[Facial neuralgia due to hypertrophic periostitis of the alveolar process].
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A brief review is presented of the Danish medieval skeletons with leprosy changes, particularly in the skulls, where the pathologic specific changes found are termed facies leprosa. The clinical aspect of facies leprosa is termed Bergen Syndrome I (nasal leprosy) and Bergen Syndrome II (the leprogenic changes of the alveolar process of the maxilla superior with loosening and/or loss of the frontal incisors). An account is given of the interim result of a clinical examination of 333 inpatients at the Prapradaeng Leprosarium in Bangkok, Thailand. In the group of 258 patients with lepromatous leprosy, 62.4% presented Bergen Syndrome I and 16.3% Bergen Syndrome II. These proportions differ clearly from the corresponding ratio found in the Danish medieval skulls.
A case is described of 2 supernumerary teeth in a male patient aged 18 years with complete bilateral cleft of the lip, alveolar process and palate. These supernumerary teeth were situated symmetrically in the vicinity of the lateral incisors. They were well developed, atypical, one was partly retained, with indentations in the crown, the other was completely retained and showed enamel hypoplasia.
The ultrastructural study of the alveolar bone surface of adult rat molars has shown the presence of resting, developing and resorbing areas. Intermediary, tight and gap junctions were observed between the cell processes of osteoblasts and osteocytes. In developing zones, the progressive differentiation of bone lacunae was followed. In resting zones, fibroblast-like cells with large intercellular spaces were observed. The ultrastructure of the osteocytes and the organic periosteocytic space was variable. The osteoclastic resorption showed an initial mineral attack followed by a collagen breakdown. Some observations suggested a relationship between the osteocytes and the origin of the osteoclast.
Mandibular defects in six patients were immediately reconstructed with pure titanium reconstruction plates and autogenous iliac bone blocks. However, an alveolar process adequate for functional fitting of a denture did not form. More than 6 months after the reconstruction, correction of the ridge deficiency was attempted using autogenous particulate iliac cancellous bone and marrow combined with hydroxylapatite particles. By this secondary reconstruction, a functional well-fitting denture could be constructed for all six patients. After more than 2 years no evidence of resorption or infection has occurred.