Importance of patient's cooperation in surgical treatment for oral submucous fibrosis.

PURPOSE: The aim of this study was to investigate the results of surgical treatment for oral submucous fibrosis (OSF) in patients who did or did not cooperate with the rehabilitation regimen. PATIENTS AND METHODS: There were 54 patients who had surgical treatment of trismus caused by OSF. Split-thickness skin grafts were used to repair surgical defects after surgery on the fibrous bands. According to postoperative collaboration in the rehabilitation regimen, patients were defined as non-cooperative patients (group I) and cooperative patients (group II). Group I (n = 28) and group II (n = 26) were analyzed separately for changes in preoperative, intraoperative, and postoperative interincisal distances (ID) for at least 6 months after surgery. RESULTS: The mean preoperative ID was 18.9 mm (range, 8 to 25 mm) in group I and 18 mm (range, 7 to 25 mm) in group II. The intraoperative ID increased to an average of 39 mm in group I and 38.5 mm in group II. The mean final follow-up ID was 22 mm in group I and 36.1 mm in group II. When evaluating the changes of ID, only a statistically significant difference was found at final visit between groups. CONCLUSIONS: In our study, we found the patient's cooperation is the primary requirement for success in the treatment of OSF.

Intraoral vertical ramus osteotomy for correction of mandibular prognathism: long-term stability.

Various techniques and modifications have been introduced in the treatment of mandibular prognathism. However, there are still few reports concerning long-term stability, especially using the intraoral vertical ramus osteotomy (IVRO) method. The purpose of this study was to investigate the long-term stability for correction of mandibular prognathism using IVRO. Twenty-five mandibular prognathism patients were treated by bilateral IVRO, and were evaluated cephalometrically by reference to the menton. A set of 3 standardized lateral cephalograms were obtained from each subject preoperatively (T1), immediately postoperatively (T2), and after 2 years postoperatively (T3). Relapse was defined as forward movement of menton after the 2-year follow-up. The mean setback of the menton was 12.8 mm in horizontal direction and 0.9 mm downward in vertical direction. The average follow-up was 33.9 months. The mean relapse was 1.3 mm (10.2% = 1.3 of 12.8) in forward direction and 0.6 mm in upward direction. There was no significant movement in the vertical direction. However, significant relapse was shown in the horizontal direction, even though the amount was small. The long-term stability of our present study suggested that IVRO is useful for correction of mandibular prognathism.

Proximal tibial bone harvesting under local anesthesia without intravenous sedation in the dental office: a case report.

Maxillary sinus enlargement often occurs in the maxillary posterior edentulous area and reduces the available bone height for implantation. Therefore, maxillary sinus lift and bone graft procedures are necessary to provide sufficient available bone. Autogenous bone grafting is the best base for implant osseointegration. Recently, tibial bone has been recognized as an alternative extraoral donor site. We present a case in which we used a proximal tibia bone graft for maxillary sinus augmentation under local anesthesia without sedation in the dental office. During a 4-year postoperative follow-up, gait was not disturbed and the scar on the donor site remained unremarkable.

Artificial dermis graft on the mandible lacking periosteum after excision of an ossifying fibroma: a case report.

Collagen-based grafts have often been used as artificial tissue substitutes for the repair of tissue and organ defects. It is common surgical knowledge that autogenous or artificial skin grafts take well on the intact periosteum of bone. However, many experienced surgeons indicate that autogenous or artificial skin grafts subsist poorly on the bone surface without periosteum. Therefore, primary closure is usually recommended in the wound healing of exposed bone. Vestibuloplasty might be needed to create enough depth of vestibule in the future. In this case report, we describe a peripheral ossifying fibroma surgically excised leaving a bony defect, which was covered by a piece of artificial dermis. Satisfactory result of the repaired surgical defect showed no need of vestibuloplasty after 6 years of follow-up.

Surgical management of accidentally displaced mandibular third molar into the pterygomandibular space: a case report.

Surgical removal of the mandibular third molar is a regular surgical procedure in dental clinics, and like all operations, it may have some complications, such as infection, bleeding, nerve injuries, trismus and so on. An accidentally displaced lower third molar is a relatively rare complication, but may cause severe tissue injury and medicolegal problems. As few papers and cases have been published on this topic, we report this case to remind dentists on ways to prevent and manage this complication. The patient, a 28-year-old male, had his right lower mandibular third molar extraction in January 2006. The dentist resected the crown and attempted to remove the root but found that it had suddenly disappeared from the socket. Assuming that the root had been suctioned out he closed the wound. The patient was not followed up regularly because he studied abroad. About 3 months later, the patient felt a foreign body sensation over his right throat, and visited a local hospital in Australia. He was told after a computed tomography (CT) scan that there was a root-like radio-opaque image in the pterygomandibular space. The patient came to our hospital for further examination and management in June 2006. We rechecked with both Panorex and CT and confirmed the location of the displaced root. Surgery for retrieving the displaced root was performed under general anesthesia by conventional method without difficulty, and the wound healed uneventfully except for a temporary numbness of the right tongue. This case reminds us that the best way to prevent a displaced mandibular third molar is to evaluate the condition of the tooth carefully preoperatively, select adequate instruments and technique, and take good care during extraction. If an accident does occur, dentists should decide whether to retrieve it immediately by themselves or refer the case to an oral and maxillofacial surgeon, and should not try to remove the displaced root without proper assurance. Localization with images and proper surgical methods are the keys to retrieving the displaced fragment successfully. When immediate retrieval is decided on, Panorex and occlusal view are useful in localizing the displaced fragment. When the fragment moves into a deeper space or the retrieval has been delayed for months, three-dimensional CT seems to be a better choice.

Interdisciplinary management of dental implant patient: a case report.

Maxillary molars can over-erupt when their antagonists are lost and there are no replacements. When the opposing molars severely extrude into the edentulous space, it is difficult to replace the missing teeth with either fixed or removable prostheses. We present the following case report, providing a solution for this type of problem. A two-stage posterior subapical osteotomy was used to reestablish the intermaxillary space. Following orthodontic treatment and implant placement, the patient regained occlusal harmony and normal masticatory function.

Caldwell-Luc procedure for retrieval of displaced root in the maxillary sinus.

OBJECTIVE: The aim of this study was to describe the standard diagnostic procedure and the application of the Caldwell-Luc approach for the retrieval of a displaced root from the maxillary sinus and to share our experience in treating this complication. STUDY DESIGN: Twenty-four patients with a fractured root accidentally displaced into the maxillary sinus were referred by general dentists to our department from 2005 to 2008. All were managed by a standardized diagnostic procedure and a Caldwell-Luc approach. We recorded the age of each patient, the gender, the tooth, the size of root fragment, the type of displacement the delay between displacement and retrieval, the length of operating time, and any complications. RESULTS: Over a 4-year period, we treated 24 patients, 14 being male and 10 female. Ages ranged from 14 to 55 years (average 26.4). The commonest tooth involved was the maxillary first molar; the length of the root fragments ranged from 3 to 7 mm. Seventeen of these roots were mobile and 7 fixed (4 being located between the sinus membrane and the bone and 3 immobilized by the sinus membrane. Twenty-three of the operations were completed in 30 minutes, and only 2 patients had a temporary complication of sinusitis. No infraorbital paresthesia occurred. CONCLUSIONS: The standardized diagnostic procedure and Caldwell-Luc approach for the retrieval of a displaced root form the maxillary sinus is a safe, simple, and fast method with minimal complications.

Gap coronoidotomy for management of coronoid process hyperplasia of the mandible.

Patients with coronoid process hyperplasia of the mandibular area are rare. The treatment of this disease is to increase the patient's mouth opening by surgery. There are various, but controversial, methods to treat it. We present a modified (gap) coronoidotomy procedure in detail and compare it with other conventional methods to treat coronoid process hyperplasia.

Mucoceles of the oral cavity in pediatric patients.

Mucoceles are quite common in the oral cavity, but reports on pediatric patients are very rare. The aims of this study were to present our data and experience in the treatment of mucoceles of the oral cavity in pediatric patients, to compare them with those of other countries, and to remind the pediatric physician to devote much attention to lesions of the oral cavity in children. This retrospective study is based on the record of the patients who received surgical treatment for mucoceles of the oral cavity with pathologic confirmation at the Department of Dentistry, Kaohsiung Medical University Hospital, Taiwan, between 2000 and 2004. Patients younger than 18 years were included in this study. The analyzed data included age, gender, site, size, histopathologic findings, surgical methods, and complications. There were a total of 289 patients with mucoceles confirmed by histopathologic examination. As many as 64 patients were younger than 18 years. Of the 64, 34 were girls and 30 were boys; 89.1% of the lesions were in the lower lip; and 48.4% of the lesions were less than 5mm in diameter. Histopathologic findings showed that all mucoceles were of the extravasation type. As many as 30 patients were treated by carbon dioxide laser vaporization, and two cases recurred (6.67%); 34 patients were treated by surgical excision, and the recurrence rate (5.88%) was not statistically different for the treatment methods. The laser vaporization has the advantage of less bleeding, no sutures, and saving time, especially suitable for children with oral mucocele.

Splint therapy for disc displacement with reduction of the temporomandibular joint. part I: modified mandibular splint therapy.

The aims of this preliminary study were to present a modified mandibular splint together with a treatment regimen and to evaluate their effects on the treatment of reciprocal joint sounds of the temporomandibular joint (TMJ). The study participants were recruited from 312 consecutive patients in the temporomandibular disorder clinic of a medical center in Taiwan from January 2003 to December 2003. From among these, 59 cases with typical reciprocal clicking were selected for this study. All participants were treated with a modified mandibular splint and then followed up for 6 months. Successful treatment was defined as leading to the disappearance of the joint sounds of TMJ, as described by patients. Based on clinical evaluation, the overall success rate was 71.2% (42/59) with minimal temporary complications. Patients with clicking at less than 3.5 cm of interincisal opening had a success rate of 92.5%, which was higher than the success rate of patients with clicking at a mouth opening of 3.5 cm or more. This study showed that a modified mandibular splint can be used to treat reciprocal clicking of the TMJ effectively and encouraged us to conduct further study on the efficacy of this splint to treat disc displacement with reduction of TMJ using magnetic resonance imaging examination.

Extensive subcutaneous emphysema after extraction of a mandibular third molar: a case report.

Surgical emphysema is an uncommon but potentially serious complication of third molar removal and other oral procedures. The purpose of this case report is to remind dentists of the risk of surgical emphysema. Surgical emphysema developed in a 32-year-old female after removal of a mandibular third molar using a high-speed dental hand-piece. Because of the extent of the swelling, the patient was admitted for observation. Because of progressive swelling, a submandibular surgical incision and drainage was performed, which led to rapid resolution. The diagnosis and differential diagnosis of surgical emphysema are discussed to draw dentists' attention to the management and prevention of this complication.

Interdisciplinary management of unfavorable posterior intermaxillary space.

The patient was a case of severe dentoalveolar extrusion of the right maxillary posterior segment due to early loss of mandibular molars. Therefore, it is difficult to replace the missing teeth with either fixed or removable prostheses. Her occlusion was Angle Class II malocclusion and no mandibular molars for anchorage on the right side. A posterior maxillary subapical osteotomy was utilized for reestablishing the intermaxillary space. A titanium alloy miniplate placed in the right mandible provide skeletal anchorage to distalize the anterior mandibular teeth. Dental implants were placed to restore masticatory function.

The displaced lower third molar: a literature review and suggestions for management.

PURPOSE: To review the literature associated with displaced lower third molars, to introduce a modified method of retrieval of an accidentally displaced lower third molar tooth or root fragment, and to recommend rational guidelines for management. MATERIALS AND METHODS: A review of the literature was performed to record the types of displacements, patient's personal data, imaging used, and the surgical approaches with their complications. A modified technique for exploration and retrieval is described. RESULTS: Nineteen reports were identified and reviewed. Some others could not be translated. In the 32 cases reviewed, there were no gender differences and the third and fourth decades of life were the most common time for this mishap to occur. Fragments were displaced into 5 different tissue spaces. The size of the fragments varied, but the whole tooth and fragment were displaced with equal frequency. Different methods of recovery were used. CONCLUSION: The accidental displacement of a lower third molar during attempted extraction is a rare but potentially serious complication. Retrieval should be effected as soon as possible. Because of differences in the direction of displacement, the size of fragment, delay in retrieval, and tissue reactions, no one technique is uniformly applicable. The modified method we suggest appears to save time and have few complications.

Surgical management of ameloblastoma in children.

OBJECTIVE: The purpose of this study was to report experience in the treatment of ameloblastoma in Taiwanese children and to discuss the treatment regimen. STUDY DESIGN: Fifteen patients, all younger than 18 years of age, with a diagnosis of ameloblastoma in our department between January 1991 and December 2004 were selected for study. Data included sex, age at surgery, tumor type, size and site of lesion, primary surgical methods, use of adjuvant therapy, complications, recurrences, and course of follow-up. RESULTS: Ages ranged from 9 to 17 (average was 13.7 years). Nine were male, 6 were female; the sex ratio was 1.5:1. Fourteen lesions were in the mandible (1 in the symphysis, 13 in the mandibular posterior area) and only 1 was in the maxilla. The size of the lesions ranged from 4 x 2.5 cm to 8 x 8 cm. Clinical typing included 8 unicystic type, 3 multicystic type, and 4 solid types. Of the histologic types, 5 were plexiform, 3 were mixed type, and 3 were acanthomatous type. Complications included numbness of the lower lip and contour defect of the face. Three cases (20%) were recurrent, and 1 patient had 2 recurrences. CONCLUSIONS: Good results can be achieved in the treatment of ameloblastoma in children using conservative surgery. In the event of recurrence, a second surgery can be successful. Patient compliance and careful follow-up are important.

Skeletal changes after modified intraoral vertical ramus osteotomy for correction of mandibular prognathism.

BACKGROUND: Orthognathic surgery is widely used to correct congenital and acquired dentofacial discrepancies. Various surgical procedures have been advocated for correction of mandibular prognathism. In this study, a modified intraoral vertical ramus osteotomy has been developed for surgical correction of mandibular prognathism. The aim of this study is to identify contributing factors to skeletal change by analysing cephalometric changes after modified intraoral vertical ramus osteotomy. METHODS: Forty-one patients, treated for absolute mandibular prognathism by bilateral modified intraoral vertical ramus osteotomy, were evaluated cephalometrically with reference to the menton point. A set of four standardised lateral cephalograms were obtained from each subject preoperatively (T1) and immediately postoperatively (T2), prior to removal of maxillomandibular fixation (T3), and at 1-year postoperatively (T4). The mean setback of the menton was 12.4 mm in the horizontal direction. Relapse was defined as forward movement of the menton during the 1-year follow-up. RESULTS: The highly significant backward movements in a horizontal direction were observed during the maxillomandibular fixation period (T3-T2). Moreover, highly significant forward movement was observed following the maxillomandibular fixation period (T4-T3). After 1-year follow-up (T4-T2), the mean changes of the menton were 0.1 mm backward in the horizontal direction. CONCLUSIONS: In this series, the mean skeletal change compared with the amount of setback was less than 1% (0.1/12.4 mm) in backward movement. The results suggest that the modified intraoral vertical ramus osteotomy technique is useful and the more stable approach for correction of severe mandibular prognathism.

The use of miniplate osteosynthesis for skeletal anchorage.

BACKGROUND: The purpose of this study was to explore the use of miniplates as skeletal anchorages for orthodontic treatment and to investigate the stability of miniplates and the causes of failure. METHODS: Forty-four miniplates were applied in the maxilla or mandible as skeletal anchorages in orthodontic treatment. Two weeks later, a force of 100 to 200 g was applied by an elastometric chain or nickel-titanium coil spring to move the teeth. To compare nominal variables related to miniplate failure, the chi-square or Fisher's exact test was used. RESULTS: The average insertion time of a miniplate was approximately 25 to 30 minutes. One miniplate loosened before orthodontic force loading. The other miniplate was removed after orthodontic force loading. The overall success rate was 95.5 percent. The authors found no significant differences in the risk factors for failure of miniplates. CONCLUSIONS: Miniplates are easy to insert for skeletal anchorage, simplify treatment mechanics, and shorten the orthodontic treatment period.

Donor site morbidity after harvesting of proximal tibia bone.

BACKGROUND: Bone-grafting procedures are common in head and neck surgery. Donor site morbidity is an important factor in deciding the site for harvest of cancellous bone. The tibia has been recommended as a harvest site. Use of the proximal tibia as a donor site is associated with few complications. Our present study used proximal tibia bone grafts to reconstruct maxillofacial defects and augment bone volume for implantation. METHODS: A retrospective study was undertaken to analyze 40 proximal tibia bone grafts in maxillofacial reconstruction. Minimal follow-up was 6 months. RESULTS: There were no major complications during the follow-up period. Early minor complications (15%) included temporary sensory loss and ecchymosis. Late minor complication (2.5%) was gait disturbance for 2 months. Long-term minor complication (2.5%) was an unsightly scar. CONCLUSION: The procedure for proximal tibia bone graft is easy, has less operative risk, and results in a lower postoperative morbidity rate. Based on our findings, we believe the proximal tibia offers a reliable site for harvest of sufficient quantities of good-quality cancellous bone.

The use of microimplants in orthodontic anchorage.

PURPOSE: Various types of temporary implants have been introduced to serve as orthodontic anchorage. The hypothesis of this study is that microimplants of 1.2 mm diameter can be used as orthodontic anchors, and that their success is related to their length. The aim of this study is to determine the incidence of anchor retention after orthodontic force application for moving teeth, and to determine the relationship of microimplant length to retention rate. METHODS: Fifty-nine microimplants (diameter: 1.2 mm) were placed in 29 patients as orthodontic anchorages. After 2 weeks of microimplant placement, a force of 100 to 200 g was loaded with an elastometric chain or NiTi coil spring. Risk factors were characterized as to why a microimplant may fail, and Fisher's exact test was used for statistical analysis. RESULTS: Nine microimplants were removed and the overall success rate was 84.7%. Exploring the causes for failure, we found significant differences between the length of microimplants and success rate; 6 mm was 72.2% and 8 mm was 90.2%. CONCLUSIONS: The results suggest that microimplants are suited as an alternative orthodontic anchorage. We recommend that 8-mm microimplants are preferable to 6-mm.