Simultaneously occurring ameloblastoma of the maxilla and mandible: case report.
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Adult↗
Biomedical subjects
R D Marciani
Publications and source records attributed to R D Marciani.
Invasive management of the fractured atrophic edentulous mandible.
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Age Factors↗
A survey of resident selection procedures in oral and maxillofacial surgery.
PURPOSE: This study was conducted to analyze the current procedures used in oral and maxillofacial surgery resident selection, to compare these selection procedures with those used 2 decades ago, to determine whether any differences exist in the selection procedures between 4-year certificate programs and programs that offer formal medical education, and to provide criteria to assist in the counseling of dental students on the application process for oral and maxillofacial surgery residencies. SUBJECTS AND METHODS: Questionnaires were sent to the 106 oral and maxillofacial surgery graduate training programs accredited by the American Dental Association. To provide for a more direct comparison to the study completed in 1976, the current questionnaire was developed, using the original survey as a model. It was divided into 5 sections: general information, information obtained from the formal application and letters of recommendation, the interview, the decision process, and a retrospective view of past decisions. The results were tabulated and the Pearson chi-square test was used to determine statistical significance when comparing the 4-year certificate programs to the programs that offer formal medical education. RESULTS: Seventy-one responses (75.5%) from nonmilitary programs were returned and analyzed. Thirty-nine responses represented dual-degree (MD) programs. Factors that were considered very important when judging a candidate's written application included dental school class rank (76.1%), dental school basic science grades (70.4%), and dental school clinical grades (63.4%). Dual-degree programs placed a greater emphasis on predental basic science grades (P < .01) and dental national board scores (P < .05). When asked about prior resident selection, 86.7% of the respondents said they would select 80% of their former residents again. In addition, 89.9% of the respondents were satisfied with their current selection process. CONCLUSIONS: The procedures used to select oral and maxillofacial surgery residents are relatively constant among programs. Although the dual-degree and 4-year certificate programs use the same criteria for resident selection, the dual-degree programs place greater emphasis on predental academic performance and on the results of the national dental boards. Criteria used 22 years ago to select residents are still applicable, but there has been a shift in the importance of some variables.
Certification↗
Maxillofacial injuries associated with all-terrain vehicles.
PURPOSE: The purpose of this article is to report the pattern and frequency of maxillofacial injuries resulting from all-terrain vehicle (ATV) accidents, to evaluate the mechanisms of injury, to document the length of hospital stay, and to characterize other associated injuries in patients presenting to a level 1 trauma center. PATIENTS AND METHODS: The records of patients admitted to the University of Kentucky Medical Center from July 1, 1995 through August 1996 with an ATV-related injury were reviewed. Patients were included in the study if the events of their injury, demographic data, and the specifics of their perioperative care were sufficiently documented to provide the information pertinent to the investigation. Age, sex, mechanism of injury, facial injuries, associated injuries, and length of stay were the factors considered for the study. RESULTS: Seventy-two patients met the criteria for the study. Fifty-nine (82%) were male, and 13 (18%) were female. Forty patients required operative intervention. Twenty-five (35%) had soft tissue or bony injuries to the maxillofacial region. One mandibular and 13 midface fractures were identified. Twelve of the patients with midface injuries had multiple facial fractures. Orbital floor fractures occurred in seven patients. Two patients required unilateral enucleation of the globe. Ten soft tissue injuries were diagnosed. Extremity fractures (n = 16) and closed head injuries (n = 17) were the most commonly associated injuries. The length of hospital stay for all the subjects identified in the study averaged 4.7 days. ATV rollover and being thrown from a moving ATV were the most common mechanisms of injury. CONCLUSIONS: Head and maxillofacial injuries, particularly midface injuries, are common findings after ATV accidents. Orbital trauma with serious globe injury was a striking feature of this study. Multiple systems injuries should always be anticipated and identified. The public should be alerted to the hazards of imprudent recreational vehicle use.
Accidents↗
Management of frontal sinus fractures: a review of 33 cases.
PURPOSE: The purpose of this article is to provide an overview of fracture patterns, patient characteristics, and surgical approaches associated with frontal sinus fractures. The short- and long-term complications of frontal sinus fractures treated over a 20-year period are presented. PATIENTS AND METHODS: The records of patients admitted to the University of Kentucky Medical Center from 1975 through 1994 with a diagnosis of frontal sinus fracture were reviewed. Fracture patterns were categorized and information collected related to demographics, circumstance of injury, perioperative management, surgical procedures, and complications. Long-term complications were studied by asking patients to return for clinical and radiographic follow-up. RESULTS: The average age of patients with frontal sinus fractures was 32 years. Thirty-one of the 33 victims were male. Motor vehicle accidents were the most common cause. Twenty-one patients had anterior table fractures (type I), 11 had combined anterior/posterior table fractures (type II = 9, type IV = 2), and one patient had an isolated posterior table fracture (type III). Short-term postoperative and perioperative complications were minimal. Long-term complications included acute frontal sinusitis (one patient), cosmetic forehead defects (two patients), and encephalitis (one patient). CONCLUSIONS: The critical elements to successful frontal sinus fracture repair are precise diagnosis of the craniofacial fracture pattern, appropriate management of the frontonasal duct(s), and prevention of serious brain sequelae. Long-term follow-up of patients with frontal sinus injuries is recommended.
Adolescent↗
Recurrent hard palate lesion in a child.
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Child↗
Patients' perception of recovery after third molar surgery.
PURPOSE: This study evaluated patients' perceptions of recovery after third molar surgery. METHODS: Two hundred forty-nine patients (age 13 to 37 years) at 2 clinical centers were enrolled in a prospective study before the surgical removal of third molars. Each patient was given a 21-item Health-Related Quality of Life instrument (HRQOL) to be completed each postoperative day (POD) for 14 days. The instrument was designed to assess patients' perception of recovery: pain, oral function, general activity measures, and other symptoms. Pain dimensions were recorded with a 7-point Likert-type scale; all other conditions were measured on 5-point Likert-type scales. The impact of each predictor variable such as age, gender, and length of surgery on recovery was assessed with Cochran-Mantel-Haenszel statistics, controlling for clinical center. RESULTS: After the 14-day postoperative period, 201 of the original 249 patients returned the completed HRQOL instrument; the 48 patients who did not return their diary had third molar conditions and surgery similar to the 201 patients who responded. On POD 1, 63.5% of patients reported their worst pain as severe (score, 5 to 7/7) at some time during the day. By POD 7, only 15% of patients reported their worst pain as severe. Average pain levels were much less; 29% reported their average pain as severe (score, 5 to 7/7) on POD 1, decreasing to 5.5% by POD 7. Patients experienced substantial interference in oral function; chewing, 85%; mouth opening 78.5%, and speaking 37.5% on POD 1. By POD 6, oral function had improved; chewing, 19%, mouth opening, 15%; and speaking, 1.5%. General measures also were affected on POD 1; social activity, 61.5%; recreation, 70.5%; and daily routine, 60%. Patients assumed a more normal lifestyle by POD 5. Swelling seemed to be at its maximum on PODs 1 and 2 (day 1, 53%; day 2, 61%) and decreased markedly by POD 5 (10%). Food collection in the surgical sites posed the biggest problem for patients on POD 9 (20%). Age was not a predictor of prolonged recovery. However, surgery time 30 minutes or longer, or having all third molars below the occlusal plane, did prolong recovery. Females also reported a longer recovery period. CONCLUSIONS: This information is valuable to patients deciding on third molar surgery and to clinicians providing informed consent.
Adolescent↗
Critical systemic and psychosocial considerations in management of trauma in the elderly.
Traumatic injuries in the elderly are increasing commensurately with the activeness and healthiness of the lifestyles seen in our expanding geriatric population. Census data suggest that the elderly population will expand by 50% in future years and will represent a larger percentage of Americans by the year 2050. The annual occurrence of traumatic injuries in the elder cohort is reported to be as high as 29%. Perioperative management of acutely injured elderly patients is different from the care rendered to younger patients and is typically more complex. The purposes of this article are to (1) review factors related to aging that may have profound effects on the care and outcomes of senior citizens with craniofacial trauma, (2) consider the perioperative medical evaluation of the older patient, (3) discuss nutritional support and anesthetic management in the elderly, (4) discuss the unique physiological factors that may influence the treatment of craniofacial trauma in older patients, and (5) provide a rationale for facial trauma repair in the elderly that is influenced by the risk-benefit outcome of treatment planning decisions.
Aged↗
Diagnosis of blunt carotid injury in patients with facial trauma.
OBJECTIVES: The purpose of this study was to review the clinical and diagnostic findings associated with blunt carotid artery injury, provide information related to clinical outcome, and report the findings of a retrospective study comparing patients with nonpenetrating and penetrating carotid artery injuries and the attendant facial injuries. STUDY DESIGN: Twenty-one patients admitted to the hospital nonelectively with a subsequent diagnosis of penetrating (11 patients) or nonpenetrating (10 patients) carotid artery injuries were included in the study. Records were analyzed for demographic data, mechanism of injury and time to diagnosis, neurologic status, presence of facial injuries, and outcome. RESULTS: Five patients had facial injuries associated with a blunt carotid artery abnormality; six patients had penetrating carotid wounds. Time from carotid injury by all mechanisms to diagnosis was 20 minutes to 12 hours (mean 4 hours). Seventeen patients survived their injury. CONCLUSION: Patients with completely asymptomatic head injuries and severe closed-head injuries must be given careful initial evaluation and subsequent secondary evaluation. The relatively high frequency of facial injuries associated with blunt carotid injury should alert the maxillofacial surgeon to consider the diagnosis.
Accidents, Traffic↗
A preliminary study of reconstruction of the monkey temporomandibular joint with autogenous tissues.
PURPOSE: This study investigated the ability of autogenous pericranium-muscle and cranial bone to restore form and function of the temporomandibular joint (TMJ). MATERIALS AND METHODS: A right TMJ discectomy, condylectomy, vertical ramus osteotomy with superior repositioning of the proximal fragment, and a cranial bone graft to the mandibular angle were performed in 12 cynomolgus monkeys. Clinical, histologic, and autoradiographic evaluation was done at intervals beginning at 3 days and continuing up to 78 weeks. RESULTS: No significant postoperative sequela were identified in any of the monkeys. Jaw mobility and function were restored. Gross morphologic condylar changes were observed. The pericranium-muscle grafts did not differentiate into normal disc-like structures and a cartilage cap did not cover the condyle stump head. CONCLUSIONS: The results of this study suggest that the previous TMJ function was restored. However, the histologic changes observed were consistent with advanced degenerative joint disease.
Animals↗
Biologic response to an intraoral extraosseous implant system: a pilot study.
Extraoral force systems in orthodontics are dependent on patient cooperation. Endosseous implants that offer intraoral anchorage are being investigated, but the implant cannot be loaded for 4 months, is limited in placement by skeletal anatomy, and must be surgically removed. The purpose of this pilot study was to investigate an intraoral extraosseous implant used as an anchorage source. Titanium ramus implants were placed on the lateral surface of the left rami of 12 sheep. Clinical evaluations were made of implant stability and tissue condition. Bone changes were assessed at the time of killing, which ranged from 43 to 84 days. Infection was present in most animals at the time of killing. The implants were mobile in all animals, and the rami experienced considerable changes due to bone resorption and apposition. The results of this animal pilot study suggest that an intraoral extraosseous implant system such as that used in this investigation may result in bone resorption, implant mobility, and infection.
Animals↗
Treatment of mandibular angle fractures: transoral internal wire fixation.
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Adolescent↗
Management of midface fractures: fifty years later.
Much has changed in the 50 years since Dr Parker described the development of rapid means of transportation as a portent of an increase in maxillofacial trauma. Contemporary surgeons must concern themselves with a host of nonsurgical care issues that are an integral part of oral and maxillofacial surgery practice. Expectations related to the patient, government, insurance carrier, and hospital staff have created a new practice environment. Standards of care are high and surgeon and patient needs are more complex. Dramatically improved diagnostic capabilities, use of open surgical techniques, improved rigid fixation devices, advances in techniques of resuscitation, and more focused surgical training have markedly improved the care of the facial trauma patient. The midface remains the central focus of our gaze when we engage in interpersonal relationships. Developmental and acquired aberrations of this region are likely to be more obvious than lower face abnormalities and, therefore, perceived as more disfiguring. Complex midface trauma repair requires precise surgical technique, with little margin for error. When ideal results are not achieved, the common contributing factors are intercurrent serious injury, anatomic and wound repair considerations, and failure to execute fracture repair principles. Hard and soft tissue volume changes may further compromise midface fracture repair, irrespective of the quality of the surgical outcome. Despite the advances made in the last 50 years, there is still room for future progress. An interdisciplinary committee of surgeons treating facial trauma should convene to establish a classification system for midface fractures that would satisfy medical record keeping and coding requirements, and facilitate fair and consistent reimbursement.(ABSTRACT TRUNCATED AT 250 WORDS)
Costs and Cost Analysis↗
Principles of management of complex craniofacial trauma.
Successful treatment of patients with complex craniofacial injuries is heavily dependent on the surgeon's appreciation of the associated nonfacial injuries, precise clinical and diagnostic imaging examinations to establish a three-dimensional configuration of the fractured segments, and the application of well-established principles of facial fracture repair. Factors that influence improved treatment outcome are 1) early definitive treatment, 2) anatomic and functional repair of naso-orbito-ethmoidal injuries, 3) wide exposure of fracture segments, and 4) anatomic repositioning and stable fixation of fracture segments in all planes of space.
Fracture Fixation↗
Treating patients before and after irradiation.
Patients undergoing irradiation treatment for head and neck cancer need not lose their teeth. Careful treatment planning improves patients' quality of life.
Dental Care for Persons with Disabilities↗
Patient compliance--a factor in facial trauma repair.
The clinical records of 25 consecutive patients who were treated for facial trauma were reviewed and analyzed to ascertain what effect patient cooperation had on the outcome of facial fracture repair. The study was designed to establish the incidence of complications and to discover what factors contributed to untoward sequela in such patients. Overall, 15 patients (60%) were noncompliant in one or more aspects of their care. Six patients (24%) had significant postoperative complications associated with their facial injuries. Four of these patients were not fully cooperative.
Adult↗
Healing following condylar shave in the monkey temporomandibular joint.
Condylar shaves were performed in monkeys, and the reparative process was studied by histologic and autoradiographic techniques. The condylar surface was found to repair mainly with fibrous connective tissue produced by cells derived from the underlying marrow spaces. The residual condylar cartilage did not play a significant role in this process.
Animals↗
Identification of patients at risk for unnecessary or excessive TMJ surgery.
Musculoskeletal pain in the head and neck may be associated with a variety of psychological and psychiatric conditions. Therefore, patients with persistent temporomandibular (TMJ) and masticatory muscle complaints must also be evaluated for affective disorders. Identification of patients at risk for unnecessary or excessive TMJ surgery is enhanced when the surgeon is aware of a pattern of persistent pain and illness insistence that characterizes these patients. This article presents a list of characteristics that may identify a patient with an undiagnosed affective disorder who may be exposed to unnecessary treatment.
Anxiety Disorders↗