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The natural history of malignant melanoma of the oral cavity is discussed with reference to the findings of previous writers, and six additional cases are reported. These demonstrate the considerable variations in detail of the course of the disease while confiriming the difficulty of treatment and the inexorable nature of the condition.
Six hundred cases of cleidocranial dysostosis have been reported since the disorder was first described in 1898. This is the first case reported with cystic involvement.
The clinical use of ultrasonic inserts in the surgical removal of alveolar bone has been evaluated. Surgical applications included the removal of 19 teeth and the osseous management of periodontal disease in 50 cases. Histologic material was provided by resected bone fragments attached by periodontal tissues in anatomic relation to removed teeth. Microscopic observations of sections revealed that planed surfaces of bone were smooth, while incised edges were irregular. Evidence for residual debris was absent. No alterations in adjacent lacunar osteocytes, vascular channels, and underlying periodontal tissues were noted in clinical use, the ultrasonic inserts were found to remove bone with ease and preciseness. Hemorrhage from surgical sites was minimal or absent. Healing of tissues was uneventful with no postoperative complications encountered. Patients reported minimal discomfort during and following the surgical application of this instrumentation.
A simplified two-stage procedure for extension of the atrophic mandibular ridge with the use of a modified application of previously known techniques can provide excellent improvement in the stability of a denture base. This technique can be performed on an outpatient basis, without the use of free grafts or stents, and shows minimal to no relapse. Complications, surgical time, discomfort, and cost to the patient are all decreased. Satisfactory results have been obtained with this procedure over a 10 year period, with greatly improved patient acceptance.
A modified technique of anterior maxillary osteotomy is described, based mainly on the Wassmund (buccal aspect) and the Wunderer (palatal aspect) methods. Experience of 148 cases operated on during 15 years is presented.
A survey was carried out to record both initial and longterm effects on the lingual and inferior alveolar nerves following third molar removal. Eight hundred and twenty five patients were included from eight West of Scotland Oral Surgery Units, and had 1339 third molars removed. Changes in sensation were recorded by direct questioning at 6 to 24 h and 7 to 10 days, and by postal questionnaire at 12-18 months. The incidence of lingual nerve damage was found to be 15% of operated sides at 6 to 24 hours, 10.7% at 7 to 10 days, and 0.6% after 1 year. The incidence of inferior alveolar nerve damage was 5.5% of operated sides at 6 to 24 h, 3.9% at 7 to 10 days, and 0.9% after 1 year. These results are proposed as an indication of the likely incidence of nerve damage complicating third molar removal in the general circumstances of current United Kingdom practice and are presented as a basis for discussion of patient information and current prudent practice. Since one in four patients suffered at least temporary sensory deficit, we believe the case for effective warning of all patients undergoing impacted third molar removal is overwhelming.
A postal audit of the main surgical variables in third molar exodontia under general anaesthesia was undertaken on consultants holding a National Health contract within the British Isles. This first paper presents the results. A response rate of 175 returned questionnaires from the 247 consultants was obtained (70.9%). Analysis revealed that the majority of consultants use antibiotics, mouthwashes, sutures, analgesics and postoperative review and the minority steroids and peroperative local anaesthetic, routinely in the majority of cases. Approximately half routinely use a chisel as opposed to a bur for bone removal. The consultants who gave all their patients steroids were significantly (p less than 0.01) more likely to possess a medical qualification than the consultants who did not.
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The crestal ostectomy with lateral antral wall compression is a simple, predictable procedure to correct soft tissue and osseous hypertrophy in the pneumatized maxillary tuberosity. It offers certain advantages over other techniques: 1) simultaneous reduction of vertical and lateral aspects of the hyperplastic tuberosity; 2) simultaneous revision of hypertrophic or mobile mucosal tissue overlying the tuberosity; 3) avoidance of a horizontal scar band in the buccal vestibule, which may subsequently interfere with the denture flange; 4) negligible effect on the depth of the buccal vestibule; 5) fixation wires are not required; 6) rapid healing of the osteotomy site, since there is intimate bony contact; 7) expedient initiation of denture fabrication is possible because the palatal aspect of the tuberosity is not mobilized; and 8) no surgical stent is necessary.
Dysesthesia following odontectomy of impacted mandibular third molars is observed in some patients. This prospective study reports the clinical incidence of this untoward sequela to occur in 3.3% of patients. An analysis of possible etiologic factors reveals that development of dysesthesia of the inferior alveolar and lingual nerves is more likely to occur with: complete bony impacted mandibular third molars; mesioangular impacted third molars; impacted third molars with the crown at the cemento-enamel junction of the second molar; and when burs are used to remove bone and when the roots approximate the inferior alveolar canal.
The results obtained with a modified surgical technique for transposition of the inferior alveolar nerve followed by immediate placement of endosseous implants in mandibles with moderate to severe atrophy are presented. Ten transpositions of the inferior alveolar nerve together with the installation of 21 implants were performed in six patients. The mean postoperative follow-up time was 23 months, with a range of 12 to 46 months. All implants with functioning pontics remained stable, with no mobility nor signs or symptoms of pain and infection during the follow-up period. Postoperative radiographic evaluation disclosed no pathologic bone loss around the implants. Neurosensory evaluation was performed using the two-point discrimination test. One patient with unilateral transposition had objective neurosensory dysfunction at 12 months postoperative, although all the nerve function were reported as normal by the patients. Strict patient selection criteria are necessary, with full awareness by the patient of the possibility of long-term or even permanent nerve paresthesia, when this procedure is contemplated.
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PURPOSE: The study goal was to investigate the adequacy of marginal resection of the mandibular bone in cases of squamous cell carcinomas of the lower alveolus and gingiva where the radiologically detected bone defect does not extend beyond the mandibular canal. PATIENTS AND METHODS: Sixty-two patients who have had a mandibulectomy performed with or without preoperative radiotherapy and chemotherapy were the study subjects. This retrospective study investigated the correlation between the preoperative radiographic appearance and histopathologic findings of the excised tissue. The results of the treatments were evaluated. RESULTS: In the cases with erosive bone defects, the extent of the bone involvement did not exceed the extent of the radiographically detected bone defects. However, in 7 (36.8%) of the cases with moth-eaten type bone defects, the extent of bone involvement exceeded the bone defects detected by radiography. Further, 10 of the 16 cases with no apparent bone defect showed apparent bone involvement by the tumors histologically. There were no differences in the 5-year cumulative survival rate between the marginal resection and segmental groups. CONCLUSIONS: Marginal resection was effective in controlling mandibular alveolus and gingival cancers when radiologically detected erosive bone defects did not extend beyond the mandibular canal. Marginal resection was inadequate when moth-eaten defects were radiologically detected, except when the bone defects were confined to the alveolar bone.
PURPOSE: Lingual nerve damage following lower third molar surgery remains a clinical problem. The traditional approach in the United States has been a buccal approach avoiding exposure or surgery on the lingual side of the crest of the ridge. An alternative technique is to deliberately expose the lingual tissues and retract the lingual nerve lingually before tooth removal. This study reports a trial of this technique. MATERIALS AND METHODS: Patients had removal of their lower third molars carried out using a technique that raises a lingual flap in addition to a buccal flap and places a specially designed lingual retractor to ensure that the lingual nerve is held out of the surgical field. This technique was used in cases where the crown of the tooth had to be sectioned or when distal bone needed to be removed. RESULTS: Two hundred fifty patients were treated by this method. There were 4 cases of transient lingual paresthesia, presumably caused by traction pressure from the retractor. Three of these cases were mild and resolved within 3 weeks. The fourth case had more profound paresthesia, but still resolved within 2 months. There were no cases of permanent nerve damage, and in many cases removal of the third molar was simplified by the superior access. CONCLUSION: Lingual retraction for third molar removal improves access to the surgical site and can simplify third molar removal. In this prospective study there were no cases of permanent lingual nerve injury.
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The periodontal, orthodontic, and prosthetic management of four indications for subgingival or subosseous tooth fractures has been discussed. The importance of having the aveolar crest a minimal distance of 2.5 mm from the margin of the restoration has been explained. The pitfalls of an external, rather than internal, bevel and flap procedure were assessed. Coordinated interspecialty therapy provides diverse, conservative treatment for the general practitioner and successful restorations for the patient.
The technology of dynamic biologic transformation of the periodontium differs from orthodontic therapy in that the primary goal of dynamic biologic transformation of the periodontium is to reshape an abnormal periodontium. The goal of orthodontic treatment usually is the straightening of teeth in the orofacial complex. The new term dynamic biologic transformation of the periodontium has been coined to differentiate between a change in the periodontium that is secondary to straightening teeth through usual orthodontic methods to one that the primary goal is the rearrangement of the periodontium in which the tooth is merely used as a handle to pull the periodontium into the desired shape and location. The tooth or teeth that are moved in this process are often reshaped or put into abnormal positions to accomplish this goal. A review of the literature revealed that these changes in the periodontium can be used in various manners that will lessen surgical morbidity and maximize esthetics in conjunction with restorative and periodontal care. Combinations of dynamic biologic transformation of the periodontium and surgery were shown through clinical reports to illustrate this principle.