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Management of the Pediatric Maxillofacial Patient
Oral Maxillofacial Surg Clin N Am 17 (2005) xi – xii
Preface
Management of the Pediatric Maxillofacial Patient
Mark A. Egbert, DDS
Bonnie L. Padwa, DMD, MD, FACS Guest Editors
In the preface to the February 1994 issue of the Oral and Maxillofacial Surgery Clinics of North America entitled bOral and Maxillofacial Surgery in Children and Adolescents,Q Dr. Leonard Kaban wrote: Oral and maxillofacial surgery (OMFS) is an anatomically defined specialty. Hence, clinicians treat at least a few patients of all ages, without emphasis on any particular group. In many OMFS training programs, the number of pediatric patients encountered is low. Therefore, graduating residents often view general oral and maxillofacial surgical management of children as an area of weakness in their training.
This description of the state of pediatric training in OMFS, with few exceptions, remains the same today. Training programs in OMFS have an obligation to provide a reasonable training and a basic exposure to a breadth of pediatric oral and maxillofacial surgery to their residents. Accreditation standards ensuring a pediatric component for training programs are lenient, but remain a challenge for many programs for a variety of reasons. As a specialty, organized oral and maxillofacial surgery continues to recognize the importance of childhood health, and the maintenance of at least a minimal standard for our trainees. Perhaps the best evidence of this commitment is the
inclusion of a pediatric section within each and every component of our specialties’ published Parameters of Care document. To date, there is one well-recognized comprehensive text on pediatric oral and maxillofacial surgery. This issue is not intended to compete with that text. Rather, a variety of articles devoted to topics of perpetual interest, and areas of evolving contemporary thought or controversy are presented to educate, and hopefully, to stimulate continued advancement and renewed awareness of pediatric oral health issues. The subject of managing impacted teeth in children leads off this collection and should be of interest to all practicing oral and maxillofacial surgeons (Tiwana and Kushner). Dentoalveolar reconstruction follows with an update on the use of dental implants in the growing patient (Brahim). Pathology is the next focus for review, with updates on soft tissue lesions in children (Oda), followed by a review of cysts of the jaws in children and the current treatment of basal cell nevoid syndrome (Heggie and Shand). These are followed by an article on advances in the diagnosis and management of fibro-osseous lesions in children by Drs. Kaban, Troulis, and Papadaki. The application of adjuvant chemotherapy augmenting and enhancing surgical outcomes is a very exciting development in the man-
1042-3699/05/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.coms.2005.10.001
oralmaxsurgery.theclinics.com
xii
preface
agement of these often locally aggressive and deforming, yet bbenignQ entities. A heightened awareness regarding the prevalence and potential signs of child abuse and neglect is provided by an article devoted to the role of the oral and maxillofacial surgeon in confronting and managing this problem. Although disturbing to read, we hope the impact of this article by Drs. Sugar and Feldman will stimulate reflection and increase the collective awareness of this most important and damaging scourge. Problems afflicting the cranio-mandibular articulation in the growing patient are the focus of the next three articles. These problems can be acquired (eg, trauma, infection, pathology, systemic disease), congenital (eg, congenital absence, syngnathia), or they can be iatrogenic (eg, poor fracture management, failed costochondral grafts). These problems always challenge the clinician to understand the relationship between morphologic form and function regarding both mobility and growth. Dr. Dodson begins with an excellent article discussing and presenting condylar fracture management in the growing patient. This is followed by Drs. Costello and Edwards’ article discussing mandibular hypomobility and ankylosis including some of the controversies currently argued. The focus on the cranio-mandibular articulation continues with an article contributed by Drs. Myall, Ueeck, and Mahmud discussing the management of juvenile rheumatoid arthritis and its effects on the growing patient. Certainly, no more current topic of interest exists than that of distraction osteogenesis, and this is
also true for its applications in the growing patient. Distraction osteogenesis is discussed in separate articles for the mandible (Ruiz, Turvey, and Costello) and for midfacial applications (Sa´ndor). To balance the enthusiasm for the new, with a review of the tried and true, finally, an excellent article devoted to the orthognathic correction of secondary deformities in the cleft and craniofacial patients is provided by Dr. Chigurupati. All of these articles provide a resource of information to educate and to stimulate further thought and reflection on the often unique issues encountered in the management of pediatric and growing patients. We wish to thank all of these authors for their considerable efforts in producing this issue. We also wish to thank John Vassallo for his help, guidance, and unending patience in bringing this issue to press. Mark A. Egbert, DDS Children’s Hospital and Regional Medical Center 4800 Sand Point Way, NE Box 5371/4E-2 Seattle, WA 98105-0371, USA E-mail address: [email protected] Bonnie L. Padwa, DMD, MD, FACS Division of Plastic and Oral Surgery Children’s Hospital 300 Longwood Avenue Boston, MA 02115, USA E-mail address: [email protected]
Preface
Management of the Pediatric Maxillofacial Patient
Mark A. Egbert, DDS
Bonnie L. Padwa, DMD, MD, FACS Guest Editors
In the preface to the February 1994 issue of the Oral and Maxillofacial Surgery Clinics of North America entitled bOral and Maxillofacial Surgery in Children and Adolescents,Q Dr. Leonard Kaban wrote: Oral and maxillofacial surgery (OMFS) is an anatomically defined specialty. Hence, clinicians treat at least a few patients of all ages, without emphasis on any particular group. In many OMFS training programs, the number of pediatric patients encountered is low. Therefore, graduating residents often view general oral and maxillofacial surgical management of children as an area of weakness in their training.
This description of the state of pediatric training in OMFS, with few exceptions, remains the same today. Training programs in OMFS have an obligation to provide a reasonable training and a basic exposure to a breadth of pediatric oral and maxillofacial surgery to their residents. Accreditation standards ensuring a pediatric component for training programs are lenient, but remain a challenge for many programs for a variety of reasons. As a specialty, organized oral and maxillofacial surgery continues to recognize the importance of childhood health, and the maintenance of at least a minimal standard for our trainees. Perhaps the best evidence of this commitment is the
inclusion of a pediatric section within each and every component of our specialties’ published Parameters of Care document. To date, there is one well-recognized comprehensive text on pediatric oral and maxillofacial surgery. This issue is not intended to compete with that text. Rather, a variety of articles devoted to topics of perpetual interest, and areas of evolving contemporary thought or controversy are presented to educate, and hopefully, to stimulate continued advancement and renewed awareness of pediatric oral health issues. The subject of managing impacted teeth in children leads off this collection and should be of interest to all practicing oral and maxillofacial surgeons (Tiwana and Kushner). Dentoalveolar reconstruction follows with an update on the use of dental implants in the growing patient (Brahim). Pathology is the next focus for review, with updates on soft tissue lesions in children (Oda), followed by a review of cysts of the jaws in children and the current treatment of basal cell nevoid syndrome (Heggie and Shand). These are followed by an article on advances in the diagnosis and management of fibro-osseous lesions in children by Drs. Kaban, Troulis, and Papadaki. The application of adjuvant chemotherapy augmenting and enhancing surgical outcomes is a very exciting development in the man-
1042-3699/05/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.coms.2005.10.001
oralmaxsurgery.theclinics.com
xii
preface
agement of these often locally aggressive and deforming, yet bbenignQ entities. A heightened awareness regarding the prevalence and potential signs of child abuse and neglect is provided by an article devoted to the role of the oral and maxillofacial surgeon in confronting and managing this problem. Although disturbing to read, we hope the impact of this article by Drs. Sugar and Feldman will stimulate reflection and increase the collective awareness of this most important and damaging scourge. Problems afflicting the cranio-mandibular articulation in the growing patient are the focus of the next three articles. These problems can be acquired (eg, trauma, infection, pathology, systemic disease), congenital (eg, congenital absence, syngnathia), or they can be iatrogenic (eg, poor fracture management, failed costochondral grafts). These problems always challenge the clinician to understand the relationship between morphologic form and function regarding both mobility and growth. Dr. Dodson begins with an excellent article discussing and presenting condylar fracture management in the growing patient. This is followed by Drs. Costello and Edwards’ article discussing mandibular hypomobility and ankylosis including some of the controversies currently argued. The focus on the cranio-mandibular articulation continues with an article contributed by Drs. Myall, Ueeck, and Mahmud discussing the management of juvenile rheumatoid arthritis and its effects on the growing patient. Certainly, no more current topic of interest exists than that of distraction osteogenesis, and this is
also true for its applications in the growing patient. Distraction osteogenesis is discussed in separate articles for the mandible (Ruiz, Turvey, and Costello) and for midfacial applications (Sa´ndor). To balance the enthusiasm for the new, with a review of the tried and true, finally, an excellent article devoted to the orthognathic correction of secondary deformities in the cleft and craniofacial patients is provided by Dr. Chigurupati. All of these articles provide a resource of information to educate and to stimulate further thought and reflection on the often unique issues encountered in the management of pediatric and growing patients. We wish to thank all of these authors for their considerable efforts in producing this issue. We also wish to thank John Vassallo for his help, guidance, and unending patience in bringing this issue to press. Mark A. Egbert, DDS Children’s Hospital and Regional Medical Center 4800 Sand Point Way, NE Box 5371/4E-2 Seattle, WA 98105-0371, USA E-mail address: [email protected] Bonnie L. Padwa, DMD, MD, FACS Division of Plastic and Oral Surgery Children’s Hospital 300 Longwood Avenue Boston, MA 02115, USA E-mail address: [email protected]