James R. Hayward

Evaluation of the regenerative capacity of the inferior alveolar nerve following surgical trauma

The fate of 52 nerves where there was altered sensation following sagittal ramus osteotomy and mandibular advancement, and 15 nerves where this occurred after third molar removal were evaluated through questionnaires involving both subjective and objective components. The study covered an interval between six and 54.5 months, with a mean of 31.9 months. Of the altered nerves from sagittal ramus osteotomy, 53.8% returned to normal, while 60% returned to normal in the third molar group. No correlation was found between terms used by the patient to describe the altered sensation and prognosis of nerve regeneration. In addition, correlation was not noted between the topographic distribution of altered sensation and the prognosis or residual deficit. No significant difference was found between the two methods of assessing nerve regeneration. A relationship was noted between age of the patient and increasing incidence of persistent altered sensation.

Lichen planus: immunologic and morphologic identification of the submucosal infiltrate.

The purpose of this investigation was to specifically identify T cells, B cells, and histiocytes in the infiltrate typically seen in lichen planus. In frozen tissue sections, AET-treated sheep erythrocytes formed immunologic rosettes with the lymphocytes in the infiltrate, designating them as T cells. Rosette assays with reagent erythrocytes, IgGEA, IgMEA, IgMEAC, and E resulted in nonadherence, indicating a lack of B cells and macrophages, and indirectly implicating them as T cells. Scanning electron microscopy of the cellular infiltrate, in situ, showed that the cells had smooth, nonvillous surfaces. These observations were consistent with a T cell origin and were considered supportive of the immunologic data. The results of this investigation support the hypothesis that lichen planus is a disease mediated by thymus-dependent lymphocytes.

Major maxillomandibular malrelations and temporomandibular joint pain-dysfunction

A retrospective questionnaire survey of 102 patients who underwent orthognathic surgery for maxillomandibular disharmonies assessed the incidence of TMJ pain-dysfunction in both pretreatment and posttreatment phases. While retrospective questionnaire studies have obvious limitations, the following conclusions deserve consideration. The incidence of TMJ pain-dysfunction symptoms found in this patient population appears to be higher than the incidence of those symptoms reported in previous epidemiologic studies of general populations which involved subjective symptoms alone. Maxillomandibular disharmonies may be an important etiologic factor in the development of TMJ pain-dysfunction. Surgical correction of the disharmony in a significant percent of patients with maxillomandibular disharmonies and concomitant TMJ pain-dysfunction may alleviate or improve the TMJ pain-dysfunction symptoms. There is a possibility that patients may develop TMJ pain-dysfunction symptoms after orthognathic surgery.

Superficial melanomas of oral mucous membranes.

In accordance with microscopic and clinical criteria established for superficial melanomas of the skin (superficial spreading melanoma, lentigo maligna melanoma, acral-lentiginous melanoma), three oral lesions have been evaluated. The literature on oral melanomas has also been reviewed, with special attention given to those cases that had pre-existing melanosis. One patient with a diagnosis of superficial spreading melanoma eventually died of his untreated lesion 11 years after its first appearance. Two patients had lesions diagnosed as acral-lentiginous melanoma (a group which also includes volar and subungual melanomas) that exhibited aggressive, recurrent behavior. These lesions had microsocpic features similar to lentigo maligna melanoma but did not behave in a manner consistent with that diagnosis. Electron microscopic study of one acral-lentiginous melanoma demonstrated malenosomes and premelanosomes that were like those seen in normal melanocytes and nevus cells. The superficial or radial growth phase of many oral melanomas has apparently gone unrecognized. Melanosis has been reported to be a common feature of invasive oral melanomas but has not generally been related to the natural history of these lesions. Oral lesions with a prolonged intra-epithelial or radial growth phase would be expected to have a better prognosis than nodular melanomas, but meaningful survival data are not available because of the infrequency with which oral melanomas have been subclassified.

A new familial syndrome of oral, cranial, and digital anomalies.

A sibship of 6 from nonconsanguineous, normal parents is described in which 5 had oneor more of a specific group of oral, cranial, and digital anomalies. The 2 brothers had cleft lip and palate, microcephalus, hypoplasia and distal placement of both thumbs, and bilateral elbow deformities which limited extension. One of the 2 brothers had toe anomalies which were also present in 3 of the 4 sisters. The other defects among the sisters included microcephalus and interphalangeal inflexibility of both thumbs in one and an occult cleft lip in another. This constellation of defects is most likely due to a single, autosomal recessive gene with variable expressivity in the homozygote.

Use of the orthognathic surgery simulating instrument in the presurgical evaluation of facial asymmetry

The use of Orthognathic Surgery Simulating Instrument (OSSI) is described. Two cases of facial asymmetry, one with hemifacial microsomia and one with unilateral condylar hyperplasia, are presented to demonstrate the diagnostic capabilities of the articulator. The OSSI has greatly improved our ability to plan the treatment of cases of gross facial asymmetry.

Venous tissue replanted on roots of teeth in monkeys

Abstract In an attempt to preserve the original periodontal membrane and stimulate fibrosis of tooth to bone in rhesus monkeys, venous segments were adapted over roots of teeth prior to replantation. Both intima and adventitia exposed to the cemental surface of roots were tested. The venous segments, as employed in this experiment, induced increased sulcus depth and varying degrees of root resorption and ankylosis. Control teeth were replanted without venous segments, and their recovery was uneventful. More extensive studies aimed at regenerating physiologic periodontal attachment in tooth grafting seems to be definitely indicated.

Effect of Keratolytic Drugs on Oral Hyperkeratosis in Syrian Hamsters

SYNOPSIS IN INTERLINGUA LE EFFECTO DE PHARMACOS KERATOLYTIC SUPER HYPERKERATOSIS ORAL.—Leslones hyperkeratotic del mucosa oral esseva inducite in albin hamsters syrian per le administration topic de 9,10-dimethyl-l,2-benzanthraceno. Post 6 applicationes de un solution de 20 pro cento de acido salicylic, un significative declino quantitative esseva observate clinicamente in le keratosis. Associate alterationes microscopic del processo de keratinisation esseva le formation de un amorphe, non-laminate strato cornee, perdita de strato lucide, e disruption del strato granulose. Mucosa hyperkeratotic tractate similemente con un solution de 20 pro cento de podophyllina manifestava nulle comparabilemente significative effecto keratolytic. Es stipulate que le inefficacia relative de podophyllina in le presente studio esseva conditionate per su supponite incapacitate de penetrar epithelio cornificate o per su inactivation therapeutic in le saliva alcalin del hamster.

Indications for microsurgical correction of the injured inferior alveolar nerve

TO the Editor:-After testifying for the defense during the last two years in three cases of inferior alveolar nerve sensory deficit and hearing the plaintiffs’ symptoms magnified and distorted by dramatic lawyers, 1 wish to respond to the article by Mozsary and Syers.1 On the first page a reference is made to “impaired speech and ability to retain saliva.” I have not seen this in my 40-plus years of following many patients with numb lips. The authors’ description of the “needle injury” is entirely hypothetical, and references for the specific mechanism do not support it. On page 357 there appears the litigation-prompting statement “damage is relatively low when careful surgical technique is used” in third molar surgery. The “surprise” postoperative deficits after minimal extraction trauma are too common to justify such a claim. Page 358 brings the statement “The microsurgical approach offers the only treatment modality available today to restore sensation.” This statement disregards the great potential for the spontaneous return of sensation for which we can be so thankful. The authors conclude that a rigid six-month dividing line for the initiation of microsurgery was the only determinant for consistent results. Considering all intraoperative variables, especially in microsurgery, this conclusion appears most speculative. Certainly. more precise criteria are needed to dictate the timing of such surgery. Well disguised in a middle paragraph on page 354 appears the statement: “Surgical treatment, therefore, is always exploratory. and the prognosis guarded.” To be consistent with the research nature of this article, I believe that this statement would be more appropriate in the summary or conclusions. Let us applaud research for this condition without promoting techniques as essential before careful controls and adequate numbers are available.

A maxillary radiolucency phantom lesion.

In radiographic diagnosis one must keep in mind a broad spectrum of possibilities and the occasional superimposition of one lesion upon bone altered by another process. In the maxilla the variable pneumatization of the maxillary sinus and the presence of the nasal cavity can be confusing. Variations of normal anatomy should be carefully considered. A treatment plan that is heavily dependent upon a radiograph without the correlation of other clinical findings has potential for therapeutic misadventure.