John W. Hudson

Use of pedicled fat pad graft as an adjunct in the reconstruction of palatal cleft defects

The purpose of this article is to provide the rationale for the use of pedicled buccal fat pad grafts as an adjunct to the reconstruction of palatal or dentoalveolar clefts in cases when healing by secondary intention may need to be considered and integrated into the initial treatment plan because of the size of the defect or qualitative or quantitative tissue constraints. Four representative cases are presented in which a pedicled buccal fat graft was adjunctively used in conjunction with pedicled mucosal flaps to gain closure of large oroantral or oronasal cleft deformity.

Malignant teratoma of the mandible

A rare case of malignant teratoma of the mandible that resembled a dentigerous cyst radiographically is presented. Treatment by surgical resection and secondary reconstruction resulted in satisfactory function and esthetics.

Improving the Medical Curriculum in Predoctoral Dental Education: Recommendations From the American Association of Oral and Maxillofacial Surgeons Committee on Predoctoral Education and Training

Dental procedures are often performed on patients who present with some level of medical fragility. In many dental schools, the exercise of taking a medical history is all too often a transcription of information to the dental chart, with little emphasis on the presurgical risk assessment and the development of a treatment plan appropriate to the medical status of the dental patient. Changes in dentistry, driven by an increasingly medically complex population of dental patients, combined with treatment advances rooted in the biomedical sciences necessitate the adaptation of our dental education to include a stronger background in systemic health. Many predoctoral educators in the American Association of Oral and Maxillofacial Surgeons (AAOMS) have expressed concern about the medical preparedness of our dental students; therefore, the AAOMS and its Committee on Predoctoral Education and Training have provided recommendations for improving the medical curriculum in predoctoral dental education, including a strengthening of training in clinical medicine and biomedical sciences, with specific recommendations for improved training of our dental students and dental faculty.

Synovial chondromatosis of the temporomandibular joint: a case report and literature review.

Abstract Synovial chondromatosis (SC) is a pathologic condition in which mesenchymal tissue rests in a given synovial membrane undergo a metaplastic process, ultimately producing and secreting cartilaginous bodies into the joint space. It is more commonly discussed in the orthopedic literature, since the axial skeleton is the most frequently affected. Although rare, it does occur within the temporomandibular joint (TMJ), with approximately 100 cases previously being described. Within the TMJ, its presentation can be variable, though most cases will show it to be unilateral with fixed and/or loose cartilaginous bodies confined to the superior joint space. Clinically, patients may present with symptoms similar to that of an internal derangement disorder, including pain, clicking, tenderness, functional limitations, and swelling.1 A thorough history and physical examination, along with proper radiographic examination, are paramount in properly diagnosing SC. Treatment options consist of arthroscopy, arthrotomy with synovectomy, excision of cartilaginous bodies, and possible discectomy.1 In the current paper, the authors describe the presentation, diagnosis, and surgical management of a SC case involving the right TMJ in a 31-year-old Caucasian female.

A 5-Year Retrospective Review of Primary Palatoplasty Cases Utilizing an Acellular Collagen Interpositional Graft

PURPOSE Multiple palatoplasty techniques have been developed, but a technique involving a partial 2-layer soft tissue closure of the posterior hard palate and nasal floor and a 3-layer soft tissue closure of the soft palate with reorientation of the levator and tensor veli muscles across the midline has been the gold standard for cleft repair. This report describes a series of primary palatoplasties reconstructed with a middle layer of acellular collagen membrane that aided in maintaining closure between the oral and nasal cavities without the development of an oronasal fistula. MATERIALS AND METHODS An acellular collagen membrane was placed between the muscular layer and the oral mucosa during primary palatoplasty. Six patients with primary cleft palatoplasty were identified and followed for 1 year (patient 1, a 10-month-old boy; patient 2, a 12-month-old girl; patient 3, a 12-month-old girl; patient 4, a 6-year-old boy; patient 5, a 12-month-old girl; and patient 6, an 18-month-old girl). RESULTS At 1 year, no oronasal fistulas had developed where augmentation with the acellular collagen membrane was used. CONCLUSIONS The use of an acellular collagen graft to aid in the 3-layer closure of primary palatoplasty surgery is a very effective strategy in primary and secondary healing and in preventing oronasal fistulation. The risk associated with the use of acellular collagen membranes appears nonexistent.

Case report of spontaneous hemorrhage in a sublingual arteriovenous malformation causing an emergent airway obstruction.

The literature is devoid of articles on spontaneous orofacial hemorrhage with hematoma formation without an underlying condition. Rupture of an arteriovenous malformation (AVM) is possibly the rarest form of spontaneous hemorrhage and life-threatening hematoma formation. This pathology is widely known because of its occurrence in the central nervous system, but it can appear in any location. AVM is not generally thought to be an inherited disorder, except in the context of a specific hereditary syndrome. AVMs can be seen using computerized tomographic angiography, but distraction angiography is the gold standard for diagnosis and treatment decision making. Surgery is the mainstay of treatment; however, endovascular embolization has become an important adjunct to surgical intervention. With shrinkage of the lesion or definitive treatment with coils, particles, or glue. Other important considerations in the choice of treatment are the patients age, lesion size and location, and prior history of hemorrhage.