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Journal: Oral and maxillofacial surgery clinics of North America


Oral lichen planus is a common immunologically mediated mucocutaneous disease. These lesions have varied clinical presentations and symptoms, which include reticular, erosive, or erythematous forms. This article reviews the diagnosis and management of oral lichen planus.

Concepts: Lichen planus, Mucosal lichen planus


Osteonecrosis of the jaw (ONJ) is a multifactorial disease in patients with primary or metastatic bone malignancy or osteoporosis undergoing systemic antiresorptive therapy, where pathophysiology has not yet been fully determined. The staging of ONJ is based on severity of symptoms and extent of clinical and radiographic findings. Treatment strategies range from conservative local wound care to aggressive resective surgery of all necrotic bone. The first ONJ cases were reported in 2003 and 2004, and although significant progress has been made in our understanding of the disease, much more work needs to be done to completely explain its pathophysiology.

Concepts: Osteoporosis, Bone, Medicine, Cancer, Death, Medical terms, Understanding, Osteonecrosis of the jaw


This article provides the best current frequency estimate of medication-related osteonecrosis of the jaws (MRONJ), and identifies factors associated with the risk of developing osteonecrosis of the jaw (ONJ) among patients exposed to relevant medications (ie, antiresorptive or antiangiogenic agents). MRONJ is a rare but serious complication of cancer treatment or osteoporosis management. This review confirms that antiresorptive medications such as oral or intravenous bisphosphonates and denosumab are the most common risk factors for developing ONJ. The risk of MRONJ is greater in patients with cancer than in those receiving antiresorptive treatments for osteoporosis by a factor of 10.

Concepts: Osteoporosis, Osteonecrosis of the jaw


This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions.

Concepts: Rheumatoid arthritis, Pain, Cranial nerves, Acupuncture, Toothache, Peripheral neuropathy, Phantom pain


The proper ablation of any neoplasm of the head and neck requires the inclusion of linear and anatomic barrier margins surrounding the neoplasm. Extirpative surgery of the major and minor salivary glands is certainly no exception to this surgical principle. To this end, the selection and execution of the most appropriate ablative surgical procedure for a major or minor benign salivary gland neoplasm is an essential exercise in oral and maxillofacial surgery. Of equal importance is the intraoperative identification and preservation of the pseudocapsule surrounding the benign neoplasm. This article reviews these important elements specifically related to ablative surgery of benign neoplasms of the parotid, submandibular and minor salivary glands with strict attention to observed nomenclature.

Concepts: Benign tumor, Sjögren's syndrome, Oral and maxillofacial surgery, Glands, Parotid gland, Salivary gland, Submandibular gland, Sublingual gland


An understanding of fundamental orthodontic principles involving diagnosis, treatment planning, and clinical strategies is essential for achieving successful outcomes in the treatment of craniofacial patients, particularly cleft lip/palate. This article focuses on: customizing a mandibular dental arch form using the WALA ridge; accurately diagnosing the maxillary skeletal transverse dimension (cusp to cusp/fossa to fossa); coordinating the upper dental arch with the lower; using a smiling profile and glabella vertical to assess anteroposterior jaw position; and leveling the mandibular curve of Spee while considering the lower one-third of the face. These concepts influence treatment outcomes to the extent they are used.


The goals of alveolar cleft repair include (1) stabilization of the maxilla, (2) permitting tooth eruption, (3) eliminating the oronasal fistula, (4) improving aesthetics, and (5) improving speech. Alveolar cleft repair should be considered one of the steps of a larger comprehensive orthodontic management plan. In conjunction with closure of the oronasal fistula, a variety of grafting materials can be used in the alveolar cleft. Autogenous grafts have been found to have greater efficacy compared with allogenic or xenogeneic bone, substitute bone, and alloplasts but with more donor site morbidity.


Uvulopalatopharyngoplasty is a generally safe and widely accepted surgical procedure for the treatment of obstructive sleep apnea. Unfortunately, uvulopalatopharyngoplasty does not always result in success, and patients who initially experienced improvement in the severity of their obstructive sleep apnea may relapse. Proper patient selection and performing uvulopalatopharyngoplasty in conjunction with other surgical procedures that are directed at other sites of upper airway collapsibility may yield favorable outcomes.


Oral and maxillofacial surgery (OMFS) has undergone a renaissance/metamorphosis as a specialty and in the technologic innovations that have enhanced the surgical care of patients. This article reviews traditional maximal transoral approaches in the management of common pathologic lesions seen by OMFS, and compares these techniques with a literature review that applies minimally invasive technology and innovative robotic surgery (transoral robotic surgery) to treat similar lesions. The traditional approaches described in this article have transcended generations and future trends are suggested that will improve the training of the OMFS legacy as clinicians move forward in the care of patients.


This article presents an overview of the history of the buccal fat pad flap, its relevant anatomy, and its indications and contraindications. The surgical technique for its harvest is described, as are the postoperative care and possible complications.