Le Fort-based maxillofacial transplantation: current state of the art and a refined technique using orthognathic applications.

Following encouraging results from the first 6 maxillofacial allotransplants, there has been a dramatic rise in interest worldwide. Numerous groups are now devoting resources to increase the frequency of these complex procedures, and with this, the craniomaxillofacial surgeon should become familiar with the emerging state of the art. This article reviews the evolution of Le Fort-based cadaveric studies pertaining to maxillofacial allotransplantation, briefly describes the clinical reports through 2010, and introduces a refined technique applying orthognathic applications.

Molecular methods for diagnosis of odontogenic infections.

Purpose: Historically, the identification of microorganisms has been limited to species that could be cultured in the microbiology laboratory. The purpose of the present study was to apply molecular techniques to identify microorganisms in orofacial odontogenic infections (OIs).

Materials And Methods: Specimens were obtained from subjects with clinical evidence of OI.

Three-dimensionally printed polycaprolactone and β-tricalcium phosphate scaffolds for bone tissue engineering: an in vitro study.

Purpose: The purpose of this study was to evaluate porcine bone marrow-derived progenitor cell (pBMPC) proliferation and penetration into a novel 3-dimensionally printed scaffold.

Materials And Methods: Four different tissue engineering scaffolds to evaluate pBMPC proliferation and penetration were examined. Scaffolds were fabricated from polycaprolactone (PCL) or the combination of β-tricalcium phosphate (β-TCP) and PCL (50:50), with 2 separate channel sizes (1 mm [small (S)] vs 2 mm [large (L)]).

Osteocutaneous maxillofacial allotransplantation: lessons learned from a novel cadaver study applying orthognathic principles and practice.

Background: Osteocutaneous maxillofacial allotransplantation is an encouraging technique for reconstruction of complex midfacial injuries (i.e., Gordon type III composite tissue allotransplantation).

Do antibiotics reduce the frequency of surgical site infections after impacted mandibular third molar surgery?

Surgical removal of impacted third molars remains the most common procedure performed by oral and maxillofacial surgeons. Given the abundance of host bacteria within the operative sites, surgical site infections are among the most common complications of third molar removal, with an estimated frequency of 1% to 30%. In this setting, significant controversy has surrounded the use of prophylactic antibiotics in the surgical management of impacted third molars.

Craniomaxillofacial reconstruction using allotransplantation and tissue engineering: challenges, opportunities, and potential synergy.

The face is composed of an intricate underlying bony/cartilaginous framework that supports muscle, secretory organs, and sophisticated skin/subcutaneous structures. These components are attached through numerous ligaments and interact dynamically with a vast neurovascular network. The most sophisticated autologous reconstructive techniques, utilizing composite free-tissue flaps, are often inadequate to restore extensive maxillofacial defects.

Percutaneous dilatational tracheostomy: review of technique and evidence for its use.

Tracheostomy is a technique for airway management commonly used by surgeons who care for critically ill patients. Patients with traumatic facial injuries, severe odontogenic infections, and head and neck malignancies are often recipients of tracheostomies. As such, the oral and maxillofacial surgeon who frequently treats such patients should be well-trained in tracheostomy placement.

After dentoalveolar surgery, most patients are satisfied with telephone follow-up.

Purpose: To estimate patient satisfaction with telephone follow-up and compare the frequencies of postoperative complications between patients undergoing telephone and those undergoing clinical follow-up after ambulatory office-based dentoalveolar procedures.

Materials And Methods: Using a retrospective study design, the investigators enrolled a cohort of subjects who had had at least 1 tooth extracted during a 2-year period. The primary study variable was subject self-report of satisfaction with the telephone follow-up.

Do perioperative antibiotics decrease implant failure?

Purpose: To execute an evidence-based review answering the following question: "Among patients receiving dental implants, do those who receive perioperative antibiotic therapy, compared with those who do not, have a decreased likelihood of implant failure?"

Materials And Methods: We performed a literature review. The primary predictor variable was an antibiotic regimen, which was grouped into 3 categories: a single preoperative dose, a single preoperative dose and multiday postoperative therapy, and no antibiotic therapy. The primary and secondary outcome variables were implant failure and postoperative infection, respectively.

Serial histologic and immunohistochemical changes in anterior digastric myocytes in response to distraction osteogenesis.

Purpose: To document histologic and immunohistochemical changes in the anterior digastric muscle during distraction osteogenesis (DO).

Materials And Methods: Nineteen Yucatan minipigs with mixed dentition were used for these experiments. Group A (n = 16) underwent unilateral mandibular distraction at a rate of 1 mm/day (no latency) for 12 days.

Upper airway length decreases after maxillomandibular advancement in patients with obstructive sleep apnea.

Purpose: Most reports on airway anatomy after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) have focused on changes in airway diameter, ie, posterior airway space (PAS), rather than airway length. The purpose of this study was to evaluate changes in cephalometrically measured upper airway length (UAL) after MMA.

Materials And Methods: This was a retrospective cohort study.

Effect of surgeon training, fracture, and patient variables on calcaneal fracture management.

Background: There appears to be a general lack of consensus in treating calcaneus fractures. Many different patient-based variables such as smoking, diabetes, or occupation, may influence treatment decisions possibly more so than the nature of the injury itself. Indications for operative versus nonoperative treatment are often unclear.

Three-dimensional computed tomographic airway analysis of patients with obstructive sleep apnea treated by maxillomandibular advancement.

Purpose: To evaluate changes in airway size and shape in patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) and genial tubercle advancement (GTA).

Materials And Methods: This was a retrospective cohort study, enrolling a sample of adults with polysomnography-confirmed OSA who underwent MMA + GTA. All subjects who had preoperative and postoperative 3-dimensional computed tomography (CT) scans to evaluate changes in airway size and shape after MMA + GTA were included.

Multidetector and three-dimensional CT evaluation of the patient with maxillofacial injury.

Interpretation of images associated with the traumatically injured face is challenging. The complexity of facial anatomy, coupled with the superimposition of numerous bony structures on plain radiographs, poses specific obstacles to accurate interpretation of facial injury. Although plain radiographs can be helpful in cases of isolated injuries, CT is the most useful modality for evaluating facial injury.

Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a disorder characterized by repetitive, episodic collapse of the pharyngeal airway. Over the last two decades, understanding of the pathophysiology of sleep disordered breathing, which includes OSA, has improved. Once thought to be predominately related to anatomic constriction of the maxillomandibular complex, central nervous system regulation of breathing is now recognized as a significant contributor to the pathogenesis of OSA.

Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea.

Purpose: The purpose of this study was to measure upper airway length (UAL) on lateral cephalograms and to assess its relationship with the presence and severity of obstructive sleep apnea (OSA).

Materials And Methods: Using a case-control study design, the investigators enrolled a sample of cases defined as adult subjects with OSA and controls who were adult patients with skeletal Class II malocclusions. The primary predictor variable was UAL.

Clinician- and patient-reported long-term evaluation of screw- and cement-retained implant restorations: a 5-year prospective study.

The purpose of this study was to evaluate the survival and success of screw- versus cement-retained implant crowns over a 5-year period. This was a multi-center prospective cohort study, consisting of patients who had ≥1 dental implant placed and restored in the anterior maxilla over a 5-year period. The primary predictor variable was the type of restoration (screw- versus cement-retained).

Validation of a diagnostic protocol used to identify intimate partner violence in the emergency department setting.

Purpose: To assess the internal validity of a diagnostic protocol developed to facilitate the identification of women with intimate partner violence (IPV)-related injuries.

Materials And Methods: Using a cross-sectional study design, we enrolled a sample of female subjects presenting to the emergency department for treatment of injuries with non-verifiable etiologies. The study sample was divided randomly into index and validation sets.

Markers for intimate partner violence in the emergency department setting.

Purpose: Intimate partner violence (IPV) is a serious, under-reported public health problem in the United States. Pilot studies suggested that injury location, that is, head, neck, or face, was a sensitive but nonspecific marker for IPV-related injuries. This study's goal was to determine whether adding a second element to the diagnostic protocol-response to an IPV-screening questionnaire-improved the specificity of the protocol.

Does computed tomographic assessment of inferior alveolar canal cortical integrity predict nerve exposure during third molar surgery?

Purpose: To evaluate the association between computed tomographic (CT) assessment of inferior alveolar nerve (IAN) canal cortical integrity and intraoperative IAN exposure.

Materials And Methods: This was a retrospective cohort study. The study sample included patients considered at high risk for IAN injury based on panoramic findings.

Use of panoramic x-ray to determine position of impacted maxillary canines.

Purpose: To evaluate the position of impacted maxillary canines in the alveolus using panoramic radiographs.

Materials And Methods: The present study was a retrospective chart review of 102 patients with 130 impacted maxillary canines from the University of Illinois at Chicago College of Dentistry and private practice. Of the 130 impacted maxillary canines, 59 were impacted buccally and 71 were impacted palatally.

Three-dimensional computed tomographic analysis of airway anatomy.

Purpose: To test the reliability of a 3-dimensional computed tomographic (3D-CT) analysis of airway size and shape and to correlate the 3D-CT findings with lateral cephalometric measurements.

Materials And Methods: Fifteen pairs of preoperative maxillofacial 3D-CT scans and digital lateral cephalograms of patients treated for obstructive sleep apnea were used in the present study. Digital 3D-CT reconstructions were created and 12 measurements of airway size and 4 of shape were analyzed.

Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea.

Purpose: To identify abnormalities in airway size and shape that correlate with the presence and severity of obstructive sleep apnea (OSA).

Materials And Methods: This was a retrospective case series of patients undergoing treatment of OSA who had preoperative computed tomographic (CT) scans of the upper airway available. Patients who had undergone CT scanning for nonairway pathologic features during the same period served as the controls.