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Objectives To evaluate the reliability of CT measurement of canine elbow axial radioulnar congruence using a duplicated circle superimposition technique. Materials and Methods CT of six cadaveric canine elbows was performed following either: (1) placement of an external fixator on the radius with ostectomy and radial shortening of 1 to 5 mm; (2) radial lengthening of 1 to 5 mm using a radial lengthening system; or, (3) no axial length adjustment. Four observers, on two occasions, blinded to the amount of radial adjustment, placed a circle of best fit of the ulnar trochlear notch on a sagittal image that was duplicated and transposed to the articular contour of the radial head; then the axial distance between circles relative to the dorsal radius was measured. Statistical analysis assessed differences between actual and observer-assessed radial length adjustment; inter−/intra-observer interclass correlation coefficients and sensitivity/specificity were calculated to evaluate measurement reliability. Results There was not a significant difference between actual and observer measures of radioulnar congruence. Inter- (intraclass correlation coefficient=0.98) and intra-observer reliability (intraclass correlation coefficient=0.94 to 0.99) were almost perfect for measurement of radioulnar incongruence when compared to the actual radial adjustment. A Bland–Altman plot revealed a 95% confidence interval range of −1.31 to 1.16 mm. Sensitivity and specificity were high for correct identification of congruent elbows and elbows with 1 or 2 mm incongruency. Clinical Significance The duplicated circle superimposition technique provides a simple and accurate means of assessing radioulnar axial incongruence.

© 2017 The American College of Veterinary Surgeons Objective: To describe the application of 3-dimensional (3D) printing in advanced oral and maxillofacial surgery (OMFS) and to discuss the benefits of this modality in surgical planning, student and resident training, and client education. Study design: Retrospective case series. Animals: Client-owned dogs (n = 28) and cats (n = 4) with 3D printing models of the skulls. Methods: The medical records of 32 cases with 3D printing prior to major OMFS were reviewed. Results: Indications for 3D printing included preoperative planning for mandibular reconstruction after mandibulectomy (n = 12 dogs) or defect nonunion fracture (n = 6 dogs, 2 cats), mapping of ostectomy location for temporomandibular joint ankylosis or pseudoankylosis (n = 4 dogs), assessment of palatal defects (n = 2 dogs, 1 cat), improved understanding of complex anatomy in cases of neoplasia located in challenging locations (n = 2 dogs, 1 cat), and in cases of altered anatomy secondary to trauma (n = 2 dogs). Conclusion: In the authors' experience, 3D printed models serve as excellent tools for OMFS planning and resident training. Furthermore, 3D printed models are a valuable resource to improve clients' understanding of the pet's disorder and the recommended treatment. Clinical relevance: Three-dimensional printed models should be considered viable tools for surgical planning, resident training, and client education in candidates for complex OMFS.

Temporohyoid osteoarthropathy (THO) is a cause of neurological disease in horses that is characterised by facial and vestibulocochlear nerve deficits. Studies reporting and comparing survival following medical or surgical treatment of THO are lacking.To compare survival and prognosis in horses with THO treated medically or surgically, and to report surgical complications.Retrospective study.The medical records of horses diagnosed with THO were retrieved, and data on signalment, clinical signs and duration, corneal ulceration and bilateral occurrence were recorded. Neurological severity was graded according to clinical signs. Preoperative radiographic and endoscopic images were graded according to the severity of changes. Factors potentially affecting survival and treatment were compared using Cox proportional hazards regression.A total of 77 horses were identified as having THO during the period 1990-2014. Of these, 25 horses underwent ceratohyoid ostectomy (CHO) and eight underwent partial stylohyoid ostectomy (PSHO). Thirteen of 20, one of 25 and one of eight horses treated by medical therapy, CHO and PSHO, respectively, died or were subjected to euthanasia as a consequence of THO. Compared with CHO, medical therapy was significantly associated with nonsurvival, but there were no significant differences in survival between horses undergoing PSHO and medical therapy. The duration of clinical signs, and neurological, radiographic and endoscopic grades were not associated with survival of THO. However, the age of the horse was significantly associated with poorer survival. Survival time was significantly shorter in the medical therapy group compared with the two surgical groups combined, but did not differ significantly between the two surgical groups. No significant difference between groups was seen in the incidence of surgical complications (33.3% in the PSHO and 22.2% in the CHO group).This was a nonrandomised study of treatment effects on survival and included a low number of cases.The survival prognosis in horses with THO is good to excellent in those submitted to surgical intervention, and fair in those treated with medical therapy alone.

This article reports on a case of a glandular odontogenic cyst (GOC) in the posterior mandible of a 25-year-old male treated with peripheral ostectomy, bone allograft, and an implant-supported fixed dental prosthesis. During a routine 3-month postoperative visit, a radiograph suggested vertical bone loss on the implant in the location of the mandibular right first molar. The three-walled defect was surgically treated with debridement, bone allograft, and a membrane. Healing of this site has been uneventful. This case report demonstrates that implants can be successfully placed and restored in previously affected GOC sites.

Various forms of vascular lesion affect the head and neck region. The head and neck vascular lesions are classified into neoplasms and malformations. Neoplasm presents either as hemangioma or lymphangioma; neoplasm usually presents in young age compared with vascular malformation. A 9-year-old female patient presented to the outpatient clinic referred from the department of pedodontics after extraction of a right mandibular second deciduous molar. Extraction was done by dental GP in outpatient clinic. Massive bleeding followed the extraction. Bleeding was controlled by electrocoagulation of bleeding site and systemic and local application of antifibrinolytic agent. An intravenous line was placed to provide fluid replacement. Injection of intravenous cyklokapron was given to stabilize the blood clot. Selective embolization was performed 24 hours prior to surgical resection of lesion and the lesion was removed under general anesthesia followed by peripheral ostectomy of bone to remove any feeders. Different protocols are used to control life-threatening bleeding. Primary local measures such as Gelfoam packing, Tranexamic or Aminocaproic topical application, Surgicel application, Electrocautery, Bone wax, Ligation of External Carotid or Common Carotid Artery, or Selective Embolization of feeder vessel may be used to control the bleeding. Interventional radiographic blockage of feeder vessel currently shows high success rate in the management of life-threatening bleeding compared with previous techniques.

The keratocystic odontogenic tumor (KCOT) according to WHO classification comprises approximately 12% of all tumors of the jaw. The pathognomonic microscopic findings are the parakeratin at the superficial layer. Their clinical and radiographic presentation is variable, showing different degrees of aggressive behavior and recurrences. We present a retrospective study with a modified conservative approach for the treatment of the KCOT. Five patients between 16 and 23 years old were treated in 2009. These presented radiologic features suggestive of KCOT such as unilocular lesions in the mandible. The diagnosis was confirmed by incisional biopsy and histopathological study of every lesion. The treatment performed was: Carnoy's solution by 5 minutes without chloroform and decompression with plastic stents from 7 to 11 months, switching the position of the stents once bone formation was evident, Carnoy's again for 3 minutes, enucleation, peripheral ostectomy, and concomitant xenograft. All the patients underwent simultaneous xenograft reconstruction after enucleation. Recurrence was negative after 8 years of follow up. No patient showed infection or fracture, only 1 reported discomfort with the stent. The modified treatment in our study suggests that this protocol so far has a low recurrence rate. The commitment of the patient is important for the long-term follow up and treatment.

Resection of a prominent mandibular angle is commonly used in Eastern society to improve the lower one third facial proportion. Historically, this procedure had a high complication rate, such as severe bleeding, asymmetry of the angle reduction, and "second mandibular angle." A safer and more effective way of performing such procedures is needed. The aim of this study is to introduce 3 instruments, a tunable guide handpiece, milling cutter, and flywheel, which were invented by the author, as well as a related ostectomy technique for correcting prominent mandibular angles using a modified full-thickness marginal ostectomy of the mandibular corpus angle, named the "stamp perforation" technique. This technique has 4 highlights: First, it ensures a smooth symmetric contour. Second, it prevents the risks of rupture of the inferior alveolar vessel and facial artery, ensuring the safety of this approach. Third, the "stamp perforation" technique eases the removal of bone fragments, shortening the operation time. Fourth, the recovery time of patients treated with this approach is much shorter than with the traditional approaches. From January 2006 to January 2016, 1106 patients underwent the surgery to contour the prominent mandible angles, and satisfactory results were achieved. Thus, we recommend the instruments as well as the "stamp perforation" technique for correcting prominent mandibular angles, and we hope that our 10 years of experience could provide a reference for other plastic surgeons.

A tapered mandibular contour is popular with Far Eastern Asians. This study describes a safe and accurate method of using preoperative virtual surgical planning (VSP) and an intraoperative ostectomy guide to maximize the esthetic outcomes of mandibular symmetry and tapering while mitigating injury to the inferior alveolar nerve (IAN). Twelve subjects with chief complaints of a wide and square lower face underwent this protocol from January to June 2015. VSP was used to confirm symmetry and preserve the IAN while maximizing the surgeon's ability to taper the lower face via mandibular inferior border ostectomy. The accuracy of this method was confirmed by superimposition of the perioperative computed tomography scans in all subjects. No subjects complained of prolonged paresthesia after 3 months. A safe and accurate protocol for achieving an esthetic lower face in indicated Far Eastern individuals is described.

Purpose To investigate and compare the probability of recurrence of keratocystic odontogenic tumors (KCOTs) for different variables and treatment protocols. Materials and methods An electronic search was undertaken in April 2016 that included clinical series of KCOTs reporting recurrences. Untransformed proportions and meta-analyses were performed to estimate the probability/risk of recurrence, according to several variables. Results A total of 94 publications were included (6427 KCOTs, 1464 recurrences). Probability of recurrence: all lesions, 21.1%; nevoid basal cell carcinoma syndrome, 35.4%; males, 20.3%; females, 19.3%; maxilla, 15.3%; mandible, 21.5%; unilocular, 14.7%; multilocular, 24.4%; marsupialization/decompression, 28.7%; decompression + enucleation ± additional therapy, 18.6%; enucleation/curettage, 22.5%; enucleation + peripheral ostectomy, 18.6%; enucleation + Carnoy's solution, 5.3%; enucleation + cryotherapy, 20.9%; marginal/segmental resection, 2.2%. The recurrence was not statistically significantly affected by lesion location (maxilla vs. mandible, risk ratio [RR] 0.92, P = 0.32) or patient's sex (male vs. female, RR 0.94, P = 0.44), but by locularity (unilocular vs. multilocular, RR 0.67, P = 0.007). Recurrence risk for surgical managements: marsupialization vs. enucleation (RR 1.65, P = 0.0006), marsupialization vs. resection (RR 3.17, P = 0.009), enucleation alone vs. enucleation + peripheral ostectomy (RR 1.66, P = 0.05), enucleation alone vs. enucleation + Carnoy's solution (RR 1.94, P = 0.03), enucleation alone vs. enucleation + cryotherapy (RR 0.88, P = 0.56). Conclusions KCOTs have a considerable rate of recurrence, which varies significantly according to some clinical, radiographic, and histopathological features, as well as surgical management.

SummaryObjective: To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique.Methods: Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed. The anatomical lateral distal femoral angle (aLDFA) was determined. Long-term clinical outcome was assessed by telephone interview with the owner.Results: A lateral closing wedge DFO was performed on 66 limbs. The mean pre- and postoperative aLDFA was 107.6° ± 5.8° and 94.1° ± 4.2°, respectively. Cranial cruciate ligament disease was identified in 28/66 affected limbs. Tibial angular deformity, torsional deformity, or both was identified in nine of the 66 limbs. Ostectomy healing was confirmed radiographically in 51/66 limbs. The mean time to union was 73 ± 37 days. All patellae were in the normal position and stable. Complications included infection (2/51), fixation failure (1/51), delayed healing (2/51), and persistent lameness (1/51).Clinical significance: In this cohort of cases, DFO was a highly successful and repeatable component of surgical treatment for dogs with medial patellar luxation associated with femoral varus. This study also provides more evidence of the high rate of concurrent cranial cruciate ligament disease in cases of medial patellar luxation complicated by fe-moral varus, and supports an association between stifle instability and medial patellar luxation.

Factors associated with the diagnosis, aetiology, and treatment of mandibular fractures occurring during the postoperative period following the removal of a lower third molar are discussed. The following databases were searched using specific key words: PubMed/MEDLINE, LILACS, Embase, and Scopus. The search yielded 124 cases. Sex, age, side, tooth position and angulation, bone impaction, relationship between the tooth and the inferior alveolar nerve, local pathological conditions, aetiology of the fracture, symptomatology, and time between surgery and fracture, as well as any displacement of the fracture and the treatment of the fracture, were evaluated. Data were tabulated and the χ2 statistical test was applied (P 35 years, with teeth in positions II/III and B/C, complete bony impaction, and local bone-like alterations, were found to have a higher frequency of fracture and pericoronitis (P

Osteoarthrosis is a degenerative joint condition characterized by progressive loss of joint cartilage. The knee joint is one of the most affected by this disease. Although there are different procedures for the surgical treatment of this pathology, fibular ostectomy in recent years is giving very good results. Although this surgical technique does not eliminate osteoarthritis of the knee, it does improve the symptoms and functional disability of the joint. Fibula Ostectomy is a palliative treatment of choice in knee osteoarthritis.

The present study aims to report a clinical case of a unilateral osteoma in a rare region and to discuss its clinical characteristics and possible forms of treatment for this lesion. In this clinical case the osteoma affected a mandibular coronary process, with a marked clinical characteristic, mushroom shape, causing zygomatic bone expansion and important limitation of buccal opening. The etiology of this lesion is unknown, but may present an association with infection, trauma, ionizing radiations, and hormonal and genetic influence. Osteoma can lead to an aesthetic complaint and, like coronoid process hyperplasia and osteochondroma, the osteoma can form a pseudoanquilosis; its treatment consists of surgical removal and osteoplasty. The treatment was satisfactorily performed through intraoral access, ostectomy, and osteoplasty.

Central giant cell lesions (CGCL) are proliferative nonneoplastic lesions more frequently presented in young female patients. Treatment often requires aggressive resection, which leads to major defects of the jaws. The authors present a CGCL case report treated with intralesional corticosteroid injection. A 24-year-old woman presenting no important medical condition had a chief complaint of a painless expansion swelling in the teeth 34 to 36 region, without alteration on oral mucosa color. Radiographically, a multilocular, radiolucent, well-defined margin measuring about 5 × 6 cm was identified. The incisional biopsy was performed to establish CGCL histologic diagnosis. The patient was successfully treated with 10 sessions of intralesional administration of corticosteroid (triamcinolone acetonide + articaine), distributed in all lesion extensions with a 15-day interval between them. Subsequently, a peripheral ostectomy was done. Follow-up with no signs of recurrence was performed, presenting a good prognosis.

CASE DESCRIPTION 4 calves were evaluated because of lameness and an angular limb deformity of the metatarsophalangeal region. CLINICAL FINDINGS 3 calves (ages, 5 days, 10 days, and 1 month) had a congenital varus deformity of the metatarsophalangeal region characterized by medial subluxation of the first phalanx of digits 3 and 4 at the metatarsophalangeal joints. A 6-month-old heifer had a valgus deformity of the metatarsophalangeal region secondary to a malunion of a Salter-Harris type II fracture. The degree of deformity angulation ranged from 16° to 54° for the 4 patients. TREATMENT AND OUTCOME A closing wedge ostectomy with transfixation pin–cast application was performed on the affected limb of all 4 patients. The ostectomy healed with only minor complications (disuse osteopenia distal to the transfixation pins [n = 4] and cast sores [1]) that were easily resolved with no long-term adverse effects. Duration of follow-up for the 4 patients ranged from 6 to 17 months, and the owners reported satisfactory ambulation with no (n = 2) or only mild (2) residual lameness in the affected limb. CLINICAL RELEVANCE Results suggested that a closing wedge ostectomy with transfixation pin–cast stabilization is an alternative for management of angular limb deformities of the metatarsophalangeal region in cattle. Such treatment improved the quality of life for all 4 patients. However, 2 of the 4 patients had congenital deformities confirmed to be heritable. There are ethical concerns associated with treating animals with heritable disorders, and exhibition and breeding of such animals should be avoided.

To compare the bending strength of a locking plate (LP), nonlocking plate (NLP), and an external skeletal fixator intramedullary pin (ESF-IM) tie-in fixation applied by a dorsal approach in an avian humerus fracture model, 5 left humeri obtained from pigeon (Columba livia) cadavers were randomly assigned to each repair technique (n = 15). The ESF-IM group was repaired with a 0.062-inch intramedullary pin tied-in with two 0.035-inch positive profile transfixation pins using acrylic filled plastic tubing. The LP group was repaired with a dorsally applied titanium 1.6-mm screw 7-hole locking plate (1 bicortical and 2 monocortical screws in each segment). The NLP group was repaired with a dorsally applied 6-hole stainless steel 1.5-mm dynamic compression plate (all bicortical screws). All constructs were applied before complete ostectomy to allow perfect reconstruction. Constructs were cyclically tested nondestructively for 1000 cycles in four-point bending before being tested to failure. Outcome measures included stiffness, strength, and strain energy. All specimens cycled without failure. The ESF-IM specimens were significantly stiffer and stronger than the plated repair groups. Plated constructs had significantly higher strain energies than ESF-IM. LP and NLP were of equal stiffness, strength, and strain energies. This study demonstrated that bending biomechanical properties of the ESF-IM configuration were superior to those of the dorsal plate fixation. Exact properties of fixation required to facilitate avian fracture healing are largely unknown. Further study, including assessments of optimal plate position and configuration, and torsional and in vivo studies in avian species are warranted.

Orthopedic research relies heavily on animal models to study mechanisms of bone healing in vivo as well as investigate the new treatment techniques. Critical-sized segmental defects are challenging to treat clinically, and research efforts could benefit from a reliable, ambulatory small animal model of a segmental femoral defect. In this study, we present an optimized surgical protocol for the consistent and reproducible creation of a 5 mm critical diaphyseal defect in a rat femur stabilized with an external fixator. The diaphyseal ostectomy was performed using a custom jig to place 4 Kirschner wires bicortically, which were stabilized with an adapted external fixator device. An oscillating bone saw was used to create the defect. Either a collagen sponge alone or a collagen sponge soaked in rhBMP-2 was implanted into the defect, and the bone healing was monitored over 12 weeks using radiographs. After 12 weeks, rats were sacrificed, and histological analysis was performed on the excised control and treated femurs. Bone defects containing only collagen sponge resulted in non-union, while rhBMP-2 treatment yielded the formation of a periosteal callous and new bone remodeling. Animals recovered well after implantation, and external fixation proved successful in stabilizing the femoral defects over 12 weeks. This streamlined surgical model could be readily applied to study bone healing and test new orthopedic biomaterials and regenerative therapies in vivo.

Aim: The aim of this study are to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molar and to evaluate whether these variations are attributable to patient anxiety and pain experienced during surgical procedure. Materials and Methods: Sixty healthy patients were evaluated (i) to determine the hemodynamic changes (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and oxygen saturation) at nine occasions: before starting the surgical procedure, 1 min and 4 min after local anesthetic injection, during the incision, at the time of ostectomy, at the completion of tooth removal, at the start and completion of suturing, and finally, after completion of surgery and (ii) to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. Hemodynamic variables were compared between the gender and at different time points by performing two-way analysis of variance for repeated measures. Global mean values of hemodynamic variables were compared between male and female using unpaired t-test. Categorical variables were compared by Chi-square test. All the tests were two-sided. P < 0.05 was considered statistically significant. Results: SBP and DBP showed significant changes; the highest value was recorded at the time of ostectomy/tooth sectioning. Maximum HR was observed 4 min after local anesthetic injection and the lowest HR was recorded after completion of tooth extraction, i.e., during the suturing. In females, mean HR was significantly increased. Conclusion: The present study suggests that dental anxiety impacts the effect of delivery of local anesthesia on blood pressure and is significantly associated with increased HR.

Background The aim of this study was to assess the effect of local application of IGF-I on osseointegration of dental implants placed in osteoporotic bones. Material and Methods 16 rabbits were randomly distributed into two groups: eight animals were ovariectomized and fed a low-calcium diet for six weeks, in order to induce experimental osteoporosis, and the others were sham-operated and fed a standard diet. A titanium implant was inserted into the tibiae in both groups. In half of the rabbits, 4 μg of IGF-I was applied into the ostectomy, prior to the implant insertion. A total of 32 implants were placed. Animals were sacrificed two weeks after surgery and decalcified samples were processed for Bone-To-Implant Contact (BIC) and Bone Area Density (BAD) measurements. Analysis of variance (ANOVA) was used for statistical evaluation. P

Ostektomija glave i vrata bedrene kosti (engl. femoral head ostectomy, FHO) jest kirurško liječenje traumatskih i kroničnih stanja koja zahvaćaju kukove, kad druge metode liječena nisu moguće ili ne daju zadovoljavajuće rezultate. Najčešći razlozi za izvođenje operacije jesu displazija kuka, komplicirani lomovi glave i vrata bedrene kosti, kod pasa Perthesova bolest, odnosno skliznuće glave bedrene kosti u mačaka. Izvodi se u općoj anesteziji pri čemu se ukloni promijenjena glava i vrat bedrene kosti. FHO uklanja bol te vraća mobilnost zglobu, indiciran je kod pasa manjih pasmina i svih mačaka, ali zbog niže cijene u odnosu na zamjenu kuka radi se i kod pasmina pasa težih od 20 kilograma. Daje se prednost kraniolateralnom pristupu zato što ne uključuje transekciju glutealnih mišića. Kožni rez započinjemo u ravnini s velikim trohanterom. Površinski i duboki glutealni mišić retraktiraju se dorzalno, bez ekscizije muskulature. Tada je moguće dobiti uvid u zglobnu kapsulu na koju se postavlja rez duž zglobne čašice. Potpuna ekscizija ligamenta glave bedrene kosti (lat. lig. teres) omogućuje dezartikulaciju zgloba. Prazan prostor koji je nastao s vremenom popunjava ožiljkasto tkivo koje služi kao lažni zglob. Fizikalna terapija pomaže vraćanju mobilnosti zgloba., Femoral head and neck ostectomy (FHO) is a procedure for surgical treatment of traumatic and chronic conditions affecting the hips, when other methods of treatment have no effect. The most common cause for surgery are hip dysplasia, complicated fractures of the femoral head and neck, Perthes disease in dogs, and slipped capital femoral epiphysis (SCFE) in cats. It is performed under general anesthesia and the femoral head and neck are removed. FHO releaves pain and returns mobility to the hip joint, and it is indicated in small breed dogs and all cats, but because of its lower cost compared to hip replacement it is also used in dog breeds weighing more than 20 kilograms. The craniolateral approach is the preferred method because it does not involve transference of the gluteal muscles. The cut begins at the level of the large trochanter. The surface and deep gluteal muscles are retracted dorsally, without excision of the musculature. It is then possible to see the joint capsule which is to be excised. The complete excision of the thigh bone ligament head allows disarticulation of the hip joint. The empty space created by the surgery is filled over time with scar tissue that serves as a false joint. Physical therapy helps restore hip mobility.

Background Functional closure of the orbicularis oris muscle and esthetic reconstruction of nasolabial components are impossible in patients with severely deformed premaxilla. Here, we review a surgical strategy for patients with unremedied premaxilla retrospectively. Results Vomerine ostectomy and premaxillary setback with nasolabial repair were performed in 12 patients with bilateral cleft lip and palate. The mean age of patients was 21.7 months. The extent of ostectomy varied between 3 and 11 mm. There were no serious complications from defective perfusion to the premaxilla or the philtral flap. The follow-up period ranged from 2 to 25 months. Proper positioning of the premaxilla and satisfactory nasolabial esthetics were achieved in all patients. Conclusions We performed nasolabial repair after premaxillary setback without jeopardizing the premaxillary segment or the philtral flap. Our surgical strategy could be recommended in poor socio-economic circumstances due to the cost effectiveness of limiting the number of surgeries.

The objective of this study was to assess epidemiological characteristics, treatment methods and recurrence of odontogenic keratocysts (OKC) in patients treated at a general hospital. This is a retrospective study of patients diagnosed with OKC and treated within a 6-year period. The sample consisted of 38 patients (20 women and 18 men), with mean age of 33 years and 2 months old. Of the 39 OKC lesions, the majority (56%) occurred in the ramus, angle and body of the mandible. In those cases in which decompression was performed before enucleation, the average time was 6 months and 6 days. Recurrence was observed in 8 patients (20.5%), in which 3 cases of OKC were treated with only enucleation (recurrence of 75%), 2 were treated with decompression and enucleation with peripheral ostectomy (recurrence of 9%) and 3 treated with only enucleation and peripheral ostectomy (recurrence of 43%). All patients with recurrence underwent further curettage and peripheral osteotomy, resulting in no further recurrences. Therefore, decompression followed by marginal enucleation seems to be the best therapeutic option in cases of OKC.

Though odontogenic keratocysts (OKCs) are benign lesions, they have a high recurrence rate. Because of their aggressive behavior, they have been classified as tumors by the WHO until 2017. Main differential diagnoses are amelobastoma and dentigerous cyst. Anatomopathological examination can reach a final diagnosis. Several treatments have been proposed: curettage, resection, enucleation (alone or together with peripheral ostectomy) and decompression. Decompression aims to decrease the volume of the lesion of “large” OKCs, in order to prevent surgery-related fractures and to preserve the surrounding important anatomical structures such as the inferior alveolar nerve. It could lead to a complete regression. If not, secondary enucleation can be performed in better conditions: a reduced volume to remove, a thicker epithelium to detach, a lower risk to damage neighboring anatomic structures and a lower recurrence rate. Long-term follow-up however remains necessary. Nowadays, minimally invasive surgery prevails. And since OKC was returned into the odontogenic cysts group in the WHO classification, decompression should be considered as the first intention treatment. The purpose of this paper is to provide an update about OKC features and biological mechanisms, to review the different treatment options and to provide a step-by-step protocol for decompression.

Background: Cystic defects that are critical sized or larger require bone replacement strategies. However, due to inherent disadvantages of the various types of grafts, none of the available materials are best suited for these defects. Among the alloplastic materials, hydroxyapatite (HA)-based grafts are the most popular, due to their osteoconductive nature and resemblance to mineral bone. The aim of the study was to assess the utility of the novel material “Chitra-HASi” as a bone substitute in the maxillofacial region. Materials and Methods: In a single-arm, prospective study, patients with radicular and dentigerous cysts were included and the minimum defect size was standardized at 20 × 20 mm or above. The Chitra–HASi material was developed by a wet precipitation technique and adopted for use following multiple in vitro and in vivo studies, confirming its safety and biocompatibility profile. All cysts underwent enucleation, followed by peripheral ostectomy and apicectomy of the teeth involved. The HASi graft was packed inside the cystic defect in a granular form and covered with a mucoperiosteal flap. Panoramic radiographs were taken preoperatively and at 3, 6, and 12 months postoperatively. Results: Twenty-three patients were included in the study, of which only 10 patients could be followed up for 12 months after graft placement. The mean preoperative bone density was found to be 14.9% ± 4.97 (standard deviation), whereas the postoperative 3-month, 6-month, and 12-month densities had a mean difference of −11.3%, −22.9%, and −37.3%, respectively, and the differences were statistically significant. Minor complications such as sinus formation (n = 7) and extrusion of granules (n = 4) were noted, which were managed conservatively. Only two patients required graft removal secondary to infection, leading to a persistent sinus tract. Conclusion: The results of the study suggest that Chitra–HASi granules show potential as an alternative to other bone substitutes. The addition of silica to the porous HA material offers superior strength characteristics and needs long-term evaluation to assess its stability in large cystic defects.

Correction of disorders during transformation into one of the most difficult tasks, both in orthodontics and in maxillofacial (orthognathic) surgery. This article presents two clinical cases of median osteotomy/ostectomy. The stages of operations are described. Surgical technique of transversal correction by osteotomy/ ostectomy is presented. Operation is combined with bilateral retromolar osteotomy. Three dimensional fragments moving helps to change lower jaw shape. Indications for this surgical manipulation: one or two side cross-bite, discrepancies between size of teeth and length of alveolar bone (lower macrognathia, microdentia, extra-teeth, huge diastema), asymmetry of mandible.Коррекция нарушений прикуса в трансверзальной плоскости является одной из самых сложных задач как в ортодонтии, так и в челюстно-лицевой (ортогнатической) хирургии. В данной статье представлены два клинических случая срединной остеотомии/остэктомии нижней челюсти как наиболее эффективного метода коррекции трансверзальных нарушений. Описаны этапы операций. Операция сочетается с двухсторонней ретромолярной остеотомией. Трехмерное перемещение фрагментов помогает изменить форму нижней челюсти. Показания к данной хирургической манипуляции: одно- или двухсторонний перекрестный прикус, несоответствие размеров зубов и длины альвеолярной кости (нижняя макрогнатия, микродентия, сверхкомплектные зубы, диастема), асимметрия нижней челюсти.

Introduction: The evaluation of surgical difficulty preoperatively is important during mandibular third molar (MTM) extraction. This study aimed to evaluate the difficulty index for the removal of impacted MTM using Pederson difficulty index (PDI), Parant Scale (PS), and total operation time (TOT). Materials and Methods: This was a prospective study of patients referred for the extraction of impacted MTM between April, 2019 and July, 2020. Estimated level of difficulty was done before a standardized surgery using the PDI and classified as: Minimally difficult (I), moderately difficult (II), and very difficult (III). Intraoperatively, it was classified as extraction requiring ostectomy only (II); extraction requiring ostectomy and coronal section (III); and complex extraction requiring coronal and root sectioning (IV) using the Modified PS. TOT was recorded by a resident with stopwatch. Results: A total of 502 patients (203 [40.4%] males and 299 [59.6%] females) with an M:F of 1:1.5. The age ranged from 17 to 69 years with a mean age ± standard deviation (SD) (31.6 ± 9.6) years. The majority of the patients were in the age group of 21–40 years. TOT ranged from 10 to 35 min with mean TOT ± SD (15.35 ± 7.02) min. The mean TOT according to PDI was 11.30 ± 2.22, 12.74 ± 4.14, and 26.44 ± 4.39 min in I, II, and III, respectively, while according to PS were 10.91 ± 0.9, 19.60 ± 4.5, 28.82 ± 3.5 min in II, III, and IV, respectively. The observed correlation coefficients® for PDI and PS were 0.716 and 0.870, respectively. Conclusion: Analysis of the surgical difficulty of impacted MTM extraction is essential for treatment planning and patient satisfaction. PS has been found to be significantly associated with TOT.

Background The keratocystic odontogenic tumour (KCOT) is a benign intraosseous odontogenic lesion relatively frequent in the oral cavity. It has a locally aggressive behaviour and exhibits a high propensity to recur after treatment. All the singular characteristics of this pathology have originated controversy in the scientific community regarding the most appropriate surgical approaches for the successful treatment of this tumour. Objectives To analyse the optimal treatment choice for this tumour, ensuring high success rates of treatment, preventing future recurrences and allowing the maintenance of the patient's quality of life. Materials and methods A search was conducted in Cochrane – 1 result – and in PubMed – 756 results. The selection of articles was based on abstracts and inclusion and exclusion criteria. Three research studies were considered for the final analysis. Results One hundred and nineteen lesions were identified (73 males and 46 females). Twenty-nine tumours were found in the maxilla and 91 in the mandible; the applied therapeutic methods were: marsupialization/decompression, marsupialization followed by enucleation and adjunctive therapies (peripheral ostectomy and Carnoy's solution), solely enucleation, enucleation and Carnoy's solution, enucleation followed by peripheral ostectomy and Carnoy's solution and resection. Discussion and conclusions Treatment by enucleation, in combination with adjunctive measures, is associated with minor recurrence rates when compared with enucleation alone. The small number of KCOT that were treated with en bloc resection did not obtain statistically relevant results. Therefore, more studies with well-established criteria are necessary to enable an adequate analysis of recurrence rates associated with each treatment modality.

Objective To verify the ability of a novel Canine Elbow Realignment Osteotomy (CERO) system for acute axial radial or ulnar lengthening to restore normal elbow congruency in a shortened radius cadaver model using assessment by computed tomography (CT). Study Design In vitro cadaver study. Animals Five pairs of greyhound forelimbs from animals euthanatized for reasons unrelated to the study. Methods CT of each elbow was performed (1) pre-operatively (pre-op), (2) after placement of a linear motor IMEX™ external skeletal fixator (ESF) on the radius with diaphyseal ostectomy and radial shorting of 1–5 mm (post-ESF), and (3) after CERO surgery to lengthen the radius proximal to the ostectomy site by an amount equal to the degree of radial shortening (post-CERO). The joint space at 7 loci on dorsal plane and 6 loci on sagittal plane reconstructions was measured to assess changes in joint congruity between pre-op, post-ESF, and post-CERO. Repeated measures ANOVA with post hoc comparisons were performed to compare measurements between the 3 groups. Results Mean joint space measurements at most loci in the dorsal and sagittal planes were significantly different post-ESF compared with pre-op, confirming development of joint incongruency with the model. Post-CERO joint space measurements did not differ significantly compared with pre-op measurements, demonstrating the return to normal joint congruency using the CERO procedure. Conclusion CERO surgery restored humeroradioulnar congruency in our cadaver model and may have application for acute correction of axial radial or ulnar incongruency in canine elbows secondary to elbow dysplasia or premature growth plate closure.

Langerhans cell histiocytosis (LCH) is characterized by proliferation of histiocyte-like cells (Langerhans cell histiocytes) with characteristic Birbeck granules, accompanied by other inflammatory cells. Treatments of LCH include surgery, chemotherapy, and radiotherapy. One of the representative forms of chemotherapy is intralesional injection of steroids. Surgical treatment in the form of simple excision, curettage, or even ostectomy can be performed depending on the extent of involvement. Radiotherapy is suggested in case of local recurrence, or a widespread lesion. This article shows the case of repetitively recurrent LCH of a 56-year-old man who had been through surgical excision and had to have marginal mandibulectomy and radiotherapy when the disease recurred. After the first recurrence occurred, lesions involved the extensive part of the mandible causing pathologic fracture, so partial mandibular bone resection was performed from the right molar area to the left molar area followed by the excision of the surrounding infected soft tissues. The resected mandibular bone was reconstructed with a segment of fibula osteomyocutaneous free flap and overdenture prosthesis supported by osseointegrated implants.

Objective The aim of this study was to evaluate the influence of clinical, radiographic, surgical and histopathologic parameters in the recurrence of disease in a series of odontogenic keratocysts (OKCs). Study Design The sample comprised 24 sporadic OKC lesions from 24 patients. All patients had no previous treatment history and were treated by the same surgeon using a uniform treatment protocol (enucleation with peripheral ostectomy preceded or not preceded by decompression). Results Fourteen lesions (58.4%) were first submitted to decompression procedure. Eight patients (33%) developed recurrent lesions, with a mean follow-up time of 60.5 months (standard deviation [SD] = 31.3) and a mean disease-free interval for recurrent lesions of 19 months (SD = 4.9). Recurrence was significantly associated with poor clinical response to decompression ( P = .027), remaining tooth with radiographic evidence of insinuation of the lesion between the dental roots ( P = .009), and the presence of budding of the basal cells layer together with epithelial islands in the fibrous capsule ( P = .019). Conclusions Clinical, radiographic and histopathologic parameters may affect the relapse rate of OKCs and should individually guide treatment choice.

Binderoid cleft lip and palate refers to patients who have complete unilateral or bilateral cleft lip and palate with nasolabiomaxillary hypoplasia and orbital hypotelorism without evidence of holoprosencephaly. These patients are characterized by hypoplastic nasal tip, conical columella, tiny prolabium, underdeveloped lateral labial elements, and small/mobile premaxilla. The ipsilateral central and lateral incisors are absent in patients with unilateral cleft, and single-toothed premaxilla is typically found in bilateral patients. Special considerations and several modifications are needed not only in the operative technique, but also in the entire treatment process, starting from the preoperative period until childhood and adolescence. A 4-year-old Indonesian girl with binderoid bilateral cleft lip and palate visited our department with the help of a relief agency. We present the surgical management of the binderoid cleft lip and palate using synchronous nasolabial repair with premaxillary ostectomy and fixation following Mulliken's principle and special considerations for the late primary repair are discussed.

Objective: To compare the biomechanical properties of dual bone fixation (DBF) constructs to radial locking compression plating (LCP) in an ex vivo feline antebrachial fracture gap model. Study Design: Ex vivo study. Sample Population: Cadaveric feline antebrachii (n=12 pairs). Methods: Antebrachii were radiographed to confirm normal skeletal appearance and maturity. After creation of a 5 mm radial and ulnar ostectomy, each antebrachium received 1 of 3 constructs using an incomplete randomized block design (n=8 per group). All groups received a 10 hole 2.0 mm radial LCP. DBF groups received either a 1.2 mm ulnar intramedullary pin (LCP with pin) or an 8 hole 2.0 mm ulnar LCP in addition to the radial LCP. Biomechanical testing was performed in axial compression and caudocranial and mediolateral 4-point bending before destruction in axial compression. Results: DBF constructs (LCP with pin and dual LCP) were significantly stiffer than radial LCP alone in axial compression and caudocranial bending. There were no differences between LCP with pin and dual LCP constructs in axial compression and caudocranial bending or between any constructs in mediolateral bending. Failure load was significantly greater for dual LCP than LCP with pin or LCP alone constructs. Failure loads were not different between LCP with pin and LCP alone. Conclusion: DBF significantly increased construct stiffness and strength. Given the high complication rate reported in cat antebrachial fractures when only the radius is stabilized, surgeons should consider DBF.

The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views.An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone.We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs.Oblique radiographs at 30̊ of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used.Estabelecer uma forma indireta, fácil, previsível e segura na obtenção do valor real do desvio da fratura do colo do quinto metacarpo a partir de radiografias oblíquas.Uma peça anatômica de quinto metacarpo humano foi dissecada e submetida à ostectomia na região do colo. Um fio de Kirschner de 1 mm foi fixado perpendicular ao eixo longitudinal do osso e paralelo ao solo. Outros seis fios de Kirschner do mesmo diâmetro foram dobrados e presos ao osso ostectomizado para simular o desvio das fraturas. Rotação axial do metacarpo foi usada para criar as radiografias nas incidências oblíquas. Imagens radiográficas foram obtidas com diferentes ângulos e em vários graus de rotação do osso.Deduzimos uma equação matemática que demonstra o real desvio da fratura do colo do quinto metacarpo por meio de radiografias oblíquas.A radiografia oblíqua com 30̊ de supinação apresenta melhor visualização do osso e menor variação do valor real do desvio da fratura do colo do quinto metacarpo. A fórmula matemática deduzida foi concordante com o modelo experimental usado.

Objective To use micro-computed tomography (CT) to evaluate the fissure–fracture pattern in dogs affected by medial coronoid disease (MCD). Study Design Prospective case-controlled study. Sample Population Client owned (n = 21) and cadaver dogs (n = 5). Methods Segments were excised by subtotal coronoid ostectomy from dogs with MCD. Two categories were identified: fissured (Fi) or fractured (F). Three subcategories were contingent on fissure–fracture orientation: tip (T), radial incisure (RI), and radial incisure encroaching tip (RIT). Control segments were from nondiseased cadavers. High-resolution micro-CT (3 dimensional and 2 dimensional) was performed on all segments. Measurements included mean bone mineral density, trabecular number and thickness, and the angle of the fissure–fracture relative to the predominant trabecular orientation. Results A total of 28 diseased segments from 21 dogs (mean age 23.3 months, mean bodyweight 31.5 kg) were analyzed and categorized according to fissure–fragment location as Fi-T (n = 2), Fi-RIT (n = 2), Fi-RI (n = 3), F-T (n = 5), F-RIT (n = 9), F-RI (n = 7). The 3D analysis revealed subchondral micro-fracturing occurred in association with fragmentation. Canalicular impaction was associated with increase in trabecular number and decrease in trabecular space, most notably in RI categories. The 2D analysis showed that predominant trabecular orientation in control segments was significantly different to RI but not to T. The mean (SD) angle difference between the orientation of fissure–fracture and the predominant trabecular pattern was 6.9 (6.9)° for RI and 44.6 (49.6) ° for T. Conclusion T and RI fissure–fracture patterns show morphologic differences and likely arise from different supraphysiologic loading. Medial compartment disease is not homogenous and pattern recognition may assist further investigation of etiopathogenesis.

Purpose To understand the frequency of use of Carnoy's solution, as a means of chemical curettage, for treating the keratocystic odontogenic tumor (KCOT). Materials and Methods A Web-based survey was distributed by e-mail to 6,880 members listed in the 2013 American Association of Oral and Maxillofacial Surgeons directory. Results Eight hundred nine participants across the United States responded to the survey (12% response rate). The most common procedures performed to definitively treat a KCOT were enucleation plus mechanical curettage (curette with or without peripheral ostectomy; 66%). Of the survey participants, 198 (25%) currently use Carnoy's solution, 111 (56%) of whom are using the solution with chloroform and 83 (42%) are using it without chloroform. Conclusion Carnoy's solution remains a common method of chemical curettage for the definitive treatment of the KCOT. Carnoy's solution with and without chloroform is being used for chemical cautery.

Many surgical procedures to improve mandibular contour have been introduced in East Asia. Despite consensus regarding mandible contouring surgery, surgery which includes angle ostectomy and lateral cortex excision, some patients require only mandibular angle ostectomy. The intraoral approach is a widely used method, but has disadvantages with regard to the need for endotracheal intubation and patients are limited in their food intake for a considerable length of time. The authors wanted to shorten the recovery period and so the postauricular approach is introduced in this study and assessed.One hundred seventy-five Asian patients underwent mandibular angle ostectomy via a postauricular approach. All operations were performed under intravenous sedation without endotracheal intubation. Superficial subcutaneous dissection and vertical dissection were performed, with special care taken to avoid injuring the facial nerve. Patients responded to a simple questionnaire during the postoperative period. Questions solicited the patient's reason for their choice of this approach and their satisfaction with it.No visible scar and no palpable bony step were observed without ear pulling. Some patients experienced temporary sensory changes in the postauricular area. None of the patients complained of perioral numbness or facial paralysis. Six patients had significant bleeding in the operative field and 1 patient experienced salivary leakage for 2 weeks which was managed well without event. Of the 175 patients, 133 responded to the questionnaire. Satisfaction was expressed by 94.7% of patients and 88.7% of patients would recommend this surgery to their friends; 69.2% of patients experienced inconvenience for 1 week or less.The postauricular approach for mandibular angle ostectomy is a very convenient method for surgeons to use for patients who want to undergo mandibular angle ostectomy with a short recovery time.

BACKGROUND Zygoma reduction is commonly performed in Asian patients because a broad face is considered stubborn in appearance and unattractive. Consequently, a number of different techniques have been developed for zygoma reduction, the majority of which involve simple manipulations. However, no consensus has been reached on the optimal method. In the present report, we introduce a new method involving ostectomy and fixation that uses a 3-dimensional approach to zygoma reduction. METHODS From 2007 to 2013, 221 Korean patients (39 men, 182 women) underwent zygoma reduction using this technique. The bone was accessed via an intraoral and preauricular incision and removed in the body area using a small L-shaped osteotome through bone cutting in the arch area. The zygoma was moved anteriorly, medially, and caudally, and then fixed with a miniplate and screws. RESULTS All patients were followed up for over 6 months and asked whether they were satisfied with the results. Four patients (1.8%) required further reduction and underwent a reoperation, but all were eventually satisfied. Two patients (0.9%) experienced overcorrection with a sunken area around the zygoma, which was corrected with autologous fat grafting after 6 months. Two patients complained of sensory changes around the upper lip, which resolved within 6 months. Two patients experienced dizziness, temporomandibular joint pain, infection, and/or cheek drooping. CONCLUSIONS This new surgical technique causes less frequent and less pronounced cheek drooping and requires less bone stepping, resulting in greater patient satisfaction.

Objective The goal of this study was to determine whether computer-assisted surgical navigation improves the accuracy of tibial component alignment in canine total knee replacement (TKR). Study Design Retrospective radiographic review and prospective ex vivo study. Sample Population Canine TKR radiographs (n = 17 sets) and canine cadaveric stifles (n = 12). Methods Radiographs from TKR surgical workshops were reviewed to determine the incidence and magnitude of tibial component malalignment. Tibial component alignment was compared after either standard (“surgeon-guided”) component placement or computer-assisted (“navigation-guided”) placement. Results were compared against the current recommendations of a neutral (0° varus–valgus) ostectomy in the frontal plane and 6° of caudal slope in the sagittal plane. A prospective cadaveric study was then undertaken by performing TKR in 12 canine stifle joints. Results Malalignment of >3° in the frontal and sagittal planes was identified in 12% and 24% of the radiographs from the retrospective review, respectively. Surgical navigation reduced both the mean error (P = .007) and the variability in frontal plane alignment (P

Background Although various techniques of mandibular angle ostectomy have been devised to correct overly prominent bony contours, none have incorporated methods to delineate the surgical line with precision. Herein, the authors describe one means of marking an ostectomy line more easily, using a specially designed oscillating-blade saw. Methods Between July 2013 and June 2014, a total of 75 patients underwent quantitative mandibular angle ostectomy using a custom oscillating-blade saw equipped with a scalable guide. Corticectomy, also done routinely to improve frontal appearance, called for a reciprocating saw only. Aesthetic outcomes gauged subjectively by the questionnaire about satisfaction and symmetry after postoperative 6 months. Results Satisfaction score was 4.9 and symmetric score was 4.7. No major complications, such as persistent nerve injury or fracture, were encountered. Conclusions Use of an oscillating-blade saw equipped with a scalable guide facilitated quantitative mandibular angle ostectomy, enabling precise, and reproducible surgery with satisfactory outcomes with less complications.

Excessive gingival display during smile can result in compromised esthetics. This study aims to report a case of excessive gingival display with multiple etiologies treated by means of modified lip repositioning technique associated with esthetic crown lengthening. A 23-year-old female patient, with 5-mm gingival display during smile caused by altered passive eruption and hypermobility of the upper lip, underwent the modified lip repositioning technique associated with gingivectomy followed by flap elevation and ostectomy/osteoplasty. Seven months after the second procedure, the patient had her esthetic complaint solved appearing stable in the observation period. The modified lip repositioning technique is an effective procedure employed to reduce gingival display and when associated with esthetic clinical crown lengthening, can appropriately treat cases of gummy smile.