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PURPOSE: The aim of this study was to evaluate effects of extended maxillary advancement osteotomy on pharyngeal airway space (PAS) in mid-facial deficient cleft lip and palate (CLP) patients and mid-facial deficient non-CLP patients. METHODS: Pharyngeal airway space (PAS) of 10 CLP and 10 non-CLP patients with the mean age of 19 years 10 months was measured on digitized lateral cephalograms taken shortly before maxillary advancement operation with Quadrangular Le Fort I osteotomy (QLF-I) (T0), early post-operative, (T1) and long term post-operative (T2). Two way repeated analysis of variance, independent samples t-test and correlations tests were used for statistical analysis of airway and skeletal changes. RESULTS: Total PAS depth and area was significantly increased after the advancement and was stable in long term post-operative period for CLP and non-CLP patients. Nasopharyngeal and velopharyngeal airway space depth and area was statistically increased at T1 and T2 for both groups. Oropharyngeal airway depth and area showed no significant statistical difference at any of the time points. The effect of QLF-I osteotomy on (PAS) was similar in both CLP and non-CLP patients. CONCLUSIONS: Nasopharyngeal, velopharyngeal, and total pharyngeal airway space depth and area increased after maxillary advancement with the QLF-I osteotomy; this increase was stable in long term follow up. Maxillary advancement with the QLF-I technique had no significant effect on oropharyngeal airway space depth and area in both CLP and non-cleft patients.
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Labio Leporino , Fisura del Paladar , Adulto , Cefalometría/métodos , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Humanos , Osteotomía Le Fort/métodos , Adulto JovenRESUMEN
Treatment of condylar fractures is variable and controversial. Treatment options for management of condylar fractures include surgical and nonsurgical methods, and if a nonsurgical method is as effective as a surgical method, the former is preferred. Although plain film radiographs and functional outcomes attained through nonsurgical treatment are well established in literature, evidence of the remodeling process through detailed, high-quality imaging is lacking. The purpose of this case series is to describe and illustrate two adults and one pediatric patient with significantly displaced condylar fractures treated nonsurgically with excellent clinical results. It is unique for such patients to have pre- and posttreatment computed tomography scans with high-quality three-dimensional reconstruction as in the case of two adults and to have 3.5-year posttrauma radiographs and 14.5-year follow-up as in the case of the pediatric patient. As such, this report is useful in visually presenting three examples of repositioning and reformation of the temporomandibular joint structures in displaced condylar fractures in a postmenarche 14-year-old female patient, a 21-year-old male patient, and an 18-month-old male patient.
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OBJECTIVE: To evaluate the horizontal and vertical stability of the quadrangular Le Fort I in patients with congenital cleft lip and palate. DESIGN: Prospective longitudinal study. PATIENTS: A total of 15 congenital cleft lip and palate patients treated with the maxillary quadrangular Le Fort I were enrolled. INTERVENTION: Lateral cephalometric radiographic examinations were obtained preoperatively, early postoperatively, and late postoperatively for four dental and skeletal landmarks. A questionnaire regarding patients' satisfaction with treatment and functional/cosmetic outcomes (airway, speech, mastication) was administered. MAIN OUTCOME MEASURES: Surgical horizontal and vertical movement, late postsurgical horizontal and vertical movement, and surgical and postsurgical movement in relation to age and cleft type were evaluated using Spearman correlation coefficients, Wilcoxon signed rank tests, and Mann-Whitney tests. RESULTS: Surgical horizontal movements of all measured points showed significant changes. Significant differences of postsurgical horizontal movement were observed in younger patients versus adult patients. Significant differences of postsurgical horizontal movement were observed in unilateral cleft patients versus bilateral cleft patients. A high percentage of patients showed significant functional improvement in nasal airflow, speech, mastication, temporomandibular joint function, and mouth versus nose breathing. CONCLUSIONS: The quadrangular Le Fort I is a functionally stable and a surgically predictable procedure for cleft lip and palate patients who present with midface deficiency. Patients under the age of 18 at the time of the osteotomy had a higher relapse rate than patients over 18 years of age. Younger patients who need surgery should be advised regarding the increased risk of skeletal relapse. Patients' satisfaction was high in all aesthetic- and function-related items on the questionnaire.
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Cefalometría , Labio Leporino/diagnóstico por imagen , Labio Leporino/cirugía , Fisura del Paladar/diagnóstico por imagen , Fisura del Paladar/cirugía , Osteotomía Le Fort , Adolescente , Adulto , Estética , Femenino , Humanos , Estudios Longitudinales , Masculino , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/cirugía , Satisfacción del Paciente , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Dimensión VerticalRESUMEN
PURPOSE: To assess the prevalence of gastrointestinal (GI) bleeding in patients after orthognathic surgery and its relation to known risk factors. PATIENT AND METHODS: With institutional review board approval, a single-center case series was conducted with data collected retrospectively from orthognathic surgical patients' medical records from 1990 to 2010. All patients were treated by 1 primary surgeon, were limited to 21 years or younger at the time of surgery, and had no coagulopathy. The authors' hypothesis was that patients concurrently exposed to mechanical ventilation and dual anti-inflammatory drugs in the postoperative period would be at a greater risk for clinically significant GI bleeding according to the American Society of Health-System Pharmacists guideline compared with those exposed to fewer risk factors. Its prevalence and relation to known risk factors were analyzed. RESULTS: In total 498 orthognathic cases consisting of 220 male patients (median age, 17 yr; age range, 3 to 21 yr) and 262 female patients (median age, 17 yr; age range, 10 to 21 yr) were reviewed. Of 17 patients admitted to intensive care unit level of care postoperatively, 4 patients were exposed to concomitant administration of ketorolac and steroids while being mechanically ventilated. Two of these 4 patients developed esophagogastroduodenoscopy-confirmed upper GI bleeding (UGIB). There was no incidence of UGIB in patients not exposed to all 3 risk factors concurrently. CONCLUSIONS: Postoperative GI bleeding complication is rare in orthognathic surgical patients, with an estimated prevalence of 0.4%. Based on these observations, orthognathic surgical patients who require mechanical ventilation and are receiving anti-inflammatory medications may have an increased risk of GI bleeding. In the absence of active bleeding from the surgical site, persistent decrease in hemoglobin concentration should alert one to consider the possibility of UGIB.
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Hemorragia Gastrointestinal/epidemiología , Procedimientos Quirúrgicos Ortognáticos/estadística & datos numéricos , Hemorragia Posoperatoria/epidemiología , Adolescente , Corticoesteroides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Trasplante Óseo/estadística & datos numéricos , Niño , Preescolar , Cuidados Críticos/estadística & datos numéricos , Endoscopía del Sistema Digestivo/estadística & datos numéricos , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Ketorolaco/uso terapéutico , Masculino , Minnesota/epidemiología , Osteotomía Le Fort/estadística & datos numéricos , Osteotomía Sagital de Rama Mandibular/estadística & datos numéricos , Prevalencia , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
PURPOSE: To evaluate the long-term clinical outcome after the removal of failed major alloplastic temporomandibular joint (TMJ) implants and the placement of an autologous abdominal fat graft. MATERIALS AND METHODS: A long-term clinical follow-up was performed in 4 patients who underwent removal of a failed alloplastic implant and insertion of an autologous abdominal fat graft under 1-stage surgical management. Postsurgical use of pain medication was documented and the vertical interincisal opening measurement was obtained at the follow-up visit. Long-term computed tomographic (CT) scans were available for 3 of 4 patients and evaluated for fat graft retention by a radiologist. Hounsfield units were used. RESULTS: The study showed long-term (average, 4.7 years) clinical success, including normal jaw function (≥30-mm vertical opening) and freedom from the use of pain-relieving medication. Long-term CT scans (average, 5 years after surgery) documented fat graft retention in 3 patients (-80 HU). CONCLUSION: Autogenous fat graft placement alone, after major TMJ alloplastic removal, provides excellent long-term clinical success.
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Grasa Abdominal/trasplante , Autoinjertos/trasplante , Materiales Biocompatibles/efectos adversos , Prótesis Articulares/efectos adversos , Articulación Temporomandibular/cirugía , Grasa Abdominal/diagnóstico por imagen , Anciano , Analgésicos/uso terapéutico , Artroplastia de Reemplazo , Autoinjertos/diagnóstico por imagen , Remoción de Dispositivos , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Luxaciones Articulares/cirugía , Estudios Longitudinales , Persona de Mediana Edad , Dolor Postoperatorio/tratamiento farmacológico , Rango del Movimiento Articular/fisiología , Procedimientos de Cirugía Plástica/métodos , Reoperación , Estudios Retrospectivos , Articulación Temporomandibular/diagnóstico por imagen , Disco de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/cirugía , Síndrome de la Disfunción de Articulación Temporomandibular/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the clinical and functional outcomes of a custom temporomandibular hemijoint fossa/eminence implant prosthesis. MATERIALS AND METHODS: This prospective cohort study enrolled patients with osteoarthritis of the temporomandibular joint. The primary study variables were pain experience, pain intensity, chewing ability, jaw opening, joint noise, and overall satisfaction of the surgical outcome at 3, 6, and 13 months after surgery. Pre- and postsurgical kinematic analyses measured maximum incisal opening, operated and unoperated condyle translations, and mandibular body axis rotation using mandibular kinematic data combined with patient-specific computed tomographic data. The primary analysis of interest concerned preoperative versus postoperative changes. RESULTS: The study sample was composed of 36 subjects (mean age, 46 years; 94% female; 40 joints). There were statistically significant improvements between pre- and postoperative measurements for each study variable. The kinematic data documented preservation or an increase of bilateral condylar motion, mandibular axis rotation, and mandibular incisor motion. CONCLUSIONS: Temporomandibular joint hemiarthroplasty with a custom metal fossa/eminence prosthesis provides satisfactory clinical and functional outcomes when used for advanced osteoarthritis in patients with focal joint pain secondary to computed tomographically documented joint pathology.
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Prótesis Articulares , Rango del Movimiento Articular/fisiología , Articulación Temporomandibular/cirugía , Adolescente , Adulto , Anciano , Artroplastia de Reemplazo/métodos , Estudios de Cohortes , Diseño Asistido por Computadora , Femenino , Estudios de Seguimiento , Humanos , Imagenología Tridimensional/métodos , Masculino , Mandíbula/fisiopatología , Cóndilo Mandibular/fisiopatología , Masticación/fisiología , Persona de Mediana Edad , Osteoartritis/cirugía , Dimensión del Dolor , Satisfacción del Paciente , Estudios Prospectivos , Diseño de Prótesis , Rotación , Sonido , Trastornos de la Articulación Temporomandibular/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To provide a comprehensive review of metastasizing (malignant) ameloblastoma, establish a new baseline of valid cases using histologic criteria and minimum documentation, and report 3 cases from the Mayo Clinic files. PATIENTS AND METHODS: Ninety-eight original reports of "metastasizing," "malignant," or "atypical" ameloblastoma were reviewed. The following data were gathered for reports that demonstrated well-differentiated ameloblastoma at the metastatic site: gender, ethnicity, age at time of primary tumor diagnosis, histologic pattern of primary tumor, anatomic sites of primary and metastatic tumors, interval from diagnosis of primary to diagnosis of metastasis, number of recurrences preceding metastasis, treatment responses to radiation and/or chemotherapy, presence of hypercalcemia, and length of survival after metastasis. RESULTS: Twenty-seven valid reports of metastasizing (malignant) ameloblastoma were identified; 81% originated in the mandible, recurring on average 4 times before metastasis. Lungs were the initial site of metastasis in 78% of reports, of which 71% were bilateral. The average time from diagnosis of primary to metastasis was 18 years. Over half of the patients were alive and had survived an average of 10 years since diagnosis of metastasis. Those patients who had succumbed to their disease had an average survival time of 3 years after diagnosis of metastasis. CONCLUSIONS: Metastasis of well-differentiated ameloblastoma occurs more rarely than previously believed. Metastasis to the lungs bilaterally, by the hematogenous route, usually follows multiple failed attempts at primary tumor control. The absence of malignant cytologic transformation correlates with relatively indolent metastatic site growth. Treatment of metastasizing (malignant) ameloblastoma should include close observation, thoracotomy with wedge resections, or experimental chemotherapeutic combinations.
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Ameloblastoma/secundario , Neoplasias Pulmonares/secundario , Neoplasias Mandibulares/patología , Neoplasias Maxilares/patología , Adulto , Distribución por Edad , Anciano , Ameloblastoma/cirugía , Femenino , Humanos , Neoplasias Pulmonares/terapia , Masculino , Neoplasias Mandibulares/cirugía , Neoplasias Maxilares/cirugía , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Distribución por SexoRESUMEN
PURPOSE: The purpose of this study is to present an extensive review of primary chronic osteomyelitis (PCO) and present long-term treatment results in 4 patients. PATIENTS AND METHODS: This is a retrospective case study analysis of 4 patients with documented PCO who were treated by a standardized surgical technique by 1 surgeon and were followed clinically and radiographically for a mean of 22 years. RESULTS: Based on follow-up visits to date and correspondence to the surgeon who treated these patients, there have been no radiographic recurrences of PCO in 4 patients followed 5, 23, 26, and 34 years, respectively. Complete symptomatic relief has been achieved in 3 of 4 patients; the fourth patient exhibits persistent recurrent myofascial pain. CONCLUSION: The surgical technique discussed herein provides a viable alternative in the range of potential treatment options for this uncommon disease of unknown etiology.
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Mandíbula/cirugía , Enfermedades Mandibulares/cirugía , Procedimientos Quirúrgicos Orales/métodos , Osteomielitis/cirugía , Adolescente , Adulto , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Mandibulares/complicaciones , Enfermedades Mandibulares/patología , Persona de Mediana Edad , Osteoartritis/etiología , Osteomielitis/complicaciones , Osteomielitis/patología , Recurrencia , Estudios Retrospectivos , Trastornos de la Articulación Temporomandibular/etiología , Extracción DentalRESUMEN
PURPOSE: To evaluate the surgical outcomes and clinical experience of the treatment of degenerative osteoarthritis of the temporomandibular joint with metal fossa-eminence hemijoint replacement. MATERIALS AND METHODS: A retrospective chart review showed 99 patients (94 females and 5 males) who underwent treatment of degenerative joint disease with hemijoint replacement surgery, including data on 141 operated joints (57 unilateral, and 42 bilateral). A visual analog scale (VAS) patient-response questionnaire with directives was mailed to the 99 patients. The questionnaire investigated the patient's experience before and after the treatment procedure in 5 areas: 1) pain intensity, 2) pain experience, 3) chewing ability, 4) mouth opening, and 5) joint noise. In addition, patients were requested to score on a VAS of 1 to 10 their overall satisfaction with the treatment outcome. Treatment outcomes were also compared between patients who received an autogenous abdominal fat graft placement before wound closure, and those who did not receive this adjunctive treatment. RESULTS: Forty-two of 99 patients responded to the questionnaires, with an average follow-up time of 5.1 years. In these 42 patients, pain experience was reduced by 68.6% (4.5 +/- 1.3 [mean +/- SD], presurgery, vs 1.4 +/- 1.7, current, on a 6-point scale). In addition, pain intensity was reduced by 58.7% (7.5 +/- 2.2, presurgery, vs 3.1 +/- 3.0, current, on a 10-point scale). Thirty-three of 42 patients (78.6%) stated in the questionnaire that they were highly satisfied with the results of surgical treatment (average, 9.0 +/- 1.2 on a 0-to-10-point VAS scale). Fifty-one patients (71 joints) did not receive an adjunctive abdominal fat graft, whereas 48 patients (70 joints) received this adjunctive treatment. In the nonfat group, 17 (21.5%) joints required revision surgery, and in the fat group, 4 joints (6.5%) required revision surgery. CONCLUSIONS: Temporomandibular hemiarthroplasty with metal fossa-eminence prosthesis provides predictable and satisfactory results in patients operated upon for advanced osteoarthritis. The incidence of revision surgery was found to be reduced with the application of fat graft adjunctive treatment.
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Artroplastia de Reemplazo/métodos , Prótesis Articulares , Osteoartritis/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/cirugía , Grasa Abdominal/trasplante , Adolescente , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Osteoartritis/complicaciones , Satisfacción del Paciente , Diseño de Prótesis , Rango del Movimiento Articular , Estudios Retrospectivos , Prevención Secundaria , Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/etiología , Resultado del TratamientoRESUMEN
The purpose of the study was to test the precision and accuracy of a method used to track selected landmarks during motion of the temporomandibular joint (TMJ). A precision phantom device was constructed and relative motions between two rigid bodies on the phantom device were measured using optoelectronic (OE) and electromagnetic (EM) motion tracking devices. The motion recordings were also combined with a 3D CT image for each type of motion tracking system (EM+CT and OE+CT) to mimic methods used in previous studies. In the OE and EM data collections, specific landmarks on the rigid bodies were determined using digitization. In the EM+CT and OE+CT data sets, the landmark locations were obtained from the CT images. 3D linear distances and 3D curvilinear path distances were calculated for the points. The accuracy and precision for all 4 methods were evaluated (EM, OE, EM+CT and OE+CT). In addition, results were compared with and without the CT imaging (EM vs. EM+CT, OE vs. OE+CT). All systems overestimated the actual 3D curvilinear path lengths. All systems also underestimated the actual rotation values. The accuracy of all methods was within 0.5mm for 3D curvilinear path calculations, 0.05mm for 3D linear distance calculations and 0.2 degrees for rotation calculations. In addition, Bland-Altman plots for each configuration of the systems suggest that measurements obtained from either system are repeatable and comparable.
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Movimiento (Física) , Articulación Temporomandibular/fisiología , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/métodos , Fenómenos BiomecánicosRESUMEN
PURPOSE: This study compared the functional kinematic outcome of the temporomandibular joint (TMJ) in patients with end-stage TMJ osteoarthritis before and after TMJ hemijoint replacement surgery. MATERIALS AND METHODS: Fourteen patients (15 joints), with a mean age of 46.1 years, undergoing metal fossa eminence hemijoint replacement surgery, participated in this study. Each patient's jaw motion was recorded using an electromagnetic tracking device and patient-specific computed tomography images. A visual analog scale patient response questionnaire was used before and after the operation to assess the subjective outcome of the surgery. RESULTS: The mean linear distance (LD) traveled by the incisors increased significantly due to the surgical intervention, from 30.4 +/- 6.9 mm preoperatively to 35.5 +/- 5.3 mm postoperatively (P = .02). The LD of the operated condyle decreased from 14.1 +/- 5.7 mm to 11.4 +/- 6.2 mm, but this was not significant. The mean LD for the unoperated condyle remained similar (preoperative, 13.2 +/- 5.9 mm; postoperative, 13.3 +/- 6.5 mm). The total mandibular rotation increased significantly, from 19.3 +/- 4.9 degrees preoperatively to 24.8 +/- 3.9 postoperatively (P < .01). CONCLUSIONS: Kinematic data support the functional efficiency of hemijoint replacement surgery, with benefits of increased maximal mouth opening, preservation of operated and unoperated condyle translation motion, and increased mandibular rotation.
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Artroplastia de Reemplazo/métodos , Prótesis Articulares , Osteoartritis/cirugía , Disco de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/fisiología , Adulto , Anciano , Aleaciones de Cromo , Humanos , Registro de la Relación Maxilomandibular , Cóndilo Mandibular/fisiología , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Movimiento , Dimensión del Dolor , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Encuestas y Cuestionarios , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/fisiopatología , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of this study was to develop a method to accurately study the kinematic changes of the temporomandibular joint (TMJ) in patients treated with hemijoint implant reconstruction for dysfunction of advanced degenerative osteoarthritis. MATERIALS AND METHODS: Mandibular kinematic motion data and patient-specific computed tomography (CT) data were acquired. Patients were fitted with custom dental stents that were embedded with metal markers to link the mandibular kinematics data with the 3-dimensional TMJ CT images. An electromagnetic tracking device was used to collect kinematic motion data during maximal mouth opening and closing. The coordinate systems of the kinematic data and CT data were registered to calculate the motion of the mandibular condyle. RESULTS: This technique was successfully used to study patients with motion aberration of the TMJ due to osteoarthritis. A typical case is illustrated in which the motion of both mandibular condyles was simulated preoperatively and postoperatively. CONCLUSIONS: The results of this study suggest that it is possible to use the proposed methodology to accurately quantify the motion of the mandibular condyle in 3 dimensions. The developed technique is user-friendly and noninvasive to the patient. The proposed methodology is a potential clinical tool that may be used in the management of patients with TMJ dysfunction.
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Fenómenos Electromagnéticos/instrumentación , Cóndilo Mandibular/fisiopatología , Osteoartritis/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Articulación Temporomandibular/fisiopatología , Femenino , Humanos , Imagenología Tridimensional , Cóndilo Mandibular/diagnóstico por imagen , Movimiento , Osteoartritis/diagnóstico por imagen , Proyectos Piloto , Rango del Movimiento Articular , Reproducibilidad de los Resultados , Stents , Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To measure the activity of superoxide dismutase (SOD) in the synovial fluid of patients with temporomandibular joint internal derangement and to show the relationship between the activity of SOD and the severity of the disease. MATERIALS AND METHODS: Twenty patients with internal derangement were classified according to Wilkes by clinical radiological examinations. SOD activity was measured by the method based on nitrobluetetrazolium reduction rate. RESULTS: The activity of SOD seemed to be progressively decreased as the stage of the disease increased. CONCLUSION: The reduction of SOD activity observed may result from insufficient scavenging capacity of free radicals. Further investigation and longitudinal studies are required to determine the role of antioxidants that scavenge the free radicals in temporomandibular joint disorders.
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Luxaciones Articulares/enzimología , Superóxido Dismutasa/metabolismo , Líquido Sinovial/enzimología , Trastornos de la Articulación Temporomandibular/enzimología , Articulación Temporomandibular/enzimología , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Articulación Temporomandibular/patologíaRESUMEN
PURPOSE: The primary purpose of this study is to quantify the kinematics of the temporomandibular joint (TMJ) in patients following unilateral TMJ arthrotomy with metal fossa-eminence partial joint replacement and compare them with TMJ kinematics of healthy individuals. MATERIALS AND METHODS: Fourteen healthy volunteers and 13 female surgical patients (minimum 4 years postoperative) participated in this study. An electromagnetic tracking device was used to record the kinematics of the mandible relative to temporal bone during opening-closing, protrusive, and lateral movements. The mean linear distance (LD) traveled by condyles was compared between operated and normal subjects. RESULTS: Patients responded with statistically significant improvement in pain and jaw function questions. Mean satisfaction with the surgical result was 25.7 on a scale of 1 to 30. The LD measured for condyles during all 4 movements showed similar measurements. However, operated and unoperated condyles showed statistically significant motion values during opening and protrusive motion from each other and from normal subjects. In addition, contralateral condyles during lateral motion showed statistically significant values in operated, unoperated, and normal condyles. CONCLUSION: The results of this study suggest that the surgical reconstruction of the TMJ with partial joint replacement provided highly significant clinical improvement. Moreover, condyle and incisor kinematics were preserved to a significant amount as compared with the normal group. The difference in kinematic measurements between the operated and unoperated condyle was significant and secondary to previous joint disease and previous surgical intervention. These results should be evaluated by prospective studies in pre- and postsurgical patients.
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Artroplastia de Reemplazo , Rango del Movimiento Articular/fisiología , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/fisiología , Adulto , Fenómenos Biomecánicos , Fuerza de la Mordida , Estudios de Casos y Controles , Femenino , Humanos , Prótesis Articulares , Masculino , Persona de Mediana Edad , Valores de Referencia , Estadísticas no Paramétricas , Articulación Temporomandibular/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: Although patients with T1 oral cavity carcinoma have a generally good prognosis, there is a significant burden of patients that have locoregional recurrence and mortality from early stage disease. The aim of this study was to investigate the specific cause of death in patients with T1N0M0 oral cavity squamous cell carcinoma (OCSCC) by analysis of death certification. PATIENTS AND METHODS: Patients were identified with T1 OCSCC treated over a 15-year period between 1986 to 2001 from the Mayo Clinic Tumor Registry. All patients were treated by operation without neck dissection or postoperative neoadjuvant therapy as the initial method of treatment. On detailed examination of the death certificate the leading cause of death was identified along with other clinical predictors of death. RESULTS: Two hundred fifty patients were identified and met inclusion criteria from the Mayo Clinic Tumor Registry. Of the study group, 8.5% and 16% developed local and regional recurrence, respectively, as the first recurrence. The majority of recurrences that were amenable to surgery were managed by radical resection and postoperative neoadjuvant therapy. Of 85 deaths in the study group, 40 death certificates were obtained and reviewed to ascertain a specific cause of death. Patients were grouped into death from oral cancer, other cancer, or medical disease. Primary cause of death from the death certificates available for review included uncontrolled locoregional disease (20%), metastatic oral cancer (15%), development of secondary nonoral malignancy (15%), and a variety of medical causes (50%). Patient age at the time of diagnosis older than 65 had a statistically significant increase in mortality. Interestingly, the presence of premorbid medical conditions, history, or persistent tobacco and alcohol use did not seem to be related to overall mortality. CONCLUSION: Early stage OCSCC continues to portend a poor prognosis. Analysis of death certification provides useful information of the specific cause of death.
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Carcinoma de Células Escamosas/mortalidad , Certificado de Defunción , Neoplasias de la Boca/mortalidad , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/mortalidad , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/cirugía , Causas de Muerte , Estudios de Cohortes , Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Neoplasias de la Boca/cirugía , Terapia Neoadyuvante/estadística & datos numéricos , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/cirugía , Neoplasias Primarias Secundarias/mortalidad , Pronóstico , Estudios Retrospectivos , Fumar/mortalidadAsunto(s)
Trasplante Óseo/métodos , Mandíbula/cirugía , Procedimientos de Cirugía Plástica/métodos , Fasciotomía , Hemostasis Quirúrgica , Humanos , Ilion/inervación , Ilion/cirugía , Músculo Esquelético/cirugía , Osteotomía/efectos adversos , Osteotomía/métodos , Complicaciones Posoperatorias , Recolección de Tejidos y Órganos/métodosRESUMEN
Bisphosphonates are effective in the prevention and treatment of bone disease in multiple myeloma (MM). Osteonecrosis of the jaw is Increasingly recognized as a serious complication of long-term bisphosphonate therapy. Issues such as the choice of bisphosphonate and duration of therapy have become the subject of intense debate given patient safety concerns. We reviewed available data concerning the use of bisphosphonates in MM. Guidelines for the use of bisphosphonates in MM were developed by a multidisciplinary panel consisting of hematologists, dental specialists, and nurses specializing in the treatment of MM. We conclude that intravenous pamidronate and intravenous zoledronic acid are equally effective and superior to placebo in reducing skeletal complications. Pamidronate is favored over zoledronic acid until more data are available on the risk of complications (osteonecrosis of the jaw). We recommend discontinuing bisphosphonates after 2 years of therapy for patients who achieve complete response and/or plateau phase. For patients whose disease is active, who have not achieved a response, or who have threatening bone disease beyond 2 years, therapy can be decreased to every 3 months. These guidelines were developed in the Interest of patient safety and will be reexamined as new data emerge regarding risks and benefits.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Imidazoles/uso terapéutico , Mieloma Múltiple/tratamiento farmacológico , Osteoporosis/prevención & control , Guías de Práctica Clínica como Asunto , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Humanos , Imidazoles/efectos adversos , Minnesota , Mieloma Múltiple/complicaciones , Osteoporosis/etiología , Pamidronato , Ácido ZoledrónicoRESUMEN
The purpose of this study is to introduce a new technique for recording the kinematics of the temporomandibular joint and incisors, using an electromagnetic tracking device and custom dental appliance. Five normal subjects took part in this kinematic study (4 females, 1 male, mean age of 34.8 years). Subjects' mandibular motion during maximal opening tasks were recorded on two different days and linear distance (LD) (i.e., the LD between the start and end position) and curvilinear path (CP) (i.e., the curvilinear distance along the curve between the start and end position) were calculated for the lower incisor landmark and both condyles in the sagittal plane (in mm). In the present study, the range of incisal movements (LD: 34.9 to 54.3 mm, CP: 36.5 to 60.3 mm) and that of condylar movements (LD: 7.5 to 25.3 mm, CP: 10.6 to 27.6 mm) in the sagittal plane during opening are in the normal range compared to the previous literature. The ability of subjects to reproduce the same motion between the two sessions was also calculated. Differences due to trial sessions and different repetitions within a session were negligible, indicating that the method can be used to assess changes between testing conditions in healthy subjects, and patients pre- and post-operatively.
Asunto(s)
Movimiento/fisiología , Rango del Movimiento Articular/fisiología , Articulación Temporomandibular/fisiología , Adulto , Equipo Dental , Fenómenos Electromagnéticos , Femenino , Humanos , Masculino , MandíbulaRESUMEN
BACKGROUND: The authors review the literature regarding osteocartilaginous loose bodies (that is, secondary synovial chondrometaplasia or secondary synovial chondromatosis) in the temporomandibular joint (TMJ), present a case report and stress the importance of early diagnosis. CASE DESCRIPTION: A 57-year-old woman was referred to an orthodontist with a chief complaint of bite changes that took place over several years as the patient intermittently experienced TMJ problems. The authors noted radiopacities around the right TMJ space on a panoramic radiograph. They referred the patient to an oral and maxillofacial surgeon for treatment. CLINICAL IMPLICATIONS: Asymmetrical occlusal changes in a nongrowing adult with progressive shifts from Class I to Class III malocclusion unilaterally may indicate a space-occupying lesion in the TMJ space on the affected side.
Asunto(s)
Cuerpos Libres Articulares/complicaciones , Maloclusión/etiología , Trastornos de la Articulación Temporomandibular/complicaciones , Condromatosis Sinovial/complicaciones , Condromatosis Sinovial/patología , Asimetría Facial/etiología , Femenino , Estudios de Seguimiento , Humanos , Cuerpos Libres Articulares/patología , Persona de Mediana Edad , Trastornos de la Articulación Temporomandibular/patologíaRESUMEN
PURPOSE: The purpose of this case series was to evaluate the late postsurgical stability of the Le Fort I osteotomy with anterior internal fixation alone and no posterior zygomaticomaxillary buttress internal fixation. PATIENTS AND METHODS: Sixty patients with maxillary vertical hyperplasia and mandibular retrognathia underwent a 1-piece Le Fort I osteotomy of the maxilla with superior repositioning and advancement or setback. A bilateral sagittal split ramus osteotomy for mandibular advancement was also performed in 22 patients. Stabilization of each maxillary osteotomy was achieved using transosseous stainless steel wires and/or 3-hole titanium miniplates in the piriform aperture region bilaterally, with no zygomaticomaxillary buttress internal fixation. (Twelve of the 60 identified patients were available for a late postoperative radiographic evaluation.) Lateral cephalometric radiographs were taken preoperatively (T1), early postoperatively (T2), and late postoperatively (T3) to analyze skeletal movement. RESULTS: These 12 patients (5 male, 7 female) had a mean age of 24.5 years at surgery. Mean time from surgery to T2 was 41.2 days; mean time from surgery to T3 was 14.8 months. One patient received anterior wire osteosynthesis fixation, while 11 patients received both anterior titanium miniplate internal skeletal fixation and anterior wire osteosynthesis fixation. Six patients underwent Le Fort I osteotomy with genioplasty, 1 patient underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy, and 5 patients underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy and genioplasty. These 12 patients all underwent maxillary superior repositioning with either advancement (11 patients) or setback (1 patient). Statistically significant surgical (T2-T1) changes were found in all variables measured. In late postsurgical measurements (T3-T2), all landmarks in the horizontal and vertical plane showed statistically significant skeletal stability. CONCLUSION: This case series suggests that anterior internal fixation alone in cases of 1-piece Le Fort I maxillary superior repositioning with advancement has good late postoperative skeletal stability.