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M A Pogrel

Publications and source records attributed to M A Pogrel.

At least 19 recordsLinked to original sources
PubMed2001

The course of the temporal branch of the facial nerve in the periorbital region.

PURPOSE: This study identified the terminal temporal and zygomatic branches of the facial nerve as they enter the orbicularis oculi muscle and related these branches to identifiable surface markings. MATERIALS AND METHODS: The temporal and zygomatic branches of the facial nerve were dissected from 5 preserved cadavers (10 sides). The most superior temporal branch entering the orbicularis oculi muscle was identified and related to the lateral canthus of the eye. A vertical line was passed through this point so that the line was equidistant from the nasal tip and chin point. A line perpendicular to the vertical line through the lateral canthus served as the horizontal scale. Vertical and horizontal lines through the lateral canthus were used to establish the anatomic relationship between the lateral canthus and the branch of the temporal nerve entering the orbicularis oculi muscle. RESULTS: The temporal branch was an average of 2.85 +/- 0.69 cm superior to the lateral canthus and an average of 2.54 +/- 0.43 cm lateral to the lateral canthus as it courses into the orbicularis oculi muscle. At the lateral border of the orbicularis oculi muscle, where the temporal and zygomatic nerves insert into the muscle, the mean vertical distance between the temporal and zygomatic nerves was 1.72 +/- 0.62 cm. CONCLUSION: Incisions superior or inferior and parallel to the course of the facial nerve, can provide access to the fronto zygomatic suture and the superior and lateral orbit without damaging its branches.

Eyelids↗
PubMed2001

Long-term hard and soft tissue relapse rate after genioplasty.

PURPOSE: The purpose of this study was to assess hard and soft tissue stability 12 months after advancement genioplasty. MATERIAL AND METHODS: This is a retrospective study of 20 patients who underwent either advancement genioplasty alone (n = 11) or in combination with bilateral sagittal split osteotomy for mandibular advancement (n = 9). Lateral cephalometric radiographs were traced and immediate postoperative changes and 12-month postoperative changes were defined. The relapse rate for the pogonion, the soft tissue pogonion, and the soft tissue B point (Bs) were evaluated. The results were compared for combined mandibular advancement plus genioplasty versus genioplasty alone. Relapse rates were also correlated with the amount of advancement. All patients were treated with rigid internal fixation. RESULTS: After 12 months, the pogonion, the soft tissue pogonion, and the soft tissue B point had a mean relapse rate of -0.38 mm, -1.2 mm, and -1.5 mm (negative value indicates a relapse, and a positive value indicates prolapse), respectively, which was not significant at probability values of.45,.069, and.054, respectively. Relapse was not statistically related to the amount of advancement. There was no significant difference between the relapse rate for genioplasty alone versus combined bilateral sagittal split osteotomy and genioplasty, even with different amounts of advancement. CONCLUSIONS: Advancement genioplasty is an important and reliable technique for the esthetic treatment of the lower facial skeleton. The results indicate that there is no significant relapse after genioplasty and bilateral sagittal split osteotomy or genioplasty alone after 12 months when rigid internal fixation is used. The changes were minimal and hard to detect clinically. Genioplasty, with or without mandibular advancement, is a stable surgical procedure when used in conjunction with rigid internal fixation.

Bone Plates↗
PubMed2000

Dentistry's role in the diagnosis and co-management of patients with sleep apnoea/hypopnoea syndrome.

The sleep apnoea/hypopnoea syndrome (SAHS) is characterized by repeated upper airway narrowing or collapse during sleep. The obstruction is caused by the soft palate and/or base of tongue collapsing against the pharyngeal walls because of decreased muscle tone. These episodes are accompanied by hypoxaemia, surges in blood pressure, brief arousal from sleep and pronounced snoring. Individuals with occult disease are at heightened risk of motorway accidents because of excessive sleepiness, sustained hypertension, myocardial infarction, and stroke. The signs and symptoms of SAHS may be recognisable in the dental practice. Common findings in the medical history include daytime sleepiness, snoring, hypertension, and type 2 diabetes mellitus. Common clinical findings include male gender, obesity, increased neck circumference, excessive fat deposition in the palate, tongue (macroglossia) and pharynx, a long soft palate, a small recessive mandible and maxilla, and calcified carotid artery atheromas on panoramic and lateral cephalometric radiographs. Dentists who recognise these signs and symptoms have an opportunity to diagnose patients with occult SAHS. After confirmation of the diagnosis by a physician, dentists can participate in the management of the disorder by fabricating mandibular advancement appliances that enlarge the retroglossal space by anterior displacement of the tongue and performing corrective upper airway surgery that prevents recurrent airway obstruction.

Adult↗
PubMed2000

Letter from California--mandatory continuing education.

In Britain, mandatory continuing dental education is on its way. In California, we have had mandatory continuing dental education for some twenty-five years. Maybe it would help to see some of the good and bad sides of this, learn from some of our mistakes and see what does work and what does not work--at least in California.

California↗
PubMed2000

Efficacy of a single occipitomental radiograph to screen for midfacial fractures.

PURPOSE: This study evaluated the use of a single 30 degrees occipitomental radiograph as an effective screening procedure for midface fractures. PATIENTS AND METHODS: The emergency room 30 degrees occipitomental films of 105 consecutive patients with suspected midface fractures were examined independently by 2 oral and maxillofacial surgeons (OMFS). They were asked to identify whether a midfacial fracture existed in each case. They also identified those cases in which they believed a computed tomography (CT) scan was indicated for definitive diagnosis of midfacial fractures. These findings and recommendations were then compared with the actual diagnosis and imaging studies for these patients to determine the efficacy of a single occipitomental film, supplemented by CT scans when indicated, in identifying midface fractures. RESULTS: Of the 105 occipitomental films, one oral and maxillofacial surgeon recommended CT scans for 13 of the 105 patients, and the second recommended CT scans for 26 patients. Seventeen patients actually had had CT scanning performed, and a midface fracture was identified in 12 cases. Of these 12 patients, 8 were treated by surgical intervention. One OMFS identified 11 of the 12 fractures that were subsequently identified in the emergency room, including all of the 8 that required surgical treatment, whereas the second OMFS identified all 12 of the fractures seen in the emergency room. CONCLUSION: A single 30 degrees occipitomental radiograph, augmented with CT scans when indicated, can accurately identify all midface fracture requiring treatment. The current practice of obtaining a series of plain radiographs may be unnecessary.

Emergency Service, Hospital↗
PubMed2000

Assessment of the pharyngeal airway space after mandibular setback surgery.

PURPOSE: This retrospective study evaluated the change in pharyngeal airway space associated with surgical mandibular setback. PATIENTS AND METHODS: Lateral cephalograms of 14 adult patients taken preoperatively, immediately postoperatively, and at long-term follow-up were traced, and the width of the pharyngeal airway space and the pharyngeal airway space area were calculated and compared. RESULTS: At long-term follow-up, the mean amount of mandibular setback was 9.7 mm. The mean reduction in the distance from the tongue base to the posterior pharyngeal wall was 4.77 mm (28% decrease). The mean reduction in pharyngeal airway space area was 1.52 cm2, which corresponded to a 12.8% reduction. There was a strong correlation between the amount of mandibular setback and the decrease in pharyngeal airway space area. CONCLUSION: Mandibular setback surgery causes a long-term decrease in pharyngeal airway space area. In patients who have other risk factors, for example, overweight, short necks, or large tongues, a mandibular setback procedure could possibly predispose to the development of sleep apnea syndrome.

Adolescent↗
PubMed2000

Anatomy of the lateral canthal tendon.

OBJECTIVE: The purpose of this study was to clarify and describe the anatomy of the lateral canthal tendon. Knowledge of this anatomy is essential in selection of appropriate surgical procedures to restore orbital anatomy. STUDY DESIGN: Gross dissections were performed of the lateral orbital soft tissues from 21 preserved Caucasian cadaveric orbits. A block of the bony attachment of each lateral canthus was taken for histologic examination. After anatomical exposure, the following measurements of the lateral canthus were made: (1) the distance from the midpoint of insertion of the lateral canthus at the lateral orbit to the zygomaticofrontal suture; (2) the horizontal width of the lateral canthus, as measured from the lateral commissure to the lateral orbit; (3) the vertical difference in height between the medial canthal and lateral canthal insertions. RESULTS: The mean midpoint of the lateral canthus insertion was 10. 24 mm inferior to the zygomaticofrontal suture (range, 5-15 mm). The mean horizontal length of the lateral canthus from the lateral commissure to the lateral orbit was 7.52 mm (range, 2-12 mm). The mean vertical difference in height between the insertions of the medial canthus and the lateral canthus was 1.35 mm (range, -2-4 mm), the lateral canthus being at a more superior point. Histologic examination of hematoxylin-eosin-stained slides showed that the fibers of the lateral canthus inserted into the periosteum but not beyond it. CONCLUSIONS: The lateral canthal tendon attaches the upper and lower tarsal plates to Whitnall's tubercle inside the orbital rim deep to the septum. A precise knowledge of the periorbital anatomy will assist the surgeon in the selection of appropriate surgical techniques that will provide for restoration of this delicate anatomical configuration.

Eyelids↗
PubMed2000

Upper lip length after V-Y versus continuous closure for Le Fort I level maxillary osteotomy.

PURPOSE: The purpose of this report is to document changes in lip length and thickness after Le Fort I maxillary osteotomy by using continuous versus V-Y closure. MATERIALS AND METHODS: This is a retrospective analysis of 18 patients who underwent Le Fort I maxillary osteotomy. Ten patients had a single midline V-Y closure and 8 patients had simple continuous closure. Lateral cephalometric analysis was performed, and preoperative and 12-month postoperative changes in lip dimensions were calculated. Lip length and thickness were analyzed at 5 points: A-point (A), subnasale (Sn), cervical margin of incisor (C), stomion superius (Ss) and labrale superius (Ls). The lengths from A to Sn, C to Ls, and Sn to Ss were calculated. RESULTS: After 12 months, there was no significant difference in lip length (P =.39) or thickness of the upper lip in its upper (P =.75) or lower (P =.19) parts, between the 2 groups. CONCLUSION: Lip length and width show no significant differences before surgery versus after surgery with either closure technique after Le Fort I osteotomy.

Cephalometry↗
PubMed2000

Proliferative verrucous leukoplakia of the gingiva.

OBJECTIVE: The purpose of this study was to describe the clinical-pathologic features of what appears to be a gingival form of proliferative verrucous leukoplakia. STUDY DESIGN: Ten adult patients with recurrent and histologically progressive gingival leukoplakias who were diagnosed and treated at the University of California, San Francisco between 1994 and 1999, comprised the subject group for this investigation. Clinical and microscopic features were reviewed. Proliferation indices and p53 expression were evaluated immunohistochemically, and the presence of human papillomavirus (HPV) DNA was determined by using polymerase chain reaction (PCR) amplification. RESULTS: Lesions presented as solitary or regional flat/papillary/verrucal leukoplakias of the free and attached gingiva (tooth-bearing areas only). With time, flat lesions developed a papillary or verruciform profile. Although lesions were recurrent, they were confined to the gingiva, and multiple lesions did not develop. Half the patients used tobacco, and HPV could not be detected by using PCR. Microscopically, 6 cases began as hyperkeratotic lesions, and 4 initially exhibited a psoriasiform pattern with a marked inflammatory component. With recurrences, the lesions became progressively atypical histologically. The proliferation indices for these lesions showed modest increases over normal epithelium, and positive p53 staining was evident in 4 of 10 cases, indicating a disruption of the keratinocyte cell cycle in these lesions. The mechanism associated with the positive p53 staining (protein binding to wild type p53 versus mutation of the p53 gene) was not determined. Lesions recurred after conservative scalpel or laser excision, and many developed into verrucous or squamous cell carcinoma. CONCLUSIONS: Proliferative verrucous leukoplakia of the gingiva (PVLG) appears to be a subset of oral proliferative verrucous leukoplakia. It can be characterized as a solitary, recurring, progressive white patch that develops a verruciform architecture and may not be associated with HPV. PVLG has an unpredictable course and is at risk for development into verrucous or squamous cell carcinoma. Currently, there is no way to determine or predict which gingival white lesions will follow the clinical course described for this group of patients with PVLG.

Aged↗
PubMed2000

Permanent nerve involvement resulting from inferior alveolar nerve blocks.

BACKGROUND: This is a prospective study of patients referred to a tertiary care center with permanent alteration in sensation of the inferior alveolar nerves, lingual nerves or both that could have resulted only from an inferior alveolar nerve block. METHODS: Working with a subject pool of 83 patients, the researchers outlined and photographed the area of altered sensation on each patient, tested it with von Frey's hairs and two-point discrimination and tested temperature sensation and direction sense. RESULTS: Among a study population of 55 women and 28 men with a mean age of 41.2 years, the lingual nerve was affected in 79 percent of patients and the inferior alveolar nerve in 21 percent of patients. In 47 patients, the causative inferior alveolar nerve block was painful when administered, but to the other 36 patients [corrected], it felt like a normal injection. Of the local anesthetic agents used, prilocaine was found to be more frequently linked to cases of nerve involvement in this study. DISCUSSION: Occasionally, an inferior alveolar nerve block can result in permanent involvement of the inferior alveolar nerve, lingual nerve or both. The incidence and exact mechanism of involvement still are unknown. By extrapolation from this study, an incidence of anywhere between 1:26,762 and 1:160,571 inferior alveolar nerve blocks can be surmised to result in this complication. A difference in referral rates for male and female patients is difficult to explain. The 34 percent [corrected] incidence of dysesthesia in the patients in this study is of concern. CONCLUSION: Permanent nerve involvement after receiving an inferior alveolar nerve block is a documented but very rare complication of the inferior alveolar nerve block, and the exact mechanism involved is still unknown. CLINICAL IMPLICATIONS: Permanent nerve damage can very occasionally occur as a result of an inferior alveolar nerve block. The exact mechanism is unknown, and there is no means of prevention. Knowledge of the risks and complications of local anesthesia is essential.

Adult↗
PubMed2000

Soft tissue surgery in the oral and maxillofacial region.

The practice of dentistry is most often perceived as the treatment of the hard tissues of the oral region, specifically the teeth and jaws. However, there are many disorders and conditions involving surgical treatment of the soft tissues that extend to the adjacent and associated structures of the oral and maxillofacial surgery region.

Adolescent↗
PubMed1999

Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success.

BACKGROUND: Functional restoration following resection or traumatic injury to the mandible depends on the reliability of the bony reconstruction to heal primarily and support endosseous implants. Although vascularized bone flaps (VBF) and nonvascularized bone grafts (NVBG) are both widely used to reconstruct the mandible, indications for each remain ill-defined. The purpose of this study was to compare bone graft/flap healing and success of implant placement in patients reconstructed with VBF versus NVBG. METHODS: Over the past 10 years, 75 consecutive mandibular reconstructions were performed (26 free bone grafts, 49 vascularized bone flaps). Etiology of the defect, history of irradiation, bone defect size, number of operations, graft/flap success, and dental implant success rates were determined and compared. Bone graft/flap success was defined as complete bony union. Implant success was defined as complete osseointegration. Mean follow-up was 3 years. RESULTS: Free flaps were used primarily for malignant disease (78%, 38/49). Bone grafts were used primarily for benign disease (88%, 23/26). History of prior irradiation: 11% (3/26) NVBG versus 45% (22/49) VBF. Length of bony defect (mean): 8.1 cm NVBG versus 9.4 cm VBF. Successful bony union, any size defect: 69% (18/26) NVBG versus 96% (47/49) VBF (p < .0005); lateral defects only: 75% (15/20) NVBG versus 100% (17/17) VBF (p < .05). Number of operations to achieve bony union (mean), any size defect: 2.3 NVBG versus 1.1 VBF (p < .001); lateral defects only: 1.9 NVBG versus 1.0 VBF (p < .005). Twenty-two patients (29%) had a total of 104 endosseous implants placed (NVBG: 8 patients, 33 implants; VBF: 14 patients, 71 implants). Immediate implants placed: 0/33 NVBG versus 54% (38/71) VBF. Overall implant success: 82% (27/33) NVBG versus 99% (70/71) VBF (p < .0001). Implant success in VBF patients with a history of RT: 100% (15/15). CONCLUSIONS: Despite the fact that patients reconstructed with VBFs were older, had larger defects, and were treated primarily for malignant disease and therefore had a higher incidence of irradiation to the affected mandible than in patients treated with NVBGs, the incidence of bony union was higher, requiring fewer operations to achieve union, and the implant success rate was significantly greater than for NVBG patients. Results were similar when considering lateral defects only. Based on these results, VBFs are indicated in most cases of mandibular reconstruction; NVBGs are effective for short bone defects (<5-6 cm), in nonirradiated tissue, and/or in patients determined to be too medically compromised to tolerate the additional operative time required for a free-flap reconstruction.

Adolescent↗
PubMed1999

Management of mandibular ameloblastoma: the clinical basis for a treatment algorithm.

PURPOSE: This article discusses the management of intraosseous mandibular ameloblastomas as the basis for a treatment algorithm. PATIENTS AND METHODS: The records of 26 consecutive patients referred for management of mandibular ameloblastoma were reviewed. Demographic data, location, number and types of prior surgical treatment, radiographic findings, number of recurrences, and reconstructive methods used were analyzed. RESULTS: All patients treated with curettage alone developed recurrence (n = 11). No patients treated with either curettage or resection plus liquid nitrogen cryotherapy developed a recurrence (n = 9). Patients whose radiographs showed large tumors with eggshell-thin bony margins, and who underwent segmental resection with excision of the involved soft tissue also had no recurrences (n = 8). In addition, 2 patients were referred with soft tissue recurrence necessitating resection. Both of these patients underwent multiple resective procedures, including neck dissections and skull base resections. All patients were reconstructed with either primary or secondary bone grafting. Only 3 patients went on to have complete dental reconstruction that included osseointegrated implants. CONCLUSIONS: Curettage of ameloblastoma results in unacceptable recurrence rates. Lesions contained within the mandible are adequately treated by curettage or marginal resection combined with cryotherapy. Segmental resection of the mandible with involved soft tissue, including periosteum, produces acceptable results when extraosseous spread has occurred. The first operation affords the best chance for cure. When tumor recurs in soft tissue, extensive surgery is necessary to salvage the patient. Few patients in this series went on to full reconstruction that included osseointegrated implants.

Adolescent↗
PubMed1999

Anatomy of the structures medial to the temporomandibular joint.

OBJECTIVE: To define the relationship of the branches of the trigeminal nerve and the infratemporal vessels to the zygomatic arch and medial capsular ligament of the temporomandibular joint (TMJ). MATERIAL AND METHOD: In a study of 20 cadaveric dissections of the infratemporal fossa, measurements were obtained in anterior-posterior and transverse directions to identify the relationship of the trigeminal nerve, carotid artery, internal jugular vein, and middle meningeal artery to the zygomatic arch. The distance from the lateral to the medial aspect of the glenoid fossa was measured to further delineate the proximity of these structures to the medial portion of the capsule of the TMJ. RESULTS: The mean transverse distance from the zygomatic arch to the middle meningeal artery was 31 mm (range, 21 mm to 43 mm). The mean anterior-posterior distance from the height of the glenoid fossa to the middle meningeal artery was 2.4 mm (-2 mm to 8 mm). The transverse distance from the carotid artery to the zygomatic arch was a mean of 37.5 mm (29 mm to 48 mm) with the mean anterior-posterior distance of -6.5 mm (-21 mm to 6 mm). The mean distance from the internal jugular vein to the zygomatic arch was 38.3 mm (31 mm to 49 mm). The mean anterior-posterior distance was -8.7 mm (-20 mm to 7 mm). The transverse distance from the trigeminal nerve to the arch was a mean distance of 35 mm (24 mm to 46 mm). The mean anterior-posterior distance was 9.2 mm (1 mm to 25 mm). The mean medial to lateral width of the glenoid fossa was 18.7 mm (16 mm to 23 mm). CONCLUSION: The arteries, nerves, and veins are close to the medial aspect of the TMJ. A knowledge of these relationships can guide the surgeon on the medial aspect of the TMJ and can help to prevent complications associated with these structures.

Carotid Artery, Internal↗
PubMed1999

The relationship between chronic facial pain and a history of trauma and surgery.

OBJECTIVE: Because pain is the most commonly reported symptom of patients presenting to temporomandibular disorders clinics, it is important to identify factors that modify the perception or reality of such pain. The purpose of this study was to investigate the hypothesis that a patient with a history of trauma and/or non-temporomandibular joint surgery might be sensitized to pain and might report increased pain levels if a temporomandibular disorder later developed. STUDY DESIGN: This was a retrospective study of 778 consecutive patients seen over a 1-year period in an Orofacial Pain Clinic. Study parameters included gender, lifetime number of self-reported traumas, lifetime number of non-temporomandibular joint operations, and location, intensity, frequency, and type of temporomandibular disorder-related pain. RESULTS: There were significantly more women than men in the study (609 to 169). There was no relationship between numbers of previous traumas and non-temporomandibular joint operations and types of temporomandibular disorder. However, there were statistically significant relationships between the severity of facial pain and the frequency of facial pain as well as between the severity and frequency of joint pain and the number of traumas. There were also statistically significant associations between the severity and frequency of facial pain and the number of non-temporomandibular joint-related surgical procedures that the patient had undergone. CONCLUSIONS: There is a relationship between a patient's reported history of trauma and/or non-temporomandibular joint-related operations and the severity and frequency of facial and temporomandibular joint pain, should it develop. It is possible that such traumas and operations sensitize the patient in such a way that the pain of subsequent temporomandibular joint disorders is heightened.

Adolescent↗
PubMed1999

The etiology of altered sensation in the inferior alveolar, lingual, and mental nerves as a result of dental treatment.

In a review of 163 consecutive patients referred with trigeminal nerve (inferior alveolar or lingual nerve) involvement following dental treatment, the most common etiology was third-molar removal (87 patients). The second most common cause was an inferior alveolar nerve block injection (34 patients), with a smaller number of endodontic and periodontal complications. Female patients outnumbered male 3.3 to 1. Twenty-seven patients were offered surgical exploration and possible nerve repair surgery; of them, 14 underwent surgery. Forty percent of the patients admitted to being involved in litigation during the time they were undergoing treatment.

Adult↗
PubMed1998

Gore-Tex tubing as a conduit for repair of lingual and inferior alveolar nerve continuity defects: a preliminary report.

PURPOSE: This report describes the results of using a Gore-Tex (Gore Company, Flagstaff, AZ) tube as a conduit for repair of continuity defects in the inferior alveolar or lingual nerves. PATIENTS AND METHODS: Seven nerve repairs were performed in five patients (M:F = 1:4) with an age range of 16 to 56 years. The duration from injury to repair ranged from 4 to 30 months. Two inferior alveolar and five lingual nerves were repaired. RESULTS: All seven patients had anesthesia by objective testing preoperatively and had a continuity defect at the time of operation. The size of the defects ranged from 2 to 15 mm. Two of the seven patients had some return of sensation, occurring in defects of 3 mm or smaller. CONCLUSION: The results of this pilot study indicate that Gore-Tex tubing may not be effective in the repair of continuity defects except in those defects 3 mm or smaller, in which it may act as a protective barrier membrane rather than as a conduit.

Adolescent↗