Dean M. DeLuke

Facial growth and the need for orthognathic surgery after cleft palate repair: Literature review and report of 28 cases

PURPOSE Controversy still exists regarding the optimal timing and surgical technique for primary cleft lip and palate (CLP) repair, and treatment protocols vary considerably. This study reviews the literature on timing and technique for primary repair and reports on the outcome for a consecutive group of patients treated by a single surgical protocol at the Sunnyview Cleft Palate Clinic. PATIENTS AND METHODS Twenty-eight patients treated by a standardized clinical protocol from infancy through adolescence were evaluated with respect to the need for orthognathic surgery to correct jaw size discrepancy. For each patient, data was collected regarding type of cleft deformity, total number of surgical procedures from infancy, surgeon performing the primary repair, and the need or indication for orthognathic surgery. RESULTS Twenty-five percent of patients treated by this protocol required orthognathic surgery because of anteroposterior jaw size discrepancy. The number of prior operations was not a significant factor. The need for orthognathic surgery was seen in all types of CLP deformity. Different primary surgeons varied considerably in the percentage of their patients who ultimately required orthognathic surgery. CONCLUSION The results of this study parallel other larger cohort studies with respect to the percentage of patients requiring orthognathic surgery. The number of prior operations does not significantly affect the later need for orthognathic surgery.

Malignant Schwannoma of the palate : a case report and review of the literature

The malignant schwannoma is an uncommon neoplasm of the head and neck region, and its presentation in the oral cavity is quite rare. Malignant schwannoma of the head and neck region represents approximately 8% to 16% of the total body distribution of this turnor.lA It can either arise independently or result from malignant change in a preexisting neurofibroma. Multiple neurofibromas, characteristic of von Recklinghausen’s disease, will demonstrate malignant change in 8% to 10% of patients. ‘J Malignant degeneration of a benign schwannoma is rare and conceptually controversial; Toriumi et al’ have noted only four adequately documented cases of such a transformation. The discussion of peripheral nerve tumors is complicated by the fact that there is disagreement over the histogenesis of these tumors and a lack of universally accepted terminology. Although there exists some debate6-9 most authors1,3,5~10,” currently believe that the Schwann cell is the precursor of the neurofibroma, schwannoma, and malignant schwannoma. A review of the literature regarding peripheral nerve sheath tumors reveals a multitude of terms for apparently similar lesions. Piatelli et al” found up to 19 terms (Table 1) for the malignant form of the schwannoma; for the sake of clarity, the term malignant schwannoma will be used in this report. Taking into account the previous literature reviews of Eversole et a127 and Martinez and Robinson6 there exist a total of 34 documented cases

Is Maximal Dosage for Local Anesthetics Taught Consistently Across U.S. Dental Schools? A National Survey

Administration of safe and effective local anesthesia is a cornerstone of dental practice, but there is some discrepancy in recommendations for maximum doses, with the Council on Dental Therapeutics and American Academy of Pediatric Dentistrys guidelines differing from the guidelines of manufacturers and contemporary textbooks. The aim of this study was to determine the level of uniformity across U.S. dental schools in teaching maximal safe doses for commonly used local anesthetics. Faculty members primarily responsible for teaching local anesthesia to dental students at all 62 U.S. dental schools that had graduated classes were invited to participate in a survey in March 2017. The survey included questions about maximum doses taught, awareness of the existence of two differing guidelines, and whether one or both guidelines were commonly taught to students. A total of 37 responses were received, for a response rate of 60%. The respondents included oral and maxillofacial surgeons, general dentists, dental anesthesiologists, and periodontists. Of the respondents, 22% reported being unaware of the existence of more than one standard, and there was inconsistency in teaching practices. A majority (73%) reported teaching the higher maximum dose (7 mg/kg) for lidocaine, while a similar but smaller majority (60%) reported teaching the lower dose threshold (4.4 mg/kg) for mepivacaine. This study found no standard recommended maximum dose of lidocaine or mepivacaine being taught in U.S dental schools. Students should be made aware that there is more than one standard, and teaching should emphasize sound medical and pharmacologic principles. There is also a need to ensure that questions on dental licensing examinations are consistent regarding maximum safe doses for local anesthesia.

Simultaneous Virtual Planning Implant Surgical Guides and Immediate Laboratory-Fabricated Provisionals: An Impressionless Technique

Abstract Since the emergence of dental implants as treatment modality, there has been a constant evolution to improve the accuracy, efficiency and long term success even in the most complicated cases. In this day and age, patients expectations are higher than ever to achieve their desired treatment in a prompt and convenient manner. To meet these expectations implant therapy has grown to be highly sophisticated. For the past decade, computed tomography (CT) scans have been utilized to improve the treatment planning process. Further more they have been used to fabricate surgical guides, making implant placement not only more accurate but also safer. On the other hand, advancements in the implant prosthetics now have made immediate restorations more feasible. This article reviews two cases, where dental implants are based through a CT fabricated surgical guide, and immediately restored with a lab fabricated screw retained bridge. This novel technique utilizes intraoral digital scanner instead of the conventional alginate impression and combines the electronic data with the CT images to fabricate both the surgical guide and the immediate provisional restoration.

Is There Uniformity and Satisfaction Among Clinical Practice Models and Faculty Compensation Plans in US Dental School-Based Oral and Maxillofacial Surgery Departments?

PURPOSE There is a lack of information regarding clinical practice models and faculty compensation plans used by dental school-based departments of oral and maxillofacial surgery (OMS) and their effectiveness. The purpose of this study was to examine 1) the level of uniformity in clinical practice models and faculty compensation plans for US dental school-based OMS departments and 2) the level of satisfaction expressed by faculty with their current compensation plan. MATERIALS AND METHODS A survey was sent to the chairs of the 40 US dental school-based OMS departments asking them specific information regarding their current practice model, the faculty compensation plan, and their satisfaction with their current plan. RESULTS Twenty-four of the 40 department chairs returned the survey, for a 60% response rate. The OMS practice was part of the dental school faculty practice in 50% of the departments and a separate entity in 33%. The most common faculty compensation plan consisted of an academic salary plus a faculty practice salary based on a collection-based incentive (38%), but in 25% it was based on production. Fifty-seven percent of the responding chairs stated they were not satisfied with their current practice and compensation plans. CONCLUSIONS There is considerable variation in the practice models and compensation plans in US dental school-based OMS departments. More than half the department chairs expressed a general dissatisfaction with their current compensation plans. The survey data indicate a need for alternative models, and this report presents one such model.

Maximum Recommended Doses of Dental Local AnestheticsThe Authors Respond

Dear Dr. Karimbux: The June 2018 issue of the Journal of Dental Education published an article by DeLuke et al. presenting results of a survey of 37 responding U.S. dental schools concerning teaching of the maximum recommended doses (MRDs) of dental local anesthetics.[1][1] As a professor of

Syndromes of the Head and Neck

This issue of the Atlas of the Oral and Maxillofacial Surgery Clinics of North America serves as an aid to identification of 70 of the more important head and neck syndromes, and organized using the same nosology as in the landmark text of Robert Gorlin. As such, it should be useful to a varied audience, including not only the oral and maxillofacial surgeon but also the oral pathologist, the practitioner of oral medicine, and members of the craniofacial team--the orthodontist, pediatric dentist, speech and language specialist, geneticist, plastic surgeon, ENT specialist, pediatrician, nurse coordinator, and others. Areas covered include: Craniosynostosis Syndromes; Syndromes Affecting Bone; Metabolic and Autoimmune Syndromes; Syndromes Affecting Skin and Mucosa; Hamartoneoplastic Syndromes; Branchial Arch Syndromes; Clefting Syndromes; Syndromes Affecting the Central Nervous System; Chromosomal Syndromes; Syndromes with Unusual Facies; and Syndromes with Unusual Dental Findings or Gingival Components.