Journal of Craniomaxillofacial Research
Volume:6 Issue: 4, Autumn 2019

In orthognathic surgery, maxillomandibular complex (MMC) refers to a  three-dimensional dento-osseous structure consisting of the surgically-mobilized part of the maxilla together with the distal segment (i.e., tooth bearing segment) of the mandible (either surgically  mobilized or not). In fact, MMC is the skeletal part of the lower face. The size, shape and position  of MMC play a major role in soft tissue esthetics of the lower face. 

A comprehensive review of the current data regarding effects of maxillomandibular complex rotation in sagittal plane, on “occlusal plane, TMJ, sleep apnea, paranasal soft tissues, upper lip, chin, cervicomental soft tissues” was conducted. 

MMC rotation and translation could take place in any of the three planes of reference  including sagittal, coronal, and horizontal. Any kind of changes in the position of MMC could  have its own functional and esthetic consequences. In general, patients with convex facial profiles  require counter clockwise rotation while patients with concave profiles require clockwise rotation. 

MMC not only has great impacts on facial esthetics, but also has significant functional  effects, for example in breathing and mastication. Alteration in the position of MMC is possible by orthognathic surgery.

Comprehensive knowledge about the anatomy of the surgical site is an important prerequisite for any surgical procedure. This study aimed to assess the prevalence, position and anatomical characteristics of mandibular incisive canal (MIC), lingual foramen (LF) and anterior loop of the mandibular canal (ALMC) in an Iranian population using cone beam computed tomography (CBCT).

This study was conducted on 103 patients who underwent CBCT prior to implant placement. The CBCT scans of patients were evaluated by two observers to determine the visibility and length of MIC, LF and ALMC. The buccolingual inclination of MIC at the initiation point of canal and canal path were also studied.

The prevalence of MIC, LF and ALMC was 90%, 76% and 84% on CBCT scans, respectively. The mean length of MIC and ALMC was 7.5mm and 1.2mm, respectively and the mean width of LF was 0.9mm. The MIC had a buccal inclination at the initiation point and approximated the lingual plate as extended towards the midline. Analytical statistics including independent samples t-test, paired samples t-test, ANOVA analyses were applied.

Considering the high prevalence of MIC, ALMC and LF and wide range of MIC (1.2mm to 20mm) and ALMC (1mm to 9.9mm) length, CBCT is recommended for patients prior to surgical procedures in the anterior mandible to determine the exact location of these anatomical structures.

Laser assisted uncovering of dental implants is one of the most interesting aspects of lasers utilization. Compared to conventional scalpel technique, this method provides less bleeding and pain and shorter healing period, leading to a better patient compliance. The objective of this study is to contribute a comprehensive review on laser assisted second-stage of implant surgery.

We searched Pubmed and Google Scholar databases using combined keyword search or medical subject headings. Eight articles from 2009 to 2019 were identified and assessed.

Selected studies were categorized according to variables including amount of pain, need for anesthesia, soft tissue healing, temperature rise and quality of impressions. All the reviewed articles, measuring the amount of required anesthesia, agreed that laser-aided uncovering of implants needs significantly less anesthesia compared to conventional scalpel technique. Laser-assisted uncovering of their implants led to less pain. Ex-vivo studies measuring temperature rise, suggested that application of a non-contact 445nm diode laser reduces the temperature rise significantly. However, Er:YAG lasers proved to generate lower temperature rise. Diode lasers showed no significant amelioration of soft tissue healing whilst Er:YAG and Er,Cr:YSGG lasers revealed superior esthetic results and shorter healing period. Impressions can be taken 4-7 days after the laser-assisted surgery with a satisfactory quality.

Laser-assisted uncovering of implants can be selected as an alternative over the conventional scalpel technique. But, further studies are advisable.

The long term clinical success of dental implants depends on the stability of crestal bone level. Different dental implantation systems focus on micro-and macro-design to reduce late bone resorption. The purpose of this study was to evaluate bone loss at the proximal (mesial and distal) surfaces of SLA implants from 2 different companies.

This retrospective cross-sectional study was done on 48 patients receiving 161 SLA-surfaced (Straumann and Dentium) dental implants. The marginal bone loss was measured at mesial & distal sides of the implants on peri-apical X-ray images. The effective factors considered in this study were patients age, implant brand, time passed from fixture placement, preprosthetic surgery and type of prosthetic treatment that were obtained from patient records & interviews.

Average mesial and distal bone loss was 1.50±1.359 and 1.517±1.3465 respectively. Pearson correlation coefficient indicates that 1) time passed from fixture placement, 2) commercial brand, 3) history of pre-prosthetic surgery and 4) age affected the amount of bone loss.

SLA-surfaced dental implants showed an acceptable amount of bone resorption and no statistically significant difference was observed between commercial brands.

Leiomyosarcoma (LMS) is an uncommon malignant spindle cell tumor of the head and neck region. It is extremely rare in the oral cavity that arises from smooth muscle differentiation. It may arise as primary, radiation-associated, or metastatic tumor. The clinical appearance of these tumors can be deceptively benign and can be mistaken for non-malignant conditions. Here We present a case with atypical leiomyoma of the mandible in a 40-year- old man who referred with complaint of pain and swelling in his jaw. He underwent surgery and histology and immonohistochemestery studies confirmed the diagnosis. After 6 months recurrence occurred. Histologic examination confirmed leiomyosarcoma so he was managed with surgical excision followed by radiotherapy and chemotherapy without any recurrence or metastasis after 2 years of follow-up.

Head and neck oncologic resections leave complex defects which are challenging to reconstruct. In head and neck region, aesthetic facial units should be considered and a thin, malleable, suitable texture and color flap should be applied. Supraclavicular artery Island flap is fasciocutaneous flap, that taken from skin on the shoulder and supraclavicular area that based on supra clavicular artery. One of the advantages of the supraclavicular artery Island flap is the possibility of one-stage reconstruction with minimal morbidity. The objective of our study were to describe our initial experience using the supra clavicular artery Island flap in conjunction with karapandzic flap for reconstruction of lower facial defects.

Lipoma is a rare benign tumor that overgrows in oral cavity. Its occurrence rate is about 1-4% with predilection for males rather than females. Lipoma is associated with adipose tissue and is usually seen in major salivary glands, buccal mucosa, and vestibule. Fifty percent of lesions are seen in buccal mucosa. The progressive and aggressive growth of these lesions may interfere with speech and mastication owing to the dimensions and location of the tumor. The lesion basically affects the individuals of 4th to 5th decades. Lipoma is managed by surgical excision using scalpel, laser, or electro-cautery.

This study presents two 63 and 18 years old male patients with lipoma in their buccal mucosa along with their improved situation following the treatment. The treatment included surgical excision of the lesion and suturing the surgical area.

The incidence of intraoral lipoma is low and buccal mucosa is the most common region for the occurrence of oral lipoma. Most clinicians suggested surgical techniques as a certain treatment