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PubMed1981

Arteriovenous malformation of the mandible.

Large intraosseous arteriovenous malformations (AVM) of the mandible are rare lesions. A review of the American literature has revealed sixty cases involving the mandible. This article presents a case of left mandibular AVM in which the initial treatment was embolization. Eventually, however, an emergency hemimandibulectomy became necessary. Postoperative physiotherapy is considered an important part of the treatment in patients who have undergone hemimandibulectomy. An unusual feature in this case has been the amount of spontaneous regeneration of bone in the surgical site.

Adolescent↗
PubMed1982

Results following simultaneous mobilization of the maxilla and mandible for the correction of dentofacial deformities: analysis of 100 consecutive patients.

One hundred consecutive cases were reviewed from two centers for correction of dentofacial deformities following simultaneous mobilization of the maxilla and mandible. The mean length of surgery was 5.15 hours, twenty patients received blood transfusions, and the mean length of hospitalization was 3.6 days. No patients experienced significant airway embarrassment requiring emergency procedures. An increased incidence of relapse, compared to single-jaw procedures, appears to be associated with these procedures. This study suggests that the simultaneous mobilization of both jaws should not be done without due consideration to specific indications and treatment planning. In select cases, with careful treatment planning, meticulous execution of surgical techniques, optimal supportive anesthesia, and postoperative care, the simultaneous mobilization of both the maxilla and the mandible can be achieved with few adverse sequelae and complications.

Adolescent↗
PubMed1982

Surgical-orthodontic treatment planning for simultaneous mobilization of the maxilla and mandible in the correction of dentofacial deformities.

Simultaneous mobilization of the maxilla and mandible is indicated for the optimal correction of specific dentofacial deformities, as discussed in the preceding publication. Because of the added complexity of this type of surgical-orthodontic treatment, it is important to determine the absolute need for surgery and to construct a detailed blueprint of the specific changes to take place at the time of surgical intervention as well as those to be made by the orthodontist prior to initiation of any treatment. The intent of this article is to describe a technique of treatment planning which includes cephalometric prediction tracings, model surgery, determination of orthodontic-surgical sequencing, splint construction, and specific sequencing of surgery. When followed, these guidelines will enable the surgeon and the orthodontist to accurately determine the need for simultaneous mobilization of both the maxilla and the mandible and provide more predictable and stable results when it is performed.

Cephalometry↗
PubMed1986

Visor osteotomy augmentation of the mandible with posterior onlay bone graft or with hydroxylapatite: a comparative study.

A frequent and severe ridge atrophy, the anterior spheroid basal bone with posterior bilateral concavities of the mandible, has been defined. Two groups of sixteen patients who had residual ridge augmentation of the mandible with two different techniques were studied. The visor osteotomy with posterior hydroxylapatite was superior to the visor with posterior onlay bone graft in terms of ridge form, bone resorption, patient satisfaction, and neurosensory disturbances. Nevertheless, there remained some problems of anterior resorption and backward rotation of the visor segment for both techniques and of posterior resorption with the partial onlay bone graft.

Adult↗
PubMed1986

Control of the condylar-proximal mandibular segments after sagittal split osteotomies to advance the mandible.

Maintenance of the normal or presurgical anatomic position of the mandibular condyles and contiguous proximal mandibular ramus segments after sagittal split ramus osteotomies is important, not only to enhance the stability of results but also to avoid iatrogenic temporomandibular joint complications. Accordingly, during the past few years, we have attempted to improve the surgical control of condyle and proximal segment position while using the sagittal split ramus osteotomy to advance the mandible. After several modifications, the device reported herein was used and the results evaluated in ten consecutive patients who underwent bilateral sagittal split ramus osteotomies with symmetric advancement of the mandible. This device enables the surgeon to obtain very precise reproduction of the "normal" proximal segment and condyle position at the time of surgery. The use of the device and documentation of its efficiency are presented.

Equipment Design↗
PubMed1990

The accuracy of osteosynthesis repositioning of the mandible--a stereophotogrammetric study.

The accuracy of repositioning of wire and plate osteosyntheses is measured by means of close-up stereophotogrammetry on cadaver mandibles. An increase of the intercondylar distance, which increases by an average of about 3.3 mm after plate osteosynthesis and by about 1.9 mm after a wire suture, is characteristic for both methods of osteosynthesis. In addition, there is a tendency to displacement of the articular condyle to caudal in osteosyntheses at the base of the mandible.

Bone Plates↗
PubMed1991

Optimal placement of bicortical screws in sagittal split-ramus osteotomy of mandible.

When a bicortical screw is used for the rigid fixation of sagittal split-ramus osteotomy, by definition the threads of the screw should engage in the buccal plates as well as in the lingual plates. In a study of six dry mandibles we found that when 2 and 2.7 mm screws are used in noncountersunk holes, it is almost certain that a thread will engage the buccal cortical plate. With countersinking 55% of the 2.7 mm and 27% of the 2.0 mm screws had no threads engaged in the buccal cortical plate. This changes these screws from bicortical to compression type. An anatomic study of bone thickness demonstrated that the thickest buccal and lingual cortical plates were in the superior border of the ramus, just distal to the last molar. In addition, a change in the intercondylar distance before and after surgery was observed in every mandible.

Bone Screws↗
PubMed1994

Frequency domain analysis of cross-sectional images of the posterior mandible.

The Siemens Orthophos (Siemens, München, Germany) is a panoramic machine that uses a microchip to control the movements of the radiation source and film. Several programs are available for different views of the facial skeleton and associated structures. Program 16 is dedicated to cross-sectional imaging of the posterior mandible. Three millimeter cross-sections were cut from 12 cadaver specimens of the mandible. These sections were imaged separately by contact radiography, 48 degrees hypocycloidal tomography of Philips Polytome (Philips-Massiot, Paris, France), and program 16 of the Orthophos panoramic machine. Program 16 of the Orthophos was also used to image the cross-sections after they were glued back together with the surrounding parts of the specimens. Four different images of the cross-sections were thus obtained. The contact radiographs were used as gold standards. Frequency domain analysis, which was used to compare the images resulting from each imaging modality, demonstrated that useful diagnostic information was in the range of 0.12 to 0.60 cycles/mm for the contact radiographs. In spite of differing tomographic angles for the Orthophos program 16 and the hypocycloidal tomography, the images of the 3 mm cross-sections showed similar frequency distribution. However, the Orthophos Program 16 did not produce diagnostically useful images when the cross-sections were imaged with the surrounding parts of the specimens probably because of the narrow tomographic angle used for this program. These images had strong low to medium frequency components compared with the gold standard images. These results suggest that diagnostically more useful images with the Orthophos might be obtained by increasing the tomographic angle.

Aged↗
PubMed1993

Fate of bioresorbable poly(lactic acid) microbeads implanted in artificial bone defects for cortical bone augmentation in dog mandible.

The fate was examined of poly(lactic acid) microbeads implanted in large artificial defects created in cortical bone of dog mandibles. Two poly(lactic acid) polymers--poly(L-lactic acid) (PLA 100) and poly(DL-lactic acid) (PLA 50)--were used to make microbeads by solvent evaporation with poly(vinyl alcohol) as surfactant. Histological observation of non-decalcified mandibular bone showed that no real bone regeneration existed in the experimental bone defects 18 months after PLA 100 microbeads implantation. The same observation was made 6 months after implantation of PLA 50 microbeads. PLA 100 and PLA 50 microbeads appeared unable to induce regeneration of cortical bone defects of dog mandible, in contrast to previous observations in man for PLA 50 large implants. The failure is tentatively assigned to the presence of poly(vinyl alcohol) at the surface of microbeads.

Animals↗
PubMed1994

Reconstruction of resected mandibles using a hydroxyapatite veterinary bone graft.

A newly developed bone equivalent hydroxyapatite was derived from veterinary bone (VHAP). Sections of 1 cm of six rabbit mandibles were equally replaced by this VHAP graft. Radiological studies by X-ray were performed pre-operatively, immediately, and 1, 2 and 3 months post-operatively. The graft host-bone interface was examined periodically by scanning electron microscopy (SEM). Accompanying structural changes of the graft 3 months post-operatively were compared with the pre-operative findings by infra-red (IR) spectroscopic analysis. Complete union of the biomaterial to the host bone after 3 months was evidenced radiologically. SEM proved complete graft integration. This was accompanied by a decrease in optical density of the IR analysis of post-operative VHAP, indicating some leaching of the ions. Clinically, the graft was completely incorporated in the mandible without any complications. We discuss the use of VHAP in humans to reconstruct post-surgical mandibular defects.

Animals↗
PubMed1987

Concentration of metronidazole in rat serum and mandible.

The levels of metronidazole in rat serum and mandibular bones was measured 2, 5 and 8 h after oral administration of three doses of 200 mg/kg. Effective levels of the drug in serum and mandible were found at all time intervals as well as a higher concentration in mandible than in serum.

Administration, Oral↗
PubMed1988

A radiolucency of the ascending ramus of the mandible associated with invested parotid salivary gland material and analogous with a Stafne bone cavity.

A 60-year-old man presented with a well demarcated radiolucency in the posterior border of the left ascending ramus of the mandible, lying below the neck of the condyle. This area appeared to have the characteristic features of a bone cavity as previously described by Stafne. Although such cavities are now frequently recognized and generally accepted to represent entrapment of the submandibular, or more rarely sublingual, salivary gland tissues; Stafne (1942) only described their location as being, 'situated below the mandibular canal in the region as far forward from the angle as the third molar'. Developmental bone cavities have not been reported previously in the region of the ascending ramus of mandible, nor in relation to the parotid salivary gland. In the case described the radiolucency in the ramus appeared to be developmental in origin and was later shown by sialography, to be closely related to salivary gland tissues of the parotid gland.

Bone Cysts↗
PubMed1991

Pre-tapped and self-tapping screws in children's mandibles. A scanning electron microscopic examination of the implant beds.

One hundred 2 mm AO miniscrews were inserted into the mandibles of eight fresh cadavers aged 8 to 12 years. Scanning electron microscopic examination of the implant beds showed cracks and accumulated bone material, as well as signs of crushing and shearing stress, regardless of whether the screws were pre-tapped or not. When, during screw insertion, the axis of the screw deviated by at least 10 degrees from the axis of the tap, two intersecting threads resulted. It is concluded that during osteosynthesis in child mandibles pre-tapping is not recommended.

Bone Screws↗
PubMed1982

Biologic basis for interpositional autogenous bone grafts to the mandible.

Interpositional autogenous bone grafting procedures were performed in the mandibles of 12 beagle dogs to assess cell survival within the graft and the superiorly repositioned alveolus, and to monitor the remodeling process. Histologic and radiologic results indicated that the grafts were well accepted and that new bone was rapidly laid down on their trabeculae. However, the osteocytes within the autografts generally did not survive. There was no evidence of necrosis of the superiorly displaced alveolus, nor any resorption of its surface cortex, and it rapidly united with the autograft and the mandible to produce a stable structure. This study confirms that the lingual pedicle of soft tissue is adequate to maintain the viability of the superiorly repositioned alveolus or segment and to allow rapid remodeling of the autogenous bone graft.

Animals↗
PubMed1987

Stability of the mandible after advancement and use of dental plus skeletal maxillomandibular fixation: an experimental investigation in Macaca mulatta.

This study examined short-term stability of the mandible following advancement surgery and the use of skeletal suspension wires plus dental maxillomandibular fixation. Twenty-four adult female Macaca mulatta underwent bilateral sagittal ramus osteotomy and advancement of approximately 6 mm. All animals had dental maxillomandibular fixation secured by bonding the upper and lower teeth together with an orthodontic composite resin. In half of the animals, the use of circummandibular wires connected to pyriform aperture wires were additionally applied. Tantalum bone markers were placed and cephalograms analyzed during the first six postoperative weeks to evaluate skeletal stability. A statistically significant mean horizontal relapse at the mandibular symphysis occurred in the group without the skeletal wires, whereas no relapse occurred in the group with the skeletal wires. A significant difference in the vertical displacement of the anterior mandible occurred, with an inferior movement of the symphysis in the group without skeletal wires, and a superior movement of the symphysis in the group with skeletal wires. The results of this study indicate that the use of skeletal suspension wires is advantageous in the prevention of horizontal and vertical skeletal relapse.

Animals↗
PubMed1989

The diagnosis and treatment of the dislocated mandible.

Dislocation of the mandible occurs commonly. Most patients present to the emergency department for treatment. This article discusses the normal temporomandibular joint (TMJ) anatomy and the etiology, types, and diagnosis of mandibular dislocation. It also describes the initial management, including techniques for reduction of the acute anteriorly dislocated mandible.

Anesthesia, Local↗
PubMed1990

Role of the lateral pterygoid muscle and meniscotemporomandibular frenum in spontaneous growth of the mandible and in growth stimulated by the postural hyperpropulsor.

Our experimental studies in young rats represent an attempt to elucidate the respective roles of the lateral pterygoid muscle (LPM), the temporomandibular frenum (TMF), and the postural hyperpropulsor (Hp) in the control of the growth rate, the growth direction, and the growth amount of the condylar cartilage. Even after surgical resection of the LPM, the growth of the condylar cartilage and the lengthening of the mandible continue but are significantly decreased. Also, the stimulating effect of postural hyperpropulsion on the condylar cartilage and mandibular growth is much less intense after resection of the LPM. The TMF, which has a blood-circulating and a biomechanical component, appears to be a mediator of the LPM in the control of the condylar cartilage growth. After the surgical resection of the TMF, the growth the condylar cartilage and the lengthening of the mandible continue but are significantly diminished.

Activator Appliances↗