Nicolas Lazaridis

Double mandibular osteotomy with coronoidectomy for tumours in the parapharyngeal space

Removal of deep-lobe parotid tumours from the parapharyngeal space is often difficult because of limited surgical access and the critical vascular and neurologic structures nearby. Mandibulotomy, when necessary, is useful for improving wider visibility and control of the vascular bundle and facial nerve, but may cause damage to the inferior dental and lingual nerves. The double mandibular osteotomy with coronoidectomy gives excellent access and avoids damage to these nerves.

Displacement of three dental implants into the maxillary sinus in two patients. Report of two cases

IntroductionReconstruction of the posterior edentulous maxilla with dental implants has become a popular practice worldwide. However, the poor bone quality and quantity in this area is sometimes related with complications. Dental implant displacement into the maxillary sinus is a rare complication.Case reportIn the present paper, we present two patients with three implants displaced into the maxillary sinus. The implants were removed soon after their displacement, using the classic intraoral approach, through the anterior wall of the maxillary sinus. The operation was performed under local anesthesia for both of the patients. The postoperative course was uneventful for both of the patients without any wound dehiscence. Recovery remained uneventful, without any signs of postoperative sinusitis.DiscussionImplant displacement into the maxillary sinus is of rare occurrence and usually related to inadequate bone quality and quantity. Dental implants into the maxillary sinus usually act as foreign bodies and should be removed, to avoid the development of sinus complications. Removal of dental implants from the maxillary sinus can be performed either with functional endoscopic sinus surgery, or with intraoral operation through the anterior maxillary wall especially in fresh cases and in the presence of oroantral communication.

Detection and typing of human papillomaviruses (HPV) in malignant, dysplastic, nondysplastic and normal oral epithelium by nested polymerase chain reaction, immunohistochemistry and transitional electron microscopy in patients of northern Greece.

OBJECTIVES To evaluate the role of HPV in oral carcinogenesis, we examined the prevalence of HPV in malignant, potentially malignant and normal oral epithelium and studied the relation of HPV prevalence with other factors obtained from the patients records. MATERIALS AND METHODS Our material consisted of 291 tissue specimens from 258 individuals. From every individual formalin fixed and paraffin embedded tissues were examined by nested Polymerase Chain Reaction (NPCR) for the detection of HPV DNA and by immunohistochemistry (IHC) for the in situ detection of HPV L1 protein. Positive PCR products were sequenced in order to type HPVs. Also 33 fresh tissues were obtained, fixed and used to detect HPV particles by transitional electron microscopy (TEM). RESULTS HPV was detected in 32.9% of the tissue specimens by NPCR, in 4.7% by immunohistochemistry and in 28.1% by TEM. In detail, by nested PCR HPV L1 DNA was detected in 40% of normal tissues, 40% of fibromas, 35.8% of non-dysplastic leukoplakias, 31.6% of dysplastic leukoplakias and 22.2% of oral squamous cell carcinomas. The HPV viral load of 96.5% of the samples was very low (1 viral copy per 10(2)-10(4) cells). HPV16 prevails in all histological groups in 89-100%. CONCLUSION We conclude that HPV does not seem, from the specific sample examined, to play a substantial role in oral carcinogenesis. However, it cannot be excluded that HPV could be involved in oral carcinogenesis only in cases with high viral load or at early stages of carcinogenesis possibly through the hit-and-run mechanism.

Retrotuberosity versus submentosubmandibular and median submental intubation: patients with maxillofacial surgery.

OBJECTIVE In certain maxillofacial trauma cases, nasotracheal intubation is contraindicated and the standard method of orotracheal intubation interferes with maxillomandibular fixation. In such cases alternative techniques, such as submental, submentosubmandibular, and retromolar intubation have been used. STUDY DESIGN We reviewed 8 patients who underwent median submental intubation, 7 patients who underwent submentosubmandibular intubation, and 10 patients who underwent a retromolar intubation with an armored endotracheal tube secured in place with a circumdental wire. The tube was positioned in the retromolar region behind the most posterior maxillary tooth. RESULTS In the group of patients who underwent median submental intubation, 1 presented difficulty in performing a median submental intubation. No complications were recorded in the rest of the patients. CONCLUSIONS Submental and submentosubmandibular intubation are useful methods with low morbidity. However, both are invasive techniques compared with retrotuberosity intubation secured in place with a circumdental wire placed around the most posterior maxillary tooth.

Maxillary sinus osteoplasty with vascularized pedicled bone flap

OBJECTIVE This article describes the use of a vascularized pedicled bone flap, superiorly based on schneiderian membrane, for osteoplasty of maxillary sinus. STUDY DESIGN A rectangular bony window was created on the anterior maxillary wall and pedicled from its inner surface with the schneiderian membrane attached to it and left intact superiorly. After the sinus pathology was addressed, the pedicled bony window was repositioned and stabilized with sutures. This technique was performed in 9 maxillary sinuses in 9 patients. A nasoantral window was opened in all of the cases. RESULTS The follow-up ranged between 12 and 38 months. Healing in all patients was uneventful. In 1 case, a temporary hypoesthesia of the infraorbital nerve was recorded. CONCLUSIONS The procedure provides excellent visibility and access in the maxillary sinus, permitting the use of an advancement buccal pedicled flap for closure of an existing oroantral communication.

Salivary Gland Trauma: A Review of Diagnosis and Treatment

Salivary gland trauma is uncommon. Parotid gland and duct injuries are far more common than injuries to submandibular and sublingual glands due to anatomic position. Several methods of treating salivary duct injuries and their complications have been advocated. Optimal treatment outcomes can be achieved with early diagnosis, adequate evaluation, and proper management. This article presents current diagnostic and treatment protocols of salivary gland trauma. The anatomy of the salivary glands is briefly described and clinical cases are also presented to illustrate the treatment options described.

The value of magnetic resonance arthrography of the temporomandibular joint in imaging disc adhesions and perforations

OBJECTIVES This study attempted to validate MR arthrography (MRAr) of the temporomandibular joint (TMJ) in detecting the position, integrity and relations of the articular disc and retrodiscal tissue. METHODS A total of 20 TMJs from 10 patients with severe TMJ dysfunction underwent MRI and MRAr. A paramagnetic contrast medium was injected into the upper joint compartment to observe possible adhesions and/or leakage into the lower compartment. 15 TMJs were surgically or arthroscopically explored and restored. RESULTS MRAr was approximately in the same diagnostic value as MRI when locating position, but superior in detecting disc perforations (eight TMJs) and adhesions (seven TMJs) appearing together in four cases. Surgery confirmed radiological findings in all but one case, where arthroscopy and surgery failed to confirm a disc perforation indicated by MRAr. CONCLUSIONS TMJ MRAr may simultaneously reveal adhesions and perforations. Sensitivity and the probability of false-positive results require further study.