Alveolar bone necrosis and spontaneous tooth exfoliation associated with trigeminal herpes zoster: a report of three cases.

Herpes zoster is a viral infection caused by the reactivation of the varicella zoster virus, an infection most commonly affecting the thoracolumbar trunk. Herpes Zoster Infection (HZI) may affect the cranial nerves, most frequently the trigeminal. HZI of the trigeminal nerve distribution network manifests as multiple, painful vesicular eruptions of the skin and mucosa which are innervated by the infected nerves. Oral vesicles usually appear after the skin manifestations. The vesicles rupture and coalesce, leaving mucosal erosions without subsequent scarring in most cases. The worst complication of HZI is post-herpetic neuralgia; other complications include facial scarring, motor nerve palsy and optic neuropathy. Osteonecrosis with spontaneous exfoliation of the teeth is an uncommon complication associated with HZI of the trigeminal nerve. We report several cases of osteomyelitis appearing on the mandible, caused by HZI, and triggering osteonecrosis or spontaneous tooth exfoliation.ope

Surgical management of edentulous/atrophic mandibular fracture: a report of two cases

According to Luhr's classification, a fracture in the mandible with a width of less than 15-20 mm is considered to be an atrophic mandibular fracture and its incidence is very rare. Because of the reduced cross-sectional area and smaller contact area of the fractured ends as well as the poorly vascularized bony structure and delayed bone healing, an atrophic mandibular fracture is a great challenge for oral and maxillofacial surgeons. Surgeons tend to perform closed reduction, because open reduction is considered a non-life-saving surgery among elderly patients. Thus, most of them have limited experience in surgical management. According to recent reports, open reduction yields a good result, and the Association for Osteosynthesis (AO) group has recommended open reduction. This is a case report of our two experiences of open reduction and rigid fixation of atrophic mandibular fractures by the AO principle. Articles were also reviewed here.ope

Reconsideration of decision making for third molar extraction

Introduction: Third molar extraction is one of the most common procedures in oral and maxillofacial surgery. The impacted third molar causes many pathological conditions, such as pericoronitis, caries, periodontitis, resorption of adjacent teeth, and cyst or tumors associated with impacted teeth. Extraction is often considered the treatment of choice for impacted lower third molars. On the other hand, imprudent extraction of deeply impacted third molars can cause permanent complications, such as inferior alveolar nerve damage. Therefore, guidelines for the extraction of lower third molars should be set to prevent embarrassing complications. This study examined the indication and current trends of the extracted lower third molars in the dental hospital of a dental college. Materials and Methods: 557 extracted third molars were evaluated at the department of oral and maxillofacial surgery of Yonsei University. The chief complaint, diagnosis, age and degree of impaction were analyzed to determine the tendency for the extraction of asymptomatic lower third molars. Results: The percentage of asymptomatic third molars was 40.8%. In cases of full impacted tooth or full erupted tooth, the percentage of asymptomatic teeth was more than 50% (52.4% and 54.3, respectively). Among those partially impacted teeth, 73.1% of them showed symptoms, such as pain, tenderness and swelling. In terms of age, pericoronitis was evident at a younger age, and dental caries/periodontitis was the main cause of removal in those aged over 50. Twenty nine cases (1.6%) had teeth associated with pathological changes Conclusion: The incidence of pathological changes to the lower third molar was relatively low. Surgical extraction is recommended in cases of partially impacted teeth. In Korea, the incidence of asymptomatic third molar extraction was relatively higher than in European countries. More careful attention would be desirable to consider the risks and benefits of lower third molar extraction.ope

Stability of maxillary position after LeFort I osteotomy using self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws

치의학과/석사본 연구는 self-reinforced biodegradable poly-70L/30DL-lactide miniplates와 screws를 이용한 LeFort I 골절제술 후 상악골의 위치 안정성을 평가하고자 하였다. Self-reinforced biodegradable poly-70L/30DL-lactide miniplates와 screws를 이용한 LeFort I 골절제술 및 내측고정을 시행한 19명의 환자들을 임상 및 방사선학적으로 평가하였다. 상악 위치의 변화를 수술 후 1주일, 1, 3, 6개월 그리고/또는 1년에 측모 두부규격 방사선사진을 촬영하여 측정하였다. Self-reinforced biodegradable poly-70L/30DL-lactide miniplates및 screws와 관련된 합병증은 술후 촬영한 방사선 사진과 의무 기록으로 평가하였다. 통계 분석을 위해 mixed model analysis for repeated measures법을 사용하였으며 다음과 같은 결론을 얻었다.1. 상악골의 위치는 수술 후 모든 기간에서 통계적으로 유의한 변화 없이 안정적으로 유지되었다.22. 수술 후 모든 기간에서 self-reinforced biodegradable poly-70L/30DL-lactide miniplates 및 screws와 관련된 합병증은 없었다.이상의 결과로 self-reinforced biodegradable poly-70L/30DL-lactide miniplates와 screws를 이용한 LeFort I 골절제술 후 내측 고정법은 수술 후 상악골의 위치를 안정적으로 유지시킬 수 있는 방법이라고 생각된다.ope

Deep circumflex iliac artery free flap in the mandibular reconstruction

Vascularized iliac crest flap include bone tissue of good quality and quantity for mandible segmental defect. Even if fibular flap can contain longer bone tissue, iliac crest has esthetic shape for mandible body reconstruction and large height for implant. Conventional vascularized iliac crest osteomyocutaneous flap is too bulky for reconstruction of intraoral soft tissue defect. But modified flap can reduce soft tissue volume, so is good for functional reconstruction of oral mucosa. It takes only one month for completely replace oral mucosa. The final mucosal texture is much better than other skin paddle flap, especially for implant prosthesis. Donor site morbidity of this method looks same level or less with other modalities functionally and socially. In case of oral mucosa-mandible combined defect, vascularized iliac crest with internal oblique muscle flap shows good outcomes for hard and soft tissueope

Stability of maxillary position after Le Fort I osteotomy using self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws.

PURPOSE: The purpose of this study was to evaluate the stability of Le Fort I osteotomy using self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws. PATIENTS AND METHODS: Nineteen patients who had Le Fort I osteotomy and internal fixation using self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws were evaluated both radiographically and clinically. Changes in maxillary position after operation were documented 1 week, 1, 3, 6 mo, and/or 1-yr postoperatively with lateral cephalometric tracings. Complications of the self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws were evaluated by follow-up roentgenograms and clinical observation. A mixed model analysis for repeated measures was used for statistical analysis. RESULTS: Maxillary position was stable after operation with no change between time points (P > .05). There were no complications with the self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws. CONCLUSIONS: Internal fixation of the maxilla after Le Fort I osteotomy with self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws is a reliable method for maintaining the postoperative maxillary position after Le Fort I osteotomy.ope

Visual pathway-related horizontal reference plane for three-dimensional craniofacial analysis

OBJECTIVES: To construct three-dimensional (3D) horizontal reference planes based on visual pathway and to determine their stability and reliability by analyzing the structural patterns of normal and dysmorphology for 3D craniofacial analysis. SETTING AND SAMPLE POPULATION: Thirty-six subjects with maxillofacial dysmorphology and malocclusion, and eight normal controls. MATERIALS AND METHODS POPULATION: On the 3D computed tomographic images of the subjects, the visual pathway-based planes, including the orbital axis plane (OAP), visual axis plane (VAP), and the optical axis plane (OpAP), were constructed and evaluated. RESULTS: The OAP, but not the VAP and OpAP, showed the ideal relationship between the midsagittal and posterior maxillary plane, and properly described the different patterns of maxillofacial dysmorphology with craniofacial plane 1 of Delaire's analysis and the occlusal plane. CONCLUSIONS: The proposed visual pathway-related horizontal reference planes, and in particular the OAP, seem to correctly express the visual axis and the position of the head in natural head position and can be used as a horizontal reference plane for the 3D analysis of craniofacial dysmorphology and anthropology.ope