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International Journal of Oral & Maxillofacial Surgery
Volume 36, Issue 8, (August 2007)

01. Cell adhesion molecules, the extracellular matrix and oral squamous carcinoma, 28 July 2007 02. 3D assessment of morbidity associated with lower eyelid incisions in orbital trauma 03. Intraoperative navigation in the maxillofacial area based on 3D imaging obtained by a cone - beam device 04. Application of orthodontic mini-implants in adolescents 05. Complications and relapse in alveolar distraction osteogenesis in partially dentulous patients 06. Effects of active non-smoking programmes on smoking behaviour in oral precancer patients 07. Clinical observations of the anatomy and function of the marginal mandibular nerve? 08. The submental island flap in head and neck reconstruction 09. Cocaine-related syndrome and palatal reconstruction: report of a series of cases 10. The reliability of frontal facial photographs to assess changes in nasolabial soft tissues 11. Prevalence, diameter and course of the maxillary intraosseous vascular canal with relation to sinus augmentation procedure: a radiographic study 12. Nicotine inhibits apoptosis induced by cisplatin in human oral cancer cells 13. Use of the Sonopet ultrasonic curettage device in intraoral vertical ramus osteotomy 14. Repair of a laryngeal fracture using miniplates 15. Endoscope-assisted reduction of long-standing condylar dislocation 16. Autosomal dominant inherence of multiple supernumerary teeth 17. Isolated hypoglossal nerve palsy due to a vascular anomaly 18. Monophasic epithelial synovial sarcoma arising in the temporomandibular joint 19. International abstracts Cell adhesion molecules, the extracellular matrix and oral squamous carcinoma International journal of Oral & Maxillofacial Surgery Volume 36, Issue 8, Pages 671-679 (August 2007) A.J. Lyons1, J. Jones2 1 Department of Oral & Maxillofacial Surgery, Guy's Hospital, London SE1 9RT, UK 2 Department of Oral & Maxillofacial Surgery, King's College London Dental Institute at Guys, King's College and St Thomas’ Hospitals, London SE1 9RT, UK Accepted 18 April 2007. published online 28 July 2007. Abstract Carcinomas are characterized by invasion of malignant cells into the underlying connective tissue and migration of malignant cells to form metastases at distant sites. These processes require alterations in cell–cell and cell–extracellular matrix interactions. As cell adhesion molecules play a role in cell–cell and cell–extracellular matrix adhesion and interactions they are involved in the process of tumour invasion and metastases. In epithelial tissues, receptors of the integrin family mediate adhesion to the adjacent matrix whereas cadherins largely mediate intercellular adhesion. These and other cell adhesion molecules such as intercellular adhesion molecule-1, CD44, dystroglycans and selectins, are involved and undergo changes in carcinomas, which provide possible targets for anti- cancer drug treatments. In the extracellular matrix that is associated with tumours, laminin 5, oncofetal fibronectin and tenascin C appear. The degree of expression of some of these moieties indicates prognosis in oral cancer and offer targets for antibody-directed radiotherapy. Metalloproteases which degrade the extracellular matrix are increased in carcinomas, and their activity is necessary for tumour angiogenesis and consequent invasion and metastases. Metalloprotease inhibitors have begun to produce decreases in mortality in clinical trials. This report provides a brief overview of our current understanding of cell adhesion molecules, the extracellular matrix, tumour invasion and metastasis. 3D assessment of morbidity associated with lower eyelid incisions in orbital trauma International journal of Oral & Maxillofacial Surgery Volume 36, Issue 8, Pages 680-686 (August 2007) Y.H. Nunu, A. Bell, S. McHugh, K.F. Moos, A.F. Ayoub Accepted 10 May 2007. published online 9 July 2007. Abstract This study compared the morbidity associated with transconjunctival and transcutaneous approaches for orbital floor exploration with respect to the position of the lower eyelid following surgery. Two groups of 32 volunteers and 32 patients (12 transconjunctival and 20 transcutaneous) were recruited and three-dimensional (3D) imaging was carried out at 6 months following surgery. In the transcutaneous group, there were significant variations in the shape of the lower eyelid, with more medial displacement of the exocanthion. No significant differences were detected in the transconjunctival group compared to controls. The use of a 3D imaging system provided an objective method of assessing this aspect of morbidity associated with the use of lower eyelid incisions. Key words: eyelid incisions, orbital trauma, 3D imaging Intraoperative navigation in the maxillofacial area based on 3D imaging obtained by a cone-beam device International journal of Oral & Maxillofacial Surgery Volume 36, Issue 8, Pages 687-694 (August 2007) R.A. Mischkowski1, M.J. Zinser1, L. Ritter2, J. Neugebauer1, E. Keeve2, J.E. Zöller1 Accepted 19 April 2007. published online 11 June 2007. Abstract The aim of this study was to evaluate intraoperative navigation in the maxillofacial area based on three-dimensional imaging obtained by a cone-beam device. Digital volume tomograms (DVT) were obtained by the prototype of GALILEOS (Sirona Dental Systems Inc., Bensheim, Germany), a newly developed, compact size, cone-beam machine with a scan volume of 15cm×15cm×15cm. Intraoperative navigation was performed in 12 patients in three selected indications. Target detection error expressing the accuracy of DVT navigation and registration performance of specially developed methods for image-to-patient registration was estimated. Target detection error was maximally 2mm and depended on the registration method chosen. The automatic detection rate of the fiducial markers ranged between 0.64 and 0.32. The preoperatively defined treatment plan was fully accomplished in 11 out of 12 cases. A favourable surgical outcome was achievable in all cases. Intraoperative complications were not observed. Intraoperative navigation based on DVT imaging can be considered as a valuable alternative to CT-based procedures. Special characteristics of the cone-beam technique, in terms of contrast resolution and the limited field-of-view size of the devices, restrict the indication spectrum and create a demand for modifications of the usual registration methods. Key words: surgery, computer assisted, surgery, image guided, imaging, three-dimensional, computed tomography, X-ray, radiography, digital, surgery, maxillofacial Application of orthodontic mini-implants in adolescents International journal of Oral & Maxillofacial Surgery Volume 36, Issue 8, Pages 695-699 (August 2007) M. Motoyoshi1, M. Matsuoka2, N. Shimizu1 1 Department of Orthodontics, Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan 2 Department of Orthodontics, Nihon University School of Dentistry, Tokyo, Japan Accepted 19 March 2007. published online 24 May 2007. Abstract The aim of this study was to determine the success rate of mini-implants in adolescents, and also whether a latent period is necessary and the optimum placement torque in an attempt to improve the success rate in adolescent patients. There were 57 orthodontic patients involved in the study, with ages ranging from 11.7 to 36.1 years, who underwent surgery to insert mini-implants (169 implants). When a mini-implant endured an orthodontic force applied for 6 months or more without any mobility, it was considered a success. The success rate was 63.8% in the early-load group (less than 1-month latent period) of adolescents, 97.2% in the late-load group (3-month latent period) of adolescents and 91.9% in the adult group. The success rate of the early-load group of adolescents was significantly inferior to those of the other groups (P<0.01). In measurements of the placement torque in adolescents, the success rate of the 5–10Ncm group was significantly higher than the other groups only in the maxilla of the early-load group. Although the optimum torque could not be defined, a latent period of 3 months before loading is recommended to improve the success rate of the mini-implant when placed in the alveolar bone in adolescent patients. Key words: anchorage, orthodontics, screw, cutting torque, survival rate Complications and relapse in alveolar distraction osteogenesis in partially dentulous patients International journal of Oral & Maxillofacial Surgery Volume 36, Issue 8, Pages 700-705 (August 2007) Eppo B. Wolvius12, M. Scholtemeijer2, M. Weijland1, W.C.J. Hop3, K.G.H. van der Wal2 1 Department of Oral and Maxillofacial Surgery, St. Anna Hospital, Geldrop, The Netherlands 2 Department of Oral and Maxillofacial Surgery, Erasmus MC Rotterdam, The Netherlands 3 Department of Epidemiology and Biostatistics, Erasmus MC Rotterdam, The Netherlands Accepted 2 May 2007. published online 9 July 2007. Abstract Vertical distraction of the alveolar process is an efficient method for augmentation prior to inserting dental implants. In this study, complications of this procedure and relapse of the transport segment were evaluated in partially dentulous patients. Twenty patients underwent distraction by means of extraosseous distractors. The location of the defects was the anterior mandible (4), posterior mandible (4), anterior maxilla (10) and posterior maxilla (2). Bone height was measured on panoramic radiographs preoperatively, after distraction and after implant placement at the mesial and distal point of the implant(s). Mean alveolar distraction was 6.5mm at the mesial point (P<0.001) and 6.1mm at the distal point (P<0.001). The mean relapse at the mesial point was 20% and at the distal point 17% (P<0.05). The intraoperative and postoperative problems encountered were fracture (1) and lingual (4) and palatal (6) displacement of the transport segment. Overall complication rate was 55%. Of all implants placed (n=63) one was lost. Implant success rate was 98%. Distraction seems to be a suitable treatment for vertically deficient alveolar bone, but a relatively high although manageable complication rate must be confronted, including considerable relapse. Key words: alveolar, distraction osteogenesis, implant Effects of active non-smoking programmes on smoking behaviour in oral precancer patients International journal of Oral & Maxillofacial Surgery Volume 36, Issue 8, Pages 706-711 (August 2007) O. Hamadah, S. Hepburn, P.J. Thomson Oral & MaxilloFacial Surgery, School of Dental Sciences, University of Newcastle upon Tyne, UK Accepted 1 March 2007. published online 24 April 2007. Abstract Smoking is the commonest risk factor for oral cancer and precancer. The objective of this study was to characterize smoking behaviour and attitude in a cohort of oral precancer patients in Newcastle upon Tyne, UK, and to determine changes in behaviour during diagnosis, treatment and follow-up. Twenty-seven consecutive, smoking patients with dysplastic oral lesions were recruited to the study and a detailed smoking history obtained, quantifying types and numbers of cigarettes smoked, length of smoking history, and changes in smoking behaviour during treatment episodes and long-term follow-up. All patients underwent an interventional management protocol comprising risk-factor education, histopathological diagnosis by incisional biopsy and laser excision of lesions. Patients were followed up for 5 years. Whilst there was a significant decrease in the number of cigarettes smoked at patients’ most recent follow-up compared with initial presentation (p<0.001), 74% continued to smoke. Patients received advice from a smoking cessation adviser on support available to them from the local NHS (National Health Service) Stop Smoking services. Six out of 10 patients who set a ‘quit date’ and attended a programme had quit at the 4-week follow-up but only 5 remained non-smokers. Smoking remains a considerable problem in oral precancer patients even after interventional treatment, with the risk of further precancerous lesions and malignant transformation. Key words: oral precancer, smoking, carbon monoxide interventional treatment Clinical observations of the anatomy and function of the marginal mandibular nerve? International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 712-715 (August 2007) R.W. Nason1, A. Binahmed2, M.G. Torchia3, J. Thliversis4 1 Department of Surgical Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada 2 Department of Surgery, King Abdulaziz Medical City Riyadh, Saudi Arabia 3 Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada 4 Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada Accepted 9 February 2007. published online 31 March 2007. Abstract The objective of this study was to assess the anatomical variation of the marginal mandibular nerve, and evaluate the risk of nerve malfunction after neck dissection. The method involved clinical assessment of the anatomy and function of the marginal mandibular nerve in 133 neck dissections. When the neck was extended the nerve was displaced in an anterior and downward direction with the lowest point 1.25±0.7cm below the mandible between the posterior and anterior facial veins. The nerve was >1cm below the lower border of the mandible in 54% of dissections. When the intent was to preserve the nerve, dysfunction was observed in 16 of 101 dissections (16%). The incidence of marginal mandibular nerve dysfunction following neck dissection is comparable to that observed following submandibular gland excision for benign disease. Placement of incisions 2cm below the lower border of the mandible will put the nerve at risk in a significant number of patients. Key words: marginal mandibular nerve, neck dissection The submental island flap in head and neck reconstruction International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 716-720 (August 2007) A. Multinu, S. Ferrari, B. Bianchi, A. Balestreri, E. Scozzafava, A. Ferri, E. Sesenna Maxillo Facial Surgery of Parma, Head and Neck Department, University and Hospital of Parma, Via Gramsci 14 43100 Parma, Italy Accepted 15 March 2007. published online 24 May 2007. Abstract The authors describe their experience with the submental island flap for the primary correction of head and neck deformities following oncologic surgery, over the past 5 years. The use of this flap is reported in 12 patients, with a mean age of 67 years, requiring facial or intraoral reconstruction. A brief review of the key points and some refinements in the operative technique are discussed. The reconstruction of defects with a submental island flap was successful in every patient. Complications encountered were one case of temporary palsy of the marginal mandibular branch of the facial nerve and one case of orocutaneous fistula. All the donor site defects were closed primarily. The submental island flap is an excellent choice for the reconstruction of head and neck defects because of its reliability, versatility, colour and texture match, and relative ease of application. Key words: submental flap, cervical skin flap, head and neck reconstruction Cocaine-related syndrome and palatal reconstruction: report of a series of cases International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 721-727 (August 2007) M. Di Cosola1, M. Turco1, J. Acero2, C. Navarro-Vila2, R. Cortelazzi1 1 Department of Oral and Maxillo-facial Surgery, Policlinico, Piazza Giulio Cesare 11, University of Bari, Italy 2 Department of Oral and Maxillo-facial Surgery, Gregorio Marañón Hospital, C/ Doctor Esquerdo 46, Complutense University of Madrid, Spain Accepted 21 March 2007. published online 28 July 2007. Abstract Intranasal cocaine abuse may cause significant local ischaemic necrosis and destruction of the nasal and midfacial bones and soft tissue, leading to development of a cocaine-induced midline destructive lesion. Review of the English- language literature reveals only a few case reports describing hard and/or soft palatal perforation related to cocaine inhalation. To date, among the reconstructive techniques of the palate, different surgical options have been reported such as local, regional and free flaps. Common prosthetic obturators have also been used. Presented here are six cases of cocaine abuse showing different types of cocaine-related palatal lesions treated with different surgical approaches including local and free flaps. Mean follow-up was 3 years. A surgical variation of Marshall's classic technique for insetting a free flap in such lesions is proposed. Key words: cocaine, palatal reconstruction, forearm flap, free flap The reliability of frontal facial photographs to assess changes in nasolabial soft tissues International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 728-734 (August 2007) M.S.M. Muradin1, A. Rosenberg1, A. van der Bilt2, P.J.W. Stoelinga34, R. Koole1 1 Department of Oral and Maxillofacial Surgery, UMC Utrecht, The Netherlands 2 Department of Special Dental Care, UMC Utrecht, The Netherlands 3 Department of Oral and Maxillofacial Surgery, UMC St Radboud Nijmegen, The Netherlands 4 Department of Oral and Maxillofacial Surgery, University Hospital of Maastricht, The Netherlands Accepted 9 May 2007. published online 28 July 2007. Abstract A simple, modified method to evaluate changes in the nasolabial soft tissues after orthognathic surgery is presented. Eighteen healthy volunteers were photographed in a standardized manner with a 2-month interval. Pictures were taken with the soft tissues in repose and ‘maximum closed mouth smile’. Discrepancies for repose and dynamic excursions (x and y coordinates) were calculated for the landmarks alare, crista philtri and cheilion. Multiple analysis of variance revealed no significant interaction for intra-observer variance and time of recording. Coefficients of reliability (repose: 90–99%, dynamic excursion (cheilion): >95%), Spearman correlation coefficients (repose: >0.8, dynamic: >0.6) and squared correlation (repose: >75%, dynamic: >50%) showed this method to be reliable for repose and dynamic excursions. The error of measurement was less than 1.8mm for both repose and dynamic excursions (SDdifferences=0.9mm). This is smaller than mean differences in nasolabial soft-tissues excursions found between the pre- and post-Le Fort I osteotomy situation in a previous study using video imaging. The discrepancies found were in keeping with other earlier reports for 2D and 3D measuring methods. The method as proposed is simple, cost effective and can be used to evaluate soft-tissue changes after orthognathic surgery. Key words: orthognathic surgery, Le Fort I osteotomy, reliability, frontal facial photographs, nasolabial dynamics Prevalence, diameter and course of the maxillary intraosseous vascular canal with relation to sinus augmentation procedure: a radiographic study International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 735-738 (August 2007) O. Mardinger1, M. Abba2, A. Hirshberg3, D. Schwartz-Arad4 1 Tel-Aviv University Savion, Israel 2 Tel-Aviv University, Israel 3 Department of Oral Medicine and Pathology, The Maurice and Gabriela Goldschleger Dental School, Tel-Aviv University, Israel 4 Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel- Aviv University, Israel Accepted 2 May 2007. published online 15 July 2007. Abstract The aim of the study was to characterize the prevalence, diameter and course of intraosseous anastomosis between the posterior superior alveolar artery and the infraorbital artery (bony canal) involved in the sinus floor augmentation procedure. Data from 208 sinuses were analyzed from reconstructed computed tomography (CT) images. The presence of the intraosseous anastomosis in the lateral antral wall was detected using sagittal plane sections, in addition, the intraosseous course and the diameter of the bony canal were examined. The bony canal was identified in 114 (55%) of the 208 maxillary sinuses, with a mean distance of 16.9mm from the alveolar ridge. From the examined canals, in 7% the diameter was 2–3mm wide, in 22% 1–2mm and in 26% it was less than 1mm wide. Because only in 50% of cases the vessel was large enough to be detected by a CT scan, it is recommended, to place the superior border of the osteotomy up to 15mm from the alveolar crest in A to C type ridges to avoid penetration of the artery. Key words: sinus floor augmentation, CT scan, posterior superior alveolar artery, infraorbital artery, complications, bleeding Nicotine inhibits apoptosis induced by cisplatin in human oral cancer cells International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 739-744 (August 2007) J. Xu, H. Huang, C. Pan, B. Zhang, X. Liu, L. Zhang Department of Oral & Maxillofacial Surgery, The Second Affiliated Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou 510120, China Accepted 18 May 2007. published online 9 July 2007. Abstract Oral cancer demonstrates a strong epidemiological association with smoking, but little is known about the effect of nicotine on oral cancer cell apoptosis. Nicotine, a major component of cigarette smoke, can regulate cell proliferation and angiogenesis and suppress apoptosis induced by chemotherapeutic drugs. The main aim of this study was to investigate the effects of nicotine on apoptosis induced by cisplatin, which is commonly used to treat advanced oral cancers, in the human oral cancer cell line Tca8113. The cells were stimulated with nicotine in the presence or absence of cisplatin, and apoptosis was assayed. The results showed that nicotine inhibited apoptosis induced by cisplatin. It was also observed that survivin played a role in the inhibitory effect of nicotine on apoptosis. Depletion of survivin reduced the protective effect of nicotine against cisplatin-induced apoptosis. Akt, a physiological survivin kinase, is activated by nicotine. Treatment of Tca8113 cells with the phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002 blocked nicotine-induced survivin expression and enhanced cell apoptosis. These studies suggest that exposure to nicotine might negatively impact on the apoptotic potential of chemotherapeutic drugs, and that survivin plays a key role in the anti-apoptotic effect of nicotine. The Akt pathway may be required for nicotine function. Key words: nicotine, oral cancer, survivin, apoptosis Use of the Sonopet ultrasonic curettage device in intraoral vertical ramus osteotomy International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 745-747 (August 2007) K. Ueki, K. Nakagawa, K. Marukawa, M. Shimada, E. Yamamoto Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan Accepted 31 January 2007. published online 31 March 2007. Abstract This study was designed to evaluate the usefulness of the Sonopet UST-2001 (Miwatec Co., Ltd., Kawasaki, Kanagawa, Japan) ultrasonic curettage device, and to assess the outcome after intraoral vertical ramus osteotomy (IVRO). Thirteen Japanese adults (age range 20–41 years, mean age 29.6 years) presented with jaw deformities diagnosed as mandibular prognathism and asymmetry; they all underwent IVRO of the mandible. This procedure was followed by ultrasonic bone curettage using the Sonopet to make a guiding notch or groove in the lateral cortex of the ramus without damaging the vessels and nerves. After surgery, the osteotomy line was evaluated by three-dimensional computed tomography. In all patients, osteotomy with the Sonopet device was achieved safely, with minimal bleeding and no major complications. The distal segment could be moved into its ideal position and all patients achieved their ideal profiles. Ultrasonic bone curettage is a safe method for making a guiding groove, without damage to surrounding tissue, prior to complete IVRO. Repair of a laryngeal fracture using miniplates International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 748-750 (August 2007) A. Thor1, A. Linder2 1 Department of Oral and Maxillofacial Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden 2 Department of Otolaryngology Head and Neck Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden Accepted 10 January 2007. published online 6 April 2007. Abstract Injuries to the larynx (voice box) can lead to loss of vital functions; the airway may be obstructed, the voice distorted or lost, and the protection of the airway during swallowing may fail. In order to preserve these functions, a stable repair that restores the anatomy as closely as possible is needed. The repair should interfere minimally with the neuromuscular functions of the larynx. The case is described of a 59-year-old male who suffered a severe laryngeal fracture in a work-place accident. Utilizing miniplates, the fracture was reduced and fixed in the correct position. After healing, the patient could be decannulated and has regained his voice, swallows without difficulty and has a patent airway. The results have been sustained over a 2-year follow-up. Endoscope-assisted reduction of long-standing condylar dislocation International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 752-755 (August 2007) M. Deng1, H. Dong2, X. Long1, X. Li1, Y. Cheng1 1 Department of Oral & Maxillofacial Surgery, Key Lab for Oral Biomedical Engineering of Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei Province 430079, PR China 2 Forensic Department, Shantou University, Medical College, Shantou, Guangdong Province 515040, PR China Accepted 14 April 2007. published online 15 July 2007. Abstract Endoscopy is widely used in the diagnosis and treatment of temporomandibular joint disorders. This paper introduces arthro-endoscopy as a new method of treatment for temporomandibular joint dislocation. As this method is minimally invasive, it is suitable for medically compromised patients who cannot tolerate open surgery. Autosomal dominant inherence of multiple supernumerary teeth International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 756-758 (August 2007) X.-X. Wang1, J. Zhang2, F.-C. Wei1 1 Department of Oral and Maxillofacial Surgery, Shandong University School of Stomatology, Jinan, Shandong, People's Republic of China 2 Department of Orthodontics, Shandong University School of Stomatology, Jinan, Shandong, People's Republic of China Accepted 24 January 2007. published online 20 March 2007. Abstract The case is presented of 16 supernumerary teeth in an 11-year-old Chinese female patient with congenital cardiopathy. It was found that the patient's mother had the same clinical manifestation. A detailed investigation into the family history was carried out. Though the etiology of this dental anomaly remains unclear, genetics as a key factor in the development of supernumerary teeth is highlighted. Isolated hypoglossal nerve palsy due to a vascular anomaly International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 759-761 (August 2007) R.M. Graham1, E.F. Thomson2, A.J. Baldwin2 1 Department of Oral and Maxillofacial Surgery, The Royal Blackburn Hospital, Blackburn BB2 3HH, UK 2 Department of Oral and Maxillofacial Surgery, North Manchester General Hospital, Crumpsall, Manchester M8 5RB, UK Accepted 5 February 2007. published online 6 April 2007. Abstract The case of a patient with an unusual cause of an isolated hypoglossal nerve palsy is presented. Magnetic resonance (MR) imaging demonstrated marked dilatation and ectasia of the right vertebral artery and basilar artery, thereby causing compression of the brainstem. It is therefore proposed that a dilated vascular loop compression of the nerve rootlets, as they exit the medulla, has caused the hypoglossal nerve palsy. This case demonstrates that excellent images can be obtained from MR imaging, and also emphasises that other pathologies must be considered in the differential diagnosis of hypoglossal nerve palsy. Monophasic epithelial synovial sarcoma arising in the temporomandibular joint International journal of Oral & Maxillofacial Surgery: Volume 36, Issue 8, Pages 762-765 (August 2007) H. Bukawa, A. Kawabata, A. Murano, K. Ono, K. Ogawara, M. Shiiba, H. Yokoe, K. Uzawa, H. Tanzawa Division of Dentistry and Oral-Maxillofacial Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan Accepted 11 February 2007. published online 14 April 2007. Abstract Synovial sarcoma is a mesenchymal spindle-cell tumour that occurs infrequently in the head and neck. It originates from unknown stem cells differentiating into mesenchymal and/or epithelial structures. Most synovial sarcomas are biphasic in character, consisting of epithelial and spindle-cell elements. Here is reported a case of monophasic epithelial synovial sarcoma arising in the temporomandibular joint. The tumour was of a predominantly epithelial pattern, although a minute area of sarcomatous cells was found. The primary mode of treatment was wide en-bloc excision. Two years after surgery, the patient died of hepatocelluar carcinoma, but there was no evidence of synovial sarcoma recurrence. International abstracts YIJOM 36_8 Abstracts, 9 March 2007, pages 766-767, Full-Text PDF (48 KB) Calendar of events ,pages 768-770, Full-Text PDF (53 KB) International News page 771, Full-Text PDF (47 KB) Opportunities for wider experience, page 772, Full-Text PDF (20 KB)