The anatomical pattern of ductal arborization in parotid glands using cone-beam computerized sialography.

Cone-Beam Computed Tomography-Sialography (Sialo-CBCT) is used to demonstrate salivary ductal structure. This study aimed to conduct a volumetric analysis of the anatomical morphology of Normal-Appearing Glands (NAGs) in parotid sialo-CBCT. Our retrospective study included 14 parotid sialo-CBCT scans interpreted as NAGs in 11 patients with salivary gland impairment. The main duct length and width, as well as number and width of secondary and tertiary ducts were manually evaluated. We found that the main parotid duct showed an average width of 1.39 mm, 1.15 mm, and 0.98 mm, for the proximal, middle and distal thirds, respectively. The arborization pattern showed approximately 20% more tertiary (average number 11.1 ± 2.7) than secondary ducts (average number 9.0 ± 2.4) and approximately 8% narrower tertiary ducts (average width 0.65 ± 0.11 mm) compared to the secondary ducts (average width 0.77 ± 0.14 mm). Our anatomical analysis of NAGs in parotid sialo-CBCT demonstrated progressive narrowing of the main duct and increasing arborization and decreasing lumen size starting from the primary to the tertiary ducts. This is the most updated study regarding the anatomy of the parotid glands as demonstrated in sialo-CBCT. Our results may provide clinicians with the basic information for understanding aberration from normal morphology, as seen in salivary gland pathologies as well facilitate planning of treatment strategies, such as minimally invasive sialo-endoscopies, commonly practiced today.

Chondrocytes supplemented to bone graft-containing scaffolds expedite cranial defect repair.

Critical maxillofacial bone fractures do not heal spontaneously, thus, often there is a need to facilitate repair via surgical intervention. Gold standard approaches, include the use of autologous bone graft, or devices supplemented with osteogenic growth factors and bone substitutes. This research aimed to employ a critical size calvaria defect model, to determine if the addition of chondrocytes to collagen-containing bone graft substitute, may expedite bone repair. As such, using a critical size rat calvaria defect, we implanted a collagen scaffold containing bone graft substitute (i.e., Bone graft scaffold, BG) or BG supplemented with costal chondrocytes (cBG). The rats were subjected to live CT imaging at 1, 6, 9, and 12 weeks following the surgical procedure and sacrificed for microCT imaging of the defect site. Moreover, serum markers and histological evaluation were assessed to determine osseous tissue regeneration and turnover. Live CT and microCT indicated cBG implants displayed expedited bone repair vs, BG alone, already at 6 weeks post defect induction. cBG also displayed a shorter distance between the defect edges and greater mineral apposition distance compared to BG. Summerizing, the data support the addition of chondrocytes to bone substitute, accelerates the formation of new bone within a critical size defect.

Repairing a critical cranial defect using WISP1-pretreated chondrocyte scaffolds.

In cranial flat bone fractures, spontaneous bone repair will occur only when the fracture ends are in close contact. However, in cases wherein bone discontinuity is extensive, surgical interventions are often required. To this end, autologous bone is harvested and surgically integrated into the site of fracture. Here we propose to use cartilage, as an alternative autologous source, to promote cranial fracture repair. The advantage of this approach is the potential reduction in donor site morbidity, likely due to the avascular and aneural nature of cartilage. As a first step we attempted to induce cartilage mineralization in vitro, using micromass primary chondrocyte cultures, incubated with BMP2 and/or WISP1, which were examined histologically following a 3-week culture period. Next, chondrocyte seeded collagen scaffolds were evaluated in vitro for expression profiles and ALP activity. Finally, chondrocyte-seeded collagen scaffolds were implanted in a Lewis rats 8 mm critical calvaria defect model, which was imaged via live CT for 12 weeks until sacrifice. End points were analyzed for microCT, histology, and serum levels of bone related markers. Micromass cultures exhibited an osseous inducing trend following WISP1 administration, which was maintained in chondrocyte seeded scaffolds. Accordingly, in vivo analysis was carried out to assess the impact of WISP1-pretreated chondrocytes (WCS) versus untreated chondrocytes (UCS) in calvaria defect model and compared to untreated control comprised of a defect-associated blood clot (BC) or empty collagen scaffold (CS) implant. Live CT and microCT exhibited higher mineralization volumes in critical defect implanted with UCS, with some structural improvements in WCS. Histological analysis exhibited higher anabolic bone formation in WCS and trabecular bone was detected in WCS and UCS groups. Chondrocytes implanted into critical cranial defect expedite the formation of native-like osseous tissue, especially after WISP1 priming in culture. Ultimately, these data support the use of autologous chondrocytes to repair critical maxillofacial defects.

"Proportional Condylectomy" for Vertical Condylar Hyperplasia Without Intermaxillary Elastics: Clinical Results and Patient Satisfaction.

OBJECTIVES: First, to investigate the clinical outcome of 'proportional condylectomy' for patients with active unilateral condylar hyperplasia without complementary treatment by intermaxillary elastics and, second, to examine their level of satisfaction regarding function and esthetics. STUDY DESIGN: A retrospective observational descriptive study was conducted. All patients included in the study suffered from active unilateral condylar hyperplasia with a vertical component. The length of the condylar-ramus unit was measured on both sides by an multidetector computed tomography scan. The difference was calculated and resected from the hyperplastic condyle during the operation. Facial, occlusal, and skeletal changes were evaluated using photographic and radiologic records, and a satisfaction questionnaire regarding function and esthetics was completed. P <0.05 was considered significant. RESULTS: Fifteen patients were included in the study. The mean participants' age was 27.93±13.06 years, and the mean follow-up duration was 12.40±6.55 months. The mean chin deviation improved by 58.47% ( P =0.001). Mean lip commissure plane tilt was improved by 61.31% ( P =0.001). Six months postoperatively, all patients exhibited centered dental midlines ( P =0.001). Occlusal plane tilt was significantly improved by 70.02% ( P =0.001), and high patient satisfaction was recorded. Twenty-six percent (4/15) of patients did not require the complementary orthodontic treatment, and none of them required complementary orthognathic surgery. CONCLUSIONS: 'Proportional condylectomy' for patients with active unilateral vertical condylar hyperplasia without complementary treatment by intermaxillary elastics is a predictable procedure in terms of function and esthetics.

Short Dental Implants (5 to 7 mm) with Expandable Apex in the Posterior Maxilla-Preliminary Results.

PURPOSE: The purpose of this study was to examine whether the use of short dental implants with an expandable compressive design could be a proper alternative to the conventional sinus elevation procedure in cases of deficient alveolar ridge height in the posterior maxillary area. MATERIALS AND METHODS: Fifty patients with 73 short dental implants with an expandable compressive design who were treated for posterior maxillary alveolar ridges of 5 to 7 mm in the vertical dimension between 2012 and 2018 were included in a retrospective study. All patients had a minimum postrehabilitation period of 1 year. Patient demographics, implant properties, primary stability, and implant success and survival rates were analyzed. RESULTS: The total success rate was 97.2%, with two failed implants at implant uncovering. The mean bone loss was 1.03 mm. No difference in bone loss was found between sexes or age groups. CONCLUSION: The results of this study suggest that short dental implants with an expandable apical compressive design could be an alternative to sinus elevation procedures in selected cases of vertically deficient maxillary alveolar ridges.

Salivary Gland Heterotopia, a Clinical and Pathological TNM Staging Challenge - Carcinoma ex Pleomorphic Adenoma Arising in a Parotid Lymph node.

INTRODUCTION: Heterotopia is the presence of a particular tissue / tumor at a non-physiological / ectopic site. The study primary goals: To review the current data investigating heterotopic, normal appearing, and diseased salivary gland tumors, in lymph nodes. To describe the meticulous pathological investigation and multidisciplinary decision-making process of a heterotopic carcinoma ex pleomorphic adenoma arising in an intra-parotid lymph node. MATERIALS AND METHODS: A literature search in the "PubMed" database using key words "carcinoma ex pleomorphic adenoma", "parotid lymph node", "salivary gland" and "heterotopia" was conducted. We describe the thorough pathological investigation and clinical decision-making process, focusing TNM staging system limitations. RESULTS: A few case reports presented either normal appearing salivary tissue, benign tumors or low and high-grade salivary malignancies arising in lymph nodes. We present the investigation, controversies and treatment decision process of a 46-year-old man with CXPA in intra-parotid lymph node. CONCLUSIONS: The staging scheme does not distinguish between nodal spread and primary tumor arising in a lymph node. Multidisciplinary input regarding prognosis and follow-up plans, may consider heterotopia differently from the usual pattern of nodal spread.

The influence of mandibular condyle morphology on TMJ anterior dislocations.

OBJECTIVES: The present study was designed to investigate the correlation between the bony morphology of the mandibular condyle and the occurrence of temporomandibular joint (TMJ) idiopathic anterior dislocation. STUDY DESIGN: A comparative retrospective study was conducted among 14 patients presenting idiopathic anterior dislocations (study group) and 15 patients who did not suffer from any TMJ disorders (control group). All patients underwent a multidetector computed tomography scan demonstrating the full extent of their joints. The scans of 58 joints were reconstructed and analyzed by tools available in Dolphine3 software. Mandibular condyle size and volume were measured, and its shape was characterized. RESULTS: Shape, width, length, height, and volume of the mandibular condyles did not differ statistically between the study and control groups. CONCLUSION: Mandibular condyle morphology does not affect TMJ idiopathic anterior dislocation.

The efficacy of a protective protocol for oral and maxillofacial surgery procedures in a COVID-19 pandemic area-results from 1471 patients.

OBJECTIVE: To examine the effectiveness of an empiric protection protocol during oral surgical treatments in a COVID-19 pandemic area and to evaluate the potential effect of postponed dental procedures on the frequency of facial infections during a lockdown period. METHODS: We performed a retrospective analysis of a case series of a broad-spectrum of oral surgeries in a COVID-19 pandemic area. Data collection included patient age, type of procedure performed, and COVID-19 status of staff and patients. Data were analyzed using descriptive statistics. RESULTS: Between February 21 and April 23, 2020, 1471 patients were treated in the outpatient clinic (n=1404) and under general anesthesia (n=67). All procedures were carried out under a strict empiric protective protocol that included patient screening, personal protective equipment allocation protocol, frequent staff testing, and patient testing before general anesthesia. Treatments included emergency and urgent elective procedures. Only one staff member was confirmed positive for COVID-19 during routine weekly testing, and an independent epidemiologic investigation suggested he was likely infected outside of hospital facilities. CONCLUSIONS: Our empiric protective protocol was found to be effective in preventing staff cross-infection with COVID-19 in an oral and maxillofacial surgery setting. CLINICAL RELEVANCE: To the best of our knowledge, this is the first report that provides data regarding oral surgical activity in a COVID-19 pandemic area. Our suggested protective protocol may assist oral surgeons in continuing dental services in a safe manner.

The influence of articular eminence morphology on temporomandibular joint anterior dislocations.

OBJECTIVE: The aim of this study was to investigate the correlation between the bony morphology of the articular eminence and the occurrence of idiopathic anterior temporomandibular joint (TMJ) dislocation. STUDY DESIGN: A comparative retrospective study was conducted in 14 patients with idiopathic anterior dislocations (study group) and 14 patients who did not suffer from any TMJ disorders (control group). All patients underwent multidetector computed tomography (MDCT), which demonstrated the full extent of their joints. The scans of 56 joints were reconstructed and analyzed by using the tools available in Dolphin 3 software. Gross morphology characteristics and fine morphologic characteristics were defined by measuring the articular eminence inclination and height on the lateral, middle, and medial aspects of the articular eminence. RESULTS: Gross and fine morphologic characteristics of the articular eminence did not differ statistically between the study group and the control group. CONCLUSIONS: Articular eminence morphology does not affect TMJ idiopathic anterior dislocation.

Sclerotherapy of Vascular Malformations in the Oral Cavity-Minimizing Postoperative Morbidity.

Vascular malformations (VMs) are a wide vascular or lymphatic group of lesions common on the head and neck. The objective of this study was to assess the efficacy and morbidity of sclerotherapy for the treatment of VMs in the oral and perioral area. Special attention was given to factors that may contribute to minimizing postoperative morbidity. Data from 25 patients (32 lesions) with oral VMs submitted to sclerotherapy with monoethanolamine oleate (EAO) were included. A structured form was used to collect data. An arbitrary score was determined to evaluate postoperative morbidity. Each of the following signs or symptoms received one point: pain, swelling, hematoma, ulceration, erythema, transient numbness, and transient itching. Pain and swelling were further divided into mild to moderate (1 point) and severe (2 points). Theoretically, the score was in the range of 0-9. Calculated scores ranged 0-4. The patients were further divided into two groups with scores of 0-1 denoting minimal morbidity (MIN) and 2-4 denoting significant morbidity (SIG). The number of lesions in each morbidity-score group were comparable (MIN 17and SIG 15). There were no statistically significant differences between the groups regarding age, number of applications, or average injection volume per mm lesion. Statistically significant differences were noted regarding gender (p = 0.05), lesion diameter (p = 0.030), total volume of first (p = 0.007) and second application (p = 0.05), and total injected volume (p = 0.03). Factors contributing to the risk for significant morbidity included being male, lesion diameter > 5 mm, volume > 0.3 mL per application, and total injected volume > 0.3 mL. A waiting time of 12 weeks prior to additional EAO application was required in 12 out of 29 lesions for clinical observation of complete regression. It was concluded that sclerotherapy with EAO as monotherapy is easy to apply, safe, and effective within a small number of sessions. Application of <0.3 mL EAO per session, and a waiting time of 12 weeks prior to the second application, would significantly minimize morbidity.

Nonfixated inlay graft for anterior localized mandibular defect.

Localized vertical bone defects within the anterior mandibular alveolar ridge frequently pose a unique challenge for functionally and aesthetically pleasing rehabilitation of this area. Causes for significant bone loss in this region may include periodontal disease, postextraction atrophy, trauma, and orthodontic treatment. In the presence of such a defect, ridge augmentation may be obligatory before installation of dental implants. Several surgical procedures, notably bone augmentation techniques, including guided bone regeneration, onlay bone grafting, and interpositional grafts, have been described. However, loss of a single incisor or a few incisors may render these methods complicated for surgical manipulation. In this article, we aim to report the outcome of 4 cases with localized vertical osseous deficits in the anterior mandible, treated by using a technique whereby we utilized the bony defect's margins through a vestibular approach to wedge inlay grafts without additional fixation or distraction hardware, thus overcoming the surgical difficulties and achieving a favorable outcome.

Computerized Navigation for Minimal Invasive Retrieval of Displaced Dental Implants in the Lower Jaw.

Displaced dental implants in the mandible may constitute a clinical challenge for both physicians and patients. The complex anatomy of the floor of the mouth, together with its subsequent violation due to implant displacement makes implant allocation and retrieval a challenging procedure. Computerized navigation surgery (CNS) has been previously described and proved successful in various surgical modalities. In this article, the authors present a recommended protocol for the use of CNS for the retrieval of displaced dental implants in the mandible and describe the workflow through the stages of diagnosis, preoperative surgical planning, and the surgical procedure.

V-stand--a versatile surgical platform for oromandibular reconstruction using a 3-dimensional virtual modeling system.

PURPOSE: The challenge of oromandibular reconstruction (OMR) after oncologic resections has been repeatedly addressed in the literature. Although final oncologic margins can be decided only during surgery, various attempts have been made to create an ideal and accurate platform for OMR. The purpose of this article is to present the V-stand, a versatile surgical platform for OMR using a 3-dimensional (3D) virtual modeling system. MATERIALS AND METHODS: Seventeen patients requiring an OMR were included in the study. A presurgical computed tomogram was obtained and virtual resection and reconstruction with a free fibular flap were planned using 3D virtual surgery software. The mandible was reconstructed intraoperatively using the V-stand, which served as a template for the lower border of the mandible and the lateral aspects of the stand were fixed to the proximal mandibular segments using 2-mm titanium screws. RESULTS: Patients' average age was 53 years (5 to 72 yr). Median follow-up was 19 months (2 to 35 months). All reconstructed mandibles resulted in good function and esthetics. CONCLUSIONS: The V-stand offers a safe and time-efficient method for OMR. It provides an excellent means for accurate spatial positioning of a fibular free flap. The V-stand preserves the original dimensions of the reconstructed mandible and can overcome surgical ablation modifications because it is not dependent on the precision of the resection, but rather provides a mold for the entire mandible.

Imperforate titanium shell enclosing recombinant human bone morphogenetic protein-2-induced bone formation for high-profile dental implants in rabbit tibia.

PURPOSE: To evaluate the use of a nonperforated titanium occlusive device over high-profile dental implants in rabbit tibia using recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) for augmentation grafting. MATERIALS AND METHODS: Eight New Zealand white rabbits were used for the experiment. All rabbits underwent computed tomography of the right tibia. A custom titanium shell was manufactured for each rabbit using a computer-assisted design to confine the graft. Three high-profile implants were placed in the right tibia of each rabbit; the middle implant was placed 8 mm in supracrestal fashion and the adjacent implants were placed 5 mm in supracrestal fashion. There were 4 groups (n = 2 per group): non-shell control, titanium shell only, titanium shell over buffered collagen, and titanium shell over the ACS enriched with rhBMP-2. The animals were sacrificed after 6 or 12 weeks. Histologic preparation was carried out to evaluate bone formation. RESULTS: After 6 weeks, negligible bone growth was found around the implants. After 12 weeks, there was minimal bone formation around the implants in the control group, whereas in the group treated with ACS enriched with rhBMP-2, the titanium shell was filled with mature bone, which was expressed at the implant surface, the shell's interior, and the exterior surfaces. CONCLUSION: The placement of ACS enriched with rhBMP-2 beneath an occlusive nonperforated titanium shell confining high-profile dental implants resulted in visibly more formation of mature bone.

Topical application of slow-release simvastatin as a bone substitute in bone defects in the rat tibia: a pilot study.

PURPOSE: It is hypothesized that local application of statins positively affects bone formation. The aim of this study was to evaluate the potential effect of topical slow-release simvastatin as a bone substitute on the healing of bone defects in rat tibia. MATERIALS AND METHODS: Granules of slow-releasing hydroxypropyl methylcellulose, with or without simvastatin, were inserted into critical-size defects in the tibiae of 16 rats (8 in the study group, 8 in the control group). Bone static and dynamic histomorphometric variables were examined at 2, 4, 6, and 8 weeks postsurgery. RESULTS: All indices examined in the study group indicated improved healing relative to the control group, although statistical significance was not demonstrated for all variables. In the static histomorphometric analysis, osteoid thickness and volume were significantly higher in the study group, but the fraction of trabecular surface covered with active osteoblasts, the fraction of trabecular surface covered with osteoid, and total calcified bone volume were not significantly higher in the experimental group. In the dynamic histomorphometric analysis, the mineral apposition rate, determined by time-repeated calcein labeling, was significantly higher in the study group than in the control group. Experimental time and dosage effects were observed for most bone values in the study group. CONCLUSION: The findings indicate that topical application of simvastatin for the treatment of bone defects enhances the process of healing. Dosage and the methodology of administration require further calibration.

Recombinant human bone morphogenetic protein-2 confined by an imperforate titanium shell over high-profile dental implants in rabbit tibiae: a pilot bone augmentation study.

PURPOSE: To evaluate the use of a nonperforated titanium occlusive device over a bone morphogenetic protein-2 in an absorbable collagen sponge (BMP-2/ACS) in grafting the bone around high-profile (ie, supracrestal) dental implants in rabbit tibiae. MATERIALS AND METHODS: Eight New Zealand white rabbits were used for the experiment. Two implants were placed in the right tibia of each rabbit, with 4 mm of each implant placed supracrestally ("high-profile" placement) in four groups of two rabbits each: control, titanium shell only, titanium shell over buffered collagen, and titanium shell over BMP-2/ACS. The animals were sacrificed after 3 or 6 weeks. Calcified and nondecalcified histologic preparation was carried out to evaluate bone formation and degree of osseointegration. RESULTS: Three of the eight animals developed tibial fractures. The two BMP-2 test animal tibiae remained intact, with the 3-week specimen showing very little bone formation inside or outside of the titanium chamber and the 6-week specimen showing bone mostly outside of the chamber. CONCLUSION: The placement of BMP-2 beneath an occlusive nonperforated titanium shell next to a high-profile implant did not result in significant bone formation. .

Macular hole: a rare complication of ocular bartonellosis.

A 37-year-old woman presented with an anterior optic neuropathy related to Bartonella henselae. Twenty-nine days after symptom onset, a partial thickness macular hole developed in the involved eye. Fundus photography and optical coherence tomography confirmed the conversion to a full-thickness macular hole in 2 months. Macular hole as a complication of cat scratch disease is a rare entity, with 2 prior reported cases in children. The development of a macular hole following cat scratch disease can appear without the clinical picture of multiple white chorioretinal lesions, macular star, or vitritis.

The clinical, histologic, and treatment spectrum in necrotizing sialometaplasia.

OBJECTIVES: The aim of this report was the clinical and histologic characterization of necrotizing sialometaplasia. STUDY DESIGN: We performed a retrospective case series analysis. RESULTS: The study included 4 women 29-71 years old. Possible contributing factors (drugs, alcohol abuse, bulimia, smoking, and pancreatic cancer) were identified. Patients presented with unilateral or bilateral rapidly progressing painful palatal ulcers. Necrotic salivary glands and inflammation were universal microscopic features; ductal metaplasia was present in only 1 case. Thrombosis and heavy fungal and bacterial overgrowth were observed in 1 case. In 3 of the cases the lesions healed within 4-6 weeks under conservative supportive care, whereas in 1 case persistent enlargement up to 25 mm diameter was observed. Surgical debridement combined with a palatal guard resulted in complete healing within 12 weeks. CONCLUSIONS: Significant variations may be observed in both clinical and microscopic manifestations of necrotizing sialometaplasia. Although this disease is considered to be self-limiting in the majority of cases, surgical intervention can be considered in unusually large cases.