Influence of Bimaxillary Surgery on Pharyngeal Airway in Class III Deformities and Effect on Sleep Apnea: A STOP-BANG Questionnaire and Cone-Beam Computed Tomography Study.

PURPOSE: To evaluate pharyngeal airway space (PAS; nasopharyngeal, oropharyngeal, and total airway) volume and the correlation of an obstructive sleep apnea (OSA) and hypopnea syndrome screening questionnaire (STOP-BANG) with various mandibular setbacks during bimaxillary surgery and compare these findings with an age- and gender-matched skeletal Class I control group. PATIENTS AND METHODS: This retrospective cohort study was composed of patients with skeletal Class III discrepancy who underwent bimaxillary jaw surgery and were assessed with STOP-BANG score, cephalometry, and cone-beam computed tomography (of the PAS). The predictor variable was bimaxillary jaw surgery and included 4-, 6-, and 8-mm setbacks. The primary outcome variables were PAS volume, body mass index, and STOP-BANG score evaluated at 1 week before surgery and after comprehensive orthodontic treatment (11.25 ± 1.95 months). Other variables were grouped into the following categories: demographic and cephalometric parameters. Statistical intragroup and intergroup differences were assessed by paired t and independent t tests (P < .05), respectively. RESULTS: The study sample was composed of 48 patients (18 to 25 yr old); group I received 4-mm setback (n = 16), group II received 6-mm setback (n = 16), and group III received 8-mm setback (n = 16) mandibular surgery, and all test groups received 4-mm maxillary advancement. The entire study group was compared with a skeletal Class I control group (n = 16). The total PAS volume after orthodontic treatment in groups I and II showed a significant decrease compared with the presurgical PAS (P < .001), but the decrease was not less than that in the control group (P > .05). In contrast, the total PAS volume in group III after orthodontic treatment (23,574 ± 1,394 mm3) was less than that in the control group (23,884 ± 1,543 mm3). CONCLUSION: After surgery, patients with Class III discrepancy exhibited a decrease in oropharynx volume; however, the STOP-BANG score showed no change in risk factors scores for OSA at 4- to 8-mm setback surgery of the mandible in bimaxillary jaw surgery.

Toll-like receptor-9 agonists increase cyclin D1 expression partly through activation of activator protein-1 in human oral squamous cell carcinoma cells.

Increasing evidence suggests that malignant transformation can result from chronic infection, and Toll-like receptors (TLRs) may play an important role in this process. We have previously reported that the increased expression of TLR-9 is associated with tumor cell proliferation in oral cancer. However, the mechanisms involved have not been elucidated. The aim of this study was to investigate whether CpG-oligodeoxynucleotides (CpG-ODN), a special TLR-9 agonist, is able to exert the proliferation-promoting effect in human oral squamous cell carcinoma (OSCC), and to explore the possible underlying molecular mechanism. Flow cytometry, MTT, and colony formation assay were used to evaluate cell proliferation and cell cycle distribution. The mRNA and protein levels were analyzed by quantitative RT-PCR and Western blot assay. Luciferase reporter gene, EMSA, and ChIP assays were used to detect the activity of activator protein-1 (AP-1) and nuclear factor-κB (NF-κB) in HB cells. Results showed that CpG-ODN could stimulate proliferation of HB cells in a dose- and time-dependent manner with a promoted G(1) /S cell cycle progression. Increased cyclin D1 expression was detected in the nuclear region after CpG-ODN treatment. Moreover, CpG-ODN promoted nuclear translocation and activation of AP-1, which appeared to be required for TLR-9-mediated cyclin D1 expression and subsequently cell proliferation, but seemed to have little impact on NF-κB activity. Our results indicate that CpG-ODN stimulates tumor cell proliferation through TLR-9-mediated AP-1-activated cyclin D1 expression in OSCC HB cells. Pharmacologic inhibition of the TLR-9/AP-1/cyclin D1 pathway may be a new therapeutic approach for prevention as well as treatment of OSCC.

Long-term results of partial double-barrel vascularized fibula graft in symphysis for extensive mandibular reconstruction.

PURPOSE: This study aimed to retrospectively review patients who underwent reconstruction of large mandibular defects with partial double-barrel vascularized fibula graft in the symphysis. MATERIALS AND METHODS: Ten patients who underwent reconstruction of large mandibular defects with partial double-barrel vascularized fibula graft in the symphysis (n = 6) and partial double-barrel vascularized fibula graft in the symphysis combined with condylar prosthesis (n = 4) were reviewed. Five patients accepted secondary implantation postoperatively. Measurements of chin labial angle on lateral cephalograms and bone height on panoramic radiographs were performed at 2 years postoperatively in 8 patients. Measurements of chin labial angle were compared with preoperative values. Bone height measurements were compared with measurements obtained preoperatively and at 1 month postoperatively. Eight patients with follow-up greater than 2 years were also asked to rate their satisfaction with their facial appearance. RESULTS: The mean follow-up period was 43.0 months. Bony union and wound healing were observed in all patients during the follow-up period. There was no significant difference in the mean chin labial angle between preoperative measurements and measurements at 2 years postoperatively (P = .128). There was no significant difference in mean bone height between 1 month postoperatively and 2 years postoperatively (P > .05). Eight patients reported that their facial appearance was excellent or good at 2 years postoperatively. CONCLUSIONS: Reconstruction of large mandibular defects with partial double-barrel vascularized fibula graft in the symphysis could not only achieve good facial appearance and function but also maintain soft and hard tissue stability in the long term.

Surgical site infection in elderly oral cancer patients: is the evaluation of comorbid conditions helpful in the identification of high-risk ones?

PURPOSE: This study was performed to gain some knowledge on the possible relation between surgical site infection (SSI) and geriatric patients who undergo surgical treatment of oral squamous cell carcinoma and to identify the risk factors in this specific population. PATIENTS AND METHODS: A retrospective study from 2004 through 2010 at the Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine was conducted. The primary outcome variable was the presence of SSIs. Twenty-seven variables of the patients concerning general characteristics, comorbidities, disease information, and treatment options were investigated. A multivariate analysis using logistic regression was implemented to find SSI risk factors. RESULTS: The data of 376 patients (183 men, 48.7%; 193 women, 51.3%) older than 65 years with the diagnosis of oral squamous cell carcinoma were included in the present analysis. In multivariate logistic regression analysis, 6 parameters were identified for a significant and independent association with the development of SSI: body mass index (P = .0086); diabetes (P < .0001); American Society of Anesthesiologists score (P = .0127); Adult Comorbidity Evaluation-27 score (P = .0392); operation time (P = .0003); and reconstruction with pectoralis major myocutaneous flaps or free flaps (P < .0001). CONCLUSIONS: Special attention to SSIs should be given to elderly patients with oral squamous cell carcinoma. The authors advocate a preoperative evaluation of comorbidities and the selection of high-risk elderly patients for a more effective prevention of SSIs.

Dental implant distractor combined with free fibular flap: a new design for simultaneous functional mandibular reconstruction.

PURPOSE: The purpose of the present study was to present a new method that combines the use of the fibular flap and a custom-made vertical distractor/dental implant device into 1 surgical procedure for simultaneous functional mandibular reconstruction. PATIENTS AND METHODS: The present retrospective case series included 10 patients who were treated using the fibular flap and dental implant distractor (DID) in a single-stage procedure. These 10 patients were treated within a 3-year period (from 2005 to 2007). RESULTS: Of the 10 patients included in the study, 5 were males and 5 were females. The mean age of the sample was 33.8 years (range 17 to 48). The cumulative survival rate of the fibular flaps was 100%. The mean vertical bone height attained with the DID device was 11.4 mm. The mean period from the first operation to the start of dental implant loading was 6.3 months. The cumulative survival rate of the dental implants was 93.75%. CONCLUSIONS: The use of the DID in the fibular flap for mandibular reconstruction is advantageous because it combines vertical distraction osteogenesis of the fibular flap and dental implantation into a single procedure. Implants placed in the reconstructed areas were found to integrate normally, with survival rates comparable to those with 2-stage operations. As such, this novel DID technique can be used for single-stage reconstruction and rehabilitation of segmental mandibular defects in selected patients.

Skeletal stability and complications of bilateral sagittal split osteotomies and mandibular distraction osteogenesis: an evidence-based review.

PURPOSE: To provide an evidence-based review comparing the skeletal stability and complications of bilateral sagittal split osteotomies (BSSOs) and mandibular distraction osteogenesis (MDO) in the treatment of mandibular hypoplasia. MATERIALS AND METHODS: A Medline search from January 1957 to December 2007 was performed wherein articles were retrieved on the basis of a set of inclusion and exclusion criteria. Data on mean skeletal stability and complications for the 2 techniques were retrieved from these articles. RESULTS: Based on the articles about stability, patients undergoing BSSO or MDO with an advancement or lengthening between 6 and 10 mm showed a similar mean skeletal relapse of 15.0% and 17.1%, respectively, within postoperative months 6 to 12. Greater skeletal relapse was reported for BSSO patients with high mandibular plane angles compared with normal mandibular plane angle patients (29.6% vs 11.3%). Based on the articles about complications, patients who underwent MDO showed a lower incidence of persistent inferior alveolar nerve disturbance (2.9%) and condylar resorption (1.4%) compared with BSSO patients, in whom the incidence of these conditions was 27.8% and 6.1%, respectively. CONCLUSION: Both BSSO and MDO showed similar relapse rates for mandibular advancements between 6 and 10 mm. Both techniques may also share similar risk factors for skeletal relapse. BSSO has a higher incidence of persistent neurosensory disturbances and condylar resorption than MDO. Randomized controlled trials of these 2 techniques are still lacking.

Acceptable clinical outcomes and recommended reconstructive strategies for secondary maxillary reconstruction with vascularized fibula osteomyocutaneous flap: A retrospective analysis.

BACKGROUND: We conducted a retrospective analysis of the clinical outcomes and evaluated the reconstructive strategies in patients who underwent secondary maxillary reconstruction with a vascularized fibula osteomyocutaneous flap (VFOF). METHODS: From May of 2001 to June of 2014, 34 patients who underwent secondary maxillary reconstruction with VFOF, with or without titanium mesh, were reviewed. The patients were divided into two groups of maxillary reconstruction, according to different planning and treatment strategies. In Group 1, presurgical planning was achieved using three-dimensional stereomodeling (n = 12). In Group 2, virtual surgical planning was performed and guided templates were produced (n = 22). The differences in the preoperative planning, intraoperative technique, postoperative complications, and long-term results between the two groups were analyzed. Statistical analysis was performed to determine the differences between the two groups and the risk factors for prognosis. RESULTS: Similar and accurate secondary maxillary reconstructions were successfully performed in Group 1 and 2. Postoperative complications were reported in 8 patients in Group 1 and 11 patients in Group 2. Complications were reported in patients who underwent radiotherapy. The incidence of postoperative complications in Group 2 were lower than that in Group 1 with the exception of midfacial collapse (P > 0.05). The long-term results of some patients with class 3 defects were not satisfactory because of midfacial collapse and lower eyelid ectropion. Stepwise regression analysis showed radiotherapy to be a risk factor for prognosis. CONCLUSIONS: The long-term results of secondary maxillary reconstruction were reported to be acceptable in our study. Radiotherapy was the risk factor for prognosis in secondary maxillary reconstruction. On the basis of these results, we highly recommend our strategy for secondary maxillary reconstruction. Good functional results could be achieved after the accurate restoration of maxillary alveolar ridge with several fibular segments using virtual surgical planning and dental restoration.

Increased tumor-infiltrating plasmacytoid dendritic cells predicts poor prognosis in oral squamous cell carcinoma.

OBJECTIVE: Accumulating evidence suggests that plasmacytoid dendritic cells (pDC) have a dual role not only in initiating anti-tumor immune responses but also in inducing immune tolerance to facilitate cancer development. The aim of this study was to investigate the distribution and function of tumor-infiltrating pDCs in primary oral squamous cell carcinoma (OSCC) and their relation to patient outcome. METHODS: The distribution of pDCs in 10 normal oral mucosa and 60 OSCC tissues was detected by immunohistochemistry. The population of pDCs in six OSCC patients and six healthy donors was evaluated by flow cytometry. The relationship between tumor-infiltrating pDCs and clinicopathological data and patient outcome was analyzed accordingly. The capacity of pDCs to produce cytokines, such as IFN-α, IL-6, IL-8 and TNF-α in response to TLR-9 ligands (CpG-ODN) was measured by ELISA. RESULT: PDCs were detected at high levels in 38.3% of the OSCC tissues, primarily in the stroma, but were absent in normal oral mucosa. The frequency of pDCs in OSCC tissue was significantly higher than that observed in normal oral mucosa. However, the distribution and population of circulating pDCs was similar between healthy donors and OSCC patients. Kaplan-Meier analysis revealed a significant association of increasing number of tumor-infiltrating pDCs with lymph node metastasis and overall survival. Multivariate analysis confirmed that high levels of tumor-infiltrating pDCs was an independent prognostic factor. Further cytokine analysis revealed a decreased secretion of IFN-α, IL-6 and TNF-α, which indicated an impaired function of tumor-infiltrating pDCs. CONCLUSIONS: The increased number of tumor-infiltrating pDCs correlates with an adverse outcome in primary OSCC patients. This finding is not only suggestive of the contribution of pDCs in the progression of oral cancer but also presents an opportunity and a new target for OSCC immune therapy in oral cancer management.

Mandibular Reconstruction Using a Custom-Made Titanium Prosthesis: A Case Report on the Use of Virtual Surgical Planning and Computer-Aided Design/Computer-Aided Manufacturing.

The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has been reported to enhance the planning for the reconstruction of mandibular continuity defects. This case report illustrates the use of this technology in the fabrication of a custom-made titanium prosthesis to restore a segmental mandibular defect. The design specifications and sequence of the custom-made titanium prosthesis are discussed. Although successful in this case, there are limitations in its application and case selection is of vital importance.

The use of a dynamic real-time jaw tracking device and cone beam computed tomography simulation.

BACKGROUND: The aim was to introduce and preliminarily evaluate a new software application, SICAT Function, which can directly combine and merge three-dimensional cone beam computed tomography (CBCT) and electronic SICAT jaw motion tracking (JMT) data. METHODS: A detailed description of the methods and dynamic clinical simulation of mandibular movements of a patient are demonstrated. Functional jaw movements on 3 days were recorded by JMT tracking system. The simulation was performed by merging CBCT and JMT data in the software SICAT Function suite. The condylar position simulated by SICAT Function suite was compared with real condyle position showed by a CBCT of the patient. RESULTS: The incisor ranges of functional movements were displayed by JMT tracking system. The visualization of patient-specific mandibular movement including the translation of the condyles was displayed after data merge. The recordings of mandibular movements of the patient were similar on 3 different days. The condylar position simulated by SICAT was coincident with real condyle position by CBCT data with the same amount of mouth opening. CONCLUSIONS: The SICAT Function software is a system capable of measuring and visualizing patient-specific jaw movement relative to the patient-specific anatomy of the jaw. Further studies are needed to validate its accuracy and its potential for future use.

Double-barrel vascularised fibula graft in mandibular reconstruction: a 10-year experience with an algorithm.

BACKGROUND: This retrospective study aims to report an algorithm to assist surgeons in selecting different modes of the double-barrel vascularised fibula graft for mandibular reconstruction. METHODS: A total of 45 patients who underwent reconstruction of mandibular defects with different modes of the double-barrel vascularised fibula graft were reviewed. Our algorithm for deciding on any one of the different modes for different mandibular defects is influenced by factors including history of radiotherapy, the length of mandibular body defect and the need to preserve the inferior mandibular border. Post-operative functional outcomes included diet type and speech, and aesthetic results gained at post-operative 2 years. Patients with implant-borne prosthetic teeth underwent assessment of their masticatory function. RESULTS: There were four modes of mandibular reconstruction according to our algorithm, which included double-barrel vascularised fibula graft (n=21), partial double-barrel fibula graft (n=11), condylar prosthesis in combination with partial/double-barrel fibula graft (n=11), and double-barrel fibula onlay graft (n=2). Flap survival in all patients was 97.78%. Good occlusion, bony unions and wound closures were observed in 44 patients. Eleven patients received dental implantation in the transplanted fibula at post-operative 9-18th months. One patient wore removal partial dentures. For 11 patients with implant-borne prosthetic teeth, the average post-operative ipsilateral occlusal force was 41.5±17.7% of the contralateral force. Good functional and aesthetic results were achieved in 38 patients with more than 2 years of follow-up, including regular diet, normal speech and excellent or good appearance, especially for patients with dental rehabilitation. CONCLUSION: Good aesthetic and functional results can be achieved after dental rehabilitation by following our algorithm when choosing the different modes of double-barrel vascularised fibula graft for mandibular reconstruction.

Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap.

BACKGROUND: This article describes our special considerations in virtual surgical planning for secondary maxillary reconstruction with vascularised fibular osteomyocutaneous flap and our revised surgical design for maxillary reconstruction. METHODS: Eleven patients with different maxillary defects according to Brown's revised classification underwent virtual surgical planning for secondary accurate reconstruction. For different horizontal class defects, the fibular was osteomised to match the maxillary alveolar arch by using the mirror image of the contralateral alveolar ridge or the curve of the mandibular arch and dentition. RESULTS: Maxillary reconstruction was performed with the guidance of preoperative virtual planning and using fibular osteotomy and reposition guide templates to replicate the virtual planning intra-operatively. Virtual surgical planning was replicated intra-operatively in all patients. The fibulae were osteotomised into four segments in three patients with the horizontal class d2 defect and three segments in eight patients with the horizontal class b-d1 defects, respectively. The overall success rate for 11 flaps was 100%. Good bony unions and wound closure were observed and intelligible speech was achieved in 11 patients. Maximum incisal opening ranged from 3.0 to 4.0 cm. All patients tolerated a regular diet postoperatively. Postoperative midfacial appearance was good in all patients. CONCLUSION: We recommend that the horizontal class d defect in Brown's revised classification of maxilla and midface be divided into two sub-types according to whether it involves the contralateral canine or not. Special considerations in virtual surgical planning are helpful to perform accurate secondary maxillary reconstruction with a vascularised fibular osteomyocutaneous flap.

Clinical analysis of 120 cases of intraoral lymphoepithelial cyst.

OBJECTIVE: The aim of this study was to analyze a single institution's experience in the clinical management of intraoral lymphoepithelial cyst (LEC). STUDY DESIGN: From 1993 to 2010, a total of 120 consecutive patients with intraoral LEC underwent surgery and were retrospectively investigated regarding its clinical appearance, clinical differential diagnosis, treatment, and prognosis. RESULTS: Of the 120 patients, 37 were male and 83 female, their ages ranging from 2 to 75 years with a mean of 44.1 years. The most common locations were the tongue (50%) and floor of mouth (38.3%). The course of disease ranged from 2 months to 10 years with a mean of 8.0 months, and 75.8% of the patients had a course of disease <6 months. Routine laboratory examinations were within normal limits. All patients underwent complete surgical removal of the lesions. During the follow-up period, no lesion recurrence occurred, and the quality of life of each patient was good. CONCLUSIONS: The clinical characteristics of intraoral LEC are not specific and may be confused with other intraoral lesions. The first choice of treatment is surgical excision, which results in a good prognosis.

Surgical management of solitary venous malformation in the midcheek region.

OBJECTIVE: The aim of this study was to analyze a single institution's experience of solitary venous malformation (VM) in the midcheek region. STUDY DESIGN: From 2002 to 2009, a total of 10 consecutive patients with solitary venous malformation in the midcheek region were retrospectively analyzed. Clinical records were reviewed for patient demographic data, presenting symptoms and signs, imaging modalities used, histologic and immunohistochemical results, surgical data, and clinical outcomes. RESULTS: The sample consisted of 5 males and 5 females with a mean age of 42.8 years. The course of disease ranged from 0.5 to 144.0 months with a mean time of 64.9 months. The mean size of the masses was 1.7 × 1.5 cm (range 1.0 × 0.8 cm to 2.5 × 2.5 cm). Investigations included Doppler ultrasonography (US) and computed tomography (CT) scanning. Surgical excision using various surgical approaches was performed in all patients. Postoperative pathologic examination confirmed the diagnosis of VM. The mean follow-up period was 41.2 months (range 2 months to 94 months) with no recurrence reported. CONCLUSIONS: For solitary VM in the midcheek region, investigations, such as Doppler US or CT scanning or the use of fine-needle aspiration cytology, may aid in clinical diagnosis. The primary treatment of these lesions is surgical excision, and in our sample, the prognosis of such treatment was good with no recurrence reported.

Synovial sarcoma involving skull base--a retrospective analysis of diagnosis and treatment of 21 cases in one institution.

To retrospectively review the diagnosis and treatment outcomes of 21 diagnosed with synovial sarcoma (SS) extending to skull base region and identify prognostic factors for local recurrence and distant metastasis. The clinical and pathological records of 21 synovial sarcoma cases involving skull base treated at Department of Oral and Maxillofacial Surgery, Affiliated to Ninth People's Hospital, Shanghai Jiao Tong University, from 2003 to 2008 were reviewed. Parameters including clinical, radiographic, histological findings, and treatment modalities were analyzed. Prognostic factors influencing overall survival, local recurrence, and metastasis were identified. Categorical variables were compared between groups for local recurrence and distant metastasis by using 2-tailed Fisher exact test. The sample consisted of 8 males and 13 females with a median age of 23. 42.9% of cases showed skull base bone erosion with 9.5% of cases presenting intracranial tumor extension. 52.4% of cases died from recurrence or metastasis with a median survival time of 11 months. Orbital involvement, perineural and cranial invasion along with other factors were statistically significant for their impact on overall survival. Local recurrence was associated with tumors located in the infratemporal space (p=0.01), perineural invasion (p=0.001), pathological grade 3 (p=0.005), and tumor size >5 cm (p=0.008). The aggressive behavior of skull base SS and its close proximity to vital structures make the diagnosis and management a challenge. The study reported high local recurrence rates despite surgical and postoperative radiotherapy. Adjuvant chemotherapy did not seem to affect distant metastasis rates.

Bilateral sagittal split osteotomies and mandibular distraction osteogenesis: a randomized controlled trial comparing skeletal stability.

OBJECTIVE: To conduct a randomized controlled trial comparing the skeletal stability of bilateral sagittal split osteotomy (BSSO) and mandibular distraction ostoegenesis (MDO) for moderate mandibular advancement. STUDY DESIGN: Fourteen class II mandibular hypoplasia patients requiring mandibular advancement between 6 and 10 mm were randomized into 2 groups for either BSSO or MDO. Serial lateral cephalographs were taken 2 weeks, 6 weeks, 12 weeks, 6 months, and 12 months after surgery for the assessment of skeletal stability. The Student t test was used to analyze stability with statistical significance set at P < .05. RESULTS: There was no significant difference (P > .05) in horizontal and vertical skeletal relapse between the 2 groups at every postoperative time period. CONCLUSIONS: Although the MDO group reported less horizontal and vertical skeletal relapse for mandibular advancements between 6 and 10 mm at 1 year, no statistically significance was found between the groups. Other patient-related factors need to be considered when choosing one technique over the other.

Meta-analysis of mandibular distraction osteogenesis: clinical applications and functional outcomes.

BACKGROUND: Mandibular distraction osteogenesis has been used effectively to treat syndromic craniofacial deformities. In recent years, its scope of application has widened to include treatment of airway obstruction in adults and children and nonsyndromic class II mandibular hypoplasia. So far, there has been no evidence-based review of mandibular distraction osteogenesis for mandibular lengthening. METHODS: Two rounds of searches were performed by two independent assessors. The first-round PubMed search used the keywords "mandible" and "distraction osteogenesis." In the second-round search, the reference lists of the articles were retrieved. For both rounds, abstracts and then full articles were reviewed and selected on the basis of a set of inclusion and exclusion criteria. RESULTS: The 178 retrieved articles yielded 1185 mandibular distraction osteogenesis patients: 539 received unilateral mandibular distraction osteogenesis and 646 received bilateral mandibular distraction osteogenesis. Mandibular distraction osteogenesis was reported to improve facial asymmetry and retrognathia (50.1 percent), correct the slanted lip commissure (24.7 percent), and improve or level the mandibular occlusal plane (11.1 percent) in unilateral asymmetry cases, whereas bilateral mandibular distraction osteogenesis was shown to be effective in preventing tracheostomies for 91.3 percent of neonates or infants with respiratory distress, and in relieving symptoms of obstructive sleep apnea for 97.0 percent of children and 100 percent of adult patients. CONCLUSIONS: Mandibular distraction osteogenesis is effective in treating craniofacial deformities, but further clinical trials are required to assess the long-term stability and to compare the treatment with conventional treatment methods, especially in cases of obstructive sleep apnea or class II mandibular hypoplasia.

Bilateral sagittal split osteotomies versus mandibular distraction osteogenesis: which is better?

Bilateral sagittal split osteotomies (BSSO) and mandibular distraction ostoegenesis (MDO) have both been applied in the surgical treatment of Class II mandibular hypoplasia. This randomized controlled trial aimed to compare the stability and morbidities of both techniques. From the preliminary data, skeletal relapse seems to be comparable between BSSO and MDO within the first post-operative six months. Objective and subjective neurosensory evaluation showed no significant difference in all mean scores for LT, 2PD and PPPT between both surgical techniques. Localized wound infection was a common post-operative complication for MDO. A greater sample size is required to ascertain which technique is better.

Characteristics of inner-city African-Americans with uncontrolled hypertension.

Hypertension control rates are low in inner-city African-Americans. This article describes the demographic and clinical characteristics of uncontrolled hypertension in this population. During a single outpatient visit, normotensive and hypertensive African-American volunteers (age 18 to 55) completed a questionnaire, and the following measurements were obtained: blood pressure (BP), anthropometric measures, and blood chemistries. Volunteers received a gift for participating. Of the 3,943 volunteers, 52% were hypertensive. Among the hypertensives, 75% were aware of hypertension, and of those aware, 76% were on antihypertensive drug therapy. BP was uncontrolled in 78% of all hypertensives and in 60% of those on drug therapy. Males were two times more likely than females to have uncontrolled hypertension. Compared to participants with controlled hypertension, those with uncontrolled hypertension were younger, had lower body mass index, and were more likely to report smoking cigarettes, drinking alcohol, and less likely to report restricting dietary salt. Lack of hypertension control was primarily related to the lack of antihypertensive drug therapy rather than to inadequate drug therapy. Uncontrolled hypertension was associated with several self-reported aversive health behaviors, including not taking antihypertensive medications. Strategies to improve hypertension control should be directed to patients and to health care providers.