Humans ; Jaw Diseases ; Osteonecrosis

PURPOSE: To investigate the diagnostic significance of cortical changes in the bone of diseased jaws utilizing computed tomography (CT). MATERIALS AND METHODS: Computed tomographic images of 91 patients, consisting of 7 osteomyelitis, 46 cysts, 18 benign tumors, and 20 malignant tumors, were analyzed. The pattern of cortical expansion was classified into three types: no expansion (N), buccal or lingual expansion (B/L), and buccolingual expansion (B and L). The pattern of cortical destruction was classified into four types: no destruction (N), point destruction (PO), gross destruction (GR), and permeative destruction (PE). The pattern of periosteal reaction was classified into four types: parallel, irregular, spicule, and Codmans triangle. The relationship between the pattern of cortical bone changes and diseases of the jaws was assessed. RESULTS: When the pattern of cortical expansion was compared to diseases of the jaw, N-type was most prevalent in cases of osteomyelitis and malignant tumors, B/L-type with cysts, and BandL-types with benign tumors. Comparison between the pattern of cortical bone destruction with diseases of the jaw showed strong correlations between PO and PE-types to osteomyelitis, N-type with cysts, N and GR-types with benign tumors, and GR-type with malignant tumors. Finally, the relationship between the pattern of periosteal reaction to diseases of the jaw showed a strong correlation between parallel-type to osteomyelitis and spicule-type to malignant tumors. CONCLUSION: The pattern of cortical expansion and cortical destruction is useful in differentiating diseases of the jaws.
Bone and Bones ; Humans ; Jaw Diseases ; Jaw* ; Osteomyelitis ; Periosteum

Granuloma, Giant Cell ; Humans ; Jaw Diseases ; pathology

Management of infants born with cleft lip and palate entails an interdisciplinary team effort that begins from infancy to adulthood. The goal of pre-surgical infant orthopedics is to reduce the severity of the cleft deformity before surgery. However, traditional methods do not address the deformity of the nasal cartilages and alveolar ridges simultaneously. The Nasoalveolar Molding (NAM) technique takes advantage of the malleability of immature nasal cartilage and its ability to maintain a permanent correction of its form. The NAM device is used to actively mold the alar dome, nasal cartilages, premaxilla, and alveolar ridges into a more normal anatomic form and position. It permits non-surgical elongation of the columella through application of tissue expansion principles. This results in better facial aesthetics and may help reduce the extent, number and cost of surgeries. The three cases presented illustrate the application of the NAM device for the pre-surgical infant orthopedics in unilateral and bilateral cleft lip and palate patients treated at the Philippine Children's Medical Center-Pediatric Dentistry Division (PCMC-PDD).
Human ; Male ; Infant Newborn ; CLEFT LIP ; CLEFT PALATE ; MUSCULOSKELETAL DISEASES ; JAW DISEASES ; JAW ABNORMALITIES

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a side effect of Bisphosphonates (BPs) use. These days, oral bisphosphonates are normally prescribed to treat osteoporosis. Intravenous BPs are used extensively to treat osteolytic bone lesions related to multiplemyeloma and bone metastasis of solid cancers, breast cancer or prostate cancer. As the prescription of BPs is universalized and the number of people treated with BPs is increasing, an accurate understanding and proper management of BRONJ are required. The aim of this study was to improve the clinicians'understanding of BRONJ by reviewing the literature. To achieve this, this paper introduces case reports as well as the current concept of BRONJ based on the 2009 updates by American Association of Oral and Maxillofacial (AAOMS) including the definition, epidemiology, etiology, diagnosis, treatment and prevention of BRONJ.
Bisphosphonate-Associated Osteonecrosis of the Jaw ; Breast Neoplasms ; Diphosphonates ; Jaw Diseases ; Neoplasm Metastasis ; Osteonecrosis ; Osteoporosis ; Prescriptions ; Prostatic Neoplasms

Choristoma ; Humans ; Infant ; Jaw Diseases ; Male ; Palate, Soft

PURPOSE: This study aimed to assess the reliability of ultrasonography (US) in comparison with cone-beam computed tomography (CBCT) as a tool for monitoring the healing of jaw lesions. MATERIALS AND METHODS: Twenty-one radiolucent lesions in jaws referred to the Oral Surgery Department at our institution were selected for this study. All lesions underwent CBCT and US examinations. The anteroposterior, superoinferior, and mesiodistal dimensions of the lesions were measured on CBCT and US images before surgery and at 6 months after surgery. The dimensions were compared between the US and CBCT images. Blood-flow velocity around the lesions was measured by color Doppler before surgery and at 1 week and 6 months after surgery to assess the capability of US to show changes in blood-flow velocity around the lesion. RESULTS: Before surgery, there were no significant differences between US and CBCT in the mesiodistal and anteroposterior dimensions, although a significant difference was found in the superoinferior dimension (P < .05). However, at 6 months after surgery, significant differences were found between US and CBCT in all dimensions, and it is likely that the US measurements more accurately reflected the extent of healing. The average blood-flow velocity increased at 1 week after surgery (5.84 cm/s) compared with the velocity before surgery (4 cm/s) (P < .05). Then, at 6 months after surgery, the blood-flow velocity significantly decreased (3.53 cm/s) compared to the velocity measured at 1 week after surgery (P < .05). CONCLUSION: US with color Doppler was confirmed to be a more efficient tool than CBCT for monitoring bone healing.
Bone Diseases ; Cone-Beam Computed Tomography ; Jaw ; Surgery, Oral ; Ultrasonography

As Westernization has taken place in the Oriental society, people's concern focuses on the correction of their lower jaw shape. Various methods were recommended to make their mandibular angle slender and beautiful, but it was difficult to achieve natural curves as planned preoperatively. This study was conducted on 6 patients who received burring hole connecting osteotomy for mandibular angle correction from 2005 to 2007. A measurement of the most natural curved line for osteotomy was made by X-ray prior to the surgery. Through intraoral approach, three to five holes were made on the estimated angle line by burring, and the consecutive holes were connected by oscillating saw to perform the one piece osteotomy. There were no unnatural, irregular osteotomy sections or asymmetrical problems in comparison of before and after operation. All of the patients had satisfactory natural mandibular angle lines. Despite difficulties with the conventional techniques, it is possible for patients to achieve natural mandibular angle lines as they wish with the burring hole connecting osteotomy technique. In addition, it was possible to secure outstanding predictability and stability, thus resulting in satisfactory outcomes in the profile.
Facial Bones ; Humans ; Hypogonadism ; Jaw ; Mandible ; Mitochondrial Diseases ; Ophthalmoplegia ; Osteotomy

Objective: To present the case of a midline Tessier 30 cleft in a baby boy who initially underwent a glossoplasty, cheiloplasty and mentoplasty. Methods: Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. Result: A 4-month-old boy with a complete midline cleft of the lower lip, alveolus and mandible, and bifid distal tongue that was fused with the floor of the mouth, underwent glossoplasty, cheiloplasty and mentoplasty with subsequent excellent aesthetic outcome and normal oral competency. Conclusion Tessier 30 is a rare congenital midline mandibular cleft. Prompt glossoplasty, cheiloplasty and mentoplasty can correct the gross deformity, restore oral competency, and address functional needs such as feeding, swallowing and early speech development. Future bony repair will hopefully complete the reconstruction.
Mandible ; Cleft Lip ; Tongue Diseases ; Jaw Abnormalities ; Plastic Surgery Procedures

INTRODUCTION: The utility of the C-terminal cross-linking telopeptide test (CTX) as a method for staging Bisphosphonate-related osteonecrosis of the jaws (BRONJ) and its healing process was examined. MATERIALS AND METHODS: A total 19 patients who were diagnosed with BRONJ underwent a fasted morning CTX test, were enrolled in this study. The serum CTX values ranged from 50 to 630 pg/mL (mean 60). The risk assessment was rated according to the CTX values of the individual patient (minimal risk, > or =150 pg/mL, moderate, 100 to 150 pg/mL, high, < or =100 pg/mL). The BRONJ scores were then calculated according to the number of BRONJ lesions and their stage. The operation was done as soon as possible, regardless of BORNJ stage. RESULTS: The mean duration of bisphosphonate therapy was 4.1 years. Of the 19 patients, 15, 2 ans 2 received alendronate, risedronate and zoledronate, respecively. Of the 19 patients who underwent a sequestrectomy, saucerization and smoothing, 15 healed after the initial surgery, 1 patient healed after one more surgical procedure, 3 patients did not heal completely but showed improvement in symptoms. Therefore, 17 out of the 19 patients healed completely with complete mucosal coverage and the elimination of pain. The risk assessment using the CTX value and disease severity were not correlated (r=-0.264, P=0.275). In addition, the risk assessment using CTX value and healing after surgery were not correlated (r=-0.147, P=0.547). CONCLUSION: The serum CTX should be considered carefully by clinicians as part of overall management. Early surgical intervention is of benefit in the treatment of stage II BRONJ.
Alendronate ; Bisphosphonate-Associated Osteonecrosis of the Jaw ; Collagen Type I ; Diphosphonates ; Etidronic Acid ; Humans ; Imidazoles ; Jaw ; Jaw Diseases ; Osteonecrosis ; Peptides ; Risk Assessment ; Risedronate Sodium