Dale E. Stringer

A technique for osseous restoration of deficient edentulous maxillary ridges

A technique for maxillary bone grafting to augment the atrophic ridge is presented, and the results from 15 cases followed from three to ten years are briefly described. Loss of postoperative ridge height ranged from 10-20% in this sample. It appears that the tendencies to postoperative resorption that occur when autogenous particulate cancellous bone grafts are employed to restore atrophic mandibles are not operative in the maxilla.

Correction of Mandibular Asymmetry Using Angled Titanium Mesh

PURPOSE Our goal was to evaluate and present a technique of correcting facial asymmetry involving the mandible using angled titanium mesh. PATIENTS AND METHODS From 1990 to 2006, 5 patients underwent augmentation of the mandibular angle with titanium mesh in conjunction with orthognathic surgery. The angle mesh was placed to correct a unilateral lower-third facial asymmetry. The mesh was placed in a subperiosteal fashion and fixated with monocortical screws. The facial asymmetries were a result of either congenital defects or trauma. A combination of clinical and radiographic examination findings, photographs, and occlusal records were used to evaluate the treatment outcome. RESULTS All 5 patients were treated successfully using the titanium mesh to augment the mandibular angle in conjunction with orthognathic surgery. No implant infection, migration, or exposure occurred. The esthetic outcome was deemed satisfactory by both the patients and the clinicians. CONCLUSION Facial asymmetries that involve the mandible can be corrected by placement of an angled titanium mesh in conjunction with orthognathic surgery.

Surgical Treatment of Jacob’s Disease: A Case Report Involving an Osteochondroma of the Coronoid Process

Although it is one of the most common benign tumors of bone in the axial skeleton, the osteochondroma is relatively rare in the maxillofacial region. Its discovery on the coronoid process is even more rare. First described by Jacob in 1899, it remains a rare entity as only a few reported cases have been described in the literature. Nevertheless, the symptomatic features remain relatively nonspecific: limited opening, tightness, and slight expansion of the affected area with or without pain. The demographic features are more established, as it affects younger males. Definitive diagnosis is made after histological analysis, post-resection of the growth. We report a 27 year-old male with a history of limited opening and tightness of the mouth. Computed Tomography (CT) imaging revealed a well corticated exophytic protuberance from the left coronoid process. Left coronoidectomy and excision of the exophytic growth was performed, and was confirmed by histologic analysis to be an osteochondroma, demonstrating Jacobs disease.

Single-Cannula Technique for Operative Arthroscopy Using Holmium:YAG Laser

i p t w a p r m i N m c S M Since the introduction of temporomandibular joint (TMJ) arthroscopy to North America by McCain and anders in 1984, research has been conducted and numerous techniques have been developed. TMJ arthroscopy is popular because of both its diagnostic potential and its therapeutic potential. Typically, operative arthroscopic surgery involves placement of 3 portals to allow triangulation. The learning curve with the triangulation technique of arthroscopy is steep and technique sensitive. Because of this fact, many younger surgeons are abandoning operative arthroscopy or simply not trained in the technique at all. We propose a simple method of single-cannula operative arthroscopy with a holmium:YAG (yttrium-aluminumgarnet) laser using a specialized cannula (Fig 1).

Intraosseous inflammatory myofibroblastic tumor in the mandible: a rare pathologic case report.

Inflammatory myofibroblastic tumor (IMT) is an extremely rare lesion found in the maxillofacial region. Its frequency diminishes further when found in the bone. Although classification has varied throughout its history, the histologic features are often diagnostic, particularly with its strong association with anaplastic lymphoma kinase-1 (ALK-1) staining. The current mode of treatment for such a lesion is surgical removal with careful followup. In this rare case report, we describe the diagnosis and treatment in a 16-year-old male. Although this rare pathology can present as—and at times mimic—more serious pathologies, it is important for the attending surgeon to initially manage the pathology conservatively.

Mandibular Surgery: Technologic and Technical Improvements

The ability of surgeons to use advanced techniques can significantly improve both surgical outcome and patient satisfaction. Surgical evolution in mandibular orthognathic surgery is no exception, because advancements have aided both surgical planning and technique. It is important for clinicians to be aware of the historical progression of improvements in this technique and appreciate the technologic advancements as they are happening. Computer-driven surgical planning is becoming increasingly popular, providing surgeons and patients with the ability to adjust to intraoperative and postoperative variations. By using these capabilities, clinicians are now able to give patients the best possible outcomes.

Laser ablation in temporomandibular joint disorders and a case report involving an ossifying fibroma: how optics could potentially advance treatments in oral and maxillofacial surgery

Introduction: In the field of oral and maxillofacial surgery, there are many applications for lasers and optics. The first part of this manuscript is to discuss laser therapy and garner suggestions on how it can be improved. The second part is to present a case in which complications of a bone graft delayed healing and a return to normalcy for the patient. It is the goal of this paper to utilize the new advancements in optics so that patient care can be improved. Laser Therapy: Laser ablation and low-level laser therapy have been used in a variety of joint adhesion cases, including arthritis of the hand and foot. In the field of oral and maxillofacial surgery, this method has been used to treat pain and mobility dysfunction in patients with temporomandibular joint disease. While the outcomes have been promising, lack of familiarity with the device or doubt about its effects have reduced its use. This reduction in use has left the actual process of laser therapy relatively unchanged. Case Presentation: A 28 year-old female presented for a mandibular resection due to an ossifying fibroma. In the next several months her reconstructed area displayed significant signs of infection, as well as graft failure. X-rays, unfortunately, did not display the actual metabolic activity. Although the patient was reconstructed successfully thereafter, with more advanced technology available the patient could have endured a more comfortable treatment. Conclusion: While there are many more areas of oral and maxillofacial surgery that could potentially benefit from advances in optical technology, we have chosen to highlight these two areas due to their prevalence within our community.