Dale A. Baur

Short- and Long-Term Effects of Sildenafil on Skin Flap Survival in Rats†

Objective: Distal ischemic necrosis of the flap remains an unsolved, challenging problem. Phosphodiesterase (PDE) inhibitors, which include the drug sildenafil, are a relatively new class of U.S. Food and Drug Administration‐approved medications whose effect on tissue viability has not been widely explored. The vasodilatory effects of these drugs have the potential to enhance blood flow to flaps and increase their survivability. The purpose of this study was to examine the short‐ and long‐term effects of sildenafil, administered intraperitoneally at a dose of 9 mg/kg per day, on the survival of surgical skin flaps in rats.

A 3-Dimensional Airway Analysis of an Obstructive Sleep Apnea Surgical Correction With Cone Beam Computed Tomography

PURPOSE The purpose of this case report is to present cephalometric changes in the craniofacial region and volumetric changes in the oropharyngeal region of a patient diagnosed with obstructive sleep apnea syndrome after maxillomandibular advancement and genial tubercle advancement surgeries. MATERIALS AND METHODS Cone beam computed tomographic images were used to evaluate cephalometric changes in the craniofacial region and linear changes in the oropharyngeal region of the patient. RESULTS A patient with obstructive sleep apnea was treated successfully with maxillomandibular advancement and genial tubercle advancement surgery. Airway analysis showed a significant increase in the volume of the patients oropharynx after surgery. CONCLUSION Cone beam computed tomographic images are recommended for 3-dimensional airway evaluation in the treatment of obstructive sleep apnea syndrome.

Use of Cone Beam Computed Tomography to Volumetrically Assess Alveolar Cleft Defects—Preliminary Results

PURPOSE The purpose of this study was to determine the utility of cone beam computed tomographic (CBCT) imaging in assessing the volume of alveolar cleft defects in patients undergoing secondary cleft repair. MATERIALS AND METHODS Fourteen patients with unilateral clefts were analyzed in a retrospective study. Preoperative CBCT imaging of patients preparing to undergo secondary repair of alveolar clefts was reviewed. Using anatomic landmarks, 3 measurements were collected from CBCT images for each patient: facial width (FW), facial height (FH), and facial-palatal length (FL). These values were used to calculate the estimated volume (EV) of the cleft and thus the amount of bone graft material that would be needed to fill the defect. RESULTS The overall mean values of FW, FH, and FL were 9.7 ± 3.1, 14.07 ± 2.7, and 5.6 ± 0.8 mm, respectively. Mean EV was 489.0 ± 151.6 mm(3). The single (0.879) and average (0.956) measurements of the intraclass correlation coefficient for FH were very good to excellent. Similar data were observed for FH (single, 0.827; average, 0.935). For FL, a decreasing trend in the mean and variability over the 3 measurement times was reflected in low single (0.305) and moderate average (0.569) intraclass correlation coefficients. CONCLUSIONS CBCT imaging can be used to reliably measure FW, FH, and FL and to calculate the EV of the cleft. These data can be used by oral and maxillofacial surgeons to quantitatively assess the volume of an alveolar cleft and aid in preoperative determination of the amount of bone that will be needed to adequately graft the cleft space. This will also aid in appropriate selection of an autogenous graft donor site before surgery.

Effect of Intermittent Systemic Administration of Recombinant Parathyroid Hormone (1-34) on Mandibular Fracture Healing in Rats

PURPOSE To establish a rat mandibular fracture model and investigate the short- and long-term effects of recombinant parathyroid hormone (PTH 1-34) on mandibular fracture healing in rats. MATERIALS AND METHODS A controlled unilateral mandibular fracture was created surgically in 29 male Sprague-Dawley rats and then stabilized using an external fixation device. The rats were divided into 2 groups: 1 group received daily subcutaneous injections of 10 microg/kg of PTH(1-34) and 1 group served as the vehicle control. The rats were killed on postoperative days 7 and 21, and radiographic densitometry and histologic evaluation of new bone formation were performed. RESULTS A novel unilateral mandibular fracture model was established that has significant differences from previously published models, both in the location of the osteotomy site and in the rigid external stabilization device. The PTH(1-34) treated rats showed a statistically significant difference (P < .05) in callous formation compared with the control animals. Radiographic densitometry evaluation of the injury site revealed an increase in bone density, apparent at day 7 in the experimental group. Visual inspection of the histologic sections stained with Massons trichrome blue showed an apparent increase in new bone formation at 21 days in the PTH-treated group compared with the control group. CONCLUSIONS Intermittent systemic administration of PTH(1-34) might enhance the healing of mandibular fractures in the early phase (7-day period). Long-term administration (21-day period) showed no statistically significant differences between the control and experimental group by radiographic densitometry.

A novel design of a computer-generated splint for vertical repositioning of the maxilla after Le Fort I osteotomy.

OBJECTIVE The objective of this study was to evaluate the efficacy of a novel tooth/bony-supported virtual splint design to control the maxillary vertical, rotational, and anteroposterior intraoperative movements. STUDY DESIGN A tooth/bone-borne splint was designed to position the osteotomized maxilla intraoperatively. Lateral cephalometric radiographs were obtained 1 week before the operation and 1 week after to compare the planned and actual movements of the maxilla. RESULTS The paired t test showed no significant difference between the planned and actual movements in both the vertical and horizontal measurements (P ≤ .05). The difference between the planned and actual horizontal movements in 4 (66.7%) of the 6 patients was 1 mm or less. For the vertical movements, 5 (83.3%) of the 6 patients showed a difference equal to or less than 1 mm. CONCLUSIONS The 2-piece surgical stent showed accurate control on the osteotomized maxilla and succeeded its repositioning to the preplanned positions.

Pseudomonas aeruginosa Infection of the Auricular Cartilage Caused by “High Ear Piercing”: A Case Report and Review of the Literature

Piercing of various parts of the body has gained tremendous popularity among adolescent and adult populations in recent years. There are no exact statistical reports on the number of body piercings being performed in the United States. One study among 481 college students in New York revealed that 42% of men and 60% of women had body piercing. In the past, the majority of complications of ear piercing were associated with the lobule. Torn ear lobes, localized infection, hypertrophic scars, allergic contact dermatitis, and keloid formations were among the most common, with no significant morbidity. However, “high ear piercing,” defined as piercing through the ear cartilage, is now very popular. Because of the lack of vascularity, piercing of the ear cartilage has been associated with a higher incidence of infections than the lobule. Staphylococcus and Pseudomonas aeruginosa are the most common causative organisms. Most commonly, such infections occur in newly pierced ears and in the warm-weather months of the year. These infections can lead to significant perichondritis and necrosis of the auricular cartilage, often resulting in permanent disfigurement and reconstructive challenges. The oral and maxillofacial surgeon may be presented with such cases and must be familiar with the prompt treatment protocol of the infection.

Management of Trauma to Supporting Dental Structures

Teeth, periodontium, and supporting alveolar bone are frequently involved in trauma and account for approximately 15% of all emergency room visits. The cause of the dentoalveolar trauma varies in different demographics but generally results from falls, playground accidents, domestic violence, bicycle accidents, motor vehicle accidents, assaults, altercations, and sports injuries. Dentoalveolar injuries should be considered an emergency situation because successful management of the injury requires proper diagnosis and treatment within a limited time to achieve better outcomes.

Osteonecrosis of the Jaws Unrelated to Bisphosphonate Exposure: A Series of 4 Cases

Osteonecrosis of the jaws (ONJ) is an entity that has received much attention in recent years because of multiple case reports of exposed bone in patients with a history of bisphosphonate (BP) exposure. The term ONJ generally means death of bone without implying specific causation. The American Association of Oral and Maxillofacial Surgeons gives 3 criteria for the diagnosis of BP-related ONJ: 1) The patient must have a history of BP exposure. 2) The patient ust have an area of exposed bone in the maxillofaial region that has persisted for greater than 8 weeks. ) The patient must not have a history of radiation to he head and neck region. In our institutions, over the last year, we have had 4 patients referred for management of areas of exposed bone that have been refractory to conservative

Diagnosis and Management of Upper Airway Obstruction Due to Lingual Hematoma: Report of a Case

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Pseudoaneurysm of the external carotid artery secondary to subcondylar fracture

Arterial pseudoaneurysms are rare in oral and maxillofacial surgery, but when they occur, quick recognition and management is necessary to avoid devastating consequences. The authors report a case of a pseudoaneurysm of the external carotid artery that developed after open reduction and internal fixation of a mandibular condyle fracture.