Daniel J. Holland

Atrophy of the mandible

Abstract Progressive atrophy of the maxilla and mandible is not uncommon. It may affect but a section of the bone in partly edentulous patients or it may involve the entire alveolar process if all the teeth have been lost. In some cases, it extends into the bone proper. The mandible, when extensively involved, may fracture from minor trauma. Three such cases are described. An unusual case of complete resorption of the mandible with progressive resorption of the maxilla, previously reported, 7 is reviewed. The etiology of atrophy of the jaws is still obscure. Local causes, as well as systemic or constitutional factors, play a role. The treatment should first of all be directed to arrest of the process of resorption. The use of bone grafts for the prevention of fracture has been discussed. In case of spontaneous fracture also, a bone graft gives best results. In irradiated jaws excision of the section involved may be indicated, since bone grafting is not likely to be successful. Cases are included to illustrate the operative procedures.

The surgical positioning of unerupted, impacted teeth (surgical orthodontics)☆

Abstract There may be instances in which this technique is applicable in an adult, assuming the risk of pulpal devitalization. After the tooth is firmly established, root canal therapy can be done. In such cases a well-positioned natural tooth, though deliberately devitalized, is preferable to an artificial replacement. The subject of this symposium is most interesting and the pooling of ideas and techniques should lead to refinements which will make our present concepts primitive within a few years.

II. Tumors of the mandibular condyle

L. B. (188922), a 4%year-old woman, was admitted to the hospital on Feb. 14, 1947, with a tumor of the right mandible. She had a history of severe MBniBre’s disease for several years, which was controlled by pot,assium chloride. Recently, she has had joint pains, particularly in the right hip, suggestive of rheumatoid arthritis. For the past four years she has had a swelling anterior to the right ear, with progressive deafness on that side. This did not change in size and produced no symptoms until two months ago, when it began to enlarge, she had difficult,y in opening her mouth, and had some pain. The increase in size and the limitation of motion of the mandible were gradual. During the past few weeks she has had numbness and tingling of the right lower lip and lower teeth. The swellin g has become increasingly tender in the last week. Examination showed a well-developed woman with a 3 by 3 cm. hard, slightly irregular swelling anterior to the tragus of the right ear. It was slightly tender to palpation. The upper jaw was edentulous, and there were but a few teeth in the mandible. The opening of Stensen’s duct appeared normal. X-ray examination showed an expanding, trabeculated lesion involving the neck of the right mandibular condyle, extending from the base of the head to the coronoid process (Fig. 625). In the anteroposterior view the condyle appeared to be 2.5 cm. in diameter (Fig. 626). There was definite limitation of motion of the head of the right condyle. Giant-cell tumor was suspected. The x-rays of the skull and long bones revealed no other lesions. Blood studies were all within normal limits. On February 19, under endotracheal gas, oxygen, and ether anesthesia, the face in the region of the right ear was prepared in the usual manner. A question mark incision was made to avoid the auriculotemporal and facial nerves, commencing about 2.5 cm. in front of the ear at the level of its upper attachment and brought down in front of the tragus. The underlying fascia was divided and the superficial temporal and transverse facial arteries were cut and tied. By blunt dissection with a periosteotome, the posterior part of the masseter

Complications in exodontia and oral surgery

Abstract A number of complications incident to the practice of exodontia and oral surgery are discussed. Suggestions for the avoidance of distressing sequelae are offered, and treatment is outlined for the common complications. The contraindications to oral surgery in the presence of a number of associated diseases are evaluated. The risks and hazards encountered in oral surgical operations are similar to those met in any surgical intervention.