This study investigated a simulated craniomaxillofacial (CMF) trauma training programme for nonspecialist clinicians involved in warfare environments. Many clinicians lack CMF surgical training and the course was designed as a one-day research programme to establish if non-specialists could acquire CMF trauma skills adequate for a warzone. The course consisted of six simulation skills, of which four used sheep heads to teach craniotomy, epistaxis, canthotomy and cantholysis and external pin fixation for mandibular fracture fixation. In addition, two skills utilised plaster dental models designed to enable fixation of mandibular fractures with the Erich arch bar or dental eyelet wiring. This simulation-based programme taught trauma management without the expense of cadavers or risks to patients [1]. The trainees were scored for each of the six skills by hierarchical task analysis (HTA) designed by CMF specialists [2, 3]. The trainee assessment scores improved significantly in all skills post-training, regardless of their medical or surgical deficiencies demonstrating that non-specialists can learn important surgical techniques, valuable for war environments.

Objective. The aim of this study was to investigate the demographic profile of Native American patients with concomitant facial fractures and closed head injuries (CHIs) and to explore the validation of the craniofacial crumple zone. Study Design. This was a retrospective, observational, case-control study of 2131 maxillofacial fractures from 2010 to 2014, of which 173 (8%) had concomitant CHIs. Results. Of the study patients, 133 (77%) were males (mean age 40.6 years). Only 2.1% of the local population was Native American, but this group represented 24% of the patients with Cl Its and sustained 4.6 times more (P value < .001) assault injuries and 2.6 times more concussion (P value < .001) compared with other groups. Other trauma comparisons were not significant. Of the 173 study patients, 86 (50%), had blood alcohol levels which exceeded 80 mg/100 ml compared with 93% of the Native Americans. Conclusions. Native American patients had a highly significant predisposition to violence and road traffic accidents resulting in maxillofacial fractures and CHIs. The high blood alcohol levels found in this group also reflected longstanding serious sociologic problems. This study provides a useful model to investigate the relative ethnic/racial role of comminuted paranasal structures for the protection of the brain (i.e., the crumple zone).

Hyperparathyroidism-jaw tumor (HPT-JT) was first observed by Jackson in 1958 in a family who exhibited hyperparathyroidism and recurrent pancreatitis. The author noticed the presence of jaw tumors in the affected family and reported them as fibrous dysplasia. However, it was not until 1990 that a familial variety of hyperparathyroidism with fibro-osseous jaw tumors was recognized as HPT-JT syndrome and reported as a clinically and genetically distinct syndrome. Hyperparathyroidism generally arises from glandular hyperplasia or parathyroid adenomas, with only about 1% of cases resulting from parathyroid carcinoma. However, parathyroid carcinoma develops in about 15% of HPT-JT patients. The true incidence of HPT-JT is unknown, although the prevalence of about 100 published cases suggests its rarity. Twenty percent of HPT-JT cases have renal hamartomas or tumors, and female patients with HPT-JT have been reported to have carcinoma of the uterus. This syndrome appears to arise from a variety of mutations that deactivate the tumor suppressor gene CDC73 (also known as HRPT2) and its production of the tumor suppressor protein parafibromin. Functional parafibromin has 531 amino acids, and mutations result in a short nonfunctional protein. CDC73 disorders exhibit dominant germline gene behavior, with varying degrees of penetration. In most cases an affected person has 1 parent with the condition, which raises the need for family investigation and genetic counseling. We report a case of HPT-JT syndrome in a male patient who presented to the local community hospital 6 years previously with a history of back pain. Investigations showed elevated serum parathyroid hormone and calcium levels, and a technetium 99m sestamibi parathyroid scan showed increased activity at the site of the lower left gland that proved to be a substernal parathyroid carcinoma. The patient's parathyroid hormone level dropped from 126 to 97 pg/mL at 5 minutes andwas 65 pg/mL at 10 minutes after excision of the gland, and the calcium chemistry findings returned to normal. Parathyroid histologic analysis showed substantial cytologic atypia with nuclear pleomorphism and prominent nucleoli, but infrequent mitoses. Although the capsule was described as showing foci of vascular invasion by the carcinoma, there has been no evidence of recurrence. Six years later, the patient presented with bilateral mandibular cemento-ossifying fibromas, but no evidence of hyperparathyroidism. The larger left tumor was excised and immediately reconstructed with an autogenous iliac crest bone graft, and the right lesion was enucleated. There has been no recurrence in 12 months. This case illustrates that the hyperparathyroidism and the fibro-osseous tumors are independent features of the persistent germline tumor suppressor gene (CDC73) mutation. The syndromic fibro-osseous tumors are odontogenic cemento-ossifying fibromas, which only occur in the jaws. (C) 2015 American Association of Oral and Maxillofacial Surgeons

Purpose. This study tests the hypothesis that near infrared spectroscopy can be used to detect changes in haemoglobin oxygenation status in the mandible, and therefore can be used to monitor the deleterious effects of radiotherapy and the possible reversion of these effects with therapeutic ultrasound.Methods. A probe was used to calculate the concentrations of deoxyhaemoglobin in the mandible bone of 30 volunteers with no known malignancies and 10 patients with malignancies in the head and neck region treated with radiotherapy.Results. Although the variability of the measurements was very high, when comparing the right side to the left side of the mandible, the measurements remained relatively similar. There was a great variability between the data for each patient, there was no correlation with age.Conclusions. The near infrared spectroscopy validation for the measurement of deoxyhaemoglobin concentrations in the mandible showed that the variability of the measurements was very high, therefore it is not appropriate to be used diagnostically for the evaluation of radiotherapy effects on the mandibular blood flow and metabolic status.

PURPOSE:The aim of this paper is to explore the current theories about pretreatment assessment and dental management of patients receiving head and neck radiotherapy, and the therapeutic options to treat osteoradionecrosis of the jaws, based on the literature review.DISCUSSION:Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilizes or gradually worsens and is notoriously difficult to manage. Because most cases occur in patients who were dentulous in the mandible at tumor onset, proper dental management is the single most important factor in prevention.CONCLUSIONS:Complete dental clearance before treatment is no longer necessary. Controversy exists regarding the management of osteoradionecrosis of the maxillofacial skeleton because of the variability of this condition. The treatment of osteoradionecrosis has included local wound care, antibiotic therapy, surgical procedures, and the administration of hyperbaric oxygenation. Recently, new methods of treatment were introduced, according to the new theory about its pathophysiology.

1 DDS; Address: Av. Raja Gabaglia, 1000 / 1209 – Gutierrez – Belo Horizonte, MG – 30441-070 – Brazil. brunochrcanovic@hotmail.com +55 31 91625090 +55 31 32920997 2 DDS, Oral and Maxillofacial Surgeon, MS in Oral and Maxillofacial Surgery, PhD in Oral and Maxillofacial Surgery (Eastman Dental Institute, University College London). Address: Pontificia Universidade Catolica de Minas Gerais, Departamento de Odontologia. Av. Dom Jose Gaspar, 500 Predio 45 Coracao Eucaristico 30535-610 Belo Horizonte, MG – Brazil. dr.peter.reher@gmail.com 3 MD, Head and Neck Surgeon, MSc in General Surgery. Address: Rua Contorno 5351 / 1202 – Cruzeiro – Belo Horizonte, MG – 30110-060 – Brazil. +55 31 96060099

PURPOSE:The aim of this paper is to explore the current theories about definition, classification, incidence and physiopathology of osteoradionecrosis (ORN) of the jaws. Moreover, it is discussed the predisposing and risk factors for the development of osteoradionecrosis based on the literature review.DISCUSSION:Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterised by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilises or gradually worsens and is notoriously difficult to manage. The most widely accepted theory to explain its cause until recently was the theory of hypoxia, hypovascularity and hypocellularity. A new theory for the pathogenesis of osteoradionecrosis was proposed. The clinical presentations of osteoradionecrosis are pain, drainage and fistulation of the mucosa or skin that is related to exposed bone in an area that has been irradiated. The tumour size and location, radiation dose, local trauma, dental extractions, infection, immune defects and malnutrition can predispose its development.CONCLUSIONS:A better understanding of risk factors for the development ORN and of the underlying pathophysiology may improve our ability to prevent this complication and help to improve the prognosis for those being treated for osteoradionecrosis.

Purpose: To provide a systematic review of the best available research literature investigating the relation of oral and maxillofacial surgical procedures to the onset or relief of chronic painful temporomandibular disorder (TMD).Materials and Methods: A comprehensive review of the databases CINAHL, Cochrane Library, Embase, Medline, NHS Evidence-Oral Health, PsycINFO, Web of Knowledge, and MetaLib was undertaken by 2 authors (P.S., M.H.) up to June 2009 using search terms appropriate to establishing a relation between orofacial surgical procedures and TMD. The search was restricted to English-language publications.Results: Of the 1,777 titles reviewed, 35 articles were critically appraised but only 32 articles were considered eligible. These were observational studies that fell into 2 groups; 9 were seeking to establish a surgical cause for TMD. Of these, only 2 of a series of 3 claimed that there was a significant link, but this claim was based on weak data (health insurance records) and was abandoned in a subsequent report. Twenty-three studies were seeking to achieve relief by orthognathic surgical intervention. These were also negative overall, with 7 articles showing varying degrees of mostly nonsignificant improvement, whereas 16 showed no change or a worse outcome. No published report on the putative effect of implant insertion was found.Conclusion: These apparently contradictory approaches underline a belief that oral surgical trauma or gross malocclusion has a causative role in the onset of TMD. However, there was no overall evidence of a surgical causal etiology or orthognathic therapeutic value. This review emphasizes that it is in the patients' best interest to carry out prospective appropriately controlled randomized trials to clarify the situation. 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:2755-2764, 2010

PURPOSE:Ultrasound therapy induces clinical healing of irradiated avascular mandibular bone and fractures. In vitro ultrasound in tissue culture has been shown to stimulate bone formation synthesis and bone remodeling factors and to stimulate osteoblast proliferation. Therefore, the aim of the present study was to investigate the effect of short-wave (1-MHz) and long-wave (45-kHz) ultrasound on the vascularity of the chorioallantoic membrane (CAM) of a fertilized egg.MATERIALS AND METHODS:The nature of the angiogenic effect was investigated using the CAM of a fertilized egg by: (1) application of sonicated fibroblast media incorporated into methylcellulose disks onto the CAM and (2) direct application of the ultrasound, using both long-wave (45-kHz) and short-wave (1-MHz) frequencies at a range of intensities, to the surface of the egg. Angiogenesis was assessed quantitatively by three independent observers.RESULTS:Both ultrasound methods showed evidence of an angiogenic effect compared to controls. The most effective results were seen with direct application of a 45-kHz wave at an intensity of 15 mW/cm(2) and indirect application of the media of fibroblasts ultrasonicated at 1 MHz with an intensity of 0.4 W/cm(2).CONCLUSION:This model confirms that ultrasound can induce neoangiogenesis in vivo.

Fundamentals of Orthognathic Surgery and Non Surgical Facial Aesthetics, pp. 385-415 (2018) No AccessChapter 13: Ankylosis of the Temporomandibular JointMalcolm HarrisMalcolm Harrishttps://doi.org/10.1142/9789813221857_0013Cited by:0 PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail Abstract: There are many causes of limited mouth opening (trismus) which may be classified as follows. Intra-articular trismus (intracapsular) Closed lock due anterior displacement of the meniscus without reduction. Osseous or fibro-osseous ankylosis, secondary to trauma, infection or osteoarthritis. Fibrodysplasia ossificans progressiva (formerly myositis ossificans). Ankylosing spondylitis, juvenile rheumatoid arthritis. Extra-articular (extracapsular) Trismus. Disuse muscle atrophy, contractures secondary to intra-articular ankylosis or psychogenic trismus. Post-radiotherapy and thermal scarring. Post-traumatic scarring. Oral submucous fibrosis. Post-cancrum oris scarring. Fibrodysplasia ossificans progressiva (formerly myositis ossificans). Only the management of intra-articular ankylosis with its marked disturbance in facial skeletal growth will be considered here. FiguresReferencesRelatedDetails Fundamentals of Orthognathic Surgery and Non Surgical Facial AestheticsMetrics History PDF download

Human osteoblast cell line (MG63) cells were treated with long wave (45 kHz, intensity 30 mW/cm(2)) continuous ultrasound (US) for 5 min and incubated for various time periods following the treatment. The reverse transcriptase polymerase chain reaction (RT-PCR) technique was used for observing the genetic expression and real-time PCR for quantitative analysis of receptor activator of NF-kappa B ligand (RANKL) and osteoprotegerin (OPG) along with alkaline phosphatase (ALP), an early bone marker, and osteocalcin (OCN) a late marker. ELISA was performed to estimate the amount of the cytokine released into the culture media. The osteoblasts responded to US by significantly upregulating both the OPG mRNA and protein levels. There was no RANKL mRNA expression observed in both the US and control groups and the protein levels were also very low in both groups. There was also no TNF-alpha expression and the TNF-alpha protein levels were insignificant. ALP and OCN mRNA were significantly upregulated in the US group.

Therapeutic angiogenesis is the controlled induction or stimulation of new blood vessel formation to reduce unfavourable tissue effects caused by local hypoxia and to enhance tissue repair. The effects of ultrasound on wound healing, chronic ulcers, fracture healing and osteoradionecrosis may be explained by the enhancement of angiogenesis. The aim of this study was to identify which cytokines and angiogenesis factors are induced by ultrasound in vitro. Two ultrasound machines were evaluated, a "traditional" (1 MHz, pulsed 1:4, tested at four intensities), and a "long wave" machine (45 kHz, continuous, also tested at four intensities). The ultrasound was applied to human mandibular osteoblasts, gingival fibroblasts and peripheral blood mononuclear cells (monocytes). The following cytokines and angiogenesis factors were assayed by ELISA techniques: interleukin-1beta(IL-1beta), IL-6, tumour necrosis factor alpha (TNF-alpha), IL-8, fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF).A slight stimulation of IL-1beta was noted in all cell types. There was no difference in the IL-6 and TNF-alpha levels. The angiogenesis-related cytokines, IL-8 and bFGF, were significantly stimulated in osteoblasts, and VEGF was significantly stimulated in all cell types. Both ultrasound machines produced similar results, and the optimum intensities were 0.1 and 0. 4 W/cm2 (SATA) with 1 MHz ultrasound, and 15 and 30 mW/cm2 (SATA) with 45 kHz ultrasound.The results show that therapeutic ultrasound stimulates the production of angiogenic factors such as IL-8, bFGF and VEGF. This may be one of the mechanisms through which therapeutic ultrasound induces angiogenesis and healing.

We have constructed 300 titanium cranioplasty plates, over 150 cases using a computerised technique, the remainder by external impression. The clinical follow-up of these cases over 8 years has shown consistently good results that justify our simple low-cost method of manufacturing these plates. Both techniques require the provision of a model on which to construct the plate. In the traditional technique, an approximate model is derived from the resected bone or a direct impression of the defect over the patient’s scalp. Using the computerised technique, a more accurate model of the defect and the surrounding bone is milled in polyurethane foam from cross-sectional computerised tomographic (CT) scans. Sheet titanium is pressed to shape from a design outlined on a counterdie. The subsequent stages of the plate construction are then the same for both methods. This study describes the stages of the model manufacture, the validation of its accuracy and the plate construction that follows. Use of the computerised method has resulted in a reduction of errors, enabling the manufacture of a smaller plate than was possible previously. It has also enabled design changes through the achievement of greater accuracy in fit.

Previous studies with normal volunteers have demonstrated distributed cortical responses to experimental heat pain within a network of structures. The network includes the insula, anterior cingulate, prefrontal, inferior parietal and somatosensory cortices. Patients suffering from chronic nociceptive pain following rheumatoid arthritis (RA) have shown damped central responses to experimental heat pain applied to the back of the right hand. In this study of patients with acute, left‐sided, post‐molar‐extraction (surgical) pain, we assessed the cortical responses to experimental heat pain, applied to the back of the right hand, using positron emission tomography (PET), and compared the responses with a previously reported control group and the RA group. In response to the experimental heat pain, the surgical group indicated significantly increased regional cerebral blood flow in the prefrontal cortex [Brodman's area (BA) 44] ipsilateral to the heat stimulus. Contralateral increases were detected in the putamen and transverse temporal gyrus (BA 40/41/42) with bilateral increases in the insular cortex. Compared to the control and RA group, there were significantly reduced responses in the anterior cingulate (BA 24), pre‐frontal medial, and orbito‐frontal (BA 9/10/32/47) cortices. These results suggest that relatively discrete regions of the cerebral cortex are responsible for acute nociceptive processing during an acute inflammatory episode. The reduced frontal and anterior cingulate responses to the experimental heat pain (applied to the right hand) during acute inflammatory pain (left jaw) illustrates cortical modulation of nociceptive processing that may be related to non‐somatotopic, bilateral, nociceptive inputs to these areas.

The previous chapters have highlighted the use of isolated osteoblasts and osteoclasts in skeletal research. While it is obviously important to investigate the functions of individual bone cell populations, the biology of bone is that of an organ system with distinct but interacting cells. Organ culture of bone provides a model that is, in certain respects, closer to the in vivo situation. Bone organ culture naturally encompasses the interactions that occur between the different cell types present in bone and bone marrow. Moreover, as bone is a tissue with a predominance of extracellular matrix, organ or expiant culture techniques allow the study of the interaction of bone cells with the natural matrix of bone.