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Biomedical subjects

M A Pogrel

Publications and source records attributed to M A Pogrel.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1998

Cephalometric norms in Japanese adults.

PURPOSE: Knowledge of the normal dentofacial patterns of adults belonging to various ethnic and age groups is important for clinical and research purposes. Lateral cephalometric standards of normal Japanese adults were developed using the Burstone and Legan comprehensive cephalometric analyses that are specific for orthognathic surgery. PATIENTS AND METHODS: Cephalometric radiographs of 217 Japanese adults were analyzed, and the mean values of their hard and soft tissue measurements were compared with those of white American adults. RESULTS: Statistically significant differences were found in the Japanese sample, who had a shorter maxilla, larger upper anterior face height, and lower posterior dental height than Burstone's white sample. A less prominent chin was observed in the Japanese male group. Soft tissue analysis of the Japanese subjects showed a retrognathic maxilla and mandible in relation to the soft tissue glabella and bilabial protrusion when compared with the white adult standards. CONCLUSION: Lateral cephalometric norms are specific for the racial group, but these values should not be interpreted as treatment goals. Normative data represents an aid for the diagnosis and treatment planning of orthognathic surgery according to the needs and expectations of each individual patient.

Adult↗
PubMed1998

The distribution of the auriculotemporal nerve around the temporomandibular joint.

OBJECTIVE: The purpose of this cadaver dissection was to study the position of the auriculotemporal nerve in relation to the mandibular condyle, capsular tissues, articular fossa, and lateral pterygoid muscle and to evaluate the anatomic possibility of nerve impingement or irritation by the surrounding structures. STUDY DESIGN: Eight cadaveric heads (16 sides) were dissected. The auriculotemporal nerve was identified by following its course around the middle meningeal artery. The course of the nerve trunk was dissected from the middle meningeal artery to the terminal branches within the temporomandibular disk. The horizontal distance between the auriculotemporal nerve and the medial portion of the condyle/condylar neck was measured. The vertical distance from the most superior portion of the articular condyle to the superior border of the auriculotemporal nerve was measured. RESULTS: The auriculotemporal nerve was identified on each side, and a single trunk was evident along the medial aspect of the condylar neck. At the posterior border of the lateral pterygoid muscle, the nerve trunk was in direct contact with the condylar neck in every specimen. The average vertical distance between the superior condyle and the nerve was 7.06 mm (+/- 3.21 mm); the range was 0 to 13 mm. The vertical distance between the nerve and the superior condyle on one side of the specimen did not correlate with the distance on the contralateral side. CONCLUSION: The auriculotemporal nerve trunk has a close anatomic relationship with the condyle and the temporomandibular joint capsular region, and there is evidence of a possible mechanism for sensory disturbances in the temporomandibular joint region. In all cases, the nerve was in direct contact with the medial aspect of the capsule or condylar neck. Because there is no correlation between the positions of the nerves on the right and left sides, only one side may be affected. The nerve was also observed to course in direct apposition to the lateral pterygoid muscle. The findings support the hypothesis that the anatomic and clinical relationship of the auriculotemporal nerve to the condyle, articular fossa, and lateral pterygoid muscle may be causally related to compression or irritation of the nerve, producing numbness or pain, or both, in the temporomandibular joint region.

Adult↗
PubMed1998

The surgical anatomy of the nasolabial fold.

OBJECTIVE: The purpose of this cadaver dissection study was to investigate the anatomy of the nasolabial fold with a view to explaining the problems of surgical softening or elimination of the fold. STUDY DESIGN: Ten formalin-fixed cadavers and 6 fresh-frozen cadavers were used for this study. In 12 cadavers (8 formalin-fixed, 4 fresh-frozen), the nasolabial fold was sectioned at right angles to the fold for histologic examination, and in 4 cadavers (2 formalin-fixed, 2 fresh-frozen) the epithelium was dissected off the fold to allow for more detailed gross examination of the underlying musculature. RESULTS: The fold was clearly identified on 14 of the cadavers but was indistinct on 2 on gross examination. Beneath the fold were 2 muscle bundles. The more superficial muscle runs parallel to the fold whereas a deeper muscle runs at right angles to it. The buccal fat pad lies above the fold and appears to be retained by horizontal septae in the fat pad and also by the musculature of the fold. Cadavers showing a poorly defined nasolabial fold had fewer muscle bundles to support the fat and fewer fibrous septae running through the fat. CONCLUSIONS: The nasolabial fold is defined by structures that support the buccal fat pad and hold it above the fold. This appears to be a combination of muscle bundles that run both across and parallel to the fold and also by fibrous septae supporting the fat pad. This has implications for the development of surgical procedures to soften or eliminate the fold, which must separate the muscles from the dermis of the fold and allow the fat to descend and soften the fold.

Adipose Tissue↗
PubMed1998

The effects of 2% lidocaine with 1:100,000 epinephrine on pulpal and gingival blood flow.

OBJECTIVE: The dental pulp is a low-compliance system that is particularly vulnerable to physiologic changes. Prolonged vasoconstriction may have detrimental effects. This goal of this study was to determine whether 2% lidocaine with 1:100,000 epinephrine, as used for buccal infiltration, decreases the blood flow in the dental pulp and adjacent gingival tissue. STUDY DESIGN: The Periflux PF3 laser Doppler monitored pulpal and gingival blood flow before and after injection with local anesthetic. Ten human volunteers with at least one healthy and unrestored maxillary premolar were used in this study. RESULTS: After injection of 0.9 ml of 2% lidocaine with epinephrine, there was a significant reduction from baseline values (p > 0.05) in both pulpal (73%) and gingival (51%) blood flow rate in all volunteers. Blood flow had not returned to baseline values after 1 hour. CONCLUSION: This study showed that 2% lidocaine with 1:100,000 epinephrine significantly reduced blood flow pulpally and gingivally. Pulpal blood flow reduction was more than gingival blood flow reduction, which may be critical for compromised pulps with already reduced blood flow. The gingival effects may be of relevance with soft tissue procedures.

Adult↗
PubMed1998

Effects of chemotherapy on osseointegration of implants: a case report.

A patient underwent mandibular resection for high-grade osteosarcoma with immediate reconstruction with a microvascular fibula free bone graft and simultaneous placement of osseointegrated implants. Following initial healing, she underwent six cycles of chemotherapy and had further revision surgery prior to implant exposure and construction of a prosthesis. The chemotherapy appears to have had no deleterious effects on implant osseointegration or survival.

Adult↗