Subjective Efficiency Evaluation after Maxillomandibular Advancement Surgery in Obstructive Sleep Apnea Patients.

PURPOSE: To investigate subjective efficiency outcomes after maxillomandibular advancement (MMA) surgery in obstructive sleep apnea (OSA) patients. MATERIAL AND METHODS: A prospective cohort study was carried out between December 2016 and May 2021, including 30 severe or treatment-refractory OSA patients treated by MMA surgery. All patients answered four validated questionnaires: the Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Mandibular Function Impairment Questionnaire (MFIQ), and EQ-5D-3L (i.e., EQ-5D and EQ-VAS). They also answered one custom-made questionnaire (AMCSQ). Questionnaires were requested to be filled out 1 week before surgery and at least 6 months after surgery. RESULTS: The total preoperative and postoperative scores on the questionnaires were compared. The mean total ESS (p < 0.01), FOSQ (p < 0.01), EQ-5D (p < 0.05), and EQ-VAS (p < 0.01) scores showed significant improvement, which was in accordance with an improvement in the mean postoperative apnea/hypopnea index score (p < 0.01). In contrast, the mean total MFIQ score (p < 0.01) indicated a decline in mandibular function. CONCLUSION: This study confirms the hypothesis that MMA surgery in OSA patients improves outcomes, both objectively and subjectively, with the exception of postoperative mandibular function.

Analgesic effects of preinjection low-level laser/light therapy (LLLT) before third molar surgery: a double-blind randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate the analgesic effects of low-level laser therapy (LLLT) on preinjection sites in patients scheduled for third molar removal. STUDY DESIGN: This double-blind randomized controlled trial included 163 healthy patients undergoing third molar extractions. The study participants were randomly divided into an LLLT and a placebo group. Objective and subjective data sets were obtained from physiologic feedback (heart rate and sweat response) and a questionnaire, respectively. In the LLLT group, each targeted injection site was irradiated twice with 198 mW continuous wave for 30 seconds with a 0.088 cm2 focal spot at an applied energy of 5.94 J and fluence of 67.50 J/cm2. Measurements were recorded from 4 time-points during data acquisition. RESULTS: There was no significant difference between the LLLT and placebo groups in pain experience scores associated with the injected sites for maxillary or mandibular third molar extractions. Mean heart rates before and during injection were lower in the LLLT group than in the placebo group for both maxillary and mandibular regions. No statistically significant differences were observed for any remaining parameters. CONCLUSIONS: The present data indicated that preinjection LLLT did not effectively decrease the pain felt during local anesthetic injections before third molar surgery.

An integrative approach for comparing microcirculation between normal and alveolar cleft gingiva in children scheduled for secondary bone grafting procedures.

OBJECTIVE: The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. STUDY DESIGN: This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary bone grafting procedures. In a split-mouth design, noninvasive real-time simultaneous measurements among tissue oxygen saturation (StO2), hemoglobin level (rHb), and blood flow parameters were obtained from normal and alveolar cleft gingiva using spectrophotometry and laser Doppler flowmetry. Subsequent noninvasive capillary density measurements and tissue microangioarchitecture were assessed using sidestream dark-field imaging. RESULTS: There were no significant differences in StO2 and rHb between normal and alveolar cleft gingiva. Blood flow, blood flow velocity, and capillary density were significantly decreased in alveolar cleft gingiva (P < 0.05). CONCLUSIONS: Alveolar cleft reconstructions alter gingival microperfusion properties, and microvascular changes adapt to conserve peak oxygen saturation.

Monitoring microcirculatory alterations in oral squamous cell carcinoma following photodynamic therapy.

BACKGROUND: One of the mechanisms through which photodynamic therapy (PDT) is thought to elicit tumour destruction is by producing microvascular damage and obstruction of nutritive blood flow. The aim of this study was to directly monitor and quantify microcirculatory changes following tissue illumination by PDT for oral squamous cell carcinoma. METHODS: Ten consecutive patients receiving PDT for a carcinoma in situ, a T1 or T2 tumour in the oral cavity without evidence of lymph node metastasis were selected for this study. Tumour and marginal healthy mucosa total capillary density (TCD) and functional capillary density (FCD) inside the field of illumination were measured and compared using sidestream dark-field (SDF) imaging prior to tissue illumination, immediately after PDT, and again after 15min. RESULTS: Baseline mean tumour TCD was 21.2±5capillaries per square millimetres (cpll/mm²) and 24.9±19cpll/mm² in the surrounding marginal healthy tissue; there were no significant differences between tumour and healthy tissue or time points. Comparisons between baseline and post-illumination time points revealed significant differences in both tumour and healthy tissue FCD (P<0.05). No significant differences in FCD were observed between the two tissues. CONCLUSIONS: Our findings using SDF imaging demonstrate that PDT significantly attenuates tumour and marginal healthy tissue perfusion by directly disrupting the functionality of the microcirculation.

Surgical treatment for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children.

PURPOSE: To compare surgical excision with surgical curettage in the treatment of nontuberculous mycobacterial (NMT) cervicofacial lymphadenitis in children. PATIENTS AND METHODS: Fifty children, 22 boys and 28 girls, with a PCR- or cultured-confirmed diagnosis of cervicofacial NTM infection were included in the study. Twenty-five children were randomized to surgical excision of the involved lymph nodes, and 25 children to surgical curettage. RESULTS: The median age of the children was 36 months (range, 14-120 months). All children had a red, fluctuating lymphadenitis, and there were no marked differences between the treatment groups with respect to mean duration of lymph node swelling before presentation, location, and the size of the lymph node swelling. Most (84%) of the involved nodes were located in the submandibular region and 6% were located in the preauricular region. Multiple locations (both preauricular and submandibular) were observed in the remaining 10%. Mycobacterium avium (74%) and Mycobacterium haemophilum (22%) were the predominant NTM species. Mean wound healing time for the excision group was 3.6 ± 1.2 weeks versus 11.4 ± 5.1 weeks for the curettage group (P ≤ .05). Postoperative transient marginal mandibular nerve weakness of the facial nerve was seen in 4 patients (16%) of the excision group. In all these patients the function of the nerve returned to normal within 12 weeks. No facial nerve problems were observed in the curettage group. Postoperative infections were not observed. CONCLUSIONS: Surgical excision leads to a quick resolution of NTM cervicofacial lymphadenitis. Curettage leads to delayed healing but might be considered as an alternative if excision of the necrotized lymph nodes is technically difficult in cases of adherence of the facial nerve branche.

One versus two titanium screw fixation of autologous onlay bone grafts in the anterior maxilla: a randomised histological pilot study.

PURPOSE: The aim of this study was to compare the histological presentation of local mandibular bone grafts fixed with one screw or two screws in buccal anterior maxillary augmentation procedures. STUDY DESIGN: Local buccal defects of the anterior maxilla were reconstructed in 12 patients (mean age 47 ± 17 years, range 18 to 67 years) using autogenous cortical bone grafts from the mandibular retromolar area. Patients were randomised using envelopes containing study identification numbers. After randomisation, two screws were used to fix the bone graft in six patients, and one screw was used in the other six patients. Four months later during implant placement, a bone biopsy was taken with a trephine. The biopsies were processed for light microscope evaluation. RESULTS: The mean total bone volume varied from 35.8% to 72.4% (mean 51.1% ± 13.4%) in the one-screw group and from 28.7% to 56.6% (mean 40.8% ± 11.5%) in the two-screw group. The mean non-vital bone volume ranged from 0% to 2% (mean 0.9% ± 0.9%) in the one-screw group and from 0% to 8.9% (mean 2.2% ± 3.7%) in the two-screw group. The mean osteoid volume ranged from 2.2% to 7.3% (mean 5.4% ± 1.7%) in the one-screw group and from 2.0% to 16.4% (mean 7.3% ± 5%) in the two-screw group. CONCLUSION: No significant histological differences were found between the use of one or two screws to fix an autologous bone graft in buccal bone grafting procedures prior to implant placement.

The influence of zoledronic acid and cyclophosphamide on microcirculation regeneration in healing oral mucosal flaps.

The use of intravenous nitrogenous bisphosphonates and antineoplastic agents as postoperative adjuvant cancer management strategies may influence the course of oral wound healing by altering tissue vascularisation kinetics. The aim of this study was to investigate if single or combined zoledronic acid (ZOL) and cyclophosphamide (CTX) would influence microcirculation regeneration in healing oral mucosal flaps. Twenty female specific-pathogen free New Zealand white rabbits were randomised into four groups. In all animals a mucosal flap was raised; three groups were treated each separately with intravenous infusions of 0.14mg/kg ZOL, 100mg/kg CTX, or both, respectively. The fourth group was used as a control. Capillary density measurements, expressed as the mean number of capillaries±SD per mm(2) (cpll/mm(2)), was performed preoperatively using sidestream dark-field (SDF) imaging and repeated immediately postoperatively and on days 2, 4, 7, 9, 11, 14, and 21. Whole blood count and body weight was assessed in each group to monitor pharmacotherapeutic responses. Preoperative mean capillary density was 74±8cpll/mm(2) and 40±11cpll/mm(2) directly after surgery (P<0.0001). Post hoc comparisons of follow-up SDF measurements on days 9-21 between control and ZOL vs. CTX and ZOL+CTX were statistically significant (P<0.05). The present study demonstrates that ZOL did not alter capillary regeneration in healing mucosal flaps. However, although the early healing phase is generally characterised by rapid progression of capillary regeneration, interventions with CTX and ZOL+CTX significantly altered capillary regeneration and persisted beyond the third postoperative week.

Intravital sidestream dark-field (SDF) imaging is used in a rabbit model for continuous noninvasive monitoring and quantification of mucosal capillary regeneration during wound healing in the oral cavity: a pilot study.

Angiogenesis and tissue revascularization are essential for proper postoperative tissue repair and regeneration. The aim of this investigation was to develop an animal model to study postoperative microcirculatory vascularization continuously in time following oral surgery. Five female specific-pathogen free New Zealand White rabbits with a mean body weight of 3.0 +/- 0.4 kg were used in this study. In all animals a palatine mucosal flap was raised, suspended for 30 min, and then repositioned for subsequent postoperative assessment of capillary regeneration. Noninvasive mucosal capillary density measurements were performed preoperatively using sidestream dark-field (SDF) imaging and repeated measurements were collected immediately postoperatively and on days 2, 4, 7, 9, 11, 14, and 21. In addition, whole blood count (Hb, RBC, WBC, PLT) and body weight were monitored in all animals at each time point. The greatest increase in mucosal capillary regeneration occurred in the early healing period on days 4, 7, 9, and recovery to baseline was achieved by postoperative day 11. Comparisons between preoperative versus postoperative, and prospective mean capillary density measurements on days 2, 4, 7, and 9 were statistically significant (P<0.05). No significant difference in capillary density development at each time point was observed between the five animals. In all animals, whole blood count and body weight remained stable and revealed no statistically significant changes. However, only on day 21 a statistically significant increase in body weight was found (P<0.05). The application of SDF imaging in the present wound model enabled continuous daily inspection of the oral microcirculation following surgery in vivo to pursue the kinetics of microcirculatory regeneration in time. We expect SDF imaging and our wound model to contribute to new insights into the kinetics of wound vascularization under various pathophysiological conditions and drug intervention studies.

Use of sidestream dark-field (SDF) imaging for assessing the effects of high-dose melphalan and autologous stem cell transplantation on oral mucosal microcirculation in myeloma patients.

BACKGROUND: Oral mucositis (OM) is a common toxic side effect among patients receiving high-dose chemotherapy (CT) with autologous stem cell transplantation (ASCT) for hematologic malignancies. The aim of this study was to investigate changes in submucosal microcirculation in myeloma patients receiving high-dose CT with ASCT by assessing capillary density and microvascular structural integrity. METHODS: Ten consecutive patients with multiple myeloma who underwent first-time CT treatment with high-dose melphalan (200 mg/m(2)) and ASCT were included in this study. Baseline buccal mucosa capillary density, expressed as the mean number of capillaries +/- SD per mm(2) (cpll/mm(2)), was measured with sidestream dark-field imaging after treatment was performed, after 30 and 60 minutes, and then on days 2, 4, 6, 8, and 14. A linear mixed model was used to examine capillary density over time and a P value of <.05 was considered to be statistically significant. RESULTS: Baseline mucosal capillary density was 19 +/- 2.4 cpll/mm(2). Mucosal capillary density after melphalan infusion after 30 and 60 minutes and on days 2 and 4 showed no statistically significant differences. A decrease in capillary density with statistical significance was observed on days 6 (10 +/- 3.0 cpll/mm(2); P < .01) and 8 (12 +/- 4.9 cpll/mm(2); P < .01). On day 14, capillary density returned to near baseline value. CONCLUSIONS: High-dose CT alters microvascular structural integrity and dysregulates tissue perfusion in the oral mucosa by decreasing the number of perfused submucosal capillaries in the oral mucosa. The findings of this investigation suggest that acute CT toxicity alters oral microcirculation and may be an important mechanism responsible for driving early mucosal barrier disturbances associated with CT-induced OM.

The temporal course of mucoperiosteal flap revascularization at guided bone regeneration-treated implant sites: a pilot study.

AIMS: To investigate post-operative capillary density regeneration in healing mucoperiosteal flaps at guided bone regeneration-treated implant sites. MATERIAL AND METHODS: A non-invasive post-operative investigation was performed in 10 patients using orthogonal polarization spectral (OPS) imaging for assessment of capillary density during the course of mucoperiosteal flap wound healing for 6 weeks in patients receiving dental implants. RESULTS: The greatest increase in capillary regeneration occurred in the early wound-healing phase, during weeks 1 and 2, and recovery to baseline was achieved between weeks 4 and 5. A comparison of adjacent OPS measurements indicated that differences between the time point immediately following administration of local anaesthesia and directly post-operatively ( p=0.002), between a directly post-operative time point and after 1 week (p=0.009), and between post-operative weeks 1 and 2 (p=0.036) were statistically significant. CONCLUSIONS: The early healing phase of mucoperiosteal flaps is characterized by rapid capillary regeneration. OPS imaging enabled the possibility to monitor and quantify the temporal development of mucoperiosteal flap revascularization following periodontal surgery.

The acute effects of CMF-based chemotherapy on maxillary periodontal microcirculation.

PURPOSE: A high incidence of oral complications is associated with chemotherapy (CT) treatment in cancer patients; however, while knowledge into molecular mechanisms of their pathobiology continue to evolve, the direct physiological effects of CT on oral tissue perfusion remain unexplored. The aim of this investigation was to assess the acute effects of CT on gingival microcirculation perfusion by measuring gingival capillary density. METHODS: Twenty female specific-pathogen free New Zealand White rabbits were randomly divided into four groups receiving four different intravenous dose levels of cyclophosphamide, methotrexate, and fluorouracil (CMF). Noninvasive measurements of gingival capillary density were performed using sidestream dark-field (SDF) imaging prior to and 30 min after CT treatment. Four rabbits receiving saline solution were used as control animals. RESULTS: Baseline gingival capillary density was 58 +/- 11 cpll/mm(2), no significant differences in baseline capillary densities between the groups were found. From low to high dose CT, capillary density 30 min after CMF treatment increased in each group by 1 +/- 7, 5 +/- 7, 13 +/- 18 and 20 +/- 13 cpll/mm(2), respectively. Capillary density increase was significant in the high-dose group. No change in gingival capillary density was found in the control group. CONCLUSIONS: Periodontal microcirculation perfusion had increased 30 min after CT treatment as indicated by a rise in gingival capillary density. Our results support the idea that CT-induced microcirculatory response not only diligently delivers but also saturates peripheral oral tissues with antineoplastic agents by increasing surface area exposure. This functional response of the microcirculation to CT drugs may play a role in contribution to oral complications and the treatment of oral tumors.

Inguinal lymphadenitis caused by mycobacterium haemophilum in an immunocompetent child.

Infections caused by Mycobacterium haemophilum in immunocompetent patients are unusual. M. haemophilum have been associated with cervicofacial lymphadenitis in children, but inguinal infections have not yet been described. We present a case of an inguinal lymphadenitis caused by M. haemophilum in an immunocompetent girl.

Influence of the application of platelet-enriched plasma in oral mucosal wound healing.

PURPOSE: The aim of this study was to describe and quantify the therapeutic value of platelet concentrate on the capillary density in oral mucosal wound healing. MATERIAL AND METHODS: The subjects included 10 healthy edentulous patients who underwent bilaterally a sinus floor elevation procedure and a buccal onlay graft with autologous iliac crest bone for maxillary reconstruction. During surgery, platelet-rich plasma (PRP) was prepared from a blood sample taken from the patient. After randomization in a split-mouth design, at one side PRP was administered in the wound and at the contralateral side a placebo. At baseline, microvascular capillary density was scored with the orthogonal polarization spectral (OPS) imaging technique and repeated measurements were performed postoperatively on a daily basis until the tenth day, after which measurements were continued weekly until the fifth postoperative week. RESULTS: Ten patients, five males and five females, were included in the study with a mean age of 54.2+/-9.1 years for females and 57.6+/-6.9 years for males. Donor platelet counts from whole blood had a mean value of 248.5+/-13.5 x 10(9)/l, while the value of platelet counts in the PRP had a mean of 975.9+/-97.9 x 10(9)/l. Wound healing was significantly accelerated in the PRP-treated mucosal wounds during the first 10 postoperative days. After the second week, no obvious differences between the PRP or placebo side could be noted. CONCLUSION: PRP has a strong stimulant effect on capillary regeneration in wound healing. These effects are mainly noticeable during the early stages of wound healing.

Immediate placement of implants in periapical infected sites: a prospective randomized study in 50 patients.

OBJECTIVE: To determine clinical success when implants are placed in chronic periapical infected sites. STUDY DESIGN: Fifty patients (25 females, 25 males, mean age 39.7 +/- 14.5 years) were included in this prospective controlled study. After randomization, 25 Frialit-2 Synchro implants were immediately placed (IP) after extraction, and 25 Frialit-2 Synchro implants were placed after a 3-month healing period (DP). Thirty-two implants were placed in the anterior maxilla and 18 implants were placed in the premolar region. Implant survival, mean Implant Stability Quotient (ISQ) values, gingival aesthetics, radiographic bone loss, and microbiologic characteristics of periapical lesions were evaluated for both groups. RESULTS: Overall, 2 implants belonging to the IP group were lost, resulting in a survival rate of 92% for IP implants versus 100% for DP implants. Mean ISQ, gingival aesthetics and radiographic bone resorption, and periapical cultures were not significantly different with the IP and DP implants. CONCLUSIONS: Immediate implant placement in chronic periapical lesions may be indicated.

First case of an oculofacial lesion due to Mycobacterium haemophilum infection in an immunocompetent child.

Oculofacial lesions caused by infections with nontuberculous mycobacterial organisms are unusual, but infections with Mycobacterium haemophilum species in immunocompetent patients have not yet been described. We present a case of an oculofacial lesion in a girl as a result of a Mycobacterium haemophilum infection.

A randomized prospective controlled trial of antibiotic prophylaxis in intraoral bone grafting procedures: single-dose clindamycin versus 24-hour clindamycin prophylaxis.

PURPOSE: The objective of this study was to compare the efficacy of a single oral dose of clindamycin with a 24-h protocol of clindamycin administration in local buccal onlay grafting procedures. MATERIAL AND METHODS: A prospective randomized study in 124 patients was performed. Eligible patients were randomized to receive antibiotic prophylaxis either as a single dose (group I) or over a 24-h period (group II). In both groups prophylaxis started with an oral dose of 600 mg clindamycin 1 h before surgery, followed by either placebo or 300 mg clindamycin every 6 h. The primary endpoint of this study was wound infection at the receptor site within 8 weeks after surgery. Secondary outcome measurements included postoperative infections at the donor site and adverse events as a result of antibiotic administration. RESULTS: The mean age of the patients was 35.9+/-10.1 years (range 18-59 years). Infections at the receptor site were seen in two patients (3.2%, 95% CI 0-7.6%) of the single-dose group and in three patients (4.8%, 95% CI 0-10.1%) of the 24-h group. Infection at the donor site occurred in four patients (6.4%, 95% CI 0-12.5%) of the single-dose group and in two patients (3.2%, 95% CI 0-7.6%) of the 24-h group. Postoperative infections were predominantly caused by alpha-hemolytic streptococci sensitive to penicillin. CONCLUSIONS: No statistically significant difference was found between the prophylactic single dose of clindamycin and the 24-h regimen of clindamycin with regard to postoperative infection in patients undergoing local bone augmentation procedures.

A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery.

OBJECTIVE: Randomized clinical prospective study to evaluate the application of MTA and IRM as retrograde sealers in surgical endodontics. STUDY DESIGN: One hundred single-rooted teeth were surgically treated. After randomization, MTA or IRM was used as a retrosealer. Radiographs were taken 1 week, 3 months, and 1 year postoperatively. Assessment was performed by 2 independent assessors 1 year after surgery. Both treatment groups were homogeneous in their composition, and clinical features and radiographic findings were classified according to Rud's classification. RESULTS: Complete healing was observed in 64% of the MTA-treated teeth vs 50% of the IRM-treated teeth. Incomplete healing was seen in 28% (MTA) vs 36% (IRM), and unsatisfactory in 6% (MTA) vs 14% (IRM). Only 1 failure was seen (MTA). No statistically significant differences were found between the 2 retrofilling materials. CONCLUSION: As root-end filling materials in this clinical prospective randomized design on single rooted teeth, MTA and IRM had the same clinical effectiveness.

A prospective placebo-controlled double-blind trial of antibiotic prophylaxis in intraoral bone grafting procedures: a pilot study.

OBJECTIVE: A pilot study was conducted to assess the efficacy of a single-dose preoperative prophylactic of the penicillin pheneticillin compared with placebo in the antibiotic prophylaxis of surgical wound infections in intra-oral bone grafting procedures. PATIENTS AND METHODS: Twenty patients (age range 20-45 years) underwent an intra-oral buccal onlay graft procedure. After randomization, a placebo or 2 grams of pheneticillin were administered orally one hour before surgery in a double-blind fashion. During three months, the postoperative course was observed according to clinical parameters of infection. Both groups were homogeneous in their composition and established risk factors for surgical wound infection. The frequency of surgical wound infections, as defined by the Centers of Disease control in 1992, were compared and evaluated statistically. RESULTS: Two patients developed a wound infection at the receptor site; two patients developed an infection at both the receptor and donor sites; and one patient developed an infection at the donor site only. All of these patients received a placebo. No infections were seen in the pheneticillin group. There was a statistically significant increased risk of having an infectious complication after an intra-oral bone graft without antibiotic prophylaxis. CONCLUSION: The results of this study support the efficacy of single-dose, preoperative, oral antibiotic administration.

The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndrome.

Upper airway obstruction and difficult tracheal intubation are often encountered in patients with Treacher Collins syndrome (mandibulofacial dysostosis). In this case report, the use of a laryngeal mask airway (LMATM) in a 10-day-old newborn with severe Treacher Collins syndrome and acute airway obstruction is described. It successfully relieved the airway obstruction and was left in situ for an exceptionally long period of 4 days. The difficult decisions with respect to the management of the airway and specifically the role of the laryngeal mask are described. In our opinion, in some newborns with severe mandibulofacial disorders and upper airway obstruction, where conservative airway management procedures have failed, the laryngeal mask can be considered not only to relieve the obstruction but also to buy time until there is full insight into the medical condition and its consequences.

Multiple recurrent and de novo odontogenic keratocysts associated with oral-facial-digital syndrome.

In 1954, Papillon-Leage and Psaume were the first to describe the clinical characteristics of oral-facial-digital syndrome (OFDS). On the basis of their clinical features and the inheritance pattern, 2 variants were initially distinguished, namely OFDS type I (Papillon-Leage and Psaume) and OFDS type II, or Mohr syndrome. At present, 11 types of OFDS have been discovered. OFDS represents a heterogeneous group of disorders characterized by oral manifestations including oral frenula, cleft or lobulated tongue, high arched palate, cleft lip and/or palate, facial anomalies, and digital abnormalities such as syndactyly, polydactyly, brachydactyly, and clinodactyly. Depending on the type of OFDS, abnormalities may be present in other organs, such as the brain and heart. We report a patient with OFDS in whom multiple recurrent and de novo keratocysts were found. Although multiple keratocysts are commonly found in Gorlin-Goltz nevoid basal cell carcinoma syndrome, a relationship between OFDS and multiple keratocysts has not been described.