Minor preprosthetic surgical procedures.

Minor preprosthetic surgical procedures used in correcting an existing problem or in preparing the mouth for prostheses must be based on an exact diagnosis and carefully planned and executed to satisfy clearly definable goals. This article emphasizes that philosophy and includes surgical techniques for managing commonly encountered problems as well as those problems associated with placement of immediate dentures. Predictable results with minimal complications can be expected when one adheres to these guidelines.

High prevalence of bedbugs Cimex hemipterus and Cimex lectularis in camps for internally displaced persons in Freetown, Sierra Leone: a pilot humanitarian investigation.

The prevalence of bedbugs Cimex hemipera and C. lectularis was investigated in camps for the internally displaced persons (IDPs) in Freetown, Sierra Leone. Two hundred and thirty eight rooms were searched during the day and at night, and 233 (98%) of those rooms in 30 booths were infested with different life cycle stages of bedbugs. There hundred and ninety-eight (68%) of the bedbugs were adults, 145 (24.8%) were nymphs of various instars, and 41 (7%) were clusters of eggs. Significantly (P > 0.05) more bedbugs were recovered during the night inspections 64.6% as compared to 35.4% during the day inspections. In addition, more adult bedbugs were recovered at night than during the day, a manifestation of their peak feeding period. Of the total of 570 adults and nymphs collected and identified, 320 (56.1%) and 250 (43.9%) were Cimex lectularis and Cimex hemipterus respectively. Clinical examination of 221 individuals living in the booths during 3 consecutive weeks of examinations and treatment for conditions suggestive of bedbug infestation (bites and skin reactions as well as treatments for other health and medical conditions) showed that 196 (86%) had wheals as a direct result of bedbug bites. The data of this pilot humanitarian investigation shows a high prevalence of bedbug infestation in these displacement camps. It is recommended that some control measures be instituted, like residual insecticide application along with integrating control methods within the primary health care system, because bedbugs are a source of great irritation and sleepless nights that could lead to stress.

Self-stabilizing approach to surgical uprighting of the mandibular second molar.

A technique for surgical uprighting of malposed mandibular second molars is described. The principal advantage of this technique is that the tooth is stabilized by bone on the distal aspect of the uprighted tooth. Long-term clinical and radiographic follow-up reveals positional stability and no adverse pulpal or periodontal sequellae.

Unilateral relapse after oblique osteotomy of the mandibular rami: report of case.

A case of unilateral relapse of mandibular prognathism after oblique osteotomy of the mandibular rami is described. A brief review of the pertinent literature is presented and a method of intraosseous fixation by Vitallium plating is illustrated. The need for close postoperative observations and reinstitution of active therapy at the first sign of a relapse tendency is emphasized.

Heparinization after Le Fort I osteotomy in a patient with chronic atrial fibrillation.

The middle-aged patient with a dentofacial deformity complicated by partial edentulism and underlying medical problems presents a challenge to the orthodontic-surgical team. The clinical management of a 51-year-old man with maxillary deficiency and chronic atrial fibrillation is presented. Preoperative evaluation and planning, and a scheme and rationale for perioperative anticoagulation, are crucial. The etiology and risks of chronic atrial fibrillation are reviewed along with anticoagulation therapy.

Long-term neurosensory deficits following transoral vertical ramus and sagittal split osteotomies for mandibular prognathism.

Twenty-six patients who had been treated for mandibular prognathism by either bilateral sagittal split osteotomy or transoral vertical ramus osteotomy were evaluated by neurosensory examination. Neuropathy was demonstrable in 28.8% of the 52 mental nerves examined. The incidence of neuropathy was significantly higher in the bilateral sagittal split osteotomy group than in the transoral vertical osteotomy group.

Management of the maxilla after alveolar ridge augmentation with hydroxylapatite when opposed by mandibular implants.

Maxillary ridge augmentation and vestibuloplasty are often adjuncts to mandibular implant reconstructions. Careful management of the augmented ridge after surgery is critical to the success of the maxillary prosthesis and osseointegration of the mandibular implant. A technique is described for alteration of an existing maxillary complete denture after ridge augmentation. Precautions regarding prosthesis function during the osseointegration phase of different types of mandibular reconstructions are noted. Technique and rationale for denture flange modification when a prosthesis is rebased for a patient who received simultaneous vestibuloplasty and ridge augmentation are described.

Arteriovenous malformation of the mandible: report of case.

A case of a potentially lethal arteriovenous malformation of the right side of the mandible has been presented. Procedures that may be helpful in diagnosing the lesion have been discussed, and a protocol for treatment of these lesions in the mandible has been proposed. Research of the cause and management of these lesions is greatly needed.

Skin graft vestibuloplasty exostosis. A report of two cases.

Two cases of exostosis developing after mandibular vestibuloplasty and floor-to-mouth lowering with split thickness skin graft are presented, one with multiple recurrences. The lesion is clinically and microscopically described. Hypotheses with respect to the development of this phenomenon are proposed.

Sarcoptes scabiei infestation among children in a displacement camp in Sierra Leone.

The prevalence of scabies was investigated among a study population of 125 children between the ages of 1-15 y. Confirmation of scabies was done by clinical examination of each child and by the identification of the mite by microscopically examining the scrapings from the scabies-like lesions. The prevalence was age dependent, with children under five years accounting for 77%, peaking to 86% among the 5 to 9-y-olds, and steadily declining with an increase in age. Lesions were found on almost all parts of the body, but lesions were more commonly located on the fingers, legs, hands, face, stomach, and genitalia. Sarcoptes scabiei var hominis was recovered from 84 (67%) of the 125 skin scrapings examined. The prevalence of scabies is high in children in the displacement camps, suggesting that it may be a serious public health problem not only in these camps, but also in the entire country. This may be due to the fact that certain environmental conditions like civil unrest, overcrowding, poor personal hygiene, poverty, and ignorance, which are conducive to the spread of scabies, is characteristically present among the camp residents. Control programs should be put in place and implemented in an integrated nature, by reducing overcrowding, and by improving health education, personal hygiene, treatment and surveillance among high-risk populations.

Long-term results of alveolar ridge augmentation.

Autologous onlay rib grafts in 22 patients were evaluated for bone remodeling patterns. The patients had been followed up for four to ten years; the mean was 6.2 years. The unquantitated increase in bony mass of the mandible, with altered ridge form and subsequent soft tissue surgery, provided consistent, predictable results and return to excellent denture function with long-term stability.

Mandibular interpositional and onlay bone grafting for treatment of mandibular bony deficiency in the edentulous patient.

The development of interpositional and onlay bone grafting techniques for atrophic mandibles is reviewed. A further modification of the visor osteotomy is presented along with follow-up evaluation of the conditions of 16 patients. Results of radiographic measurements show the procedure to be stable, vertical resorption of the augmented mandible in the body regions being 11.2% over a mean follow-up of 8.8 months. Neurosensory evaluation showed altered sensation and dysesthesia as a significant problem in these patients. The results are presented and discussed.

Aggressive ossifying fibroma of the maxilla: review of the literature and report of case.

A case of a large aggressive ossifying fibroma of the maxilla has been presented. Review of the literature shows the literature shows the difficulty in establishing a definitive diagnosis through any single diagnostic modality. Much of this is due to the confusion surrounding classification of the tumor. Adjunctive radiographic and nuclear medicine diagnostic aids were utilized, as were clinical, laboratory, and histopathologic studies, in resolving the diagnostic questions posed by this large and aggressive tumor. Surgical intervention through conservative enucleation produced few operative or postoperative difficulties and minimal residual deformity. Differentiation of ossifying fibroma from other benigh and malignant neoplasms as well as fibrous dysplasia is important in the correct management of this lesion.

Blood loss and hypotensive anesthesia in oral-facial corrective surgery.

To evaluate accurately changes in blood volume during oral-facial corrective surgery, double-tagged radioisotope blood volume studies were performed preoperatively and postoperatively. Unexpectedly large RCV deficits that were not consistent with EBL were observed in studies conducted at two separate facilities. Hypotensive general anesthesia was used for the intended purpose of reducing blood loss in oral-facial corrective surgery. Various physiological parameters were measured preoperatively, intraoperatively, and postoperatively to evaluate patient response to this anesthetic method. The MAP was reduced from 89.94 +/- 2.13 to 72.79 +/- 1.63 mm Hg under the influence of NaN infusion supplemented with halothane. No dose-response relationship existed between NaN and the intraoperative MAP. A 44% reduction in the measured red cell volume was observed in comparison to a previously studied group of patients who underwent similar surgical procedures under normotensive anesthesia. It is concluded from an extensive review of the literature that the most vulnerable period for serious complications is in the immediate postoperative period. No significant complications or adverse effects were observed in this study. It cannot be emphasized too strongly that the safety of this hypotensive technique lies in constant and careful monitoring of the patient and meticulous attention to all details of anesthetic management.

Bone scanning with 99mtechnetium phosphate to assess condylar hyperplasia. Report of two cases.

Condylar hyperplasia poses a problem in planning treatment because it is a self-limiting process for some but not all patients. Continued growth creates a progressive deformity that requires condylectomy, whereas an enlarged condyle can be left in place after hyperplastic growth ceases, even if ramus surgery is needed to correct asymmetry. Bone scan with 99mtechnetium phosphate can be used to assist in making the differential diagnosis. In the two patients reported here, abnormal metabolic activity revealed by bone scans supported clinical and historical evidence that the condylar hyperplasia was active and required surgical correction, including condylectomy. The two cases demonstrate different approaches to postsurgical orthodontic treatment, depending on the amount of normal growth expected.

Squamous-cell carcinoma arising in a lateral periodontal cyst.

A rare case of well-differentiated squamous-cell carcinoma arising in the epithelial lining of a lateral periodontal cyst is reported. Submission of surgically removed tissues for histopathologic evaluation is emphasized. The surgical site has been reconstructed and functions well. Because of early diagnosis and treatment, the patient has no evidence of clinical disease 2 1/2 years postoperatively.