Cases reported "Bone Resorption"

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1/24. Anterior open-bite malocclusion: stability of maxillary repositioning using rigid internal fixation.

    A retrospective cephalometric study was performed to investigate the stability of 37 non-growing anterior open-bite cases using mini-plate rigid fixation. The sample was divided into two groups: Group A: maxillary repositioning alone (17 cases) and Group B: bimaxillary surgery (20 cases). Tracings were performed pre-operatively (T1), immediately post-operatively (T2) and at a minimum of one year follow-up (T3) (12-90 months). In Group A, the maxilla was advanced (3.8 /- 2.8 mm, p < 0.01) and superiorly repositioned at PNS (2.8 /- 2.3 mm, p < 0.001). In Group B, the maxilla was advanced (3.5 /- 3.0 mm, p < 0.01) and superiorly repositioned at PNS (3.7 /- 1.8 mm, p < 0.001); and the mandible (11.7 /- 3.8 mm, p < 0.001), with no significant change in the vertical plane (p > 0.05). Late relapse due to condylar remodelling or resorption was found as a cause of large horizontal relapse (8.0 < x < 14.0 mm) in three cases (15%), the amount being associated with the amount of operative advancement (r = 0.7, r-sq = 40%, p < 0.01). It was concluded that the correction of anterior open bite by posterior repositioning of the maxilla using rigid fixation is a stable procedure during the follow-up period, and that in bimaxillary cases, post-operative stability depends largely on the stability of the mandibular advancement, which in turn relates to the amounts of advancement, the pre-operative anterior open bite and the mandibular plane angle.
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ranking = 1
keywords = operative
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2/24. Intrapelvic protrusion of the acetabular component following total hip replacement.

    Protrusion of the acetabular component into the true pelvis following total hip replacement has occurred in 5 patients, 4 with severe rheumatoid arthritis and 1 with a destructive type of degenerative hip disease. Preoperatively all hips had severe protrusio acetabuli, a markedly thin acetabular medial wall and advanced osteoporosis. Four had a McKee-Farrar prosthesis, a metal-to-metal device with high frictional torque, particularly when the contact is equatorial, and no damping capacity against marginal impingement in the extreme range of motion. In order to reduce the incidence of intrapelvic protrusion, extreme care should be given to preserve the medial bone stock of the acetabulum, more so when it is already damaged or defective. If anchoring holes are used they should be restricted to the superior ilium, pubis and ischium and should not perforate the medial wall. Once loosening is present, reoperation is indicated to avoid progressive bone reabsorption by the abrasive motion of the loosened prosthesis, that might lead to irreparable bone loss. To reduce the stress transmitted to an already weakened acetabulum, select a total prosthetic device with low friction; fix it with acrylic cement in order to distribute the stress over a large surface; carefully orient both components to avoid marginal impingement; be certain to preserve the medial wall as much as possible and if it is already defective reinforce it by bone grafting and/or wire mesh.
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ranking = 0.2
keywords = operative
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3/24. Complications with intermaxillary fixation screws in the management of fractured mandibles.

    A dedicated bicortical bone screw for temporary intraoperative intermaxillary fixation (IMF) during open reduction and fixation of mandibular fractures offers many benefits to surgeons and patients. We have used this system for 2 years and confirm the benefits over traditional methods of intermaxillary fixation. However, complications can arise. One hundred and twenty-two patients with mandibular fractures had IMF screws of which five (4%) developed complications intraoperatively and postoperatively. Complications included fracture of the screws on insertion, iatrogenic damage to teeth causing loss and bony sequestra around the area of screw placement.
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ranking = 0.6
keywords = operative
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4/24. Case report 736: Retained surgical sponge (gossypiboma) with a foreign body reaction and remote and organizing hematoma.

    This 50-year-old woman presented with progressive pain in the left thigh. Radiographs showed a 9 x 6 cm soft-tissue mass located at the lateral border of the left femur. Magnetic resonance (MR) examination showed an eccentric, nonhomogeneous, soft-tissue mass abutting the femur. The preoperative differential diagnosis was schwannoma, low-grade neurogenic tumor, large periosteal ganglion, or fibroma. At operation, the cut surface of the specimen had features of an organizing hematoma with recent remote hemorrhage and areas of fibrosis. Histopathological examination confirmed the presence of polarizable foreign body material in a background of foreign body reaction. The specimen represented a retained surgical sponge which had been present since the patient's surgery for a comminuted fracture 35 years earlier. Gossypiboma, or cotton balloma, is a term used to describe a mass within the body composed of cotton matrix. Radiopaque markers are now present on surgical sponges, and their appearances have been well documented. The gossypiboma, however, may still present a diagnostic problem if the marker is distorted by folding, twisting, or disintegration over a period of time. Without the radiopaque markers, retained sponges are difficult, if not impossible, to diagnose, as was the situation in this case.
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ranking = 0.2
keywords = operative
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5/24. Maxillary brown tumor and uremic leontiasis ossea in a patient with chronic renal insufficiency.

    Findings of renal osteodystrophy in cranial bones are not uncommon and include osteomalacia, osteosclerosis, erosion of the cortical bone, brown tumors and resorption of the lamina dura. However, massive thickening of the cranial vault and facial bones, called uremic leontiasis ossea, have been reported very rare. In the present article, we describe the case of an uncooperative female patient with a brown tumor, involving the left maxillary sinus and massive thickening of the cranial vault and facial bones, secondary to severe secondary hyperparathyroidism during 8 years of regular hemodialysis treatment.
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ranking = 0.2
keywords = operative
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6/24. Severe hypercalcemia in a child with acute nonlymphocytic leukemia: the role of parathyroid hormone-related protein and proinflammatory cytokines.

    Among the hematological malignancies, hypercalcemia has often been reported in lymphoid malignancies such as multiple myeloma and adult T cell leukemia/lymphoma, but it has only rarely been described in acute nonlymphocytic leukemia. We describe here a 14-month-old girl with acute monocytic leukemia complicated by severe hypercalcemia (4.6 mmol/l) at presentation. A bone survey showed generalized bone resorption, but no localized osteolytic lesions. A search for the etiology of the hypercalcemia revealed that the serum levels of parathyroid hormone-related protein (PTHrP) and also proinflammatory cytokines with stimulatory effects on osteolytic bone resorption - TNF-alpha, IL-6 and M-CSF - were elevated. The patient achieved complete remission with induction chemotherapy, and the levels of PTHrP and the cytokines became normalized. In this case, PTHrP and cytokines might have acted cooperatively to exacerbate bone resorption, resulting in severe hypercalcemia.
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ranking = 0.2
keywords = operative
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7/24. Hard and soft tissue augmentation in implant therapy using acellular dermal matrix.

    The use of acellular dermal matrix to correct soft and hard tissue defects involving implants is described through three case reports. Correction of a ridge deformity caused by a root fracture, submerging of an existing implant and correction of recession defects around adjacent teeth, and ridge preservation for implant placement are presented. The use of acellular dermal matrix prevented the need for a second surgical site for donor material and the possible attendant postoperative complications. It also enhanced patient comfort and satisfaction with the procedure. All three cases demonstrated excellent functional and esthetic results for both the patients and professionals involved in the therapy.
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ranking = 0.2
keywords = operative
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8/24. Spontaneous bone graft resorption in os odontoideum.

    Two children are presented who had posterior fusion of the upper cervical spine for os odontoideum. Both patients achieved radiographic fusion but spontaneous bone graft resorption occurred, resulting in a recurrence of the original instability. An awareness of this phenomenon, which has been rarely reported, is important in the pre-operative counselling and postoperative follow-up of these patients.
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ranking = 0.4
keywords = operative
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9/24. Pseudoarthrosis of the ulna in neurofibromatosis. A report of four cases.

    Four children suffering from neurofibromatosis with ulnar pseudarthrosis and progressive reabsorption of the middle and distal thirds of the ulna are reported. None had any pain or sensory loss, but all had progressive deformity of the forearm. Instability of the elbow and wrist were present in three cases, while one case showed good stability and function. A cross-union of the ulna with the radius to produce a one-bone forearm was accomplished using screw fixation and iliac bone grafting, and a one-bone forearm was achieved in three cases. Non-operative management was decided on in the patient with slow ulna reabsorption. The creation of a one-bone forearm is more likely to produce sound union, thus avoiding the need for further operations, while conservative management should be reserved for patients with a slowly progressive condition.
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ranking = 0.2
keywords = operative
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10/24. Osseo-integrated implant treatment of a patient with rapidly progressive periodontitis. A case report.

    The case report presented describes placement of osseointegrated fixtures in a patient with a probable history of rapidly progressive periodontitis. A 12-year history is presented. The post-operative sequelae of placing fixtures in a fully edentulous maxilla and partially edentulous mandible were the worst seen by the Implant Team at Emory University. The hypothesis presented is that patients with aggressive forms of periodontal disease should be subjected to appropriate mechanical and antimicrobial therapy to produce a healthy oral flora before any implants are placed.
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ranking = 0.2
keywords = operative
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