Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This study was designed to quantify the important anatomical landmarks and the path of the inferior alveolar nerve (IAN) within the human mandibular body and ramus, in particular with reference to the bilateral sagittal split osteotomy... more
This study was designed to quantify the important anatomical landmarks and the path of the inferior alveolar nerve (IAN) within the human mandibular body and ramus, in particular with reference to the bilateral sagittal split osteotomy (BSSO). Four hundred and eleven CT scans were studied, 299 of these were involved in determining the position of lingula; and 230 were involved in determining the course of IAN in the mandibular molar region, namely from the mesial of the mandibular first molar to the distal of the mandibular second molar; 118 were involved with both measurements. On average, the lingula was located 17.0 ± 2.2 mm from the external oblique ridge; 11.6 ± 2.0 mm from the internal oblique ridge; 17.2 ± 2.7 mm from the sigmoid notch; and 15.6 ± 1.9 mm from the posterior border of the mandible. The course of the IAN in the mandibular molar region was found to descend vertically from the distal of the mandibular second molar (7) to reach its lowest point between the first an...
Research Interests:
Malignant melanoma is an aggressive and unpredictable cancer with the propensity for widespread metastasis. Whilst metastatic spread to the axial skeleton is relatively common, metastasis to the jaws is rarely reported and the optimal... more
Malignant melanoma is an aggressive and unpredictable cancer with the propensity for widespread metastasis. Whilst metastatic spread to the axial skeleton is relatively common, metastasis to the jaws is rarely reported and the optimal approach to investigation and management is yet to be defined. A 58-year-old woman presented with dental pain, swelling and mental neuropathy on a background of an excised cutaneous melanoma. Early radiological investigations showed non-specific osteolysis despite strong clinical findings. It was not until later that magnetic resonance imaging showed changes consistent with metastatic disease. Dental extraction and biopsy confirmed the diagnosis of metastatic melanoma to the mandible. Metastatic melanoma to the mandible is a rare phenomenon which may arise many years following treatment of the cutaneous primary. This case demonstrates the difficulties in early diagnosis as symptoms preceded radiographic findings using high-resolution modalities. Earlier use of magnetic resonance imaging with or without the use of bone scintigraphy may provide the sensitivity required for early identification of metastatic disease in the mandible.
Research Interests:
Research Interests:
The ectopic placement of mandibular third molars in the subcondylar region is an uncommon phenomenon. Most patients are asymptomatic but can present with acute infection or associated pathology necessitating surgical intervention.... more
The ectopic placement of mandibular third molars in the subcondylar region is an uncommon phenomenon. Most patients are asymptomatic but can present with acute infection or associated pathology necessitating surgical intervention. Surgical approaches have been described utilizing both extraoral and intraoral approaches to the region.This paper presents a clinical report of a patient presenting with acute fascial space infection arising from an ectopic third molar in the mandibular subcondylar region, managed with surgical removal via an endoscopically assisted intraoral approach.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The practicing dentist must frequently advise on the risks involved with dental extractions in the patient taking an anticoagulant. This study assessed the risk of bleeding in a large heterogeneous cohort of patients on warfarin treated... more
The practicing dentist must frequently advise on the risks involved with dental extractions in the patient taking an anticoagulant. This study assessed the risk of bleeding in a large heterogeneous cohort of patients on warfarin treated by practitioners in training (dental students and junior staff in a teaching hospital). This was a retrospective case-and-control study of 439 patients on warfarin (1,022 extractions) and 439 matched controls (1,049 extractions). Patients with an international normalized ratio (INR) lower than 2.2 had no specific measures, those with an INR 2.2 to 4 received suturing and tranexamic acid mouthwash, and those with an INR higher than 4 did not undergo extraction. Bayesian methods were used to estimate posterior probabilities of bleeding. Of cases, 63% were men, 25% were older than 80 years, 40% had an INR lower than 2.2, and 9% had an INR higher than 3. Nine cases bled 0 to 10 days postoperatively, with 1 requiring admission and transfusion. Significant...
Research Interests:
Research Interests:
To describe our experience in prevention and treatment of mandibular and maxillary osteonecrosis, an emerging complication of long-term intravenous administration of bisphosphonates. Between February 2004 and February 2006, 10 patients... more
To describe our experience in prevention and treatment of mandibular and maxillary osteonecrosis, an emerging complication of long-term intravenous administration of bisphosphonates. Between February 2004 and February 2006, 10 patients who had received zoledronic acid intravenously because of multiple bone myelomas or bone metastases were treated for mandibular and maxillary osteonecrosis in the Departments of Otorhinolaryngology and Maxillofacial Surgery of our institution. All of the patients underwent surgical sequestrectomies. More extensive surgery was necessary in 3 cases. There were no major complications, and the majority of the patients are alive with no signs of infection or bone exposure. Our experience confirms that bisphosphonate therapy contributes to the pathogenesis of mandibular and maxillary osteonecrosis. Surgery seems to be necessary in the majority of the patients, although the most adequate procedure is far from being standardized and prevention seems to play a pivotal role.
Research Interests: Dentistry, Humans, Female, Multiple Myeloma, Male, and 6 moreAged, Middle Aged, Jaw Diseases, Imidazoles, Osteonecrosis, and climacteric
Research Interests:
Research Interests:
This paper reviews all 17 cases of facial bone osteoradionecrosis (ORN) which were treated in Adelaide, South Australia, in a nine-year period (1987 1996). This was 1.2% of all cases of head and neck cancer treated with radiotherapy (RT).... more
This paper reviews all 17 cases of facial bone osteoradionecrosis (ORN) which were treated in Adelaide, South Australia, in a nine-year period (1987 1996). This was 1.2% of all cases of head and neck cancer treated with radiotherapy (RT). Fourteen cases received treatment following the Marx principles of staging and the protocols of hyperbaric oxygen plus or minus surgery. The three exclusions were two patients who died of recurrent cancer before treatment was complete and one who declined treatment. The eleven cases of mandibular ORN occurred within a few years of the initial RT treatment. All except one occurred after surgical trauma, with dental extractions being the factor in nine cases. All responded to HBO, with or without surgery depending on stage. The three cases of temporal bone ORN were all of late spontaneous onset. All were stage I and all responded to HBO alone. This study shows that the incidence of ORN in Adelaide is low, probably through use of conservative doses of...
Research Interests: Dentistry, Oral and Maxillofacial Surgery, Humans, Head and Neck Cancer, Female, and 12 moreMale, South Australia, Mandible, Aged, Middle Aged, Oral Squamous Cell Carcinoma (OSCC), Hyperbaric Oxygen, Osteoradionecrosis, Retrospective Studies, Hyperbaric Oxygenation, Temporal Bone, and Head and neck neoplasms
This consensus statement reflects the current status of temporomandibular joint surgery in the international community of oral and maxillofacial surgeons in the early 1990s. It is not the end, and it is not the beginning; it is a step... more
This consensus statement reflects the current status of temporomandibular joint surgery in the international community of oral and maxillofacial surgeons in the early 1990s. It is not the end, and it is not the beginning; it is a step forward in the treatment of patients with temporomandibular disorders. It is hoped that this statement will encourage member organizations, and individual members to pursue the issues raised by the proposed criteria. Also there should be continuing debate on the findings presented and on future developments, as well as efforts to teach others the skills the specialty has acquired.
Research Interests:
A postal survey of the views of 100 international experts in temporomandibular joint surgery was performed. Generally, there was a considerable degree of consensus on definitions, diagnosis, and broad treatment principles. However,... more
A postal survey of the views of 100 international experts in temporomandibular joint surgery was performed. Generally, there was a considerable degree of consensus on definitions, diagnosis, and broad treatment principles. However, specific surgical techniques for particular stages of internal derangement and osteoarthrosis as well as measurement of treatment outcome clearly need more consideration and investigation.
Research Interests:
Thirty-four patients with the Myofascial Pain Dysfunction (M.P.D.) syndrome of the masticatory system were investigated and treated using physiotherapy techniques. Resisted static contraction of the temporomandibular joints, passive... more
Thirty-four patients with the Myofascial Pain Dysfunction (M.P.D.) syndrome of the masticatory system were investigated and treated using physiotherapy techniques. Resisted static contraction of the temporomandibular joints, passive movement tests of the muscles and electromyography indicated that the joint function was abnormal in all cases with minimal muscle involvement. Cervical spine tests indicated that pain referral from the cervical spine was involved in 19 of 34 patients (56%). Physiotherapy treatment armed at restoring a normal painless range of movement to the temporomandibular joint was successful in six of 10 patients (60%). Generalized relaxation therapy with biofeedback was successful in 19 of 24 patients (80%). It was found that with the five of 24 patients (20%) in whom generalized relaxation failed, there were significant psychiatric factors.
Research Interests:
Research Interests:
The aim of this study was to create in a sheep model an intracapsular oblique vertical split fracture, and observe the histopathological changes in the temporomandibular joint (TMJ) condylar head. In 10 sheep, the right TMJ was operated... more
The aim of this study was to create in a sheep model an intracapsular oblique vertical split fracture, and observe the histopathological changes in the temporomandibular joint (TMJ) condylar head. In 10 sheep, the right TMJ was operated through the preauricular region. The anterior and posterior attachments of the disc were cut; an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of condylar neck. The condylar fragment was pushed anteriorly, inferiorly and medially together with the disc. The non-operated left TMJ served as control. Two sheep were killed at 1 week and four at both 4 and 12 weeks. Computed tomography scans were taken and histopathological changes of the joint observed. There was severe bone erosion and a new bony outgrowth on the lateral side of the condylar stump and temporal bone. The joint spaces were filled with fibrous tissue, cartilage tissue and bone in the 4 and 12 weeks operated groups. These results show that an ob...
Research Interests:
The temporalis muscle flap can be used as an inter-positional graft placed into a gap arthroplasty site in temporomandibular joint (TMJ) ankylosis. The purpose of this study was to investigate the role of the muscle graft in sheep. Five... more
The temporalis muscle flap can be used as an inter-positional graft placed into a gap arthroplasty site in temporomandibular joint (TMJ) ankylosis. The purpose of this study was to investigate the role of the muscle graft in sheep. Five pure-bred adult Merino sheep were used and ankylosis was induced in all right TMJs. At 3 months, the ankylosis was released by gap arthroplasty and reconstructed with a masseter muscle graft, because the temporalis muscle is short and poorly vasculized in sheep. The sheep were killed at 3 months after muscle grafting. The maximal mouth opening was recorded before and after operation and at death. The joints were examined radiologically and histologically. In 4 sheep mouth opening remained at the pre-operative level. A clear radiolucent space remained between the smooth temporal and ramus stumps. Histologically, the muscle graft remained vital but with some fibrous tissue formation between the bone ends. One sheep developed an infection at the operati...
Research Interests:
This study was set-up to describe main areas of service by patient and visit characteristics and compare trends in services between 1990 and 2000. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000... more
This study was set-up to describe main areas of service by patient and visit characteristics and compare trends in services between 1990 and 2000. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Service provision data were collected from a one-week log. Data were available from 79 surgeons from 1990 (response = 73.8%) and 116 surgeons from 2000 (response = 65.1%). Service distributions were dominated by dentoalveolar surgery in 1990 (66.6%) and 2000 (63.5%). Multivariate analysis showed: patient age, location of visit (office/theatre/inpatient facility) and referral source (general/specialist and dental/medical) were associated with all five main areas of service; type of visit (consult/operation/review) was associated with four main areas; patient sex and place of visit (private/public) was associated with three main areas; the only significant change over time was an increased percentage of ortho...
Research Interests: Dentistry, Australia, Public Health Dentistry, Adolescent, Multivariate Analysis, and 15 moreOral and Maxillofacial Surgery, Humans, Child, Female, Oral Surgery, Male, Service provision, Aged, Middle Aged, Questionnaires, Adult, Private Practice, Logistic Models, Child preschool, and Health facilities
This study was undertaken to describe practice patterns of oral and maxillofacial surgeons in Australia and compare trends over time. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed... more
This study was undertaken to describe practice patterns of oral and maxillofacial surgeons in Australia and compare trends over time. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). In both 1990 and 2000 the majority of surgeons worked 80+% of the time in the private sector (64.1 and 71.4%), had 80+% referrals from dental versus medical sources (74.0 and 74.7%), and had 80+% of patients from dentoalveolar rather than major maxillofacial surgery (70.7 and 69.7%). The percentage of dual qualified (dental plus medical degree) surgeons increased from 2.5% in 1990 to 17.1% in 2000 (P < 0.05; chi2). In 2000, surgeons who worked less than 80% in the private sector were more likely to report being overworked (57.9%) and that more surgeons were required in the public sector (65.0%) t...
Research Interests: Dentistry, Australia, Public Health Dentistry, Public Health, Public sector, and 15 moreLinear models, Multivariate Analysis, Oral and Maxillofacial Surgery, Bone graft, Humans, Female, Oral Surgery, Male, Middle Aged, Questionnaires, Adult, Private Sector, Private Practice, Multivariate linear regression, and Referral and consultation
Research Interests:
The aim of this study was to demonstrate the functional and anatomical changes after gap arthroplasty release of unilateral temporomandibular joint (TMJ) ankylosis. Five adult sheep weighing an average of 57 kg were used. All right joints... more
The aim of this study was to demonstrate the functional and anatomical changes after gap arthroplasty release of unilateral temporomandibular joint (TMJ) ankylosis. Five adult sheep weighing an average of 57 kg were used. All right joints were operated. Ankylosis was induced in the right TMJ by articular damage, disk removal and placement of a bone graft plus immobilization wire. At 3 months the gap arthroplasty were performed. All TMJs were examined functionally, radiologically, macroscopically and histologically. Functionally, the range of jaw movements decreased following induction of ankylosis (P<0.0001), increased immediately on release but was reduced again at 3 months after release (the vertical movement, no statistically significant difference; the right movement, P<0.001; the left movement, P<0.0001). Histologically, all operated joints showed fibrous adhesions across the gap, and further, the articular surface was irregular with osteophytes and with bony islands i...
Research Interests: Dentistry, Surgery, Nonparametric Statistics, Treatment, Temporomandibular Joint, and 13 moreOral and Maxillofacial Surgery, Anatomy, Bone graft, Sheep, Animals, Technique, Statistical Significance, Arthroplasty, Experimental Study, Analysis of Variance, Temporomandibular Joint Disorders, Ankylosis, and Treatment Failure
The initial effect of deep-frozen stored auricular cartilage replacement was tested on the progression of experimentally induced osteoarthritis in sheep. Bilateral osteoarthritis was induced in the sheep temporomandibular joint. Three... more
The initial effect of deep-frozen stored auricular cartilage replacement was tested on the progression of experimentally induced osteoarthritis in sheep. Bilateral osteoarthritis was induced in the sheep temporomandibular joint. Three months later, discectomy and deep-frozen auricular cartilage allograft repair were performed unilaterally, with the other side being left as a control. Six months post induction of osteoarthritis, 3 months post repair, the sheep were killed. The stored auricular cartilage allografts were not firmly attached to the surrounding tissue and tended to be markedly thinned and perforated. The effect of storage detrimentally affected the properties of the graft.
Research Interests:
The analysis presented involves projections of the future requirements for the oral and maxillofacial surgeon labour force in Australia under a range of different recruitment scenarios, followed by a consensus-seeking exercise with the... more
The analysis presented involves projections of the future requirements for the oral and maxillofacial surgeon labour force in Australia under a range of different recruitment scenarios, followed by a consensus-seeking exercise with the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS) Council in an attempt to produce estimates of the most probable future requirement for oral and maxillofacial surgeons. The resulting consensus estimates would result in the maintenance of the present population-to-surgeon ratio. Different premises or beliefs underlying the projections were viewed as counterbalancing each other.
Research Interests:
Psychological factors are involved in TMJ dysfunction but much previous research has tried to identify single personality factors. Multiple factors, however, are involved. These can be divided into 2 main groups: external social factors... more
Psychological factors are involved in TMJ dysfunction but much previous research has tried to identify single personality factors. Multiple factors, however, are involved. These can be divided into 2 main groups: external social factors and the innate psychiatric state of the patient. The concepts involved and their measurement by life events and illness behaviour questionnaires are discussed. The clinical importance of this to the oral surgeon is emphasised, in relation to the patient who fails to respond to conservative therapy and for whom TMJ surgery is planned. Some of these difficult patients may be less well socially integrated than the majority of TMJ patients.
Research Interests:
Case histories of 15 patients with dental pain who were examined at the Royal Adelaide Hospital Pain Clinic were reviewed. These were the only patients with dental pain seen at the clinic over a 10-year period and represent less than 1%... more
Case histories of 15 patients with dental pain who were examined at the Royal Adelaide Hospital Pain Clinic were reviewed. These were the only patients with dental pain seen at the clinic over a 10-year period and represent less than 1% of the total patients fully examined at the clinic. Only one patient had an underlying organic problem; the remainder had a diagnosis of atypical facial pain. Common characteristics that pointed to the diagnosis of intractability were the duration of the pain, extensive and multiple ineffective treatments, a history of pain elsewhere in the body, and a history of psychologic disturbance. Ten of the 12 patients who were offered and accepted psychotherapeutic treatment had appreciable symptomatic relief. No dental or surgical treatments resulted in any pain relief.
Research Interests:
The anatomical, histological and surgical details of sheep as a model for temporomandibular surgery are presented. The advantages are the similarities in size, shape and structure of the joint to humans, coupled with low cost and high... more
The anatomical, histological and surgical details of sheep as a model for temporomandibular surgery are presented. The advantages are the similarities in size, shape and structure of the joint to humans, coupled with low cost and high ethical acceptability.
Research Interests:
A high frequency of remodeling changes was demonstrated radiographically in a series of patients having pain in the temporomandibular joint region. Radiologic morphologic differences between painful and asymptomatic temporomandibular... more
A high frequency of remodeling changes was demonstrated radiographically in a series of patients having pain in the temporomandibular joint region. Radiologic morphologic differences between painful and asymptomatic temporomandibular joints were in frequency rather than type. Caution should be taken not to overestimate the significance of radiologic abnormality in patients with pain in the temporomandibular joint region.
Research Interests:
A high frequency of remodeling changes was demonstrated radiographically in a series of 200 female patients with asymptomatic temporomandibular joints. Fewer than 10% of joints were completely radiologically "normal". Generally,... more
A high frequency of remodeling changes was demonstrated radiographically in a series of 200 female patients with asymptomatic temporomandibular joints. Fewer than 10% of joints were completely radiologically "normal". Generally, there was an increasing incidence of changes with increasing age and for edentulous patients, but these relationships were by no means direct or mutually exclusive.
Research Interests:
The relationships between training and qualifications and the scope of oral and maxillofacial surgical practice was investigated by a survey of all full members of the Australian and New Zealand Association of Oral and Maxillofacial... more
The relationships between training and qualifications and the scope of oral and maxillofacial surgical practice was investigated by a survey of all full members of the Australian and New Zealand Association of Oral and Maxillofacial surgeons. It was found that scope did correlate to length of training. Three were differences in scope for more recently trained surgeons and by practice location. The possession of medical qualification did not necessarily affect scope of practice but did affect attitudes.
Research Interests:
The effect of surgical perforation of the disc on intra-articular morphology was examined using sheep. Eight sheep had bilateral perforations and 2 animals were used as controls. After 8 months the sheep were killed and the joints... more
The effect of surgical perforation of the disc on intra-articular morphology was examined using sheep. Eight sheep had bilateral perforations and 2 animals were used as controls. After 8 months the sheep were killed and the joints examined radiologically and histologically. Osteophytes were seen on all the condylar radiographs. Histologically, there were proliferative changes in both the condylar and temporal surfaces adjacent to the disc perforations.
Research Interests:
The effects of temporal fascia graft repair of temporomandibular joint disk perforation on intra-articular structure were examined on four sheep. Four sheep had bilateral disk perforations. At 20 weeks the perforation in the right joint... more
The effects of temporal fascia graft repair of temporomandibular joint disk perforation on intra-articular structure were examined on four sheep. Four sheep had bilateral disk perforations. At 20 weeks the perforation in the right joint was repaired with a temporal fascia graft. At 40 weeks the sheep were killed and the joints were examined radiologically and histologically. It was found that the temporal fascia graft did not survive and the disks remained perforated. However, histologically and radiologically there were fewer changes than in the joints where the perforated disks were not repaired.
Research Interests:
The oral effects of prolonged intermaxillary fixation were investigated in 106 severely obese patients who had been jaw wired as an aid to weight loss. The principal complications during fixation were episodes of periodontal pain and... more
The oral effects of prolonged intermaxillary fixation were investigated in 106 severely obese patients who had been jaw wired as an aid to weight loss. The principal complications during fixation were episodes of periodontal pain and tooth mobility (40%). After removal of fixation, the principal sequelae were residual periodontal problems (9%) and mandibular limitation (9%). These findings were confirmed in a subgroup of 11 patients who had detailed measurements made of their periodontal index, oral hygiene index and range of jaw movements. These findings were discussed in relation to other methods of management of obesity.
Research Interests: Obesity, Humans, Oral health, Female, Oral Surgery, and 7 moreMale, Mandible, Jaw, Oral, Adult, Periodontal Diseases, and Immobilization
Research Interests:
Computed tomography (CT) is currently the standard in postoperative evaluation of orbital wall fracture reconstruction, but cone beam computed tomography (CBCT) offers potential advantages including reduced radiation dose and cost. The... more
Computed tomography (CT) is currently the standard in postoperative evaluation of orbital wall fracture reconstruction, but cone beam computed tomography (CBCT) offers potential advantages including reduced radiation dose and cost. The purpose of this study is to examine objectively the image quality of CBCT in the postoperative evaluation of orbital fracture reconstruction, its radiation dose, and cost compared with CT. Four consecutive patients with orbital wall fractures in whom surgery was indicated underwent orbital reconstruction with radio-opaque grafts (bone, titanium-reinforced polyethylene, and titanium plate) and were assessed postoperatively with orbital CBCT. CBCT was evaluated for its ability to provide objective information regarding the adequacy of orbital reconstruction, radiation dose, and cost. In all patients, CBCT was feasible and provided hard tissue image quality comparable to CT with significantly reduced radiation dose and cost. However, it has poorer soft t...
Research Interests:
Research Interests:
The aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed... more
The aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). The rate of provision of services per visit changed over time with increased rates observed overall (from 1.43 +/- 0.05 services per visit in 1990 to 1.66 +/- 0.06 services per visit in 2000), reflecting increases in pathology and reconstructive surgery. No change over time was observed in the provision of services per year (4,521 +/- 286 services per year in 1990 and 4,503 +/- 367 services per year in 2000). Time devoted to work showed no significant change over time (1,682 +/- 75 hours per year in 1990 and 1,681 +/- 94 hours per year in 2000), while the number of visits per week declined (70 +/- 4 visits p...