Shlomo Taicher

Radiologic features of central giant cell granuloma of the jaws.

The radiologic features of central giant cell granuloma (CGCG) have not been clearly defined, and conflicting descriptions appear in the literature. This study analyzes the radiologic and clinical features of 80 cases of CGCG. In nearly 50% of the cases the lesion is located in the posterior area of the jaws, that is, the molar, ramus, and tuberosity, and not in the deciduous teeth-bearing area as was accepted in the past. Only 51% of CGCGs are multilocular, and the frequency of these lesions is significantly higher in the mandible than in the maxilla. The correlation between the lesions size and its locularity is statistically significant, and larger lesions assume a multilocular appearance. Only 6% of the lesions crossed the midline of the jaws, a feature that was considered in the past as typical for CGCG.

Anatomic and radiologic course of the mandibular incisive canal.

The purpose of this article was to define the anatomic and radiographic courses of the incisive mandibular canal and discuss its clinical significance. The study group comprised of 46 hemimandibles fixed in formalin. After radiographic examination, the buccal cortical plate of the mandible was removed leaving the bony frame of the incisive bundle intact. The morphology of the bony walls of the canal was evaluated, as having complete, partial, or no cortical walls. The course of the intraosseous pathway of the canal and its diameter in four different locations were recorded. An incisive bundle was anatomically found in all hemimandibles, travelling within a canal with complete (n = 10), partial (n = 27), or no (n = 9) bony cortical borders. The diameter of the canal ranged from 0.48 mm to 2.9 mm. Radiographically, the canal was either well defined (n = 11, 24%), poorly defined (n = 15, 32%), or undetectable (n = 20, 44%). A statistically significant correlation was found between the anatomic structure of the incisive canal bony borders and its radiographic detectability (p = 0.043). No correlation was found between the anatomic and radiological width of the incisive canal diameter. An incisive canal with a large diameter could have an important role in successful osteointegration and prevention of postoperative sensory disturbances. According to the present study, the ability to interpret the incisive canal from conventional radiographs is limited. Therefore, it is recommended to use conventional tomographs or computerised tomographic dental scans for better imaging of the intermental foraminal area.

Lingual cyst with respiratory epithelium: an entity of debatable histogenesis.

PURPOSEnThe purpose of this report was to describe a new case of lingual cyst with respiratory epithelium, to review and analyze the literature regarding lingual cyst of foregut origin and lingual alimentary cyst, and to discuss the suitable terminology for these uncommon cysts.nnnMATERIAL AND METHODSnData from articles published in the English language between the years 1942 and 1947 were used.nnnRESULTSnThe review of the literature showed 53 lingual cysts of which 29 could be grouped into lingual alimentary tract cysts and 24 into lingual cysts of foregut origin. There was an overlap in histologic and clinical features and embryogenesis of both cysts.nnnCONCLUSIONSnDifferentiation between both cysts cannot be supported, and until further information is accumulated it is suggested that histologic descriptive terms be used such as lingual cyst with respiratory epithelium, lingual cyst with gastric epithelium, or lingual cyst with respiratory and gastric epithelium.

Recovery of the infraorbital nerve after zygomatic complex fractures: A preliminary study of different treatment methods

The infraorbital nerve (ION) is often involved in trauma to the zygomatic complex (ZC), resulting in sensory disturbance of the area innervated by it. The purpose of the study was to compare the incidence of persistent sensory disturbance after recovery from isolated simple fractures of the ZC, with four treatment methods: 1) closed reduction via subcutaneous approach without fixation; 2) open reduction via subcutaneous approach without fixation; 3) open reduction via oroantral approach and support of the complex by an intraantral Foley catheter; and 4) open reduction via Gillies approach with fixation of the frontozygomatic (FZ) fracture with wire osteosynthesis, and open reduction via Gillies approach with fixation of the FZ fracture with miniplate osteosynthesis. Analysis revealed that patients treated with miniplate osteosynthesis exhibited a trend for higher recovery rate of the (ION) than with the other three methods. No significant differences were found among the other three methods.

Radiologic features of desmoplastic variant of ameloblastoma

Desmoplastic variant of ameloblastoma is a newly described variant characterized by unique histologic and radiographic features. This study reviews and analyzes the clinical and radiographic features of 15 cases of desmoplastic variant of ameloblastoma (14 cases from the literature and one case from our files). Desmoplastic variant of ameloblastoma shows a predilection for the maxilla and has a tendency to occur in the anterior region of the mandible and maxilla. Radiographically, almost all desmoplastic variant of ameloblastomas exhibit a mixed radiolucent-radiopaque appearance. Most show poorly defined or diffused borders and are mistakenly diagnosed as fibro-osseous lesions.

Risk factors contributing to symptomatic plate removal in orthognathic surgery patients

PURPOSEnThis study analyzed the fate of miniplates in orthognathic surgery and defined risk factors that eventually result in plate removal.nnnPATIENTS AND METHODSnThe outpatient clinic files of 70 patients who had undergone orthognathic surgery were reviewed. All osteotomies were rigidly fixed with stainless steel or titanium miniplates. Study variables included age, gender, plate material, site of plates, and reasons for plate removal.nnnRESULTSnOf 260 plates used for fixation, 31 were removed (12%). When all factors were considered together, only age was statistically significant. Patients older than 30 years of age were more likely to have plate removal (22% vs. 9%). Only when each factor was considered separately were gender and plate material statistically significant. Females (15.4% vs. 6.7%) and stainless steel plates (15.5% vs. 6.7%) were more prone to plate removal. Although more plates were removed from the buttress (15.5%) and chin (14.5%) compared with the piriform area (6.4%), this was not statistically significant.nnnCONCLUSIONSnAge can be defined as a primary risk factor for plate removal, whereas gender and plate material are secondary. Although age and gender are not controllable, the use of titanium plates and infection control may lower the number of symptomatic plates and the need for their removal.

Oral manifestations of sarcoidosis.

OBJECTIVEnTo report two new cases of sarcoidosis of the buccal mucosa and to analyze the literature on oral manifestations of sarcoidosis.nnnSTUDY DESIGNnOral lesions with histologic features of sarcoidosis were analyzed according to their location and appearance.nnnRESULTSnAnalysis of 45 cases of oral sarcoidosis (43 from the literature and the 2 new presented cases) revealed 12 lesions in the jaws, 10 in the buccal mucosa, 6 in the gingiva, 5 in the lips, 5 in the floor of the mouth, 4 in the tongue, and 3 in the palate. Sarcoidosis in the jaw was located in the alveolar bone and presented as an ill-defined radiolucency. Submucosal nodules were observed in sarcoidosis affecting the buccal mucosa, palate, and lip. Swelling was the main manifestation in the gingiva. In the floor of the mouth, sarcoidosis presented as ranula and that of the tongue as induration. In most of the cases, the lesions in the buccal mucosa, gingiva, and tongue were the first clinical manifestation of the disease.nnnCONCLUSIONnOral sarcoidosis lesions should be considered in the differential diagnosis of oral soft tissue swellings and jaw lesions.

Life-threatening bleeding following maxillofacial trauma

Life-threatening bleeding associated with facial trauma is considered rare, and most references on this subject do not recommend a precise treatment plan. The purpose of the present study is to review the origin of bleeding and various treatment methods, and to formulate a plan of management for these patients, emphasizing the role of the maxillofacial surgeon in the immediate intervention to control the bleeding. 222 patients with midface fractures were treated between 1985 to 1990. 10 of them had severe and life-threatening bleeding on admission. Bleeding was controlled by nasal packing (9 patients) combined with temporary fracture reduction (7 patients).

Salivary flow and its relation with oral symptoms in terminally ill patients.

Patients with terminal malignant disease commonly report hyposalivation or xerostomia. This leads to “dry mouth,” fungal infection, and mucosal abnormalities. To the authors knowledge oral symptomatology and findings have not been correlated previously with accurate salivary flow measurements.

Location of the mandibular foramen in panoramic radiographs

The reliability of two panoramic x-ray machines (Philips Orthoralix SD Ceph and Gendex Panelipse II) for determination of the location of the mandibular foramen was studied with the use of human dry mandibles. A significant correlation was found between the location of the mandibular foramen in the radiograph and the narrowest anteroposterior dimension of the ramus. A linear logistic regression equation was developed that could predict the actual location of the mandibular foramen from the radiographs. This finding will improve treatment planning of surgical splitting or fracturing of the ramus in cases that require orthognathic surgery provided the surgeon is aware of which panoramic machine was used. The Philips Orthoralix SD was found to be more reliable for this purpose than the Panelipse II (R2 = 0.94 and R2 = 0.87, respectively, in the vertical dimension and R2 = 0.87 and R2 = 0.75, respectively, in the horizontal dimension.