Vascularized cranial bone grafts for mandibular and maxillary reconstruction. The parietal osteofascial flap.

The authors have performed 13 cases of vascularized cranial bone grafts for reconstruction of maxillofacial defects since 1986. Two types of flaps were used: the parietal osteofascial flap pedicled to the parieto-temporal fascia based on the superficial temporal artery and the temporalis osteomuscular flap pedicled to the temporalis muscle based on the deep temporal artery. Zygomatico-orbital complex, maxilla and mandible were reconstructed and hemifacial microsomia was also treated. The results of vascularized cranial bone grafts pedicled to fascia were as good as those of grafts pedicled to muscle. There were no major complications. Two types of vascularized cranial bone grafts seem to be useful in reconstruction of maxillofacial defects with avascular recipient beds because of their good blood supply. The parietal osteofascial flap has additional advantages including easy rotation of the flap to the defect, particularly a mandibular defect, and versatile use of fascia without bulkiness for reconstruction of soft tissue defects. This flap can be designed as a full- or partial-thickness cranial bone graft with good vascularity. In this paper, our technique for mandibular and maxillary reconstruction using the parietal osteofascial flap is introduced, and the results compared with our temporalis osteomuscular flap technique are reported.

Rudimentary polydactyly.

A case of rudimentary polydactyly on the radial aspect of the thumb of a 4-year-old male was examined. Histologic examination revealed hyperkeratosis and acanthosis in the epidermis and large numbers of nerve bundles in the dermis. With immunoperoxidase staining for S-100 protein, the nerve corpuscles were positively stained. We think that rudimentary polydactyly is a kind of congenital traumatic neuroma and that the possible cause may be intrauterine amputation.

[Clinical studies on oral infections in the oral cavity and maxillofacial regions].

The author has undertaken clinical studies on oral infections in the oral cavity and maxillofacial regions by analyzing 987 patients with infections among 3,921 in-patients hospitalized in the Department of Oral and Maxillofacial Surgery, Seoul National University Hospital past 7 years from 1980 to 1987. The results obtained were as follows: 1. Oral infection as inflammatory disease in dentistry is still very important disease occupying 25.4% of diseases in oral and maxillofacial regions. 2. The high 3 top inflammatory diseases in the department of oral and maxillofacial surgery admitted were odontogenic maxillary sinusitis (37.6%), osteomyelitis (29.1%), and abscess (22.2%) among 14 kinds of oral infections. 3. Anaerobic bacterial infections tend to be increasing since new developed bacterial culture chamber has been used.

[Experimental studies on wound healing of the jaw bone fracture].

The author has studied on wound healing of the jaw bone fractures in 5 Malaysian monkeys aging around 2 years and weighing about 3 Kg. For the experimental studies, fractures of the jaw bone in terms of oblique osteotomies from angle to sigmoid notch of the mandible of the Malaysian monkeys were made by using #700 fissure bur and reduced and fixed them in terms of interosseous wiring. The experimental animals were sacrificed on the 1st, 2nd, 3rd, 4th and 5th week thereafter, and the fracture sites were obtained to make microscopic slides stained with Hematoxylin-Eosin, and Van Gieson method. The results obtained were as follows: 1. The blood of hematoma situated in fractured crevice are getting replaced with granulation tissue 1 week after fracture. 2. The granulation tissue occurred in fractured crevice are getting replaced with connective tissue as bone matrix 2 weeks after fracture. 3. Immature new bone formation with bony trabeculation formed 3 weeks after fracture. 4. The secondary bony callus with abundant osteoblasts and osteocytes in bone matrix formed 4 weeks after fracture. 5. The fractured wound completely healed with a new bone formation 5 weeks after fracture.

[Clinical studies on treatment of fractures of the zygomatic bone].

The author has made clinical studies on treatment of fractures of the zygomatic bone in terms of frequency of fractures according to sex, age, fracture type, main manifestations and treatment methods from 106 patients with zygomatic bone fractures among 969 patients with maxillofacial bone fractures. The results obtained were as follow: 1. The frequency of malar bone fracture was 4 times more in male than that in female. 2. The most prevalent age of malar bone fracture was 21-30 years of age, and the nexts were followed 11-20, 31-40, 0-10, 41-50, 51-60, 61-70, and over 71 in the orders. 3. Among maxillofacial bone fractures, mandibular fracture was most prevalent as 76.3%, and the nexts were followed by the maxilla (10.8%), the molar bone (9.7%) and the nasal bone (3.3%). 4. Among 106 fractures of the malar bone, zygomatic bone fracture only was occupied 48.1%, but the rests were accomplished by another maxillofacial bone fractures. 5. In classification of molar bone fractures according to Knight and North's, group 3 fractures were most prevalent, and followed by group 2, 1, 4 and 6 in the orders. 6. Main manifestations were upper cheek flattening, lower eyelid ptosis, subconjunctival ecchymosis, epistaxis, difficulty of mouth opening, pain during mouth opening and others in the orders. 7. 93.4% of malar bone fracture has been treated surgically, but the rests treated conservatively, and [symbol: see text] shaped elastic stapler wire has been effectively used to get fixation at zygomatico-maxillary fractures.

[Clinical study on treatment of internal derangement of the T.M. joint].

The author has studied on treatment of internal derangement of the temporomandibular joint induced by incision of the retrodiscal ligament, and on an extracapsular surgical treatment method composed of lower repositioning of the mandibular condyle with oblique osteotomy of the ramus on the animals and 5 patients with internal derangement of the T.M. joint. To induce internal derangement on experimental animals, 5 Malaysian monkeys aging around 2 years and weighing about 3kg. were used, the retrodiscal ligament of the left temporomandibular joint was incised, and 1mm lower repositioning surgery of the condyle was performed 3 weeks after. The animals were observed and sacrificed on the 1st, 2nd, 3rd, 4th and 5th weeks thereafter, and the temporomandibular joints and their surrounding tissues were obtained to make microscopic specimens stained with Hematoxylin-Eosin and with Van Gieson method and patient treated by means of lower reposition surgery and 5 patients treated have been observed clinically. And 5 patients treated have been observed clinically. The results obtained were as follows: 1. Internal derangement of the T.M. joint occurred in by resecting retrodiscal ligament. 2. A lots of bone resorption on articular eminence was shown, 1-2 weeks after lower repositioning surgery. 3. Bone healing on articular eminence was shown, 3-5 weeks after lower repositioning surgery. 4. Displased articular disks came back to normal positions by lower repositioning surgery. 5. 5 patients with internal derangement completely treated by application of lower repositioning surgery.

[An investigation on the oral surgery patients and their treatments].

The author has studied on the various diseases occurring in the oral and maxillofacial region for the year of 1987 at the Department of Oral & Maxillofacial Surgery, Seoul National University Hospital. The diseases diagnosed and treated have been analyzed according to each disease such as inflammatory, traumatic, cyst, tumor, neoplastic, deformities and so on, in order to get accurate information on the diseases of the oral & maxillofacial region and the information might be helpful to plan the education programmes for students, and interns and residents. The results obtained are as follows; 1. The sex distinction and the percentage of occurrence rate as follow Male 2090 (49.6%) Female 2127 (50.4%) 2. To study compare with the age, both male and female patients showed the highest ratio at the 20-29 age group, and the percentage of the 20-49 age group is 64.1% and the percentage of geriatric patients over 60 years old is 10.2%. 3. To study compare with the month (the patient came first time), August was most abundant in a year. 4. To study compare with the disease, dental-periodontal disease, impacted tooth and eruption abnormality are the most prevalent (51.2%), and next is odontogenic infection (22.4%), cyst & tumor (7.6%), traumatic injury (7.5%), and anomaly or deformity (3.8%). The number of medically compromised patients with oral surgery problems is 183 (4.3%). 5. Classifying the treatments according to the operator group, 1) For students(senior class), simple extraction showed the highest ratio, next is surgical extraction. 2) For interns, simple extraction showed the highest ratio, next is surgical extraction, pre-prosthetic surgery (alveoloplasty and vestibuloplasty).(ABSTRACT TRUNCATED AT 250 WORDS)

An intraoral approach to treatment of condylar hyperplasia or high condylar process fractures using the intraoral vertico-sagittal ramus osteotomy.

PURPOSE: The intraoral vertico-sagittal ramus osteotomy (J Craniomaxillofac Surg 20:153, 1992) can be used to reduce high condylar process fractures and recontour hyperplastic condyles while simultaneously correcting the malocclusion. This article presents the technique and reports the clinical results. PATIENTS AND METHODS: A technique for removal and replantation of the condyloid process using the vertico-sagittal ramus osteotomy and rigid fixation was used to treat 23 patients with markedly displaced, high condylar process fractures and condylar hyperplasia associated with malocclusion. RESULTS: The replanted condyles did not show ischemic necrosis or any functional disturbance when followed for more than 3 years. All patients showed nearly normal mouth opening, with slight mandibular deviation, usually in sixth postoperative month. CONCLUSIONS: In selected patients, this technique allows intraoral accessibility to the condyle and its repositioning. The method is particularly useful to treat vertical discrepancies associated with the hyperplastic or hypoplastic condyle.