Gary J. Nishioka

Neurosensory disturbance with rigid fixation of the bilateral sagittal split osteotomy

Twenty-one patients who underwent bilateral sagittal split osteotomies using rigid fixation were evaluated by neurosensory testing. Neurosensory tests included light touch (LT), brush stroke direction (BSD), two-point discrimination (2-P), and temperature (T). Tests were conducted using the two-alternate forced choice method. The density of neurosensory disturbance was examined as well as the incidence of neurosensory disturbance as it correlated with age of the patient. The incidence of neurosensory disturbance was 45.2% (19/42) to LT, 52.4% (22/42) to BSD, 33.3% (14/42) to 2-P and 7.1% (3/42) to T. The majority of demonstrable neurosensory disturbances were not dense. Increased age was associated with an increased incidence of neurosensory disturbance.

Human Curvularia infections: Report of five cases and review of the literature

Curvularia lunata is a saprobic dematiaceous mould that resides primarily in soil (Ellis, 1966). Reports of human disease caused by this organism are rare but include: endocarditis, brain abscess, skin infections, onychomycosis, keratitis, pneumonia, disseminated disease, mycetoma, allergic bronchopulmonary disease, and one case of sinusitis. Since 1983, we have encountered five cases of paranasal sinusitis due to C. lunata. None of the patients suffered from known immunologic disorders or underlying debilitating diseases. These five cases are presented and the literature of human phaeohyphomycosis caused by Curvularia spp. is reviewed.

Neurosensory disturbance associated with the anterior mandibular horizontal osteotomy

Fifteen patients who underwent an anterior mandibular horizontal osteotomy (genioplasty) were retrospectively studied by neurosensory testing to evaluate light touch (LT) and temperature (T) discrimination. Testing was conducted using the two-alternative forced choice method. Density of a neurosensory disturbance (NSD), when it occurred, was also evaluated. A questionnaire was administered to determine if patients with a NSD perceived that their quality of life was adversely affected. The incidence of NSD was 3.4% (one of 30) to LT and 0% (none of 30) to T. The one abnormal mental nerve with a NSD to LT was moderately dense, but was not perceived by the patient as adversely affecting her quality of life.

Intraoral open reduction with rigid internal fixation of mandibular subcondylar fractures

Open reduction of subcondylar fractures achieves precise anatomic alignment of bony fragments and may prevent the postoperative sequelae seen with some closed reductions. Using an extraoral approach, a fracture can be easily seen and manipulated. An intraoral approach avoids large facial scars, facial nerve injury, and allows visualization of the occlusion during the procedure. Cases for this technique should be carefully selected.

A lateral cephalometric analysis of nasal morphology following Le Fort I osteotomy applying photometric analysis techniques

Fifty patients who had undergone Le Fort I maxillary osteotomies were studied. Cephalograms were available preoperatively and at least 6 months postoperatively. Soft-tissue analysis of the nasal profile was done employing three angles commonly used in the photometric analysis performed for rhinoplasty: nasal tip projection angle, columellar angle, and supratip break angle. Maxillary movement was assessed in two ways: 1) horizontal and vertical component vectors of A-point movement were calculated, and 2) maxillary rotation, defined as the change in the angle of a line drawn from the anterior nasal spine to the posterior nasal spine relative to the anterior cranial base, was calculated. The component vectors of A-point movement and maxillary rotation were then used as predictor variables for change in the soft-tissue angles in a multiple-regression analysis. A weak correlation was found between A-point movement in both the horizontal and vertical dimensions and the nasal tip projection angle. When A-point was moved in an anterior and superior direction, the nasal tip rotated up. The converse was true with movement in the posterior and inferior direction. Only A-point movement in the horizontal dimension had a significant relationship with columellar angle. When A-point was moved in an anterior direction, columellar angle increased. This study shows that prediction of the soft-tissue profile of the nose following maxillary surgery is difficult.

Frontal soft tissue morphology with double V-Y closure following le fort I osteotomy

This prospective study compares the nasal and maxillary vermillion morphology in three groups of patients who underwent maxillary osteotomies and whose soft tissues were managed by different surgical techniques. Eleven of these patients had simple primary closure (SPC) of the maxillary circumvestibular incision; ten were treated with single V-Y closure (SVY) combined with nasolabial muscle reconstruction, and the remaining 11 were treated with a double V-Y closure (DVY) combined with nasolabial muscle reconstruction. All three groups showed significant increases in the alar dome width. Further inspection of the data revealed that the DVY group showed significant, strong correlations between the preoperative and postoperative vertical vermillion measurements. Although the SVY and SPC techniques showed significant correlations for the same measurements, their correlation values were less. Small significant decreases averaging from 0.5 mm to 1.0 mm were seen in all but one of the vertical vermillion measurements with the DVY technique. Larger individual decreases and increases were seen with the SVY and SPC techniques. These findings suggest a level of predictability in the postoperative vermillion height change with the DVY closure that is not obtainable with the SVY or SPC techniques.

A comparative study of normal sensibility of the inferior alveolar nerve and the infraorbital nerve

In order to assess the degree of similarity of the infraorbital nerve and inferior alveolar nerve, thirty subjects with no history of sensory injury were examined by a battery of neurosensory tests including: light touch, brush stroke direction, two-point discrimination, and thermal disk temperature assessment. In a matched sample experimental design, the sensibility of the inferior alveolar nerve (lower lip) was compared to the inferior orbital nerve (upper lip). The product moment correlations revealed a significant relationship (degree of sameness) between the upper and lower lip. The comparison of the upper and lower lip appear to be acceptable for retrospective tests for detection of neurosensory injury of the inferior alveolar nerve. Of these tests, light touch appears to be the most consistent while remaining sensitive to individual variation. The thermal disk assessment was least sensitive in that no individual variation could be demonstrated. In addition, there appear to be greater variations in men than in women.

Granulocytic sarcoma of the mandible

The case is presented of a 54-year-old black man with a mass apparently involving only the soft tissue retromolar trigone on panoramic and mandibular series radiographs. A granulocytic sarcoma involving the mandible was diagnosed on biopsy with the aid of histochemical stains, immunologic cell surface markers, and electron microscopy. The autopsy also revealed involvement of the ribs and liver.

The role of bacterial-laden biofilms in infections of maxillofacial biomaterials

Biomaterials from 11 consecutive patients with persistent infections refractory to antimicrobial therapy and local wound care were surgically removed and studied by scanning electron microscopy for the presence of bacterial-laden biofilms. Unlike previously reported biomaterial infections involving other regions of the body, infections in this study were not associated with a conspicuous bacterial-laden biofilm. Instead, adherent light bacterial colonization without a biofilm layer was noted. The only specimen that was suggestive of a bacterial-laden biofilm was in a patient who suffered from a chronic infection. Consistent with previous reports, bacterial colonization was frequently polymicrobial. Observations made in this study suggest that bacterial adherence may not require an obvious biofilm layer.

Transoral plating of mandibular angle fractures: A technique

A technique has been presented for transcutaneous management of angle fractures with employment of two plates: one at the tension band, the second at the compression zone of the mandible. Our preliminary experience with this procedure has been favorable. When a comparison is made of an intraoral approach to an extraoral one, there are three advantages. First, the cutaneous scar is minimal when compared with a transcutaneous one. Second, visualization of the occlusion is maintained throughout the procedure. Third, injury to branches of the facial nerve and other anatomic structures is reduced.