A single-centre retrospective 10-year experience of the rhombic 3D condylar fracture plate for open reduction and internal fixation of condylar neck and base fractures.

Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented. The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle. In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side. Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.

A review of the use of patient reported outcome measures (PROMS) in temporomandibular joint (TMJ) surgery.

Temporomandibular joint (TMJ) surgery accounts for a significant number of patient episodes in oral and maxillofacial surgery, and treatment effectiveness is commonly assessed using measures of pain and mouth opening. Patient-reported outcome measures (PROMs) enable assessment of the patient's perspective and perception of the diseases and treatment outcomes. The purpose of this review was to assess the use of PROMs in TMJ surgery. A review of 3 databases (PubMed, OVID, Trip) was carried out to assess the use of PROMs when reporting on TMJ surgical interventions. Studies were limited to the English language, involving humans and at least one surgical intervention of the TMJ. A total of 214 articles met the inclusion and exclusion criteria, of which only 28 used 18 PROMs among them. Half of these PROMs were single-question visual analogue scales or Likert scales on quality of life and disability. The Oral Health Impact Profile and the Helkimo Clinical Dysfunction Index were the second most used (n = 3). PROMs were used most in studies on internal derangement (n = 9) and in cohort study designs (n = 26), but this was not statistically significant. In the majority of research on TMJ surgery, no PROMs are used, and when one is, there is a tendency to use weaker single-question PROMs as opposed to multi-question PROMs to assess outcomes. With the increasing importance of PROMs for assessing patients' perception of treatment outcomes, further research is needed to establish valid and reproducible PROMs for TMJ surgery.

Alloplastic reconstruction of the mandible after subtotal mandibulectomy for medication-related osteonecrosis of the jaw: An update of the method.

BACKGROUND: Reconstruction of continuity defects following osteonecrosis in multimorbid patients is challenging. In all cases of the predescribed palliative treatment method for alloplastic mandible reconstruction, plate fractures were detected in follow-up. We hypothesized that a modification could avoid these fractures, leading to stable long-term results. METHODS: This retrospective study compares the original method with a modification using single, laser-sintered CAD-CAM plates instead of manually bent miniplates. The predescribed shuttering technique was used to reconstruct the mandible in its original shape with bone cement. RESULTS: Uneventful wound healing was observed in 86% of the cases after modification of the method. No implant or plate fracture occurred. CONCLUSIONS: The presented method should be considered as a treatment option for mandible reconstruction in elderly, multimorbid patients in palliative situations. The results of this study suggest that the modification of the method leads to significantly improved long-term stability. Donor site morbidity is avoided with this method of palliative surgery.

Treatment of fractures of the mandibular condylar head with ultrasound-activated resorbable pins: early clinical experience.

Controversy continues about the benefits and disadvantages of open reduction and internal fixation of fractures of the condylar head. Once a decision to treat surgically has been made, an appropriate method of fixation must be chosen. Standard titanium fixation has a number of complications, including the risk of protrusion of the screw beyond the condylar head and the possible need for removal later. Resorbable fixation is an alternative, and ultrasound-activated resorbable pins are a new innovation. We have treated a series of 15 patients with 17 fractures of the condylar head, in which the use of ultrasound-activated resorbable fixation has provided adequate strength and stability during early healing. Complications included technical difficulties in achieving complete anatomical reduction as a result of fragmentation of the condylar head, and three facial nerve palsies, two of which recovered within three months. No pins failed, and there was no sign of instability during healing.

An orthodontic bracket embedded in the medial pterygoid surface: a case report.

There is a potential risk that orthodontic brackets can become dislodged into the aerodigestive tract. This case illustrates the management of an orthodontic bracket, which became embedded in the deep tissues of the oropharynx. We aim to highlight the potential risk misplaced dental instruments and materials pose, including that they may become embedded in the soft tissues of the throat and suggest that that this possibility should be considered when they cannot be localized.

An orthodontic bracket embedded in the medial pterygoid surface: a case report.

There is a potential risk that orthodontic brackets can become dislodged into the aerodigestive tract. This case illustrates the management of an orthodontic bracket, which became embedded in the deep tissues of the oropharynx. We aim to highlight the potential risk misplaced dental instruments and materials pose, including that they may become embedded in the soft tissues of the throat and suggest that that this possibility should be considered when they cannot be localized.

In vitro effect of bisphosphonates on oral keratinocytes and fibroblasts.

PURPOSE: Osteonecrosis of the jaws is a potential complication of bisphosphonate (BP) therapy. The underlying mechanisms remain unclear. Although most research has concentrated on the effects of BPs on osteoclast and osteoblast functions, the disease is diagnosed and classified based on of mucosal breakdown, suggesting that oral soft tissues may be involved in its pathogenesis. The aim of this study was to determine the effect of 3 different BP drugs (alendronate, zoledronate, and clodronate) on the function of oral keratinocytes and fibroblasts. MATERIALS AND METHODS: Human oral keratinocytes (OKF6) and fetal foreskin fibroblasts (HFFF2) were exposed to each drug at several concentrations and the effect on cell proliferation was assessed by counting the viable cells after different lengths of treatment. The effect on cell migration was examined using Transwell migration assays. An organotypic coculture model using keratinocytes and fibroblasts, which recapitulated the morphology of the oral mucosa, was used to assess the effect of the drugs on epithelial stratification and differentiation. RESULTS: The 3 BPs affected the viability and proliferation of OKF6 and HFFF2 cells at concentrations in keeping with their known relative in vitro potencies. There was no effect on cell migration or tissue architecture in organotypic cultures at subtoxic concentrations. CONCLUSION: The lack of effect of these drugs on cell migration below concentrations known to affect cell viability suggests that BP-related osteonecrosis is not caused through suppression of keratinocyte or fibroblast motility.

Bisphosphonate osteonecrosis of the jaw: a historical and contemporary review.

The use of bisphosphonate drugs has been popularised in the late 20th century for the management of many conditions associated with abnormalities of bone turnover, particularly metastatic and haematogenous malignancy and osteopenia. The increase in indications for the use of bisphosphonates was supported by what was thought to be a very good safety profile. However in 2003 cases of osteonecrosis related to the use of bisphosphonates were first described. The pathogenesis, and with this the explanation of why it only appears to affect the maxillofacial skeleton, and the best way of managing this problem remains unknown. In this review we examine the process of identification of this pathology and the development of guidelines from medical societies and professional bodies on the management of patients before commencing bisphosphonate therapy, requiring dental treatment whilst on therapy, or with a diagnosis of bisphosphonate associated osteonecrosis of the jaws.

Consent for orthognathic surgery: a UK perspective.

Obtaining consent to undertake orthognathic surgery is a legal requirement that starts at the initial visit when treatment is being considered and continues until the operation itself. The process includes discussion of the benefits, risks, and potential complications of the proposed procedure, and any alternative (including doing nothing), but there is no consensus about how much information should be disclosed. Guidance is provided on the basis of case law, which is itself evolving. The purpose of this study was to look at the current practice of obtaining consent for orthognathic surgery by oral and maxillofacial surgeons in the UK to act as a benchmark and potentially to stimulate further debate. We also review common and serious complications that might be included in the process.

Bisphosphonate osteonecrosis of the jaw: a literature review of UK policies versus international policies on the management of bisphosphonate osteonecrosis of the jaw.

Despite the increasing number of cases of osteonecrosis of the jaws related to bisphosphonate therapy described in the literature there is a paucity of evidence-based treatment for the condition. In this second article on bisphosphonate-related jaw complications we discuss the different treatment strategies for the condition, review current literature, particularly in relation to the recommendations that have been published, and discuss the evidence behind them.

Bisphosphonate osteonecrosis of the jaw--a literature review of UK policies versus international policies on bisphosphonates, risk factors and prevention.

There has been an exponential rise in the literature of osteonecrosis and its complications in patients taking bisphosphonate drugs. Despite this increase, there is little evidence-based publications on how best to manage this complication. In this article (the first of two on bisphosphonate related jaw complications), we compare the guidelines produced by national specialist medical associations and expert panels on the prevention of bisphosphonate osteonecrosis of the jaws and review the evidence behind these guidelines.

Management of patients at risk of osteoradionecrosis: results of survey of dentists and oral & maxillofacial surgery units in the United Kingdom, and suggestions for best practice.

We aimed to find out whether dental practitioners take specific measures to identify patients who are at risk of osteoradionecrosis (ORN) of the jawbones; how oral and maxillofacial surgery units in the United Kingdom manage patients who have had radiotherapy and require dental extractions, and the evidence behind current practice. We sent postal questionnaires to 60 dentists and 117 maxillofacial units. Dentists were questioned about measures used to identify radiotherapy patients, and use of antibiotic prophylaxis. Maxillofacial units were questioned about the existence of written protocols and the measures used to minimise the risk of ORN. Thirty-five percent of dentists questioned ask specifically about head and neck cancer or radiotherapy as part of their medical history, and 5% of maxillofacial units questioned had written protocols for the management of patients who had had radiotherapy or had previously been diagnosed with ORN. Prophylactic antibiotics are recommended for patients at risk of ORN by 16% of dentists and 81% of maxillofacial units. Preoperative mouthwash is recommended by 59% of maxillofacial units. Identification of patients at risk of ORN is the first step in prevention but it is not done efficiently at present. Recommendations include the use of preoperative mouthwash and prophylactic antibiotics. Operations should be atraumatic and should be done by experienced clinicians.

Role of chest CT in staging of oropharyngeal cancer: a systematic review.

BACKGROUND: The prevalence of synchronous or metastatic tumors in patients with head and neck squamous cell carcinoma (HNSCC) ranges from 6% to 20% and has implications for prognosis and management of the primary disease. There is no consensus about the role of chest CT prior to definitive treatment patients with HNSCC. METHODS: A systematic review of all chest CT studies in relation to HNSCC was performed, together with a review of our local database. RESULTS: Twenty-four studies were identified in addition to our local data. Prevalence of positive chest CT was 7.93%. Patients were significantly more likely to have a positive chest CT with N2 or N3 neck disease (p = .0062) and stage III or IV disease (p = .0001), and significantly less likely with tumors of the oral cavity (p = .0007). CONCLUSION: We advocate chest CT as part of the initial investigations for patients with HNSCC.

Trigeminal neuralgia: assessment and management by oral and maxillofacial surgeons in the United Kingdom.

We aimed to find out how oral and maxillofacial surgeons in the United Kingdom currently assess and manage patients with suspected trigeminal neuralgia, and compared this with best practice. We undertook a postal survey of 297 consultant oral and maxillofacial surgeons in the UK (of whom 178 (60%) replied) asking questions about examinations and routine investigations of new patients with symptoms of trigeminal neuralgia, and their subsequent management. Clinical examination including cranial nerve function was made by almost all respondents (92%). Magnetic resonance imaging gives the most helpful diagnostic information and was requested by most surgeons (55%). Current publications have suggested that medical management of trigeminal neuralgia is appropriate for most patients, and this was reflected in current practice. Most surgeons (93%) used carbamazepine as their first choice of drug.

Peripheral alcohol injections in the management of trigeminal neuralgia.

OBJECTIVE: To assess the effectiveness of peripheral alcohol injections in the management of trigeminal neuralgia. STUDY DESIGN: Retrospective case audit of patients who received peripheral alcohol injections in 1994-1999 was conducted. We examined for occurrence and duration of effect of alcohol blocks, the effect of age and repeated administration, and the effect of their use on other surgical treatments. RESULTS: Peripheral alcohol injections lasted for a mean of 11 months. Their effectiveness and complication rates were not affected by age or repeated administration. Their use did not affect, nor was their effectiveness affected by, the use of other surgical treatments. CONCLUSION: Peripheral alcohol injections continue to have a role in the management of trigeminal neuralgia. They are particularly useful in those refractory to medical management and in those who are unable or unwilling to undergo neurosurgical treatment. Peripheral alcohol injections also have a role in those awaiting neurosurgical opinions or treatment.

Birth prevalence of cleft lip and palate in Sucre, Bolivia.

OBJECTIVES: To determine the birth prevalence of cleft lip and palate (CL +/- P) in the municipality of Sucre, Bolivia. To ascertain whether the birth prevalence in this region differs significantly from birth prevalence reported in similar populations and other racial groups. RESULTS: Twenty-eight clefts were identified among 22,746 live births between the years 1995 and 2001 in three maternity hospitals in the city. The total birth prevalence of CL +/- P was 1.23/1000 live births per year. There were 12 clefts of the lip alone (birth prevalence 0.53/1000 per year), 15 cleft lip and palate (0.66/1000 per year), and one cleft palate only (0.04/1000 per year). CONCLUSIONS: The birth prevalence was not significantly different from birth prevalence published previously in South American populations, although it is lower than previously published data from Bolivia. The birth prevalence of CL +/- P in this South American population was similar to published data in white subjects and between those found in black and oriental groups. The sex ratio and birth prevalence of simultaneous congenital malformations also did not differ from previously published figures.