Fellowship Training in Oral and Maxillofacial Surgery: Opportunities and Outcomes.

The pursuit of fellowship training stems from one's desire to master a focused area of surgery. Successful applicants tend to have published articles and participated in other scholarly activities. They commonly have a mentor within the subspecialty of their interest.

Brush swab as a noninvasive surrogate for tissue biopsies in epigenomic profiling of oral cancer.

Background: Oral squamous cell carcinoma (OSCC) has poor survival rates. There is a pressing need to develop more precise risk assessment methods to tailor clinical treatment. Epigenome-wide association studies in OSCC have not produced a viable biomarker.

Virtual Surgical Planning in Oral and Maxillofacial Surgery.

Virtual surgical planning provides the ability to visualize the patient anatomy and pathologic condition, establish pertinent reference points, and simulate osteotomies and reconstruction design in advance of the surgery. Virtual surgical planning is also an ideal environment for improved communication between the patient and the surgical team.

Preparation of the Neck for Advanced Flap Reconstruction.

Microvascular free tissue transfer has revolutionized the reconstruction of complex maxillofacial defects. These cases often necessitate a 2-teamed approach, with an ablative surgeon at the head and a reconstructive surgeon at a distant site for flap harvest. Careful attention to recipient vessel identification and preservation establishes the foundation for successful reconstruction.

Single-Unit 3D-Printed Titanium Reconstruction Plate for Maxillary Reconstruction: The Evolution of Surgical Reconstruction for Maxillary Defects-A Case Report and Review of Current Techniques.

The complex 3-dimensional anatomy of the facial skeleton creates a unique challenge for surgical reconstruction. Even more difficult is the precise reconstruction of the maxilla owing to its lack of solid bony support after large resections. Virtual surgical planning (VSP) technology has many applications in head and neck surgery, such as preoperative planning, fabrication of cutting guides and stereolithographic models, and fabrication of custom implants.

The Use of Acellular Urinary Bladder Matrix as Coverage for Fasciocutaneous Free Flap Donor Sites: An Alternative to Traditional Grafting Procedures.

Purpose: The purpose of this review is to 1) evaluate our early experience with urinary bladder matrix as a dressing for the management of complex wounds subsequent to fasciocutaneous or osteocutaneous vascularized tissue harvests, 2) assess coverage of exposed tendons and the duration of granulation and epithelial coverage, and 3) assess esthetic and functional outcomes compared with traditional means for the management of vascularized tissue harvest sites.

Patients And Methods: This prospective study consisted of 8 consecutive patients in whom a substantial cutaneous component was harvested as part of a vascularized tissue reconstruction, which did not permit for primary closure (n = 7) or had skin graft failure (exposed tendon) that required additional treatment (n = 1).

Results: Functional and esthetic outcomes were comparable to those of traditional methods of donor site closure as determined by clinical evaluation and subjective assessment by the patient.

Immediate Transoral Allogeneic Bone Grafting for Large Mandibular Defects. Less Morbidity, More Bone. A Paradigm in Benign Tumor Mandibular Reconstruction?

Purpose: Reconstruction of hard tissue continuity defects caused by ablative tumor surgery has been traditionally reconstructed with autogenous bone grafts or microvascular free flaps. Although results have been predictable from these 2 methods of reconstruction, the morbidity associated with bone harvest is quite serious for the patient. Predictable results have been obtained with using a combination of 100% cadaver bone, bone marrow aspirate concentrate (BMAC), and recombinant human bone morphogenic protein in immediate reconstruction for benign tumor extirpations through the extraoral approach.

Resection of an ameloblastoma in a pediatric patient and immediate reconstruction using a combination of tissue engineering and costochondral rib graft: A case report.

Background And Overview: Ameloblastoma is an odontogenic tumor predominantly occurring in patients who are in their 20s and 30s. Approximately 10% to 15% of ameloblastomas occur in patients younger than 18 years. Although it is a benign tumor, an ameloblastoma can have a devastating effect on children both physically and emotionally.

A technique for the treatment of oral-antral fistulas resulting from medication-related osteonecrosis of the maxilla: the combined buccal fat pad flap and radical sinusotomy.

Objective: Bisphosphonates and monoclonal antibodies directed at osteoclastic function are frequently used to treat postmenopausal and corticosteroid-induced osteoporosis. They are also used in the treatment of certain metastatic malignancies. However, osteonecrosis of the jaw has been reported after intravenous, subcutaneous, or oral use of these agents.

Reconstruction of Temporal Hollowing Defect With Anterior-Lateral Thigh Free Flap Following Resection of Recurrent Ameloblastoma of the Infratemporal Fossa and Right Mandible (a Case Report).

Recurrent invasive ameloblastoma of the infratemporal fossa is an uncommonly encountered phenomenon in the practice of oral and maxillofacial surgery and presents many surgical challenges for the practitioner. This case report describes a patient who underwent previous resection of a mandibular ameloblastoma with multiple recurrences. The patient was diagnosed with a recurrent ameloblastoma of the infratemporal fossa that was subsequently resected and reconstructed using an anterolateral thigh (ALT) free tissue transfer.

Use of Botox (OnabotulinumtoxinA) for the Treatment of Parotid Sialocele and Fistula After Extirpation of Buccal Squamous Cell Carcinoma With Immediate Reconstruction Using Microvascular Free Flap: A Report of 3 Cases.

Purpose: Buccal squamous cell carcinoma is an aggressive form of oral carcinoma with a high recurrence rate. Injury to the parotid duct is often unavoidable when surgically treating buccal squamous cell carcinoma because of the intimate anatomic relation among the buccal mucosa, Stensen duct, and parotid gland. It is often difficult to achieve negative margins and preserve the integrity of the parotid duct.

Adenoid cystic carcinoma of the minor salivary glands: a retrospective series of 29 cases and review of the literature.

Objective: Approximately 78% of minor salivary gland tumors are malignant, of which adenoid cystic carcinoma (ACC) represents 15% in our series. ACC is an uncommon tumor characterized by slow growth and a high potential for recurrence. This series of 29 consecutive patients examines clincopathologic features, management, and survival outcomes.

Oral surgery in patients undergoing chemoradiation therapy.

Oral health care in patients undergoing chemotherapy and/or radiation therapy can be complex. Care delivered by a multidisciplinary approach is timely and streamlines the allocation of resources to provide prompt care and to attain favorable outcomes. A hospital dentist, oral and maxillofacial surgeon, and a maxillofacial prosthodontist must be involved early to prevent avoidable oral complications.

Evaluation and staging of the neck in patients with malignant disease.

This article presents an overview of the evaluation and staging of the neck in the context of malignant disease. The current tumor-nodes-metastasis (TNM) nodal classification is reviewed followed by a brief discussion of the common malignant processes encountered in the head and neck and their associated risk factors for cervical metastasis. Common imaging modalities, such as ultrasound, magnetic resonance imaging, Computed tomography, and positron emission tomography, for the investigation of the neck are also summarized.

Parotid lymphoma: a review of clinical presentation and management.

Lymphoma of the parotid gland is a relatively rare occurrence among head and neck tumors. Presentation is indistinguishable from other swellings of the parotid gland; therefore, it is important to consider lymphoma in the differential diagnosis when examining parotid swellings. Parotid lymphomas are most likely to be B-cell non-Hodgkin lymphoma of 1 of 3 types, which include follicular, marginal zone, and diffuse large B cell, although other histologic patterns have been described.

Robotic surgery: a new approach to tumors of the tongue base, oropharynx, and hypopharynx.

Oropharyngeal cancer was traditionally treated with en bloc resection of the tumor via lip-split mandibulotomy approach, often with adjuvant radiation and chemotherapy. In the 1990s, organ-sparing definitive chemoradiation therapy without surgery became the standard of care for oropharyngeal squamous cell carcinoma. Although organ-sparing treatment provided acceptable locoregional disease control with preservation of anatomic organs adjacent to the tumors and less disfiguration from lack of surgical incisions, it often resulted in significant deficits in speech and swallowing.

Resection and immediate reconstruction of a pediatric vascular malformation in the mandible: case report.

Arteriovenous malformations (AVMs) within the mandible are rare and potentially life-threatening conditions that can pose a therapeutic dilemma. We present the case of a child with significant spontaneous gingival bleeding, radiographic evidence of a space-occupying lesion of the mandible, and delayed diagnosis and treatment because of parental reluctance to accept invasive treatment. Imaging studies and intravascular embolization with coils limited, but did not stop blood flow to this lesion.

Cavernous sinus thrombosis secondary to fracture of posterior maxillary sinus wall. Case report.

The presentation of cavernous sinus thrombosis can be ominous and, in many cases, lead to death or serious morbidity. Infections from the face can tract via a valveless venous system in a retrograde manner to the cavernous sinus. A case of cavernous sinus thrombosis secondary to a non-operable posterior maxillary sinus wall fracture is reported.

Convergent signaling by acidosis and receptor activator of NF-kappaB ligand (RANKL) on the calcium/calcineurin/NFAT pathway in osteoclasts.

Systemic acidosis has detrimental effects on the skeleton, and local acidosis coincides with bone destruction in inflammatory and metastatic diseases. Acidification dramatically enhances osteoclastic resorption, although the underlying mechanism has remained elusive. We investigated the effect of acidosis on the osteoclastogenic transcription factor NFATc1, which upon dephosphorylation translocates from the cytoplasm to nuclei.