Surgical Clinics likelihood of cure. An enucleation and curettage surgery is generally regarded as conservative, yet appropriate and curative surgery for this subtype of ameloblastoma. A similar approach may be followed for management of the ameloblastic fibroma and ameloblastic fibro-odontoma. The malignant odontogenic tumors, represented by the ameloblastic carcinoma and the clear cell odontogenic carcinomas, require more aggressive cancer surgeries, and are associated with a less favorable prognosis. Long-term postoperative follow-up is generally recommended for all patients with odontogenic tumors so as to ensure effective tumor control.
A cost-effectiveness comparison is made among the various available antibiotics and their combinations both by the oral and intravenous routes. Salient pharmacology and antibiotic drug interactions are discussed. References Flynn TR, Halpern LR. Antibiotic Selection. Oral Maxillofac Surg Clin N Am 2003;15 (Feb):17-38 Flynn TR, Shanti RM, Levy M, Adamo, AK, Kraut RA, Trieger N. Severe Odontogenic Infections, Part One: Prospective Report. J Oral Maxillofac Surg 2006;64:1093-1103 Flynn TR, Shanti RM, Hayes C. Severe Odontogenic Infections, Part Two: Prospective Outcomes Study. J Oral Maxillofac Surg 2006;64: 1104-1113
References Carlson ER: Odontogenic Cysts and Tumors. In: Miloro M (ed): Peterson’s Principles of Oral and Maxillofacial Surgery, 2nd edition, Chapter 30, Hamilton, BC Decker, 575-596, 2004 Carlson ER, Marx RE: The ameloblastoma – primary curative surgical management. J Oral Maxillofac Surg 64: 484-494, 2006 Carlson ER, August M, Ruggiero S: Locally Aggressive Benign Processes of the Oral and Maxillofacial Region. Selected Readings in Oral and Maxillofacial Surgery, volume 12, number 3, 2004
S211 A Comprehensive Approach to Mandibular Reconstruction
S126 Microbiology and Antibiotic Therapy of Oral and Maxillofacial Infections
The Oral and Maxillofacial Surgeon is frequently required to reconstruct mandibular defects. Appreciation of the extent of the defect and the functional deficits is central to choosing the optimal reconstructive techniques. This clinic will provide a systematic approach to the classification of mandibular defects, review the available techniques and demonstrate a comprehensive approach to reconstruction. Participants are encouraged to bring difficult cases for discussion.
Thomas R. Flynn, DMD, Boston, MA The changing microbiology of odontogenic deep space infections has been a topic of considerable interest in recent years. Improved culturing techniques have helped to identify the synergistic roles that anaerobes and streptococci play in these infections. Molecular methods for identifying unculturable pathogens have shown that over 60% of the species found in these infections cannot be cultured in the laboratory. The implications of this new understanding of oral microbiology in culturing and antibiotic therapy are discussed. Antibiotic resistance is a growing problem in the head and neck region. The effect of antibiotic therapy on antibiotic resistance within individuals and communities is explored, along with the mechanisms of antibiotic resistance. Strategies for treatment of highly resistant organisms are also described. Recent data on the antibiotic sensitivity of the commonly isolated pathogens of odontogenic infections indicate that penicillin is still the empiric drug of choice, at least for outpatients. The effectiveness of erythromycin and the new macrolides is weak against the oral streptococci and anaerobes, yet concentration of azithromycin into phagocytes may make this macrolide useful. Clindamycin retains its effectiveness in serious (hospitalized) and chronic cases. One can estimate also from these data the usefulness of some newer antibiotics, including new fluoroquinolones and cephalosporins, in odontogenic infections, and that certain older antibiotics are now obsolete. AAOMS • 2008
Stephen MacLeod, BDS, MBChB, FDS RCS, FRCS, Minneapolis, MN Deepak Kademani, DMD, MD, Rochester, MN
References Kademani D, Keller Iliac Crest Grafting for mandibular reconstruction Atlas Oral Maxillofac Surg Clin North Am. 2006; 14:160 Mitchell, D.A., MacLeod, S.P.R. Strategies for avoiding complications with vascularised bone flaps in head and neck microvascular reconstruction. Seminars in Plastic Surgery (in press) MacLeod, S.P.R Non Union of the Mandible and Irradiated Mandible Hom, D.B., Hebda, P.A., Gosain A.K, Friedman C.D. Essential Tissue Healing of the Face and Neck. Hamilton. BC Decker (In press)
S212 Evaluation and Rejuvenation of the Upper Facial Third Eve Bluestein, MD, DDS, Boulder, CO Pamela J. Hughes, DDS, Minneapolis, MN Cosmetic surgery is now a fundamental part of an Oral and Maxillofacial Surgeon’s training. In fact, proficiency in cosmetic surgery follows the OMS’s experience with trauma management and orthognathic surgery, and is included in the same section of the American Board of Oral and Maxillofacial Surgery’s oral certification examination. The number of people undergoing Cosmetic Surgery is increasing at an amazing rate worldwide. What used to 149