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Your Office Emergency Plan: What to Have and How to Use It
Surgical Mini-Lectures
M641 Advanced Approaches to Odontogenic Cysts and Tumors
complications noted in the classic “TMJ Prostheses” thereby allowing immediate cosmetic and a functional results to also be realized in patients that undergoes a condylar extirpation.
Robert E. Marx, DDS, Miami, FL References
There is much too much confusion and “controversy” concerning odontogenic keratocysts (OKC) than there ought to be. Although this cyst can and does recur, it is not a tumor and does not invade into soft tissue. Its recurrences are mostly related to surgical imperfection which results from ripping or shredding the cyst to leave part of the lining behind which then redevelops into a recurrent cyst. A smaller percentage of “recurrences” are actually new primary keratocysts from other activated odontogenic rests. Most keratocysts can be cured by a wide access enucleation which removes the cyst in a single unit. Usually this can be accomplished from a transoral approach, but sometimes requires a transcutaneous approach. In no case should Camoy’s solution, cryotherapy, phenol or bur reduction of the bony wall be necessary. However, a small percentage of odontogenic keratocysts do require a resection for cure. These are essentially those which are the large destructive multilocular ones that an enucleation would eventuate into a fracture or continuity defect or those that have “recurred” on multiple occasions. Many odontogenic tumors are actually hamartomas with limited growth ie: odontomas, ameloblastic fibrodontomas, ameloblastic fibromas, etc. However, ameloblastomas, odontogenic myxomas, the calcifying epithelial odontogenic tumor and the ameloblastic fibrosarcoma which will microscopically mimic the harmartomatous ameloblastic fibroma are true invasive neoplasms. These require resections with 1cm to 1.5cm margins for cure. Despite such resections required to cure odontogenic true neoplasms, most all can be accomplished without creating a deformity, malocclusion or significant neurosensory loss. In the mandible these tumors are removed en-bloc for a predictable cure with a new nerve pull-back reanastomosis technique which obviates the need for a nerve graft, returns 90 or more sensation and does not affect the cure. This is possible because of the inability of benign tumors to invade nerve sheaths as they instead merely displace the nerve. Combined with titanium reconstruction plates, this approach achieves a maximum in returning facial form, maintaining the residual occlusion, preparing for a definitive bone graft reconstruction and returning the highest percentage of useful neurosensory function. In addition, the troublesome resections that include the condyle need not result in a jaw deviation, malocclusion, prolonged jaw fixation, external pin fixation or a costochondral grafts. With a retained disc, titanium condylar replacements in the adult and allogeneic (tissue bank) condylar replacements in children and teenagers permits long term stable function without the 110
Marx RE, Stem D: Oral and Maxillofacial Pathology; A Rationale for Diagnosis and Treatment. Chicago, IL, Quintessence Publishing Co, 2002, pp 590-602 Marx RE, Smith BH, Smith BR, et al: Swelling of the retromolar region and cheek associated with limited opening; CPC. J Oral Maxillofac Surg 51:304, 1993 Marx RE, Stem D: Oral and Maxillofacial Pathology; A Rationale for Diagnosis and Treatment. Chicago, IL, Quintessence Publishing Co, 2002, 684-703
M642 Your Office Emergency Plan: What to Have and How to Use It Patrick J. Vezeau, DDS, MS, Sioux City, IA Daniel S. Sarasin, DDS, Cedar Rapids, IA No abstract provided.
M643 Tibia Bone Graft Technique: In the OR and in the Office George M. Kushner, DMD, MD, Louisville, KY Brian Alpert, DDS, Louisville, KY The oral and maxillofacial surgeon faces many reconstructive challenges in contemporary practice. Reconstruction of the bony maxillofacial skeleton is frequently required for trauma, pathology, implant site preparation, and a host of other clinical scenarios. The ‘gold standard’ in bony reconstruction is autogenous grafting. Several sites, including the calvarium, iliac crest, tibia, and the mandible itself, are currently popular in clinicians’ hands. Each site has its own advantage and disadvantages or limitations must be evaluated for each patient. We feel the tibia bone graft site is very versatile and technically easy to perform and has a low complication rate. The amount of bone that can be harvested is usually more than adequate. Additionally, this procedure can easily be adapted to use in the office. We will present the technical aspects of this surgical procedure and show its use in a variety of surgical cases. Lastly, we will discuss the University of Louisville experience and our complications with the tibia bone graft. References Catone GA, Reimer BL, McNeir D, et al: Tibial autogenous cancellous bone as an alternative donor site in maxillofacial surgery: A preliminary report. J Oral Maxillofac Surg 50:1258, 1992
AAOMS • 2005
M641 Advanced Approaches to Odontogenic Cysts and Tumors
complications noted in the classic “TMJ Prostheses” thereby allowing immediate cosmetic and a functional results to also be realized in patients that undergoes a condylar extirpation.
Robert E. Marx, DDS, Miami, FL References
There is much too much confusion and “controversy” concerning odontogenic keratocysts (OKC) than there ought to be. Although this cyst can and does recur, it is not a tumor and does not invade into soft tissue. Its recurrences are mostly related to surgical imperfection which results from ripping or shredding the cyst to leave part of the lining behind which then redevelops into a recurrent cyst. A smaller percentage of “recurrences” are actually new primary keratocysts from other activated odontogenic rests. Most keratocysts can be cured by a wide access enucleation which removes the cyst in a single unit. Usually this can be accomplished from a transoral approach, but sometimes requires a transcutaneous approach. In no case should Camoy’s solution, cryotherapy, phenol or bur reduction of the bony wall be necessary. However, a small percentage of odontogenic keratocysts do require a resection for cure. These are essentially those which are the large destructive multilocular ones that an enucleation would eventuate into a fracture or continuity defect or those that have “recurred” on multiple occasions. Many odontogenic tumors are actually hamartomas with limited growth ie: odontomas, ameloblastic fibrodontomas, ameloblastic fibromas, etc. However, ameloblastomas, odontogenic myxomas, the calcifying epithelial odontogenic tumor and the ameloblastic fibrosarcoma which will microscopically mimic the harmartomatous ameloblastic fibroma are true invasive neoplasms. These require resections with 1cm to 1.5cm margins for cure. Despite such resections required to cure odontogenic true neoplasms, most all can be accomplished without creating a deformity, malocclusion or significant neurosensory loss. In the mandible these tumors are removed en-bloc for a predictable cure with a new nerve pull-back reanastomosis technique which obviates the need for a nerve graft, returns 90 or more sensation and does not affect the cure. This is possible because of the inability of benign tumors to invade nerve sheaths as they instead merely displace the nerve. Combined with titanium reconstruction plates, this approach achieves a maximum in returning facial form, maintaining the residual occlusion, preparing for a definitive bone graft reconstruction and returning the highest percentage of useful neurosensory function. In addition, the troublesome resections that include the condyle need not result in a jaw deviation, malocclusion, prolonged jaw fixation, external pin fixation or a costochondral grafts. With a retained disc, titanium condylar replacements in the adult and allogeneic (tissue bank) condylar replacements in children and teenagers permits long term stable function without the 110
Marx RE, Stem D: Oral and Maxillofacial Pathology; A Rationale for Diagnosis and Treatment. Chicago, IL, Quintessence Publishing Co, 2002, pp 590-602 Marx RE, Smith BH, Smith BR, et al: Swelling of the retromolar region and cheek associated with limited opening; CPC. J Oral Maxillofac Surg 51:304, 1993 Marx RE, Stem D: Oral and Maxillofacial Pathology; A Rationale for Diagnosis and Treatment. Chicago, IL, Quintessence Publishing Co, 2002, 684-703
M642 Your Office Emergency Plan: What to Have and How to Use It Patrick J. Vezeau, DDS, MS, Sioux City, IA Daniel S. Sarasin, DDS, Cedar Rapids, IA No abstract provided.
M643 Tibia Bone Graft Technique: In the OR and in the Office George M. Kushner, DMD, MD, Louisville, KY Brian Alpert, DDS, Louisville, KY The oral and maxillofacial surgeon faces many reconstructive challenges in contemporary practice. Reconstruction of the bony maxillofacial skeleton is frequently required for trauma, pathology, implant site preparation, and a host of other clinical scenarios. The ‘gold standard’ in bony reconstruction is autogenous grafting. Several sites, including the calvarium, iliac crest, tibia, and the mandible itself, are currently popular in clinicians’ hands. Each site has its own advantage and disadvantages or limitations must be evaluated for each patient. We feel the tibia bone graft site is very versatile and technically easy to perform and has a low complication rate. The amount of bone that can be harvested is usually more than adequate. Additionally, this procedure can easily be adapted to use in the office. We will present the technical aspects of this surgical procedure and show its use in a variety of surgical cases. Lastly, we will discuss the University of Louisville experience and our complications with the tibia bone graft. References Catone GA, Reimer BL, McNeir D, et al: Tibial autogenous cancellous bone as an alternative donor site in maxillofacial surgery: A preliminary report. J Oral Maxillofac Surg 50:1258, 1992
AAOMS • 2005