George M. Kushner

Myositis ossificans traumatica of the masseter muscle: Review of the literature and report of two additional cases

Myositis ossificans traumatica of the masseter muscle is uncommon. The condition is benign and results in reactive heterotopic bone formation, usually producing limitation of opening of the jaws. Radiographic and microscopic examination can confirm the diagnosis. Treatment of myositis ossificans traumatica of the masseter muscle is surgical, with other modalities used when occurring in other muscles of the body.

Management of Atrophic Edentulous Mandibular Fractures: The Case for Primary Reconstruction With Immediate Bone Grafting

t s m c n trophic edentulous mandibular fractures, particuarly bilateral fractures (Fig 1) have always posed a roblem for not only those who suffer them, but lso for the treating surgeon. The patients are often lderly and infirm. The bone is brittle; often the onsistency of porcelain, the surface area is quite mall, and the entire bone-periosteal complex has arkedly diminished healing capacity. Opposing uscle groups come into play, both displacing and indering reduction of the fractures and comproising stability. The diminished surface area of the racture allows no load sharing capacity, and the one adjacent to the fracture does not lend itself to crew fixation. The construction of accurate dental plints is difficult if not impossible to achieve. All of hese factors can mitigate the successful outcome

Management of comminuted fractures of the mandible.

Comminuted fractures of the mandible are unusual but not rare. They are complex injuries with a high complication rate. Gunshot wounds are a frequent cause. Traditional management with closed techniques is noted for good long-term results, but may involve an extended period of treatment. Treatment with open reduction and rigid internal fixation significantly shortens the course of treatment and simplifies the convalescence.

Safety and efficacy of purified factor IX concentrate and antifibrinolytic agents for dental extractions in hemophilia B

This study evaluated the safety and efficacy of combined treatment with ϵ‐aminocaproic acid or tranexamic acid and monoclonal antibody purified factor IX (MAb factor IX) for prophylaxis against bleeding in eight hemophilia B patients undergoing nine dental extraction procedures. All patients achieved excellent hemostasis without clinical evidence of thrombosis. There were no significant changes in hemoglobin or hematocrit or in markers of hemostatic system activation (prothrombin fragment F1–2, fibrinopeptide A, and fragment B β15–42) after surgery. Thus, a highly purified factor IX concentrate and antifibrinolytic therapy can be effectively and safely combined in hemophilia B patients undergoing dental extractions.

Fractures of the Growing Mandible

Oral and maxillofacial surgeons must constantly weigh the risks of surgical intervention for pediatric mandible fractures against the wonderful healing capacity of children. The majority of pediatric mandibular fractures can be managed with closed techniques using short periods of maxillomandibular fixation or training elastics alone. Generally, the use of plate- and screw-type internal fixation is reserved for difficult fractures. This article details general and special considerations for this surgery including: craniofacial growth & development, surgical anatomy, epidemiology evaluation, various fractures, the role rigid internal fixation and the Risdon cable in pediatric maxillofacial trauma. It concludes with suggestions concerning long-term follow-up care in light of the mobility, insurance obstacles, and family dynamics facing the patient population.

Facial skeletal trauma in the growing patient.

The management of pediatric craniomaxillofacial trauma requires the additional dimension of understanding growth and development. The surgeon must appreciate the considerable influence of the soft tissue envelope and promote function when possible. Children heal well but with an exuberant tissue response that may contribute to greater scarring, therefore, careful and prudent attention given to meticulous soft tissue repair and support is critical. Support must also be given and sought from the family of the injured child. Follow-up management of children must continue to ensure that the growth of the craniomaxillofacial skeleton continues within the normal parameters of development.

Failed Fixation in Atrophic Mandibular Fractures: The Case against Miniplates

Despite advances in the treatment of the fractured atrophic edentulous mandible, treatment continues to be difficult. Patient management is more complicated due to patients often being elderly with more complex medical problems. Rigid internal fixation has greatly improved outcomes with shorter treatment times, yet a consensus has yet to be reached regarding which method yields the most predictable results. Options include using small miniplates to larger reconstruction plates. Although each method has advantages, we present our experience with retreatment of failed miniplate fixation using load-bearing reconstruction plates of fractured atrophic edentulous mandibles.

Role of nuclear medicine imaging in recognizing different causes of osteonecrosis of the jaw.

The incidence of osteonecrosis of the jaw (ONJ) among patients with cancer and metastatic bone disease being treated with bisphosphonates is as high as 10%, which dictates that an understanding of the risk factors, preventative measures, means of early diagnosis, and treatment is critical. Despite ONJ occurring in the clinical setting of intravenous bisphosphonates, there are other causes associated with higher risk of ONJ, such as multiple dental extractions. Overall, it is important for imaging health care professionals to recognize, describe, and understand ONJ to help minimize biopsies and allow proper treatment to begin as soon as possible.

Bisphosphonate-related osteonecrosis of the jaws.

Purpose of reviewThe purpose of this article is to review a new pathologic entity named bisphosphonate-related osteonecrosis of the jaws (BRONJ). Recent findingsBRONJ was observed and first reported in 2001–2002 when clinicians noticed cases of refractory osteomyelitis after simple dental procedures such as dental extractions in patients who had received bisphosphonate therapy. The condition was initially seen in patients who received i.v. bisphosphonates for malignancies such as multiple myeloma and metastatic breast cancer. However, with the use of bisphosphonate therapy for osteoporosis, BRONJ is seen in patients without a cancer diagnosis. SummaryThe incidence of BRONJ remains unclear. Treatment recommendations based on sound scientific data are sparse. The management of BRONJ remains a difficult and controversial situation that continues to challenge the clinician.

Contemporary management of infected mandibular fractures.

The treatment of infected mandibular fractures has advanced rather dramatically over the past 50 years. Immobilization with maxillomandibular fixation and/or splints, removal of diseased teeth in the fracture line, external fixation, use of antibiotics, debridement, and rigid internal fixation has played a role in management. Perhaps the most important advance was the realization that infected fractures also result from moving fragments and nonvital bone, not just bacteria. Controlling movement and eliminating the dead bone allowed body defenses to also eliminate bacteria. The next logical step in the evolution of treatment was primary bone grafting of the resulting defect following application of rigid internal fixation and debridement of the dead bone. We offer our results with this treatment in 21 infected fractures, 20 of which achieved primary union.