The aim of the present study was to evaluate the effectiveness of interventional sialendoscopy in... more The aim of the present study was to evaluate the effectiveness of interventional sialendoscopy in the management of non-stone obstructive sialadenitis. In the present retrospective study, we assessed the treatment outcomes of 51 patients (34 women and 17 men) who had been diagnosed with sialadenitis without salivary duct stones. The included patients had an obstructive duct condition coupled with recurrent episodes of swelling or pain in a major salivary gland. The patients who had a sialolith detected during the sialendoscopic procedure or by preoperative imaging were excluded from the present study. The outcomes assessment was based on successful removal of the obstructive etiology during the endoscopic procedure and the absence of clinical symptoms after 6 months. The involved glands included 16 submandibular glands and 35 parotid glands. The sialendoscopic navigation was successful in 43 of 51 patients (84%). Of the 43 patients, 37 (86%) were free of symptoms from the obstructive gland after the endoscopic procedure. Of the 6 patients who were still symptomatic after the procedure, 5 had involvement of the parotid gland. Finally, 1 of the original 37 symptom-free patients developed recurrent symptoms and denied additional treatment, resulting in 36 of 43 patients (84%) remaining asymptomatic 6 months after endoscopic navigation. The outcomes of the present study suggest that interventional sialendoscopy can provide symptomatic improvement in most subjects. Clinicians should consider sialendoscopy as a useful and minimally invasive procedure to treat sialadenitis without sialolithiasis.
International journal of oral and maxillofacial surgery, 2007
The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduc... more The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduced postoperative pain and less oedema, have led to a continuous interest in laser applications for bone cutting. The ability to cut bone with a laser beam would also be of great technical benefit in minimally invasive maxillofacial surgery (endoscopic). The Erbium:yttrium aluminum garnet (Er:YAG) laser has been demonstrated to result in minimal thermal damage of bone, precise cutting, rapid osseous healing and osteoinduction. The purpose of this study was to assess the feasibility of using Er:YAG laser to perform vertical ramus osteotomy, and to determine the most efficient energy per pulse for its completion. Two fresh pig mandibles, one pig cadaver head and one human mandible were used. A different energy per pulse (0.5, 1, 1.5 and 2J/pulse) was used for each osteotomy on the pig mandibles (n=4). Vertical ramus osteotomy was feasible with all energy settings but time decreased consider...
The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduc... more The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduced postoperative pain and less oedema, have led to a continuous interest in laser applications for bone cutting. The ability to cut bone with a laser beam would also be of great technical benefit in minimally invasive maxillofacial surgery (endoscopic). The Erbium:yttrium aluminum garnet (Er:YAG) laser has been demonstrated to result in minimal thermal damage of bone, precise cutting, rapid osseous healing and osteoinduction. The purpose of this study was to assess the feasibility of using Er:YAG laser to perform vertical ramus osteotomy, and to determine the most efficient energy per pulse for its completion. Two fresh pig mandibles, one pig cadaver head and one human mandible were used. A different energy per pulse (0.5, 1, 1.5 and 2J/pulse) was used for each osteotomy on the pig mandibles (n=4). Vertical ramus osteotomy was feasible with all energy settings but time decreased considerably from 28 to 5.33 min as the energy per pulse increased. The human and the pig cadaver head mandibles were osteotomized bilaterally with 2000 mJ/pulse that was the most efficient in terms of time. Bone cuts were smooth with no carbonization in all cases.
Tissue engineering is a rapidly growing interdisciplinary field that focuses on the interactions ... more Tissue engineering is a rapidly growing interdisciplinary field that focuses on the interactions between cells, growth factors, and scaffolds to produce replacement tissue and organs. Recent developments in tissue engineering technology include refinements in isolation and differentiation of progenitor cells, 3-D printing technology to produce scaffolds, new biomaterials for scaffolds, and growth factor delivery systems. The purpose of this article is to review advances in biomaterials, scaffolds, and implant coatings for craniomaxillofacial (bone) tissue engineering.
Quintessence international (Berlin, Germany : 1985)
The case of a maxillary third molar displaced into the infratemporal fossa, with difficulty in lo... more The case of a maxillary third molar displaced into the infratemporal fossa, with difficulty in localization due to the synchronous creation of oroantral communication, is described in this article. The patient was referred to the oral and maxillofacial department and underwent successful surgical treatment through an intraoral access. The causes of tooth displacement into the infratemporal fossa, the aid of a computerized tomography (CT) scan in tooth localization, and the difficulty in treating this complication, particularly when the tooth migrates toward the base of the skull, are emphasized. Prevention of maxillary third molar displacement into the infratemporal fossa predominates over removal and is achieved by adequate flap design, correct extraction technique, and a distal retractor during surgical extraction. In the case of displacement, no effort to retrieve the tooth is recommended because of the risk of hemorrhage, neurologic injury, and further displacement of the tooth....
Quintessence international (Berlin, Germany : 1985), 2008
The accidental displacement of foreign bodies into the maxillary sinus is not an unusual complica... more The accidental displacement of foreign bodies into the maxillary sinus is not an unusual complication in dental clinical practice. However, dental materials, and, in particular, dental impression materials, introduced into the sinus several weeks to months after a maxillary tooth extraction or dentoalveolar surgery through either a small, long-standing oroantral fistula or an insufficiently healed extraction wound is uncommon. In the case reported, 3 months after a maxillary molar extraction, the material used for maxillary impression was pushed into the antrum through a small, almost invisible, oroantral fistula that was unseen by the specialists the patient had been visiting, worsening the patient's existing sinusitis.
BACKGROUND: Distraction osteogenesis (DO) is a technique of bone lengthening that makes use of th... more BACKGROUND: Distraction osteogenesis (DO) is a technique of bone lengthening that makes use of the body's natural healing capacity. An osteotomy is created and a rigid distraction device is attached to the bone. After a latency period, the device is activated 2-4 times per day for a total of 1 mm/day of bone lengthening. This technique is used to correct a variety of congenital and acquired deformities of the mandible, midface and long bones. To shorten the treatment period and to eliminate the complications of patient activation of the device, an automated continuous distraction device would be desirable. It has been reported that continuous distraction generates adequate bone with lengthening at a rate of 2 mm/day, thereby reducing the treatment time. METHOD OF APPROACH: The device we describe here uses miniature high-pressure hydraulics, position feedback, and a digital controller to achieve closed-loop control of the distraction process. The implanted actuator can produce up...
Cherubism is a skeletal dysplasia characterized by bilateral and symmetric fibro-osseous lesions ... more Cherubism is a skeletal dysplasia characterized by bilateral and symmetric fibro-osseous lesions limited to the mandible and maxilla. In most patients, cherubism is due to dominant mutations in the SH3BP2 gene on chromosome 4p16.3. Affected children appear normal at birth. Swelling of the jaws usually appears between 2 and 7 years of age, after which, lesions proliferate and increase in size until puberty. The lesions subsequently begin to regress, fill with bone and remodel until age 30, when they are frequently not detectable. Fibro-osseous lesions, including those in cherubism have been classified as quiescent, non-aggressive and aggressive on the basis of clinical behavior and radiographic findings. Quiescent cherubic lesions are usually seen in older patients and do not demonstrate progressive growth. Non-aggressive lesions are most frequently present in teenagers. Lesions in the aggressive form of cherubism occur in young children and are large, rapidly growing and may cause t...
The purpose of this study was to evaluate the outcomes in patients with active bilateral idiopath... more The purpose of this study was to evaluate the outcomes in patients with active bilateral idiopathic condylar resorption treated by condylectomy and costochondral graft (CCG) reconstruction. This was a retrospective evaluation of 15 consecutive patients treated at Massachusetts General Hospital from 1999 to 2004 who had: 1) active bilateral idiopathic condylar resorption confirmed by clinical examination, plain radiographs, and technetium-99 bone scan; 2) adequate documentation; and 3) a minimum of 12 months follow-up. Patients with an identifiable cause of condylar resorption such as rheumatoid or degenerative arthritis, trauma, or steroid use, or who had less than 12 months follow-up were excluded. Preoperative, immediate postoperative, 6-month, 12-month, and latest follow-up clinical examinations, lateral cephalograms, and panoramic radiographs were used to evaluate the outcomes. Inferior alveolar and marginal mandibular nerve function, jaw motion, and occlusion were evaluated by history and physical examination. All patients underwent bilateral condylectomy and CCG reconstruction. There were 13 female and 2 male patients with a mean age of 24 years. Mean follow-up was 34 months (range, 12 to 84). Preoperatively, all patients had Class II malocclusion: mean overjet 6.2 mm and mean anterior open bite -2.65 mm. At latest postoperative follow-up, all patients showed Class I occlusion with no anterior open bite, a stable and reproducible occlusion, and a normal range of TMJ motion with a mean maximal incisal opening of 39 mm. The results of this study indicate that a stable and satisfactory outcome is achievable in patients with active idiopathic condylar resorption treated by condylectomy and CCG reconstruction.
The aim of the present study was to evaluate the effectiveness of interventional sialendoscopy in... more The aim of the present study was to evaluate the effectiveness of interventional sialendoscopy in the management of non-stone obstructive sialadenitis. In the present retrospective study, we assessed the treatment outcomes of 51 patients (34 women and 17 men) who had been diagnosed with sialadenitis without salivary duct stones. The included patients had an obstructive duct condition coupled with recurrent episodes of swelling or pain in a major salivary gland. The patients who had a sialolith detected during the sialendoscopic procedure or by preoperative imaging were excluded from the present study. The outcomes assessment was based on successful removal of the obstructive etiology during the endoscopic procedure and the absence of clinical symptoms after 6 months. The involved glands included 16 submandibular glands and 35 parotid glands. The sialendoscopic navigation was successful in 43 of 51 patients (84%). Of the 43 patients, 37 (86%) were free of symptoms from the obstructive gland after the endoscopic procedure. Of the 6 patients who were still symptomatic after the procedure, 5 had involvement of the parotid gland. Finally, 1 of the original 37 symptom-free patients developed recurrent symptoms and denied additional treatment, resulting in 36 of 43 patients (84%) remaining asymptomatic 6 months after endoscopic navigation. The outcomes of the present study suggest that interventional sialendoscopy can provide symptomatic improvement in most subjects. Clinicians should consider sialendoscopy as a useful and minimally invasive procedure to treat sialadenitis without sialolithiasis.
International journal of oral and maxillofacial surgery, 2007
The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduc... more The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduced postoperative pain and less oedema, have led to a continuous interest in laser applications for bone cutting. The ability to cut bone with a laser beam would also be of great technical benefit in minimally invasive maxillofacial surgery (endoscopic). The Erbium:yttrium aluminum garnet (Er:YAG) laser has been demonstrated to result in minimal thermal damage of bone, precise cutting, rapid osseous healing and osteoinduction. The purpose of this study was to assess the feasibility of using Er:YAG laser to perform vertical ramus osteotomy, and to determine the most efficient energy per pulse for its completion. Two fresh pig mandibles, one pig cadaver head and one human mandible were used. A different energy per pulse (0.5, 1, 1.5 and 2J/pulse) was used for each osteotomy on the pig mandibles (n=4). Vertical ramus osteotomy was feasible with all energy settings but time decreased consider...
The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduc... more The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduced postoperative pain and less oedema, have led to a continuous interest in laser applications for bone cutting. The ability to cut bone with a laser beam would also be of great technical benefit in minimally invasive maxillofacial surgery (endoscopic). The Erbium:yttrium aluminum garnet (Er:YAG) laser has been demonstrated to result in minimal thermal damage of bone, precise cutting, rapid osseous healing and osteoinduction. The purpose of this study was to assess the feasibility of using Er:YAG laser to perform vertical ramus osteotomy, and to determine the most efficient energy per pulse for its completion. Two fresh pig mandibles, one pig cadaver head and one human mandible were used. A different energy per pulse (0.5, 1, 1.5 and 2J/pulse) was used for each osteotomy on the pig mandibles (n=4). Vertical ramus osteotomy was feasible with all energy settings but time decreased considerably from 28 to 5.33 min as the energy per pulse increased. The human and the pig cadaver head mandibles were osteotomized bilaterally with 2000 mJ/pulse that was the most efficient in terms of time. Bone cuts were smooth with no carbonization in all cases.
Tissue engineering is a rapidly growing interdisciplinary field that focuses on the interactions ... more Tissue engineering is a rapidly growing interdisciplinary field that focuses on the interactions between cells, growth factors, and scaffolds to produce replacement tissue and organs. Recent developments in tissue engineering technology include refinements in isolation and differentiation of progenitor cells, 3-D printing technology to produce scaffolds, new biomaterials for scaffolds, and growth factor delivery systems. The purpose of this article is to review advances in biomaterials, scaffolds, and implant coatings for craniomaxillofacial (bone) tissue engineering.
Quintessence international (Berlin, Germany : 1985)
The case of a maxillary third molar displaced into the infratemporal fossa, with difficulty in lo... more The case of a maxillary third molar displaced into the infratemporal fossa, with difficulty in localization due to the synchronous creation of oroantral communication, is described in this article. The patient was referred to the oral and maxillofacial department and underwent successful surgical treatment through an intraoral access. The causes of tooth displacement into the infratemporal fossa, the aid of a computerized tomography (CT) scan in tooth localization, and the difficulty in treating this complication, particularly when the tooth migrates toward the base of the skull, are emphasized. Prevention of maxillary third molar displacement into the infratemporal fossa predominates over removal and is achieved by adequate flap design, correct extraction technique, and a distal retractor during surgical extraction. In the case of displacement, no effort to retrieve the tooth is recommended because of the risk of hemorrhage, neurologic injury, and further displacement of the tooth....
Quintessence international (Berlin, Germany : 1985), 2008
The accidental displacement of foreign bodies into the maxillary sinus is not an unusual complica... more The accidental displacement of foreign bodies into the maxillary sinus is not an unusual complication in dental clinical practice. However, dental materials, and, in particular, dental impression materials, introduced into the sinus several weeks to months after a maxillary tooth extraction or dentoalveolar surgery through either a small, long-standing oroantral fistula or an insufficiently healed extraction wound is uncommon. In the case reported, 3 months after a maxillary molar extraction, the material used for maxillary impression was pushed into the antrum through a small, almost invisible, oroantral fistula that was unseen by the specialists the patient had been visiting, worsening the patient's existing sinusitis.
BACKGROUND: Distraction osteogenesis (DO) is a technique of bone lengthening that makes use of th... more BACKGROUND: Distraction osteogenesis (DO) is a technique of bone lengthening that makes use of the body's natural healing capacity. An osteotomy is created and a rigid distraction device is attached to the bone. After a latency period, the device is activated 2-4 times per day for a total of 1 mm/day of bone lengthening. This technique is used to correct a variety of congenital and acquired deformities of the mandible, midface and long bones. To shorten the treatment period and to eliminate the complications of patient activation of the device, an automated continuous distraction device would be desirable. It has been reported that continuous distraction generates adequate bone with lengthening at a rate of 2 mm/day, thereby reducing the treatment time. METHOD OF APPROACH: The device we describe here uses miniature high-pressure hydraulics, position feedback, and a digital controller to achieve closed-loop control of the distraction process. The implanted actuator can produce up...
Cherubism is a skeletal dysplasia characterized by bilateral and symmetric fibro-osseous lesions ... more Cherubism is a skeletal dysplasia characterized by bilateral and symmetric fibro-osseous lesions limited to the mandible and maxilla. In most patients, cherubism is due to dominant mutations in the SH3BP2 gene on chromosome 4p16.3. Affected children appear normal at birth. Swelling of the jaws usually appears between 2 and 7 years of age, after which, lesions proliferate and increase in size until puberty. The lesions subsequently begin to regress, fill with bone and remodel until age 30, when they are frequently not detectable. Fibro-osseous lesions, including those in cherubism have been classified as quiescent, non-aggressive and aggressive on the basis of clinical behavior and radiographic findings. Quiescent cherubic lesions are usually seen in older patients and do not demonstrate progressive growth. Non-aggressive lesions are most frequently present in teenagers. Lesions in the aggressive form of cherubism occur in young children and are large, rapidly growing and may cause t...
The purpose of this study was to evaluate the outcomes in patients with active bilateral idiopath... more The purpose of this study was to evaluate the outcomes in patients with active bilateral idiopathic condylar resorption treated by condylectomy and costochondral graft (CCG) reconstruction. This was a retrospective evaluation of 15 consecutive patients treated at Massachusetts General Hospital from 1999 to 2004 who had: 1) active bilateral idiopathic condylar resorption confirmed by clinical examination, plain radiographs, and technetium-99 bone scan; 2) adequate documentation; and 3) a minimum of 12 months follow-up. Patients with an identifiable cause of condylar resorption such as rheumatoid or degenerative arthritis, trauma, or steroid use, or who had less than 12 months follow-up were excluded. Preoperative, immediate postoperative, 6-month, 12-month, and latest follow-up clinical examinations, lateral cephalograms, and panoramic radiographs were used to evaluate the outcomes. Inferior alveolar and marginal mandibular nerve function, jaw motion, and occlusion were evaluated by history and physical examination. All patients underwent bilateral condylectomy and CCG reconstruction. There were 13 female and 2 male patients with a mean age of 24 years. Mean follow-up was 34 months (range, 12 to 84). Preoperatively, all patients had Class II malocclusion: mean overjet 6.2 mm and mean anterior open bite -2.65 mm. At latest postoperative follow-up, all patients showed Class I occlusion with no anterior open bite, a stable and reproducible occlusion, and a normal range of TMJ motion with a mean maximal incisal opening of 39 mm. The results of this study indicate that a stable and satisfactory outcome is achievable in patients with active idiopathic condylar resorption treated by condylectomy and CCG reconstruction.
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