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Stability of mandibular advancement osteotomy using rigid internal fixation
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CURRENT LITERATURE
This article provides a concise review of the adverse effects of transfusions. The material is presented in tabular form, and is divided into two categories: “serious adverse effects,” which includes viral hepatitis, circulatory overload, acute lung injury, acute hemolytic transfusion reaction, anaphylactic hypotensive reaction, hemosiderosis, hemostatic defect, hypothermia, bacterial/ endotoxin reaction, malaria and other parasitic infections, graft versus host disease, and acquired immune deficiency syndrome; and “troublesome adverse effects,” which includes depression of erythropoiesis, leukocyte and/or platelet alloimmunization, cytomegalovirus seroconversion, red blood cell alloimmunization, Epstein-Barr virus seroconversion, febrile non-hemolytic reaction, allergic reaction, nonspecific (chill) reaction, delayed hemo!ytic reaction, metabolic abnormalities, immunologic alterations, and post-transfusion purpura. Also included in the table are the approximate frequencies of each entity, references to comments in the main body of the article, and references to the bibliography for each adverse effect. The comments, which compose the bulk of the article, discuss causes, prevention, treatment, and other appropriate factors pertaining to each of the effects.-B. R. HIPP Reprint requests to Dr. Walker: William Beaumont Hospital, Royal Oak, MI 48072.
Stability of Mandibular Advancement Osteotomy Using Rigid Internal Fixation. Barer PG, Wallen TR, McNeil1 RW, et al. Am J Orthod Dentofac Orthop 925, 1987 This retrospective longitudinal cephalometric analysis examined 43 patients who underwent mandibular advancement by way of the inverted-L osteotomy using rigid internal fixation and bone grafting. The postoperative follow-up period ranged from 6 months to 4 years 6 months. Each patient underwent a period of preoperative orthodontic treatment. At surgery, prefabricated acrylic splints were used to position the distal mandibular segment into a Class I canine relationship. The condyles were placed in the most superior position in the fossa and fixation was obtained with a Vitallium mesh plate and screws. The gap between segments was filled with corticocancellous bone from the iliac crest. Maxillomandibular fixation was maintained from a period of 0 to 48 days. Orthodontic treatment was resumed 2 to 4 weeks after release of fixation or, where fixation was not used, 2 to 4 weeks after surgery. Skeletal and dental changes were evaluated by superimposing preoperative and postoperative cephalometric radiographs. Results showed that although considerable individual variation existed, no mean postoperative relapse was demonstrated for the sample as a whole. No significant changes in the gonial angle were observed, indicating that rigid fixation results in improved positional stability of the mandibular segments. Length of maxillomandibular fixation time had no effect on relapse. An increased relapse tendency was associated with an increasing amount of mandibular advancement. The authors conclude that excellent stability, with negligible relapse, can be obtained with this procedure.W. L. FOLEY Reprint requests to Dr. Barer: 1807-805 West Broadway, couver, BC, Canada V5Z 1Kl.
Van-
Influence of Early Closure of Soft Palatal Clefts on the Pharyngeal Skeleton: Observation by CT Scan. Oesch IL, Looser C, Bettex MC. Cleft Palate J 24:291, 1987 Early surgical closure of the soft palate has been shown to be important in the development of better phonation. One factor may be its effect on the volume of the epipharynx, which is dependent on the distance between pterygoid processes and their orientation in space. The authors contend that early closure redirects the forces of the soft palate musculature and normalizes the position and direction of the pterygoid processes. Axial and semifrontal CT scans were obtained on 33 patients, one at age 3 to 4 months, prior to any surgery, and a second 1 year later. Patients with isolated clefts of the lip and alveolus without cleft of the secondary palate served as controls. Patients with cleft of the lip, alveolus, and hard and soft palate who had early soft palate closure at 3 to 4 months were compared with a group of similar patients who had their surgery planned for late closure at 2% years. The distance the pterygoid processes, the pterygomandibular index; and pterygoid abduction angle was measured. The distance between the processes in all CTs was subject to great variations due to growth and not suitable for evaluation. The measurement of PM index and PAA in patients with cleft lip and palate prior to and after early surgical closure, and in patients with cleft lip and palate without closure, showed significant differences in both groups. In patients without palatal cleft, PM index and PAA were normal and stayed so after 1 year. With an open palatal cleft, PM index and PAA were greater than normal and remained so after 1 year. With early clos’ure at 3 to 4 months of age, PM index and PAA tended to become normal. The authors conclude that correct pterygoid position is dependent upon the appropriate connection of the velar musculature to the processes. Furthermore, they conclude that early closure of the soft palate corrects the position of the pterygoid processes, thereby reducing the functioning volume of the epipharynx.-G. L. LANZI Reprint request to Dr. Oesch: Inselspital Beme, Berne, Switzerland.
at the University
of
Oral Squamous Carcinoma Presenting in a Mucocele. Gallagher T, Lichtenstein JL, Oral Med 42:2, 1987 Mucoceles of the oral cavity are relatively common. In one routine biopsy survey, they comprised 5.6% Iof the cases. This article reported the case of an extravamsation mucocele of the buccal sulcus in a 57-year-old woman. The ductal change in this case resulted from an early invasive squamous cell carcinoma. The patient presented with a chief complaint of a lump on her jaw that had come up overnight. She did not relate any recent episodes of trauma. Clinically a nodule was observed in the mandibular mucobuccal fold on the left side, approximately overlying the region of the mental foramen. The nodule was covered by normal appearing oral mucosa and no erythroplakia, leukoplakia, erosions, or ulcerations were found. The nodule was 1 cm in diameter, firm, but somewhat mobile. Regional lymph nodes were not enlarged. The lesion was excised and submitted for histologic examination. Arising from the surface epithelium were foci of proliferating epithelial cells that extended multiple finger-like
CURRENT LITERATURE
This article provides a concise review of the adverse effects of transfusions. The material is presented in tabular form, and is divided into two categories: “serious adverse effects,” which includes viral hepatitis, circulatory overload, acute lung injury, acute hemolytic transfusion reaction, anaphylactic hypotensive reaction, hemosiderosis, hemostatic defect, hypothermia, bacterial/ endotoxin reaction, malaria and other parasitic infections, graft versus host disease, and acquired immune deficiency syndrome; and “troublesome adverse effects,” which includes depression of erythropoiesis, leukocyte and/or platelet alloimmunization, cytomegalovirus seroconversion, red blood cell alloimmunization, Epstein-Barr virus seroconversion, febrile non-hemolytic reaction, allergic reaction, nonspecific (chill) reaction, delayed hemo!ytic reaction, metabolic abnormalities, immunologic alterations, and post-transfusion purpura. Also included in the table are the approximate frequencies of each entity, references to comments in the main body of the article, and references to the bibliography for each adverse effect. The comments, which compose the bulk of the article, discuss causes, prevention, treatment, and other appropriate factors pertaining to each of the effects.-B. R. HIPP Reprint requests to Dr. Walker: William Beaumont Hospital, Royal Oak, MI 48072.
Stability of Mandibular Advancement Osteotomy Using Rigid Internal Fixation. Barer PG, Wallen TR, McNeil1 RW, et al. Am J Orthod Dentofac Orthop 925, 1987 This retrospective longitudinal cephalometric analysis examined 43 patients who underwent mandibular advancement by way of the inverted-L osteotomy using rigid internal fixation and bone grafting. The postoperative follow-up period ranged from 6 months to 4 years 6 months. Each patient underwent a period of preoperative orthodontic treatment. At surgery, prefabricated acrylic splints were used to position the distal mandibular segment into a Class I canine relationship. The condyles were placed in the most superior position in the fossa and fixation was obtained with a Vitallium mesh plate and screws. The gap between segments was filled with corticocancellous bone from the iliac crest. Maxillomandibular fixation was maintained from a period of 0 to 48 days. Orthodontic treatment was resumed 2 to 4 weeks after release of fixation or, where fixation was not used, 2 to 4 weeks after surgery. Skeletal and dental changes were evaluated by superimposing preoperative and postoperative cephalometric radiographs. Results showed that although considerable individual variation existed, no mean postoperative relapse was demonstrated for the sample as a whole. No significant changes in the gonial angle were observed, indicating that rigid fixation results in improved positional stability of the mandibular segments. Length of maxillomandibular fixation time had no effect on relapse. An increased relapse tendency was associated with an increasing amount of mandibular advancement. The authors conclude that excellent stability, with negligible relapse, can be obtained with this procedure.W. L. FOLEY Reprint requests to Dr. Barer: 1807-805 West Broadway, couver, BC, Canada V5Z 1Kl.
Van-
Influence of Early Closure of Soft Palatal Clefts on the Pharyngeal Skeleton: Observation by CT Scan. Oesch IL, Looser C, Bettex MC. Cleft Palate J 24:291, 1987 Early surgical closure of the soft palate has been shown to be important in the development of better phonation. One factor may be its effect on the volume of the epipharynx, which is dependent on the distance between pterygoid processes and their orientation in space. The authors contend that early closure redirects the forces of the soft palate musculature and normalizes the position and direction of the pterygoid processes. Axial and semifrontal CT scans were obtained on 33 patients, one at age 3 to 4 months, prior to any surgery, and a second 1 year later. Patients with isolated clefts of the lip and alveolus without cleft of the secondary palate served as controls. Patients with cleft of the lip, alveolus, and hard and soft palate who had early soft palate closure at 3 to 4 months were compared with a group of similar patients who had their surgery planned for late closure at 2% years. The distance the pterygoid processes, the pterygomandibular index; and pterygoid abduction angle was measured. The distance between the processes in all CTs was subject to great variations due to growth and not suitable for evaluation. The measurement of PM index and PAA in patients with cleft lip and palate prior to and after early surgical closure, and in patients with cleft lip and palate without closure, showed significant differences in both groups. In patients without palatal cleft, PM index and PAA were normal and stayed so after 1 year. With an open palatal cleft, PM index and PAA were greater than normal and remained so after 1 year. With early clos’ure at 3 to 4 months of age, PM index and PAA tended to become normal. The authors conclude that correct pterygoid position is dependent upon the appropriate connection of the velar musculature to the processes. Furthermore, they conclude that early closure of the soft palate corrects the position of the pterygoid processes, thereby reducing the functioning volume of the epipharynx.-G. L. LANZI Reprint request to Dr. Oesch: Inselspital Beme, Berne, Switzerland.
at the University
of
Oral Squamous Carcinoma Presenting in a Mucocele. Gallagher T, Lichtenstein JL, Oral Med 42:2, 1987 Mucoceles of the oral cavity are relatively common. In one routine biopsy survey, they comprised 5.6% Iof the cases. This article reported the case of an extravamsation mucocele of the buccal sulcus in a 57-year-old woman. The ductal change in this case resulted from an early invasive squamous cell carcinoma. The patient presented with a chief complaint of a lump on her jaw that had come up overnight. She did not relate any recent episodes of trauma. Clinically a nodule was observed in the mandibular mucobuccal fold on the left side, approximately overlying the region of the mental foramen. The nodule was covered by normal appearing oral mucosa and no erythroplakia, leukoplakia, erosions, or ulcerations were found. The nodule was 1 cm in diameter, firm, but somewhat mobile. Regional lymph nodes were not enlarged. The lesion was excised and submitted for histologic examination. Arising from the surface epithelium were foci of proliferating epithelial cells that extended multiple finger-like