Gingival mass with massive soft-tissue necrosis.
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Biomedical subjects
Publications and source records attributed to S J Schaberg.
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A case of neurofibromatosis, or von Recklinghausen's disease, was presented. The skin manifestations include the development of numerous, variable sized, smooth-surfaced nodules (benign neural tumors) and asymmetric areas of hyperpigmentation called cafe-au-lait spots. Oral manifestations are not always apparent but, when they do occur, include multiple, discrete, nonulcerated mucosal nodules (typically benign neural tumors). Intraosseous tumors (usually neurofibromas) occasionally develop in the mandible as was reported in this patient. Clinicians should be aware of the characteristics of this hereditary disease, especially the possibility of malignant transformation of the neural tumors.
This study evaluated the efficacy of utilizing the fibrin-adhesive-system in lieu of a mandibular stent in securing split thickness skin grafts during vestibuloplasty procedures. The technique proved to be easier and less time-consuming than stent utilization and provided results that were marginally superior to those of the conventional method.
A technique for securing skin grafts for vestibuloplasty with the Fibrin Adhesive System is described. This technique proved to be less time-consuming than the standard technique and provided secure, immobile stabilization of the skin grafts without hematoma formation.
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The limitations of autologous vascularized grafts include morbidity at the donor site and the increased surgical time associated with graft retrieval. To overcome these limitations, freeze-dried allogeneic and fresh autologous vascularized rib grafts were compared in 6-cm mid-radial defects of dogs. There was no statistically significant difference between the two graft systems when postoperative radiographs, in vivo intraarterial angiograms, and histologic evaluation of vessel patency were compared. However, clinical assessment of graft stability favored the autologous grafts, and force deflection tests revealed that the freeze-dried grafts had only 64% of the graft strength of the fresh autologous grafts at the end of the experiment at 26 weeks.
An enzyme-linked immunosorbent assay was used to evaluate and compare the immunoglobulin G antibody response to Staphylococcus aureus cell walls of rabbits with either chronic staphylococcal osteomyelitis or subcutaneous abscesses. Osteomyelitis of the femur was produced by the intramedullary application of a sclerosing agent (3% sodium tetradecyl sulfate) and S. aureus. Radiographic evidence of osteomyelitis was observed in 10 of the 13 animals that survived the 10-week experimental period, and the diagnosis was confirmed by histopathology in 8 of the 10 instances. Abscess formation was initiated in a separate group of rabbits by the subcutaneous injection of S. aureus cells. All 10 of these rabbits subsequently developed abscesses, which usually resolved spontaneously within 3 to 5 weeks. Elevated levels of immunoglobulin G antibodies to the cell wall antigen were detected in 7 of 10 rabbits with osteomyelitis at 21 days postinfection, and these animals continued to display high antibody levels even at 59 days postinfection. In contrast, elevated levels of anti-cell-wall antibodies were only detected in 1 of 10 rabbits with subcutaneous abscesses. The enzyme-linked immunosorbent assay was found to be a rapid and sensitive serological technique for the detection of cell wall antibodies in this experimental osteomyelitis model and may be useful for the diagnosis of staphylococcal bone infections in humans.
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The use of antibiotic-supplemented bone allograft as a material for placement in contaminated fractures of the dog ulna was investigated. Demineralized, freeze-dried bone allografts mixed with antibiotics and gelatin were placed in five fractures contaminated with Staphylococcus aureus (Washington Hospital strain) and Pseudomonas aeruginosa (PA 220). The results of treatment with antibiotic-supplemented bone allografts were compared with the results of conventional treatment in five additional experimental animals in which fractures contaminated with S. aureus and P. aeruginosa were created. The five fractures treated by conventional methods developed acute osteomyelitis and nonunion, whereas the ASBA-treated fractures resulted in bone union without infection. ASBA-treated fractures were stable and had 89% of the shearing strength of the non-fractured, contralateral ulnae five months after treatment.
The effectiveness of methylprednisolone for the reduction of postoperative facial edema was evaluated by the computed tomographic examination of 39 patients who underwent either a Lefort I osteotomy or a transoral vertical osteotomy. Results of the CT scans, which were performed preoperatively and at 24 and 72 hours postoperatively, showed that in the LeFort I osteotomy patients methylprednisolone reduced the degree of facial edema by 61% at 24 hours postoperatively and by 10% at 72 hours. In the transoral vertical osteotomy patients methylprednisolone reduced the degree of facial edema by 38% at 24 hours postoperatively and by 45% at 72 hours. It was concluded that methylprednisolone is effective for the control and management of postoperative facial edema following orthognathic surgery.
A case of Garre's osteomyelitis of the mandible is presented. The occlusal radiographs are good examples of the redundant cortical layering of the bone (onion skinning) that is classically found with this phenomenon. The cause of this case was a necrotic pulp in a carious molar with a periapical radiolucent area. We believe this is the first reported case in which an odontogenic source of infection (carious tooth) was treated not by extraction but by endodontic therapy. During the year after the root canal filling, the periapical radiolucent area filled in with new bone and the bony expansion of the mandible was completely resolved.
The segmented LeFort I osteotomy technique is presented as a surgical alternative for the correction of severe posterior maxillary vertical excess prior to prosthodontic procedures. It allows the extruded maxillary dento-osseous segment to be retained and a normal plane of occlusion to be reestablished. The superior visibility, accessibility, and versatility afforded by the segmented LeFort I osteotomy technique make it particularly suited to the correction of severe posterior maxillary excess.
A poorly controlled diabetic patient who developed a life-threatening deep neck infection from a periodontal abscess is presented. Despite treatment reflecting the current surgical and medical approach to management of this infection, he failed to show the consistent improvement that would be expected in a nondiabetic patient. The physiologic differences in the defense systems of the diabetic versus the nondiabetic host are discussed, and general guidelines for identification of the diabetic patient are offered.
This article describes the microsurgical training model used at the Naval Regional Medical Center in San Diego, where first year residents spend two weeks of concentrated effort developing basic skills in microsurgery. This training is done outside the busy hospital environment so that no interruptions are encountered. Following this initial experience, weekly research sessions are continued to maintain proficiency and to develop new techniques. A description of the medical center's modifications of several previously used microsurgical techniques is presented. This model is economical and realistic for a student's initial exposure to microvascular surgery. It also serves as an expedient, yet challenging, means of maintaining proficiency when laboratory time is limited.
The peripheral ameloblastoma is a rare tumor of the oral cavity, of which relatively few well-documented cases have been reported. A 54-year-old Caucasian male was found to have such a lesion in the posterior maxilla. The origin, histological appearance, and surgical treatment of this lesion is discussed. Histologically, the peripheral ameloblastoma is indistinguishable from the basal cell carcinoma, the occurrence of which is controversial in the oral cavity.
An unusual case of cementoblastoma is presented. It is the second case to be published demonstrating involvement of the pulp, and it is the first instance of a cementoblastoma that appears to have evolved from an impacted tooth. A review of the literature substantiates the fact that this lesion may not be so uncommon as was previously thought, and that pain and facial asymmetry may be significant clinical features.