Percutaneous cryoablation of benign bony tumours of the mandible Publication date: Available online 15 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): L. May, J. Blatter, P. Bize, G. Tsoumakidou, A. Denys, M. Broome Abstract Treatment of bony tumours of the oral and maxillofacial area usually involve resection. However, access to certain areas may be difficult because of the size or site of the tumour. A poor view of the lesion during operation is another limiting factor, which can lead to incomplete resection in difficult cases. Percutaneous cryoablation is a common procedure for treating benign and malignant bony lesions outside the oral and maxillofacial area, but has to our knowledge never been used as a stand-alone treatment as we describe here. In 2016, three patients with benign bony tumours of the mandible (one a keratocyst, one an angiofibroma, and one a giant cell granuloma) were treated with one session of percutaneous cryoablation. Outcomes were monitored with computed tomography or magnetic resonance imaging at one year. No patient had a procedure-related complication, and there were no other complications. Radiological controls showed complete recovery. Percutaneous cryoablation seems to be an interesting and valuable alternative to resection for bony lesions with its limited access and high operative morbidity.

Partial duplication of the jaw: case reports and review of relevant publications Publication date: Available online 15 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): Y. Wang, H. Liu, N. Zhang, E. Luo Abstract Craniofacial duplication is a rare congenital malformation with a wide phenotypic range. The signs and symptoms range from partial craniofacial duplication to bicephalus. We describe two cases of partial duplication of jaw: a girl with a duplication of the maxilla, and a boy with duplication of the mandible. We review the relevant publications and discuss the pathogenesis.

Laurence Oldham 1931 - 2019, BDS, FDS Publication date: Available online 13 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): A.G. Miller

Intraosseous venous malformation of the craniofacial region: diagnosis and management Publication date: Available online 13 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): B. Srinivasan, E. Chan, T. Mellor, P. Ramchandani, M. Ethunandan Abstract Vascular lesions mainly affect soft tissues, and less than 1% affect bone. In 1982, they were categorised by Mulliken and Glowacki as haemangiomas or vascular malformations, and an updated classification was subsequently published by the International Society for the Study of Vascular Anomalies. These lesions, however, continue to be termed haemangiomas and there is little attempt to differentiate between them. We report eight cases of intraosseous venous malformation that were inappropriately labelled as haemangioma by clinicians, pathologists, and radiologists. We highlight tailored management, and describe the clinical features, results of investigations to aid accurate designation (histological and immunohistochemical, including GLUT1 staining and cross-sectional imaging), and outcomes.

Protocol for the management of ankylosis of the temporomandibular joint Publication date: Available online 13 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): J.N. Khanna, Radhika Ramaswami Abstract Ankylosis of the temporomandibular joint (TMJ) is a severely deforming, disabling condition as a result of craniomandibular fusion caused mainly by condylar fractures with displacement of the meniscus. Ankylosis may be fibrous, fibro-osseous, or bony, and unilateral or bilateral. The severity of the deformity is based on the onset, duration, and type of ankylosis. Various surgical techniques have been described for treatment, but no single treatment is recommended because of inconsistent results and the high rate of failure. While our total experience extends to 300 cases, we have developed a protocol using the most recent 193 patients to address our earlier high failure rate. The onset was during childhood in 168 patients, and 25 were adults. We describe the protocol that we developed for these two groups. Our management included gap arthroplasty, costochondral grafting, temporalis flaps, ramus osteotomies, and transport distraction.

Development of a biomarker of efficacy in second-line treatment for lymphangioma of the tongue: a pilot study Publication date: Available online 12 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): V. Pandey, P. Tiwari, S.P. Sharma, R. Kumar, P. Panigrahi, O.P. Singh, S. Patne Abstract Lymphangioma of the tongue is a rare lymphatic malformation, and various authors have reported the successful use of sirolimus for its treatment. However, the safety of sirolimus in children needs further evaluation so that those who do not respond are not necessarily exposed to its potential adverse effects. We hypothesised that assessment of lymphangiogenesis can be used to predict whether the patient will respond to sirolimus, so we organised a prospective study after ethics committee approval had been given. After clinical and histological diagnoses of lymphangioma of the tongue had been confirmed, 16 patients were given sirolimus 0.8 mg/day in three divided doses. Clinical response was assessed and compared with lymphatic microvessel density (LMVD), which was calculated immunohistochemically using the monoclonal antibody D2-40 as the lymphatic endothelial marker. Nine patients responded well, five partially, and two failed to respond. Mean (SD) LVD among the good responders was 21.00 (3.74), whereas among non-responders it was 8.00 (4.24). There was a significant difference in mean LVD between good responders, partial responders, and non-responders (p = 0.04). Sirolimus is effective in treating children with lymphangioma of the tongue, and lymphangiogenesis is a useful therapeutic predictive marker.

Submental intubation in oral and maxillofacial surgery: a systematic review 1986–2018 Publication date: Available online 11 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): E.Z. Goh, N.H.W. Loh, J.S.P. Loh Abstract Submental intubation is a low-risk alternative to tracheostomy when nasotracheal or orotracheal intubation is not appropriate. To improve the selection of patients and clinical outcomes we have explored published papers on submental intubation in oral and maxillofacial surgery, and included a proposal for a decision pathway. Systematic searches of PubMed, Scopus, and Cochrane databases for papers published between 1986 and 2018 yielded 116 eligible articles (one randomised controlled trial, 61 case series, 40 case reports, six surgical techniques, and eight letters) that included 2 229 patients. Measured outcomes were the indications, techniques, devices used, time taken to complete the procedure, and complications. Indications were trauma (81%), orthognathic surgery (15%), disease (2%), and cosmetic surgery (1%). Technical preferences were for a one-tube (84%) over a two-tube technique (6%), and a paramedian (52%) over a median incision (33%). The preferred device was a reinforced endotracheal tube (85%). The mean (range) intubation time was 10 (2–37) minutes. The complication rate was 7% (n = 152), the most common being superficial skin infection (n = 54), hypertrophic scarring (n = 18), and damage to the tube apparatus (n = 15). Submental intubation has minimal complications, takes a short time to do, and it is a useful alternative to tracheostomy in some oral and maxillofacial operations. More robust evidence regarding the selection of patients, modifications to the technique, and a comparison of risk with that of tracheostomy, are needed for further evaluation of its feasibility.

Posting a pericranial flap through a “letterbox” into the frontal bone to reconstruct an anterior cranial defect: a new approach Publication date: Available online 11 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): R.J.J. Pilkington, N.R. Aculate, D. Gahir, M. Isles

Use of a chalazion clamp for intraoral biopsies: a technical note Publication date: Available online 11 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): L. Shah, S. Fogden, A. Majumdar Abstract Oral biopsies are common diagnostic and therapeutic procedures in oral and maxillofacial surgical (OMFS) outpatient departments. The chalazion clamp is similar to a pair of forceps. One extension has a flat, solid, oval plate, the other, a ring-like structure that is used to clamp and retract soft tissues. We highlight the benefits of using this simple, widely-available tool during oral biopsies. We find that the clamp increases effectiveness and efficiency for the clinician and assistant. We recommend its use in daily OMFS practice.

Postoperative stability of conventional bimaxillary surgery compared with maxillary impaction surgery with mandibular autorotation for patients with skeletal class II retrognathia Publication date: Available online 11 November 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): S. Kita, K. Fujita, H. Imai, M. Aoyagi, K. Shimazaki, I. Yonemitsu, S. Omura, T. Ono Abstract We aimed to compare the postoperative stability of conventional bimaxillary surgery (with bilateral sagittal split osteotomy) with that of maxillary impaction surgery (with mandibular autorotation without bilateral sagittal split osteotomy) in patients with skeletal class II retrognathia. Patients were assigned to have conventional bimaxillary surgery (conventional group, n = 6) or mandibular autorotation (experimental group, n = 7). Measurements were made using serial lateral cephalometric radiographs taken immediately preoperatively (T0), immediately postoperatively (T1), and one year later (T2) to assess the variation in operative change (T1-T0) and relapse (T2-T1). There was no significant difference in median (range) surgical change in the anterior movement at point B (conventional group, 4.5 (3.0–11.0) mm; experimental group 4.1 (2.1–6.4) mm). However, there was a significant difference in median (range) surgical posterior movement relapse at point B (conventional group −1.7 (−2.3 to −0.5) mm; experimental group −0.6 (−1.0 to 1.0) mm; p = 0.032). Mandibular advancement with mandibular autorotation is therefore a more stable procedure than mandibular advancement with bilateral sagittal split osteotomy in patients with skeletal class II retrognathia.