H.David Hall

Early results of secondary bone grafts in 106 alveolar clefts

Eighty-three patients with cleft lip and cleft palate were treated by secondary bone grafts to the 106 alveolar clefts. In 98% of the alveolar clefts, the graft was successful and the oronasal fistula was closed. There were only occasional other complications, all but one of which were minor and did not affect the final result. Morbidity was low. Compared with older patients, the pre-teen group of patients not only had no complications of consequence but experienced less morbidity. The 100% success rate and the lower morbidity in the pre-teen group of patients thus favor operating on patients at the younger age.

Modified condylotomy for treatment of the painful temporomandibular joint with a reducing disc

Data from a pool of approximately 400 patients operated on with modified condylotomy during a 9-year period are presented. The chief findings were good relief of pain and dysfunction, and reversal of the internal derangement in a high percentage of patients. There was low morbidity and remarkably few complications. Comparison of these findings with published results of alternative surgical and nonsurgical procedures seems to favor modified condylotomy.

Disk position before and after modified condylotomy in 80 symptomatic temporomandibular joints

OBJECTIVE Our primary objective was to determine the frequency of disk reduction after modified condylotomy and whether the type of displacement affected outcome. DESIGN We classified reducing disk displacements from magnetic resonance images of 80 symptomatic temporomandibular joints before modified condylotomy. Disk position was reassessed after surgery. RESULTS The disk and condyle typically move in reciprocal directions. The disk was reduced by surgery in 79% of the joints. The rate of reduction varied by the type of displacement, but the differences between the groups were not statistically significant. CONCLUSION This finding reaffirms that modified condylotomy has a high rate of disk reduction. The unexpected observation that the increase in joint space resulting from the surgery typically permitted a variable degree of spontaneous movement of the disk has implications for the nature of osteoarthrosis and internal derangement and for surgical treatments intended to reduce the risk.

Growth pattern of postnatally developing rat parotid gland.

Summary The time course of postnatal growth and differentiation of rat parotid has been described, and the mechanisms involved in gland growth examined. An early phase of extensive cellular proliferation, which persists at levels of 17-23/1000 acinar cells through 23 days of age, was seen. This was accompanied by small increases in cell size; after 23 days of age, cell size became the prominent cellular event and mitotic rate decreased markedly. Changes after 64 days of age in gland weight, cell size, state of cellular differentiation, and cell number were not conspicuous. These determinations were based on histological examination and measurement of cell size, nuclear size, and mitotic indices. DNA-RNA content also increased with time postnatally, and both exhibited, like mitotic rate, the sharpest increment between 16–23 days of age. Parallels between the biphasic mechanism of postnatal parotid growth and that of heart and skeletal muscle were examined, and comparison was made to growth patterns exhibited under other conditions of growth.

Neural regulation of compensatory enlargement of the parotid gland of the rat.

SummaryThe role of the innervation in mediating compensatory enlargement of the parotid gland of the rat after partial desalivation was examined. The results of denervation experiments show that full compensatory growth requires both parasympathetic and sympathetic innervation. The presence of the parasympathetic innervation alone results in an increase in the number of cells, but not the size of the cells. The sympathetic innervation alone does not mediate either response. We, therefore, conclude that the two types of innervation have a synergistic action on the parotid to produce the maximal compensatory response, which includes an increase in both number and size of acinar cells.

Functional mediation of compensatory enlargement of the parotid gland

SummaryThe role of functional activity in mediating compensatory enlargement of the parotid gland after removal of the other major salivary glands was investigated. Increased levels of activity were achieved by feeding rats a bulk diet. Conversely, a liquid diet was used to reduce the functional demands on the parotid. It was found that the liquid diet completely prevented the compensatory response from occurring. Bulk diet, on the other hand, caused an even greater compensatory response than did the standard chow diet. Compensatory enlargement of the parotid, therefore, depends on its functional activity and not on other, e.g., humoral factors dissociated from function. The character of the cellular response in compensatory enlargement was also examined. The chow diet caused compensatory enlargement by an increase in cell size with little, if any, increase in cell number.

Massive osteolysis (phantom bone, disappearing bone): Report of a case with mandibular involvement

Abstract A rare case of spontaneous osteolysis is reported. The mandible was the only bone seriously affected, although numerous bones were involved. This case is of particular interest because of the extensive information obtained during investigation of the disease over a 7-year period. The natural course of the disease during this interval showed little change, except for the progressive resorption of the mandible. Attempts to detect metabolic abnormalities and to influence the course of the disease by systemic therapy were unsuccessful. Similarly, numerous biopsies of the involved bones failed to show appreciable change from normal. Conventional, conservative treatment of several pathologic fractures resulted in eventual healing of all but two fractures.

Physiological Activity and Regulation of Growth of Developing Parotid

Summary Physiological activity of the parotid gland was reduced by maintenance of immature and adult rats on a liquid diet. The general status of the gland was determined by measurements of weight while the status of the individual cellular components was determined by measurements of cell size and nucleic acids. In the developing parotid, reduced physiological activity inhibited the growth of the gland by inhibiting growth in both cell number and cell size. In the mature parotid, reduced physiological activity resulted in a decrease in cell size only. When glandular activity was returned to normal by feeding solid food in both the immature and adult rat, the gland and its cellular components were restored to expected levels.

Modification of the modified condylotomy

PURPOSE This article describes the results of modification of the condylotomy procedure for treating painful internal derangements of the temporomandibular joint. MATERIALS AND METHODS Data on postoperative disc position, joint space, and pain were evaluated in patients who underwent either the original modified condylotomy or the newly modified procedure. RESULTS Less anterior and inferior sag of the condyle was produced by the new technique. Pain relief and disc reduction were about the same with both procedures. CONCLUSIONS The new modifications make the operation quicker and easier, while producing outcomes similar to those obtained with the original modified procedure.

Results of reoperation after failed modified condylotomy

PURPOSE This retrospective study reports the reoperation rate for failure after modified condylotomy. MATERIALS AND METHODS A consecutive series from each of two surgeons constituted the study group of 361 joints in 235 patients. Reoperation rates were calculated for all joints and by type of disc displacement. RESULTS A second operation occurred in 4.2% of all joints. However, the cumulative rate of reoperation was 4.4%, because one of the joints required a third operation. Although the rate of reoperation varied (0% to 6.5%) according to the type of disc displacement, the differences were not statistically significant. All joints requiring reoperation had a displaced disc, and more than half had lost nearly all the joint space gained by the primary operation. CONCLUSION The rate of reoperation for modified condylotomy is low. Risk factors for reoperation appear to be recurrent or residual disc displacement and loss of joint space after the first operation. Bilateral operation was not a risk factor.