Maano Milles

Reduction of postoperative facial swelling by low-dose methylprednisolone: An experimental study

The effectiveness of a low-dose, preoperative regimen of methylprednisolone for the reduction of postoperative facial edema after impacted third molar surgery was evaluated using the facial plethysmograph. Eleven patients were given 16 mg methylprednisolone orally the evening before surgery, combined with 20 mg methylprednisolone intravenously immediately preoperatively, in a double blind, randomized, crossover study. Facial contour was measured preoperatively, and then on days 1, 2, 3, 4, and 7 postoperatively. The low dose of methylprednisolone reduced swelling by 42% at 24 hours and 34% at 48 hours postoperatively. By the third day the difference was only 19%, suggesting the need for either a sustained release formulation or a multiday course. Trismus or the need for analgesic medication were not affected by this dose of methylprednisolone.

Clear cell odontogenic carcinoma with lymph node metastasis

Clear cell odontogenic tumors are rare. Review of the literature showed 9 cases with a prominent clear cell component. These lesions have exhibited an aggressive behavior characterized by an infiltrative local growth pattern, recurrence, or metastases. We report a case of an odontogenic tumor that exhibited a biphasic pattern and was characterized by lymph node involvement identical histologically to the primary tumor. We conclude that the presence of a clear cell component in an ameloblastomatous tumor should be viewed as a sign of de-differentiation, and that a malignancy with or without metastases should be considered and ruled out in such cases.

Management of the oral and maxillofacial surgery patient with sickle cell disease and related hemoglobinopathies

The oral and maxillofacial surgery patient with a sickle cell hemoglobinopathy presents a complex and challenging clinical management problem. The potential for significant morbidity and mortality among these patients is great. Thus the surgeon must adhere to sound principles of medical and surgical practice to avoid major difficulties. This article describes the complex pathophysiology, clinical course, and management principles of the oral and maxillofacial surgery patient with sickle cell disease.

Use of Monocortical Miniplates for the Intraoral Treatment of Mandibular Fractures

Fixation of mandibular fractures using rigid hardware has gained wide acceptance over the past 3 decades. The goal of rigid internal fixation is to allow for fracture healing with limited, or no, time in maxillo-mandibular fixation. There has been significant evolution in plate and screw materials and design over the past 30 years. The term miniplate is used to describe a fracture plate with a screw diameter of 2.0 mm or less. With correct diagnosis and understanding of the forces affecting mandible fractures, miniplates can be applied transorally in various situations, allowing for less invasive treatment with open reduction of mandible fractures. This article describes the use of monocortical miniplates for the intraoral treatment of mandibular fractures.

Cheiloplasty using Michel clips

C heiloplasty for the correction of enlarged lips is a well-known and straightforward surgical procedure. Techniques have been described in various texts’ and by Turvey and Epker2 as an adjunct to orthognathic surgery to improve soft-tissue facial balance. Enlarged or redundant lip tissue may be of congenital origin, a result of hyperplastic or hypertrophic labial salivary gland or muscle, or secondary to scar tissue formation resulting from trauma to the lips. Regardless of cause, the result is an imbalance in facial soft-tissue contour and compromise in facial esthetics. A simplified technique for cheiloplasty using Michel clips has been used for the correction of enlarged lips, regardless of etiology, with satisfactory results. This variation of the classic cheiloplasty procedure offers several advantages: (1) The amount of tissue to be removed is clearly outlined; (2) a reversible preview of results is achieved prior to performance of surgery; (3) an area-by-area determination of the amount of tissue to be removed is possible; (4) the potential removal of an excessive amount of tissue, with creation of a “fish mouth” appearance, is minimized.