The Showcases of Dental History - A time machine in miniature at the University of Puerto Rico: Part II - The Exhibits

The University of Puerto Rico School of Dentistry was established in 1957. Over the years, it has played an important role in Puerto Rico's healthcare system. That legacy is displayed through the walls of the School of Dentistry. In Part 1, the evolution of 20-year-old dental museum-like showcases located in the lobby and the main hallway of the school were described along with important professions who impacted on this development. In this paper, we will describe in detail the items available at the museum.

The Showcases of Dental History - A Time Machine in Miniature at the University of Puerto Rico: Part I

The evolution of 20-year-old dental museum-like showcases located in the lobby and the main hallway of the School of Dental Medicine, Puerto Rico (PR) are described along with important professionals who impacted on this development.

Facial Injuries in the National Basketball Association

BACKGROUND

Sport injuries can negatively impact physical and psychological aspects of athletes. There is a gap in the literature regarding facial trauma present in basketball.

PURPOSE

The purpose of this study is to identify and describe facial trauma present in the National Basketball Association (NBA).

STUDY DESIGN, SETTING, SAMPLE

This is a retrospective cohort study in which the sample (n = 206) consists of players that missed games due to facial injuries in the NBA, the data were collected from a public access online resource.

INDEPENDENT VARIABLE

The predictor variables were player position (center, point guard, shooting guard, small forward, and power forward), team conference (Eastern/Western), and if played games occurred in playoff season.

MAIN OUTCOME VARIABLES

The primary outcome variable was the injury location (upper, middle, and lower facial third), and the secondary outcome was type of injury (soft tissue/bone fracture).

COVARIATES

Player's age, height, weight, and body mass index were collected.

ANALYSES

χ2 and logistic regression were calculated to determine associations between predictor and outcome variables. Logistic regression was used to determine if variables were predictive for injury. Odds ratio was also computed for significant results. P value less than .05 (95% confidence interval) was considered statistically significant.

RESULTS

A total of 206 players missed games due to facial injuries, and a total of 212 injuries were quantified. The mean age of the injured players was 27.24 ± 4.06 years, mean height (centimeters) was 201 ± 59.31 cm, mean weight (kilograms) was 99.48 ± 12.41 kg, and body mass index was 24.52 ± 1.75 kg/m2. Of the 212 injuries, none of them occurred in the upper facial third, 158 (75%) were in the middle third, and 54 (25%) were in the lower third; 151 of them were fractures (61%) and 61 were soft tissue injuries (29%). Most injuries were concentrated in centers (23%) and power forwards (23%). The most common fracture occurred in the nasal bones (39.2%), and most soft tissue injuries occurred in the eye globes (25%). Almost all injuries occurred during regular season games (97%), and the Eastern conference was slightly predominant (52%).

CONCLUSION AND RELEVANCE

Significant facial trauma in the NBA has risen in recent years. The player's position, height, and weight were the primary factors associated with facial trauma in the NBA.

Histologic features of bone regenerated by means of negative pressure in the context of odontogenic keratocyst

PURPOSE

The objective of the present research is to describe the histologic features of the bone regenerated by means of negative pressure (sugosteogenesis) in a group of patients diagnosed with odontogenic keratocyst (OKC) who underwent active decompression and distraction sugosteogenesis (ADDS) at our institution.

MATERIALS AND METHODS

The authors designed a retrospective case series study. The population included patients with a histologic diagnosis of odontogenic keratocyst in whom active decompression and distraction sugosteogenesis followed by enucleation was performed. All patients were seen and followed from July 2019 to January 2021. The investigation was approved by the Institutional Review Board, and it observed the Declaration of Helsinki on medical protocol. Variables of this study included age, gender, anatomic location (mandible or maxilla), and histologic characteristics of the bone regenerated by means of negative pressure. Histologic features were defined as being consistent or inconsistent with viable mature bone.

RESULTS

Bone biopsies of 6 patients were considered. In total, 83.33% of patients were males and 16.66% females. One hundred percent of the bone samples subjected to negative pressure showed features of viable mature bone.

CONCLUSIONS

In this study, the histological features of the bone subjected to negative pressure demonstrated the normal characteristics of the mature, normal bone.

Odontogenic Keratocyst: A Clinical Entity With Favorable Response to Active Decompression and Distraction Sugosteogenesis

Objective

The purpose of this study was to determine the usefulness of active decompression and distraction sugosteogenesis (ADDS) for the management of non-syndromic odontogenic keratocysts (OKC).

Materials and Methods

A retrospective case series study was designed and implemented. The study observed the Declaration of Helsinki on medical protocol and ethics and it was approved by the university's Institutional Review Board (IRB). The medical files of all patients who underwent ADDS for OKCs of the jaws at the Department of Oral and Maxillofacial Surgery of a tertiary university-affiliated medical center were reviewed. Data were collected on patient's age, gender, presenting signs and symptoms, lesion location, locularity, pre-ADDS, size of the lesion, post-ADDS, pain, days with bloody discharge and/or proteinaceous fluid inside the system's external unit, days to achieve hermetic seal, size of the lesion 2 weeks after ADDS, percentage of reduction, patient's complaints/complications, and follow-up period. Pre- and post-ADDS panoramic radiographs were reviewed for reduction parameters.

Results

Six patients, 5 males and 1 female, with an average age of 45.16 years (range 16-74 years) were studied. ADDS was performed during 4 weeks in all patients. During the therapy, the extraoral unit collected blood during 2.83 days in average. In average, after the third day, the cystic cavity started to drain a proteinaceous fluid for about 9.33 days (range 6-15 days). The average pre-ADDS Standard Lesional Area Index (SLAI) was 18.17 cm2 (range 4.40 cm2-34.58 m2) and, after 2 weeks of ADDS, the average SLAI was 5.47 cm2 (range 0.49 cm2-15.39 cm2). The average percentage of reduction, after 2 weeks, was 73.93% (range 55.49%-97.51%), which yielded an overall good reaction of OKCs to ADDS. No significant reduction of the lesions was observed from week 2 to week 4, when ADDS ceased. All lesions were enucleated after 3 months. After an average of 14 months of follow-up (12 to 17 months), no signs of recurrence have been observed.

Potential role of active decompression and distraction sugosteogenesis for the management of ameloblastomas: Report of two cases and review of the literature

Ameloblastomas are aggressive odontogenic entities well-known for their high tendency to recur. Clinical presentation includes lesions discovered on routine examination or radiographs, pathologies causing facial swelling, pain, cortical expansion, tooth mobility, root resorption, and paresthesia. Radiographic findings comprise large unilocular or multilocular radiolucencies with well-defined borders associated to an impacted tooth. Ameloblastomas are classified as unicystic, multicystic/solid, and peripheral. Treatment options include marsupialization, decompression, enucleation, or curettage with or without adjuvant measures such as Carnoy's solution, marginal resection, and segmental resection. Recently, active decompression with distraction sugosteogenesis (ADDS) was introduced for the conservative management of odontogenic cystic conditions. The purpose of this paper is to present 2 cases of a conventional ameloblastoma treated by means of ADDS. The purpose of this novel approach is to significantly reduce the amount of time required to decompress cystic-like lesions. In these cases, ADDS proved to be a viable treatment because it demonstrated a reduction in size of the initial lesion by new osseous formation within 2 weeks of placement of the device. The cases presented in this paper demonstrate that ADDS could be a valuable treatment modality for this type of ameloblastoma, although further research is necessary to validate this philosophy.

Historical evolution of surgical approaches to the face-part III: lower face

Surgical approaches to the head and maxillofacial area have been described and modified by many authors throughout history. It was, however, during the nineteenth and twentieth centuries when most of the techniques were described, mainly thanks to the advent of anesthesia and antibiotic therapy. Currently, a myriad of surgical techniques are employed to access the maxillofacial complex, with each of them having advantages and disadvantages. Although the approaches are the subject of textbooks and articles, most do not describe the circumstances or the historical context under which they were designed. In a series of three articles, we will provide a historical perspective of the most common surgical approaches to the head and face employed today. Descriptions contain advantages and disadvantages and modifications are provided. The purpose of the present article (3/3) is to review the approaches to the lower face.

Does active decompression of odontogenic keratocyst change the histologic diagnosis?

AIM

The purpose of this study was to compare the histopathologic findings of pre- and post-active decompression of odontogenic keratocyst and to establish if such findings were consistent.

MATERIALS AND METHODS

A retrospective case series from a group of patients diagnosed with odontogenic keratocyst who underwent active decompression and distraction sugosteogenesis followed by final enucleation was designed and implemented. The dependent variable was changed in histologic diagnosis, as evaluated by an oral and maxillofacial pathologist. Other variables included age, gender, anatomic location of the lesion, and time elapsed from initial biopsy to final enucleation.

RESULTS

Six patients diagnosed with odontogenic keratocyst who underwent active decompression followed by enucleation and curettage were studied. The mean age was 45.6 years (range, 16 to 74) 83.33% were males, 16.66 females. Lesions were located in the mandible in 83.33% of cases and in the maxilla in 16.66% of cases. Post-active decompression histologic examination at the time of definitive enucleation was consistent with the initial diagnosis in 83.33% of cases.

CONCLUSIONS

The histopathological diagnosis at the time of definitive treatment by enucleation and curettage is consistent with the pre-active decompression diagnosis.

Historical evolution of surgical approaches to the face-part II: midface

Surgical approaches to the head and maxillofacial area have been described and modified by multiple authors throughout history. It was during nineteenth and twentieth century when most of the techniques evolved due to advances in anesthesia and antibiotic therapy. Currently, a myriad of surgical approaches are employed to gain access to the maxillofacial complex, with each of them having advantages and disadvantages. Although the approaches are presented in numerous textbooks and articles, few texts describe the circumstances or historical context under which they were developed. In a series of three articles, we will provide a historical perspective of the evolution of the most common surgical approaches to the head and face employed today. Descriptions contain advantages and disadvantages of the approaches and modifications are also provided. The purpose of the present article (2/3) is to review the approaches to the midface.

Historical evolution of surgical approaches to the face-part I: head and upper face

Surgical approaches to the head and maxillofacial area have been described and modified by many authors throughout history. It was, however, during the nineteenth and twentieth centuries due in large part to improvements in the delivery of anesthesia and antibiotic therapy when most of the techniques were described. Currently, a myriad of surgical techniques are employed to access the maxillofacial complex with advantages and disadvantages for each one. Although each approach is described in many text and articles, few describe the circumstances or the historical context under which they were designed. In a series of three articles, a historical perspective will be provided on the evolution of some of the most commonly employed today. Descriptions will enumerate the advantages and disadvantages of as well as later modifications. The purpose of the present article (1/3) is to review the approaches to the head and upper face.

Maxillofacial Trauma in the Ultimate Fighting Championship

PURPOSE

The Ultimate Fighting Championship (UFC) is an American mixed martial art (MMA) company. This study aims to characterize patterns and trends of maxillofacial injuries in MMA.

MATERIALS AND METHODS

The study design is a retrospective cohort study. Study sample consisted of fighters that suffered injuries during the matches from January 2015 to December 2019 (N = 259). The Athletic Commissions and corresponding fighting regulatory departments from 16 states and 24 countries were screened for medical reports released by UFC ringside physicians. Predictor variables were sex, weight division, injury location, injury type, and fight outcome (i.e., Technical Knockout/Knockout, Submission, Decision). Primary outcome variables were need for medical suspension and duration of medical suspension, secondary outcome variable was frequency of injury. Chi-square test was used to determine any statistical significance between predictor variables. One-way analysis of variance was used to determine any statistically significant differences between medical suspension times, sex, injury location, type of injury, weight divisions and fight outcome throughout the years. P value less than .05 (95% confidence interval [CI]) was considered statistically significant.

RESULTS

A total of 259 fighters suffered injuries. Of the 319 total injuries, 291 (91.2%) occurred in male fighters, and 28 (8.8%) in females. Middle facial third injuries were the most common for both males and females; lower facial third injuries were proportionally similar. The male weight division with the longest medical suspensions were the light heavyweight (110.68 days) and welterweight (108.25 days) (P < .10166); the female weight division with the longest medical suspension was strawweight (88.92 days) and shortest was bantamweight (81.75 days) (P < .921123).

CONCLUSIONS

Upper and midface trauma was predominant with fractures concentrated in the light heavyweight and welterweight divisions. Medical suspensions duration were longer in the light heavyweight and welterweight divisions.

Third molar surgery: Past, present, and the future

Third molar surgery is the most common ambulatory procedure done by oral and maxillofacial surgeons. Surgical approaches for the removal of third molars have been published since the 20th century. This article reviews the history and development of extraction techniques through a literature review. The literature was selected through a search of an electronic database. Key words for the Medline search were "mandibular/maxillary third molar," "impacted mandibular/maxillary third molar," "mandibular/maxillary third molar flap design," and "mandibular/maxillary third molar incision." The search was restricted to English-language articles. Additionally, a manual search in the major oral surgery journals and books was performed. The aim of this article is to examine the evolution of third molar surgery, recognize pioneering techniques, and compare these techniques to current approaches. Common approaches employed today are discussed and treatment philosophies with thoughts for future therapies are provided.

The Use of Inferior Meatal Antrostomy to Decrease Sinusitis with the Placement of Zygomatic Implants

PURPOSE

To present a case series treated by inferior meatal antrostomy as a prophylactic maneuver after the placement of zygomatic implants to decrease the risk of sinusitis.

MATERIALS AND METHODS

All patients undergoing zygomatic implant placement using the lower meatal antrostomy protocol between June 2011 and March 2019 at the Department of Oral and Maxillofacial Surgery, Universidad El Bosque, were included. Patients were evaluated after 12 months of the procedure using clinical and radiologic criteria described by Kuriyama and Reiskin.

RESULTS

Forty-eight patients were included, in whom 184 implants were placed. Complications were as follows: paresthesia (6.2%), orosinusal fistula (4.1%), skin infection (2.1%), and loss of the implant (1.6%). There were no cases of sinusitis.

CONCLUSION

This study provides evidence that the technique is effective and should be considered because of its simplicity. The inferior meatal antrostomy has been proven to be a simple, effective, and reliable technique to decrease the risk of sinusitis associated with the placement of zygomatic implants.

Active decompression and distraction sugosteogenesis for the treatment of calcifying odontogenic cyst

The calcifying odontogenic cyst is as a benign, rare developmental odontogenic cyst with a wide range of histologic characteristics. It may present along with other odontogenic pathologies such as odontoma, ameloblastoma, adenomatoid odontogenic tumor, ameloblastic fibroma, and ameloblastic fibro-odontoma. Clinically, it can be an either intra- or extraosseous painless swelling that can produce cortical expansion. It affects mostly the anterior area of the mandible. Radiographically, it appears as a well-circumscribed unilocular radiolucency containing flecks of indistinct radiopacities. In about one third of cases, an impacted tooth is associated. In this paper, we employ a patient with an enormous calcifying odontogenic cyst to review both the pathology and active decompression and distraction sugosteogenesis, a novel technique employed to treat odontogenic entities. This dual approach usually results in an accelerated bone healing (sugosteogenesis), partial removal of the cystic epithelium, thickening of the wall, and migration of chronic inflammatory cells which triggered epithelial modulation, ultimately causing a realignment in the biologic behavior of the lesion.

The Oral and Maxillofacial Surgery Residency Program at the University of Puerto Rico: A Historical Perspective

A former Spanish colony, Puerto Rico has been an unincorporated US territory since 1898 when Spain relinquished all claims over it under the terms of the Treaty of Paris. Half a century later, Universidad de Puerto Rico created the School of Dental Medicine, which began activities in 1957. In 1961, Lowell E. McKelvey became Dean of the School and in 1963 he established the Oral and Maxillofacial Surgery advanced specialty education program following the US model. Created as a 36-month program with 2 residents per year, currently it is a 48-year program accepting 3 residents annually. The purpose of this paper is to review the history of this CODA-accredited program and to analyze the circumstances under which this program was developed.

Biodegradable polymerized simvastatin stimulates bone formation

Previous research from our labs demonstrated the synthesis of polymerized simvastatin by ring-opening polymerization and slow degradation with controlled release of simvastatin in vitro. The objective of the present study was to evaluate the degradation and intramembranous bone-forming potential of simvastatin-containing polyprodrugs in vivo using a rat calvarial onlay model. Poly(ethylene glycol)-block-poly(simvastatin) and poly(ethylene glycol)-block-poly(simvastatin)-ran-poly(glycolide) were compared with simvastatin conventionally encapsulated in poly(lactic-co-glycolic acid) (PLGA) and pure PLGA. The rate of degradation was higher for PLGA with and without simvastatin relative to the simvastatin polyprodrugs. Significant new bone growth at the circumference of poly(ethylene glycol)-block-poly(simvastatin) disks was observed beginning at 4 weeks, whereas severe bone resorption (4 weeks) and bone loss (8 weeks) were observed for PLGA loaded with simvastatin. No significant systemic effects were observed for serum total cholesterol and body weight. Increased expression of osteogenic (BMP-2, Runx2, and ALP), angiogenic (VEGF), and inflammatory cytokines (IL-6 and NF-ĸB) genes was seen with all polymers at the end of 8 weeks. Poly(ethylene glycol)-block-poly(simvastatin), with slow degradation and drug release, controlled inflammation, and significant osteogenic effect, is a candidate for use in bone regeneration applications. STATEMENT OF SIGNIFICANCE: Traditional drug delivery systems, e.g., drug encapsulated in poly(lactic-co-glycolic acid) (PLGA), are typically passive and have limited drug payload. As an alternative, we polymerized the drug simvastatin, which has multiple physiological effects, into macromolecules ("polysimvastatin") via ring-opening polymerization. We previously demonstrated that the rate of degradation and drug (simvastatin) release can be adjusted by copolymerizing it with other monomers. The present results demonstrate significant new bone growth around polysimvastatin, whereas severe bone loss occurred for PLGA loaded with simvastatin. This degradable biomaterial with biofunctionality integrated into the polymeric backbone is a useful candidate for bone regeneration applications.

From Cystostomy to Active Decompression: The Surgeons' Battle Against Odontogenic Cysts

Odontogenic cysts represent a challenge for oral and maxillofacial surgeons. Treatment options include resective surgery and conservative approaches. The purpose of this paper is to review the history of marsupialization/decompression and other techniques based on similar principles.

Subacute Granulation Tissue of the Fornix after Resorbable Orbital Implant: An Unusual Case and Review of the Literature

Orbital blow-out fractures are very common. Goals of surgical treatment are to reestablish form and function with excellent cosmetic results. Materials used for orbital floor repair include autologous grafts and a variety of alloplastic materials. In this article, we present a case of subacute granulation tissue of the fornix that developed as a foreign body reaction 4 months after placing a resorbable implant to repair an orbital floor fracture. The implant was removed and the patient continued to heal uneventfully. Management of the case and biomaterials employed are discussed in light of current research.

Atrophic Mandible Fractures: Are Bone Grafts Necessary? An Update

PURPOSE

The management of atrophic mandibular fractures poses a challenge because of anatomic variations and medical comorbidities associated with elderly patients. The purpose of this article is to review and update the literature regarding the management of atrophic mandible fractures using load-bearing reconstruction plates placed without bone grafts.

MATERIALS AND METHODS

We performed a review of the English-language literature looking for atrophic mandibular fractures with or without continuity defects and reconstruction without bone grafts. Included are 2 new patients from our institution who presented with fractures of their atrophic mandibles and had continuity defects and infections. Both patients underwent reconstruction with a combination of a reconstruction plate, recombinant human bone morphogenetic protein 2, and tricalcium phosphate. This study was approved as an "exempt study" by the Institutional Review Board at the University of Kentucky. This investigation observed the Declaration of Helsinki on medical protocol and ethics.

RESULTS

Currently, the standard of care to manage atrophic mandibular fractures with or without a continuity defect is a combination of a reconstruction plate plus autogenous bone graft. However, there is a need for an alternative option for patients with substantial comorbidities. Bone morphogenetic proteins, with or without additional substances, appear to be a choice. In our experience, successful healing occurred in patients with a combination of a reconstruction plate, recombinant human bone morphogenetic protein 2, and tricalcium phosphate.

CONCLUSIONS

Whereas primary reconstruction of atrophic mandibular fractures with reconstruction plates supplemented with autogenous bone graft is the standard of care, in selected cases in which multiple comorbidities may influence local and/or systemic outcomes, bone morphogenetic proteins and tricalcium phosphate can be used as a predictable alternative to autogenous grafts.

Virtual Surgical Planning for the Management of Severe Atrophic Mandible Fractures

Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 hours. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results.

Colombian Dental Literature During the Twentieth Century

Colombia is one of the Latin American countries in which both research and academic writing are considered virgin areas. The dental profession is not the exception. The purpose of this paper is to construct a database of the dental books written in Colombia from the mid-1800s to 1900s and to analyze those books according to the decades in which they were published. The first book published in Colombia on Dentistry was Odontotecnia u observaciones sobre la estructura, fisiología, anatomía y enfermedades de los dientes (Dental Techniques or Observations on the Structure, Physiology, Anatomy and Dental Diseases), written by American dentist Joseph Watson ver Valen and released in Bogotá in 1849. In 150 years, a total of 72 dental books were found, most of which were published in Bogotá and Medellin.

Inferior Meatal Antrostomy as a Prophylactic Maneuver to Prevent Sinusitis After Zygomatic Implant Placement Using the Intrasinusal Technique

PURPOSE

To determine whether performing an inferior meatal antrostomy as a prophylactic intraoperative maneuver in patients who underwent zygomatic implant surgery significantly reduces the incidence of postoperative sinusitis.

MATERIALS AND METHODS

A double-blind randomized controlled trial was implemented. The study included 44 patients seen at the Oral and Maxillofacial Surgery Department at Universidad El Bosque in Bogota, Colombia, who required zygomatic implant surgery. Patients were randomly allocated to either group 1 (without inferior meatal antrostomy) or group 2 (with inferior meatal antrostomy). Patients were evaluated clinically and radiographically 15 days and 3 months after surgery, and classified depending on whether they did or did not develop sinusitis. Results were analyzed using descriptive and bivariate statistics. The control group event rate, experimental group event rate, relative risk, relative risk reduction, absolute risk reduction, and number needed to treat values were calculated for further analysis.

RESULTS

Three patients allocated to group 1 showed clinical and radiographic signs of sinusitis after zygomatic implant surgery, for an overall rate of sinusitis of 13.6%. No patient in group 2 developed clinical or radiographic signs of sinusitis.

CONCLUSION

The results of this study suggest that performing an inferior meatal antrostomy as a prophylactic intraoperative maneuver in patients who require zygomatic implant surgery is an effective method to prevent postoperative sinusitis.

Decompression of Odontogenic Cystic Lesions: Past, Present, and Future

Tumors and cystic lesions of the jawbones have been described since the late 1600s and it took another 200 years for classification systems to appear in the medical, surgical, and dental literatures. In the late 1800s, Carl Partsch introduced cystostomy, a method by which the cyst is converted into a pouch by suturing its lining to the mucosa of the oral cavity. The purpose of this article is to analyze the history, present, and future of cystic conditions of the jaws and decompression, a modality of treatment that during the past few years has regained the attention of oral and maxillofacial surgeons and pathologists owing to its relative simplicity and effectiveness compared with other conservative options.

Cystic Conditions of the jawbones: A Review of Early Classification Systems

Cystic conditions of the jawbones were recognized long before the establishment of the American Academy of Oral Pathology (AAOP) in 1948, but it was around this time when they were studied, characterized, and classified. The history of the classification systems implemented by oral pathologists to study the cystic conditions of the maxillary bones is intimately related with the birth of oral and maxillofacial pathology as a specialty of dentistry. The purpose of this paper is to review the early classification systems proposed for the cystic conditions of the jawbones.

Facial fractures in children: a historical perspective on treatment techniques

The surgical principles for the treatment of facial fractures in children have evolved progressively over the past 70 years. In 1943 Waldron and colleagues published what is probably the first paper on the subject, thus setting a paradigm for the conservative treatment of pediatric facial fractures. This standard remained viable for about five decades. Therefore, during many years children with facial fractures did not benefit in the same manner as their adult counterparts from the multiple advances made in the management of facial trauma. In the 1990s craniofacial surgeons used plates and screws to correct craniofacial deformities in children with congenital malformations. As a consequence of their findings, pediatric oral and maxillofacial surgeons started to apply such principles to the management of facial fractures in young, growing patients, which eventually paved the way for the open reduction with external fixation paradigm. The aims of this article are to detail Waldron's initial directives, to evaluate the publications that contributed to its consolidation, and to analyze the factors that led to its challenge fifty years later.

Maxillary reconstruction with bone transport distraction and implants after partial maxillectomy

Maxillary and mandibular bone defects can result from injury, congenital defect, or accident, or as a consequence of surgical procedures when treating pathology or defects affecting jaw bones. The glandular odontogenic cyst is an infrequent type of odontogenic cyst that can leave a bony defect after being treated by aggressive surgical means. First described in 1987 by Padayachee and Van Wyk, it is a potentially aggressive entity, having a predisposition to recur when treated conservatively, with only 111 cases having been reported hitherto. Most reports emphasize its clinical, radiographic, and histologic features, including a few considerations on rehabilitation for these patients. The aim of this article is to present the case of a 24-year-old male patient who, in 2001, was diagnosed with a glandular odontogenic cyst and to focus on the surgical approach and rehabilitation scheme. We performed an anterior partial maxillectomy. The osseous defect was treated using bone transport distraction. Dental and occlusal rehabilitation was achieved with titanium implants over transported bone and an implant-supported overdenture. A 9-year follow-up shows no evidence of recurrence of the pathology, adequate shape and amount of bone, functional occlusal and dental rehabilitation, and patient's satisfaction.

The evolution of oral and maxillofacial surgery in Colombia: from the dental school of Bogotá to Waldemar Wilhelm and his legacy

The evolution of the dental specialty of oral and maxillofacial surgery (OMS) in Colombia can be attributed to a myriad of altruistic, visionary leaders who paved the way for future generations. The process started with the indigenous groups who inhabited Colombia before Spanish rule, and continued with the founding of the Dental School of Bogotá in 1888 and the subsequent efforts of Waldemar Wilhelm in 1950, and consolidated with Wilhelm's legacy and surgical descendants. This article recognizes the pioneers, analyzes the circumstances under which they worked, describes how Colombian oral and maxillofacial surgeons fought plastic surgeons for the right to be in the operating room, and details the events involved in the structuring of the different oral and maxillofacial surgery residency programs in Colombia today.

Effects of internal rigid fixation on mandibular development in growing rabbits with mandibular fractures

PURPOSE

The aim of this research was to determine whether rigid internal fixation interferes with mandibular growth and development in growing New Zealand white rabbits with induced mandibular fractures.

MATERIALS AND METHODS

Ten 3-month-old New Zealand white rabbits were included in the study. Surgical fractures were performed in the right mandibular bodies of the 10 rabbits. These fractures were reduced with internal rigid fixation by use of a 1.0-mm titanium system, taking the contralateral left mandibular bodies as the control group. We obtained radiographs preoperatively and at 1, 2, and 3 months postoperatively. Predetermined cephalometric points were used to measure and compare jaw growth. The protocol was approved by the Bioethics Committee of Universidad El Bosque, Bogotá, Colombia.

RESULTS

There were no statistically significant differences between the experimental and control groups (P = .95). Mandibular growth in the studied rabbits was not affected by the use of internal rigid fixation.

CONCLUSIONS

The use of internal rigid fixation for the treatment of induced mandibular fractures in growing rabbits did not alter the normal process of growth and development. The findings of this study should lead to investigations using larger samples and to long-term prospective follow-up studies of children who have undergone open reduction and internal rigid fixation.

History of the Oral and Maxillofacial Surgery Residency Program at Universidad el Bosque, Bogotá, Colombia

The formal training of oral and maxillofacial surgeons in Colombia started in 1958 at Hospital Sanjos6, thanks to the titanic work of Waldemar Wilhelm, a German-born surgeon who settled in BogotA in 1950. Today there are seven institutions in Colombia that offer residency programs in oral and maxillofacial surgery. The aim of this article is to describe the history of the Oral and Maxillofacial Surgery Residency Program at Universidad El Bosque in Bogota.

Waldemar Wilhelm: father of oral and maxillofacial surgery in Colombia

Waldemar Wilhelm (1913-1994) was honored by the Asociación Colombiana de Cirugía Oral y Maxilofacial (Colombian Association of Oral and Maxillofacial Surgery) as the Father of Oral and Maxillofacial Surgery in Colombia. Born in Karlsruhe, Germany, Wilhelm graduated as a dentist from Johann Wolfgang Goethe University in 1936. He emigrated shortly thereafter to Colombia, receiving his dental license there in 1943. He completed his oral and maxillofacial surgery training at Nordwestdeutsche Kieferklinic, under the tutelage of Prof. Dr. Dr. Karl Schuchardt in Hamburg. In 1950, he settled in Bogotá, where he joined the Universidad Nacional School of Dentistry, opened Colombia's first oral and maxillofacial surgery department at Hospital San José, and trained the first maxillofacial surgeons in Colombia in 1958.