An Overview of Maxillofacial Approaches to Smile Design.

The oral and maxillofacial surgeon (OMS) has the knowledge and skills to make drastic skeletal changes in favor of a more cosmetic smile. OMS can alter intraoral and extraoral soft tissues to make subtle or significant changes in facial cosmesis. This article provides an overview of the scope of the OMS in smile design.

Anatomical Location of Initial and Repeat Mandible Fractures: A 5-Year, Multi-Institution Retrospective Study.

Purpose: The purpose of the present study was to investigate new fracture patterns resulting from low velocity mechanisms in subjects who had previously fractured their mandible and had been treated with open reduction and internal fixation (ORIF) or closed reduction.

Methods And Materials: A multi-institutional retrospective cohort study was designed to analyze subjects presenting at 2 tertiary care centers with mandibular fractures with specific interest in subjects who had repeat mandible fractures. Variables recorded included demographic (age, sex, etc) data, fracture location of all fractures treated, and the location of previous fracture.

Immediate Reconstruction of Segmental Mandibular Defects With Nonvascular Bone Grafts: A 30-Year Perspective.

Purpose: The use of nonvascular bone grafts for immediate mandibular reconstruction has remained a controversial topic. The purpose of the present study was to investigate the variables that might influence graft survival examining the outcomes from 30 years of experience.

Materials And Methods: We designed a retrospective cohort study to analyze the data from patients at a tertiary university medical center who had undergone segmental mandibular resection with immediate reconstruction with a nonvascularized free bone graft with or without adjuncts from 1989 to 2019.

Are Psychiatric History and Substance Use Predictors of Mortality in Self-Inflicted Gunshot Wounds to the Face?

Purpose: Self-inflicted gunshot wounds to the face are one of the most challenging clinical scenarios encountered by oral and maxillofacial surgeons. Knowledge is lacking regarding which factors might influence survival after these devastating injuries, especially pertaining to psychiatric history and substance use. The purpose of the present study was to evaluate the risk factors that might influence the survival of subjects with self-inflicted gunshot wounds to the face.

In-House Digital Workflow for the Management of Acute Mandible Fractures.

Computer-aided design and additive manufacturing are revolutionizing oral and maxillofacial surgery. Current methods use virtual surgical planning sessions and custom plate milling via third-party vendors, which is costly and time-consuming, negating the effectiveness in acute facial trauma. This technical note describes a state-of-the-art in-house expedited digital workflow for computer-aided virtual fracture reduction, 3-dimensional printing, and preoperative reconstruction plate adaptation for the management of an acute mandible fracture.

Management of Mandibular Osteomyelitis With Segmental Resection, Nerve Preservation, and Immediate Reconstruction.

Purpose: The purpose was to present our experience with management of mandibular osteomyelitis with segmental resection, nerve preservation, and immediate reconstruction with nonvascularized bone grafts.

Patients And Methods: We completed a retrospective analysis of 18 cases overseen by a single practitioner at a university medical center from June 2011 to July 2018. All patients had osteomyelitis and were treated with segmental mandibular resection, inferior alveolar nerve (IAN) preservation, and immediate reconstruction with autogenous bone graft from the tibia.

The use of risdon cables in pediatric maxillofacial trauma: a technique revisited.

Although less common than adult fractures, fractures of the pediatric maxillofacial skeleton present unique challenges. Different considerations including variations of anatomy including tooth buds, dental variations, as well as considerations for future growth must be addressed. When traditional techniques to treat adult fractures are applied for securing intermaxillary fixation (IMF) such as arch bars, difficulty arises because the primary teeth are shorter and conventional arch bar techniques may slip off intra or postoperatively.

Failed Fixation in Atrophic Mandibular Fractures: The Case against Miniplates.

Despite advances in the treatment of the fractured atrophic edentulous mandible, treatment continues to be difficult. Patient management is more complicated due to patients often being elderly with more complex medical problems. Rigid internal fixation has greatly improved outcomes with shorter treatment times, yet a consensus has yet to be reached regarding which method yields the most predictable results.

Bisphosphonate-related osteonecrosis of the jaws.

Purpose Of Review: The purpose of this article is to review a new pathologic entity named bisphosphonate-related osteonecrosis of the jaws (BRONJ).

Recent Findings: BRONJ was observed and first reported in 2001-2002 when clinicians noticed cases of refractory osteomyelitis after simple dental procedures such as dental extractions in patients who had received bisphosphonate therapy. The condition was initially seen in patients who received i.

Management of comminuted fractures of the mandible.

Comminuted fractures of the mandible are unusual but not rare. They are complex injuries with a high complication rate. Gunshot wounds are a frequent cause.

Contemporary management of infected mandibular fractures.

The treatment of infected mandibular fractures has advanced rather dramatically over the past 50 years. Immobilization with maxillomandibular fixation and/or splints, removal of diseased teeth in the fracture line, external fixation, use of antibiotics, debridement, and rigid internal fixation has played a role in management. Perhaps the most important advance was the realization that infected fractures also result from moving fragments and nonvital bone, not just bacteria.

Lag screw fixation of anterior mandibular fractures: a retrospective analysis of intraoperative and postoperative complications.

Purpose: To review, retrospectively, the outcomes of 102 patients who underwent lag screw technique fixation of fractures of the anterior mandible.

Patients And Methods: A total of 102 consecutive, skeletally mature patients who have undergone open reduction internal fixation for fractures of the anterior mandible utilizing the lag screw technique were reviewed. All patients had a clinically mobile fracture between the mental foramina of the mandible.

Cone beam computed tomographic findings in refractory chronic suppurative osteomyelitis of the mandible.

Aims: To report the imaging features of osteomyelitis of the mandible in various two-dimensional multiplanar and three-dimensional reformations using cone beam computed tomography (CBCT).

Methods: The images were 12-bit DICOM files acquired with a 10cm field of view and voxel resolution of 0.4mm.

The use of immediate bone grafting in reconstruction of clinically infected mandibular fractures: bone grafts in the presence of pus.

Purpose: Current approaches to the treatment of infected mandibular fractures include antibiotics, drainage, immobilization of the segments, and debridement followed by secondary bone grafting of residual defects once the infection is resolved and the wound healed. Over the past 30 years, the time from debridement to grafting has diminished from several months to a few weeks. We present our experience with a treatment model managing clinically infected fractures of the mandible with antibiotics, debridement, rigid internal fixation, and immediate autogenous bone grafting.

New innovations in craniomaxillofacial fixation: the 2.0 lock system.

Rigid internal fixation with plates and screws is now standard for the treatment of fractures, osteotomies and reconstruction of the craniomaxillofacial skeleton. The latest innovations are self-drilling, self-tapping screws and locking miniplates. These screws offer the prospect of less instrumentation and faster application.

Principle and stability of locking plates.

A new internal Mini-Locking-System was tested compared with conventional 2.0 mm Miniplates. Standardised osteotomies in the angular region of 16 human cadaver mandibles were fixed with a 6-hole-plate at the oblique line.