Bilateral lingual anesthesia following surgically assisted rapid palatal expansion: report of a case.
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Adult↗
Biomedical subjects
Pushkar Mehra
Publications and source records attributed to Pushkar Mehra.
Maxillary sinus disease of odontogenic origin.
Odontogenic sinusitis is a well-recognized condition and accounts for approximately 10% to 12% of cases of maxillary sinusitis. An odontogenic source should be considered in patients with symptoms of maxillary sinusitis who give a history positive for odontogenic infection or dentoalveolar surgery or who are resistant to standard sinusitis therapy. Diagnosis usually requires a thorough dental and clinical evaluation with appropriate radiographs. Common causes of odontogenic sinusitis include dental abscesses and periodontal disease perforating the Schneidarian membrane, sinus perforations during tooth extraction, or irritation and secondary infection caused by intra-antral foreign bodies. The typical odontogenic infection is now considered to be a mixed aerobic-anaerobic infection, with the latter outnumbering the aerobic species involved. Most common organisms include anaerobic streptococci, Bacteroides, Proteus, and Coliform bacilli. Typical treatment of atraumatic odontogenic sinusitis is a 3- to 4- week trial of antibiotic therapy with adequate oral and sinus flora coverage. When indicated, surgical removal of the offending odontogenic foreign body (primary or delayed) or treatment of the odontogenic pathologic conditions combined with medical therapy is usually sufficient to cause resolution of symptoms. If an oroantral communication is suspected, prompt surgical management is recommended to reduce the likelihood of causing chronic sinus disease.
Humans↗
Changes in temporomandibular joint dysfunction after orthognathic surgery.
PURPOSE: We sought to evaluate the effects of orthognathic surgery on temporomandibular joint (TMJ) dysfunction in patients with known presurgical TMJ internal derangement who underwent double-jaw surgery for the treatment of dentofacial deformities. PATIENTS AND METHODS: Treatment records of 25 patients with magnetic resonance imaging and clinical verification of preoperative TMJ articular disc displacement who underwent double-jaw surgery only were retrospectively evaluated, with an average follow-up of 2.2 years. Signs and symptoms of TMJ dysfunction, including pain, range of mandibular motion, and presence/absence of TMJ sounds, were subjectively (visual analog scales) and objectively evaluated at presurgery (T1), immediately postsurgery (T2), and at longest follow-up (T3). Surgical change (T2-T1) and long-term stability of results (T3-T2) were calculated using the superimposition of lateral cephalometric and tomographic tracings. RESULTS: Presurgery, 16% of the patients had only TMJ pain, 64% had only TMJ sounds, and 20% had both TMJ pain and sounds. Postsurgery, 24% of the patients had only TMJ pain, 16% had only TMJ sounds, and 60% has both TMJ pain and sounds. Thus, presurgery 36% of the patients had TMJ pain, and postsurgery, 84% had pain. Average visual analog scale pain scores were significantly higher postsurgery and none of the patients with presurgery TMJ pain had relief of pain postsurgery. In addition, 6 patients (24%) developed condylar resorption postsurgically, resulting in the development of Class II open bite malocclusion. CONCLUSIONS: Patients with preexisting TMJ dysfunction undergoing orthognathic surgery, particularly mandibular advancement, are likely to have significant worsening of the TMJ dysfunction postsurgery. TMJ dysfunction must be closely evaluated, treated if necessary, and monitored in the orthognathic surgery patient.
Adolescent↗
Soft tissue healing after parasagittal palatal incisions in segmental maxillary surgery: a review of 311 patients.
PURPOSE: This study retrospectively evaluated the soft tissue healing after using parasagittal soft tissue incisions for surgical segmental maxillary expansion. PATIENTS AND METHODS: The records of 311 patients (224 females, 87 males), with an average age of 28.5 years (range, 12 to 62 years) who had transverse maxillary hypoplasia, were retrospectively evaluated. All patients underwent segmental maxillary osteotomies, surgical maxillary expansion greater than 5 mm, and placement of midpalatal porous block hydroxyapatite (PBHA). Parasagittal palatal soft tissue incisions were used to facilitate expansion, minimize soft tissue damage, and maintain soft tissue coverage over the PBHA implants. At postoperative follow-up visits, any signs or symptoms of complications associated with the use of the parasagittal incisions were recorded. RESULTS: Average patient follow-up was 3.4 years (range, 1.0 to 7.2 years). In 293 patients (94%), the palates healed uneventfully without complications. Eighteen patients (6%) had complications; 9 (2.9%) had infections associated with the midpalatal implants, 8 (2.6%) had oronasal communications, and 1 (0.3%) had problems associated with a palatal wire. Six patients with midpalatal implant problems required removal of the implant, 4 patients required closure of their oronasal communications, and 1 patient required removal of a palatal wire. Therefore, 11 patients (3.5%) required minor secondary surgical procedures. No teeth or alveolar bone were lost in any of the cases. CONCLUSIONS: The use of parasagittal palatal incisions appears to be a safe technique for soft tissue management during large surgical maxillary expansions associated with segmental maxillary osteotomies and midpalatal placement of PBHA implants.
Adolescent↗
Use of conservative condylectomy for treatment of osteochondroma of the mandibular condyle.
PURPOSE: The aim of the present study was to present a conservative condylectomy technique (condylectomy performed below the condylar head but high in the condylar neck) and articular disc repositioning as the surgical treatment approach for management of osteochondroma of the head of the mandibular condyle. PATIENTS AND METHODS: Six patients (4 females and 2 males) with an average age of 22.3 years (range, 13 to 32 years) and with an osteochondroma of the mandibular condyle were treated with conservative condylectomy. The remaining condylar neck stump was recontoured, and the articular disc was repositioned and stabilized over the "new" condyle. Any indicated orthognathic surgical procedures were then performed to optimize occlusion, function, and aesthetics. Clinical and radiographic evaluation was performed before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3). RESULTS: Average follow-up for the patients was 51 months (range, 22 to 108 months). No recurrence of the tumor was encountered in any of the cases. Subjective and objective evaluations of postsurgical temporomandibular joint function and range of mandibular motion were normal. Associated maxillary and/or mandibular orthognathic procedures were found to be stable in the long term. CONCLUSION: Conservative condylectomy with recontouring of the residual condylar neck to function as a condyle and repositioning of the articular disc is a viable option for treatment of osteochondromas of the mandibular condyle. The use of this method of treatment permits effective removal of the tumor and eliminates the need for autogenous grafts or total joint prostheses for temporomandibular joint reconstruction.
Adolescent↗
Concomitant temporomandibular joint and orthognathic surgery: a preliminary report.
PURPOSE: In the present study, we evaluated the outcome of concomitant temporomandibular joint (TMJ) and orthognathic surgery in patients with TMJ articular disc dislocation and coexisting dentofacial deformities. PATIENTS AND METHODS: The records of 70 patients treated with TMJ articular disc-repositioning surgery and concomitant orthognathic surgery (double jaw or only mandibular surgery) were retrospectively evaluated. Patients were divided into the following 3 groups: group 1 patients had mandibular advancement, group 2 patients had mandibular setback, and group 3 patients had a mandible that remained in the original position. Lateral cephalometric radiographs and lateral cephalometric tomograms were assessed at the following intervals: before surgery (T1), immediately after surgery (T2), 6 to 12 months after surgery (T3), and at the longest follow-up (T4). Lateral cephalometric tracings were superimposed to calculate surgical change (T2 - T1), short-term stability (T3 - T2), and long-term stability (T4 - T3) of the orthognathic surgery procedures. Maximum interincisal opening (MIO) and subjective TMJ pain (visual analog scales) were comparatively evaluated at T1 and T4. RESULTS: Subjective TMJ pain levels and MIO improved in all 3 groups after surgery. Before surgery, 56 of 70 patients (80%) had pain and 14 of 70 patients (20%) had no pain. At the longest follow-up, 42 of 70 patients (60%) reported complete relief of TMJ pain. Only 5 of 70 patients (7%) had severe pain after surgery compared with 37 of 70 patients (53%) before surgery. At the longest follow-up, 6 of 70 patients (9%) showed less than 35 mm MIO, residual severe pain, or both. One patient had significant condylar resorption after surgery. The orthognathic procedures were found to be stable in the long term. Concomitant TMJ and orthognathic surgery had an overall success rate of 91.4% based on a greater than 35 mm MIO and a decrease in pain. CONCLUSIONS: When indicated, TMJ and orthognathic surgery can be concomitantly performed with predictable results and a good success rate. Strong consideration should be given to early surgical intervention because the success rate decreases significantly with pre-existing TMJ dysfunction of greater than 48 months' duration.
Adolescent↗
Efficacy of high condylectomy for management of condylar hyperplasia.
The purpose of this study was to compare the treatment outcome and long-term stability of 2 groups of young adult patients diagnosed with active condylar hyperplasia and treated with 2 different surgical methods. Thirty-seven patients (19 females and 18 males) met the criteria for inclusion in the study. Group 1 (n = 12; average age at surgery, 17.5 years) was treated with orthognathic surgery only, while group 2 (n = 25; average age at surgery, 16.7 years) had high condylectomy, articular disc repositioning, and orthognathic surgery. All patients underwent standardized clinical and radiographic examination at initial consultation, immediately before surgery, immediately after surgery, and at longest follow-up. Objective evaluation of temporomandibular joint (TMJ) function included maximum incisal opening and lateral excursions. Subjective evaluations were performed in group 2 for TMJ pain, jaw function, and diet. Lateral cephalometric radiographs were evaluated for presurgical and postsurgical mandibular growth. There were no statistically significant differences (P >.05) between the 2 groups for maximal incisal opening, lateral excursions, or subjective jaw function before surgery. Presurgical growth differed significantly (P <.05), with group 2 showing more active growth. At the long-term follow-up, no differences were found in lateral excursions or subjective jaw function. There was a statistically significant difference in maximum incisal opening (P <.01), with a greater increase in group 2, as well as a statistically significant difference (P <.05) in cephalometric stability, with group 2 being much more stable at long-term follow-up. All patients in group 1 grew back into skeletal and occlusal Class III relationships and required secondary intervention. Only 1 patient in group 2 required secondary surgery, involving maxillary surgery to correct postsurgical transverse maxillary relapse; the mandible was stable at long-term follow-up. The results of this study showed that patients with active condylar hyperplasia treated with high condylectomy, articular disc repositioning, and orthognathic surgery have stable, predictable outcomes compared with those treated with orthognathic surgery alone.
Adolescent↗
Stability of the Le Fort I osteotomy for maxillary advancement using rigid fixation and porous block hydroxyapatite grafting.
PURPOSE: The purpose of this study was 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. PATIENTS AND METHODS: The records of 78 patients (55 female, 23 male) with a diagnosis of anteroposterior maxillary hypoplasia were retrospectively evaluated. All patients underwent greater than 5 mm Le Fort I maxillary advancement with rigid fixation and PBHA interpositional grafting. The study sample was divided into 3 groups on the basis of the concurrent superior or inferior positioning of the maxillary incisors. Presurgery (T1), immediately postsurgery (T2), and longest follow-up (T3) lateral cephalometric tracings were superimposed to analyze for horizontal and vertical changes at the following landmarks: (1) point A, (2) incisal edge of the maxillary incisor, and (3) mesial cusp tip of maxillary first molar. RESULTS: The maxilla was inferiorly repositioned in 27 patients, superiorly repositioned in 21 patients, and advanced horizontally without a significant vertical change in 30 patients. All groups showed 0.5 mm or less horizontal and vertical relapse. There was no statistically significant difference between the 3 groups. CONCLUSIONS: Maxillary advancement with Le Fort 1 osteotomies by using rigid fixation and interpositional PBHA grafting is a stable and predictable procedure regardless of the direction of vertical maxillary movement.
Adolescent↗