The use of erythropoietin in a patient having major oral and maxillofacial surgery and refusing blood transfusion.
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Aged↗
Biomedical subjects
M A Pogrel
Publications and source records attributed to M A Pogrel.
Liquid nitrogen cryosurgery and immediate bone grafting in the management of aggressive primary jaw lesions.
PURPOSE: This study evaluated whether simultaneous bone grafting will accelerate healing and reduce the complication rate of aggressive mandibular lesions treated by enucleation and liquid nitrogen cryotherapy. MATERIALS AND METHODS: Twenty patients with locally aggressive mandibular lesions were evaluated. All were treated by enucleation and liquid nitrogen cryotherapy. Ten received simultaneous bone grafting and 10 did not. Patients were matched as closely as possible for age and size of lesion. RESULTS: None of the patients who received enucleation, cryotherapy, and simultaneous bone grafting developed complications. Of the 10 patients having enucleation, cryotherapy, and no bone grafting, two patients developed pathologic fractures and one developed a wound dehiscence that healed on conservative management. Residual alveolar bone height was 81% of the preoperative level in the grafted group and 78% of the preoperative level in the nongrafted group. Additionally, 15 osseointegrated implants were placed in the group receiving bone grafting whereas none was placed in the group that was not grafted. All complications occurred with lesions greater than 4.0 cm in greatest diameter. CONCLUSION: For locally aggressive lesions larger than 4.0 cm in greatest diameter, simultaneous cancellous bone grafting following enucleation and liquid nitrogen cryosurgery will decrease the risk of complications and result in greater residual bone height and a better ability to place endosseous dental implants.
Adolescent↗
The relationship of the lingual nerve to the mandibular third molar region: an anatomic study.
PURPOSE: This study evaluated the relationship of the mandibular third molar to the lingual nerve. MATERIALS AND METHODS: An anatomic dissection of the lingual nerve in the third molar region was done on 20 cadavers (40 sides). RESULTS: The position of the nerve on one side bore no statistical relationship to the position of the nerve on the opposite side. The position of the lingual nerve was variable in both the sagittal and coronal planes. In two specimens the nerve lay superior to the lingual plate and in another the superior surface of the nerve was level with the crest of the lingual plate. CONCLUSION: These findings have implications for the avoidance of lingual nerve damage during surgery in the third molar and retromolar region of the mandible.
Cadaver↗
The surgical uprighting of mandibular second molars.
The mandibular second molars can become impacted beneath the crown of the first molars and fail to erupt normally. A study of 22 cases with follow-up periods of at least 18 months shows the results obtained by surgical uprighting of these teeth. Of 22 teeth, one has been lost but none of the remaining 21 has developed infection or required root treatment, and all are in good occlusion. Six teeth give a normal response to electrical pulp testing. In most cases, with judicious bone removal, the second molar is firm and stable after uprighting and requires no splinting, but in some cases temporary stabilization is required. The bone defect normally seen mesially after uprighting reossifies both clinically and radiographically.
Adolescent↗
A comparison of single-photon emission computed tomography and planar imaging for quantitative skeletal scintigraphy of the mandibular condyle.
A prospective study was designed to compare two methods of quantifying technetium-99m methylene diphosphonate uptake in the mandibular condyle. The standard technique expresses condylar activity as a ratio of condylar uptake to a reference (often the fourth lumbar vertebra) with planar scans (lateral images of the mandible). The experimental technique quantifies condylar activity as a ratio of condyle to clivus uptake with single-photon emission computed tomography (SPECT). The results of this study indicated that the uptake ratio of condyle/clivus by SPECT scintigram was positively correlated (p = 0.039) with the planar scan technique. The SPECT technique, similar to an axial computed tomography scan, was easier to perform with better reproducibility than the standard planar technique. In addition, activity in the clivus showed less variation than activity in the fourth lumbar vertebrae. With the development of normal uptake standards in the clivus, the SPECT technique may replace the planar image technique in nongrowing patients.
Adolescent↗
Simultaneous multifocal polymorphous low-grade adenocarcinoma. Report of two cases.
The polymorphous low-grade adenocarcinoma is a recently described variant of salivary gland adenocarcinoma with a comparatively good prognosis. Polymorphous low-grade adenocarcinoma occurs most frequently in the palate with a peak incidence between 30 and 70 years of age. The female/male ratio is approximately 2:1, and the tumors exhibit slow growth with a low recurrence rate. The simultaneous occurrence of polymorphous low-grade adenocarcinoma has not been previously reported. This article reviews the existing literature and describes the first two reports of simultaneous intraoral polymorphous low-grade adenocarcinoma.
Aged↗
Transplanting teeth successfully: autografts and allografts that work.
This article suggests tooth transplantation as an alternative to other restorative options. The 10-year success rates for autografts--teeth moved from one location to another in a patient's mouth--range from 60 percent to 95 percent. Allografts, teeth moved from one person to another, are less successful. The authors report on one case of each type of transplant.
Adolescent↗
Nerve damage associated with inferior alveolar nerve blocks.
The authors reviewed 12 cases in which altered sensation occurred in the distribution of the inferior alveolar or lingual nerves following injection of a local anesthetic for restorative treatment only. Most patients suffered only partial damage, but recovery was poor. The exact mechanism of the nerve damage is unknown, but a number of theories are proposed. The extent of this problem is also unknown, but many more cases probably exist than have been reported to date.
Adult↗
Massive gingival enlargement and alveolar bone loss: report of two cases.
We present two cases of massive gingival enlargement and osteolysis of alveolar bone in a 30-year-old female and a 36-year-old male. The etiology could not be established in either case. Histologically, both lesions contained hyperplastic fibrous connective tissue and intense plasma cell infiltrates. Both patients responded well to extensive gingivectomy, extraction of all teeth, and alveoplasty.
Adult↗
Injuries to the inferior alveolar and lingual nerves.
Both the inferior alveolar and the lingual nerve are at risk for damage following various surgical procedures. Sensory nerve function following potential damage should be tested and evaluated for treatment, with microneurosurgery considered under certain conditions. Repair between three and six months following injury has the best results. A study of 43 patients who underwent microneurosurgery for various types of injuries, and have been followed for at least one year, found four (9.3 percent) with essentially complete return of sensation; five (11.6 percent) with good return; 19 (44.2 percent) with some return; 13 (30.2 percent) with no return; and two (4.6 percent) with a decrease in sensation.
Dental Care↗
The risk management of infections.
Unfortunately, risk management, that is avoiding lawsuits, is a retro-active pastime instead of being pro-active. What this means is that we often take action only after a problem has manifested itself, rather than identifying potential problems and correcting them. This is, however, only human nature and occurs in most other walks of life. In dental malpractice, what appears to have been happening during the past few years in California is that plaintiff's lawyers have identified a problem and then started to sue dentists for it (and even run courses on how to sue dentists for it!), after which the profession has tried to take steps to identify the cause of the problem, and has then attempted to reduce it or eliminate it altogether. In the past, the dental malpractice companies (the equivalent of the Medical Protection Society and Medical Defense Union) were merely bystanders who paid out on claims and subsequently raised premiums accordingly. Now that most of the malpractice companies in California are actually run by (and often owned by) members of the profession, they are much more interested in getting involved at a very early stage, as soon as a potential problem is identified, in order to take action so that premiums do not rise unnecessarily.
Anti-Bacterial Agents↗
Calcification of the cricoid cartilage mistaken for a foreign body: report of a case.
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Adult↗
Trigeminal somatosensory evoked potentials: a normal value study.
Normal somatosensory evoked potentials were obtained from the lower lip of 40 volunteers. Efforts were made to exclude artefact. A consistent triphasic wave form of three peaks and troughs was defined. There were greater variations in amplitude than latency between subjects. Statistically, one side of the lower lip can be used as a control for the contralateral side, but it may not be possible to have reliable normal values between subjects. Somatosensory evoked potentials may however represent an objective method of evaluating trigeminal sensory nerve function.
Adult↗
A substrate-gel assay for hyaluronidase activity.
Hyaluronic acid (HA) is a key structural element of the extracellular matrix. Turnover rates of HA are determined in part by hyaluronidases, that are themselves modulated by hyaluronidase inhibitors. A substrate polyacrylamide gel electrophoresis procedure is described here that separates enzyme from inhibitors. The HA is embedded in the gel, and following electrophoretic separation, enzymatic digestion of the HA is allowed to occur. The gel is stained with Alcian blue and can be secondarily stained with Coomassie blue. Enzymatic activities appear as cleared bands on a light blue background, while major proteins appear as dark blue bands. The procedure can be performed in the presence or absence of sodium dodecylsulfate, though levels of hyaluronidase activity decrease when the detergent is used. Hyaluronidases active in the neutral or acid pH range can be detected. This technique will facilitate characterization of hyaluronidases and inhibitors from a wide variety of sources.
Alcian Blue↗
Surgically assisted rapid maxillary expansion in adults.
Twelve adults with maxillary width discrepancy of greater than 5 mm were treated by surgically assisted rapid maxillary expansion. The procedure consisted of bilateral zygomatic buttress and midpalatal osteotomies combined with the use of a tooth-borne orthopedic device postoperatively. Mean palatal expansion of 7.5 mm (range of 6 to 13 mm), measured in the first molar region, was achieved within 3 weeks in all patients. Expansion remained stable during the 12-month study period, with a mean relapse for the entire group of 0.88 +/- 0.48 mm. Morbidity was limited to mild postoperative discomfort. The results of this preliminary study indicated that surgically assisted rapid maxillary expansion is a safe, simple, and reliable procedure for achieving a permanent increase in skeletal maxillary width in adults. Further study is necessary to document the three-dimensional movements of the maxillary segments and long-term stability of the skeletal and dental changes.
Adolescent↗
What are normal esthetic values?
The management of dentofacial deformities is at least partially assessed on the basis of standardized radiographs and photographs, which are analyzed according to accepted norms. Although one frequently hears the cry of "Treat the patient, not the cephalometric radiograph," with the development of sophisticated computer-assisted digitizing systems and cephalometric analysis programs, there may be a greater reliance on cephalometric and photometric norms than previously. If we are to become more dependent on these normal values, it is necessary to know their origin and significance.
Cephalometry↗
Bicoronal flap approach to the temporomandibular joints.
The bicoronal scalp flap provides an excellent approach to the temporomandibular joint, particularly in cases where bilateral operation is required. It is also indicated when wide exposure is required and when previous surgery may make more conventional techniques difficult. In this report, the anatomy and indications for this approach are reviewed, the operative technique is described and complications are discussed.
Ankylosis↗
Application of laser and cryosurgery in oral and maxillofacial surgery.
The laser, with its ability to use electromagnetic energy in its most efficient and concentrated form, has held out promise as a surgical tool for 20 years. However, its early promise has not been fulfilled, and with a few isolated exceptions, the laser has not gained widespread acceptance in surgical circles. Recent developments regarding delivery systems and different lasing media have, however, stimulated renewed interest. Similarly, cryosurgery, with its ability to devitalize tissues by the use of extreme cold, has been available in a controllable form in surgery for nearly 30 years. Lack of precision has prevented its widespread use, but it may still have an important role in a number of specialized areas, such as cryoneurectomy and the management of locally aggressive tumors of bone.
Animals↗