Oral and Maxillofacial Surgery Clinics of North America

Head and neck and base of skull malignancies are challenging for surgical and radiotherapy treatment due to the density of sensitive tissues. Carbon ion radiotherapy (CIRT) is a form of heavy particle therapy that uses accelerated carbon ions to treat malignancies that may be radioresistant or in challenging anatomic locations. CIRT has an increased biological effectiveness (ie, increased cell killing) at the end of the range of the carbon beam (ie, within the target tissue) but not in the entrance dose. This increased biological effectiveness can overcome the effects of radioresistant tumors, tissue hypoxia, and the need for radiotherapy fractionation...

There is a broad spectrum of pathology that occurs in the oral cavity. Knowledge of the different anatomic subsites and contents of each is important for accurate diagnosis and treatment. Oral cavity tumors are predominantly malignant in nature, but there are many nonmalignant lesions of which the practicing clinician should be aware. This article will discuss the anatomy, imaging approaches, and imaging characteristics of nonmalignant and malignant pathology in the oral cavity.

Infectious and inflammatory disorders are the commonest pathologies to affect the major salivary glands however frequently overlap in clinical presentation. Imaging plays an important role in diagnosis, usually initially performed by CT or ultrasound. MRI, with its superior soft-tissue characterization compared with CT, provides a better evaluation of tumors and tumor-like conditions. Imaging features may suggest that a mass is more likely to be benign versus malignant, however, biopsy is often needed to establish a definitive histopathologic diagnosis...

Acute infections of the oral cavity and suprahyoid neck range from simple superficial conditions that can be treated as an outpatient to complex multispatial processes that require surgical intervention and inpatient admission. This article provides an imaging overview of the range of infections in this region that may be encountered by oral and maxillofacial surgeons, emergency physicians, and primary care providers.

Maxillofacial trauma is common. Computed tomography is the primary imaging tool for diagnosis. Study interpretation is aided by understanding regional anatomy and clinically relevant features of each subunit. Common injury patterns and the most important factors related to surgical management are discussed.

Rhinosinusitis is a commonly encountered disease. Imaging is not typically required in acute uncomplicated rhinosinusitis; however, it is integral in the evaluation of patients who present with prolonged or atypical symptoms or when acute intracranial complications or alternate diagnoses are suspected. Knowledge of the paranasal sinus anatomy is important to understand patterns of sinonasal opacification. Bacterial, viral, and fungal pathogens are responsible culprits and, with duration of symptoms, serve to categorize infectious sinonasal disease...

The anatomy of the paranasal sinuses is complex with multiple anatomic variants that can predispose patients to disease. Knowledge of this complex anatomy is important not only for successful treatment but to also avoid complications at the time of surgery. This article will review the anatomy with emphasis on a variety of clinically important anatomic variants.

Imaging plays a critical role in the diagnosis, staging, and management of segmental mandibular defects. Imaging allows mandibular defects to be classified which aids in microvascular free flap reconstruction. This review serves to complement the surgeon's clinical experience with image-based examples of mandibular pathology, defect classification systems, reconstruction options, treatment complications, and Virtual Surgical Planning.

Percutaneous image-guided biopsy has largely replaced open surgical biopsies for many head and neck (H&N) lesions, being very safe and minimally invasive. Although the radiologist plays the primary role in these cases, it requires a multidisciplinary approach. Depending upon numerous factors, these biopsies can be either fine-needle aspiration or core needle biopsy, using ultrasound for superficial lesions and computed tomography for deep neck lesions. The most crucial part of H&N biopsies is planning a trajectory to avoid injury to critical anatomic structures...

No abstract text is available yet for this article.

Perineural tumor spread (PNS) is a well-recognized entity in head and neck cancers and represents a mode of metastasis along nerves. The trigeminal and facial nerves are most affected by PNS, and their connections are reviewed. MRI is the most sensitive modality for detecting PNS, and their anatomy and interconnections are reviewed. MRI is the most sensitive modality for detecting PNS, and imaging features of PNS and important imaging checkpoints are reviewed. Optimal imaging protocol and techniques are summarized as well as other entities that can mimic PNS...

Cranial vault and skull base fractures in children are distinctly different from those seen in adults. Pediatric skull fractures have the benefit of greater capacity to remodel; however, the developing pediatric brain and craniofacial skeleton present unique challenges to diagnosis, natural history, and management. This article discusses the role of surgical treatment of these fractures, its indications, and techniques.

No abstract text is available yet for this article.

Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in the United States. More than 10% of all visits to pediatric emergency rooms (ER) present with craniofacial injuries. The most common etiologies for facial injuries in children and adolescence are motor vehicle accidents, assault, accidental injuries, sports injuries, nonaccidental injuries (eg, child abuse) and penetrating injuries...

Understanding craniofacial growth and development is important in the management of facial trauma in the growing pediatric patient. This manuscript is a review of craniofacial growth and development and clinical implications of pediatric facial fractures.

Anatomic differences of the primary dentition may hinder traditional methods of intermaxillary fixation. Furthermore, the presence of both the primary and permanent dentition can complicate establishing, and maintaining, the preinjury occlusion. The treating surgeon must be aware of these differences for optimal treatment outcomes. This article discusses and illustrates methods that facial trauma surgeons can use to establish intermaxillary fixation in children aged 12 years and younger.

Although acute immune-mediated lesions of the oral cavity (AIML) can have an onset over several months, they often demonstrate rapid onset and can be self-limited. Despite the self-limiting nature of some disorders, patients with AIML can have significant pain and multisystem involvement. It is vital for the oral health care provider to arrive at the proper diagnosis with distinction from overlapping conditions, as the oral manifestations may be harbingers of more serious systemic complications.

White lesions in the oral cavity may be diverse in etiology and may present with significant clinical and sometimes histologic overlap between categories, making accurate diagnosis difficult at times. Although white lesions of immune and infectious etiology are covered in another article, this article discusses the differential diagnosis between developmental, reactive, idiopathic, premalignant, and malignant white lesions focusing on clinical features of each category.

Several dermatological conditions may manifest in the oral cavity, particularly those that are immune-mediated, and they must be distinguished from the various other types of oral ulcerations. This chapter discusses the clinical features, pathogenesis, differential diagnosis, and diagnostic features, including histology and immunofluorescence findings, as well as management of vesiculobullous diseases. These diseases include pemphigus Vulgaris, benign mucous membrane pemphigoid, bullous pemphigoid, and epidermolysis bullosa acquisita...

The human herpesvirus (HHV) family is a group of enveloped DNA viruses containing 8 members known to produce oral mucosal lesions. Following initial exposure, which may result in symptomatic primary infection, the viruses establish latency within specific cells/tissues. After reactivation, herpesviruses can cause localized symptomatic or asymptomatic recurrent (secondary) infections or diseases. HHV may have a significant role in the cause of oral mucosal infectious diseases in immunocompromised patients. This article discusses the role of those herpesviruses that can induce oral mucosal lesions, with focus on the clinical features and treatment/management...