Ronald M. Kaminishi

Improved maxillary stability with modified LeFort I technique

This modification of the LeFort I osteotomy places the horizontal bony cut higher and into the dense cortical bone of the maxillozygomatic complex. It gives greater stability and also provides a more solid bony base for intraosseous wiring of the mobilized segment. This usually eliminates the need for dento-osseous or maxillomandibular fixation, and the segments appear to solidify more quickly. Over the last year, we have used this technique in 23 cases (four maxillary advancements, seven one-piece maxillary intrusions, and 12 segmental maxillary intrusions) with very favorable results. This modification has given us greater control and stability, especially in combined maxillary and mandibular osteotomies.

Surgically uprighting and grafting mandibular second molars

A two-year follow-up was made of twenty-one impacted, mesially inclined mandibular molars which were surgically uprighted and splinted with autogenous bone grafts. There were two instances of follicular cysts in the adjacent impacted third molars and two instances of supereruption of uprighted teeth. With these exceptions, all uprightings were successful according to the criteria of continued root growth, normality of pulp chambers, normal periodontium, and normal contiguous structures.

Modified distolingual splitting technique for removal of impacted mandibular third molars: Technique

This first of two articles describes a modified distolingual splitting technique for removal of impaction of various classes. The second article evaluates the efficacy of the technique by reporting and comparing the incidence of postoperative sequelae with earlier research findings. In this technique, the lingual soft tissue is not separated from the bone. In addition, the fragmented lingual bone attached to the periosteum is not removed. The procedure is best performed with the patient under sedation or general anesthesia.

Arthroscopic surgery for treatment of temporomandibular joint hypomobility after mandibular sagittal osteotomy

Arthroscopic surgery is an effective method for treating painful hypomobility of the temporomandibular joint. Decreased range of motion after sagittal ramus osteotomies of the mandible has been reported. Causes may include intra-articular factors. These cases may be effectively treated with arthroscopic lysis and lavage after failure of nonsurgical modalities. A series of 15 patients is presented.

Reconstruction of alveolar width for orthodontic tooth movement: A case report

A problem that has limited orthodontic treatment is lack of buccal-lingual alveolar width into which teeth can be moved. Causes may range from surgical obliteration to physiologic constriction after tooth removal. Lack of buccal-lingual alveolar width does not have to be an orthodontic limitation anymore. A technique used routinely to graft alveolar clefts can remedy this problem. Autogenous cancellous bone is placed subperiosteally on the buccal aspect of the constricted edentulous space. The flap is closed over the bone. The adjacent teeth may be orthodontically moved into the grafted edentulous area in approximately 6 weeks. Long-term follow-up has revealed excellent orthodontic stability, periodontal health, and dental vitality. A case report of one patient with loss of buccal-lingual alveolar space is presented. It is concluded that loss or lack of sufficient buccal-lingual alveolar width no longer must be an orthodontic limiting factor.

Synovial chondromatosis of the temporomandibular joint

S ynovial chondromatosis is a rare, benign, usually monoarticular condition in which numerous cartilaginous bodies form by metaplasia of the sublining connective tissue of the synovial membrane.’ Although the etiology is uncertain, it is likely that the condition results when cells in the synovial lining undergo metaplastic change into chondroblasts that subsequently form cartilaginous bodies that may or may not calcify or ossify. As these bodies enlarge, they may become pedunculated and eventually break away, remaining trapped in and around the joint. Here, nourished by the synovial fluid, they remain viable and sometimes continue to increase in size. The clinical symptoms of synovial chondromatosis are similar to those of other internal derangements of the joints, including limited motion, swelling, and pain. The histological picture is, however, unique and includes evidence of cartilaginous metaplasia of the synovial connective tissue with nests of connective tissue cells undergoing transformation into cartilage. Only 26 patients with histologically confirmed synovial chondromatosis of the temporomandibular joint (TMJ) have been described in the English literature since the first case was reported in 1933.‘-” This report of this relatively rare condition serves to review the salient features of the condition.

Optimizing Format and Display Options in MRI of the Temporamandibular Joint

AbstractThe organization, format, and display of an imaging study on film play asignificant part in arriving at an accurate diagnosis and confidently communicating those results to referring physicians. Efficient and logical display is especially important in examinations with potentially large numbers of images such as magnetic resonance imaging (MRI) of the TMJ. We have developed a format for recording TMJ MRI studies such that the complete bilateral examination (open and closed mouth views) is recorded on a single 14x17 inch transparency in accordance with principles arrived at in conjunction with strong clinical input. This is implemented with the standard display options of a commercially available MR scanner. In addition, at the suggestion of referring clinicians, we have used the reverse mode (white on black instead of black on white) filming option in selected cases, because it produces images that look similar to x-rays or x-ray tomograms. Occasionally, this is extremely appealing to clinicians b...

Temporalis tendon release during mandibular sagittal ramus split osteotomy

Since the original description of the sagittal ramus six dissected specimens (Fig 2). The lingual nerve was also identified and found to be consistently inferior and medial to the temporalis tendon. The tendinous tissue was always easily distinguishable from nerve tissue. The lingual nerve location has been previously described as being on average 0.58 mm + 0.9 horizontally from the lingual plate and 2.28 mm f 1.96 on the average vertically below the alveolar crest (Fig 3).5 This location, verified in the cadaveric dissections, is clearly distinct from the location of the temporalis tendon. split osteotomy by Obwegeser,’ there have been a number of modifications to decrease relapse, reduce complications, and improve the ease with which the osteotomy is performed. Most modifications have dealt with changes in osteotomy design or soft tissue reflection.2.3 Our modification focuses on the insertion of the temporalis muscle and its influence on medial access, tissue reflection, and relapse. It involves elevation and transection of the tendonous insertion of the anterior temporalis muscle along the medial aspect of the mandibular body. Classically, the insertion of the temporalis muscle is described as being into the upper and anterior borders of the coronoid process, with the major portion on the medial side of the ramus and entire medial side of the coronoid. However, Hollinshead4 also found the anterior temporalis insertion to include the anterior part of the ramus, extend’hrg approximately to the third molar region.4 Clinically this is seen as a horizontal tendinous band that runs along the internal oblique ridge just superficial to the periosteum. It is found directly medial to the most common soft tissue incision used for the bilateral sagittal ramus split osteotomy, and is exposed and reflected each time the medial ramus is approached, often appearing as a tight band. After the sagittal ramus split osteotomy, the tendinous insertion remains attached to the distal or advancing segment of the mandible (Fig 1). This structure is easily indentified and has been verified on multiple cadaveric dissections. On exposure of the anterior insertion, the temporalis tendon was found to extend to the distal aspect of the second molar tooth in each of

Postoperative stabilization and intrusion of midface osteotomies with high-pull headgear

The two cases presented here illustrate advantageous uses of orthopedic-type craniomandibular headgear. Both cases demonstrate the use of headgear for postoperative cephalad movement of the maxilla. In Case 1 the use of headgear accomplished 6 mm. of anterior maxillary cephalad movement and 3.5 mm. of posterior maxillary cephalad movement. In Case 2 the use of postoperative headgear accomplished 8 mm. of anterior maxillary cephaled movement and 6.25 mm. of posterior maxillary cephalad movement. Table I indicates the duration of intermaxillary immobilization and the ensuing time that the cranial traction appliance was used. Fig. 10 illustrates the profile changes for Cases 1 and 2.