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PubMed1997

[The histologic study on chronological changes of bone trabeclae in human postnatal mandible].

The histologic study on chronological changes of human mandible was performed using 35 postnatal cases. The changes of bone density were divided into following 2 stages. In cases of a 11 hours new born to 2 months (No. 13) baby, the bone density consisted of rather moderate parts that low. In cases of 2 months (No. 14) baby to 66 years adult, it consisted of rather low parts than moderate parts. The changes of bone maturation were divided into next 2 stages. In cases of a 11 hours new born to 3 months baby, the mandible consisted of woven-lamellar or lamellar bone. In cases of after 7 months baby to 66 years adult, it only consisted of lamellar bone. And then, the mandibular bone were exhibited manifold arrangements. The reticular arrangements were appeared locally in cases of a 11 hours new born to 2 months baby but after 3 months, these were disappeared. The oblique and horizontal arrangements were appeared mainly in cases of a 11 hours new born to 7 months baby, and after 1 years old, not only these arrangements but also islet-like and vertical arrangements were appeared partially. After 40 years old, islet like arrangements were appeared remarkably. The bone resorption was noted at the whole mandible in a case of 3 months, and it extended larger in a case of 7 months. And after 1.1 years old, it was noted as same as 7 months.

Adolescent↗
PubMed1996

A radiographic analysis of the mandibular canal of the edentulous mandible in different racial and gender groups.

Studies on the mandibular canal in the edentulous mandible have rarely been correlated with mandibular canal position, mandibular body width, mandibular canal width, thickness of bony plates, gender and race. The aim of this investigation was to examine the above parameters by studying the bucco-lingual relationship of the mandibular canal in dry edentulous mandibles of Black and White, males and females (n = 13 in each group), of similar age (mean 58, 17 yrs). The mandibles were radiographed cross-sectionally. The position of the mandibular canal in relation to the buccal and lingual cortical plates, and the widths of the mandibular canal and mandibular body, measured at selected distances, were recorded and the values statistically analysed. Race and gender do not seem to influence the position of the mandibular canal in the bucco-lingual plane. The location of the canal is predominantly closer to the lingual cortex in the bucco-lingual plane. It was found that the widths of the left and right halves of the mandibular body are not statistically significantly different but widths of the left and right mandibular canal are significantly different.

Adult↗
PubMed1998

Dislocation of the mandible during the course of cataract surgery.

Spontaneous dislocation of the mandible is a well-described clinical entity with which the ophthalmologist may not be familiar. However, the widespread use of intravenous sedation places susceptible individuals at risk for the development of dislocation of the mandible. The authors describe a patient who underwent routine cataract surgery and suffered a dislocation of the mandible that initially went unrecognized. Ophthalmic surgeons who use intravenous sedation need to be aware of this complication and need to recognize the symptoms so that patients may receive timely attention.

Aged↗
PubMed1998

Distraction osteogenesis of the mandible with a modified intraoral appliance: a pilot study in miniature pigs.

The purpose of this study was to evaluate an intraoral, nontooth-borne, submucosal distraction appliance in the pig mandible from a clinical, radiographic, and histologic perspective. Intraoral distraction appliances were fabricated, tested for strength, and then adapted and rigidly fixated to the mandibles of three growing miniature Yucatan pigs. A bicortical osteotomy was performed on the right side of the mandible, and a buccal and lingual corticotomy on the left. Two amalgam markers were placed on each side of the osteotomy/corticotomy sites as references. Measurements were taken to evaluate the length and vector of the distraction site, and radiographs were obtained perioperatively. After a latency period of 5 days, distraction was commenced and continued for 13 days at a rate of 1 mm/day. Clinical evidence of distraction was apparent in all cases, with resulting Class III skeletal deformities. Distraction progressed further for the corticotomy sides than the osteotomy sides because of distraction device failure. Radiographic examination revealed increased bone density at the periphery of the distracted callus, with less density apparent centrally. Histologic examination showed fibrous connective tissue in the center of the callus, with cartilage and osteoid formation at the periphery. Bone formation was parallel to the vectors of distraction in all cases. This study confirms that the use of a modified intraoral appliance for distraction osteogenesis is feasible. Use of this device overcomes many of the problems associated with extraoral devices and may have clinical applications.

Animals↗
PubMed1982

Treatment of the patient with extensive osteoradionecrosis of the mandible.

The management of osteoradionecrosis of the mandible remains controversial. Involvement of large areas of the mandible or the entire mandible with osteoradionecrosis may result in severe functional disability and cosmetic deformity. Pain, trismus, difficulty with speech and eating, and a malodorous wound are all problems that must be corrected. Local forms of therapy may be inadequate in the treatment of extensive osteoradionecrosis, and more aggressive surgical management is required. The extent of surgical intervention depends on the individual case. However, preservation of function and avoidance of disfigurement are important goals in the treatment plan. From both a functional and cosmetic standpoint, surgical management can be effective in achieving satisfactory rehabilitation goals.

Adult↗
PubMed1995

Traditional methods vs rigid internal fixation of mandible fractures.

OBJECTIVE: To compare traditional methods (ie, intermaxillary fixation with interosseous wiring or external fixation) with newer techniques (ie, plating, use of lag screws) of open reduction and fixation of mandible fractures. DESIGN: Retrospective analysis of data from medical records. SETTING: Academic urban medical center. PATIENTS: Nonrandomized sample of 356 patients admitted to the hospital for treatment of mandible fractures from 1987 through 1991; 155 patients treated with open reduction and fixation were studied. INTERVENTIONS: Sixty-nine patients were treated with interosseous wire fixation or external fixation, 86 patients with rigid internal fixation. MAIN OUTCOME MEASURES: Presence of infection, nerve impairment, nonunion, malunion, operative time, and follow-up. RESULTS: No significant difference was noted between the two groups for sex, treating service, delay in presentation, antibiotic coverage, mechanism of injury, or type of fracture. The incidence of infection, nerve injury, and unavailability for follow-up were greater in patients treated by the newer techniques. Overall expense and operative time were greater in the group treated with plates and lag screws. CONCLUSIONS: We advocate traditional techniques for patients with mandible fractures requiring open reduction and fixation.

Bone Plates↗
PubMed2000

Brief communication: bilateral aplasia of the condyles in a 1,400-year-old mandible from Israel.

A rare pathological mandible, manifesting bilateral absence of the condyles, is discussed. The pathology was identified as hemifacial microsomia. The mandible, dated to the Byzantine period in Israel, manifests bilateral aplasia of the condyles and extreme shortness, but normal width, of the body. The extremely well-developed coronoid process, the grooved masseter insertion area, and the manifestation of a medial pterygoid tubercle (MPT) suggest hypertrophy of the occlusal muscles. The presence of a large MPT is considered a Neanderthal autapomorphy. Studying the biomechanic forces acting on the deformed mandible in hemifacial microsomia patients may shed light on the mastication process in Neanderthals.

Adult↗
PubMed2005

Osteoblastoma of the mandible: clinicopathologic study of four cases and literature review.

BACKGROUND: Osteoblastoma is a benign bone tumor accounting for 1% of all bone tumors; it commonly involves the spine and the sacrum of young individuals, with less than 5% being localized to the posterior mandible. In view of its rarity in the maxilla and mandible, osteoblastoma is rarely diagnosed as such in the absence of interdisciplinary cooperation. METHODS: A retrospective study of four benign osteoblastomas was performed based on a review of the clinical, radiographic, and histopathologic features of all cases. RESULTS: The tumors involved the posterior mandible of young patients (age range, 10-21 years; two male and two female patients) and appeared as painful bone expansions. Radiologically, they were poorly defined, radiolucent/radiopaque lesions containing calcifications and not showing sclerotic borders or periosteal reactions. Histologically, they were composed of osteoid and woven bone surrounded by plump osteoblast-like cells with interposed fibroblasts, inflammatory cells, and red blood cells. All patients were disease free after prolonged follow-up. CONCLUSIONS: Osteoblastomas may be distinguished from other bone tumors, fibro-osseous lesions, and odontogenic neoplasms on the basis of integrated clinical, radiologic, and histologic features and usually manifest an indolent clinical course.

Adolescent↗
PubMedDate not supplied

The restoration of resected mandibles in children without the use of bone grafts.

Following resection of the mandible for various types of neoplastic disease, six patients between the ages of 5 and 14 were followed for a period of 8 to 12 years after osseous surgical reconstructive surgery. It was found in children of this age group that a surgical technique may be employed which will effect complete bone regeneration without the use of bone graft materials. All six of the patients spontaneously regenerated large segments of the mandible from full-body ostectomy to hemimandibulectomy defects. The surgical procedure involves the use of a titanium mesh implant between the ostectomized bone fragments to maintain the surrounding soft tissues in a distracted position. It is found that if the soft tissues of the growing child are surgically prepared using the described technique, a new periosteum and bone will be formed along the titanium mesh implant. The titanium mesh may be removed at a later date or, depending on its method of placement, may be allowed to remain as the child grows, regenerating additional bone structure. It was found that in only one case was additional grafting necessary to obtain osseous union between the spontaneously regenerated mandibular bone and the host-bone ostectomized fragments. The technique is advocated for bone restoration in cases of large osseous discontinuity defects of the mandible in children.

Adolescent↗
PubMed1980

Surgical lengthening of the mandible: a laboratory model.

Mandibular lengthening in mongrel dogs was evaluated in four animals. Extraoral approaches were used for mandibular exposure. Step osteotomies were performed on the buccal aspect and oblique osteotomies were performed on the lingual aspect of the mandible. The anterior fragment of the mandible was advanced 10 mm. A Dacron-urethane mesh tray, in the form of the mandible, was placed across the defect as a container of bone graft material and to help stabilize the segments. The bone graft material was harvested by aspirating the bone particles formed when the osteotomy cuts were made, thus creating a bone slurry which was placed within the implant. The results suggest that the use of the implant tray in conjunction with the bony slurry provided an appropriate physiologic setting for rapid new bone formation, restoring continuity to the defect.

Alveolar Ridge Augmentation↗
PubMed1992

Primary tuberculous osteomyelitis of the mandible. A case report.

A case of tuberculous osteomyelitis of the mandible in a 76-year-old woman is reported. The patient sought treatment for a periostitis of the left side of the mandible. A purulent discharge was evident. Roentgenographic examination of the mandible revealed bone destruction from the midmandible to the ramus on the left side. The diagnosis was made by microscopic examination of the specimen from the involved bone. This case proved to be primary tuberculous osteomyelitis caused by the absence of the primary focus.

Aged↗
PubMed2006

Osteopetrosis complicated by osteomyelitis of the mandible: a case report including characterization of the osteopetrotic bone.

A case of a 53-year-old Japanese man with osteopetrosis complicated by osteomyelitis of the mandible is presented. The patient experienced frequent exacerbations and remissions of osteomyelitis of the mandible, despite undergoing several surgical debridements and sequesterectomies with appropriate antimicrobial therapy, for 3 years. Finally, the patient underwent mandibular segmental resection followed by reconstruction with a titanium reconstruction plate. Fifty-one months after surgery there is no evidence of recurrent osteomyelitis of the mandible, suggesting that a more radical surgical approach is preferable for patients with severe complications resulting from osteopetrosis. Also presented here are the histopathological and biochemical features of the osteopetrotic bone. The osteopetrotic cortical bone was morbidly sclerotic with compact and irregular laminations. Degradation of osteocytes in the osteopetrotic bone was due to hypoxia and lack of nutrition resulting from osteosclerosis. There were no significant differences between osteopetrotic and normal bone according to X-ray diffraction, Fourier transform infrared spectroscopy, collagen content or mineral content. Micro-Vickers hardness measurements showed that osteopetrotic bone was significantly harder than normal bone, and the standard deviation of hardness was greater in osteopetrotic bone. Such a loss of integrity in osteopetrotic bone is considered to be a primary reason for the greater risk of a variety of complications such as pathological fracture and refractory osteomyelitis.

Bone Plates↗
PubMed2003

Central acinic cell carcinoma of the mandible. Case report.

Central acinic cell carcinoma (of the mandible) is rare, and, to our knowledge, only seven cases of this disease have been reported in the literature. A case in a 67-year-old Japanese woman is presented. Clinical examination revealed a 10.0x6.0mm mass located on the buccal aspect of the gingiva of the second molar in the left mandible. Radiographic examination revealed a radiolucency from the second to the third molar of the left mandible. Computed tomography disclosed destruction of the lingual cortical bone of the third molar region. The preliminary diagnosis was of odontogenic tumour. The patient was admitted, and removal of the tumour and of the involved teeth were carried out. Histological examination disclosed the diagnosis of acinic cell carcinoma. Subsequently, the tumour area was widely excised from the second premolar region to the coronoid process, and radical neck dissection was performed. A lymph node metastasis was found in the submandibular region. No recurrence or metastasis was observed during the 34-month follow-up.

Aged↗
PubMed2005

Peripheral osteoma of the mandible: case report and review of the literature.

BACKGROUND: Osteoma is a benign often asymptomatic neoplasm, consisting of well-differentiated mature bone. This paper reports a case of peripheral osteoma located in the anterior mandibular region and provides a review of the literature about this lesion in the jaws. PATIENT AND METHODS: A 43-year-old white woman presented with a swelling in the left mandible of 7 years duration. The English literature was reviewed over the past 76 years and data about location, histopathology and number of the peripheral osteomas, sex, and age of the patients were evaluated. RESULTS: Data analysis showed 69 well-documented cases of peripheral osteoma. Peripheral osteomas are more frequent in the mandible than the maxilla and the cancellous type was most frequent; males and females are equally affected in the mandible; the age range was 9-85 years. CONCLUSION: The peripheral type of osteoma is most common in the lower jaws, occurs at the surface of the cortical bone and is sessile or pedicled.

Adult↗
PubMed2004

A prospective randomized clinical trial comparing 2.0-mm locking plates to 2.0-mm standard plates in treatment of mandible fractures.

PURPOSE: The purpose of this study was to compare standard 2.0-mm monocortical plates to 2.0-mm locking plates in the treatment of mandible fractures. PATIENTS AND METHODS: A prospective randomized clinical trial was conducted at Harborview Medical Center in Seattle, WA, from January 1, 2002, to February 1, 2003, to compare 2.0-mm locking plates to 2.0-mm standard plates in treating consecutive mandible fractures. Patients were randomly assigned to receive locking 2.0-mm plates (group A) or nonlocking 2.0-mm plates (group B). Complications were divided into major and minor categories. Each complication was analyzed according to which plate was used and where the fracture occurred. The number of days from injury to operation, average age, gender, American Society of Anesthesiologists (ASA) classification,compliance, and social habits were all reviewed. RESULTS: Ninety patients with 122 fractures met the inclusion criteria. Sixty-four fracture sites were treated with locking plates and 58 with standard plates. A total of 6 complications occurred: 2 occurred at the angle, 3 at the parasymphysis, and 1 at the body. Three complications occurred in the locking group and 3 in the standard group with complication rates equaling 4.6% and 5.2%, respectively. When comparing the overall complication rates according to plates used, the Fisher exact test showed no statistically significant difference between the locking and standard plates (P = .90). The 95% confidence interval for the odds ratio is from 0.1 to 7. CONCLUSION: Mandible fractures treated with 2.0-mm locking plates and standard 2.0-mm plates present similar short-term complication rates.

Adolescent↗
PubMed2003

A three-dimensional numerical simulation of mandible fracture reduction with screwed miniplates.

A three-dimensional finite element model of a fractured human mandible treated with plating technique was developed to simulate and to study the biomechanical loads and the stress field distribution. Biomechanical properties of bone have been thoroughly investigated experimentally. In this work, using the finite element method, complete clinical conditions (after surgical reduction, post-operatory period, complete healing period) were simulated. The mandible fracture was located in the symphysis region and one or two titanium miniplates, fixed with monocortical screws, were evaluated. The behaviour of a reduced human mandible with screwed miniplates, as well as its complete healing, is investigated and described.

Bone Plates↗
PubMed2000

Nutritional status of substance abusers with mandible fractures.

PURPOSE: The purposes of this study were 1) to assess the validity of patient self-report in identifying illegal substance abuse and 2) to identify nutritional deficiencies in substance abusers presenting for treatment of mandible fractures. PATIENTS AND METHODS: To address the research purposes, a prospective cohort study was conducted of patients presenting for treatment of mandible fractures. A urine drug screen was used to determine the validity of patient self-report of substance abuse. For purposes of assessing nutritional status, 2 categories of substance abusers were identified: illegal and legal (alcohol). The nutritional status was measured using various laboratory markers. RESULTS: The sample was composed of 93 subjects. Urine drug studies were available for 32 patients. Of the 22 patients who denied illegal drug use, 12 (55%) had a positive drug screen. Of the 10 patients reporting a positive history of illicit drug use, 7 (70%) had a positive urine drug screen (P = .47). A positive correlation was found between alcohol exposure and serum aspartate aminotransferase, mean corpuscular volume, and lactate dehydrogenase. Positive drug screens also were associated with increased serum ferritin levels. CONCLUSIONS: The results of this study suggest that patient self-report of illicit drug use may be unreliable. The findings also suggest that legal and illegal substance abusers presenting for treatment of mandible fractures have minimal nutritional deficiencies.

Adult↗
PubMed2003

Determinants of surgical decisions about mandible fractures.

PURPOSE: The study goal was to explore contextual patient- and surgeon-related characteristics that influence the perception of injury severity and treatment strategy for mandible fractures. METHODS: After reviewing plain radiographs of 22 patients with mandible fractures, 18 oral and maxillofacial surgeons were queried on summary severity ratings and treatment decisions for each injury. Subsequently, they were asked to indicate how various hypothetical fracture and patient-specific factors would alter their perception of injury severity and original treatment recommendations. The effect of the level of clinician trauma expertise on perception of injury severity and treatment choice was also assessed. RESULTS: Each of the fracture-specific characteristics-number of constituent fractures, fracture complexity, degree of displacement, and summary injury severity-influenced the choice of treatment modality. Surgeon-specific characteristics were related to both perception of injury severity and treatment choice. Although clinicians with greater trauma loads tended to provide higher summary severity ratings for the same range of injuries (P <.001), they appeared to recommend maxillomandibular fixation for a much broader spectrum of injury severity (R = -0.42). Surgeons' perception of injury severity appeared to escalate with increasing damage to the soft tissue envelope; the influence of patient-related risk factors was less distinct. More than half of the surgeons suggesting maxillomandibular fixation for a particular case changed their treatment recommendation to rigid internal fixation on learning that the patient was noncompliant. CONCLUSIONS: Clinical decision making for mandible fractures is not a precise and fully reliable activity. Contextual factors (fracture, patient, and surgeon related) appear to influence the clinical decision and may be responsible for the existing variations in practice patterns.

Analysis of Variance↗