[Harvesting of autologous bone graft for the mandible: from the hip or the jaw?] / Oogsten van autologe botgraft voor de mandibula: uit heup of kaak?

A 61-year-old edentulous patient presented with dental problems. Examination revealed a very narrow alveolar process in the symphysis area of the chin, with moderate vertical resorption. The decision was made for bone augmentation by means of harvesting an autologous bone graft from the alveolar process. This method can be carried out in an outpatient or day surgery unit and is much more cost effective and less invasive than harvesting an autologous bone graft from the hip area.

[Subcutaneous emphysema in the head and neck region]. / Subcutaan emfyseem in het hoofd-halsgebied.

Subcutaneous emphysema is a relatively harmless finding which is pathognomonic for a mid-facial fracture in most cases. Increasing pressure will cause air to expand beyond the tissues. It is often caused by blowing one's nose, but can also result from intubation in cases of more severe trauma. Crepitus can be heard or felt subcutaneously upon palpitation. Two cases of patients presenting at an oral and maxillofacial unit with extensive emphysema in the head and neck region illustrate both a common and an unusual cause.

[Follicular cyst steadily pushes tooth upwards, with all the consequences thereof]. / Folliculaire cyste drukt gebitselement steeds hoger, met alle gevolgen van dien.

A 60-year-old man was referred to an oral and maxillofacial surgeon with discomfort caused by pressure on the left-hand side of the maxilla. Examination revealed a very elevated third molar in contact with the orbital floor and infundibulum, and, possibly, a follicular cyst. On account of the threat to the orbital floor, it was first decided to decompress the cyst and place an in situ drain. After 4 months, the tooth and cyst could be removed and the diagnosis of a follicular cyst was confirmed.Auteursinformatie.

[The optimal approach to severe facial trauma following a horse's kick]. / Optimale behandeling van ernstig aangezichtstrauma na trap van paard.

A 15-year-old girl was brought to the emergency department of a hospital by ambulance with extensive facial trauma following a horse's kick. The considerable impact resulted in a combination of injuries to the bone, teeth and soft tissue. Following the transfer from the ambulance, the AE physician immediately consulted an oral and maxillofacial surgeon. Consequently, the patient could be brought to the operating theatre almost straight after stabilisation. There, the oral and maxillofacial surgeon first repositioned her teeth in anatomical position, followed by repositioning and fixation of the mandibular fracture. Next, the teeth in the upper front were stabilised with an acid-etch composite splint and the lip was reconstructed.

[Needle breakage during local anaesthesia]. / Naaldbreuk tijdens het geven van lokale anesthesie.

Two patients were referred to a maxillofacial surgeon in connection with the occurrence of needle breakage during local anaesthesia. In the first case, of a 67-year-old woman, it concerned a needle breakage after giving mandibular block anaesthesia. The needle could be removed quite easily under local anaesthesia. The second case concerned a less cooperative patient of 8 years old with whom needle breakage occurred after infiltration anaesthesia in the mucobuccal fold of the maxilla with the so-called QuickSleeper 5, needle breakage. After exact localisation by means of cone beam computerised tomography, the 9 mm size needle was removed under general anaesthesia with some difficulty.

[A solitary, defined radiolucency on a panoramic radiograph; cyst or no cyst?] / Een solitaire, begrensde radiolucentie op de panoramische röntgenopname; wel of geen cyste?

Sharply defined radiolucencies on a panoramic radiograph are often interpreted as cystic laesions. In some cases, however, it appears to be another condition, or an anatomical variation. In the present case, involving 2 healthy patients, 1 or more sharply defined lucencies were seen in the lateral parts of the mandible. After exploration, in both cases, an empty cavity was found without epithelial lining, which is pathognomonic for a simple bone cyst. Multiple occurrences are uncommon.

[Radiolucent and opaque lesions on a panoramic radiograph; a cyst or not?] / Radiolucente en opake laesies op de panoramische röntgenopname; wel of geen cyste?

In the context of pain diagnostics, several lesions, partially radiolucent and partially opaque, were identified by chance in the mandible and maxilla. On the basis of the characteristic x-ray image, it was assumed to be cemento-osseous dysplasia. At an early stage, this cannot easily be distinguished from apical periodontitis. An incorrect diagnosis could lead to needless endodontic treatment.

[A Stafne cyst. A cyst or not?] / De cyste van Stafne. Wel of geen cyste?

In an 80-year-old man, a radiolucent laesion was seen on the panoramic radiograph of the right mandible. The localisation of the radiolucent laesion under the mandibular canal and the additional finding of fatty tissue or submandibular salivary gland in the concavity on the cone beam computed tomography are virtually probative for a Stafne cyst.

The use of Straumann Bone Ceramic in a maxillary sinus floor elevation procedure: a clinical, radiological, histological and histomorphometric evaluation with a 6-month healing period.

OBJECTIVES: In this study, we evaluated the quality and quantity of bone formation in maxillary sinus floor elevation procedure using a new fully synthetic biphasic calcium phosphate (BCP) consisting of a mixture of 60% hydroxyapatite and 40% of beta-tricalcium phosphate (Straumann Bone Ceramic). MATERIAL AND METHODS: A unilateral maxillary sinus floor elevation procedure was performed in six patients using 100% BCP. Biopsy retrieval for histological and histomorphometric analysis was carried out before implant placement after a 6-month healing period. RESULTS: In this study, the maxillary sinus floor elevation procedure with the use of BCP showed uneventful healing. Radiological evaluation after 6 months showed maintenance of vertical height gained immediately after surgery. Primary stability was achieved with all Straumann SLA dental implants of 4.1 mm diameter and 10 or 12 mm length. The implants appeared to be osseointegrated well after a 3-month healing period. Histological investigation showed no signs of inflammation. Cranial from the native alveolar bone, newly formed mineralized tissue was observed. Also, osteoid islands as well as connective tissue were seen around the BCP particles, cranial from the front of newly formed mineralized tissue. Close bone-to-substitute contact was observed. Histomorphometric analysis showed an average bone volume/total volume (BV/TV) of 27.3% [standard deviation (SD) 4.9], bone surface/total volume (BS/TV) 4.5 mm(2)/mm(3) (SD 1.1), trabecula-thickness (TbTh) 132.1 mum (SD 38.4), osteoid-volume/bone volume (OV/BV) 7.5% (SD 4.3), osteoid surface/bone surface (OS/BS) 41.3% (SD 28.5), osteoid thickness (O.Th) 13.3 mum (SD 4.7) and number of osteoclasts/total area (N.Oc/Tar) 4.4 1/mm (SD 5.7). CONCLUSIONS: Although a small number of patients were treated, this study provides radiological and histological evidence in humans confirming the suitability of this new BCP for vertical augmentation of the atrophied maxilla by means of a maxillary sinus floor elevation procedure allowing subsequent dental implant placement after a 6-month healing period. The newly formed bone had a trabecular structure and was in intimate contact with the substitute material, outlining the osteoconductive properties of the BCP material. Bone maturation was evident by the presence of lamellar bone.

[Haematoma of the floor of the mouth following implant surgery]. / Hematoom in de mondbodem na een implantaatbehandeling.

A patient experienced severe bleeding in the floor of the mouth as a consequence of the placement of 2 implants in the resorbed anterior segment of the mandible. The resulting swelling of the floor of the mouth caused a life-threatening obstruction of the trachea. The patient was urgently transferred to a hospital. Treatment there consisted of the administration of medication and intensive observation. In the literature an intubation or the carrying out of a tracheotomy with possible surgical interventions is also described. The cause lay in damage to the lingual cortical plate of the mandible and trauma of the underlying vascular structures. Especially the cuspid and bicuspid regions are vulnerable because of the often seen lingual concavity in the processus alveolaris. Serious atrophy of the processus alveolaris is also a predisposition. To reduce the probability of such complications knowledge of the local anatomy, good clinical inspection and various radiographic evaluations are important. In case of obstruction of the trachea it is of vital importance to immediately transport the patient to the nearest hospital for further treatment.

[Surgical dilemmas. Sinus floor elevation]. / Chirurgische dilemma's. De sinusbodemelevatie.

Limited alveolar bone height prevents the placement of dental implants. Sinus floor elevation is an internal augmentation of the maxillary sinus that allows implants to be placed. The principle of this surgical procedure is the preparation of a 'top hinge door', that is raised together with the Schneiderian membrane in the cranial direction. The space which created under this lid is filled with a bone transplant. Autogenous bone is the standard transplant material, despite the fact that a second surgery site is necessary. Under certain circumstances bone substitutes can be used, with a longer healing phase. If sufficient alveolar bone height is available to secure implant stability, simultaneous implantation and sinus floor elevation are possible. Considering the significant anatomical variation in the region of the maxillary sinus, a sound knowledge of the anatomy is of great importance.

[Mediastinitis and cervical fasciitis necroticans post extraction of 2 molars]. / Mediastinitis en cervicale fasciitis necroticans na extractie van 2 molaren.

A 38-year-old man developed dysphagia, fever and marked trismus, resulting in an abcess of the parafaryngeal region, soon after the surgical extraction of 2 mandibular molars. Despite systemic antibiotics and surgical drainage, the abcess spread to the mediastinum. Within a short space of time, cervical fasciitis necroticans and descending necrotizing mediastinitis developed. Because of the life-threatening health condition, the patient was admitted to a hospital for further treatment. He underwent surgical exploration of the cervical and sternal region, thoracotomy for mediastinal drainage, debridement, and daily mediastinal rinsing with hydrogen peroxide and betadine iodine. After 5 weeks intensive treatment, the patient could be discharged from the hospital in a fairly good condition of health.

[Pre-implantation surgery of the atrophied maxilla. A review of the literature]. / Pre-implantologische chirurgie bij de geatrofieerde bovenkaak. Een overzicht van de literatuur.

The aim of preprosthetic reconstructive surgery of the resorbed maxilla is to create sufficient bone of good quality for implant placement. The classification of the edentulous jaws by Cawood and Howell is mostly used as point of departure in planning preprosthetic reconstructive surgery. In this review article some procedures and results are mentioned as described in recent literature.

Management of posttraumatic malocclusion caused by condylar process fractures.

PURPOSE: The aim of the study was to evaluate the results of orthognathic surgery in cases with posttraumatic malocclusion as a long-term complication of condylar process fractures. PATIENTS AND METHODS: A retrospective study on 21 patients with posttraumatic malocclusions attributable to condylar process fractures was performed. In group I, 15 patients were treated for asymmetric malocclusion with unilateral or bilateral mandibular ramus osteotomies. In group II, six patients were treated for anterior open bit with either a Le Fort I osteotomy (n=5) or a bilateral ramus osteotomy (n=1). All patients had clinical and radiographic follow-up for at least 1 year. RESULTS: Stable dental and cephalometric results were obtained in all patients except the one in group II who was treated with bilateral sagittal split osteotomies. In two cases, both in the asymmetric group, minor occlusal interferences had to be treated by equilibration in the early postoperative period. CONCLUSIONS: Orthognathic surgery is a predictable and stable method for the treatment of posttraumatic malocclusion due to condylar process fractures. Maxillary orthognathic surgery is successful in correcting symmetric anterior open bites due to bilateral condylar process fractures. Because posttraumatic malocclusion is a rare complication after closed treatment of condylar process fractures, and it can be treated satisfactorily using orthognathic surgery, routine open reduction and fixation of condylar process fractures is not indicated to prevent posttraumatic malocclusion.

Preoperative antibiotic prophylaxis in orthognathic surgery: a randomized, double-blind, and placebo-controlled clinical study.

PURPOSE: This study evaluated the need for antibiotic prophylaxis in orthognathic surgery. PATIENTS AND METHODS: Fifty-four patients (age range, 18 to 40 years) underwent bimaxillary orthognatic surgery. After randomization, a placebo (n = 19), 2,200 mg amoxicillin-clavulanic acid (n = 18), or 1,500 mg cefuroxime (n = 17) was administered in a double-blind fashion. During the first month, the postoperative course was observed according to the clinical parameters of infection, total leukocyte count and erythrocyte sedimentation rate (ESR). RESULTS: Fifteen of 54 patients developed a wound infection. Of these, 10 had received a placebo; 3, cefuroxime; and 2, amoxicillin-clavulanic acid. CONCLUSIONS: There was a statistically significant (P<.004) increased risk of having an infectious complication after bimaxillary orthognathic surgery without antibiotic prophylaxis. No significant difference in the incidence of infectious complications was found between the 2 medications.