S414Surgical Management of OdontogenicTumorsEric Carlson, DMD, MD, Knoxville, TNJ. Michael McCoy, DDS, Knoxville, TN

Odontogenic tumors represent a fascinating spectrumof benign and malignant tumors whose managementoccupies a time-honored place in our specialty’s surgicalrepertoire. The number of recommended surgical tech-niques is at least as significant as the number of tumors,leading to much confusion as to the best way to treatthese tumors. While it is clear that a majority of thesetumors are benign, different types of treatment shouldbe offered to patients with curative intent. Benign odon-togenic tumors are highly curable entities such thatappropriate, first-line surgical therapy must be plannedlogically and appropriately. This notwithstanding, thereis substantial disagreement in the international literatureregarding the biologic behavior of these tumors and howbest to treat them. An evidence-based approach to themanagement of these tumors is therefore required tooptimize the chance for cure of our patients, while at thesame time minimizing the deformity that might occur. Inparticular, the solid or multicystic ameloblastoma is alocally aggressive slow-growing benign neoplasm that isprone to persistence when treated in a conservativefashion. As such, it is generally recommended that aresection with 1.0 to 1.5 cm linear bony margins beperformed at the onset of disease so as to cure suchpatients. Such treatment is curative, while also allowingfor effective reconstruction to be performed on an im-mediate or delayed basis. It is our belief that similarsurgical treatment should also be performed for theodontogenic myxoma and Pindborg tumor. The unicys-tic ameloblastoma exhibiting exclusively intraluminal tu-mor, however, may be treated more conservatively withthe same likelihood of cure. An enucleation and curet-tage surgery is generally regarded as conservative, yetappropriate and curative surgery for this subtype ofameloblastoma. A similar approach may be followed formanagement of the ameloblastic fibroma and ameloblas-tic fibro-odontoma. The malignant odontogenic tumors,represented by the ameloblastic carcinoma and the clearcell odontogenic carcinomas, require more aggressivecancer surgeries, and are associated with a less favorableprognosis. Long-term postoperative follow-up is gener-ally recommended for all patients with odontogenic tu-mors so as to ensure effective tumor control.

S415Microbiology and Antibiotic Therapy ofOral and Maxillofacial InfectionsThomas Flynn, DMD, Boston, MA

The changing microbiology of odontogenic deepspace infections has been a topic of considerable interestin recent years. Improved culturing techniques havehelped to identify the synergistic roles that anaerobesand streptococci play in these infections. It appears thatthe initial colonization of the infected site by oral facul-tative streptococci provides nutrients and a favorablereduced oxygen environment for later growth of obli-gate anaerobes, mainly Prevotella and Porphyromonasspecies, Fusobacteria, and peptostreptococci. Immuno-compromised patients may, however, harbor unusualpathogens. The implications of this new understandingof oral microbiology in culturing and antibiotic therapyare discussed.

Antibiotic resistance is a growing problem in the headand neck region. The effect of antibiotic therapy onantibiotic resistance within individuals and communitiesis explored, along with the mechanisms of antibioticresistance. Strategies for treatment of highly resistantorganisms are also described.

Recent data on the antibiotic sensitivity of the com-monly isolated pathogens of odontogenic infections in-dicate that penicillin is still the empiric drug of choice, atleast for outpatients. The effectiveness of erythromycinand the new macrolides is weak against the oral strep-tococci and anaerobes, yet concentration of azithromy-cin into phagocytes may make this macrolide useful.Clindamycin retains its effectiveness in serious (hospital-ized) and chronic cases. One can estimate also fromthese data the usefulness of some newer antibiotics,including new fluoroquinolones and cephalosporins, inodontogenic infections, and that certain older antibioticsare now obsolete.

A cost-effectiveness comparison is made among thevarious available antibiotics and their combinations bothby the oral and intravenous routes. Salient pharmacologyand antibiotic drug interactions are discussed.

References

Sakamoto H, Kato H, Sato T, et al: Bull Tokyo Dent Coll 39:103,1998

Flynn TR: Oral and Maxillofacial Surgery Knowledge Update 2002.Rosemont, IL, American Association of Oral and Maxillofacial Sur-geons, 2002

Flynn TR, Halpern LR: Oral Maxillofac Surg Clin North Am 15:17,2003

S416Bone Anchored Hearing Aid ApplicationJonathan E. Burke, DMD, Haddonfield, NJGuy L. Lanzi, DMD, Haddonfield, NJ

Patients who suffer from conductive and mixed losshearing impairment have previously had limited optionsfor rehabilitation. Those who also suffer from chronicear canal infections, draining ears, congenital ear malfor-

Surgical Clinics

132 AAOMS • 2003