Oral and Maxillofacial Surgery Clinics RSS feed: Current Issue. The Oral and Maxillofacial Surgery Clinics of North America updates you on the latest trends in patient management and the newest advances as well as provides a sound basis for choosing treatment options. Each issue focuses on a single topic in oral and maxillofacial surgery and is presented under the direction of an experienced guest editor. Subscribers to Oral and Maxillofacial Surgery Clinics can subscribe to the companion Atlas at a reduced rate.http://www.oralmaxsurgery.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Oral and Maxillofacial Surgery Clinics1042-3699221February 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.oralmaxsurgery.theclinics.com/article/PIIS1042369910000142/abstract?rss=yesContributors List10.1016/S1042-3699(10)00014-2Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4iiivhttp://www.oralmaxsurgery.theclinics.com/article/PIIS1042369910000154/abstract?rss=yesContents10.1016/S1042-3699(10)00015-4Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4viixhttp://www.oralmaxsurgery.theclinics.com/article/PIIS1042369910000166/abstract?rss=yesForthcoming Issues10.1016/S1042-3699(10)00016-6Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4xixihttp://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001198/abstract?rss=yesWhen one thinks about advances in science or medicine, it is important to put them in perspective within a historical and philosophic context. Ultimately, advances, or even revolutions, are a cumulative enterprise, hopefully with the credit falling to those who laid the groundwork before the sentinel event that defines a particular discovery. It is a process by which invention and discovery often grow out of unsuspected or newly observed phenomena. This process was described by Kuhn as one in which observation occurs, conceptualization happens, assimilation to theory transforms, and discovery arises. This process must take some amount of time. The cumulative occurrences then lead to a change in paradigm that happens as a result of deliberate, but not necessarily long, conceptual assimilation. Often, acceptance of the advancement occurs by violating deeply entrenched expectations (eg, the world is flat). As a result, considerable debate typically surrounds transformative advances.PrefaceBernard J. Costello10.1016/j.coms.2009.11.004Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4xiiixivhttp://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909000909/abstract?rss=yesOutcomes research is focused on measuring the results or end products of health care interventions, processes, and practices. Data derived from outcomes research informs clinical practice, quality assurance, and patient safety activities, and can be the nidus for hypothesis-driven, patient-oriented research. This article introduces a definition of outcomes research, reviews how outcomes research may guide evidence-based surgical practice and health care processes, and reviews a model for outcomes research.Outcomes Research and the Challenge of Evidence-Based SurgeryThomas B. Dodson10.1016/j.coms.2009.10.004Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-414http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909000892/abstract?rss=yesMany advances in health care are built on the evolution of technology. An entirely new patient has emerged in fetal medicine, with these advances in prenatal imaging allowing one to see and diagnose disease not previously appreciated. Clinicians can better plan for the delivery of the neonate, with identified anomalies being optimally managed and the impact on the neonate's health minimized. The oral and maxillofacial surgeon offers expertise in the management of craniomaxillofacial anomalies, including congenital tumors, facial clefts, craniosynostosis, micrognathia, and other congenital abnormalities. The techniques for perinatal care of the patient with craniofacial abnormalities continue to evolve as the technology improves. The authors describe their experience and some of the more common abnormalities with their management considerations that may be encountered by the oral and maxillofacial surgeon on the fetal diagnosis and treatment team.Prenatal Diagnosis and Treatment of Craniomaxillofacial AnomaliesBernard J. Costello, Sean P. Edwards10.1016/j.coms.2009.10.003Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4515http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909000934/abstract?rss=yesCraniomaxillofacial surgery has many indications for bone regeneration and augmentation, ranging from socket preservation to reconstruction of large skeletal defects. The discovery of bone morphogenetic proteins (BMPs) as osteoinductive agents and the subsequent development of commercially available recombinant forms of BMPs have offered the potential to replace traditional grafting techniques with de novo bone formation. Extensive preclinical and clinical research has focused on establishing the safety and efficacy of using recombinant BMPs to regenerate bone in the facial skeleton. This article reviews the development and current scientific basis behind the use of these new biologics.Bone Morphogenetic Proteins in Craniomaxillofacial SurgerySarah D. Davies, Mark W. Ochs10.1016/j.coms.2009.10.007Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-41731http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001071/abstract?rss=yesRegenerative medicine has recently seen much activity in basic and translational research. These advances are now making their way into surgical practice. A convergence of technologies has afforded opportunities previously not available with conventional surgical reconstructive techniques. Patients requiring complex reconstructive surgery in the craniomaxillofacial region typically benefit from local or regional flaps, nonvascularized grafts, microvascular tissue transfer, or substitute alloplastic materials to restore function and form. In these clinical situations, grafting procedures or alloplastic substitute materials provide best-case replacements for resected, injured, or congenitally missing tissues. However, ideal reconstructive goals, such as a complete return to original form and function, are frequently not completely achieved. Regenerative techniques now in clinical use and at the translational research stage hold promise for custom-tailored constructs with the potential to regenerate tissue in the host without significant donor site morbidity. These techniques may provide better structure, aesthetics, and function than the best currently available options. This article presents the latest concepts in craniomaxillofacial regenerative medicine and reviews the multipronged approach to restoring architecture using novel “smart” multifunctional scaffolds, cellular technologies, growth factors, and other novel regenerative medical strategies.Regenerative Medicine for Craniomaxillofacial SurgeryBernard J. Costello, Gaurav Shah, Prashant Kumta, Charles S. Sfeir10.1016/j.coms.2009.10.009Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-43342http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001125/abstract?rss=yesThe comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century. It is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. In the United States, current estimates place the prevalence of cleft lip and palate or isolated cleft lip at approximately 1 in 600. There is significant phenotypic variation in the specific presentation of facial clefts. Understanding outcome data is important when making clinical decisions for patients with clefts. This article provides an update on current primary cleft lip and palate outcome data.Cleft Lip and Palate Surgery: An Update of Clinical Outcomes for Primary RepairAndrew Campbell, Bernard J. Costello, Ramon L. Ruiz10.1016/j.coms.2009.11.003Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-44358http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001216/abstract?rss=yesMuch has been written about the repair of orbital fractures, yet some debate still exists among surgeons with regard to indications for and timing of fracture repair and various surgical techniques. Controversies regarding the surgical maneuvers include the incision, surgical approach, and methods of wound closure. More detailed imaging modalities have allowed clinicians to understand the injuries more completely and plan for and execute more ideal reconstructions. Recent advances in orbital implant materials and the role of endoscopy in orbital fracture repair add to this debate about which techniques would be best for particular injuries. This article discusses these issues and provides the most current literature review regarding the management of various orbital fractures.Orbital Surgery: State of the ArtJason Liss, S. Tonya Stefko, William L. Chung10.1016/j.coms.2009.11.006Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-45971http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001101/abstract?rss=yesWith the refinement of microvascular technique, free-tissue transfer has emerged as the standard of care in head and neck reconstruction. Success rates and reductions in operative time have reduced “flap take” from being the marker of reconstructive success to being an expectation. Interest has now shifted to improvement of technique, with surgeons placing increasing importance on donor site morbidity, quality of tissue harvested, and esthetic and functional outcomes. Much of the recent success can be attributed to technological advance through improvement in instrumentation and technique and enhancement of the understanding of flap physiology and anatomy. This article reviews some of the recent advances and how they have affected microvascular surgery from preoperative, operative, and postoperative standpoints.Technology in Microvascular SurgeryAlessandro Cusano, Rui Fernandes10.1016/j.coms.2009.11.001Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-47390http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001095/abstract?rss=yesThis article discusses the recent advances and basic concepts of skeletal anchorage devices of various types and reviews the current literature on their use. Temporary skeletal anchorage devices allow orthodontic movements that were previously thought to be difficult if not impossible. Much like the concepts introduced during the beginnings of orthognathic dentofacial teams, treatment that uses skeletal anchorage requires interdisciplinary collaboration and planning with regular interaction, continuing education, and a regular review of the latest relevant literature.Temporary Skeletal Anchorage Devices for OrthodonticsBernard J. Costello, Ramon L. Ruiz, Joseph Petrone, Jacqueline Sohn10.1016/j.coms.2009.10.011Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-491105http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909000880/abstract?rss=yesImaging plays a key role in dental implantation, management of maxillofacial trauma, facial reconstruction, temporomandibular joint pathology, and evaluation and treatment of neoplasms and infections. In addition to traditional conventional radiography, recent advances in computer tomography, magnetic resonance imaging, and positron emission tomography–computed tomography fusion technology have made radiology an even more vital component of patient care in dental and craniomaxillofacial practice.Advances in Head and Neck ImagingTao Ouyang, Barton F. Branstetter10.1016/j.coms.2009.10.002Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4107115http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001204/abstract?rss=yesComputer-assisted surgery (CAS) describes all forms of surgery planning or execution that incorporate various forms of advanced imaging, software, analysis, and planning and, in some cases, rapid prototyping technology, robotics, and image-guidance systems. Innovation is progressing rapidly, and new forms of technology continue to be incorporated and evaluated for their value in improving daily operations. This article reviews imaging, enhanced three-dimensional diagnostics, tactile models, CAS concepts, reconstructive surgery, bone flap shaping, distraction osteogenesis, and orthognathic surgery in relation to craniomaxillofacial surgery.Computer-Assisted Craniomaxillofacial SurgerySean P. Edwards10.1016/j.coms.2009.11.005Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4117134http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001083/abstract?rss=yesPreoperative computer design and stereolithographic modeling combined with intraoperative navigation provide a useful guide for and possibly more accurate reconstruction of a variety of complex cranio-maxillofacial deformities. Although probably not necessary for routine use, the author's early experience confirms that of other surgeons with more than a decade of experience: computer-assisted surgery is indicated for complex posttraumatic or postablative reconstruction of the orbits, cranium, maxilla, and mandible; total temporomandibular joint replacement; orthognathic surgery; and complex dental/craniofacial implantology. Further study is needed to provide outcomes data and cost-benefit analyses for each of these indications.Computer Planning and Intraoperative Navigation in Cranio-Maxillofacial SurgeryR. Bryan Bell10.1016/j.coms.2009.10.010Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4135156http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909000910/abstract?rss=yesSkull base surgery is evolving from traditional transfacial and transcranial approaches to the endoscopic endonasal approach, a less intrusive corridor for accessing the ventral skull base. This technique eliminates facial scars, expedites recovery, and obviates brain retraction. The goals of surgical excision, whether palliative or curative, are identical: an approach that is less disruptive to normal tissues. By exploiting the sinonasal corridor, the entire ventral skull base may be accessed to successfully treat benign and malignant lesions. The expanding limits of endoscopic skull base surgery have been accompanied by commensurate innovations in reconstructive techniques that are reliable and have been shown to limit postoperative complications. This article describes the basis for this approach and provides the latest outcome data supporting the current state of the art for endoscopic skull base surgery.Endonasal Surgery of the Ventral Skull Base—Endoscopic Transcranial SurgeryAmol M. Bhatki, Ricardo L. Carrau, Carl H. Snyderman, Daniel M. Prevedello, Paul A. Gardner, Amin B. Kassam10.1016/j.coms.2009.10.005Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4157168http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909001113/abstract?rss=yesOral and maxillofacial surgery is entering a new era. Surgeons can use the latest technological advances in equipment in an attempt to improve patient outcomes. Minimally invasive surgery with the use of the endoscope has improved in recent years because of technological advancements in optics and associated instrumentation. Trauma, orthognathic, sialoendoscopy, and temporomandibular joint surgery are commonly performed with the assistance of the endoscope. From an educational standpoint, surgical anatomy and various other principles can easily be taught to trainees with the assistance of the endoscope. The operating surgeon can visualize an area via the endoscope, and instruct regarding the surgical maneuvers on the monitor, without obstructions to view. This technique also allows others in and out of the room to view the image. Endoscopically assisted surgery is gaining popularity and is becoming a tool frequently used by surgeons to assist in and simplify some of the more difficult techniques that often require more extensive surgical exposure for visualization.Endoscopic Techniques in Oral and Maxillofacial SurgeryFred Pedroletti, Brad S. Johnson, Joseph P. McCain10.1016/j.coms.2009.11.002Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4169182http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369909000922/abstract?rss=yesMolecular diagnostic techniques are quickly finding a role in the detection and diagnosis of tumors, and in predicting their behavior. They may also prove useful in developing new therapeutic approaches to head and neck cancer. The surgeon working in the craniomaxillofacial region should have an understanding of these technologies, their availability in various settings, and how they affect various aspects of treatment, particularly in the detection and treatment of malignancies. This article offers an overview of recent advances in molecular diagnostic techniques, with their implications for diagnosis and management of head and neck tumors.Molecular Diagnostics for Head and Neck PathologyElizabeth Bilodeau, Faizan Alawi, Bernard J. Costello, Joanne L. Prasad10.1016/j.coms.2009.10.006Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4183194http://www.oralmaxsurgery.theclinics.com/article/PIIS104236990900106X/abstract?rss=yesPresently, tissue adhesives and sealants have limited use in oral and maxillofacial surgical procedures. Skin closure occurs regularly with cyanoacrylate adhesives. Sealing of dural tears in conjunction with dural closure has been shown to be very successful. With the development of more head and neck reconstructive procedures and cosmetic procedures, demand will increase for better surgical adhesives. Clinical trials are beginning for newly developed adhesives with the chemical characterizations, the safe reabsorptive profile, and the adhesive strength necessary to benefit oral and maxillofacial surgery patients in the near future. Adhesives for bone fixation, while in early development, also show a promising chemical profile and will be of significant benefit to oral and maxillofacial surgical patients.Adhesive Use in Oral and Maxillofacial SurgeryMichael J. Buckley, Eric J. Beckman10.1016/j.coms.2009.10.008Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4195199http://www.oralmaxsurgery.theclinics.com/article/PIIS1042369910000178/abstract?rss=yesIndex10.1016/S1042-3699(10)00017-8Oral and Maxillofacial Surgery Clinics 22, 1 (2010)2010-02-01Oral and Maxillofacial Surgery Clinics2010-02-01221S1042-3699(10)X0002-4201207