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Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Kallikrein-related peptidases have been identified as biomarkers in many human tumors and may influence tumor behavior. We investigated KLK1-15 messenger ribonucleic acid and proteins in PA specimens to determine a KLK expression profile for this tumor. Fresh frozen PA tissue specimens (n = 26) and matched controls were subjected to quantitative real-time reverse transcription polymerase chain reaction to detect KLK1-15 mRNA. Expression of KLK1, KLK12, KLK13, and KLK8 proteins were then evaluated via immunostaining techniques. Statistical analyses were performed with the level of significance set at P < .05. We observed downregulation of KLK1, KLK12, and KLK13 mRNA expression, and immunostaining studies revealed downregulation of the corresponding proteins. Histologic evidence of capsular perforation was associated with increased KLK1 protein expression. Tumor size was not associated with capsular invasion and/or perforation. This study is the first to detail a KLK expression profile for PA at both the transcriptional level and the protein level. Future work is required to develop clinical applications of these findings.

Introduction Affecting approximately one billion people worldwide, obstructive sleep apnea (OSA) occurs when an individual’s airway self‐obstructs during sleep. Persons suffering OSA are generally less healthy and are more likely to develop a myriad of conditions known collectively as Metabolic Syndrome. One OSA solution is maxillomandibular advancement surgery (MMA), involving maxillomandibular complex (MMC) repositioning. While the surgery reports an 87‐100% success rate, the mechanisms of how MMA reduces OSA is not as clear. Further, a proportion of patients are dissatisfied with their appearance after the procedure. This project aims to simulate ventilation in cadavers who have undergone MMA surgery using an incremental MMA approach to measure airway resistances and relate these changes to resulting facial alteration. Surgery The MMA procedures were performed by the same dental surgeon. The oral distraction devices (KLS Martin, Florida) were left intact for the entirety of the experiment for manual jaw advancements. For each dependent variable, the MMC was advanced from 0mm to 14mm in 2mm increments. Ventilation A patient ventilator (LTV 1000 Pulmonetics, Minnesota) simulated ventilation at each MMA increment. Tidal volumes (TV) were calculated for each cadaver at 6ml/kg of body mass, over the same breathing frequency (12 breaths/minute), resulting in constant air flow rates. At each advancement of the MMC, airway resistance (R) is calculated using breath‐by‐breath analysis of peak inspiratory pressure and plateau pressure at each flow rate. A minimum of 10 breaths were used to calculate R at each MMA increment. Facial Scans After every ventilation condition, topographical scans measured 3D changes in the face (Space Spider Scanner, Artec, California). Scan areas of interest extended from hyoid to infraorbital foramen and to the tragi, laterally. The 3D meshes enable calculation of discreet skin surface alterations at each MMA increment and comparisons to baseline topography. Comparing incremental changes to baselines as percentages, a facial alteration index (∆F%) allows comparisons across individuals. Discussion Determination of cadaveric breath‐by‐breath airway forces during MMA is novel and ongoing. Preliminary results (n=1, F, 27yrs, 46kg) demonstrate inverse relationships between incremental MMA and R. With each 2mm MMA, R decreased an average of 4.3 cmH2O/L/s (r = ‐0.82). The foundation of the change in R is supported by an average decrease in peak inspiratory pressure of 3.67 cmH2O (r = ‐0.95) and an average decrease in plateau pressure of 2.81 cmH2O (r = ‐0.97) with each 2mm MMA. Use of ∆F% analysis enables demonstration of the relationship between MMA, airway resistance, and resultant facial alteration. The combined approaches are hypothesized to predict relationships between airway resistance and facial alteration at each level of MMA. Determination of this relationship will be a powerful tool, enabling surgeon and patient to be involved in informed decision‐making.

The temporomandibular joint's (TMJ) articular disc facilitates normal function in the healthy joint. Temporomandibular disorders (TMDs) are associated with disc derangement or damage resulting in joint dysfunction. TMD can progress to an end‐stage where surgical removal of condyle and disc are performed. No adequate prosthetic replacement exists for the disc. A dimensional model for the disc is yet to be provided. Our objective is to assess the dimensions of the articular disc providing a structural scaffold for tissue engineering of replacement constructs. Discs were dissected bilaterally from 12 cadavers (56–100yrs). Linear surface dimensions of the discs were measured using digital calipers to assess absolute and regional anteroposterior width (APW) and mediolateral length (MLL). Regional measurements were taken perpendicularly at relative ratios of the absolute dimensions (50% central; 20% from borders). All measurements (mm) were repeated twice by 2 observers to assess reliability. Mean absolute APW (15.31±1.08) and MLL (24.71±2.29) were calculated from 9 specimens along with mean values for 6 regional surface measurements and 9 regional depth measurements per disc. Within the limits of this study it is possible to provide reliable dimensions for use in creating a structural scaffold of the TMJ articular disc.Grant Funding Source: Departmental Funding

The mandibular interforaminal region is considered a safe zone for cortical bone graft harvesting. Incidence of sensory disturbance of the anterior dentition is reported following harvest at the mandibular symphysis. Anatomical understanding of the incisive nerve within the bony mandible is required to prevent nerve injury. Our study of the anatomy of the incisive nerve, its variation, and position within the mandible will provide a comprehensive map for surgeons. Thirty‐eight cadaveric mandibles will be dissected to reveal the incisive nerve within the mandibular symphysis. The nerve formation will be categorized as: Type A (trunk with branches to anterior teeth), B (a disorganized plexus), or C (nearby nerve contribution). Categorical prevalence will be compared in dentate and edentulous mandibles. A subset of mandibles will be sagittally sectioned between the mental foramina to show the incisive nerve relative to the inferior border of the mandible. Preliminary results of 11 dissected dentate mandibles reveal a prevalence of the ‘Type A’ formation between the mental foramina (8/11). Two dentate mandibles have shown ‘Type B’ formation. Dissected edentulous mandibles reveal a prevalence of ‘Type A’ formation (3/3). Elucidation of anatomical formation, variation, and position of the incisive nerve will help decrease the morbidity of incisive nerve damage and provide a better long‐term outcome for patients.