Comparative study between lag screw and miniplate fixation for straight midline mandibular osteotomy.

The mandibular swing approach is a surgical approach for the resection of malignant lesions localized in the posterior oral cavity and oropharynx. We analyzed 15 years of experience with fixation of the straight midline mandibulotomy and compared two fixation methods: lag screws and miniplates. A total of 117 patients underwent a straight midline mandibulotomy during the study period; 85 had fixation with two lag screws and 32 with two miniplates. The overall complication rate was low and there was no significant difference in complication rate regarding the fixation method (9% for miniplates vs. 7% for lag screws). The most serious complication over the whole study period was non union, which occurred in only two patients, followed by orocutaneous fistula and infection. Radiotherapy did not cause serious complications and is not regarded as hazardous in midline mandibulotomy patients. We conclude that lag screw fixation is at least as safe as miniplate fixation, but because of better fragment compression, offers faster bone healing.

Evaluation of sensitivity of teeth after mandibular fractures.

The sensitivity of teeth anterior to a fracture between the mental and mandibular foramina has been tested and followed up until reinnervation or 3 years has passed. This study assessed the reinnervation period, the number of denervated teeth, and their clinical importance. Fifty patients and 459 teeth were examined. Two hundred and seventy-three teeth were affected and had potentially impaired innervation. Tests after injury showed non-responsive teeth in 81% of affected teeth. Six weeks after injury, 19% of teeth were reinnervated; by 1 year after injury, 92% of initially non-responsive teeth were reinnervated. Most teeth (34%) were reinnervated from 6 weeks to 3 months. All 23/186 initially non-responsive, unaffected, contralateral corresponding teeth were reinnervated within 6 weeks. A year after injury, 95% of incisors, 91% of canines, 94% of premolars, and 82% of molars were reinnervated. Three years after injury, 8% of teeth remain denervated. During the second and third years, no reinnervation occurred, but clinical signs of pulp devitalisation of denervated teeth occurred in 18% or 1% of the initially non-responsive affected teeth. The results revealed the stability of pulp 1 year after injury. Denervated teeth should not be treated if no clinical or radiological signs of devitalisation exist.

Preoperative antiseptics in clean/contaminated maxillofacial and oral surgery: prospective randomized study.

In order to show the effectiveness of preoperative antiseptic mouthwash the authors undertook a prospective study in 120 patients who underwent elective surgery under general or local anesthesia. Patients were allocated toone of 4 groups, depending on whether the oral cavity was washed preoperatively with 1% cetrimide, chlorhexidine, povidon-iodine or sterilized normal saline solution (control group). Aerobic and anaerobic bacterial samples were taken from the inferior vestibulum mucosa before surgery, 5 min after the start of the operation and at the end of the procedure. The results show a statistically significant reduction in bacterial counts during procedures in which antiseptics are used to wash the oral cavity preoperatively. 1% cetrimide solution was the most successful in reducing intra-oral bacterial counts and produced the longest lasting antiseptic effect. Chlorhexidine is a good option for procedures longer than 1 hour, while povidon-iodine is recommended for procedures lasting up to 1 hour. Normal saline reduced bacterial counts in the specimen taken 5 min after washing but this short-lasting effect is due to mechanical cleansing rather than the antiseptic effect.

Reconstruction following radical maxillectomy with flaps supplied by the subscapular artery.

The authors present their experience of 27 cases with repairs of defects following radical maxillectomies with free flaps. A total of 28 flaps were used (five latissimus dorsi, six scapula, 16 combination flaps of scapula and latissimus dorsi and one combination of scapula, latissimus dorsi and serratus anterior flap). Only one scapula flap was completely lost and in three cases where a combination of scapula and latissimus dorsi flap was used, partial necrosis of one component occurred. The authors first choice for reconstruction is a scapula bone flap raised on the angular artery combined with the latissimus dorsi flap. The combination of flaps with a long pedicle and of the bony and muscular components provides the surgeon with the option of customizing the flap to meet individual patient needs. For intraoral closure the authors prefer the latissimus dorsi muscle which rarely requires secondary procedures for prosthesis placement following epithelialization and atrophy. The main disadvantage of the flap is the difficulty of two teams working simultaneously, thus increasing the average operating time. All postoperative corrections and prosthetic rehabilitation should be postponed for at least 2 months following surgery because of postoperative swelling.

Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects.

OBJECTIVE: To evaluate and discuss the free flap reconstructive options for patients with partial and total maxillectomy defects. DESIGN: Retrospective review of cases. SETTING: Two tertiary referral centers. PATIENTS: Fifty-one patients had partial or total maxillectomy defects resulting from oncologic surgical resection, and 7 had partial maxillectomy defects resulting from trauma. Inferior or partial maxillectomy defects included 10 anterior arch and hemipalate defects and 12 subtotal or total palate defects. Total maxillectomy defects with and without orbital exenteration included 36 maxilla defects with hemipalate and malar eminence. INTERVENTION: There were 11 fibula, 14 rectus abdominis, 9 scapular, 10 radial forearm, 5 latissimus dorsi, and 13 combination latissimus dorsi and scapular flaps. MAIN OUTCOME MEASURES: Separation of the oral cavity from the sinonasal cavities, diet, type of dental restoration, type of orbital restoration, speech intelligibility, and complications. RESULTS: Only 1 flap failure was reported. There was loss of bone in 2 flaps and loss of the skin paddle in 1 flap. All palatal defects were sealed by the separation of the oral and sinonasal cavities. Thirty-eight patients were able to eat a regular diet while the remaining patients maintained a soft diet. All patients conversed on the telephone without difficulty in intelligibility. Eight patients had an implant-borne dental prosthetic, and 30 patients had a conventional partial prosthetic. Orbit restoration was achieved in 2 patients with an implant-borne prosthetic, and 6 patients retained a standard orbit prosthetic. CONCLUSIONS: Free flap reconstruction of the maxilla creates reproducible permanent separation of the oral and sinonasal cavities in a single-stage procedure. In addition, there exists the potential for dental rehabilitation with restoration of masticatory and phonatory function. Free flap reconstruction also provides a good cosmetic result, which improves patients' outlook and contributes to their overall well-being. Reconstructive flaps are designed to fit specific maxillary defects and patient needs to provide optimally functional and cosmetic results.

Are the new staging rules better for T4 oral cancer?

BACKGROUND: In order to find whether the changes in primary tumor definition influence the distribution of T (tumor extent) stages and prognoses, a retrospective study was undertaken. PATIENTS AND METHODS: There were 1,040 patients with adequate data for staging and 868 of those patients underwent surgical treatment. Among the surgically treated patients, 187 fulfilled the new (American Joint Committee on Cancer [AJCC]/International Union Against Cancer 1988) and 77 fulfilled the old (AJCC 1977) criteria for T4 tumors. The distribution of all patients, rate of patients initially treated with surgery, incidence of metastases, and survival were analyzed. RESULTS: The neck was clinically positive (N+) in 50% of T4 patients staged according to the new rules and 69% of patients staged according to the old rules. The 5-year overall survival rate for T4-staged patients irrespective of therapy was 29% using the new rules and 13% using the old rules. The 5-year disease-free survival rate for T4-operated patients was 60% using the new rules and 45% using the old rules. CONCLUSIONS: The previous AJCC rules for the T4 tumors were a better indicator of poor prognosis.

Maxillofacial war injuries in civilians and servicemen during the aggression against Croatia.

Although civilian populations have been heavily involved in most of the recent wars and conflicts throughout the world, most reports analyzed casualty data of military personnel, often leaving civilian casualties excluded or underestimated. A comparison of epidemiologic and medical data for maxillofacial injuries between civilians and servicemen (policemen, soldiers, and United Nations Protection Forces) during the aggression against Croatia is attempted. Of the 220 casualties admitted to the Department of Maxillofacial Surgery in Zagreb between August 1991 and December 1992, almost one-fourth were civilians. A significant difference between civilians and servicemen was noted in age and sex distribution. The incidence and severity of maxillofacial and associated injuries is almost equal, and the pattern of injuries is of the same type for civilian and military personnel.

Musculomucosal nasolabial island flaps for floor of mouth reconstruction.

A modification of the musculomucosal nasolabial island flap based on the facial artery for reconstruction of anterior floor of mouth defects is presented. Surgical technique and advantages in comparison to conventional nasolabial flaps are described. A series of 14 flaps in 8 patients is presented.

A method of zygomatic arch stabilization.

A new method for zygomatic arch stabilization with a silicone tube placed under the zygomatic arch is described. The method is safe, easy to perform and, in our experience, without complications.

Evaluation of mandibular fracture treatment.

A total of 124 patients treated for mandibular fractures were analyzed. Patients were divided into three groups according to treatment: intermaxillary fixation, wire fixation and mini-plate fixation. For each method, the success of treatment was evaluated with respect to surgical approach, fracture site and injury to treatment interval. Five basic parameters were used for evaluation of the outcome: occlusion, appearance, mastication, duration of IMF and complications. The treatment was surveyed based on both the surgeon's and patient's-evaluation. All parameters were scored and average values for every parameter calculated. The most successful treatment was achieved with mini-plate fixation in symphyseal and angle fractures. Intermaxillary fixation is indicated for mandibular body fractures with or without minimal displacement and a sufficient number of teeth. However, mini-plate fixation should be used for fractures with displacement. Wire fixation has been shown to be the poorest choice for all sites. Results showed that the intraoral approach has advantages over the extraoral one. The optimal time for treatment of mandibular fractures is within 72 h from time of injury. Even in fractures older than 7 days we recommended mini-plate fixation.

Primary hyperparathyroidism: evaluation of different treatments of jaw lesions based on case reports.

On the basis of three case reports, different treatment modalities of primary hyperparathyroidism of the jaws are presented. Surgical intervention made as the result of misdiagnosis in the first case caused an unnecessary bone defect and delayed bone regeneration for several months. Two other cases showed spontaneous regeneration of bone after parathyroidectomy. The second case disproved the earlier opinion that regeneration of the bone lesions could last for several years, and that the normal morphology could be restored. Complete resolution of the central giant-cell lesion was found 6 months after removal of the parathyroid adenoma.

[Ameloblastic fibroma--case report and discussion about relationship of mixed odontogenic tumors]. / Ameloblasticki fibrom--prikaz slucaja i prilog raspravi o medusobnoj vezi mjesovitih odontogenih tumora.

The authors have presented the case of ameloblastic fibroma of the upper jaw in 21 years old adult. Dimensions of the tumor, which were the result of long standing growth, and the occurring at the age when odontogenesis was practically completed, have supported the concept of distinct pathologic entity, but have not been agree with the theory of interrelationship of ameloblastic fibroma, ameloblastic fibro-odontoma and odontoma. In the context of those two studies the authors have discussed relationship of the mixed odontogenic tumors.

Congenital epulis: a case report.

An unusual case of a double congenital epulis involving the alveolar mucosa of both the maxilla and mandible is reported. The authors discuss the clinical picture, histological findings, etiology and treatment of this rare lesion.

[Diffuse sclerosing osteomyelitis--a review and case]. / Difuzni sklerozirajuci osteomijelitis gornje celjusti: pregled literature i prikaz slucaja.

The bone responds to stimulation with new bone formation, resorption or the combination of both. Exclussive bone formation i.e. sclerosation is defined as an increase in the bony mass which is a result of either decreased resorption or excessive bone production. The authors describe the following inflammatory sclerosing jaw lesions: sclerosing osteitis, sclerosing periostitis of Garre and diffuse sclerosing osteomyelitis. The etiopathogenesis, clinical features, histologic findings, diagnostic procedures, therapy and prognosis are presented for each pathologic entity. Further a case of rare localisation of diffuse sclerosing osteomyelitis in maxilla is reported. In conclusion, the authors point out that all persistent complication following tooth extraction must arise suspection of among other problems, of diffuse sclerosing osteomyelitis, bearing in mind. Despite therapy the disease frequently recures.