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• Correlation of expression of hypoxia-related proteins with prognosis in oral squamous cell carcinoma patients.

  Authors: A W Eckert, M Kappler, J Schubert, H Taubert

  Oral and maxillofacial surgery.

  INTRODUCTION: Hypoxia plays a major role in tumor progression, therapy resistance and for prognosis of oral squamous cell carcinoma (OSCC). The crucial step as a response to hypoxia is the activationINTRODUCTION: Hypoxia plays a major role in tumor progression, therapy resistance and for prognosis of oral squamous cell carcinoma (OSCC). The crucial step as a response to hypoxia is the activation and stabilization of the alpha subunit of hypoxia inducible factor 1 (HIF-1α). HIF-1: HIF-1 regulates the expression of different genes to adapt the tumor cells to reduced oxygenation. The HIF-1 system is intrinsic regulated by von Hippel-Lindau protein (pVHL). Main downstream proteins are the glucose transporter 1 (GLUT-1), carbonic anhydrase IX (CAIX), and vascular endothelial growth factor (VEGF). For therapeutical stratification in OSCC, it is important to understand the mechanism caused by hypoxic stress and to comprehend the resulting adaptive process in cancer cells. Therefore, an overview of HIF-1α-depending protein expression, focussed on the expression of GLUT-1, CAIX, and VEGF and their prognostic significance in OSCC is given. CONCLUSION: Several unique roles of hypoxic pathway in the context of tumor progression are described in this review. As a consequence, a marker panel is proposed to allow a more individualized prognosis in OSCC patients. This marker panel should include beside HIF-1α, pVHL, and GLUT-1.

• Surgical management of the N0 neck in early stage T1-2 oral cancer; a personal perspective of early and late impalpable disease.

  Authors: R A Ord

  Oral and maxillofacial surgery.

  INTRODUCTION: The management of the N0 neck in early stage oral cancer remains controversial. The evidence in the literature for elective neck dissection, which is reviewed in this paper, isINTRODUCTION: The management of the N0 neck in early stage oral cancer remains controversial. The evidence in the literature for elective neck dissection, which is reviewed in this paper, is conflicting. My personal view is that most papers mistakenly assume that the N0 equates to an "early stage" neck whereas a neck with palpable nodes represents disease at a "late" stage. DISCUSSION: I believe that this is the same mindset that prevented us from realizing that depth rather than size was the important prognostic determinant for the primary tumor; because the T stage was based on tumor size. The N stage is also based on size and number of nodes and by these criteria N0 would be the earliest stage. However, although an N0 neck with impalpable intra-nodal disease may be regarded as early impalpable disease an N0 neck with microscopic extra-capsular spread (ECS) would be "late/advanced" impalpable disease. Likewise, a clinically positive neck with intra-nodal disease still represents early disease compared to a clinically positive neck with ECS. CONCLUSION: The lack of trials and studies stratifying NO and N +ve necks into early and late disease and comparing outcomes between these cohorts may explain the lack of clear-cut evidence regarding the role for elective neck dissection.

• Odontoma associated with calcifying cystic odontogenic tumor in deciduous dentition: case report.

  Authors: Marcelo Lupion Poleti, Bruno Gomes Duarte, Vanessa Soares Lara, Patrícia Freitas-Faria, Izabel Regina Fischer Rubira-Bullen, Eduardo Sanches Gonçales

  Oral and maxillofacial surgery.

  BACKGROUND: Initially described by Gorlin et al. in 1962, the calcifying cystic odontogenic tumor (CCOT) may be associated with unerupted teeth, ameloblastomas, adenomatoid odontogenic tumors, and,BACKGROUND: Initially described by Gorlin et al. in 1962, the calcifying cystic odontogenic tumor (CCOT) may be associated with unerupted teeth, ameloblastomas, adenomatoid odontogenic tumors, and, in many cases, with odontomas. It is rare in patients in the first decade of life, particularly involving deciduous teeth. Surgery is the treatment of choice, with low recurrence rates. CASE REPORT: We present a clinical case of CCOT associated with odontoma and a missing deciduous tooth in a 3-year-old female patient. The lesion was removed under general anesthesia. The patient has been followed up for 1 year, and no recurrence was found. This appears to be the first report in such a young age.

• Ipsilateral, isolated amaurosis after inferior alveolar nerve block: report of two rare cases.

  Authors: Dinesh Kumar Verma, Ritesh Rajan, Sundararaman Prabhu

  Oral and maxillofacial surgery.

  BACKGROUND: Local anesthetics are utilized all over the world for performing painless dental procedures. Usually, the administration of local anesthetic is an uncomplicated process that passes offBACKGROUND: Local anesthetics are utilized all over the world for performing painless dental procedures. Usually, the administration of local anesthetic is an uncomplicated process that passes off uneventfully. Complications, when seen, are not usually serious. However, blindness is an alarming complication both for the patient and for the dentist. Amaurosis can occur with both maxillary and mandibular nerve blocks. Amaurosis is usually associated with other ocular complications like ptosis, diplopia, and periorbital blanching. CASE REPORT: We report two rare cases of transient isolated amaurosis. Both the instances of amaurosis were seen after inferior alveolar nerve blocks. The condition was transient and resolved without any active intervention. DISCUSSION: Though permanent amaurosis has been reported, it is usually transient in nature. Various causes have been proposed like intravascular injection, sympathetic impulse generation, and embolism. The etiology in the present case was believed to be intravascular injection.

• Maxillary ameloblastoma mimicking an oroantral fistula.

  Authors: Aydin Gulses, Altan Varol, Yavuz Sinan Aydintug, Ramazan Koymen, Omer Gunhan

  Oral and maxillofacial surgery.

  BACKGROUND: The aim of this current report is to present an unusual case of a maxillary ameloblastoma mimicking an oroantral fistula. CASE REPORT: A left subtotal maxillectomy via Weber-Ferguson-typeBACKGROUND: The aim of this current report is to present an unusual case of a maxillary ameloblastoma mimicking an oroantral fistula. CASE REPORT: A left subtotal maxillectomy via Weber-Ferguson-type incision was performed. The patient tolerated the procedure well, the postoperative course was uneventful, and the patient was discharged 3 days after surgery with a mild paraesthesia of the right infraorbital nerve distribution. The infraorbital nerve paraesthesia has resolved 5 months after resection. The patient has been followed-up for 3 years without recurrence. DISCUSSION: Ameloblastoma is a well-known pathology of the maxillofacial region. However, unusual manifestations of this tumor can represent a serious challenge for diagnosis.

• Efficacy of the Silensor for treating obstructive sleep apnea syndrome.

  Authors: Hiroyuki Nakano, Katsuaki Mishima, Asuka Matsushita, Hokuto Suga, Mayumi Matsumura, Takamitsu Mano, Teruyu Fukuda, Hirotaka Hara, Hiroshi Yamashita, Yoshiya Ueyama

  Oral and maxillofacial surgery.

  INTRODUCTION: Although mandibular repositioning devices were found to be very effective for treating obstructive sleep apnea (OSAS), they can cause side effects such as temporomandibular jointINTRODUCTION: Although mandibular repositioning devices were found to be very effective for treating obstructive sleep apnea (OSAS), they can cause side effects such as temporomandibular joint disorder and occlusal deviation. A semi-rigid device with a low frequency of side effects, the Silensor, (Erkodent Gmbh, Tuttlingen, Germany) was reported previously. The purpose of this study is to determine whether the Silensor is effective for treating OSAS. MATERIALS AND METHODS: Thirty-five OSAS patients (27 males and 8 females) who were treated with the Silensor were enrolled in this study. The mean age and body mass index of the patients were 52.2 years (23-72 years) and 24.5 kg/m(2) (19.3-31.6 kg/m(2)), respectively. The patients were classified into two groups based on the length of the apparatus connector: 0-2 or 3-4 mm. A polysomnography test was performed twice, at the first visit and after the improvement of subjective symptoms. These data were statistically analyzed using the Wilcoxon signed-rank test. RESULTS: The apnea-hypopnea index significantly improved in all OSAS patients, the mild to moderate OSAS patients, severe OSAS patients, 0- to 2-mm group, and the 3- to 4-mm group (91.4 %; p < 0.01, 88.9 %; p < 0.01, 100 %; p < 0.05, 86.4 %; p < 0.01, 100 %; p < 0.01, respectively). The only side effects of the Silensor were broken apparatus and damage to the buccal mucosa. DISCUSSION: The Silensor is useful for the treatment of OSAS. In particular, the Silensor is suitable for the first phase of OSAS treatment with oral appliances because the efficacy of the Silensor was equal to that of other oral appliances and had few side effects.

• Survival and complications of zygomatic implants: a systematic review.

  Authors: Bruno Ramos Chrcanovic, Mauro Henrique Nogueira Guimarães Abreu

  Oral and maxillofacial surgery.

  PURPOSE: This systematic review attempted to answer the focused questions: "What is the survival rate of zygomatic implants (ZIs)?" and "What are the most common complications related to surgery ofPURPOSE: This systematic review attempted to answer the focused questions: "What is the survival rate of zygomatic implants (ZIs)?" and "What are the most common complications related to surgery of zygomatic implants?" METHODS: An electronic search without date or language restrictions was undertaken in PubMed in March 2012. Titles and abstracts from these results (n = 123) were read for identifying studies that meet the eligibility criteria. Eligibility criteria included studies reporting clinical series of zygomatic implants (ZIs). Because of the scarcity of articles with high-level grades of evidence, all articles, including studies with few case reports, were considered for inclusion. All reference lists of the selected and review studies were hand-searched for additional papers that might meet the eligibility criteria. Simple case report articles were not included. Review articles without original data were excluded. Quantitative data extracted from the included studies that provided data for the period of failure of ZIs were used for the calculation of interval survival rate during each follow-up period and cumulative survival rate (CSR) over a 12-year period. RESULTS: Thirty-seven studies were identified without repetition and five more studies were included by hand-searching, giving a total of 42; 12 evaluated the use of ZI applied with immediate function protocols and 3 for rehabilitating patients after maxillary resections for tumor ablations. These latter three studies showed smaller ZI success. Postoperative complications reported were as follows: 70 cases of sinusitis, 48 of soft tissue infection, 15 of paresthesia, and 17 cases of oroantral fistulas. However, this number may be underestimated, since most of the studies did not mention the presence or absence of these complications. Most ZI failures were detected at the abutment connection phase (6 months after the surgery of implant placement) or before. The CSR over a 12-year period was 96.7 %. CONCLUSIONS: Despite the high survival rate observed, there is an impending need for conducting randomized controlled clinical trials to test the efficacy of these implants in comparison with the other techniques to treat the atrophic maxilla. Thus, the findings reported in the review must be interpreted with considerable caution. Moreover, more studies with longer follow-up periods involving adequate number of ZIs are needed. This will help to obtain a better understanding of the survival of ZIs in a long term. It is suggested that multicenter, randomized controlled clinical trials and longer clinical studies should be implemented in this area, before recommending routine use of ZIs for patients could be given. The placement of zygomatic implants requires very experienced surgeons because it is not risk free since delicate anatomic structures such as the orbita and brain may be involved.

• Advances in imaging of obstructed salivary glands can improve diagnostic outcomes.

  Authors: B Sobrino-Guijarro, L Cascarini, R K Lingam

  Oral and maxillofacial surgery.

  INTRODUCTION: Obstruction of the major salivary glands is a relatively common condition defined as the blockage of the salivary outflow in the glandular ductal system. It can however mimic moreINTRODUCTION: Obstruction of the major salivary glands is a relatively common condition defined as the blockage of the salivary outflow in the glandular ductal system. It can however mimic more aggressive pathology. METHODS: The most common cause of salivary obstruction is sialolithiasis, followed by ductal strictures. Salivary obstruction is clinically characterized by a food-related painful swelling of the affected gland, known as 'mealtime syndrome'. RESULTS: When obstruction is clinically suspected, the role of imaging consists of confirming the obstruction, identifying its cause, evaluating the position and extent of the obstruction and evaluating for associated complications. However, if imaging shows up signs of a tumour or other pathology which can mimic an obstructed gland clinically instead, the radiologist can alert the clinician accordingly to change the course and plan of treatment. Several imaging techniques are available for investigating the obstructed salivary glands. CONCLUSIONS: This review looks at the causes of obstruction and the use, diagnostic performance and practicality of the various imaging modalities. Importantly, an imaging approach algorithm for the evaluation of the obstructed salivary gland is also proposed.

• Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry.

  Authors: Jan Rustemeyer, Alice Martin

  Oral and maxillofacial surgery.

  PURPOSE: Since improvement of facial aesthetics after orthognathic surgery moves increasingly into the focus of patients, prediction of soft tissue response to hard tissue movement becomes essentialPURPOSE: Since improvement of facial aesthetics after orthognathic surgery moves increasingly into the focus of patients, prediction of soft tissue response to hard tissue movement becomes essential for planning. The aim of this study was to assess the facial soft tissue response in skeletal class II and III patients undergoing orthognathic surgery and to compare the potentials of cephalometry and two-dimensional (2-D) photogrammetry for predicting soft tissue changes. MATERIAL AND METHODS: Twenty-eight patients with class II relationship and 33 with class III underwent bimaxillary surgery. All subjects had available both a traced lateral cephalogram and a traced lateral photogram taken pre- and postsurgery in natural head position (median follow-up, 9.4 ± 0.6 months). RESULTS: Facial convexity and lower lip length were highly correlated with hard tissue movements cephalometrically in class III patients and 2-D photogrammetrically in both classes. In comparison, cephalometric correlations for class II patients were weak. Correlations of hard and soft tissue movements between pre- and postoperative corresponding landmarks in horizontal and vertical planes were significant for cephalometry and 2-D photogrammetry. No significant difference was found between cephalometry and 2-D photogrammetry with respect to soft to hard tissue movement ratios. CONCLUSIONS: This study revealed that cephalometry is still a feasible standard for evaluating and predicting outcomes in routine orthognathic surgery cases. Accuracy could be enhanced with 2-D photogrammetry, especially in class II patients.

• Prospective study of postoperative sensory disturbances after surgical treatment of mandibular fractures.

  Authors: Gabriela Mayrink, Roger William Fernandes Moreira, Marcelo Marotta Araujo

  Oral and maxillofacial surgery.

  INTRODUCTION: This present study's purpose is to evaluate the degree of paresthesia and recovery of inferior alveolar nerve in patients with mandible fractures who underwent surgical treatment.INTRODUCTION: This present study's purpose is to evaluate the degree of paresthesia and recovery of inferior alveolar nerve in patients with mandible fractures who underwent surgical treatment. MATERIAL AND METHODS: Nineteen patients were evaluated (27 hemimandibles) at six different times: preoperative (T1), postoperative 1 week (T2), postoperative 1 month (T3), postoperative 3 months (T4), postoperative 6 months (T5), and postoperative 1 year (T6). Subjective and objective methods were used for this evaluation. RESULTS: The results were analyzed using likelihood ratio chi-square test for the hypothesis of no association between indicators of sensitivity and responses to the questionnaire, and the Cochran-Mantel-Haenszel test for equality hypothesis. All objective tests showed a statistically significant worsening in sensitivity at T2 (p < 0.0001) and a significant improvement after T4 (α < 0.05). The subjective tests showed an association with the objectives tests, and improvement in sensitivity after T4 (p < 0.0001) was noted. DISCUSSION: The first postoperative week is the period in which there are major changes with respect to sensitivity, and after 3 months postoperatively, the recovery reaches its apex with little difference observed after this period. In this research 100 % of the patients analyzed recovered all sensibility until T6.

• Maxillofacial trauma and seat belt: a 10-year retrospective study.

  Authors: Marcelo Mendes, Márcia Borba, Renato Sawazaki, Luciana Asprino, Márcio de Moraes, Roger Willians Fernandes Moreira

  Oral and maxillofacial surgery.

  INTRODUCTION: Brazil is among the countries with the highest prevalence of people injured by traffic accidents, showing that in 2008, levels reached 18.3 victims for 100,000 habitants were victims ofINTRODUCTION: Brazil is among the countries with the highest prevalence of people injured by traffic accidents, showing that in 2008, levels reached 18.3 victims for 100,000 habitants were victims of traffic accidents. MATERIALS AND METHODS: This retrospective study involved data collected from treated patients' charts at seven different hospitals located in three different cities all in the state of São Paulo, Brazil. Information was obtained through a standardized form, which was designed to investigate the epidemiologic features of maxillofacial traumas, restricted to victims of car accidents. RESULTS: Three hundred ninety-six patients were victims of car crashes with mean age 29.75 years. The age group 18-30 years showed an association with facial trauma in 96 patients, 41.56 % of whom reported using seat belt. Le Fort I, II and III (70 %) and mandible (63.11 %) were more associated with body traumas and seat belt use. The most common soft tissue lesion was laceration with 189 cases (42.3 %). The treatment way was assessed, 93 (23 %) were treated surgically and 303 (77 %) underwent conservative treatment. DISCUSSION: Classically, it is known front seat belt use was positively correlated with back seat belt use, healthy diet, dental and general health, regular walking, adequate sleep and no smoking. Accidents involving cars occurred more frequently in age group 18-30 years, suffering more general traumas and representing the nonusers group that wore fewer seat belts, caused, perhaps, by bigger access of the youth to cars, driving in high speed and to an inefficient fiscalization of the traffic laws.

• Mandibular fracture scoring system: for prediction of complications.

  Authors: D Prabhu Shankar, P Manodh, Pradeep Devadoss, Titus K Thomas

  Oral and maxillofacial surgery.

  INTRODUCTION: Mandibular fractures are one of the most commonly encountered injuries in trauma clinics. Although several widely accepted classification systems exist, these are mostly regionINTRODUCTION: Mandibular fractures are one of the most commonly encountered injuries in trauma clinics. Although several widely accepted classification systems exist, these are mostly region specific, differ in the classification criteria used, and are sometimes only correlated with specific treatment modalities, thereby making it impossible to uniformly and comprehensively document facial fracture patterns. In this study, we developed a modified scoring system for mandibular fractures and analyzed the relationship between scoring of fractures that were treated and the incidence of complications after surgical treatment. MATERIALS AND METHODS: To evaluate the suitability of the proposed scoring system, a prospective study on a series of 116 patients was performed. All the fractures were classified using the proposed scoring system. The scoring was based on clinical and radiological evaluation of each fracture. Patients were followed up postoperatively for presence of complications. RESULTS: A good correlation between the proposed scoring system and the incidence of complications was detected. DISCUSSION: This scoring system for mandibular fractures facilitates an objective and standardized assessment of the degree of severity of a fracture, thereby allowing for systematic evaluation of facial fracture outcomes, including assessment of complications. However, it is our understanding that a multicenter study should be performed before the effectiveness of the proposed classification can be clearly stated.

• Rare case of superolateral dislocation of the condyle.

  Authors: Sathish Radhakrishna, Bindu Ramesh

  Oral and maxillofacial surgery.

  BACKGROUND: Dislocation of the mandibular condyle occurs most commonly in the anterior direction. When there is an intracranial displacement of the condyle, it is often associated with CSF leak.BACKGROUND: Dislocation of the mandibular condyle occurs most commonly in the anterior direction. When there is an intracranial displacement of the condyle, it is often associated with CSF leak. Superolateral dislocation of the condyle from the glenoid fossa is a rare condition which commonly occurs following traumatic insult to the mandible. When there is a superlolateral displacement, the condyle is often lodged in the temporal fossa. CASE REPORT: We report an unusual case of a 50-year-old male with a superolateral dislocation of the left mandibular condyle into the zygomatic arch along with a fracture of the right mandible following road traffic accident. Manual reduction of the condyle was first attempted under general anaesthesia which was futile, following which the displaced condyle was reduced by a combination of open traction and manual reduction using Keen's approach in left maxillary vestibule. After reduction of the condyle, intermaxillary fixation (IMF) was done and X plate was used to fix the mandible fracture on the right body. Postoperatively, patient was placed on IMF for a period of 2 weeks. DISCUSSION: Superolateral dislocations of the condyle can be unilateral or bilateral. These types of dislocations generally occur following traumatic injury to the mandible when the mouth is open. Early diagnosis and reduction of the condyle is required to achieve satisfactory occlusion which should be followed by physiotherapy to prevent ankylosis.

• Multiple primary enoral soft tissue manifestations of a Hodgkin lymphoma-case report and literature review.

  Authors: P W Kämmerer, E Schiegnitz, T Hansen, G F Draenert, H D Kuffner, M O Klein

  Oral and maxillofacial surgery.

  BACKGROUND: Hodgkin lymphoma (HL) are lymphoproliferative neoplasms, histologically comprising of mononuclear and multinucleated Hodgkin and Reed Sternberg cells (HRS). About 4 % of all lymphaticBACKGROUND: Hodgkin lymphoma (HL) are lymphoproliferative neoplasms, histologically comprising of mononuclear and multinucleated Hodgkin and Reed Sternberg cells (HRS). About 4 % of all lymphatic malignancies of the head and neck are HL. The typical disease presents itself as a nodal lesion. Extranodal, enoral soft tissue involvement by HL is very rare. CASE REPORT: A 73-year-old man with a suspect, ulcerating lesion in the left retromolar region of the mandible was assigned to our hospital. Prior anti-inflammatory therapy has been without success. Subsequently, three biopsies were taken which could only show inflammation. Finally, two biopsies from the left retromolar region and the left inner cheek showed HRS cells with positive expressions of CD15 and CD30 corresponding to a Hodgkin lymphoma. No lymphatic node or bone involvement could be detected. The patient was designated to receive radio-chemotherapy, but died 3 weeks after diagnosis of multiple organ failure. In a literature review, together with this report, nine cases were found concerning primary HL of the oral mucosa. Accordingly, this is the first case of primary multiple extranodal HL in the oral mucosa in absence of lymphatic node involvement. DISCUSSION: Neither clinical features nor radiological appearances of HL presenting as primary enoral lesions are pathognomonic. Especially when only small biopsy specimens are available, histological diagnosis remains challenging, may lead to a delay in therapy and may result in a significant worse prognosis.

• Epithelioid myoepithelioma of the hard palate.

  Authors: Atsushi Kasamatsu, Masashi Shiiba, Dai Nakashima, Ken Shimada, Morihiro Higo, Takashi Ishigami, Shunsaku Ishige, Katsunori Ogawara, Hideki Tanzawa, Katsuhiro Uzawa

  Oral and maxillofacial surgery.

  BACKGROUND: Myoepithelioma, a generally benign tumor comprised of myoepithelial cells, is an uncommon salivary gland tumor. Among four morphologic variants of myoepithelioma, epithelioid type has notBACKGROUND: Myoepithelioma, a generally benign tumor comprised of myoepithelial cells, is an uncommon salivary gland tumor. Among four morphologic variants of myoepithelioma, epithelioid type has not been reported in the oral and maxillofacial region. CASE REPORT: A 61-year-old man first noticed the mass 3 years previously. The oral examination revealed a firm, non-tender, and well-circumscribed mass in the middle of the hard palate. A magnetic resonance imaging scan showed a well-circumscribed mass with low signal intensity (T(1)-weighted image) or increased signal intensity (T(2)-weighted image). DISCUSSION: Immunohistochemically, the tumor cells in the present case reacted to the epithelial (CK HMW and CAM5.2) and the mesenchymal (vimentin) markers. However, myoepithelial markers (S-100 protein, α-smooth muscle actin, glial fibrillary acidic protein, and calponin), except p63, were not expressed in the tumor cells. These results indicated that the epithelial myoepithelioma cells differentiated into epithelial cells rather than myoepithelial cells. We believe that epithelioid myoepithelioma of the palate is a distinctive subtype of myoepithelioma that should be included in the differential diagnosis of tumors of the palate.

• Accuracy of cone-beam computed tomography to assess the configuration and extent of ligature-induced peri-implantitis defects. A pilot study.

  Authors: Vladimir Golubovic, Ilja Mihatovic, Jürgen Becker, Frank Schwarz

  Oral and maxillofacial surgery.

  PURPOSE: This is a pilot study which aims to evaluate the accuracy of cone-beam computed tomography (CBCT) to assess the configuration and extent of ligature-induced peri-implantitis defects.PURPOSE: This is a pilot study which aims to evaluate the accuracy of cone-beam computed tomography (CBCT) to assess the configuration and extent of ligature-induced peri-implantitis defects. MATERIALS AND METHODS: Radiographic evaluation of advanced ligature-induced peri-implantitis defects (n = 9) in canine was performed using CBCT (central cross-sections) and compared with the corresponding histomorphometrical measurements of the respective site serving as a validation method. Deviations were calculated for the supracrestal (SC), and intrabony (IC) defect components, as well as defect width (DW) assessed at both vestibular (v) and oral (o) aspects. RESULTS: Mean differences between CBCT and histological analyses were -0.53 ± 1.48 mm (SC), +0.49 ± 1.18 mm (IC), and +0.18 ± 0.54 mm (DW) at vestibular aspects, and -0.13 ± 0.44 mm (SC), -0.05 ± 0.62 mm (IC), and +0.15 ± 0.48 mm (DW) at the oral aspects (P > 0.05; paired t test, respectively). CONCLUSION: CBCT may represent an accurate diagnostic tool to estimate the histological extent of advanced peri-implantitis defects.

• Comparison of clonidine and midazolam as anxiolytic premedication before wisdom tooth surgery: a randomized, double-blind, crossover pilot study.

  Authors: Franziska R Studer, Klaus W Grätz, Till S Mutzbauer

  Oral and maxillofacial surgery.

  PURPOSE: Anxiolytic and possible side effects of clonidine 150 μg compared to midazolam 7.5 mg for premedication in surgical wisdom tooth extraction were evaluated. METHODS: In a prospective,PURPOSE: Anxiolytic and possible side effects of clonidine 150 μg compared to midazolam 7.5 mg for premedication in surgical wisdom tooth extraction were evaluated. METHODS: In a prospective, randomized, double-blind crossover trial, ten patients undergoing bilateral wisdom tooth surgery received clonidine or midazolam orally 1 h before the treatment. Patients receiving midazolam for the first surgery received clonidine at the second surgery and vice versa. The anxiolytic efficacy was evaluated with a visual analogue scale (VAS) upon admission and 30, 50 and 60 min after administration of the medication. Patient satisfaction was recorded on a VAS after surgery and 7 days postoperatively. RESULTS: As soon as 30 min after administration of midazolam (p < 0.03) and clonidine (p < 0.02), an anxiolytic effect was recorded. Both medications did not differ in patient satisfaction. CONCLUSION: Oral administration of clonidine 150 μg and midazolam 7.5 mg were rated as medications with equal anxiolytic effects before wisdom tooth surgery under local anesthesia.

• Editorial OMFS-Announcement of Prof. Peter Ward Booth as Co-Editor-in-Chief.

  Authors: Friedrich Wilhelm Neukam, Peter Ward Booth

  Oral and maxillofacial surgery. 16(1):1.

• Evaluation of the ability of collagen-glycosaminoglycan scaffolds with or without mesenchymal stem cells to heal bone defects in Wistar rats.

  Authors: M Alhag, E Farrell, M Toner, T Clive Lee, F J O'Brien, N Claffey

  Oral and maxillofacial surgery. 16(1):47-55.

  The aim of this experiment was to examine the capacity of collagen-glycosaminoglycan scaffolds, with or without mesenchymal stem cells, to satisfactorily repair a 5-mm rat calvarialThe aim of this experiment was to examine the capacity of collagen-glycosaminoglycan scaffolds, with or without mesenchymal stem cells, to satisfactorily repair a 5-mm rat calvarial defect. Fifty-five Wistar rats were used in the study. The defects were either left empty to serve as controls (n = 7) or filled with cell-free scaffolds (n = 11), cell-seeded scaffolds that were pre-cultured in standard culture medium (n = 13), cell-seeded scaffolds that were pre-cultured in osteoinductive factor-supplemented medium (n = 12) or particulate autogenous bone (n = 12). The animals were sacrificed at 12 weeks after surgery, and specimens were prepared for histomorphometric analysis. The linear bone healing and the bone area within the defect were measured. Comparable results were obtained using cell-free collagen-glycosaminoglycan scaffolds and autogenous bone both in terms of linear bone healing (P < 0.986) and area of new bone (P < 0.846). While the test groups showed significantly more bone formation compared to the empty defect control group, the linear bone healing and area of new bone within the defect were significantly lower in the cell-seeded scaffolds than in the cell-free scaffolds. The results have demonstrated that a cell-free collagen-glycosaminoglycan scaffold is capable of repairing a 5-mm rat calvarial defect as effectively as autogenous bone and that seeding the scaffold with pre-cultured mesenchymal stem cells prior to implantation offered no beneficial effect and resulted in incomplete healing of the defect. The results thus suggest that the scaffold has immense potential for tissue repair showing favorable osteoconductive properties, biocompatibility and degradability.

• Report of a rare and aggressive case of oral malignant melanoma.

  Authors: Fatemeh Ahmadi-Motamayel, Parisa Falsafi, Fahimeh Baghaei

  Oral and maxillofacial surgery.

  BACKGROUND: Oral melanoma is a very rare malignancy with unknown etiology. Its higher incidence is between 41 and 60 years of age. A high localization of oral melanoma was found in the maxilla.BACKGROUND: Oral melanoma is a very rare malignancy with unknown etiology. Its higher incidence is between 41 and 60 years of age. A high localization of oral melanoma was found in the maxilla. Gender distribution was reported as 1:1. Oral melanoma represents 0.2% to 8% of the all the total cases of melanoma of the body. CASE REPORT: In this article we report an aggressive case of oral melanoma in a 71-year-old male with chief complaint of black swelling of the gingiva, paresthesia, and denture ill fitting. DISCUSSION: Most oral melanomas are asymptomatic and painless in early stages and unfortunately diagnosis delayed until symptoms occurred. Early detection of suspected melanotic lesions by patient, dentist, and physician is very important.

• Oral field cancerization: current evidence and future perspectives.

  Authors: Punnya V Angadi, J K Savitha, Sanjay S Rao, Y Sivaranjini

  Oral and maxillofacial surgery.

  INTRODUCTION: Oral field cancerization implies that oral cancer does not arise as an isolated cellular phenomenon but rather as an anaplastic tendency involving many cells at once and results in theINTRODUCTION: Oral field cancerization implies that oral cancer does not arise as an isolated cellular phenomenon but rather as an anaplastic tendency involving many cells at once and results in the multifocal development of cancer at various rates within the entire field in response to a carcinogen especially tobacco. This concept has been frequently used to explain the occurrence of multiple primary cancers and recurrences following complete excision of oral cancer. DISCUSSION: This review deals in detail with the origin, principle, various theories used to explain this effect and molecular, genetic, as well as cytogenetic findings related to oral field cancerization. Further, the clinical implications and future research directives are also discussed.

• Oral pyogenic granuloma-a review of 215 cases in a South Indian Teaching Hospital, Karnataka, over a period of 20 years.

  Authors: Rekha Krishnapillai, Kurian Punnoose, Punnya V Angadi, Anila Koneru

  Oral and maxillofacial surgery.

  INTRODUCTION: Pyogenic granuloma (PG) is a solitary, benign vascular growth. The precise cause for the development of pyogenic granuloma is unknown. It is believed, however, to be an exuberant tissueINTRODUCTION: Pyogenic granuloma (PG) is a solitary, benign vascular growth. The precise cause for the development of pyogenic granuloma is unknown. It is believed, however, to be an exuberant tissue response to local irritation or trauma. Up to date, few studies have been carried out among Asians, particularly on the Indian subcontinent. MATERIALS AND METHODS: Biopsy services were researched from 1989 to 2009. Two hundred-fifteen histologically confirmed PGs were retrieved and retrospectively analyzed for incidence, age, gender, site distribution, clinical presentation and histopathology. These cases were also evaluated for recurrence. RESULTS AND DISCUSSION: Pyogenic granuloma accounted for 50.35% among reactive lesions in this study with a mean age of 34.27 years and a peak incidence in the third decade of life. PG was more common in females with a greater predilection for the maxillary gingivae (50.23%). Eighteen cases occurred in pregnant women. Clinically, PG occurred more frequently as pedunculated lesions (103). Gingival irritation and inflammation due to poor oral hygiene were the major precipitating factors. Histologically, PG presented a greater number of vascular channels of varied sizes, lined with plump endothelial cells, capillary budding, and chronic inflammatory cells, namely lymphocytes and plasma cells. Recurrence was seen in 14.88% of patients, predominantly in females, especially in the maxillary anterior region. CONCLUSION: Among the reactive lesions, PG had the highest incidence. The frequency of pyogenic granuloma in the southern part of India was much higher compared to other studies. Additional epidemiological research is required to understand the frequency.

• Zygomatic implants: a critical review of the surgical techniques.

  Authors: Bruno Ramos Chrcanovic, Alexsander Ribeiro Pedrosa, Antônio Luís Neto Custódio

  Oral and maxillofacial surgery.

  PURPOSE: The purpose of the present study is to identify and describe the different surgical techniques for placement of zygomatic implants reported in the literature and discuss the differencesPURPOSE: The purpose of the present study is to identify and describe the different surgical techniques for placement of zygomatic implants reported in the literature and discuss the differences between them. METHODS: An electronic search was undertaken in July 2011. The titles and abstracts from these results (n = 130) were read for identifying studies, which reported different surgical techniques for placement of zygomatic implants, which resulted in 41 articles. RESULTS: Five different surgical approaches were identified: (1) the classical approach, (2) the sinus slot technique, (3) the exteriorized approach, (4) the minimally invasive approach by the use of custom-made drill guides, and (5) the computer-aided surgical navigation system approach. When the maxilla is severely resorbed, the concavity formed by the ridge crest is small, and the original classical technique should be used. When maxillary resorption generates a large concavity, it would be better to exteriorize the zygomatic implant. The externalized technique has fewer surgical steps than the classical and sinus slot methods, is less invasive, and reduces surgical time. It is recommended that utilization of the sinus slot technique together with the CT-based drilling guide would enhance the final results. Although the technique that uses the computer-aided surgical navigation system approach may produce an improved precision in the clinical procedure, its use is expensive, prolongs the operation time, and is limited to centers that have the necessary equipment for the surgery. CONCLUSIONS: Preference for one technique over the other should take into consideration the concavity formed by the ridge crest, maxillary sinus, and region of implant insertion in the zygomatic bone.

• Severe florid cemento-osseous dysplasia: a case report treated conservatively and literature review.

  Authors: Dmitry José de Santana Sarmento, Bárbara Vanessa de Brito Monteiro, Ana Miryam Costa de Medeiros, Ericka Janine Dantas da Silveira

  Oral and maxillofacial surgery.

  BACKGROUND: Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. Radiographically, FCOD appears as dense,BACKGROUND: Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. FCOD is usually asymptomatic. In severe cases, focal expansion may occur due to infection. Management of the symptomatic patient is more difficult due to the avascular nature of the lesion which contributes to susceptibility severe infection, bone sequestration, and osteomyelitis when surgery is performed. CASE REPORT: This paper presents a rare case of severe FCOD; the black woman patient was diagnosed based on clinical and radiographic findings and treated conservatively. The examination of panoramic radiographs revealed a multiple sclerotic masses with radiolucent borders, found in the mandible and maxilla which were symmetrical at presentation. The patient continuous with the follow-up. DISCUSSION: This report confirms that a diagnosis can be made with accurate clinical and radiographic assessment. The correct selection of treatment for FCOD depends on this information.

• Electromyographic analysis of anterior temporalis and superficial masseter muscles in mandibular angle fractures-a pilot study.

  Authors: Saurab Bither, Uma Mahindra, Rajshekhar Halli, Makarand Bakshi, Yogesh Kini, Mahendra Shende, Rupika Bither

  Oral and maxillofacial surgery.

  INTRODUCTION: Fracture of the mandible occurs more frequently and the surgical anatomy of the mandible and adjacent structures is extremely important in understanding the pattern of fracture, theINTRODUCTION: Fracture of the mandible occurs more frequently and the surgical anatomy of the mandible and adjacent structures is extremely important in understanding the pattern of fracture, the displacement of fractured fragments, and factors necessary for uncomplicated healing. In the field of dentistry, surface electromyography, electrokinesiography, and more recently, TMJ sound analysis have been particularly important developments. Previous electromyographic studies involving anterior temporalis and superficial masseter have been conducted in mandibular condylar fractures and in orthognathic and cosmetic procedures of the jaws. MATERIALS AND METHODS: This experimental study was undertaken to measure the electrical activity of the anterior temporalis and superficial masseter muscles in mandibular angle fracture cases (n = 6) and the changes in the electrical activity over a period of 6 months. RESULTS: The study shows that muscle activity increases significantly over a period of time but never matches the muscle activity of the normal subjects of same sex and age in a follow-up of 6 months post-trauma. DISCUSSION: Electrodiagnostic testing is a potentially valuable tool for the management of patients who have suffered craniomaxillofacial trauma. Electromyography is being employed in clinical practice, and allows the inclusion of quantitative data on the qualitative aspects of a diagnosis. These data are often of significant importance in the correct management of therapy and patient follow-up, particularly if the subject is at risk of developing a different and/or more serious disease.

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