- Email: [email protected]
Transmucosal fixation of the fractured edentulous mandible
Myositis ossificans traumatica of the medial pterygoid Competing interests
None declared. Ethical approval
6. 7.
Not required. References 1. Aoki T, Naito H, Ota Y, Shiiki K. Myositis ossificans traumatica of the masticatory muscles: review of the literature and report of a case. J Oral Maxillofac Surg 2002: 60: 1083–1088. 2. Arima R, Shiba R, Hayashi T. Traumatic myositis ossificans in the masseter muscle. J Oral Maxillofac Surg 1984: 42: 521–526. 3. Arrington ED, Miller MD. Skeletal muscle injuries. Orthop Clin North Am 1995: 26: 411–422. 4. Carey EJ. Multiple bilateral parosteal bone and callus formations of the femur and left innominate bone. Arch Surg 1924: 8: 592–603. 5. Conner GA, Duffy M. Myositis ossificans: a case report of multiple recurrences following third molar extractions and
8.
9. 10. 11.
12.
review of the literature. J Oral Maxillofac Surg 2009: 67: 920–926. Cushner FD, Morwessel RM. Myositis ossificans traumatica. Orthop Rev 1992: 21: 1319–1326. Dimitroulis G. The interpositional dermis-fat graft in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 2004: 33: 755–760. Kim DD, Lazow SK, Berger JR HarELG. Myositis ossificans traumatica of the masticatory musculature: a case report and literature review. J Oral Maxillofac Surg 2002: 60: 1072–1076. Narang R, Dixon RA. Myositis ossificans: medial pterygoid muscle—a case report. Br J Oral Surg 1974: 12: 229–234. Parkash H, Goyal M. Myositis ossificans of medial pterygoid muscle. Oral Surg Oral Med Oral Pathol 1992: 73: 27–28. Rattan V, Rai S, Vaiphei K. Use of buccal pad of fat to prevent heterotopic bone formation after excision of myositis ossificans of medial pterygoid muscle. J Oral Maxillofac Surg 2008: 66: 1518–1522. Shirkhoda A, Armin AR, Bis KG, Makris J, Irwin RB, Shetty AN. MR imaging of myositis ossificans: variable
549
patterns at different stages. J Magn Reson Imaging 1995: 5: 287–292. 13. Spinazze RP, Heffez LB, Bays RA. Chronic progressive limitation of mouth opening. J Oral Maxillofac Surg 1998: 56: 1178–1186. 14. Takahashi K, Sato K. Myositis ossificans traumatica of the medial pterygoid muscle. J Oral Maxillofac Surg 1999: 57: 451–456. 15. Woolgar JA, Beirne JC, Triantafyllou A. Myositis ossificans traumatica of sternocleidomastoid muscle presenting as cervical lymph-node metastasis. Int J Oral Maxillofac Surg 1995: 24: 170–173. Address: Annamalai Thangavelu Division of Oral and Maxillofacial Surgery Rajah Muthiah Dental College and Hospital Chidambaram 608002 Tamil Nadu India Tel.: +91 94432 44213 Fax: +91 41442 38080. E–mail: [email protected] doi:10.1016/j.ijom.2010.10.024
Case Report Trauma
Transmucosal fixation of the fractured edentulous mandible
G. A. Wood, D. F. Campbell, L. E. Greene Regional Maxillofacial Unit, Southern General Hospital, Glasgow, UK
G. A. Wood, D. F. Campbell, L. E. Greene: Transmucosal fixation of the fractured edentulous mandible. Int. J. Oral Maxillofac. Surg. 2011; 40: 549–552. # 2010 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons. Abstract. Transmucosal fixation is a new strategy for the treatment of edentulous mandibular fractures using external fixation principles within the oral cavity. The component parts of this technique are not new. External fixation, locking plates and transmucosal implants represent the foundations of this technique; the authors’ development has been to bring these established methods together as a transmucosal intra oral locking plate fixation technique. The first eight patients treated with this technique have achieved bony union, they have no long-term sensory deficit and all patients were able to eat a soft diet with minimal discomfort the day after surgery. The first five of eight patients on long-term review showed bony union confirmed radiographically. For the remainder and subsequent patients, radiographs have not been scheduled at review, in the absence of symptoms.
Accepted for publication 29 October 2010 Available online 23 December 2010
550 [()TD$FIG]
Wood et al. tion of the nerve4. Since the screws are angled laterally in the posterior area, the benefit of bi-cortical fixation may be achieved and there is less risk to the neurovascular bundle. Anteriorly, the screws are medial to the inferior dental canal. In the authors’ experience, stability is sufficient with fixation through one cortical plate as STOELINGA et al. described in the fixation of mandibular osteotomies10. Bi-cortical fixation would increase the firmness of fixation and can be achieved with this technique. The aim of this study was to establish whether rigid fixation could be achieved transmucosally using existing locking plates and established external fixation concepts. The first eight cases are reported. Materials and method
Fig. 1. A suitably long mini-locking plate straddling the fracture site was placed and fixed. Transmucosal fixation of a mobile fracture through the right body of the mandible associated with an unerupted tooth, an ink mark represents the clinical estimate of the fracture position, also showing fixation in position and 6-month review x ray.
Treatment of the edentulous fractured mandible presents special difficulties3,8. Many methods of immobilisation have been suggested over the years, most of historic interest1 given the modern acceptance of rigid plate fixation. Patients are often elderly9 with acute and chronic comorbidities frequently complicating management and adding to anaesthetic risks5. The specific problems of edentulous mandibular fractures relate to the remaining mandibular bone height. The difficulty of achieving bony union is well known. Fractures amenable to mini-plate fixation often leave a plate near the denture bearing area and/or place a screw near the inferior alveolar neurovascular bundle risking anaesthesia or paraesthesia in the distribu-
[()TD$FIG]
Patients with an edentulous fractured mandible that required fixation were selected. If they were unfit for a general anaesthetic the procedure could be carried out under local anaesthetic with or without sedation. An impression taken before surgery can facilitate plate contouring prior to plate placement, alternatively the plate can be contoured intra-operatively. The fracture site(s) were palpated and if there was any problem with the accuracy of reduction a small incision was made to visualize the fracture line. A suitably long mini-locking plate straddling the fracture site was placed and fixed (Fig. 1). Postoperative and 6-month review radiographs were taken. There was a buried premolar in the area of this fracture, the authors avoided extracting the tooth at the time of fixation, as this would have increased the risk of non-union. Bony union was confirmed by radiography and the tooth remained buried and asymptomatic. In later cases, longer plates were used, which
Fig. 2. In the retro-molar region the screws are angled from a lingual entry directed downwards and slightly buccally.
[()TD$FIG]
Transmucosal fixation of the fractured edentulous mandible
551
and did not complain of any significant pain. After fixation removal, carried out under local anaesthesia, all patients had clinical bony union so radiography was not considered appropriate at this stage on clinical grounds and no patient required further follow-up beyond 3 months. The first three patients were recalled at 6 months and agreed to assist the study by allowing clinical examination and a review radiograph, all had achieved bony union (Figs 1c and 3b). Of the first eight patients (Table 1), one had a dense unilateral sensory deficit in the distribution of the mental nerve following bilateral fracture fixation, but this had resolved by the time fixation was removed. One patient had evidence of plate bending with plate fracture (Synthes 2.0 locking) at 7 weeks but this did not cause any significant discomfort and did not affect the outcome. One of the early bilateral fracture cases had a screw placed in the left fracture line (Fig. 3a) but the patient reported no problems and bony union is seen on the 6-month review radiograph (Fig. 3b). Discussion Fig. 3. (a) One of the early bilateral fracture cases had a screw placed in the left fracture line; and (b) the 6-month review radiograph shows bony union.
Table 1. Clinical outcomes from the first eight patients are listed. Total number of patients Plating type Plate fracture Plate bending Rigid union at time of removal Subjective sensory deficit following surgery Postoperative infection
ideally extended from retro-molar to retromolar region where screws were grouped in three specific regions, both retro-molar regions and the bone anterior to the mental foramina. In the retro-molar region the screws are angled from a lingual entry directed downwards and slightly buccally and may engage the lateral cortex but mono-cortical engagement is adequate (Fig. 2)2. The authors now avoid the mandibular body for screw placement. To avoid mucosal compression a periosteal elevator was used (Fig. 1). The locking screw could then be engaged fully without compressing the mucosa. Although initially two screws were used on either side of the fracture line, the authors considered that a minimum of
8 Synthes 2.0 locking 1/8 (patient 3) 1/8 (patient 3) 8/8 Temporary (2 months) Nil
three mono-cortical screws in the ramus regions and in the anterior mandible would be better. Postoperatively, orthopantomograms were carried out to confirm satisfactory reduction. At review, following fixation removal, patients were assessed for mobility or pain at the fracture site. If patients remained symptom free 2 weeks after fixation removal they were discharged. The first three patients returned for follow-up and radiography to confirm bony union. Results
All patients were able to eat a soft breakfast on the first postoperative day, seemed untroubled by the procedure
Treating the fractured edentulous mandible is a challenge and the more atrophic the mandible the greater the challenge11. Problems include the risks of general anaesthesia in the elderly, nerve injury, non-rigid union resulting in pain, denture rehabilitation problems, and psychological issues. The authors reviewed the notes available for patients in the preceding 2 years (seven patients) who had been treated with open reduction with internal fixation for similar fractures and followed this up with a retrospective questionnaire to determine the significant morbidities associated with conventional techniques. All had sensory deficits as a result of surgery and two had problems with drooling and would no longer eat in public. One had returned to theatre and another was re-admitted with infection. Five had problems with dentures and four had chronic pain. The authors conclude that the simple technique of transmucosal fixation can reduce operative complications and outcome in the treatment of fractures of the edentulous mandible, including ‘bucket handle’ fractures6,7. The authors have continued with this technique and report further success in the fixation of two patients treated under local anaesthesia because of medical co-morbidities rendering them unfit for
552
Wood et al.
general anaesthesia. The 2 mm locking plate showed bending with subsequent fracture in one case and as a result a more suitable plate and locking device are being developed to enhance the technique. Competing interests
The authors are seeking to commercialize a new plate based on what they have learned from this research. Funding
Scottish Health Innovations Ltd have funded a patent application total funding circa US$7K. Ethical approval
Not required. References 1. Barber H. Part I: Conservative management of the fractured atrophic edentulous mandible. J Oral Maxillofac Surg 2001: 59: 789–791.
2. Borstlap WA, Stoelinga PJW, Hoppenreijs TJM, van’t Hof MA. Stabilization of sagittal split advancement osteotomies with miniplates: a prospective study with two-year follow-up. Part II: Radiographic parameters. Int J Oral Maxillofac Surg 2004: 33: 535–542. 3. Bruce RA, Ellis 3rd E. The second Chalmers J. Lyons Academy study of fractures of the edentulous mandible. J Oral Maxillofac Surg 1993: 51: 904– 911. 4. Gerbino G, Roccia F, De Gioanni PP, Berrone S. Maxillofacial trauma in the elderly. J Oral Maxillofac Surg 1999: 57: 777–782. 5. Jones RL. Anesthesia risk in the geriatric patient. In: McLeskey CH, ed: Perioperative Geriatrics Problems in Anesthesia, vol. 3. Philadelphia: PA Lippincott 1989: 529. 6. Luhr HG, Reidick T, Merten HA. Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a retrospective evaluation of 84 consecutive cases. J Oral Maxillofac Surg 1996: 54: 250–254. 7. Mathog RH, Toma V, Clayman L, Wolf S. Nonunion of the mandible: an analysis of contributing factors. J Oral Maxillofac Surg 2000: 58: 746–752.
8. Nasser M, Fedorowicz Z, Ebadifar A. Management of the fractured edentulous atrophic mandible. Cochrane Database Syst Rev 2007 Issue 1. Art. No. CD006087. 9. Scott RF. Oral and maxillofacial trauma in the geriatric patient. In: Fonseca RJ, Walker RV, Betts NJ, eds: Oral and Maxillofacial Trauma, vol. 2. Philadelphia: PA Saunders 1997: 1045–1072. 11. Wittwer G, Adeyemo WL, Turhani D, Ploder O. Treatment of atrophic mandibular fractures based on the degree of atrophy—experience with different plating systems: a retrospective study. J Oral Maxillofac Surg 2006: 64: 230–234. Address: Duncan Campbell Regional Maxillofacial Unit Southern General Hospital 1345 Govan Road Glasgow G51 4TF Scotland UK Tel: +44 7801568946 Fax: +44 0141 232 7508 E–mail: [email protected] doi:10.1016/j.ijom.2010.10.027
Case Report Oral Medicine
Non-alcoholic steatohepatitis (NASH) and oral lichen planus: a rare occurrence D. Conrotto, E. Bugianesi, L. Chiusa, M. Carrozzo: Non-alcoholic steatohepatitis (NASH) and oral lichen planus: a rare occurrence. Int. J. Oral Maxillofac. Surg. 2011; 40: 552–555. # 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Abstract. Oral lichen planus (OLP) is frequently associated with hepatitis C virus infection but uncommonly with other causes of liver disorder. The authors report the case of a 41-year-old male patient with a clinical and histological diagnosis of OLP who presented with a marked alteration of the transaminase values, with no signs of past or present HBV, HCV, HGV or TTV infection. The patient did not consume alcohol and no exposure to hepatotoxic substances was reported. All autoantibodies were negative. Hepatic fine needle biopsy showed macrovesicular steatosis with a slight chronic portal inflammatory infiltrate and signs of siderosis. Iron metabolism was slightly altered. Genetic tests showed a heterozygotic mutation for hereditary
D. Conrotto1, E. Bugianesi2, L. Chiusa3, M. Carrozzo4 1 Division of Otorhinolaryngology, Department of Clinical Physiopathology, Oral Medicine Section, University of Turin, Italy; 2Division of Gastro-Hepatology, Department of Internal Medicine, University of Turin, Italy; 3 Department of Biomedical Sciences and Human Oncology, Pathology Section, University of Turin, Italy; 4Department of Oral Medicine, University of Newcastle upon Tyne, UK
None declared. Ethical approval
6. 7.
Not required. References 1. Aoki T, Naito H, Ota Y, Shiiki K. Myositis ossificans traumatica of the masticatory muscles: review of the literature and report of a case. J Oral Maxillofac Surg 2002: 60: 1083–1088. 2. Arima R, Shiba R, Hayashi T. Traumatic myositis ossificans in the masseter muscle. J Oral Maxillofac Surg 1984: 42: 521–526. 3. Arrington ED, Miller MD. Skeletal muscle injuries. Orthop Clin North Am 1995: 26: 411–422. 4. Carey EJ. Multiple bilateral parosteal bone and callus formations of the femur and left innominate bone. Arch Surg 1924: 8: 592–603. 5. Conner GA, Duffy M. Myositis ossificans: a case report of multiple recurrences following third molar extractions and
8.
9. 10. 11.
12.
review of the literature. J Oral Maxillofac Surg 2009: 67: 920–926. Cushner FD, Morwessel RM. Myositis ossificans traumatica. Orthop Rev 1992: 21: 1319–1326. Dimitroulis G. The interpositional dermis-fat graft in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 2004: 33: 755–760. Kim DD, Lazow SK, Berger JR HarELG. Myositis ossificans traumatica of the masticatory musculature: a case report and literature review. J Oral Maxillofac Surg 2002: 60: 1072–1076. Narang R, Dixon RA. Myositis ossificans: medial pterygoid muscle—a case report. Br J Oral Surg 1974: 12: 229–234. Parkash H, Goyal M. Myositis ossificans of medial pterygoid muscle. Oral Surg Oral Med Oral Pathol 1992: 73: 27–28. Rattan V, Rai S, Vaiphei K. Use of buccal pad of fat to prevent heterotopic bone formation after excision of myositis ossificans of medial pterygoid muscle. J Oral Maxillofac Surg 2008: 66: 1518–1522. Shirkhoda A, Armin AR, Bis KG, Makris J, Irwin RB, Shetty AN. MR imaging of myositis ossificans: variable
549
patterns at different stages. J Magn Reson Imaging 1995: 5: 287–292. 13. Spinazze RP, Heffez LB, Bays RA. Chronic progressive limitation of mouth opening. J Oral Maxillofac Surg 1998: 56: 1178–1186. 14. Takahashi K, Sato K. Myositis ossificans traumatica of the medial pterygoid muscle. J Oral Maxillofac Surg 1999: 57: 451–456. 15. Woolgar JA, Beirne JC, Triantafyllou A. Myositis ossificans traumatica of sternocleidomastoid muscle presenting as cervical lymph-node metastasis. Int J Oral Maxillofac Surg 1995: 24: 170–173. Address: Annamalai Thangavelu Division of Oral and Maxillofacial Surgery Rajah Muthiah Dental College and Hospital Chidambaram 608002 Tamil Nadu India Tel.: +91 94432 44213 Fax: +91 41442 38080. E–mail: [email protected] doi:10.1016/j.ijom.2010.10.024
Case Report Trauma
Transmucosal fixation of the fractured edentulous mandible
G. A. Wood, D. F. Campbell, L. E. Greene Regional Maxillofacial Unit, Southern General Hospital, Glasgow, UK
G. A. Wood, D. F. Campbell, L. E. Greene: Transmucosal fixation of the fractured edentulous mandible. Int. J. Oral Maxillofac. Surg. 2011; 40: 549–552. # 2010 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons. Abstract. Transmucosal fixation is a new strategy for the treatment of edentulous mandibular fractures using external fixation principles within the oral cavity. The component parts of this technique are not new. External fixation, locking plates and transmucosal implants represent the foundations of this technique; the authors’ development has been to bring these established methods together as a transmucosal intra oral locking plate fixation technique. The first eight patients treated with this technique have achieved bony union, they have no long-term sensory deficit and all patients were able to eat a soft diet with minimal discomfort the day after surgery. The first five of eight patients on long-term review showed bony union confirmed radiographically. For the remainder and subsequent patients, radiographs have not been scheduled at review, in the absence of symptoms.
Accepted for publication 29 October 2010 Available online 23 December 2010
550 [()TD$FIG]
Wood et al. tion of the nerve4. Since the screws are angled laterally in the posterior area, the benefit of bi-cortical fixation may be achieved and there is less risk to the neurovascular bundle. Anteriorly, the screws are medial to the inferior dental canal. In the authors’ experience, stability is sufficient with fixation through one cortical plate as STOELINGA et al. described in the fixation of mandibular osteotomies10. Bi-cortical fixation would increase the firmness of fixation and can be achieved with this technique. The aim of this study was to establish whether rigid fixation could be achieved transmucosally using existing locking plates and established external fixation concepts. The first eight cases are reported. Materials and method
Fig. 1. A suitably long mini-locking plate straddling the fracture site was placed and fixed. Transmucosal fixation of a mobile fracture through the right body of the mandible associated with an unerupted tooth, an ink mark represents the clinical estimate of the fracture position, also showing fixation in position and 6-month review x ray.
Treatment of the edentulous fractured mandible presents special difficulties3,8. Many methods of immobilisation have been suggested over the years, most of historic interest1 given the modern acceptance of rigid plate fixation. Patients are often elderly9 with acute and chronic comorbidities frequently complicating management and adding to anaesthetic risks5. The specific problems of edentulous mandibular fractures relate to the remaining mandibular bone height. The difficulty of achieving bony union is well known. Fractures amenable to mini-plate fixation often leave a plate near the denture bearing area and/or place a screw near the inferior alveolar neurovascular bundle risking anaesthesia or paraesthesia in the distribu-
[()TD$FIG]
Patients with an edentulous fractured mandible that required fixation were selected. If they were unfit for a general anaesthetic the procedure could be carried out under local anaesthetic with or without sedation. An impression taken before surgery can facilitate plate contouring prior to plate placement, alternatively the plate can be contoured intra-operatively. The fracture site(s) were palpated and if there was any problem with the accuracy of reduction a small incision was made to visualize the fracture line. A suitably long mini-locking plate straddling the fracture site was placed and fixed (Fig. 1). Postoperative and 6-month review radiographs were taken. There was a buried premolar in the area of this fracture, the authors avoided extracting the tooth at the time of fixation, as this would have increased the risk of non-union. Bony union was confirmed by radiography and the tooth remained buried and asymptomatic. In later cases, longer plates were used, which
Fig. 2. In the retro-molar region the screws are angled from a lingual entry directed downwards and slightly buccally.
[()TD$FIG]
Transmucosal fixation of the fractured edentulous mandible
551
and did not complain of any significant pain. After fixation removal, carried out under local anaesthesia, all patients had clinical bony union so radiography was not considered appropriate at this stage on clinical grounds and no patient required further follow-up beyond 3 months. The first three patients were recalled at 6 months and agreed to assist the study by allowing clinical examination and a review radiograph, all had achieved bony union (Figs 1c and 3b). Of the first eight patients (Table 1), one had a dense unilateral sensory deficit in the distribution of the mental nerve following bilateral fracture fixation, but this had resolved by the time fixation was removed. One patient had evidence of plate bending with plate fracture (Synthes 2.0 locking) at 7 weeks but this did not cause any significant discomfort and did not affect the outcome. One of the early bilateral fracture cases had a screw placed in the left fracture line (Fig. 3a) but the patient reported no problems and bony union is seen on the 6-month review radiograph (Fig. 3b). Discussion Fig. 3. (a) One of the early bilateral fracture cases had a screw placed in the left fracture line; and (b) the 6-month review radiograph shows bony union.
Table 1. Clinical outcomes from the first eight patients are listed. Total number of patients Plating type Plate fracture Plate bending Rigid union at time of removal Subjective sensory deficit following surgery Postoperative infection
ideally extended from retro-molar to retromolar region where screws were grouped in three specific regions, both retro-molar regions and the bone anterior to the mental foramina. In the retro-molar region the screws are angled from a lingual entry directed downwards and slightly buccally and may engage the lateral cortex but mono-cortical engagement is adequate (Fig. 2)2. The authors now avoid the mandibular body for screw placement. To avoid mucosal compression a periosteal elevator was used (Fig. 1). The locking screw could then be engaged fully without compressing the mucosa. Although initially two screws were used on either side of the fracture line, the authors considered that a minimum of
8 Synthes 2.0 locking 1/8 (patient 3) 1/8 (patient 3) 8/8 Temporary (2 months) Nil
three mono-cortical screws in the ramus regions and in the anterior mandible would be better. Postoperatively, orthopantomograms were carried out to confirm satisfactory reduction. At review, following fixation removal, patients were assessed for mobility or pain at the fracture site. If patients remained symptom free 2 weeks after fixation removal they were discharged. The first three patients returned for follow-up and radiography to confirm bony union. Results
All patients were able to eat a soft breakfast on the first postoperative day, seemed untroubled by the procedure
Treating the fractured edentulous mandible is a challenge and the more atrophic the mandible the greater the challenge11. Problems include the risks of general anaesthesia in the elderly, nerve injury, non-rigid union resulting in pain, denture rehabilitation problems, and psychological issues. The authors reviewed the notes available for patients in the preceding 2 years (seven patients) who had been treated with open reduction with internal fixation for similar fractures and followed this up with a retrospective questionnaire to determine the significant morbidities associated with conventional techniques. All had sensory deficits as a result of surgery and two had problems with drooling and would no longer eat in public. One had returned to theatre and another was re-admitted with infection. Five had problems with dentures and four had chronic pain. The authors conclude that the simple technique of transmucosal fixation can reduce operative complications and outcome in the treatment of fractures of the edentulous mandible, including ‘bucket handle’ fractures6,7. The authors have continued with this technique and report further success in the fixation of two patients treated under local anaesthesia because of medical co-morbidities rendering them unfit for
552
Wood et al.
general anaesthesia. The 2 mm locking plate showed bending with subsequent fracture in one case and as a result a more suitable plate and locking device are being developed to enhance the technique. Competing interests
The authors are seeking to commercialize a new plate based on what they have learned from this research. Funding
Scottish Health Innovations Ltd have funded a patent application total funding circa US$7K. Ethical approval
Not required. References 1. Barber H. Part I: Conservative management of the fractured atrophic edentulous mandible. J Oral Maxillofac Surg 2001: 59: 789–791.
2. Borstlap WA, Stoelinga PJW, Hoppenreijs TJM, van’t Hof MA. Stabilization of sagittal split advancement osteotomies with miniplates: a prospective study with two-year follow-up. Part II: Radiographic parameters. Int J Oral Maxillofac Surg 2004: 33: 535–542. 3. Bruce RA, Ellis 3rd E. The second Chalmers J. Lyons Academy study of fractures of the edentulous mandible. J Oral Maxillofac Surg 1993: 51: 904– 911. 4. Gerbino G, Roccia F, De Gioanni PP, Berrone S. Maxillofacial trauma in the elderly. J Oral Maxillofac Surg 1999: 57: 777–782. 5. Jones RL. Anesthesia risk in the geriatric patient. In: McLeskey CH, ed: Perioperative Geriatrics Problems in Anesthesia, vol. 3. Philadelphia: PA Lippincott 1989: 529. 6. Luhr HG, Reidick T, Merten HA. Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a retrospective evaluation of 84 consecutive cases. J Oral Maxillofac Surg 1996: 54: 250–254. 7. Mathog RH, Toma V, Clayman L, Wolf S. Nonunion of the mandible: an analysis of contributing factors. J Oral Maxillofac Surg 2000: 58: 746–752.
8. Nasser M, Fedorowicz Z, Ebadifar A. Management of the fractured edentulous atrophic mandible. Cochrane Database Syst Rev 2007 Issue 1. Art. No. CD006087. 9. Scott RF. Oral and maxillofacial trauma in the geriatric patient. In: Fonseca RJ, Walker RV, Betts NJ, eds: Oral and Maxillofacial Trauma, vol. 2. Philadelphia: PA Saunders 1997: 1045–1072. 11. Wittwer G, Adeyemo WL, Turhani D, Ploder O. Treatment of atrophic mandibular fractures based on the degree of atrophy—experience with different plating systems: a retrospective study. J Oral Maxillofac Surg 2006: 64: 230–234. Address: Duncan Campbell Regional Maxillofacial Unit Southern General Hospital 1345 Govan Road Glasgow G51 4TF Scotland UK Tel: +44 7801568946 Fax: +44 0141 232 7508 E–mail: [email protected] doi:10.1016/j.ijom.2010.10.027
Case Report Oral Medicine
Non-alcoholic steatohepatitis (NASH) and oral lichen planus: a rare occurrence D. Conrotto, E. Bugianesi, L. Chiusa, M. Carrozzo: Non-alcoholic steatohepatitis (NASH) and oral lichen planus: a rare occurrence. Int. J. Oral Maxillofac. Surg. 2011; 40: 552–555. # 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Abstract. Oral lichen planus (OLP) is frequently associated with hepatitis C virus infection but uncommonly with other causes of liver disorder. The authors report the case of a 41-year-old male patient with a clinical and histological diagnosis of OLP who presented with a marked alteration of the transaminase values, with no signs of past or present HBV, HCV, HGV or TTV infection. The patient did not consume alcohol and no exposure to hepatotoxic substances was reported. All autoantibodies were negative. Hepatic fine needle biopsy showed macrovesicular steatosis with a slight chronic portal inflammatory infiltrate and signs of siderosis. Iron metabolism was slightly altered. Genetic tests showed a heterozygotic mutation for hereditary
D. Conrotto1, E. Bugianesi2, L. Chiusa3, M. Carrozzo4 1 Division of Otorhinolaryngology, Department of Clinical Physiopathology, Oral Medicine Section, University of Turin, Italy; 2Division of Gastro-Hepatology, Department of Internal Medicine, University of Turin, Italy; 3 Department of Biomedical Sciences and Human Oncology, Pathology Section, University of Turin, Italy; 4Department of Oral Medicine, University of Newcastle upon Tyne, UK