Thomas R. Flynn

Cephalometric norms for Orthognathic Surgery in black American adults

Normal values for the Cephalometrics for Orthognathic Surgery (COGS) analysis for American black adults were developed in this study. The cephalometric radiographs of 33 black American adults with ideal dentitions were analyzed, and a statistical description of their hard and soft tissue cephalometric measurements is presented. In addition, mean values for black American adults were compared with those of white American adults. In black subjects, there was greater maxillary skeletal prognathism, skeletal lower face height, skeletal facial convexity, lower incisor proclination, anterior dental heights, upper and lower lip lengths, and soft tissue thickness of the lips and chin than in white subjects. There was less nasal depth and projection, less bony chin depth, and a smaller nasolabial angle in black subjects. The results of this study may be useful in providing racially specific cephalometric values for diagnosis and treatment planning for orthognathic surgery in American black adults.

THE SWOLLEN FACE: Severe Odontogenic Infections

Owing to the widespread availability of preventive dental care and the development of effective antibiotics for the treatment of orofacial infection, the incidence of serious odontogenic infections has decreased dramatically over the past 50 years. Serious dental infections still occur, however, and their occasionally severe complications or even mortality warrant serious study of the clinical presentation, anatomy, and pathophysiology of orofacial infections. The goal of this review is to provide the emergency practitioner with a concise description of the clinical presentation, relevant anatomy, and treatment principles of odontogenic infection in the patient who presents to the ED with a swollen face or difficulty in opening the mouth widely. Prompt institution of surgical therapy for the infection, aided by appropriate antibiotic therapy enables the healthcare professions to continue their remarkable progress in treating these once-dreaded infections.

Antibiotic selection in head and neck infections

Oral and maxillofacial surgeons see patients with infections as part of their everyday practice. It is imperative to understand the mechanisms of antimicrobial resistance, its potential problems, and the means of overcoming it. This situation raises several important questions with respect to antimicrobial therapy for odontogenic infections: 1. Is there a problem of antibiotic resistance? 2. How does antibiotic resistance arise?

The use of drains in oral and maxillofacial surgery: A review and a new approach

The use of drains in oral and maxillofacial surgery is reviewed and discussed. Their relative advantages and disadvantages and potential complications are explained, and principles for wound drainage are developed. Use of the Jackson-Pratt drainage system, a versatile type of suction that minimizes the complications associated with wound drainage, is described.

Molecular Methods for Diagnosis of Odontogenic Infections

PURPOSE Historically, the identification of microorganisms has been limited to species that could be cultured in the microbiology laboratory. The purpose of the present study was to apply molecular techniques to identify microorganisms in orofacial odontogenic infections (OIs). MATERIALS AND METHODS Specimens were obtained from subjects with clinical evidence of OI. To identify the microorganisms involved, 16S rRNA sequencing methods were used on clinical specimens. The name and number of the clones of each species identified and the combinations of species present were recorded for each subject. Descriptive statistics were computed for the study variables. RESULTS Specimens of pus or wound fluid were obtained from 9 subjects. A mean of 7.4 ± 3.7 (standard deviation) species per case were identified. The predominant species detected in the present study that have previously been associated with OIs were Fusobacterium spp, Parvimonas micra, Porphyromonas endodontalis, and Prevotella oris. The predominant species detected in our study that have not been previously associated with OIs were Dialister pneumosintes and Eubacterium brachy. Unculturable phylotypes accounted for 24% of the species identified in our study. All species detected were obligate or facultative anaerobes. Streptococci were not detected. CONCLUSIONS Molecular methods have enabled us to detect previously cultivated and not-yet-cultivated species in OIs; these methods could change our understanding of the pathogenic flora of orofacial OIs.

Oral and Maxillofacial Infections: 15 Unanswered Questions

1a Meta-analyses and systematic reviews of multiple randomized clinical trials (RCT) 1b Individual RCTs 2 Quasi-experimental research: cohort studies, low-quality RCTs, outcomes research 3 Case-control studies 4 Case series 5 Expert opinion, practice guidelines, experimental laboratory research cl in ic s. co m In all affairs it’s a healthy thing now and then to hang a question mark on the things you have long taken for granted. —Bertrand Russell (1872–1970)