A. Thomas Indresano

An epidemiologic survey of facial fractures and concomitant injuries

A 5-year review of facial fractures and concomitant injuries at a level I trauma center is presented. The anatomic location of the facial fractures, age and sex of the patients, cause of injury, and associated systems injuries are presented. The majority of facial fractures were found in males; the most prevalent age range was 16 to 30 years. Mandible fractures outranked zygomatic and maxillary fractures (6:2:1). Assaults and motor vehicle accidents were the most frequent causes of facial fractures, and lacerations followed by neurologic and orthopedic injury were the most frequently encountered concomitant injuries. Motor vehicle accidents were the most frequent cause of associated injury.

Temporomandibular joint arthroscopy: A 6-year multicenter retrospective study of 4,831 joints

Four health outcomes (range of motion, pain, diet, and disability) were measured in six diagnostic categories (internal derangement with closed lock, internal derangement with painful click, osteoarthritis, hypermobility, fibrous ankylosis, and arthralgia) in a 6-year retrospective multicenter study of 4,831 temporomandibular joints having undergone arthroscopic surgery. After arthroscopic surgery, 91.6% of all patients had good or excellent motion; 91.3% had good or excellent pain reduction; 90.6% had good or excellent ability to maintain a normal diet; and 92% had a good or excellent reduction in disability. These health outcomes compare favorably with all other known treatments for these conditions. Also, the surgical technique was relatively free of complications (4.4%).

Radiographic findings in bisphosphonate-treated patients with stage 0 disease in the absence of bone exposure.

PURPOSE Radiographic features in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) are well described, but less is known in bisphosphonate-exposed individuals with stage 0 disease (clinical symptoms without exposed necrotic bone) considered at risk for BRONJ. We sought to characterize radiographic findings in a subgroup of patients with concerning clinical symptoms and bisphosphonate exposure to identify imaging features that may presage development of BRONJ. MATERIALS AND METHODS A dental symptom survey was returned by 8,572 Kaiser Permanente Health Plan members receiving chronic oral bisphosphonate therapy, and 1,005 patients reporting pertinent dental symptoms or complications after dental procedures were examined. Those without BRONJ but with concerning symptoms were referred for clinical evaluation, including imaging. Among the subset who received maxillofacial imaging, we identified those with stage 0 disease and abnormal radiographic features. RESULTS There were a total of 30 patients without exposed bone but with concerning symptoms who received maxillofacial imaging (panoramic radiography or computed tomography) in the context of clinical care. Among these 30 patients, 10 had stage 0 disease with similar radiographic features of regional or diffuse osteosclerosis in clinically symptomatic areas, most with extension beyond the involved site. Other findings in these 10 patients included density confluence of cortical and cancellous bone, prominence of the inferior alveolar nerve canal, markedly thickened and sclerotic lamina dura, uniform periradicular radiolucencies, cortical disruption, lack of bone fill after extraction, and a persisting alveolar socket. None had exposed bone develop during 1-year follow-up. The remaining 20 patients had normal or localized radiographic findings consistent with odontogenic pathology. CONCLUSION In 10 of 30 symptomatic patients referred for clinical evaluation and imaging, a consistent finding was conspicuous osteosclerosis in clinically symptomatic areas characteristic of stage 0 disease. These data support the need to better understand radiographic features associated with bisphosphonate exposure and to determine whether osteosclerosis is a specific finding indicative of the risk for progression to BRONJ.

Arthroscopic surgery of the temporomandibular joint: Report of 64 patients with long-term follow-up

One hundred temporomandibular joints (64 patients) were examined arthroscopically. Complications from the procedure were low (4%). Eighty joints (50 patients) received superior compartment sweep and lavage. Patients with anteriorly displaced nonreducing discs (closed lock) had the highest success rate (83%) from this procedure when evaluated 9 to 30 months later.

Characteristics of implant failures in patients with a history of oral bisphosphonate therapy.

PURPOSE This study examines the pattern of implant failures reported in a large cohort of patients who received oral bisphosphonate therapy. MATERIALS AND METHODS A total of 8,572 individuals who received oral bisphosphonate drugs returned a dental survey that obtained information pertaining to implant placement and related complications. Among the 589 individuals reporting dental implants, 16 reported implant failures that were verified by dental records. Implant placement, timing of failure, and bisphosphonate duration were ascertained to determine the characteristics of implant loss in the setting of oral bisphosphonate exposure. RESULTS Among the 16 patients (all women, aged 70.2 +/- 7.6 yrs) there were 26 implant failures; 8 had failure of 12 implants in the maxilla and 9 had failure of 14 implants in the mandible. Early failure (<or=1 yr after placement) was experienced by 8 patients (8 implants), whereas late failures (>1 yr after placement) occurred in 10 patients (18 implants); 2 patients had both early and late failures. CONCLUSIONS Overall, few patients reported implant failures. However, among these, there were more late than early failures and a slightly higher proportion of failures in the mandible versus the maxilla. Further studies should investigate the role of chronic bisphosphonate therapy in implant survival and long-term implant osseointegration.

Evaluation of porous block hydroxylapatite for augmentation of alveolar ridges.

Twenty-nine alveolar ridges were augmented with porous block hydroxylapatite (HA). Sixty-five percent of the implants had to be partially or totally removed within one year. Thirty-eight percent of the patients had significant delay in receiving their dentures because of delayed healing.

Rapid condylar degeneration after glenoid fossa prosthesis insertion: Report of three cases

Three cases of temporomandibular joint disc replacement with a polymer glenoid fossa prosthesis, followed by rapid condylar degeneration, are reported. The relationship between this degeneration and a consistent foreign body reaction to fragments caused by implant wear is postulated.

Pancreatic carcinoma metastatic to the mandibular gingiva

Abstract A case of metastatic pancreatic adenocarcinoma to the gingiva of a 46-year-old black man is presented. The literature of these rare lesions is reviewed.

A new flap in the dog containing a vascularized rib graft—The latissimus dorsi myoosteocutaneous flap

Abstract A new island flap is described in the dog which is based upon the subscapular vessels and contains latissimus dorsi muscle, overlying skin and a segment of posterior rib. The posterior rib graft is vascularized by perforating vessels which connect the overlying skin and muscle to the posterior intercostal vessels. The rib segment is supplied by the medullary branch off the posterior intercostal artery. This flap was elevated in 10 dogs. Adequate blood supply to the rib was indicated by the observation of blood flow in the posterior intercostal vessels, by bleeding from the medulla of the rib, by routine histologic examination of the rib, and by tetracycline binding to amorphous calcium phosphate. Similar perforating vessels between the latissimus dorsi muscle and the posterior intercostal vessels have been found in primates and humans. This flap may have clinical application when an island or free composite tissue transfer is needed to reconstruct a defect requiring skin, bone, and possibly muscle.

The infected prosthetic total temporomandibular joint replacement: Report of two cases

Two cases of infected total temporomandibular joint replacements are reported. The WBC count, erythrocyte sedimentation rate, and temperature were within normal limits, but erythema, edema, and pain provided the initial clue to the infection. Ultrasonography ultimately revealed a fluid collection and allowed aspiration of the fluid-filled cavity, providing a diagnosis and directing antibiotic therapy.