Evaluation and treatment of mandibular and midface fractures.

The classification of mandibular and midface fractures is discussed. Signs and symptoms of fractures are presented and the radiographic examinations described. The latest treatment modalities, including the use of skeletal fixation with titanium plates, are also discussed.

Restoration of squamous mucosa after ablation of Barrett's esophageal epithelium.

BACKGROUND: Antireflux therapy has generally failed to induce regression of Barrett's epithelium. It was hypothesized that squamous epithelium could be restored if the columnar tissue was ablated while gastric acid secretion was suppressed. METHODS: Ten white men with Barrett's esophagus received 40 mg of omeprazole daily. Thereafter, every 2-5 weeks they underwent videotaped endoscopies to argon laser photoablate columnar tissue, obtain biopsy specimens, and assess results. Squamous re-epithelialization was assessed by correlation of videotapes and directed biopsies. RESULTS: Patients had one to eight areas ablated, totaling 0.5-12.0 cm2. Videotape assessments were corroborated by biopsy in all but one instance. Thirty-eight of 40 treatment locations partially or completely re-epithelialized with squamous tissue. Squamous regrowth appeared to occur by spread from contiguous squamous borders and de novo from glandular tissue. Regrowth was influenced by the extent of squamous borders and completeness of ablations. Nonablated glandular tissue persisted beneath squamous epithelium. CONCLUSIONS: Ablation of Barrett's epithelium and suppression of acid secretion facilitated squamous re-epithelialization. A progenitor cell within the metaplastic tissue has the potential to differentiate normally.

Prosthodontic restoration with dental implants and an intraoral cranial bone onlay graft: a case report.

In 1988, a 54-year-old edentulous patient received a cranial bone onlay graft with the immediate placement of five dental implants. Treatment procedures and early results of restoration are described.

A two-stage procedure for temporomandibular joint disc replacement using free pericranial grafts: a preliminary report.

A preliminary study of the use of free pericranial grafts as an alternative to other autogenous or alloplastic materials for temporomandibular joint disc replacement is presented. Postoperative results show improved function and alleviation of other symptoms.

Familial gigantiform cementoma: classification and presentation of a large pedigree.

Very few cases of gigantiform cementoma have been reported, and those associated with a positive family history are especially rare. Confusion exists about the relationship of gigantiform cementoma to florid osseous dysplasia, cementifying fibroma, and diffuse chronic sclerosing osteomyelitis. It has been unclear whether gigantiform cementoma should be accorded the status of a separate entity. In this article, we report our findings on a family that, over five generations, has exhibited clinical, radiographic, and/or histologic findings consistent with the designation familial gigantiform cementoma. This pedigree consists of 55 members. Significant heterogeneity in expression of this trait was noted. The pattern of occurrence of the trait is consistent with an autosomal dominant mode of inheritance with variable expressivity of the phenotype. We suggest that familial gigantiform cementoma should be recognized as a separate entity.

Accurate radiographic evaluation of mandibular fractures.

Proper radiographic evaluation is essential to confirm the presence and location of a mandibular fracture. The panoramic view of the mandible is considered to be a very accurate technique and has been heavily relied on by many clinicians as the initial or sole means of diagnosing mandibular fractures. Three cases of mandibular fractures are presented in which a panoramic view failed to demonstrate fractures of the mandible that were obvious on plain film radiographs. Diagnosis and treatment planning should not be based on the information obtained from a single roentgenogram such as a panoramic view. The combination of the mandibular series with the panoramic view provides increased diagnostic information that should enable accurate diagnosis of fractures in all areas of the mandible.

Reconstruction of the mandibular condyle using ramus osteotomies: a preliminary report.

Reconstruction is required for a number of conditions in which condylar bone is lost resulting in dental and skeletal change. Ramus osteotomies are described as an alternative to the currently used methods. Four cases are described to illustrate the use of this technique. These osteotomies have several advantages over other methods and have the potential for better functional results.

Skeletal stability following mandibular advancement and rigid fixation.

Twenty non-growing subjects underwent sagittal ramus osteotomies and rigid fixation. Cephalograms were analyzed before surgery, immediately after surgery and at least six months following surgery to evaluate skeletal stability. A mean horizontal relapse of 0.42 mm (8%) and a mean vertical increase in lower face height of 0.2 mm were found six months after surgery. Both were statistically insignificant. The mean backward rotation of the mandible of 0.55 degrees found six months after surgery was statistically significant (P less than 0.015), but was considered to be clinically insignificant. The results of this study show that surgical mandibular advancement with rigid fixation is a very reliable and stable procedure.

Generalized eruptive keratoacanthoma.

Two forms of keratoacanthoma are presently recognized: a solitary form and a multiple form. The multiple form has two variants: multiple self-healing epitheliomas of skin or Ferguson Smith type and eruptive keratoacanthoma or Grzybowski type. Though solitary cutaneous keratoacanthomas are common, the multiple variants are extremely rare. A case of eruptive keratoacanthoma with oral involvement is presented with a brief discussion contrasting the two variants of multiple keratoacanthoma.

Comparison of meclofenamate sodium with buffered aspirin and placebo in the treatment of postsurgical dental pain.

The efficacy of meclofenamate sodium (Meclomen) at two different doses was compared with that of buffered aspirin and placebo in the control of postsurgical pain in a double-blind, randomized study of 205 patients. Meclofenamate sodium, 200 mg, was significantly better than meclofenamate sodium, 100 mg, in some efficacy parameters. Both doses of meclofenamate sodium were superior to buffered aspirin in most parameters of efficacy, and more effective than placebo in every parameter.

Immediate permanent reconstruction of a mandibular continuity defect with use of a prosthesis of chromium-cobalt alloy.

A report of ten-year follow-up examinations of a patient who had a hemimandibulectomy with disarticulation because of fibrous dysplasia and immediate permanent reconstruction of the mandible with a Vitallium custom-cast prosthesis is presented. Careful preoperative planning, operative technique, and postoperative follow-up examinations are essential for successful maintenance of the prosthesis. Autogenic bone grafts are, in general, superior to alloplasts in permanent reconstruction of defects in mandibular continuity after resection. However, there are indications for alloplastic reconstruction when the condyle is disarticulated with the resection.

Immediate temporary reconstruction of mandibular continuity defects in cancer patients.

A technique is described in detail which will produce a predictable immediate temporary reconstruction of a mandibular continuity defect. The procedure is quick, inexpensive and reliable. A review of various methods of reconstruction is presented and compared with our technique. Complications are discussed. A review of our patients is presented.