Dennis-Duke R. Yamashita

Tisssue responses in corticotomy- and osteotomy-assisted tooth movements in rats: histology and immunostaining.

INTRODUCTION The purpose of this histologic study was to examine underlying cellular responses to corticotomy- and osteotomy-assisted tooth movements. METHODS Thirty-six rats were divided into 5 groups: corticotomy-assisted tooth movement (CO + TM), sham corticotomy without tooth movement (CO alone), osteotomy-assisted tooth movement (OS + TM), sham osteotomy without tooth movement (OS alone), and unassisted tooth movement (TM alone). Standard orthodontic springs were activated to produce mesial tooth movement. The rats were killed at 3, 21, and 60 days after activation for osteoclast and blood vessel counts, and immunostaining with proliferating cell nuclear antigen (PCNA), transforming growth factor beta 1 (TGF beta 1), vascular endothelial growth factor (VEGF), and osteocalcin were performed. RESULTS The CO + TM group had significantly more osteoclasts at 3 days (P <0.005) compared with the OS + TM group. The alveolar bone surrounding the dental roots was replaced with multicellular tissue at 21 days in the CO + TM group but was intact in the OS + TM group with the exception of a distal distraction site. At day 21, immunostaining with PCNA, TGF beta 1, VEGF, and osteocalcin occurred at the mesial border of bone in the CO + TM group, whereas a diffuse pattern was observed in the distal distraction sites at 21 and 60 days in the OS + TM group. CONCLUSIONS Corticotomy-assisted tooth movement produced transient bone resorption around the dental roots under tension; this was replaced by fibrous tissue after 21 days and by bone after 60 days. Osteotomy-assisted tooth movement resembled distraction osteogenesis and did not pass through a stage of regional bone resorption.

Closure of an unusually large palatal fistula in a cleft patient by bony transport and corticotomy-assisted expansion

The management of cleft lip and palate can vary among patients because the size of a cleft defect and its anatomy vary. Although treatments involving orthodontics and surgery have been developed that can help a large number of children with cleft lip and palate, there are always unusual clefts that defy conventional treatments. In such cases, with each gain made during treatment, there also is the possibility of introducing an additional complication. The secondary bone graft performed during the mixed dentition stage of dental development is an example of treatment gains that are balanced against additional complications. Ordinarily, the maxillary segments are expanded to attain a normal archform before the alveolar bone graft. If there is an anterior palatal fistula present before orthodontic expansion, the size of the fistula concomitantly increases as the expanders widen the anterior maxillary segments. There are, however, extreme cases that present with a combination of collapsed maxillary segment, large anterior palatal fistula, and large alveolar clefts. In such cases, orthodontic expansion could make both the alveolar clefts and anterior palatal fistula unmanageable. In the expanded position, there would be insufficient soft tissue to close the fistula or cover the alveolar bone graft. Consequently, dental prosthetics is often needed to cover the palatal fistula to support speech and eating. In this report, we present the case of an 11-year-old girl who had a 20-mm anterior palatal fistula before orthodontic expansion. In the opinion of our surgeons, the fistula was too large to close before the segments were expanded and would prove more difficult to treat after expansion. To make the palatal fistula and cleft sites manageable, the treatment sequence and procedures were modified. Rather than expand the maxillary segments, the segments were compressed to make the cleft space narrower so that the surgeons could graft the alveolar cleft. To provide more bone support and donor soft tissue for a palatal flap, the palatal tooth and surrounding bone were distracted across the anterior palatal opening. A sequence of minor procedures allowed the cleft sites to be grafted, the unusually large palatal fistula to be closed, the lateral segments to be expanded, and the dental alignment to be improved.

Substance use in vulnerable patients with orofacial injury: prevalence, correlates, and unmet service needs

BACKGROUND A large portion of the injuries treated at urban trauma centers are preventable with alcohol and substance use presenting as common antecedent risk factors. METHODS Alcohol and drug use characteristics of vulnerable adults treated for intentional orofacial injury at a regional trauma center were investigated. Patients (N = 154) presenting with intentional facial injury were recruited. Patients were considered eligible for recruitment if they were adults, recently used alcohol or drugs, and had a fracture within the 30 days preceding recruitment that involved the jaw, orbit, nose, or cheekbone as determined by clinical history, examination, and radiographic findings and that injury was due to interpersonal violence. RESULTS This patient cohort evidenced significant levels of alcohol use, with 58% of our patient cohort meeting the criteria for problem drinking. Although lower than alcohol use rates, the reported use of illicit drugs was substantial. Almost half of the sample reported other substance use in the previous month, with 24% meeting the criteria for problem drug use. CONCLUSIONS Despite the very high percentage of individuals needing alcohol or drug treatment, only a small proportion of the patient sample reported having seen a professional for alcohol or drug treatment. Integrating substance use services into trauma care is discussed.

Dental Implant Reconstruction in a Patient With Ectodermal Dysplasia Using Multiple Bone Grafting Techniques

Ectodermal dysplasia is a syndrome in which 2 ectodermally derived structures fail to develop. Patients have a reduced number of teeth, and dental implant reconstruction is the preferred method of replacing teeth. We report the use of the tent pole technique in the severely resorbed mandible with sinus lifts and block grafting in the maxilla to restore the maxillofacial complex of a female patient with ectodermal dysplasia. The treatment sequence and techniques are discussed.

Glomus Tumor: Report of a Rare Case Affecting the Oral Cavity and Review of the Literature

The glomus apparatus, first discovered in 1862 bySucquet and confirmed by Hoyer in 1877, is an arte-riovenous anastomosis located in the stratum reticu-laris of the dermis, particularly prevalent on the palmand digits of the hand, as well as on the ventralsurface of the feet. Functionally, when this apparatusis constricted, heat is conserved, and when patent,heatislost;thereby,theglomusapparatuscontributesto thermal regulation.

Clinical Applications of Orthodontic Microimplant Anchorage in Craniofacial Patients

Microimplant anchors, also known as temporary anchorage devices, mini- and micro-screws, have been used to enhance orthodontic anchorage for difficult tooth movements. Here, the authors describe how microimplants can be used to help treat craniofacial patients by supporting distraction osteogenesis procedures, maxillary protraction procedures, cleft segment expansion and stabilization, and tooth movement into narrow alveolar cleft sites. While most craniofacial patients are treated without microimplants, it would be worthwhile to identify which cases could benefit from microimplant anchorage. As an adjunct to orthodontic treatment, the microimplant offers a potential method for solving troublesome orthodontic and surgical problems such as guiding distraction procedures with orthodontics when primary teeth are exfoliating, addressing residual maxillary cants after vertical distraction osteogenesis of a ramus, stabilizing an edentulous premaxilla, and moving teeth into atrophic alveolar ridges. These cases are presented to open a dialogue on their possible uses in craniofacial patients.

Bilateral maxillary duplication: case report and literature review

Accessory maxillary jaws are extremely rare occurrences. Currently, there is only 1 report of bilateral accessory maxillary jaws in the English-language literature. We present a case of a 7-year-old girl with bilateral bony exostoses extending from the maxillary tuberosities. The patient also had restricted protrusive and lateral excursive movements of the mandible. The histologic report revealed teeth in various developmental stages within the bony exostoses. We concluded that these structures were an isolated form of bilateral accessory maxillary jaws.

Factors Associated With Orofacial Injury and Willingness to Participate in Interventions Among Adolescents Treated in Trauma Centers

PURPOSE Assault is the most common cause of facial injuries in adolescents treated at inner-city trauma centers, yet little is known about the behavioral and environmental antecedents of these injuries or the willingness of such at-risk adolescents to participate in behavioral interventions to minimize reinjury. The purpose of this study was to identify possible risk and protective factors among adolescents with assault-related facial injury and to assess their willingness to participate in prospective observational research and behavioral interventions. PATIENTS AND METHODS Interviews were conducted with 67 adolescents (range 14 to 20 yrs) who were treated in trauma centers for facial injuries. Most of these injuries were assault-related (59%), followed by motor vehicle or other accidents (29%), gunshot wounds (9%), and sports injuries (3%). The subjects were predominantly male (86%) and of ethnic minorities (91%). RESULTS The adolescents showed high rates of intentional injuries in the past 6 months (56%), unhealthy alcohol use, and in more than half (55%) problem levels of substance use. Compared with those with unintentional injuries, adolescents who experienced assault-related injuries were more likely to report using alcohol, tobacco, and other substances. Although a significant segment of the sample (55%) had been arrested previously, no differences in arrest rates or types of crimes for which adolescents were arrested were observed by injury type. Most subjects were unwilling to participate in interventions that involved multiple sessions; however, greater family cohesion predicted the likelihood of being willing to participate. CONCLUSIONS Most facial injuries in inner-city adolescents result from assault. Unhealthy alcohol use, problem levels of substance use behaviors, and family history of alcohol problems are associated markers of assault-related injuries that can be useful for risk assessment and targeted intervention. Interventions need to be brief if they are to engage these at-risk youth.

Complications of Local Anesthesia Used in Oral and Maxillofacial Surgery

Local anesthetics are used routinely in oral and maxillofacial surgery. Local anesthetics are safe and effective drugs but do have risks that practitioners need to be aware of. This article reviews the complications of local anesthesia. A brief history is provided and the regional and systemic complications that can arise from using local anesthesia are discussed. These complications include paresthesia, ocular complications, allergies, toxicity, and methemoglobinemia. Understanding the risks involved with local anesthesia decreases the chances of adverse events occurring and ultimately leads to improved patient care.

Postoperative Alopecia Following Orthognathic Surgery

Postoperative alopecia is a pressure-induced, circumscribed area of occipital hair loss, usually after lengthy operative procedures. Prolonged hair follicle ischemia, a result of constant pressure from improper head positioning, is thought to be causative. Most commonly a reversible condition, it can be quite distressing for a patient. The maxillofacial surgeon must understand the pathophysiology and natural history of the condition to correctly identify it and employ measures to prevent it. Here we report a case of postoperative (pressure) alopecia in a female patient after orthognathic surgery. Report of a Case A 37-year-old female underwent Le Fort I osteotomy, bilateral sagittal split osteotomies, and sliding genioplasty to correct a dentofacial deformity, consisting of vertical maxillary excess, mandibular deficiency, and retrogenia. The patient’s head was positioned in the usual fashion, by first placing a head drape, and then resting it on a foam doughnut. The patient had very long hair that had to be gathered posteriorly into the head drape. The 5-hour surgery progressed without complications using a hypotensive anesthesia technique. Mean arterial blood pressure during the case was 65. The patient was discharged on postoperative day 2. At the 3-week follow-up, the patient complained of a “bald” spot at the occipital region near the vertex of the scalp (Fig 1). Upon further questioning, the patient reported a slight discomfort in this area the preceding 3 weeks, but no swelling or ulceration. The patient was reassured and had resolution of hair loss 6 months later.