Larry M. Wolford D.M.D.

Bianchi, J., G. M. Porciuncula, L. Koerich, J. Ignacio, L. M. Wolford and J. R. Goncalves (2018). “Three-dimensional stability analysis of maxillomandibular advancement surgery with and without articular disc repositioning.” J Craniomaxillofac Surg 46(8): 1348-1354.

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This retrospective cohort study aimed to assess, three-dimensionally, mandible and maxilla changes following maxillomandibular advancement (MMA), with and without repositioning of TMJ articular discs. The sample comprised cone-beam computed tomography data from 32 subjects: group 1 (n = 12) without disc displacement and group 2 (n = 20) with bilateral disc repositioning. An automatic cranial base superimposition method was used to register the images at three time points: T1 (preoperative), T2 (postoperative), and T3 (at least 11 months follow-up). To assess surgical changes (T2-T1) and adaptive responses (T3-T2), the images were compared quantitatively and qualitatively using the shape correspondence method. The results showed that surgical displacements were similar in both groups for all the regions of interest except the condyles, which moved in opposite directions – group 1 to superior and posterior positions, and group 2 to inferior and anterior positions. For adaptive responses, we observed high individual variability, with lower variability in group 2. Sagittal relapse was similar in both groups. In conclusion, there were no significant differences in skeletal stability between the two groups. The maxillomandibular advancement surgeries, with rotation of the occlusal plane, had stable results for both groups immediately after surgery and at 1-year follow-up.

Yuen, H., P. E. Rossouw, L. M. Wolford and H. Wang (2018). “Pharyngeal Airway Space Changes After Condylar Replacement and Mandibular Advancement Surgery.” J Oral Maxillofac Surg 76(6): 1165-1174.

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PURPOSE: The aim of this study was to examine the total volume and cross-sectional areas of the pharyngeal airway after bilateral condylar replacement and mandibular advancement surgery. MATERIALS AND METHODS: A total of 137 patients (126 women and 11 men) underwent bilateral temporomandibular joint total joint replacement performed by 1 surgeon. A subsample of 30 patients who underwent condylar replacement and only mandibular advancement were evaluated for impact on the airway. Measurements were taken preoperatively, postoperatively, and at a follow-up 1 year after surgery on cone beam computed tomography scans. InVivoDental 3-dimensional imaging (Anatomage, San Jose, CA) was used to measure airway space regarding total volume (in cubic centimeters); minimum cross-sectional area (in square millimeters); minimum cross sections of the first, second, and third cervical vertebrae; and whether the patient had mandibular retrognathia before surgery. A second operator was used to test for interoperator error. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS: There was a significant increase in all measurements at the follow-up visit compared with the preoperative visit. There were no significant differences between groups based on simultaneous Le Fort I surgery, mandibular retrognathia, and gender. However, there were statistically significant differences in cross sections 1 and 2, as well as minimum cross-sectional area, regarding age. Condylar replacement and mandibular advancement have a significant association with an increase in airway space. The intraclass correlation coefficient showed excellent agreement between interoperator measurements. CONCLUSIONS: Patients undergoing bilateral temporomandibular joint replacement and mandibular advancement surgery showed an increase in pharyngeal airway space at a 1-year follow-up. In this study, age was significantly associated with the cross-sectional areas of the airway, with older patients having smaller values.

Al-Moraissi, E. A., A. Louvrier, G. Colletti, L. M. Wolford, F. Biglioli, M. Ragaey, C. Meyer and E. Ellis, 3rd (2018). “Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches.” J Craniomaxillofac Surg 46(3): 398-412.

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PURPOSE: The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches. MATERIALS AND METHODS: A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches. RESULTS: A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid approach with preauricular extension 2.3% for CNFs/CBFs. H) For preauricular approach a) deep subfascial dissection plane 0% in CHFs b) for subfascial approach using traditional preauricular incision 10% (8.5% in CHFs and 11.5% in CNFs). I) For retroauricular approach 3% for CHFs. PFNI rates reported in the literature were as follows: A) for low submandibular approach 2.2%, B) for retromandibular transparotid approach 1.4%; C) for preauricular approach 0.33%; D) for high submandibular approach 0.3%; E) for deep retroparotid approach 1.5%. CONCLUSION: According to published data for CHFs, a retroauricular approach or deep subfascial preauricular approach was the safest to protect the facial nerve. For CNFs, a transmassetric anteroparotid approach with retromandibular and preauricular extension was the safest approach to decrease risk of FNI. For CBFs, high submandibular incisions with either transmassetric anteroparotid approach with retromandibular or transmassetric subparotid approach, followed by intraoral (with or without endoscopic/transbuccal trocar) were the safest approaches with respect to decreased risk of FNI.

Albilia, J. B., H. Weisleder and L. M. Wolford (2018). “Treatment of Posterior Dislocation of the Mandibular Condyle With the Double Mitek Mini Anchor Technique: A Case Report.” J Oral Maxillofac Surg 76(2): 396.e391-396.e399.

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Posterior dislocation of the mandibular condyle is a rare disorder caused by trauma to the chin accompanied by damage to the external auditory canal. Treatment of posterior condylar dislocation (PCD) is directed at repositioning the condyle into the glenoid fossa, preventing recurrent dislocations, and maintaining patency of the ear canal. With early intervention, closed reduction with manual manipulation is successful but could be ineffective for chronic protracted PCD. This case report describes an elderly patient with a chronic protracted PCD resulting from a blow to the chin and in which manual reduction was unsuccessful. An open arthroplasty for condylar reduction and application of a “reverse” double Mitek mini anchor technique was required to prevent recurrence of PCD, with a successful outcome.

Wolford, L. M. and A. Galiano (2017). “Adolescent internal condylar resorption (aicr) of the temporomandibular joint, part 1: A review for diagnosis and treatment considerations.” Cranio: 1-10.

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Background Adolescent internal condylar resorption (AICR) is a temporomandibular joint (TMJ) pathology that develops predominately in teenage females during pubertal growth (onset between ages 11 and 15 years), with a distinct clinical, radiographic, and magnetic resonance imaging (MRI) presentation. Clinical and imaging presentation The condition usually occurs bilaterally with: (1) Progressive retrusion of the mandible; (2) High occlusal plane angle facial morphology; (3) Worsening Class II occlusion; and (4) TMJ symptoms such as pain, headaches, noises, etc. MRI imaging demonstrates decreased condylar head size and anterior disc displacement. Treatment protocol AICR can be successfully treated when the condyles and discs are salvageable with the following surgical protocol: (1) Removal of bilaminar tissue surrounding the condyle; (2) Reposition the disc with the Mitek anchor technique; and (3) Orthognathic surgery to advance the maxillo-mandibular complex in a counterclockwise direction. Conclusion AICR can be successfully treated using the specific protocol presented herein to provide stable and predictable outcomes.