Journal of Oral and Maxillofacial Surgery, Jun 1, 1990
Major intraoperative or postoperative bleeding associated with Le Fort I osteotomies can be venou... more Major intraoperative or postoperative bleeding associated with Le Fort I osteotomies can be venous and/or arterial in nature. Arterial hemorrhage generally involves the maxillary artery and its terminal branches. Arterial hemorrhage tends to be more persistent and can be recurrent, which makes it more difficult to manage. Postoperative bleeding following Le Fort I osteotomies generally presents as epistaxis and usually occurs initially within the first 2 weeks following surgery. Treatment modalities that have been used to successfully arrest postoperative hemorrhage include anterior and/or posterior nasal packing; packing of the maxillary antrum; reoperating with clipping or electrocoagulation of bleeding vessels, or the use of topical hemostatic agents in the pterygomaxillary region; external carotid artery ligation; and selective embolization of the maxillary artery and its terminal branches.
This investigation expands on a previous pilot study of the effects of TENS on the resting positi... more This investigation expands on a previous pilot study of the effects of TENS on the resting position of the mandible. The tendency is for an increase in freeway space, but the variability of results makes individual evaluation essential.
A statistical correlation is found between the S-N/mandibular plane angle and clinical freeway sp... more A statistical correlation is found between the S-N/mandibular plane angle and clinical freeway space, but there was no correlation after TENS stimulation. The S-N/MP angle did not prove to be a reliable predictor of freeway space.
Five cases of paradental cyst are reported which were found to arise buccal to a mandibular first... more Five cases of paradental cyst are reported which were found to arise buccal to a mandibular first permanent molar in children under the age of 10 years. The justification for calling these lesions paradental cysts is discussed. Since the histopathological findings of this lesion are nonspecific, the clinical and radiographic features are of prime importance in diagnosis when the lesion occurs in this site in patients of this age. Buccal swelling adjacent to a mandibular first molar which is partially erupted or which has a soft tissue cover is a common clinical finding. Occlusal projections generally give the best presurgical diagnostic information, demonstrating the presence of a radiolucent lesion with a periosteal bone reaction buccal to the involved tooth and displacement of the roots to the lingual. The cyst can be successfully treated by simple enucleation without disturbing the associated tooth.
Clinical Reports Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac... more Clinical Reports Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex Three case reports are presented to illustrate the existence and importance of reflex bradycardic responses that can occur during maxillofacial surgical procedures. All three patients were healthy young ad, dts undergoing operations which did not include any manipulation of orbital structures. After the patients had been anaesthetized for some time and were haemodynamically stable, profound bradycardia or ventricular asystole occurred suddenly in response to manipulations of the bony structures of the maxilla or mandible, or dissection of, or traction on, the attached soft tissue structures. The parasympathetic supply to the face is carried in the trigeminal nerve. Alternative afferent pathways must exist via the maxillary and/or mandibular divisions, in addition to the commonly reported pathway via the ophthabnic division of the trigeminal nerve in the classic oculocardiac reflex. The efferent arc involves the vagus, regardless of which branch of the trigeminal nerve transmits the afferent impulses. All patients undergoing maxillofacial procedures should be monitored carefully for reflex bradycardia and ventricular asystole. Voici trois cas inerrant en lumi~re l'existence d'une importante bradycardie r~flexe pouvant survenir pendant une intervention chirurgicale maxillo-faciale. AIors que ranesthdsie durait depuis un bon moment, que leur hdmodynamie ~tait stable, et en l' absence de manipulation des structures de I' orbite, nos trois
Abstract A statistical correlation is found between the S–N/mandibular plane angle and clinical f... more Abstract A statistical correlation is found between the S–N/mandibular plane angle and clinical freeway space, but there was no correlation after TENS stimulation. The S–N/MP angle did not prove to be a reliable predictor of freeway space.
Canadian family physician Médecin de famille canadien, 1982
Sinus tracts presenting on the face may be the result of dental pathosis. This etiologic possibil... more Sinus tracts presenting on the face may be the result of dental pathosis. This etiologic possibility should be ruled out before such lesions are treated by prolonged antibiotic therapy or surgical excision. The diagnosis can often be confirmed by a good clinical intraoral examination supplemented by appropriate radiographs. Four cases are presented in which treatment of the underlying pathology resulted in resolution of the sinus tract.
Journal of oral surgery (American Dental Association : 1965), 1980
The incidence of fractures of the upper third of the face appears to be increasing. An accurate d... more The incidence of fractures of the upper third of the face appears to be increasing. An accurate diagnosis must be made and proper treatment carried out to avoid the functional problems and severe facial deformities associated with untreated or inappropriately treated supraorbital rim fractures. The etiology, pathogenesis, signs and symptoms, and surgical treatment of these fractures are discussed and salient points brought out in the case histories reported.
Condylysis has not previously been described as a complication of a mixed collagen vascular disea... more Condylysis has not previously been described as a complication of a mixed collagen vascular disease. A case is presented in which apertognathia and mandibular retrognathism occurred secondary to condylysis in a 26-year-old woman with features of rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and Sjögren's syndrome. The disease was manifested by polyarthritis, morning stiffnes, subcutaneous nodules, and acrosclerosis. Important laboratory findings included RA slide latex negative, increased DNA binding, ANA positive, ENA negative, and an abnormal parotid scan. The malocclusion secondary to condylysis was corrected by surgical procedures usually employed for the treatment of mandibular retrognathism and apertognathia on a developmental basis.
International Journal of Oral and Maxillofacial Surgery, 1993
Pterygoid plate fractures, resulting from the pterygomaxillary separation in a Le Fort I osteotom... more Pterygoid plate fractures, resulting from the pterygomaxillary separation in a Le Fort I osteotomy, may be associated with untoward fractures that extend to the base of the skull and orbit and which can lead to rare but significant complications. Five alternative approaches to the pterygomaxillary dysjunction were studied in 50 fresh cadavers. The results of this study show that the use of a curved Obwegeser osteotome to achieve the pterygomaxillary dysjunction should be abandoned, as it leads to an unacceptably high incidence of high-level pterygoid plate fractures at, or near, the base of the skull. The best results were obtained with a Stryker micro-oscillating saw.
The objective of the study was to evaluate the type of pterygomaxillary separation that occurs wi... more The objective of the study was to evaluate the type of pterygomaxillary separation that occurs with use of a micro-oscillating saw. Patients and Methods: Sixteen patients underwent a postoperative computed tomography scan. Results: Ideal or near-ideal separations occurred on 26 of 32 sides (81%), while low-level fractures occurred in 6 of 32 sides (19%). No high-level fractures of the pterygoid plates, or fractures extending to the base of the skull or orbit, were seen. There was a striking difference in the number of ideal separations on the right-hand side (94%), compared with the left-hand side (50%), probably because of the greater difficulty of a right-handed surgeon positioning the saw blade correctly on the left side without bending the thin flexible saw blade backward. Conc/usion: In view of the high percentage of ideal pterygomaxillary separations achieved using a micro-oscillating saw, and the absence of high-level pterygoid plate fractures extending to the base of the skull, this technique is recommended for the pterygomaxillary dysjunction.
In 1984, Lanigan and West' did an extensive review of cases with postoperative hemorrhage after t... more In 1984, Lanigan and West' did an extensive review of cases with postoperative hemorrhage after the Le Fort I osteotomy. In that article, they presented a protocol for the management of postoperative bleeding. They suggested that vigorous bleeding would require at least anterior and posterior nasal packing for 3 to 5 days. Furthermore, in the event of continuous hemorrhage, the patient should be taken to the operating room to release the maxilla and explore the surgical area. The most frequent vessels involved in postoperative bleeding were the greater palatine artery, the internal maxillary artery, or the pterygoid venous plexus. Embolization of the internal maxillary artery and its distal branches were suggested as a possible treatment. The purpose of this report is to present two cases of massive delayed hemorrhage after Le Fort I osteotomies in which surgical intervention was the only option because of the size of the vessel injured. Report of Cases Case 1 On January 17, 1994, a 32-year-old man underwent a twopiece maxillary Le Fort I osteotomy and a bilateral sagittal split osteotomy (BSSO) to advance his mandible. The surgery was uneventful. He was discharged from the hospital in 48 hours. Two weeks later he returned to the emergency room with epistaxis. The bleeding was minor in nature and was managed by observation in the emergency room. He was dismissed with no signs of bleeding. Twenty-four hours
Journal of Oral and Maxillofacial Surgery, Jun 1, 1990
Major intraoperative or postoperative bleeding associated with Le Fort I osteotomies can be venou... more Major intraoperative or postoperative bleeding associated with Le Fort I osteotomies can be venous and/or arterial in nature. Arterial hemorrhage generally involves the maxillary artery and its terminal branches. Arterial hemorrhage tends to be more persistent and can be recurrent, which makes it more difficult to manage. Postoperative bleeding following Le Fort I osteotomies generally presents as epistaxis and usually occurs initially within the first 2 weeks following surgery. Treatment modalities that have been used to successfully arrest postoperative hemorrhage include anterior and/or posterior nasal packing; packing of the maxillary antrum; reoperating with clipping or electrocoagulation of bleeding vessels, or the use of topical hemostatic agents in the pterygomaxillary region; external carotid artery ligation; and selective embolization of the maxillary artery and its terminal branches.
This investigation expands on a previous pilot study of the effects of TENS on the resting positi... more This investigation expands on a previous pilot study of the effects of TENS on the resting position of the mandible. The tendency is for an increase in freeway space, but the variability of results makes individual evaluation essential.
A statistical correlation is found between the S-N/mandibular plane angle and clinical freeway sp... more A statistical correlation is found between the S-N/mandibular plane angle and clinical freeway space, but there was no correlation after TENS stimulation. The S-N/MP angle did not prove to be a reliable predictor of freeway space.
Five cases of paradental cyst are reported which were found to arise buccal to a mandibular first... more Five cases of paradental cyst are reported which were found to arise buccal to a mandibular first permanent molar in children under the age of 10 years. The justification for calling these lesions paradental cysts is discussed. Since the histopathological findings of this lesion are nonspecific, the clinical and radiographic features are of prime importance in diagnosis when the lesion occurs in this site in patients of this age. Buccal swelling adjacent to a mandibular first molar which is partially erupted or which has a soft tissue cover is a common clinical finding. Occlusal projections generally give the best presurgical diagnostic information, demonstrating the presence of a radiolucent lesion with a periosteal bone reaction buccal to the involved tooth and displacement of the roots to the lingual. The cyst can be successfully treated by simple enucleation without disturbing the associated tooth.
Clinical Reports Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac... more Clinical Reports Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex Three case reports are presented to illustrate the existence and importance of reflex bradycardic responses that can occur during maxillofacial surgical procedures. All three patients were healthy young ad, dts undergoing operations which did not include any manipulation of orbital structures. After the patients had been anaesthetized for some time and were haemodynamically stable, profound bradycardia or ventricular asystole occurred suddenly in response to manipulations of the bony structures of the maxilla or mandible, or dissection of, or traction on, the attached soft tissue structures. The parasympathetic supply to the face is carried in the trigeminal nerve. Alternative afferent pathways must exist via the maxillary and/or mandibular divisions, in addition to the commonly reported pathway via the ophthabnic division of the trigeminal nerve in the classic oculocardiac reflex. The efferent arc involves the vagus, regardless of which branch of the trigeminal nerve transmits the afferent impulses. All patients undergoing maxillofacial procedures should be monitored carefully for reflex bradycardia and ventricular asystole. Voici trois cas inerrant en lumi~re l'existence d'une importante bradycardie r~flexe pouvant survenir pendant une intervention chirurgicale maxillo-faciale. AIors que ranesthdsie durait depuis un bon moment, que leur hdmodynamie ~tait stable, et en l' absence de manipulation des structures de I' orbite, nos trois
Abstract A statistical correlation is found between the S–N/mandibular plane angle and clinical f... more Abstract A statistical correlation is found between the S–N/mandibular plane angle and clinical freeway space, but there was no correlation after TENS stimulation. The S–N/MP angle did not prove to be a reliable predictor of freeway space.
Canadian family physician Médecin de famille canadien, 1982
Sinus tracts presenting on the face may be the result of dental pathosis. This etiologic possibil... more Sinus tracts presenting on the face may be the result of dental pathosis. This etiologic possibility should be ruled out before such lesions are treated by prolonged antibiotic therapy or surgical excision. The diagnosis can often be confirmed by a good clinical intraoral examination supplemented by appropriate radiographs. Four cases are presented in which treatment of the underlying pathology resulted in resolution of the sinus tract.
Journal of oral surgery (American Dental Association : 1965), 1980
The incidence of fractures of the upper third of the face appears to be increasing. An accurate d... more The incidence of fractures of the upper third of the face appears to be increasing. An accurate diagnosis must be made and proper treatment carried out to avoid the functional problems and severe facial deformities associated with untreated or inappropriately treated supraorbital rim fractures. The etiology, pathogenesis, signs and symptoms, and surgical treatment of these fractures are discussed and salient points brought out in the case histories reported.
Condylysis has not previously been described as a complication of a mixed collagen vascular disea... more Condylysis has not previously been described as a complication of a mixed collagen vascular disease. A case is presented in which apertognathia and mandibular retrognathism occurred secondary to condylysis in a 26-year-old woman with features of rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and Sjögren's syndrome. The disease was manifested by polyarthritis, morning stiffnes, subcutaneous nodules, and acrosclerosis. Important laboratory findings included RA slide latex negative, increased DNA binding, ANA positive, ENA negative, and an abnormal parotid scan. The malocclusion secondary to condylysis was corrected by surgical procedures usually employed for the treatment of mandibular retrognathism and apertognathia on a developmental basis.
International Journal of Oral and Maxillofacial Surgery, 1993
Pterygoid plate fractures, resulting from the pterygomaxillary separation in a Le Fort I osteotom... more Pterygoid plate fractures, resulting from the pterygomaxillary separation in a Le Fort I osteotomy, may be associated with untoward fractures that extend to the base of the skull and orbit and which can lead to rare but significant complications. Five alternative approaches to the pterygomaxillary dysjunction were studied in 50 fresh cadavers. The results of this study show that the use of a curved Obwegeser osteotome to achieve the pterygomaxillary dysjunction should be abandoned, as it leads to an unacceptably high incidence of high-level pterygoid plate fractures at, or near, the base of the skull. The best results were obtained with a Stryker micro-oscillating saw.
The objective of the study was to evaluate the type of pterygomaxillary separation that occurs wi... more The objective of the study was to evaluate the type of pterygomaxillary separation that occurs with use of a micro-oscillating saw. Patients and Methods: Sixteen patients underwent a postoperative computed tomography scan. Results: Ideal or near-ideal separations occurred on 26 of 32 sides (81%), while low-level fractures occurred in 6 of 32 sides (19%). No high-level fractures of the pterygoid plates, or fractures extending to the base of the skull or orbit, were seen. There was a striking difference in the number of ideal separations on the right-hand side (94%), compared with the left-hand side (50%), probably because of the greater difficulty of a right-handed surgeon positioning the saw blade correctly on the left side without bending the thin flexible saw blade backward. Conc/usion: In view of the high percentage of ideal pterygomaxillary separations achieved using a micro-oscillating saw, and the absence of high-level pterygoid plate fractures extending to the base of the skull, this technique is recommended for the pterygomaxillary dysjunction.
In 1984, Lanigan and West' did an extensive review of cases with postoperative hemorrhage after t... more In 1984, Lanigan and West' did an extensive review of cases with postoperative hemorrhage after the Le Fort I osteotomy. In that article, they presented a protocol for the management of postoperative bleeding. They suggested that vigorous bleeding would require at least anterior and posterior nasal packing for 3 to 5 days. Furthermore, in the event of continuous hemorrhage, the patient should be taken to the operating room to release the maxilla and explore the surgical area. The most frequent vessels involved in postoperative bleeding were the greater palatine artery, the internal maxillary artery, or the pterygoid venous plexus. Embolization of the internal maxillary artery and its distal branches were suggested as a possible treatment. The purpose of this report is to present two cases of massive delayed hemorrhage after Le Fort I osteotomies in which surgical intervention was the only option because of the size of the vessel injured. Report of Cases Case 1 On January 17, 1994, a 32-year-old man underwent a twopiece maxillary Le Fort I osteotomy and a bilateral sagittal split osteotomy (BSSO) to advance his mandible. The surgery was uneventful. He was discharged from the hospital in 48 hours. Two weeks later he returned to the emergency room with epistaxis. The bleeding was minor in nature and was managed by observation in the emergency room. He was dismissed with no signs of bleeding. Twenty-four hours
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