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Surgical technique for horizontal alveolar distraction
Metastatic malignant mesothelioma in the mandible Background.—Exposure to asbestos is a major etiologic factor contributing to malignant mesothelioma. Only 1 or 2 cases per million per year are seen, with the male to female ratio being 2.2:1. The tumor arises from the pleura or peritoneum, and distant hematogenous metastasis has developed in more than half the reported cases. A case in which the tumor metastasized to the mandible was reported. Case Report.—Man, 53, had had pain for 2 months on the right side of his scapula and chest. He also found an enlarging mass in the right axilla, which was examined and a biopsy taken. On plain chest radiographs, there was right pleural effusion and thickening. Histopathologic tests led to a diagnosis of metastatic mesothelioma. He was referred for exclusion of focal infection before having chemotherapy. He had a hard tumor measuring 15 15 mm located subcutaneously over the left submandibular area. The left lower wisdom tooth had evidence of decay but lacked abnormal mobility or gingival swelling. A poorly defined radiolucent area was present in the periapical region. On computed tomography (CT) scans, there was a low-density rounded area in the mandibular bone. The lingual cortex was absorbed. The tooth was removed in the belief that the lesion was a radicular cyst. The excised mass was composed of granular-like tissue surrounding a center containing foul-smelling and necrotic tissue. Histologically, there were interlacing bands of spindle-shaped cells and many
mitotic figures in the high power fields. Tumor cells stained positively for vimentin and cytokeratin-AD1/3 but negative for CD34, CK10, and epithelial antigen Ber-EP4. The ultimate diagnosis was metastatic mesothelioma. Discussion.—The lesion found at the primary site in this patient was a malignant mesothelioma. This lesion rarely occurs and is even less often seen in the oral region, but it should be considered when the patient has a highly metastatic neoplasm in any organ.
Clinical Significance.—This particular tumor is rare, but this case points out the need to carefully study oral radiographs for signs of malignancy whenever examining a patient with a highly metastatic tumor.
Terakado N, Shintani S, Nakashiro K, et al: Malignant pleural mesothelioma metastasis to the mandible. Int J Oral Maxillofac Surg 33:798-800, 2004 Reprints available from N Terakado, Dept of Oral and Maxillofacial Surgery, Ehime Univ School of Medicine, Shitsukawa, Shigenobucho, Onsen-gun, Ehime 791-0295, Japan; fax: +81 89 960 5396; e-mail: [email protected]
Oral and Maxillofacial Surgery Surgical technique for horizontal alveolar distraction Background.—The placement of dental implants may be impeded by insufficient alveolar ridge width. Autologous bone grafts, guided bone regeneration (GBR), and bone-splitting and bone-spreading techniques have
been used to address the problem. A surgical technique was developed to prepare a transport segment pedicled to the mucoperiosteum to be used in horizontal alveolar distraction.
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Fig 1.—A, Diagram of the alveolar ridge (vestibular view) and transport segment, showing A, alveolar bone; B, mucosa of the alveolar ridge; C, ridge splitting osteotomy; D, lateral osteotomies; and E, basal osteotomy. B, F, Incision in the ridge mucosa; G, tunneling between mucosa and bone, and subsequent lateral osteotomies with chisels. C, H, Small vestibular incision and subsequent basal osteotomy. D, Ridge splitting osteotomy via the incision in the ridge mucosa. E, I, Distractor screw in place, crossing the transport segment. Despite the ridge incision, small vestibular incision, and lateral tunneling (see preceding figures), the transport segment maintains extensive contact with the vestibular mucoperiosteum. F, Relocated transport segment at the end of the distraction process. (Reprinted from Garcia-Garcia A, Somoza-Martin M, GandaraVila P, et al: Horizontal alveolar distraction: A surgical technique with the transport segment pedicled to the mucoperiosteum. J Oral Maxillofac Surg 62:1408-1412, 2004. Copyright 2004, with permission from the American Association of Oral and Maxillofacial Surgeons.)
Technique.—An incision is made in the mucosa along the crest of the alveolar ridge (Fig 1). No trapezoidal cuts are made, and the attached pedicle to the mucoperiosteum is maintained. A tunnel is created between the vestibular mucosa and bone, extending from the incision in the alveo-
216 Dental Abstracts
lar ridge crest to the level of the base of the transport segment. Lateral osteotomies are accomplished with the use of a chisel. As little mucoperiosteum as possible is detached. Next, a small vestibular incision is made to allow passage of the chisel and its horizontal movement in performing the
premolars. However, her alveolar ridge was too narrow for placement of adequately sized dental implants, requiring horizontal alveolar distraction. The technique described was accomplished, then distraction was performed in a palatalvestibular direction. The shortest distraction screw available was used, then shortened to an appropriate length. Only the transport plate was used so the tip of the distractor screw pushed directly against the basal bone (Fig 4). Distraction began 5 days later at 0.5 mm/day and was continued for 15 days. After 12 weeks, 2 implants were placed.
Fig 4.—Distractor screw placed horizontally through the vestibular mucosa of the alveolar ridge. (Reprinted from GarciaGarcia A, Somoza-Martin M, Gandara-Vila P, et al: Horizontal alveolar distraction: A surgical technique with the transport segment pedicled to the mucoperiosteum. J Oral Maxillofac Surg 62:1408-1412, 2004. Copyright 2004, with permission from the American Association of Oral and Maxillofacial Surgeons.)
vestibular osteotomy. After the vestibular and lateral osteotomies are made, a ridge-splitting osteotomy is done to free the transport segment. The distractor screw is placed through the freed transport segment in a vestibular-tolingual direction so that distraction can be accomplished. Case Report.—Woman, 30, needed dental implants in the upper jaw at the level of the first and second upper right
Discussion.—The use of horizontal alveolar distraction proved relatively easy in this patient. The ridge width was increased to permit placement of standard dental implants. Cases should be approached individually, considering the specific requirements of each patient.
Clinical Significance.—Presented is a technique for increasing alveolar width to accommodate implant placement. Traditional methods have included autologous bone grafts, guided bone regeneration, bonesplitting and bone-spreading techniques.
Garcia-Garcia A, Somoza-Martin M, Gandara-Vila P, et al: Horizontal alveolar distraction: A surgical technique with the transport segment pedicled to the mucoperiosteum. J Oral Maxillofac Surg 62:1408-1412, 2004 Reprints available from A García-García, Facultad de Odontología, Entrerrios s/n, Santiago de Compostela, Spain; e-mail: ciabelgg @usc.es
Horizontal alveolar distraction and endosseous implants Background.—The distraction osteogenesis procedure offers the advantages of bone formation without grafting and simultaneous lengthening of the soft tissues. Horizontal alveolar distraction of a narrow maxillary ridge was done by modifying the application of the distractor to permit the placement of endosseous implants.
Case Report.—Woman, 17, was otherwise healthy but had unilateral partial maxillary edentulism. Dentoalveolar trauma had eliminated 4 teeth between the maxillary left central incisor and the left first premolar 2 years before she came for treatment (Fig 1). Her alveolar ridge was Class IV, with adequate height but inadequate width to support
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mitotic figures in the high power fields. Tumor cells stained positively for vimentin and cytokeratin-AD1/3 but negative for CD34, CK10, and epithelial antigen Ber-EP4. The ultimate diagnosis was metastatic mesothelioma. Discussion.—The lesion found at the primary site in this patient was a malignant mesothelioma. This lesion rarely occurs and is even less often seen in the oral region, but it should be considered when the patient has a highly metastatic neoplasm in any organ.
Clinical Significance.—This particular tumor is rare, but this case points out the need to carefully study oral radiographs for signs of malignancy whenever examining a patient with a highly metastatic tumor.
Terakado N, Shintani S, Nakashiro K, et al: Malignant pleural mesothelioma metastasis to the mandible. Int J Oral Maxillofac Surg 33:798-800, 2004 Reprints available from N Terakado, Dept of Oral and Maxillofacial Surgery, Ehime Univ School of Medicine, Shitsukawa, Shigenobucho, Onsen-gun, Ehime 791-0295, Japan; fax: +81 89 960 5396; e-mail: [email protected]
Oral and Maxillofacial Surgery Surgical technique for horizontal alveolar distraction Background.—The placement of dental implants may be impeded by insufficient alveolar ridge width. Autologous bone grafts, guided bone regeneration (GBR), and bone-splitting and bone-spreading techniques have
been used to address the problem. A surgical technique was developed to prepare a transport segment pedicled to the mucoperiosteum to be used in horizontal alveolar distraction.
Volume 50 • Issue 4 • 2005 215
Fig 1.—A, Diagram of the alveolar ridge (vestibular view) and transport segment, showing A, alveolar bone; B, mucosa of the alveolar ridge; C, ridge splitting osteotomy; D, lateral osteotomies; and E, basal osteotomy. B, F, Incision in the ridge mucosa; G, tunneling between mucosa and bone, and subsequent lateral osteotomies with chisels. C, H, Small vestibular incision and subsequent basal osteotomy. D, Ridge splitting osteotomy via the incision in the ridge mucosa. E, I, Distractor screw in place, crossing the transport segment. Despite the ridge incision, small vestibular incision, and lateral tunneling (see preceding figures), the transport segment maintains extensive contact with the vestibular mucoperiosteum. F, Relocated transport segment at the end of the distraction process. (Reprinted from Garcia-Garcia A, Somoza-Martin M, GandaraVila P, et al: Horizontal alveolar distraction: A surgical technique with the transport segment pedicled to the mucoperiosteum. J Oral Maxillofac Surg 62:1408-1412, 2004. Copyright 2004, with permission from the American Association of Oral and Maxillofacial Surgeons.)
Technique.—An incision is made in the mucosa along the crest of the alveolar ridge (Fig 1). No trapezoidal cuts are made, and the attached pedicle to the mucoperiosteum is maintained. A tunnel is created between the vestibular mucosa and bone, extending from the incision in the alveo-
216 Dental Abstracts
lar ridge crest to the level of the base of the transport segment. Lateral osteotomies are accomplished with the use of a chisel. As little mucoperiosteum as possible is detached. Next, a small vestibular incision is made to allow passage of the chisel and its horizontal movement in performing the
premolars. However, her alveolar ridge was too narrow for placement of adequately sized dental implants, requiring horizontal alveolar distraction. The technique described was accomplished, then distraction was performed in a palatalvestibular direction. The shortest distraction screw available was used, then shortened to an appropriate length. Only the transport plate was used so the tip of the distractor screw pushed directly against the basal bone (Fig 4). Distraction began 5 days later at 0.5 mm/day and was continued for 15 days. After 12 weeks, 2 implants were placed.
Fig 4.—Distractor screw placed horizontally through the vestibular mucosa of the alveolar ridge. (Reprinted from GarciaGarcia A, Somoza-Martin M, Gandara-Vila P, et al: Horizontal alveolar distraction: A surgical technique with the transport segment pedicled to the mucoperiosteum. J Oral Maxillofac Surg 62:1408-1412, 2004. Copyright 2004, with permission from the American Association of Oral and Maxillofacial Surgeons.)
vestibular osteotomy. After the vestibular and lateral osteotomies are made, a ridge-splitting osteotomy is done to free the transport segment. The distractor screw is placed through the freed transport segment in a vestibular-tolingual direction so that distraction can be accomplished. Case Report.—Woman, 30, needed dental implants in the upper jaw at the level of the first and second upper right
Discussion.—The use of horizontal alveolar distraction proved relatively easy in this patient. The ridge width was increased to permit placement of standard dental implants. Cases should be approached individually, considering the specific requirements of each patient.
Clinical Significance.—Presented is a technique for increasing alveolar width to accommodate implant placement. Traditional methods have included autologous bone grafts, guided bone regeneration, bonesplitting and bone-spreading techniques.
Garcia-Garcia A, Somoza-Martin M, Gandara-Vila P, et al: Horizontal alveolar distraction: A surgical technique with the transport segment pedicled to the mucoperiosteum. J Oral Maxillofac Surg 62:1408-1412, 2004 Reprints available from A García-García, Facultad de Odontología, Entrerrios s/n, Santiago de Compostela, Spain; e-mail: ciabelgg @usc.es
Horizontal alveolar distraction and endosseous implants Background.—The distraction osteogenesis procedure offers the advantages of bone formation without grafting and simultaneous lengthening of the soft tissues. Horizontal alveolar distraction of a narrow maxillary ridge was done by modifying the application of the distractor to permit the placement of endosseous implants.
Case Report.—Woman, 17, was otherwise healthy but had unilateral partial maxillary edentulism. Dentoalveolar trauma had eliminated 4 teeth between the maxillary left central incisor and the left first premolar 2 years before she came for treatment (Fig 1). Her alveolar ridge was Class IV, with adequate height but inadequate width to support
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