- Email: [email protected]
Orbital Apex Syndrome: A Case Series and Review of the Literature
Oral Abstract Track 2 Results: The CPAP study group was composed of 28 adult patients (mean age, 50.9 9.7 year; 75% men) with severe OSA (baseline AHI, 67.9 29.0). The average hours of CPAP use during the study was 4.0 2.8 with a range from 0 to 8.7 hours. A high correlation was found between the true effective AHI and the ET-AHI calculation (r = 0.82) with a mean difference in the AHI of 2 events/hr. The MMA comparator group was composed of 37 adult patients (mean age, 44.2 9.0 years; 73% men) with severe OSA (baseline AHI, 56.3 22.6). MMA produced a significant reduction in OSA (Post-MMA AHI, 11.6 7.4). ET-AHI calculations predicted that an average of nearly 5 hours of nightly CPAP use would be necessary to achieve equivalence with the AHI scores following MMA, which is greater than the observed 4 hours of use in the CPAP cohort in this study. Conclusions: The results of this study indicate that the calculated ET-AHI provides a very close approximation of the true effective AHI when patients use CPAP as they do at home. Furthermore this study shows that MMA compares very favorably with CPAP for treatment of severe OSA as relatively high levels of nightly CPAP use may be necessary to achieve equivalency with MMA. Support: This investigation was supported in part by a Research Support Grant Award from the Oral and Maxillofacial Surgery Foundation and in part by CTSA award No.UL1TR000445 from the National Center for Advancing Translational Sciences.
diets. Outcomes were assessed by malocclusion, infection, wound dehiscence, plate exposure, and nonunion. Results: The sample composed of 42 patients; 40 men and 2 women, and 45 total angle fractures. The mean duration of follow-up was 102 days, with a median of 43 days. The most common complication was malocclusion, occurring in 4/45 (8.9%) of patients immediately postoperatively; all four cases were fully resolved with post-operative elastics by the first follow-up visit at one week. Infection occurred in 3/45 (6.7%) patients, developing at a mean of 23.6 days, and 2/45 (4.4%) of those required extra-oral incision and drainage. There was one instance (1/45, 2.2%) of hardware failure at day 23, with loose proximal screws requiring removal and closed reduction for treatment. There were no instances of long term paresthesia, tooth injury, wound dehiscence, or plate exposure. Conclusion: The trans-buccal superior-lateral border approach to plate fixation of mandibular angle fractures achieves comparable results to other methods of plate fixation, including transoral miniplate fixation described by Champy, while foregoing inter-maxillary fixation and allowing earlier return to function. References: 1. Ellis E and Walker LR. Treatment of mandibular angle fractures using one noncompression miniplate. Journal of Oral and Maxillofacial Surgery. 1996; 54(7): 864-871. 2. Feller K-U, Schneider M, Hlawitschka M, Pfeifer G, Lauer G, Eckelt U. Analysis of complications in fractures of the mandibular angle—a study with finite element computation and evaluation of data of 277 patients. Journal of Cranio-Maxillofacial Surgery. 2003; 31(5): 290-295.
Single, Non-Compression Superior-Lateral Border Plate in the Treatment of Mandibular Angle Fractures; a Retrospective Study
Orbital Apex Syndrome: A Case Series and Review of the Literature
F. K. Yip: LAC+USC Medical Center, N. Cho, D. D. R. Yamashita
R. E. Warburton: University of North Carolina at Chapel Hill, C. C. Dicus Brookes, T. A. Turvey
Purpose: To assess the utility and complication rate of superior-lateral plate open reduction internal fixation (ORIF) of angle fractures. Methods: A retrospective chart review of patients with isolated, bilateral, or combination mandibular angle fractures at the LAC+USC Medical Center over the course of one year from 2010-2011 was conducted with IRB approval. The sample was composed of patients with at least one angle fracture, with or without other mandible fractures, that were treated with 2.3 (Stryker) or 2.4 (Synthes) 4- or 5-hole, superior lateral border plate ORIF. Treatment involved an intra-oral approach to expose and reduce the fracture, with plate fixation established trans-facially with trochar. This allowed the use of bicortical screws at the proximal segment, and either bicortical or monocortical screws at the distal segment depending on presence of dentition. No patients were placed in inter-maxillary fixation following surgery. All patients were allowed free range of motion and soft mechanical
Orbital apex syndrome (OAS) is an uncommon disorder characterized by ophthalmoplegia, proptosis, ptosis, anesthesia of the forehead, and vision loss. It may be classified as part of a group of orbital apex disorders that includes superior orbital fissure syndrome (SOFS) and cavernous sinus syndrome (CSS). Complete SOFS presents similarly to OAS, without the accompanying optic nerve impairment. CSS may include anesthesia of the cheek in addition to the signs seen in OAS. CSS can occur bilaterally. Each of these disorders are differentiated chiefly by the anatomical location of the causative process. While historically described separately, these three disorders share similar causes, diagnostic evaluation, and management strategies1. Each requires prompt recognition to ensure timely intervention and to maximize patient outcomes. The purpose of this study is to report three cases of orbital apex disorders recently treated and to review the literature related to these conditions. The authors
AAOMS 2014
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Oral Abstract Track 3 describe a case of SOFS during a modified Le Fort III osteotomy, OAS secondary to a rapidly progressive maxillary sinus infection with orbital involvement, and CSS as a result of carotid-cavernous fistula formation after a motor vehicle collision. Inflammatory and vascular disorders, neoplasm, infection, and trauma are potential causes of orbital apex disorders2. Management is directed at the causative process. The cases described represent a rare but important group of disorders seen by the oral and maxillofacial sur-
geon. A review of the clinical presentation, etiology, and management of these conditions may prompt timely recognition and treatment.
References: 1. Lenzi GL, Fieschi C. Superior orbital fissure syndrome. Review of 130 cases. Eur Neurol. 1977;16(1-6):23-30. 2. Yeh S, Foroozan R. Orbital apex syndrome. Curr Opin Ophthalmol. 2004 Dec;15(6):490-8.
Oral Abstract Track 3 DENTOALVEOLAR, DENTAL IMPLANTS, RECONSTRUCTION September 12, 2014, 1:00 PM-3:00 PM
Comparison of heat generation between low and high speed drilling for dental implants: An experimental study B. H. Choi, J. S. Son, J. H. Oh: Wonju Severance Christian Hospital, Y. Fang Purpose: Overheating during implant site preparation leads to failure of the implant. The purpose of this study was to evaluate whether low-speed drilling is clinically acceptable during the drilling procedure in terms of heat generation. Materials and Methods: Artificial bone blocks that were similar to human D1 bone were used in this study. The baseline temperature was set to be 37.0 C. In group 1, drill was performed with the speed of 50 rpm without irrigation. In group 2, drill was performed with the speed of 1500 rpm with irrigation. In group 3, drill was performed with the speed of 1500 rpm without irrigation. The temperature changes were measured during Ø2 mm drilling by thermocouples. In each group, the drilling was done 60 times. Result: The mean temperatures during drilling were 40.91.7 C in group 1, 39.71.5 C in group 2, and 44.53.6 C in group 3. The maximum temperatures were 43.9 C in group 1, 43.3 C in group 2, and 54.0 C in group 3. There was a statistically significant difference on the mean temperature between the three groups. Conclusion: These findings suggest that low-speed drilling without irrigation may not significantly increase the bone temperature during drilling for dental implants. References: 1. Eriksson RA, Albrektsson T. Temperature threshold levels for heatinduced bone tissue injury: A vital-microscopic study in the rabbit. J Prosthet Dent 1983;50:101-107
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2. Sun-Jong KIM, Jaeyoung YOO, Young-soo KIM, Sang-Wan SHIN. Temperature change in pig rib bone during implant site preparation by low-speed drilling. J Appl Oral Sci 2010;18(5):522-527
Trehalose-Coated Implant for Prevention of Inflammation in Bone M. S. Kook: Chonnam National University, H. J. Park, H. K. Oh, S. Y. Ryu, S. Y. Park, J. Y. Jung, W. J. Kim Bone inflammation is one of major causes in dental implant failure. This study is aimed to investigate whether autophagy may ameliorate or prevent bone inflammation associated with dental implant failure. In the present study, autophagy was directly involved in odontogenic differentiation from human dental pulp stem cell but not in osteogenic differentiation from MC3T3 mesenchymal stem cell under differentiation inductive medium (DM) including 50 mM/L ascorbic acid and 5 mM/L b-glycerophosphate. Lipopolysaccharide(LPS), a bacterial endotoxin, inhibited osteogenic differentiation from MC3T3 stem cell co-cultured with RAW 264.7 cell, a macrophagy cell line but did not influence osteogenic differentiation from MC3T3 mesenchymal stem cell without RAW 264.7 cell under DM. LPS up-regulated and released inflammatory cytokines such as IL-1,6 and TNF in RAW 264.7 cell. Trehalose, an autophagy enhancing agent, rescued LPS induced impaired osteogenic differentiation from MC3T3 stem cell co-cultured with RAW 264.7 cell and ameliorated LPS -induced up-regulated and -released inflammatory cytokines such as IL-1 and 6 in RAW 264.7 cell. In the rabbit calvarium, implants coated with trehalose showed an increment of new bone formation and a decrement of inflammatory responses under P gingivalis and LPS treatment compared to the control. AAOMS 2014
diets. Outcomes were assessed by malocclusion, infection, wound dehiscence, plate exposure, and nonunion. Results: The sample composed of 42 patients; 40 men and 2 women, and 45 total angle fractures. The mean duration of follow-up was 102 days, with a median of 43 days. The most common complication was malocclusion, occurring in 4/45 (8.9%) of patients immediately postoperatively; all four cases were fully resolved with post-operative elastics by the first follow-up visit at one week. Infection occurred in 3/45 (6.7%) patients, developing at a mean of 23.6 days, and 2/45 (4.4%) of those required extra-oral incision and drainage. There was one instance (1/45, 2.2%) of hardware failure at day 23, with loose proximal screws requiring removal and closed reduction for treatment. There were no instances of long term paresthesia, tooth injury, wound dehiscence, or plate exposure. Conclusion: The trans-buccal superior-lateral border approach to plate fixation of mandibular angle fractures achieves comparable results to other methods of plate fixation, including transoral miniplate fixation described by Champy, while foregoing inter-maxillary fixation and allowing earlier return to function. References: 1. Ellis E and Walker LR. Treatment of mandibular angle fractures using one noncompression miniplate. Journal of Oral and Maxillofacial Surgery. 1996; 54(7): 864-871. 2. Feller K-U, Schneider M, Hlawitschka M, Pfeifer G, Lauer G, Eckelt U. Analysis of complications in fractures of the mandibular angle—a study with finite element computation and evaluation of data of 277 patients. Journal of Cranio-Maxillofacial Surgery. 2003; 31(5): 290-295.
Single, Non-Compression Superior-Lateral Border Plate in the Treatment of Mandibular Angle Fractures; a Retrospective Study
Orbital Apex Syndrome: A Case Series and Review of the Literature
F. K. Yip: LAC+USC Medical Center, N. Cho, D. D. R. Yamashita
R. E. Warburton: University of North Carolina at Chapel Hill, C. C. Dicus Brookes, T. A. Turvey
Purpose: To assess the utility and complication rate of superior-lateral plate open reduction internal fixation (ORIF) of angle fractures. Methods: A retrospective chart review of patients with isolated, bilateral, or combination mandibular angle fractures at the LAC+USC Medical Center over the course of one year from 2010-2011 was conducted with IRB approval. The sample was composed of patients with at least one angle fracture, with or without other mandible fractures, that were treated with 2.3 (Stryker) or 2.4 (Synthes) 4- or 5-hole, superior lateral border plate ORIF. Treatment involved an intra-oral approach to expose and reduce the fracture, with plate fixation established trans-facially with trochar. This allowed the use of bicortical screws at the proximal segment, and either bicortical or monocortical screws at the distal segment depending on presence of dentition. No patients were placed in inter-maxillary fixation following surgery. All patients were allowed free range of motion and soft mechanical
Orbital apex syndrome (OAS) is an uncommon disorder characterized by ophthalmoplegia, proptosis, ptosis, anesthesia of the forehead, and vision loss. It may be classified as part of a group of orbital apex disorders that includes superior orbital fissure syndrome (SOFS) and cavernous sinus syndrome (CSS). Complete SOFS presents similarly to OAS, without the accompanying optic nerve impairment. CSS may include anesthesia of the cheek in addition to the signs seen in OAS. CSS can occur bilaterally. Each of these disorders are differentiated chiefly by the anatomical location of the causative process. While historically described separately, these three disorders share similar causes, diagnostic evaluation, and management strategies1. Each requires prompt recognition to ensure timely intervention and to maximize patient outcomes. The purpose of this study is to report three cases of orbital apex disorders recently treated and to review the literature related to these conditions. The authors
AAOMS 2014
e-27
Oral Abstract Track 3 describe a case of SOFS during a modified Le Fort III osteotomy, OAS secondary to a rapidly progressive maxillary sinus infection with orbital involvement, and CSS as a result of carotid-cavernous fistula formation after a motor vehicle collision. Inflammatory and vascular disorders, neoplasm, infection, and trauma are potential causes of orbital apex disorders2. Management is directed at the causative process. The cases described represent a rare but important group of disorders seen by the oral and maxillofacial sur-
geon. A review of the clinical presentation, etiology, and management of these conditions may prompt timely recognition and treatment.
References: 1. Lenzi GL, Fieschi C. Superior orbital fissure syndrome. Review of 130 cases. Eur Neurol. 1977;16(1-6):23-30. 2. Yeh S, Foroozan R. Orbital apex syndrome. Curr Opin Ophthalmol. 2004 Dec;15(6):490-8.
Oral Abstract Track 3 DENTOALVEOLAR, DENTAL IMPLANTS, RECONSTRUCTION September 12, 2014, 1:00 PM-3:00 PM
Comparison of heat generation between low and high speed drilling for dental implants: An experimental study B. H. Choi, J. S. Son, J. H. Oh: Wonju Severance Christian Hospital, Y. Fang Purpose: Overheating during implant site preparation leads to failure of the implant. The purpose of this study was to evaluate whether low-speed drilling is clinically acceptable during the drilling procedure in terms of heat generation. Materials and Methods: Artificial bone blocks that were similar to human D1 bone were used in this study. The baseline temperature was set to be 37.0 C. In group 1, drill was performed with the speed of 50 rpm without irrigation. In group 2, drill was performed with the speed of 1500 rpm with irrigation. In group 3, drill was performed with the speed of 1500 rpm without irrigation. The temperature changes were measured during Ø2 mm drilling by thermocouples. In each group, the drilling was done 60 times. Result: The mean temperatures during drilling were 40.91.7 C in group 1, 39.71.5 C in group 2, and 44.53.6 C in group 3. The maximum temperatures were 43.9 C in group 1, 43.3 C in group 2, and 54.0 C in group 3. There was a statistically significant difference on the mean temperature between the three groups. Conclusion: These findings suggest that low-speed drilling without irrigation may not significantly increase the bone temperature during drilling for dental implants. References: 1. Eriksson RA, Albrektsson T. Temperature threshold levels for heatinduced bone tissue injury: A vital-microscopic study in the rabbit. J Prosthet Dent 1983;50:101-107
e-28
2. Sun-Jong KIM, Jaeyoung YOO, Young-soo KIM, Sang-Wan SHIN. Temperature change in pig rib bone during implant site preparation by low-speed drilling. J Appl Oral Sci 2010;18(5):522-527
Trehalose-Coated Implant for Prevention of Inflammation in Bone M. S. Kook: Chonnam National University, H. J. Park, H. K. Oh, S. Y. Ryu, S. Y. Park, J. Y. Jung, W. J. Kim Bone inflammation is one of major causes in dental implant failure. This study is aimed to investigate whether autophagy may ameliorate or prevent bone inflammation associated with dental implant failure. In the present study, autophagy was directly involved in odontogenic differentiation from human dental pulp stem cell but not in osteogenic differentiation from MC3T3 mesenchymal stem cell under differentiation inductive medium (DM) including 50 mM/L ascorbic acid and 5 mM/L b-glycerophosphate. Lipopolysaccharide(LPS), a bacterial endotoxin, inhibited osteogenic differentiation from MC3T3 stem cell co-cultured with RAW 264.7 cell, a macrophagy cell line but did not influence osteogenic differentiation from MC3T3 mesenchymal stem cell without RAW 264.7 cell under DM. LPS up-regulated and released inflammatory cytokines such as IL-1,6 and TNF in RAW 264.7 cell. Trehalose, an autophagy enhancing agent, rescued LPS induced impaired osteogenic differentiation from MC3T3 stem cell co-cultured with RAW 264.7 cell and ameliorated LPS -induced up-regulated and -released inflammatory cytokines such as IL-1 and 6 in RAW 264.7 cell. In the rabbit calvarium, implants coated with trehalose showed an increment of new bone formation and a decrement of inflammatory responses under P gingivalis and LPS treatment compared to the control. AAOMS 2014