L. George Upton

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.

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.

Particulate allogeneic bone grafts into maxillary alveolar clefts in humans: A preliminary report

The purpose of this study was to determine the ability of particulate allogeneic bone graft to adequately bridge unilateral maxillary alveolar clefts in humans. Twenty patients with unilateral alveolar clefts and oronasal fistula underwent alveolar cleft grafting with a clinically appropriate amount of particulate allogeneic bone. The grafted cleft area was followed radiographically for three to six months postsurgery. Although it was difficult to quantitate, it was both clinically and radiographically apparent at three months that bone bridging and filling of the cleft had occurred in 100% of the cases. From this study, it appears that allogeneic bone is a viable alternative for repairing alveolar clefts and that its use has a significant benefit to the patient by eliminating the morbidity of a second operative site.

The treatment of temporomandibular joint internal derangements using a modified open condylotomy: A preliminary report

A modified open condylotomy was used to treat 44 patients who presented with painful temporomandibular joints, and in whom the clinical and arthrographic findings were indicative of disc displacement. A total of 64 joints (20 bilateral) were operated on. Postoperatively, the patients showed an overall improvement in their functional symptoms. Ninety-one percent of patients had improvement in clicking and popping, and 96% reported decrease in locking. Complaints related to pain and headache were improved 85% and 95%, respectively. The modified technique, as well as the anatomic basis for its use, are discussed.

An unusual complication after excision of a recurrent mucocele of the anterior lingual gland

A case report of a recurrent mucous extravasation phenomenon in the anterior lingual gland is presented. Multiple surgical procedures were necessary to eradicate the lesion. Alginate impression material was used during one of the surgical procedures to aid in defining the margins of the lesion. A foreign-body reaction arose in the tongue as a result of residual alginate within the tissues, necessitating further surgery. The use of this technique cannot be recommended in areas where extension into surrounding tissue planes is possible.

Potential Biomarkers of Temporomandibular Joint Disorders

PURPOSE The purpose of this study was to identify protein markers present in subjects with temporomandibular joint disorders (TMDs) and clicking compared with the levels in controls. MATERIALS AND METHODS This was a pilot case-control study, and we report the preliminary results. Samples of joint aspirate collected from patients with TMDs and controls who had undergone surgery for a problem other than TMDs were analyzed using isobaric tags for relative and absolute quantitation (iTRAQ) and biotin-labeled-based protein arrays. The data obtained from these techniques were used to identify the proteins of interest, which were then quantitated using enzyme-linked immunosorbent assay (ELISA). The patient samples studied included joint aspirate collected clinically from the controls and patients and included samples from both the right and the left sides of each patient with a TMD. RESULTS The 8 TMJ aspirate samples from 6 subjects included 5 aspirate samples from 4 patients and 3 from 2 controls. The greatest standardized protein concentration of endocrine gland-derived vascular endothelial growth factor/prokineticin-1 (EG-VEGF/PK1) and D6 was found in both joints of the controls compared with the levels from the joints of the patients. With 1 exception, the standardized protein concentration was significantly lower in the patients than in the controls. The lower levels of EG-VEGF/PK1 and D6 in the patients compared with the controls suggest that these cytokines might be possible biomarkers for TMDs. CONCLUSION In the present pilot study, greater levels of EG-VEGF/PK1 and D6 were found in the controls than in the patients with TMDs. Proteomic analysis of the proteins present in the diseased joints compared with those in the controls might help to identify proteins present when pain or degeneration of the joint occurs. The proteomic information might be useful in the development of future therapies.

Double-blind evaluation of etodolac (200 mg, 400 mg) compared with zomepirac (100 mg) and placebo on third molar extraction pain

This controlled, single dose study has demonstrated that compared with placebo, substantial analgesia is obtained with 200 and 400 mg doses of etodolac. The analgesic effects of both doses of etodolac were not notably different from each other or significantly different from zomepirac, a proven analgesic. With respect to safety, both doses of etodolac were well tolerated, with no reports of serious or dose related adverse side effects.

Double-gloving and the incidence of perforations during specific oral and maxillofacial surgical procedures

The concerns of surgeons about effective means of barrier protection during surgery is increasing owing to concern about the human immunodeficiency virus (HIV). There are various oral and maxillofacial surgical procedures that require the use of sharp instruments, and the oral and maxillofacial surgeon may be at risk for contamination due to possible perforation of the surgical gloves when manipulating these instruments. This study evaluated the incidence of perforations when performing specific oral and maxillofacial surgical procedures when double-gloving barrier protection was used. It found an increased incidence of perforations when performing procedures that required the use of sharp instruments in comparison with those procedures that did not require the use of such instruments.

A cephalometric evaluation of edentulous Rhesus monkeys (Macaca mulatta): A long-term study

Abstract 1. The rate, location, and magnitude of residual bone resorption, and morphologic changes in the gonial region, the ramus, and the condyle of the mandible were monitored cephalometrically for a period of 234 weeks in four adult Rhesus monkeys (Macaca mulatta) following complete extraction of the dentition. 2. Bone resorption in the residual ridges of the maxillae and mandible was most apparent in the first year following extraction. However, it continued at a reduced rate throughout the entire period studied. 3. The residual ridges of both the maxillae and mandible in their anterior-most regions underwent bone resorption during the first 2 years of the study, following which both areas became depositional. It was suggested that this reversal in alveolar bony remodeling may have been a result of behavioral-functionalfactors related to altered perioral muscle function. 4. The magnitude of residual bone resorption in the mandible was found to be between 4% (just mesial to the canine) and 45% (just mesial to the first molar) and greater in the mandible than in the maxillae. 5. Within the arch, variability in the amount of residual bone resorption was found. For the maxillae, the posterior, middle, and anterior regions, respectively, underwent increasingly greater amounts of resorption. Within the mandible, the posterior and anterior regions lost approximately equal amounts of alveolar bone, while the middle portion of the mandibular residual ridge underwent significantly greater resorption. 6. It was hypothesized that the increase in residual bone resorption in the middle region of the mandible is probably due to relatively greater compressive forces transmitted through that region during mastication. 7. Alterations in the morphology of the gonial region and the mandibular condyle during the experimental period were not pronounced and did not differ from values obtained in normally growing control animals. 8. The mandibular ramus, however, underwent relatively greater resorption along its anterior border than deposition along its posterior border, resulting in a narrower ramus. It was suggested that this was probably due to a reduction in the functional activity of the temporal and masseter muscles.

The case for mandibular condylotomy in the treatment of the painful, deranged temporomandibular joint

Ward et al’ first published the results of condylotomy in 1957. They reported on 21 patients from his original series reported in 1961,’ finding marked improvement or complete relief of symptoms in 15 of these cases. Campbell3 using the same technique, demonstrated 84% clinical improvement in a series of 80 cases, with 32.2% being completely cured. Sada, in a series of 33 patients, reported relief of symptoms in 83% of the cases. In 1973, Tasanen and von Konow’ evaluated the results of closed condylotomy for both idiopathic pain and dysfunction and traumatic pain and dysfunction of the temporomandibular joint (TMJ) in a series of 37 patients. Clinically, the two groups presented with similar symptoms, with the exception of clicking being more common in the idiopathic group. Complete satisfaction was noted in 23 of these cases; none of their patients were dissatisfied. Three of 37 cases had temporary VII nerve weakness, whereas 48% required “cuspal grinding on the operated side.” Banks and Mackenzie,6 reporting from the East Grinstead unit, evaluated 119 patients clinically and radiographically, which represented 68.3% of their surgical population. They found that 91% were “cured” or improved by surgery. They described the long-term findings of backward angulation of the condylar neck, a shortening of the ramus height, and an increased radiographic joint space. Of 117 patients who were radiographically evaluated on postoperative follow-up, a higher percentage were cured if the increased joint space was maintained (59% vs 28%). It was also noted that bilateral cases had a greater relapse (86.8% vs 41% unilateral). Of interest was the effect of clinically