Mandibular subluxation for distal internal carotid exposure: technical considerations.

Purpose: Carotid endarterectomy (CEA) has become one of the most commonly performed vascular procedures, because of the beneficial outcome it has when compared with medical therapy alone and because of the anatomic accessibility of the artery. In cases of distal carotid occlusive disease, high cervical carotid bifurcation, and some reoperative cases, access to the distal internal carotid artery may limit surgical exposure and increase the incidence of cranial nerve palsies. Mandibular subluxation (MS) is recommended to provide additional space in a critically small operative field.

Early diagnosis of asymptomatic oral and oropharyngeal squamous cancers.

An examination of the oral cavity and oropharynx in asymptomatic patients at high risk requires an orderly visual inspection of the entire oral and oropharyngeal mucosa with particular attention to the tongue, floor of mouth, soft palate, uvula, tonsillar pillars, and the lingual aspects of the retromolar trigones. Completion and clear documentation of the entire examination should be recorded. Detected lesions that do not resolve in a reasonable length of time--two to three weeks--require intense and assiduous investigation.

Cephalometric templates based on the Bolton standards.

An accurate, simple, rapid method of cephalometric profile analysis is proposed. Templates, derived photographically from the 9-year through 18-year male-female Bolton standard tracings, are used to define the optimal locations for any selected hard or soft tissue dentofacial landmarks. Discrepancies between the ideal and actual positions of each landmark are immediately apparent and graphically reveal existing deformities.

Early detection, diagnosis, and management of oral and oropharyngeal cancer.

1. Drinkers and cigarette smokers are at very high risk for the development of upper aerodigestive tract and lung squamous carcinomas. 2.

Crestal ostectomy and lateral wall compression for management of the enlarged pneumatized tuberosity.

The crestal ostectomy with lateral antral wall compression is a simple, predictable procedure to correct soft tissue and osseous hypertrophy in the pneumatized maxillary tuberosity. It offers certain advantages over other techniques: 1) simultaneous reduction of vertical and lateral aspects of the hyperplastic tuberosity; 2) simultaneous revision of hypertrophic or mobile mucosal tissue overlying the tuberosity; 3) avoidance of a horizontal scar band in the buccal vestibule, which may subsequently interfere with the denture flange; 4) negligible effect on the depth of the buccal vestibule; 5) fixation wires are not required; 6) rapid healing of the osteotomy site, since there is intimate bony contact; 7) expedient initiation of denture fabrication is possible because the palatal aspect of the tuberosity is not mobilized; and 8) no surgical stent is necessary.

Complications associated with skin graft vestibuloplasty. Experiences with 100 cases.

The mandibular skin graft vestibuloplasty with lowering of the floor of the mouth is a relatively complex surgical procedure and can be accompanied by a large number of diverse complications. In our experience, these have ranged from minor inconveniences to a life-threatening emergency. Most could be easily prevented or simply managed.

Instrument-marking tapes: an unnecessary hazard.

Instrument-marking tapes facilitate instrument preparation and packaging but can be responsible for increased surgical morbidity by fragmenting into the wound or harboring bacteria when old or damaged. Four cases of submandibular abscess formation and the potential failure of an oro-antral closure were directly attributed to the use of marking tapes.

Management of bilateral fractures three weeks after mandibular skin graft vestibuloplasty.

Management of bilateral fractures of the atrophic mandible is a difficult problem. A recent skin graft vestibuloplasty with lowering of the floor of the mouth compromises the blood supply to the fractured segments and jeopardizes the changes for bony union. The viability of the skin graft and the stability of the vestibular extension are also at risk.

Cryosurgical management of benign and dysplastic intraoral lesions.

Benign and dysplastic diseases of oral mucous membranes commonly present problems in management. The recurrent nature and sometimes widespread involvement of these lesions necessitates a treatment that is easy to use, adaptable to the variations of disease, and relatively free of complications. Cryosurgery meets these treatment requirements admirably.

Pre-auricular oat cell carcinoma metastases.

The oat cell tumor is a particularly lethal form of bronchogenic carcinoma. Cutaneous metastases occur occasionally in the pre-auricular area. In addition to benign and malignant parotid lesions, the differential diagnosis of a pre-auricular mass must now include metastatic disease, particularly if a history of a thoracic malignancy is elicited.

Necrotizing sialometaplasia.

Three additional cases of necrotizing sialometaplasia are discussed. Clinical appearance of the lesion is not diagnostic. Microscopy shows pseudoepitheliomatous hyperplasia, squamous metaplasia, and acinar necrosis.

Malignant melanoma metastatic to the mandible.

Metastatic malignant melanoma to the jaws is uncommon and is usually accompanied by generalized involvement. Hematogenous dissemination with deposition and growth in areas of hematopoietic marrow (that is, the mandibular molar region) is the accepted mechanism for involvement of the jaw. Clinical and radiographic findings are nonspecific.

Intraoral basal cell carcinoma.

The evaluation and treatment of an intraoral lesion over a period of 8 years is presented. Clinical appearance and course, microscopic findings, and response to treatment were consistent with a diagnosis of basal cell carcinoma of the mucous membrane. Current theories of histogenesis and the biological behavior of basal cell lesions are discussed.