Yee-Shyong Shen

DONOR SITE MORBIDITY AFTER HARVESTING OF PROXIMAL TIBIA BONE

Bone‐grafting procedures are common in head and neck surgery. Donor site morbidity is an important factor in deciding the site for harvest of cancellous bone. The tibia has been recommended as a harvest site. Use of the proximal tibia as a donor site is associated with few complications. Our present study used proximal tibia bone grafts to reconstruct maxillofacial defects and augment bone volume for implantation.

Importance of Patient’s Cooperation in Surgical Treatment for Oral Submucous Fibrosis

PURPOSE The aim of this study was to investigate the results of surgical treatment for oral submucous fibrosis (OSF) in patients who did or did not cooperate with the rehabilitation regimen. PATIENTS AND METHODS There were 54 patients who had surgical treatment of trismus caused by OSF. Split-thickness skin grafts were used to repair surgical defects after surgery on the fibrous bands. According to postoperative collaboration in the rehabilitation regimen, patients were defined as non-cooperative patients (group I) and cooperative patients (group II). Group I (n = 28) and group II (n = 26) were analyzed separately for changes in preoperative, intraoperative, and postoperative interincisal distances (ID) for at least 6 months after surgery. RESULTS The mean preoperative ID was 18.9 mm (range, 8 to 25 mm) in group I and 18 mm (range, 7 to 25 mm) in group II. The intraoperative ID increased to an average of 39 mm in group I and 38.5 mm in group II. The mean final follow-up ID was 22 mm in group I and 36.1 mm in group II. When evaluating the changes of ID, only a statistically significant difference was found at final visit between groups. CONCLUSIONS In our study, we found the patients cooperation is the primary requirement for success in the treatment of OSF.

EFFECTIVE ERADICATION OF ORAL VERRUCOUS CARCINOMA WITH CONTINUOUS INTRAARTERIAL INFUSION CHEMOTHERAPY

We evaluated the effectiveness of intraarterial methotrexate infusion as a primary therapy for oral verrucous carcinoma (VC).

Intraoral vertical ramus osteotomy for correction of mandibular prognathism: long-term stability.

Various techniques and modifications have been introduced in the treatment of mandibular prognathism. However, there are still few reports concerning long-term stability, especially using the intraoral vertical ramus osteotomy (IVRO) method. The purpose of this study was to investigate the long-term stability for correction of mandibular prognathism using IVRO. Twenty-five mandibular prognathism patients were treated by bilateral IVRO, and were evaluated cephalometrically by reference to the menton. A set of 3 standardized lateral cephalograms were obtained from each subject preoperatively (T1), immediately postoperatively (T2), and after 2 years postoperatively (T3). Relapse was defined as forward movement of menton after the 2-year follow-up. The mean setback of the menton was 12.8 mm in horizontal direction and 0.9 mm downward in vertical direction. The average follow-up was 33.9 months. The mean relapse was 1.3 mm (10.2% = 1.3 of 12.8) in forward direction and 0.6 mm in upward direction. There was no significant movement in the vertical direction. However, significant relapse was shown in the horizontal direction, even though the amount was small. The long-term stability of our present study suggested that IVRO is useful for correction of mandibular prognathism.

The use of miniplate osteosynthesis for skeletal anchorage.

Background: The purpose of this study was to explore the use of miniplates as skeletal anchorages for orthodontic treatment and to investigate the stability of miniplates and the causes of failure. Methods: Forty-four miniplates were applied in the maxilla or mandible as skeletal anchorages in orthodontic treatment. Two weeks later, a force of 100 to 200 g was applied by an elastometric chain or nickel-titanium coil spring to move the teeth. To compare nominal variables related to miniplate failure, the chi-square or Fishers exact test was used. Results: The average insertion time of a miniplate was approximately 25 to 30 minutes. One miniplate loosened before orthodontic force loading. The other miniplate was removed after orthodontic force loading. The overall success rate was 95.5 percent. The authors found no significant differences in the risk factors for failure of miniplates. Conclusions: Miniplates are easy to insert for skeletal anchorage, simplify treatment mechanics, and shorten the orthodontic treatment period.

Artificial Dermis Graft on the Mandible Lacking Periosteum After Excision of an Ossifying Fibroma: A Case Report

Collagen‐based grafts have often been used as artificial tissue substitutes for the repair of tissue and organ defects. It is common surgical knowledge that autogenous or artificial skin grafts take well on the intact periosteum of bone. However, many experienced surgeons indicate that auto‐genous or artificial skin grafts subsist poorly on the bone surface without periosteum. Therefore, primary closure is usually recommended in the wound healing of exposed bone. Vestibuloplasty might be needed to create enough depth of vestibule in the future. In this case report, we describe a peripheral ossifying fibroma surgically excised leaving a bony defect, which was covered by a piece of artificial dermis. Satisfactory result of the repaired surgical defect showed no need of vestibuloplasty after 6 years of follow‐up.

Interdisciplinary Management of Dental Implant Patient: A Case Report

Maxillary molars can over‐erupt when their antagonists are lost and there are no replacements. When the opposing molars severely extrude into the edentulous space, it is difficult to replace the missing teeth with either fixed or removable prostheses. We present the following case report, providing a solution for this type of problem. A two‐stage posterior subapical osteotomy was used to reestablish the intermaxillary space. Following orthodontic treatment and implant placement, the patient regained occlusal harmony and normal masticatory function.

Eye patch sandwich technique for stabilizing the intraoral skin graft to the cheek.

It is very important to secure skin graft in the defect of oral cavity. The tie-over bolster technique is the most common method for securing intraoral skin grafts. However, gauze is the best material as a bolster that can easily accumulate saliva and debris and cause odor and discomfort to the patient. We describe an alternative technique to stabilize intraoral skin graft between 2 aluminous eye patches and to readily keep the oral hygiene during the securing period.

Clinical evaluation of a new bilayer artificial dermis for repair of oral mucosal defects: report of two cases.

Free mucosal grafts or split‐thickness skin grafts have been used in patients undergoing repair procedures for oral mucosal defects. Conventional methods require the creation of second surgical wounds for use as donor sites. We applied two bilayers of artificial dermis to repair a buccal mucosal defect in one case and vestibular extension in another case. After removal of the sutures, no infection, pain, or hemorrhage developed in these patients. The results of granulation and epithelialization were good. Satisfactory appearance and function were achieved in both cases. Therefore, bilayer artificial dermis may be recommended for the repair of oral mucosal defects.