Multifocal eosinophilic granuloma of the jaw: long-term follow-up of a novel intraosseous corticoid treatment for recalcitrant lesions.

Eosinophilic granuloma of the jaws is a rather benign and localized form of Langerhans' cell histiocytosis. Treatment is usually required in larger lesions that cause local pain and swelling and pose the risk of spontaneous fractures. There are several accepted forms of treatment, which include surgery, radiation therapy, systemic and local therapy with corticoids, and systemic chemotherapy. No studies exist that compare the effectiveness of these treatment modalities. We report a novel therapeutic regimen that uses repeated intraosseous injections of triamcinolone-1 16 alpha 21-diacetat, a synthetic corticoid, which led to a rapid, complete, and durable treatment. The patient had a multilocal eosinophilic granuloma of the mandible in which radiation therapy, systemic corticoid therapy, and systemic chemotherapy had failed.

Elevated activation markers of coagulation in patients undergoing orthognathic surgery.

Surgery is associated with a variable but increased incidence of postoperative venous thromboembolism (VTE). The risk of VTE after orthognathic surgery is unknown. Recently developed assays for activation markers of blood coagulation allow the detection of a prethrombotic state and may thus help to identify surgical procedures with a risk of postoperative VTE. The pre- and postoperative levels of thrombin-antithrombin complex (TAT) and prothrombin fragment 1+2 (F1+2) were studied in ten patients undergoing orthognathic surgery. Mean levels of TAT and F1+2 were within the normal range preoperatively (TAT:2.6+1.0 microg/L, F1+2:0.8+0.2 nmol/L). A significant increase in both parameters occurred postoperatively (TAT:21.8+21.4 microg/L, P<0.005; F1+2:1.3+0.4, P<0.02). No increase was observed in a control group (n=13) consisting of patients undergoing minor surgical procedures in general anesthesia. Our study shows that a marked activation of the coagulation cascade occurs during orthognathic surgery which warrants further studies on the true incidence of postoperative VTE in patients undergoing orthognathic surgery.

Local injection of corticosteroids for central giant cell granuloma. A case report.

Central giant cell granulomas are benign, but occasionally aggressive lesions that traditionally have been treated surgically. A case of central giant cell granuloma of the mandible is reported that was successfully treated with intralesional injection of corticosteroids.

Ankylosis of the temporomandibular joint. Follow-up of thirteen patients.

We undertook a postoperative clinical study of 13 patients with ankylosis of the temporomandibular joints. The study consisted of an evaluation of the surgical concepts of resection and subsequent surgical reconstruction by osteotomy in previous height of the joint space and lining of the glenoid fossa with lyophilized dura. Early mobilization and aggressive physiotherapy are mandatory postoperative measures. According to the theory of mandibular growth as a result of functional matrix, early surgical intervention to correct ankylosis should be performed, regardless of the age of the patient, to prevent recurrence and later asymmetry or distoclusion.

[Autogenous auricular cartilage grafts after TMJ discectomy. A comparative study with and without silastic implants]. / Autogener Ohrknorpel nach Diskektomie des Kiefergelenkes. Eine Vergleichsstudie mit und ohne Silastikimplantation.

Following TMJ discectomy an interposed autogenous graft is to be preferred. In our study we examined the effect of short-term Silastic grafts on the surrounding tissue. When the silicone material was removed 12 weeks after surgery, foreign body granulations were present only in those cases where the Silastic surface had been mechanically roughened.

[Fixation screws and tension bolt technique for osteotomies. Stability study]. / Fixationsschrauben- und Zugschraubentechnik bei Osteotomien. Eine Stabilitätsstudie.

Following sagittal mandibular osteotomy the mandibles of Class II patients were stabilized using two different fixation techniques. It was the goal of this study to delineate the effects of these two techniques on stability. The patient population was approximately the same on both groups. 1 year after surgery differences in stability were not found. The functional and esthetic results, too, were equal in both groups.

Autogenous auricular cartilage graft for temporomandibular joint repair. A comparison of technique with and without temporary silastic implantation.

Four Macaca fascicularis monkeys underwent bilateral temporomandibular joint surgery including disc removal, condyle recontouring and disc replacement using autogenous auricular cartilage grafts. One side was treated with the cartilage graft alone while the other side was treated with a cartilage graft combined with a temporarily implanted 0.02 inch dacron-reinforced silastic sheet. The silastic sheeting was removed at twelve weeks after the initial surgery. The monkeys were sacrificed at fourteen, twenty-four, thirty-six and fifty-two weeks after the initial disc removal and cartilage grafting. The joints treated with cartilage grafts alone showed significant fibrous connective tissue adhesions which had formed between the inferior surface of the graft and the articulating surface of the condyle. In the joints treated with a cartilage graft and silastic sheeting a joint space was clearly maintained between the cartilage graft and condylar surface without the formation of fibrous connective tissue adhesions. It appears that temporary implantation of a thin silastic sheet combined with autogenous cartilage grafting may prevent the formation of fibrous connective tissue adhesions within the joint.

Lag screw versus position screw techniques for rigid internal fixation of sagittal osteotomies: a comparison of stability.

Both lag screw and position screw techniques have potential advantages and disadvantages when used for securing sagittal osteotomies of the mandible. This study evaluated 56 patients undergoing bilateral sagittal split osteotomies for mandibular advancements. Osteotomies were fixed with either a position screw or lag screw technique using 2-mm self-threading screws. Five cephalometric points and two angles were used to evaluate skeletal changes. There were no statistically significant differences in the postsurgical movement of point B or the mandibular incisor. There were slight statistically significant differences in the horizontal and vertical movements of gonion. Overall, similar postoperative stability existed in both groups. Gonion and gonial angle changes were detected cephalometrically but had no effect on the clinical outcome.

Stability of mandibular advancement after sagittal osteotomy with screw or wire fixation: a comparative study.

Stability and clinical results in 70 patients who underwent bilateral sagittal ramus osteotomy for mandibular advancement were studied. The patients were grouped by the method of fixation (screws vs. wire) and matched for the amount of advancement. There were 35 patients in each group, and the age, sex, and presurgical mandibular plane angle distributions were similar for the two groups. Although the pattern of skeletal and dental changes during the first postsurgical year were quite different for the groups, stability, incisal opening, and clinical results were equivalent at 1 year following surgery. In the first 6 weeks postsurgery, the screw fixation group was more stable horizontally and vertically than the wire group, but between 6 weeks and 1 year, the wire group showed recovery, and the mean differences all but disappeared.