Long-term quality of life outcomes of maxillomandibular advancement osteotomy in patients with obstructive sleep apnoea syndrome.

This study was performed to evaluate the long-term impact of maxillomandibular advancement (MMA) surgery on the apnoea-hypopnoea index (AHI) and quality of life (QoL) in patients with obstructive sleep apnoea syndrome (OSAS). The medical files of 12 OSAS patients who underwent MMA by one surgeon between 1995 and 1999 were reviewed retrospectively. Patients received a clinical assessment, polysomnography, and QoL questionnaires as part of routine care preoperatively (n=12), within 2 years postoperative (n=12), and again in 2016 (n=9). A successful surgical outcome was defined as an AHI decrease of >50% with <20 events/h. Of the 66.7% (8/12) of patients who were initially cured, 66.7% (4/6) remained stable at a median follow-up of 19 years. Only the two patients with the highest AHI showed abnormal Epworth Sleepiness Scale scores. After convalescence, most patients reported stable symptomatic improvement. Aesthetic changes were found acceptable and all but one patient stated that they would undergo the surgery again. It is concluded that MMA is a safe and effective procedure. Ageing and weight gain might counterbalance the positive effects of surgery in the long term. It is therefore suggested that re-evaluation every 5 years should be scheduled, since a spontaneous AHI increase over time does not seem to be reflected by symptomatic changes.

Gastro-intestinal manifestations in cystic fibrosis patients.

Cystic fibrosis (CF) is a life-limiting disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). This defective chloride channel, present in different organ systems such as respiratory system, gastrointestinal tract, reproductive system and sweat glands, disturbs the ion and water transport over the membranes leading to the well known CF symptoms. CF has outgrown paediatric care, as half of CF patients are currently adults. The CF gastrointestinal tract has its own particularities. Some gastrointestinal manifestations are the direct consequence of the CFTR defect whilst others are secondary to treatment. The gastrointestinal diseases are classified according to the way they usually present in symptoms at diagnosis, acute and chronic abdominal pain and silently evolving conditions. (Acta gastroenterol. belg., 2016, 79, 481-486).

Monitoring the prevalence of methamphetamine-related presentations at psychiatric hospitals in Cape Town, South Africa.

OBJECTIVE: This study aimed to determine a demographic profile of methamphetamine (MA)-related admissions to major psychiatric services in Cape Town, obtain a substance use profile from admitted patients, a profile of common MA-related symptoms encountered during the assessment of the patients presenting with MA-related problems, and a brief profile of the psychiatric diagnoses made. METHOD: Staff in six psychiatric hospitals or wards in Cape Town collected data on methamphetamine related admissions between July and December 2008 using a one-page record review form. The data collection form consisted of the patient's demographic details, presenting symptoms, previous admission details, current MA and other substance use information, and DSM-IV diagnosis. RESULTS: A total of 235 forms were completed. Most patients were male (69%) and the mean age was 25 years. The most common presenting symptoms were aggressive behaviour (74%), followed by delusions (59%) and hallucinations (57%). Males were two times more likely to present with aggression as compared to females, while females were significantly more likely to present with depressed mood or euphoric/elevated mood. The majority of patients had substance-induced psychotic disorder (41%), followed by schizophrenia (31%). Twelve percent (12%) had bipolar mood disorder. CONCLUSION: MA-related psychiatric admissions pose serious challenges to all health services dealing with these patients. Further training and treatment protocol development and distribution is indicated.

Robotic surgery in oral and maxillofacial, craniofacial and head and neck surgery: a systematic review of the literature.

A systematic review of the literature concerning robotic surgery in oral and maxillofacial (OMF), craniofacial and head and neck surgery was performed. The objective was to give a clear overview of the different anatomical areas of research in the field of OMF, craniofacial and head and neck surgery, in all its fields (pre-clinical and clinical). The present indications are outlined and the critical reader is invited to assess the value of this new technology by highlighting different relevant parameters. A PubMed and Cochrane library search yielded 838 papers published between 1994 and 2011. After screening the abstracts, 202 articles were considered clinically or technically relevant and were included. These full papers were screened in detail and classified as articles on synopsis (n=41), educational aspects (n=3), technical/practical aspects (n=11) and clinical papers (n=147). Regarding clinical feasibility this systematic review revealed the following main indications: transoral robotic surgery (TORS) for upper digestive and respiratory tract lesions; TORS for skull base surgery; and TORS for trans-axillary thyroid and endocrine surgery. Regarding functional outcome, this systematic review revealed a promising reduction of morbidity in patients with cancer of the upper digastric and respiratory tract.

Presentation of a cone-beam CT scanning protocol for preprosthetic cranial bone grafting of the atrophic maxilla.

The use of autologous calvarian split thickness bone grafts is a well accepted preprosthetic surgical procedure for reconstruction of the severely atrophied maxilla. Although generally accepted as being a superior bone graft regarding long-term stability, the reported risks in the literature may dissuade the surgeon. A modified cone-beam computed tomography (CBCT) scanning protocol (extended field of view starting from 1cm below the occlusal plane up to the limit of the cranial vault, 0.4 voxel) is proposed that allows assessment of both the cranial donor site as the maxillary receptor site and the sinus conditions with a single scan. Issues regarding quality of the data, radiation dose and clinical practicability are discussed.

Immediate functional loading of provisional implants in the reconstructed atrophic maxilla: preliminary results of a prospective study after 6 months of loading with a provisional bridge.

Implant-prosthetic rehabilitation of atrophic maxillae remains a challenging problem. The aim of this paper is to describe a novel treatment for functional rehabilitation of the atrophic maxilla and to discuss preliminary results of this treatment protocol. A prospective pilot study was carried out in 10 patients who underwent bony reconstruction of atrophic maxillae under general anaesthesia, with autologous calvarial bone grafts and simultaneous placement of six provisional implants. The provisional implants were loaded with a provisional acrylic bridge 1 day after surgery. After 6 months, the provisional implants were removed and final implants were placed under local anaesthesia, again in an immediate loading concept with a provisional bridge, followed by a final bridge after another 6 months of healing. The bone grafts integrated well in all 10 patients without infectious complications. The prosthetic survival of the provisional bridge at the time of placing the implants was 100%. All final implants could be placed and immediately loaded with a second provisional bridge. Patient satisfaction was high due to limited postoperative inconvenience and immediate fixed prosthetic rehabilitation. The preliminary results of this pilot study demonstrate that this treatment protocol is a well tolerated treatment for patients with maxillary atrophy desiring dental rehabilitation.

Limits on a muon flux from neutralino annihilations in the sun with the IceCube 22-string detector.

A search for muon neutrinos from neutralino annihilations in the Sun has been performed with the IceCube 22-string neutrino detector using data collected in 104.3 days of live time in 2007. No excess over the expected atmospheric background has been observed. Upper limits have been obtained on the annihilation rate of captured neutralinos in the Sun and converted to limits on the weakly interacting massive particle (WIMP) proton cross sections for WIMP masses in the range 250-5000 GeV. These results are the most stringent limits to date on neutralino annihilation in the Sun.

A cone-beam CT based technique to augment the 3D virtual skull model with a detailed dental surface.

Cone-beam computed tomography (CBCT) is used for maxillofacial imaging. 3D virtual planning of orthognathic and facial orthomorphic surgery requires detailed visualisation of the interocclusal relationship. This study aimed to introduce and evaluate the use of a double CBCT scan procedure with a modified wax bite wafer to augment the 3D virtual skull model with a detailed dental surface. The impressions of the dental arches and the wax bite wafer were scanned for ten patient separately using a high resolution standardized CBCT scanning protocol. Surface-based rigid registration using ICP (iterative closest points) was used to fit the virtual models on the wax bite wafer. Automatic rigid point-based registration of the wax bite wafer on the patient scan was performed to implement the digital virtual dental arches into the patient's skull model. Probability error histograms showed errors of < or =0.22 mm (25% percentile), < or =0.44 mm (50% percentile) and < or =1.09 mm (90% percentile) for ICP surface matching. The mean registration error for automatic point-based rigid registration was 0.18+/-0.10 mm (range 0.13-0.26 mm). The results show the potential for a double CBCT scan procedure with a modified wax bite wafer to set-up a 3D virtual augmented model of the skull with detailed dental surface.

Extending the search for neutrino point sources with IceCube above the horizon.

Point source searches with the IceCube neutrino telescope have been restricted to one hemisphere, due to the exclusive selection of upward going events as a way of rejecting the atmospheric muon background. We show that the region above the horizon can be included by suppressing the background through energy-sensitive cuts. This improves the sensitivity above PeV energies, previously not accessible for declinations of more than a few degrees below the horizon due to the absorption of neutrinos in Earth. We present results based on data collected with 22 strings of IceCube, extending its field of view and energy reach for point source searches. No significant excess above the atmospheric background is observed in a sky scan and in tests of source candidates. Upper limits are reported, which for the first time cover point sources in the southern sky up to EeV energies.

Radiation-induced mandibular adult spindle cell rhabdomyosarcoma.

Spindle cell rhabdomyosarcoma (RMS), a variant of embryonal RMS, is a rare tumour, especially in adults. Imaging techniques are used to evaluate the extent of the tumour whereas a biopsy is required to make the final diagnosis. In this article we describe a case of mandibular Spindle cell RMS in a previously irradiated field in a 56-year-old male, and discuss the clinicopathologic and imaging findings. Although the aetiology is still unclear, this case suggests that previous radiation therapy can be a causal factor.

[Treatment of age-related macular degeneration with intravitreous injections of bevacizumab (Avastin): short-term results]. / Traitement de la dégénérescence maculaire liée à l'âge par injections intravitréennes de bevacizumab (Avastin): résultats à court-terme.

PURPOSE: To analyse short term visual outcomes and macular morphologic changes associated with intravitreal injection of bevacizumab (Avastin) therapy for subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) METHOD: Retrospective study of 59 eyes. Each included eye received 3 intravitreal injections of 1.25 mg bevacizumab at 4 to 6-week intervals. Mean follow-up was 5.5 months (range 3 to 9). Best-corrected visual acuity, ophthalmoscopic examination, optic coherence tomography and fluorescein or green indocyanin angiography were performed before and routinely after the treatment. RESULTS: A total of 160 injections were performed with a mean value of 2.7 (1-6) per eye. Visual acuity improved at least two lines in 17% (10 eyes), worsened at least two lines in 14% (8 eyes) and was stabilized in 69% (41 eyes). Among that last group of 41 eyes, a significative reduction of macular thickness was observed in more than 39% (12 eyes) and a subjective improvement with less metamorphopsia and better visual comfort was noticed in 24% (10 eyes). No intraocular or systemic adverse effects were observed except a self-limited iritis in two cases. CONCLUSION: Intravitreal bevacizumab therapy resulted in visual and morphologic improvements in a significant number of cases of advanced AMD with CNV. Randomized studies and longer follow-up are needed to confirm these preliminary results.

Limits on the high-energy gamma and neutrino fluxes from the SGR 1806-20 giant flare of 27 December 2004 with the AMANDA-II detector.

On 27 December 2004, a giant gamma flare from the Soft Gamma-Ray Repeater 1806-20 saturated many satellite gamma-ray detectors, being the brightest transient event ever observed in the Galaxy. AMANDA-II was used to search for down-going muons indicative of high-energy gammas and/or neutrinos from this object. The data revealed no significant signal, so upper limits (at 90% C.L.) on the normalization constant were set: 0.05(0.5) TeV-1 m;{-2} s;{-1} for gamma=-1.47 (-2) in the gamma flux and 0.4(6.1) TeV-1 m;{-2} s;{-1} for gamma=-1.47 (-2) in the high-energy neutrino flux.

Concomitant adsorption of poly(ethylene oxide)-b-poly(epsilon-caprolactone) copolymers and sodium dodecyl sulfate at the silica-water interface.

Upon addition of silica to aqueous solutions of poly(ethylene oxide)-b-poly(epsilon-caprolactone) copolymers (PEO-b-PCL) and sodium dodecyl sulfate (SDS), adsorption of the solutes occurs at the silica-water interface. The amount of the adsorbed constituents has been measured by the total concentration depletion method. Small-angle neutron scattering experiments (SANS) have been carried out to investigate the structure of the adsorbed layer. Although SDS is not spontaneously adsorbed onto hydrophilic silica, adsorption is observed in the presence of PEO-b-PCL diblocks, in relation to the relative concentration of the two compounds. Conversely, SDS has a depressive effect on the adsorption of the copolymer, whose structure at the interface is modified. Copolymer desorption is however never complete at high SDS content. These observations have been rationalized by the associative behavior of PEO-b-PCL and SDS in water.

Search for extraterrestrial point sources of neutrinos with AMANDA-II.

We present the results of a search for point sources of high-energy neutrinos in the northern hemisphere using AMANDA-II data collected in the year 2000. Included are flux limits on several active-galactic-nuclei blazars, microquasars, magnetars, and other candidate neutrino sources. A search for excesses above a random background of cosmic-ray-induced atmospheric neutrinos and misreconstructed downgoing cosmic-ray muons reveals no statistically significant neutrino point sources. We show that AMANDA-II has achieved the sensitivity required to probe known TeV gamma-ray sources such as the blazar Markarian 501 in its 1997 flaring state at a level where neutrino and gamma-ray fluxes are equal.

The effect of mandibular nerve block on opioid consumption, nausea and vomiting in bilateral mandibular osteotomies.

UNLABELLED: The purpose of this study was to compare the efficacy of a mandibular nerve block to placebo, in patients undergoing mandibular osteotomy surgery, regarding opioid consumption and adverse opioid induced side effects. Forty healthy individuals with a mean age of 19.7 years participated in the study. All subjects received lidocaïn 2% + adrenaline 1/80,000 versus placebo for mandibular nerve block in a randomized double-blind manner. Opioid consumption and opioid related side effect such as postoperative nausea and vomiting (PONV), and respiratory depression were assessed. RESULTS: The placebo group received significantly more sufentanil during the surgical procedure than the lidocaïngroup. There were no significant differences in adverse opioid induced side effects. In the postoperative phase there was no difference in additional pain intervention between the two groups. CONCLUSION: The mandibular block during mandibular osteotomy reduces intra-operative opioid consumption but does not alternate the opioid related side-effects in the postoperative phase.

Limits on diffuse fluxes of high energy extraterrestrial neutrinos with the AMANDA-B10 detector.

Data from the AMANDA-B10 detector taken during the austral winter of 1997 have been searched for a diffuse flux of high energy extraterrestrial muon neutrinos. This search yielded no excess events above those expected from background atmospheric neutrinos, leading to upper limits on the extraterrestrial neutrino flux measured at the earth. For an assumed E-2 spectrum, a 90% classical confidence level upper limit has been placed at a level E2Phi(E)=8.4 x 10(-7) cm(-2) s(-1) sr(-1) GeV (for a predominant neutrino energy range 6-1000 TeV), which is the most restrictive bound placed by any neutrino detector. Some specific predicted model spectra are excluded. Interpreting these limits in terms of the flux from a cosmological distributions of sources requires the incorporation of neutrino oscillations, typically weakening the limits by a factor of 2.

[Rehabilitation of the anterior portions of the maxilla and mandible by means of implants and bone grafts]. / Réhabilitation orale des régions antéro-inférieure et antéro-supérieure à l'aide d'implants et de greffons osseux.

This article describes the possibilities and difficulties of reconstruction in the front regio by means of implants and bone transplants in five patients. First of all, planning is the most important step. Sometimes the class III relationship is a real challenge. Different bone transplants, the inlay and onlay technique, the number of the implants, the importance of the way the implants are uncovered in the second stage are discussed. In the front region, we aim for functional and esthetic reconstruction.

[Treatment of a congenitally missing upper lateral incisor with an implant]. / Traitement de l'agénésie de l'incisive latérale supérieure au moyen d'un implant.

The presentation of a case where an agenetic lateral tooth was replaced by an oral implant, has been described. The following parameters are important: oral hygiene, the moment of implant surgery, presurgical orthodontic treatment, alternative prosthetic treatment possibilities and recall of the patient.

[Vertical augmentation of the alveolar process by distraction osteogenesis]. / Augmentation de la hauteur du procès alvéolaire par distraction osseuse.

This article describes the treatment of a boy with Class II deep bite and hypoplasia of the alveolar process due to agenesis of the canines and premolars. At first, the occlusion has been adjusted by advancement of the mandible and opening of the bite after bilateral sagittal split osteotomy. Later, under local anaesthesia, a segmental osteotomy of the hypoplastic alveolar process has been performed. Distraction of the hypoplastic alveolar process has been achieved by orthodontic traction on the residual dentition in the segments. After sufficient augmentation of the alveolar process, 6 implants for two bridges have been placed.

Perioperative complications in corrective facial orthopedic surgery: a 5-year retrospective study.

PURPOSE: Frequency and severity of complications have a profound impact on referral patterns for facial orthopedic surgery. Therefore, a retrospective study was undertaken to determine the incidence of such problems in a large series of patients, with the intent to use these data to make possible changes in the perioperative protocol used in our clinic. PATIENTS AND METHODS: The files of all patients operated on between 1992 and 1996 were studied. These comprised 1,108 patients with 1,872 osteotomy procedures. The following parameters were descriptively analyzed: airway obstruction, hemorrhage, hematoma, infection, neurosensory disturbances, unfavorable fractures, malposition of condyles and nasal septum, and vascularization problems. RESULTS: The most frequent complication was impairment of trigeminal nerve function. In 31.5% of the mandibular base osteotomies, 43.6% of the combined mandibular base and chin osteotomies, and 13% of the chin osteotomies, lip sensibility was decreased immediately postoperatively. After 1 year, this number was reduced to approximately 5%. The function of 17 lingual nerves and 45 infraorbital nerves was temporarily impaired. A wound infection was next in frequency. Fifty-three infections (mandible-to-maxilla ratio, 2.5:1) were treated with drainage under local anesthesia and antibiotic therapy. Loss of part or all of an osteotomized segment did not occur. Other complications were rare and/or temporary. CONCLUSIONS: The most frequent complication was impairment of inferior alveolar nerve function. Life-threatening complications were not encountered. The frequency of infections (<5%) requires further consideration regarding ways to reduce the incidence.