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Biomedical subjects

L M Wolford

Publications and source records attributed to L M Wolford.

At least 19 recordsLinked to original sources
PubMed2003

TMJ Concepts/Techmedica custom-made TMJ total joint prosthesis: 5-year follow-up study.

This prospective study evaluated the 5 to 8 year subjective and objective results of 42 consecutive patients who had TMJ reconstruction using the TMJ Concepts/Techmedica custom made total joint prosthesis. Criteria for use of the prosthesis included the following TMJ conditions: (1) multiply operated, (2) previous alloplastic implants, (3) osteoarthritis, (4) inflammatory or resorptive arthritis, (5) connective tissue or autoimmune disease, (6) ankylosis, and (7) absent or deformed structures. Thirty-eight of 42 patients (90%) with 69 TMJs reconstructed using the TMJ Concepts/Techmedica total joint prosthesis had appropriate data for inclusion in the study. The average age at surgery was 36 years and average follow-up was 73.5 months. The entire group and three subgroups were objectively evaluated for incisal opening, lateral excursions, and occlusal stability, while subjectively assessed for pain and jaw function. Paired t-test and comparison analyses were used to assess outcomes. For the group of 38 patients, there was statistically significant improvement in incisal opening (P=0.001), jaw function (P=0.001), and pain level (P=0.0001). Lateral excursion movements significantly decreased (P=0.04). The occlusion remained stable in all cases. Complications occurred in six patients. Comparison analysis of the three groups demonstrated significantly better outcomes for patients with fewer previous TMJ surgeries and without exposure to Proplast-Teflon or Silastic TMJ implants. This study demonstrated that the TMJ Concepts/Techmedica total joint prosthesis is a viable technique for TMJ reconstruction as a primary procedure and for patients with previous multiple TMJ surgeries and mutilated anatomy of the TMJ.

Adolescent↗
PubMed2001

Use of Gore-Tex tubing as a conduit for inferior alveolar and lingual nerve repair: experience with 6 cases.

PURPOSE: This report evaluates treatment outcomes associated with the use of Gore-Tex (GT; W.L. Gore & Associates, Flagstaff, AZ) vein graft tubing as a conduit for repair of inferior alveolar nerve (IAN) and lingual nerve (LN) continuity defects. PATIENTS AND METHODS: Six patients (5 female and 1 male) with painful dysesthesia secondary to injuries of the IAN (n = 3) or LN (n = 3) underwent surgical exploration and resection of pathologic tissue. Reconstruction of the resultant continuity defects was performed using 3-mm diameter GT tubing sutured to the epineurium of the proximal and distal nerve trunks. Nerve reconstruction was performed an average of 20 months after injury (range, 4 to 48 months). Patients were tested before and after surgery with the following tests: subjective pain level using an analogue scale, sharp stimulus, touch, cold sensation, directional sense, and 2-point discrimination. RESULTS: Four patients reported no change in subjective pain level, and 2 patients had minimal decrease in pain. Two patients reported some sensation to sharp stimulus, and 1 patient was hypersensitive. Three patients responded to touch, and 3 had no response. Four patients had no response to cold sensation, and 2 had a delayed response. Only 1 patient could detect brushstroke direction. Three patients had no response to 2-point discrimination, and 3 responded at greater than 20 mm. CONCLUSIONS: Use of GT tubing in this group of patients produced poor clinical outcomes and is not recommended for nerve reconstruction of IAN and LN continuity defects.

Adult↗
PubMed2001

Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars.

PURPOSE: This study compared the number of unfavorable fractures after sagittal split osteotomies (SSOs) of the mandible when third molars were present or absent. PATIENTS AND METHODS: The treatment records of 262 patients (500 SSOs) were retrospectively evaluated. Group 1 consisted of 250 SSOs and concomitant removal of impacted mandibular third molars and group 2 consisted of 250 SSOs with absence of third molars. A modified SSO technique with inferior border cuts was used on all patients, and the third molars, when present, were removed after separation of the proximal and distal segments. Rigid fixation was applied using bicortical bone screws. Bone plates with monocortical screws were additionally used to secure the free bony segments of the proximal segment in cases with unfavorable fracture. RESULTS: There were 11 (2.2%) unfavorable fractures in 500 SSO procedures. The incidence of unfavorable splits was 3.2% in group 1 and 1.2 % in group 2. In group 1, all fractures occurred in teenagers, with 7 of 8 fractures extending through the extraction socket in the distal segment. Six of the 8 fractures were associated with completely impacted third molars, and 2 involved partially impacted teeth. All 3 fractures in group 2 occurred in the proximal segment. No significant difference was seen in the amount of relapse in patients with unfavorable or favorable splits. CONCLUSIONS: The occurrence of unfavorable splits is uncommon when using a modification of the SSO that includes an inferior border osteotomy. Although more unfavorable fractures occurred in teenage patients with third molars, this had no impact on the stability of the final result.

Adolescent↗
PubMed2001

The osseointegration of Mitek mini anchors in the mandibular condyle.

PURPOSE: This study examined the histomorphology of the bone around the Mitek mini anchors (Mitek Inc, Norwood, MA) after 3 to 59 months of implantation. MATERIALS AND METHODS: Thirteen condylar specimens from 8 patients were evaluated. Each of these patients had had previously placed Mitek mini anchors and braided polyester sutures for temporomandibular joint (TMJ) articular disc stabilization. Histologic evaluation of each specimen was performed to determine the degree of osseointegration. Each specimen was also evaluated for anchor configuration, fracture, and particulation and the presence or absence of intervening fibrous connective tissue or an inflammatory cell infiltrate. RESULTS: All anchors became osseointegrated without evidence of associated inflammation or fibrous connective tissue formation along the surface. There was no evidence of anchor fracture or particulation. CONCLUSIONS: The Mitek mini anchor can osseointegrate in the mandibular condyle. These suture anchors remain intact and biocompatible for as long as 59 months, the longest interval examined in this study.

Adolescent↗
PubMed2001

The Mitek mini anchor for TMJ disc repositioning: surgical technique and results.

This study evaluated our treatment outcomes in 105 patients (188 discs) using the Mitek mini anchor for temporomandibular joint (TMJ) articular disc repositioning surgery, with 88 patients having simultaneous orthognathic surgery. Criteria for inclusion into the study were: (1) Presurgical TMJ disc displacement with salvageable disc; (2) No prior TMJ surgery; (3) TMJ disc repositioning with the Mitek mini anchor; (4) Absence of connective tissue/autoimmune disease; (5) Absence of postsurgical trauma; and (6) Minimum of 12 months postsurgery follow up. Presurgery (T1), immediately postsurgery (T2), and longest follow up (LFU) clinical and radiographic evaluations were performed. The mean age of the patients was 32.6 years (range 14-57 years), and mean follow-up time was 46.2 months (range 14-84 months). Radiographic evaluation at LFU demonstrated no significant condylar resorption or positional changes of the anchors. At LFU, there was a statistically significant reduction in: TMJ pain, facial pain, headaches, TMJ noises and disability, and improvement in jaw function and diet. Maximum incisal opening improved slightly and lateral excursive movements decreased slightly. The Mitek mini anchor provides a predictable method for stabilizing the TMJ articular disc to the condyle and a high success rate in decreasing TMJ dysfunction and pain in patients with no previous TMJ surgery.

Adolescent↗
PubMed2001

Considerations for orthognathic surgery during growth, part 2: maxillary deformities.

The growing patient can present to the clinician with significant dentofacial deformities that require surgical correction. In some cases, certain functional, esthetic, and psychosocial factors may necessitate early surgical intervention. Although there is extensive literature on the effects and stability of orthognathic surgical correction of maxillary deformities in adults, the same is not true for the pediatric and adolescent growing patient. Not much is known about the predictability of orthognathic surgical procedures performed during growth or the effects such procedures have on subsequent facial growth. There is always the possibility that secondary corrective procedures may be required after the initial corrective surgery. This article presents recommendations based on available research and personal clinical experience in surgical correction of maxillary deformities in growing patients. The common maxillary dentofacial deformities, age considerations, and surgical alternatives and sequencing are presented. The treatment of mandibular deformities is addressed in Part 1 of this article.

Adolescent↗
PubMed2001

Considerations for orthognathic surgery during growth, part 1: mandibular deformities.

Management of the growing patient with mandibular dentofacial deformities presents a unique and challenging problem for orthodontists and surgeons. The surgical procedures required for correction of the deformity may affect postsurgical growth and dentofacial development. Further, facial growth may continue postoperatively and negate the benefits of surgery performed, resulting in treatment outcomes that are less than ideal. From individual patient characteristics, the type of deformity, and the indications for early surgical intervention, it is possible to effectively treat many cases during growth. A thorough understanding of facial growth patterns is essential, and each case needs to be evaluated individually. Surgery is often undertaken with the expectation that additional treatment, including more surgery, may be required after the completion of growth. The material presented here is based on the available research and the senior author'ss clinical experience of more than 25 years in the correction of mandibular deformities in the growing patient. Advantages and disadvantages of specific surgical techniques for correction of common mandibular deformities and pertinent age and surgical considerations are discussed. The material should be viewed as a general outline that provides broad guidelines for management of these patients. The management of maxillary deformities will be discussed in Part 2 of this article.

Adolescent↗
PubMed2001

Postsurgical growth changes in the mandible of adolescents with vertical maxillary excess growth pattern.

This case-control study investigates the effects of superior maxillary repositioning by LeFort I osteotomy on adolescent mandibular growth. A total of 15 growing patients (average age, 12.8 years) with vertical maxillary excess who had undergone maxillary surgery were compared with matched untreated control subjects. Lateral cephalograms were evaluated and superimposed to describe the presurgical (1.6 years), surgical, and postsurgical (4.0 years) changes. During the presurgical period, comparisons of traditional measures and mandibular modeling changes showed no significant differences between the 2 groups. During surgery, the maxilla was impacted approximately 3 mm anteriorly and 1 mm posteriorly, which caused a 3.2 degrees autorotation of the mandible. During the postsurgical period, there was no change in the vertical growth pattern of the surgical patients, with the vertical facial heights increasing the same as the control subjects and the mandible rotating backwards. Although there was no inhibition of mandibular growth in the patients postsurgically, there was a decrease in horizontal maxillary growth compared with control subjects. There were clear postsurgical changes in the mandibular modeling and condylar growth, which were indicative of adaptive compensations for surgical mandibular repositioning and autorotation. It is concluded that early maxillary impaction does not normalize or inhibit the vertical maxillary excess growth pattern; mandibular modeling and condylar growth undergo adaptive changes in response to repositioning.

Adaptation, Physiological↗
PubMed2001

Pharyngeal airway space changes after counterclockwise rotation of the maxillomandibular complex.

The purpose of this study was to evaluate the effects of double-jaw surgery with counterclockwise rotation of the maxillomandibular complex on the pharyngeal airway space and velopharyngeal anatomy in patients with high occlusal plane facial morphology. Fifty patients (22 men, 28 women) with high occlusal plane facial morphology underwent double-jaw surgery with counterclockwise rotation of the maxillomandibular complex. The patients were divided into 2 groups: group 1, 30 patients (8 men, 22 women) who underwent maxillary and mandibular advancement and group 2, 20 patients (14 men, 6 women) who underwent maxillary advancement and mandibular setback. Presurgery and postsurgery lateral cephalometric radiographs were analyzed to correlate changes in pharyngeal airway space dimensions and velopharyngeal anatomy with maxillary and mandibular positional changes. The calibration showed a more than 0.94 correlation for both intra- and interoperator error. The average follow-up time was 29.6 months in group 1 and 22.2 months in group 2. Mean maxillary surgical change at point A was 4.15 mm in group 1 and 2.5 mm in group 2. Mean mandibular surgical change at the genial tubercles was 7.5 mm in group 1 and -4.95 mm in group 2. After surgery, group 1 patients had an increase in pharyngeal airway space of 47% at the soft palate and 76% at the base of the tongue relative to the amount of mandibular advancement. Group 2 patients had a decrease in pharyngeal airway space of 47% at the soft palate and 65% at the base of the tongue relative to the amount of mandibular setback. Double-jaw surgery with counterclockwise rotation of the maxillomandibular complex significantly affects the pharyngeal airway space and velopharyngeal anatomy in patients with high occlusal plane facial morphology, with both mandibular advancement and setback.

Adolescent↗
PubMed2001

Frequency of chlamydial antibodies in patients with internal derangement of the temporomandibular joint.

PURPOSE: This study investigates whether an increased frequency of serum antibodies to Chlamydia trachomatis is found in patients with internal derangement of the temporomandibular joint (TMJ). PATIENTS AND METHODS: An indirect immunofluorescence antibody assay for the detection of serum immunoglobulin G antibodies for C trachomatis was used for most patients. Forty-one female patients were evaluated. RESULTS: Three of 41 patients (7%) had serum antibody titers that were considered positive for active C trachomatis infection. Eleven patients (27%) were considered to have had a past infection based on the immunoglobulin G or immunoglobulin A titer results. Using the binomial test, we found that the probability of observing 14 positive results (34%) was significant (P < .0001). CONCLUSIONS: An increase in the frequency of serum antibodies to C trachomatis was found in patients with internal derangement of the TMJ. Serologic testing for antibodies to bacteria associated with reactive arthritis might be useful in the evaluation of patients with internal derangement of the TMJ.

Adolescent↗
PubMed2001

Substance P and mast cells: preliminary histologic analysis of the human temporomandibular joint.

PURPOSE: Neuropeptide-containing nerves can serve as a mechanism for nervous system regulation of host defense responses. Because bacteria associated with reactive arthritis have been identified in the temporomandibular joint (TMJ), this study investigates whether the presence of substance P (SP) neuropeptide-containing nerves and mast cells can be identified in the TMJ. MATERIAL AND METHODS: Posterior bilaminar tissue removed during TMJ surgery from 9 women was evaluated for the presence of neuropeptide-containing nerves by staining with a monoclonal antibody to SP. Staining of the TMJ tissue sections with 0.5% toluidine blue was performed to identify the presence of mast cells. RESULTS: SP-containing nerves and mast cells were identified within the posterior bilaminar tissue associated with the vasculature. CONCLUSIONS: The presence of neuropeptide nerves and mast cells within the TMJ has been shown. Mast cell degranulation products and SP release can contribute to TMJ inflammation.

Adult↗
PubMed2001

Mitek anchors for treatment of chronic mandibular dislocation.

OBJECTIVE: The purpose of this study was to present a new technique for limiting mandibular translation in patients with chronic mandibular dislocation. TECHNIQUE DESIGN: This relatively simple procedure uses 2 Mitek mini bone anchors with osseointegration potential. One anchor is placed in the lateral pole of the condyle, and the other is placed in the posterior root of the zygomatic arch. Heavy suture material is threaded through the eyelet of each anchor and tightened to function as a restraining ligament. RESULTS: This technique has been used on 5 patients with a follow-up of 2 to 4 years, with no failures. CONCLUSIONS: This technique provides an effective method for the prevention of condylar dislocation while permitting some controlled translation.

Chronic Disease↗
PubMed2001

Stability of maxillary advancement using rigid fixation and porous-block hydroxyapatite grafting: cleft palate versus non-cleft patients.

This study was undertaken to evaluate the stability of maxillary advancement using bone plates for skeletal stabilization and porous block hydroxyapatite (PBHA) as a bone graft substitute for interpositional grafting in cleft and non-cleft patients. The records of 74 patients (41 females, 33 males) who underwent Le Fort I maxillary advancement using rigid fixation and PBHA interpositional grafting were evaluated retrospectively. All patients also underwent simultaneous sagittal split mandibular ramus osteotomies. Patients were divided into 2 groups for study purposes: group 1 consisted of 17 cleft palate patients and group 2 consisted of 57 non-cleft patients. Each group was further subdivided into 2 subgroups based on the concurrent vertical positioning of the maxillary incisors: groups 1a and 2a, where the maxilla underwent 3 mm or more of inferior repositioning, and groups 1b and 2b, where the maxilla underwent minimal vertical change (< or = 1 mm). Presurgery, immediate postsurgery, and longest follow-up lateral cephalometric tracings were superimposed and analyzed to calculate surgical change and long-term stability of results by assessing horizontal and vertical changes at point A, incisor superius, and the mesial cusp tip of maxillary first molar. The average follow-up time in group 1 was 37.9 months (range 12 to 136) and in group 2 was 28.77 months (range 17 to 88). Average maxillary advancement at point A was: group 1a, 5.4 mm; group 1b, 5.25 mm; group 2a, 5.48 mm; group 2b, 5.46 mm. Average relapse at point A was: group 1a, -0.75 mm; group 1b, -1 mm; group 2a, -0.47 mm; group 2b, -0.48 mm. Average horizontal and/or vertical relapse at the central incisors and first molars was 1 mm or less in group 1 and less than 0.5 mm in group 2. Although there was a slightly greater relapse in group 1, no statistically significant difference was observed between the groups. Maxillary advancement with Le Fort 1 osteotomies using rigid fixation and interpositional PBHA grafting during bimaxillary surgery is a stable procedure with good predictability in cleft and non-cleft patients, regardless of the direction of vertical maxillary movement.

Adolescent↗