Description

The International Journal of Oral & Maxillofacial Surgery is one of the leading journals in oral & maxillofacial surgery in the world. The Journal publishes papers of the highest scientific merit and widest possible scope on work in oral and maxillofacial surgery and supporting specialties. It had an Impact Factor of 0.932 in 2000, considerably ahead of its closest rivals. The Journal is divided into sections, ensuring every aspect of oral and maxillofacial surgery is covered fully through a range of invited review articles, leading clinical and research articles, technical notes, abstracts, case reports and others. The sections include: Congenital and craniofacial deformities, Cosmetic facial surgery, Orthognathic surgery/trauma/TMJ disorders, Head and neck oncology, Reconstructive pre-prosthetic surgery/implantology, Clinical pathology/dentoalveolar surgery, Medicine/pharmacology, Research and emerging technologies, Evidence-based therapy.

Publisher details

Elsevier

Publications in this journal

• Ki-67 expression predicts radiosensitivity in oral squamous cell carcinoma.

  Authors: C Freudlsperger, K Freier, J Hoffmann, M Engel

  International journal of oral and maxillofacial surgery.

  The prognostic relevance of Ki-67 expression in oral squamous cell carcinoma (OSCC) is still controversial. As proliferating cells are more susceptible to ionizing radiation, the authors investigatedThe prognostic relevance of Ki-67 expression in oral squamous cell carcinoma (OSCC) is still controversial. As proliferating cells are more susceptible to ionizing radiation, the authors investigated if a high proliferation rate reflected by Ki-67 expression, predicts radiosensitivity in OSCC patients. In 52 patients with OSCC who received primary surgery followed by radiation therapy, the proliferation rate was assessed by Ki-67 immunhistochemistry and correlated to recurrent free survival and overall survival. Low proliferative carcinomas showed a significantly shorter mean time to recurrence of 27.5 months compared to 49.5 months of high proliferative tumours (p=0.048). The 5-year survival rate of low proliferative tumours was 49% compared to 80% for high proliferative tumours (p=0.042). This study indicates that tumours with high proliferative activity are more susceptible to radiation therapy. Ki-67 might be used as a marker to predict the response to radiation therapy in patients with OSCC.

• A comparative study of the effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery.

  Authors: O D Osunde, R A Adebola, B D Saheeb

  International journal of oral and maxillofacial surgery.

  The aim of this prospective randomized study was to evaluate the effect of not using sutures on postoperative pain, swelling and trismus after lower third molar surgery. 80 patients with impactedThe aim of this prospective randomized study was to evaluate the effect of not using sutures on postoperative pain, swelling and trismus after lower third molar surgery. 80 patients with impacted lower third molars were referred for surgical extraction (42 males; 38 females; aged 18-38years). The patients were randomly divided into two equal groups (sutures n=40; suture-less n=40). In the experimental group, the flaps were replaced without suturing. The control group was selected using the same criteria and treated under the same surgical protocol as the experimental group, except that the flaps were apposed using multiple sutures. Pain, swelling and trismus were evaluated at 24h, 48h and 1week postoperatively in both groups. The operation time was found to be significantly longer in the multiple sutures group (p<0.05). There was significantly less pain, swelling and trismus at 24h and 48h, respectively, in the suture-less group (p<0.05). There was no significant difference between the two treatment groups in terms of pain, swelling and trismus, at 1week postoperatively (p>0.05). There is less postoperative pain, swelling and trismus with the suture-less technique in third molar surgery.

• Primary salivary gland-type carcinomas of the nasopharynx: Prognostic factors and outcome.

  Authors: C N Cao, X M Zhang, J W Luo, G Z Xu, L Gao, S Y Li, J P Xiao, J L Yi, X D Huang, S Y Liu, Z G Xu, P Z Tang

  International journal of oral and maxillofacial surgery.

  Primary salivary gland-type carcinomas of the nasopharynx (SNPC) are a rare malignancy with diverse clinical behaviour and different prognoses. Previous studies have reported on limited patientPrimary salivary gland-type carcinomas of the nasopharynx (SNPC) are a rare malignancy with diverse clinical behaviour and different prognoses. Previous studies have reported on limited patient populations, and few long-term studies have outlined outcomes and prognostic factors. Controversy exists regarding the treatment policy for SNPC. The aim of this study was to define management approaches, therapeutic outcomes, and prognostic factors for SNPC. The medical records of 54 patients with SNPC at one institution between 1963 and 2006 were reviewed. Patient records were analysed for management approaches, outcomes, and prognostic factors. After a median follow-up of 61.3 (1.8-245.2) months, the 2-, and 5-year overall survival rates (OS), loco-regional failure free survival rates (LRFFS) and distant failure free survival rates (DFFS) were 84.6% and 61.3%, 74.4% and 55.4%, and 92.0% and 70.0%, respectively. Multivariate analyses indicated that lymph node metastases, date of treatment, and surgical treatment were independent factors for DFFS, whereas histological subtypes and distant metastases were independent factors affecting OS. The optimal treatment policy for patients with SNPC might be surgery plus radiotherapy.

• Strategies for surgically assisted rapid maxillary expansion according to the region of transverse maxillary deficiency.

  Authors: M D Pereira, R A M de Abreu, G P R Prado, L M Ferreira

  International journal of oral and maxillofacial surgery.

  This study evaluated different techniques for surgically assisted rapid maxillary expansion (SARME) according to the type of transverse maxillary deficiency using computed tomography (CT). Six adultThis study evaluated different techniques for surgically assisted rapid maxillary expansion (SARME) according to the type of transverse maxillary deficiency using computed tomography (CT). Six adult patients with bilateral transverse maxillary deficiencies underwent SARME. The patients were equally divided into three groups: Group I, maxillary atresia in both the anterior and posterior regions; Group II, greater maxillary atresia in the anterior region; and Group III, increased maxillary atresia in the posterior region. In Group I, a subtotal Le Fort I osteotomy was used. In Group II, a subtotal Le Fort I osteotomy was used without pterygomaxillary suture disjunction. In Group III, a subtotal Le Fort I osteotomy was used with pterygomaxillary suture disjunction and fixation of the anterior nasal spine with steel wire. The midpalatal suture opening was evaluated preoperatively and immediately after the activation period using CT. For Group I, the opening occurred parallel to midpalatal suture; for Group II, the opening comprised a V-shape with a vertex on the posterior nasal spine; and for Group III, the opening comprised a V-shape with a vertex at the anterior nasal spine. The conclusion was that the SARME technique should be individualized according to the type of transverse maxillary deficiency.

• Accuracy assessment of prototypes produced using multi-slice and cone-beam computed tomography.

  Authors: B T Primo, A C Presotto, H W de Oliveira, H T Gassen, S A Q Miguens, A N Silva, P A G Hernandez

  International journal of oral and maxillofacial surgery.

  The objective of this study was to assess and quantify the dimensional error of prototypes produced using multi-slice and cone-beam computed tomography (MSCT and CBCT). Titanium screws were insertedThe objective of this study was to assess and quantify the dimensional error of prototypes produced using multi-slice and cone-beam computed tomography (MSCT and CBCT). Titanium screws were inserted into a dry skull at different points of the midface. The skull was scanned using MSCT (LightSpeed16(®)) with pixel size 0.3mm and CBCT (i-CAT Cone-Beam 3D™) with voxel sizes 0.25 and 0.4mm. Prototypes were printed (fabricated) using a ZPrinter 310(®) device. Both the dry skull (gold standard) and the prototypes were measured using a Mitutoyo 3D coordinate measuring system with three perpendicular axes (X, Y, and Z). The prototype produced from MSCT data presented a mean dimensional error of 0.62%; the two models produced with CBCT images yielded errors of 0.74% with voxel size 0.25mm and 0.82% with voxel size 0.40mm. No significant differences in dimensional errors were observed across the prototypes (p=0.767; Friedman's non-parametric test). Prototypes produced from CBCT data using voxel sizes of 0.25 and 0.4mm, and also the one produced from MSCT data using pixel size 0.3mm, showed acceptable dimensional errors and can therefore be used in the fabrication of prototypes in dentistry.

• Finite element analysis of different surgical approaches in various occlusal loading locations for zygomatic implant placement for the treatment of atrophic maxillae.

  Authors: M I Ishak, M R Abdul Kadir, E Sulaiman, N H Abu Kasim

  International journal of oral and maxillofacial surgery.

  The aim of this study was to compare two different types of surgical approaches, intrasinus and extramaxillary, for the placement of zygomatic implants to treat atrophic maxillae. A computationalThe aim of this study was to compare two different types of surgical approaches, intrasinus and extramaxillary, for the placement of zygomatic implants to treat atrophic maxillae. A computational finite element simulation was used to analyze the strength of implant anchorage for both approaches in various occlusal loading locations. Three-dimensional models of the craniofacial structures surrounding a region of interest, soft tissue and framework were developed using computed tomography image datasets. The implants were modelled using computer-aided design software. The bone was assumed to be linear isotropic with a stiffness of 13.4GPa, and the implants were assumed to be made of titanium with a stiffness of 110GPa. Masseter forces of 300N were applied at the zygomatic arch, and occlusal loads of 150N were applied vertically onto the framework surface at different locations. The intrasinus approach demonstrated more satisfactory results and could be a viable treatment option. The extramaxillary approach could also be recommended as a reasonable treatment option, provided some improvements are made to address the cantilever effects seen with that approach.

• One year postoperative hard and soft tissue volumetric changes after a BSSO mandibular advancement.

  Authors: T J J Maal, M J J de Koning, J M Plooij, L M Verhamme, F A Rangel, S J Bergé, W A Borstlap

  International journal of oral and maxillofacial surgery.

  In this study, cone beam computed tomography (CBCT) and three dimensional (3D) stereophotogrammetry are used to compare the 3D skeletal and soft tissue changes caused by a bilateral sagittal splitIn this study, cone beam computed tomography (CBCT) and three dimensional (3D) stereophotogrammetry are used to compare the 3D skeletal and soft tissue changes caused by a bilateral sagittal split osteotomy (BSSO) 1 year after a mandibular advancement. Eighteen consecutive patients with a hypoplastic mandible were treated with a BSSO according to the Hunsuck modification. Preoperatively and 1 year postoperatively, a CBCT scan was acquired and a 3D photograph. The pre- and postoperative CBCT scans were matched using voxel based registration. After registration, the mandible could be segmented in the pre- and postoperative scans. The preoperative scan was subtracted from the postoperative scan, resulting in the hard tissue difference. To investigate the soft tissue changes, the pre- and postoperative 3D photographs were registered using surface based registration. After registration the preoperative surface could be subtracted from the postoperative surface, resulting in the overall volumetric difference. As expected, a correlation between mandibular advancent and volumetric changes of the hard tissues was found. The correlation between advancement and soft tissues was weak. The labial mental fold stretched after surgery. This study proved that using 3D imaging techniques it is possible to document volumetric surgical changes accurately and objectively.

• Robotic sialoadenectomy of the submandibular gland via a modified face-lift approach.

  Authors: A De Virgilio, Y M Park, W S Kim, S Y Lee, J H Seol, S-H Kim

  International journal of oral and maxillofacial surgery.

  The purpose of this study was to describe and analyse the advantages and disadvantages of submandibular gland (SMG) resection using a robotic surgical system through a modified face-lift approach.The purpose of this study was to describe and analyse the advantages and disadvantages of submandibular gland (SMG) resection using a robotic surgical system through a modified face-lift approach. The authors performed robotic sialoadenectomy of the SMG on 5 patients using the daVinci robot system through a modified face-lift approach. Three robotic arms were inserted through a modified face-lift incision; a face-down 30-degree endoscopic arm and two operative arms. The right arm was equipped with a harmonic scalpel and the left arm with a Maryland forceps. In all patients, robotic sialoadenectomy of the SMG was completed successfully. Diagnoses were sialolithiasis in two patients, pleomophic adenoma in two patients, and ranula in one patient. The mean robotic operative time was 90.2min (range 62-185min) and that for setting the robotic system was 8.2min (range 5-15min). No significant intra-operative or postoperative complications were observed. All patients were satisfied with the outcome and especially the cosmetic results at their last follow-up visit. In the authors opinion robotic sialoadenectomy of the SMG is technically feasible and secures a better cosmetic outcome than endoscopic submandibular resection.

• Clinical and pathological characteristics of polymethylmethacrylate and hyaluronic acid in the rat tongue.

  Authors: S P Moure, K F de Vargas, R L Borghetti, F G Salum, K Cherubini, V D da Silva, M A Z de Figueiredo

  International journal of oral and maxillofacial surgery.

  Adverse effects on the oral mucosa after the use of dermal fillers have been increasingly reported due to their increased use for facial aesthetics. The objective of this study was to evaluate theAdverse effects on the oral mucosa after the use of dermal fillers have been increasingly reported due to their increased use for facial aesthetics. The objective of this study was to evaluate the clinical and histologic effects of two types of product, 10% polymethylmethacrylate and 20mg/ml hyaluronic acid, locally and at long distance, examining initial and late reactions. Each substance was randomly and separately injected in rats' tongues (polymethylmethacrylate, n=16; hyaluronic acid, n=18). They were compared with the control group (n=16) at 3 observation times (7, 60 and 90 days) for clinical analysis, intensity of local inflammatory response (haematoxylin and eosin staining), amount of newly formed blood vessels and macrophages (immunohistochemical assays), density of collagen fibres (picrosirius staining) and systemic migration of the product to the liver and kidney (haematoxylin and eosin staining). The results showed inflammation triggered by the injection of the material, suggesting that both substances cause responses in local tissue, although there was biocompatibility with hyaluronic acid. This research highlights the importance of experimental studies on this subject, since adverse reactions have been observed routinely in dental practice.

• Effects of anodized implants coated with Escherichia coli-derived rhBMP-2 in beagle dogs.

  Authors: Jung-Bo Huh, Sung-Eun Kim, Hyo-Eon Kim, Seong-Soo Kang, Kyung-Hee Choi, Chang-Mo Jeong, Jeong-Yol Lee, Sang-Wan Shin

  International journal of oral and maxillofacial surgery.

  This study evaluated the effects of Escherichia coli-derived rhBMP-2 (ErhBMP-2) coated onto anodized implants to stimulate bone formation, osseointegration and vertical bone growth in a vertical boneThis study evaluated the effects of Escherichia coli-derived rhBMP-2 (ErhBMP-2) coated onto anodized implants to stimulate bone formation, osseointegration and vertical bone growth in a vertical bone defect model. Six young adult beagle dogs were used. After a 2-month bone healing period, anodized titanium implants (8mm in length) were placed 5.5mm into the mandibular alveolar ridge. Eighteen implants coated with ErhBMP-2 (BMP group) and another 18 uncoated implants (control group) were installed using a randomized split-mouth design. The implant stability quotient (ISQ) values were measured. Specimens were fabricated for histometric analysis to evaluate osseointegration and bone formation. The ISQ values at 8 weeks after implant placement were significantly higher in the BMP group than in the control group (p<0.05). Histological observations showed that the changes in bucco-lingual alveolar bone levels were higher in the BMP group than in the control group (p<0.05). The ErhBMP-2 coated anodized implants can stimulate bone formation and increase implant stability significantly on completely healed alveolar ridges in dogs. Further studies evaluating the effects of ErhBMP-2 on osseointegration in the bone-implant interface are warranted.

• Effect of low level laser therapy and zoledronate on the viability and ALP activity of Saos-2 cells.

  Authors: Hilal Bayram, Halime Kenar, Ferda Taşar, Vasıf Hasırcı

  International journal of oral and maxillofacial surgery.

  A limited number of clinical studies indicate the supportive role of low level laser therapy (LLLT) on medical and/or surgical approaches carried out in treatment modalities for bisphosphonateA limited number of clinical studies indicate the supportive role of low level laser therapy (LLLT) on medical and/or surgical approaches carried out in treatment modalities for bisphosphonate related necrosis of jaws (BRONJ), the most common side effect of bisphosphonates used to inhibit bone resorption. The purpose of this study was to investigate the effects of LLLT on cell proliferation and alkaline phosphatase (ALP) activity of human osteoblast-like cells (Saos-2) treated with different doses of zoledronate, the most potent bisphosphonate. Saos-2 cells were treated with different concentrations of zoledronate and were irradiated with diode laser (wavelength 808nm, 10s, 0.25 or 0.50W). Cell numbers and ALP activity of the cells were determined. LLLT mildly increased the proliferation rate or ALP activity, while zoledronate reduced both. When applied together, LLLT lessened the detrimental effects of zoledronate and improved cell function and/or proliferation. Based on the results of this study, it was concluded that LLLT has biostimulative effects on Saos-2 cells, even after treatment with zoledronate. LLLT may serve as a useful supportive method for BRONJ treatment through enhancement of healing by osteoblasts.

• Three-dimensional analysis of dentolabial relationships: effect of age and sex in healthy dentition.

  Authors: R Rosati, M De Menezes, A Rossetti, V F Ferrario, C Sforza

  International journal of oral and maxillofacial surgery.

  Morphological changes in three-dimensional (3D) dentolabial relationships during ageing were assessed in healthy individuals. 38 subjects with healthy dentition were analysed. They were divided intoMorphological changes in three-dimensional (3D) dentolabial relationships during ageing were assessed in healthy individuals. 38 subjects with healthy dentition were analysed. They were divided into a youthful group (21-34 years, mean 26 years, SD 4) and an older group (45-65 years, mean 53 years, SD 5). Stone labial and dental models were made, digitized and 3D virtual reproductions of dentolabial morphology were obtained. From the digital reconstructions, the relative positions of the labial commissure and of the maxillary dental clinical crowns in the vertical direction were obtained. Sex and age effects were compared using two-way analysis of variance. Lip position relative to the teeth was significantly different in youthful and older subjects (P<0.01). No statistically significant effects of sex in dentolabial relationship were demonstrated, but a sex×age effect was found in the anterior labial segments (P<0.05). The perioral soft tissues drop down in older subjects and the soft tissue descends on the entire labial arch. These differences may help the clinician when estimating, planning and evaluating surgical, orthodontic and prosthetic treatments.

• Central cystadenocarcinoma of the mandible.

  Authors: R Takei, K Tomihara, N Arai, M Noguchi

  International journal of oral and maxillofacial surgery.

  Papillary cystadenocarcinoma (PCAC) of the salivary gland is a rare malignant tumour and occurs in major and minor salivary glands. PCAC of the mandible is exceptionally rare; only 2 cases have beenPapillary cystadenocarcinoma (PCAC) of the salivary gland is a rare malignant tumour and occurs in major and minor salivary glands. PCAC of the mandible is exceptionally rare; only 2 cases have been reported. In this study, the authors report a case of PCAC within the mandible. The patient presented with a painful right mandibular mass that had gradually increased in size. The lesion appeared radiographically as a well-demarcated multilocular radiolucent area, similar to an odontogenic cystic lesion. The authors present a case of PCAC with reference to the relevant literature.

• The use of buccal fat pad flap in the treatment of osteoradionecrosis.

  Authors: S Nabil, R Ramli

  International journal of oral and maxillofacial surgery.

  The use of buccal fat pad in the management of osteoradionecrosis has not been described previously. A series of 10 consecutive cases of osteoradionecrosis treated with a combination ofThe use of buccal fat pad in the management of osteoradionecrosis has not been described previously. A series of 10 consecutive cases of osteoradionecrosis treated with a combination of sequestrectomy and buccal fat pad is presented. The data were obtained by reviewing operative and medical records. The combination of sequestrectomy and buccal fat pad flap was successful in 86% of cases of stage II osteoradionecrosis and in 0% of cases of stage III. The overall success rate was 60%. Based on the result of this series, this treatment regime appeared to be beneficial in stage II osteoradionecrosis.

• Superficial parotidectomy for chronic parotid sialadenitis.

  Authors: R Sharma

  International journal of oral and maxillofacial surgery.

  Chronic sialadenitis (CS) of the parotid gland is an insidious inflammatory disorder which tends to progress and may lead to the formation of a fibrous mass. This is a review of the author'sChronic sialadenitis (CS) of the parotid gland is an insidious inflammatory disorder which tends to progress and may lead to the formation of a fibrous mass. This is a review of the author's experience of superficial parotidectomy (SP) with duct ligation for non-specific CS of the parotid gland not responding to conservative management. 21 patients (11 females; 10 males) with intractable non specific CS underwent SP with duct ligation. The mean duration of symptoms was 1.93 years (SD 0.48). Fine needle aspiration cytology and magnetic resonance imaging were carried out prior to SP to rule out benign or malignant tumours. The mean duration of observation was 1.71 years (SD 0.39). Six patients (28.57%) developed temporary facial nerve palsy. Three (14.28%) patients developed Frey's syndrome. Paresthesia of the ear lobe was found in all cases. One case (4.76%) each of sialocoele and hypertrophic scar was found. There was complete resolution of symptoms in all the cases. The histopathological report confirmed three cases (14.28%) of mild CS and 18 cases (85.72%) of CS of greater degree. SP along with ligation of the duct is a safe and effective treatment for non-specific CS of the parotid gland.

• Morbidity and mortality associated with tracheotomy procedure in a university medical centre.

  Authors: D Oreadi, E R Carlson

  International journal of oral and maxillofacial surgery.

  This prospective study assessed the morbidity and mortality associated with 192 consecutive tracheotomies. Complications were assessed including intraoperative and/or postoperative bleeding,This prospective study assessed the morbidity and mortality associated with 192 consecutive tracheotomies. Complications were assessed including intraoperative and/or postoperative bleeding, infection, tracheoinnominate fistulae, tracheoesophageal fistulae, dislodgement of the tracheotomy tube, pneumothorax, wound infection and obstruction of the airway. 16% of the tracheotomy procedures resulted in complications. 22 tracheotomy procedures (11%) resulted in postoperative bleeding, 6 procedures (3%) had intraoperative bleeding which exceeded an estimated blood loss of 5cc and 2 procedures (1%) developed a tracheoesophageal fistula. One patient (0.5%) experienced airway distress related to obstruction of the airway proximal to the tracheotomy tube. No patients required a return to the operating room to manage their complication, no patients developed a tracheoinnominate fistula and none of the tracheotomy sites became infected. The post tracheotomy ventilator wean to trach-collar supplemental oxygen protocol was accomplished with a mean of 6 days in 119 patients for whom data was available. Results demonstrate that the open tracheotomy procedure is a safe and frequently life saving manoeuvre in situations with an unsecured airway, and it provides better outcomes in patients requiring long term ventilatory support. Mortality rates are low and its potential morbidity is exceeded by its benefits.

• Evaluation of bone volume changes after sinus floor augmentation with autogenous bone grafts.

  Authors: M Arasawa, Y Oda, T Kobayashi, K Uoshima, H Nishiyama, H Hoshina, C Saito

  International journal of oral and maxillofacial surgery.

  The aim of this study was to establish an objective method for quantitative evaluation of bone volume change after sinus augmentation. 11 sinuses in 9 patients were evaluated by computed tomographyThe aim of this study was to establish an objective method for quantitative evaluation of bone volume change after sinus augmentation. 11 sinuses in 9 patients were evaluated by computed tomography images taken before treatment (T0), and 3 months (T1) and at least 1 year (T2) after sinus augmentation. Based on the 3D digital subtraction technique, augmented bone images were extracted and bone volumes were calculated from voxel numbers of the extracted images. The mean augmented bone volumes at T1 and T2 were 2.46cm(3) and 1.85cm(3), respectively. These bone volume changes were statistically significant and the mean bone volume change±SE was -24.8%±6.1%. Loss of augmented bone was observed in all except one of the patients. The correlation coefficient between bone volume change and elapsed time was -0.64, which was statistically significant and indicated that bone resorption progressed with elapse of time after sinus augmentation. The authors' method of analysis enabled visualization of augmented bone and objective assessment of bone volume change. Within the limited number of cases, the present investigation demonstrated a significant decrease in augmented bone volume between 3 and 23 months after surgery.

• Coronoidectomy, masticatory myotomy and buccal fat pad graft in management of advanced oral submucous fibrosis.

  Authors: M C Kothari, N Hallur, B Sikkerimath, S Gudi, C R Kothari

  International journal of oral and maxillofacial surgery.

  The purpose of this study is to evaluate coronoidectomy, masticatory myotomy and buccal fat pad graft in advanced (Stage III-IV) oral sub mucous fibrosis (OSF). 10 patients with clinically andThe purpose of this study is to evaluate coronoidectomy, masticatory myotomy and buccal fat pad graft in advanced (Stage III-IV) oral sub mucous fibrosis (OSF). 10 patients with clinically and histologically confirmed advanced OSF underwent surgery entailing bilateral coronoidectomy, masticatory muscle myotomy and closure with a pedicled buccal fat pad graft followed by vigorous mouth opening exercises. The result was evaluated using the interincisal distance at maximum mouth opening as the objective outcome measure over a follow up period of 12 months. Results showed a mean interincisal opening of 14.7mm preoperatively and 32.5mm at 12 months postoperatively. Relapse was encountered in one patient who did not cooperate with the postoperative exercise regime. Results suggest this regime is effective.

• Reconstruction of large mandibular and surrounding soft-tissue defects using distraction with bone transport.

  Authors: N Zwetyenga, F Siberchicot, A Emparanza

  International journal of oral and maxillofacial surgery.

  Reconstruction of large bone and soft-tissue defects of the inferior third of the face is possible using various surgical techniques. Patients who require these procedures need to be in good generalReconstruction of large bone and soft-tissue defects of the inferior third of the face is possible using various surgical techniques. Patients who require these procedures need to be in good general health, may have sequelae linked to donor sites, and require several interventions to achieve good aesthetic and functional results. The aim of this study was to report outcomes in patients with large mandibular and soft-tissue defects treated using osteogenic distraction with bone transport. Between 2001 and 2008, 14 patients had distraction with bone transport. Most patients were men (92.1%). The mean age was 43.1 years. The average mandibular bone reconstruction was 13.6cm. The mean duration of distraction was 2.3 months. No infections occurred, and in all cases reconstruction of soft tissues was obtained. Two patients had non-union and underwent reconstruction using an iliac bone graft. Patients with sufficient bone height (57.1%) had dental implants. 44 implants were inserted, two of which were lost. 36 implants were activated. Six patients had satisfactory oral rehabilitation with implant-supported prostheses. Osteogenic distraction with bone transport allows total or partial restoration of oral function, provides an acceptable appearance, and enables patients to resume a reasonable quality of life.

• Masticatory efficiency in class II and class III dentofacial deformities.

  Authors: M N C Picinato-Pirola, W Mestriner, O Freitas, F V Mello-Filho, L V V Trawitzki

  International journal of oral and maxillofacial surgery.

  Masticatory efficiency may be impaired in individuals with dentofacial deformities. The objective of the present study was to determine the condition of masticatory efficiency in individuals withMasticatory efficiency may be impaired in individuals with dentofacial deformities. The objective of the present study was to determine the condition of masticatory efficiency in individuals with dentofacial deformities. 30 patients with class II (DG-II) and 35 patients with class III (DG-III) dentofacial deformity participated in the study, all had an indication for orthognathic surgery. 30 volunteers (CG) with no alterations of facial morphology or dental occlusion and with no signs or symptoms of temporomandibular joint dysfunction also participated. Masticatory efficiency was analysed using a bead system (colorimetric method). Each individual chewed 4 beads, one at a time, over 20s measured with a chronometer. The groups were compared in terms of masticatory efficiency using analysis of variance (ANOVA), with the level of significance set at P<0.05. Masticatory efficiency was significantly greater in CG (P<0.05) than in DG-II and DG-III in all chewing tasks tested, with no significant difference between DG-II and DG-III (P>0.05). It was observed that the presence of class II and class III dentofacial deformity affected masticatory efficiency compared to CG, although there was no difference between DG-II and DG-III.

• Effects of maxillary advancement and impaction on nasal airway function.

  Authors: F Pourdanesh, R Sharifi, A Mohebbi, A Jamilian

  International journal of oral and maxillofacial surgery.

  The effects of Le Fort I osteotomy on the nasal airway are controversial. This study aimed to evaluate nasal airway changes after Le Fort I. 25 patients underwent conventional Le Fort I osteotomy andThe effects of Le Fort I osteotomy on the nasal airway are controversial. This study aimed to evaluate nasal airway changes after Le Fort I. 25 patients underwent conventional Le Fort I osteotomy and were separated into three groups depending on the type of surgery they underwent. 11 patients needed maxillary impaction, 9 underwent maxillary advancement, and 5 had both maxillary impaction and advancement. Rhinological examinations, anterior rhinomanometry and acoustic rhinometry were carried out 1 week before surgery and 3 months after that. Wilcoxon and χ(2) tests were used for data analysis. The samples included 19 females and 6 males with a mean age of 22.4±3.32 years. Rhinomanometric assessment showed that total nasal airflow was increased from 406±202ml/s to 543±268ml/s in all three groups. Significant decrease in nasal airway resistance was seen in all three groups. Acoustic rhinometry revealed a significant decrease in total nasal volume but an increase in the cross-sectional areas of isthmus nasi (IN) and inferior concha. The rhinomanometric measurements showed improvements in the total nasal airflow after Le Fort I osteotomy with alar base cinch suture in cases where the impaction was not higher than 5.5mm.

• Signs and symptoms of parotid gland carcinoma and their prognostic value.

  Authors: D Stodulski, B Mikaszewski, C Stankiewicz

  International journal of oral and maxillofacial surgery.

  The aim of this study was to analyse signs and symptoms present in patients with parotid gland carcinoma and to assess their prognostic value. A retrospective study of data from 131 patients who wereThe aim of this study was to analyse signs and symptoms present in patients with parotid gland carcinoma and to assess their prognostic value. A retrospective study of data from 131 patients who were treated surgically was performed. Evaluation of prognostic factors was possible in 109 patients who completed a minimum 5 year follow up. The most common sign and symptoms were parotid mass (96.9%), pain (40.4%), enlarged cervical lymph nodes (32.0%), facial nerve palsy (20.6%) and overlying skin infiltration (19.8%). In 20% of all cases there were no symptoms of tumour malignancy. The average duration of symptoms suggesting malignancy was 4 months. In univariate analysis, the strongest prognostic value was found for facial nerve palsy; it reduced nearly tenfold (9.7) the 5-year disease-free survival. The subsequent poor prognostic factors were: skin infiltration, enlarged cervical lymph nodes, tumour fixation and tumour size (>4cm). Pain and the dynamics of tumour growth were not statistically significant for survival rate. Significant difference in 5-year disease free survival rate was found between the groups of patients, according to the number of symptoms suggesting malignancy. The multivariate analysis showed that only facial nerve palsy and skin infiltration were independent prognostic factors.

• Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review.

  Authors: M Clementini, A Morlupi, L Canullo, C Agrestini, A Barlattani

  International journal of oral and maxillofacial surgery.

  This study assessed the success rate of implants placed in horizontal and vertical guided bone regenerated areas. A systematic review was carried out of all prospective and retrospective studies,This study assessed the success rate of implants placed in horizontal and vertical guided bone regenerated areas. A systematic review was carried out of all prospective and retrospective studies, involving at least five consecutively treated patients, that analysed the success rate of implants placed simultaneously or as second surgery following ridge augmentation by means of a guided bone regeneration (GBR) technique. Studies reporting only the survival rate of implants and studies with a post-loading follow up less than 6 months were excluded. From 323 potentially relevant studies, 32 full text publications were screened and 8 were identified as fulfilling the inclusion criteria. The success rate of implants placed in GBR augmented ridges ranged from 61.5% to 100%; all studies, apart from three, reported a success rate higher than 90% (range 90-100%). The data obtained demonstrated that GBR is a predictable technique that allows the placement of implants in atrophic areas. Despite that, studies with well-defined implant success criteria after a longer follow-up are required.

• Maxillary stability after Le Fort I osteotomy using three different plate systems.

  Authors: K Ueki, K Okabe, A Moroi, K Marukawa, M Sotobori, Y Ishihara, K Nakagawa

  International journal of oral and maxillofacial surgery.

  The purpose of this study was to compare postoperative changes in maxillary stability after Le Fort I osteotomy in three groups: with an unsintered hydroxyapatite (u-HA)/poly-l-lactic acid (PLLA)The purpose of this study was to compare postoperative changes in maxillary stability after Le Fort I osteotomy in three groups: with an unsintered hydroxyapatite (u-HA)/poly-l-lactic acid (PLLA) plate; a PLLA plate; and a titanium plate. Subjects comprised 60 Japanese patients diagnosed with mandibular prognathism. All patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. All patients were randomized in groups of 20 to a u-HA/PLLA group, a PLLA plate group and a titanium plate group. Changes in postoperative time intervals between the plate groups were compared using lateral and posteroanterior cephalography. The uHA/PLLA group had significantly larger values than the PLLA group regarding change of mx1-S perpendicular to SN between 3 and 12 months (T3) (P=0.0269). The uHA/PLLA group had a significantly larger value than the PLLA group regarding change of S-A perpendicular to SN between baseline and 1 month (T1) (P=0.0257). There was no significant difference in the other measurements. This study suggests that maxillary stability with satisfactory results could be obtained in the u-HA/PLLA, PLLA plate and titanium plate groups, although there was a slight difference between the u-HA/PLLA and PLLA plate systems in Le Fort I osteotomy.

• An accurate maxillary superior repositioning technique without intraoperative measurement in bimaxillary orthognathic surgery.

  Authors: S Omura, S Kimizuka, T Iwai, I Tohnai

  International journal of oral and maxillofacial surgery.

  This article describes a simple and accurate technique for maxillary superior repositioning without any intraoperative measurement using reference points that can be the source of error inThis article describes a simple and accurate technique for maxillary superior repositioning without any intraoperative measurement using reference points that can be the source of error in bimaxillary orthognathic surgery. A bilateral straight locking miniplates (SLMs)/screw system secured to the maxilla and mandible maintains the three-dimensional relationship between the mandible and the skull base precisely like the incisor pin of an articulator in model surgery. The maxilla can then be accurately moved into the planned position identical to that in model surgery by the SLMs technique.

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