Does lifestyle modification (physical exercise and listening to music) improve symptoms in patients with a temporomandibular disorder? A randomized clinical trial.

Introduction: The aim of the study was to compare pain relief in temporomandibular disorder (TMD) patients with or without lifestyle modification. Materials and Methods: This randomized clinical trial was performed on patients with TMD, who did not regularly exercise or listen to music. The participants were allocated into two groups. In the treatment group, the participants were instructed to exercise five times or more per week (30 minutes per session) and listen to the music of their choice five times or more per week (15 minutes per session) for 12 weeks. In the control group, the participants had their usual lifestyle without any modifications. The participants were examined for clicking and crepitus in the joint and maximum mouth opening before and after the intervention. The pain severity was also documented based on a visual analog scale. Results: Thirty five patients were studied in each group. Twelve weeks after the intervention, the mean pain severity was 2.70 ± 0.73 in the treatment group and 4.63 ± 0.77 in the control group. The results of data analysis demonstrated a significant difference between the two groups regarding the mean pain severity at 12 weeks after the intervention (P <.001). Conclusions: Lifestyle modification through physical exercise and listening to music may reduce pain in TMD patients.

Complications after craniofacial reconstruction with calcium phosphate cements: a case report and review of the literature.

Among different graft materials for craniofacial reconstruction, calcium phosphate cements have the advantages of alloplastic grafts and wide use. The authors report a case of foreign body reaction following frontal reconstruction with JectOS (an injectable calcium orthophosphate cement; Kasios) and reviewed the literature on complications of this material after craniofacial reconstruction from 2002 to 2017. Complications were categorized into two groups: immunologic reactions (consisting of seroma collection, chronic sinus mucosa swelling, and foreign body reaction) and non-immune events (infection, fragmentation, and ejection). It is wise to use calcium phosphate-based material only in selected cases with small defects, and long-term follow-up is needed to observe their consequences.

Cephalometric changes in nasopharyngeal area after anterior maxillary segmental distraction versus Le Fort I osteotomy in patients with cleft lip and palate.

OBJECTIVE: The present study was designed to compare the effects of two surgical methods, anterior maxillary segmental distraction (AMSD) versus conventional Le Fort I osteotomy, on cephalometric changes of velopharyngeal area of patients with cleft lip and palate. MATERIALS AND METHODS: This study was conducted on 20 CLP in two groups. The first group had classic Le Fort I maxillary advancement and the second group had AMSD with a modified hyrax as an intraoral tooth-borne distractor. In the second group, 1 week after the surgery, activation of hyrax screw was started with the rate of 2 times a day for about 10 days. Initial and final lateral cephalograms were traced and analyzed by OrthoSurgerX software. RESULTS: The changes in variables evaluating velopharyngeal status showed a significant difference between the two groups. In Group A (conventional), the mean of nasopharyngeal area and Nasopharynx floor length showed a significant increase (P < 0.05) after the surgery, while in Group B (DO), the trend of changes was vice-versa. The changes in SNA, overjet, and soft-tissue convexity were similar in both groups. CONCLUSION: AMSD can improve facial profile, almost similar to the conventional Le Fort I advancement, while there is a significant decrease in nasopharyngeal; hereby there is no increase in the velopharyngeal sphincter.

The effect of autologous leukocyte platelet rich fibrin on the rate of orthodontic tooth movement: A prospective randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the effect of LPRF, placed in extraction sockets, on orthodontic tooth movement (OTM). MATERIALS AND METHODS: Thirty extraction sockets from eight patients (five males, three females, with a mean age of 17.37 years; range 12-25 years) requiring extraction of first premolars based on their orthodontic treatment plan participated in this split-mouth clinical trial. In one randomly selected quadrant of each jaw, the extraction socket was preserved as the experimental group by immediate placement of LPRF in the extraction socket. The other quadrant served as the control group for secondary healing. Immediately, the teeth adjacent to the defects were pulled together by a NiTi closed-coil spring with constant force. A piece of 0.016 × 0.022-inch stainless steel wire was used as the main arch wire. The amount of OTM was measured on the study casts at eight time points with 2-week intervals for 3 months. Analysis of random effect model was performed for the purpose of comparison between the experimental and control groups. RESULTS: According to the random effect model, a statistically significant difference was found between the experimental and control group in rate of OTM (P = 0.006). CONCLUSION: According to the results, application of LPRF, as an interdisciplinary approach combining orthodontics and surgery, may accelerate OTM, particularly in extraction cases.

Does Fixation Method Affect Stability of Sagittal Split Osteotomy and Condylar Position?

PURPOSE: Fixation methods are important for condylar position and stability in sagittal split osteotomy (SSO) procedures. The aim of the present study was to compare the changes in the condylar position and stability after SSO for mandibular setback in plate fixation with monocortical screws and bicortical screws. PATIENTS AND METHODS: In the present retrospective cohort study, patients who had undergone mandibular setback were studied in 2 groups. In group 1, fixation was performed using a miniplate with 4 monocortical screws. In group 2, fixation was performed using 3 bicortical screws. Cone beam computed tomography scans were taken before and immediately after the SSOs and 1 year later. The condylar position was evaluated linearly (mediolateral movement in the coronal view) and angularly (condylar axis with Frankfort plane in the coronal view). The stability of the mandible was determined at the B point horizontally and vertically. RESULTS: A total of 50 patients were studied in 2 equal groups; however, 2 patients were lost to follow-up in group 2. A significant difference in the mediolateral changes of the condyle before and after osteotomy was detected between the 2 groups (P = .003). No difference was found between the 2 groups in the angular changes of the condyle before and after SSO in the coronal view (P = .45). Analysis of the data did not reveal any differences for vertical relapse at the B point (P = .47) or horizontal relapse between the 2 groups (P = .21). CONCLUSIONS: According to our results, bicortical screw fixation might be associated with more condylar displacement. However, we could not find significant differences in surgical stability between miniplate fixation with monocortical screws and bicortical screw fixation after 1 year of follow-up.

Skeletal stability following mandibular advancement: is it influenced by the magnitude of advancement or changes of the mandibular plane angle?

OBJECTIVES: The aim of this study was to investigate the effects of advancement magnitude and changes in mandibular plane angle on the stability of mandibular advancement. MATERIALS AND METHODS: This retrospective cohort study evaluated the postoperative stability of mandibular advancement in class II skeletal subjects who underwent bilateral sagittal split osteotomy. Radiographs taken preoperatively, immediately postoperatively and 1 year postoperatively were traced and analyzed using linear and angular measurements. To determine horizontal and vertical relapse, an X-Y coordinate system was established in which the X-axis was constructed by rotating S-N downward by 7° (approximation of the Frankfort horizontal plane) and the Y-axis was defined as a line perpendicular to the X-axis and passing through the point Sella. For certain reference points including point A, point B, pogonion and menton, the perpendicular distance between each point and both axes was determined and cephalometric variables were recorded as X and Y coordinates. RESULTS: Twenty-five subjects were studied. A significant correlation between the amount of mandibular advancement and relapse in the B point (vertical and horizontal) and the pogonion point was observed (vertical and horizontal, P<0.001). Evaluation of data demonstrated a positive correlation between the mandibular plane angle (SN/ML) change and vertical relapse in the B point (P<0.05). A simple regression model demonstrated that 74% of horizontal relapse and 42.3% of vertical relapse in the B point was related to the amount of mandibular advancement. The receiver operating characteristic test showed that 8.5 mm mandibular advancement is related to a relapse rate of 1 mm or more in the pogonion, vertically or horizontally. CONCLUSION: The magnitude of mandibular advancement is a stronger surgical predictor for horizontal rather than vertical relapse at the B point. Changes in mandibular plane angle (SN/ML) during surgery affect vertical, but not horizontal relapse at the B point.

A New Approach to Survival Analysis of Head and Neck Squamous Cell Carcinoma.

BACKGROUND: Squamous cell carcinoma is the most common histological subtype of head and neck cancers. METHODS: In a retrospective longitudinal study, we assessed the risk of local or metastatic recurrence and death in 140 patients with head and neck squamous cell carcinoma (HNSCC). Multivariate and shared frailty models were used for survival analysis with sex, primary tumor site, grade and stage of the tumor, and treatment modalities as contributing factors. RESULTS: The most frequent site for HNSCC was the oral cavity (30%), followed by the tongue (26.4%). For most primary sites, men were at nearly 2-fold higher risk of local recurrence than women, but there was no difference by sex in the risk of metastatic recurrence. Undifferentiated HNSCC was associated with a higher risk of local recurrence (nearly 4-fold) and metastasis (6-15-fold based on the primary site) than well-differentiated tumors. In early months after surgical resection alone, the risk of local recurrence was higher compared to other treatment modalities. There was a strong dependency between the risk of local and metastatic recurrence. CONCLUSION: In conclusion, men diagnosed with HNSCC, those with higher grade or advanced state tumor, and those treated by surgery alone are at higher risk of unfavorable outcomes than others and may need more frequent follow-up visits.

Ameloblastic Fibrosarcoma of the Mandible With Distant Metastases.

Ameloblastic fibrosarcoma is a mixed odontogenic tumor that can originate de novo or from a transformed ameloblastic fibroma. This report describes the case of a 34-year-old woman with a recurrent, rapidly growing, debilitating lesion. This lesion appeared as a large painful mandibular swelling that filled the oral cavity and extended to the infratemporal fossa. The lesion had been previously misdiagnosed as ameloblastoma. Twenty months after final surgery and postoperative chemotherapy, lung metastases were diagnosed after she reported respiratory signs and symptoms.

Evaluation of mandibular wing osteotomy in obstructive sleep apnea cases with retrognathia.

OBJECTIVE: The aim of this study is to evaluate the efficacy of wing osteotomy for treating obstructive sleep apnea (OSA). MATERIALS AND METHODS: We performed mandibular wing osteotomy in subjects who had an apnea-hypopnea index (AHI) of more than 15, a previous unresponsive conservative treatment for the OSA, moderate to severe retrognathia and no suggested conventional orthognathic surgery because of dentition or lack of willingness. The subjects were evaluated using the Epworth Sleepiness Scale (ESS), AHI and posterior airway space (PAS) before and 1 year after surgery. RESULTS: We evaluated 10 subjects (4 males, 6 females) who underwent wing mandibular osteotomy. The mean age of the subjects was 37.8 ± 7.26 years. Analysis of the data demonstrated a significant change in ESS and AHI 1 year after operation. However, PAS was not changed 1 year after surgery. Results did not show any correlation between age, ESS and AHI before and 1 year after surgery. CONCLUSION: Mandibular wing osteotomy is a novel procedure that improves signs of OSA. It may be a surgical option in retrognathic patients with OSA who are not candidates for conventional maxillomandibular advancement.

Cutaneous Metaplastic Synovial Cyst: A Case Report and Literature Review.

INTRODUCTION: Cutaneous metaplastic synovial cyst (CMSC) is a rare cutaneous lesion characterized by a tender subcutaneous nodule, which usually occurs at the site of previous surgical or local trauma. Histologically, the lesion includes a cystic structure with villous-like projections and a lining mimicking hyperplastic synovium. CASE PRESENTATION: We reported the first case of CMSC which developed at the surgical incision site of treatment of a maxillofacial fracture. In addition, we reviewed English literature to evaluate all previously reported CMSC cases and discussed its clinical and histopathological features and etiology. From 1987 to now, reviewing the English literature about CMSC includes 17 studies that described 28 cases, and our presented case was the 29th. There was no sex predilection and age of patients ranged from 7 to 82 years, but most of them were over 40 years. We can see this lesion in any site of the body and hand/arm is the most prevalent involved region (28% cases). Most of the patients had a history of previous local trauma or operation in the involved area. CONCLUSIONS: Although the actual etiology of CMSC remains unclear, trauma, as the most probable etiologic factor, plays a role in development of CMSC. Surgical excision of the lesion is the preferable treatment choice and rate of recurrence is low.

Ethnic rhinoplasty in Iranians: the oral and maxillofacial surgery experience.

PURPOSE: Rhinoplasty is a common esthetic procedure in Iran. The aim of the present study was to evaluate Iranian patient satisfaction. The role of ethnicity in surgical planning was assessed. MATERIALS AND METHODS: This cross-sectional study examined participants aged between 18 and 45 years who underwent primary rhinoplasty. Patients' photographs were analyzed for tip projection, nasolabial angle, and nasofrontal angle. The surgical methods were chosen on the basis of the anatomic part of the nose treated. Patient satisfaction was assessed. RESULTS: Of 279 participants, 210 (75.53%) had a chief complaint of a large nasal tip. A hump nose was a problem for 230 (82.44%) of the participants. Tip droop was a problem for 248 participants (88.89%). The number who wished to have a natural nose was 213 (76.34%), and 66 (23.66%) preferred to have an exaggerated nose. For the recall phase of the study, 248 patients (89 men, 159 women) agreed to participate. Men were more satisfied than women 1 year after rhinoplasty. Patients with an elevated tip had a higher satisfaction rate than others. The satisfaction level of patients increased when nose projection decreased. CONCLUSIONS: It seems that tip defining and elevation were major concerns of Iranian surgeons. Iranian patients were satisfied with an elevated and low-profile tip.

In vitro and in vivo evaluation of a new nanocomposite, containing high density polyethylene, tricalcium phosphate, hydroxyapatite, and magnesium oxide nanoparticles.

In this study, a new nanocomposite, which contained high density polyethylene (HDPE), tricalcium phosphate (Ca3(PO4)2) nanoparticles (TCP NPs), hydroxyapatite nanoparticles (HA NPs), and magnesium oxide nanoparticles (MgO NPs) was prepared. As in vitro experiment, human osteoblasts (HOB) cells were exposed to pristine HDPE and its nanocomposite for a period of 1, 4, and 7 days at 37 °C, and then different assays were carried out, including osteoblast cell proliferation, Trypan blue staining, cell viability, alkaline phosphatase (ALP), and cell adhesion. Antibacterial property of pristine HDPE and its nanocomposite was evaluated, and also their mechanical properties were measured after 2 and 4 months. As in vivo experiment, pristine HDPE and its nanocomposite were separately implanted on calvarium bone of rabbits, and tissue inflammation and osteogenesis were investigated after 2, 4, and 6 months. In case of HOB cells treated with HDPE or nanocomposite, as incubation time was increased, cell proliferation, live/dead ratio, and cell viability were decreased. But, the ALP activity and cell adhesion of HOB cells which treated with nanocomposite were raised after increase of incubation time. This study demonstrated that although the mechanical properties of nanocomposite were similar to HDPE sheet, but their antibacterial property was not similar. The in vivo experiment showed that both pristine HDPE and its nanocomposite had same inflammation responses. Interestingly, osteogenesis was observed after 2 months at bone/nanocomposite interface, and was highly increased after 4 and 6 months. It must be noted that such pattern was not seen at bone/HDPE interface.

Intracranial meningioma at the site of a previous cranial penetrating trauma due to shrapnel.

Meningiomas are common and mostly benign intracranial tumors, which originate from arachnoid cells of the meninges, and account for approximately 25% of all primary intracranial tumors. Many external etiological factors have been described as etiology of meningioma in the literature, one of which is head trauma. However, trauma as a cause of meningioma remains a controversial subject. Here, a case of a patient with posttraumatic meningioma, who was wounded 25 years before, is presented. The assessment of the clinical characteristics of the patient and those reported in the literature seem to confirm that, in some cases, head trauma may be a factor contributing to the development of meningioma.

Therapeutic effects of local application of dexamethasone during bilateral sagittal split ramus osteotomy surgery.

PURPOSE: Bilateral sagittal split ramus osteotomy (BSSO) is one of the most common procedures used in the treatment of mandibular deformity. One common complication of this surgical procedure is hypoesthesia of the inferior alveolar nerve. The authors hypothesized that perioperative local application of dexamethasone would have positive therapeutic effects on neurosensory function. MATERIALS AND METHODS: This study investigated 18 patients (10 male, 8 female; mean age, 26.1 ± 4.9 yr) who underwent BSSO. One side of each patient's mandible was randomly selected as the control side and the opposite side as the experimental side. A solution of dexamethasone 4 mg/1 mL was drawn into a syringe and poured directly on the distal segment of the exposed inferior alveolar nerve during splitting and 1 mL was poured on the same nerve immediately before the start of fixation. Neurosensory tests, including light touch, direction of movement, static 2-point touch, thermal stimuli, and pin prick discrimination, were conducted. The χ(2) and Fisher exact tests were used to evaluate the data. RESULTS: The difference between the control and experimental groups at all intervals was not significant for any of the neurosensory tests. CONCLUSION: Local application of dexamethasone on the exposed inferior alveolar nerve during BSSO is not recommended.

Silver and gold nanostructures: antifungal property of different shapes of these nanostructures on Candida species.

The shape of nanoparticles is an important determinant of their physical and chemical properties, possibly including the little-explored area of their use as antifungal agents. Therefore, we evaluated the in vitro antifungal activities of three different shapes of silver and gold nanostructures, including nanocubes, nanospheres, and nanowires, on Candida albicans, C. glabrata and C. tropicalis, using the microdilution and disk diffusion methods as per the guidelines of the Clinical and Laboratory Standards Institute. We found that silver and gold nanocubes had higher antifungal properties against the test species than nanospheres and nanowires. While some isolates were resistant to silver and gold nanospheres and nanowires, none of the isolates were resistant to silver and gold nanocubes. The occurrence of resistance is a new finding which should be further explored.

General anesthesia in orthognathic surgeries: does it affect horizontal jaw relations?

PURPOSE: The aim of this study was to evaluate the influence of general anesthesia on centric jaw relation (CR) records of orthognathic surgical patients in different postural positions. MATERIALS AND METHODS: Fifty patients undergoing orthognathic surgery at Taleghani Hospital (Tehran, Iran) in 2008 were prospectively studied. CR records were obtained in conscious patients in 2 different positions (upright and supine) 1 day before surgery and in the supine position under general anesthesia. The impressions were made and the corresponding casts were mounted on a semiadjustable articulator. Differences were measured to the nearest 0.10 mm using a caliper. Paired t test and a general linear regression model were used for statistical analysis. RESULTS: Fifty patients (27 women and 23 men; mean age, 22.5 ± 3.5 yr) were enrolled. Angle Class I (group I), Class II (group II), and Class III (group III) malocclusions were detected in 16% (n = 8), 54% (n = 27), and 30% (n = 15) of patients, respectively. Although mean changes were smaller than 2 mm, statistically significant differences were found by paired t test in all Angle classification groups. No significant differences were found between the supine and conscious and the supine and unconscious patient positions in groups I and III (P > .05). However, in group II, this difference was statistically significant (P = .001). Regarding the impact of anesthesia on CR records of patients with different Angle classes, this study showed a significant effect, particularly in group II. Assessment of the outcome of interest (difference between the supine and conscious and the upright and conscious positions) versus position after adjustment for Angle class using a general linear regression model showed that the difference was significant only for Angle class (ß = +0.29; t = 3.05; P = .003). CONCLUSION: General anesthesia may not adversely affect the mandibular condylar position in orthognathic patients in a supine position compared with a supine and conscious position. However, among all study groups, group II showed more significant changes in CR records under general anesthesia. Oral and maxillofacial surgeons should be well aware of such changes in these particular positions and avoid possible mismanagement and potential complications.

Closure of large oroantral communication using coronoid process pedicled on temporalis muscle flap: a new alternative approach.

Proximity of maxillary molar teeth roots to the maxillary sinus floor can potentiate oroantral communication (OAC) after extraction. Considering the defect size and situation, surgical treatment may become essential. Surgical treatment modalities are variable and would be indicated in special clinical circumstances.In this article, a chronic case of OAC with a size of 25 × 15 mm(2) in a 30-year old man with history of heavy smoking and drug abuse was treated with combination of buccal fat pad (for covering sinus floor), coronoid process pedicled on temporalis flap, and mucosal closure. There was no complication during and after operation. Short- and long-term follow-up revealed success of this novel technique despite the patient's poor compliance.

Pseudoaneurysm of the superficial temporal artery following penetrating trauma.

Pseudoaneurysm of superficial temporal artery (STA) is an uncommon complication of blunt and penetrating trauma. It accounts for only 1% of all traumatic aneurysms. Most pseudoaneurysms of STA present as a painless pulsating mass, and its diagnosis can be made with physical examination and ultrasound or computed tomography angiogram. The treatment of choice is ligation and resection. This report includes a review of the anatomy, histopathology, etiology, diagnosis, and treatment options for STA pseudoaneurysm and presents a very rare documented case of STA pseudoaneurysm following penetrating trauma that was presented to the hospital with severe hemorrhage, and surgical resection of the lesion mandated the external carotid artery to be exposed for proximal control.

Complication following reconstruction of orbital floor with temporalis-coronoid flap after subtotal maxillectomy.

A 33-year-old lady was referred to the Department of Oral and Maxillofacial Surgery of Taleghani hospital in 2008. She complained of firm swelling on the left side of her face with toothache, lacrimation, and nasal stiffness. There was a large mass in the left maxillary sinus with extension to the orbital floor, nasal bone, ethmoid sinus, and infratemporal fossa. The incisional biopsy revealed a neurofibroma of the maxilla. She underwent hemimaxillectomy and simultaneous reconstruction with temporalis-coronoid flap for orbital floor reconstruction. After 2 months' follow-up with no complication, she complained of left globe upward movement during gum chewing. The orbital and visual examinations were otherwise normal. This unusual complication has continued for 4 years with no resolution, although the patient does not worry about it any more.

Pattern of odontogenic infections at a tertiary hospital in tehran, iran: a 10-year retrospective study of 310 patients.

OBJECTIVE: To retrospectively evaluate the treated cases with odontogenic abscess and identify the outcome of odontogenic infections, their characteristics and treatment modalities. MATERIALS AND METHODS: This retrospective study was performed by collecting data from 310 patient records at the oral and maxillofacial surgery department of Taleghani hospital, Tehran, Iran from January 2001 to January 2011. The variables were age, gender, affected teeth, affected facial spaces, type of bacterial source, type of antibiotic therapy, previous medication, hospital stay, body temperature on admission and past medical history. RESULTS: The patients' ages were between 2 and 84 years and 62.6% of the patients with odontogenic infection were younger than 35 years old. Most of the patients had a body temperature of 37-37.5°C. The most involved teeth were mandibular third molar. Deciduous teeth contained 6.4% of the involved teeth, among which mandibular molars were the most involved. 24.3% of the patients were hospitalized for 4 days. Streptococci were the most detected bacterial strain. The most involved anatomic space was the buccal space and 22.5% of the cases had multi space involvement and 17 cases had Ludwig's angina. The most common used antibiotic regimens were penicillin G and metronidazole or cefazolin and metronidazole. The mortality rate was 1%, all of whom had Ludwig's angina. CONCLUSION: The main affected facial spaces were buccal and submandibular spaces. The most common used antibiotic was penicillin, proving its effectiveness in the treatment of jaw infections. Odontogenic abscesses are mostly related to the eruption of mandibular molars.