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.

Inborn errors of metabolism in Singapore.

Between 1992 and 1994 the Paediatric Metabolic Centre screened 403 patients for inherited metabolic disease. Seventeen patients were diagnosed, including 7 with organic acidurias, 5 with mucopolysaccharidoses, 2 with amino acid disorders, 2 with carbohydrate disorders and 1 with hyperlipidaemia. The ethnic distribution of disorders in Singapore is compared with incidences reported by others in this part of the world. It is likely that further studies will indicate which diagnostic or screening tests would best serve this community.

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.

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.

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.

Analysis of the metallic composition of orofacial talismans.

Four metallic talismans, commonly called "charm needles" in Southeast Asia, were surgically removed from the facial soft tissues of three patients. The talismans were found to be superficially placed and were not corroded. The average length of the needles was 8.14 mm, and average diameter was 0.47 mm. They were found to contain an average gold content of 89.75% and an average copper content of 10.25%.

Esthetic arch bar for maxillomandibular fixation in orthognathic surgery.

Arch bars are well-known dental appliances for the management of fractures and orthognathic surgery. Traditionally both the commercially available, prefabricated arch bars as well as the custom-made arch bars are made of metal so as to provide good rigidity. Each of these types of arch bars has its own advantages as well as drawbacks. This article looks at a type of custom-made arch bar that is easy to construct and use. At the same time, it provides good rigidity, fit, and esthetics.

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.

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.

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.

Bifid mandibular condyle.

This report brings the total number of bifid mandibular condyles reported so far in the English-language literature to 15 cases. In addition, one dried specimen with two distinct condylar heads is reported. This rare anomaly does not appear to have a predilection for any particular race or either gender. At the time of initial consultation, almost all patients are adults. Sixty-seven percent of the patients have no complaints related to the affected condyles, but the condition is an incidental dental panoramic radiographic finding. The left condyles seem to be affected twice as often as the right condyles. We do not yet fully know the etiology, epidemiology, and long-term functional effects of this condition. We recommend the transorbital condylar view as a good, inexpensive, and lower dosage technique, compared with the tomogram, to demonstrate this anomaly.

Evaluation of soft tissue profile following intraoral ramus osteotomy in Chinese adults with mandibular prognathism.

Twenty-five Chinese adults with mandibular prognathism were treated with either the intraoral vertical subcondylar osteotomy or the bilateral sagittal split ramus osteotomy. The patients were kept in maxillomandibular fixation for 6 to 8 weeks while osteosynthesis was achieved with the use of intraosseous wiring. Serial lateral cephalograms were taken presurgery and between 12 and 26 months postsurgery, and specific soft and hard tissue points were digitized on a computer. The mean mandibular setback postsurgically was 8.4 +/- 3.2 mm, with a 5.2-degree reduction in point A-nasion-point B angle. Posterior movement of pogonion, point B and the mandibular incisal edge was accompanied by posterior movement of 95% at soft tissue pogonion (r = .96), 89% at soft tissue point B (r = .83), and 67% at labrale inferius (r = .81), respectively. The correlation between changes in the labrale superius and mandibular setback appeared to be dependent on both the amount of mandibular setback and the degree of mandibular rotation during the setback surgery. The presently reported ratios of the soft tissue response to hard tissue movement vary from those reported in white patients by other researchers, which confirms the need for different ratios for different racial types.

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.