saeedeh khajehahmadi

Temporoparietal flap (TPF) is recommended when thin delicate tissue for medium sized defect is needed. The most used form of this flap is for auricle reconstruction. In this article usage of this flap for facial reconstruction other than auricle is discussed, emphasing on donor site morbidity.

In this retrospective study, archived files of the Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Mashhad, Iran were evaluated from 2016-2020. Patients whom TPF was used for facial reconstruction were included. Flap survival was checked and donor site morbidity was evaluated in the form of skin scar and frontal nerve branch injury.

This flap was used in 8 patients for facial reconstruction. All the cases had experienced Alopecia and this was the greatest when the skin of scalp was also included. All of the patients could elevate the eyebrow that means intact frontal branch of facial nerve.

TPF is a versatile flap for facial reconstruction. However, alopecia is high in composite fasciocutaneous form of this flap.

Large anterior palatal fistula and special alveolar clefts, such as edentulous atrophic premaxilla and absent premaxilla (premaxillectomy or agenesis), as well as wide unilateral alveolar cleft, are complicated cases in alveolar cleft bone grafting surgery. A superiorly-based buccinator myomucosal flap is suitable in this regard. The cleft patients whose large anterior palatal fistula and superiorly based buccinator myomucosal flap had been used for palatal or alveolar reconstruction were recruited in the study. The reconstruction method of the nasal floor, follow-up time, and hospital length of stay were recorded. A total of 10 patients had been treated by this method. The majority of them were male (6/10), the age range of the patients was 14-25 years. All flaps survived and a case of partial necrosis occurred. As evidenced by the obtained results, a superiorly-based facial artery musculomucosal flap is suitable when the palatal fistula is continuous with the alveolar cleft. Transmaxillary transfer is the other option in patients with closed maxillary arch.

The inferiorly and laterally based platysma myocutaneous flap contains hair in some ethnics; therefore, it is required to change the myocutaneous flap to myofascial flap to prevent the hair growth after its transfer to the oral cavity.   Five male mongrel dogs were selected for this study. De-epithelialized laterally based platysma flap, muscle part facing the oral cavity, was used for buccal reconstruction. The clinical healing process was photographed every week. After 40 days, biopsy specimens were obtained from the transferred flap.   According to the results, all flaps survived. At the end of the first week, the flap was covered with fibrinous exudate. On the third week, only the center of the transferred flap was not covered with mucosa. Within 40 days, the flap was distinguishable clinically from the adjacent buccal mucosa just by hypopigmentation. Hematoxylin and eosin staining of the biopsy specimens taken on day 40 showed thin stratified squamous epithelium covered with a tiny parakeratin layer.   Myofascial platysma flap, muscle part faced oral cavity, survives and undergoes mucosalization after adaptation to the recipient oral tissue.

Mandibular continuity defects after pathologic resections or traumatic events are difficult cases for reconstruction. Defects involving both hard and soft tissue loss are more challenging, because of problems in soft tissue coverage. The role of the submental flap in this regard is presented.
In a retrospective study from the archived files of Ghaem Hospital, Mashhad, Iran between 2007–2016, lateral mandibular defects that were managed with submental flap for soft tissue coverage were selected.
Ten patients had been treated, of whom four cases were due to trauma/gunshot events and six cases were defined as pathologic resection; five patients with malignant lesions and one with benign intraosseous pathology, but with soft tissue invasion. There was one complication overall, concerning orocutaneous fistula formation.
Submental flap is indicated for coverage of the reconstruction plate when the lateral mandible is resected/avulsed with soft tissue loss limited to the oral cavity or due to through and through defects in the lower third of the face.

Treatment of edentulous atrophic mandible with severe atrophy is a challenge based on local conditions and systemic diseases confronted by the age group affected. If bone grafting is indicated, it is often used in lateral or inferior aspects of the mandible.
Case Report: A 70-year-old male with a unilateral fracture of the atrophied left mandibular body was managed by lingual bone grafting and inferior border miniplate fixation to prevent two common problems after fracture healing; the need for plate removal before denture fabrication and facial asymmetry in the unilateral body fracture.
If bone grafting is indicated in the management of displaced edentulous mandibular fracture with severe atrophy, a combination of plating at the inferior border of the mandible and lingual corticocancellous bone grafting should be considered in treatment planning.

Saddle nose deformities mostly result from trauma. Most reports of saddle nose correction after trauma relate to isolated fractures, but in this article the experience of the authors is presented in relation to bone grafting for the correction of the saddle nose in multiple facial fracture patients..
The current study aimed to report the results of a protocol for choosing the source of bone graft for dorsal nasal bone grafting in acute trauma patients with multiple facial fractures..
Patients and In a retrospective study, archived files of maxillofacial trauma patients who were treated between 2005 and 2012 at Mashhad Emdad hospital (a level one trauma center) were reviewed. Cases were selected in which a traumatic saddle nose deformity concomitant with other facial fractures had been corrected with dorsal nasal bone grafting. The donor site, type of fixation, access to the dorsum of the nose, associated facial fractures, shape of the graft (cantilever or L-shaped), and plane of dissection in the dorsum of the nose (subperiosteal or subcutaneous) were assessed..
There were 11 patients treated using this method. The male-to-female ratio was 7:5. One miniscrew with the lag technique was the preferred method for the fixation of the dorsal nasal bone graft. Splitcalvarial bone graft was the most commonly used type of bone graft. An open rhinoplasty approach and maxillary degloving were two commonly used incisions, and the most commonly associated fractures were maxillary Lefort fractures. The cantilever design was used in eight patients for the correction of the saddle nose deformity, and in four patients the bone graft was inserted into the nose in the subcutaneous plane..
Saddle nose reconstruction with bone graft in multiple facial fracture patients is a predictable method if surgical accesses to the region are carefully designed, considering the accompanying fractures..

Palatal fractures are frequently associated with maxillary fractures in midfacial trauma. These fractures may cause diagnostic and therapeutic challenges. If treated improperly, results would be malunion, malocclusion, and oronasal fistula formation. Herein, we aimed to evaluate the effectiveness of the conventional miniplates used overmucosaly in the management of maxillary palatal fracture.
Under general anesthesia, arch bar was fixed to the existing teeth. After fixation of palatal fractures, appropriate occlusion was obtained by transpalatal wiring. Fixation of palatal fractures was performed with a conventional four-hole, straight-bar miniplate with 2 mm thickness and four 8-mm-long screws on both fracture sides. The patients remained with intermaxillary fixation for seven days and elastic therapy for two weeks. Miniplate and screws were removed about 8-12 weeks after their application. Follow-up was performed every three months for one year.
This technique was applied for 10 trauma patients with maxillary palatal fracture. Palatal overmucosal plate and screws remained rigid in their position until their removal. None of the patients suffered from oronasal fistula, bone exposure, or mucosal necrosis. Interference with speech and swallowing, as well as tongue irritation and difficulty in oral hygiene maintenance were not reported by any of the patients. Palatoalveolar segments remained in proper position, and pretraumatic occlusal patterns and facial width were restored except in one case.
Fixation of the palatal fractures with the conventional miniplates without elevation of mucoperiosteal flap helps with stability and preventing palatal width problems. In so doing, complications including fistula formation and interference with oral cavity functions are avoided.

The final result of tooth decay or periodontal diseases is tooth loss. The high frequency of edentulism demonstrates the fact of undesirable oral health care in society and also the unawareness of the people toward oral health care. The aim of this study was to determine the prevalence of tooth loss in Jajarm City during 2011-2012.
In the current descriptive cross-sectional study, 560 patients were selected using cluster random sampling. Variables in a questionnaire included age, gender, occupation, education, personal hygiene, income, and certain habits in which the amount of edntulism was defined. To investigate the difference between the study groups, Chi Square test was used. The statistical significance level was considered less than 0/05.
322 women and 238 men among 20,000 residents of Jajarm city were studied in this study. Mean age of participants was 28/02 ± 5/11. 42/5% men and 57/5% women of participants had missing teeth. The Edentulism was observed in 86/9% employees and 70/8% staffs. A statistically significant relationship was between gender, occupation, education, personal hygiene, certain habits and income.
the prevalence of tooth loss was 71.4% in JaJarm City. Regarding to the results of this study, preventive policies in the prevention of edentulism, replacement of missing teeth and training on prevention principles of the tooth decay and periodontal diseases by the use of effective methods are essential to prevent edentulism.

Reconstruction of the oral cavity witha flap design containing the buccal mucosa and buccinator muscle but excluding the facial artery and vein is the topic of these case reports.
Case Reports: This article uses random pattern vertically oriented partial thickness buccinator myomucosal flap for intraoral reconstruction in two cases. The first was for lining the mandibular anterior vestibule in a trauma patient. The second was for oral side coverage of bone graft in special cleft patient. In both patients, this flap survived and good bone coverage with non-keratinized mucosa was obtained.
Thin long buccal myomucosal flap not including facial artery and vein can survive.

Pediatric mandibular fractures have been successfully managed in various ways. The use of a lingual splint is an option. This article presents a 4-year old boy who was treated by an alternative conservative method with a combination of an arch bar plus a lingual splint, circum-mandibular wiring and IMF for the reduction, stabilization and fixation of a severely displaced bilateral mandibular body fracture. This technique is a reliable, noninvasive procedure; it also limits the discomfort and morbidity associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients.

The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned.. Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects.. The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss..

Wound dehiscence after lower third molar surgery extends the postoperative treatment period and may cause long-standing pain. The aim of this study was to compare wound dehiscence after removal of wisdom teeth in the most prevalent mandibular impaction (mesioangular class IB) by two different soft tissue flap designs. Partially-erupted mandibular third molars with mesioangular class IB impaction (Pell and Gregory classification) were selected. Split mouth technique was used to compare the two flap designs (envelope vs. triangular transposition flap—TTF). The patients were recalled one week and a month later and rechecked for dehiscence, infection, and dry socket formation. There were no cases of infection in either group. However, three cases of dry socket in the envelope group and four in the TTF group were recorded. In the envelope group, dehiscence occurred in 43% of cases during the first week, with 67% of cases being a large dehiscence (diameters of more than 5 mm). Extra appointments (those requested by the patient exclusively related to the problem of the hole distal to the second molar) were scheduled in 10% of cases in the envelope group. In the TTF group, dehiscence occurred during the first week for the same impaction in 19% of cases with large dehiscence cases occurring in 65% of cases and extra appointment rate at 4.1%. According to the results in the evaluated operation, TTF may prevent postoperative wound dehiscence more probably than the envelope flap.

Dermoid/Epidermoid cysts are rare pathologic lesions that may involve the floor of the mouth. Infection and inflammation of the cyst can produce a clinical picture very similar to the submandibular and submental abscesses with odontogenic origin. Dermoid/epidermoid cysts are on the floor of the mouth with submental or submandibular component can be mistaken for odontogenic infections. Four biopsy proven dermoid/epidermoid cysts operated in the Mashhad University of Medical Sciences, Ghaem hospital (2012-2013), were reviewed. Four patients, including two classic cases and two infected dermoid/epidermoid cysts, were erroneously diagnosed as odontogenic infection. The lesions located solely below mylohyoid muscle need to be removed through anextraoral approach but the lesions above the mylohyoid muscle or those that have both supra- and infra-mylohyoid components can be removed through an intraoral incision. Dermoid/epidermoid cysts should be considered in the differential diagnosis of submental/submandibular swellings. In the absence of an odontogenic cause of infection, fine-needle aspiration biopsy and appropriate imaging evaluation techniques with sonography, CT or MRI are mandatory for correct diagnosis and surgical treatment planning. The clinicians should be very cautious to differentiate odontogenic infections from infected dermoid/epidermoid cysts.

Periapical lesions are induced in response to injuries to periapical tissues, which are generally the result of infections within the root canal. Mast cells actively participate to the inflammatory infiltration of periapical granulomas and cysts.. The aim of this study was to detect and compare the presence of mast cells in inflammatory periapical lesions, including cysts and granulomas.. In this cross-sectional study, 26 samples of inflammatory periapical lesions (17 cysts and nine granulomas) were stained with an immunohistochemical technique using CD117 (C-KIT) antibody to detect mast cells. Then, mast cell count (the number of mast cells in 0.2 mm2) and the intensity of mast cell staining were determined by two board certified pathologists. Fisher exact test and t-test were used for statistical analysis, with P < 0.05 for statistical significance.. Although mast cells were observed in all samples, there were more numerous in periapical granulomas compared to periapical cysts, with no statistically significant difference (P = 0.076). The results also demonstrated that the staining in periapical cysts and granulomas were of strong and moderate intensity, respectively, without any significant difference (P = 0.411).. According to the results of this study, it appears that mast cells are present in all the investigated inflammatory periapical lesions and might play a role in the pathogenesis of these lesions..

The glandular odontogenic cyst (GOC) is a rare lesion with odontogenic origin. It shows a propensity for recurrence revealed in 30% of all case. This investigation reports a case of recurrent GOC in a 35-year-old female in the anterior region of the maxilla, which is uncommon and discusses about IHC finding, surgical methods, and differential diagnosis. Under general anesthesia, peripheral bone ostectomy via large round bur for removal of remaining epithelium of the cyst wall was done. Finally liquid nitrogen was used to remaining bone. This article recommends that soft tissue adjacent to the cortical bone perforation should be excised, as well as peripheral bone ostectomy by large round bur for removal of remaining epithelium of the cyst and liquid nitrogen application to the bony cavity. Because of high recurrence rate of the lesion close follow up of the patients is needed.

Orthodontic elastic has been investigated for tooth movement. Study about their use in treatment of jaw fractures is limited. This study is designed to measure force relaxation of 3/16 inch heavy latex orthodontic elastics in jaw fracture treatment simulated conditions. This study is designed to study the force relaxation of 45 heavy 3/16 inch orthodontic elastic (American Orthodontist, AO) (4/8 mm internal diameter) were measured using Zwick testing machine (Zwick GmbH & Ulm Germany) in 0, 1, and 14 days of immersion in simulated oral environment. In each of these three occasions, 15 specimens were placed in jigs with metallic pins that inserted 15 mm and 20 mm apart that is equivalent to the normal inter-arch space in a closed mouth position. The jigs were incubated in 37°C and each 24 hours they received 10 thermal cycles of 55°C and 5°C for 30 seconds in a thermocycle. The distribution of the data was evaluated by Klomogrov-Simirnov test and after confirmation of a normal distribution; data was analyzed using analysis of variance (ANOVA). Mean force decay at 15 mm stretch was significantly differ between 0-1 days and 0-14 days (P < 0.05) but was not significantly differ between 1-14 days. The same relations exist for 20 mm stretch. This study creates scientific basis for use of orthodontic elastics in treatment of fractured jaws.

Knowledge of the presence of the alveolar antral artery in the lateral maxillary sinus wall is essential for surgeons who operate in this region. The purpose of this study was to investigate the correlation between alveolar antral artery diameter and lateral maxillary bony wall thickness in dentate patients. Thirty five Cone-Beam Computed Tomography (CBCT) scans from 35 dentate patients were selected in coronal sections in three locations; second premolar (P2), first molar (M1), and second molar (M2). The presence of the alveolar antral artery in each situation was determined and the bone thickness in the region of alveolar antral artery was measured perpendicular to the lateral wall of the maxilla. The alveolar antral artery was present in 67.1% CBCTs. The difference between the alveolar antral artery diameter was only significant in the first and second molar area (P=0.039).There were significant differences between bone thickness in three locations, with the thickest bone in the first molar area followed by the second molar and second premolar, respectively. The correlation coefficient showed that there is a positive correlation between bone thickness and alveolar antral artery diameter. This study showed that the thicker the bones in dentate patients, the greater the chance of interference with the large caliber intra-osseous alveolar antral artery.

Assessment of the lateral wall thickness of the maxillary sinus is very important in decision making for many surgical interventions. The association between the thickness of the lateral wall of the maxillary sinus and the dental status is not well identified.. To compare the thickness of the lateral wall of the maxillary sinus in individuals with and without teeth to determine if extraction of the teeth can lead to a significant reduction in the thickness of the maxillary sinus lateral wall or not..Patients and In a retrospective study on fifty patients with an edentulous space, the thickness of the lateral wall of the maxillary sinus,one centimeter above the sinus floor in the second premolar (P2), first molar (M1) and second molar (M2) areas was determined by cone beam computed tomography scans(CBCTs) and a digital ruler in Romexis F software (Planmeca Romexis 2.4.2.R) and it was compared with values measured in fifty dentated individuals. Three way analysis of variance was applied for comparison after confirmation of the normal distribution of data.. The mean of the wall thickness in each of these points was lower in patients with edentulous spaces; however it was not significant. There was no association between gender and the thickness of the lateral wall of the maxillary sinus, but location was associated with different thicknesses.. The differences in the thickness based on the location and dental status necessitates assessment of the wall thickness of the maxillary sinus in addition to the current evaluation of bone thickness between the sinus floor and the edentulous crest before maxillary sinus surgery..

The horizontal bony canal in the lateral maxillary wall is the site of anastomosis between the arterial branches from the posterior superior alveolar artery (PSAa) and the infraorbital artery. This anatomic structure is known as the ‘alveolar antral artery’. We performed a literature review. The anatomic location of the alveolar antral artery in the lateral maxillary sinus wall was researched and its importance in surgical procedures routinely performed on this bony wall discussed. This artery can be accidentally involved during surgical procedures on the lateral maxillary sinus wall, such as open sinus lift surgery, horizontal osteotomy of the maxilla, Le Fort I fracture treatment, and Caldwell-Luc surgeries. The alveolar antral artery is an important anatomic structure in the lateral maxillary sinus wall. A preoperative cone beam computed tomography (CBCT) scan can be used as a good diagnostic procedure to reduce surgical complications in suspected cases as well as conditions that may involve this artery.

In open reduction and internal fixation for the treatment of mandibular fracture, the fixation technique used is very important in reducing post-operative complications and promoting the healing process. This study assessed the results of fixation of the mandible using two mini-plates perpendicular to each other in the lower border of the mandible for fracture treatment. Access to the fractures was via an extraoral approach (through existing scars or incisions). After reductions of mandibular fractures, the fracture line fixation was accomplished using two mini-plates perpendicular to each other. One-week intermaxillary fixation (IMF) was applied and 3 weeks of soft diet was recommended in the post-operative period. All patients were followed up for at least 1 year regarding infection and malocclusion. Twenty-five patients (28 fracture lines) underwent this technique. Most (81.8%) patients were male and the mean age was 41.3±7.59 years (range, 17–73 years). Symphyseal fracture (frequency, 52%) was the most prevalent followed by angle (32%) and body (16%) fractures. Among the patients who underwent surgery, only one malocclusion and no cases of infection were observed. No cases [Rachel1] of facial nerve weakness or damage were observed in this study. This method can be used in specific cases to replace treatment with one mini-plate, which necessitates a more intensive fixation or reconstruction plate therapy.

Assessment of the lateral wall thickness of the maxillary sinus is very important in decision making for many surgical interventions. The association between the thickness of the lateral wall of the maxillary sinus and the dental status is not well identified.. To compare the thickness of the lateral wall of the maxillary sinus in individuals with and without teeth to determine if extraction of the teeth can lead to a significant reduction in the thickness of the maxillary sinus lateral wall or not..Patients and In a retrospective study on fifty patients with an edentulous space, the thickness of the lateral wall of the maxillary sinus,one centimeter above the sinus floor in the second premolar (P2), first molar (M1) and second molar (M2) areas was determined by cone beam computed tomography scans(CBCTs) and a digital ruler in Romexis F software (Planmeca Romexis 2.4.2.R) and it was compared with values measured in fifty dentated individuals. Three way analysis of variance was applied for comparison after confirmation of the normal distribution of data.. The mean of the wall thickness in each of these points was lower in patients with edentulous spaces; however it was not significant. There was no association between gender and the thickness of the lateral wall of the maxillary sinus, but location was associated with different thicknesses.. The differences in the thickness based on the location and dental status necessitates assessment of the wall thickness of the maxillary sinus in addition to the current evaluation of bone thickness between the sinus floor and the edentulous crest before maxillary sinus surgery..

Lateral ridge split technique is a way to solve the problem of the width in narrow ridges with adequate height. Simultaneous insertion of dental implants will considerably reduce the edentulism time. Twenty-five patients who were managed with ridge splitting technique were enrolled. Thirty-eight locations in both jaws with near equal distribution in quadrants received 82 dental fixtures. Beta Tricalcium phosphate (Cerasorb®) was used as biomaterial to fill the intercortical space. Submerged implants were used and 3 months later healing caps were placed. Direct bone measurements before and after split were done with a Collis. Patients were clinically re-evaluated at least 6 months after implant loading. All the data were analyzed by Statistical Package for Social Sciences (SPSS) software version 11.5 (SPSS Inc, Chicago Illinois, USA). Frequency of edentulous spaces and pre/post operative bone width was analyzed. Paired t-test was used for statistical analysis. Difference was considered significant if P value was less than 0.05. Mean value for presplit width was 3.2 ± 0.34 mm while post-split mean width was 5.57 ± 0.49 mm. Mean gain in crest ridge after ridge splitting was 2 ± 0.3 mm. Statistical analysis showed significant differences in width before and after operation ((P < 0.05). All implants (n = 82) survived and were in full function at follow up (at least 6 months after implant loading). Ridge splitting technique in both jaws showed the predictable outcomes, if appropriate cases selected and special attention paid to details; then the waiting time between surgery and beginning of prosthodontic treatment can be reduced to 3 month.

Squamous cell carcinoma of the tongue (SCCOT) is the most common malignant neoplasm in oral cavity. At the time of the diagnosis of SCCOT regional metastases with a high mortality rate are common, which is due to the extensive lymphatic system drainage of the tongue. Although the level of healthcare has significantly improved, the survival rate is still low with an unsatisfactory cure rate. The present study was designed to establish a clinical review on adults with SCCOT and to determine whether the rate of SCCOT has been changed over the 20-year. A cohort of 102 patients was recruited for this retrospective study. The study was carried out by reviewing the medical reports and case notes of patients with histologically confirmed SCCOT. The peak incidence was observed between 60 and 70 years. Stage I disease was found in 24, stage II in 64, stage III in 10 and stage IV in four patients. Seventy-three patients were treated with combined therapy; surgery and radiation, whereas, 29 patients received only surgery. The overall 5-year survival was 60%. Thirty patients developed tumor recurrence including 12 local, 12 nodal, four locoregional, and two distant. Thirty-four patients died during the follow-up period, six with persistent disease, and 62 remained cancer free, giving a mortality and morbidity rate of 39%. This study recommends aggressive early treatment of patients with SCCOT including resection of the primary tumor with a safe margin (1.5cm) in addition to an appropriate neck dissection.

Recent investigations show that both proliferation and secretion of macromolecules by cells can be regulated by low level laser therapy (LLLT). The aim of this study was to determine whether LLLT could induce a bio-stimulatory effects on human gingival fibroblasts (HGF3-PI 53). Therefore, the effect of laser irradiation on human gingival cell proliferation and collagen type I gene expression was studied. HGF3-PI 53 were cultured in 96-well plate and then irradiated with LLLT gallium-aluminum-arsenide (Ga–Al–As), 810 nm, 50 mW diode laser (energy: 4 J/cm2) for three consecutive days. The cell proliferation was measured on days 1, 2 and 3 after irradiation with LLLT using MTT assay. Real time PCR analysis was utilized on day 3 to evaluate the expression of collagen type I gene. Evaluation of cellular proliferation, one day after laser treatment showed no difference compared to control group. But on days 2 and 3, significant increase in proliferation was observed in the irradiated cell populations in comparison to the control group. Treatment of HGF3-PI 53 by laser resulted in a significant increase in collagen I gene expression on 3 day. The results demonstrated that LLLT stimulated human gingival fibroblast proliferation as well as collagen type I gene expression in vitro.