Wire loop sinus membrane elevator: a novel instrument for lateral window sinus lift.

This technical note introduces a novel instrument to facilitate lateral window sinus membrane elevation. The fabrication and use of the instrument are reported. The features of this instrument include easy control, good tactile sensation, flexibility in adjusting the instrument, and simple to replicate. Since its introduction, it has been the preferred instrument of our implant surgical trainees. Most importantly, it has proved to be an invaluable teaching tool, as it has helped not only to boost trainee confidence in the procedure, but also in their use of other sinus elevation instruments.

Traumatic asphyxia compounding craniofacial trauma.

Traumatic asphyxia is a condition characterized by cervicofacial petechiae, subconjunctival ecchymosis and other possible accompanying problems particularly ophthalmic, thoracic and cardiovascular injuries. While the facial petechiae per se are of little consequence, the attendant injuries to other organ systems can be serious and even fatal. Craniofacial injuries also present with fatal ecchymosis and haematoma formation due to the underlying skeletal injuries which may require active management. Clinicians managing trauma patients should be well aware of these two different entities which may occur separately or simultaneously so as to ensure correct and adequate treatment.

Serious circulatory disturbance after Le Fort I osteotomy. A case report.

Severe impairment of the blood supply occurred in a patient who underwent a Le Fort I type osteotomy in which the fragment was displaced in a cranio-dorsal direction. Necrosis with sequestration of the torus palatinus present and some permanent parodontal damage ensued. Alternative procedures and management of developing circulatory impairment during surgery are discussed.

Subsequent treatment of chronic recurrent dislocation of the mandible after eminectomies.

A patient with recurrent bilateral dislocation of the mandible of 10 years duration had been treated by bilateral eminectomies. Recurrent dislocation, however, persisted and a LeClerc procedure, using rigid bone plating, was performed as a salvage operation.

Acute osteomyelitis of the maxilla in the newborn.

Acute osteomyelitis of the maxilla in the new born is a rare infective condition of the maxilla which subsequently spreads to include the eye, nasal and oral cavities with their attending signs and symptoms. Possible sequelae include death, ophthalmological, laryngological and dental complications. The organism responsible is usually Staphylococcus aureus and early diagnosis and treatment can result in rapid resolution of the condition.

Orthopantomographic survey.

An orthopantomographic survey was carried out on patients who attended routine dental appointments. The objectives were; to find out the incidence of clinically undetected pathologies and also to ascertain if normal anatomical structures are readily visible on the radiographs. The identification of these structures is important in correct diagnosis and oral surgical procedures. The survey showed that most normal anatomical structures can be positively identified and the inter-examiner consistency was high. The survey also showed that the consistency ratio in detecting dental caries was poor. About 50% of the patients had impacted/non-erupted teeth with female patients having a higher incidence. The percentage of patients with radiolucencies and radiopacities were 11% and 19% respectively. The orthopantomogram was found to be not ideal in measuring bone loss as a high percentage of the proximal surfaces were not measurable.

Retrograde removal of fractured endodontic instruments.

During root canal therapy, accidental fracture of endodontic instruments may occur. While in the majority of such cases the fragment concerned can be retrieved non-surgically, there are some occasions that surgical intervention is needed in order to remove the broken tip lodged within the root canal. In this paper the authors would like to suggest a management approach to this uncommon and extremely unpleasant complication in dental practice.

The geriatric dental patient.

The life expectancy of our citizens has increased due to better living conditions and medical care. This poses new challenges to dental surgeons because geriatric dental patients have different needs brought on by ageing. Tooth loss, periodontal disease, alveolar bone resorption, mucosal changes, edentulism are just some of the problems faced by the elderly. Recognition of the dental needs of this special category of the population compels us to bear the responsibility of treating them now and in the future. We require a gerodontology programme that emphasizes prevention, maintenance of the oral health and understanding of their psychological status.

Intraoral vertical ramus osteotomy.

In corrective surgery for mandibular prognathism, the vertical ramus osteotomy, also known as the vertical subsigmoid osteotomy (VSS) is one of the simplest osteotomy to perform and therefore widely popular with oral & maxillofacial surgeons. Traditionally, the surgical approach for VSS is by the extra-oral approach although the approach may be either extraoral or intraoral. In this paper, the main advantages and disadvantages of the following three techniques, i.e. VSS via extraoral approach, VSS via intraoral approach and the sagittal split ramus osteotomy will be discussed. The vertical ramus osteotomy via the intraoral approach is not usually performed in Singapore until recently. The authors would like to present the observations and a surgical technique employed by them to perform VSS osteotomy via an intraoral approach.

Multiple odontogenic keratocysts of the jaws. Case report.

Single odontogenic cysts are very well documented in the literature. Of those less common reports concerning multiple jaw cysts, many have been associated with systemic conditions or syndromes such as Gorlin-Goltz or basal cell naevus syndrome, Hunter's syndrome and mucopolysaccharidosis, for example, Maroteaux-Lamy syndrome. A case of multiple odontogenic keratocysts unassociated with any syndrome is reported so as to add to the growing number of such cases in the literature. The possibility of this case being a partial expression of the Gorlin-Goltz syndrome is discussed.

Amyloidosis with oral involvement. Case report.

A patient with chronic renal failure was investigated after complaining of oral discomfort which was found to be due to macroglossia and generalized involvement of the oral soft tissues by amyloidosis. A search for multiple myeloma proved to be positive. She also had a previous history of Carpal-tunnel syndrome. Despite an initial good response to treatment with phenylalanine nitrogen mustard (melphalan hydrochloride), she finally succumbed to end-stage renal failure.

Auditory canal haemorrhage following mandibular condylar fracture.

A case of haemorrhage from the external auditory meatus associated with condylar fracture is presented. It is important that haemorrhage from the ear following maxillofacial injuries be investigated thoroughly because displacement of the condyle into the middle cranial fossa also presents in this manner. The patient was treated by intermaxillary fixation and packing of the auditory canal. Packing is not only effective for haemostasis but is also important in preventing subsequent stenosis of the auditory canal.

Radiation dosage of a dental imaging system.

This study compared the radiation dosage necessary for obtaining clinically acceptable images with a new dental imaging system (radiovisiography) to that required with a conventional-film radiographic technique. Results showed that radiovisiography required significantly less radiation exposure, only 22.3% of that used in the conventional technique. Problems, such as lack of flexibility and the limited size of the x-ray-sensitive surface, are associated with radiovisiography; however, the system effectively complements conventional-film radiography.

A new technique of alar base cinching following maxillary osteotomy.

Alar base cinching for the correction of flat and flaring noses was first described about 10 years ago. Its use to correct, without the use of skin incisions, nasal base flaring that results from Le Fort I osteotomy has also been reported. The use of the nasotracheal tube in orthognathic surgery hampers or otherwise affects the use of alar base cinch sutures. A technique is described to effect alar base cinching in a more predictable manner.

Technical modification of the sagittal split mandibular ramus osteotomy.

The sagittal split mandibular ramus osteotomy is a versatile surgical option for the correction of mandibular prognathism, retrognathism, and asymmetry. At the same time, it enables the use of internal rigid fixation. However, surgical complications including injury to the inferior dental neurovascular bundle and unfavorable fracture can occur. A technical modification and a concept in instrumentation is suggested with the view of minimizing such complications.

A comparison of profile changes between ramus and anterior mandibular subapical osteotomies in class III Chinese patients.

The purpose of this study was to compare cephalometrically the differences in soft-tissue profile changes produced by intraoral ramus and anterior subapical osteotomies for the treatment of Chinese patients with class III malocclusion. Thirty-seven Chinese adults whose class III malocclusion was treated either with an intraoral ramus (group A) or an anterior subapical (group B) osteotomy were selected for the study. Serial lateral cephalograms taken presurgically (T1) and at least 6 months postrentention (T2), showed marked improvement in the soft-tissue profile in both groups. Although the percentage response of soft- to hard-tissue movement was similar at lebrale inferius, the response at soft-tissue point B was found to be statistically less in group B than in group A (P less than .05). Although the correlation between the upper lip response to mandibular ramus setback in group A was weak (r = 0.11), there appeared to be a relatively strong correlation between posterior movement of the upper lip and the magnitude of the lower segmental setback (r = 0.65). The differences in soft- to hard-tissue response with the two osteotomy procedures appear to vary with those reported in whites. This study emphasizes the need for different prediction ratios of soft- to hard-tissue movement in different racial types.

Florid osseous dysplasia in Orientals.

Florid osseous dysplasia has been described as a condition that characteristically affects the jaws of middle-aged black women. It usually manifests as multiple radiopaque cementum-like masses distributed throughout the jaws. This condition has also been classified by various authors as sclerosing osteomyelitis, sclerosing osteitis, sclerotic cemental masses, gigantiform cementoma, and various other terms. In this series, we want to document eight cases of florid osseous dysplasia in middle-aged, female ethnic Chinese and one case in an Indian subject on the basis of radiographic and histopathologic findings. On the basis of this series, incidence is estimated to be 0.01 case per year 100,000 population. Florid osseous dysplasia constitutes 11% of cemental lesions in our files.