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The tongue flap in alveolar bone grafting
Abstracts not hard tissue replacement promotes healing and reduces the risk of osteoradionecrosis, the material was used in eight patients with 45 extraction sites. The radiation doses ranged from 4000 cGy to 7440 cGy. The times of extractions after radiation ranged from 2 to 11 years. The grafting material consists of porous polymethylmethacrylate spheres coated with polyhydroxyethylmethacrylate and calcium hydroxide. Before placement of HTR. blood from the extraction site(s) was aspirated into the syringe containing it and tetracycline powder was added. The material was then compacted with a blunt instrument into the socket(s), the soft tissue was sutured over the site(s). The patients were examined at I-2-week intervals postoperatively. Epithelization occurred in all within 2-3 weeks. Clinically and radiographically, no infection, exfoliation of bone or suppuration characteristic of osteoradionecrosis developed. HTR appears to act as scaffolding for bone and soft tissue neoformation and offers a practical and easily applied approach to extractions without hyperbaric oxygen treatment in irradiated patients.
TMD: clinical and laboratory analyses to develop risk assessment criteria for surgical/non-surgical therapy. D. C. C/zuse DOS, L. R. Hdprrn DDS, MD, D. A. Gerard PhD. M. M. B&T DDS. University of Tennessee Graduate School of Medicine. Knoxville. Tennessee, USA. Presented by: Leslie R. Halpern DDS. MD, TMD describes not only TMJ dysfunction but disease of related musculoskeletal structures, affecting up to 40% of the population with a preponderance of females (10: 1 male). We describe a study of 55 patients with failed surgical manipulation to relieve the TMD. All patients had previous non-surgical therapy. The patients were separated into 6 groups and 1 control group. Group ( I ) early ID; (2) arthrotomy/meniscectomy; ( 3) failed IVSCOs; (4) Christensen glenoid fossa; (5) Christensen total joint; (6) Eagle’s syndrome. The control group consisted of asymptomatic patients both clinically and radiographically. Lab tests included HLA-A,B,DRW.RF. ANA sub-types, ESR. anemia profile, acute-phase reactants. uric acid and hormonal levels of Prolactin, estradiol and TFTs. Medical histories of groups 3-6 elicited significant inflammatory bowel disease, headaches, vertigo. tinnitus and anemia. Surgical histories included tonsillectomies. appendectomies and choleystectomies. Controls were negative for their past medical and surgical histories. HLA frequencies of groups 4-6 were significant for HLA-A2,A3,A26,HLA-B-B7,BS,B17.B44,B44,B6O,B62. Fifty percent of the groups 2 6 were positive for RF, ANA subtypes, increased ESR and anemia. The control group was negative for each lab examined at the same sex and age. There was no significant diffkrences in hormonal levels between control and experimental groups of the same sex and age. These findings suggest that, in the experimental groups, surgical failure may be secondary to autoimmunc dysfunction with a predisposition to multisystem disease. The utilization of genetic markers, serological testing and thorough medical histories should allow the clinician to determine which patients are good surgical risks. Furthermore. the markers in our study will enable the clinician to monitor the progression of disease to determine alternative treatment modalities.
Outpatient maxillofacial surgery: the transition 200 cases. J. J. Dunn MD, DMD. PTl~.WltPd hy: J. J. Dam MD, DMD.
and outcomes
after
Short-acting anesthetic agents, deliberate hypertension. decreased operating times, rigid fixation and non-narcotic analgesics have combined to yield a remarkable decrease in the perioperative morbidity associated with maxillofacial surgical procedures and a more rapid predictable recovery from surgery. This has allowed a transition of procedures traditionally performed in an inpatient setting to an outpatient setting. The transition of major maxillofacial surgery to an outpatient setting involved adoption of protocols dealing with: case and patient selection criteria; anesthetic management; criteria for discharge disposition; staff training. The process of developing and adopting those protocols is discussed. Treatment outcomes for the first 200 cases are discussed. Case types, OR times and blood loss are presented. No cases required transfusion. A subsequent
admission underwent
from
the ACOMS
18th Annual
rate of 1% was experienced. unplanned revision.
Less
Conference than
The tongue flap in alveolar bone grafting. R. H. Eilhros DMD, MD, C. Hull MD. Veteran’s Medical Center. East Orange. New Jersey. USA. Presented by: Robert DeFalco DDS.
443
I’:/;) of cases
DeFuko DDS. Administration
A posteriorly based tongue flap has been utilized to provide oral soft tissue coverage over an alveolar bone graft. It is presented as a method of managing the challenging defect seen in patients with bilateral cleft lip and palate whose premaxillary segment has been removed. Such defects may occur where access to a sophisticated level of primary cleft care is limited. Standard techniques for accomplishing a tension-free closure over the grafted material ma> not be applicable in these cases. The treatment of one such patient is described. The nasal floor was reconstructed in a typical fashion using locally elevated soft tissue flaps. The defect was measured and a posteriorly based tongue flap of appropriate size was developed. The flap was sutured to the posterior and lateral wound margins, leaving an anterior tunnel for placement of autogenous bone from the iliac crest. After placement of the graft and closure of the anterior margin. a wedge of tissue was excised to allow for esthetic reconstruction of the anterior tongue. Upon release of the flap 20 days later, good soft tissue coverage of the grafted defect was noted and function and esthetics were quite satisfactory. This technique, which has been reported for a variety of other applications. appears well suited for use in patients as described above.
Tetracycline in the surgical management of osteomyelitis. R. DrFtrlw DDS, H. Ephrus DMD, MD. L. Signum DDS. Seton Hall University School of Graduate Medical Education, South Orange. New Jersey, USA. Presented by: Robert De Falco DDS. Tetracycline is used as a marker to identify the borders of vital bone in patients with osteomyelitis who reqiire surgical treatment. The techniaue described below allows for a guided debridement which may be more thorough yet more conser;ative. Patients with osteomyelitis of the mandible are treated with tetracycline 250 mg b.i.d. for three to five days prior to surgical debridement. This is in addition to and does not replace the indicated antibiotic therapy for these patients. Intraoperatively, the area is approached using standard techniques exposing several centimeters of bone on either side of the involved area. Operating room lights are turned off and an ultraviolet light source is used to illuminate the operative site. Vital bone fluoresces brightly, while nonvital bone simply reflects the light source. The dull glow of the nonvital area is clearly distinguishable from the brilliant fluorescence seen where boric is vital. We believe that the intraoperative guidance provided by this technique has resulted in definitive debridements with maximal preservation of uninvolved tissue. The technique appears to be a useful tool in the management of osteomyelitis. particularly in the most Dersistent and difficult case,.
The PTFE wound dressing in alveolar hone grafting. H. Ephros DMD, MD. R. DeFdco DDS. C’. HuII MD. Seton Hall University School of Graduate Medical Education. South Orange, New Jersey. USA. Presented by: Robert DeFalco DDS. A polytetrafluoroethylene (PTFE) wound-dressing technique has been utilized to protect the oral closure after alveolar bone grafting. It is presented as a method that may reduce the incidence of dehiscence and graft loss. Failure to produce and maintain an adequate bony bridge in the grafted site occurs in a small percentage of cases and may be attributable. at least in part. to early dehiscence of the overlying soft tissue. This complication can be initiated and!or aggravated by exploration of the surgical site by the patient’s tongue, a behavior noted even in compliant children. The use of a 0.4 mm PTFE cardiovascular patch to cover the intraoral surgical site may result in fewer dehiscences. The patch is cut and shaped to cover the oral closure, is retained by silk sutures. and is generally left in place for ten days. No statistically significant data
TMD: clinical and laboratory analyses to develop risk assessment criteria for surgical/non-surgical therapy. D. C. C/zuse DOS, L. R. Hdprrn DDS, MD, D. A. Gerard PhD. M. M. B&T DDS. University of Tennessee Graduate School of Medicine. Knoxville. Tennessee, USA. Presented by: Leslie R. Halpern DDS. MD, TMD describes not only TMJ dysfunction but disease of related musculoskeletal structures, affecting up to 40% of the population with a preponderance of females (10: 1 male). We describe a study of 55 patients with failed surgical manipulation to relieve the TMD. All patients had previous non-surgical therapy. The patients were separated into 6 groups and 1 control group. Group ( I ) early ID; (2) arthrotomy/meniscectomy; ( 3) failed IVSCOs; (4) Christensen glenoid fossa; (5) Christensen total joint; (6) Eagle’s syndrome. The control group consisted of asymptomatic patients both clinically and radiographically. Lab tests included HLA-A,B,DRW.RF. ANA sub-types, ESR. anemia profile, acute-phase reactants. uric acid and hormonal levels of Prolactin, estradiol and TFTs. Medical histories of groups 3-6 elicited significant inflammatory bowel disease, headaches, vertigo. tinnitus and anemia. Surgical histories included tonsillectomies. appendectomies and choleystectomies. Controls were negative for their past medical and surgical histories. HLA frequencies of groups 4-6 were significant for HLA-A2,A3,A26,HLA-B-B7,BS,B17.B44,B44,B6O,B62. Fifty percent of the groups 2 6 were positive for RF, ANA subtypes, increased ESR and anemia. The control group was negative for each lab examined at the same sex and age. There was no significant diffkrences in hormonal levels between control and experimental groups of the same sex and age. These findings suggest that, in the experimental groups, surgical failure may be secondary to autoimmunc dysfunction with a predisposition to multisystem disease. The utilization of genetic markers, serological testing and thorough medical histories should allow the clinician to determine which patients are good surgical risks. Furthermore. the markers in our study will enable the clinician to monitor the progression of disease to determine alternative treatment modalities.
Outpatient maxillofacial surgery: the transition 200 cases. J. J. Dunn MD, DMD. PTl~.WltPd hy: J. J. Dam MD, DMD.
and outcomes
after
Short-acting anesthetic agents, deliberate hypertension. decreased operating times, rigid fixation and non-narcotic analgesics have combined to yield a remarkable decrease in the perioperative morbidity associated with maxillofacial surgical procedures and a more rapid predictable recovery from surgery. This has allowed a transition of procedures traditionally performed in an inpatient setting to an outpatient setting. The transition of major maxillofacial surgery to an outpatient setting involved adoption of protocols dealing with: case and patient selection criteria; anesthetic management; criteria for discharge disposition; staff training. The process of developing and adopting those protocols is discussed. Treatment outcomes for the first 200 cases are discussed. Case types, OR times and blood loss are presented. No cases required transfusion. A subsequent
admission underwent
from
the ACOMS
18th Annual
rate of 1% was experienced. unplanned revision.
Less
Conference than
The tongue flap in alveolar bone grafting. R. H. Eilhros DMD, MD, C. Hull MD. Veteran’s Medical Center. East Orange. New Jersey. USA. Presented by: Robert DeFalco DDS.
443
I’:/;) of cases
DeFuko DDS. Administration
A posteriorly based tongue flap has been utilized to provide oral soft tissue coverage over an alveolar bone graft. It is presented as a method of managing the challenging defect seen in patients with bilateral cleft lip and palate whose premaxillary segment has been removed. Such defects may occur where access to a sophisticated level of primary cleft care is limited. Standard techniques for accomplishing a tension-free closure over the grafted material ma> not be applicable in these cases. The treatment of one such patient is described. The nasal floor was reconstructed in a typical fashion using locally elevated soft tissue flaps. The defect was measured and a posteriorly based tongue flap of appropriate size was developed. The flap was sutured to the posterior and lateral wound margins, leaving an anterior tunnel for placement of autogenous bone from the iliac crest. After placement of the graft and closure of the anterior margin. a wedge of tissue was excised to allow for esthetic reconstruction of the anterior tongue. Upon release of the flap 20 days later, good soft tissue coverage of the grafted defect was noted and function and esthetics were quite satisfactory. This technique, which has been reported for a variety of other applications. appears well suited for use in patients as described above.
Tetracycline in the surgical management of osteomyelitis. R. DrFtrlw DDS, H. Ephrus DMD, MD. L. Signum DDS. Seton Hall University School of Graduate Medical Education, South Orange. New Jersey, USA. Presented by: Robert De Falco DDS. Tetracycline is used as a marker to identify the borders of vital bone in patients with osteomyelitis who reqiire surgical treatment. The techniaue described below allows for a guided debridement which may be more thorough yet more conser;ative. Patients with osteomyelitis of the mandible are treated with tetracycline 250 mg b.i.d. for three to five days prior to surgical debridement. This is in addition to and does not replace the indicated antibiotic therapy for these patients. Intraoperatively, the area is approached using standard techniques exposing several centimeters of bone on either side of the involved area. Operating room lights are turned off and an ultraviolet light source is used to illuminate the operative site. Vital bone fluoresces brightly, while nonvital bone simply reflects the light source. The dull glow of the nonvital area is clearly distinguishable from the brilliant fluorescence seen where boric is vital. We believe that the intraoperative guidance provided by this technique has resulted in definitive debridements with maximal preservation of uninvolved tissue. The technique appears to be a useful tool in the management of osteomyelitis. particularly in the most Dersistent and difficult case,.
The PTFE wound dressing in alveolar hone grafting. H. Ephros DMD, MD. R. DeFdco DDS. C’. HuII MD. Seton Hall University School of Graduate Medical Education. South Orange, New Jersey. USA. Presented by: Robert DeFalco DDS. A polytetrafluoroethylene (PTFE) wound-dressing technique has been utilized to protect the oral closure after alveolar bone grafting. It is presented as a method that may reduce the incidence of dehiscence and graft loss. Failure to produce and maintain an adequate bony bridge in the grafted site occurs in a small percentage of cases and may be attributable. at least in part. to early dehiscence of the overlying soft tissue. This complication can be initiated and!or aggravated by exploration of the surgical site by the patient’s tongue, a behavior noted even in compliant children. The use of a 0.4 mm PTFE cardiovascular patch to cover the intraoral surgical site may result in fewer dehiscences. The patch is cut and shaped to cover the oral closure, is retained by silk sutures. and is generally left in place for ten days. No statistically significant data