Journal of the Korean Association of Oral and Maxillofacial Surgeons
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- P-ISSN2234-7550
- E-ISSN2234-5930
- SCOPUS, KCI, ESCI
ISSN : 2234-7550
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e-SubmissionVol.40 No.6
Abstract
Objectives: The aim of this study was to verify the clinical effectiveness of decompression in decreasing the size of a cyst. In addition to the differ-ent types of cysts, we tried to reveal what effect host factors, such as the initial size of the lesion and the age of the patient, have on the velocity of cyst shrinkage.Materials and Methods: With the aid of a panoramic view, we measured the size of the cysts before and after decompression in 13 dentigerous cysts (DCs), 14 keratocystic odontogenic tumors (KTOCs), and 5 unicystic ameloblastoma (UA) cases. The velocity of shrinkage in the three cystic groups was calculated. Relationships between the age of the patient, the initial size of the cyst, and the shrinkage velocity were investigated.Results: The three types of cysts showed no inter-type differences in their velocity of shrinkage. However, there was a statistically meaningful rela-tionship between the initial size of the lesion and the absolute velocity of shrinkage in the DC group (P=0.02, R=0.65) and the KTOC group (P=0.02, R=0.56). There was also a significantrelationship between the age of the patient and the absolute velocity of shrinkage in the KTOC group (P=0.04, R=0.45) and the UA group (P=0.04, R=0.46).Conclusion: There was no difference in the decrease in size due to decompression among the different types of cysts. However, the age of the patient and the initial size of the lesion showed a significant relatioship with the velocity of shrinkage.
Abstract
Objectives: The purpose of this study was to analyze the survival rate of reconstruction plates that were used to correct mandibular discontinuity de-fects.Materials and Methods: We analyzed clinical and radiological data of 36 patients. Only discontinuous mandibular defect cases were included in the study. Reconstruction plate survival rate was analyzed according to age, gender, location of defect, defect size, and whether the patient underwent a bone graft procedure, coronoidectomy, and/or postoperative radiation therapy (RT).Results: Plate-related complications developed in 8 patients, 7 of which underwent plate removal. No significantdifferences were found in plate sur-vival rate according to age, gender, location of defect, defect size, or whether a bone graft procedure was performed. However, there were differences in the plate survival rate that depended on whether the patient underwent coronoidectomy or postoperative RT. In the early stages (9.25±5.10 months), plate fracture was the most common complication, but in the later stages (35.75±17.00 months), screw loosening was the most common complication.Conclusion: It is important to establish the time-related risk of complications such as plate fracture or screw loosening. Coronoidectomy should be considered in most cases to prevent complications. Postoperative RT can affect the survival rate and hazard rate after a reconstruction plate is fitted.
Abstract
Objectives: Non-vascularized iliac crest bone graft (NVIBG) is a known treatment option in mandibular reconstruction following jaw resection, but no documented review of patients treated with NVIBG exists for northern Nigeria. The experience and technique from a Nigerian tertiary hospital may serve as baseline data for comparison and improvement of practice for other institutions.Materials and Methods: A retrospective review of medical records and patient case filesfrom January 2012 to December 2013 was undertaken. All case filesand other medical records of patients who had reconstruction with NVIBG for benign or malignant lesions with immediate or delayed recon-struction were selected for review.Results: Twenty patients had mandibular reconstruction with NVIBG during the study period. Two patients were excluded because of incomplete medical records. Eighteen patients’ (male=14, female=4) records were reviewed. Their ages ranged from 13 to 62 years (mean 26.0±10.6 years). Indi-cations for NVIBG included jaw tumors (n=16; 88.3%), jaw cyst (n=1; 5.6%) and gunshot injury (n=1; 5.6%). Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%). Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmen-tal resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%). Patients’ postoperative reviews and radiographs revealed good facial profie and continued bone stability up to 1 year following NVIBG.Conclusion: NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.
Abstract
Objectives: This study used cone-beam computed tomography (CBCT) images to categorize the relationships between the mandibular canal and the roots and investigated the prevalence of nerve damage. Materials and Methods: Through CBCT images, contact and three-dimensional positional relationships between the roots of the mandibular third molar and the mandibular canal were investigated. With this data, prevalence of nerve damage according to the presence of contact and three-dimen-sional positional relationships was studied. Other factors that affected the prevalence of nerve damage were also investigated. Results: When the mandibular third molar and the mandibular canal were shown to have direct contact in CBCT images, the prevalence of nerve damage was higher than in other cases. Also, in cases where the mandibular canal was horizontally lingual to the mandibular third molar and the man-dibular canal was vertically at the cervical level of the mandibular third molar, the prevalence of nerve damage was higher than in opposite cases. The percentage of mandibular canal contact with the roots of the mandibular third molar was higher when the mandibular canal was horizontally lingual to the mandibular third molar. Finally, the prevalence of nerve damage was higher when the diameter of the mandibular canal lumen suddenly decreased at the contact area between the mandibular canal and the roots, as shown in CBCT images.Conclusion: The three-dimensional relationship of the mandibular third molar and the mandibular canal can help predict nerve damage and can guide patient expectations of the possibility and extent of nerve damage.
Abstract
Objectives: We compared resorbable plates with titanium plates for treatment of combined mandibular angle and symphyseal fractures.Materials and Methods: Patients with mandibular angle and symphysis fractures were divided into two groups. The control (T) group received tita-nium plates while the experimental (R) group received resorbable plates. All procedures were carried out under general anesthesia using standard surgi-cal techniques. We compared the frequency of wound dehiscence, development of infection, malocclusion, malunion, screw breakage, and any other technical difficulties between the two groupsResults: Thirteen patients were included in the R group, where 39 resorbable plates were applied. The T group consisted of 16 patients who received 48 titanium plates. The mean age in the R and T groups was 28.29 and 24.23 years, respectively. Primary healing of the fractured mandible was ob-tained in all patients in both groups. Postoperative complications were minor and transient. Moreover, there were no significantdifferences in the rates of various complications between the two groups. Breakage of 3 screws during the perioperative period was seen in the R group, while no screws or plates were broken in the T group.Conclusion: Resorbable plates can be used to stabilize combined mandibular angle and symphysis fractures.
Abstract
Objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a side effect of bisphophonate therapy that has been reported in recent years. Osteoclastic inactivity by bisphosphonate is the known cause of BRONJ. Bone morphogenetic protein-2 (BMP-2) plays an important role in the devel-opment of bone. Recombinant human BMP-2 (rhBMP-2) is potentially useful as an activation factor for bone repair. We hypothesized that rhBMP-2 would enhance the osteoclast-osteoblast interaction related to bone remodeling. Materials and Methods: Human fetal osteoblast cells (hFOB 1.19) were treated with 100 μM alendronate, and 100 ng/mL rhBMP-2 was added. Cells were incubated for a further 48 hours, and cell viability was measured using an MTT assay. Expression of the three cytokines from osteoblasts, receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), and macrophage colony-stimulating factor (M-CSF), were analyzed by real-time polymerase chain reaction and enzyme-linked immunosorbent assay.Results: Cell viability was decreased to 82.75%±1.00% by alendronate and then increased to 110.43%±1.35% after treatment with rhBMP-2 (P<0.05, respectively). OPG, RANKL, and M-CSF expression were all decreased by alendronate treatment. RANKL and M-CSF expression were increased, but OPG was not significantly afected by rhBMP-2.Conclusion: rhBMP2 does not affect OPG gene expression in hFOB, but it may increase RANKL and M-CSF gene expression.
Abstract
Objectives: To compare the clinical and radiological outcomes after closed reduction (CR) and open reduction and internal fixation(ORIF) in the management of subcondylar fractures.Materials and Methods: Forty-eight patients presenting with subcondylar fracture between January 2010 and March 2013 were evaluated retrospec-tively. Fifteen patients were treated with CR and 33 patients with ORIF. The clinical and radiologic parameters were evaluated during follow-up (mean, 7.06 months; range, 3 to 36 months).Results: In the CR group, no patients had any problems with regard to the clinical parameters. The average period of maxillomandibular fiation (MMF) was 5.47 days. The preoperative average tangential angulation of the fractured fragment was 3.67º, and loss of ramus height was 2.44 mm. In the ORIF group, no clinical problems were observed, and the average period of MMF was 6.33 days. The preoperative average tangential angulation of the sub-condylar fragment was 8.66º, and loss of ramus height was 3.61 mm.Conclusion: CR provided satisfactory clinical results, though ORIF provided more accurate reduction of the fractured fragment. So there is no dis-tinct displacement of fractured fragment, CR should be selected than ORIF because of no need for surgery.
Abstract
Coronoid process hyperplasia is a rare condition that causes mouth opening limitation, otherwise known as trismus. The elongated coronoid processes impinge on the medial surfaces of the zygomatic arches when opening the mouth, which limits movement of the mandible and leads to trismus. Pa-tients with trismus due to coronoid process hyperplasia do not have any definitesymptoms such as temporomandibular joint pain or sounds upon clini-cal examination, and no significantabnormal signs are observed on panoramic radiographs or magnetic resonance images of the temporomandibular joint. Thus, the diagnosis of trismus is usually very difficult.However, computed tomography can help with the diagnosis, and the condition can be treated by surgery and postoperative physical therapy. This paper describes four cases of patients who visited our clinic for trismus and were subse-quently diagnosed with coronoid process hyperplasia. Three were successfully treated with a coronoidectomy and postoperative physical therapy.
Abstract
Ossifying fibromasare benign fibro-osseoustumors of mesenchymal origin. Although ossifying fibromashave principally been found in the jaw, they have also been reported in the frontal, ethmoid, sphenoid, and temporal bones, as well as the orbit and anterior cranial fossa. Ossifying fibromasaffect-ing the jaw exhibit variable behaviors ranging from slow growth to occasionally aggressive local destruction. In the present article, we discuss a differ-ential diagnosis considered for maxillary swellings and report a rare case of ossifying fibroma occurring in the maxilla.
Abstract
An oral foregut cyst is a rare congenital choristoma lined by the respiratory and/or gastrointestinal epithelium. The exact etiology has not been fully identified,but it is thought to arise from misplaced primitive foregut. This lesion develops asymptomatically but sometimes causes difficultyin swal-lowing and pronunciation depending on its size. Thus, the firstchoice of treatment is surgical excision. Surgeons associated with head and neck pathol-ogy should include the oral foregut cyst in the differential diagnosis for ranula, dermoid cyst, thyroglossal duct cyst and lymphangioma in cases of pediatric head and neck lesions.