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Objective The aim of this study was to assess the efficacy of the “SMARTLock” hybrid system and determine whether it results in fewer intraoperative and postoperative complications compared with placement of intermaxillary fixation (IMF) screws in trauma patients. Study Design This prospective study, which was approved by the institutional review board, compared the results of MMF in mandibular fractures by using the Stryker “SMARTLock” hybrid system versus traditional IMF screws. Patients were recruited and assigned randomly to either group. The 2 groups were compared for placement time, intraoperative complications, loosening of hardware, postoperative complications, and time to device removal. Results We enrolled 32 patients in the study, with 13 patients randomized to the group receiving hybrid MMF (HMMF) with the SMARTLock system and 19 to the group of patients receiving MMF with traditional IMF screws. The mean application time for HMMF was 25.92 minutes compared with 18.28 minutes for IMF screws. After removal, the HMMF was associated with gingival overgrowth and gingival edema. Conclusions This is the first study to compare HMMF with MMF with the use of IMF screws. Hybrid arch bars do require more manipulation for ideal placement compared with individually placed bone screws to achieve ideal MMF. Compared with IMF screws, the hybrid device was associated with gingival edema and overgrowth, but there was decreased incidence of loosening in the postoperative period.

Purpose Takotsubo syndrome (TS) is an acute and potentially serious cardiac disorder that is often attributed to an exuberant catecholaminergic response to a severely physical or emotional event. As there is a paucity of information in the dental literature on TS, this article will provide an overview of this uncommon syndrome, including clinical presentation, demographic characteristics, etiopathogenesis, diagnosis, management, and recovery, particularly emphasizing its occurrence with oral and maxillofacial procedures. Patients and Methods A PubMed search with the keyword “takotsubo” for publications from 1991 through May 2018 yielded 3,778 articles. Case reports and case series of TS associated with surgical and nonsurgical procedures in the oral and maxillofacial region were reviewed. Other cases were identified using a defined search strategy. Results The literature search identified 28 documented episodes of TS that occurred with head and neck surgical procedures, mostly sinus, carotid, nasal, and cancer reconstruction surgical procedures, and notably, 3 cases occurred concurrently with dental extractions. In all of the featured patients, some degree of cardiovascular impairment developed and phenotypic overlap with acute occlusive coronary disease was shown. Most patients recovered within 2 weeks, and recovery in the remainder extended up to 3 months. Conclusions On rare occasions, TS has been reported in association with oral and maxillofacial procedures. As stress appears to be a precipitating factor in the development of TS, perioperative efforts should be instituted to reduce an adrenergic cascade.

Numerous incisions around the ear have been described, and many have been used in oral and maxillofacial surgery for procedures involving the temporomandibular joint (TMJ), condylar neck, and parotid gland, as well as for rhytidectomy.1-5 Although the traditional preauricular and endaural incisions will frequently provide an excellent outcome, they will heal with a visible scar.1,4 The incision we have described aims to refine the incision to further improve this esthetic outcome. Additionally, surgical procedures around the ear have often resulted in the unpleasant and inconvenient collection of blood or surgical skin preparation in the ear canal. Although not recorded in reported studies, in our experience, patients have commonly complained of "blocked ears" for 1 to 2 weeks in the postoperative period. Although this complication represents minimal risk, it can often be difficult, once clotted or dried, to remove and will be bothersome to the patient. In addition, any packing placed in the external auditory canal (EAC) intraoperatively to mitigate the collection of blood will often and repeatedly dislodge from the EAC, requiring replacement multiple times during the procedure to the frustration of the surgeon. The techniques we have described are 2 straightforward, but innovative, surgical techniques that refine surgery around the ear to improve the esthetics and patient comfort, facilitate the surgical procedure, and increase reliable anatomic access. The modified incision we have described is predominately aimed at operations requiring access to the TMJ, condylar neck, or parotid gland. The techniques were, to the best of our knowledge, first used in our unit at the University of Maryland.

Purpose The purpose of this study was to estimate the penetration of cone-beam computed tomography (CBCT) in oral and maxillofacial surgery (OMS) residency programs in the United States. In addition, this study was designed to assess the education and training, relevance, and image interpretation responsibility of CBCT as experienced by OMS residents. Materials and Methods The authors performed a cross-sectional study of all 102 US-based OMS program directors (PDs) from January 1, 2014 through April 30, 2014. Study variables included questions about 4 key factors in CBCT in OMS programs: access, education and training, relevance, and image interpretation responsibility. Data analysis was a product of the percentage of positive responses to each question. Results Fifty-four PDs participated in the study. The results showed that 87% of responding OMS programs have access to CBCT and that CBCT is used primarily for dental implant-related procedures. Conclusion OMS residents are actively involved in CBCT use in their residency. OMS residents' access to CBCT is increasing, and their education, training, and image interpretation responsibility is increasing.

There is no clinical consensus for the treatment of Keratocystic Odontogenic Tumor (KCOT). KCOTs are regarded as benign aggressive tumors and resection is usually considered as a last option. We review the clinical indications for resection based on a case series.This is a retrospective study of patients with KCOT treated in a single unit over 17 years. Eighty patients were identified, of which 12 (15 %) underwent resection. The remaining 68 patients were managed by enucleation and curettage, enucleation with peripheral ostectomy, or decompression with secondary enucleation. Data extracted includes gender, age, race, location, previous treatment for the lesion, surgery and outcome/follow up.Twelve patients treated by resection were identified. The location in the ten benign resected KCOTs was either the mandibular ramus or the posterior maxilla. All mandibular KCOTs exhibited perforation of the lingual plate and involvement of the pterygoid musculature. Seven of the ten cases were recurrent KCOTs and three had no prior treatment. Two had malignant changes in the KCOT and were also resected.The primary reason for resection of KCOT was involvement of the pterygoid muscles. The presence of malignant change was a separate indication for resection.

Open and arthroscopic surgeries of the temporomandibular joint (TMJ) are common and effective treatments for selected patients with TMJ disorders. However, complications inevitably occur, even in the hands of experienced TMJ surgeons. An understanding of the surrounding anatomy, as well as a knowledge of the potential complications, is essential and not only helps in avoiding these complications but also in their recognition and appropriate management, when they do occur. The TMJ is located in a complex anatomical region within the head and neck. It is bounded posteriorly by the external auditory canal and superiorly by the middle cranial fossa. Consequently these structures are at risk during open surgery and arthroscopy with the potential for serious complications.

Bisphosphonate-associated osteonecrosis (BON) is a recently recognized oral complication of bisphosphonate (BP) therapy. Currently, research into the pathogenesis of BON has been hampered by being deficient in studies capable of measuring the level of BP in saliva or at the bone-soft tissue interface. The objective of this current study was to develop a novel bioassay model representative of the oral levels of BPs in patients presenting with or at risk for BON.Zoledronic acid (ZA) injectable was used to develop standardized MTS cell proliferation assay curves at concentrations of 0-10 microM, which were used either in a dilution in normal media, mimicking BP freed from bone or used to "spike" saliva individuals not taking BPs and mimicking BP levels being excreted. This bioassay was then used to estimate BP levels from samples of saliva and bone ex vivo from patients with and without BON.Saliva and bone from patients with existing BON showed levels of BP ranging from 0.4 to 4.6 microM, while patients receiving IV infusion of BP and naïve to BON showed levels in saliva ranging from 0.4 to 5 microM. All control specimens and patients naïve to BP showed levels at 0 microM.Given the fact that BPs are poor candidates for detection using standard methods (HPLC), this bioassay provides us with the ability to estimate clinically relevant concentrations of BP capable of producing apoptosis and the inhibition cell proliferation of oral mucosal cells based on previous studies. Subsequently, apoptosis and the inhibition of proliferation could lead to BON, secondary to the exposure of the bone in the unique microenvironment of the oral cavity.

Purpose Lymph node metastasis from oral squamous cell carcinoma (SCC) correlates with a poor prognosis. Therefore, accurate assessment of lymph node status is crucial in treatment planning. Furthermore, prediction of delayed neck metastasis (DNM), especially in early stage tumors with a clinically negative (N0) neck, will determine the need for neck dissection or irradiation. In this study, we assess various clinical, histopathological and lymphangiogenic parameters in early stage oral SCC and their association with DNM. Materials and Methods Clinical, histological, and immunohistochemical analyses were undertaken for 29 patients with T1N0M0 or T2N0M0 oral SCC affecting the tongue or floor of mouth and correlated with the development of DNM. Results Tumor thickness, nuclear pleomorphism, pattern of invasion, and immunohistochemical expression of the lymphangiogenesis-associated molecules VEGFR-3 and VEGF-C were associated with DNM. Conclusions Analysis of these parameters may help to identify patients who would benefit from a neck dissection or irradiation by predicting the likelihood of lymph node metastasis.

Aim: Oral lichen planus (OLP) is an oral lesion with an enigmatic etiology. To explore the possibility of psycho-somatization, we evaluated the psychological personality profiles of OLP patients. Methods: Twenty patients with reticular; 20 with erosive form of OLP, and 25 controls were tested with the psychological Minnesota Multiphasic Personality Inventory (MMPI)-202 test. Eight clinical scales (hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, psychasthenia, schizophrenia, and hypomania) as well as cortisol level, CD3, CD4, CD8, and CD16 markers by group were compared. Psychosomatization was evaluated by the use of internalization ratio (IR) Index. Results: A characteristic MMPI profile was noted in the OLP groups with high IR index value. Significant differences among the groups were detected for cortisol, CD4, CD8, and CD16 counts. Mean values for hypochondriasis, depression, and hysteria were all significantly different with significantly higher mean scores for both reticular and erosive OLP subjects compared with controls. Conclusions: Prolonged emotive stress in many OLP patients may lead to psychosomatization and may contribute to the initiation and clinical expression of this oral disorder. Clinical significance: If additional research involving a larger and more diverse sample of patients confirms these findings, clinical trials will be needed to determine whether adjunctive psychological intervention provides a benefit in treating patients with OLP.

Tissue injury in the oral mucosa activates a cascade of transcriptional events important during the healing process that are not yet clearly defined. To characterize these events and identify potential gene targets for future studies, we used cDNA expression arrays in a clinical model of tissue injury. Mucosal biopsies were taken before third molar extraction, 2-4 hours postoperatively, or at 48 hours. Hybridization patterns were analyzed and validated using real-time polymerase chain reaction. Prior to extraction, the biopsied mucosal tissues were characterized by a panoply of genes that were constitutively expressed. After injury, analysis revealed differential expression of genes involved in transcription, inflammation, and remodeling. At 2-4 hours after injury, genes such as Fos, Jun, and early growth response protein were up-regulated, while genes responsible for intercellular adhesion were down-regulated. At 48 hours after injury, the gene profile had shifted toward tissue remodeling. Here we identify genes constitutively expressed in normal oral mucosa and transcriptional events following mucosal tissue injury, which may be useful in identifying new therapeutic targets.

Approximately 5 million people are diagnosed with valvular heart disease in the United States each year. Many of these will present to the general dentist for routine dental care. The dentist must then understand the implications of this disease process to treat these patients safely and effectively. Of course patients with pathologic valve disease are managed in close consultation with their physicians. Even so, a dentist with knowledge of the disease process, as well as its diagnosis and treatment, has greater confidence when treating these patients. This article summarizes issues related to valvular heart disease and heart failure and provides guidance to dentists treating patients with such conditions.

Various combinations of the SIBLING family of proteins have been found to be up-regulated in many human cancers and have been linked to different stages of tumor progression, including metastasis. Bone sialoprotein (BSP), osteopontin (OPN) and dentin matrix protein 1 (DMP1) specifically bind and activate MMP-2, MMP-3, and MMP-9, respectively. These proteases have also been shown to play important roles in oral squamous cell carcinoma (OSCC) invasion and metastasis. However, with the exception of OPN, there are no reports on the expression of the family of five SIBLING proteins in OSCC. This study examines the expression patterns of the SIBLING family (and MMP partners when known) in OSCC, correlating expression to outcome variables. Archived paraffin sections of 87 cases of primary OSCC were screened by immunohistochemistry for the SIBLINGs and their MMP partners. Three SIBLINGs (BSP, DSPP, and OPN), were expressed in OSCC, while DMP1 and MEPE expression were never observed. Furthermore, BSP and OPN were always expressed with their known MMP partners, MMP-2 and MMP-3, respectively. Poorly differentiated tumors exhibited reduced or no immunoreactivity for BSP and OPN but increased immunoreactivity for DSPP. Seventy eight (90%) cases were positive for BSP and DSPP, while 79 cases (91%) were positive for OPN. Overall, 91% of the cases were positive for at least one SIBLING. There were no correlations between SIBLING expression and tumor size ("T"; of the Union Internationale Contre le Cancer [UICC]-TNM classification for OSCC), and between SIBLING expression and lymph node spread for the T1/T2 tumors. The levels of DSPP expression for floor of mouth and retromolar region tumors were higher than for tongue tumors. Statistically significant correlations were, however, found between the expression levels of BSP and MMP-2 (p

s / British Journal of Oral and Maxillofacial Surgery 52 (2014) e43–e74 e63 fellowships supported by both research council funding and BAOMS. We emphasise the availability of trainee led collaboratives such as the North West OMFS/Otolaryngology Trainee Collaborative (NOTCh) that exist with the express aim of helping drive novel research projects from concept to implementation. Results & Discussion: As a direct consequence of new initiatives in surgical clinical trial training, fellowship establishment and design education, A Phase III Randomised Controlled Trial aimed at “Determining the Efficacy of Fibrin glue in Neck Dissection (DEFeND)” can be reported upon. http://dx.doi.org/10.1016/j.bjoms.2014.07.064

with an odds ratio of 2.7173 (95% confidence interval(CI), 1.0995-6.7151). IgG FcgRIII(NA) was slightly associated with the frequency of the NA2 allele (p 0.1001) with an odds ratio of 1.6086 (95% CI, 0.91062.8413), showing no significant differences. No significant results were obtained for the remaining 12 genes. Conclusion: The variation of TNFRII( 587)T/G affected tumor necrosis factor-alpha induced apoptosis, and was associated with systemic lupus erythematosus, rheumatoid arthritis and severe chronic periodontitis. These results suggested that TNFRII( 587) genetic polymorphism was useful as the sensitivity marker in OLP.