A prospective histomorphometric and cephalometric comparison of bovine bone substitute and autogenous bone grafting in Le Fort I osteotomies.

PURPOSE: The aim of the present study was the histomorphometric and cephalometric comparison of autogenous bone grafting of the anterior iliac crest and the application of bovine bone substitute concerning new bone formation and postoperative stability in patients undergoing orthognathic Le Fort I osteotomy. PATIENTS AND METHODS: Twenty-five patients requiring orthognathic surgery with Le Fort I osteotomy were included in this study. Patients were randomly divided into three groups receiving either autogenous iliac crest BONE grafting (BONE; n = 8) or xenogenic bovine bone grafting (Bio-Oss®) in INTER (n = 12) or in ONLAY (n = 5) position. Histomorphometric analysis was performed using trephine bone biopsies from the autogenous, respectively xenogenic bone grafting region. Postoperative stability was evaluated using teleradiographies of three different timepoints. RESULTS: All groups showed comparable mineralized fractions in bone biopsies of 50.2% (±13.2%) INTER, 46.48% (±12.3%) ONLAY and 57.1% (±20.6%) BONE as well as comparable percentage of connective tissue. Patients in the INTER-group revealed the lowest relapse rate of 20.5% (INTER) compared to 30.3% (ONLAY) and 33.0% (BONE). All groups underwent comparable maxillary advancement and healing time. CONCLUSIONS: Present results indicate that block shaped bovine bone substitute is a promising alternative to autogenous bone grafting to bridge the Le Fort I osteotomy gap in orthognathic surgery.

Malignant tumors could be misinterpreted as temporomandibular joint disorders.

OBJECTIVES: This article stresses the importance of exclusion of malignant tumors as a cause of temporomandibular joint disorder, which is usually caused by intra-articular or musculoligamental dysfunction without considering malignant tumors as a cause of such complaints. METHOD AND RESULTS: Three patients were referred to us because of persistent and recurrent temporomandibular joint dysfunction. All patients were treated more than once through their general practitioner, ear nose and throat physician, or dental physician without significant improvement. After adequate clinical and radiological examination, malignant tumors were discovered as a cause of such complaints. CONCLUSIONS: Patients with primary or secondary tumors could present with symptoms simulating temporomandibular joint disorder and will therefore be treated similarly. In such condition, missing that rare cause will consequently lead to unnecessary delayed diagnosis and may cost the patients their lives.