Increased Osteogenic Activity of Dynamic Cultured Composite Bone Scaffolds: Characterization and In Vitro Study.

PURPOSE: The purpose of this study was to develop and characterize beta-tricalcium phosphate (ß-TCP)/polycaprolactone (PCL) scaffolds, with 2 different ratios (50/50% and 65/35%), using 3-dimensionally (3D) printed dissolvable molds, and to evaluate cellular growth and osteogenic differentiation of both groups seeded with porcine bone marrow stem cells (pBMSCs) under dynamic culture in vitro. MATERIALS AND METHODS: Two different groups of scaffolds were produced: group 1 (n = 40) with a ratio (wt%) of 50/50% and group 2 (n = 40) with 65/35% of ß-TCP/PCL. Physicochemical, morphological, and mechanical characterization of the scaffolds were performed. Scaffolds were seeded with pBMSCs and differentiated osteogenically in dynamic culture. Cell density, distribution, and viability were assessed. Osteogenic differentiation was examined through alkaline phosphatase (ALP) staining, immunofluorescence, and photospectrometry. RESULTS: Osteogenic differentiated constructs showed homogenous and viable cell distribution. Cell density was significantly higher (P < .05) for 65/35% scaffolds at 10 days postseeding, whereas at 6 weeks, cell number equalized for both groups. ALP activity increased over time and was significantly higher (P < .05) for 65/35% scaffolds at 14 days postseeding. CONCLUSIONS: The mechanical properties of the developed 65/35% scaffolds were within the range of natural trabecular bone. Moreover, the 65/35% scaffolds showed biological advantages, such as higher cell growth and higher ALP activity.

Impact of Zika virus on the human type I interferon osteoimmune response.

BACKGROUND: The developing field of osteoimmunology supports importance of an interferon (IFN) response pathway in osteoblasts. Clarifying osteoblast-IFN interactions is important because IFN is used as salvage anti-tumor therapy but systemic toxicity is high with variable clinical results. In addition, osteoblast response to systemic bursts and disruptions of IFN pathways induced by viral infection may influence bone remodeling. ZIKA virus (ZIKV) infection impacts bone development in humans and IFN response in vitro. Consistently, initial evidence of permissivity to ZIKV has been reported in human osteoblasts. HYPOTHESIS: Osteoblast-like Saos-2 cells are permissive to ZIKV and responsive to IFN. METHODS: Multiple approaches were used to assess whether Saos-2 cells are permissive to ZIKV infection and exhibit IFN-mediated ZIKV suppression. Proteomic methods were used to evaluate impact of ZIKV and IFN on Saos-2 cells. RESULTS: Evidence is presented confirming Saos-2 cells are permissive to ZIKV and support IFN-mediated suppression of ZIKV. ZIKV and IFN differentially impact the Saos-2 proteome, exemplified by HELZ2 protein which is upregulated by IFN but non responsive to ZIKV. Both ZIKV and IFN suppress proteins associated with microcephaly/pseudo-TORCH syndrome (BI1, KI20A and UBP18), and ZIKV induces potential entry factor PLVAP. CONCLUSIONS: Transient ZIKV infection influences osteoimmune state, and IFN and ZIKV activate distinct proteomes in Saos-2 cells, which could inform therapeutic, engineered, disruptions.

Do Graduating Oral-Maxillofacial Surgery Residents Feel Confident in Practicing the Full Scope of the Specialty?

PURPOSE: Laskin (2008) suggested that the core of oral and maxillofacial surgery could be divided into 3 levels: 1) areas of expertise, such as oral pathology, oral medicine, dentoalveolar surgery, preprosthetic surgery, and maxillofacial traumatology; 2) areas of competence, including orthognathic surgery, temporomandibular joint surgery, and local reconstructive surgery; and 3) areas of familiarity that include cleft lip and palate surgery, craniofacial surgery, regional reconstructive surgery, oncologic surgery, and cosmetic surgery. The purpose of this study is to assess residents' confidence in practicing the full scope of oral-maxillofacial surgery and their perception of gaps existing in their training. The investigators hypothesized that graduating residents' confidence in practicing the full scope of oral-maxillofacial surgery falls within the suggested levels by Laskin. METHODS: The investigators implemented a cross-sectional study. A questionnaire was designed, and a link to a Partners REDCap (Nashville, TN) survey was electronically mailed to 252 chief residents in the final month (July 2018) of their program. The questionnaire included resident demographic characteristics, program demographic characteristics, and residents' perceived preparedness, level of proficiency, comfort, and experience for each area. RESULTS: The sample was composed of 78 graduating residents, with a response rate of 31%. Analyses included univariate statistics and a Wilcoxon signed rank test. Significance was set at P < .05. There was no significant difference between orthognathic surgery and each area in the expertise category, and in some cases, a significantly higher perception of ability in orthognathic surgery (P < .05). There was a significantly lower perception of training in oral medicine than each area in the expertise category (P < .05), suggesting a deficit in oral medicine training. CONCLUSIONS: Residents perceived that their training in orthognathic surgery was at the level of expertise, higher than expected. They also perceived a training deficit in oral medicine. Training proficiency in dentoalveolar surgery was found to be at a level higher than any other area.

Diagnosis and Treatment of Pediatric Primary Jaw Lesions at Massachusetts General Hospital.

PURPOSE: To review the demographic data, presenting symptoms, location, radiographic findings, treatment, and prognosis of pediatric jaw lesions in children treated at a single academic institution. PATIENTS AND METHODS: A retrospective medical record review was undertaken of patients younger than 18 years who presented to the Massachusetts General Hospital for Children between 2006 and 2018 with a primary jaw lesion. RESULTS: About 164 patients were identified. The most common lesions were giant cell tumors (n = 25), odontogenic keratocysts (n = 24), simple bone cysts (n = 19), odontomas (n = 17), fibrous dysplasia (n = 11), and dentigerous cysts (n = 11). Fifty-one patients (30.7%) were asymptomatic. About 94% were referred by their dentist, outside oral and maxillofacial surgeon or orthodontist. Most common presenting symptoms were swelling (66.9%), pain (32.5%), tooth mobility (17.5%), and neurosensory change (6.6%). Mandibular location was most common (72.3%). Radiographically, most were well-circumscribed radiolucencies with mean size of 2.9 cm (range, 0.7 to 15.6). Treatment varied from excisional biopsy to wide composite resection. Mean follow-up time was 38 months (range, 1 to 204). Recurrence was found in 21%. CONCLUSIONS: Pediatric jaw lesions are often asymptomatic and discovered incidentally by dental practitioners on routine examination. Clinical features (age, gender, location, and radiographic appearance) can help narrow the differential and expedite treatment. It is important that clinicians involved in the care of children be familiar with the wide differential diagnosis and management considerations of primary jaw lesions.

Induction, Treatment, and Prevention of Temporomandibular Joint Ankylosis-A Systematic Review of Comparative Animal Studies.

PURPOSE: Several animal models of temporomandibular joint ankylosis (TMJA) have been described for more than the past 2 decades. The aim of this study was 2-fold: 1) to compile and summarize the evidence of animal studies that compare different forms to induce, treat (disease already established), or prevent (after trauma) TMJA; and 2) to address the following focused question: what is the quality of reporting in these studies? MATERIALS AND METHODS: A systematic review was conducted. Animal studies conducted up to October 2019 comparing at least 2 procedures to induce, treat (disease already established), or prevent (after trauma) TMJA were considered. Compliance with the Animal Research Reporting In Vivo Experiments guidelines was checked for all studies. Studies evaluating treatment of TMJA or preventive measures also were evaluated using the SYstematic Review Center for Laboratory animal Experimentation's risk of bias tool for animal studies. RESULTS: A total of 24 studies were included. The studies were evaluated for feasibility regarding data synthesis, and a meta-analysis was not suitable because of methodological differences, mainly regarding the animal model chosen and surgical procedures performed to induce TMJA. In 17 articles, authors aimed to investigate different procedures to induce TMJA (fibrous, fibro-osseous, or bony). In 7 articles, different treatment or preventive strategies were compared. The sheep was the most used animal in models of TMJA. Only 25% (6 of 24) of studies reported some step to minimize bias (ie, blinding of investigators, randomization procedures, or allocation concealment). Approximately 54% (13 of 24) of articles clearly commented on study limitations and potential sources of bias. Further animal studies on TMJA should consider improving their reporting standards to increase their validity and improve the reproducibility of animal experiments.

A Meta-Analysis and Systematic Review of the Incidences of Complications Following Facial Thread-Lifting.

BACKGROUND: Facial thread-lifting (FTL) has gained more popularity, but the incidences of complications following FTL remain controversial. We aimed to perform a meta-analysis and systematic review to estimate the incidences of complications and to compare the short- and long-term satisfaction rates following FTL. METHODS: We searched PubMed, Web of Science, Embase and Cochrane library for eligible studies. The primary outcome was the incidences of complications following FTL. The secondary outcome was the satisfaction rate immediately and 6-month after FTL. The pooled incidences of complications and 95% confidence intervals were estimated using random-effects models. RESULTS: A total of 26 studies were included in this meta-analysis. Swelling was the most commonly reported complication with a pooled incidence of 35%, followed by skin dimpling (10%), paresthesia (6%), thread visibility/palpability (4%), infection (2%), and thread extrusion (2%). Absorbable threads were associated with a significantly lower risk of paresthesia (3.1% vs. 11.7%) and thread extrusion (1.6% vs. 7.6%) than non-absorbable threads. Patients older than 50 years had a significantly higher risk of dimpling (16% vs. 5.6%) and infection (5.9% vs. 0.7%) than their younger counterparts. In addition, the pooled long-term satisfaction rate was significantly decreased compared to it immediately after FTL (88% vs. 98%). CONCLUSION: Non-absorbable threads and older age of patients are associated with higher risks of complications. Therefore, we recommend a judicious use of non-absorbable threads and FLT in older patients. Furthermore, it should be discussed with patients preoperatively that the rejuvenation effect of FTL may not maintain in the long-term. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Benign Pediatric Jaw Lesions at Massachusetts General Hospital Over 13 Years.

PURPOSE: To the best of our knowledge, no study has reported pediatric jaw lesions according to the latest World Health Organization (WHO) classification of head and neck tumors. We reviewed the spectrum of benign pediatric jaw lesions treated at the Massachusetts General Hospital during a 13-year period according to the 2017 WHO classification. PATIENTS AND METHODS: We implemented a retrospective cohort study of patients younger than 18 years old with benign bony lesions. The primary predictor variable was the histopathologic diagnosis, grouped into odontogenic tumors (OTs), non-OTs, and odontogenic cysts. The primary outcome variables were the incidence of recurrence and the interval to recurrence. Other outcome variables included symptoms, radiographic findings, and treatment modalities. Descriptive statistics were computed. Kaplan-Meier analyses and Cox regressions were performed. RESULTS: The sample included 131 patients (58 males and 73 females; mean age, 12.6 ± 3.7 years) with 14 pathologic diagnoses. These were grouped as follows: non-OTs (n = 67), OTs (n = 36), and odontogenic cysts (n = 28). Odontogenic cysts were predominantly radiolucent, unilocular, and well-circumscribed cysts compared with the OTs and non-OTs (P < .05). Enucleation was the most commonly performed surgical procedure (72.5%). Adjuvant nonoperative procedures included cryotherapy for 10 patients, interferon therapy for 9 patients, and chemotherapy with denosumab for 3 patients to treat aggressive tumors. The overall incidence of recurrence was 0.77/100 person-years. The Cox hazard ratio of non-OTs/OTs was 3.1 (P = .13) and cysts/OTs was 4.3 (P = .075). Neither the incidence of recurrence nor the interval to recurrence among the 3 groups showed significant differences. A high incidence of recurrence was noted for aggressive central giant cell tumors (39.1%) and odontogenic keratocysts (40%) during a median follow-up of 3 years. CONCLUSIONS: Although pediatric jaw lesions are uncommon, symptoms such as swelling could indicate potential pathologic findings and require panoramic examination. Management of pediatric jaw lesions should consider the biologic behavior of the lesion, maxillofacial development, and growth. Enucleation combined with pharmacologic therapy is a promising strategy for the management of aggressive central giant cell tumors in children.

Long-Term Stability of Condylectomy and Costochondral Graft Reconstruction for Treatment of Idiopathic Condylar Resorption.

PURPOSE: To assess and update long-term outcomes of endoscopic condylectomy and costochondral graft (CCG) reconstruction for treatment of active idiopathic condylar resorption (ICR). PATIENTS AND METHODS: This study is a continuation of a retrospective cohort study of patients with active ICR who underwent bilateral condylectomies and CCG reconstruction from 1999 to 2016. Predictor variables were demographic and operative factors. The primary outcome variable was occlusal stability, as defined by normal overbite (1 to 4 mm) at latest follow-up. Overbite; overjet; the angle formed by the sella, nasion, and B point (SNB); mandibular plane angle; and ramus-and-condyle unit height were measured. Time points were preoperative (T0) and immediate (T1), 1 year (T2), 2 years (T3), 3 to 5 years (T4), and at least 5 years (T5) postoperative. Descriptive and bivariate statistics were computed. A Firth logistic regression model was used to identify variables associated with occlusal instability. RESULTS: Twenty-six patients (25 female; mean age, 23.1 yr) who underwent bilateral endoscopic condylectomies and CCG reconstruction were included: 14 from the original cohort and 12 additional patients for the present analysis. Median follow-up was 3.65 years (range, 1.11 to 17.1 yr). Preoperatively, all patients had a Class II malocclusion with a mean overjet of 6.89 mm (range, 1.2 to 17.1 mm) and a mean anterior open bite of -2.12 mm (range, -0.4 to -7.9 mm). Normal overbite (1 to 4 mm) and overjet (2 to 4 mm) were achieved postoperatively in all patients. There were no significant changes in overjet, overbite, SNB, mandibular plane angle, and ramus-and-condyle unit height from T1 to T4. At latest follow-up, 88.5% of patients had a normal overbite. Three patients developed an anterior open bite postoperatively: 1 at 2 years (0.1 mm; preoperative, -3.4), 1 at 9 years (-0.8 mm; preoperative -7.9), and 1 at 11 years (-1.3 mm; preoperative -1.1). Subjects at T5 (n = 9 of 26) had mean overjet and overbite of 3.48 and 1.56 mm, respectively. Non-white race and follow-up time were significant predictors of occlusal instability in the regression model. CONCLUSIONS: Stable and predictable long-term outcomes can be achieved using endoscopic condylectomy and CCG reconstruction for treatment of active ICR.

The Development of Dual-Degree Programs in Oral and Maxillofacial Surgery: Celebrating the 75th Anniversary of the Journal of Oral and Maxillofacial Surgery and the 100th Anniversary of Our Specialty.

The concept and history of dual-degree residency education and training are reviewed.

Long-Term Effects of Distraction Osteogenesis of the Mandible.

PURPOSE: 1) To assess the fate of the permanent teeth in and adjacent to the regenerate in pediatric patients who underwent mandibular distraction osteogenesis (DO) and 2) to compare the postoperative growth of the distracted mandible with age- and gender-matched controls. PATIENTS AND METHODS: This was a retrospective cohort study of children who underwent mandibular DO during the primary or mixed dentition period and before completion of somatic growth (boys aged ≤14 years and girls aged ≤12 years) at Massachusetts General Hospital from 1996 to 2014. From the DO registry, patients were selected who had complete clinical and radiographic records and at least 1 year of follow-up. Patients with disorders of dental development (eg, ectodermal dysplasia) were excluded. Panoramic radiographs were used to assess changes in morphology, eruption, and orientation of the dentition. Standardized digital lateral cephalograms were used to assess the mandible (sella-nasion-B point, mandibular unit length, ramus height, body length) preoperatively, at the end of distraction, at 1 year after device removal, and at longest follow-up. RESULTS: A total of 118 patients of all ages in the registry underwent some form of DO during the study period. For assessment of the effects on dentition, 26 subjects, who had 36 osteotomies and distraction wounds, met the inclusion criteria. In this sample, 22 of 26 subjects (85%) had 52 adverse effects in 38 of 90 permanent teeth (42.2%) assessed. Cephalometric measurements indicated that there was net mandibular growth at longest follow-up, after a period of skeletal relapse from the end of distraction to 1 year after device removal; however, only 2 of 25 subjects (8%) regained a growth rate in the vector of DO that matched or exceeded normal age- and gender-matched controls. CONCLUSIONS: DO commonly results in adverse effects on the dentition within and adjacent to the DO gap, with only a minority resolving over time. Net growth of the mandible occurs after DO but at a slower rate and lesser magnitude than that of age- and gender-matched controls.

Evaluation of Oral and Maxillofacial Surgery Residents' Operative Skills: Feasibility and Engagement Study Using SIMPL Software for a Mobile Phone.

PURPOSE: There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient. MATERIALS AND METHODS: This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates. RESULTS: From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident. CONCLUSIONS: SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. Additional prospective trials to assess this tool further are planned.

Mandibular Tissue Engineering: Past, Present, Future.

Almost 2 decades ago, the senior author's (M.T.J.) first article was with our mentor, Dr Leonard B. Kaban, a review article titled "Distraction Osteogenesis: Past, Present, Future." In 1998, many thought it would be impossible to have a remotely activated, small, curvilinear distractor that could be placed using endoscopic techniques. Currently, a U.S. patent for a curvilinear automated device and endoscopic techniques for minimally invasive access for jaw reconstruction exist. With minimally invasive access for jaw reconstruction, the burden to decrease donor site morbidity has increased. Distraction osteogenesis (DO) is an in vivo form of tissue engineering. The DO technique eliminates a donor site, is less invasive, requires a shorter operative time than usual procedures, and can be used for multiple reconstruction applications. Tissue engineering could further reduce morbidity and cost and increase treatment availability. The purpose of the present report was to review our experience with tissue engineering of bone: the past, present, and our vision for the future. The present report serves as a tribute to our mentor and acknowledges Dr Kaban for his incessant tutelage, guidance, wisdom, and boundless vision.

Sialadenitis Without Sialolithiasis Treated by Sialendoscopy.

PURPOSE: The aim of the present study was to evaluate the effectiveness of interventional sialendoscopy in the management of non-stone obstructive sialadenitis. PATIENTS AND METHODS: In the present retrospective study, we assessed the treatment outcomes of 51 patients (34 women and 17 men) who had been diagnosed with sialadenitis without salivary duct stones. The included patients had an obstructive duct condition coupled with recurrent episodes of swelling or pain in a major salivary gland. The patients who had a sialolith detected during the sialendoscopic procedure or by preoperative imaging were excluded from the present study. The outcomes assessment was based on successful removal of the obstructive etiology during the endoscopic procedure and the absence of clinical symptoms after 6 months. The involved glands included 16 submandibular glands and 35 parotid glands. RESULTS: The sialendoscopic navigation was successful in 43 of 51 patients (84%). Of the 43 patients, 37 (86%) were free of symptoms from the obstructive gland after the endoscopic procedure. Of the 6 patients who were still symptomatic after the procedure, 5 had involvement of the parotid gland. Finally, 1 of the original 37 symptom-free patients developed recurrent symptoms and denied additional treatment, resulting in 36 of 43 patients (84%) remaining asymptomatic 6 months after endoscopic navigation. CONCLUSION: The outcomes of the present study suggest that interventional sialendoscopy can provide symptomatic improvement in most subjects. Clinicians should consider sialendoscopy as a useful and minimally invasive procedure to treat sialadenitis without sialolithiasis.

Assessment of the OsteoMark-Navigation System for Oral and Maxillofacial Surgery.

PURPOSE: To assess the accuracy of a novel navigation system for maxillofacial surgery using human cadavers and a live minipig model. MATERIALS AND METHODS: We tested an electromagnetic tracking system (OsteoMark-Navigation) that uses simple sensors to determine the position and orientation of a hand-held pencil-like marking device. The device can translate 3-dimensional computed tomographic data intraoperatively to allow the surgeon to localize and draw a proposed osteotomy or the resection margins of a tumor on bone. The accuracy of the OsteoMark-Navigation system in locating and marking osteotomies and screw positions in human cadaver heads was assessed. In group 1 (n = 3, 6 sides), OsteoMark-Navigation marked osteotomies and screw positions were compared to virtual treatment plans. In group 2 (n = 3, 6 sides), marked osteotomies and screw positions for distraction osteogenesis devices were compared with those performed using fabricated guide stents. Three metrics were used to document the precision and accuracy. In group 3 (n = 1), the system was tested in a standard operating room environment. RESULTS: For group 1, the mean error between the points was 0.7 mm (horizontal) and 1.7 mm (vertical). Compared with the posterior and inferior mandibular border, the mean error was 1.2 and 1.7 mm, respectively. For group 2, the mean discrepancy between the points marked using the OsteoMark-Navigation system and the surgical guides was 1.9 mm (range 0 to 4.1). The system maintained accuracy on a live minipig in a standard operating room environment. CONCLUSION: Based on this research OsteoMark-Navigation is a potentially powerful tool for clinical use in maxillofacial surgery. It has accuracy and precision comparable to that of existing clinical applications.

Tissue-engineered bone with 3-dimensionally printed ß-tricalcium phosphate and polycaprolactone scaffolds and early implantation: an in vivo pilot study in a porcine mandible model.

PURPOSE: Deep bone penetration into implanted scaffolds remains a challenge in tissue engineering. The purpose of this study was to evaluate bone penetration depth within 3-dimensionally (3D) printed ß-tricalcium phosphate (ß-TCP) and polycaprolactone (PCL) scaffolds, seeded with porcine bone marrow progenitor cells (pBMPCs), and implanted early in vivo. MATERIALS AND METHODS: Scaffolds were 3D printed with 50% ß-TCP and 50% PCL. The pBMPCs were harvested, isolated, expanded, and differentiated into osteoblasts. Cells were seeded into the scaffolds and constructs were incubated in a rotational oxygen-permeable bioreactor system for 14 days. Six 2- × 2-cm defects were created in each mandible (N = 2 minipigs). In total, 6 constructs were placed within defects and 6 defects were used as controls (unseeded scaffolds, n = 3; empty defects, n = 3). Eight weeks after surgery, specimens were harvested and analyzed by hematoxylin and eosin (H&E), 4',6-diamidino-2-phenylindole (DAPI), and CD31 staining. Analysis included cell counts, bone penetration, and angiogenesis at the center of the specimens. RESULTS: All specimens (N = 12) showed bone formation similar to native bone at the periphery. Of 6 constructs, 4 exhibited bone formation in the center. Histomorphometric analysis of the H&E-stained sections showed an average of 22.1% of bone in the center of the constructs group compared with 1.87% in the unseeded scaffolds (P < .05). The 2 remaining constructs, which did not display areas of mature bone in the center, showed massive cell penetration depth by DAPI staining, with an average of 2,109 cells/0.57 mm(2) in the center compared with 1,114 cells/0.57 mm(2) in the controls (P < .05). CD31 expression was greater in the center of the constructs compared with the unseeded scaffolds (P < .05). CONCLUSION: 3D printed ß-TCP and PCL scaffolds seeded with pBMPCs and implanted early into porcine mandibular defects display good bone penetration depth. Further study with a larger sample and larger bone defects should be performed before human applications.

Bilateral Continuous Automated Distraction Osteogenesis: Proof of Principle.

The purpose of this study was to demonstrate that automated, continuous, curvilinear distraction osteogenesis (DO) in a minipig model is effective when performed bilaterally, at rates up to 3 mm/day, to achieve clinically relevant lengthening. A Yucatan minipig in the mixed dentition phase underwent bilaterally, at a continuous DO at a rate of 2 mm/day at the center of rotation; 1.0 and 3.0 mm/day at the superior and inferior regions, respectively. The distraction period was 13 days with no latency period. Vector and rate of distraction were remotely monitored without radiographs, using the device sensor. After fixation and euthanasia, the mandible and digastric muscles were harvested. The ex vivo appearance, stability, and radiodensity of the regenerate were evaluated using a semiquantitative scale. Percent surface area (PSA) occupied by bone, fibrous tissue, cartilage, and hematoma were calculated using histomorphometrics. The effects of DO on the digastric muscles and mandibular condyles were assessed via microscopy, and degenerative changes were quantified. The animal was distracted to 21 mm and 24 mm on the right and left sides, respectively. Clinical appearance, stability, and radiodensity were scored as "3" bilaterally indicating osseous union. The total PSA occupied by bone (right = 75.53 ±â€Š2.19%; left PSA = 73.11 ±â€Š2.18%) approached that of an unoperated mandible (84.67 ±â€Š0.86%). Digastric muscles and condyles showed negligible degenerative or abnormal histologic changes. This proof of principle study is the first report of osseous healing with no ill-effect on associated soft tissue and the mandibular condyle using bilateral, automated, continuous, and curvilinear DO at rates up to 3 mm/day. The model approximates potential human application of continuous automated distraction with a semiburied device.

Lymphoma mimics obstructive sialadenitis: three cases.

Obstructive sialadenitis is a common salivary gland disorder usually secondary to viral or bacterial infections, sialolithiasis, duct stricture, or mucous plug. The differential diagnosis also should include dehydration, trauma, and scarring secondary to oral mucosal surgical procedures or neoplasm. It is important to consider neoplasm in these patients, especially when symptoms do not resolve as expected after treatment for obstruction. In a series of 591 cases referred to the Massachusetts General Hospital Oral and Maxillofacial Surgery Service for "obstructive sialadenitis" from 2009 through 2012, 3 patients had obstruction secondary to low-grade follicular lymphoma.

Interventional sialoendoscopy for treatment of obstructive sialadenitis.

PURPOSE: This follow-up study documents the overall success rate of interventional sialoendoscopy; it is a novel, less invasive treatment for obstructive sialadenitis. PATIENTS AND METHODS: This was a retrospective follow-up study of 189 patients who underwent a sialoendoscopic procedure at Massachusetts General Hospital from 2004 through 2013. Included were patients who underwent sialoendoscopic treatment for symptoms and clinical findings consistent with obstructive sialadenitis. Four different interventional sialoendoscopic techniques were used: dilation of stricture and irrigation, stone retrieval by basket, stone fragmentation with lithotripsy or laser, and stone removal by endoscopic-assisted "cutdown" operation using the "modified McGurk" technique. The outcome assessed was whether the patient was asymptomatic at 6 months postoperatively. RESULTS: Interventional endoscopic navigation was accomplished in 164 of 189 patients (87%). In 17 cases, the duct orifice was inaccessible owing to scarring, so the duct could not be navigated. Symptomatic relief was achieved in 148 of 164 patients (90%). Dilatation and lavage for sialadenitis without a stone was accomplished in 52 of 189 patients (28%). Sialoliths were retrieved or fragmented in 137 of 164 cases (84%). CONCLUSION: The results of this study show a high success rate in the treatment of obstructive sialadenitis using interventional sialoendoscopy.

Orbital fractures and ocular injury: is a postoperative ophthalmology examination necessary?

PURPOSE: To determine whether formal ophthalmology evaluation is necessary after operative repair of orbital fractures and the association of an ocular injury to the severity of facial injury. PATIENTS AND METHODS: This was a retrospective cohort study of patients with orbital fractures undergoing operative repair from 2005 to 2013. Subjects were included if they had undergone reconstruction of orbital floor fractures and had data from pre- and postoperative examinations by the oral and maxillofacial surgery and ophthalmology services available. The predictor variables included the service performing the ocular examination (oral and maxillofacial surgery or ophthalmology) and the number of fractures present. The outcome variables were the presence of pre- and postoperative ocular injuries. Logistic regression models were used to determine the relationship of the fracture number to ocular injury. RESULTS: A total of 28 subjects had undergone repair of orbital fractures with preoperative and postoperative examinations performed by both services. Preoperative ocular injuries were found in 17 of the 28 subjects. Those detected by oral and maxillofacial surgeons were limited to changes in visual acuity, pupillary response, and extraocular muscle dysfunction in 11 subjects. Two subjects had new postoperative ocular findings that were considered minor and did not alter management. An increasing number of facial fractures was associated with an increased risk of ocular trauma. Those with 3 or more fractures had an odds ratio of 14.625 (95% confidence interval, 2.191 to 97.612, P = .006) for the presence of ocular injury. CONCLUSIONS: Operative repair of orbital fractures did not lead to new ocular injuries that would change the management. Thus, those without preoperative ocular injuries will not require a formal postoperative ophthalmology examination. However, the subjects with more fractures had an increased likelihood of ocular injuries.