Maintenance of Segmental Maxillary Expansion: The Use of Custom, Virtually Designed, and Manufactured Palatal Appliances Without the Use of an Occlusal Splint.

Expansion of the maxilla using a segmental Le Fort I osteotomy is a routine and commonly used procedure in the treatment of dentofacial deformities. Although orthognathic surgery has seen tremendous advancement in technology, including virtual surgical planning and customized hardware, some room for advancement exists in the maintenance of surgical maxillary expansion. Traditionally, this has been accomplished with retention of a maxillary occlusal splint 4 to 8 weeks postoperatively. This article introduces some novel techniques to help maintain this expansion, including the intraoperative transpalatal archwire and custom palatal strap appliance in conjunction with autogenous bone harvest and grafting in lieu of using occlusal-based splints. The aim of these techniques is to improve postoperative patient comfort and surgical outcomes and shorten postoperative orthodontic treatment time.

Zoledronate, smoking, and obesity are strong risk factors for osteonecrosis of the jaw: a case-control study.

PURPOSE: Bisphosphonates (BPs) effectively treat metastatic bone disease, hypercalcemia, and osteoporosis. BP exposure, however, may be associated with osteonecrosis of the jaw (ONJ). The aim of the present study was to estimate the magnitude of the association between intravenous (IV) BP exposure and ONJ, and to identify potential confounders. MATERIALS AND METHODS: Using a case-control study design, the investigators identified and adjudicated a sample of cases with ONJ and matched them randomly with 5 controls per case. The controls were matched to cases on age, gender, cancer type, and date of cancer diagnosis. The medical records were abstracted and data on BP exposure, cancer therapy, and comorbidities were recorded. Statistical analyses were carried out using conditional logistic regression in Stata 9.0 (Stata Corp, College Station, TX). RESULTS: Thirty cases of ONJ were identified at Massachusetts General Hospital from February 2003 through February 2007. Zoledronate was found to confer significant risk toward development of ONJ (adjusted odds ratio = 31.8, P < .05). Although a trend toward increased risk was noted for pamidronate, this association was not significant after controlling for zoledronate. Obesity and smoking were associated significantly with ONJ development, whereas oral BPs had no effect. CONCLUSION: In this study, cancer patients who had received zoledronate exhibited a significant 30-fold increase in their risk to develop ONJ. More studies are needed to elucidate the exact role of obesity and smoking in the development of ONJ, and the complex interactions of IV BPs with other chemotherapies during cancer treatment.

Internal Maxillary Artery Preoperative Embolization Using n-Butyl Cyanoacrylate and Pushable Coils for Temporomandibular Joint Ankylosis Surgery.

BACKGROUND: Temporomandibular joint (TMJ) ankylosis causes disability through impaired digestion, mastication, speech, and appearance. Surgical treatment increases range of motion with resultant functional improvement. However, substantial perioperative blood loss can occur (up to 3 L) if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult because of limited proximal IMAX access and poor visualization. Our aim is to investigate the technical feasibility and preliminary safety of preoperative IMAX embolization in patients undergoing TMJ ankylosis surgery. METHODS: Case series using chart reviews of 2 patients who underwent preoperative embolization before TMJ ankylosis surgery. RESULTS: Both patients were women (28 and 51 years old) who had severely restricted mouth opening. Embolization was performed using general anesthesia with nasal intubation on the same day of TMJ surgery. Both patients underwent bilateral IMAX embolization using pushable coils (Vortex, Boston Scientific) of distal IMAX followed by n-butyl-cyanoacrylate (Trufill, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurologic examination results. TMJ surgery occurred with minimal operative blood loss (≤300 mL for each surgery). Maximum postoperative mouth opening was 35 mm and 34 mm, respectively. One patient had a postoperative TMJ wound infection that was managed with antibiotics. CONCLUSIONS: Preoperative IMAX embolization before TMJ ankylosis surgery is technically feasible with encouraging preliminary safety. There were no complications from the embolization procedures and surgeries occurred with low volumes of blood loss.

Active Raman sounding of the earth's water vapor field.

The typically weak cross-sections characteristic of Raman processes has historically limited their use in atmospheric remote sensing to nighttime application. However, with advances in instrumentation and techniques, it is now possible to apply Raman lidar to the monitoring of atmospheric water vapor, aerosols and clouds throughout the diurnal cycle. Upper tropospheric and lower stratospheric measurements of water vapor using Raman lidar are also possible but are limited to nighttime and require long integration times. However, boundary layer studies of water vapor variability can now be performed with high temporal and spatial resolution. This paper will review the current state-of-the-art of Raman lidar for high-resolution measurements of the atmospheric water vapor, aerosol and cloud fields. In particular, we describe the use of Raman lidar for mapping the vertical distribution and variability of atmospheric water vapor, aerosols and clouds throughout the evolution of dynamic meteorological events. The ability of Raman lidar to detect and characterize water in the region of the tropopause and the importance of high-altitude water vapor for climate-related studies and meteorological satellite performance are discussed.