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J Oral Maxillofac Surg ; 77(6): 1316.e1-1316.e12, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30615847


Functional reconstruction of the temporomandibular joint (TMJ) is a controversial topic among oral and maxillofacial surgeons; this controversy becomes more complicated when one dives into the dilemma of the ideal reconstructive modality. TMJ defects might result from various etiologies, such as blunt or penetrating traumatic injuries, advanced degenerative joint disease, or various pathologic conditions, including benign and malignant conditions, that might arise from the TMJ or adjacent tissues. Reconstruction of the TMJ is vital because of its essential function in mastication, articulation, speech, and facial esthetics and symmetry. In the pediatric population, the TMJ acts as a growth center. TMJ reconstructive surgery might be influenced by various factors that can steer the surgeon toward adopting a specific reconstructive modality. These factors can be classified into preoperative factors that include the overall general health of the patient, expectations, and socioeconomic status that might be an obstacle in using custom-made solutions. The surgeon's experience, level of comfort, and training are crucial influencing factors. TMJ reconstructive options consist of autogenous grafts or alloplastic options. Autogenous grafts encompass 2 broad subcategories. The first is the vascularized option, and a good example is the vascularized fibula free flap. The second subcategory includes nonvascularized grafts, such as costochondral grafts and sternoclavicular grafts. Alloplastic grafts include various TMJ stock joints or custom-made patient-specific prostheses and stock condylar prostheses. The goals of TMJ reconstruction are to establish a pain-free normal range of mouth opening, stable occlusion, and absence of facial deformity. Complication rates in TMJ surgery are low and include surgical infection, nerve injury, failure or fracture of the prosthesis, or injury to adjacent structures. This report presents a case of a stock condylar prosthesis displaced into the middle cranial fossa, which was managed with a 2-stage approach of removing the displaced prosthesis and then reconstruction with a fibula vascularized free flap and a simultaneous contralateral sagittal split osteotomy.

Fossa Craniana Média , Retalhos de Tecido Biológico , Prótese Articular , Transtornos da Articulação Temporomandibular , Criança , Fossa Craniana Média/cirurgia , Estética Dentária , Fíbula , Humanos , Articulação Temporomandibular
Oral Maxillofac Surg Clin North Am ; 29(4): 465-473, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28823889


The management and treatment of odontogenic infection, and its frequent extension into the head and neck, remains an important section of oral and maxillofacial surgical practice. This area of maxillofacial expertise is widely recognized by the medical community and an essential component to the hospital referral system. Although the general principles of infection management have not changed, there have been modifications in the timing of treatment sequences and treatment techniques. These modifications are influenced by the development of diagnostic methods and advances in bacterial genetics and antibiotic usage. This article reviews treatment considerations and controversies surrounding this subject.

Face , Infecção Focal Dentária/terapia , Infecções dos Tecidos Moles/terapia , Antibacterianos/uso terapêutico , Biofilmes , Celulite (Flegmão)/diagnóstico por imagem , Celulite (Flegmão)/terapia , Meios de Contraste , Drenagem , Infecção Focal Dentária/diagnóstico por imagem , Humanos , Infecções dos Tecidos Moles/diagnóstico por imagem , Tomografia Computadorizada por Raios X
J Oral Maxillofac Surg ; 75(10): 2230-2234, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28336306


PURPOSE: During trigeminal nerve repair, a gap is sometimes encountered that prevents the tension-free apposition of nerve endings. The use of a processed acellular nerve allograft is a novel technique that shows promise in overcoming this problem. The goal of the present study was to support the slowly evolving body of evidence that acellular processed nerve allografts (Avance; Axogen, Alachua, FL) are a viable alternative to autogenous nerve grafting and the use of conduits for reconstructing defects of the trigeminal nerve. PATIENTS AND METHODS: The study design consisted of a retrospective review of the medical records of patients referred to Rutgers School of Dental Medicine for management of trigeminal nerve injuries from July 2008 to August 2014. Sixteen patients met the inclusion criteria for the present study. All patients underwent nerve grafting using a processed nerve allograft. All operations were performed by the same surgeon (V.Z.). Serial neurosensory testing was performed by 1 clinician (V.Z.) in a standardized fashion. The primary outcome variable was the interval to functional sensory recovery as defined by the Medical Research Council Scale. RESULTS: The participants ranged in age from 16 to 62 years (mean 32). Of the 16 patients, 12 were female (75%) and 4 were male (25%), and 3 were smokers (18.75%) and 13 were nonsmokers (81.25%). One half of the patients (n = 8; 50%) underwent surgery on the inferior alveolar nerve, and 8 (50%) underwent surgery on the lingual nerve. The most common mechanism of injury was impacted third molar removal (n = 9; 56.25%) Of the 16 patients, 15 (93.75%) achieved functional sensory recovery during the study period. CONCLUSIONS: The results of the present study support the hypothesis that processed nerve allografts are effective in reconstructing small (<2-cm) trigeminal nerve defects.

Traumatismos do Nervo Trigêmeo/cirurgia , Adolescente , Adulto , Aloenxertos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Adulto Jovem
J Oral Maxillofac Surg ; 73(11): 2241-50, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26172990


The present report describes 2 patients who underwent mandibular reconstruction after segmental mandibulectomy for benign pathology. The potential of an ultrasonic-aided biodegradable system for containment of a nonvascularized bone graft is discussed.

Mandíbula/anormalidades , Mandíbula/cirurgia , Telas Cirúrgicas , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia Panorâmica , Tomografia Computadorizada por Raios X
J Biomed Mater Res A ; 83(3): 747-58, 2007 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-17559109


The in vivo bone response of 3D periodic hydroxyapatite (HA) scaffolds is investigated. Two groups of HA scaffolds (11 mm diameter x 3.5 mm thick) are fabricated by direct-write assembly of a concentrated HA ink. The scaffolds consist of cylindrical rods periodically arranged into four quadrants with varying separation distances between rods. In the first group, HA rods (250 microm in diameter) are patterned to create pore channels, whose areal dimensions are 250 x 250 microm(2) in quadrant 1, 250 x 500 microm(2) in quadrants 2 and 4, and 500 x 500 microm(2) in quadrant 3. In the second group, HA rods (400 microm in diameter) are patterned to create pore channels, whose areal dimensions of 500 x 500 microm(2) in quadrant 1, 500 x 750 microm(2) in quadrants 2 and 4, and 750 x 750 microm(2) in quadrant 3. Each group of scaffolds is partially densified by sintering at 1200 degrees C prior to being implanted bilaterally in trephine defects of skeletally mature New Zealand White rabbits. Their tissue response is evaluated at 8 and 16 weeks using micro-computed tomography, histology, and scanning electron microscopy. New trabecular bone is conducted rapidly and efficiently across substantial distances within these patterned 3D HA scaffolds. Our observations suggest that HA rods are first coated with a layer of new bone followed by subsequent scaffold infilling via outward and inward radial growth of the coated regions. Direct-write assembly of 3D periodic scaffolds composed of micro-porous HA rods arrayed to produce macro-pores that are size-matched to trabecular bone may represent an optimal strategy for bone repair and replacement structures.

Regeneração Óssea , Substitutos Ósseos , Durapatita , Tecidos Suporte , Animais , Tinta , Teste de Materiais , Porosidade , Coelhos , Fraturas Cranianas/terapia