Faculty Bibliography

The review considers management strategies for malignant melanoma metastatic to the larynx. This rare clinical entity lacks clear treatment recommendations because extirpative surgery can often result in severe functional debilitation in patients with limited life expectancy. Here, we report a case of melanoma metastatic to the larynx in a patient with a prior history of Hodgkin lymphoma. The patient was treated with partial laryngectomy and local radiation therapy. The rationale for treatment decisions and for surgical and radiotherapeutic techniques and the associated literature are discussed

PURPOSE: To test the strength to failure and fracture mode of three indirect composite materials directly applied onto Ti-6Al-4V implant abutments vs cemented standard porcelain-fused-to-metal (PFM) crowns. MATERIALS AND METHODS: Sixty-four locking taper abutments were randomly allocated to four groups and were cleaned in ethanol in an ultrasonic bath for 5 min. After drying under ambient conditions, the abutments were grit blasted and a custom 4-cusp molar crown mold was utilized to produce identical crowns (n = 16 per group) of Tescera (Bisco), Ceramage (Shofu), and Diamond Crown (DRM) according to the manufacturer's instructions. The porcelain-fused-to-metal crowns were fabricated by conventional means involving the construction and a wax pattern and casting of a metallic coping followed by sintering of increasing layers of porcelain. All crowns were loaded to failure by an indenter placed at one of the cusp tips at a 1 mm/min rate. Subsequently, fracture analysis was performed by means of stereomicroscopy and scanning electron microscopy. One-way ANOVA at 95% level of significance was utilized for statistical analysis. RESULTS: The single load to failure (+/- SD) results were: Tescera (1130 +/- 239 N), Ceramage (1099 +/- 257 N), Diamond Crown (1155 +/- 284 N), and PFM (1081 +/- 243 N). Stereomicroscopy analysis showed two distinct failure modes, where the loaded cusp failed either with or without abutment/metallic coping exposure. SEM analysis of the fractures showed multiple crack propagation towards the cervical region of the crown below a region of plastic deformation at the indenter contact region. CONCLUSION: The three indirect composites and PFM systems fractured at loads higher than those typically associated with normal occlusal function. Although each material had a different composition and handling technique, no significant differences were found concerning their single load to fracture resistance among composite systems and PFM.

The gracilis myocutaneous flap has limited functional donor site morbidity and effectively contours genitoperineal reconstructions. When harvested using a traditional vertical skin paddle, distal-tip necrosis (secondary to inconsistent perforator anatomy) is a well-documented complication. Orienting the skin paddle transversely provides a reliable alternative with a shorter rotational arc but results in a more conspicuous deformity and smaller skin paddle when primary closure is desired. On the basis of recent anatomic studies, we designed a pedicled gracilis myocutaneous flap with a bilobed cutaneous paddle to maximally incorporate both the transverse and longitudinal dimensions of the flap's nearly circular angiosome. The bilobed design allows harvest of a larger transverse skin flap (with a shorter arc of rotation) while a shorter, more dependable vertical skin flap is inset into the transverse flap donor site (rather than inside the critical wound bed). Herein, we detail our surgical technique and provide 2 illustrative case examples.

OBJECTIVE: The aim of this study was to evaluate the effect of surface treatment at the cervical region of endosseous dental implants on the alveolar bone remodeling after implantation immediately after tooth extraction in a dog model. STUDY DESIGN: The third and fourth premolars of 6 dogs were bilaterally extracted with a full-thickness flap, and threaded implants presenting a textured or a polished surface at the cervical regions were placed on the distal root extraction sockets. Submerged healing was allowed for 4 weeks, and bone-to-implant contact (BIC) and buccal and lingual bone loss were morphometrically measured. RESULTS: The BIC and lingual bone loss were not significantly different between textured and polished groups. Significantly lower buccal bone loss (P < .01) was observed for the textured surface at 4 weeks in vivo. CONCLUSION: Textured surface implants placed immediately after tooth extraction resulted in less bone loss only at the buccal cervical region compared with smooth surface implants.

OBJECTIVES: To evaluate the effect of framework design on the fatigue life and failure modes of metal ceramic (MC, Ni-Cr alloy core, VMK 95 porcelain veneer), glass-infiltrated alumina (ICA, In-Ceram Alumina/VM7), and veneered yttria-stabilized tetragonal zirconia polycrystals (Y-TZP, IPSe.max ZirCAD/IPS e.max,) crowns. METHODS: Sixty composite resin tooth replicas of a prepared maxillary first molar were produced to receive crowns systems of a standard (MCs, ICAs, and Y-TZPs, n=10 each) or a modified framework design (MCm, ICAm, and Y-TZPm, n=10 each). Fatigue loading was delivered with a spherical steel indenter (3.18mm radius) on the center of the occlusal surface using r-ratio fatigue (30-300N) until completion of 10(6) cycles or failure. Fatigue was interrupted every 125,000 cycles for damage evaluation. Weibull distribution fits and contour plots were used for examining differences between groups. Failure mode was evaluated by light polarized and SEM microscopy. RESULTS: Weibull analysis showed the highest fatigue life for MC crowns regardless of framework design. No significant difference (confidence bound overlaps) was observed between ICA and Y-TZP with or without framework design modification. Y-TZPm crowns presented fatigue life in the range of MC crowns. No porcelain veneer fracture was observed in the MC groups, whereas ICAs presented bulk fracture and ICAm failed mainly through the veneer. Y-TZP crowns failed through chipping within the veneer, without core fractures. CONCLUSIONS: Framework design modification did not improve the fatigue life of the crown systems investigated. Y-TZPm crowns showed comparable fatigue life to MC groups. Failure mode varied according to crown system

BACKGROUND: The purpose of this study was to introduce the use of selective ipsilateral C7 spinal nerve transfer to the armamentarium of the dynamic procedures used for facial reanimation in Moebius patients. METHODS: Between 1991 and 2007, the selective ipsilateral C7 technique was used in four patients. In three patients with bilateral paralysis, both C7 spinal nerves were utilized as nerve donors. Thus, evaluation of outcomes was carried out in seven hemifaces. RESULTS: Short-term paresthesia on the index pulp of the donor upper extremity was observed in four limbs, which recovered spontaneously. Motor deficits were never noticed. Neurotization of the free-muscle transfer for smile was performed in five hemifaces, with good results in three hemifaces (p < 0.01, z = 2.61). Eye closure neurotization was made in six hemifaces, with good results in four hemifaces (p < 0.01, z = 2.88). Depressor neurotization was made in one case and resulted in improved depressor complex function. In two cases of free muscle transfer for masseter substitution, electromyographic interpretations revealed full motor activity after bilateral latissimus dorsi transfer. Tongue neurotization was performed in two instances. Postoperatively, the patients' speech intelligibility improved as well as tongue motility and bulk. CONCLUSION: The use of the C7 as a motor donor in Moebius cases with multicranial nerve involvement supplies the typical mask-like face with an abundance of motor fibers for facial reanimation and, if there is a coexisting twelfth nerve palsy, for speech restoration

Head and neck reconstruction is a multidisciplinary field, requiring communication among various surgical and dental specialists. The free fibular flap is the standard method for reconstructing large mandibular defects after benign or malignant tumor ablation. The graft has to be precisely contoured to fit the three-dimensional defect to meet the functional and aesthetic goals.Virtual surgical planning using computed tomographic imaging and computer-aided design and manufacturing technology allows the surgeons to perform virtual surgery and generates templates and cutting guides that allow for the precise and expedient recreation of the plan in the operating room. The authors describe 2 cases where virtual planning was used for the extirpative and reconstruction phases to achieve precise reconstruction and decreased time under anesthesia.

PURPOSE: This study tested the null hypothesis that differences in surgical instrumentation, macrogeometry, and surface treatment imposed by different implant systems do not affect early biomechanical fixation in a canine mandible model. MATERIALS AND METHODS: The lower premolars of 6 beagle dogs were extracted and the ridges allowed to heal for 8 weeks. Thirty-six (n = 12 each group) implants were bilaterally placed, remaining for 1 and 3 weeks in vivo. The implant groups were as follows: group 1, Ti-6Al-4V with a dual acid-etched surface with nanometer scale discrete crystalline deposition (Nanotite; Certain Biomet-3i, West Palm Springs, FL); group 2, Ti-6Al-4V with a titanium oxide-blasted fluoride-modified surface chemistry (Osseospeed 4.0 S; Astra Tech, Molndal, Sweden); group 3: Ti-6Al-4V with a bioceramic microblasted surface (Ossean; Intra-Lock International, Boca Raton, FL). Following euthanasia, implants were torqued to interface failure and histologically evaluated. General linear modeling (ANOVA) at 95% level of significance was performed. RESULTS: Histology showed that interfacial bone remodeling and initial woven bone formation were observed around all implant groups at 1 and 3 weeks. Torque values were significantly affected by time in vivo, implant group, and their interaction (P = .016, P < .001, and P = .001, respectively). Regarding torque values, group 3, group 2, and group 1 ranked highest, intermediate, and lowest, respectively. CONCLUSION: Early biomechanical fixation at 1 and 3 weeks was affected by surgical instrumentation, macrogeometry, and surface treatment present for one of the implant systems tested. The null hypothesis was rejected.