomitant nodal spread. A 61-year-old man presented with an MCC of the right thigh with rapid nodal recurrence. INVESTIGATIONS: Skin biopsy samples proved the MCC nature of the neoplasm in both patients. Staging procedure included clinical and radiological investigations. DIAGNOSIS: Advanced stage II MCC. MANAGEMENT: Neoadjuvant cisplatin, etoposide and cyclophosphamide (EPC) regimen led to local control in the first patient and allowed curative surgery associated with adjuvant radiation therapy. Complete remission was maintained for 32 months. The second patient was treated by surgery plus radiation therapy. Nodal and cutaneous recurrences were treated with a neoadjuvant EPC regimen leading to a 5-year complete remission.

Result of maxillomandibular fixation using intraoral cortical bone screws for condylar fractures of the mandible.

PURPOSE: Treatment of mandibular condylar fractures is not standardized. The maxillomandibular cortical bone screw fixation technique carries many advantages. The aim of this work was to evaluate this technique for routine method. MATERIALS AND METHODS: Fifty patients treated by maxillomandibular fixation (MMF) by use of cortical bone screws from 2004 to 2006 were retrospectively analyzed. In our maxillofacial surgery unit in Bordeaux, France, our indication is to treat extra-articulated fractures without severe displacement by MMF. RESULTS: The mean time required for MMF was 13 minutes, and fixation occurred after a mean of 16 days. Screw removal was performed after a mean of 26 days, and this required local anesthesia. Of the patients, 48 had good occlusion. Two patients had persistent lateral cross bites. Two patients had mandible deviation when they opened their mouths, and mouth opening was limited in one patient. Two patients had temporomandibular joint pain. CONCLUSIONS: MMF screws have more advantages and fewer disadvantages than arch bars when closed treatment has been selected as the treatment of choice.

Septa within the sinus: effect on elevation of the sinus floor.

Elevation of the sinus floor allows the correct number and length of oral implants to be placed. The sinus membrane is dissected blindly, usually by a crestal approach, but several internal configurations of the maxillary sinus or intrasinus septa can cause problems. We studied 150 sinuses from 40 male cadavers, and 35 randomised male patients by anatomical dissection and computed tomography. Forty-six subjects (61%) had no bony septa or had septa less than 4mm. Twenty-nine (39%) had bony septa of which seven were incomplete, one had a complete bony septum in each maxillary sinus, and 20 had symmetrical bony septa. We present the results of a study of bony intramaxillary sinus septa and the potential problems they can cause during elevation of the sinus floor.

Vascular connections of the lateral wall of the sinus: surgical effect in sinus augmentation.

PURPOSE: There are several vascular vessels that supply the maxillary sinus, such as the posterior superior alveolar artery, the anterior superior alveolar artery, and the infraorbital artery (IOA). These vessels have to be taken into consideration during a sinus augmentation because of the potential risk of bleeding during the procedure. The objective of this investigation was to study variations in maxillary sinus artery connections with the potential surgical effect during a sinus floor elevation by the lateral wall. MATERIALS AND METHODS: The first part of the study was done in 32 anatomical specimens embedded in 10% formaldehyde solution and aged between 55 and 70 years (mean, 61.3 years). The second part of the study was a radiographic study using computerized tomographic (CT) scan images in 35 randomized patients treated in odontology and maxillofacial surgery departments. RESULTS: Results were recorded for 134 sinuses. In most cases, there was no vessel visible or no vessel present with a diameter less than 0.5 mm after dissection or CT-scan analysis: 120 sinuses (89.5%). In 14 cases (10.5%) there were vessels in the lower two thirds of the anterolateral wall. In 10 sinuses (71.4% of the 14 cases), there was an intraosseous or intrawall artery and in 2 sinuses (14.3%) they were in the intrasinusal position. In 8 of the 14 sinuses (57.1%, about 6% of overall sinuses) the diameter was between 1 and 2.5 mm. CONCLUSION: Knowledge of the arterial supply is essential for surgical treatment in the sinus area. A CT scan is recommended and the radiologist must be advised to search for intraosseous or extraosseous vessels in the lower two thirds of the maxillary sinus.

Oculo-ectodermal syndrome: a new tumour predisposition syndrome.

We report a new case of oculo-ectodermal syndrome who developed giant cell granulomas of the jaw, similar to the patient previously described by Toriello et al. (1999). We review reported cases to better delineate the clinical spectrum of this rare condition. Giant cell granulomas developing in childhood seem to be part of the oculo-ectodermal syndrome. This condition appears to be a new tumour predisposition syndrome.