Shigeki Ochiai

Elongated styloid process as a cause of difficult intubation

1. Frederiksen NL, Wesley RK, Sciubba JJ, et al: Massive osteolysis of the maxillofacial skeleton: A clinical, radiographic, histologic and ultrastructural study. Oral Surg 55:470, 1983 Pedicelli G, Mattia P, Zorzoli AA, et al: Gorham syndrome. JAMA 252:1449, 1984 Hamptom J, Arthur JF: Massive osteolysis affecting the mandible. Br Dent J 120:538, 1966 Ellis DJ, Adams TO: Massive osteolysis: Report of case. J Oral Surg 29:659, 1971 Cherrick HM, King OH, Dorsey JN: Massive osteolysis (disappearing bone, phantom bone, acute absorption of bone) of the mandible and maxilla. J Oral Med 27:67, 1972 Kriens 0: Progressive maxillofacial osteolysis. A case report. Dentomaxillofac Rad 2:73, 1973 Murphy JB, Doku HC, Charter BL: Massive osteolysis: Phantom bone disease. J Oral Surg 36:318, 1978 Black MJ. Cassisi NJ, Biller HF: Massive mandibular osteolysis. Arch Otolaryngol 100:314, 1974 Philips RM, Bush OB. Hall HD: Massive osteolysis (phantom bone, disappearing bone). Report of a case with mandibular involvement. Oral Surg 34:886, 1972 1225

Prediction of neurosensory alterations after sagittal split ramus osteotomy

Prediction of neurosensory deficit in the lower lip and chin after sagittal split ramus osteotomy (SSRO) is challenging. This study aimed to elucidate factors related to the development and improvement of neurosensory disturbance (NSD) after SSRO with respect to surgical procedure and the anatomical and structural characteristics of the craniomaxillofacial skeleton. Subjects comprised 50 patients treated by a single experienced surgeon. Anatomical data and landmarks were obtained by computed tomography (CT) imaging. There was a significant difference between patients with or without NSD for the surgical space on the medial side of mandibular ramus 1 week after SSRO (P=0.006). Less than 15.0mm between the lingula and mandibular notch (relative risk, 6.7; 95% CI, 1.7-33.8) and 195.0mm(2) or more space on the medial side of the mandibular ramus (relative risk, 17.2; 95% CI, 3.9-100.4) indicated a significant risk of NSD development at 6 months postoperatively. These results suggested that the development of NSD is related to the surgical space on the medial side of the mandibular ramus and subsequent manipulation of the inferior alveolar nerve (IAN) in that region. Limited periosteal degloving prevents excessive stretching of the IAN during SSRO, thus lowering NSD incidence.

Risk of surgical glove perforation in oral and maxillofacial surgery.

Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.

Factors predictive of pterygoid process fractures after pterygomaxillary separation without using an osteotome in Le Fort I osteotomy

OBJECTIVE This study demonstrated pterygomaxillary disjunction patterns and elucidated factors related to unfavorable pterygomaxillary junction fractures in Le Fort I osteotomy without using an osteotome. STUDY DESIGN Clinical and anatomical data obtained from computed tomography images (100 sides) were analyzed for their ability to predict patterns of pterygomaxillary disjunction. RESULTS Separation of the pterygomaxillary junction was most frequently performed at the maxillary tuberosity (48.0%). Twenty-eight pterygoid plates were fractured. Male gender, increased age, thickness of the pterygomaxillary junction, and length of the maxillary tuberosity were significant risk factors for pterygoid process fractures. We also identified that a pterygomaxillary junction thickness less than 2.6 mm and a maxillary tuberosity length of more than 11.5 mm indicated a statistically significant risk of pterygoid process fractures. CONCLUSIONS Prediction of frangible pterygoid plates by preoperative quantitative evaluation of morphometric values provides useful information for selecting safe procedures.

Endoscopic-assisted resection of peripheral osteoma using piezosurgery.

Endoscopic-assisted surgery has gained widespread popularity as a minimally invasive procedure, particularly in the field of maxillofacial surgery. Because the surgical field around the mandibular angle is extremely narrow, the surrounding tissues may get caught in sharp rotary cutting instruments. In piezosurgery, bone tissues are selectively cut. This technique has various applications because minimal damage is caused by the rotary cutting instruments when they briefly come in contact with soft tissues. We report the case of a 33-year-old man who underwent resection of an osteoma in the region of the mandibular angle region via an intraoral approach. During surgery, the complete surgical field was within the view of the endoscope, thereby enabling the surgeon to easily resection the osteoma with the piezosurgery device. Considering that piezosurgery limits the extent of surgical invasion, this is an excellent low-risk technique that can be used in the field of maxillofacial surgery.

A case of the accessory nerve passing through the internal jugular vein

Modified radical neck dissection with preservation of the accessory nerve is often used for elective neck dissection or early-stage neck metastasis.Dissection of the upper neck, requires confirmation of several anatomical landmarks, such as the internal jugular vein, occipital artery, hypoglossal nerve, accessory nerve, vagus nerve, and digastric muscle. During the dissection, surgeons should be aware that the anatomical relations of these landmarks can vary.After the accessory nerve leaves the jugular foramen, it crosses the internal jugular vein and descends obliquely to the trapezius muscle.Variations in the relation of the accessory nerve to the internal jugular vein should be taken in account to perform the dissection correctly.We encountered a patient in whom the accessory nerve passed through the internal jugular vein.