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Most Cited British Journal of Oral and Maxillofacial Surgery Articles
The most cited articles published since 2011, extracted from Scopus.
Volume 49, Issue 4, June 2011, Pages 261-269
C. J. Burke | R. H. Thomas | D. Howlett
Advances in imaging have led to improved sensitivity in the diagnosis of diseases that involve the major salivary glands. Ultrasound (US), plain radiography and sialography, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear scintigraphy/positron emission tomography (PET) all play a part, and imaging often assists in the planning of further management, operative or otherwise. We review the methods used for imaging the major salivary glands, and apply the indications for these methods to the principal pathological processes. © 2010 The British Association of Oral and Maxillofacial Surgeons.
Bisphosphonate osteonecrosis of the jaw: A literature review of UK policies versus international policies on the management of bisphosphonate osteonecrosis of the jaw
Volume 49, Issue 5, July 2011, Pages 335-342
Niall M H McLeod | Vinod Patel | Atul Kusanale | Simon N. Rogers | Peter A. Brennan
Despite the increasing number of cases of osteonecrosis of the jaws related to bisphosphonate therapy described in the literature there is a paucity of evidence-based treatment for the condition. In this second article on bisphosphonate-related jaw complications we discuss the different treatment strategies for the condition, review current literature, particularly in relation to the recommendations that have been published, and discuss the evidence behind them. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
The increasing clinical relevance of human papillomavirus type 16 (HPV-16) infection in oropharyngeal cancer
Volume 49, Issue 6, September 2011, Pages 423-429
Richard Shaw | Max Robinson
Human papillomavirus type 16 (HPV-16) has been established beyond doubt as a causative agent in oropharyngeal squamous cell carcinoma (SCC). The incidence of oropharyngeal cancer has risen in recent decades, as has the proportion of patients who have a biologically relevant HPV-16 infection. Combined data from 14 recently published studies (2006-2010) show that 57% of 1316 reported cases of oropharyngeal SCC were HPV-16 positive. They had significantly better prognosis (hazard ratio (HR) for 5-year overall survival range 0.05-0.64), although smoking and higher T stage often appear as confounding factors to this favourable prognostic benefit. HPV-16 therefore has increasing importance as a clinically useful prognostic biomarker, but a benefit in survival has been seen in the use of surgery, radiotherapy, and chemotherapy, so specific changes in the preferred methods of treatment are hard to justify. Future trials that include oropharyngeal SCC will consider HPV-16 routinely as a stratification factor, and its use as a predictive biomarker awaits the development of effective targeted treatments. The undeniable and impressive prognostic significance of HPV-16 should hasten its addition to standard pathological reporting of oropharyngeal SCC, and ultimately to its inclusion in TNM staging systems of the American Joint Committee on Cancer (AJCC) and the International Union against Cancer (UICC). © 2010 British Association of Oral and Maxillofacial Surgeons.
Volume 49, Issue 7, October 2011, Pages 510-515
Niladri Ghosal | Kathleen Mais | Patrick Shenjere | P. Julyan | D. Hastings | T. Ward | W. D. Ryder | Iain Bruce | J. Homer | N. J. Slevin
Patients with adenoid cystic carcinoma of the salivary glands show over-expression of KIT in a high proportion of cases. Options for systemic treatment are limited in locally advanced and metastatic disease. We explored the efficacy of imatinib and cisplatin combined in this group of patients. A Gehan's two-stage, phase II trial was conducted on 28 patients. Those with progressive, locally advanced, and metastatic disease with an over-expression of KIT were treated with single agent imatinib 800 mg daily for two months, followed by a combination of imatinib 400 mg daily and cisplatin 80 mg/m 2 at four-weekly intervals for six cycles. This was followed by maintenance single agent imatinib 400 mg daily until the disease progressed. Response was monitored using fluorodeoxyglucose positron emission tomography (FDG-PET) and morphological imaging using computed tomography, magnetic resonance, and chest radiographs (CT/MRI/CXR). Morphological imaging showed partial response in three of 28 patients, and five patients showed a response on FDG-PET. In addition, 19 patients had useful stabilisation of disease. The median time to progression and overall survival was 15 months (range 1-43) and 35 months (range 1-75), respectively. The combination of imatinib and cisplatin was reasonably well tolerated. This combination may provide stabilisation in locally advanced and metastatic adenoid cystic carcinoma of the salivary glands. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Volume 50, Issue 1, January 2012, Pages 8-12
Gururaj Arakeri | Atul Kusanale | Graeme A. Zaki | Peter A. Brennan
Many factors have been implicated in the development of bony ankylosis following trauma to the temporomandibular joint (TMJ) or ankylosis that recurs after surgical treatment for the condition. Although many reports have been published, to our knowledge very little has been written about the pathogenesis of the process and there are few scientific studies. Over the last 70 years various treatments have been described. Different methods have been used with perceived favourable outcomes although recurrence remains a problem in many cases, and ankylosis presents a major therapeutic challenge. We present a critical review of published papers and discuss the various hypotheses regarding the pathogenesis of the condition. © 2010 The British Association of Oral and Maxillofacial Surgeons.
Computer-assisted surgical planning and simulation for condylar reconstruction in patients with osteochondroma
Volume 49, Issue 3, April 2011, Pages 203-208
Xiaoqin Yang | Jing Hu | Songsong Zhu | Xinhua Liang | Jihua Li | En Luo
We describe the use of computer-assisted three-dimensional surgical planning in condylar reconstruction by vertical ramus osteotomy for patients with osteochondroma, and its clinical effects. Seventeen patients with osteochondroma of the mandibular condyle who were seen from March 2005 to March 2009 were divided into 2 groups treated by condylectomy and condylar reconstruction using vertical sliding osteotomy of the mandibular ramus with and without three-dimensional simulation using Surgicase CMF Materialise software. Clinical examination, radiographs, photographs, and details of operation and outcome were used postoperatively to evaluate the clinical effects of the technique. Satisfactory mouth opening was achieved in all cases. Mean (SD) osteotomy and fixation time, duration of intermaxillary fixation, and degree of postoperative numbness of the lower lip were considerably reduced among patients who had three-dimensional simulation. The combined use of computer-assisted three-dimensional surgical planning and simulation with vertical ramus osteotomy to reconstruct the condyle for patients with osteochondroma after excision of the tumour makes the operation more accurate and more convenient, and avoids damage to vital structures.
Bisphosphonate osteonecrosis of the jaw - A literature review of UK policies versus international policies on bisphosphonates, risk factors and prevention
Volume 49, Issue 4, June 2011, Pages 251-257
Vinod Patel | Niall M H McLeod | Simon N. Rogers | Peter A. Brennan
There has been an exponential rise in the literature of osteonecrosis and its complications in patients taking bisphosphonate drugs. Despite this increase, there is little evidence-based publications on how best to manage this complication. In this article (the first of two on bisphosphonate related jaw complications), we compare the guidelines produced by national specialist medical associations and expert panels on the prevention of bisphosphonate osteonecrosis of the jaws and review the evidence behind these guidelines. © 2010 The British Association of Oral and Maxillofacial Surgeons.
Volume 50, Issue 2, March 2012, Pages 176-180
Tadaharu Kobayashi | Naoya Izumi | Taku Kojima | Naoko Sakagami | Isao Saito | Chikara Saito
Progressive condylar resorption is an irreversible complication and a factor in the development of late skeletal relapse after orthognathic surgery. We have evaluated cephalometric characteristics, signs and symptoms in the temporomandibular joint (TMJ), and surgical factors in six patients (one man and five women) who developed it after orthognathic surgery. The findings in preoperative cephalograms indicated that the patients had clockwise rotation of the mandible and retrognathism because of a small SNB angle, a wide mandibular plane angle, and a "minus" value for inclination of the ramus. There were erosions or deformities of the condyles, or both, on three-dimensional computed tomography (CT) taken before treatment. The mean (SD) anterior movement of the mandible at operation was 12.1 (3.9) mm and the mean relapse was -6.4 (2.5) mm. The mean change in posterior facial height was 4.5 (2.1) mm at operation and the mean relapse was -5.3 (1.8) mm. Two patients had click, or pain, or both, preoperatively. The click disappeared in one patient postoperatively, but one of the patients who had been symptom-free developed crepitus postoperatively. In the classified resorption pattern, posterior-superior bone loss was seen in three cases, anterior-superior bone loss in two, and superior bone loss in one. Progressive condylar resorption after orthognathic surgery is multifactorial, and some of the risk factors are inter-related. Patients with clockwise rotation of the mandible and retrognathism in preoperative cephalograms; erosion, or deformity of the condyle, or both, on preoperative CT; and wide mandibular advancement and counterclockwise rotation of the mandibular proximal segment at operation, seemed to be at risk. The mandible should therefore be advanced only when the condyles are stable on radiographs, and careful attention should be paid to postoperative mechanical loading on the TMJ in high-risk patients. © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Volume 49, Issue 6, September 2011, Pages 451-454
K. S. George | M. McGurk
Extracapsular dissection was adopted by the salivary clinic at Guy's Hospital as the treatment of choice for benign parotid lumps in 1999. We present here our experience gained in its use as the main method of treatment of benign parotid tumours in an unselected, consecutive series of 156 patients treated over a 10-year period. © 2010 British Association of Oral and Maxillofacial Surgeons.
Volume 49, Issue 2, March 2011, Pages 142-147
M. Ethunandan | B. T. Evans
The management of orbital blowout fractures remains controversial, particularly in patients with a white-eye or trapdoor-type injury. We report our experience with 10 such cases (mean age 19.6 years, range 4-53) and show, unlike previous reports, that this pattern of injury is not restricted to children. Although most patients had a white eye (70%), the presence of subconjunctival haemorrhage and periorbital bruising did not exclude this injury, and the patients often (60%) had serious autonomic symptoms such as nausea and vomiting. A high index of suspicion and cross-sectional imaging is required to confirm the diagnosis. Early intervention (less than 7 days) seems to be associated with better outcome, but patients benefitted from intervention up to 41 days after injury. The mechanism underlying this pattern of injury and the rationale behind early intervention is also discussed. © 2010 The British Association of Oral and Maxillofacial Surgeons.
Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: Treatment
Volume 49, Issue 1, January 2011, Pages 2-8
Richard J. Shaw | Jagtar Dhanda
Osteoradionecrosis (ORN) is a serious condition following treatment for head and neck cancer with serious associated morbidity and mortality. While the use of hyperbaric oxygen (HBO) in treating established osteoradionecrosis has been standard practice in many units for years, the evidence base for this remains remarkably weak. The published evidence has been made even more controversial by trial protocols that do not use HBO as it is generally advocated. This review describes the classification, incidence, and treatment of ORN, and explores the available published evidence with particular emphasis on randomised trials of treatment with HBO. © 2010 The British Association of Oral and Maxillofacial Surgeons.
Volume 50, Issue 3, April 2012, Pages 239-243
Zaid H. Baqain | Wael Yousef Moqbel | Faleh A. Sawair
The objective of this prospective study was to estimate the incidence of early loss of dental implants and the potential risk factors. The predictive variables were classified as being patient, implant, anatomical, or operation-specific. The outcome variable was early failure of the implant. The significance of differences was assessed using bivariate analyses, and then a multivariate logistic regression model to identify independent predictors for early loss of implants. A total of 169 patients, 116 women and 53 men, mean age 47 (range 16-80) years, had 399 implants inserted. Fifteen implants were lost in 14 patients (8%). The early loss of dental implants was significantly associated with width of keratinised gingiva (p = 0.008), the use polyglactin sutures (p = 0.048), and the use of narrow implants (p = 0.035). Multivariate logistic regression analysis established the significance of narrow keratinised gingiva (OR = 4.7, p = 0.005) and the use of polyglactin sutures (OR = 3.8, p = 0.042), which we conclude are probably the strongest predictors of early failure of implants. © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Computed tomography-guided implant surgery for dental rehabilitation in mandible reconstructed with a fibular free flap: Description of the technique
Volume 50, Issue 1, January 2012, Pages 30-35
Giacomo De Riu | Silvio Mario Meloni | Milena Pisano | Olindo Massarelli | Antonio Tullio
The fibular free flap, with or without a cutaneous component, is the gold standard for reconstructing mandibular defects. Dental prosthetic rehabilitation is possible this way, even if the prosthesis-based implant is still a challenge because of the many anatomical and prosthetic problems. We think that complications can be overcome or reduced by adopting the new methods of computed tomography (CT)-assisted implant surgery (NobelGuide®, Nobel Biocare AB, Goteborg, Sweden). Here we describe the possibility of using CT-guided implant surgery with a flapless approach and immediate loading in mandibles reconstructed with fibular free flaps. © 2010 The British Association of Oral and Maxillofacial Surgeons.
A novel method of computer aided orthognathic surgery using individual CAD/CAM templates: A combination of osteotomy and repositioning guides
Volume 51, Issue 8, December 2013, Pages e239-e244
Biao Li | Lei Zhang | Hao Sun | Jianbing Yuan | Steve G F Shen | Xudong Wang
The maxilla is usually positioned during orthognathic surgery using surgical splints, which has many limitations. In this preliminary study we present a new computer-aided design and manufacture (CAD/CAM) template to guide the osteotomy and the repositioning, and illustrate its feasibility and validity. Six patients with dental maxillofacial deformities were studied. The design of the templates was based on three-dimensional surgical planning, including the Le Fort osteotomy and the repositioning of the maxilla, and were made using a three-dimensional printing technique. Two parts of the templates, respectively, guided the osteotomy and repositioned the maxilla during operation. The traditional occlusal splint was used to achieve the final occlusion with the mandible in the expected position. Postoperative measurements were made between maxillary hard tissue landmarks, relative to reference planes based on computed tomographic (CT) data. The results of the measurements were analysed and compared with the virtual plan. The preliminary results showed that we achieved clinically acceptable precision for the position of the maxilla (<1.0 mm). Preoperative preparation time was reduced to about 145 min. All patients were satisfied with the aesthetic results. Our CAD/CAM templates provide a reliable method for transfer of maxillary surgical planning, which may be a useful alternative to the intermediate splint technique. Our technique does not require traditional model surgery, scanning of dental casts, or recording of the CAD/CAM splint. © 2013 The British Association of Oral and Maxillofacial Surgeons.
Volume 49, Issue 1, January 2011, Pages 29-36
A. J. Barber | C. J. Butterworth | S. N. Rogers
The aim of this paper is to provide a systematic review of articles concerning primary osseointegrated dental implants in the head and neck oncology setting. We searched MEDLINE (1950 to March 2009) and Embase (1980 to March 2009) using the terms head and neck, oral, maxillofacial, craniofacial, jaws, mandible, maxilla, zygoma, dental implants, osseointegrated implants, implants, tumour, cancer, oncology, immediate, simultaneous, and primary. Two authors independently reviewed the abstracts, and all those written in the English language that referred to the placement of primary dental implants in patients with cancer of the head neck were included. Articles that referred to craniofacial or extraoral implants were excluded. Of 892 abstracts 83 were eligible for further consideration; the full articles were evaluated, and 41 that complied fully with the inclusion criteria are presented as a tabulated summary. There are three case reports, 13 reviews, and 25 clinical studies. Eight of the clinical studies refer solely to the insertion of dental implants at the time of primary oncological resection, and only two were of a prospective design. We have concisely summarised publications concerning primary dental implants, and our findings will help to inform head and neck cancer teams, particularly oncological surgeons, restorative dentists, and maxillofacial prosthodontists of the evidence base surrounding this approach to oral rehabilitation. © 2010 The British Association of Oral and Maxillofacial Surgeons.
Volume 49, Issue 2, March 2011, Pages 127-130
Caitriona Howley | Nayeem Ali | Robert Lee | Shirley Cox
The alar base cinch suture is often used to mitigate the unfavourable increase in nasal width after Le Fort I impaction or advancement of the maxilla. Recently a number of studies have looked at the stability and clinical outcome of this intervention. We investigated the effect of an alar base cinch suture on the change in width of the alar base after Le Fort I osteotomy using a three-dimensional imaging system. Twenty-eight patients were prospectively randomised into an intervention group where a cinch suture was used, and a control group. The width of the alar base was measured before operation, and then at one, and six months. At six months it had increased from baseline by a median of 2 mm in all patients. The median increase was greater in the control group than in the cinch placement group, but the difference was small. The range in both groups was large, indicating great individual variability. There was an overall reduction in the width of the alar base between one and six months after operation, which indicated some resolution of soft tissue oedema associated with the operation, but the median reduction was small and unlikely to be clinically significant. The preliminary findings suggest that the suture confers little benefit in controlling the width of the alar base of the nose after Le Fort I osteotomy. More recently it has been suggested that procedures using a modified cinch suture may result in greater stability. © 2010 The British Association of Oral and Maxillofacial Surgeons.
Volume 49, Issue 5, July 2011, Pages 349-353
Simon N. Rogers | Shreya V. Vedpathak | Derek Lowe
Patients with oral and oropharyngeal cancer (OOC) often delay presenting to their doctor or dentist. The aims of this study were to ask a consecutive cohort following treatment for OOC about their initial symptoms and the time spent before presentation to the healthcare profession. Also to discover their views on how to reduce delays in presentation. From a 2-year cohort treated within 2 years, 71 completed a short survey and 44 were subsequently interviewed by telephone. A non-healing ulcer or sore was the commonest symptom patients first related to having cancer. Around half interpreted their symptoms as something minor, staying much the same initially, and something that probably would get better by itself. Most would have sought advice earlier if they had been more aware of oral cancer. Although many patients talked about their symptoms to spouse, partner, family or friends, over one-third said they spoke to nobody about it. Our sample did not find that access to a doctor or a dentist was a barrier to seeking advice. This study highlights that from the patients perception they generally thought their symptoms were trivial, would get better by themselves and gave little thought as to whether it might be cancer. Patients commented they knew nothing more about the disease. In their views the best way to get patients to self refer earlier was through improved awareness of the disease, as many felt there was a gross lack of knowledge in this field of cancers compared to other cancers. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Pleomorphic adenoma (benign mixed tumour) of the salivary glands: Its diverse clinical, radiological, and histopathological presentation
Volume 49, Issue 1, January 2011, Pages 14-20
Ravi K. Lingam | Ahmed A. Daghir | Ezra Nigar | Syeda A B Abbas | Mahesh Kumar
Pleomorphic adenoma is the single most common salivary gland tumour. It has a diverse histological presentation because of varying proportions of different epithelial and mesenchymal elements, and presents clinically and radiologically in various ways as it occurs at many different sites in the head and neck region. The choice of imaging is influenced by its site and size, and a range of options for treatment includes both operation and radiotherapy. The tumour can also present in various ways if it is not removed or treated successfully. © 2009 The British Association of Oral and Maxillofacial Surgeons.
Correlation of mandibular bone quality with neurosensory disturbance after sagittal split ramus osteotomy
Volume 49, Issue 7, October 2011, Pages 552-556
Izumi Yoshioka | Tatsurou Tanaka | Amit Khanal | Manabu Habu | Shinji Kito | Masaaki Kodama | Masafumi Oda | Nao Wakasugi-Sato | Shinobu Matsumoto-Takeda | Yuji Seta | Kazuhiro Tominaga | Sumio Sakoda | Yasuhiro Morimoto
Our aim was to find out whether the quality of bone around the inferior alveolar nerve is correlated with neurosensory disturbance to the nerve after sagittal split ramus osteotomy (SSRO) in patients with mandibular prognathism. Computed tomograms (CT) were taken of 35 patients with mandibular prognathism and 35 without. To assess the density of bone around the inferior alveolar nerve, the width of the buccal cortical bone in the mandibular second molar regions was measured on CT. The Hounsfield units (HU) in the same regions were also measured. The number of HU in the mandible around the second molar regions was significantly higher (p < 0.01) in those with neurosensory disturbance (p < 0.01). The quality of bone measured by HU is associated with an increased risk of neurosensory disturbance, but the width of buccal bone is not. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Computer-assisted orthognathic surgery: Waferless maxillary positioning, versatility, and accuracy of an image-guided visualisation display
Volume 51, Issue 8, December 2013, Pages 827-833
Max J. Zinser | Robert A. Mischkowski | Timo Dreiseidler | Oliver C. Thamm | Daniel Rothamel | Joachim E. Zöller
There may well be a shift towards 3-dimensional orthognathic surgery when virtual surgical planning can be applied clinically. We present a computer-assisted protocol that uses surgical navigation supplemented by an interactive image-guided visualisation display (IGVD) to transfer virtual maxillary planning precisely. The aim of this study was to analyse its accuracy and versatility in vivo. The protocol consists of maxillofacial imaging, diagnosis, planning of virtual treatment, and intraoperative surgical transfer using an IGV display. The advantage of the interactive IGV display is that the virtually planned maxilla and its real position can be completely superimposed during operation through a video graphics array (VGA) camera, thereby augmenting the surgeon's 3-dimensional perception. Sixteen adult class III patients were treated with by bimaxillary osteotomy. Seven hard tissue variables were chosen to compare (ΔT1-T0) the virtual maxillary planning (T0) with the postoperative result (T1) using 3-dimensional cephalometry. Clinically acceptable precision for the surgical planning transfer of the maxilla (<0.35 mm) was seen in the anteroposterior and mediolateral angles, and in relation to the skull base (<0.35), and marginal precision was seen in the orthogonal dimension (<0.64 mm). An interactive IGV display complemented surgical navigation, augmented virtual and real-time reality, and provided a precise technique of waferless stereotactic maxillary positioning, which may offer an alternative approach to the use of arbitrary splints and 2-dimensional orthognathic planning. © 2013 The British Association of Oral and Maxillofacial Surgeons.
Volume 50, Issue 8, December 2012, Pages 689-694
Hatem Algraffee | Farzad Borumandi | Luke Cascarini
The number of osseointegrated dental implants is increasing. Healthy peri-implant soft and hard tissues are required for the stability and survival of dental implants. In this paper we review factors that lead to peri-implant mucositis and peri-implantitis, and review treatment. © 2011 The British Association of Oral and Maxillofacial Surgeons.
Identifying appearance-related concerns in routine follow-up clinics following treatment for oral and oropharyngeal cancer
Volume 50, Issue 4, June 2012, Pages 314-320
J. Flexen | N. Ghazali | D. Lowe | S. N. Rogers
Facial disfigurement can be a consequence of treatment for oral or oropharyngeal cancer. Patients' concerns about appearance and the impact this has on quality of life are very important, but are often not recognised in a busy outpatient clinic. We aimed to assess concerns about appearance using the University of Washington Quality of Life questionnaire version 4 (UW-QoL) and the Patient Concerns Inventory (PCI), a self-administered questionnaire that allows patients to choose what they would like to discuss in their consultation. Prospective data were collected from 204 patients who attended routine follow-up clinics from August 2007 to mid-July 2009. Fifty-seven percent were male, 68% had cancer of the oral cavity, 78% had clinical T1-T2 tumours, 19% had node positive tumours, 44% had had radiotherapy since diagnosis, and 48% had had free-flap reconstructive surgery. They all completed the questionnaires using touch-screen computer technology at 454 clinic appointments. Appearance was raised on the inventory at 9% (42/454) of clinics, and at 10% (47/454) it was indicated as a serious problem on the UW-QoL questionnaire. Concerns about appearance were raised on the inventory or were shown to be a serious problem on the UW-QoL in 14% (64/454) of patients. The main factors associated with those who reported concerns about appearance were age (younger patients), sex (female), T stage (III and IV), and site (oropharynx). Patients who choose concerns about appearance for discussion on the UW-QoL questionnaire and not on the PCI risk being missed if only the PCI is completed. Both tools compliment the screening of patients who have problems with facial disfigurement; failure to identify them can have serious clinical and psychosocial implications. © 2011 The British Association of Oral and Maxillofacial Surgeons.
Comparative evaluation of surgical outcome after removal of impacted mandibular third molars using a Piezotome or a conventional handpiece: A prospective study
Volume 50, Issue 6, September 2012, Pages 556-561
Manoj Goyal | Karan Marya | Aakarsh Jhamb | Sonia Chawla | Priyanshu Ranjan Sonoo | Veenita Singh | Anuj Aggarwal
Our aim was to compare the use of a conventional rotary handpiece and a Piezosurgical unit for extraction of lower third molars. We studied 40 patients, who were allocated alternately to have the third molar removed with either the handpiece or the Piezosurgical unit. Pain, trismus, and oedema were evaluated at baseline and then postoperatively, together with paraesthesiae, on postoperative days 1, 3, 5, 7, and 15. Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards. More patients complained of pain in the conventional group, they also required more analgesics, and they developed trismus more often than in the Piezosurgery group. There was also significantly more postoperative swelling in the conventional group. Patients were also evaluated using the subjective Postoperative Symptom Severity (PoSSe) scale. Our results suggest that apart from some inherent limitations with the Piezotome, it is a valuable alternative for extraction of third molars. © 2011 The British Association of Oral and Maxillofacial Surgeons.
Short-term outcomes using the Christensen patient-specific temporomandibular joint implant system: A prospective study
Volume 50, Issue 2, March 2012, Pages 149-153
A. N. Kanatas | C. Needs | A. B. Smith | A. Moran | G. Jenkins | S. F. Worrall
Thirty-one patients were assessed for changes in pain and maximal mouth opening (MMO) before and after total temporomandibular joint (TMJ) replacement. All prosthetic joint replacements used the Christensen fossa-eminence prosthesis system; 18 were unilateral and 13 bilateral. There were more women (n = 22) than men (n = 9), and their mean age was 45 years (women 46, range 18-74, and men 42, range 28-69). Indications for replacement included osteoarthritis, ankylosis, and "other". There were overall significant improvements in pain scores for the whole group at one year (95% CI 6.3-8.5 compared with 0.2-3.0) and for women alone (6.5 to 9.2 compared with -0.5 to 2.0). There were also significant improvements in pain scores in both those with osteoarthritis (95% CI 8.1 to 8.9 compared with -0.8 to 3.8) and the group with "other" diagnoses at the 12-month follow-up (95% CI 4.4 to 10.7 compared with -0.2 to 0.5). Finally, there was a significant improvement in MMO in the whole group at the time of 12-month follow-up (95% CI 15.8-23.5 compared with 24.0-32.3). © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Volume 49, Issue 5, July 2011, Pages 376-380
Julia Cadogan | Ian Bennun
We explored the experiences of a group of participants with craniofacial conditions before, during, and after orthognathic surgery. Semi-structured interviews were conducted, recorded, transcribed, and analysed using interpretative phenomenological analysis, and purposive sampling focused on a homogenous group was selected. Participants described unpleasant experiences related to their appearance, the difficulties they had in adjusting to facial changes as a result of surgery, and the differences these changes had made to their body image. The superordinate themes identified after interpretive phenomenological analysis were: self-awareness of facial appearance; attitudes of others and facial appearance; treatment issues; impact of surgery; and support and coping. The accounts provide information about living with an unusual appearance, medical aspects of facial operations over time, changes in body image before, during, and after operation, and the effects of support and coping styles on resilience. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.