1
|
Chappuis L, Barthelemy I, Pham Dang N. Persistent foramen of Huschke: Clinical manifestations and complications, systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101455. [PMID: 36965816 DOI: 10.1016/j.jormas.2023.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Foramen of Huschke is a bone defect with wide clinical symptoms which ca can be responsible for severe complications. Clinical history and imaging are unspecific, it is therefore essential to recognize and treat the pathology related to the persistence of this foramen, to avoid destruction of the TMJ, chronic pain or OBJECTIVE: The aim of this review was to summarise the clinical manifestations and complications of persistent foramen of Huschke in adult patients, through a review of the cases reported in the literature. METHODS & MATERIALS A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to November 2022 to identify studies and case reports concerning clinical manifestations and complications of persistent foramen of Huschke in adult patients, with the key words "foramen of Huschke" or "foramen tympanicum". RESULTS 74 papers where firstly identify, and 21 were selected. This correspond to 46 patients with the additional case from our department. Symptoms mostly reported consisted of otitis (63%, 29/46), otorrhea (28.26%, 13/46), and masticatory tinnitus (19.57%, 9/46). Diagnosis was priority made by CT-scan (95.65%, 44/46). Surgery was the most performed treatment (28.26%, 13/46). In our case, the use of FLUOBEAM® NIR camera was help-full for TMJ surgery. CONCLUSION Persistent foramen of Huschke should be suspected in the presence of otitis, otorrhea and masticatory tinnitus. Knowledge of this anatomical variation could help to treat certain pathology like TMJ disorders or TMJ septic arthritis.
Collapse
Affiliation(s)
- Louis Chappuis
- Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France; Université d'Auvergne, Faculty of Medicine, F- 63001, Clermont-Ferrand cedex 1, France.
| | - Isabelle Barthelemy
- Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France; Université d'Auvergne, Faculty of Medicine, F- 63001, Clermont-Ferrand cedex 1, France; Inserm U1107 Neuro-Dol, Trigeminal Pain and Migraine, Faculty of Dental Surgery, F-63100 Clermont-Ferrand, France
| | - Nathalie Pham Dang
- Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France; Université d'Auvergne, Faculty of Medicine, F- 63001, Clermont-Ferrand cedex 1, France; Inserm U1107 Neuro-Dol, Trigeminal Pain and Migraine, Faculty of Dental Surgery, F-63100 Clermont-Ferrand, France
| |
Collapse
|
2
|
Ozbek L, Kyriakides J, Asokan A. A case of otogenic septic arthritis of the knee. J Surg Case Rep 2023; 2023:rjad682. [PMID: 38115949 PMCID: PMC10728415 DOI: 10.1093/jscr/rjad682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023] Open
Abstract
Septic arthritis is a serious condition resulting in rapid destruction of articular cartilage and potential sepsis. Bacterial invasion of a joint occurs most commonly as a result of haematogenous spread from a distant infection. However, an otogenic source of this transient bacteraemia and resultant septic arthritis has not yet been reported in the literature. We report a case of acute septic arthritis of the knee with Streptococcus pyogenes, secondary to acute otitis media of the ear.
Collapse
Affiliation(s)
- Leyla Ozbek
- Otolaryngology Department, University College Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Jonathon Kyriakides
- Trauma and Orthopaedics Department, Barnet Hospital, Wellhouse Lane, London EN5 3DJ, United Kingdom
| | - Ajay Asokan
- Trauma and Orthopaedics Department, Barnet Hospital, Wellhouse Lane, London EN5 3DJ, United Kingdom
| |
Collapse
|
3
|
Bernkopf E, Bernkopf G, De Vincentiis GC, Macrì F, Capriotti V. Gnatological considerations on "Pediatric temporomandibular joint ankulosis and arthritis: Forgotten complications of acute otitis media". Am J Otolaryngol 2023; 44:103727. [PMID: 36528973 DOI: 10.1016/j.amjoto.2022.103727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Affiliation(s)
| | - Giulia Bernkopf
- Dental Clinic, Viale della Repubblica, 63, 36066 Sandrigo (VI), Italy.
| | | | - Francesco Macrì
- Department of Pediatrics and Child Neuropsychiatry, Pediatric Unit, University "La Sapienza", Rome, Italy
| | - Vincenzo Capriotti
- Department of Neuroscience, Otorhinolaryngology Unit, Ospedale di Treviglio-Caravaggio, ASST Bergamo Ovest, Treviglio (BG), Italy.
| |
Collapse
|
4
|
Parrino D, Val M, Lovato A, de Filippis C, Nardini LG. Pediatric temporomandibular joint ankylosis and arthritis: Forgotten complications of acute otitis media. Am J Otolaryngol 2022; 43:103599. [PMID: 35988366 DOI: 10.1016/j.amjoto.2022.103599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Temporomandibular joint (TMJ) arthritis and ankylosis represent unusual but potential complications of ear suppuration, especially in children. We performed a review of the literature of pediatric otogenic TMJ arthritis and ankylosis, discussing their clinical and radiological features, their mechanism of infection spread, and the importance of a prompt diagnosis and treatment. We additionally describe a case of TMJ ankylosis following acute mastoiditis in a 4-year-old female patient. METHODS A search of English literature from January 1, 1980 to December 31, 2021 was performed on the electronic databases (PubMed, Web of Science and Scopus) in order to identify studies concerning TMJ complication after ear suppuration. RESULTS Seventeen articles were considered eligible for the review. Eight and nine studies described otogenic TMJ ankylosis and arthritis, respectively. A total of 17 children affected by ankylosis consequent to ear infection and a total of 31 cases of TMJ arthritis concurrent to otomastoiditis were identified. Mean time elapsed between ear infection and diagnosis of TMJ ankylosis was 4.8 years (range 0.5-13). CONCLUSION TMJ involvement during complicated otitis media should be kept in mind. Its prompt recognition is mandatory to set up appropriate treatment and follow-up and reduce the risk of ankylosis with its functional and psychological complications.
Collapse
Affiliation(s)
- Daniela Parrino
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Matteo Val
- Unit of Oral and Maxillofacial surgery, Ca'Foncello Hospital, Treviso, Italy
| | - Andrea Lovato
- Department of Neuroscience DNS, University of Padova, Audiology and Phoniatrics Unit, Ca'Foncello Hospital, Treviso, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, University of Padova, Audiology and Phoniatrics Unit, Ca'Foncello Hospital, Treviso, Italy
| | - Luca Guarda Nardini
- Unit of Oral and Maxillofacial surgery, Ca'Foncello Hospital, Treviso, Italy
| |
Collapse
|
5
|
Pediatric temporomandibular joint (TMJ) arthritis, an elusive complication of acute mastoiditis. Int J Pediatr Otorhinolaryngol 2022; 158:111163. [PMID: 35500398 DOI: 10.1016/j.ijporl.2022.111163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/29/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Septic arthritis of the Temporomandibular joint (TMJ) is a rare complication of acute middle ear infection. Presentation is elusive and could be easily missed. Often diagnosis is made only with consequential development of TMJ ankylosis. This study intends to characterize patients and course of disease and suggest a diagnostic and therapeutic strategy. METHODS Retrospective review of all children diagnosed with TMJ arthritis and/or TMJ ankylosis secondary to acute middle ear infection, treated in a tertiary pediatric medical center between the years 2005 and 2021. RESULT Seven patients were identified with otogenic TMJ arthritis. Median age at presentation was 1.14 years (IQ range 1.1-1.5). All seven were diagnosed with acute mastoiditis. CT scans demonstrated TMJ related collections in 5/7 and intracranial complications in 3/7. Treatment included cortical mastoidectomy for 5/7. One patient had a concomitant surgical washout of the TMJ. Two patients had drainage only of subperiosteal collections. Six of the seven patients went on to develop TMJ ankylosis that presented within a median of 2.8 years (IQ range 2.6-3.9) after the episode of acute mastoiditis. All six patients presented with trismus and facial growth anomalies, and all but one required surgery to release the ankylosis. CONCLUSION Otogenic TMJ arthritis develops mostly in young children with acute mastoiditis and intratemproal and/or intracranial suppuration. Imaging is helpful in making the diagnosis, with TMJ related collections on CT being the most common finding. TMJ ankylosis can develop within a few years and present with trismus and abnormal facial growth. Cortical mastoidectomy does not seem to prevent ankylosis. It remains unclear whether focused treatment to the TMJ or physiotherapy could be beneficial in that.
Collapse
|
6
|
Festa P, Arezzo E, Vallogini G, Vittucci AC, Barbuti D, Galeotti A. "Multidisciplinary management of post- infective osteoarthritis and secondary condylar resorption of temporomandibular joint: a case report in a 9 years-old female patient and a review of literature". Ital J Pediatr 2022; 48:62. [PMID: 35505365 PMCID: PMC9066812 DOI: 10.1186/s13052-022-01255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Osteoarthritis and condylar resorption of temporomandibular joint (TMJ) has rarely been reported in children as consequence of otologic disease. We describe the management of a case in a 9-year-old female as long-term complication of an otomastoiditis and review the literature currently available on this topic. Case presentation A nine-years-old female patient referred to Emergency Room of Bambino Gesù Children’s Research Hospital, IRCCS (Rome,Italy) for an acute pain in the left preauricular area and reduced mandibular movements. In the medical history an otomastoiditis and periorbital cellulitis was reported at the age of six with complete remission of symptoms after antibiotic treatment. No recent history of facial trauma and no previous orthodontic treatment were reported. She was referred to a pediatric dentist that conducted a clinical examination according to the Diagnostic Criteria of Temporomandibular Disorders (DC/TMD) and was diagnosed with bilateral myalgia of the masticatory muscles and arthralgia at the level of the left TMJ. Then, a complete diagnostic path was performed that included multidisciplinary examinations by a rheumatologist, infectious disease specialist, ear nose and throat (ENT) doctor, a maxillofacial surgeon and a medical imaging specialist. Differential diagnosis included juvenile idiopathic arthritis, idiopathic condylar resorption, trauma, degenerative joint disease, neurological disease. Finally, unilateral post-infective osteoarthritis of the left TMJ with resorption of mandibular condyle was diagnosed. The patient went through a pharmacological therapy with paracetamol associated to counselling, jaw exercises and occlusal bite plate. After 1 month, the patient showed significant reduction of orofacial pain and functional recovery that was confirmed also one-year post-treatment. The novelty of this clinical case lies in the accurate description of the multidisciplinary approach with clinical examination, the differential diagnosis process and the management of TMD with conservative treatment in a growing patient. Conclusions Septic arthritis of temporomandibular joint and condylar resorption were described as complications of acute otitis media and/or otomastoiditis in children. We evidenced the importance of long-term follow-up in children with acute media otitis or otomastoiditis due to the onset of TMJ diseases. Furthermore, in the multidisciplinary management of orofacial pain the role of pediatric dentist is crucial for the diagnostic and therapeutic pathway to avoid serious impairment of mandibular function.
Collapse
Affiliation(s)
- Paola Festa
- Dentistry Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy
| | - Elena Arezzo
- Dentistry Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy
| | - Giulia Vallogini
- Dentistry Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy
| | - Anna Chiara Vittucci
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Domenico Barbuti
- Radiology and Diagnostic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Galeotti
- Dentistry Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
| |
Collapse
|
7
|
Arzi B, Vapniarsky N, Fulton A, Verstraete FJM. Management of Septic Arthritis of the Temporomandibular Joint in Dogs. Front Vet Sci 2021; 8:648766. [PMID: 33855056 PMCID: PMC8039310 DOI: 10.3389/fvets.2021.648766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Septic arthritis of the temporomandibular joint (TMJ) in dogs and other mammals is a rare condition. It is typically associated with notable pain, swelling, and difficulty in opening the mouth. Unlike degenerative TMJ disease, septic arthritis requires urgent intervention. The etiology of the condition may include penetrating trauma, an extension of local infection, such as otitis media, or the hematogenous spread of a pathogen. However, the precise cause may not always be identified. Diagnostic imaging with Computed Tomography (CT), cone-beam CT (CBCT), and/or Magnetic Resonance Imaging (MRI) are helpful for honing the definitive diagnosis and formulating a treatment plan. Subsequently, exploratory surgery may be required to obtain samples for culture and sensitivity and histology and to lavage the joint. In this “methods” article, we provide a detailed description of our approach to diagnosis and management of septic TMJ arthritis in four dogs.
Collapse
Affiliation(s)
- Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Natalia Vapniarsky
- Department of Pathology, Microbiology and Immunology School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Amy Fulton
- Aggie Animal Dental Center, Mill Valley, CA, United States
| | - Frank J M Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| |
Collapse
|
8
|
Omiunu A, Talmor G, Nguyen B, Vakil M, Barinsky GL, Paskhover B. Septic Arthritis of the Temporomandibular Joint: A Systematic Review. J Oral Maxillofac Surg 2021; 79:1214-1229. [PMID: 33716006 DOI: 10.1016/j.joms.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to describe the characteristics of the patient history, clinical findings, laboratory tests, treatment, and long-term function of septic arthritis of the temporomandibular joint (SATMJ). METHODS All articles in the English literature related to SATMJ were queried using PubMed, Embase, and the Cochrane Library (1950 to July 1, 2020). The reference lists were reviewed for additional articles. RESULTS A preliminary search of the literature returned 241 results, of which 37 met inclusion criteria, with an additional article from reference review. There were 93 total cases, with a mean age of 35.7 years (0.1 to 85). Symptoms mostly consisted of pain in the temporomandibular joint/preauricular region (n = 84, 90.3%), trismus (n = 73, 78.5%), and facial/preauricular swelling (n = 68, 73.1%). Most patients had no systemic symptoms (n = 80, 86.1%). The mean degree of mouth opening was 13.1 mm (5 to 35). Diagnosis was made with the following imaging modalities: radiograph (n = 48, 51.6%), CT scan (n = 35, 37.6%), MRI (n = 25, 26.9%), and ultrasound (n = 3, 3.2%). Staphylococcus aureus (n = 19, 20.4%) was most commonly isolated. About 92 patients (98.9%) received antibiotics and 85 patients underwent surgery (eg, arthrocentesis, arthroscopy, etc.), of which 15 patients (17.6%) required repeat surgery. Most long-term outcomes were favorable. Sequelae occurred in 26 of 85 patients (30.6%) with documented follow-up. CONCLUSIONS SATMJ should be suspected in the presence of trismus, jaw pain, and preauricular swelling. Management includes prompt evaluation and treatment with broad-spectrum antibiotics. Surgery is not always indicated but can be life-saving in severe cases.
Collapse
Affiliation(s)
- Ariel Omiunu
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and MD Candidate.
| | - Guy Talmor
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Resident Physician
| | - Brandon Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Resident Physician
| | - Mayand Vakil
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Resident Physician
| | - Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and MD Candidate
| | - Boris Paskhover
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Assistant Professor, Facial Plastics & Reconstructive Surgery
| |
Collapse
|
9
|
Castellazzi ML, di Pietro GM, Gaffuri M, Torretta S, Conte G, Folino F, Aleo S, Bosis S, Marchisio P. Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review. Ital J Pediatr 2020; 46:122. [PMID: 32883359 PMCID: PMC7470606 DOI: 10.1186/s13052-020-00882-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cerebral venous sinus thrombosis in children is a rare but potentially fatal complication of acute mastoiditis, one of the most common pediatric infectious diseases. Due to its subtle clinical presentation, suspicion is essential for a prompt diagnosis and appropriate management. Unfortunately, no standard treatment options are available. To discuss the possible clinical presentation, microbiology, and management, we here report the case of a child with otogenic cerebral venous sinus thrombosis and perform a literature review starting from 2011. Case presentation The child, a 10-months-old male, presented clinical signs of right acute otitis media and mastoiditis. Brain computed tomography scan detected right sigmoid and transverse sinus thrombosis, as well as a subperiosteal abscess. Fusobacterium necrophorum and Haemophilus Influentiae were detected on cultural sampling. A multidisciplinary approach along with a combination of medical and surgical therapy allowed the patient’s full recovery. Conclusion Cerebral venous sinus thrombosis is a rare but severe complication of acute otitis media and mastoiditis. The management of this pathological condition is always challenging and an interdisciplinary approach is frequently required. Current therapeutic options include a combination of medical and surgical therapy. A patient-centered approach should guide timing and treatment management.
Collapse
Affiliation(s)
- Massimo Luca Castellazzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Emergency Department, Milan, Italy
| | | | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giorgio Conte
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | | | - Sebastiano Aleo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy.
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Sachs A, Ziegler E, Shupak RP. Septic arthritis of the temporomandibular joint in an unvaccinated adolescent. BMJ Case Rep 2020; 13:13/7/e235597. [PMID: 32646938 DOI: 10.1136/bcr-2020-235597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Septic arthritis of the temporomandibular joint (TMJ) is a rare condition, particularly in the paediatric population. Our case involves a 15-year-old unvaccinated Amish man with acute pain and trismus of the TMJ. The diagnosis was reached after history, clinical examination, radiographic and laboratory examinations were performed. The patient improved after a minimally invasive surgical procedure and medical therapy. Failure to recognise and treat septic arthritis in a timely fashion can result in serious sequalae. Infectious aetiologies should be kept on the differential for any patient with acute TMJ pain.
Collapse
Affiliation(s)
- Alexander Sachs
- Department of Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Erik Ziegler
- Department of Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raymond Patrick Shupak
- Department of Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|