Nasopalatine duct cysts are the most common nonodontogenic developmental cyst originating in the incisive canal of maxilla and occuring in approximately 1% of the population. Clinical presentation is asymptomatic in small cysts, but shows swelling, pain and drainage from the hard palate in large cysts. The definite diagnosis should be based on clinical, radiological and histopathologic findings. The treatment of nasopalatine duct cysts consists of an enucleation of the cystic tissue, only in rare cases a marsupialization needs to be performed. We report a case of infected nasopalatine duct cyst in a 65-year-old man. He complained of painful swelling in the midline and nasolabial area. Physical examination revealed a huge tender mass in the midline of upper jaw. Diagnosis was suggested on the basis of computed tomography. Under the general anethesia, an enucleation was performed via sublabial approach.
Aged ; Drainage ; Humans ; Jaw ; Jaw Cysts ; Maxilla ; Nonodontogenic Cysts ; Palate ; Palate, Hard ; Physical Examination

Maxillary and mandibular fractures account for a large proportion of facial bone fractures. The primary objective in reduction of marillary or mandibular fractures is to return the structures to normal position of function and cosmetic contour, i.e. restoration of normal occlusal relations through proper positioning of the teeth and bony structures. Interdental wiring, intermaxillary fixation, rigid internal fixation or external pin fixation are common methods in the management of jaw fractures, varying with the age of the patient, location or extent of fracture. Malocclusion is not an uncommon complication after management of jaw pacture. We managed 16 patients (13 males, 3 females) of mandibular or maxillary fractures with model surgery and occlusal splint from July 1998 to August 1999. The average age of patients was 27.4 years and the average follow-up period was 6 months. We achieved good occlusal relationship without malunion, nonunion, or loss of teeth. Acrylic occlusal splints are rigid, strong, easily adjusted and repaired, translucent, lightweight and tolerated well by the oral mucosa. It is useful in the maintenance of intermaxillary fixation and in maintaining continuity of the maxillary or mandibular dental arch, as well as providing precise dental alignment during healing. Splints are helpful in managing fractures of the symphysis, parasymphyseal region, body and alveolar ridges of the mandible, sagittal fractures of the hard palate, and severely comminuted mandible fractures.
Body Regions ; Dental Arch ; Facial Bones ; Follow-Up Studies ; Humans ; Jaw ; Jaw Fractures ; Male ; Malocclusion ; Mandible ; Mandibular Fractures* ; Maxillary Fractures ; Mouth Mucosa ; Occlusal Splints* ; Palate, Hard ; Splints ; Tooth

Osteoma is a benign osteogenic tumor composed of cancellous or compact bone, classified as peripheral, central, or extraskeletal. Peripheral osteomas are uncommon. Excluding the maxillary sinuses, the maxilla is a rare site for osteomas. The purpose of this report was to describe clinicopathological and radiological features of two peripheral osteomas occurring in the jaws, one located in the mandible and another in the edentulous maxillary alveolar ridge. The tumors were asymptomatic and were fully excised without any complications or recurrence. The lesions were submitted to histopathological analysis and diagnosed as peripheral osteoma, compact type.
Alveolar Process ; Durapatite ; Jaw ; Mandible ; Maxilla ; Maxillary Sinus ; Osteoma ; Recurrence

OBJECTIVETo investigate the biomechanical force distribution of three different cleft maxillary finite-element models pre- and post-bone graft with specified load to certain area of the models.

METHODSDeveloping a cleft palate bony model from a 15-year cleft palate male CT scan DICOM data and generating alveolar bone-grafted, alveolopalatal bone-grafted cleft maxillary finite-element model was set up through gluing the graft model. Also the pre-grafted model as compared, vector lip force on the anterior and anteriolateral face of the alveolar ridge was applied, and studied the press distribution properties and localized area.

RESULTSThe press principal spread along the alveolar ridge and focused on anterior wall of maxillary prior to graft. But the press tended to be evenly distributed after bone grafted, whether alveolar or/and hard palate bone grafted. The grafted bone could resisted the medially deformation of alveolar crest and decreased the shear press to the nasal base bony structure. The map showed no significant differences along with alveolar or/and hard palate bone graft.

CONCLUSIONThe postoperative lip pressure plays an important role for the deformation and deviation of alveolar ridge. Alveolar bone graft could even the distribution of the stresses and should be emphasized. But the grafted bony palatal appears superior to but no significant mapping and anti-deformation difference with alveolar bone graft.

Alveolar Process ; Bone Transplantation ; Cleft Lip ; Cleft Palate ; Face ; Humans ; Male ; Maxilla ; Palate, Hard ; Tomography, X-Ray Computed

The contemporary two-jaw surgical approach usually involves a Le Fort osteotomy of the maxilla and a ramal osteotomy of the mandible with 3-dimensional repositioning of the jaws as well as the occlusal planes. After making the surgical treatment plan, the surgical movements are duplicated in the model surgery. During this procedure, reference points and lines are drawn on the base of the models over the dental arch, and sawcuts are made according to these marked osteotomy lines. This technique, however, has been found to be inexact, especially when the jaws are moved in several dimensions simultaneously. To overcome this, different methods have been developed for an accurate repositioning of the jaws as planned. A new appliance, Surgical Jaw Relator, has been devised by the author for the simple 3-dimensional relocation of the upper and lower models, resulting in the easy construction of the splints such as centric relation splint, intermediate and final splint. This article describes an introduction and a clinical application of this appliance. Through the application of this system to the orthognathic cases including two-jaw surgery, it is proved that the new device is very clinically useful.
Centric Relation ; Dental Arch ; Dental Occlusion ; Jaw* ; Mandible ; Maxilla ; Osteotomy ; Osteotomy, Le Fort ; Splints

OBJECTIVE: The purpose of this study was to investigate the horizontal skeletal pattern and dental arch differences between Class III malocclusion patients and normal occlusion patients. METHODS: Twenty skeletal Class III malocclusion patients and ten normal occlusion patients were selected and 3D facial CT were taken to analyze the horizontal skeletal differences between the two groups. RESULTS: In the horizontal comparison of the maxilla, skeletal width and perimeter were significantly smaller in skeletal Class III patients on ANS and A point reference planes. The difference between maxillary width of ANS and A point reference planes showed that there was greater constriction of the first and second premolar in skeletal Class III patients. In the horizontal comparison of the mandible, the widths of the canine and premolar area were significantly larger in skeletal Class III patients on B point reference plane. The differences between width of the upper and lower jaws (comparison of A and B reference planes) were significantly large in the canine and premolar area. CONCLUSIONS: From this study, the characteristics of Class III malocclusion patients were shown through horizontal constriction of the maxilla. But to make clear further detailed characteristics of Class III malocclusion patients, additional studies are necessary.
Bicuspid ; Constriction ; Dental Arch ; Humans ; Imaging, Three-Dimensional ; Jaw ; Malocclusion ; Mandible ; Maxilla ; Prognathism

PURPOSE: This is to review the complicated jaw fractures that had been referred for revision of the unsatisfactory results, and to provide proper managements for the easily complicated jaw fractures. MATERIALS AND METHODS: Twenty-nine patients who had been revised due to malunion or complicated fractures of facial bones for last 3 years were reviewed. The main problems required for revision, type of fractures complicated, the primary managements to be reclaimed, the specialties to be involved, the management to be reclaimed, time elapsed to seek reoperation, type of revision surgeries, residual complication were analysed with medical records, radiographs and final examinations. RESULTS: The major complaints were malocclusion(79.3%), facial disfigurement(41.3%), TMJ problems (13.7%), neurologic problems(10.3%), non-union(10.3%), and infection(6.8%). Unsatisfactory results were occurred most frequently after improper management of the multiple fractures of the mandible (62.2%), combined fractures of maxilla and mandible (20.6%), fracture of zygomatico-maxillary complex and midpalate (17.2%). The complications to be corrected were widened or collapsed dental arches (79.3%), improperly reduced condyles (41.3%), painful TMJ (34.4%), limited jaw excursion (31.0%), over-reduction of zygoma (13.7%), and nonunion with infection(13.7%). and dysesthesia (10.3%). The primary managements were nendereet by plastic surgeons in 82.7%(24/29) and by oral surgeons in 7.6%(2/29). Main causes of malunion are inadequate ORIF in 76%, unawareness & delay in 17%, and delayed due to systemic cares in 17%. 76% of 29 patients had been in state of intermaxillary fixation for over 4 weeks. Revision were done by means of "refracture and ORIF" in 48.2%(14/29), orthognathic osteotomies with bone grafts in 55.1%(16/29), and camouflage ountering & alloplastic implantations in 37.9%(11/29), TMJ surgeries in 17.2%, micro-neurosurgeries in 11.6%. Residual complications were limited mouth opening in 24.1% (7/29), paresthesia in 13.7%, resorption of reduced condyle in 10.3%. CONCLUSIONS: Failure of initial treatment of jaw fractures is due to improper diagnosis and inadequate treatment with lack of sufficient knowledge of stomatognathic system. It is crucial to judge jaw fracture and patients accurately, moreover, the best way of treatments has to be selected. Consideration of these factors in treatment could minimize the complication of jaw fractures.
Dental Arch ; Diagnosis ; Facial Bones ; Humans ; Jaw Fractures* ; Jaw* ; Mandible ; Maxilla ; Medical Records ; Mouth ; Osteotomy ; Paresthesia ; Reoperation ; Stomatognathic System ; Temporomandibular Joint ; Transplants ; Zygoma

BACKGROUND: Along with the advances in technology of three-dimensional (3D) printer, it became a possible to make more precise patient-specific 3D model in the various fields including oral and maxillofacial surgery. When creating 3D models of the mandible and maxilla, it is easier to make a single unit with a fused temporomandibular joint, though this results in poor operability of the model. However, while models created with a separate mandible and maxilla have operability, it can be difficult to fully restore the position of the condylar after simulation. The purpose of this study is to introduce and asses the novel condylar repositioning method in 3D model preoperational simulation. METHODS: Our novel condylar repositioning method is simple to apply two irregularities in 3D models. Three oral surgeons measured and evaluated one linear distance and two angles in 3D models. RESULTS: This study included two patients who underwent sagittal split ramus osteotomy (SSRO) and two benign tumor patients who underwent segmental mandibulectomy and immediate reconstruction. For each SSRO case, the mandibular condyles were designed to be convex and the glenoid cavities were designed to be concave. For the benign tumor cases, the margins on the resection side, including the joint portions, were designed to be convex, and the resection margin was designed to be concave. The distance from the mandibular ramus to the tip of the maxillary canine, the angle created by joining the inferior edge of the orbit to the tip of the maxillary canine and the ramus, the angle created by the lines from the base of the mentum to the endpoint of the condyle, and the angle between the most lateral point of the condyle and the most medial point of the condyle were measured before and after simulations. Near-complete matches were observed for all items measured before and after model simulations of surgery in all jaw deformity and reconstruction cases. CONCLUSIONS: We demonstrated that 3D models manufactured using our method can be applied to simulations and fully restore the position of the condyle without the need for special devices.
Chin ; Congenital Abnormalities ; Equidae ; Glenoid Cavity ; Humans ; Jaw ; Joints ; Mandible ; Mandibular Condyle ; Mandibular Osteotomy ; Maxilla ; Methods ; Oral and Maxillofacial Surgeons ; Orbit ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Surgery, Oral ; Temporomandibular Joint

We introduce a simple rehabilitation program after the miniplate fixation of high-condylar fracture of mandible. Intermaxillary fixation with arch bar is used. The length of the fixation period is about 14 days after surgery. At the end of this period, the bracket is applied to maxillary incisor, the occlusion becomes stable and reproducible and then aggressive jaw opening excercise begins. From postoperative day 15 to 21, elastics are applied 24 hours a day. They are placed lightly during the daytime to assist guiding protrusion of the mandible. The patient is instructed to protrude the mandible and to open the mouth simultaneously. From postoperative day 22 to 28, the exercise is modified to lateral movement. After the bracket is removed on postoperative day 29, the patient excercised the chin laterally without any guiding elastic fixation for approximately 1 week. This regimen can be widely used in ostectomy-osteosynthesis cases.
Chin ; Fracture Fixation ; Humans ; Incisor ; Jaw ; Mandible ; Mandibular Condyle ; Mouth ; Rehabilitation*

PURPOSE: This study was performed to analyze human maxillary and mandibular trabecular bone using the data acquired from micro-computed tomography (micro-CT), and to characterize the site-specific microstructures of trabeculae. MATERIALS AND METHODS: Sixty-nine cylindrical bone specimens were prepared from the mandible and maxilla. They were divided into 5 groups by region: the anterior maxilla, posterior maxilla, anterior mandible, posterior mandible, and mandibular condyle. After the specimens were scanned using a micro-CT system, three-dimensional microstructural parameters such as the percent bone volume, bone specific surface, trabecular thickness, trabecular separation, trabecular number, structure model index, and degrees of anisotropy were analyzed. RESULTS: Among the regions other than the condylar area, the anterior mandibular region showed the highest trabecular thickness and the lowest value for the bone specific surface. On the other hand, the posterior maxilla region showed the lowest trabecular thickness and the highest value for the bone specific surface. The degree of anisotropy was lowest at the anterior mandible. The condyle showed thinner trabeculae with a more anisotropic arrangement than the other mandibular regions. CONCLUSION: There were microstructural differences between the regions of the maxilla and mandible. These results suggested that different mechanisms of external force might exist at each site.
Anisotropy ; Hand ; Humans* ; Imaging, Three-Dimensional ; Jaw* ; Mandible ; Mandibular Condyle ; Maxilla