Faculty Bibliography

One hundred ten cases of internal derangement of the temporomandibular joint were treated by high condylectomy (47) and eminectomy (63) in combination with discorrhaphy and disc repair. Preoperative and postoperative findings (greater than 24 months follow-up) relating to mandibular mobility, pain, and stability of occlusion were compared. Both procedures resulted in a reduction in symptoms, but differences in postoperative findings were observed. Each procedure resulted in increased translation, with eminectomy patients exhibiting greater opening distances at endstage evaluation. In addition, a greater incidence of residual deviation to the affected side occurred in the majority of high condylectomy patients. Although pain was reduced in both groups, less residual pain was observed in the eminectomy group. Alteration in maxillomandibular centric relation was a rare finding, seen only in two high condylectomy patients. Possible factors contributing to these differences are discussed

A technique for repair of the inferior alveolar nerve of the rat involving a collagen tube conduit with laminin gel lining was compared with unguided regeneration in both large and small nerve gaps. No significant morphologic differences were noted between the groups with small defects. With large defects, however, only the tubular repairs were effective in restoring neural continuity. The implications of the results of this study are discussed

Bilateral clefts of the palate pose difficult and unique problems in surgical rehabilitation. The premaxilla traditionally has been a controversial subject with a historic lack of uniformity in treatment protocol. Based on a review of facial growth and the evolution of premaxillary cleft surgery, principles of management and secondary reconstruction of the premaxilla are discussed. Timely surgical intervention combining osteotomies and bone grafting in conjunction with closure of soft tissue defects is shown to result in satisfactory functional and aesthetic results

A model for advanced microsurgical training that uses the cervical neurovascular structures of the rat is presented. Various uses and technical considerations are discussed

A prospective study of 287 patients who underwent temporomandibular surgery for disc dysfunction was conducted. The patients were evaluated by combinations of polydirectional tomography, microfocus magnification, and arthrographic radiographic modalities. Abnormalities of the hard and soft tissue structures of the joints were determined radiographically and compared with the findings of surgical examination. Polydirectional tomography and microfocus magnification compared favorably with each other, as well as in their ability to show the actual abnormalities. Arthrography had a high degree of correlation with actual pathologic disc alterations, except for the 15% incidence of false-positive findings of perforation. The combination of either polydirectional tomography or microfocus magnification with arthrography is recommended for complete evaluation of the painful temporomandibular joint that shows evidence of limited range of motion

Retrospective and prospective studies were conducted on the incidence of infection in a population of 230 patients undergoing temporomandibular joint surgery. In the retrospective study, 136 patients were treated with cephalosporin antibiotics before, during, and after surgery. In the prospective study, 94 patients were treated without antibiotic coverage. The number of infections in the two groups was not significantly different

Four cases of multiple nevoid basal cell carcinoma syndrome are presented. No one component of the syndrome is present in all patients; instead, the many malformations associated with the syndrome have variable expressivity. The triad of jaw cysts, basal cell epitheliomas, and skeletal anomalies is well known, whereas other aspects, such as intracranial calcifications, hypertelorism, mental retardation, ectopic calcification, cleft lip and palate, cutaneous cysts, and palmar and plantar dyskeratosis, are more subtle and easily overlooked

Published reports of metastatic adenocarcinoma from the colon or rectum to the mandible are extremely rare. Only eight cases had been reported from 1884 to the time this article was written. A case is presented where a metastatic lesion was found to be histologically similar to the known primary tumor in the cecum. The patient first noted dental pain, isolated to his mandibular left second bicuspid, 10 months after a primary tumor was diagnosed. Subsequently, the tooth was extracted, and it was only after the extraction site failed to heal that a biopsy was performed which confirmed a metastatic lesion. Retrospective study of the preextraction radiograph confirmed the presence of a suspicious area in the osseous structure of the mandible at the time of extraction. It must be emphasized that in patients with a positive history of malignancy, metastatic disease must be considered in the differential diagnosis of oral and dental symptoms, and that need for biopsy should be considered with all surgical procedures, including simple extractions

Intramuscular hemangiomas are rare tumors. Their occurrence in the head and neck region is even more unusual. The first reported case involving the orbicularis oris muscle is presented. The histologic classification is that of the mixed-vessel type, which occurs in the head and neck region only 5 percent of the time. Included is a review of the literature, with a discussion of the current philosophy of etiology, diagnosis, and treatment. Knowledge of this type of tumor is important to the oral and maxillofacial surgeon who evaluates mass lesions

Patients with a history of hereditary angioneurotic edema can adequate and safely have nonelective surgical procedures performed with proper preoperative and postoperative management. Deficient amounts of C1 esterase inhibitor can be replaced with fresh frozen plasma; capillary permeability and spreading edema can be prevented with antifibrinolytic agents such as Amicar. Once edema has occurred peripherally and no laryngeal symptoms are present, conservative treatment is advisable. When epiglottic and laryngeal edema occurs, intubation or tracheostomy is preferred for maintenance of airway until the edema subsides. During oral surgical procedures, minimal surgical trauma must be achieved. Edema that involves the airway presents the greatest danger to patients. These attacks are usually associated with dental or some sort of oral or pharyngeal manipulation