Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction.

In recent years, the field of mandibular reconstruction has made great strides in terms of hardware innovations and their clinical applications. There has been considerable interest in using computer-aided design, finite element modelling, and additive manufacturing techniques to build patient-specific surgical implants. Moreover, lattice implants can mimic mandibular bone's mechanical and structural properties. This article reviews current approaches for mandibular reconstruction, their applications, and their drawbacks. Then, we discuss the potential of mandibular devices with lattice structures, their development and applications, and the challenges for their use in clinical settings.

Human Tissue Kallikreins in Polymorphous Adenocarcinoma: A Polymerase Chain Reaction and Immunohistochemical Study.

Polymorphous adenocarcinoma (PAC) is the second most common malignant salivary gland tumour of minor salivary glands. Human tissue kallikreins (KLKs) are a family of highly conserved serine proteases expressed by various tissues and organs. The literature demonstrates a link between KLKs and salivary gland neoplasms. The purpose of this study was to determine levels of KLK mRNA in tissue samples of PAC and to determine if KLK expression is limited to tumour cells. Nineteen cases of PAC were reviewed (1987-2013). The diagnosis was confirmed, demographic data was collected, and formalin fixed paraffin-embedded PAC and normal salivary gland tissue samples were obtained. RNA isolation was achieved, followed by conversion to complementary DNA via reverse transcription. Using PCR, the quantitative level of expression of KLKs1-15 was recorded. Samples exhibiting high and low KLK expression were selected for immunohistochemistry staining. Results revealed a statistically significant increase in mean KLK mRNA expression for KLK1, KLK4, KLK10, KLK12 and KLK15 in PAC tissue samples, compared with normal salivary gland tissue (Mann-Whitney U test, p < 0.05). Immunohistochemistry results demonstrated that KLKs were present in tumor cells. Notably, all samples demonstrating relatively higher KLK mRNA expression showed equivalent or increased staining scores relative to the low KLK mRNA expression samples. In conclusion, there appears to be aberrant kallikrein expression in polymorphous adenocarcinoma, suggesting the possibility of a kallikrein cascade influence on tumor development and progression.

Ligneous gingivitis secondary to plasminogen deficiency: a multidisciplinary diagnostic challenge.

Plasminogen deficiency is a genetic condition resulting in deposition of extravascular fibrin within mucosal tissues. Lesions associated with plasminogen deficiency most commonly affect the eyes, while intraoral lesions, when present, affect the marginal aspects of the gingiva. We report a diagnostically challenging case of ligneous gingivitis, which developed in a young male patient in the absence of other clinical lesions. Due to the rarity of this condition, it may fall under the radar of dentists and dental specialists, leading to missed or delayed diagnosis.

A modified retromaxillary approach to the infratemporal fossa: three case studies.

The infratemporal fossa (ITF) is an anatomically complex region with multiple neural and vascular structures entering and exiting through foramina in the skull base. The main obstacles to approaching the ITF are the zygomatic arch, the parotid gland, the facial nerve, and the ascending ramus AND condylar head of the mandible. Different surgical approaches to the ITF exist and the best approach should provide optimal visibility, minimal impairment of temporomandibular joint function, and preservation of motor and sensory nerve integrity. This report describes a modified Obwegeser retromaxillary approach to access lesions within the ITF. A multidisciplinary team was involved, which included an oral and maxillofacial surgery team, a neurosurgery team, and an otolaryngology team. Three patients with large skull base lesions, including an aneurysmal bone cyst, a giant cell tumor of the bone, and an invasive melanoma, underwent resection using this approach and were followed postoperatively. Excellent exposure of the floor of the middle cranial fossa and ITF was achieved with this approach. Functional status remained unchanged with respect to mastication, speech, swallowing, and cosmesis. Given the severity of the patients' conditions and extent of involvement of the skull base, outcomes were favorable, with minimal morbidity. This experience suggests that this approach provides safe access to an anatomically complex region and lessens challenges associated with more conventional approaches.

Ultrasound-guided greater palatine nerve block: a case series of anatomical descriptions and clinical evaluations.

BACKGROUND: Greater palatine nerve (GPN) block is commonly performed for maxillary and palatal anesthesia by using bony landmarks. Ultrasound (US) can be used to consistently identify greater palatine foramen (GPF) as a defect in the bony palate enabling US-guided injections near the foramen. METHODS: We scanned and injected 16 undissected well-embalmed hemisectioned cadaveric heads after excluding major anatomical malformations. A linear high-frequency hockey stick probe (7-13 MHz) positioned in long axis to the hard palate visualized GPF as a discontinuity in the hard palate. US-guided injections of 0.1 mL India ink were made in an oblique plane. Specimens were dissected immediately after injection, and dye distribution was noted. The success rate of identification of GPF, number of attempts, and number of successful injections were recorded. The technique was evaluated clinically in 7 patients undergoing dental procedures. Five patients had US-guided injections, and 2 patients received US-assisted greater palatine canal blocks. RESULTS: GPF was successfully identified in 16 hemisectioned heads (n = 16). In 7 of 16 hemisectioned cadaveric specimens (n = 7/16), needle pass was seen on the US and traces of India ink were found within the greater palatine canal and pterygopalatine fossa. In the remaining heads (n = 9/16), the dye was observed in the mucosal tissue of the hard palate anterior to the GPF or in the soft palate. Clinical evaluation reconfirmed successful identification of GPF by US in 6 of 7 patients (n = 6/7). US-guided injections were successful in 6 of the 8 attempted blocks (n = 6/8) with median number (range) of attempts being 2 (1-4). US-assisted injections were successful in 2 patients (n = 2/2). CONCLUSIONS: US has the potential to successfully locate and characterize GPF in normal and edentulous maxilla. US-guided GPN blocks can be technically challenging. The clinical applicability of US guidance or assistance for GPN block needs further evaluation in a larger sample of patients.

Oral manifestations of gastrointestinal diseases.

The present paper offers a detailed review of the oral manifestations of various gastrointestinal diseases or conditions, with suggestions on how they may be relevant to the practice of gastroenterology. The review includes Crohn's disease, ulcerative colitis, Gardner syndrome, Peutz-Jeghers syndrome, malabsorption conditions related to hematopoesis, gastrointestinal malignancy metastatic to the jaws, jaundice and gastric reflux diseases.