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82 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

https://t.me/med1917

HEMIFACIAL MICROSOMIA (HFM) CLASSIFICATION – PRUZANSKY (MODIFIED BYKABAN)

e following classication is used to report progressive mandibular deciency and to determine treatment protocols based on the degree of osseous deciency present in the body, ramus and temporomandibular joint.

1. Hypoplastic, normal rotation, limited translation will not require surgery

2a. Anteromedial, TMJ still functioning, will also usually not

require surgery

2b. Moderate-severe hypoplasia, reduced function/range

of motion, but does have a posterior stop; the presence of anterior open bite (AOB) will require surgical management with distraction osteogenesis (DO) or costochondral graft

3. No condyle/ramus unit will require surgery with costochon- dral gra or TMJ prosthesis

LEVELS OF SKULL BASE ACCESS

e following list highlights the levels of access to the skull base, which can be a challenging area due to its complex anatomy.

1. Supraorbital bar (transfrontal) provides access to anterior cranial fossa (ACF)

2. Frontonasal bar is a supraorbital bar plus nasal bones (transfrontonasal), provides access to nasopharynx/clivus/orbit

3. Fronto-naso-orbital (as preceding plus orbitotomy) gives access to large ACF lesion, etc.

4. Nasomaxillary (trans-nasomaxillary) approach for large nasopharynx and clival tumours, etc.

5. Maxillary (or Le Fort 1 approach) to access small nasopharynx tumours

6. Palatal (transpalatal) approach for lower clival/upper cervical spine

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Craniofacial Surgery 83

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OMENS-PLUS – ANALYSIS OF CRANIOFACIAL AND EXTRA-CRANIOFACIAL ANOMALIES IN HEMIFACIAL MACROSOMIA

e following classication highlights which patients with hemifacial microsomia may have extra-craniofacial anomalies.

●

O – orbit (1 – size, 2 – position, 3 – abnormal size AND position)

●

M – mandible (1 – small, 2 – shape, 3 – no TMJ/ramus/glenoid)

●

E – ears (1 – small/cupping, 2 – no EAM, 3 – absent auricle)

●

N – nerve (1 – upper divisions TZ, 2 – lower divisions BMC, 3 – all divisions)

●

S – so tissue (1 – mild, 2 – moderate, 3 – severe)

●

+ – epibulbardermoids/vertebral anomalies

●

C – craniofacial cle Tessier 7 (1 – medial to masseter, 2 – into or beyond anterior border of masseter)

PIERRE ROBIN SYNDROME (PRS) SEVERITY GRADING BY COLE ET AL.

e following severity grading creates provides claried care pathways and enhanced communication regarding optimal treatment strategies for these patients to help manage and prevent risk of airway compromise.

1. Micrognathia, cle palate and glossoptosis with no obvious signs of respiratory distress; management: nurse side to side, squeezy bottle

2. Features of PRS (as Grade 1), but on assessment by a cle specialist nurse has intermittent signs of respiratory distress; management: nurse side to side, needs nasogastric tube (NGT), has respiratory distress supine

3. Features of PRS (as Grade 1) but moderate-to-severe upper airway obstruction and signs of respiratory distress; management: nurse side to side, needs NGT and nasopharyngeal airway (NPA)/surgical airway and saturations monitor

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84 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

https://t.me/med1917

SCHOBINGER ARTERIOVENOUS MALFORMATION (AVM) CLASSIFICATION

e following classication is a clinical assessment of vascular shunting that is predictive of treatment success.

1. Quiescent (warm)

2. Expansile (swelling with bruit/thrill/pulse)

3. Destructive (ulceration/pain)

4. Decompensating [(high-output cardiac failure (HOCF)]

FURTHER READING

Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall

GT. Classiﬁcation and treatment of spontaneous carotid-cavernous sinus ﬁstulas. J Neurosurg. 1985;62(2):248–56.

Cole A, Lynch P, Slator R. Anew grading of Pierre Robin

sequence. Cleft Palate Craniofac J. 2008;45(6):603–6.

Derderian C, Seaward J. Syndromic craniosynostosis. Semin Plast

Surg. 2012;26(2):64–75.

Faughnan ME, Palda VA, Garcia-Tsao G, etal. International

guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet. 2011;48(2):73–87.

Finn MC, Glowacki J, Mulliken JB. Congenital vascular lesions:

Clinical application of a new classiﬁcation. J Pediatr Surg. 1983;18(6):894–900.

Horgan JE, Padwa BL, LaBrie RA, Mulliken JB. OMENS-Plus:

Analysis of craniofacial and extracraniofacial anomalies in hemifacial microsomia. Cleft Palate Craniofac J. 1995;32(5):405–12.

Jawa DS, Sircar K, Somani R, Grover N, Jaidka S, Singh S. Gorlin-

Goltz syndrome. J Oral Maxillofac Pathol. 2009;13(2):89–92. doi: 10.4103/0973-029X.57677.

Laestadius ND, Aase JM, Smith DW. Normal inner canthal and

outer orbital dimensions. J Pediatr. 1969;74(3):465–8.

t.me/Dr_Mouayyad_AlbtousH

Craniofacial Surgery 85

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Luquetti DV, Heike CL, Hing AV, Cunningham ML, Cox TC.

Microtia: Epidemiology and genetics. Am J Med Genet A. 2012;158A(1):124–39.

Mulligan PR, Prajapati HJ, Martin LG, Patel TH. Vascular anoma-

lies: Classiﬁcation, imaging characteristics and implications for interventional radiology treatment approaches. Br J Radiol. 2014;87(1035):20130392.

Papadaki ME, Lietman SA, Levine MA, Olsen BR, Kaban

LB, Reichenberger EJ. Cherubism: Best clinical practice. Orphanet J Rare Dis. 2012;7(Suppl 1):S6.

Pellerin P. Management of hypertelorism. J Pediatr Neurosci.

2022;17(Suppl 1):S4–S13. doi: 10.4103/jpn.JPN_43_22.

Prada Madrid JR, Montealegre G, Gomez V. Anew classiﬁcation

based on the Kaban’s modiﬁcation for surgical management of craniofacial microsomia. Craniomaxillofac Trauma Reconstr. 2010;3(1):1–7.

Sirkek B, Sood G. Hypertelorism [Updated 2022 Jul 25].

In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2023.

t.me/Dr_Mouayyad_AlbtousH

https://t.me/med1917

Dentoalveolar

ACKERMAN’S CLASSIFICATION OF UNICYSTIC AMELOBLASTOMA

e following system is used to classify unicystic ameloblastomas into subtypes. Ameloblastomas are rare benign tumours of the odontogenic epithelium.

1. Luminal (enucleate and curettage) – on luminal surface only

2. Intraluminal – proliferates into lumen

3. Intramural (needs resection)

BRANEMARK’S FIVE PRINCIPLES TO ENSURE OSSEOINTEGRATION

e following principles were introduced by Branemark (1969) for osseointegration. Osseointegration is a direct connection between living bone and endosseous implants at a microscopic level.

1. Direct contact with bone

2. Graded drills, with tapping at 15 RPM

3. Temperature not more than 47 degrees Celsius

4. Do not load until 3–6 months

5. Expose in second stage (we now can load much earlier)

DOI: 10.1201/9781003156895-11 87

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88 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

https://t.me/med1917

CAWOOD AND HOWELL CLASSIFICATION OFEDENTULOUS RIDGE

e following classication is used for edentulous jaws based upon randomised cross-sectional studies. e classication serves to simplify the description of the residual ridge and thereby assist communication between clinicians; to aid selection of appropriate prosthodontic technique; and to oer an objective baseline from which to evaluate and compare dierent methods.

1. Dentate

2. Immediately post-extraction

3. Height and width

4. Height but no width (knife edge)

5. Inadequate height and width (at ridge)

6. Depressed (basilar loss)

DIFFERENTIAL DIAGNOSIS FOR CYSTIC LESIONS/TUMOURS ON ORTHOPANTOMAGRAM (OPG)

e following is a list of dierential diagnoses a clinician should consider for the patient presenting with a cystic lesion/tumour seen on an OPG.

●

Multilocular

●

Odontogenic – Ameloblastoma – Odontogenic keratocyst – Pindborg – Myxoma – Ameloblastic broma

●

Non-Odontogenic – Giant cell lesion – Central giant cell granuloma – Cherubism – Aneurysmal bone cyst – Brown tumour of hyperparathyroidism – Central haemangioma

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Dentoalveolar 89

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●

Unilocular

●

Odontogenic – Unicystic ameloblastoma – Radicular (or residual radicular) – Dentigerous – Lateral periodontal – Fibroma – Adenomatoid odontogenic tumour – Odontome (complex/compound)

●

Non-Odontogenic – Metastasis

○

LUCENT – breast, lung, kidney, thyroid, colorectal

○

SCLEROTIC – prostate – Stafne’s bone cyst – Idiopathic solitary bone cyst – Nasopalatine duct cyst (if >6mm diameter)

ELLIS CLASSIFICATION OF TOOTH FRACTURES

e following classication is used for tooth fractures based on the extent of damage to the tooth structure.

1. Enamel

2. Enamel and dentine

3. Enamel, dentine and pulp

4. Root

FEDERATION DENTAIRE INTERNATIONALE (FDI) NOTATION (UPPER RIGHT QUADRANT CLOCKWISE TO UPPER LEFT, LOWER LEFT, FOLLOWED BY LOWER RIGHT)

e FDI notation is a commonly used system for the number and naming of teeth. It uses a two-number system for the location and naming of each tooth.

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90 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

https://t.me/med1917

●

Assigns a number to each quadrant of the mouth followed by the tooth number – for example, the upper right second premolar will be denoted as 15, whilst lower le canine will be denoted as 33

●

Zsigmondy-Palmer notation (UK) – dental arches are divided into four quadrants denoted by the symbols

┘

describes upper right rst premolar)

●

Universal system in which the upper right third molar is

┐┌

┘└

(for example,

number 1 and lower right third molar is number 32 (US)

FIVE CRITERIA FOR IMPLANT ‘SUCCESS’ BY ALBREKTSSON ET AL. (1986) AND ADAPTED BY THE AMERICAN ACADEMY OF PERIODONTOLOGY

e following criteria are used to dene implant success and can be used as objective markers for successful implants.

●

Mobility (none)

●

Lucency (none)

●

Symptoms (none)

●

Crestal loss (up to 1.5mm in year 1 and then no more than

0.2mm per year thereaer)

●

Restorable

KENT CLASSIFICATION OF EDENTULOUS RIDGE

e following classication serves to simplify the description of the residual ridge and thereby assist communication between clinicians; to aid selection of appropriate prosthodontic technique; and to oer an objective baseline from which to evaluate and compare dierent methods.

1. Height but no width

2. Inadequate height and width

3. To basilar bone (concave)

4. Into basilar bone (pencil thin)

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Dentoalveolar 91

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LOADING PROTOCOLS FOR IMPLANT DENTISTRY

e following protocols are used to allow for successful implant placements at various time points dependent upon varying pathologies.

●

Immediate restoration

●

Immediate loading (e.g. implant-supported dentures, must avoid implant risk factors of diabetes, smoking, periodontal disease, radiotherapy and other minor ones; pathology, parafunction, type 4 bone, short implants; need four in anterior mandible with AP spread more than 10mm, six in maxilla; need primary implant stability)

●

Early (less than 3 months)

●

Conventional (3–6 months)

●

Delayed (more than 6 months)

LECKHOLM AND ZARB CLASSIFICATION OF BONE DENSITY FORIMPLANTS

e following classication is used to evaluate bone quality using cone beam computed tomography. Bone quality is believed to be the one of the most important etiological factors in predicting early implant failure.

1. Mainly cortical bone (anterior mandible), risk of overheating and need to tap

2. ick cortex, dense cancellous (posterior mandible, anterior maxilla)

3. in cortex but still dense cancellous

4. Mainly cancellous (posterior maxilla) – consider osteotome technique and underpreparation

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92 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

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NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) INDICATIONS FOR EXTRACTION OF THIRD MOLARS

e following guidelines were created by NICE to allow clinicians to have a standard protocol that would warrant third molar extraction in patients.

●

More than one (or single severe) episode of pericoronitis

●

Pathology of tooth – unrestorable caries, fracture, untreatable periapical/pulpal pathology

●

Severe infection – cellulitis/osteomyelitis/abscess

●

Disease of follicle – cyst/tumour

●

Resorption of adjacent teeth

●

Pathology of bone – jaw reconstruction/in eld of tumour resection (tooth in way of surgery)

PELL AND GREGORY CLASSIFICATION OF LOWER THIRD MOLARS

is classication is based on the relationship between the impacted lower wisdom tooth to the ramus of the mandible and the second molar.

A. At same level as second molar occlusal plane B. Between occlusal plane (OP) and cemento-enamel junction (CEJ) C. Below CEJ

I. Anterior to ramus (the distance between the distal surface

of the second molar and the anterior margin of the mandibular ramus is greater than the anteroposterior dimension of the crown of the third lower molar)

II. Half-covered (the distance between the distal surface of

the second molar and the anterior margin of the mandibular ramus is less than the anteroposterior dimension of the crown of the third lower molar)

III. Embedded in ramus (the complete absence of space

between the distal surface of the second molar and the anterior margin of the mandibular ramus)

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