Faculty Bibliography

BACKGROUND: Surface modifications to dental implants have been used in an attempt to accelerate the osseointegration process. The objective of this study was to biomechanically/histomorphometrically evaluate a bioceramic grit-blasted and acid-etched surface (BGB/AA; test) versus a dual acid-etched implant surface (control) in a beagle dog model. METHODS: Control and BGB/AA implants were subjected to a series of physicochemical characterization tools, including scanning electron microscopy (SEM), atomic force microscopy (AFM), and auger photoelectron spectroscopy (APS). The animal model included the placement of 72 implants along the proximal tibiae of six beagle dogs, which remained in place for 2 or 4 weeks. After euthanization, half of the specimens were biomechanically tested (removal torque), and the other half was non-decalcified processed to slides of approximately 30 microm thickness for histomorphologic and histomorphometric (percentage of bone-to-implant contact [%BIC]) evaluation. Analysis of variance at the 95% confidence level and the Tukey post hoc test were used for multiple comparisons. RESULTS: SEM and AFM showed that surface microtextures were qualitatively and quantitatively different and that the BGB/AA surface presented higher submicrometer average roughness values (R(a)) and root mean square (RMS) values compared to control surfaces. Ca and P were detected at the BGB/AA surface by APS. Higher degrees of bone organization were observed along the perimeter of the BGB/AA surface compared to control, despite the non-significant differences in %BIC between the surfaces (P >0.25). Significantly higher removal torque was observed for the BGB/AA implants at both time periods (P <0.0001). CONCLUSION: According to the biomechanical and histomorphologic results, early biomechanical fixation was positively affected by the BGB/AA surface compared to the dual-acid etched surface.

BACKGROUND: Oral cancer continues to be diagnosed and treated at a late stage, which has a negative effect on outcomes. This study identified and quantified delays in diagnosis and treatment. METHODS: The authors conducted a study that included all new patients seen in the Department of Oral and Maxillofacial Surgery, University of California, San Francisco, between 2003 and 2007 who had a diagnosis of squamous cell carcinoma of the oral cavity. They identified the time intervals for six stages, beginning with the time at which patients first became aware of symptoms and ending with the time at which definitive treatment began. RESULTS: The total time from patients' first sign or symptoms to commencement of treatment was a mean of 205.9 days (range, 52-786 days). The longest delay was from the time symptoms first appeared to the initial visit to a health care professional (mean time, 104.7 days; range, 0-730 days). CONCLUSIONS: Health care professionals need to place greater emphasis on patient education to encourage early self-referrals. CLINICAL IMPLICATIONS: Patients should be encouraged to visit a health care professional when signs or symptoms of oral cancer first develop

BACKGROUND: Bilateral cleft lip-cleft palate is associated with nasal deformities typified by a short columella. The authors compared nasal outcomes of cleft patients treated with banked fork flaps to those of patients who underwent nasoalveolar molding and primary retrograde nasal reconstruction. METHODS: A retrospective review of 26 consecutive patients with bilateral cleft lip-cleft palate was performed. Group 1 patients (n = 13) had a cleft lip repair and nasal correction with banked fork flaps. Group 2 patients (n = 13) had nonsurgical columellar elongation with nasoalveolar molding followed by cleft lip closure and primary retrograde nasal correction. Group 3 patients (n = 13) were age-matched controls. Columellar length was measured at presentation and at 3 years of age. The number of nasal operations was recorded to 9 years. The Kruskal-Wallis and Tukey-Kramer tests were used for statistical analysis. RESULTS: Initial columellar length was 0.49 +/- 0.37 mm in group 1 and 0.42 +/- 0.62 mm in group 2. Post-nasoalveolar molding columellar length was 4.5 +/- 0.76 mm in group 2. By 3 years of age, columellar length was 3.03 +/- 1.47 mm in group 1, 5.98 +/- 1.09 mm in group 2, and 6.35 +/- 0.99 mm in group 3. Group 2 columellar length was significantly greater (p < 0.001) than that of group 1 and not statistically different from that of group 3 (p > 0.05). All group 1 patients (13 of 13) needed secondary nasal surgery. No nasoalveolar molding patients (zero of 13, group 2) required secondary nasal surgery. CONCLUSION: Nonsurgical columellar elongation with nasoalveolar molding followed by primary retrograde nasal reconstruction restored columellar length to normal by 3 years and significantly reduced the need for secondary nasal surgery.

Breast cancer often leads to significant alteration of body image and disfigurement of the breast. Reconstruction for breast cancer defects can provide the patient with a restored breast contour. The potential benefit of breast cancer reconstructive surgery is to increase the patient's post-surgical quality of life and alleviate the posttraumatic psychological sequelae of breast cancer surgery. Time of breast cancer diagnosis is an important point of access for patients to receive information on breast reconstruction. Access to this information and plastic surgeons in the early phases of diagnosis is critical to a patient's decision to undergo reconstructive surgery, but is currently underutilized in the United States. Breast cancer reconstruction is a complex process that should be treated in a multidisciplinary fashion. This process must begin with the identification and treatment of psychological issues preceding or accompanying breast cancer diagnosis. These psychological problems should be addressed immediately and can significantly influence a patient's decision toward and level of satisfaction with breast cancer reconstruction. Breast reconstruction continues to be an essential element in helping patients recover from the diagnosis and treatment for breast cancer.

The objective of this study was to evaluate the in vitro degradation of pellet and powder forms of a poly-L-D-lactic acid material used to produce plates and screws for orthopedic, oral, and maxillofacial applications. MATERIALS AND METHODS: In order to produce the powder form the as-received pellets were milled in a cryogenic chamber. Particles size distribution (PSD) histograms were developed for both forms. The materials were then characterized by Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry (DSC), and Thermogravimetric Analysis (TGA) before and after immersion in simulated body fluid for 30, 60, and 90 days. RESULTS: SEM showed that for both forms material degradation started after 30 days of immersion in SBF and evolved until 90 days. Degradation started at the amorphous zones of the polymer and exposed of deeper crystalline layers. The pellet and powder samples PSD showed polydispersed patterns with mean diameters of 673.98 microm and 259.55 microm. Thermal onset degradation temperatures were 365.64 degrees C and 360.30 degrees C, and of 363.49 degrees C and 359.83 degrees C before immersion and after 90 days in SBF for the pellet and powder forms, respectively. The Tg's of the pellets and the powder were approximately 61.5 degrees C and 66 degrees C, and their respective endothermic peaks were observed at approximately 125 degrees C and 120 degrees C. The specific heat (c) was approximately 8.5 J/g and 6.2 J/g for the pellet and powder material, respectively. CONCLUSION: According to the results obtained, cryogenic milling resulted in particle plastic deformation, and alterations in glass transition temperature, melting temperature, and specific heat of the material.

BACKGROUND: The authors' experience in the management of late ulnar nerve injuries is presented. METHODS: A retrospective study of 44 patients with severe ulnar nerve injuries was conducted and the outcomes were analyzed in relation to various factors, such as age at injury, denervation time, level of injury, length of nerve graft, and type of reconstruction (e.g., neurolysis, secondary end-to-end repair, or nerve grafting). Most patients were late cases who were referred to the authors' center for treatment. The mean time between injury and surgery was 14.6 months (range, 2 to 64 months). The mean follow-up period was 2.6 years. RESULTS: Overall, good and excellent motor results (>or=M3+) were seen in 31 of 44 cases (70 percent) and good and excellent sensory results were seen in 28 of 44 cases (64 percent). The age of the patient, level of injury, denervation time, length of nerve graft, and type of surgical reconstruction significantly influenced the functional outcome. CONCLUSIONS: Functional results were significantly better if surgery was performed within 5 months, the length of the graft was 5 cm or less, and the patient was younger than 25 years. Advanced microsurgical techniques, such as interfascicular neurolysis and the use of vascularized nerve grafts or vascularized fascia, should be kept in mind in complex and/or previously failed cases

BACKGROUND: The application of distraction osteogenesis is an effective treatment for mandibular deficiencies. A priori, a horizontal vector of distraction was hypothesized to produce horizontal movement of the mandible and a vertical vector of distraction to produce primarily downward vertical elongation of the ramus. This study was designed to test this hypothesis. METHODS: A retrospective clinical and radiographic review was conducted of all patients who underwent bilateral, uniplanar distraction with an external device at the New York University Medical Center between October of 1990 and February of 2004 (n = 185). A subset of 15 patients was identified who satisfied inclusion criteria and had adequate predistraction and postdistraction lateral cephalograms. Cephalometric tracings were made and multiple landmarks were assessed before and after distraction. RESULTS: A strong correlation was noted between the vector of distraction and rotation of the symphyseal plane, movement of the mandibular symphysis, and change in interocclusal angle. A horizontal vector of distraction resulted in minimal counterclockwise rotation of the symphyseal plane, greater downward vertical translation of the mandibular symphysis, and minimal closure of an anterior open bite. In contrast, a vertical vector resulted in greater counterclockwise rotation of the symphyseal plane, greater horizontal projection of the mandibular symphysis, and greater closure of an anterior open bite. Mathematical formulas were derived to correlate the distraction vector and mandibular movements. CONCLUSIONS: Successful distraction is dependent on accurate prediction of outcomes. This study demonstrates that the vector of distraction predictably affects the mandibular response during bilateral distraction osteogenesis but contradicts the a priori hypothesis

PURPOSE: To acquaint wound care practitioners with new information related to debridement of chronic wounds. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Explain the role of keratinocytes in wound healing. 2. Discuss new research findings on the physiological differences between healing and nonhealing wounds.3. Identify implications of the new research for debridement of chronic wounds

BACKGROUND: The recommended treatment for Blauth types IIIB and IV congenital thumb hypoplasia is index pollicization and amputation of the functionless, hypoplastic thumb. Instead of completely discarding the functionless part, the authors retain a portion of the soft tissue as an adipofascial vascular island flap. This flap is inset at the base of the new thumb to simulate a thenar eminence and to improve the appearance of these hands. METHODS: This flap was used to augment the thenar base in 14 hands in 14 children. Follow-up ranged from 1 to 26 years. RESULTS: All pollicizations were successful and there were no major complications. All of the adipofascial flaps improved the appearance of the thenar eminence and held up their shape in the long term. CONCLUSIONS: Use of an adipofascial island flap is recommended for thenar eminence augmentation in index pollicization of types IIIB and IV thumb hypoplasia. This tissue improves the appearance of the hand, is easy to harvest, and adds no morbidity