Oral Surg Research Articles

The Oral Medicine workforce and impact on access to care in the United States

The objective of this study was to characterize the current oral medicine (OM) workforce by examining the distribution of OM diplomates (OMDs) across the Unites States and to determine the need for expanding access to care. The OMD access was calculated based on the OMDs per 10,000 state population from the 2020 US Census data as well as their distance from state capitals and most populated cities. OMD penetrance in hospitals and cancer centers was assessed at National Cancer Care Network (NCCN) cancer centers, and Best Hospitals as reported in the 2022 US News and World Report (USNWR). OMDs are present in 64% of the states with an uneven geographic distribution. Primary workplaces included dental schools (47%), hospitals (30%), and private practices (19%). Of the OMDs in private practice, 57% limited their practice to OM. OMDs were noted at 28% of NCCN cancer centers, 30% of USNWR Best Hospitals for Cancer, and 20% of USNWR Best Hospitals. There is low density and uneven distribution of OMDs with approximately one-third of the population without access to an OMD in their state, thus limiting access to care. This suggests both vast opportunities for growth and expansion of OM, as well as challenges in developing and training the necessary workforce. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Relationship of microvascular density and tumor-associated macrophages with orofacial squamous cell carcinoma progression

The current study aimed to investigate the characteristics of tumor-associated macrophages (TAMs) and their association with microvascular density (MVD) in tumor progression in different grades of orofacial squamous cell carcinoma (OSCC) in the Pakistani population. This prospective study included 234 patients with oral cancer reported at different hospitals in Pakistan diagnosed with OSCC. Tumors were graded on the Anneroth grading system and the association between the frequency of TAMs and MVD was examined in vivo. The macrophages visible through immunohistochemistry for CD68 and the microvessels observed through immunohistochemistry for CD34 were manually counted in 3 high-power fields. The CD68 and CD34 counts were significantly lower in well-differentiated squamous cell carcinoma compared to poorly differentiated squamous cell carcinoma. Linear regression analysis revealed a positive correlation between the area percentage of CD68 immunoreactivity and the grade of the tumor (r = 0.776). Vice versa, a positive correlation also existed between the area percentage of CD34 immunoreactivity and the grade of the tumor (r = 0.690). Pearson correlation revealed a positive association between the TAMs and MVD (r = 0.680; P < .001). There was an increased population of tumor-associated macrophages and tumor angiogenesis with the increasing grade of orofacial squamous cell carcinoma. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Recurrent Giant Myofibroblastic Sarcoma of Neck in a Teenager: Overcoming Treatment Challenges

Sarcomas are rare tumors arising from a variety of mesenchymal tissues which are even rarer in head and neck region amounting 1% only of the 5% of sarcomas. About 80% of head and neck sarcomas originate in soft tissue while the remaining 20% arise from bone (Cormier and Pollock in J Clin 54:94−109, 2004). One among the commonly presenting variants of sarcomas in head and neck that our patient was diagnosed with is Low grade myofibroblastic sarcoma (LGMS). These even though uncommon have a predilection for head and neck region particularly the tongue (Mentzel et al. in Am J Surg Pathol 22:1228−38, 1998; Cai et al. in Virchows Arch 463:827−36, 2013; Meng et al. in Chin Med J 120:363–9, 2007; Demarosi et al. in Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 108:248–54, 2009). LGMS was reclassified as a distinct entity by the WHO classification of soft tissue tumors in 2002 (Qiu et al. in Oncol Lett 9:619−25, 2015). Oncological resection is the mainstay of treatment. In case of bulky tumor, resection and reconstruction would be challenging. We report a recurrent LGMS of 15-year-old girl who presented with a ginormous soft tissue swelling in her left neck region which made her day-to-day activities strenuous and made her non ambulatory and the line of treatment executed in order to get her back on feet, healthy & free of the debilitating tumor.

Gumbel distribution-based technique enables quantitative comparison between streak metal artifacts of multidetector row CT and cone-beam CT: a phantom study

Cone-beam computed tomography (CBCT), derived from multidetector row CT (MDCT), has a high spatial resolution and has recently been applied to various organs. One of the severe limitations common to CBCT and MDCT is metal artifacts. In particular, streak metal artifacts (SMAs) between multiple metal materials often hinder diagnosis. However, no studies have quantitatively compared the strength of SMAs in MDCT and CBCT. Nomura et al. reported an evaluation method specialized in SMAs of CBCT using the Gumbel distribution (GD), which can also be applied to SMAs of MDCT (Oral Surg Oral Med Oral Pathol Oral Radiol 131: 494-502,2021, https://doi.org/10.1016/J.OOOO.2020.08.031 ). This study aimed to quantitatively compare SMAs occurring between titanium materials on MDCT and CBCT images using the GD-based method. The SMAs were investigated as follows: A hydroxyapatite block was sandwiched between two titanium rods to generate an SMA. They were placed in an acrylic phantom, simulating a human head, and scanned using an MDCT scanner and two CBCT scanners. The obtained images were analyzed using Gumbel plots and location parameters, and the SMA strength was calculated. The results showed that the SMAs on the MDCT images were significantly weaker than those on the CBCT images. In the CBCT scans, a smaller volume CT dose indexvalue caused stronger SMAs. These results indicate that MDCT is more advantageous than CBCT in terms of SMA reduction when bone morphology between titanium materials must be evaluated. The characteristic should be considered in clinical cases.

New perioral warts in a patient with human immunodeficiency virus during the COVID-19 pandemic

British Journal of Hospital MedicineEarly view Images in MedicineNew perioral warts in a patient with human immunodeficiency virus during the COVID-19 pandemicR Amarnani, CB BunkerR AmarnaniDermatology Department, University College London Hospital NHS Foundation Trust, London, UKSearch for more papers by this author, CB BunkerCorrespondence to: CB Bunker; E-mail Address: [email protected]Dermatology Department, University College London Hospital NHS Foundation Trust, London, UKSearch for more papers by this authorR Amarnani; CB BunkerPublished Online:8 Mar 2023https://doi.org/10.12968/hmed.2022.0368AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Baccaglini L, Atkinson JC, Patton LL et al.. Management of oral lesions in HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(Suppl):S50.e1–S50.e23. https://doi.org/10.1016/j.tripleo.2006.11.002 Medline, Google ScholarCameron JE, Hagensee ME. Oral HPV complications in HIV-infected patients. Curr HIV/AIDS Rep. 2008;5(3):126–131. https://doi.org/10.1007/s11904-008-0020-6 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 8 March 2023 Information© MA Healthcare LimitedPDF download

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea.

To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance worn for a minimum of 4.5 years. This retrospective study conducted in patients with healthy baseline periodontium recruited participants among consecutive sleep apnea patients treated with an oral appliance between 2004 to 2014. Eligible participants were recalled for a follow-up visit at which a periodontal examination was performed and a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit. Twenty-one patients enrolled with a mean treatment length of 7.9 ± 3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4 ± 0.5 mm, recession 0.6 ± 1.1 mm, and clinical attachment loss 0.8 ± 1.0 mm. Compared with baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1 degrees) with the continued use of an oral appliance. Gingival levels were maintained with clinically insignificant changes during the observation period. Inclination of the mandibular incisors increases significantly with the use of an oral appliance in patients with obstructive sleep apnea. Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession. Heda P, Alalola B, Almeida FR, Kim H, Peres BU, Pliska BT. Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2067-2074.

Thyroid storm, clouds and silver linings

J Oral Med Oral Surg 2021;27:35 Letter to the Editor Thyroid storm, clouds and silver linings John Laszlo* London, UK * Correspondence: jonlaszlo@hotmail.com Received: 9 April 2021 Accepted: 13 April 2021 Dear Editor, In addition to the use of personal protective equipment (PPE), significant interest has developed recommending topical application of Povidone Iodine (PVP-I) for pre-exposure prophylaxis (PEP) against COVID-19 transmission. PVP-I is safe, demonstrating a 99.9% reduction in MERS and SARS activity, far greater than chlorhexidine or benzalkonium-chloride [1]. As oral and nasal fluids contain greater than 107 COVID-19 viruses per mL, PVP-I is a theoretically useful PEP adjunct with PPE. However, the evidence for using PVP-I as PEP, is neither clear nor clinical, extrapolations were made assuming Covid-19 will be just as susceptible to PVP-I in-vivo, as MERS and SARS were in-vitro [1]. Placing those concerns aside, 15% of the population with Thyroid disease are excluded from PVP-I use, but a similar proportion, who are as yet undiagnosed for thyroid disease remain at physiological risk from inadvertent exposure to iodine in PVP-I [2]. In healthy patients, iodine exposure initiates the Wolff-Chaikoff effect;transiently reducing thyroid hormone levels and this is a valuable response to control hypermetabolic morbidity and mortality from the thyroid storm [3]. However, for patients with unrecognised thyroid dysfunction, iodine exposure can either lead to chronic hypothyroidism with no adaptation to Wolff-Chaikoff down-regulation, or it can lead to the Jos-Basedow phenomenon and critical thyroid storm initiation from a loss of negative feedback [3]. Therefore the 15% of patients excluded from PVP-I use are not placed at risk but those patients undiagnosed as yet not recognised as having a thyroid dysfunction will be placed at risk if exposed to PVP-I. If the bidirectional relationship between thyroid disease and kidney function is considered with regard to renal drug excretion;the association of cardiovascular and psychiatric illness with underlying and undiagnosed thyroid disease is problematic. With such patients, the risk of adverse pharmacokinetic drug interactions demands even closer attention if we are to use PVP-I for any patient. Given the positive relationship of thyroid function with RAAS (renin-angiotensin-aldosterone-system), the potential to amplify ACE 2 expression with PVP-Iodine exposure could increase COVID-19 infection risk as more ACE 2 receptors become activated and the potential for viral cellular entry increases [4]. Thyroid disease exhibits a 10:1 female to male predisposition [2], whereas the morbidity and mortality from COVID-19, with equal infectivity is predominantly male. Using PVP-I as PEP may be intuitive, but paradoxically counter-productive;as a greater risk of infection arises in patients more at risk from the effects of COVID-19 by using PVP-I. With 37 isotopes and as many molecular formulations, iodine has many benefits, for example;Silver-Iodide can precipitate rainfall and disinfect surfaces, but there are environmental and medical risks too. To realise the full PEP potential of PVP-I against COVID-19, the theoretical concerns outlined above require further analysis. Thyroid patients are not at increased risk of morbidity and mortality from COVID-19 [5] and this silver lining in a nebulous cloud of PEP should be recognised when considering measures that could potentially do more harm than good.

Fusion or gemination? A radiologic approach

A supernumerary tooth is an entity in addition to the normal series of teeth that, although rare, can be fused to a tooth, whether deciduous or permanent. Diagnosis and management in cases involving supernumerary teeth in the anterior region of the maxilla are often challenging. The clinical examination associated with the radiographic examination is decisive for the diagnosis and planning of cases. This article describes a case of unilateral fusion of a supernumerary tooth to a permanent upper lateral incisor, in which clinical and radiographic diagnosis was essential for a conservative approach.&#x0D; Descriptors: Diagnosis; Fused Teeth; Tooth, Supernumerary.&#x0D; References&#x0D; &#x0D; Rajab LD and Hamdan MA. Supernumerary teeth: review of the literature and a survey of 152 cases. Int J Paediatr Dent. 2002;12:244–54.&#x0D; Yang G. Supernumerary teeth and gemination. Br J Oral Maxillofac Surg. 2012;50:15–8. &#x0D; Zhu M, Liu C, Ren S, Lin Z, Miao L, Sun W. Fusion of a supernumerary tooth to right mandibular second molar: a case report and literature review. Int J Clin Exp Med. 2015;8(8):11890-95.&#x0D; Rudagi K, Rudagi BM, Metgud S, Wagle R. Endodontic management of mandibular second molar fused to a supernumerary tooth, using spiral computed tomography as a diagnostic aid: a case report. Case Rep Dent. 2012;2012:614129. &#x0D; Nandini DB, Deepak BS, Selvamani M, Puneeth HK. Diagnostic dilemma of a double tooth: a rare case report and review. Journal of Clinical and Diagnostic Research. 2014;8(1):271-72.&#x0D; Duncan WK, Helpin ML. Bilateral fusion and gemination: a literature analysis and case report. Oral Surg Oral Med Oral Pathol.1987;64(1):82-7.&#x0D; Gupta S, Singla S, Marwah N, Dutta S, Goel M. Synodontia between permanent maxillary lateral incisor and a supernumerary tooth: treatment J Oral Health Comm Dent. 2007;1:52-5.&#x0D; Mader CL (1979) Fusion of teeth. J Am Dent Assoc 98:62-4.&#x0D; Kumar V, Pandey V, Rohini G, Jyoti B. Fusion Between Maxillary Premolar and A Supernumerary Tooth: A Rare Case Presentation. J Clin Diagn Res. 2015;9(11): ZJ03-4.&#x0D; Maréchaux SC. The treatment of fusion of a maxillary central incisor and a supernumerary: report of a case. ASDC J Dent Child. 1984;51:196-99.&#x0D; De Siqueira VC, Braga TL, Martins MA, Raitz R, Martins MD. Dental fusion and dens evaginatus in the permanent dentition: literature review and clinical case report with conservative treatment. J Dent Child (Chic) 2004;71:69-72. &#x0D; Karacay S, Guven G, Koymen R. Management of a fused central incisor in association with a macrodont lateral incisor: a case report. Pediatr Dent. 2006;28:336-40. &#x0D; Cetinbas T, Halil S, Akcam MO, Sari S, Cetiner S. Hemisection of a fused tooth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:e120-24. &#x0D; Nunes E, deMoraes IG, de Novaes PM, de Sousa SM. Bilateral fusion of mandibular second molars with supernumerary teeth: case report. Brazilian Dent J. 2002;13:137-41. &#x0D;

Oral squamous cell carcinoma, a potential risk factor for SARS-CoV-2 infection and COVID-19 associated complications

Oral squamous cell carcinoma, a potential risk factor for SARS-CoV-2 infection and COVID-19 associated complications - JOOO- Print ISSN No: - 2395-6186 Online ISSN No:- 2395-6194 Article DOI No:- 10.18231/j.jooo.2020.037, Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology-J Oral Med Oral Surg Ora

Evaluation of tolonium chloride as an aid in diagnosis of dysplastic changes in oral mucosa among tobacco smokers

Evaluation of tolonium chloride as an aid in diagnosis of dysplastic changes in oral mucosa among tobacco smokers - JOOO- Print ISSN No: - 2395-6186 Online ISSN No:- 2395-6194 Article DOI No:- 10.18231/j.jooo.2020.025, Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology-J Oral Med Oral Surg Oral P

Clinical outcome and oncological safety of submental flap for reconstruction in head and neck cancer patients

Clinical outcome and oncological safety of submental flap for reconstruction in head and neck cancer patients - JOOO- Print ISSN No: - 2395-6186 Online ISSN No:- 2395-6194 Article DOI No:- 10.18231/j.jooo.2020.029, Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology-J Oral Med Oral Surg Oral Patho

A new challenge for ‘Dental Professionals’ during this pandemic situation of COVID-19

A new challenge for ‘Dental Professionals’ during this pandemic situation of COVID-19 - JOOO- Print ISSN No: - 2395-6186 Online ISSN No:- 2395-6194 Article DOI No:- 10.18231/j.jooo.2020.028, Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology-J Oral Med Oral Surg Oral Pathol Oral Radiol

Bilateral mandibular dentigerous cyst in non-syndromic patient: technical strategy and literature review

Bilateral mandibular dentigerous cyst in non-syndromic patient: technical strategy and literature review

Global research trends in complex oral sensitivity disorder: A systematic bibliometric analysis of the structures of knowledge.

A systematic bibliometric analysis of the structure of knowledge was performed to investigate the co-word analysis, the co-citation analysis, and the social network analysis regarding complex oral sensitivity disorder (COSD). Web of Science database from 1985 to 2018 was systematically searched to identify all relevant articles using the MeSH terms "complex oral sensitivity disorder" and all synonyms used in the literature. We included original articles, review articles, letters to the editor, and book chapters in the English language and in 27 different ISI categories of medical sciences. Several bibliometric indicators were used. The co-word analysis identified 741 KeyWords Plus (KWP) grouped into 4 different clusters. The terms "pain," "management," "prevalence," and "efficacy" reached the highest centrality, whereas the top 10 KWP had a frequency of 7%-29% in 443 articles. Over a period of 32years, a complex thematic evolution occurred, going from 2 to 6 different themes, and the KWP migration rate from one cluster to another ranged from 11% to 100%. The co-citation network analysis based on the complete reference list (5932 references) of 443 articles identified only 2 clusters for journals, authors, and articles. The most prominent co-cited journal was "Oral Surgery Oral Medicine Oral Pathology" (centrality: 171.75), the most co-cited author was "Grushka M" (centrality: 330.95), and the most co-cited article was "Grushka M. Oral Surg Oral Med Oral Pathol (1987) 63:30-36" (centrality: 269.79). On the other hand, the direct citation network revealed that "Scala A et al, 2003" reached both the highest global citation score (GCS=231) and local citation score (LCS=161). Lastly, the social network analysis revealed an isolated collaboration among groups of authors, or countries or institutions. The worldwide collaboration analysis indicated that United States-Israel and United Kingdom-Italy were the most collaborative countries. The structure of knowledge of publications on COSD revealed that research in this field has been dominated by few core topics and a limited collaboration among authors and institutions from different countries. More multicenter studies on COSD are warranted in the near future when launching new projects.

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Endodontic retreatment due to secondary periapical injury: case report

Endodontic retreatment due to secondary periapical injury: case report

SAT-364 Brown Tumor of the Mandible in Severe Uncontrolled Primary Hyperparathyroidism

Background: Brown tumors are a part of the complex “osteitis fibrosa cystica” which is a diffuse resorptive process of the bone resulting from uncontrolled hyperparathyroidism. Although these brown tumors were fairly common in the past1, the incidence of brown tumors is now extremely rare in the United States due to early diagnosis and treatment of hyperparathyroidism. Here we describe an unusual presentation for osteitis fibrosa cystica. Clinical Case: A 38 year old woman was admitted to the hospital with rapidly growing facial swelling in June 2019. The swelling initially appeared in January 2019 and had rapidly increased in size since April 2019. The mass was malodorous, painful and interfered with oral intake. The patient smoked 1 pack per day for 13 years. A CT scan of the head and neck with contrast showed a 3.6 x 4.5 x 3.3 cm mass destroying the right mandibular body, involving the right platysma muscle and displacing the central and lateral incisor teeth and was concerning for malignancy. The initial impression was that this was likely a squamous cell carcinoma with local and perhaps distant metastases, complicated by humoral hypercalcemia of malignancy and she was admitted for management.Upon admission, her calcium level was 14 mg/dL, albumin 4.1 g/dL, phosphorus 1.4 mg/dL PTH level was 890 pg/mL and vitamin D level was 22 ng/mL. Since the high PTH did not fit with hypercalcemia of malignancy, further evaluation was undertaken. A thyroid ultrasound showed a 4.6 x 1.8 x 1.5 cm isoechoic, heterogeneous lesion in the left lower pole, and Tc-99 sestamibi scan suggested parathyroid origin. The biopsy of the mouth lesion showed fibro histiocytic proliferation with multiple giant cells, negative for malignancy and consistent with a brown tumor. CT scan of the chest, abdomen and pelvis did not reveal any other masses or lytic lesions. . A skeletal survey showed another 2 cm lytic lesion in the proximal left humeral metaphysis which was not biopsied.On parathyroidectomy, the patient was found to have an enlarged left inferior parathyroid gland measuring 3.3 x 3.0 x 0.8 cm weighing 7.093 grams. Intraoperatively PTH level decreased from 890 pg/mL to 69 pg/mL. Her calcium levels returned to normal post-operatively and she was discharged home. Pathologic examination report revealed the mass to be a parathyroid adenoma. The patient reports a reduction in the size of her mandible mass since the surgery.Conclusion: Although uncommon, brown tumors can be seen in uncontrolled primary hyperparathyroidism. The mandible is a common site, though, as in this case, it is less common for it to be the only site affectedReference:1. Rosenberg, E. H. (1962). Hyperparathyroidism. A review of 220 proved cases with special emphasis on findings in the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 15(2), 84–94.

Development of temporomandibular ankylosis after diagnosis of Jacob’s disease: clinical and tomographic assessment

Jacob's disease is a rare condition that consists of the formation of a pseudo joint structure between the mandibular coronoid process and the zygomatic bone, resulting in limited mouth opening. The disease is difficult to diagnose and etiology is uncertain. This article describes a clinical case of a 6-year-old child with limited mouth opening, which resulted in the formation of a temporomandibular ankylosis leading to complete immobility due to delayed diagnosis and treatment of the disease. A review of this pathology and the most precise imaging exams are discussed for the early and differential diagnosis of the disease.&#x0D; Descriptors: Ankylosis; Temporomandibular Joint; Temporomandibular Joint Disorders.&#x0D; Referências&#x0D; &#x0D; Wang WH, Xu B, Zhang BJ, Lou HQ. Temporomandibular joint ankylosis contributing to coronoid process hyperplasia. Int J Oral Maxillofac Surg. 2016;45(10):1229-33.&#x0D; Zhong SC, Xu ZJ, Zhang ZG, Zheng YH, Li TX, Su K. Bilateral coronoid hyperplasia (Jacob disease on right and elongation on left): report of a case and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Mar;107(3):e64-7.&#x0D; Coll-Anglada M, Acero-Sanz J, Vila-Masana I, Navarro-Cuéllar C, Ochandiano-Caycoia S, López de-Atalaya J, Navarro-Vila C. Jacob's disease secondary to coronoid process osteochondroma. A case report. Med Oral Patol Oral Cir Bucal. 2011;16(6):e708-10.&#x0D; Yesildag A, Yariktas M, Doner F, Aydin G, Munduz M, Topal U. Osteochondroma of the coronoid process and joint formation with zygomatic arch (jacob disease): report of a case. Eur J Dent. 2010;4(1):91-4. &#x0D; Çorumlu U, Kopuz C, Demir MT, Pirzirenli ME. Bilateral elongated mandibular coronoid process in an Anatolian skull. Anat Cell Biol. 2016;49(3):217-20.&#x0D; Choi JG, Kim SY, Perez-Atayde AR, Padwa BL. Bilateral coronoid process hyperplasia with pseudocartilaginous joint formation: Jacob disease. J Oral Maxillofac Surg. 2013;71(2):316–21.&#x0D; Losa-Muñoz PM, Burgueño-García M, González-Martín-Moro J, Sánchez-Burgos R. Osteochondroma of coronoid process: a rare etiology of jacob disease. Craniomaxillofac Trauma Reconstr. 2014;7(4):306-9. &#x0D; Escuder i de la Torre O, Vert Klok E, Marí i Roig A, Mommaerts MY, Pericot i Ayats J. Jacob's disease: report of two cases and review of the literature. J Craniomaxillofac Surg. 2001;29(6):372-76.&#x0D; Hernández-Alfaro F, Escuder O, Marco V. Joint formation between an osteochondroma of the coronoid process and the zygomatic arch (Jacob disease): report of case and review of literature. J Oral Maxillofac Surg. 2000;58(2):227-32.&#x0D; Sreeramaneni SK, Chakravarthi PS, Krishna Prasad L, Raja Satish P, Beeram RK. Jacob's disease: report of a rare case and literature review. Int J Oral Maxillofac Surg. 2011;40(7):753-57. &#x0D; D'Ambrosio N, Kellman RM, Karimi S. Osteochondroma of the coronoid process (Jacob's disease): an unusual cause of restricted jaw motion. Am J Otolaryngol. 2011;32(1):52-4.&#x0D; Shackelford RT, Brown WH. Restricted jaw motion due to osteochondroma of the coronoid process. J Bone Joint Surg Am. 1949;31A(1):107-14.&#x0D;

Use of autogenous bone graft of the anterior wall of the maxillary sinus in the management of oroantral fistula

Introduction: The oroantral fistula consists of a persistent communication between the maxillary sinus and the buccal cavity, being a complication resulting from traumas, pathologies or dental extractions. Objective: To present a clinical case of oroantral fistula closure using autogenous bone graft from the anterior sinus wall as a treatment option. Materials and Methods: Patient with a history of traumatic extraction of the upper left molars about 4 months ago. During the clinical examination, there was an orifice in the left maxillary alveolar crest, suggestive of oroantral fistula, responding positively to the Valsalva maneuver. Panoramic radiographic examination evidenced continuity between the oral cavity and the left maxillary sinus, which presented with opacification, suggestive of acute maxillary sinusitis on the left side. Sinusitis was treated within 15 days. After treatment, we evaluated the patient who was asymptomatic and, at that moment, the surgical procedure for the oroantral fistula closure was planned, removing a bone block from the anterior wall of the left maxillary sinus presenting the sinus membrane and grafting with fixation using System 1.5 mm with an "L" plate and four bolts. Conclusion: This surgical technique is useful for the closure of chronic oroantral fistulas in patients with oroantral fistulas.Descriptors: Oroantral Fistula; Bone Transplantation; Maxillary Sinus.ReferencesMartín-Granizo R, Naval L, Costas A, Goizueta C, Rodriguez F, Monje F, Muñoz M, Diaz F. Use of buccal fat pad to repair intraoral defects: review of 30 cases. Br J Oral Maxillofac Surg. 1997;35(2):81-4.Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula:experience with 27 cases. Am J Otolaryngol. 2003;24(4):221-23.Anavi Y, Gal G, Silfen R, Calderon S. Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(5):527-34.Haas R, Watzak G, Baron M. A preliminary study of monocortical bone grafts for oroantral fistula closure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(3):263-66Zide MF, Karas ND. Hydroxylapatite block closure of oroantral fistulas: report of cases. J Oral Maxillofac Surg. 1992;50(1):71-5.Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R. Closure of oroantral communications with Bichat's buccal fat pad. J Oral Maxillofac Surg. 2009;67(7):1460-6.Jain MK, Ramesh C, Sankar K, Lokesh Babu KT. Pedicled buccal fat pad in the management of oroantral fistula: a clinical study of 15 cases. Int J Oral Maxillofac Surg. 2012;41(8):1025-29.Amaratunga NA. Oro-antral fistulae--a study of clinical, radiological and treatment aspects. Br J Oral Maxillofac Surg. 1986;24(6):433-37.Proctor B. Bone graft closure of large or persistent oromaxillary fistula. Laryngoscope 1969;79(5):822-26.Visscher SH, van Minnen B, Bos RR. Closure of oroantral communications: a review of the literature. J Oral Maxillofac Surg. 2010;68(6):1384-91.Visscher SH, van Roon MR, Sluiter WJ, van Minnen B, Bos RR. Retrospective study on the treatment outcome of surgical closure of oroantral communications. J Oral Maxillofac Surg. 2011;69(12):2956-61.Hanazawa Y, Itoh K, Mabashi T, Sato K. Closure of oroantral communications using a pedicled buccal fat pad graft. J Oral Maxillofac Surg. 1995;53(7):771-75.