Operative management of temporomandibular joint ankylosis: a systematic review and meta-analysis.

PURPOSE: Two common treatments of temporomandibular joint ankylosis are gap arthroplasty and ankylosis resection and reconstruction of the ramus-condyle unit with a costochondral graft. The purpose of the present study was to answer the following clinical question: "Among patients with temporomandibular joint ankylosis, do those patients who undergo gap arthroplasty, compared with those who undergo ankylosis resection and ramus-condyle unit reconstruction with a costochondral graft have better postoperative mandibular range of motion?" METHODS: A systematic search of the published data was performed to identify eligible studies. The primary predictor variable was treatment type (ie, gap arthroplasty or ankylosis resection and ramus-condyle unit reconstruction). The main outcome was the change in maximal incisal opening postoperatively. A random effects model was used to compute the pooled weighted mean difference between the pre- and postoperative maximal incisal opening in both treatment groups. RESULTS: Four studies met the inclusion criteria. Those undergoing gap arthroplasty had a significantly greater maximal incisal opening than the group undergoing ankylosis resection and ramus-condyle unit reconstruction. The weighted mean difference between the 2 groups was 2.4 mm (95% confidence interval 0.9 to 4.0; P = .002). CONCLUSIONS: Subjects with temporomandibular joint ankylosis who underwent gap arthroplasty had significantly better postoperative maximal incisal opening than those undergoing ankylosis resection and ramus-condyle unit reconstruction with a costochondral graft.

Anterior versus posterior approach to iliac crest for alveolar cleft bone grafting.

PURPOSE: The goal of this study was to compare perioperative outcomes for the anterior versus posterior approach to the iliac crest for alveolar bone grafting in patients with cleft lip and palate (CLP). MATERIALS AND METHODS: A retrospective cohort study of patients with CLP who had an anterior or posterior iliac crest bone graft during a 10-year period was performed. Available medical records were reviewed and the outcome variables documented included the operation site for bone graft procurement (anterior or posterior), estimated blood loss, duration of operation, concurrent procedures, and length of hospital stay. The 2 groups were compared by t test, Fisher exact test, and multivariate regression to show differences. RESULTS: There were 239 patients with CLP who had an iliac crest bone graft to the alveolar cleft; 133 had an anterior and 106 a posterior approach for bone graft procurement. The mean estimated blood loss was significantly less with the posterior approach (85 vs 177 mL; P < .0001). The mean operation duration with the posterior approach was longer (4.6 vs 3.5 hours; P < .0001). Most patients in this group (67%), however, had 2 or more additional procedures during the same anesthetic, whereas only 16% of patients in the anterior group had 2 or more additional procedures. The mean length of stay was significantly shorter for the posterior approach (1.7 vs 2.2 days; P < .0001). CONCLUSIONS: These results suggest that patients having a bone graft from the posterior iliac crest have a smaller estimated blood loss and a shorter length of stay. In addition, this approach permits repair of the alveolar cleft and additional procedures, including augmentation of the median tubercle and correction of nasolabial distortions, which are often present in patients with CLP.

Use of panoramic x-ray to determine position of impacted maxillary canines.

PURPOSE: To evaluate the position of impacted maxillary canines in the alveolus using panoramic radiographs. MATERIALS AND METHODS: The present study was a retrospective chart review of 102 patients with 130 impacted maxillary canines from the University of Illinois at Chicago College of Dentistry and private practice. Of the 130 impacted maxillary canines, 59 were impacted buccally and 71 were impacted palatally. The inclination of the impacted maxillary canines to a horizontal line from the mesiobuccal cusps of the maxillary molars was measured. We used these measurements to predict the position of the tooth and correlate this prediction with the actual approach used during surgery. RESULTS: The mean angulation of the buccally impacted maxillary canines was 75.1 degrees +/- 18.2 degrees (range, 8 degrees to 111 degrees ). The mean angulation of the palatally impacted maxillary canines was 51.3 degrees +/- 15.3 degrees (range, 12 degrees to 91 degrees ). The mean difference between the angulation of the impacted maxillary canines as measured on the panoramic radiographs was statistically significant (P < .001). From a receiver-operator characteristic curve and using a logistic regression model, impactions greater than 65 degrees were 26.6 times more likely to be buccally impacted maxillary canines (P < .001). CONCLUSIONS: Panoramic radiographs are useful for predicting the location of impacted maxillary canines and the subsequent surgical approach required for exposure and orthodontic appliance attachment when computed tomography is unavailable or unnecessary otherwise. The use of panoramic radiographs for determing impacted maxillary canine position has a high sensitivity and specificity, with angulations greater than 65 degrees associated with buccal impactions.

Clinical evaluation of implants in radiated fibula flaps.

PURPOSE: The success of osseointegrated implants in the radiated fibula flap used for mandibular reconstruction is variable, and there are few long-term data available in the literature. The purpose of this study is to evaluate implant success in radiated fibula flaps and the native mandible after ablative tumor surgery. MATERIALS AND METHODS: The medical records of 44 patients who underwent resection and reconstruction of the mandible from 1994 to 2006 were reviewed retrospectively. A total of 206 implants were placed; 144 were placed in a fibula flap, and 92 were placed in the native mandible. Before implant placement, 22 patients (50%) received adjuvant tumoricidal doses of radiation therapy (>6,000 cGy). All patients who received radiation received a standard regimen of 20 preoperative and 10 postoperative hyperbaric oxygen treatments. The follow-up period ranged from 4 to 108 months (mean, 41.1 months). Comparisons were made between groups regarding long-term implant success based on several variables. RESULTS: Implants were considered to be successful if there was no radiographic evidence of peri-implant bone loss and if they were clinically osseointegrated. Of 206 implants, 31 failed, with an overall success rate of 85%. The success rate of implants placed in fibula flaps was 82.4%, and the success rate in native mandibles was 88%. Most of the failures in the fibula (90%) occurred within the first 6 months after implant placement, whereas most of the failures in the mandible occurred after 6 months. The cumulative survival rate was 91.9%, and there was no difference in survival between implants placed in the fibula versus the native mandible or depending on whether the patient received radiation therapy. CONCLUSION: Acceptable long-term implant success rates may be achieved in the radiated mandible with vascularized fibula flap reconstruction.

Peripheral ameloblastic fibroma of the maxilla: report of a case and review of the literature.

Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. Also referred to as extraosseous or soft tissue odontogenic tumors, peripheral odontogenic tumors share the same histopathologic characteristics of their central or intraosseous counterparts. Ameloblastic fibroma is a rare odontogenic tumor that arises from both odontogenic epithelium and connective tissue. Only 2 cases of peripheral ameloblastic fibroma have been reported in the English-language literature, one of which did not show the classic features of an ameloblastic fibroma. In this report, we describe a rare case of a peripheral ameloblastic fibroma in the maxilla of a 3-year-old girl.

Illinois dental anesthesia and sedation survey for 2006.

This is a 10-year follow-up survey of a 1996 study of all dentists in Illinois holding a permit to administer sedation or general anesthesia. The survey describes the scope of sedation and anesthesia services provided in dental offices in Illinois. A mail survey was sent to 471 dentists who were registered with the department of professional regulation to administer sedation or general anesthesia. Classification by specialty area of practice showed: 63% (84% in 1996) are oral and maxillofacial surgeons, 20% (11% in 1996) general dentists, 6% (5% in 1996) periodontists, 9% (0% in 1996) pediatric dentists, 1% (less than 1% in 1996) dentist anesthesiologists. Advanced cardiovascular life support (ACLS) training was reported by 90% (85% in 1996) of the respondents. The total number of sedations and general anesthetics administered for the year was 115,940. Two mortalities and two cases of long-term morbidity were reported for the 10-year period. Respondents reported that 30 patients required transfer to a hospital but suffered no long-term morbidity. Other practice characteristics were detailed.