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Oral manifestations of side effects of medications, such as methotrexate (MTX) for management of rheumatoid arthritis (RA) and mycophenolate mofetil (MMF) for solid organ transplant (SOT), are very rare. The known side effects include entities called other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) due to immunosuppression caused by these medications. While there has been an increased incidence of oral cavity LPD reported in the literature associated with MTX, oral presentations that involve MMF are rare. This case report will detail a 74-year-old man with scleroderma treated with MMF who developed Epstein-Barr virus + polymorphic B-cell lymphoproliferative disorder in the right maxillary gingiva presenting as osteonecrosis of the jaw (ONJ). His oral presentation was successfully treated with a combination of surgery and MMF dosage reduction with an oral presentation free of disease at 6 months follow-up. This is the first known case report of an oral manifestation of MMF-related OIIA-LPD.

Purpose Because limited data have been reported, the purpose of the present study was to evaluate the long-term craniofacial cephalometric skeletal changes associated with maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA). Materials and Methods We performed a retrospective cephalometric cohort study of craniofacial skeletal changes in patients who had undergone MMA for OSA. The primary predictor and outcome variables were time and the change in SNB over time, respectively. Digitized cephalometric radiographs were analyzed by an independent third-party cloud-based tracing software for 6 skeletal landmarks at 3 points—preoperatively, within 1 month postoperatively, and at the last follow-up evaluation. Post hoc stratification bidimensional analyses by gender and preoperative age and body mass index (BMI) were performed. Clinically significant results were determined as a greater than 2% change from baseline. Univariate and bivariate statistics were computed, and the statistical significance level was set at P Results Thirty consecutive subjects with an even gender distribution were included in the present study. The average preoperative age, apnea hypopnea index, and BMI were 43.7 years, 59.8, and 39.3 kg/m2. The average follow-up duration was 10.7 years (range, 5.6 to 18.8). Statistically and clinically significant long-term postoperative changes were found only for SNA (+4.9° or +6.0%; P Conclusions Within the limitations of the present study, MMA for OSA produced statistically and clinically significant long-term cephalometric skeletal horizontal angular advancement of the maxilla and mandible of 6 and 4.9%, respectively, independently of gender, age, or BMI.

The purpose of this study was to evaluate neurosensory recovery after mental nerve skeletonization in open reduction and internal fixation (ORIF) of mandible fractures.This was a prospective nonrandomized observation study of adult subjects treated at a Level I trauma center between April 1, 2016 and December 31, 2019, with mental nerve skeletonization for ORIF of mandible fractures. Age, sex, and mandibular injury severity score (MISS), and functional sensory recovery (FSR) and subjective neurosensory recovery of skeletonized mental nerve were recorded at preoperative and regularly scheduled follow-up appointments. Uninomial and multinomial logistic regressions were conducted with a significance level of0.05.Twenty-six subjects (all male) completed all the postoperative protocol requirements and were included in this study. All subjects had a loss of FSR (S0) and subjective neurosensation immediately after surgery. Half of the subjects achieved FSR (S3) and subjective neurosensory recovery (VAS 4) an average of 42 days after surgery. All subjects improved FSR (S4) by 57 days and subjective neurosensory recovery by 90 days after surgery. These were independent of MISS but had decreased recovery time with increased age. No incidences of mental nerve neuropathic pain during the trial period were found.FSR and subjective neurosensory recovery from mental nerve skeletonization in intraoral ORIF of mandible fractures was achieved in all subjects by the end of this study. Neurosensory recovery was independent of MISS but decreased with increased age. Initial inverse correlations between objective and subjective neurosensory assessments were insignificant at study completion. No incidences of neuropathic pain were identified during the time of this study. Mental nerve skeletonization in ORIF of mandible fracture may be performed with an anticipated return of functional and subjective neurosensory recovery within 3 months of surgery.

Purpose We sought to evaluate the effect of maxillomandibular advancement (MMA) on long-term subjective quality of life (QOL) in obstructive sleep apnea (OSA). Patients and Methods This was a retrospective cohort analysis of long-term postoperative QOL issues in patients who underwent MMA for polysomnogram-confirmed severe OSA (apnea-hypopnea index > 30). The inclusion criteria included a history of MMA in the treatment of OSA, willingness to complete the Ottawa Sleep Apnea Questionnaire (OSA-Q) survey, and minimum of 5-year follow-up. The OSA-Q was used to evaluate sleep quality, daytime function, physical health, mental and emotional health, and sexual health. The independent variable was time of follow-up, and the dependent variables were the responses to the OSA-Q. Data collection was completed, and statistical analyses were performed with the 1-sample Wilcoxon signed rank test with a median score of 3 (no change) to evaluate for significant changes in the categories. P Results A total of 27 of 51 eligible patients (53% response rate) responded to the questionnaire (15 men and 12 women). The average postoperative age was 59.1 ± 11.7 years, with an average follow-up period of 12.7 ± 3.8 years. Statistically significant long-term QOL improvements from MMA for OSA were found in overall QOL (mode, 4; P Conclusions MMA for OSA provided significant improvement in overall patient QOL as well as personal satisfaction, sleep quality, and functional outcomes at very long-term follow-up at an average of more than 12 years after surgery. MMA for OSA produces significant very long-term subjective QOL improvement.

Purpose The relationship between edentulism and the severity of obstructive sleep apnea syndrome (OSAS) is not well established. The purpose of the present study was to evaluate the relationship of edentulism on the severity of OSAS compared with equally at-risk dentate subjects. Patients and Methods We performed a retrospective matched cohort study of edentulous and dentate subjects with OSAS matched by age, gender, and body mass index (BMI). The primary predictor variable was dentate status (dentate vs edentulous) and the primary outcome variable was the OSAS severity measured using apnea hypopnea index (AHI). The secondary outcome variables were the Epworth sleepiness scale (ESS) score and nadir oxygen level. Inferential, univariate, and multivariate statistical analyses were completed. Results A total of 26 subjects (13 edentulous and 13 dentate) were included in the present study. The edentulous subjects had more severe OSAS compared with the equally at-risk dentate subjects, with statistically significant differences between the 2 groups for AHI (47 ± 25 vs 23 ± 11; P = .0044) and ESS score (16 ± 4.2 vs 11 ± 5.2; P = .0094). A significant multivariate effect for OSAS was only found for the covariates of gender (female vs male; P = .016) and edentulism status (yes vs no; P = .01), with no significant interaction between them (P = .24). Conclusions Within the limits of the present study, edentulous subjects, compared with dentate subjects, and controlling for age, gender, and BMI, had more severe OSAS, as evidenced by the significantly increased AHI and ESS. Male gender and edentulism are significant risk factors for more severe OSAS compared with equally at-risk dentate patients.

Traumatic genial tubercle fracture of the mandible is a rare event that may cause airway compromise owing to loss of the support to the base of the tongue. Over the last 70 years, only 7 known cases of traumatic genial tubercle fractures have been reported. We detail the surgical management of 2 traumatically induced genial tubercle fractures that involved varying levels of airway compromise. These 2 cases add to the limited body of knowledge of the surgical management of this rare and potentially fatal mandible fracture pattern.

We evaluated and correlated the long-term subjective perioral neurosensory deficit intensity and oral functional behavior difficulty after maxillomandibular advancement (MMA) for adult obstructive sleep apnea (OSA).We implemented a long-term retrospective cohort study of adult subjects who had undergone MMA for OSA, with subjective assessments using 7-point visual analog scales. Adult subjects who had undergone MMA for OSA with a minimum of 5 years of follow-up data available who had agreed to participate were included in the present study. The 1-sample Wilcoxon signed rank test and Spearman correlation coefficients were used to evaluate the data. Statistical significance was set at the P .05 level.Of the 51 eligible subjects, 27 (53% response rate) were included in the present study. The mean age preoperatively was 59.8 years, with a mean follow-up of 12.7 years. Most subjects (85%) had, overall, reported the long-term subjective perioral neurosensory deficit intensity to be none to very mild (mode, 0; mean, 2.20; P .05) and oral functional behavior to have none to very mild difficulty (mode, 0; mean, 1.6; P .05). Statistically significant moderate to strong positive correlations between the subjective assessments of oral functional behavior and perioral neurosensory deficit intensity were found for chewing (r = 0.74), kissing (r = 0.50), eating (r = 0.80), speaking (r = 0.81), and drooling (r = 0.67).Within the limitations of the present study, more than 12 years after MMA for severe OSA, most subjects (85%) had minimal to no subjective perioral neurosensory deficits and very minimal to no difficulty in the subjective assessment of oral functional behavior. Strong positive correlations between the subjective decreased perioral neurosensory deficit intensity and decreased oral function behavior difficulty suggest that the return of perioral neurosensation might contribute to the return of oral functional behavior.

We present an adalimumab-related dental implant surgical-site infection. A 55-year-old patient with a history of twice-weekly adalimumab subcutaneous injections for ulcerative colitis underwent mandibular extractions and placement of 5 immediate dental implants. She experienced intraoral purulent drainage from all 5 dental implant sites with submental and submandibular space infections 2 weeks after surgery. Treatment consisted of extraoral incision and drainage of involved fascial spaces, removal of all mandibular dental implants, and debridement of necrotic mandibular bone. She went on to heal uneventfully. In individuals taking adalimumab, severe infection with loss of implants and bone may develop.

Purpose To evaluate long-term clinically significant cephalometric skeletal stability with maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA). Materials and Methods We performed a retrospective cohort analysis of long-term clinically significant skeletal stability in patients who underwent MMA for OSA. The primary predictor and outcome variables were the occurrence of and time to loss of clinically significant skeletal stability, respectively, at sella–nasion–B point (SNB). The inclusion criteria included severe OSA (apnea-hypopnea index > 30), MMA, diagnostic preoperative and postoperative lateral cephalometric radiographs, and a minimum of 5 years of follow-up. Digitized cephalometric radiographs were analyzed at 3 time points: preoperatively, postoperatively, and at last follow-up. Statistical analyses included Kaplan-Meier time–to–loss of clinical stability analysis, the log-rank test, and the Cox proportional hazards model for hazard ratio determination for the influence of the following independent variables on loss of clinical stability: gender, age at the time of surgery, time to follow-up, and amount of surgical movement. Post hoc stratification for bone grafting was completed. Statistical significance was set at the P Results Thirty consecutive patients with an even gender distribution and average follow-up period of 10.7 years were included in this study. Preoperatively, the average age was 43.7 years; apnea-hypopnea index, 59.8; and body mass index, 39.3. Half of the cohort had clinically significant loss of skeletal stability at sella–nasion–A point (SNA), SNB, and A point–nasion–B point (ANB) approximately 13 years after surgery, with no statistically significant difference between SNA, SNB, and ANB curves (χ2 = 0.12) independent of the independent variables at SNB (χ2 = 1.9), SNA (χ2 = 1.3), or ANB (χ2 = 1.3). The average hazard ratio ranged from 0.89 to 1.02. Conclusions Within the limitations of this study, MMA in the treatment of severe OSA is a highly skeletally stable long-term procedure independent of gender, age at the time of surgery, time to follow-up, and amount of surgical movement.

To comprehensively determine the effectiveness and safety of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA).We designed and implemented a prospective multicenter cohort study to evaluate OSA patients who underwent MMA. The primary outcome measures and associated instruments included sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (QOL) (Functional Outcomes of Sleep Questionnaire [FOSQ]), sleep-disordered breathing (apnea-hypopnea index), cardiovascular risk (office blood pressure and levels of high-sensitivity C-reactive protein), and neurocognitive performance (psychomotor vigilance testing [PVT]). The outcomes were measured preoperatively and approximately 6 months postoperatively. Other variables were grouped into the following categories: demographic and pre-MMA use of continuous positive airway pressure. Descriptive and bivariate statistics were computed.The sample was composed of 30 adult patients (63% men; mean age, 45.9 ± 9.8 years). The median length of follow-up was 6.7 months (range, 4.3 to 12.7 months). The ESS score decreased from a mean of 13.3 to 4.9 (P .001). The FOSQ score increased from a mean of 14.1 to 18.3 (P .001). The apnea-hypopnea index decreased from a mean of 39.6 to 7.9 events per hour (P .001). Mean diastolic blood pressure decreased from 83 to 79.7 mm Hg (P = .025). PVT response times improved after MMA (P = .04). Few treatment-related adverse events occurred, which had minimal impact on the QOL. Additional improvements in sleepiness (mean ESS score change, -7.6; P .001), QOL (mean FOSQ score change, 3.9; P .001), and PVT (mean change, 0.5; P = .004) occurred after MMA for patients using continuous positive airway pressure before surgery.MMA is a highly effective and safe treatment for OSA, which predictably leads to significant improvements in sleepiness, QOL, sleep-disordered breathing, and neurocognitive performance, as well as a reduction in cardiovascular risk (blood pressure).

Purpose The purpose of this study was to determine the frequency and relative risk (RR) of early postoperative major medical complications after surgery for the management of obstructive sleep apnea. Patients and Methods This was a retrospective cohort analysis of patients who had undergone surgery for the treatment of polysomnogram-confirmed obstructive sleep apnea at 2 hospitals in Pittsburgh, PA, between 1992 and 2013. Early postoperative major medical complications were defined as either a life-threatening complication requiring intensive care unit intervention or death within the immediate hospital course. Standard demographic data, apnea-hypopnea index, Epworth Sleepiness Score, minimum nocturnal oxygen saturation, and body mass index were collected. The 2-tailed independent t test, Fisher exact test, and RR with 95% confidence interval were used. Results A total of 267 consecutive patients who underwent surgery for obstructive sleep apnea and met the inclusion criteria were included in this study. A total of 6 patients (6 of 267, 2.2%) had early major medical postoperative complications. When stratified by surgical group (intrapharyngeal vs extrapharyngeal), there were 162 intrapharyngeal patients with 2 complications (1.2%) and 105 extrapharyngeal patients with 4 complications (3.8%). We found no statistically significant difference in frequency (2 of 162 intrapharyngeal patients [1.2%] vs 4 of 105 extrapharyngeal patients [3.8%], P = .17) or RR (3.1; 95% confidence interval, 0.58 to 16.55; P = .1885) between the groups. There were statistically significant differences for mean age, apnea-hypopnea index, Epworth Sleepiness Score, minimum nocturnal oxygen saturation, and body mass index between the surgical groups. Conclusions The overall frequency of early major medical postoperative complications in upper airway surgery for obstructive sleep apnea is low, with no statistically significant difference in frequency and RR between intrapharyngeal and extrapharyngeal surgery. There may, however, be a clinically significance difference in RR possibly because of associated differences in risk factors between the groups.

The sixth biennial Clinical and Scientific Innovations in Oral and Maxillofacial Surgery, formerly the Research Summit, of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois from April 28 to 30, 2017. The goal of the symposium is to provide a forum for the latest clinical and scientific advances to be brought to the specialty. It also nurtures collaboration and the development of relationships between oral and maxillofacial surgeons and researchers to bridge the gap between clinical and basic science. The goal is to improve the care of oral and maxillofacial surgical patients through the advancement of translational and clinical research.

The purpose of this study was to determine the efficacy of pre-emptive analgesia with pregabalin and celecoxib on narcotic consumption and perceived pain in adult patients undergoing maxillomandibular advancement surgery for obstructive sleep apnea.This was a prospective, randomized, double-blinded, placebo-controlled study of adult patients undergoing elective maxillomandibular advancement surgery for obstructive sleep apnea. The groups received a masked 1-time preoperative oral dose of pregabalin 150 mg and celecoxib 400 mg (experimental group) or lactose powder 2 g (placebo group). In the postoperative period, pain management consisted of intravenous morphine patient-controlled analgesia and oral oxycodone 5 mg and acetaminophen 325 mg. Patients completed a daily pain and narcotic log. Statistical significance between group means was determined by the 2-tailed independent t test.There were statistically significant differences between the pregabalin plus celecoxib and placebo groups in average intravenous morphine consumption per 4-hour interval (6.0 ± 5.9 vs 9.3 ± 7.9 mg; P.05), mean daily narcotic pill consumption (2.9 ± 2.9 vs 6.8 ± 1.8 pills; P.05), and mean daily visual analog scale scores (4.3 ± 3.5 vs 5.5 ± 5.0; P.05).Within the limitations of this study, a 1-time preoperative oral dose of pregabalin and celecoxib before adult maxillomandibular advancement surgery for obstructive sleep apnea decreased mean intravenous morphine consumption, mean daily narcotic pill consumption, and mean patient perceived pain.

The American Association of Oral and Maxillofacial Surgeons, the Oral and Maxillofacial Surgery Foundation, and the International Association of Oral and Maxillofacial Surgeons sponsored the fifth research summit, which convened on May 2 and 3 in Rosemont, Illinois. The Research Summits are convened biennially to facilitate the discussion and collaboration of oral and maxillofacial surgeons with clinical and basic science researchers in fields affecting the specialty. The goal is to advance the field of oral and maxillofacial surgery through exposure and education in topics that ultimately benefit the oral and maxillofacial surgical patient. This edition of the research summit included the topics of robotic surgery and antiresorptive-related osteonecrosis of the jaws (ARONJ). Most importantly, this research summit saw the development of research interest groups (RIGs) in the fields of anesthesia, maxillofacial oncology and reconstructive surgery, obstructive sleep apnea and orthognathic surgery, temporomandibular joint surgery, and trauma. These RIGs developed specific research goals with a plan to continue working on potential projects at the AAOMS Clinical Trials Course on May 7 to 9, 2013 at the University of Michigan in Ann Arbor. The summit program was developed by the AAOMS Committee on Research Planning and Technology Assessment. The charge of the committee is to encourage and promote research within the specialty and to encourage interdisciplinary collaboration. The research summit serves as a platform for oral and maxillofacial surgeons to lead the goal of advancement of research relevant to the specialty. This article provides an overview of the presentations that were made in the sessions on robotic surgery and ARONJ. The research summit keynote address and two additional presentations on patient registries are summarized and updates from the RIGs that were formed at the 2013 research summit are highlighted.

The purpose of this study was to evaluate the hemodynamic stability and efficacy of 3 different propofol-ketamine admixtures compared with a propofol-saline solution admixture for continuous-infusion intravenous general anesthesia in outpatient adult dentoalveolar surgery.This was a prospective, randomized, positive-controlled clinical trial between a propofol-saline solution admixture and 3 propofol-ketamine admixtures comprising 4 groups: group A (control), propofol and saline solution; group B, 10:1 propofol-ketamine ratio; group C, 5:1 propofol-ketamine ratio; and group D, 3:1 propofol-ketamine ratio. The bispectral index (BIS) was used to monitor all patients for time to induction (BIS70) to recovery time (BIS90). The outcome variables-noninvasive systolic, diastolic, and mean blood pressures; pulse; and BIS-were recorded at baseline and every 5 minutes during surgery. One-way analysis of variance and χ(2) analysis were conducted on the groups to determine statistical significance, set at P.05. Post hoc pair-wise comparisons with Bonferroni adjustments were conducted on statistically significant groups.A total of 64 adult patients (37 men and 27 women; mean age, 27.3 years) who had dentoalveolar surgery under intravenous general anesthesia in an outpatient oral and maxillofacial surgery clinic setting were enrolled in this study. There were statistically significant differences between mean values of groups only for mean systolic blood pressure and mean blood pressure in groups A and D (127 mm Hg vs 146 mm Hg and 96 mm Hg vs 109 mm Hg, respectively). There were statistically significant differences in percent change from baseline measurements only between groups A and D for systolic blood pressure (-6.9% vs +1.3%), diastolic blood pressure (-5.4% vs +0.7), and mean arterial pressure (-0.5% vs +2.6%). All mean percent changes from baseline were within 20% of baseline. There were statistically significant differences between groups for number of boluses but not time to surgery start, movement on injection, or length of surgery. Statistically significant differences in recovery times were found between all groups except between groups A and C and groups C and D. There were no incidences of postoperative nausea or vomiting in the immediate postoperative period.Through maintenance of hemodynamic stability and faster recovery time, the group B admixture (10:1 propofol-ketamine ratio) provided the greatest benefit for continuous intravenous general anesthesia in adults undergoing dentoalveolar surgery in an outpatient clinic setting.

Purpose This study sought to determine the changes in cephalometric facial profile soft tissue measurements after simultaneous elliptical-window genioglossus advancement and hyoid suspension procedures for obstructive sleep apnea. Patients and Methods A retrospective analysis of preoperative and postoperative lateral cephalometric soft tissue changes in 23 consecutive patients who had undergone combined elliptical-window genioglossus advancement and hyoid bone suspension for polysomnogram-confirmed obstructive sleep apnea. Six cephalometric soft tissue measurements of the lower face were evaluated: pogonion (Pg′-Pg), menton (Me′-Me), gnathion (G′-G), lower lip (LI-L1i), B point (B-B′), and horizontal distance from subnasale perpendicular to the soft tissue chin at the level of pogonion (SN-Pg′). Statistical analysis was conducted with the paired Student t test (with 95% confidence interval of difference between means) and found significant for P Results There were no statistically significant differences among all 6 preoperative and postoperative cephalometric, radiographic soft tissue measurements of the lower facial profile. Conclusions The combined elliptical-window genioglossus advancement and hyoid suspension procedures for obstructive sleep apnea do not significantly change the cephalometric lower facial profile. In patients with an adequate lower facial profile with base-of-tongue obstruction who require surgical management of obstructive sleep apnea without alteration of their lower facial profile, this procedure does not significantly alter the preoperative facial profile.

Purpose Replacement of the mandibular condyle with alloplastic materials is sometimes required when the mandibular condyle is involved in pathology or trauma. Previous investigations into alloplastic mandibular condylar replacement have met with mixed results because they reported only a limited number of patients with short-term follow-up. This investigation sought to determine the long-term outcome of alloplastic replacement of the mandibular condyle in a large population of patients after disarticulation due to pathology or trauma. Materials and Methods This was a prospective, long-term investigation of 131 consecutive patients who had undergone alloplastic replacement of 132 mandibular condyle(s) for reconstruction after disarticulation for pathology or trauma. Metallic mandibular condylar replacement was carried out using standard principles of rigid fixation after disarticulation with placement of the metallic condylar head against the native condylar disc or a soft tissue interface of either autogenous or allogeneic grafts. Only patients with a minimum of 3-year follow-up were included in this study. Assessment analysis was conducted at 6-month intervals by direct questioning, direct clinical observation, measurements, and radiographic examination. Results A total of 131 consecutive patients underwent 132 mandibular condylar replacements with a metallic condylar head attached to a 2.3- or 2.4-mm reconstruction plate after disarticulation. Follow-up time ranged from 3.4 to 18.6 years with an average of 7.8 years. A total of 13 (9.8%) patients developed minor complications including pain (2/132, 1.5%), loose plate (2/132, 1.5%), limited jaw opening (4/132, 3.0%), and plate exposures all of which were in irradiated patients (6/132, 4.5%). One patient (0.8%) who also was irradiated developed an erosion into the external auditory meatus with pain. None developed an erosion into the middle cranial fossa. Conclusions Alloplastic replacement of the mandibular condyle with a metallic condyle on a rigid reconstruction plate functioning against a natural disc or a soft tissue graft in the temporal fossa after disarticulation for pathology or trauma provides long-term stability with minimal complications (a total complication incidence of 10.6%).

embers suggests a sporadic mutation affecting one f the genes responsible for bone homeostasis in this atient. Cranial nerve compression has been described in atients’ with van Buchem disease; however, cerebroascular accidents have not been identified comonly in these patients. Although the patient decribed some disturbance in facial sensation and isplayed skull bone thickening radiographically, it is ifficult to say whether the condition contributed to he cerebrovascular accidents without radiologic evience of compression of the brain or vascular canals n the skull base. Previous reports of surgical intervention on paients with van Buchem disease and ADO have ndicated normal healing although no comments have een made on longer term recurrence at surgicallyddressed sites. We were concerned about the healng capacity of the bone and carried out more limited urgery at the first intervention. These fears seem to e unfounded and, ironically with the wisdom of indsight, the history of palmidronate infusions hould have caused greater concern.

Purpose To analyze the outcomes of treatment for double unilateral mandibular fracture. Materials and Methods Retrospective chart review of patients who were treated between 1994 and 2004 for 2 mandibular fractures on the same side of the mandible. Data collected involved age, gender, race, cause of fracture, treatment modality, length of follow-up, occlusal relationship at last visit, preoperative and postoperative clinical photographs and radiographs, and incidence and management of complications. Standard descriptive statistics were used. Results From a total of 1,287 mandibular fractures for which charts were available, 31 double unilateral mandibular fractures were treated during a 10-year period, for an occurrence rate of 2.4%. Demographic characteristics of these patients were similar to those of patients in other published studies on mandibular fracture. Fractures involved angle + body (18/31, 58%), condyle + body (11/31, 35%), and condyle + angle (2/31, 6%). Various treatments were provided for these fractures, but open reduction and internal fixation were applied to at least 1 of the fractures. Follow-up ranged from 6 weeks to 5 months (average, 9.6 weeks). Eight patients (8/31, 25.8%) developed complications involving visible gonial flaring; 3 of these also had cross-bite. Conclusion Double unilateral mandibular fracture is a rare event. The difficulty inherent in treating these fractures can be alleviated with the use of proper techniques of open reduction and internal fixation; however, treatment continues to be associated with a high complication rate.

To evaluate the hemodynamic stability of medically treated hypothyroid patients undergoing intravenous sedation for dentoalveolar surgery.A retrospective chart analysis of 20 consecutive white male patients actively being treated for hypothyroidism undergoing intravenous sedation for dentoalveolar surgery. Twenty consecutive normothyroid white male patients undergoing intravenous sedation for dentoalveolar surgery were used as controls. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), pulse pressure (PP), peripheral oxygen saturation (S(p)O(2)) and pulse were recorded at 5-minute intervals during intravenous sedation.Statistically significant lower average hemodynamic values were seen in hypothyroid patients compared to normothyroid patients in SBP (P = .05) and PP (P = .003). There were highly significant baseline changes for hypothyroid patients in DBP (P.001) and MAP (P.001) and significant baseline changes for normothyroid patients in DBP (P = .03), PP (P = .02) and pulse (P = .03). All changes were maintained within +/- 10% of baseline (range, -8.9% to +9.6%).Intravenous sedation for dentoalveolar surgery in medically treated hypothyroid patients maintains hemodynamic stability.

The Fifth Biennial Research Summit of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois on May 6 and 7, 2015. The goal of the symposium is to provide a forum for the most recent clinical and scientific advances to be brought to the specialty. The proceedings of the events of that summit are presented in this report.

PURPOSE: The geriatric population is rapidly increasing in number with increased demand on health care resources including those spent on the treatment of maxillofacial trauma. The purpose of this analysis was to investigate the independent and cumulative associations between potential risk factors (age, gender, mechanism of injury, drug use, and alcohol use) for and the severity of geriatric facial trauma. METHODS: This was a cross-sectional analysis of secondary data of geriatric (individuals aged ≥65 years) facial trauma using the Allegheny General Hospital Trauma Registry database. Data were collected for diagnosis codes that reflected facial trauma (International Classification of Diseases, Ninth Revision codes 802.0 to 802.9, 800.1 to 801.9, and 803.0 to 804.9) and specific mechanisms of injury (E810 to E819, motor vehicle traffic accidents; E880 to E888, accidental falls; and E960 to E969, injury purposely inflicted by other persons). The Facial Injury Severity Scale (FISS) is a validated measurement that was used to determine the severity of the facial trauma and calculated through analysis of the abstracted data obtained from the trauma registry and patient records. Pearson correlations, 2-way independent t test, 1-way analysis of variance, and multiple linear regression were used to test hypotheses for independent and cumulative associations between the risk factors for and the severity of geriatric facial trauma. Statistical significance was set at the P RESULTS: The sample was composed of 229 patients with a mean age of 72.3 ± 4.5 years. A statistically significant association between mechanism of injury and the severity of geriatric facial trauma (P =.019) was found. Specifically, interpersonal violence (assault) was associated with the greatest facial trauma severity (FISS score, 4.2) when compared with motor vehicle collisions (FISS score, 2.2; P =.011) and falls (FISS score, 2.4; P =.016). CONCLUSIONS: Interpersonal violence (assault) is associated with increased severity of geriatric facial trauma compared with other risk factors. Language: en

Purpose The excisional biopsy of subcutaneoous facial cysts and lipomas can be problematic due to the high esthetic nature of the affected area. Remote scar placement has advantages in allowing access to subcutaneous pathology while placing incision lines in cosmetic locations. This article will review excisional biopsies of subcutaneous facial cysts and lipomas using cosmetic approaches. Patients and Methods Patients with superficial facial cysts or lipomas undergoing excisional biopsies utilizing contemporary cosmetic surgery approaches (rhytidectomy, lower blepharoplasty, and submental) with tumescent anesthesia and either intravenous sedation or general anesthesia. Results All patients had successful removal of superficial facial pathology with good cosmetic results. Conclusion The use of contemporary cosmetic surgical approaches for the excisional biopsy of superficial facial cysts and lipomas provides adequate surgical access, a cosmetically acceptable result, and is well-tolerated by patients.

The purpose of this study was to evaluate noninvasive intraoperative hemodynamics in an elderly population with coronary artery disease (CAD) undergoing midazolam/fentanyl intravenous sedation-analgesia, with or without propofol for dentoalveolar surgery.A retrospective chart analysis of 24 consecutive male patients aged 60 years or greater, with coronary artery disease, undergoing midazolam/fentanyl intravenous sedation-analgesia with or without propofol for dentoalveolar surgery. Data recorded included noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and pulse (P).The addition of propofol to elderly CAD patients resulted in statistically significant lower averages for SBP (126.1 mm Hg vs 131.3 mm Hg, P.01), DBP (64.1 mm Hg vs 74.3 mm Hg, P.001), MAP (84.3 mm Hg vs 94.2 mm Hg, P.001) and PP (57.7 mm Hg vs 61.8 mm Hg, P = .01) with statistically insignificant differences in pulse (74.2 beats per minute vs 75.8 beats per minute, P = .1). Baseline changes in elderly CAD patients who received propofol were within +/-20% (range: -13.8% to +6.9%).Midazolam/fentanyl intravenous sedation provided stable intraoperative hemodynamics in elderly CAD patients. The addition of propofol to elderly CAD patients also resulted in stable intraoperative hemodynamics and may be a safe adjunct to intravenous sedation in elderly CAD patients.

To subjectively assess the long-term outcomes of combined functional open rhinoplasty with spreader grafts and laser-assisted uvuloplasty (LAUP) for polysomnogram (PSG)-confirmed sleep-disordered breathing (SDB).Postoperative Epworth Sleepiness Scale (ESS) questionnaires were given to 30 patients and compared with preoperative ESS. Patients were also asked questions concerning postoperative improvement in upper airway breathing, nasal appearance, and snoring. Statistical analysis used 2-tailed parametric and nonparametric tests.Thirty patients (average age 55 years) with an average (+/- standard deviation) preoperative apnea-hypopnea index (AHI) of 37 +/- 27 and mean follow-up times of 21 months were evaluated. A statistically significant 50% (P.001) postoperative decrease in average ESS was observed. Patients with severe (AHI30) and very severe obstructive sleep apnea (OSA) (AHI60) also had statistically significant (61% and 66%, respectively, P.001) postoperative decreases in average ESS. In all patients, subjective upper airway breathing was statistically improved (P.008), graded as significantly in 47% and moderately in 33% of patients. According to the patient's bed partner, snoring was improved and/or decreased in 76% of patients (P = .008). All patients were satisfied with the postoperative cosmetic appearance of their nose (P.0001). Finally, 90% of patients stated that they would have the procedure again (P = .009) and 90% stated that they would recommend the procedure to a friend or relative with the same condition (P = .009).Subjective assessment at long-term follow-up for combined open rhinoplasty with spreader grafts and LAUP for PSG-confirmed SDB produced a statistically significant decrease in excessive daytime sleepiness, even in patients with very high AHI, with high patient satisfaction.

Purpose The purpose of this project was to retrospectively compare and correlate body mass index (BMI) and hemodynamics in hypertensive and normotensive patients undergoing intravenous sedation for dentoalveolar surgery. Patients and Methods A retrospective chart analysis of 263 consecutive male patients undergoing intravenous (IV) sedation for dentoalveolar surgery was divided into 5 BMI groups: underweight, normal weight, overweight, obese, extremely obese. Data recorded were noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and pulse (P). Statistical analysis of mean values between groups was carried out using multivariate linear regression analysis, Pearson’s correlation coefficient, and Student’s t test and found significant for P Results Average hemodynamic values for normotensive patients were significantly lower for all groups except for pulse in the normal group, pulse in the obese group, and DBP in the extremely obese group. For normotensive patients, there were statistically significant strong positive correlation for elevated BMI and increased baseline changes in SBP and PP. For the hypertensive group, there was a statistically significant moderate positive correlation for elevated BMI and increased baseline changes in PP and statistically significant strong positive correlation for baseline changes in MAP. Baseline changes were significant for greater increases in SBP and decreases in DBP and MAP in the underweight hypertensive group. Significant increases from baseline in the normotensive group were for PP in the normal BMI group and for pulse in the obese group. All baseline changes, with the exception of normotensive underweight SBP (+26.7%) and hypertensive PP (+23.9%), were within ±20% of baseline (range, −12.2% to +17.4%). Conclusion In general, normotensive patients in this study had lower average hemodynamic values than hypertensive patients in all BMI groups. Great variability was seen in baseline changes for all BMI groups, but a substantial majority of changes were within ±20% of baseline. There were statistically significant moderate and positive correlations in BMI for changes from baseline for several hemodynamic measurements. Intravenous sedation for oral and maxillofacial surgery procedures maintains a stable hemodynamic state in hypertensive and normotensive patients regardless of BMI.

Purpose Patients undergoing office-based laser-assisted uvuloplasty (LAUP) for snoring or mild obstructive sleep apnea are generally obese and have a high Mallampati score. Because avoidance of supplemental oxygen during laser procedures is generally mandated, the potential for intraoperative desaturation is high. This study was designed to look at intraoperative hemodynamic changes, respiration patterns, and oxygen saturations during intravenous sedation with midazolam and fentanyl during LAUP procedures. Materials and Methods This was a retrospective anesthesia chart review of 15 consecutive patients undergoing midazolam/fentanyl intravenous sedation for office-based LAUP treatment for snoring and/or mild obstructive sleep apnea. Data recorded were noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse (P), and rate-pressure product (RPP). Data collected were reported as mean values with standard deviation. Statistical analysis using the Student’s t test was performed and found significant for P Results All changes from baseline were statistically insignificant, SBP ( P = .4), DBP ( P = .2), MAP ( P = .2), P ( P = .1), PP ( P = .9), RPP ( P = .5), RR ( P = .9), and SpO 2 ( P = .4), and all within ±20% of baseline (range, −5.0% to +7.5%). Conclusion Midazolam and fentanyl intravenous sedation with local anesthesia maintained intraoperative hemodynamic and oxygenation variables close to baseline for office-based LAUP procedures.

o r d O s s i r s a a s a a I t u t d s t c o p t s p d t i significant consideration when performing interental osteotomies for segmental Le Fort I surgery is he effect of interdental osteotomy on the adjacent eriodontium. The concern is significant enough to arrant numerous studies to investigate the effect f interdental osteotomies on the periodontium durng segmental maxillary surgery. These studies have hown that interdental maxillary osteotomies perormed with rotary instruments may cause minor, but linically insignificant complications. The greatest limiting factor to interdental osteotoies using a rotary handpiece is the available bone etween roots adjacent to the planned osteotomy. he closer the adjacent roots are to an osteotomy, ragmatic sense would presume the greater the poential risk to the overlying periodontium. An alternaive device to traditional rotary instruments is the ush osteotome. The push osteotome is a modified igid, sharp, and extremely thin straight osteotome ith a large handle used manually to accomplish the nterdental osteotomies (Figs 1-4). Gripped in the alm of the hand, the push osteotome takes advanage of the viscoelastic property of bone to be comressed and manipulated even in cases with minimal vailable bone between adjacent tooth roots. This llows for greater tactile sensation and manual control ompared with rotary instruments when performing nterdental osteotomies. In addition, unlike rotary nstruments, the push osteotome generates no heat, hich can be detrimental to bone healing and/or

Purpose The study goal was to retrospectively review the effectiveness of a modified tumescent technique to provide anesthesia for facial laser resurfacing in an office-based setting. Patients and methods The charts of 54 consecutive patients treated with facial laser resurfacing at a large outpatient clinic were retrospectively reviewed for type of intravenous sedation/analgesia, adequacy of anesthesia, complications, and discharge criteria. All patients were treated with a modified tumescent technique with or without intravenous sedation. Results All patients tolerated the procedure extremely well. There were no anesthesia-related complications regarding loss of airway/airway obstruction, desaturation, or prolonged recovery periods. Several patients tolerated the procedure comfortably without intravenous sedation/analgesia. Conclusions The modified tumescent technique is a valuable method to provide patient comfort during facial laser resurfacing while reducing the risk for anesthesia-related complications.

Purpose: Arthritic diseases of the temporomandibular joint, such as rheumatoid arthritis and osteoarthritis, suggest that inflammatory mediators and metalloproteinases may play a role in their pathogenesis. Recent clinical evidence from physical therapy and other modalities has shown a significant decrease in temporomandibular joint symptoms in patients with early disease. This project examines the effect of mechanical strain on synovial fibroblasts' production of inflammatory mediators including prostaglandin E2 (PGE2) and proteinases. Materials and Methods: An established synovial fibroblast cell line (HIG-82) was grown to confluency in modified Eagle's medium supplemented with 10% fetal calf serum. The monolayer of fibroblasts was then subjected to mechanical strain using the Flexercell Strain Unit (Flexcell International Corporation, McKeesport, PA) at 3 cycles per minute, with 10 seconds' elongation of up to 24% and 10 seconds of relaxation. Levels of PGE2 were determined by radioimmunoassay using commercially available product and measured in nanograms per milliliter of supernatant. Proteinases collagenase, gelatinase, and stromelysin were measured by H3 radioactive labeling of acidic anhydride to the specific substrate. Enzymatic proteolysis of the radiolabeled substrate was then measured in supernate as units per milliliter. Statistical analysis of all results was performed using Student's t test in triplicate. Results: PGE2 levels of mechanically activated cells was 18.1 ± 13.4 ng/mL, with control levels being 58.0 ± 9.2 ng/mL. This is a statistically significant decrease, between strained and unstrained cells with P

Objective: An understanding of bone cellular biology is a basic necessity to understanding events such as distraction osteogenesis. The goal of this study was to determine the effect of continuous cyclic mechanical stretch as a fundamental event in distraction osteogenesis on the expression of 3 bone growth factors, transforming growth factor-beta 1 (TGF-β1), insulin-like growth factor 1 (IGF-1), basic fibroblast growth factor (bFGF) and 2 cytokines, interleukin (IL)-1 (IL-1) and 6 (IL-6) in human osteoblast-like cells. Material and Methods: A human osteoblast-like cell line, SaOS-2, capable of forming a ground substance and mineralizing it, was maintained. Cells were transferred to 6-well plates with flexible silicon bottoms grown to confluence and either subjected to tensile stretch for different time intervals or used as the control group. RNA was isolated to conduct Northern blot analysis for the expression of 3 bone growth factors, transforming TGF-β1, IGF-1, bFGF, and 2 cytokines, IL-1 and IL-6. Results: After 8 hours, mRNA for TGF-β1 and IGF-1 increased in the experimental group, whereas bFGF decreased but cytokines IL-1 and IL-6 were not affected. At 16 hours, TGF-β1, IGF-1, and bFGF showed increased levels of mRNA; IL-6 showed a slight increase. After 24 hours, TGF-β1, IGF-1, bFGF, and IL-6 had increased mRNA levels. IL-1β did never show significant alterations in mRNA production as compared with the control. Conclusion: Tensile stretch on osteoblast-like cells alter local regulation of bone formation, increasing the expression of bone growth factors, whereas catabolic cytokines are unaffected. These findings suggest a direct effect of mechanical strain on osteoblasts and may be the driving factors of bone growth during distraction. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:147-54)

The goal of this study was to evaluate the presence of the inflammatory cytokines interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) within the superior temporomandibular joint (TMJ) space in patients with internal derangements and to compare these values with the pathologic findings seen arthroscopically.Thirty patients with symptomatic TMJ dysfunction and clinical and imaging evidence of internal derangements of the TMJ were evaluated. Before entering the superior joint space with the arthroscope, 2 mL sterile saline was injected and, after 30 seconds of equilibration, was aspirated for analysis. The surgeon then performed diagnostic arthroscopy. The degree of synovitis, degeneration, percent condylar roofing, and any pathologic changes, such as perforations, were recorded. The level of total protein in each sample was ascertained, as well as the levels of IL-1 beta, IL-6, and TNF-alpha.Of 30 samples tested, three were discarded because of failure to gain access into the superior joint space. Of the 27 remaining samples, IL-6 showed the closest correlation with the level of acute synovitis demonstrated arthroscopically. Two of the higher IL-6 levels (167 and 324 pg/microg protein) were seen with patients with a significant disc perforation. In patients with a high degree of vascularity, IL-6 was found to be between 0 to 581 pg/microg protein with an average of 80 pg/microg protein and a median value of 43 pg/mg. These values significantly correlated with the degree of vascularity (Por = .02). This is in comparison with the 10 remaining patients, who showed significantly fewer vascular changes arthroscopically. In these patients, the range of IL-6 was 0 to 35 pg/microg protein, with an average of 19 pg/microg protein and a median value of 14.5 pg/microg. These values significantly correlated with the smaller degree of vascularity (Por = .02). In seven patients, the role of nonsteroidal antiinflammatory drug (NSAID) use resulted in decreased levels of IL-6, which has been noted in previous studies. In patients with higher rated redundancy of the synovial tissue, the average IL-6 level was 92 pg/microg protein, whereas the median value was 44 pg/microg protein. In patients with little or no redundant synovial tissue, an average IL-6 level of 22 pg/microg protein was present. The median value in these same joints was 15 pg/microg protein. These IL-6 values significantly correlated with the degree of redundancy (Por = .03). The degree of degenerative change (chondromalacia, fibrillation), disc displacement (roofing), and the presence or absence of adhesions did not significantly affect the levels of IL-6 within the patients studied. The presence of IL-1 beta and TNF-alpha was not found to correlate with the arthroscopic findings in the superior joint space.The presence of IL-6 correlated with the degree of acute synovitis. IL-1 beta and TNF-alpha were not found in significant levels within the superior joint space. These findings correlated with those reported by other investigators. The production of IL-6 by synovial cells and its role in TMJ disease warrants further investigation.

Purpose There is very limited evaluation of the management of fractures of the bilateral mandibular angles. The purpose of this study was to determine the incidence, etiology, and outcomes of bilateral mandibular angle fractures treated with the transoral application of rigid fixation on one side and nonrigid fixation on the other. Patients and Methods Patients 18 years of age or older with isolated, noncomminuted fractures through the right and left mandibular angles and treated solely with 2.0-mm miniplates through intraoral incisions (and trocar) were collected from 2 sources. Patients treated at Allegheny General Hospital (Pittsburgh, PA) were prospectively collected from August 1, 2006 through December 31, 2012. Patients treated at Parkland Memorial Hospital (Dallas, TX) and University Hospital in San Antonio (San Antonio, TX) from January 1, 1992 through December 31, 2012 were retrospectively added to the sample. Data collected included age, gender, race, cause of fracture, presence or absence of mandibular third molars, occlusal relation documented at last visit, and occurrence and management of complications. Standard descriptive statistics were used and the relation between initial displacement and adequacy of reduction was evaluated with the Fisher exact test. Results Of 1,565 patients with 2,195 mandibular fractures, 33 (2.1%) presented with bilateral mandibular angle fractures. The average age of the cohort was 25.2 ± 1.8 years (range, 18 to 48 yr). The mechanisms of injury were assaults (30 of 33, 90.9%), motor vehicle collisions (2 of 33, 6%), and a fall (1 of 33, 3%). Twenty-seven patients (81.8%) had at least 1 mandibular third molar at the time of injury. Three patients (9.1%) had minor postoperative wound problems, with 1 incident (3.0%) of malocclusion. There was no statistically significant relation between the initial displacement and the adequacy of reduction. Conclusions Bilateral mandibular angle fractures are a rare traumatic event that may be successfully treated with transoral rigid and nonrigid fixation with 2.0-mm miniplates.

The objective and subjective outcomes of combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures have not been evaluated. This study was conducted to evaluate postoperative changes in the apnea hypopnea index (AHI) and subjective daytime sleepiness with this combination of procedures in the surgical management of obstructive sleep apnea (OSA).This was a retrospective cohort analysis of patients who had undergone combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty performed at Allegheny General Hospital (Pittsburgh, PA) from July 1, 2006 through December 31, 2008 for polysomnogram-confirmed OSA. Inclusion criteria included patients who had undergone the combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures with preoperative and minimum 6-month postoperative AHI and Epworth Sleepiness Scale (ESS). Statistical significance between mean differences of pre- and postoperative AHI and ESS was determined with the 2-tailed paired t test and 95% confidence intervals.Thirteen male patients (average age, 43.0 ± 2.4 yr; average follow-up, 18.0 ± 3.6 months) were included in this study. There were statistically significant differences between mean pre- and postoperative AHI (28.3 vs 12.1; P.05; mean change, -16.2; 57.2% decrease) and ESS (15.2 vs 6.3; P.05; mean change, -8.9; 58.6% decrease).The combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures for the treatment of OSA decrease AHI and subjective daytime sleepiness.

Purpose To evaluate the relation of specific cephalometric landmarks, body mass index, and the apnea-hypopnea index in patients diagnosed with obstructive sleep apnea syndrome (OSAS) and treated with functional upper airway surgery. Materials and Methods This was a retrospective cohort analysis of 89 consecutive patients over a 3-year period diagnosed with overnight-attended polysomnogram-confirmed OSAS who underwent functional upper airway surgery. Five predetermined specific cephalometric parameters were analyzed: posterior airway space, soft palate length, hyoid to mandibular plane angle, sella-nasion to mandibular plane angle, and gonion to gnathion length. Simple and multiple linear regression analyses were used to establish a relation between independent and dependent variables. Results There were no statistically significant associations between the 5 specific cephalometric craniofacial structures in combination with other potential confounders, body mass index and apnea-hypopnea index, and the presence of OSAS. Conclusions No one skeletal or soft tissue parameter can be directly linked to OSAS.

Purpose To evaluate the long-term outcome of simultaneous split thickness skin graft (STSG) vestibuloplasty and endosseous implant placement for implant-supported overdentures in patients with shallow mandibular vestibules. Patients and Methods This was a retrospective evaluation of 13 consecutive white male patients who underwent simultaneous mandibular vestibuloplasty with STSG combined with placement of 2 to 4 mandibular endosseous implants for construction of an implant-supported mandibular overdenture with a minimum of 2-year follow-up. Patients' charts were evaluated for implant survival and prosthetic success. Results Thirteen male patients at an average age of 60.4 years who had undergone simultaneous STSG mandibular vestibuloplasty and endosseous implant placement in the anterior mandible, were followed for an average of 43 months and were retrospectively evaluated. A total of 40 implants (average of 3 implants per patient) were placed in the anterior mandible in preparation for an implant-supported overdenture placement. There were no complications in graft or recipient sites, implant placement, or overdenture construction. The endosseous dental implant integration rate was 97.5% and the prosthetic success rate was 100%. Conclusion Simultaneous STSG mandibular vestibuloplasty for vestibular lengthening and placement of mandibular endosseous implants in preparation for mandibular implant-supported overdentures is a reliable method in patients with shallow mandibular vestibules.

Purpose To assess the risk and time course of oral bisphosphonate-induced osteonecrosis of the jaws. Materials and Methods Detailed data from 30 consecutive cases were compared with 116 cases due to intravenous aminobisphosphonates. Results Results in part noted a higher incidence related to alendronate (Fosamax; Merck, Whitehouse Station, NJ), a 94.7% predilection for the posterior mandible, and a 50% occurrence spontaneously, with the remaining 50% resulting from an oral surgical procedure, mostly tooth removals. Just over 53% of patients were taking their oral bisphosphonate for osteopenia, 33.3% for documented osteoporosis, and 13.4% for steroid-induced osteoporosis related to 4 or more years of prednisone therapy for an autoimmune condition. There was a direct exponential relationship between the size of the exposed bone and the duration of oral bisphosphonate use. There was also a direct correlation between reports of pain and clinical evidence of infection. The morning fasting serum C-terminal telopeptide (CTX) test results were observed to correlate to the duration of oral bisphosphonate use and could indicate a recovery of bone remodeling with increased values if the oral bisphosphonate was discontinued. A stratification of relative risk was seen as CTX values less than 100 pg/mL representing high risk, CTX values between 100 pg/mL and 150 pg/mL representing moderate risk, and CTX values above 150 pg/mL representing minimal risk. The CTX values were noted to increase between 25.9 pg/mL to 26.4 pg/mL for each month of a drug holiday indicating a recovery of bone remodeling and a guideline as to when oral surgical procedures can be accomplished with the least risk. In addition, drug holidays associated with CTX values rising above the 150 pg/mL threshold were observed to correlate to either spontaneous bone healing or a complete healing response after an office-based debridement procedure. Conclusions Oral bisphosphonate-induced osteonecrosis is a rare but real entity that is less frequent, less severe, more predictable, and more responsive to treatment than intravenous bisphosphonate-induced osteonecrosis. The morning fasting serum C-terminal telopeptide bone suppression marker is a useful tool for the clinician to assess risks and guide treatment decisions.

Purpose To evaluate the hemostatic efficacy of autologous platelet-poor plasma (PPP) gel following posterior iliac crest bone graft harvesting for oral and maxillofacial reconstruction. Patients and Methods This was a prospective study of 24 consecutive patients involving 26 posterior iliac crest bone harvests that had bone wax and either 1-gram of bovine microfibrillar collagen or 20 mL of autologous PPP, activated as a gel, used as adjunct hemostatic agents. Compression bulb suction drain was placed into the graft site and drain output recorded every 8 hours for 64 hours. Cost analysis was also undertaken between the 2 methods. Statistical significance between means of each group was determined by Student’s t test and found significant for P Results There were no statistically significant differences in average drain output between the PPP and MFC groups for each 8-hour interval. There was no statically significant difference in average total drain output between the PPP and MFC groups over the entire 64 hour period. Additionally, unlike the addition of MFC, the addition of PPP added no additional costs to the procedure. Conclusion PPP gel, when compared with bovine microfibrillar collagen, is an effective and inexpensive adjunct in hemostasis following posterior iliac crest bone harvest.

The purpose of this study was to compare the anesthetic requirements and hemodynamic and oxygenation variables involved between the bolus midazolam/fentanyl intravenous sedation-analgesia technique, and the same technique combined with continuous-infusion propofol.This was a retrospective chart analysis of 41 consecutive patients undergoing full-face carbon dioxide laser resurfacing with either bolus midazolam/fentanyl (n = 15) or midazolam/fentanyl with continuous propofol infusion anesthesia (n = 26) techniques. Data recorded were noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse (P), and rate-pressure product (RPP), respiratory rate (RR), and oxygen saturation (SpO2). Data collected were reported as mean values with standard deviation. Statistical analyses were performed with the Student's t test and found statistically significant for P.05.Statistically significant decreases in averages were seen in SBP (P.001), DBP (P = .02), MAP (P = .004), P (P.00l), RPP (P.00l), and RR (P.001), but not PP (P = .4) and SpO2 (P = .08) in the midazolam/fentanyl/continuous propofol infusion group compared with the midazolam/fentanyl only group. Changes from baseline were statistically significant only for MAP (P = .04), but statistically insignificant for all other measurements, SBP (P = .7), DBP (P = .4), P (P = .95), PP (P = .97), RPP (P = .6), RR (P = .6), and SpO2 (P = .4). Statistically significant smaller amounts of midazolam (P = .01) and fentanyl (P.001) were used in the midazolam/fentanyl/continuous propofol infusion pump group. Length of procedure was statistically insignificant between groups (P = .4). Conclusion The addition of a continuous propofol pump maintained hemodynamic and oxygenation values close to baseline, while decreasing the amount of respiratory depressing opiates administered and without affecting the length of the procedure.

The squamous odontogenic tumor (SOT) is a rare benign odontogenic tumor first described by Pullon et al. This lesion is thought to arise from the epithelial rests of Malassez. Rests of Malassez represent remnants of Hertwig’s epithelial root sheath, an epithelial membrane that helps to guide root formation. While these epithelial rests may be found anywhere within the periodontal ligament, they are most numerous on the lateral root surface. Therefore, the typical radiographic presentation is a triangular radiolucent defect involving the lateral root surface of erupted teeth. This is the first known report of a squamous odontogenic tumor in a pericoronal location associated with an impacted tooth.